Common Mental Health Misconceptions in Media

Common Mental Health Misconceptions in Media

 

As a licensed social worker who has worked as a therapist, as well as visited clients in inpatient psychiatric settings, nothing annoys me more than seeing therapy, social workers, and psychiatric wards misrepresented – and stigmatized – in books, TV shows, and movies.

So I recently got into a great Twitter conversation with several other writers who have worked in the mental health field or written about mental health, and learned that I’m not alone in feeling this way. Therefore, I decided to write this post about common misconceptions about mental health that I’ve noticed in books, movies, and TV.

Please remember that this is not an “all hospitals / therapists / social workers” list, and there will always be exceptions. These are only from my personal experiences. If anyone is writing about mental illness or therapy (which I’d love to see more books about!) I’d always encourage extensive research first.

So here they are.

Myth #1: All patients in psychiatric hospitals are held there against their will.

Reality: It’s VERY hard to legally hold someone in a psychiatric ward involuntarily. In order for this to happen, a person must pose a significant threat to themselves or others. Even if a client says, “I want to kill myself,” it’s very hard to hold them in a facility if they don’t want to be there. They must show intent (desire to die / hurt someone else), means (access to weapons, pills, etc.), and a plan (not just blowing off steam, they’ve thought it through). For example, if a client says, “I want to kill my boss,” you can’t commit them. If they say, “I want to kill my boss, I bought a gun, and I’m planning to shoot him at work tomorrow,” that’s a different story. Likewise, in 99.9% of cases, it is illegal to force a client to take medication against their will unless they are a direct threat to themselves or someone else.

Most clients I’ve met in psychiatric hospitals want to be there, and actually, many are forced out sooner than they’d like due to insurance restrictions.

Myth #2: Modern psychiatric hospitals are like dirty prisons, full of people who are either belligerent, or muttering to themselves.

Reality: First of all, if psychiatric wards were as dirty as they are depicted in TV and movies, they would be shut down by the department of public health. I feel like every time a psych ward is depicted on TV, this is the scenario: a group of half-unconscious, half-belligerent individuals are crowded around a dirty, broken TV. Someone’s talking to themselves, and someone else is screaming. This couldn’t be farther from the truth.

Most psychiatric wards in which I’ve visited clients (and I’ve seen a range) look more like college dorms than prisons. They are full of light, and have decorations on the walls. Often, they will have various therapy groups during the day (including groups like AA / NA, and DBT), and free time, time outdoors, or other activities, like movies, in the evenings. Many I’ve visited also have computers, and clients can decorate their rooms. While some clients wear medical robes, most wear their regular clothing.

Again, this is not an “all psychiatric wards” list, this is simply a “the psychiatric wards I’ve visited.” I’m sure there are exceptions, but as a whole, I’d say that if your contemporary novel has a psychiatric facility that looks like something out of “One Flew Over the Cuckoo’s Nest,” you need to do more research.

Myth #3: You can stay in a psychiatric hospital for months.

Reality: Insurance doesn’t allow that. Honestly, I’ve struggled getting insurances to allow clients to stay in a hospital longer than a couple days. In my experience, most clients stay in a hospital for less than a week. There are “extended stay” programs, and residence options, but they are very expensive, and many insurances won’t pay for them. Another option is called “partial hospitalization,” which is a little cheaper and more common, and essentially is where the client goes to the hospital during the day and participates in all the daily therapy groups, but goes home to sleep at night. Still, insurances will likely constantly ask for proof of need and doctors’ notes in order to justify paying for any of these.

Granted, this is in America. I can’t speak for other countries’ health systems.

Myth #4: “Multiple Personalities” is Schizophrenia.

Reality: The media loves to depict people with Dissociative Identity Disorder (commonly known as “multiple personality disorder”) as having Schizophrenia. They are two completely different diagnoses, with different treatment and different symptoms. If you are writing a character with mental illness, I recommend you read through the diagnostic criteria in the DSM V, which you can find in the reference section of your local library.

Myth #5: The curmudgeonly old therapist who grumbles and constantly asks “how do you feel about that?” in a monotone while doodling in his sketchpad and only half paying attention.

Reality: I’ve never seen, been to, or worked with a therapist like this. I’m sure there are some out there, but I always groan when I see this representation on TV. Most therapists are actively engaged in their client’s treatment, and ask more creative questions than the same one over and over.

Myth #6: If you clean / alphabetize / wash your hands a lot, you have OCD.

Reality: No. Just, no. As a professor in college told us, “you can have obsessions, and you can have compulsions, but that doesn’t make them Obsessive Compulsive Disorder.” OCD is when obsessive compulsive behaviors and magical thinking (i.e. “if I don’t step on any cracks in the sidewalk or tiles, my parents won’t get divorced”) interfere with your daily functioning. I see OCD stigmatized and misused all the time. Being anal-retentive Type A personality does not mean you have OCD. Also, for the love of God, don’t ever say “I’m so OCD about this.” If you wouldn’t say “I’m so diabetic about this” or “I’m so asthmatic about this,” don’t say it about OCD. If you are writing a character with OCD, I’d strongly recommend reading up on it in the DSM.

While I’ve yet to read them (my TBR is so long!) I’ve heard the books “OCD LOVE STORY” by Corey Ann Haydu and “DON’T TOUCH” by Rachel M. Wilson are accurate depictions.

Myth #7: The therapist gets into an argument with a client about whether or not his / her visual hallucinations are real.

Reality: Okay. There may be some therapists who do this. But the social work model is that you always “meet the client where they’re at.” Even if the therapist knows the client’s hallucinations aren’t real, they are real to the client, and telling them they aren’t real won’t make them any less real to the client.

Myth #8: Anxiety is a personality trait and not a mental illness.

Reality: It depends. Everyone feels anxious from time to time. When the anxiety is pervasive and disrupts your everyday life, that’s when it can become a disorder. A close friend has an anxiety disorder, and she recently told me one of her biggest peeves is when anxiety is minimized in media, as “just do it anyway, don’t be nervous” or “stop stressing out!” Anxiety can manifest in many different disorders, but some of the most common are phobias and Generalized Anxiety Disorder. Again, read the criteria in the DSM. When a person with an anxiety disorder is written off as “just anxious,” my social work red flags go up – let’s stop stigmatizing!

Myth #9: If you’re a bad parent, a social worker will come to your house and take your kids away.

Reality: As a social worker, this stereotype drives me nuts. I’ve had clients fearful of meeting with me / speaking to me, because they think if their kid throws a tantrum I’m going to haul them off to foster care. It is very hard to legally remove a child from their home. The goal is always for the child to remain with their parents unless there are extreme circumstances of abuse or neglect.

In most cases, if abuse or neglect is reported, a social worker will visit the home and work out a plan with the parents. Sometimes this plan just involves getting the kid and parents into therapy, or helping connect them to resources (like parenting classes). If the situation is extreme and the children are removed (a last resort), the goal will be to fix the situation and reunite the children and their parents. A situation in which a child is permanently removed from their home is extremely rare. It should also be noted that there are scenarios in which social workers report a case, and after a brief follow up, the case is closed – even when the social worker wishes more action would be taken.
Social workers do not want to remove kids from their homes. Their first priority is to keep everyone in the family safe; removing kids from their parents / caretakers is a LAST RESORT.

It should also be noted that while all social workers and therapists are mandated reporters (they are legally obligated to call and report cases of child abuse or neglect), most social workers don’t work in child protective services. The term “social worker” is broad, and could mean many things; social workers are in business employee assistance programs, in non-profits, in community action, in mental health centers, in hospitals, in schools, in the military, and in research fields. Social workers work with cancer patients, children in schools, veterans, the elderly, college kids, people with disabilities, and many others. There is no “one role” social workers fill.

Myth #10: Electroshock therapy is scary, and hospitals use it as a weapon OR electroshock therapy doesn’t exist anymore.

Reality: Electroshock therapy – called ECT – is still around! It’s used only on clients who consent to the treatment. It’s considered a last resort treatment for illnesses like depression, and it’s very effective. It does have some unwanted side effects like memory loss, but to many clients experiencing extreme and pervasive depression, it’s worth it. Despite what movies will show you, ECT patients are put under, and are completely unconscious during the treatment. They will likely undergo a certain number of treatments over a certain number of months.

Myth #11: The therapist hands a child a doll and says “show me where he touched you.”

Reality: I think I can thank police procedural shows for this myth. There are some therapists who might use this, but honestly, I never would, and I’ve never seen any therapist do this. A much more realistic example of play-therapy would be the therapist and the child sit at a doll house, and the therapist asks questions about the dollhouse while the child plays – i.e. “why isn’t the little brother at the dinner table with the rest of the family?” and “show me the kids getting ready for school.” It’s more open-ended.

Another technique I’ve seen a lot in real life practice is “draw a picture of your family.” While this isn’t an end-all to see the inner dynamics of a complex family system, the therapist can use it to make observations. i.e. “Why is daddy standing so far away from you and your mother?” and “I noticed you drew your mother without a mouth” or “I noticed you drew your little sister a lot taller than everybody else.”

 

Those are just eleven myths I came up with – there are many more! And again, please remember that this is not a definitive list, and there are always exceptions.

For further reading, I’d recommend these books:

If you are writing about a character with a substance use problem, check out DRINKING: A LOVE STORY by Caroline Knapp.

If you are writing about Bipolar Disorder, check out AN UNQUIET MIND by Kay Redfield Jamison.

If you are writing about the mental health system and mental health hospitals, check out CRAZY: A FATHER’S SEARCH THROUGH AMERICA’S MENTAL HEALTH MADNESS by Pete Earley.

And of course, if you are writing about ANY mental illness, check out the DIAGNOSTIC STATISTICAL MANUAL OF MENTAL DISORDERS… also known as the DSM V.

Hope you found this helpful! I’d be interested to hear about other people’s experiences or thoughts on these. 🙂

 

-Meredith

Cover Reveal: LIFE UNAWARE by Cole Gibsen!

Today I’m doing a cover reveal for fellow St. Louis author, Cole Gibsen, whose YA contemporary novel LIFE UNAWARE comes out 04/28/15 through Entangled Teen! I’m so excited to read it.

 

Here’s the summary of the book:

Regan Flay has been talking about you. 

Regan Flay is on the cusp of achieving her control-freak mother’s “plan” for high school success―cheerleading, student council, the Honor Society—until her life gets turned horribly, horribly upside down. Every bitchy text. Every bitchy email. Every lie, manipulation, and insult she’s ever said have been printed out and taped to all the lockers in school.

Now Regan has gone from popular princess to total pariah.

The only person who even speaks to her is her former best friend’s hot but socially miscreant brother, Nolan Letner. Nolan thinks he knows what Regan’s going through, but whatnobody knows is that Regan isn’t really Little Miss Perfect. In fact, she’s barely holding it together under her mom’s pressure. But the consequences of Regan’s fall from grace are only just beginning. Once the chain reaction starts, no one will remain untouched…

Especially Regan Flay.

 

Add to Goodreads

 

About the Author

Cole Gibsen first realized she different when, in high school, she was still reading comic books while the other girls were reading fashion magazines.

It was her love of superheroes that first inspired her to pick up a pen. Her favorite things to write about are ordinary girls who find themselves in extraordinary situations.

Cole Gibsen author photo

Find Cole Online:

WebsiteGoodreadsTwitterFacebook

 

 

 

 

 

 

 

So now, without further ado, here’s the beautiful cover for LIFE UNAWARE!

 

 

 

 

 

life unaware

Be sure to catch LIFE UNAWARE in April, and check out Cole’s other awesome YA books, the KATANA trilogy!

Cover Reveal Organized by:

YA Bounk Tour Button

YA Bound Book Tours

Types of Publishing

There used to be only one way to publish a book: go through a large publishing house in New York. Now, times have changed. There’s traditional publishing, self-publishing, small-press publishing, hybrid publishing, and partner publishing. There are e-books and print books, and “digital first” books.

So with all these options, how do you know which one is right for you?

I can’t answer this, because each person is different. Every writer has different goals, different projects, and different opinions. So let’s look at the pros and cons of each option!

Traditional Publishing: A large or mid-sized press publishes your book.

Pros:

  • The publisher handles all costs – other than additional marketing you choose to do on your own, you pay nothing. Note: if any publisher asks for money up front, RUN.
  • Your novel will be professionally edited, usually multiple times, including content editing, proof-reading, and copy-editing.
  • Networking with other, more well-known authors who also are signed with your publisher.
  • Usually, traditional publishing comes with a paid advance.
  • Access to the publisher’s distribution, including possible bookstore placement or prominent placement in e-book retailers.
  • A professional cover design.
  • A professional contract.

Cons:

  • Time. Usually, a publisher will schedule books several years ahead of time, so you may not actually get your book out for a few years. If you need an agent for a particular publisher, this might take longer, as you will need to query agents first.
  • Minimal – if any – input on cover design. While some publishers ask for author input, some won’t.
  • The editor may want changes to your book that you don’t necessarily agree with.
  • The market. Sometimes, even if a book is awesome, it will be a tough sell to a large publisher due to saturated markets (currently, this includes genres like dystopian and paranormal romance).

Ask yourself these questions:

  • Am I willing to accept a cover design for my book that may not match – or even slightly resemble – my vision for its appearance?
  • Am I willing to be patient and wait, knowing it could take months – if not longer – to get an agent, and then several years after that to get my book out? (Note – not all large / mid-sized presses require an agent – and some larger publishers have imprints that do not require agents to submit).
  • Am I willing to be flexible and compromise when it comes to editing this book with a professional editor?
  • If I don’t have an agent, am I willing to pay a lawyer to look over my contract before I sign it? (Note: no one HAS to do this, but I STRONGLY recommend having a lawyer look over any legal contract regarding rights to your book before you sign).
    ———If you answered “no” to these questions, traditional publishing might not be the best route for your book.

Small Press Publishing: A small press publishes your book. Can be considered a “hybrid” between traditional and self-publishing.

Pros:

  • The publisher handles all costs – other than additional marketing you choose to do on your own, you pay nothing. Note: if any publisher asks for money up front, RUN.
  • Your novel will be professionally edited. The depth and number of edit rounds depend on the publisher.
  • More control and input over your edits and cover design; small presses generally allow the author to be more involved in this process than a larger publisher.
  • Usually a larger royalty than a large publisher.
  • There will be some level of distribution and marketing done by the publisher, although not as much as a larger press.
  • Your book does not need to fall within the strict genre lines of larger publishers. For example, many larger publishers want your book to fall neatly into one specific genre for marketing purposes. Also, “saturated genres,” which today include dystopian and paranormal romance books, can be a hard sell for a large publisher, but eagerly welcomed by small presses.
  • A lot of small presses utilize the ever-growing e-book market, and can rack up significant sales this way.
  • A professional contract.
  • You can get into all small presses without an agent.

Cons:

  • Usually, small presses don’t pay an advance. If they do, it’s very small.
  • You book will likely not be in bookstores, unless the author physically goes to specific bookstores and requests it.
  • Some Amazon reviewers have pointed out that books from some small presses (NOT all) have typos and other basic editing errors.
  • “Staying power.” Unfortunately, with today’s economy, it’s difficult for publishers to stay in business. Some small presses that don’t have the same distribution as larger publishers have unexpectedly gone out of business, thus leaving their authors in the lurch.

Not a pro or con, but a lot of small presses have taken on the “digital first” model, in which an ebook is released first, with the clause that a print option of the book will possibly come available later, dependent on sales. Similarly, a lot of small presses have taken on “ebook only” models. This is especially true with small erotica presses.

Ask yourself these questions:

  • Am I willing to accept the fact that my book will not be in most bookstores?
  • Am I willing to spend time doing research on different small presses, including reading reviews on Amazon and Goodreads, before submitting?
  • As with traditional publishing, am I willing to accept that I might not get the final say on the cover design for my book?
  • Also as with traditional publishing, am I willing to be flexible and compromise when editing with a professional editor?
  • If I don’t have an agent, am I willing to pay a lawyer to go over my contract for me before I sign? (Note: no one HAS to do this, but I STRONGLY recommend having a lawyer look over any legal contract regarding rights to your book before you sign).
  • Am I willing to make and actively use social media sites such as Facebook, Twitter, Pinterest, a personal blog, or others in order to market my book? (Note: This can be a requirement by the publisher that the author develops social media sites).
  • ———If you answered “no” to these questions, a small press might not be the best route for your book.

Self-Publishing: The author publishes his / her own book, using a service like Smashwords or Createspace.

Pros:

  • You have complete control over your book. You choose the cover design, and you don’t have to make any significant editing changes to your book if you don’t want to.
  • All profits are yours – without having to give cuts to the publisher, editors, or agent.
  • You set the price for your book.
  • With the ever-growing popularity of e-books, as well as print-on-demand options, self-publishing is becoming more and more accepted, and self-published books are getting straight to the hands of readers. Many authors have made a significant amount of money through self-publishing.
  • Unlimited control over access to these books. If you want to give out a hundred free copies to reviewers, you don’t need to ask anyone’s permission.

Cons:

  • All costs come out of your pocket. Unless you trust your own editing and cover-design skills, or have a very competent and very generous friend, you must be prepared to spend a significant amount of money to hire someone to do this. This can cost in the thousands.
  • All marketing responsibility falls on the author. You must be active on social media to spread the word, and all printed “Swag” such as posters or bookmarks come out of the author’s pocket.
  • “How do I know when I’m ready?” Without a team working for your book, it’s easy to be unsure when your book is ready to be seen by the world. I’ve known people who have self-published, and then regretted doing it before their book was truly “ready.”
  • Unfortunately, there is still sometimes a stigma around self-publishing. Despite the fact that more and more authors are choosing to publish independently (and making a lot of money doing it!), there are still people who look down on these authors. Luckily, this attitude is starting to shift.

Ask yourself:

  • Am I in a place financially where I can afford to hire a professional editor and cover designer? If not, am I comfortable doing these tasks myself?
  • Am I active on social media? If not, am I willing to start?
  • Am I willing to accept that my book will likely not be in bookstores?

———If you answered “no” to these questions, self-publishing might not be the best route for your book.

 

In conclusion, there is no “right” answer. There is no perfect publishing option. Each option has pros and cons, and in the end, it’s a very personal decision. You need to do what’s not only best for you, but for your book!

Happy Writing!
-Meredith