The Psych Writer on Narcissistic Personality Disorder

Gilderoy Lockhart. Zaphod Beeblebrox. Scarlett O’Hara. What do these three characters have in common?

Well, if you read the title, then you could guess they’re all different portrayals of Narcissistic Personality Disorder (NPD). Even though I enjoyed reading those books, and find many parts of their characterizations to be spot-on accurate, your job as a writer is not to copy those characters. You need to make your own. Make them human. Because a person has a PD does not make them any less human, but they are extremes of the human condition.

The Psych Writer is here to help you with this. Remember, this is not a substitute for therapeutic advice. If you somehow manage to see yourself in these symptoms and it also somehow bothers you (or, you know, if your loved ones are ready to throw you out of the house because you have these signs and symptoms), then seek the advice of a professional health care provider.

Without further ado, here is the lowdown on NPD.

NPD is part of the Cluster B personality disorders. They used to be in the Axis II, but the DSM no longer uses that multiaxial diagnosis (much to their detriment, if I’m to be blunt). Cluster B is the cluster of dramatic, emotional, and erratic personality disorders. That means it’s in the same group as Borderline, Histrionic, and Antisocial personality disorders. (There are ten total, in three clusters.)

People who fit into Cluster B have difficulties with impulse control and regulating their emotions. Ever seen someone in line at the store who is just outrageously angry because the cashier won’t honor a coupon, and they start threatening to sue the store and the cashier personally, calling the employee every name in the book and demanding to speak to the president of the company? Yeah, like that. That’s a problem with regulating one’s emotions.

In order to receive a diagnosis of NPD, the person must have an enduring and persistent pattern of grandiose behavior and feelings, a continuous desire for admiration, and a lack of empathy for others.

NPD begins in early adulthood and is often lifelong (especially if untreated), and can be observed in a variety of contexts (home, work, school, social gatherings, public areas).

The disorder is only diagnosed if the person exhibits five or more of the following signs/symptoms (again, some have all nine, but this isn’t seen often):

  1. Has an exaggerated sense of self-importance that’s grandiose. In other words, they expect you to recognize them as your superior without proportionate credentials or achievements.
  2. They are preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love. (In some cases, they are so preoccupied with the fantasy that they don’t do the work to make those dreams a reality, such as putting in work for promotions or completing their coursework.
  3. They believe they are special and unique to the point where they can only be understood and appreciated by high-status people or institutions, or they may also believe that they should only associate with the above-mentioned.
  4. They require excessive admiration. (If they aren’t constantly complimented and admired, they often become depressed or use manipulative tactics to gather attention.)
  5. They have an enormous sense of entitlement, unreasonably expecting favorable treatment, or having their expectations met without resistance or delay. Think about the coupon explanation above as an example.
  6. They are interpersonally exploitative. That means they’ll take advantage of others to achieve their own ends.
  7. They lack empathy. They refuse to identify or recognize other people’s feelings or needs.
  8. Envy issues: they think people are envious of them, and/or are often envious of others.
  9. They display  and possess attitudes of arrogance and haughtiness.

Behavioral characteristics include what’s known as “narcissistic rages,” which are hellish for the people who have to endure them. Some threaten suicide, some threaten homicide. Some come close to going through with it, and some complete it. Mostly, though, these rages are part of the loss of emotional regulation and sometimes impulse control. Occasionally, they are done to manipulate the other person into the behavior that the person with NPD wants from them.

Are they like this all the time? Yes. The majority of the time they are like this. That’s what pervasive and consistent mean. Don’t forget that when you’re writing the character!

When you do write a character with NPD, remember, you don’t have to hit all of these points. Not everyone is a textbook case and not everyone has every single symptom (in fact, they rarely do have all of them). Infuse your characters with what makes them uniquely human.

Happy writing.


Anne Hogue-Boucher won’t go into a narcissistic rage if you don’t follow her on Twitter or Facebook, but why risk it? You can also buy her books, and that will enable her to eat a sandwich.

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What to Write When You Don’t Know What to Write

This week, I’m taking a break from The Psych Writer to discuss writing.

Writing is my bread and butter. I have some posts I’ve written about writer’s block, and facing the terror of the blank page. In fact, I’ve written about the blank page twice, at least. But writer’s block still seems to be one of the biggest complaints I’ve seen among young writers or writers who are just starting out.

Recently, I got this in the form of a question. “What am I supposed to write when I don’t know what to write?”

Since I am trained as a therapist, I tend to want to pick apart problems and either reframe them or otherwise deconstruct them in order to help.

So when you don’t know what to write, it could be for a variety of reasons.

  • You may be afraid of failing and not completing a project.
  • You may be afraid of succeeding and not knowing what to do next.
  • You may think your writing will never be good enough, so part of you feels it’s not even worth starting.

There are obviously many more reasons for keeping that page blank, but for this post, let’s just focus on these three. If you have one or two you’d like me to address, please shoot me a message on Facebook if you’d like, and I’ll address them in future posts.

  1. You’re afraid of failing and not completing a project.
    It happens. I have a few manuscripts I’ve abandoned about 3/4 of the way through because the idea wasn’t panning out, I couldn’t write the characters in a way that satisfied me, or a variety of other reasons. It happens to everyone. Think of your favorite writer, living or dead, and I could almost guarantee you they have abandoned and unfinished work.

    The best way to get around this is the “fuck it” philosophy. Say to yourself that you’re going to start a project and if it doesn’t pan out, fuck it. Start over, change direction, whatever. You can also just keep going even if you know it sucks, because the first draft of everything sucks. So go until you’re finished. Write until there’s no story left. You can revise it later.

  2. You may be afraid of succeeding and not knowing what to do next.
    This is one I’ve heard a few times now, so it’s not terribly uncommon. In this case, you’re fortune-telling. Can you really see the future and know you’ll be devoid of further ideas? Well, so what? One book that’s finished beats the hell out of one half-finished story that never got off the ground. Preventing yourself from succeeding because of what might be next cheats you out of the satisfaction of a finished project.
  3. You may think your writing will never be good enough, so part of you feels it’s not even worth starting.
    There’s one thing I’ve learned, and I’ve said it above–the first draft of everything is a steaming pile of crap. Some of it has potential, but every first draft needs to be reworked. You will learn to kill your darling manuscript with a hatchet at first, then come back with fine, surgical editing tools to improve it. Tell the part of you that tells you it’s not worth starting to shut up,  because that part of you cannot know what it feels like to finish a project. You have to get to the end to know what that’s like.

When you sit down to the keyboard, or sit with a pen and paper, block out the future. Block out expectations. Block out everything but you and that page, and tell it your passions, your fears, your world.

Get writing.


I am Anne Hogue-Boucher, and I write books. You can read them here.

The Psych Writer: Exploring Borderline Personality Disorder

I had an idea for introducing the personality disorders after I went through some of the others, but I also take requests, as I said in one of my previous posts. Via Facebook, a request came in for me to write about Borderline Personality Disorder. So I’ll be moving into the Personality Disorders a little earlier than I expected.

That having been said, personality disorders are what we consider “bigger” in therapy. Personality disorders are deeply ingrained into the personality of the client. They are invasive, pervasive, and ever-present.

I live in Georgia. Here in Georgia we have an invasive plant called kudzu. It’s everywhere. It grows all over the place and it can’t just be cut down or even burned (burning is illegal anyway because duh, we’re in a drought most of the time and the place would go up in flames faster than Michael Jackson’s hair in that Pepsi commercial). It has to be uprooted from the ground by its root crown.

That’s exactly what personality disorders are–they’re the kudzu of our personalities. They strangle the existing plant and take over completely. They become the plant itself.

So when we’re dealing with a personality disorder, it takes a long time to get to that root crown and eliminate it so that the person can be less miserable and learn to function better so that the people around them can have improved relationships with them. With several of the personality disorders, close relatives and friends grow weary of the “antics.” It makes it difficult to sustain and maintain relationships.

Personality disorders can also interfere with work relationships and productivity, as well as the general day-to-day functioning of the patient. While the same can be said for any disorder in the DSM-5, with a personality disorder, it is much  more treatment resistant, prone to severe relapse, and is lifelong.

A patient has a personality disorder for life. They are never cured. But they can manage it, find relief, improve their relationships, and even help themselves hold down steady employment. They can work towards stability if they work hard enough. It takes a demanding amount of work.

Borderline Personality Disorder (BPD) falls into “cluster B” of the personality disorders. If you don’t count Personality Change due to Another Medical Condition or Other Specified Personalty Disorder and Unspecified Personality Disorder (which we don’t), you have ten personality disorders in three clusters:

  • Cluster A: This is know as the odd or eccentric cluster. It includes Paranoid Personality Disorder, Schizoid Personalty Disorder, and Schizotypal Personality Disorder.
  • Cluster B: This is the dramatic, emotional, erratic cluster. It includes Antisocial Personality Disorder, Borderline Personality Disorder, Histrionic Personality Disorder, and Narcissistic Personality Disorder.
  • Cluster C: This is the anxious and fearful cluster. It includes Avoidant Personality Disorder, Dependent Personality Disorder, and Obsessive-Compulsive Personality Disorder (which is not the same as OCD).

Borderline is considered to be in the dramatic, emotional, erratic cluster. It is characterized by a lifelong pattern of of instability in interpersonal relationships, self-image and affects, and marked impulse control issues (DSM-5, p. 645).

So what the hell does that mean? That means the patient has little to no stability in their relationships with others (professional and personal), erratic behavior and lack of self-control to the point where self or others are harmed.

According to the DSM-5, the signs and symptoms of BPD are a pervasive pattern (as stated above)–but what makes up these patterns? The DSM-5 reports that for a person to be diagnosed with BPD, they must have five (or more) of the following (which I will give in plain English):

  • Frantic efforts to keep from being abandoned, whether that threat of abandonment is real or imaginary. This does not include suicidal behavior or self-mutilation as that is a separate criterion.
  • Repeated unstable and intense relationships that alternate between extremes of idealization and devaluation. Going from “you’re perfect” to “you’re the scum of the earth.”
  • Unstable sense of self. This instability is marked and persistent and goes to extremes. Not only does the love-hate relationship apply to other people, it applies to themselves and their self-image.
  • Recklessness/lack of impulse control in at least two areas of life that will cause them harm, such as unprotected sex with strangers that could result in STIs, overspending, substance abuse, reckless driving, binge eating, etc.). This still doesn’t include suicidal behavior or self-harm.
  • Recurrent suicide attempts, threats, gestures and behavior, or self-mutilation.
  • ‘Affective instability due to a marked reactivity of mood.’ This one’s a bit hard to explain. Imagine the worst overreacting you’ve ever seen. Now imagine it could happen at any time for any reason. You run out of cotton balls and the person has a massive anxiety attack and the anxiety affect lasts for a few hours. It’s a bit like that.
  • Chronic feelings of emptiness. (Exact words from the DSM. Self-explanatory.)
  • Difficulty controlling anger. Intense anger fits. Inappropriate anger to the stimulus. Imagine telling the person you’re out of donuts and they smash a table in response, demand to see your manager, threaten to sue, and threaten to kill you. While that might be funny and unbelievable, yes, it is that extreme.
  • Stress-related paranoia or severe dissociative symptoms that are transient. In other words, it doesn’t last, but the person will abruptly become paranoid, or they’ll dissociate (the world isn’t real, people are inhuman or automatons, etc.).

Now, writing a character with BPD is actually a challenge. Sure, you can go through all nine of the criteria, but I could almost guarantee you that you’ll create a caricature instead of a character. Even with black-and-white perceptions that many people with BPD have, they are still human beings. Avoid making a cookie cutter. You’ll want to add lines of sympathy to that character. He or she didn’t get there on their own. In many cases of BPD, there is not just a genetic component–there is often a history of abuse–sexual, physical, etc.

The person with BPD does not mean to do these things. They cannot help it. That’s why Dialectical Behavior Therapy helps so much. Patients learn from a system of mindfulness and awareness. DBT was developed by Marsha M. Linehan, who has successfully managed the disorder herself. Bear in mind that if you are writing someone with BPD, remember, they cannot help themselves when they do these things. Yes, some of the behaviors are purposefully manipulative, but they are not malingering. Until they get professional help, they are often unaware that these things are not acceptable, because even though people tell them so, they are often focused on assigning blame to others for their reactions.

Always remember, you are still writing a human being, though these are the extremes of the human condition.

If you came here looking for help with BPD, know that it’s out there. Start with this article here and then search for a therapist in your area who specializes in DBT.


Anne is a former supervised therapist and current author. You can read her books, stare at her Twitter, or stalk her on Facebook if you want.

The Psych Writer on Major Depressive Disorder, Part One

Disclaimer: This is not a substitute for medical advice and is for educational purposes only. If you read this and any of the below sounds like you, seek the help of a licensed professional in your area.

Depression is a big topic. There are different types of depressive disorders, but for the purposes of this post, I’m going to focus on Major Depressive Disorder (MDD), which affects about 6.7% of the US population. That’s around 15 million adults.

Last week, we reviewed an introduction to MDD, and I still didn’t even get into all of it. So I’ll do that here, briefly. Because of the many sufferers of MDD, there get to be a whole slew of levels of severity and specifiers. While you’re writing about these characters who have these disorders, don’t forget they are a person and they are not their pathology.

Nothing is worse than a character whose only interesting thing about them is their disorder. Remember Forgetful Jones from Sesame Street? Even he had more than one dimension. He was a cowboy. So if a cowboy Muppet with amnestic disorder can be more than just a one-dimensional character, Depressive Jones can, too.

When you decide to write from a place where your character has MDD, decide what type they have. This can be mild, moderate, or severe. They can have psychotic features (delusions, hallucinations, etc.). They can have partial or full remission as well. (Partial remission is having some of the symptoms but not meeting the full criteria for MDD for a period of less than two months. Full remission is an absence of symptoms for more than two months.)

MDD also can come with certain specifiers, such as with anxious distress or with catatonia, but there are too many specifiers to go into without scaring you away from the subject forever. I could likely write a book on each of the specifiers. So, in the interest of time and space constraints (which I will now call space-time constraints to either irritate or amuse mathematicians and physicists), I won’t list them all here. You may wish to skip over certain specifiers, but with psychotic features you can often cross it over with supernatural fiction. This should be handled carefully, though, because otherwise you risk it becoming a trope.

Another important thing to remember is that MDD distorts a person’s perceptions. I used to tell patients that their brains were trolling them. This troll brain is part of the illness. It is best expressed through Beck’s cognitive triad. The person with depression has a negative view of themselves, of the future, and of the world. They often don’t believe they’ll ever get better, this is the way it is, and that there is no one or nothing that can help them. This triad does not necessarily apply to all people with depression all of the time, but there tends to be more leaning towards negative and pessimism during the course of a depressive episode.

When writing from a therapist’s point of view, your character would see the person as ill. They would note things such as poor attention to personal hygiene, being tearful, and a depressed affect (they look “sad” or “down”). It’s an ethical therapist’s job to help a patient process their thoughts and reframe things that happen to them–to teach them how to rethink things. They also do things such as medication education and other interventions. Treatment often consists of Cognitive Behavioral Therapy (CBT).

An unethical therapist would do things such as foster dependency, and interventions that keep the patient depressed and vulnerable to manipulate them into doing things the patient would not normally do. People with depression can be quite vulnerable, and so open to suggestion in order to find relief, a therapist without ethics could possibly ruin the patient’s life further.

I’m not sure if it’s as interesting to write about a therapist treating someone with depression as it is to write about someone who has depression, but even then, it’s important to give your characters full dimensions.

No matter what, though, write your character as a person first, and their condition second. Otherwise, you risk making a flat character that’s nothing more than a stereotype.

If you came here looking for help with depression, please seek the help of a licensed professional in your area. Depression is a horrible, soul-sucking disorder that takes your life piece-by-piece. Don’t let it take control over you. Call for help. It’s out there.


There is little more horrific than what lies in our own imaginations. If you love reading about nightmare worlds and strange happenings, check out my author page. You can also follow me on Twitter or Facebook.

The Psych Writer: Introducing Depression

This is part of a series of The Psych Writer. I tend to write about pretty heavy topics because they’re mainly about mental illness, and though there are many things we can laugh and joke about to alleviate pain, these topics can be painful for some. So I ask you to stay with me and be tough. Put on your writer’s cap and use one of my favorite defense mechanisms–intellectualize with me.

And now, for a disclaimer: None of this is a substitute for professional medical advice. This is for the sole purpose of writing a character with realistic tones. Of course, there’s always poetic license. If you have Major Depressive Disorder (MDD), note your individual experience may vary. If you see yourself in anything I’m describing, consult with a licensed clinician in your area for help.

This is only an introduction. MDD is a complex mood disorder with several possible complications and offshoots, so in order to keep your eyes from falling out of your head (disclaimer: not responsible for deleterious effects), I am going to have to break it up into parts other than this introduction.

So for now, let’s just get to know what MDD is all about. MDD has a lengthy symptom list. The DSM-5 lists MDD as a mood disorder. I’m going to attempt to put it all into plain English here for you, using the copy I have at home.

Here are the criteria for diagnosing Major Depressive disorder:

  • The symptoms must be present daily or nearly every day for a minimum of two weeks before a diagnosis can be made. That means it’s persistent and pervasive.
  • The symptoms must be a change from how the person functioned previously.
  • Five or more of the symptoms must be present during that two-week minimum period. On top of that, the person must have either a depressed mood (feelings of emptiness, sadness, irritability) or loss of interest and pleasure (aka anhedonia). They can have both, but at least one of these must be consistently present.
  • You’re not allowed to include symptoms that can belong to other medical conditions. In other words, they want you to make sure it’s not something else before treatment. Other physical conditions to rule out include:
    • Central nervous system diseases (e.g., Parkinson disease, dementia, multiple sclerosis, neoplastic lesions)
    • Endocrine disorders (e.g., hyperthyroidism, hypothyroidism)
    • Drug-related conditions (e.g., cocaine abuse, side effects of some CNS depressants)
    • Infectious disease (e.g., mononucleosis)
    • Sleep-related disorders
    • Adjustment Disorders
    • Anemia
    • Chronic Fatigue Syndrome
    • Dissociative Disorders
    • Hypochondriasis
    • Hypoglycemia
    • Hypopituitarism (Panhypopituitarism)

    Other psychological conditions to rule out include:

    • Dysthymia
    • Bipolar Disorder
    • Anxiety Disorders (e.g, PTSD, OCD, GAD)
    • Eating Disorders
    • Personality Disorders
    • Schizoaffective Disorder
    • Schizophrenia
    • Somatic Symptom Disorders

      ET CETERA

Okay, so now, the clinician gets into the symptoms. Symptoms of MDD (remember, there is a minimum of five with depressed mood and/or anhedonia being one of them) include:

  • Depressed mood most of the day, nearly every day for at least two weeks. The person can report this themselves (“I feel sad,” “I feel empty,” or “I feel hopeless), or it can be observed by others (“Patient appears tearful.”). For kids and teenagers, there is often a sharp increase in irritability, although irritability is sometimes seen in adults with depression, too. It’s just more often seen in the young ones.
  • Noticeably losing interest and/or pleasure in all or almost all activities that the person enjoyed before. This can be self-reported or by observation from someone else.
  • Significant weight loss when not dieting or weight gain–within one month, losing or gaining more than 5% of the person’s starting weight–or, an increase or decrease in appetite nearly every day (e.g., the person who used to eat their three square can barely choke down a bowl of pudding every day, or a person who used to eat lightly now eats constantly. In kids, this will be seen as failure to make their expected weight gain.
  • Not sleeping (insomnia) or sleeping too much (hypersomnia) almost every day.
  • Moving around too much (fidgeting) or not moving around enough (lethargy) nearly every day. This criterion is known as psychomotor agitation or psychomotor retardation. It also cannot be self-report alone–this must be observable by others.
  • Lack of energy nearly every day (fatigue). Can be self-reported or observed.
  • Feeling worthless or guilty inappropriately, sometimes to the point of being delusional. This isn’t just basic self-reproach or feeling guilt about an illness. It’s a magnified feeling.
  • Difficulty concentrating or making decisions nearly every day. This can be self-reported or observed.
  • Thoughts of death repeatedly–not just fear of death, suicidal thoughts without a plan, with a plan, or an attempt to commit suicide. This also includes repeated suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

And finally, the criteria for these symptoms has to fit as below:

  • The symptoms cause significant distress or inability to function in social situations, on the job, or anywhere a person needs to function.
  • The episode isn’t because of any of the conditions listed previously or because of drugs.
  • The depression isn’t better explained by another psychological condition as listed above.
  • The depression didn’t come with any mania or hypomania. Clinicians can’t count this exclusion if the mania/hypomania is due to a drug/substance or because of a medical condition.

Did you think that MDD was easy to diagnose? As you can see from above, it’s not always clear-cut. That’s why it’s important to pay attention to symptoms.

Keep all this in mind as we venture into the depths of writing MDD, and again, if you need help, contact a licensed clinician in your area for help.


I am a former supervised therapist with experience in the mental health field since I began graduate schooling in 2003. Now, I write about the things in my head.

On Writing Reviews – The Dude

Have any of you read Food with the Dude? Well, it’s not your average food critic site, where someone who’s all stuck up their own ass gives a review/critique of the service in relation to their own personal snobbery.

If you want to become a reviewer and food critic, I think you need to follow The Dude. His unique approach is fair and covers multifaceted aspects of a restaurant, including accessibility, sanitation, food quality, and service. What I like most about it is that he keeps it fair.

Take a look at one of the more negative reviews about a restaurant that couldn’t quite get his mother’s steak right. Now, some of these food snobs who call themselves “foodies” because they’re too afraid of the word gourmand and couldn’t spell it if they tried could really afford to take a lesson from The Dude. He uses tact and thoughtfulness to express why service was not up to par, or why the food wasn’t as tasty as it could have been. Blame isn’t assessed, it’s analyzed.

The Dude keeps a rule of “Be Nice, Be Respectful,” and it works. When I read his reviews, I feel like I know exactly what to expect when I visit the restaurant he’s reviewing. He follows ethical critique which is a refreshing break from the bombastic style of “food critics” who just want to be crabby, snobbish bitches.

I suppose I could take a lesson from The Dude, myself, as I’m a bit crabby. But in all seriousness, I enjoy reading his reviews and am looking forward to a road trip to try out some of these places. If The Dude ever comes to Atlanta, I’ll be pleased as a pig at the trough.

This review style is the kind of succinct, straightforward writing I enjoy seeing in a review. He cuts out the nonsense and presents you with the real experience.

It’s a great example if you’re looking for inspiration on how to write your own reviews.

Nicely done, Dude.


I like to write about writing, and I do a little writing, myself. If you’re looking for something to read that’s a fun scare and enjoy Lovecraftian nightmares, check out my author page on Amazon. You can also follow me on Twitter and Facebook.

The Psych Writer: Grief – Phase Seven: Acceptance

This is the final installment of the grief section in The Psych Writer series. Last week, we took a look at The Depression Phase. But now we can take a nice, deep breath and look at how far we’ve come. All the way to acceptance.

These phases are organized for the benefit of the clinician. They are not set in stone and the patient will likely not feel these things in order, or one at a time. They might, but they might not. Grief is individualized. There is also fluidity in acceptance. It can fluctuate, just like the other phases.

Oh, acceptance, this phase is so lovely, right? Happy bluebirds sing all around you as you realize you fully accept that x loss has happened and sunbeams arch from your head in a golden halo of enlightenment.

NO.

Acceptance isn’t pretty. It’s not always peaceful. It’s not often a loving, gentle tutor that allows us to smile once again. No. It’s part of the process, and sometimes, perhaps most of the time, it’s ugly before it is fine. The experience varies from person to person.

What acceptance is can be anything from a bitter resignation to one’s fate, to a calm recognition of this is how the way things are, and everything in between. This is the moment where a person says, “my mother is dead. Nothing can change that,” or “I lost my job and there’s no going back.”

Acceptance is the first step to putting one foot in front of the other and rebuilding life without whatever was lost.

Acceptance from the Patient’s POV
The patient feels the loss, though often less acutely than in the other stages. The grief has been replaced with the ability to function without the target of their loss. There may be lingering feelings of sadness, anger, and those feelings may resurge from time to time, but there is a sense in the person that they need to move forward. Acceptance of a non-lethal event, such as job loss or divorce, a spark of interest in other activities may arise. The person may have found a new love interest, or a new job may have them ready to move on from the old one.

Acceptance from the Therapist’s POV
While this is often a good sign that the patient is ready to make significant leaps into moving forward, it is important to check in with them to see how they feel about their newly found acceptance. Is there resignation? Optimism? Pessimism? Fear of moving forward? It will be up to the therapist to help the patient work through those retentive feelings so that the patient can move toward healthy and more helpful feelings.

What this Means for You, The Writer
Getting to acceptance might be a good starting point for your character, and however they get there will be far more interesting than the feelings themselves. Does your character need revenge in order to accept something that was taken from them? Will it help? Will they regret what they’ve done, or will they accept it and move on to better things? Starting a character in the acceptance phase might be interesting if you can flip the acceptance on its ear. What comes next after they’ve accepted their fate? These are all questions you may wish to answer for your character.

If you came here looking for psychological assistance, please contact your local crisis line. Dial 2-1-1 in the US for the United Way, or contact the Samaritans in the UK. For a list of international crisis lines, click here.

Breathe easy, we’ve gotten through this together. Now go write.


Now that we’ve done this in-depth examination of grief, let’s move onto some other topics. I take requests (you can ask via Facebook or Twitter). Next week I’ll do some fluffy topics or post a picture of my cat. Maybe. Or I might drag you further into the abyss. Who knows with me? If you’re in need of some lighthearted diversions, check out my Facebook and Twitter. Or for some entertaining fiction that touches on grief and loss, grab a copy of Exit 1042.

The Psych Writer: Grief – Phase Six: Depression

This has been a dreary series for some, I’m sure, so thank you to all the readers who are stubborn enough to get through it with me. For others, you understand that death and grief are part of the human condition. It’s worth closer examination. Sometimes it even helps.

Last week as part of The Psych Writer series, we took a look at the fifth phase of grief: anger. This week, we examine depression.

Remember (and for regular readers, say it with me): these phases are organized for the benefit of the clinician. They are not set in stone and the patient will likely not feel these things in order, or one at a time. They might, but they might not. Grief is individualized.

As clinicians we have a bit of a conundrum on the use of the term “depression” here, because depression is a clinical diagnosis. It’s more than just feeling sad. Depression is an illness that is typically long-term, can be lifelong, and can be hazardous to the patient. Yet we use the term here because depression not only means feelings of sadness, but a patient can develop Major Depressive Disorder in this phase. Not only that, those who already have MDD can face a downturn in mood or behavior. In other words, grief can push them further down the spiral.

Basically, you’ve got a lot of shit to do in this phase, too.

Depression from the Patient’s POV
Life is empty and pointless without X, where X is the source of loss. This is the phase most commonly associated with grief, so chances are, you’re familiar with it. Life is colorless. Bland. Some of the things I’ve heard from people in this phase have been soul-sucking. The depths of despair when facing a loss can be, well, depressing.

“I cannot live without them.”

“Not even food tastes the same.”

“I’ll never be able to listen to jazz again. It reminds me too much of my [loved one].”

“We used to go for walks together every day. Now I can’t even get out of bed. Without X, it’s just not worth it.”

“If I’m dead, then I can join them.”

Anything you can imagine that reflects the loss that’s depressing as hell can be found in this phase. It is utter disaster for a patient. Some believe they will never recover.

Sadly, some won’t recover. Some will spiral into MDD, and some will get worse if they already have MDD.

Depression from the Therapist’s POV
It is up to you to help the patient move away from this phase. It is not done quickly, and there is no efficient magic trick to make them better. Sometimes, you have to call in a psychiatrist’s consultation, particularly if the patient is already on medication for MDD, or they really should be on something for MDD. No, you’re not giving them a magic pill that will take away their pain of loss; nothing will do that. When you suggest medication, it’s because you are using a tool that may help pull them back from the abyss and give grief clarity.

In other words, you are helping them to just grieve, rather than get sucked down into the horrific abyss of MDD.

Remember some of the things I mentioned that I’ve heard from people in the depression phase? Let’s look at them through the lens of an ethical therapist.

“I cannot live without them.” (Silent warning bells. Find out if the patient is suicidal. Find out if they have the plans, and means. You may have to hospitalize.)

“Not even food tastes the same.” (Anhedonia is possible. Discuss what this means for the patient. Find out if they’ve had any unexpected weight loss. Note it. If patient has history of an eating disorder, consult with treatment team. Work with them and the patient. Work with the patient to help them find a way to remember their loved one through food, but in a healthy way.)

“I’ll never be able to listen to jazz again. It reminds me too much of my [loved one].” (Anhedonia is possible. Discuss the reasons. Let the patient talk and tell you a story about their loved one’s favored music. Help them remember this is a process and that over time it may become a positive way to remember the loved one.)

“We used to go for walks together every day. Now I can’t even get out of bed. Without X, it’s just not worth it.” (Loss of a physical activity can make depression worse. Discuss and explore alternatives, or how to get back to walking, etc.)

“If I’m dead, then I can join them.” (MAJOR ALARM BELLS BETTER BE GOING OFF IN YOUR HEAD. Patient has suicidal ideation. Check for plans and means. Hospitalization may be necessary.)

What this Means for You, The Writer
Of course it depends on where you’re going with the story. Usually when a writer examines grief in fiction, this is the phase that they start at because it’s the most recognizable and seemingly the one that gets the point across. Your character may have stopped eating. They may overeat. They stopped showering and grooming.

But consider writing from one of the different phases or combining a few instead of starting at depression. If and when you do choose to write this part, don’t forget the impact of show over tell. Show me the uneaten dinner in the fridge. Show me the ashtray full of cigarettes and the character lying in bed with a red face puffy from crying. Show me the dirty hair and stench of two-week’s worth of unwashed laundry, piled up in the corner and threatening to grow legs and walk off. Show me the guitar in the other corner just gathering dust. The darkened room. The unmade bed. The broken mirror.

Remember, it’s not the grief itself that’s interesting, it’s how the character faces it, doesn’t face it, or makes matters worse that is interesting to the reader.

If you came here looking for psychological assistance, please contact your local crisis line. Dial 2-1-1 in the US for the United Way, or contact the Samaritans in the UK. For a list of international crisis lines, click here.

Now go write. Go for a walk, too. Get a little fresh air.


Wow, just one more topic and you can breathe easier. We’ll move onto other subjects too, and I do take requests (you can ask via Facebook or Twitter). If you’re in need of some lighthearted diversions, check out my Facebook and Twitter. Or for some entertaining fiction that touches on grief and loss, grab a copy of Exit 1042.

Facing the Blank Page

For some novice writers (and, on occasion, seasoned writers), that blank page is the ultimate enemy. The white screen stares you in the face, and you’re lost for something to put on it.

Sure, it’s easy for me to say “just put your fingers on the keys and start writing.” It’s easy for me because that’s what I do. But I didn’t get to this point all at once. No, I was trained to do it–and you can train yourself to do it, too.

See, for me, I’m a writer for a living. If I don’t write, I don’t eat. That’s not a great plan for effective weight loss, by the way. I don’t recommend it.

In order to keep my stellar figure, that means I have to put words on the page so I can get paid for them. So the blank page has to be eliminated.

Now, for creative writers, especially those starting out, may need a little nudge to get training. One tool that can provide the nudge is using writing prompts. Once you’re trained, you might discover that you even like using them now and then.

These prompts may vary. They can be vague, such as “rain pattering,” or specific, such as “your character discovers an ancient coin on the beach.” No matter what, though, it can be enough to get your brain juiced (yum?).

One of the more valuable tools I found is here at 365 Creative Writing Prompts – ThinkWritten. You can train yourself for a year with these prompts. Agree to a daily word count (start with 500 if you’re a new writer and build your muscles by adding 25 words to that count each day till you’re somewhere between 1500-3000), and use each of these prompts to tell yourself a story. Who knows? Some of these might turn into short stories, and others, a novel.

As always, the advice is: just write. This is one tool that will help you defeat the blank page.

Happy writing.


I write, and I edit like a fiend. You can follow me on Twitter for semi-frequent weirdness, or on Facebook for kicks (not literal kicks).

Writing Device: Anadiplosis

Anadiplosis

The term anadiplosis is a Greek word which means “to reduplicate”. It refers to the repetition of a word or words in successive clauses in such a way that the second clause starts with the same word which marks the end of the previous clause.

WHAT?

Simply put, all this means is that you use a word or word-set in a repetitive matter immediately following the first part.

This is Anne’s example of anadiplosis in writing, in writing that can be strengthened, strengthened by using such devices.

I like to use it when I want to have a character make a powerful speech or get his or her point across in a moving way. This is one that can be overused, though, so be sure to monitor your repetition in your manuscript.


Need professional advice on where your manuscript is going? Let me know and I’ll be happy to help. Want to be entertained from time to time? Follow me on that tweet place and that other place for your face and a book.