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 Three – MDD with Psychotic Features

This is the final installment of The Psych Writer series on Major Depressive Disorder. This week, we turn our focus on MDD with Psychotic Features.

Of course, when writing any disorder, focus on showing rather than telling, and remember, your character is human. Give them more dimensions than their disorder.

What’s tricky about writing MDD with psychotic features is not making it look like schizophrenia or bipolar with psychotic features. You will need to make sure that the depressive features are most prominent, otherwise the reader isn’t going to get it.

Naturally our writings are always open to interpretation by the reader–that’s what makes it such an enriching experience. It’s not the focus on the symptoms that makes the writing interesting, anyway. It’s the expression of the character and their life that makes the reading compelling.

So, we’ve already reviewed what MDD is all about, but what about psychotic features? Psychotic is a word that’s used in lay terms that tends to get confused with other terms (hell, even I’ve confused the terms when I was exhausted at one point). Psychotic is a term for losing touch with external reality.

The patient who is psychotic can experience any of the following, with some examples for illustrative purposes:

  • delusions – believing someone has bugged their home, is being gang stalked, they have a terrible disease, or that they’re the Archduke Ferdinand.
  • hallucinations – seeing, hearing, tasting, or smelling things that aren’t there, such as seeing a person that no one else can see.
  • anxiety – the person may seem anxious and restless.
  • withdrawal from family and friends – sometimes due to the delusions and hallucinations, the patient withdraws from social interactions. This is not just an “oh, I don’t want to go to the mall.” This is more like they don’t answer any of their phone calls and they stop talking to people entirely. Think the most extreme form of withdrawal possible.
  • suicidal ideation and actions – they may attempt to kill themselves or think about it all the time.
  • disorganized speech – this isn’t your average non-sequitur. Disorganized speech is often completely incoherent. There are several types of DS:
    • word salad – seemingly random words put together in a sentence. “My pants raisin toggle the burp slurped in a cat.”
    • derailment – completely unrelated or tenuously related ideas put together as if they were related. “I have to pick up my dry cleaning. There’s a bar in the street that keeps me from walking to the park.”
    • neologisms – words that are made up. “I took my wife to the helgistahooven for a new haircut.”
    • perseveration – a response repeated uncontrollably (this can be verbal or gestural). “Did you pack a pair of socks?” “Socks, socks, socks, socks, socks, socks, socks…”
    • thought blocking – when a person stops talking abruptly in the middle of a sentence without any explanation. “I went to the store and-” *silence*
    • pressured speech – rapid speech that sometimes is incoherent.
  • difficulty concentrating – this is pretty self-explanatory.
  • hypersomnia or insomnia – sleeping too much or not enough.
  • suspicion of others and situations – this is usually due to delusions.

Keep in mind that the person with psychosis is typically unaware of these symptoms and signs. They are often so out of touch with external reality that they have no idea that their delusions or hallucinations aren’t real, and that their behavior has changed to be out of the ordinary.

Here you see there are some things that crossover with depression, such as suicidal thoughts or actions, anxiety, and withdrawal. Knowing this, it’s easy to understand how difficult differential diagnosis can be.

The standard treatment for MDD with psychotic features is antidepressants and antipsychotics. If that doesn’t bring relief, ECT (electroconvulsive therapy) is another common method.

Overall, when writing a character with this disorder, there’s an opportunity to do a little reality bending. Just don’t make it too much of a trope.

Coming up for The Psych Writer, we’ll tackle some of the following subjects (not necessarily in this order):

  • Bipolar Disorder I and II
  • Munchausen Syndrome
  • Munchausen-By-Proxy Syndrome
  • Anxiety Disorders – Generalized Anxiety Disorders, Panic Disorder, PTSD
  • Schizophrenia
  • Autism Spectrum Disorder
  • Personality Disorders: Exploring the three clusters of the ten disorders.

I also take requests. Any disorder you’d like me to explore? Contact me via Facebook.


Anne is a former supervised therapist at the Master’s level who abandoned it all to become a writer. Visit her shiny Author Page to learn more about her and read some of her more macabre thoughts on paper (or eBook).

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.

The Editor’s Corner – The Rough Draft

As you know, last week we just finished up a section on grief in The Psych Writer Series. So this week I wanted to take a break and head to The Editor’s Corner. After all, we’re writers, not psychologists. (For those of you enjoying TPW, we’ll get back to it soon!)

I have a little online writing group and as a freelance editor, I give writing tips and tricks to the youngsters on how to improve their writing (they are ages 13-20). But I don’t care to be all high-and-mighty. I write, too.

And my rough drafts are hellacious.

Everyone’s are. But I put them up in the group, anyway.

There is a reason that I post my rough drafts for their critique. I want to show them that even an editor who picks apart everything about a novel from start to finish to help them make a better piece of writing also has crappy rough drafts. We all have our quirks and problems in our first draft.

This is why I present them a rough draft, so they can see that.

Why?

Because the first time a person gets their manuscript back with line-by-line changes and more “red ink” on it than black, it’s effing discouraging and makes people want to throw their work out the window and into a bonfire.

But I assure them: if you get something back that marked up, it means you have potential. An editor will not waste time on a work if they don’t think it can grow.

So if they or you ever ask me for my professional feedback and you get it, even if some of it’s difficult to take, know that me spending time on your work means something. It means I think it has potential, and that’s the highest compliment an editor can pay to a writer.

In a letter to 19-year-old Arnold Samuelson, Ernest Hemingway once wrote the following:

“Don’t get discouraged because there’s a lot of mechanical work to writing. There is, and you can’t get out of it. I rewrote the first part of A Farewell to Arms at least fifty times. You’ve got to work it over. The first draft of anything is sh*t. When you first start to write you get all the kick and the reader gets none, but after you learn to work it’s your object to convey everything to the reader so that he remembers it not as a story he had read but something that happened to himself.”

This is what an editor helps people do. We don’t function as writers in that moment. What we do is massage the work into a shape that will leave the reader euphoric, devastated, or otherwise moved. They will incorporate your story into the tapestry of their lives.

This is why I share my rough drafts with my group. To show them that the work is always, without exception, in need of more refinement.

So when you share a work with a professional and it’s a rough draft, expect a lot of feedback. A lot of it. That doesn’t mean it’s bad or it’s crap. In fact, it’s the opposite.

Happy writing!


I am Anne Hogue-Boucher. I write stuff and then I edit it, and then edit it some more. I also get it edited. If you’d like to read some of my work, pick up a copy of Exit 1042. There’s more on the way. You can also follow me on Twitter and Facebook.

The Psych Writer: Grief – Phase Five: Anger

Last week, we explored the guilt phase of grief as part of The Psych Writer series. Thanks for sticking with me thus far, as we’re almost finished with grief, and it’s a difficult topic to face. But after this, there are only two more left in the series, so hang in with me.

So after guilt, the anger phase often follows. Keep in mind the codicil that you can pretty much repeat with me now: 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.

Now back to anger. The person who is experiencing the anger phase may lash out in a variety of ways. That will depend on the person, the source of loss, and their current circumstances. They get angry with a person for dying, they get angry with the doctors or medical team for “not doing enough” or making a mistake (whether there was a mistake or not doesn’t matter), or they get angry with people for tangential reasons.

While the anger is a natural reaction and completely expected, it is vital that the person doesn’t get stuck in this phase, and it’s probably one of the most addictive phases to get into. You may already know this, but emotions are handled by the amygdala in the brain, and judgment is handled by the prefrontal cortex, and the left prefrontal cortex can shut down emotions. (This is basic information for the sake of brevity: if you want to read more, about anger, check out this article.) When a person is angry, there are a number of hormones released, including adrenaline and noradrenaline. Because those are “pump you up” hormones to get the body ready for a fight, anger can be addictive. It’s like runner’s high without all the knee blowout from running.

Anger from the Patient’s POV
The patient is pissed off royally. How dare X happen? How could grandma do that to you? How dare she die at a time like this?! How dare Phyllis divorce you?! Who does she think she is? Those fucking doctors don’t know anything! They couldn’t save Uncle Phillip and they’re all just money-grubbing bastards. What were they thinking?

There is a touch of the indignant to this type of anger. Remember, the focus of the anger can be anywhere, even at themselves. Grief is necessarily selfish, so the anger is most likely due to the fact that this person has been left alone, holding the bag as they say. There are underlying feelings that are feeding this phase.

Anger from the Therapist’s POV
As the therapist, it is your job to dig with the patient and find out which feelings are feeding the beast. Sometimes it’s fear. Fear of being alone. Fear of loss. Fear of mortality. Sometimes it’s feelings of helplessness. They were abandoned. They lost their sense of control. Or all of the above, plus ones you can’t fathom at the moment.

All of these feelings, and more, are normal and expected. When someone dies, and the patient is angry, it’s important to let them explore those feelings in a safe environment.

Here, you monitor for homicidal ideation even more (although you always monitor for suicidal as well, homicidal should not be forgotten) than before, because people who are angry may not be able to switch on the prefrontal cortex’s ability to stop them from doing something that could ruin even more lives.

Other things you have to watch for is increased substance abuse and self-harm.

What this Means for You, the Writer
This is the perfect opportunity to get your character set up for starting their revenge against whomever caused their loss. It can also be a good opportunity to write about their anger turned inward, and how they fell into a pit of depression, struggled with addiction, or committed acts of self-harm.

If you’re writing an unethical therapist, keeping the patient in this phase can help them orchestrate a murder, create chaos, or other unsavory ends via unsavory means.

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.

Good luck, and get writing.


Just two more to go and then we’ll move on to other mental health topics. You’re almost at the end of the grief series, can you believe it? 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.

20 Misused Words That Make Smart People Look Dumb

While I was looking through my ProWritingAid newsletter, I found something they shared via 20 Misused Words That Make Smart People Look Dumb and had a blast reading it.

As some of you know, I offer freelance editing services as well as being a writer. The only thing is the use of irony has far more than just one definition, but arguing over irony itself can be quite ironic.

The only time you can really break these rules is in dialog when you want your character to sound realistic and prone to making silly mistakes. It also helps if you want a character to correct the other person and show off what a smart-ass they are.


How about following me around on Twitter or Facebook? I’m pretty entertaining when I’m not busy hiding from the Great Old Ones. Oh and by the way, if you’re looking to edit your book, contact me on Facebook or via Twitter. I charge reasonable rates and give your manuscript the attention it deserves to get ready for publishing.

Writer’s Resource: Literary Devices

Even if you’ve had writing workshops and lessons, it’s often helpful to have a reference resource.

One of my favorites is Literary Devices. I found it one day while trying to justify the use of Polysyndeton and explain to a friend that they really weren’t true run-on sentences.

While the trend is for short, staccato sentences, there is beauty in the flow an prose of a long sentence. When used appropriately and sparingly, it can put rhythm into your writing and make it sound hurried and rushed if you want action. It can also stretch out the pacing when used properly. It’s a flexible device.

Literary Devices has plenty of examples and definitions of diverse devices that you can use in your writing.