Carolyn Kaufman Psy.D.

Psychology for Writers

Should Your Character Really Get A Diagnosis?

Like Charlie Sheen, your character could be getting a premature diagnosis.

Posted Mar 15, 2011

image of Charlie Sheen

We know he should be diagnosed with something!

Before I get into a few guidelines to keep in mind if you're thinking of giving your character a psychological disorder, I have to acknowledge that it isn't just fiction writers having the problem — other types of media are also quick to cast about for possibly uncalled-for diagnoses.

Let's take Charlie Sheen, for example. "Bipolar disorder" is being bandied about an awful lot by the media, and while it's not out of the realm of possibility that Sheen is manic, there's also a far simpler explanation: drugs. Drugs can easily induce states that resemble psychological disorders, and in the infamous ABC News interview, Sheen emphatically volunteered that he was "bangin' 7 gram rocks [of cocaine]...because that's how I roll." Cocaine abuse can certainly make a person look manic. Add that to the threat to Sheen's ego now that his show has been taken away, and his behavior looks like a frantic, stimulant-influenced attempt to shore up that ego.

In other words, before you decide to look for a diagnosis, Dear Writer, consider a) whether your character's problem is extreme enough to be a disorder, b) whether the behavior could be explained by something besides a disorder (or by a less stigmatizing disorder), and c) whether you can portray a disorder consistently if you do decide to portray one.

Is My Character's Problem Extreme Enough to be a Disorder?

Remember, disorders are often extreme versions of normal behavior.  Everybody has a blue day here and there, and it's only when your blue days dominate your life, are out of proportion to the situation, and are keeping you from having a normal work, home, and/or school life that you have a disorder.

Can It Be Explained By Something Besides a Disorder (or By a Less Stigmatizing Disorder)?

"Bipolar disorder" may sound more erudite than "drug addict," but in Sheen's case, the latter may be more accurate. And even if it turns out that he does have bipolar disorder, the drug abuse can't be neglected or swept aside just because a bipolar diagnosis exists. Granted, some people believe that all people who abuse drugs are self-medicating another psychiatric problem, but not everyone agrees.

Diagnoses should always be parsimonious—which means that the diagnostician provides as few diagnoses as possible (because it's less stigmatizing). And more stigmatizing diagnoses (like bipolar disorder) should be made more slowly than less stigmatizing diagnoses (like drug abuse).

Look at your story. Sure, your character may have symptoms that look disordered, but if they can be explained by context they may not qualify. For example, if your character lives under rotten conditions, her blue mood may not be out of proportion to the situation, and that means it's not a disorder. (Although if your character is abusing drugs, as Sheen has, you already have a built-in diagnosis, since, as noted, substance use and abuse can be diagnosed using the DSM-IV.)

Can You Portray the Disorder Consistently?

Let's say that a disorder is an important part of your character's profile. It genuinely adds something to the way the plot progresses. Your challenge at this point is to portray the disorder consistently.  Many writers have symptoms wax and wane depending on whether they serve the story.  But the reality is that if someone has a mood disorder, they have a mood disorder all the time.  Though it might be affected by stress or other things going on in the person's life, overall you need to portray the illness as having a consistent effect on the individual's life.

Consider, for example, Stieg Larsson's bestselling novel, The Girl with the Dragon Tattoo.  The heroine appears to have Asperger's Disorder, which means that she has trouble interacting socially with others.  Larsson does a fantastic job of capturing the heroine's approach to the world—in her thoughts, in her speech, and especially in her behavior toward others and their behavior toward her.  In other words, the character's disorder is drawn consistently throughout the novel.

© 2011 Carolyn Kaufman, PsyD ♦ Psychology for Writers on Psychology Today 

Want more information about common misconceptions and getting your own psych right? Get a copy of Dr. Kaufman's book, The Writer's Guide to Psychology: How to Write Accurately About Psychological Disorders, Clinical Treatment and Human Behavior.  More information is available on the book's website.