A review of psychosis and fiction research over the last three decades concludes there are a number of reasons why writers create disassociated voices for characters with psychosis. Clark (2009), Lodge (2002) and Geekie et al (2012) refer to fiction being able to put the person at the centre of the disease – something medicine has often failed to do.
Oyebode (2002) and Crawford & Baker (2009) point out the similarities in role between the writer and psychiatrist – attempting to put order to chaos. Keitel (1989), Oyebody (2004) and Pridmore & Walter (2013) all stress that fictional characters can take us where medicine can’t – into the mind of the psychotic character – because it represents a state of mind that can only really be expressed by the character experiencing it.
How writers establish disassociated voices in first-person fiction is slightly more complicated. Each psychotic character needs their own unique mix of symptoms – their inward destruction and their outward manifestations – in order to be able to present a sense of realism.
Crawford & Baker (2009) point out the human mind is too complex to be reduced to a set of tick-box symptoms. And the fictional psychotic characters that feel well drawn don’t just display the better-known symptoms such as delusions and hallucinations. Using these as a character’s foundation, they build upon them with lesser-known symptoms, such as fragmentation and distractibility. It is this additional set of symptoms that gives the character quirks; which fine-tune their personality, reflect their other symptoms.
Social factors and life traumas also play a significant role in the make-up of a psychotic character. It is not enough for a character to simply present with such symptoms; they must have a reason for being how they are – although the reason does not need to be fully disclosed to the reader.
The final element of creating a disassociated voice is that of the voice itself – the semantics, the grammar, the syntax. Some ‘thought disorder’ speech symptoms – derailment, clanging – can be moulded by the writer to provide a veneer of psychosis within a character’s speech. However, as
Keitel (1989), Lodge (2002), Felman (2003) and Oyebode (2004) all point out, the writing has to be readable. Some more pronounced speech symptoms – such as word salad – run the risk of straying too far from recognised speech to be used for prolonged periods in first-person narrative.
Our current levels of understanding of psychosis from a medical and academic perspective paint only part of the picture for the fiction writer; it is the writer’s job to ‘imagine’ how a sufferer of psychosis would think, feel and ultimately tell their story.
As advancements in the understanding of psychosis occur within these fields, writers will be able to interpret them in improved and more realistic character development. As long as fiction writing keeps abreast of any advancements in medicine and academia, it will be able to continue to present effective and relatively believable psychotic disassociated voices in first-person fiction.
And as to establishing levels of ‘believability’ within fiction, there seems to be an as yet undefined tipping point where characters who are more than just an accumulation of their symptoms become the guide a reader is ready to follow through a book. As Lodge (2002) points out, where there is uncertainty, the reader will hold onto what there is to believe – the first-person narrative on the page in front of them.