Making the Strange Familiar

Why thrillers and horror are a way to go inside mental illness. Some thoughts, and some book recs.

This post is going to talk about mental illness. If that is hard for you to read about, maybe skip down to the books recs.

Entering the dark woods...

Where it Began

When I was nineteen, a friend of mine had a mental breakdown. Something inside this kind, funny, talented woman was breaking apart. Several months before, she’d been assaulted by someone she knew and trusted, but we, her closest friends, thought she was healed, or healing. We were so naive.

And then late one night, while we were hanging out at her apartment, something changed—inside her head. I don’t remember the fine details, just how it felt: like she was breaking apart in front of us. She was in so much pain that she wanted to hurt herself—anything to make it stop. (We didn’t know at the time that she’d already started doing this.) We were losing her to something dark and huge, and nothing we said could reach her. My first instinct was to look for an adult—someone else who would know what to do, but no one was coming to fix this. In that moment, we were all she had.

We called a cab. (We didn’t know enough to call an ambulance, a mistake that astounds me now.) She begged—begged—us not to make her go to the hospital. The cabbie arrived. She cowered in her bed, and we felt like monsters. Should we send him away? Could we make tea and talk it through the way we always had up until now? But this was so much more than we were capable of handling, and as cruel as it felt, we took her to the hospital.

My friend had gone into darkness and I couldn’t follow her. I couldn’t see what she was seeing. I didn’t know how to fix it or even make it stop hurting just a bit less.

Over the months that followed, she was in and out of the hospital. On one medication and then another as the doctors tried to find something that would work. Each one seemed to have a side effect - she puffed up, then she became thin and stopped eating; she couldn’t stay awake, then she couldn’t sleep; she was jittery, she was sluggish, but mostly, she was just different.

It was the first time I’d seen the ravages of mental illness firsthand. Keep in mind, this was the late 1990s, the conversation around mental illness, if it was happening (and obviously it was in some spaces), was not something I was aware of. Today, I think it would be different. My college students speak openly about their mental health in a way that would have been utterly foreign to me when I was their age. I didn’t see it in books, films, or plays, and if I did, the person who was “insane” was made so unrecognizable. They were either infantilized—utterly incapable of caring for themselves—or they were a monster.

As I talked to more people, I began to learn how many people I knew who were quietly, always quietly, in therapy, and/or on medication. And I learned about statistics. One in three. One in three people are impacted by mental illness, whether directly or through someone they are close to. How can something so common be so hidden?

Several years later, when I began to experience depression myself, I told no one. Logically, I knew there was nothing to be ashamed of, but logic doesn’t have any chance against that deeper gut feeling that was telling me this is ugly, you are ugly with this. This is weakness. Hide it.

If the main representations of mental illness in pop culture are that it makes you a monster or means you’re weak and childish, then, of course, you hide it.

Fiction gives us a chance to see the world through someone else’s eyes. And thrillers and horror, which are all about the world being a dangerous place, are an excellent place to go inside the mind of a person struggling with mental illness. They are a way inside something otherwise invisible and isolating. Fear is not rational, but it’s also undeniable. If the world becomes dangerous, if your safe space is no longer safe, logic becomes irrelevant. Terror is all about perception. Sometimes the thing you’re afraid of is real, and sometimes it’s not, but that doesn’t make it any less terrifying. It’s the blurring of the external and internal. People ride roller coasters for the thrill of the drop, that feeling of being out of control from the safety of a track. A book does the same. On the page, I can walk inside a haunted house, I can track a serial killer or confront a monster, and get the dopamine rush, but I can exit any time I want.

I think thrillers and horror can evoke that thrill, but they can also lead to a deeper understanding of the altered perceptions that can come with mental illness.

Beyond The Bell Jar

Here are some books that (in my non-medical professional opinion) do a great job of putting the reader inside the complex experience of someone dealing with a mental health crisis:

The Ascent by Allison Buccola. This one just came out this week (huzzah!!), but I got to read it a while ago and can attest to its awesomeness. It’s a fantastic look at long-term grief caused by abandonment and postpartum anxiety. I’ll be doing another post about PMADs (Perinatal Mood and Anxiety Disorders), so stay tuned.

Broken Harbour by Tana French. The story of a man trapped in the grips of an obsession to discover the cause of a noise in his house. What starts as a protective instinct to help his young family becomes all-consuming paranoia.

The Children on the Hill by Jennifer McMahon. At the center of this story is a young girl who has been institutionalized and is brought to live with the chief psychiatrist’s grandchildren. The children catalogue monsters of all kinds, but “monster” takes on a whole new meaning as they discover the secrets about how their identities have been erased and reconstructed.

A History of Fear by Luke Dumas. An American grad student in Edinburgh who suffers from satanophobia. As his reality becomes more distorted and he sinks deeper into paranoia, he murders a classmate and discovers that he may be working for Satan himself.

The Empathetic Imagination

I write characters who struggle with their mental health because there’s still stigma around it, and I think that’s because it is invisible. If someone has cancer, that’s terrible. If someone has crippling anxiety it can still be seen as a sign of personal weakness. These characters are not weak; they are vulnerable. It fascinates me how our behavior is shaped by our perception of the world. I write these characters because mental illness is so human.

But it’s essential to get it right.

And how do you do that? Especially when individual experiences can vary so widely, even if they are given the same clinical name? One of my biggest fears is that someone will write me an angry email saying, “You got it all WRONG!!”

For my first book, Beneath the Stairs, my focus was on Borderline Personality Disorder. The character was inspired by a friend who had suffered for many years from BPD, and, as with many people who struggle with mental health, her family also lived through the experience with her. It wasn’t just seeing the hellride BPD took her on, but learning about the fallout on those around her. At the heart of that pain was the question, “Why her?” and that was the question that was the inspiration for the book.

For my research, I contacted a clinical psychologist who specializes in Dialectical Behavior Therapy, a treatment often used in conjunction with this diagnosis. In our conversation, I was able to present the character to her as if she were an actual patient, including their history, the manifestation of the illness, age of first onset, and so on, to ensure the representation was accurate. I also spoke to a friend who was using Dialectical Behavior Therapy in her own therapy and got her side of it. Once the manuscript was in its final draft, I forwarded the relevant passages to the therapist and asked her to look them over to make sure they seemed accurate.

For my second book, Keep This for Me, the process was similar. This one has two characters who are new mothers and dealing with postpartum anxiety and psychosis. I spoke to a friend who had dealt with something similar, did a lot of reading, consulted a professional, and I had my own lived (though much less severe) experience.

So, obviously, you can and should do all the research you want, but the other part, and the reason why I think it is okay for writers to write about something they haven’t directly experienced, is the empathetic imagination. To put yourself in the body and mind of someone vastly different from yourself. To examine not just how they see the world, but why. The construction of a character is a slow thing. Perception is built in layers. So, as the writer, you build these layers. Nothing is neutral. A kitchen isn’t just a kitchen. A kitchen is the space where you made coffee each morning, but it’s also where you came to rest after your first day at a new job, and where you got that phone call from the hospital, and it’s where you sat up all night waiting for someone to get home, and, and, and…

Make the strange familiar. And make the familiar strange.

It’s taken me a while to write this post because I’m still wrestling with how to articulate all of this (see the title of the Substack!). If you’re a writer, I’d love to know how you approach characters who are outside your lived experience and who you want to get right. And, as always, I’d love your book recs for other stories that enter into this territory.

Thanks for reading.