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Writing Schizophrenia and Psychosis: Hallucinations and Delusions

[Plain text: Writing Schizophrenia and Psychosis: Hallucinations and Delusions]

So you've read our lovely guide on parts of schizophrenia and psychosis unrelated to hallucinations and delusions, you've skimmed our tag, but it's finally time to tackle the most commonly known part of schizophrenia: hallucinations and delusions.

So, hearing voices or seeing shadow people and thinking everyone is after you, right? I'm done?

Nope!

This is a guide to the many many kinds of hallucinations and delusions that exist, written with experience by people with psychosis.

A note obviously that psychosis is highly personal and your mileage may vary. This is not meant to be an all-encompassing post.

Conditions that can cause psychosis (not exhaustive):

Schizophrenia,

Schizoaffective Disorder,

Schizophreniform Disorder,

Delusional Disorder,

Brief Psychotic Disorder,

Major Depressive Disorder with Psychotic Features,

Bipolar Disorder,

Psychotic Disorder Due to Another Medical Condition (yes that's the real name and the Another Medical Condition usually refers to things like Alzheimer's, Parkinson's, brain tumors, etc.),

Substance/Medication-Induced Psychotic Disorder.

The first three are also known as the "schizo-spec" (schizophrenia spectrum) disorders, with delusional disorder and brief psychotic disorder sometimes also being included in that definition.

Hallucinations

[Plain text: Hallucinations]

There are many kinds of hallucinations, the most commonly discussed being auditory and visual. However, they are not the only ones! There are also tactile, olfactory, gustatory, and somatic ones (the latter are often categorized under tactile or vice-versa).

The most frequent kind of hallucination experienced changes depending on the exact disorder. Overall, the most common ones are either auditory or visual (e.g. auditory are the most common in schizophrenia, and visual in neurological disorders), then the other one of the aforementioned two, then tactile/somatic, then olfactory, and then gustatory.

A person can experience any number of those, and multimodality (involving multiple senses) is more common than unimodality (involving just one sense) in people who have a primarily-psychiatric condition. In other words, having hallucinations that involve multiple senses is common for those on the schizo-spec, but very rare for those with ocular conditions, for example.

Types of hallucinations:

[Plain text: Types of hallucinations:]

Auditory hallucinations: There are many things a person can hear, the most common and most discussed being voices. However, other common auditory hallucinations are whispering, hearing your name being called, music, and hearing people walking around.

Command hallucinations: a subset of auditory hallucinations. My absolute enemy. A hallucination, usually external voice but sometimes an "implanted voice" that commands the listener to do things, from something simple like standing up to hurting themselves or others. The listener can resist, but I personally find the longer I have command hallucinations the harder they become to resist or ignore. Often the thing that gets me sent to inpatient. The most important distinction for command hallucinations are that they are not intrusive thoughts - the person is insistent they are external from them.

Visual hallucinations: Less common than auditory hallucinations but still incredibly common. Not always shadow people or recognizable people - I see strangers and have never had the same visual hallucination twice, although some people do see returning "characters". I do see shadow people occasionally, but they aren't the only thing people see and can be a somewhat exaggerated depiction. I know a lot of people who see cats, for some reason. If you can think it, someone can see it!

Obviously hallucinations can but don't have to be scary, it simply depends on the person and experience.

A person can see almost anything as a hallucination. Some people experience what are known as "simple" visual hallucinations (as opposed to "complex" ones) - basic patterns, spots, geometric shapes, lights, lines. They are not lifelike or clear, and are visibly out of place. Simple hallucinations are less common on the schizo-spec, but anyone can have them.

Tactile hallucinations: my absolute enemy (hey, different mod here). Tactile hallucinations are less common than visual or auditory ones, and often come with other kinds of hallucinations as a bonus - especially somatic ones, since there's no clear distinction between those two a lot of the time. They encompass touch, feeling, and spatial sense in the broadest sense you can possibly imagine. They can be annoying in their own manner as there is often no way to check their validity - you usually can't just record or take a picture of them to verify them.

Tactile hallucinations can be, as most hallucinations, basically anything. One of the most common types is the feeling of parasites, bugs, or other animals, like snakes, moving across or under the person's skin.

Parasitic/formication hallucination is the main example of tactile hallucinations to the point that there are sometimes used as synonyms. It's also very often associated with delusional parasitosis, where the person actually believes that they are in fact infested, which will be mentioned in the "delusions" section.

For many people tactile and somatic hallucinations will be one and the same, or otherwise inseparable, like the feeling of blood or urine dripping down their body, being burned, feeling their organs or bones "move around", or having their skin stretched.

In my personal experience - YMMV - tactile hallucinations are the most difficult to acknowledge as fake (for me, this is in comparison to visual and olfactory ones). Even if you are aware of the possibility of being in psychosis, since they can't be reliably verified for the most part, are often at least theoretically possible, and frequently co-appear with delusions of the same theme.

Olfactory hallucinations: smelling things that aren't there. Those can be pleasant, gross, or completely neutral, as most hallucinations in general. Smell hallucinations can be (unofficially; this is just a distinction I've used myself) categorized into external (smells "outside" the person having the hallucination, like a fire) and internal ("in/on" the person having the hallucination, like the smell coming from their own body). In my anecdotal experience, people tend to have more of only one of these types rather than both.

One of the most common ones is the perception of having extremely offensive body odor or bad breath, but it can also do with urine, blood, even decomposition, etc. The hallucinations generally revolve around mundane things (there's nothing "OMG I must be in psychosis!" about thinking you smell bad), which might make them difficult to spot as fake, even if someone is aware that they are overall psychotic.

Many kinds of olfactory hallucinations might make the person feel insecure (body related smells), paranoid (chemical related smells; e.g. I had a recurrent hallucination of smelling spilled gasoline), or cause problems with things like eating (smelling non-edible things in food; rot, mold...).

Gustatory hallucinations [warning: none of the mods have first-hand experience with this one; this is entirely based on external sources]: tasting things that aren't there. The rarest kind of hallucinations statistically, though it shows up in some non-shizo-spec conditions more often (e.g. epilepsy).

Gustatory hallucinations are mostly realistically plausible (for example, feeling a bitter or sour taste) or realistic but unusual (e.g. metallic taste). They often coexist with other kinds of hallucinations and delusions, often exacerbating the problem (e.g. a person with delusions of being poisoned might experience a hallucination of dangerous chemicals in their food, solidifying the delusion).

Hallucinations FAQ

[Plain text: Hallucinations FAQ]

Q: How to describe hallucinations in a sensitive manner?

A: Sensitivity and hallucinations is less about being sensitive about the hallucinations and more about the person having them. Hallucinations can be anything, and I mean it. For every "stereotypical" hallucination, there's a thousand real people who will have it. Unless you're considering doing something extremely out there, I wouldn't worry about the content of hallucinations being sensitive or not; anything that's common enough to be listed as an example of a hallucination is more than safe. Some hallucinations are scary, a lot are deeply unpleasant. That's okay to show.

So, how do you describe the person having the hallucinations? First of all, don't make them violent towards others. This is a very harmful stereotype that writers love to use. Psychotic people can be violent since they are people, but they're much more likely to be victims of violence as well as committing violence towards themselves (both in the self-harm context, as well as in attempts of dealing with psychosis that ultimately result in unintentional self-injuries). Don't make someone into a murderer because they are hearing voices or smelling blood in their food.

Second, show them as a full person and that psychosis is part of them as that person. Why* are they psychotic? How do they experience it? When did it start, and how often do they have episodes? Do they go to therapy? Do they take medication? How do they feel about it? Make them seem human while integrating psychosis into their character, not just a "normal" person with a "scary gimmick" slapped on top without considering what it actually means for them.

*- not as in "there needs to be a reason for a character to be disabled", but as in "what condition is causing them to hallucinate".

Third: don't push people with low insight under the bus. Someone who can't tell their hallucinations apart from reality isn't stupid or "worse" than someone who has higher awareness. It also doesn't translate to morals; someone who fully can't tell what's real isn't more likely to be evil. It also doesn't make them blissfully unaware angels that should be treated like children - don't moralize a mental illness in either direction.

To go back to the actual hallucinations - treat them as what they are: hallucinations. They aren't future-telling, prophecies, visions from an alternate dimension, sources of magic, whatever else, they aren't those things. A delusional person (or character) might believe that what they're experiencing is something "greater", but that'd be a part of a delusion; it's not something you should put as part of your objective worldbuilding. Even just implying that psychosis has some "deeper meaning" can mess some people up.

This is my least favorite form of psychosis representation in media. Honestly, personally, I'd rather be portrayed as violent than like I have some secret gift, but don't do either.

Q: How to integrate hallucinations into a story without the story becoming about them?

A: Depends greatly on whose POV you're writing from, how much insight the character has, and what emotions do they experience while hallucinating.

If it's a non-POV character who is aware they are in psychosis and are relatively unbothered by it, you can just describe them glancing around, or otherwise checking where the hallucination is. In most cases someone with high insight won't be interacting with a hallucination (an exception could be a pleasurable hallucination that the person enjoys).

They might ask another character if they also see/hear/feel the hallucination - even if someone is fully aware they are currently in psychosis, it might be difficult to verify which things are fake and which aren't. Maybe the character is sure that the person they're "seeing" is fake, but aren't sure about the dog that's with them.

You can describe the character being clearly distracted by something; looking into a specific place, moving weirdly, or not being able to stay on topic.

If you're trying to write about the character experiencing hallucinations and having low insight, it might be much more difficult to not make the story (or the scene) about it - if you don't go out of your way to acknowledge them as hallucinations then it will look like there is no hallucinations present, since the character will just consider them to be real. It'd just be another part of the setting - you can obviously throw in something that would be clearly out of place for the reader, but it will raise questions that you should probably address, thus making the scene about the hallucinations.

A similar thing can happen if your character is experiencing an unpleasant hallucination - you kinda have to make the scene about it. if the character is scared, it'd be weird to ignore that. You can of course go "they saw a peculiar creature in the yard, one so weird that they knew right away it wasn't really there, so they decided to ignore it," since you can be aware of a hallucination being fake while still being disturbed. In that situation you can have the character purposefully trying to distract themself, show them being under stress, or having another kind of reaction (e.g., using some sort of grounding technique, having a panic attack, etc).

Q: What are some common ways to tell what is and isn't a hallucination?

A: Visual: taking pictures/videos, taking off your glasses (hallucinations will sometimes stay in-focus when the real world blurs accordingly), asking another person if they also see it.

Auditory: recording the sound, asking another person.

Blind people having visual hallucinations and deaf people having auditory ones usually just assume that the hallucination is fake, especially if it's the only thing they are able to see/hear.

Olfactory: asking another person.

Tactile/somatic: no consistent way as far as I'm aware. In some circumstances you can tell by just looking (e.g. you feel like you're having a nosebleed, you can just look in the mirror to check) or asking another person (e.g. you feel like you're levitating), but for most hallucinations there is no way of telling (e.g. how would you check if there's something happening to your internal organs? Get a body scan of some sort maybe?).

Gustatory: if it's about a real food you can ask another person if they also feel the same taste, otherwise no way of telling as far as I'm aware.

Q: Does being able to logically differentiate between reality/hallucinations stop emotional responses?

A: It can, but it's not a guarantee by any means. Imagine you're on a rollercoaster or watching a horror movie: logically speaking, you know that you are safe - but still, you get scared, it's a natural response. If the insight helps someone emotionally, it's usually partial.

That said, being able to recognize something as a hallucination might (key word here) help someone stop having a psychotic episode, which could end the emotional response. But just because you know that something is fake doesn't mean you'll stop believing it. In fact knowing that you're believing something that is fake can be even more distressing than not knowing it's fake.

For some people, a hallucination could be traumatic or plain upsetting and continue to disturb them even after it's gone and they are no longer having an episode.

Not everyone will be particularly emotional though. Some people hallucinate 24/7 and just treat their hallucinations as another part of their day, even if they're fully conscious of them being fake.

Q: Can blind people have visual hallucinations/deaf people have auditory hallucinations?

A: Yes. For those where the two are connected, the former is called Charles Bonnet syndrome, the latter Musical Ear syndrome. The major distinction is that in both of those, the person experiencing the hallucinations usually has high insight (i.e., is aware that they are hallucinations) and they don't generally co-occur with delusions.

Blind and deaf people with residual vision/hearing can also experience "regular" visual/auditory hallucinations as well (and obviously other kinds too - nothing is stopping a deaf person from having olfactory hallucinations).

The one important caveat is that people with congenital cortical blindness do not, for unknown reasons, ever develop schizophrenia.

Delusions

[Plain text: Delusions]

Delusion is a fixed belief in something that is considered false, even after seeing evidence for the thing being untrue. The delusional belief isn't a part of the person's culture or religion, and isn't accepted as true among other members of their community. The belief is generally disturbing to the person and causes them distress.

The delusions that one can have are basically endless in terms of options, but they can be broadly put into two categories:

Bizarre: delusions that are impossible to occur in real life.

Examples:

being abducted by aliens,

having your thoughts broadcast over the radio,

being a supernatural entity.

Non-bizarre: delusions that are possible to occur, even if highly unlikely.

Examples:

being poisoned,

having a partner cheat on you,

being watched by the government.

Of course, in terms of fiction, what's considered "possible to occur in real life" might differ from these examples.

Delusions can also be categorized in "themes", such as:

Persecutory: the theme surrounds believing that one is being harassed, attacked, stalked, or conspired against, often by powerful entities. Frequently reported as the most common type of delusion, especially in schizo-spec disorders.

Grandiose: surrounds believing that one has special powers, status, knowledge, skills, has relationships with famous, powerful, and otherwise important people, or is such a person themself.

Jealousy: surrounds believing that one's partner is unfaithful.

Erotomanic: surrounds believing that another person, often of higher status, such as a celebrity, is in love with them.

Somatic: surrounds believing that there is something wrong with one's physical body, such as being infested with parasites, having blood replaced with a different liquid, or missing internal organs.

Religious: surrounds believing that one is a god or another religious figure, like a prophet or a saint, or is receiving directions/commands from those. A person doesn't have to actually be religious to experience religious delusions, nor has to be of the same religion that the delusion is about.

Thought manipulation: surrounds believing that one's thoughts are being manipulated in some way. Common examples include believing that one's thoughts are being broadcast, or that foreign thoughts are being purposefully inserted into their brain.

Mixed: delusions that match multiple of the aforementioned types. E.g. a character who thinks the government wants to kidnap them for their magical powers (persecutory+grandiose); a character who thinks that they are married to a famous pop star, and that she's cheating on them (erotomanic+jealousy), etc.

Unspecified: literally everything else.

There are also specific delusions which are often referred to as their own syndromes/disorders. They are generally considered very rare but they are frequently referenced in media. Some of them are:

Clinical lycanthropy: a delusion that one is turning into a werewolf. Often clinical lycanthropy is a catch all term now for clinical zooanthropy, which is the belief you are transforming into any sort of animal. It's very rare and can be part of a disorder such as schizophrenia or exist as a delusion on its own. Often people with it will start to behave alongside the disorder, such as eating raw meat or feeling somatic transformation, or hiding so as not to hurt others in their beastly state.

Delusional parasitosis/Ekbom's syndrome: a somatic delusion where you believe there are bugs/bacteria/parasites inside your body, generally under the skin. Commonly co-occurs with tactile/somatic hallucinations, adding realism to the delusion.

It very frequently results in self-harming behaviors in an attempt to "get them [parasites] out". That can be anything from skin scratching to auto-amputation or disembowelment. The less extreme ways can result in infections and painful skin conditions, sometimes solidifying the person in the delusion that their body is in fact infested. The more extreme ways can and probably will result in death for obvious reasons.

A common phenomenon associated with it is the "matchbox sign" where the person finds "evidence" of the "parasites" (usually dead skin, fabric, small pieces of food, etc.) and shows it to someone, often a doctor, as proof of the infestation (matchbox coming from it being the go-to container for the "specimen", but honestly it can be anything. Who even has matchboxes anymore). A person with this disorder can also obsess over parasites/other animals that can in fact infest humans, potentially forcing them to avoid certain activities as much as possible (not eating meat, not going into forests, obsessively washing themself, etc).

To my knowledge this is the most common syndromic delusion, though it could be related to the fact that people with delusional parasitosis are also the most likely to see a doctor about it (though the doctor of choice would practically always be a dermatologist, not a psychiatrist) and thus get counted in statistics.

[Warning: the next three are entirely based on external sources since no mods have first-hand experience with them.]

Capgras syndrome: a delusional misidentification syndrome where the person believes that someone else has been replaced by a clone/double/impostor. Most commonly the person who was "replaced" is a close family member or a spouse. Rarely, a person can also think that multiple people or a group were "replaced". Very rarely, the person with the delusion might think that they themself have been "replaced".

The delusion might be persecutory in nature, where the person believes the "clone" is there to spy on them or hurt them. This can sometimes lead to attempts of "unmasking" or confronting the "impostor" in an attempt to get their loved one "back".

Fregoli syndrome: a delusional misidentification syndrome where the person believes that strangers or acquaintances are someone they know in disguise. While generally it centers around people, it can also happen with animals or objects. It usually has a persecutory aspect to it, where the person thinks the "disguised" person is trying to follow or harm them in some way.

Cotard syndrome: also sometimes known as "walking corpse syndrome". It's a wide-spectrum delusion where the person believes that they already are dead, are currently dying, are immortal (and thus unable to die), have died but were reborn in some way, or just don't exist. People who have it might also believe that their organs are gone, rotting, or dying. Some can also abandon their basic human needs (such as eating) since they think it's no longer necessary.

Cotard syndrome is very rare in real life, especially in young people.

This is not an exhaustive list, just some examples.

Delusions FAQ

[Plain text: Delusions FAQ]

Q: What do delusions feel like?

A: So, it primarily depends on "insight" - whether the person has no, low, or high insight into their own delusion. The vast majority of people who experience delusions will have very little to no insight during their psychotic episodes.

Delusions feel like every other thing that's real, except they aren't, well, real. During a psychotic episode, delusions are facts as much as everything else around you - you don't question them since they feel obvious.

In delusions, there's lack of proof - which can be filled in by hallucinations (person believes they have a lethal disease, and starts hallucinating symptoms), explained by the delusion itself (person believes that someone else is in love with them, and interprets regular behaviors as "signs"), or simply ignored (the average person also doesn't know how [random everyday technology] actually works, but knows that it's a real thing that exists - people don't tend to question things they simply consider to be true, even if they don't really understand them).

Q: How to describe delusions in a sensitive manner?

A: To quote myself from earlier: Sensitivity and delusions is less about being sensitive about the delusions, and more about the person having them. Delusions can be of anything, about anything, they can sound stupid and seem absurd to outsiders. I'm not saying "write the most ridiculous delusion you can think of for fun", more so "yes, some people do have unusual beliefs due to having the Unusual Belief Disorder".

Delusions are frustrating for everyone involved almost by definition. They aren't true and they directly affect what you believe, so they make you believe nonsense. And you can't "just explain lol" to the person that what they're saying/thinking is untrue because, well, it's a delusion. By definition, the belief being verifiably false really doesn't matter.

What's important to remember is that the delusional person isn't doing it on purpose. It's not a case of someone Purposefully Spreading Misinformation or rejecting factual data to further their agenda, it's a mental illness. Portraying it as a choice or some moral failure is simply incorrect. You can't just "opt-out" and magically stop being delusional.

So, what to actually do?

Recognize that delusions generally aren't fun. Obviously, everyone's experience is different, but delusions tend to be distressing. Persecutory ones will almost always be very negative, while a religious or grandiose one could even feel positive for someone if they think they are an angel or have some amazing talent.

Try to show the character's feelings in a sympathetic way, not a mocking one. What they believe isn't true, but their feelings are as real as anyone else's.

It's also important to remember that a delusion is something you genuinely believe. Try to put yourself in that position: you simply know some things. What your name is, how your pet looks like, where you live, whatever. If someone tried to convince you that you are wrong about these things you'd think they're crazy. Imagine your coworker talking to you like they know your home life better than you do. Depending on the exact circumstances, you would probably have some sort of reaction - whether that be anger, being baffled, or just kinda weirded out.

It's the same when someone is delusional, and the "things you simply know" just happen to not actually be true.

This kinda leads to considering the ways in which a delusional character interacts with others. Some delusions are ignorable - the other character can kinda just nod and change the topic and move on. Others are a bit more in your face (e.g. the character thinks they are some higher being, or they think the character they're directly talking to wants to hurt them). Again, just telling someone "that's not true lol" doesn't really do much, if anything it can make the delusion worse (again: imagine you confront someone who you think is poisoning you, and they just say "um but I'm not?? what are you talking about lol you sound crazyy"). Try to consider what the relationship between the characters is, and what their personalities are - are they considerate, are they impatient, do they understand how the delusions affect the other character? Does the other character realize/know that the psychotic character is in psychosis at all?

Q: How do I incorporate delusions into a character's voice realistically?

A: TLDR: It's can be hard to make dialogue that sounds realistic for a character who has the disconnect-with-reality disorder.

First, try to consider how your character experiences their delusions in general. Are they extremely disturbed and can't stop thinking about their delusion when they're having an episode, or is it more of a background noise?

If it's disturbing them, then it probably won't sound realistic. When the delusion is all-consuming, the person having it might talk about it in circles and relate everything to it. Depending on how the psychotic character actually behaves, other characters might feel like they're being pranked because it just seems like "too much". It might be "like in the movies". The character can be going in circles trying to figure out how to stop NASA from broadcasting their thoughts around the globe; this happens.

At the same time, sometimes the delusion is much more covert. Sometimes on purpose (e.g. character with persecutory delusions believes that they are being observed, and doesn't want the observer to realize that they are aware of the observing, so they actively choose not mention anything about it), sometimes as a by-product of the way the delusion affects them (e.g. character with an erotomanic delusion isn't distressed by it, and they just vaguely mention their 'partner' in a way that doesn't really even tip anyone off).

If it's the first, you might be dealing with a character who is simply nervous/hiding something (because, well, they are). They might avoid certain topics or visibly get more stressed if the conversation goes into uncomfortable territory.

If it's the second, it will probably be more subtle. Perhaps you-wouldn't-be-able-to-tell-it's-a-delusion subtle. It depends on the character's exact delusion though. Some would just be considered non-events (they say they have a partner who's famous, or that they are accomplished in some way), relatively normal/common events (partner is cheating on them, they have some serious illness), and some would be clearly bizarre (they say that their parents have been replaced by robotic clones, or that they are some mythical creature). If it's the first or the second, there might be no "tell", or maybe there will be some logical errors that other characters can catch on to, maybe there will be some inconsistencies when the character asks about it further, or maybe there will be nonsensical changes that happen between different retellings of the story that let others know something is off.

If it's the third clearly-bizarre option, then the "delusion reveal" might feel like it's coming out of nowhere, or create a sudden tone shift. It will be explained further in the post more, but psychosis isn't always obvious. Sometimes you learn that someone is psychotic because they say one thing that makes absolutely no sense. Again: it might feel abrupt, unexpected, other characters might think that they are being pranked at first. Just don't make the narrative make fun or mock the delusional character.

As to what you shouldn't do: no matter how delusional someone is, people still have other traits. Delusions aren't a replacement for backstory, relationships, preferences, or personality. They can and do affect them (and vice-versa), but if all the character talks about is their delusions, it will come off as either boring and flat, or a parody.

Psychosis FAQ

[Plain text: Psychosis FAQ]

Q: Can psychosis go undetected by the people around the person experiencing it, or is it very obvious?

A: Depends (sorry). But yes, sometimes it can absolutely go undetected, especially in case of a person experiencing mundane non-bizarre delusions and/or hallucinations.

It can also depend on the actual cause of the psychosis - for example, schizophrenia often comes with disorganized speech (among other things) which is definitely noticeable.

On the other hand, Delusional Disorder is often referred to as a "high functioning" disorder where it can be very hard for others to notice anything is wrong. It's generally characterized by non-bizarre delusions, unremarkable behavior ("not odd"), relatively non-impaired functioning, and any hallucinations that come with it are relatively minor and most importantly, fit the theme of the (probable) delusion.

My own absolutely worst psychotic episode went undetected by everyone I was living with at the time (in a tiny apartment at that). For someone else, a stranger could notice that they are experiencing psychosis from the other side of the road. It's a very wide spectrum, and a person can be on different ends of it at different times of their life.

It's basically: could you tell that your coworker who is ranting about their wife cheating on them is having a psychotic episode? Because they could be, and you probably wouldn't even consider it as an option since it's a very mundane delusion. On the other hand, if the coworker told you that their wife has been replaced by an identical evil clone overnight, you will know there's something going on because that's not a thing that happens.

Q: What impacts what hallucinations and delusions come up? Are they random?

A: As far as I'm aware, there's no actual research on this. We know that certain types of hallucinations and delusions are more common in specific disorders (e.g. in schizophrenia, auditory hallucinations and persecutory delusions are more common than other types), but that's about it. We don't know why certain people hallucinate cats meowing, and other ones hear demonic screaming.

Anecdotally speaking, people tend to stick to their delusions rather than have a completely new kind every time they have a new psychotic episode. It could be literally the same delusion following them ("the government is watching me"), it could branch out over time ("the government is spying on me and stealing my thoughts"), or incorporate other delusions that still somewhat connect, either in theme (in this case persecutory) or in subject (in this case government-related). In my experience, it would be very unusual for a person to have a psychotic episode where their delusions center around one thing with a specific theme, go into remission, and then have their next episode center something completely different with a fully unrelated theme (excluding "major event happening between the two episodes" type stuff).

Having unrelated hallucinations is more frequent since multimodality is very common.

The content of delusions or hallucinations is essentially "anything". It can be related to trauma, but doesn't have to. It can be related to the person's daily life, but doesn't have to. It can make sense from the outside, but doesn't have to.

Q: What do antipsychotics do from a more first-person perspective? How do they affect the symptoms of psychosis?

A: Make you sleepy... no, the biggest thing my antipsychotics have done when dosed correctly and on the right mix is they have helped give me a tool to more easily establish what is real or true and not. Even "in remission", a person with psychosis may experience hallucinations or mild delusions. It's less the symptoms that stop and more that they stop being as disturbing and disruptive, in my (mod bert again!) experience. They do not affect speech or negative symptoms for me, however.

Other mod here! When on the wrong antipsychotic, my delusions and hallucinations got meaner. They were more persecutory and I also experienced "old" hallucinations that I had not seen in a while returning. However, on my best dosage, my antipsychotics made my hallucinations nicer and quieter. Not as in like literally less loud, but they became easier to ignore. Like above, I have never seen an improvement in my speech or cognitive symptoms from medication.

Q: What kind of things can trigger a psychotic episode?

A: Technically speaking, anything can. It depends a lot on the actual disorder causing the psychosis (no points for guessing what triggers an episode in someone who has Medication-Induced Psychotic Disorder), but the most common triggers would be:

high stress,

recent traumatic event,

substance use,

sleep deprivation,

and social isolation.

My symptoms can be triggered by talking about them or seeing content similar to my hallucinations and delusions. For example, hearing a bible story triggered a religious hallucination, etc.

Sometimes the trigger is also "nothing" as far as the person experiencing the episode knows.

Things to Avoid

[Plain text: Things to Avoid]

Violent psychotic characters, especially ones that kill others because of "the voices"/"the visions". Psychotic people are much more likely to be violent towards themselves than anyone else.

Magical psychotic characters where the psychiatric disorder is some sort of magic system mechanic. A mentally ill character can have powers or whatever, but don't make symptoms into something they aren't.

Delusions/hallucinations that predict the future or have some other kind of omniscient quality to them. Again, this is a real medical condition, not a writing prompt.

Rule of thumb: would you still make the character psychotic even if their symptoms served no purpose in terms of worldbuilding and/or establishing something supernatural? Because if the answer is no, you have to rethink some things.

Psychotic characters who always have to be one of the like, four possible character archetypes (evil cannibalistic serial killer/mad scientist/Victorian era child in a horror movie/side character whose delusions are played for a joke and/or to show how 'dumb' they are).

Things We Want to See

[Plain text: Things We Want to See]

Regular people who just happen to be psychotic because of a mental health condition.

Psychotic characters who also experience other symptoms of their condition. Schizophrenia, the most commonly portrayed psychotic disorder, has many more symptoms than just that.

Psychotic characters who aren't young. Elderly people are actually the most likely to develop psychosis, childhood onset is extremely rare in comparison.

Psychotic characters who aren't white, physically abled men. Your character can be of literally any background, anyone can develop psychosis. In media it's almost exclusively either white men with poorly "researched" schizophrenia to portray them as crazy and dangerous, or sometimes women with delusions (usually erotomanic/jealousy type for obvious reasons) to portray them as crazy and unbearable to be around.

Characters who experience other kinds of hallucinations than just auditory and visual ones.

Characters who experience cognitive and speech symptoms.

Characters with other disabilities.

Characters who need a lot of support as a direct result from their psychosis. This should be portrayed as a neutral thing.

Psychotic characters who still have a social life! And hobbies!

Characters with MDD [major depressive disorder] that experience hallucinations/psychosis as a result. This was something I experienced during one of my worse periods and I have quite literally never seen anyone talk about MDD with psychosis outside of a medical context.

Happy writing!

mod Sasza, mod Bert, & mod Patch

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Free Customisable (and Animateable) Wheelchair Model

This is the last of the free downloads I had planned for Disability pride month, and it's the one I'm most excited about!

This wheelchair model made for Blender is able to be customised to suit a wide variety of characters with different personalities, lifestyles, needs and disabilities. Everything from the overall shape to the colours and (in some cases) textures can be controlled via a customisation rig, with several parts that can be enabled or disabled entirely. The rig is also animateable (via a different set of controllers to prevent conflict).

You can get the model for free on my Ko-Fi store

or you can download it from my Google Drive.

This Download includes:

The original .Blend file to edit in Blender.

an .obj file of the default version of the wheelchair that can be imported into programs like Clip Studio Paint.

A texture file for the spoke cover + .clip/.psd templates for making your own custom cover (overwrite the original file and restart Blender to replace it on the model)

a HDRI texture for lighting (from Polyhaven)

A link to the user's manual (found here) for more detailed instructions on how to use the model.

I plan to update and continue adding more options to the model over time too, including things like higher/more supportive back rest options, different types of side guards/arm rests, handles and spokes, and power-assist modules. I'd also like to add the option for a foldable frame at some point, though that may take some time (or it might have to be a different model entirely, we'll see).

I've also included a bug report and feature request form here in the User Manual, so if there's anything you want to see or you find any problems, let me know!

More info below:

At first, I had just planned to update the original 5 wheelchair models but the problem with making active-style wheelchair models, is that in real life, these chairs are made to fit their users perfectly. As a result, It's basically impossible to create a pre-made one for artists to use as reference and have it actually fit their characters the way it should. So instead, I made a model with a Blender rig that can be adjusted to best suit your character. Just like the previous models I made, you can export the whole thing to an .obj to use it in Clip Studio Paint and other 2D art programs.

As well as the overall shape, the colours and materials can also be edited through the rig, so you don't need to know much about Blender's material editor to change things (in general, I've tried to make the rig as beginner-friendly as possible). The only exception to that is the texture on the Spoke Cover. You can change that the usual way via the material settings, or simply overwrite the texture file and restart Blender. There are also .clip and .psd templates included to show you how to make your own custom texture for it. Finally, There's also an option to swap out all the metal shaders for ones that resemble wood for a more fantasy vibe (though I want to continue to edit that so it will eventually look more like a fantasy wheelchair rather than just a pallet/texture swap)

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Writing a Schizophrenic Character: Everything But Hallucinations

Plain text: Writing a Schizophrenic character: Everything But Hallucinations

Hey! Mod Bert here. 

So: you’ve decided to write a character with schizophrenia or schizoaffective disorder (there are other disorders on the schizophrenia spectrum but I will be focusing on these for today)

You’ve done it, you have their hallucinations and maybe even delusions picked out. Maybe they are one of many who experience auditory hallucinations or maybe they also have visual hallucinations or a combination. Maybe they have olfactory hallucinations as well. They may have persecutory delusions or delusions of reference or something like Cotard’s delusion or clinical lycanthropy. Awesome, you’ve done it!

What, I hear you say? What do you mean that’s only 2 of the 5 components needed to be diagnosed with schizophrenia? What do you mean, you don’t need to hallucinate at all to be schizophrenic?

What Goes Into a Diagnosis of Schizophrenia

Plain Text: What goes into a diagnosis of schizophrenia

Not a lot of people realize there’s more to schizophrenia and schizoaffective than just hallucinations or delusions. There are 5 diagnostic criterias that are needed for schizophrenia, and only 2 of the 5 are needed for a month, with larger symptoms happening for six months or more. Let’s get into it.

Delusions

Hallucinations

Disorganized speech or thinking*

Disorganized or unusual motor behavior (catatonia)*

Negative symptoms (avolition, anhedonia, flat affect)*

I’m going to focus on disorganized speech/thinking, catatonia, and negative symptoms.

Disorganized Speech/Thinking

Plain Text: Disorganized Speech/Thinking

Schizophrenia and related disorders are often called “thought disorders” for a reason. Speech and thinking can be extremely affected, and for people like me this can be one of the first and most striking examples of an episode coming. Some people will always have disorganized symptoms that will flare during episodes. A myth is that schizophrenia can be indistinguishable with medicine: most people will have some level of symptoms even during moments of peace or “remission”. More on remission later. 

So, disorganized speech. Some examples are: word salad (schizoaphasia), thought blocking, poverty of speech (alogia), pressurized speech, clanging, and echolalia.

Word salad: a combination of words that do not make sense together. Often called schizoaphasia for its similarity to jargon in Wernicke’s aphasia, this is instead a disconnection with the brain and not due to damage to the language part of the brain.

(Example: the salad would be yellow in the fat cow).

Thought blocking: A severe loss of thought, often paired with connecting two trains of thought that are not connected

(Example: I went to the………Do you like grapes?)

Poverty of speech: A lack of organic responses to speech or organically speaking, it can be severe enough that a person only responds to questions or in one word responses. Can also happen in severe depression.

(Example: Person A: Did you do anything fun today?

Person B: Yes.

Person A: Oh, what did you do?

Person B: Store

Person A: How was it?

Person B: Fun)

Pressurized speech: A sort of frenzied way of speaking associated with psychosis or mania.

Clanging: Connecting phrases together because of what they sound like instead of meaning

(Example: I went bent tent rent).

Echolalia: Repeating word’s and phrases. Commonly also associated with Autism Spectrum Disorder. 

(Example: Person A: I went to the store.

Person B: To the store.)

These are not the only examples but they are some ones I thought I'd highlight, either because they’re well known or I have experience with them, or because they’re famously thought of with other disorders as well and I wanted to point out how things overlap.

Personal experience: I had severe alogia for the duration of my last and worst episode. People thought I was mad at them because of the clipped way I spoke and the lack of really speaking. It got me in a lot of trouble. I didn’t realize what I was saying was different or weird (I have the least insight when it comes to my speaking patterns affected by my schizoaffective, meaning I can’t hear any difference and all of this is from repeated conversations with my mom, who was my caretaker for a bit and knows the most about my speech and what it means). The best solution was talking with people and being honest and educating myself and others. I don’t know about others, but I couldn’t have used AAC at that time.

Catatonia

Plain text: Catatonia

Fun fact: catatonia means unusual motor behaviors! Any unusual motor behaviors mean catatonia. This includes what we think of when we think of catatonia in schizophrenia (inability to move) as well as the opposite (being unable to stop moving) as well as strange movements and ways of holding and moving the body! Catatonia in the DSM-5 includes 3 or more of these 12 behaviors:

-Agitation unrelated to external stimuli

-Catalepsy

-Echolalia

-Echopraxia

-Grimacing

-Mannerism

-Mutism

-Negativism

-Posturing

-Stereotypy

-Stupor

-waxy flexibility

I have some experiences with catatonia-like symptoms but since they were never identified as such I’ll skip those for now. I will say that catatonia is a symptom that can happen in many disorders besides schizophrenia as well.

Negative Symptoms! Yay!

Plain text: negative symptoms! Yay!

So a positive symptom (Hallucinations or delusions) are symptoms that add something to reality or a person. Negative symptoms are symptoms that take away. There are 5 A’s:

-Alogia (Again, poverty of speech, our favorite)

-Avolition (Lack of energy and motivation)

-Affect (Blunted affect, or a flat way of speaking)

-Anhedonia (Lack of pleasure in things that used to bring you pleasure, often thought of with depression)

-Asociality (Lack of interest in social events and relationships)

There are also often cognitive changes including thinking and memory, information recall, understanding, and acquisition, and so forth. 

Schizophrenia and schizoaffective often (but not always) happen with what’s called a prodromal period. This period can be months to years (mine was a little less than a year) and mainly consists of negative symptoms. Slowly, positive symptoms are added. There are thought to be stages to schizophrenia including prodrome, active phases, and remission.

I’ll talk about that a little for a second because I’m currently in remission and no one knows what that means. I was diagnosed with schizoaffective depressive type in January 2021. As of February 2024, I no longer qualified to be rediagnosed because my symptoms were strongly under control and no longer severe enough to qualify for a diagnosis. They also didn’t distress me or impact my daily life severely. Day to day now I still have mild symptoms and take my antipsychotics (trying to go off them have made it clear that I still have some symptoms I choose to keep medicating) but I haven’t had a delusion in 2 years and been hospitalized in 3. There’s always a possibility of another episode but I work with my team to keep myself one step ahead if that happens.

What I want from a character with schizophrenia

Plain Text: What I want from a character with schizophrenia

Alright the writing advice part. What do I want from a character with schizophrenia or schizoaffective (which is schizophrenia plus either depression or bipolar). 

-Characters with caregivers.

-Characters using coping strategies (recording hallucinations to tell if theyre hallucinations, taking medication, having service animals that greet people so they know if they’re a hallucination, using aids for the cognitive symptoms like sticky notes and organizational tools)

-Characters who know other characters with their disorder, either online or in support group or through running in similar circles

-Characters having autonomy

-Characters who aren’t the killer or horror victim. I know it’s cool to have the schizophrenic protagonist in horror, and I love horror, but I don’t want to read about the horror being symptoms the whole time

-Characters who are in magical scenarios, who are in fantasy and sci-fi. The schizophrenic princess and the schizoaffective robot technician aboard the spaceship.

-Medication and hospitalization treated casually. Sometimes we need higher care. That’s morally neutral

-Characters with negative symptoms and speech symptoms.

-Characters with catatonia! 

-Characters with other disorders as well

-characters with side effects from medicine treated casually

-Characters with cognitive symptoms

Thank you for reading this incredibly long thing! Happy writing!

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"dolphins are completely evil" I actually don't think we should assign human morality to animals with no concept of law or civilisation with an intelligence roughly equating to that of a toddler

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Everyone who got annoyed at me over the cis woman who couldn't understand a man knowing what experiencing misogyny is like post is proving my point btw.

Everyone who had something to say about "do you want to be seen as a man or not" is proving my exact point that people cannot fully accept the notion of men who are not welcomed into the boys club of cis manhood. The notion of "Man" is entwined inextricably with Power, Control, if I am a man that must mean I wear The Boot because Man means Wearing The Boot. You want me to chose between my sense of self and my lived experiences because to you, a "real man" would not have had my experiences.

You people are incapable of understanding gender as an internal sense of self and not as a magic spell. You fail to progress your feminism past a no boys allowed sign hung on the door of a playhouse. You are deeply fucking unserious and it's frankly embarrassing.

There's a serious problem in progressive spaces wrt seeing people as entire people with flexible experiences and not just identities listed like Pokémon types. Be better.

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On the subject about parents needing to control their child's reading and invade their privacy in order to "protect" them from "inappropriate material:

Until I was in....college? At least? The vast, vast majority of the books I read were either a) assigned by my school or b) (the vast majority of my reading) provided to me by my mother.

My mom is a librarian. She filled our rooms with books, picked especially for us. She pointed out books on the shelves in our home library (separate from our bedroom shelves) that she thought we would like. She bought us books for birthdays, Christmas, and just stacks of recommendations. She once paid me $10 to read one of the Cirque Du Freak books because she said I needed "to be exposed to bad literature."

She respected my privacy in room, didn't go through my belongings. She explicitly pointed out to us that she wouldn't know if we took a particular book of the shelf, as long as we returned it, if we didn't want her to know we were reading it. She purposely brought us books that she didn't care for herself, because she thought we might find them valuable or enjoyable.

And if we wanted to read something she thought might upset or disturb us, she would explain why. She wouldn't stop us from reading it - just ask us to check in with her, to talk through it.

And so when I read something that upset or disturbed me, I would go to her. She would listen and talk through it with me.

If she said she didn't think I would like something, or that a book might disturb me, or that she thought I should wait until I was older, I listened to her.

She didn't need restrictions or control to protect me. Because she proved I could trust her.

Controlling kids is never about "protecting" them. It's just about control.

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I’ll read over 200 comics about a character and still be like “hm idk if I know enough yet to write a fic about them, what if I get something wrong?” Girl please go sit down and write, half the fandom hasn’t even read one comic.

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hey

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Working Late

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Okay, so I'm not really sure what this is. I was playing around with Knight helmet ideas and it wasn't really clicking but I liked the colors of the pink knight, so I just made it Ace Attonery because AA got me back in the choke hold so everything gets to be them.

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liking a widely popular thing is a curse because i know too much now. i was reading a fic for an entirely different fandom but they started talking about batman comics and i went 😮🫵 batman! from my comics! but THEN they mentioned harley quinn even though the story is supposed to take place in the 70s and it pissed me off so bad i had to stop reading

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He’s just kinda chilling

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I like to think that all of the Hellblazer writers who have claimed to see John in real life have all been victim to an elaborate and decades long hoax by Sting. I like to imagine every few decades he manages to get near one of the writers and sometimes he say's something and sometimes he doesn't. There's an interview from the early 90's and he seems at least aware of the comics and then when he was asked to write the 30th Anniversary Edition's forward he dressed up in the coat and made a video to promote it, apparently without anyone suggesting it to him. The guy has read at least some of the comics and though the chances are slim it would be very interesting and funny if this were the case.

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welcome to the Murdersex zine, a zine celebrating all things sex and murder. but um. we don't want to romanticize it or anything so don't make your submissions too murdersexy. we will do extensive background checks on all applicants and if we decide a past work of yours has too much sexy murder we'll have to remove you, sorry. we have limits, you know, we want a tasteful gory spread you could put on your coffee table, and having the Wrong people in it would kill the vibe (and we condemn all killing! wholeheartedly!)