Why do we STILL equate psychosis with evil intent?

I had intended to write a second entry on the nature of change, but I just finished reading a novel that I enjoyed. Until the ending. Which resolved the mystery by explaining that the long, convoluted plot for revenge was concocted and carried out single-handedly by a character so deranged that she was later declared incompetent to stand trial.

I keep reminding myself that this was entertainment. Just like all the tv shows that do the same thing. I can’t help but wonder, though, how much this misinformation affects the way we look at the seriously mentally ill. How much does it explain the dearth of quality care and the paltry rates that insurance companies are willing to shell out for mental health care?

All right. I’ll get down off my soap box for that speech, but I still want to say to authors and other interested parties that people with uncontrolled schizophrenia or other psychoses may indeed have voices telling them to do something illegal or harmful. The jails are full of the  mentally ill. But the acts they get arrested for are usually impulsive:  interrupting a court session, bad-mouthing a policeman, disrobing in public, even pulling out a weapon and shooting someone. But in full-blown psychosis, an individual’s thoughts are too disordered to conceive a plot, impersonate someone, perform at a job without raising questions, or even explain a complicated plan to an accomplice or a policeman. In all my career as a psychologist, I have NEVER worked with a psychotic patient who wasn’t his or her own worst enemy, and much more likely to be the targets of abuse rather than the perpetrators. Not a one of them could have begun to formulate such a plot as the one described in the novel I read.

If you are writing a story about a career criminal or a shyster involved in a tangled conspiracy, give your protagonist a personality disorder. (They used to be called character disorders.) Narcissistic, borderline, or, for the big guns, antisocial (also known as sociopath or psychopath) are accurate possibilities. They each have their own characteristics and would play out differently in your story. I’ll offer more details later. But please don’t depict people with rampant psychoses as evil geniuses.

I’m off to popcorn and a movie now. Take care!

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