I’ve been seeing a trend in book reviews questioning the use of mental illness in works of fiction, as a plot device or even the main theme of a novel. (And yes, that includes reviews of one of my books.)

Also, it happens to be Mental Health Awareness Month, so this is a good time to address the topic.

This post has more questions than answers.

Some reviewers declare they will not read or favourably review any book that uses mental illness as a plot device to create tension or conflict.

But what about the unreliable narrator? What about the psychological thriller? What about the character who does terrible or puzzling things because of mental illness?

When might it be OK?

• Never?
• If the writer has experienced mental illness and writes from that experience
• If the writer has done extensive research on the specific illness in their story and/or interviewed people who have experienced it, and writes about it respectfully
• If the writer has had the manuscript reviewed by a sensitivity reader
• If the writer avoids stereotypes or tropes associated with mental illness
• If there are trigger warnings in the book description and/or at the beginning of the book
• If mental illness is not explicitly mentioned in the story, even though one or more characters display what might be termed symptoms?

If it’s never okay, that means writers are limited to pure evil (whatever that is) to motivate the serial killer, or inexplicable confusion for the unreliable narrator. Or simply an inexplicable tendency to lie. Is it okay to leave it up to readers to carry out a diagnosis?

And why is it okay to show murder, bloody combat, and child abuse in fiction, but not mental illness?

What about all those characters who remember or discover terrible things that were done to them as children?

Psychological conditions are common in real life and therefore in fiction. It’s just as unacceptable to pretend they don’t exist as to treat them casually and thoughtlessly. But I see objections, in recent reviews and articles, to writers using the terminology or descriptions of symptoms because it’s “unfair,” or because it might “trigger” a reader who has experienced or is experiencing mental illness.

And what about suicide? Is it ever okay to mention or depict that in fiction? Strangely enough, even though a search on “mental illness in fiction” brings up many articles that say don’t do it, a search on “suicide in fiction” yields lists such as “the 10 best suicides in literature.” Is suicide just too useful as a plot device?

And what about trigger warnings? How detailed should they be? What about spoilers?

For what it’s worth, I think it’s undeniable that a greater awareness of mental illness requires us writers to avoid treating it casually in our fiction. We must think of it as something that can affect any of us, rather than a peculiarity of people who are “not us.”

Have you read or written books that mention or include mental illness? Is anyone prepared to revise their published works to address issues mentioned here?

For a more extensive look at the issue, have a look at this post from Rabbit With a Red Pen.

The Wikipedia entry titled “Mental disorders in fiction” lists numerous works that include mental illness.