Category Psychology and Writing

May 30 2017

Cognitive Dissonance or How a villain sees herself

Writing a villain can be fun, particularly if you’re going for humor. Take a look at Alan Rickman’s performance as the Sheriff in “Robin Hood: Prince of Thieves.” It’s absolutely over the top. He portrays the Sheriff as totally evil. The audience ends up laughing. If you want that reaction from your readers, go for it, by all means. (Take a look at The best of Alan Rickman in Robin Hood: Prince of Thieves.)

alan rickman

The difficulty comes when we’re not writing humor. This brings us to the concept of “Cognitive Dissonance.” Back in 1957, Leon Festinger came out with a theory that posited that people strive to maintain internal, psychological consistency. In other words, we strive to make sense of ourselves to ourselves even when we maintain contradictory beliefs. For example: Your character believes himself to be a good person, but is a serial killer. To most of us, this is very contradictory. We often write off such a person as “a monster.” It reduces our own cognitive dissonance. But what about the villain herself? How does she live with herself?

There are several tactics that can be used. Your villain could simply ignore the dissonance or deny reality. She could even call the contradiction “fake news.” (Sorry, I just couldn’t resist.) She could use some sort of justification. “They deserved to die.” This seems to be fairly common across a range of horrendous behavior. The idea in reducing dissonance is to make those contradictory beliefs/behaviors somehow compatible.

Remember that few of us see ourselves as bad, evil. Some do, however.  I think this is often an issue of very poor self-esteem. Dissonance is reduced by agreeing with one side and rejecting the other. Our serial killer might just reject the idea she is basically good and accept that she is evil. I think (without any research), that she would still use some sort of justification such as genetics or upbringing. “I’m evil because it’s in my blood. I come from a long line of evil people.”

Profilers often talk about post-crime behavior as a possible tip-off. They note that after committing the crime, the perpetrator often displays a change in behavior. Maybe she starts drinking a lot, or becomes reclusive, or any of a myriad of behaviors that aren’t typical. I wonder if this change is driven by the dissonance and attempts to reduce it.

The bottom line here is that even your villain has to make some sense of herself to herself. She can do this through denial, justification or acceptance of one belief and rejection of the other. Her behavior may change as she grapples with her cognitive dissonance and this can be a tip-off to investigators or witnesses.

In this post, I have talked mostly about “villains,” but the concept applies to any and all of your characters. It applies to all people, though beliefs are likely to differ based on culture. In writing your characters, it might be helpful to try to get into the head of each of your major characters and think about how each justifies herself to herself. You might just end up with much more believable characters.

 

Apr 5 2017

Needs and Motivations

The past several years have been difficult. At last, my life is improving and I feel like writing again. Many years ago (actually in 1943), Maslow published his Hierarchy of Needs. At the bottom are Physiological (food, water, sleep) and Safety. Until these are assured, the later, higher level needs generally won’t be of much importance. For me, my writing fulfills the highest need: Self-actualization. It also touches on Love/Belonging and Esteem. Here’s the usual graphic of Maslow’s Hierarchy.

1052px-maslowshierarchyofneeds-svg

 

Now that I’ve got those basic needs taken care of, I can turn to the higher needs and begin fulfilling them. I’ve set aside several hours each morning to work on writing.

Character Motivation

This is a basic way to view the motivations of your characters, both the good guys and the bad guys. The cliché of a person stealing food is familiar to most of us. But what about a character who kills another over access to water? Can you think of a scenario where access to air is a critical factor for one of your characters? This might be a good motivation for a science fiction story, but then I’m probably biased. 😉

Of course, how a person reacts to the lack of various needs will depend on the individual. A child who grows up experiencing frequent hunger is likely to have a large focus on food in later life. He or she might become obese. Or possibly a farmer or grocer. Maybe a biologist working to increase the yield of crops. Can you think of other reactions? The idea here is to make the reaction logically consistent with the denied need from childhood.

None of this implies that the individual is aware of his/her motivation at this level. Most people just aren’t that self-aware. A serial killer who kills prostitutes could justify his/her behavior by proclaiming a “moral” motivation. “They are an abomination and must be eliminated.” But what underlies that might be a need for safety and thus striving to eliminate the threat he/she feels the prostitutes pose. While your character might not understand his or her motivations, you, the writer, should keep needs and motives in mind. Your characters will benefit by becoming that much more realistic.

 

ASSIGNMENTS:

  1. Go through the needs listed in the Wikipedia article and come up with characters that are motivated by the different needs. You might not like all the ideas you come up with, but you might just create an interesting situation and decide to pursue it.
  2. Pick a book and list out the needs motivating the major characters. You can also do this with a movie.
Feb 18 2016

Obsessive Compulsive Disorder and Obsessive Compulsive Personality Disorder

monk

 

Most of you have probably seen a character on tv who suffers from obsessive-compulsive disorder. Baby boomers can refer to The Odd Couple and the character of Felix Unger. You younger folks have probably seen Monk and its iconic character Adrian Monk. Just how well these shows depicted this disorder is complicated. First off, we need to distinguish between Obsessive-Compulsive Disorder (OCD) and Obsessive Compulsive Personality Disorder (OCPD).

N.B.: I just realized that a new The Odd Couple has been shown on CBS. I didn’t see it, so I can’t make any comment.

felixunger

 

Obsessive-Compulsive Disorder (OCD)

According to the National Institute of Mental Health, OCD is a chronic and long-lasting disorder that involves uncontrollable recurring thoughts (obsessions) and behaviors (compulsions). The sufferer feels compelled to repeat these thoughts and behaviors again and again, even though he/she realizes they are absurd. Typical obsessions include:

  • Fear of germs
  • Having things in symmetrical or perfect order
  • Fear of dirt
  • Superstitious ideas about lucky or unlucky numbers

You can find more here.

Compulsions are repetitive behaviors the person with OCD does in response to the obsessive thoughts. So the above obsessions could lead to:

  • Excessive hand washing
  • Ordering or arranging things in a specific, precise way
  • Excessive cleaning
  • Compulsive counting

Part of the definition for OCD is that the behaviors and/or thoughts take up at least an hour out of the day and that they cause significant problems in daily life. The person with OCD can’t control these thoughts and behaviors despite awareness that they are excessive. It’s also important to remember that the person with OCD doesn’t get pleasure out of these thoughts and behaviors, although they might feel some relief from anxiety when they have performed the compulsive behavior.

The onset of OCD  is often in childhood or early adulthood, usually before the age of 25. Symptoms typically wax and wane.

Treatments include both medications and therapy. Medications often used include selective serotonin reuptake inhibitors (SSRIs) like Prozac, Paxil and Zoloft. Sometimes atypical antipsychotics like Risperdal or Abilify are used. Cognitive Behavioral therapy (CBT) is often used in the treatment of OCD. The prognosis is good, particularly for children and adolescents.


Obsessive Compulsive Personality Disorder (OCPD)

While Obsessive Compulsive Personality Disorder (OCPD) shares some features with OCD, it is different. The person with OCD finds their thoughts and behaviors unwanted, while the person with OCPD believes their thoughts and behaviors are correct. These individuals are preoccupied with

  • Rules
  • Orderliness
  • Control

It typically begins in the teen years or early 20s, somewhat later than seen with OCD.

People with OCPD can become quite upset when others try to interfere with their rigid routines. Often anger is not expressed directly and may instead express anxiety or frustrations, feelings that they believe are more appropriate.

The key is a need to be perfect, but it is this perfectionism that often leads the person to fail to complete tasks. Emotional closeness is difficult, since the person with OCPD often feels a lack of control in intimate relationships. Flexibility is not to be found in this individual. According to MedLine Plus, other signs of OCPD include:

  • Over-devotion to work
  • Not being able to throw things away, even when the objects have no value
  • Lack of flexibility
  • Lack of generosity
  • Not wanting to allow other people to do things
  • Not willing to show affection
  • Preoccupation with details, rules, and lists

Treatment often involves either psychotherapy or medications or both. The prognosis is fair.

 

TV Portrayals

So, what have the writers of Monk and The Odd Couple gotten right and what have they gotten wrong? Let’s look first at Adrian Monk. (Please note that I’m getting a lot of my information about the show from Wikipedia.) First off, many of the funny behaviors Monk displays are the result not of OCD or OCPD, but of his multiple phobias. It is true, however, that some of the phobias may actually be more like obsessions. The backstory here is that Monk developed his psychological problems after his wife was killed. Thus, the age of onset is somewhat out of limits for either OCD or OCPD. The dramatic precipitant is also quite unusual for these disorders. The episode in which Monk takes a “new” medication and is instantly “cured” in more than a little problematic. As noted on Health24.com, Monk’s multitude of symptoms are not typical and smack of excessiveness. OCD is hard enough to live with. The authors, however, do point out that the show raised awareness and treated Monk sympathetically, so there are some redeeming factors here.

Turning now to The Odd Couple’s Felix Unger, we see a man obsessed with neatness and order, who is also a hypochondriac. He doesn’t seem to enjoy much in life and his marriage is in shambles due to his behavior. The preoccupation with cleanliness and order sounds a lot like OCPD. The strained interpersonal relationships is quite consistent with this disorder. This portrayal is much more understated than Monk and comes across as more realistic. The movie came out in 1968, long before the current definition of either OCD or OCPD.

 

The OCD/OCPD Character

If you chose to include a character with OCD/OCPD in your story, go for it. These disorders can provide a lot of conflict and difficulties for your story. You don’t need to restrict these disorders to secondary characters either. They could provide excellent “flaws” for your protagonist. In the tv show Monk, the titular character’s OCD/OCPD is supposed to help him see details that others miss. At the same time, it complicates his solving the crimes due to the impact of his illnesses on daily functioning. We can also look to Felix Unger to see how OCD/OCPD can impact interpersonal relationships.

What about giving your antagonist OCD/OCPD? Handled well, this could provide some sympathy for the antagonist. If the antagonist has OCD, he/she is aware his/her behavior is excessive but can’t seem to stop. If the antagonist has OCPD, he/she would believe that his/her behavior is appropriate and right. Either way, these disorders can give quite a bit of dimension to your character.

My advice is to avoid the excessiveness seen in Adrian Monk. OCD and OCPD are fertile grounds for character features and don’t need to be overdone.

 

 

 

References:

Everyday Health: http://www.everydayhealth.com/anxiety-disorders/experts-common- obessions-and-compulsions.aspx

MedLine Plus: https://www.nlm.nih.gov/medlineplus/ency/article/000942.htm

National Institute of Mental Health: http://www.nimh.nih.gov/health/topics/obsessive- compulsive-disorder-ocd/index.shtml

Ilse Pauw (Clinical psychologist) and Olivia Rose-Innes, Health24, November 2005,             http://www.health24.com/Mental-Health/Disorders/Monks-OCD-Fact-or-fiction- 20120721

Stanford University: http://ocd.stanford.edu/about/

Wikipedia: Monk (TV Series) https://en.wikipedia.org/wiki/Monk_%28TV_series%29

 

 

 

 

 

Feb 11 2016

I’m Back: Psychotic vs Psychopathic

I’m back. I know it’s been a long time since I’ve posted anything, but often life intervenes in ways we don’t always anticipate.

I’d like to talk today about the difference between “psychotic” and “psychopathic.” Trust me, there’s a vast difference. In the media, however, the two are often used interchangeably. They’re not. Let’s take a look at the differences.

 

Psychotic

 

This is a term used that refers to someone who is suffering from a serious mental illness such as schizophrenia or other such disorders. It implies that the sufferer has lost touch with reality and is experiencing delusions and/or hallucinations. According to MedLine Plus: (https://www.nlm.nih.gov/medlineplus/psychoticdisorders.html)

            Psychotic disorders are severe mental disorders that cause abnormal thinking and  perceptions. People with psychoses lose touch with reality. Two of the main symptoms are delusions and hallucinations. Delusions are false beliefs, such as thinking that someone is plotting against you or that the TV is sending you secret messages.  Hallucinations are false perceptions, such as hearing, seeing, or feeling something that is not there.

 

Psychopathic

 

This term refers to someone who has a serious personality disorder often referred to as Antisocial Personality Disorder. According to Psychology Today (https://www.psychologytoday.com/basics/psychopathy) , psychopaths often appear almost normal.

            Psychopathy is among the most difficult disorders to spot. The psychopath can appear normal, even charming. Underneath, they lack conscience and empathy, making them   manipulative, volatile and often (but by no means always) criminal. They are an object of  popular fascination and clinical anguish: adult psychopathy is largely impervious to treatment, though programs are in place to treat callous, unemotional youth in hopes of preventing them from maturing into psychopaths.

 

Psychotic vs Psychopathic

 

As you can see, they really are different. It is true that the psychopath will often display some disordered thinking, usually narcissistic. We can also see disordered thinking in the fantasies held by psychopathic serial killers. Most professionals would agree that these fantasies don’t quite reach the criteria to be called delusions. (I know, that sounds like hair splitting and it may just be so.)

One important distinction for you crime writers out there: psychotic killers are usually “disorganized” while the psychopathic is more often “organized.” Psychotic killers are going to have a much more difficult time planning out “the perfect crime.” Not to say they can’t do some pretty extensive planning. They can. The mass murder at the Aurora, CO, movie theater involved multiple weapons, tear gas, and tactical clothing, to say nothing of the explosives rigged in the shooter’s home. That all sounds pretty organized, doesn’t it? Still, Holmes was caught in the parking lot, waiting around and watching the chaos. That doesn’t sound very logical or organized.

 

On the other hand, let’s look at the Ted Bundy, the quintessential psychopathic serial killer. He operated during the 1970s and is often described as charming and manipulative. He cared nothing for his victims and totally lacked empathy or remorse. Towards the end, he did become less organized which led to his capture and trial. At no time, however, did Bundy evidence anything like delusions or hallucinations. From what I’ve read, he maintained his manipulative behavior right up to the end.

 

Takeaway

 

What’s the bottom line here?

*   A Psychotic and a Psychopath are NOT the same.

Yes, you can have a character making the error, but I ask you, please have another character correct the error. I don’t think any one of us wants to perpetuate false information. You can use the distinction to further your story’s search for a killer (assuming you’re writing a mystery or thriller).

 

Suggested Assignments

 

  1. Develop a dialog in which one character corrects another for believing psychotic and psychopathic are the same.

 

  1. Develop a character who is either psychotic or psychopathic. Show the character in a brief vignette.

 

Feel free to ask any questions you might have. I’d be happy to help.

Jul 20 2015

Narcissism

I thought this topic might be apropos given all the attention Donald Trump has been getting lately. I don’t know if he really fits the definition of Narcissistic Personality Disorder, but he still seems to have a large dose of this personality trait.

So, what does a narcissist look like? DSM-5 lists the following (see Wikipedia):  Impairment is self-functioning and impairment in interpersonal functioning). This definition is for the personality disorder. Narcissists are very taken up with how great they are and seek out confirmation of this opinion in the views of others. In my experience, narcissists very often have what’s been called “I love me” walls: Prominent displays of anything that might show the world how wonderful the person is. Included would be degrees, photos with prominent people, news clipping that mention the individual. They show little empathy for others and rarely, if ever, apologize for errors (’cause of course there’s no way I could make a mistake). Relationships are superficial and often status-based. The narcissist is often grandiose and self-important. Towards others, he or she is likely to be condescending. Narcissists are often attention-seeking and love to be in the limelight.

Does kinda sound like Mr Trump, doesn’t it? He might be a good image to hold in mind as you develop your own narcissistic character. Of course, a female character could also be a narcissist. Off-hand, I’m having trouble thinking of a good example, so feel free to leave a comment and note female narcissists. I’d love to hear your ideas.

Narcissism isn’t always a disorder. Sometimes it appears as part of other disorders, particularly anti-social personality disorder and/or psychopaths. It is also part of a healthy personality! Yes, you heard me right…a healthy person needs to have a dose of narcissism in terms of a sense of worth. Just be careful it doesn’t go too far!

Let’s talk about narcissism. I’d love to get your impressions and thoughts. These sorts of characters can be fun to develop and can make great antagonists. They can also be used in other ways in stories. What about a friend of the protagonist? or a love interest of the protagonist? Oooh, the complications!  Or…what about an alien species that is generally narcissistic? What sort of society might they develop? I’ll guarantee that it won’t look like ours!

330px-Narcissus-Caravaggio_(1594-96)_edited

May 30 2015

“Crossing Lines”: The role of psychiatrists

Last night I watched the final episode of the tv show “Crossing Lines”. It featured a psychiatrist who had been treating a bad guy in prison for a couple years, supposedly twice a week. Now, I fully understand “poetic license” and I acknowledge that procedures in Europe are likely to be different from those followed in the US. Still and all, it struck me that this psychiatrist was supposed to be doing some sort of therapy with the bad guy. This was, of course, never specified.

I find it unlikely that a psychiatrist, who usually focuses on medication management, would be doing such therapy, whatever it was. Sure, the story needed to have the psychiatrist “fall in love” with the bad guy (or not). Or perhaps she needed to get bored or whatever it was that was supposed to motivate her. If the story needed to have a professional in frequent and protracted contact with the bad guy, why oh why couldn’t the author have specified her profession as a psychologist? It would have changed nothing to the story line but it would have made the story more plausible. She would still have been a “doctor”, carrying the status that involves. A simple change and the story would have made more sense.

BTW, the writers did handle another aspect fairly well. When questioned about the psychiatrist staying in the home of a former patient, the doc makes it clear that the friendship developed a year after termination of the therapeutic relationship. In the US, developing a personal, sexual relationship with a client is a big no-no. Really big no-no. In California, a psychologist is restricted from a sexual relationship following a therapy relationship for two years. Non-sexual relationships are not specifically mentioned. So, why did the writer’s make a big deal about this? I’m not sure but at least they were aware of the potential for an ethical problem here.

I don’t understand why the writers of this show felt that they needed to have the doc be a psychiatrist. There was never an issue about medications. Why not, then, use the profession that would have made some sense?

CROSSING LINES -- Season: 1 -- Pictured: (l-r) Donald Sutherland as Dorn, Richard Flood as Tommy McConnel, William Fichtner as Carl Hickman, Gabriella Pession as Eva Vittoria, Tom Wlaschiha as Sebastian Berger and Marc Lavoine as Louis Bernard -- (Photo by: Dusan Martincek/Tandem)

CROSSING LINES — Season: 1 — Pictured: (l-r) Donald Sutherland as Dorn, Richard Flood as Tommy McConnel, William Fichtner as Carl Hickman, Gabriella Pession as Eva Vittoria, Tom Wlaschiha as Sebastian Berger and Marc Lavoine as Louis Bernard — (Photo by: Dusan Martincek/Tandem)

May 29 2015

Insanity vs mentally ill: the case of James Holmes

Apparently James Holmes has pleaded not guilty by reason of insanity. This week, copies of his notebooks were released which seem to show that he carefully selected his target (the movie theater) and also seemed to be quite aware that what he was doing was wrong. This would argue against a finding of legal insanity. He knew what he was doing and knew it was wrong.

The writings also make it clear that he was (and probably is) very mentally ill. His illness seemed to torment him, from what I’ve heard on the news. This is something I’ve seen in many of my clients over the years. Very often they know something is wrong with them but they don’t know what to do about it. I find it almost heartbreaking that Holmes seems to have studied neuroscience in an attempt to figure out what was wrong with him. I can almost imagine the despair when his studies didn’t provide him with the answers he sought.

From what I’ve gathered in the news, it seems unlikely he will be found insane by the standards in Colorado. That’s not to say that this killer isn’t sick. He most definitely is. I suppose his illness will become important again when we get to sentencing.

As an example of the difference between the legal term “insanity” and the more medical term of “mentally ill” or even “schizophrenic”, this is about as perfect as you can get.

BTW: we are dealing here with a serious mental illness like schizophrenia. We are not talking about a personality disorder or psychopathy. Please, please do not confuse psychopathy with “psychotic” or insane. Personally I do think psychopaths are “sick”, but not like Holmes. Apples and oranges, folks. Apples and oranges.

JamesHolmesColoradoShootingAndyCrossColorado theater shooting suspect James Holmes

May 28 2015

Life Impinges Sometimes: Stress

Sorry I haven’t been around lately. It’s been a difficult month or so and I find it difficult to write about psychology and mental health problems when I’m upset and stressed myself. Guess it gets just a bit too close. I want to provide you all with the best information I can and I don’t want my own issues and difficulties to unduly slant what I write.

So, is there anything I can learn from the past couple months that I can pass on to you, my readers? Any insights that can help you develop realistic characters? I’m not sure. I’m sorting through my thoughts at this point. I can say that prolonged stress can really alter the way a character (and person!) acts and thinks and feels. Even a highly competent character can realistically be expected to have difficulties when trying to cope with prolonged stress.

This reminds my of some old research on stress. I don’t recall the researchers and I probably don’t have the details right, but when dogs were exposed to electric shock in the floors of a cage and they couldn’t predict or control what was happening, eventually they just ended up cowering in a corner. This led to the development of the idea of “Learned Helplessness.” (I know: the ethics of such research are questionable to me too.) For humans, the reaction may show up in a person (character) staying in bed, or spending all the time playing solitaire or some such game. It’s avoidance and at the same time, a giving up.

Cognitively, the thoughts may be something like “Why bother?” Thinking is difficult and feels muddied or like your character’s head is encased in cotton or molasses. It’s hard to see beyond the immediate. Of course, that tends to keep the stress going in many cases.

The stress your character is going through doesn’t have to be life threatening, like captivity and torture. I would think (I don’t know, haven’t done much reading in this area) that learned helplessness might just develop in such situations also. I would recommend if your character is in such dire straits that you do a bit of research on the effects of torture and prolonged captivity. Amnesty International might be a place to start.

So, what sort of things could set this up? Caring for an elderly, demanding parent; living in an abusive relationship; poverty and inability to make ends meet; chronic illness. The list is probably endless.

Mar 31 2015

Personality Disorders

I’m going to continue to talk about the #Germanwings case since someone on CNN has brought up the possibility that Andreas Lubitz had some sort of personality disorder. I’ll talk about the specific personality disorders in later posts.

Personality disorders are long-term, pervasive ways of relating to the world. There are a variety which include Anti-Social, Borderline, Narcissistic, Paranoid, Histrionic, and others. All are different. Note that: all are different. A Histrionic person will seem very different from the person with Paranoid Personality Disorder. Personality disorders are also more difficult to diagnose in many cases. They can underlie the more acute mental illnesses most of us think of when we talk about mental health problems. Or they can stand alone and the person with the personality disorder may never suffer from any other acute mental illness.

Nothing I’ve heard so far leads me to think that Lubitz suffered from a personality disorder. He may have or he may have not. I can’t tell from what’s been in the media. Yes, some people with a personality disorder may kill others. But not all. And not all killers have a personality disorder. To assume a personality disorder just because this individual killed 149 other people is not professional.

Back when I was in graduate school, my class was discussing the issue of insanity. During the break, the professor and a couple of us were sitting at a table talking about crime and mental illness. It was mentioned that anyone who could kill others had to be mentally ill. I mean, it just made sense. We all nodded our heads, but the professor cautioned us. We can’t diagnose by one action and insanity was a legal issue (as I’ve mentioned in a prior post).

Just a quick note: a person with Anti-social Personality Disorder (which includes psychopaths) rarely suffers from depression. The exception being when they get caught. So, in this case, Lubitz’s history of depression and anxiety argue AGAINST him suffering from Anit-Social Personality Disorder. Could he have suffered from a different personality disorder? Of course, but we just don’t have the information at this point. A person with Borderline Personality Disorder or Narcissistic Personality Disorder or Paranoid Personality Disorder could all commit murder, even mass murder.

For writers: if you decide you want your character to have a personality disorder, be sure to show the full picture. If you have a character saying, based on extremely limited information, “He’s got a personality disorder”, please have someone call that character out as an idiot who doesn’t know what he’s talking about.

Mar 30 2015

Antipsychotic Medication and Flying

Okay, folks, let’s talk about antipsychotic meds. Remember, I’m a psychologist and not a psychiatrist. However, many of my clients over the years have taken these medications, so I think I have more than a passing knowledge of them.

Antipsychotic medications are primarily used to treat psychotic disorders. Makes sense, eh? Specifically, these medications help with the hallucinations and delusions experienced during many psychoses. I have sent patients to psychiatrists when it’s clear they’re suffering from a psychotic disorder. There are two basic types: the older “typical” antipsychotics and the newer “atypical” antipsychotics. The typical antipsychotic include Chlorpromazine (Thorazine) and Haloperidol (Haldol). The “atypicals” include:Risperidone (Risperdal), Olanzapine (Zyprexa), Quetiapine (Seroquel),Ziprasidone (Geodon), Aripiprazole (Abilify), Paliperidone (Invega), and Lurasidone (Latuda).

In recent years (say the past 10 or so), I’ve seen antipsychotics also being used as sleep aids and to help when patients are highly agitated. I’m not sure I really agree with this, particularly because of all the side effects. But I have seen it. BTW, the use of antipsychotics for agitation has been something I’ve seen in hospitals and is usually administered by injection (at least in my experience).

The side effects are numerous and can be very serious. Here’s what the NIMH (National Institute of Mental Health) has to say:

Most side effects go away after a few days and often can be managed successfully. People who are taking antipsychotics should not drive until they adjust to their new medication. Side effects of many antipsychotics include:

  • Drowsiness
  • Dizziness when changing positions
  • Blurred vision
  • Rapid heartbeat
  • Sensitivity to the sun
  • Skin rashes
  • Menstrual problems for women.

Atypical antipsychotic medications can cause major weight gain and changes in a person’s metabolism. This may increase a person’s risk of getting diabetes and high cholesterol.

In addition they note:

Typical antipsychotic medications can cause side effects related to physical movement, such as:

  • Rigidity
  • Persistent muscle spasms
  • Tremors
  • Restlessness.

Long-term use of typical antipsychotic medications may lead to a condition called tardive dyskinesia (TD). TD causes muscle movements a person can’t control. The movements commonly happen around the mouth. TD can range from mild to severe, and in some people the problem cannot be cured. Sometimes people with TD recover partially or fully after they stop taking the medication.

These other side effects are not as common with the atypicals.

The next question is whether or not a person on any of these medications should be flying. Unequivocally I can say: NO! No matter what the reason for the use of the meds. My opinion. I don’t think a person on antipsychotics should be using heavy machinery either. Should they drive a car? Not at first, not until they know how it’s going to affect them. I can tell you, though, that most of those clients of mine in the past who were on antipsychotics *did* drive. To the best of my knowledge, psychiatrists are not required to contact the Department of Motor Vehicles (DMV) when they prescribe antipsychotics. They probably don’t contact the FAA either if the patient happens to be a pilot. Is this a loophole that should be plugged? I don’t know.

For you writers: consider having a character who is taking Seroquel for sleep (i.e. she’s not psychotic) and struggling with the side effects of that medication. A number of the soldiers I’ve worked with had been prescribed this med for sleep and they had a horrible time showing up on time for formation at zero-dark-thirty. So, now they were getting in trouble for that!