I was 10 years old when I read my first crime fiction novel. A charity shop copy of Agatha Christie’s 1935 Death in the Clouds, gifted from my gran. For the 38 years since I have devoured crime fiction and thrillers. And I am not alone. In the UK in June 2020, the publishing industry saw a crime genre sales boom, with 120,000 more crime and thriller titles bought than in June 2019.
What stops me turning the page now is this: the increasing use of sensational mental health storylines, all too often depicting post-traumatic stress disorder (PTSD).
A male character suffering from PTSD is typically portrayed as damaged and unpredictable, with flashback sequences, night terrors, alcohol use and violence driving the plot towards a bombastic climax. A female character might present a less violent narrative arc, one in which her traumatic past severely torments her and limits her life. Again flashbacks, alcohol and other unhelpful behaviours are revealed as, increasingly unstable, she seeks escape or revenge.
I am sure this sounds familiar. Yet these negative stereotypes in crime and thriller titles do not accurately or helpfully represent life with the chronic illness and the disability of PTSD.
Let me tell you how I live. I work part-time as an academic, cohabit in a long-term relationship, and have decades-old friendships. I am a caring and reliable person. I laugh a lot; at other times I am grumpy, even irate. I have anxious dreams and insomnia, fatigue, anxiety and negative thought patterns. Occasionally, feelings of shame slide slowly into worthlessness.
The reality of more stable and chronically ill lives like mine don’t heighten drama on the page. And this is the problem: the sensational PTSD character-turned-caricature frequently seems to be merely a plot device linking mental illness, danger and violence for thrills.
For those of us with mental health conditions, this stereotyping is offensive and disturbing, but worse: it is exploitative. Why? Because, as with other marginalised groups, these tortured characters are often written and published by those who do not share this lived experience.
Despite the frequent caricaturing of PTSD, this condition is less common than others. The NICE Clinical Knowledge Summaries, updated in 2020, detail that approximately 3.7% of men and 5.1% of women have screened positively for PTSD. Mind, the mental health charity, states that PTSD is experienced by approximately four in 100 people, less than generalised anxiety disorder (six in 100) and mixed anxiety and depression (eight in 100). Yet the focus on and frequency of PTSD caricatures and their narrow set of symptoms depicted doesn't represent this fact.
The publishing industry is selling fiction not fact, and the mental illness myth is often the hook that sells the book.
Why does this stereotyping matter? According to Mind, inaccurate representation of the violent and dangerous mentally ill person perpetuates myths, stigma and discrimination, which are reinforced by sensationalism. This can lead to sufferers being unable to discuss their conditions or seek help in case they are seen as dangerous. A quote from one of Mind's case studies is telling: "The stigma of being violent and dangerous is the worst for me. I am a caring and empathetic soul who would do anything for the people I love."
It would seem that in crime fiction and thrillers, the danger comes not from the mentally unstable character, but in publishing titles which continue to portray harmful stereotypes and myths.
I want to love the crime and thriller genre again and not feel disturbed by what I am reading. So as we write and publish these books, let's keep the thrills—and the nuanced, complex characters with difficult pasts—but without the harmful stereotypes. To do this we should follow these five steps:
- Research better: seek out charities and organisations for guidance on these health conditions; listen to people who have lived experience; avoid building character portrayals on those we see in books and films.
- Build a fully rounded life for a character which includes mental illness but is not limited to it.
- Commit to The Fries Test, developed by Kenny Fries for disability which I feel is applicable to mental illness:
- Does the work have more than one disabled (mentally ill) character?
- Do the disabled (mentally ill) characters have their own narrative purpose other than the education and profit of (and I would add harm of) nondisabled (non-mentally ill) characters?
- Is the character’s disability (mental illness) not eradicated either by curing or killing?
- Consider with compassion the impact that the portrayal of mental illness may have on readers who live with it and to readers who know little of it.
- Finally, ask ourselves: can we create the danger and tension the plot arc needs without the device of a mentally ill character?
Crime and thrillers won’t sell without narrative tension, fear, danger and often violence: it is what hooks us as readers to these books. But the publishing industry must act more responsibly towards mental illness storylines. The repeated equating of mental health conditions to danger and violence has to stop. So in writing, representing, publishing and marketing crime and thriller titles, let’s commit instead to doing no harm.
J L Hall is an award-winning writer and academic based in Edinburgh. Her fiction, non-fiction and poetry are widely published in print, podcasts, and online, including “Lucky”, which features in the anthology A Wild and Precious Life.