Writing mental illness: When they should sound crazy

“I was judged insane and others felt that this was the place for me. I am too weak. You look to me like Uncle Joe and he is so far away. He knew how much I loved him. We could always get along. I never meant to be disobedient to you. The darn son of a bitch, you couldn’t smile at me. You are the Pope and I must be obedient to the Pope. He is the only one I must be obedient to. You didn’t flinch when I said “son of a bitch”. You are trying to help me. All the others are different. That I can’t fake in your presence, my Lord. You will understand me as my friends didn’t. Russia is the only Catholic country. Russia is to the rest of the world what God is to the Pope.” ia is the only Catholic country. Russia is to the rest of the world what God is to the Pope.”                                                      — Source: Silvano Arieti’s book Interpretation of Schizophrenia

Today we had some discussion about how to make characters speech reflect mental illness without making the characters sound too much like Golem in Lord of the Rings.  I’ve actually been writing a book for a while on how to write characters with mental illness, and I’ll include an excerpt of a few suggestions here that are symptomatic of certain mental illnesses.

Focus on your audience..(s)

      The quote at the beginning of this blog was spoken alternately to different hallucinations and to the psychologist. Especially if your character has voices in their head, or lots of different people you want to give a piece of your mind to, change who you are addressing throughout the talk. One moment its a specific person in the audience, another its someone outside of the room, your priest, then a fratbuddy, then a Roman Catholic priest, the ghost of Crispus Atticus, then a three year old girl, then its your mom. You don’t have to tell the audience you’re addressing someone else–just like in the example, there’s no real separation between addressing one voice and addressing the next, but you can tell something has changed with the different pronouns and such. Think of how we all tend to change the words we use and tone we use them depending on who we’re talking to. Smaller words for the little kid, simple ideas, a coaxing tone. Remove all the foul language when talking to your mother, and let it all back in and more when you’re talking to that semiaphasic curr that should be disembowled with a tuning fork and drowned in his own smegma.

Focus on the meanings

      A more cerebral route to go is to have an idea in mind that you are trying to convey, and try to express it using examples that are only related through that single idea. You have to try to sum up the different words in order to figure out what’s trying to be conveyed… For example: Cherry, Rose, Blood, Sunset, Rust, Flamingo is used to express the idea of Redness… (Example blatantly stolen from ideograms and Ezra Pound). People without mental illness will sometimes do this when there’s that word right on the tip of the tongue that we can’t remember, and we list off every related idea we can as we try to either jog our own memories, or get the listener to understand the missing word.

Loose Associations and Derailments

      When a man with schizophrenia was asked about his itchy arms, he responded:
      “The problem is insects. My brother used to collect insects. He’s now a man 5 foot 10 inches. You know, 10 is my favorite number. I also like to dance, draw, and watch television” Source: Vetter, H. J.
      Language behavior and psychopathology

      The associations between actual sentences are minimal, but one often unimportant word from the previous sentence becomes the topic for the next sentence. This is also sometimes known as “knight’s move thinking”


      Clanging is where rhyming words are drawn into the sentence. They may be worked into the sentence somehow, like the patient who describes the weather as “So hot, you know it runs on a cot.”
      Patients can also get stuck on clangs: “I went to the beach and saw a little girl, curl, girl, curl, whirl..”

      I like combining clanging with loose associations… start out coherently for a little while until you hit a clang, then the topic of the next sentence is one of the rhyming words. Bring in snippets of song or poetry and link them in. I love the Butterfly’s speech from The Last Unicorn in this regards. Partway through the speech on some horribly serious thing, switch to a children’s nursery rhyme and continue speaking with the same kinds of pauses, emphasis and dramatic flair that you used for the previous topic, switch back to the original speech as if you’d never left the topic.

More fun with rhymes

      Replace a normal word in the sentence with a word that rhymes with it. Some Australian and Cockney slang is based on this. Sometimes, phrases that rhyme the initial word are used–and the end of the phrase (the part that actually rhymes) ends up getting dropped over time, such as the Cockney phrase “rabbit and pork”, as a rhyme for “talk”, which got abbridged to simply saying “rabbit” in place of “talk.”



      “I am here from a foreign university … and you have to have a “plausity” of all acts of amendment to go through for the children’s code. It is no mental disturbance or “putenence”, it is an “amorition” law… there is nothing to disturb me … it is like their “privatilinia” … and the children have to have this “accentuative” law so they don’t go into the “mortite” law of the church.” Source: Vetter, H. J. _Language behavior and psychopathology_.

      Neologisms involves the use of (usually) made up words that only have meaning to the person using them. It is my belief that many college textbooks are written this way in order to make the author sound really smart…


      Perseveration is simply repeating something over and over. I ran into this with a woman who had traumatic brain injury. She would understand everything said to her, and would start responding back and all the vocal tones and expression were appropriate for responding, but she was only repeating one word over and over again. She seemed to be unaware that her own speech was abnormal.


      This is repeating something that someone else said in an involuntary and meaningless way.   Echolalia is a rarer symptom of schizophrenia, autism, or intellectual disability. Although people who have echolalia typically repeat the words immediately after they hear them, there is an even rarer symptom called delayed echolalia where someone may repeat the words hours or even days after initially hearing them.  It can be tricky to converse with someone who has echolalia because you have to make sure you don’t end a question with words that could be an answer to the question. Otherwise you can get situations like “We’re going to run another mile, is that okay?” and the person echoes “okay” when really they are exhausted and don’t want to keep running at all.

Echopraxia (also known as echomotism)

      Echopraxia is where someone else’s movements & gestures are repeated involuntarily. Although this isn’t something that would affect your character’s speech, it would affect their nonverbal behavior. Echopraxia is associated with some forms of schizophrenia and sometimes traumatic brain injury.

Change your character’s mind – or body

      Have the character start out arguing for something, change his or her mind and argue just as voraciously against it. On a smaller scale, this can also occur with movements, the character may out as if she were about to slam her hand down on the arm of her chair to emphasize something, then stops sharply before she actually hits the arm and puts her hand back calmly in her lap. It really wasn’t that important after all… Initiating some kind of a movement, then changing their mind is a symptom of some forms of schizophrenia known as ambitendence.

Decide on a few things to leave out

      Maybe the character never uses words with the letter ‘n’ in them, or perhaps they never use adjectives.  Although a reader is unlikely to pick up on that as being the key to the character’s speech patterns, but trying to avoid a common letter may force you to use unusual word choices in order for the character to express themselves.
      I have another friend who talks so exhuberantly, rapidly, and with so many hand gestures and body language that it gets hard to follow what she’s saying sometimes… After one particularly long and excited outburst, most of us stand there stunned, trying to parse out what she just said. But there was one person who said “Wow, that was really easy to follow for something that didn’t contain any verbs. Its like you’ve taken language to a new level!”… He managed to follow it fine (though he later explained that he was able to follow it because he’d had experience with the drugs that produced similar effects…)
      And that was the key, without having that filter that allowed him to ignore the irrelevent body language and other distractions so that he could keep up with how fast she was speaking, it was impossible to tell what exactly was wrong with what she was saying. All the words were in a language that we understood, it was obvious there was a message being conveyed, it was obvious the message was important to her, but I still can’t tell you what it was.

Point out the obvious

      State something that is absolutely true, but that there should be absolutely no reason to say:

        Marcellus: “Do you know where you are?”
        Rowan: “Yes… I’m in a forest, and I’m not a rabbit.”

        There is really no way someone can disagree with what Rowan said, but it is clear that something is deeply wrong with the character’s thinking that she feels the need to specify her species when she is clearly human. It is almost more disturbing than if she had said she thought she was a rabbit: At least there, it gives her audience something concrete about her thoughts that they can try to disprove.


        Admittedly, most people do this on occasion, usually when we’re really tired, but most of us also catch our mistakes. Spoonerisms are when the the front half of two different words get exchanged. Like:

          • Cute frocktail (fruit cocktail)
          • Go shake a tower! (Go take a shower!)
          • Lark Dong hair
          • Slow and sneet
        Sometimes spoonerisms result in sentences that make sense (but not with the context of the words around them), other times you end up with words that don’t exist. Of course, if you really want to hear spoonerisms brought to an artform, you should check out Zilch the Torysteller.


        Another thing that tends to happen in language is replacing one word with another that sounds alike, but means something entirely different.

          • Illiterate him! (Obliterate him!)
          • I can assert the truth of it without fear of contraception.

    Inappropriate Emotional Content

        Lack of facial or vocal expression, inappropriate facial expression, vocal expression, or laughter can have wonderfully unnverving effects on a conversation as well. Inappropriate happiness is also known as habromania.


    1 comment for “Writing mental illness: When they should sound crazy

    1. H. R. Ryder
      H. R. Ryder
      November 1, 2014 at 10:34 am

      Here’s a couple of malapropisms from the student papers I’ve been grading this weekend:

      “This could lead to people being wrongly accused and faced with carpal punishment.”

      “We must consider things from a different angel.” (I find this one especially funny because the course is at a religious college.

      My roommate also heard someone this weekend talk about picking up “partridge paper” for her baking.

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