May 25 – 31: “Have you used the American Psychological Association’s DSM V to help develop characters?”

thriller-roundtable-logo5The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the handbook used by health care professionals in the United States and much of the world as the authoritative guide to the diagnosis of mental disorders. This week ITW Members Wendy Tyson, Cat Connor, Linell Jeppsen, JG Faherty, Jean Heller, Colby Marshall and C. E. Lawrence discuss whether they’ve used the DSM V, or previous versions of the Diagnostic and Statistic Manuel of Mental Disorders, to help develop characters.


Eraserbyte by Cat ConnorCat Connor is a Cantabrian who’s lived most of her life as a northerner. (Makes it a bit hard when the Crusaders play the Hurricanes but apart from that it’s not too bad.) She shares her office with a retired racing greyhound called Romeo and Missy the fat grey cat. Luckily the animals don’t mind loud music. Hosting a fortnightly writing workshop at the Upper Hutt City Library: A Writer’s Plot, is something Cat truly enjoys, and she’s been doing so for 3 years. A coffee addict, lover of pinot, and Jose Cuervo tequila, Cat has been described as irresistible, infectious, and addictive. She believes music is as essential to life as breathing. Cat is a member of The New Zealand Society of Authors and International Thriller Writers. Her latest book, databyte, is longlisted for the 2015 Ngaio Marsh best crime novel Award.

hellerMost of Jean Heller’s career was as an investigative and projects reporter and editor in New York City, Washington, D.C. and St. Petersburg Florida. Her career as a novelist began in the 1990s with the publication of the thrillers, “Maximum Impact” and “Handyman” by St. Martin’s Press. Then life intervened and postponed her new book, “The Someday File,” to publication in late 2014. Jean has won the Worth Bingham Prize, the Polk Award, and is an eight-time Pulitzer Prize nominee.


TheCureJG Faherty is the author of six novels, seven novellas, and more than 50 short stories. His latest novel is THE CURE, a paranormal thriller about a veterinarian who can heal by laying hands. He has been a finalist for the Bram Stoker Award® and the ITW Thriller Award. To learn more, please visit his blog and follow him on Facebook and Twitter.



Dying Brand by Wendy TysonWendy Tyson is an author, lawyer and former therapist whose background has inspired her mysteries and thrillers. The first Allison Campbell mystery, KILLER IMAGE, was named a best mystery for book clubs in 2014 by, and the third Campbell installment, DYING BRAND, is due out on May 5, 2015. Wendy lives near Philadelphia with her husband, three sons and two muses, dogs Molly and Driggs.


silentCarole Bugge (C. E. Lawrence) is the author of nine published novels, award-winning plays, musicals, poetry and short fiction. A two time Pushcart Poetry Prize nominee, her most recent Lee Campbell thrillers are Silent Slaughter and Silent Stalker, under the pen name C. E. Lawrence. Her short stories were selected for the two most recent Mystery Writers of America anthologies. Her Sherlock Holmes novels, The Star of India and The Haunting of Torre Abbey, have recently been reissued, along with her Claire Rawlings mystery series.


Double Vision by Colby MarshallColby Marshall is especially qualified to write about grapheme-color synesthesia as she has this rare condition. She is a member of International Thriller Writers and Sisters in Crime, and is a contributing columnist for M Food and Culture, a local Georgia magazine.



Lucky Chance by Linell JeppsenLinell Jeppsen is a writer of science fiction and fantasy. Her vampire novel, Detour to Dusk, has received over 44- four and five star reviews. Her novel Story Time, with over 130- 4 and 5 star reviews, is a science fiction, post-apocalyptic novel, and has been touted by the Paranormal Romance Guild, Sandy’s Blog Spot, Coffeetime Romance, Bitten by Books and 64 top reviewers as a five star read, filled with terror, love, loss, and the indomitable beauty and strength of the human spirit. Story Time was also nominated as the best new read of 2011 by the PRG! Her dark fantasy novel, Onio (a story about a half-human Sasquatch who falls in love with a human girl), was released in December 2012 and won 3rd place as the best fantasy romance of 2012 by the PRG reviewers guild.

  1. Actually, I haven’t used that particular book, though I do have a copy in my library! What I have used is many other useful books, several by Katherine Ramsland, known to all of us, I’m sure, as a terrific writer and psychologist.

    I especially like The Forensic Psychology of Criminal Minds and The Unknown Darkness, which she co-authored with my friend, FBI Profiler Gregg McCrary.

    I’d be interested in hearing about some books the rest of you have read and recommend.

    1. I have found the DSM-V very useful, but there are few others I like in particular. If you’re writing someone on the sociopath/psychopath scale, I recommend Dr. Hare’s WITHOUT A CONSCIENCE and Martha Stout’s THE SOCIOPATH NEXT DOOR. They are both fantastic.

      The American Psychiatric Association’s psychiatry [dot] org is also a wonderful resource.

  2. I’ve used all the editions at various times both for novel writing and to create magic effects associated with this. Writer beware, however: make sure you utilize the edition that covers your historical period and of the controversies that each of these editions engendered both during their preparation and after their publication. Often these are better fiction fodder then the work itself since it gives a more nuanced view of the classified conditions.

    Also, as Carole rightly noted, there are other excellent references, especially as you narrow things down. On the general level there’s also the ICD-10:2015, which is widely used in Europe. Section V deals with mental and behavioral disorders. It’s interesting, and somes even instructive, to compare the classifications and devotions/criteria of the DSM with the ICD.

  3. For one thing (to show how long in the tooth this old gal is!) I used to study the DSM 3. Although I haven’t broken out that dusty, old guide in years, I know enough about neurosis and psychosis to last a lifetime.
    Both my mother and Auntie were clinical psychologists and they wanted me to follow in their footsteps. I went a ways, too, in college, but in the end, decided #1 I couldn’t afford to carry on and #2 I was probably not a patient enough person to spend my days amongst crazy folks.
    Kudos to those that do… I’m just not cut out for it, I guess. Which doesn’t mean I don’t recognize some symptoms when I see them!
    Each of my (Western) novels have a “bad guy”, meaning that they are either afflicted with “border-line” personalities or are sociopaths. Many men and women who came out of the Civil War intact, carried a lot of baggage. Some of them were just strong people with an even stronger will to survive. But others who were tough enough to make it out west were also quite insane, and used the wide open spaces, and lack of rules (and those who were inclined to enforce them) to their advantage.

  4. I neglected to mention one important observarion: the DSM, while useful, is but a catalogue on conventional consensus. Adherence to it is more appropriate for psychiatrists submitting medicare reimbursement form than novelists, save the rote racked and riden.

    In short, a jumping off point. Now get yer arse over to the deep end!

  5. The last novel in my DEADMAN series features my hero, Matthew Wilcox, falsely accused of insanity and committed to the Eastern Washington Hospital for the Criminally Insane. A scary time for him, and something that happened more often than we might like to admit.
    I did a lot of research on the mental hospitals in Washington State during that time frame… there were two big institution and a number of smaller, privatized hospitals. Neither was a place anyone would want to end up in. Teeth-pulling (many doctors thought that infection of the dental cavities was the main cause of mental maladies), rubber jackets, cold water baths and shock treatments were common.
    Often, back then anyway, men and women were “sent away” for reasons of insanity. Menopause was misdiagnosed, (God knows I was pretty looney… and sweaty! LOL!) as were many other physical maladies. Sometimes, husbands and wives were stashed away in the “Bug-House”, if they were inconvenient. (Yikes!)

  6. In all honesty, I can’t say that I have. I’ve seen it, and I know people that have used it, and I’m sure that in the right circumstance it’s an invaluable tool. But in my writing, I’ve never needed to go that deep into the intricacies of human mental disorders, never needed to create a character who had to adhere to the personality traits of a specific disorder. Now, if I was writing the type of books that Thomas Harris, or Jim Thompson, or Jeff Lindsay write, then I’d most likely have it on my computer or next to my desk. But while I’ve definitely had my share of mentally unusual characters, I’ve never worked from profiles or had a psychologist/psychiatrist as a main character.

    I would be interested in hearing what others have to say about this, though. Does it make for a more convincing villain? Do people use it for their protagonists as well as their antagonists? Talk to me about it!

  7. As a caveat, I should say that for one of my novels, I read through a whole box of actual patient records that I ‘obtained’ from the records room of an abandoned psychiatric institution. They dated from the 1960s to the 1980s. Since the institution itself featured in the novel (Cemetery Club) I wanted to know exactly the types of disorders they dealt with and how the doctors referred to their patients, rather than going with generalized information.

  8. See… as both Gary and Carole mentioned, the DSM is not a definitive tool. I would say that reading through patient case files would qualify as deep research and give the author insight as to how their protagonists…or antagonists might think.
    Besides, it’s my opinion that no mental disorder can be shoe-horned. Each case is quite different, which makes treatment of these diseases so terribly difficult!

  9. Right you are, Linelll, both on the value of case studies and the danger of shoehorning.

    The DSM is an atlas of sorts: it can lead you to certain streets–even show you the houses if it’s Google Maps or the like– and from the area environment you can make some general inferences, usually socio-economic. But when it comes to the particulars of the house dwellers, ah that’s a different story–or a trite story if you stop there, content with cookie cutter characters.

  10. I have used both DSM 4 and 5, and I find them helpful, though not definitive. The DSM isn’t written for amateurs, so when I am looking for a problem, and I’m pretty sure I’ve found what I need, I then find a human expert to check it out. But it certainly points me in the right direction.

    An even more helpful book is called PRACTICAL HOMICIDE INVESTIGATION. It’s always a huge help when I need to know how a crime would be investigated by pros. Believe me, the CSI television series, while very entertaining, was not a great teacher. Mostly they took dramatic license because they had to. You don’t get DNA results in an hour. It can take days, or weeks. But a TV drama only has about 44 minutes to tell a story. PHI is more helpful and and much more realistic.

  11. Great comments from everyone.
    Yes, I have Practical Homicide Investigation too – that’s a wonderful book!
    I’m kind of envious of you, with your family background. My family was super suspicious of ANY mental health experts (god knows we needed them, too.)
    You make so many great points, especially about matching the research to the time period. I’m teaching Historical Fiction at the Cape Cod Writers Conference this summer, and I will be sure to mention that – and give you credit, of course!

  12. Ah, Carole, it’s been a while. Thank you for the kind words. How I envy your students at the Cape Conference learning from such a multi-talented teacher. Make sure to leave time for breakfast at The Egg and I and browse at Tim’s Used Books.

    BTW, seen a King Bolete yet?

  13. I’m a bit late to the party today, but with a main character who is a forensic psychiatrist, I find the DSM-V extremely useful and use it often. However, as others have mentioned, it is not written for amateurs. So, being an amateur myself, I find it necessary to use supplemental materials to explain some of the concepts in it in more of a “For Dummies” fashion to make sure I have a full understanding of certain diagnoses and aspects of them before I use them in stories. For supplemental material, it depends on the particular traits I’m looking at as far as which other books or materials I pick up. The DSM is a good tool to help me narrow down a diagnosis to look into further materials for study and also helps to keep characters somewhat consistent (though as others mention, it isn’t 100% definitive since mental disorders don’t always fall into a perfect box), so it can be a big help in pointing me in the directions of the disorder or personality type I need or want to look into further. I’m also lucky to have a forensic psychiatrist who consults on things I run into I don’t fully understand and also recommends further reading, so one huge resource for authors in psychiatry can and always will be finding a professional who is willing to give an interview to field questions.

  14. In an evaluative piece a few days ago on Todd Haynes’ new film “Carol,” an adaptation of Patricia Highsmith’s “The Price of Alt,” a lesbian romance, New York Times film critic Manohla Dargis (IMHO, one of the best of the best) noted that in 1952, the year the book appeared, “the American Psychiatric Association on declared homosexuality a ‘sociopathic personality disturbance.’” (Apologies for the lengthy sentence. Now let’s all take a breath.)

    Apropos to this discussion, the American Psychiatric Association’s dictum illustrate the need to get back to the sources available at the time to accurately portray a fully-fleshed character as well as the need to check our own natural tendencies to read back our current thinking lest it “taint” that portrayal. (Although, as I mentioned in an earlier post, we should also consider “anti-establishment” views, but only those that were appropriate to the time. (This is neither the time nor the place to argue the pros and cons of Presentism, no matter how worthy.)
    However, reading back into history with the benefit of current knowledge, even though that current knowledge may also be supplanted at some point, can be beneficial for a writer in certain circumstances. Enter an approach I call FARENSICS, which, in its simplest form, is reconstructing a time period of which we have no personal recollection, through the gathering of various pieces of ERADENCE, or era evidence. So, say, for someone born in 1975, “far” would be anything prior to that, and probably anything prior to 1977-1980.

    The example above provides an example of an embedded piece of eradence (eradence embedding is a common occurrence). Discovering how psychiatrists classified homosexuality in 1952 and analyzing it with the “tools” of a 2015 mindset, reveals traces emotional elements such as fear. This, in turn, leads to other eradence—for example, how prevalent was fear in the politics of the period and could that fear somehow be linked to how and why the American Psychiatric Association came up with its particular description of homosexuality. Keep gathering and piecing together the eradence and soon you’ve come up with a description of the period, at least in social/cultural and economic terms. In short you’ve got the Geist of the period, at least in The United States, and this can be used to season your story, heavily or subtly according to taste.

    Understand, Farensics, as I mentioned, it’s an approach, exploratory and more philosophical than technical. It is not, I repeat NOT, to be in any way considered one of the “rules” that writers should/must be followed/obeyed to produce a “good” book. (There are no rules for writers, only ruled writers.) There’s much more to Farensics, but not here. I only brought it up because it ties in with the discussion at hand.

    And with that, I’ll shut my big mouth since my views often tend to get me into trouble and not only with the ITW. However, anyone who may be mad enough to want to know more about the subject can let me know and I’ll keep you in the loop about the when and where of more detailed postings.

  15. Gary, excellent post. I have found myself horrified by what “society” did and felt in the 1800- early 1900’s. Forensic psychology was brutal in the extreme, although I believe most doctors were truly trying to help the afflicted.
    Many decent citizens, at that time, were highly critical(and frightened) of the mentally ill. Often, they thought folks were either haunted or “bedeviled” and took whatever steps they thought necessary to rid themselves of the problem.
    The consequences of those societal beliefs were often tragic… both for the mentally ill- and for homosexuals ( a practice that, in many states, was a hang-able offense.)

  16. You’re spot on, Linell. The classic conflict between “insiders” and “outsiders” or “strangers.” And who decides which is which? Easy.Whoever rules.

    This discussion topic is so amazingly rich both in and of itself and in its logical(?) extensions. I just wish others would chime in.

  17. Hi everyone! Sorry I’m late to this discussion but I’ve enjoyed reading all the comments. Gary and Linell, couldn’t agree more. As a recovering therapist (and lawyer), I’ve often marvelled at the us/them, outsiders/insiders dichotomy in the mental health field, a paradigm that continues to exist, especially in the social services world. I left the field in part because of it. I do use DSM (IV is what sits on my shelf), but only for purposes of consistency and authenticity. Like Colby, when what I am writing about goes beyond my own knowledge and experience or the information I can glean from a book, I prefer to consult an expert. Regardless of whether it’s an exact science, studying and understanding human behavior (or trying to, at least) is key in fiction writing–and nuance is important. Often I will consult DSM-IV or V and then contact a trusted resource to talk through the details.

  18. Gary,
    So sorry to be so late in replying – the week spun out of control unexpectedly!

    Thanks for the kind words – I LOVE that breakfast place! We discovered it three years ago when I first taught at Cape Cod. Will definitely hit it, and also the bookstore you mention.

    No, I have still not found the legendary King Bolete, though last year was a decent one for chanterelles. Thanks for asking, and have a great summer!

  19. PS
    In the interest of full disclosure, Gary, I confused the place you mentioned with this charming spot, Common Ground, run by a group called Twelve Tribes, allegedly a cult:

    Cult or not, they are friendly, hippy-ish in appearance, and I love the place. It looks like a Hobbit den – cozy, woody, comforting, and the food is lovely. They didn’t try to impose their beliefs on me, so I will return!

    I will try to get to the place you mention as well – thanks.

  20. Hey, Carole, thanks for giving me a new place to scout out on my next jaunt to Nantucket, which is when we generally hit Hyannis. Much appreciated.

    Wendy, I hear you loud and clear. And it’s always good to get a first-hand report from one who;s been there, fought the good fight and then said, ah, screw it.

    Just to correct any misinterpretation, since jibberish and not English is my first language: I certainly believe that sources such as the DSM are valuable jumping off points, but that’s where it stops. (The same is true of such classification or of “blueprint” such as The Hero’s Journey or beat sheets.

    If I may poorly paraphrase Wittgenstein, whose latter philosophy in particular has much to say to writers, what’s truly significant is not the similarities between/among things, but the differences. So hold up DSM, beats, whatever as a mirror, but create characters based on how they differ (dare one say in this context, deviate?) not how they line up. Therein lies the uniqueness of character.

    And now, before I get banned from the board, back to the recesses of nothingness where I can continue to follow with much envy better and more informed views than my own.

  21. PS: Apologies, Carole, for neglecting to thank you for your nice words about Farensics. Hope to post more on this soon, although not necessarily here.

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