The Most Realistic Depictions of Mental Health in Fiction

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As literature graduates, we’ve studied a range of novels. But, for mental health awareness week, we look at the best ways that mental illness has been portrayed in fiction. These excellent novels navigate a fine balance between being resonant, shocking, and educational. From what we know of mental health, these stories show the difficulties our brains can cause. 

When discussing these depictions of mental health in fiction and film we must mention trigger warnings. Although not always mentioned in these reviews, some of these texts include upsetting themes, such as suicide, self harm and violence.

Mrs. Dalloway, written by Virginia Woolf, follows a few different characters. They live in close proximity to each other, even overhearing each other’s conversations. But the words seem vastly different. They all struggle with mental health in different ways. As it is one of the older books on this list, the phrases and descriptions of these issues are dated. Yet, Woolf knew the difficulties of mental health so much, personally. Her use of the stream of consciousness, almost Joyce-like, is an effective perspective. Especially when depicting thought processes, and the complex way our brains process experiences and trauma. 

Michael Cunningham wrote The Hours based on Mrs. Dalloway. You see his characters reading Woolf’s text, and how they engage with it in their lives. As a more recent novel, the characters are somewhat more relatable and sensitively depicted. Cunningham won the Pultizer Prize for The Hours, and there was an award-winning film adaptation. If you’re looking for a more accessible depiction of Mrs. Dalloway, Cunningham cleverly adapts it to suit the 1990s, with some clever and fresh perspectives.

Tender is the Night, by F.Scott.Fitzgerald could be triggering for those who have suffered psychosis or are diagnosed with schizo-affective conditions. In developing the character of Nicole, we finally discover her schizophrenia from the perspective of 1920s medicine. As someone of privilege, at that time, Nicole does seem to get treatment from the best of the field. It is somewhat jarring to mostly see her experience from the perspective of men, especially considering her specific experience relating to men.

But Fitzgerald writes in an insightful way, for the time. There are racial and class issues, and comments or phrases that would definitely not be acceptable today. But, as Fitzgerald saw schizophrenia first-hand, the narrative is accurate and written in an interesting way. I respect that we get to know Nicole, long before we discover the details of her illness. Although it is a big part of her personality, we have a glimpse of who she could have been had she not suffered the trials she did. 

Normal People, by Sally Rooney, is an amazingly accurate and relatable depiction of mental health. Many now know the story from the awe-inspiring TV adaptation streamed in the midst of COVID-19. But Rooney’s writing is broad, well researched, and clearly based in truth. I found myself relating most to Connell filling out his questionnaire about depression. Ranking your feelings and behaviours on a scale of ‘agree, mostly agree, disagree’ felt confusing and difficult. Rooney nailed it, and I’m sure it will be a classic for many years. 

I Never Promised You a Rose Garden by Joanne Greenberg is a semi-autobiographical novel published in the 1960s under the pen name Hannah Green. For the majority of the text, Deborah Blau is being treated for schizophrenia at a mental health institution. Although Deborah’s experiences are extremely overwhelming, the account did not feel over-dramatised for shock value. The text explored how Deborah’s reality often fused with another, one in which she spoke a different language and was influenced by hallucinatory figures.

Importantly, the novel expressed how mental health affects families and relationships. The concerns of Deborah’s parents were well highlighted, demonstrating their struggle to communicate honestly about their daughter’s treatment. The relationship between Deborah and her doctor was also well exhibited. Dr. Fried was a character who cared about her patient but did not endeavour to act as a hero. She did not promise a cure to Deborah but was clear in stating that their work together could help her take control of her own life. 

Kissing Doorknobs is another work which echoes the experiences of the writer themselves. Published in 1998, Terry Spencer Hesser writes the story of Tara Sullivan, a young girl living with undiagnosed Obsessive-Compulsive Disorder. The text illuminates the types of intrusive thoughts which at different periods can dominate the life of someone living with OCD, offering an unobstructed view of the weight that such overpowering thoughts can carry.

The text is dated in several ways and has some undertones which are not always helpful. For example, Tara’s mother is violent and Keesha, Tara’s friend, is arguably stereotyped by Hesser’s portrayal of her dialect. There are also one or two uncomfortable references to disability. In addition, approaches to OCD have undoubtedly changed in the past twenty years. I think, however, this novel is very successful in openly communicating a young person’s internal struggle and their realisation that they are not alone.

There’s a variety of mental illnesses and conditions, but these texts go some way to understanding the difficulties our minds can face. It’s important to depict these conditions in a sensitive and understanding way. More awareness needs to be had about mental health, to help reduce the stigma. I hope you enjoy these amazing novels, all of which highlight the importance of realistic portrayals of mental health in fiction.

Words by Annie Gray and Mary Crotty

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