Writing and Psychology: The difference between Psychopathy and Psychosis

People just love to write the mentally ill.

And why not- from Joker to Hannibal to Anton to freaking Eeyore, the mentally ill make for some captivating characters.

Unfortunately, many creators don’t seem to put any effort into their mentally ill characters, even going so far as to wrongly identify their character’s illness, or, at least I think, give them whatever mental illness sounds the coolest.

As a psychologist-in-training and a writer, this pisses me right off. Not so much with indie creators, but with the big mainstream guys who should really know that freaking Wikipedia is a thing by now or have someone around to fact check this stuff. Today I’m going to go into two very popular ones that people miss-use and switch around: Psychosis and Psychopathy.

Indie writers, read on and avoid the mistakes the so-called pros make. Pros- seriously. Wikipedia.


Example of a Character: look up basically any episode of Criminal Minds. I’ll wait. 

Psychosis is, quite simply, loss of contact with reality. Psychosis is a symptom associated with schizophrenia and, obviously, brief psychotic disorder, and it can be induced by substances such as marijuana and cocaine. Psychosis comes in episodes- though one can be psychotic constantly, this is very rare. Also, there are medications to intervene.

Not all psychotic episodes are created equal. The most common experiences during a psychotic episode include changes in thinking pattern and behaviour associated with such, unusual or false beliefs, changes in perception and changes in mood or feeling. There can be hallucinations as well.

Hollywood would have you believe that a psychotic person is dangerous, but a psychotic person is more of a danger to themselves than to others and is more likely to experience social withdrawal and depression. Their disordered thinking may cause them to act unpredictably.

Psychosis in the media seems to be the device to absolve guilt from a killer, as if they are not in reality they cannot be in control of their actions, right? It also seems to be used as a fear factor- if someone is not in reality, how can they be reasoned with? You are most likely to see someone who is psychotic cast as a serial killer because of this. While if done right, the psychotic character is engaging and very human, if done wrong it’s a walking cliché. It would be nice to see psychotic people as something other than serial killers or plot devices.

It would also be nice not to see them confused with this disorder….


Example of a character: Patrick Bateman- American Psycho by Bret Easton Ellis

Psychopathy is even more popular than psychosis, and just as likely to be cast as a serial killer. However, the media’s psychopathic serial killer is suave, manipulative and of course, cut throat to the core and willing to do anything to get what they want.

Unfortunately, this is not what the psychopath is like.

Psychopathy is not itself in the DSM- IV. The disorder of psychopathy (and sociopathy, because they’re the same thing) is correlated with Anti-Social personality disorder in the DSM-IV and most of the diagnostic criteria is the same. The one of most reliable ways to measure a psychopath is Hare’s psychopathy checklist. The diagnosis of psychopathy is wrought with controversy.

Psychopathy is supposed to be diagnosed only in people over the age of 18, who often have had a conduct disorder earlier in their life. Some diagnostic criteria for the psychopath is: Inflated and arrogant self-appraisal, lacking remorse or empathy, deceitful and manipulative and impulsive with poor behaviour control. Psychopathy is more commonly diagnosed among men, and few psychopaths make it to old age. Psychopathy is both a disorder of nature and nurture- there are some brain structural differences in psychopathy, but there are also nurture correlates as well such as poverty and abuse as a child.

Most psychopaths are not serial killers. Bundy and Dahmer were, yeah, but they are not representative of all psychopaths. Most are non-violent individuals. There are some positives to being a psychopath, namely a go-getter attitude. A psychopath can live a “normal life” and can respond to treatment (if they think they have a problem). You may know a psychopath- they’re estimated to be 1% of the population. The one thing the media gets right is that you may not know someone is a psychopath until you get to know them, as most psychopaths are very charming. Other than that, the media once again gets it wrong, but no one wants to hear a story about some normal person who doesn’t feel bad for running a red light.

Psychopathy in the media seems to be characters like the aforementioned Patrick Bateman; the suave asshole who kills people. Who happens to be white, most of the time. They also have a fear factor like the psychotic, but the tragedy factor can be a little bit harder to go for. As with the psychotic, it would be nice to see a psychopath as something other than a serial killer.

Thanks for reading the first episode of Psychology and Writing. I hope you enjoyed it.

God Bless,

Kelsey J.










6 thoughts on “Writing and Psychology: The difference between Psychopathy and Psychosis

  1. A very articulate and timely post.

    As someone who has lived with Bipolar (with psychotic features), yet has managed to avoid eating delivery boys with a side of fava beans, I would only like to add it is possible to have psychotic symptoms and still function as a contributing member of society. I was a successful pastor for almost 20 years even though I often had to preach, teach, and counsel over a din of voices running through my diseased brain.

    Thanks for the post.

      • No need to apologize. It wasn’t the focus on your post. But I certainly didn’t gain the impression you were misrepresenting people with psychotic symptoms. I simply thought my comment would be a nice addition (plus I’m grateful it drew you to my blog). Welcome aboard, WordPress mate!

  2. Pingback: A little more on psychopathy « Sweetly Snobbish

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