Writing YA Small Behaviors Add Up a little more on showing intense emotions

Last week I blogged about showing emotion through the pacing and organization of narration and characters' inner thoughts. This week, I've been reading the excellent Hold Still by Nina LaCour. It's about a girl grieving after her best friend's suicide. If you're looking for another example of thought disorganization as a demonstration of strong emotion, definitely check out this book. The first few pages in particular are beautifully instructive.

As I was reading this book, I noticed another technique the author uses to demonstrate the character's intense emotions:

Idiosyncratic behaviors.

Let me explain. Caitlin, the MC, begins the book with her response to the news of her best friend's death. And instead of saying, "OMG, I was so devastated," and screaming and crying, Caitlin does this:

But my hands are wild, they need to move, so I pick at a piece of the bench where the wood is splintering. I break a short nail on my right hand even shorter, but I manage to pull off a small piece of wood. I drop it into my cupped palm and pry off another ... My left hand is all the way full of wood now, and it's starting to spill over.

At another point, she does this:

I'm pulling the fake fur from the front seat covers even though I love them. I can't stop my fingers; white tufts are falling everywhere ... the backs of the seat covers are furless. My hand aches.

Whoa. Is this book about a kid with OCD? No! In these moments, the author is showing us just how deeply distressed Caitlin is by having her perform a seemingly purposeless, idiosyncratic behavior. Simple. Concrete. Fascinating. We're not being told Caitlin is crying/moping/sobbing/lamenting. We're being shown that there are things inside her, intense feelings, deep regrets, panic ... all screaming, growing, the pressure building up and ... it comes out in these behaviors. Something tangible. Something observable.

What I love about the way Ms. LeCour does this (there are many other wonderful examples in the book, in addition to it just being a great read) is that it's not expected. It's not stereotypical. It's not predictable. But, at the same time, it is BELIEVABLE.  And I understand. Without being told Caitlin is really, super-duper upset, I totally get it.

Because this is the way human beings actually behave. We don't always know or say exactly how we're feeling. Sometimes there are no words. Sometimes it's not the right time to talk. Sometimes there's so much there that we can't even scream and cry. Sometimes that's just not the type of person we are. But sometimes, those emotions find their way to the surface through our random behaviors.

We pick at things. We move our bodies/fingers/toes/tongues in funny ways. We engage in odd activities and rituals, like scrubbing the dishes clockwise or counting the ceiling tiles. We touch ourselves in ways of which we're not even conscious (hey now, calm down), like tugging at our earlobes or pinching ourselves or pressing our fingers against a hard surface until the tips turn white. No matter what those behaviors are, they can be outlet valves, a pressure release. Things that keep us from exploding or collapsing or becoming completely catatonic. As writers, we can use that understanding to create 3-D characters. And we can use those idiosyncratic behaviors to make those characters stick with the reader long after he/she reads the last page.

How about your characters? How do you SHOW their intense emotions? How do you get beyond the basics--just saying "she was devastated" or "tears poured down her face" or "her head/heart pounded with grief"--and get to something deeper ... and maybe more basic? More believable? More demonstrative? Unique? UNPUTDOWNABLE?

Addict Cleans Up THEN is Shunned by Family

An interesting letter appeared in the advice column Dear Abby on 11/30/14:

DEAR ABBY: I am a former drama queen and addict now enjoying long-term sobriety, or trying to. What's missing in my life is my family. Since returning from rehab, I have been "going it alone" -- and I'm not sure why. My kids are the only grandchildren in the family. I work and go to school. I am pleasant. There have been some rough spots I have had to deal with, and when I have needed to, I have called my mom or sister, but they don't call me or visit. They have expressed no love for me through all of this. When I call, I feel like I'm intruding. Aren't I entitled to their love and caring? I feel abandoned. It's hard doing things on my own. My family lives close by, so distance isn't the issue. What am I missing? I want my kids and me to have a family, but when I try to reach out, I end up hurt by their lack of interest. Should I just get on with my life? I have been going through this for years. -- MOVING ON IN FLORIDA

DEAR MOVING ON: It's possible that the "drama" and turmoil you put your family through while in the throes of your addiction is the reason your mother and sister avoid you. They may be reluctant to take a chance again. Because they have made it plain that they aren't interested in a closer relationship with you and your children, you should absolutely get on with your life.

Abby's response was predictable. There were also several comments on the website from the public about the letter, and the commenters were more or less unanimous: the letter writer had probably "burned her bridges," the family probably got sick of giving her one chance after another and were burned out, etc. etc. 

After all, as another commenter opined, "Addicts hurt a lot of people and cause a lot of problems." The family's response is due to their need for "self preservation." The writer probably used to call them "only when she needed something."

These responses were in fact so predictable that the letter writer herself undoubtedly knew what she was going to get. She was setting herself up, and making herself look bad while all the while criticizing her poor family. The criticisms of the family did not go over well at all with Abby's readers. With her criticism the writer was in fact garnering sympathy for her family, rather than making them look bad. She had to know that would happen.

The burning bridges thing probably contains an element of truth. But more likely a half truth.

How did this former drama queen/addict turn out the way she did in the first place? Wasn't she in fact raised by the very family that is now shunning her? How many chances did they give her before giving up on her? When she was actively using did they get involved with her over and over again?  Enable her? Try to "rescue" her?

Notice that she identifies herself as a former drama queen. Where did that label come from? Is that what everyone in her family would call her over and over again until it became a role she would play in order to confirm their opinion of her? 

Was she in fact the only one in the family who had been expressing feelings that everyone else was stuffing? Was she the identified patient, as  family systems therapists call such folks, who gets all the blame for a problem shared by the entire family?

And most importantly, did they abandon her only after she cleaned up?

Inquiring minds want to know the answers to these questions before passing judgment.

This is a counter intuitive way to look at this. I understand that. But when the whole story comes out from patients in therapy, the answers to my questions are often yeses. Respected interpersonal theorist Lorna Smith Benjamin describes an analogous dynamic in which she lists two of the four characteristics she has observed in families that produce offspring with borderline personality disorder (BPD) - who often share many characteristics with both drama queens and addicts:

1. Parental love and concern is elicited only by misery, sickness and debilitation

2. Family chaos - The borderline individual is subtly blamed for problems or expected to exert control over them.

(The other two characteristics:  3. Episodes of traumatic abandonment are interspersed with periods of traumatic over-involvement, and 4. Efforts by the person with borderline disorder to establish autonomy are interpreted by the family as indicated disloyalty).

What may be happening in the case of the letter writer is that her family needs a black sheep, and she was elected to play the part. Because she finally stopped playing the part, they then shun her. In this situation, they would be in effect be punishing her for not being who they need her to be. However, they would also be helping her out in a strange way - by protecting her from their own pernicious presence. As Dr. Benjamin has also said, pathological behavior can be a gift of love.

This could be the real answer to the letter writer's question.

States Pick up Where Feds Left Off in Fining Drug Companies for Deceptive Advertising

After the Feds did their job, the states are now getting into the action.  Pharmaceutical companies are now starting to be fined in state courts for fraudulent promotion of their psychiatric medications.

Anyone who is still wondering why there has been an explosive increase over the last two decades in the use of two classes of psychiatric medications  - so-called “atypical” antipsychotic medication and anti-convulsants - for the treatment of a variety of diagnoses for which they are not indicated need look no further than to my previous posts about U.S. Department of Justice fines levied against pharmaceutical companies for said fraudulent promotion. (2/17/10, 3/22,10, 3/27/10, 4/28/10, 4/30/10, 10/1/10, 12/20/10).  

This blog has also focused on how, with an enthusiastic assist from pharmaceutical companies, the definitions of the psychiatric disorders for which the drugs actually are indicated have been expanded to the point where they are in danger of becoming FUBAR’S (F***’d up beyond all recognition).

To summarize what the US Department of Justice previously found:

May, 04. American pharmaceutical manufacturer Warner-Lambert agreed to plead guilty and pay more than $430 million to resolve criminal charges and civil liabilities in connection with its Parke-Davis division’s illegal and fraudulent promotion of Neurontin.  One of these uses was for bipolar disorder.  Studies later indicated the drug was ineffective for bipolar disorder.

January, 2009. Eli Lilly pays a settlement to the DOJ of $1.4 billion for concealing side effects and off-label marketing of Zyprexa just as their biggest seller, Prozac was about to go off patent in 2001.

September, 2009. Pfizer agrees to a settlement for $2.3 billion for off label marketing of several drugs including the atypical anti-psychotic Geodon

April 2010 - AstraZeneca fined $520 million – off label marketing of Seroquel.

April 2010 - Ortho-McNeil-Janssen Pharmaceuticals Inc., fined $81 - off label marketing of Topamax.

September 2010 - Novartis Pharmaceuticals Corporation fined $422.5 million off label marketing of Trileptal.

December 2010 – Elan Pharmaceuticals fined $203 million – off label marketing of Zonegran.

Now the states of South Carolina and Arkansas have fined Ortho-McNeil-Janssen Pharmaceuticals, a subsidiary of Johnson and Johnson, for overstating the effectiveness and minimizing the risks of their antipsychotic medication Risperdal.

The following summaries of what happened are paraphrased without permission from the American Psychiatric Association’s Psychiatric News.  These legal actions were also widely reported by the press throughout the country.

First was South Carolina, from January of 2012:

A South Carolina judge upheld a $327 million civil penalty against Johnson & Johnson for overstating the safety and effectiveness of Risperdal.  A  jury had decided that they violated consumer protection laws by sending doctors a misleading letter in 2003 about this. The jurors also determined that the warning-label information was deceptive.  They found that the company had falsely claimed that Risperdal was better than competing drugs in a letter was sent to some 700,000 doctors nationwide,. The Food and Drug Administration (FDA) issued the company a warning letter about false and misleading claims that minimized risks such as diabetes and overstated the drug’s benefits. South Carolina’s law allows a judge to decide whether the company can be fined as much as $5,000 for each letter sent to South Carolina doctors.

Arkansas got involved just recently:

Johnson & Johnson "lied to patients and doctors" in its claims about Risperdal, said Arkansas Attorney General Dustin McDaniel, after a jury found the company guilty.  This is the latest case regarding fraudulent claims about the company's second-generation antipsychotic). The jury determined that the company downplayed and hid risks associated with the drug, which has been linked to increased risk of stroke and death in elderly dementia patients and to seizures, weight gain, and diabetes. After the jury's decision, Arkansas Circuit Court Judge Tim Fox, issued a penalty of $1.19 billion for the nearly 240,000 violations of the state's Medicaid fraud law. The New York Times reported that he also fined the company $11 million for violations of the state's deceptive practices act. 

Like the title to one of my previous posts, the hits just keep on coming.  Unfortunately, the companies are treating these fines as a cost of doing business and are still making huge profits on these medications.  They know quite well that the damage has already been done.

With Rispiridal, it’s kind of a shame, since in my clinical experience its side effect profile in some ways actually does compare somewhat favorably with two of its main competitors -  for patients who are actually psychotic, of course.