What’s a Non-Ableist Alternative to “Losing Sanity” in Stories?

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I’ve read your article on addressing ableism in sanity systems, and I’ve been wondering how to write about horrible things that do cause radical alterations in people. I come from the land of the SCP Foundation Wiki and they have anomalies that hijack and alter the mind. From that article I read, it’s awful to use the usual trope of characters “losing sanity” from exposure to horrid things and beyond, but I’ll admit to not being so sure of the alternatives proposed, especially “Use magical story elements to create fantastical and mind-altering effects” or “erode their convictions, ethics, or core beliefs.”

— S


Thanks for the question! Writing about horrible things that affect people’s minds without falling back on ableist concepts like “sanity” and “insanity” can be difficult.

“Insanity” is an outdated and stigmatizing concept that started as a generic category for all types of mental illness and divergence that resulted in behavior that was considered “abnormal.” This history gives “insanity” a generic quality that allows it to be used in a lot of different ways, but this genericness is also part of the problem. In addition to being stigmatizing, “insanity” is a bunch of separate things that are being treated as if they are connected or interchangeable, which in no way matches reality. Because “insanity” is so broad, there is not a single thing that can replace “insanity” in all stories. Instead, there are a bunch of different things that we replace it with depending on the circumstance and what we are trying to do.

Eroding a character’s convictions, ethics, or beliefs is all about depicting the way that the terrible events of the story affect the character over time. The first step in using this alternative is choosing one conviction, value, or core beliefs for each main character. In a horror setting, altruistic, optimistic, and rational beliefs like “Always help a person in need,” “Everything happens for a reason,” “People get what they deserve,” and “There is a rational explanation for everything,” will be particularly easy to erode.

Next, decide how this belief helps the character cope with difficult situations. For example, does it keep the character calm, help them focus, or aid them in thinking logically? Knowing how this belief helps the character is useful for guiding their behavior when that belief is being eroded.

Once this has been decided, put each character in situations that challenge their belief. For example, if a character’s belief is “Always help a person in need,” then putting them in a situation where helping someone in need would be incredibly dangerous directly challenges that belief. Another example is challenging a character that believes in rationality by having them encounter increasingly inexplicable and irrational things.

As the character grapples with each challenge to their belief, their belief erodes and they start to lose whatever type of stability their beliefs helped them have. Perhaps they start doing irrational things in order to maintain their belief. Or maybe who they are changes as their core belief is forced to change, causing a radical change in their behavior. If desired, this can lead to a crisis point where the character’s belief suddenly crumbles and they have to find a way to cope without it.

In contrast, using magical story elements to create fantastical and mind-altering effects is a way to portray situations that warp reality, or that externally alter a character’s perception of reality, while avoiding the ableist concept of “insanity.” For example, instead of a horrifying monster that causes everyone around it to “go mad” and attack each other, the monster could instead create disturbing hallucinations that cause everyone around it to attack each other. Here the ableist concept of “insanity” is being replaced with a supernatural mind-altering effect.

In this situation, “insanity” is being used as an intermediary between the cause, the horrifying monster, and its desired effect: people attacking each other. This means that we can replace “insanity” with any other fantastical story element that can create the same effect. In the above example, “disturbing hallucinations” were used, but other story elements, like magically-induced anger, mind control, or supernaturally-caused violent possessiveness, could have been used.

This process of examining how “insanity” is being used and replacing it with a different story element that has the same effect is broadly applicable. To demonstrate this, I’m going to work through another example. Because corruption is a common theme in cosmic horror, let’s use the example of a magical book that makes its user “lose sanity” each time they use it, resulting in increasing irrational behavior. Focusing in on the desired effect of this “lost sanity” we can select a different story element that can produce the desired irrational behavior. The book could whisper lies into its user’s mind. Each time they use it, those lies get harder to resist. Eventually the user starts to believe some of the lies, resulting in increasingly irrational behavior.

There are a lot of other options too. Maybe each time the character uses the corrupting book, its magic changes them a little. They could lose a happy memory, suddenly hate a food they used to love, or start having different aesthetic tastes. Or perhaps the book messes with their emotional stability, causing them to get irrationally angry about small things. Or the book could cause changes that prevent them from relaxing. Calming music could now sound discordant to them, or there could be shadows constantly flitting at the edge of their vision. The character’s inability to relax leads to stress which then results in irrational behavior.

I hope that this demonstrates that there are many options for replacing “insanity.” It is all about delving into how “insanity” is being used in each story and replacing it with something specific that fits the story’s scenario. Not only does this remove ableism from the story, it also helps us create more vivid and interesting stories by pushing us to be specific about what is happening.

Hopefully that this answers your question. Good luck with your storytelling project!

— Fay from Writing Alchemy

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  1. Jeppsson

    We have the Arkham horror board game at home, where it’s part of the game mechanics that you can both lose “sanity points” and “physical health points” from encounters with monsters and stuff. A physical doctor can bring up your physical health points again and a psychologist can bring up your sanity levels. But if your levels go too low, you have to go to either regular hospital or mental hospital for some time. Different characters also start on different levels in these areas, and they are differently vulnerable.

    This is obviously unrealistic in its simplification, but I can roll with it because, well, it’s a board game, and doesn’t have the same level of nuance as you could have in certain roleplaying games. And I get that “insanity” is often considered an offensive term. HOWEVER, I actually don’t see the problem with the idea that after having encountered a sufficient amount of horrifying shit, you could “go insane” in the sense of having a psychotic breakdown. Your head is chaos, you can’t think properly, you lose your grip on reality, and it will take time and proper care before you can do anything useful again. The mental equivalent of getting so physically injured that you really need hospital care before you can do much again.

    Now, once again, in a board game you can have characters acting as if they’re fine until the very point where they suddenly need hospital care ASAP. In other games you might need more nuance. And Fay does have good suggestions! I guess my main point was that… it’s not some weird ableist myth that people can have psychotic breakdowns. It’s a thing that can happen. I know, I’ve been there myself! (Done that and bought the t-shirt…) I didn’t even have to fight Cthulu for this to happen.

  2. Dave L

    You may want to research Post Traumatic Stress Disorder, for characters who repeatedly face awful and horrifying situations

  3. Rose

    Honestly, i feel that it is to some extent a terminology issue?

    It is totally reasonable for people to be /traumatized/ by horrific events, and thus develop mental health conditions. That’s a thing that happens and, frankly, given what most protagonists go through, it probably doesn’t happen enough in fiction. It’s totally understandable that an organisation like the SCP foundation would have a lot of traumatized employees even before including any mind-altering supernatural stuff.

    It’s when its framed as “losing sanity” in some nebulous way that gives you some randomly generated mental health condition that’s an issue.

    If you research actual trauma and how it affects people, I think you’re probably fine.

    • Andy Onimoose

      “…given what most protagonists go through, it probably doesn’t happen enough in fiction.”

      Probably because if it did, most of these stories would about as long and hopeful as The Ugly Barnacle by Patrick Starr. That, and your average protagonist is meant to be ultimately aspirational.

      • Bellis

        I don’t see how being traumatised makes someone not “aspirational”? It’s not a character flaw. On the contrary, similar to “courage is not the absence of fear, it is overcoming the fear”, strength of character could be shown in how someone handles trauma rather than showing someone just not being affected by things that would traumatise almost everyone else. Such heroes who “don’t look at explosions” because they’re just that cool aren’t relatable to me at all and thus I can’t aspire to them or learn from them.

        It seems more common nowadays to depict trauma and its consequences in a more realistic and compassionate way in stories, I hope this trend continues. Showing how characters support each other in coping and healing from trauma can add great character and relationship development as well as fight real-world stigma. Especially since early support can prevent a full-blown disorder like PTSD to develop or become chronic even if the initial trauma was horrible.
        I guess showing coping mechanisms and mutual support (and/or therapy or medication) is often a more practical choice in an action-focused story than having a character be unable to continue fighting because their untreated trauma developed into a chronic mental health problem that takes months or years to adress. Unless you do a lot of summarising or time jumps.

  4. Sydney

    This answer was very helpful and gave me some great writing inspiration. Besides removing an ableist trope, I found the alternatives far more compelling than just a vague loss of sanity. The idea that a corrupting object can steal happy memories or create visual hallucinations provokes more unease and fear than “going mad.”

    • Bryan

      Before Winter Grimoire: ” I love spring blossoms!”.
      After Winter Grimoire: “What is that Daisy doing in my Garden? The only flowers I like are frozen ones!”

  5. Jenn H

    A lot of the ableism in this trope comes from ascribing a supernatural cause to conditions similar to real world mental illnesses. The possibility of “going crazy” is mined for horror at the expense of those dealing with something similar in real life.

    There are a few ways around it. A common one for instance is to deal with things such as PTSD and phobias in a way that is realistic and respectful.

    Another way is existential horror. The characters are confronted with truths about the world that are so strange and horrifying that they can’t really function in normal society anymore. They aren’t “insane”, though they may appear to be acting irrationally from the perspective of anyone who doesn’t know the truth.

    A third way (as Fay suggests) is to have the character’s mind altered by exposure to the supernatural in a specific way. Their brain or their soul might be transformed in some way, either removing something good or adding something bad. Being specific about what changes can really add to the horror while avoiding unintentional parallels with real conditions.

  6. Daisy

    ” HOWEVER, I actually don’t see the problem with the idea that after having encountered a sufficient amount of horrifying shit, you could “go insane” in the sense of having a psychotic breakdown”

    Yeah, I think it is fine as a game mechanic. After all, the “health points” mechanic rarely tracks where on your body the wounds are, or if it is actually organ failure, or whatever.

    For the actual roleplaying, players can choose whatever condition seems fitting to the horror encountered. Be that a phobia or ptsd or the crushed self esteem that comes from realizing that we humans are as insigificants as ants to the Elder Ones.

    As for the word being used, I think “sanity” isn’t so bad. Any word used as replacement would enter the euphemism treadmill and become as pejorative as insanity after a while.

    And the thing about it being game mechanics means it affects the player characters. That pretty much guarantees that every player (who actually identifies with their character, at least) will feel a need to plausibly explain the choices made by that character.

    As long as NPCs get actual description as to why they attack people (just like no GM worth her salt would go “you see an injured villager who seems to have lost x health points” but would instead say that the villager has a broken leg) I don’t think it’s that much of a problem.

  7. Nate

    In stories where the protagonist sees supernatural apparitions and nobody believes them, there tends to be this general progression.

    1. Protagonist sees apparition
    2. Other characters think the protagonist is joking or mistook a shadow or something for an apparition.
    3. Protagonist convinces themself that they mistook something for the apparition.
    4. Protagonist keeps seeing apparition.
    5. Other characters question protagonist’s sanity.
    6. Protagonist starts questioning own sanity.
    7. The supernatural force reveals itself and proves the protagonist correct.

    There are obviously variations, but there is almost always the questioning of sanity. Is there a non-ableist way to do this story? Maybe if you keep having the other characters think that the protagonist is joking and skip over the whole sanity part? Is there a substitution for the doubting of sanity?

    I think The Invisible Man did this story well, because the protagonist never doubted her own sanity and the movie made it clear she was always correct. Also, the movie used this to comment on society’s reluctance to believe women about abuse. However, it still brought up the ableism.

  8. Rose Keith

    I find it can be not only more sensitive and respectful, but also more fun and a tool for more consistent writing, to forego the vague, nebulous idea of “insanity” in favour of actually describing what the effects are, describing why and how something causes psychological harm.

    This accomplishes a few things; first, it makes clear that this is not a portrayal of an existing mental condition such as PTSD (unless it is, in which case do it specifically and accurately), thus dodging many potential implications. A related point, by understanding what is actually going on which is abnormal in a character’s mind, their condition can be portrayed more consistently, with discernible reasons for atypical behaviours, and can allow them to remain a relatable and sympathetic figure, rather than a “madman” stereotype. It might even help to drive home the horror for your audience if they can actually imagine what it would be like to have this happening in their own head.

    A personal favourite of mine is the idea of things which stick in your mind, demanding focus until they consume all your mental faculties. Imagine getting a song stuck in your head, but instead of eventually fading, it just gets louder and louder, and you become less and less able to focus on anything else. Maybe you see a strange symbol and it never leaves your mind, when you wake up, when you’re eating, when you’re driving, when you’re working, when you’re reading, when you’re trying to sleep. Imagine what that would do! A similar but weirder example, I have the idea of an “infected word,” a pathogenic thought which spreads through communication of the word, which slowly takes over your entire mind. At first, the word just slips randomly into your speech, replacing correct words, until eventually it’s what comes out regardless of what you’re trying to say. As time goes on, the effect becomes more extreme as it even takes over your thoughts, until one word is all you can say or think.

    For more standard Lovecraftian fare, like what might happen if you look at Cthulhu’s yearbook photo, perhaps the insight you gain into a higher or truly alien reality is so dissonant with everything we’ve learned to understand that you experience profound dissociation from the mundane world. Imagine how difficult it would be to function and to be invested in daily life if you learned that everything is just a simulation. Alternatively, there’s the “information overload” – something is so advanced or beyond what our minds are capable of comprehending that it’s like trying to run the latest version of Adobe Photoshop on an Apple II, and you become locked in and unresponsive because all of your mental resources are occupied trying to perceive or make sense of something you simply can’t process.

    For something cumulative, a simple solution is disillusionment, your collective experiences challenging your understanding of what’s real and what isn’t so frequently that it becomes difficult to maintain a concept of reality and stave off paranoia. First your neighbour’s dog turns out to be a werewolf, then you discover the fortune teller at a carnival really can read people’s minds, then aliens have been stealing your socks out of the dryer, then the credit card offer you got in the mail turns out to be a page from the Necronomicon, then it’s revealed that politicians aren’t lizard people – but every country singer ever is. After all of that, if someone told you they saw Bigfoot, there’s a pretty good chance you’d believe them, and if someone in the room with you decided they were going to try the “Bloody Mary” ritual, you’d probably panic in a way which would appear irrational to most people, but would be consistent with your experiences.

    Now tell me those aren’t more interesting takes than “experienced something scary, went mad.”

    • BeardedLizard

      Most definitely. The ideas about a contagious word remind me of the antagonist in the game “Control”: Where a resonance base entity invade or world and it’s victim started repeating the same verses over and over and over again (while floating in the air, of course).

      Regardless, using precise and somewhat relatable symptoms to describe a form of madness is way more effective, since you can imagine what’s it like. Therefore, it can get under your skin more effectively to create discomfort and fear. (I’m not scare of being mad, since it doesn’t mean anything. I mean, I’m autistic and I have anxiety. Technically, I’m already mad. But having a though dominating every single second of every single day is way scarier).

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