# Treatment of mental illness in a dystopian society

I am writing a sci-fi novel, set in a 1984-style dystopia, so a society which is obsessed with order and surveillance where non-predictable behaviour is punished. My protagonist is a person with a mild form of autism:

1. How would such a society treat people with this and other mental illnesses? I assume that it will find subtle ways to isolate them, but other suggestions are also accepted.

2. What are the ways in which a person that does not want to conform to these norms (i.e. does not want to live in a room without a window for the rest of his life) could escape such treatment, and hide his illness from society?

The novel is set in the near future.

One symptom that is particularly developed in the text is his very bad (but still existing) episodic memory: so, for example, he remembers the people who are close to him, like his landlord and his friends, but he does not remember particular conversations with them. To combat that, I gave him Sherlock Holmes's style deductive powers which allow him to deduce the things that normal people remember.

If you are interested, you can read the first few chapters of the novel here.

Some of clarifications and personal thoughts (not essential for answering the question): Upon hearing the word "dystopia", many people assume that I mean that my protagonist will be persecuted - in the past there have been a lot of violent and inhumane treatments of mentally ill people both in totalitarian and non-totalitarian societies, however, this was at a time when mental illness was way less understood and talked about, therefore I don't think that the same treatments will be used in the future.

Also, many people asserted that no special treatment is required because a mentally-ill person does not pose a direct threat to the regime. That is not entirely true - running a (dystopian) society is not as simple as "punish those who are a threat and reward the others". Such societies are, for me, much more fragile than people generally think and keeping everything in its right place is crucial for the whole thing to work. I will give you one example, this is a story of how writers were treated in Soviet Russia and its satellites (I know this to be particularly true in Bulgaria). Many people know that they were persecuted and jailed but that is actually not the whole story. Another option for a writer was to join the "Writer's Club", situated at a glamorous building at the city centre with a bar and restaurant that were free for members. There he/she could meet other writers and members of the country's intellectual elite. Every member of the club could also publish his work with no effort in one of the state-owned publishing houses. The money was very good and there were very few topics that were censored. However once a person became a part of the elite he/she could no longer produce a decent critic of the regime, even if he/she wanted to. And most members had no desire to do criticize the regime either. That meant giving up on their privileges, financial stability, and social circle and substituting that for the life of poverty and persecution.

• He has autism or amnesia? I've heard of amnesia being a symptom of autism. BTW, a person with a mild form of autism is not that different from neurotypicals; they can, and do, function perfectly well in society. – AlexP Aug 6 '17 at 11:03
• He has autism, which is sometimes related to memory impairment among other things. But I don't want to concentrate on his memory problems too much (there has been a wide variety of stories that do that) - in this case I gave them only as an example of what I am asking for. My main focus is the way menally ill people are treated in a dystopian society. – Bobby Marinoff Aug 6 '17 at 11:10
• You got an upvote from be for including a link to your work. More people should do that! Still I think you should specify what makes your society different from ours for question 2 and 3 and ask question 1 in another forum since people here do not like story based/opinion based questions. Especially when it comes to actual medical issues, you should not expect answers here for obvious reasons – Raditz_35 Aug 6 '17 at 11:14
• Sorry, me again, now with your edits I'm a bit confused. I'm not a doctor, but aren't people with autism generally drawn to certain routines and generally prefer more order in their lifes? How does that create conflict in your world? You see that medical issues are somewhat difficult and I have yet to encounter a doctor here. As I know from people that work with the mentally ill, everyone is different. Could you maybe specify where the tension comes from, what makes live difficult for your patient in your world specifically? It would also make answering without causing offense much easier. – Raditz_35 Aug 6 '17 at 11:25
• @Raditz_35 speaking from the viewpoint of a diagnosed: It's less about preferring routine and more about needing it. Regularity provides security, rules & guidances provide a fallback and something solid to 'stand on'. – dot_Sp0T Aug 6 '17 at 13:15

As you novel is set in near future, I would guess they would refrain from controversial physical isolation, as modern drugs could achieve the goal of controlling unpredictable behaviour so much better. This would be promoted as "treatment", and, if potential for damaging behaviour considered high, he would have become ward of the state, and be assigned visiting "caregiver" whose responsibility includes ensuring he takes drugs and does periodic visits to psychiatrist for regular assessment and providing authorities with observations and recommendation as to further actions. So to achieve his goal of staying free your protagonist would have to use his deducing abilities to play cat-and-mouse with both caregiver and doctor.

Or, if by some miracle his condition was not discovered yet, he might want to play this game with AIs of facebook-like social networks that in your society likely will be tasked to identify "risky" behaviours and flag at-risk individuals. I would not worry too much about handling suspicious neighbours, as today you can avoid in-person contacts almost completely.

You are mistaken about autism; my grandson has it. He has no problem with memory at all; in fact one aspect of his autism is difficulty in learning language (he did not start speaking until about 4 1/2); in essence the "natural" part of language development is missing in many autistic children, and they have to learn language as you and I might have to learn a second language in adulthood; but without any tutors and a restricted form of rationality.

As a result, even at 11, my grandson continues to use "scripting" as his primary communications method: He watches children's shows on TV (meant for children half his age), apparently remembers hundreds of hours of it, and when he wants to say something he repeats verbatim and in the same tone and volume what one of the characters has said. This is usually appropriate usage: One example; in a children's show one character accidentally drops something and says, "Oops, that wasn't supposed to happen!". My grandson, trying to pour himself a glass of milk from a full gallon, spills a lot on the counter and floor. He goes to his mother and says "Oops, that wasn't supposed to happen!", which has become his script for most minor accidents. She knows this and asks him, "What wasn't supposed to happen?", and he takes her hand and brings her to the spilt milk. He uses another script, another character on the same show: "We have to clean up this mess!", and his mother says, "Right. I'll get the paper towels." (she does not stay on script, but he talks almost entirely in them). Because he mimics his TV characters, his speech is clear; he doesn't slur or make errors.

Despite this apparent inability to form his own sentences, on paper he understands grammar, and he clearly understands spoken commands. He laughs when appropriate if his mother is playing with him and says something funny. He is sad when scolded or told he cannot do something or go somewhere.

My grandson has an awesome memory for people, places and things. He remembers their names and uses them (as single words). If you ask him what he wants at a restaurant; he will say "taco", "burger", even "enchilada". He just can't seem to string these together into a sentence; I suspect even his scripts are the equivalent, in his mind, are not ten words, but just one very long word: His word for "accident" is "Oops...that..wasn't..supposed..to..happen", longer than "Supercalifragilisticexpialidocious".

My grandson's primary difficulty isn't language; but imagination, and theory of mind. He does not understand motives. He doesn't think of new things. He is stuck on the children's shows because he cannot understand a plot, or that one character knows something and another doesn't. He does not understand implications of some event. He does not understand "money," if you hand him a \$100 bill he will just drop it on the floor. He doesn't get the multi-step process of getting money, holding it, then spending it on something. (His mother has tried: He loves smoothies, she has given him \$10 to give to the clerk at the counter. When she said, "Now you give her the money," he had a \\$10 bill in his hand, but dropped it on the floor so he could go through the motions of handing the clerk money.)

### Where would a person like this fit in?

Before political correctness (which I endorse, BTW) I suspect all these people were lumped into the "retarded" category. Originally that was not a pejorative at all; it was a medical description meaning delayed development. It became a pejorative because the people thusly labeled are, indeed, not very intelligent by normal standards; they fail to understand things a normal person understands without effort.

Such people, in the past, were relegated to laborer and service jobs that they could memorize. If they were autistic, they may well have had near perfect memories for their tasks and executed them flawlessly.

They could be quite useful on a farm, or as a worker for blacksmith. My grandson can clean his room flawlessly (and put every single building block in exactly the same place every time, and all his picture books in exactly the same order on the shelf).

In a dystopian society with no public care, I suspect that is how they would get by: Working for a living and being housed, fed and cared for by parents, siblings or lacking those, by profiteers exploiting them as "labor for food".

Problems with the plot: Sherlock Holmes deduction relies very heavily on memory, of how things should transpire but did not. A person with memory problems cannot do this! An Autistic person generally has either no theory of mind, or an impaired theory of mind: This means they cannot understand why other people are doing things; they struggle with the idea that others know things they do not, or they know things others do not. The idea of secrets is difficult for them to grasp. This prevents them from having deductive ability about even the most minor of motives or how what they do affects other people. My grandson again: When he is looking through a picture book, he doesn't like noise. So if his mother turns on the TV to watch the news, he will walk to the coffee table, see that his mother has the remote, then walk to the TV and press the mute button and walk away, all without saying a word. He doesn't realize she wants to hear what she is watching, he just solved the problem of the TV mysteriously coming on and making noise he didn't want to hear.

Here is how that transpires: He mutes it. She calls his name, and says, "I'm going to listen to TV." He calmly says, "No." She calmly says, "Yes." He sighs, she un-mutes the TV, and he takes his book to the furthest back room and shuts the door.

My grandson is not the only autistic child I know; because of him I have exposure to about a dozen. Although that is a small sample, I can report that not one of them has "episodic memory" or Sherlockian deductive powers, their inability to emotionally understand other people (or even grasp that other people have intents or desires) prohibits that.

Although your character could be made plausible; Attributing these traits to "autism" will be both implausible and an insult to the autistic community. It is like confusing "tuberculosis" with "lung cancer".

I suggest you attribute your character's traits to something simple, like brain damage due to a physical accident, brain surgery to remove a tumor, or brain damage suffered due to an inadvertent or accidental medicinal overdose as an infant; perhaps in response to a seizure event.

• I really enjoyed your response and particularly the first-hand account and I like to discuss your points further. First is about memory being an important element in making Sherlock Holmes-style deductions. I think that they help but are not necessary - what fictional detectives do is mostly to analyse a very small number of awkward details that they have noticed. One does not have to have perfect memory to remember these details - he/she can write them down on a piece of paper and go from there. Noticing them is what makes the biggest difference. – Bobby Marinoff Aug 6 '17 at 17:55
• An autist cannot guess people's motives. Maybe it is true of people who have a strong case of the condition, but the ones who are mild can actually be good at it - they would just have to do it in a different way. I liked your metaphor about your son learning to talk as if he is learning a second language. What if a person can study all other social codes and norms that we confront to, but not the way we learn them (naturally with living) but as if they area part of a big research project. I'd argue that that person (an outsider) can be very good at noticing things that we do not. – Bobby Marinoff Aug 6 '17 at 17:58
• I will inform myself about the link to autisim and memory or lack thereof. Maybe I am not understanding the condition correctly. Take the incident with the remote control as an example - what you describe strikes me as something that every other child does - caring about himself and not the others. The only thing that would stop me as a child from doing the same thing in the same situation will not be understanding but memory - I would just remember that my mother won't let me mute the TV and I will just go to my room without going through the whole pointless routine. – Bobby Marinoff Aug 6 '17 at 18:01
• I think you are mistaken about understanding vs. memory. His mother will let him mute the TV, and he is expert at controlling the TV and the volume. What he lacks is a theory of mind; which is knowing that other people are thinking and making decisions, too. If the TV comes on, it doesn't occur to him that somebody else wants it on; he doesn't understand that other people want things. See autism.com/understanding_theoryofmind Or search for ' Autism AND "Theory of Mind" '. This is not selfishness or egocentrism of children; this is a real disability. – Amadeus-Reinstate-Monica Aug 6 '17 at 19:54
• As for Sherlock: The only way Sherlock succeeds is by knowing what is in place, and what is out of place, no matter how small the clue. That requires memory; you cannot notice something is out of place without a mental model of what it looks like when it is not out of place; and that requires memory. You don't recognize unusual behavior without a clear memory of what constitutes usual behavior. That detective work is not arithmetic, it is an encyclopedic knowledge of how everything should be, or should have turned out, and finding discrepancies between the story and reality. – Amadeus-Reinstate-Monica Aug 6 '17 at 19:59

Provided that autistic people, once placed in an environment they like, will never ever put effort in changing it, I see no problem for a dystopian a la 1984 society.

If they like yellow, paint their room yellow and let them enjoy their room. He will be the rightous example of a citizen, enjoying the sober apartment the government provides to all. If they dislike green food, savings for your artificial coloring in the kitchens. If he likes having any set arranged in perfectly matched rows and lines, appoint him as organizer for the year Joy March!

Paranoid governments are more afraid of unpredictable people than of methodical routine obsessed people. Once they know the routine, they will be sure it won't change.

• The question is where is that yellow room. In some hidden institution? In a school, which is next to a university, which is next to the place where everybody who finished the school works. Other than that I agree with your point - the plot of the novel has nothing to do with overthrowing the regime. – Bobby Marinoff Aug 6 '17 at 15:22

I won't speak to the autism. It's merely the "why" you're using to separate your protagonist from the world around him/her. You could use almost anything to do that, so I recommend (a) that you find a reason to use one over the other (even Sci-Fi stories should have a purpose) and (b) that you research the snot out of it before using it. Illnesses and disabilities are sensitive issues to the many people affected by them (both the sufferer and those around them). Since we live in a world were anger over a perceived disrespect is often instantaneous and virulent, it's worth every second of your time to be absolutely sure you're representing your choice correctly.

Question #1 Maybe subtle, maybe not. Most people don't realize that Nazi Germany was a nearly perfect example of a dystopian society that dealt with everything different from the ideal norm (including illness and disability) with brutal efficiency. How did they do that? Euthanasia. Forced sterility. Violence. (See here, here, and here.) One of the problems of a dystopian context is that it requires both an excuse and the ability to devalue humanity. Anything that can devalue an entire society requires a fair amount of power. The Nazis used fear through secret police and the simple removal of anything not supportive of the cause.

Question #2 Dystopian books are ususally stories of redemption where the dystopia is the framework for the conflict to be overcome. In reality, escaping the destypian influence means resistance groups and "underground" networks to hide or move people away (think Anne Frank or the various Jewish underground railroads during WWII). The despair caused by dystopia is a critical concept in such a story.

Our modern YA novels cheat the power of these societies in that they all have ways to overcome the powerful influence. We must suspend our disbelief to enjoy the story. Indeed, allow me to give you a quote from a friend of mine that describes the fundamental flaw that's necessary for a YA book to be popular:

We write stories about children saving the world for our own sake. We realize as adults that the world is lost to us and we well know no child has the resources, education, or wisdom to overcome this fate. Our stories are our fantasies that the world can be made right by the innocent. – E. Keith Howick, Jr.

Therefore, to offer insight beyond the two ways to escape already mentioned (hiding and an underground railroad), let me suggest that any mental disability would need to be almost inconsequentially light to avoid society's distaste without help. So, I would begin with asking, "how can others assist the weak to overcome their tormentors?"

If you are set with the idea that the afflicted individual overcome the dystopia him- or herself, then you'll need a wonderful story to help people suspend their disbelief as that seriously increases the difficulties. Note that you're suggesting to escape treatments — remember that dystopian societies are usually interested in removing, not assisting. What would be the point of a treatment that further dibilitates the dibilitated? Such a person would be seeking illicit treatments that would help him/her hide their limitation. They would seek employment or other social integration that did not make demands that would exceed their limitation. They would seek partnership with people whose educational or social skills were equal to those imposed by the limitation. These all would work so long as no one suspected their situation and turned them in to avoid a similar fate themselves.