How I Used My PhD in Neuroscience to Design a Better Villain

Had my parents known that a concussion of this magnitude could leave traces years later — beginning as tiny, barely recognizable changes — they likely would have insisted on more thorough examinations.
(AMATEA — Memoirs of the Last City)

Writers love complex characters. We love broken minds, unreliable perceptions, and moral ambiguity. What we are less comfortable with is the responsibility that comes with writing mental illness as something other than metaphor.

In my novel AMATEA, the most difficult structure I had to design was not a city of Amatea, but the mind of Liliana Bernstein — a character often labeled “evil,” though her trajectory follows a pattern well documented in early-onset psychosis.

With this essay, I’m aiming to do three things: dissecting Liliana as a fictional character, tracing her condition through real neuroscience, and show how writers can build such complexity without sacrificing either scientific accuracy or narrative force.

The Organic Catalyst: A Childhood Interrupted

Liliana’s descent began at the age of eight. A victim of severe school bullying, she was tripped and struck the ground with such force that she suffered a heavy concussion. Clinically, according to systems like the ICD-10, schizophrenia is diagnosed only when organic brain diseases are absent. However, in Liliana’s case, the trauma likely caused a cerebral contusion — a physical bruising of the brain.

Soon after the fall, the so called “prodromal phase” (from the Greek prodromos, meaning “running before”) began. Statistically, in about 75% of cases, a fully developed psychosis is preceded by such a phase, often lasting for several years before acute symptoms manifest. At just eight years old, Liliana experienced: Persistent headaches and balance issues, which doctors dismissed as lingering effects of the concussion. The first whispers of auditory hallucinations, masked by the chaos of a developing child’s imagination. And early social withdrawal, which in 30–50% of cases overlaps with symptoms of early childhood developmental disorders.

The Breakdown: The “Made” Experience

Nearly a decade later, the sudden death of her parents acted as a massive psychological shock, bringing the dormant illness back with a vengeance. Liliana moved from a quiet, “negative” state into full-blown “positive symptoms.”

As a writer, I used the ICD-10 criteria to build her reality. An experienced psychiatrist would recognize the markers immediately:

Thought Broadcasting and Insertion: The feeling that her thoughts are no longer private or are being placed in her mind by others.
The Experience of Being “Made”: A delusion of control, where Liliana feels her body movements, actions, and very sensations are being dictated by an outside force.
Bizarre Delusions: Even later in life, after her pregnancy, she developed a paranoid conviction that her sister was plotting to steal her child — a culturally inappropriate and unrealistic delusion.

In these moments, “illness insight” disappears. For Liliana, the threat is not a thought; it is an undeniable physical reality. This lack of insight makes informative dialogue nearly impossible, as the patient’s mistrust and thought disorders create an impenetrable wall. From a narrative standpoint, these recurring symptoms matter not because they add drama, but because they explain why insight never returns.

The Biology of the “Villain”

We often label characters who lash out as “evil.” But looking at Liliana through the lens of Early-Onset Schizophrenia, we see a different picture.

While the biological causes remain largely unexplained, imaging provides a grim look at the physical reality. In “Very-Early-Onset Schizophrenia” (beginning before age 13), significant cerebral atrophy is often detectable at the start of the illness.

Histologically, we see changes in the morphology of the pyramidal cells in the prefrontal cortex. Liliana’s aggression toward her husband and sister isn’t born from an intrinsic intent to harm, but from a biological loss of self-steering capability. When her husband (now the dictator of a city) secures her in a psychiatric ward and cuts off her medication, he is ensuring that her “atrophy” becomes permanent.

A Note on the Craft: Navigating the Scientific Maze

If this medical depth feels intimidating as a writer, that reaction is part of the problem this article is addressing. You might have hit a few points in the previous paragraphs where you thought, “Wait, what?” and wondered how you could ever ground your own characters in such specific medical detail without a science degree.

Of course, not every writer holds a PhD in neuroscience, but you don’t need one to anchor your fiction in reality. While diagnostic manuals like the ICD or DSM are excellent starting points, they can be dense and unintuitive for laypeople. If you want to bridge the gap between “madness” as a trope and “mental illness” as a lived experience, there are more accessible paths.

I recommend looking for “Review Articles” on Google Scholar— like the one I cited below. They act as summaries of current knowledge, are far more narrative than raw data and are often available in your native language. In the U.S., publications like Scientific American offer specialized issues that translate complex neurology into compelling prose.

But perhaps the most overlooked resource is human expertise. In my experience, university professors, post-docs, and PhD students are often surprisingly willing to discuss their research if you approach them with a polite, specific question. They spend their lives in the lab; having a novelist ask how their work might affect a character’s soul is often a refreshing change of pace for them.

Using these resources doesn’t just prevent plot holes, but it gives you the confidence to write a character whose tragedy is written in their very biology.

Conclusion: The Invisible 1%

The lifetime prevalence of schizophrenia or a psychotic episode is about 1% worldwide. Liliana Bernstein represents the tragic end of that spectrum, where the onset occurs just as a young woman is supposed to start her life.

Through Ruth’s eyes in AMATEA, we see a sister who doesn’t understand the neuroscience, only the loss. But as readers, we can look deeper. Understanding the biological and traumatic roots of such a condition doesn’t just make for a better story; it makes for a more empathetic world.

Liliana Bernstein may eventually appear to “function” again, but the damage remains. In the city of Amatea, concrete can be repaired. The human mind, once fragmented, is far more fragile. And a shattered one like Liliana’s can become deadly.

Reference / Further Reading

Mehler-Wex, C., & Schriml, S. (2013). Jugend- und Adoleszentenpsychiatrie: Schizophrenie. Erste Symptome bei Kindern und Jugendlichen oft verkannt. NeuroTransmitter, 24(1), 34–45. Springer Medizin Verlag

About the Author

Saskia Karges, PhD is a neuroscientist, corporate strategist, and author. She earned her doctorate from the University of Bologna, where her research in Organic Bioelectronics focused on the interface between neural cells and machine communication — investigating the very foundations of how our brains process reality.

After years of pioneering research into the brain’s physiology, Saskia transitioned into the corporate world. Today, she leads strategic initiatives for Fortune 500 companies, managing the kind of complex, large-scale systems that mirror the intricate urban landscapes of her fiction.

In her novel, AMATEA — Memoirs of the Last City, she bridges these two worlds. She combines her deep understanding of neuro-pathophysiology with her expertise in strategic infrastructure to explore the most complex architecture ever built: the human mind.

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Previously Published on substack

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