Many characters who may be mentally ill reject treatment out of hand, considering therapy a waste of time and suspecting medication will turn them into a zombie. Why are these narratives so popular? What are the alternatives? We gathered new and familiar contributors to discuss this topic.
Kayla Whaley: Hello, everyone! Let’s start with brief introductions.
Kelly Jensen: I’m Kelly. I’m an associate editor for Book Riot and have been a blogger at Stacked going on 6 (!) years now. I should note I’m a writer, too. Just sold a book to Algonquin last month.
Alex Townsend: I’m Alex. I’m a freelance writer and author.
Sarah Hannah Gómez: I’m Hannah, a blogger, book reviewer, school librarian.
Kayla: And I’m Kayla, co-editor of Disability in Kidlit and your moderator for this evening. I want to start out pretty broad and we’ll work our way down to more specific topics as we go. This isn’t going to be super structured, though, so feel free to follow the conversation wherever it goes.
To start out, what does stigmatizing medication/treatment tend to look like? What forms does it take?
Alex: I think the biggest issue is all the stories where treatment isn’t even mentioned. Like mental illness is just something you get over.
Hannah: Yeah, in fiction, it’s never something you just live with, even though that’s what it is in real life. It’s always a hurdle to jump that will eventually be cleared FOREVER instead of a thing that may be more or less of a problem at different times of life.
Kelly: The big one for me is seeing it eschewed as an option in YA over and over. OR, the big old “but it’ll make me feel like a zombie.” I see medication demonized for what the potential side effects may be and that’s the end of the discussion.
Hannah: Or it becomes a jumping-off point for some kind of addiction to medication because it’s EVIL.
Alex: And therapists are often portrayed as not understanding. Fictional professionals will make someone with mental illness into just their diagnosis and not a full person.
Hannah: Or they’re overly quirky, rather than professionals.
Alex: I hate the stories where the “brave” choice is throwing one’s pills away.
Kelly: Oh, yes, that too. And it’s not a comment that’s challenged. I can only name one YA book (Saving Francesca by Melina Marchetta)—and I’ve read many!—where medication being a crutch or a bad thing is challenged. I hate seeing the pills being thrown away so much.
Hannah: I threw away $200 of pills once. Still mad at myself, but I totally understand why I did it. I completely bought into the idea that pills were for weaklings and it was better to find alternate ways of dealing or just ignore how I felt.
Kelly: I’ll admit I find a lot of therapist scenes in YA … boring to read.
Alex: I haven’t found any convincing therapy scenes yet.
Kelly: Which I think in part has to do with depression and mental illness in general boring to deal with, thus not always exciting to write.
Hannah: Yes! Like how many other books about depression or anxiety are exist, but aren’t publicized that way because they aren’t sensationalized or dragged out?
Alex: True. The main appeal of writing mental illness seems to be the tragedy of it.
Kelly: Through to You by Emily Hainsworth does a good job with a therapist, actually. That’s one I can call to mind where there’s actual therapist scenes, rather than talk of therapy, etc.
Hannah: I’m trying to remember if Dr. Bird’s Advice for Sad Poets ends with an actual therapist. I think it does, but I’d have to check.
Kelly: I think you might be right there, too. If I went through my read list, I could probably pull out more, but rarely do they stick out to me.
Alex: I’d like to see the evolution of therapy more. Often, if it’s included at all, it’s the symbolic thing at the end of a story about how the person will get better. In reality, therapy is a lot of work.
Kayla: I’d like to talk a little more about that idea that Kelly mentioned about “becoming a zombie.” There’s a perception that medication always numbs, strips creativity or individuality, etc. That the likely negative side effects aren’t worth the potential benefits. Why do you think it’s so pervasive in YA especially? And of course, medication isn’t right for everyone, but why are these by far the most common narratives we see?
Alex: I think people like not having to depend on any outside substance to live. It’s similar with other disabilities. Like, there’s a lot of narratives about “overcoming” a disability. So pills are okay for something temporary but not permanent.
Kelly: I think part of it might be that people don’t recognize the power of what medications do, either because they haven’t been treated with the medication that works best for them as an individual or they’re relying on outdated narratives, or hear only from those who haven’t had good experiences.
There’s a scene in Saving Francesca where the mother, who is depressed, doesn’t want to take medication because of what she believes to be harmful effects, and Francesca says to her that’s wrong, those are old, outdated beliefs, and medications have improved tremendously. It rung true to me that might be part of the issue: antiquated beliefs, as well as bad experiences.
Hannah: Or the fact that maybe your body reacts to a medication when it’s brand new, and that reaction tells you never to take it again, when in reality it takes a while for your body to get in sync with anything new.
Kelly: I believed that for a long time: that a possible bad reaction means you should avoid medication forever.
Hannah: Everyone knows that tired muscles from exercising are a good thing and mean you should try again tomorrow, but with a medication reaction, it’s like it means the med is awful instead of the med is resetting some stuff and working things out with your body.
Kelly: The narrative isn’t that medication rewires your brain—that it actually changes the chemistry—but rather, that it makes you feel bad/wrong/etc.
Kelly: Of course something that’s changing your fundamental chemistry is going to be tough, especially at first. And rarely do the professionals get it right immediately. It takes work to do it right.
Alex: There’s a lot of problems with any narrative where medication changes the “real” person.
Hannah: That’s what’s missing in almost all of these books: work.
Kayla: And it seems like a lot of times in YA the characters don’t even get to the stage where they actually take medication, right? They dismiss it before even trying it?
Kelly: Yes! It bothers me how the belief before it’s presented as an option is “but it will dull me.” As if depression itself isn’t a state of being dulled. That’s depression lying.
Alex: Ooo, or how about the artists who can no longer be inspired?
Kelly: Oh yeah, that too.
Hannah: Yes, that is a problem, and I believed it for so long thanks to books and movies.
Kelly: There’s not much deconstructing of the narratives, period. Whatever choices the character makes or doesn’t make go unchallenged. And that’s where the issues really arise.
Hannah: Don’t you think it’s weird that we eat up television shows about people working hard to lose weight and manage OCD and stuff with tough love and coaches and setbacks and stuff (sensationalized, but at least it’s true that it’s a lot of work), but in books we’re like nuh-uh?
Kelly: How much are we more willing to see hard work than read it, though?
Is reading it boring? This is something I’ve talked with writers about: when you live with a mental illness, you know how boring it is to live with. When you write it, you know how boring it is to write it. Is the same true of reading it?
Alex: Even if the character kills themselves, it’s never an issue of “Maybe we should have pushed them towards treatment more.” It’s just “If only we’d seen their pain!”
Hannah: Oh, Alex! That brings us to “depression is never a thing in your brain; there’s always a reason, like probably somebody dumped or bullied you, and deconstructing that is the one and only key.” I think that’s why I’m not excited about reading 13 Reasons Why.
Alex: Ugh, I hate that.
Kelly: YES, Hannah. That. This reminds me of a blog post by Francisco X. Stork.
I got asked to blurb that book, and thought it was tremendously well done, and it’s about a depression that occurs without a “reason.” That blog post hit on it really well.
Hannah: And there have been a rash of teen suicides on train tracks around here, and the discussion is always pressure —> depression —> suicide, instead of pressure + depression = suicide.
Kelly: Alex, I thought that book was … really a disservice. Painful disservice to people who do suffer depression.
Alex: How do you think depression should be portrayed when it isn’t an issue book? What about incidental depression? I’d like to see books about depressed people where that isn’t the plot at all.
Kelly: I thought that depression presented pretty well in None of the Above, even though that wasn’t the issue at all. It was an effect.
Hannah: Alex, the same way other parts of your identity are. Sometimes it’s really relevant that I’m black and other times it’s more relevant that I can’t eat gluten.
Kayla: Let’s talk a little more about that “suicide trend” in YA lately.
Kelly: The depression —> suicide trend is … so sticky for me in YA.
Alex: It is a problem.
Kelly: Because it does feel romanticized to an extreme and often leads to romance in these books. I never had suicidal ideation with my depression. Moreover, I know this is just my personal experience, but no one wants to spend time with me when I’m in a state. I don’t want to spend time with me.
Hannah: UGH, romance as the cure for mental illness is ridiculous.
Alex: I’m sorry to hear that. You shouldn’t have to be alone.
Kelly: Oh, no need to be sorry! I manage it perfectly fine and have a killer support system. My point is more that the romance never feels convincing or real. And it’s certainly not a cure. It’s not going to fix your mental illness.
Hannah: Exactly. It’s going to fix your relationship status on Facebook.
Alex: I’ve been in really bad places and the worst advice I got was things like, “You should hike a mountain at dawn!”
Kelly: “What if you take a nap?”
Hannah: “But think of all the good things in your life!”
Kelly: “Why not go hang out with your friends?”
Hannah: “But you smile a lot and are nice! How can you be depressed if you’re friendly?”
Alex: “But you’ve got so much going for you!” My depression is just about not appreciating life.
Kelly: “You’re so productive, though, and you take care of yourself. How?” Because it’s not about not appreciating life or not functioning. It’s deeper.
Hannah: I have so much trouble explaining to people that I don’t want my mental illness to be a part of their life and so I do my best to get through my day and interact with the world, and then I go home and deal with (or don’t) my mental illness on my own time.
Kelly: OH YEAH, that one. Same, Hannah. I worked so hard to convince myself I didn’t have a problem. Since everyone seemed to think I was fine. But it was depression straight up lying to me. It wasn’t until support said to me, “You need to get help. You’re miserable and you deserve to be happy. This is an emergency,” that I sat up and realized it was.
Hannah: It’s damaging. Then the more you do that, the more you have trouble finding support.
Alex: It’s unfortunate that treatment is so demonized, because it would also be helpful to talk about the ways treatment can go wrong or not suit everyone. Like, I’ve had awful therapists.
Kelly: What’s so complicated about mental illness is everyone’s method of dealing with it is different. Yet we see such a … singular narrative in YA.
Alex: Yup. Depressed people have awful lives, then they fall in love or something and get better. That’s it.
Kelly: YES. And they’re generally considering suicide too.
Hannah: Or they cut themselves until a quirky person in treatment helps them get better. It’s like the white-man-meets-MPDG narrative, but in therapy.
Alex: Maybe they’ll cut or take too many pills, but rarely enough to be life-threatening.
Kayla: I do want to talk more about the fact that there’s really only one narrative we get in YA. Why is that a problem? What are the real-life consequences when that’s all we see?
Hannah: Raise your hand if the dominant narrative kept/keeps you from seeking out treatment.
Hannah: Or if it keeps other people from believing you have a problem.
Kelly: I avoided getting help and medication because of that narrative.
Alex: I’ve had depression all my life and only recently recognized it as something that has always affected me and that needs treatment.
Kelly: It’s hard with teens to tease out what’s a mental illness vs. what might be a case of teen hormones in overdrive. So having only one narrative of depression or mental illness suggests that those who are struggling may never see themselves in a way that makes them realize they need help.
Alex: It suggests something is wrong with you if you can’t get over your mental illness.
Hannah: I just came back from a conference on censorship, and I do hate that “Think of the Children!” hand-wringing that comes with left- and right-initiated censorship, but I have a little of that myself when it comes to the portrayal of mental illness. And I want books that won’t tell teens to stop seeking treatment.
Alex: And I want books that offer better options at the back than just “Here’s a suicide hotline!” Have you ever called those? I had awful experience with them.
Kelly: And I want books that don’t offer depression —> suicide. For someone who doesn’t have that element, they can so easily be convinced they don’t have a problem because “at least it’s not that bad.”
Hannah: Do you think it would help if the more subtle characteristics of mental illness in characters (as in, not the main plot) were named so that teens could see that mental illness is a) a named thing; b) treatable; c) not the only part of the story.
Being told to go to a website (basically wiki for psychiatrists) and read a description of what I was diagnosed with blew my mind, because it told me that not having extremes did not mean I didn’t “count” or that my illness wasn’t real.
Kelly: I think that would help. I really do.
Alex: Good point, Hannah.
Kelly: And actually, I wonder how valuable it would be to have more narratives where it’s not the MC with the illness, but a friend. And we see how it plays out differently when we’re not in that headspace.
Hannah: Yes. Like Saving Francesca.
Kelly: Just read it in A Sense of the Infinite, too, with a depressed friend. The handling was outstanding.
Alex: I can see the value there, but I want to see more depressed MCs too. I want to see my experience validated.
Kelly: I would like to see more MCs, too, absolutely. But I do think seeing the mental illness outside the MC might be really valuable. I think of it in terms of a reader picking up a book and seeing the world around them differently. Since it’s not their world.
Hannah: If you asked a psychiatrist to read a bunch of YA books not explicitly about mental illness, do you think they would diagnose some characters we have missed?
Kelly: This will be really, really grim, but a thing we need to see more of, too, are characters who fail. That’s my biggest problem with suicide books, and it’s extremely personal in my thoughts on this.
Alex: Fail how?
Kelly: I read Challenger Deep, and there’s a character in treatment there, he’s suicidal. And he dies. Because the illness wins. It’s not the MC, it’s a side character.
Alex: I disagree.
Kelly: But that hit me because … it’s the truth of these things sometimes.
Hannah: Verisimilitude is powerful.
Alex: I think there need to be more books where a character realistically learns to live with their illness. Because we need hope more than anything else.
Kelly: Oh, I agree there, too.
Kayla: What it sounds like is just more narratives all around, yes?
Alex: Good general rule.
Hannah: Oooh, how about friends who don’t abandon friends with mental illness? “That’s my friend who has depression. Sometimes I give her a ride to therapy. Then we hang out. Or if she wants to be alone, I leave her alone.”
Alex: Yes, but who also don’t expect to heal their friend.
Kelly: Or those who have to abandon them for their own sake—there’s both of those going on in Chasing Shadows. She really sticks by her friend, really really tries to help her through, but eventually realizes she can’t save her friend from her illness.
Alex: I’d like to see people joke about depression too, humanize it more.
Kelly: Going back to I Was Here a second … and something I keep thinking about with that one. How the hell did the best friend not know? I don’t buy it for a second. They lived in a small town. By all accounts, each knew when the other peed.
Alex: Some people hide their illness well. But yeah, I just finished that book and I really don’t like it.
Hannah: I haven’t read that book, but I believe it, not because she didn’t “know,” but because we don’t know what depression actually looks like when it’s not the very specific narrative we’re shown over and over.
Like, I bet if you asked anyone I know, they wouldn’t think I have mental illness, but if you asked them to describe me, they would describe characteristics tied to it. Not that people should be diagnosing left and right, but we need more narratives where symptoms and characteristics are actually described.
Alex: I Was Here is another one where the story is just about the non-depressed MC coming of age, more or less.
Kelly: It felt like she missed a huge opportunity to offer a real narrative of depression.
Alex: Yeah, I agree.
Kelly: I’d have bought it more if we didn’t get the “Surprise! Depression!” at the last 15 pages. Maybe that was the problem itself. We never got to know Meg at all, thus the depression felt like … unbuyable for me.
Alex: Did you think it was more of a murder mystery than a depression book?
Kelly: YES. It felt more like a murder mystery. Even though it wasn’t.
Hannah: Is that because we need reasons for everything? We don’t want to admit that mental illness is still biological, because with other biological things, we can say that the liver did this which led to that, and we can’t with mental illness?
Kelly: We’re definitely uncomfortable with discomfort and lack of closure/explanation.
Alex: Yes, I think that was actually a point I Was Here was trying to make. It was just done very poorly.
Kayla: Needing reasons is possibly especially true in narrative form, yes? Stories need arcs and conclusion and that’s not always present with mental illness.
Hannah: Yes, Kayla.
Kayla: Since it’s getting close to the hour (not that we have a time limit or anything, but still) is there anything else we want to discuss about stigmatizing medication/treatment? Or mental illness in general?
Kelly: I’d just love to see it more naturally woven into the narrative. MC takes meds, the end. Moves on with their life. With further treatment, understanding, self-care, etc.—as though the medication isn’t a life-altering thing. Life changes are.
Hannah: Right. If that’s not enough for a “plot,” I imagine therapy certainly could be. All kinds of steps forward and back there.
Alex: We need a new normative. If we were to have a default mental illness narrative, I’d want it to be about how a person should obviously try treatment, not what we have now. Stories are so often how we learn about the world and this is an area we just need more information about.
Kelly: We need options! We need challenges to the dominate narratives/beliefs, too.
Hannah: Yes! So to compare to my conference again, one speaker talked about how generations of LGBTQIA books have moved from bad endings to coming out to having older role models. Do we need something like that for mental illness?
Hannah: Like, a character who has been fed the dominant narrative but also another one who mentors them or at least acts as a model for what treatment can do?
Alex: Role models with mental illness would be fantastic.
Kelly: And I do think that by more people talking about these things, outside of books themselves, those who are writing these stories learn better.
Hannah: I sure hope so.
Kayla: I hope so, too. That’s a major reason Disability in Kidlit exists!
Alex: We have had some progress already, I guess. Mental illness used to be a shameful secret. At least we talk about it more now.
Hannah: Very true.
Kelly: Part of the challenge is, of course, that none of us are the singular expert and our experiences vary so much. So it’s always cause for hesitation when you point out bad examples. Or good ones, too.
Hannah: Kind of like how I feel with multicultural narratives. I would rather have a bunch of mediocre and getting-there stuff join the good stuff if it means more in general, so long as nothing is patently offensive or harmful. I think I’m of the same opinion with mental illness. And by “mediocre” I just mean getting some stuff right and some stuff wrong and being in the middle.
Alex: As long as it isn’t romanticizing MI.
Kelly: I think when we have a canon from which to draw, we can highlight the strong better.
Hannah: But I’m fine with some characters tossing their meds and exploring why that was a waste if some other characters go through therapy and some others have already been on meds for years and just have flare-ups, etc.
Kelly: That range is what we need.
Alex: And then you can have stories where someone goes to a bad therapist and it won’t be saying “All therapists are awful!”
Or we could have characters that are completely aware of when their depression is acting up and think, “Hmm, I’m in hysterics because I lost at Jenga. This is not logical. Sucks that I’m crying anyway.”
Kelly: And you can have stories where many treatments are tried. Where more than one medication is explored, etc.
Something else I wonder if we don’t see enough of is the emotional impact of it all. How do these characters feel about what’s going on inside them?
Hannah: What’s it like to be in the middle? Not newly diagnosed but not “fixed” either?
Kelly: We see actions—we see suicide attempts—but do we hear them say they’re scared about their mental illness? I’m a big fan of interior stories, and maybe that’s a big missing piece for me here.
Hannah: I think that’s it.
Kelly: They’re slow and quiet though, which may not appeal to “The Market” and be more difficult to publish.
Hannah: Ahh yes, that magical place where only straight, abled, white people read books about themselves.
Also, to put in the hippie perspective, why does no one ever consider holistic approaches or multiple approaches or behavioral/lifestyle ones? It’s all “meds or nothing.” “Meds are evil, so nothing.” “Therapy or nothing.” “Therapists are quirky weirdos. So nothing.” The end.
Kelly: Yes to that too!
Hannah: Why not try some meds, try some yoga, try some new activities, try a new diet, whatever.
Alex: I’m open to holistic, but wary as some use that word with the whole “hiking at dawn” perspective.
Hannah: Both/and. But people look at it as either/or.
Kelly: Medication and diet changes. Therapy and new activities. … dare I say acupuncture?
Hannah: I LOVE ACUPUNCTURE IT MAKES MY LIFE SO GOOD
Alex: Really? How so?
Hannah: I’m not convinced it works, but it does force you to lie down and be still and take a nap, and every human in the world needs to do that sometimes.
Kelly: I haven’t done it in years, but it was amazing. My acupuncturist used to say to me after a session: you sparkle. In a lot of ways it’s about the relationship you have with your acupuncturist as well as the one you rebuild with your whole self.
Kayla: So the takeaways from this discussion are: more narratives and more acupuncture. 🙂
Kelly: Ha ha ha.
Hannah: Mental illness = solved
Kayla: You all are geniuses.
Hannah: This has been really good for me. I think I am on a much earlier leg of the journey than you all are, and now I have somewhere to look.
Kelly: I only just got on medication this year, actually. But I’ve been struggling with this for years.
Hannah: Well damn. Look at us making assumptions because of single narratives. (By “us” I mean me, obviously.)
Kayla: And on that note, I think we can call it a night! Thank you all for being here! It’s been awesome.