Responsible Handling of Mental Health in YA Literature

Last weekend my husband and I attended NerdCon: Stories in Minneapolis. The first session I went to was titled “Mental Health in Young Adult Literature,” and it was presented by Amanda MacGregor with Teen Librarian Toolbox — a GREAT resource for those working in teen services or anyone who cares about YA lit. (This session made me miss my days as a teen services librarian so much.)

MacGregor talked a lot about how common mental illness is among teens (and the population in general — up to 25 percent of us will experience mental illness firsthand in our lives) and the importance of its presence in teen literature to show teens who have mental health struggles that they are not alone, and to foster greater compassion in those who don’t struggle personally. She stressed that it’s important that YA lit neither stigmatize nor romanticize mental illness, and that it show that help is possible. A work of fiction may be the first time a teen encounters someone who has a mind that works the same way as their own.

MacGregor shared her own lifelong struggle with anxiety, and she shared writing from YA authors who had written about mental illness, many of whom had personal experience with the mental health issues faced by their characters.

I agreed with MacGregor about the importance of portraying mental illness in a sensitive way when writing for young audiences, and I found myself examining my middle-grade novel through that lens.

Authors often talk about writing the book that they wished they’d had when they were young. I did the same, and much of what my protagonist, Maddy, goes through, I also experienced at her age. That includes my first brush with depression.

I struggled with depression throughout my adolescence, encountering it for the first time when I was about 10 years old — from there it would come and go in waves, hitting its apex when I was 16; I finally found relief when I was prescribed antidepressants to treat my chronic migraines.

My novel opens with Maddy’s suicide attempt; later in the book she experiments with self-harm. She is also the victim of bullying, to which, I would argue, depression is a natural response. She is never clinically diagnosed — I have never received a clinical diagnosis, either. She does encounter the concept of mental illness through her father, who falls into a depression after he loses his job. Because his depression interferes with his ability to contribute fully as a parent, Maddy’s mother pushes him to get help, and he does. So Maddy is aware that depression exists, and also that help exists for it. She even wonders briefly if she (and her mother) should get treatment. But she never sets foot in a therapist’s office, and she finds other ways to heal.

I have no doubt that adolescents struggling with mental illness fall through the cracks all the time. Part of it is that we just expect teenagers to be “moody” or “difficult.” As an adult or a parent, I’m sure it’s difficult to discern when a teenager’s struggles are a natural result of the seismic hormonal and social changes of that age, and when they signify an underlying chemical issue that should be professionally or medically treated. And often, teens themselves do not have the vocabulary to name what they are experiencing — or the agency to ask for help.

In light of MacGregor’s discussion, I find myself questioning whether it is irresponsible to portray mental illness without explicitly naming it in books aimed at children. Part of the challenge is that mental illness exists on a spectrum and is somewhat subjective, despite the existence of diagnostic questionnaires and the DSM-V. Although I, as the author, can diagnose depression in my main character, a reader could argue, based on the events of the story, that she has schizophrenia and/or dissociative identity disorder. I don’t agree with either of those diagnoses, but I certainly wouldn’t try to talk a reader out of that interpretation.

So the state of Maddy’s mental health, while described in some detail in the book, is never named. This wasn’t a decision I made consciously; and now that I have become more conscious of it, I’m resistant to changing it. Primarily this is because, unlike books such as Challenger Deep or Every Last Word, my novel is not ABOUT mental illness. Some of the characters in it are afflicted, just like some of the population is. Up until this point, I’ve always felt that what’s important is for young readers to recognize themselves in the feelings and experiences of a book’s protagonist — not necessarily that they have names for all those experiences.

But I’m having trouble thinking of similar books for young people that portray mental illness without explicitly naming it. It seems like characters in YA novels are either diagnosed with a named mental illness before or within the course of the story, or they are assumed to be mentally healthy. Does the genre have room for middle ground? And if it does, do you know of books that occupy that space?