Ann Jacobus and Nancy Bo Flood | April 2022

Ann Jacobus and Nancy Bo Flood

Mental illness is often invisible but is one of the most frequent disabilities affecting children. One in six children and one in five adults are currently struggling with a mental health condition,1 and many more young people are impacted indirectly via caregivers, siblings, or other loved ones. Early indications are that for all populations, the number of individuals experiencing mental health issues during the Covid-19 pandemic has doubled.2

Isolation, shame, and silence delay effective interventions, and may lead to life-threatening complications, even death. Suicide is the second leading cause of death for teens and young adults in the United States, and suicide attempts and completions have increased alarmingly in the last decade.3

Bibliotherapy—using books to treat illness—can help. Fortunately, the number of excellent books featuring young characters confronting mental illness has increased significantly (up from almost none) in the last two decades. These stories present authentic and nuanced characters who grapple with mental health issues along with all the other challenges their authors devise for them. These stories portray mental illness accurately and sensitively. They show characters who seek support and use resources to cope and ultimately thrive. Mental health may be the protagonist’s main challenge or it may affect their lives tangentially. In any event, the message, “You are not alone,” is clearly communicated.

Magination Press is the children’s book imprint of the American Psychological Association. Their books address the full spectrum of mental health issues and neurological diversity. Editorial Director Kristine Enderle says, “Over the last several years, it’s been amazing to see so many protagonists who are providing normalized, sensitive portrayals of a young person’s experience with mental health struggles, and authors willing to tell their stories.” Books that provide “mirrors and windows” into mental illness are critical and popular successes eagerly read by young readers.

However, if books that tackle this subject are to accurately mirror society, then the reality of children’s lives is woefully underrepresented, and the number of books currently available is miniscule.

Stigma is the key barrier—the negative attitudes, prejudice, fear, and silence that surround mental illness. The many different forms these illnesses take are also shrouded in misinformation and misunderstanding.

Stigma leads to isolation, negative and destructive ways of coping, and death. Mental health is still difficult to discuss, and in some communities remains taboo. The need for more books dealing accurately and responsibly with the problem is urgent, because stories are a potent weapon against stigma.

Amy Fitzgerald, Editorial Director for Carolrhoda Books and Carolrhoda Lab at Lerner Publishing Group, says that her editorial ethos can be summed up as, “Getting fictional teens into therapy since 2018.” She actively seeks mental health stories: “…a balance of honesty and hope is crucial; I believe it’s the key to individual growth and societal change.” She adds, “It’s in the interest of the whole industry to recognize that young people want these books, that openness about mental health isn’t a passing trend, and that our relevance hinges on delivering stories that tell all kinds of truths.”

Author Kimberly Brubaker Bradley won her second John Newbery Honor in 2020 for Fighting Words.4 It stars ten-year-old Della, short for Delicious—who has a problem with swearing. Her beloved older sister, Suki, instructs her to use “snow” instead of cursing, as in “don’t you take snow from nobody.” Their substance-abusing, incarcerated mother is “no better than a hamster,” and the sisters are in foster care together.

This middle-grade novel adroitly reveals the crippling effects of long-term sexual abuse, including depression, self-harm, a suicide attempt, and psychiatric hospitalization. It’s written with warmth, laugh-out-loud humor, nothing graphic, and will gently inform young readers. Della and Suki are up against formidable circumstances yet manage to seek out life-saving support from adults and professionals. It’s an excellent example of how therapeutic care can empower characters to change internally, break their isolation, and finally speak out (as in the iconic novel Speak by Laurie Halse Anderson5).

Sexual assault, abuse, or any traumatic experience can precipitate mental health problems during a child’s early years, but especially during adolescence, after the initial trauma has been repressed and pathologized. One out of four girls and one in six boys endures the trauma of sexual assault before the age of eighteen.6 The right book can help a child realize they are not the only one.

Trauma isolates, causes self-blame, and can result in poor academic performance, avoiding peers, dropping out of positive activities (i.e. sports, music), and destructive outbursts.

Nikki Grimes describes these reactions poignantly in her 2019 memoir in verse, Ordinary Hazards. Grimes spent part of her childhood in foster care because of her mother’s repeated hospitalizations for paranoid schizophrenia.7 She also relates how books became an escape, and how journaling was her relief valve for exploding emotions.

Mental health is emerging from the shadows thanks to the work of advocacy groups, celebrities, and writers. Books not only increase awareness, they give permission for conversations. Fiction writers can bring stories of mental illness into the fresh air and light of public attention, discourse, and dare we say, entertainment. As Rebecca Solnit writes, “The key to the work of changing the world is changing the story.”8 And that’s our job.

As storytellers, our characters’ initial inability to cope is what makes a story, and mental illness can provide a formidable challenge for any character.

Martine Leavitt’s Calvin,9 winner of the Governor General’s Award for English-language fiction, is about a young man, diagnosed with schizophrenia, who journeys across frozen Lake Erie in a delusional effort to reach cartoonist Bill Watterson. Schizophrenia is a daunting character obstacle and in Leavitt’s book, the reader begins to question the very nature of reality itself.

For a story to communicate that suffering from poor mental health is no different than suffering from poor physical health is powerful. Bottom line: We write about a character, not about a disability or diagnosis.

John Corey Whaley’s popular Highly Illogical Behavior stars teenager Solomon Reed who has severe agoraphobia.10 New friend Lisa misguidedly decides she’ll “fix” Solomon as a project for her college applications, with the help of her boyfriend Clark. Things get complicated when Solomon, who is gay, is attracted to Clark. As one YA Goodreads reviewer gushed: “…I WAS SUPER, SUPER NERVOUS TO READ THIS. Why? Because (A) anxiety is a very complex topic to get right, and (B) the blurb says that one of the characters attempts to “fix” the other which—nope, nope, nope... but I seriously could not put it down. It has complex characters, it’s hilarious, and IT DOES NOT END WITH A ‘CURE FOR ALL.’ Bless this book.”11

Picture books have used metaphor to represent aspects of mental illness. Dan Santat’s After the Fall: How Humpty Dumpty Got Back Up Again shows not only the power of depression, but also the possibility of climbing out of fear and isolation back up the “impossible wall.”12 Aunt Pearl, by

Monica Kulling, illustrated by Irene Luxbacher, depicts the complex problems of mental illness, family rejection, and homelessness from a young person’s point of view.13

Middle-grade books tackling the subject often involve a young protagonist dealing with the mental health of a family member or friend. Middle-grade novel, Planet Earth is Blue by Nicole Panteleakos14 concerns two sisters who are in foster care because of their mother’s chronic mental illness. The story is told from the point of view of twelve-year-old Nova, who suffers from severe autism. Despite being nonverbal, Nova’s intelligence, fascination with the space program (set in 1986), and wry observations make her an intriguing and sympathetic character.

As mentioned before, suicide is the second leading cause of death among those aged ten to thirty-four. A survey by the Centers for Disease Control found that one out of every six high school students reported having suicidal thoughts during the previous year.15 Most teens (90%) who have died from suicide had an underlying diagnosable and often untreated mental health condition.16 Not only can a book offer hope, but the right book at the right time can break the isolation, get these young adults into treatment sooner, and save lives.

In Ned Vizzini’s YA novel It’s Kind of a Funny Story, after a near suicide attempt, fifteen-year-old Craig Gilner checks himself into the psychiatric ward of his local hospital for treatment for depression and anxiety.17 Craig’s recovery has been criticized for being unreasonably quick, but the book is brilliant in its insistence that laughter is crucial for those suffering from mental illness. Published in 2007, it was one of the first novel for young readers to take on in-patient psychiatric care. Tragically, Vizzini took his own life in 2013.

Conversely, YA Author Francisco Stork’s The Memory of Light begins when sixteen-year-old Vicky Cruz wakes up in a psychiatric hospital after attempting suicide.18 This title focuses on Vicky’s fitful recovery from severe depression with the support of her doctor, new friends with their own mental health issues, and eventually her family. Stork renders Vicky’s illness convincingly—the reader feels the weight of her suicidal tendency. In an endnote, Stork describes his own depressive illness and suicide attempt as a college student.

Editor Kristine Endlerle remarked, “It’s a bonus, and still a little bit uncommon, to have therapy, both psychologists and therapeutic standards of care, modeled in books that touch on mental health concerns.”

Even if therapy is now modeled in novels for younger readers, it remains stigmatized in many communities. African Americans and Hispanic Americans used mental health services at about one-half the rate of whites in the past year despite higher rates of illness and suicide, and Asian Americans used them at about one-third the rate.19 Young readers are in even greater need of books featuring characters of color handling mental illness and seeking professional care with success.

Brandy Colbert’s YA novels, Pointe,20 and Little and Lion,21 tackle eating disorders, depression, PTSD, and bipolar disorder of BIPOC characters and the toll they can take on individuals and family members.

Other authors who write about characters of color up against mental health issues include I.W. Gregorio, Jasmine Warga, Benjamin Alire Saenz, Sharon Draper, and Stephanie Kuehn, to name a few.

Which brings us to the complicated #ownvoices. Many people involved with mental health are open about their own suffering from mental illness. It was a slow and difficult process for coauthor Ann Jacobus to face, then admit to others, then to write publicly about her own teenage clinical depression, anxiety, and especially, suicidality. Coauthor Nancy Bo Flood followed a similar path with the anorexia she battled in her adolescence. Others may have family members who cope or have coped with it (both authors do). But because the price of stigma can still be so high, insisting that these stories may only be told by those who publicly self-identify as mentally ill seems counter-productive at best.

The need for stories that deal with any aspect of this subject accurately and responsibly is so urgent that we believe anyone who is interested in telling them, should—as long as the writer gets it right.

Ideally, more good stories will improve responses to mental illness. According to the National Alliance on Mental Illness (NAMI), research shows that “early detection, assessment, and linkage with treatment and supports can prevent mental health problems from compounding and poor life outcomes from accumulating.”22 The average length of time between onset of a mental illness and seeking treatment is currently eleven years. Books that model seeking help may encourage a reader to seek supportive resources sooner.

We as writers can address mental health and its place in our society accurately and sensitively, showing characters living with mental health issues, getting support, and coping; at the same time they’re desiring, failing, and growing through our fiction, doing the things young characters do.

In the end, we strive to offer a young reader, who is searching for understanding, direction, and hope—let alone a reason to live—a “window“ and “mirror,” a realistic story about a character coping successfully with mental illness. A book that helps a reader break the silence and say, “This is who I am. Mental illness is part of my life or that of a loved one, and there are many others like me. It’s not my fault. Help and support are out there.” We can change social reality by changing the story.

Ann Jacobus, author of YA novel Romancing the Dark in the City of Light and the forthcoming The Coldest Winter I Ever Spent, is a crisis line and outreach volunteer with San Francisco Suicide Prevention. She has an MFA in Writing for Children and Young Adults from Vermont College of Fine Arts.
www.annjacobus.com

Nancy Bo Flood is the author of numerous novels, picture books, nonfiction, and poetry for younger readers, and she holds a PhD in Psychology with postdoctoral studies in neurology. She has an MFA in Writing for Children and Young Adults from Vermont College of Fine Arts.
www.nancyboflood.com

Notes

SIDEBAR

What is mental illness, anyway? The National Alliance on Mental Illness (NAMI) defines it as “a condition that affects a person’s thinking, feeling or mood, as well as someone’s ability to relate to others and function each day. There are multiple, linking causes including genetics, lifestyle, history and environment (i.e. experiences of trauma, abuse, neglect, sexual assault), all of which can influence whether someone develops a mental health condition.”23 Environment is a big risk factor for children, as both acute and chronic trauma suffered early can lead to mental illness later in life.24

There are over 300 mental illnesses all ranging from mild to severe.25 Addiction falls in here, too, but it’s a whole other, complex topic. Addiction to anything and substance abuse disorders in particular are so often attempts to cope with or self-medicate a mental illness, and frequently develop as a comorbidity (the simultaneous presence of two chronic diseases.)

YOUNG ADULT

All the Bright Places by Jennifer Niven (suicidality, depression)

Challenger Deep by Neal Shusterman (schizophrenia)

Darius The Great is Not Okay by Adib Khorram (depression)

Fangirl by Rainbow Rowell (depression, parent with mental illness)

Gone to the Woods: Surviving a Lost Childhood by Gary Paulson (depression, parent with mental illness)

Impulse by Ellen Hopkins (suicidality, hospitalization)

Last Night I Sang to the Monster by Benjamin Alire Sáenz (mental illness, addiction)

My Heart and Other Black Holes by Jasmine Warga (suicidality, depression)

Scars by Cheryl Rainfield (self harm)

The Disturbed Girl’s Dictionary by NoNieqa Ramos (trauma, sexual abuse)

The Weight of Zero by Karen Fortunati (bipolar disorder, suicidality)

This is My Brain in Love by I.W. Gregorio (anxiety, depression)

Turtles All the Way Down by John Green (OCD, anxiety)

We Are Okay by Nina LaCour (mental illness, addiction)

Wintergirls by Laurie Halse Anderson (eating disorders) 

When We Were Infinite by Kelly Loy Gilbert. (depression, anxiety, suicidality)

MIDDLE GRADE

A Thousand Minutes to Sunlight by Jen White (anxiety, family substance abuse) 

Finding Perfect by Elly Swartz (OCD)

Hurricane Season by Nicole Melleby (parent with mental illness)

Missing May by Cynthia Rylant (parent with mental illness)

Nest by Esther Ehrlich (parent with mental illness)

OCDaniel by Wesley King (OCD)

One Square Inch by Claudia Mills (parent with mental illness)

Small as an Elephant by Jennifer Richard Jacobson (parent with mental illness)

Some Kind of Happiness by Claire Legrand (depression, anxiety)

The Goldfish Boy by Lisa Thompson (OCD)

PICTURE BOOKS

A Friend For Henry by Jenn Bailey, illus. by Mika Song (neurodiversity) 

Blossom and Bud by Frank Sileo, illus. by Brittany Lakin (mental health)

Ruby Finds a Worry by Tom Percival (anxiety)

Scaredy Squirrel by Melanie Watt (anxiety)

Small Things by Mel Tregonning (anxiety, depression)

The Red Tree by Shaun Tan (depression)

The Boy and the Gorilla by Jackie Azua Kramer, illus. by Cindy Derby (grief/depression)

For a database of over 2,000 traditionally published children’s novels dealing with mental illness as well as neurodiversity, please visit:
www.anovelmind.com.