Mental Illness Representation in YA

Tropes I especially dislike: being fascinating. Confusing medical description of symptoms (that's for outsiders) for accurate portrayal of how it feels.

Depression, for me, feels like grief, almost exactly, but with attention issues on top of that. When my mom died I knew I was not depressed because I arranged the funeral. Would have been impossible if depressed.

PTSD: best books I've read on what it is like are on the topic of war and moral injury, strangely. Advocates outright reject or avoid talking about PTSD. But hands down, Killing From The Inside Out and Theater of War (non-Fiction books) nail what it's like. It's like body horror: "what I had to become to survive."

The communication issues especially are well portrayed in those books. I think the only thing not covered is how hard it is to tell that people aren't trying to freak you out by going about their lives. If your week can be ruined by someone forgetting not to hold their fork a certain way, it feels so personal when they don't know or forget, and then it just spirals into thoughts about why you can't be normal and what happened and every other time you did not hold it together, and how people will judge you, and, and, and. Also, how compelled you are to repeat your story and how difficult it is to do so. Huge communication problems. Huge feeling of being tainted. And people will insist you are not tainted in direct contradiction of your lived experience, as if that should make you feel better.

I research mental illness and I have had mental illness present in some of my books (PTSD in one and depression in the other). I'm most familiar with addiction (due to my research on it) and with anxiety (since I have panic disorder myself), but I've come across a lot of different illnesses in my research and with working with people and patients.

It depends on your book, of course, but in general, if a character has mental illness, it should be a part of, but not their entire, character. This is a hard line to walk on. I've seen books where a character is nothing but a collection of symptoms, which is insulting. I've seen books where characters state that they have a certain diagnosis but then show either no symptoms or symptoms that do not match that illness. That's annoying to see as well. You can get a surprising amount of information from reading about symptoms of illnesses in psychology books and looking up patient experiences, and I encourage you to do that.

As for advice specific to PTSD or depression, in my own work, my PTSD character was a soldier who tended to dissociate (in the form of emotional numbing) and who would have strong visceral reactions to certain triggers as well as nightmares. My depressed character was a college student who worked hard but failed to succeed over and over, eventually feeling helpless and hopeless. In both cases, though, the characters also had personalities independent of their illnesses. In both, I also never explicitly stated that the characters had these illnesses, although with the depressed student it became very clear that it was a problem. With depression, my character had external reasons, but you can also have a depressed character who simply feels hopeless or anhedonic without anything really being unfortunate in their lives.

But yeah, most important advice, in my mind: If your character has a certain illness, make sure you're giving them the right symptoms.

c.k.archer said:

My current WIP is a YA contemporary with two male MCs that both deal with some form of mental illness. One has PTSD, and the other Clinical Depression. While they're important to the plot and character development, this is not specifically a 'mental illness book.' There is a larger overarching plot going on other than just them dealing with their mental illnesses. However, I, of course, still want to represent the mental illnesses properly and respectfully. So I want to know, what are some of your biggest pet peeves about mental illness representation in YA? What are some things that you think I and other writers should know when writing a character (or two) with a mental illness? Should the illness be stated outright or implied? Also If you want to throw in anything about PTSD and depression specifically, that'd also be helpful.Thanks!

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The worst, imo, is the 'magical mentally ill' character -- a character with a mental illness who has special insights, abilities, creativity, etc., and/or who teaches the other characters a lesson. It's just gross. Close second is getting stuff way wrong, mixed up, based on pop psych or very outdated ideas.

People with depression can be highly-functioning and they can hide it well. They seem very normal and sometimes even those close to them don't notice that something is really wrong for a long time.
They're not all curled up in a ball and crying all the time.

That's true, remister. Depressed people also aren't completely lacking in basic social graces. If we get invited to a birthday party or a wedding or some other happy occasion, we're well-aware that those are supposed to be happy occasions. So we will suck it up and pretend to be happy for everyone else's, because no one likes being known as a complete and utter killjoy. Sometimes we do a good enough job, we're able to fool even ourselves for a bit. But moments of happiness during Depression tend to last about as long as a drop of rain in a dry cornfield.

If you want the experience, try reading/consuming works by people with mental health issues themselves that address those issues. There are some wonderful and sobering insights to be found there. My favorite example is a webcomic called Broodhollow (author is great and I believe has Depression?) It is a horror comic, which I love but isn't everyone's cup o' tea. But it brilliantly shows what it feels like to be unable to trust your own mind and perception. Plus one of the main characters is actually a psychologist.

As for my least favorite trope? I'm gonna go with "love/companionship as cure" idea. It's a hormonal/chemical imbalance guys, not a witch's curse. It's treated with a combination of therapy and medication. Pretty sure true love is not going to work as a long term solution, but some people seem to believe that it does.

I dislike when a character who suffers from mental illness can't function in the real world in any capacity or have any thoughts that extend beyond "I'm sad." It's especially bad for me if there's another character whose sole purpose is to cheer up their friend/relative and try to convince them to stop being so depressed. In terms of YA, I think John Green strikes a good balance in The Fault in Our Stars when he shows how Hazel copes with her frustrations while also trying to live her life.

My biggest pet peeve is when a person with a mental illness is treated like a life challenge for a neurotypical person. You know the memes and articles you see posted on Facebook all the time that go "God sent this person into my life to teach me how to be a better, more understanding person"? That's the type of stuff I'm talking about. Plots where a person struggling with mental illness are a device for the MC to improve or discover something about themselves. It's infantile and dehumanizing to treat people who are so regularly depicted one-dimensionally in terms of what they can do for you (or your MC).

And this is not limited to people with mental illnesses, it includes mental and physical disabilities, LGBTQ people, people from a lower socioeconomic status or education level, people of color, etc.

This link might be of use: Mental Illness In Fiction: Getting It Right

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Science in Sci-Fi, Fact in Fantasy is a blog series for authors and fans of speculative fiction. Just as science fiction often has roots in hard sciences — physics, astronomy, genetic engineering, microbiology — fantasy world-building relies on everything from economics to military strategy to animal husbandry.

Each week, we discuss elements of sci-fi or fantasy with an expert in a relevant topic area. We debunk the myths, correct the misconceptions, and offer advice on getting the details right. You’ll find most of the experts on this Twitter list.

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I think my biggest pet peeve in books is teens with clinical depression have a reason for being depressed - for example, being bullied, having no friends or losing a parent. Sure, those things can make you depressed, but there doesn't have to be a specific reason for being clinically depressed. To me that's the same as someone having cancer...because they were bullied. I really didn't like the book Thirteen Reasons Why because of this. I also strongly disliked the book Before I Fall - because obviously the depressed suicidal teen comes from a bad home, is bullied and has no friends. *smh*

Oh, I hated Thirteen Reasons Why so much. For those of you thinking about reading it, I'll spoil it and save you some time: the reason the manic pixie dream girl killed herself, was so that Protagonist Dude could listen to her tapes, go on wacky adventures, and learn and grow as a person.

So yeah, another mental illness trope that pisses me off: where said character with mental illness exists more as a plot device, so the Protagonist (usually a guy, but not always) can grow and become a better person for loving someone in spite of their mental illness.

Have you thought about reading some memoirs from people who suffer from these mental illnesses? That can be a great way to get an insight into what it means to live with one. With the caveat that, of course, every individual's experiences will be nuanced and different. A great one for depression is William Styron's Darkness Visible. I read it while I was suffering from clinical depression, and it really spoke to my experience. You could also get a basic psychology textbook for the disorders and study them to get the clinical details right. I would also suggest going to open support groups (after gaining permission from the members, and being completely transparent about what you're trying to do).

Some of my pet peeves: Getting details of the clinical picture wrong; describing PTSD sufferers as "dangerous" or unable to ever be happy.

For me, it just has to be portrayed authentically. I have had a lifetime of dealing with depression (BP). I also have PTSD as a result of childhood sexual abuse. When I see them dealt with inauthentically, I want to burn the book. When I read a story and I don't fall into the skeez factor or the 'they did that well' thing...I mean, when it's simply well told and I don't even reflect on whether or not it's good, but I just read the story...then it's done right. This is one of those things I really can't give advice on, because it's one of those things "I'll know it when I see it". Just do the research and write the story as someone who KNOWS these things. Otherwise, leave it for those who do.

KTC said:

For me, it just has to be portrayed authentically. I have had a lifetime of dealing with depression (BP). I also have PTSD as a result of childhood sexual abuse. When I see them dealt with inauthentically, I want to burn the book. When I read a story and I don't fall into the skeez factor or the 'they did that well' thing...I mean, when it's simply well told and I don't even reflect on whether or not it's good, but I just read the story...then it's done right. This is one of those things I really can't give advice on, because it's one of those things "I'll know it when I see it". Just do the research and write the story as someone who KNOWS these things. Otherwise, leave it for those who do.

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This about five hundred billion times, bolding mine. Totally and absolutely. If it's not done right, skip it. And a lot of writing about MI is not. done well (Yes, depressed folks can plan funerals, go on trips, show up at parties and whatever else. Doesn't mean they don't meet criteria. Quiet misery is just that. People with trauma histories can also suit up and show up--again totally agree that not everyone is in a fetal-like ball on the couch!! And plenty of folks with trauma histories are also depressed)

This is one area research is critical and yes, yes, yes to talking to people who actually suffer from whatever disorder one wants to write about. The media in general does NOT get it right, so going from movies or other novels is not likely to prove fruitful. I also agree with KTC that if I just read the story, and the character's actions seem plausible, it's done right. Mainly, if those actions are germane to the plot and are not some pointless digression ("Marcus had been diagnosed with a personality disorder, that is, a maladaptive pattern...") Show me what the person does and I'l figure for myself - oh that person sounds like they have a conversion disorder.

So yeah, reading memoirs, or message boards of those who have whatever it is one wants to write about is great, but really talking to people is, IMO, the best, as there is SO MUCH variation in symptoms. Just reading the DSM is NOT going to be much help.

What are some of your biggest pet peeves about mental illness representation in YA? I don't like when that's all there is to a character. It sounds like you're doing good to make this just a part of the stories and not fully who your characters are.

My biggest pet peeve is actually in some reactions to works involving persons with mental illness. I've seen a lot of people complain about the "glorification" of mental illness in a book or complain that the person with mental illness was presented as "special" - creative, insightful, etc. Here's the thing, you either have a mental illness or you don't, so it doesn't matter how glorified it is or how "special" you make someone with a disorder. No one can make themselves have a mental illness because they read about it in a glorified manner. In contrast, as writers, we don't want to glorify things that are choices - suicide, violence, etc. But there are in fact strengths that more often come with the weakness of mental illness (in general, strengths and weaknesses are flip sides of each other). Persons with certain mental illnesses are more likely to be creative (there's a reason for the "creative genius and madness" link), to be passionate and so on. As someone with multiple mental health disorders myself, multiple related degrees and experience with persons with mental illness, this is my reaction: Why rob us of our strengths and focus only on the negative aspects?

What are some things that you think I and other writers should know when writing a character (or two) with a mental illness? That a lot of us don't come across much differently than anyone else and often learn to hide things related to the difficulties. The numbers of people suffering from one mental illness or another is high, and much higher if all the undiagnosed cases are included. Study up on whatever illness you're portraying, but remember that no one person has all the signs and symptoms, so characters and people with the same illness can present pretty differently.

Should the illness be stated outright or implied? I don't have a preference and think it depends on how evident you want it to be, how necessary the information is to your story, your own purposes in your work, etc.

Good question that shows you care. Best to you.

Chiming in to say that there is a *spectrum* when it comes to mental illness. While depictions of people who are curled up, in a fetal position on their couch might seem ''tired'' they are also true of certain people at certain times. I have struggled with depression intermittently for most of my life (I have bipolar disorder) and while I am often high-functioning, I am just as often laid up on my couch, unable to move, unable to think and unable to do (esp prior to medicating). Sometimes, I am so unable to function -- whether manic or depressed -- that I have to be hospitalised. Sometimes I am unable to function as a side-effect of my medication and have to be hospitalised.

Additionally, even when I am ''highly-functioning'' I tend to use a number of crutches to ''get through'' (alcohol, drugs, avoiding people I love etc etc that look ''invisible'' or ''normal'' but are actually highly self-destructive) -- but that is just my experience of mental illness. Some people are far more self-contained.

Ditto people who are mentally ill for a *reason*. Yes, some mental illness is genetic (mine certainly is!), but a lot of mental illness *is* caused by external factors. Even my highs and lows, which are bound to be set off at some point, are often 'triggered' by an external event. This isn't some problematic stance authors are taking, imo. Mental illness might be chemically based, but situational factors will exacerbate or bring on symptoms.

People in survival situations are likely to exhibit the signs of mental illness (and imo, it's *good* that there are these depictions -- because depression is so often seen as a wealthy, white person's disease, just because these are the people who have the ability to advocate the most re: mental health. The mental illness of POC and those from a lower socioeconomic background, which often manifests differently, can become ''invisible'' as a result).

As someone who is mentally ill and has been exposed to a lot of mental illness irl, these are my pet peeves with YA novels:
- isolated mentally ill teen in perfectly happy family. Mental illness has heritable aspects, so it's highly likely that someone else in the family has been through this before
- teen with single, uncomplex diagnosis eg depression is kind of likely to be comorbid with anxiety and vice versa. There's a link between anorexia and borderline that's emergent in recent literature.
- lack of medication. I have very, very rarely read about a teen taking antidepressants or mood stabilizers etc and the attendant anxiety that comes with that. There's a lot of 'talk therapy' but tbh, for someone with the kind of mental illness I have (and for someone with difficult to treat clinical depression), no amount of therapy is going to fix things entirely.
- overly focused on the internal. There are lots of angsty passages in YA about teens feeling sad, experiencing suicidal ideation etc, but in the books I've read there is less of a focus on the external -- the way that mental illness can change (for the worse) your relationships with your family, friends, sig others etc (esp PTSD, here). Like I said, some people may be self-contained and mentally ill, but ime most are not, even if they are ''high-functioning''.
- lack of stress about how to *pay* for all the treatment that is often required. Hospital stays and trips to the psychiatrist and psychologist cost mad $$$ and unless a teen is from a wealthy family, this is going to be a serious impediment to them getting better (personal experience, I went totally broke paying for my mental health care when I was in college and I *am* from a well-to-do family -- who thankfully bailed me out).

Big pet peeve for any genre (and this is certainly not in reference to anyone here): people writing books about someone with mental illness as one more badge of diversity. Not to mention, how is one defining "mental illness"? Someone who has had a panic attack? Someone who is despondent over a break up? The point is, what about having a specific diagnosis drives the plot? I really dislike books that seem like the author checked out webMD and created a cardboard character to match symptoms (with no real relation to the plot)

I very much disagree that either one has "mental illness" or one does not. Many, many people have subclinical symptoms of something--don't necessarily meet full criteria, but are suffering nonetheless. That's why symptoms are more interesting that the diagnosis. And as already noted, some "mental illness" is related to events--certainly trauma. we do know that trauma begets trauma, so that having suffered one trauma, it's more likely someone would suffer another, but perfectly healthy, happy folks can experience a devastating event and suffer as a result (and in many cases their happy healthy family doesn't get it.) And many issues are heritable, some less so. But many don't necessarily show up with parents but might some where else in the family.

Again, there is so much variation! (some folks with borderline features have eating issues, some don't, some trauma survivors are so devastated they can't get off the couch, others are --on the outside anyway--very high functioning) Yes, getting the details right is important, but so is making clear the relevancy of the symptoms. Otherwise it does seem like a "glorification" of MI. Why is a mentally ill character included? If there are symptoms of something that drive the plot, as KTC noted, it feels natural and interesting. If not, and it's just to show MENTALLY ILL PERSON HERE, well, I don't finish those books. People familiar with the disorder can feel frustrated.

People do read novels/go to movies and take what's offered as "truth" whether it's about the Jamaican bobsled team, psychologists or mental illness, snipers, rodeo or anything else, so it's great to get the details as right as possible.

Not a YA book but as far as "getting it right" in fiction The Last Surgeon (Michael Palmer) did a pretty good job of the symptoms and treatment of trauma, AND they were really what drove the plot, in large part. While I have plenty of issues with Prince of Tides, Conroy wove the MI issues so adroitly into the plot it didn't seem like HEY! I AM WRITING ABOUT MENTALLY ILL PEOPLE HERE! Judith Guest, in Ordinary People, did a fantastic job of depicting both trauma and its impact on families without detailing a DSM checklist of symptoms.

This thread is super fascinating - but it has made me concerned about my own works. (Which I suppose is a good thing - better to be concerned now, when they're easily fixed, rather than when they're published and everyone is mad at me.) See, I write YA in fantastical and science fiction settings, and often, there is an intersection between the fantastical and futuristic and the mundane - heck, that's why we write sci-fi and fantasy, right?

So, for example, I just finished editing the second novel in my Lunar Cycle series. In it, the protag suffers from PTSD from her time space - but...it also takes place in a future where the human brain is better understood and advancements in therapy have made curing PTSD far easier than it is today. But spacer culture is really judgmental about mental illnesses, so the MC fights back against treatment - she doesn't want to seem to be weak. The plot in the book basically comes down to: "Get over your cultural hangups and take your medicine."

Is that insensitive?

Would that hurt someone who actually suffers from PTSD - and with the modern cultural hangups on mental health? (mental health = weakness being a meme I've seen far too often out there.)

And then we come to something that is even more concering. My friend and I have been working out the magic system for a fantasy universe - a universe where emotions are literally magic. So, spellcasters store their emotions up, then release them via songs or stories to cast spells that literalize the metaphoric qualities of emotion. (Anger drives change, so cast an anger spell to turn this chunk of raw iron into a sword, fear blinds people so cast a fear spell to turn invisible, and so on.)

The issue crops up when we come to Gaunts: People who have been twisted by extremes of magic into beings that can only experince a single emotion. One of the main characters is a Wrathgaunt - everything she feels transmutes into anger. But there are also Sorrowgaunts and Joygaunts and Feargaunts, and there is intersection between being a Gaunt and certain disorders in our world.

Which means I'm brushing close to...well...the extremely squicky theme of "My mental illness gives me SUPER POWERS!" like Rainman or every other episode of Star Trek that deals with this kind of thing. And then we get to the treatment - becuase in this universe, you can unburden your emotional baggage by casting a spell - which makes therapy a lot more easy and a lot more useful (cause...magic.)

See, to me, this is all an interesting thought experiment on how a world with a different kind of physics would work.

But I don't suffer from depression, or PTSD, or bipolar disorder. I don't have to deal with that every day.

So what to me is an interesting fantasy, other people might find incredibly offensive.

What do you guys think?

bombergirl69 said:

Big pet peeve for any genre (and this is certainly not in reference to anyone here): people writing books about someone with mental illness as one more badge of diversity. Not to mention, how is one defining "mental illness"? Someone who has had a panic attack? Someone who is despondent over a break up? The point is, what about having a specific diagnosis drives the plot? I really dislike books that seem like the author checked out webMD and created a cardboard character to match symptoms (with no real relation to the plot)

I very much disagree that either one has "mental illness" or one does not. Many, many people have subclinical symptoms of something--don't necessarily meet full criteria, but are suffering nonetheless. That's why symptoms are more interesting that the diagnosis. And as already noted, some "mental illness" is related to events--certainly trauma. we do know that trauma begets trauma, so that having suffered one trauma, it's more likely someone would suffer another, but perfectly healthy, happy folks can experience a devastating event and suffer as a result (and in many cases their happy healthy family doesn't get it.) And many issues are heritable, some less so. But many don't necessarily show up with parents but might some where else in the family.

Again, there is so much variation! (some folks with borderline features have eating issues, some don't, some trauma survivors are so devastated they can't get off the couch, others are --on the outside anyway--very high functioning) Yes, getting the details right is important, but so is making clear the relevancy of the symptoms. Otherwise it does seem like a "glorification" of MI. Why is a mentally ill character included? If there are symptoms of something that drive the plot, as KTC noted, it feels natural and interesting. If not, and it's just to show MENTALLY ILL PERSON HERE, well, I don't finish those books. People familiar with the disorder can feel frustrated.

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Hey, so I agree with much of this post, and I see what you're trying to get at. But I find the bolded line of reasoning very dangerous. It reminds me of people saying, years ago, that there had to be ''plot reasons'' to include a Muslim character, a gay character etc or it seemed annoying and as if the author were pursuing a diversity quota.

Muslim characters, gay characters, and mentally ill characters are people, too. They deserve representation and their presence doesn't have to be *directly tied* to the plot -- there are a lot of Muslim and gay teens out there who don't want to read an ''issue'' book about themselves, for once, but rather want to read a soap opera or an epic fantasy featuring someone like them. It's the same with mentally ill people. Our characters shouldn't have to be the ''invisible norm'' (ie -- white, male, able-bodied and mentally well) unless the presence of ''the Other'' is necessitated by the plot.

I don't think this is actually what you were trying to get at (I think you're just against characters whose disability is mentioned once and then never referred to again so that the author receives diversity brownie points) -- but I wanted to point out how this read, just in case + as food for thought for those who are reading silently.

ETA: Zoombie -- I haven't thought about any of it very deeply, but I've got no problem with any of what you mentioned. Tbh, I am not as offended by ''my mental illness gives me superpowers'' as a trope as many, though -- because bipolar hypomania + mania does often feel like having superpowers in a way that having depression or PTSD really, really doesn't. It sounds like the kind of superpowers ''gaunts'' have are kind of negative and harmful, too -- which is fitting, imo.

LillithEve said:

Hey, so I agree with much of this post, and I see what you're trying to get at. But I find the bolded line of reasoning very dangerous. It reminds me of people saying, years ago, that there had to be ''plot reasons'' to include a Muslim character, a gay character etc or it seemed annoying and as if the author were pursuing a diversity quota.

Muslim characters, gay characters, and mentally ill characters are people, too. They deserve representation and their presence doesn't have to be *directly tied* to the plot -- there are a lot of Muslim and gay teens out there who don't want to read an ''issue'' book about themselves, for once, but rather want to read a soap opera or an epic fantasy featuring someone like them. It's the same with mentally ill people. Our characters shouldn't have to be the ''invisible norm'' (ie -- white, male, able-bodied and mentally well) unless the presence of ''the Other'' is necessitated by the plot.

I don't think this is actually what you were trying to get at (I think you're just against characters whose disability is mentioned once and then never referred to again so that the author receives diversity brownie points) -- but I wanted to point out how this read, just in case + as food for thought for those who are reading silently.

ETA: Zoombie -- I haven't thought about any of it very deeply, but I've got no problem with any of what you mentioned. Tbh, I am not as offended by ''my mental illness gives me superpowers'' as a trope as many, though -- because bipolar hypomania + mania does often feel like having superpowers in a way that having depression or PTSD really, really doesn't. It sounds like the kind of superpowers ''gaunts'' have are kind of negative and harmful, too -- which is fitting, imo.

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Hmm. Was there something I wrote that suggested I don't think "Muslim characters, gay characters and mentally ill characters are people too"? I guess I am not a fan of "writing for representation." I am a fan of good writing and a good story, whatever that entails. If a story calls for someone who has mental health issues, great, as long as it's very well researched or the author is familiar with the terrain. I'm delighted that,for example, James Welsh, terrific Native American writer, when he was writing Fool's Crow, about 1870's Blackfeet, did not decide, "Well, i've got Indians but what I really need is a white guy in a wheelchair." Terri McMillan, in Waiting to Exhale, did not decide to make one of the women schizophrenic.

Anyway, i'm okay disagreeing. It's just my opinion. In the same way many lawyers get frustrated with inaccuracies in legal thrillers, I get frustrated with inaccurate (and thus distracting) stuff about psychologists or mental health issues.

Except that stories don't just pick people, do they?

Like, I mean, is there any particular reason to not write a story about, say, exploring the depths of space wherein the main character has aspergers or bipolar disorder? While having mental health issues is a big chunk of someone's personality, it doesn't dictate everything that they do for the rest of their lives, right?

You can include a character for the metatextual reason that diversity is cool and good while not just falling prey to tokenism.

Sure, but wouldn't Aspergers or BP be relevant? Otherwise, it does seem like tokenism ("okay, got a white guy, a gay guy--oh! Need a woman and a mentally ill person!") Obviously, people can write anything they want. i'm just giving my opinion about times I think they get it wrong.

And no, BTW, I didn't see anything about your description that would bother me. I don't read that genre, so not at all familiar, but anything involving any kind of fantasy I think has different rules or expectations (from me anyway!)

I don't know that including someone who's Swedish or short or blind or blond or even blonde is that different from including someone who's snide or funny or left-handed or single or queer or married or queer and married or in a wheelchair or bi polar or diabetic or green-eyed.

They're all human traits.