s.e. smith is a writer, agitator, and commentator based in Northern California, with a journalistic focus on social issues, particularly gender, prison reform, disability rights, environmental justice, queerness, class, and the intersections thereof, with a special interest in rural subjects. International publication credits include work for the Sydney Morning Herald, The Guardian, and AlterNet, among many other news outlets and magazines. smith’s writing on representations of disability in science fiction and fantasy was recently featured in The WisCon Chronicles, Volume 7. Assisted by cats Loki and Leila, smith lives in Fort Bragg, California. You can follow s.e. on Twitter, ou personal site, Goodreads, and lots of other exciting places online.
As a mentally ill reader, one of my most pressing frustrations when reading YA, or interacting with any pop culture, is the handling of mental illness. Mental illness is frequently dealt with in very troped, and often harmful, ways, illustrating that creators didn’t take the time to research, learn about the lived experiences of the communities they are writing about, or think about the responsibility involved in depicting mentally ill people, an already marginalised group within our larger culture.
To be crazy is to be dangerous, and not necessarily to yourself or others. Mental health diagnoses are used as a tool for power and control, to silence people, to take their children away, to deny employment and benefits, to abuse people, to threaten people. Mentally ill people, like others with disabilities, are highly vulnerable to abuse and exploitation.
Somewhat uniquely, though, this is a disability that hits adolescents and teens particularly hard, because mental illness often onsets around this age. Unlike other disabilities, which may be congenital or acquired at any age, and thus can play an emergent role in any stage of life, mental illness is often something people grapple with for the first time in their teen years (though younger people can and do have mental illnesses). The fiction they’re interacting with at the time can have a profound effect on how they deal with their diagnoses, and unfortunately, that fiction often sends very negative messages.
The onset of mental illness doesn’t happen like flipping a switch; you will not wake up one morning and suddenly be crazy. Instead, it happens by stages, often so subtly that you may not fully realise what is happening to you. You don’t understand why you’re getting increasingly tired, everything is hard to do, and you’re losing the will to get out of bed. You don’t see any reason to go on living. There’s a voice in your head compelling you to do something—and warning you not to listen to other people who tell you the voice in your head isn’t there. You’re bounding with abundant energy, you can take on the world, you don’t need to sleep or rest EVER AGAIN! Everything makes you cry and you feel like the entire world is fracturing around you. You trust no one, and everyone is obviously out to get you.
These are just some of the many symptoms youth can experience at the onset of mental illness. Often, they happen late in high school and early in college, when people are trying to live independently and may be afraid or unwilling to reach out. Thanks to tropes and stereotypes about mental illness, and the stigma associated with mental health conditions, people who think they might be sick could be reluctant to seek help, and they may not even recognise what they’re experiencing as mental illness.
After all, OCD is when you’re super particular about your kitchen, right? So compulsively washing your hands, needing to check and recheck and recheck your doors, or being constantly worried about leaving the stove on isn’t OCD. You’re not sure what it is, but you definitely don’t have a treatable mental health condition. And schizophrenia is when you have a split personality, right? So experiencing a break with reality, not being sure about what is real and what is not, that’s definitely not schizophrenia—besides, schizophrenia is scary and it only happens to crazy people, like that freaky homeless guy by the post office.
So we come to mental illness in YA, which is often depicted in very stereotyped and inaccurate ways; like TV OCD, as I affectionally (and bitterly) call depictions of OCD on television, the handling of mental health conditions in YA often leaves much to be desired. It reflects the fears and imaginations of the author, rather than the reality of the mental health condition, and it is perhaps not surprising that the best examples of mental illness in YA come from authors who have experienced it themselves.
One of the most troubling things about the way mental illness is handled in YA is that, as in society, it is framed as something inherently wrong and awful, rather than a simple fact of life. It’s estimated that around 20% of people will experience mental health conditions at some point during their lives, making them extremely common—and breaking down stereotypes about them would make it a lot easier for people to seek treatment.
There are two recurrent tropes around mental illness in YA that particularly trouble me, beyond falsities in the depictions of specific mental health conditions. One is the character who thinks she’s mentally ill who later realises she has superpowers. The underlying message here is actually a kind of interesting one: here’s a protagonist experiencing something totally unfamiliar, scary, and alien (which the onset of mental illness can feel like) who doesn’t know how to handle it…but then it usually gets twisted, and she is afraid she’s crazy, because being crazy is bad.
Maybe she has a mentally ill family member or friend who has exposed her to the ‘horrors’ of craziness. Maybe she’s institutionalised, either mistakenly or with malice by another character who wants to keep her from accessing her powers. In all cases, the takeaway is that being crazy is definitely not okay, but having superpowers, of course, is awesome.
What’s notable about this, other than the underlying assumption that being crazy is wrong, is that this is never actually challenged in the narrative. Never once does the protagonist ask herself what would be so wrong about having a mental health condition, and rarely do we see her exploring treatment and management options. Instead, she flails in terror until she finds out she has superpowers, at which point everything is usually fine again, except more awesome, because superpowers.
What’s the difference between being crazy and having superpowers? Why is one good, while the other is not? Why do we consider one to be a condition that must be managed in a particular way, and the other something that people should be trained to use and then harness for good? Picking apart these distinctions is critical for authors who want to explore storylines like this, because while ‘woah, I think I am going crazy’ may be a legitimate response to seeing things others don’t, appearing to experience a break with reality, and appearing to alter the world around you, the followup response shouldn’t be ‘how terrible, now I am a crazy person! Oh no!’
Similar narrative structures take place within the framework of institutionalisation, where the asylum is framed as something horrifying and awful…for sane people. When we see institutions in YA, we usually see them crop up in one of two contexts: a sane person wrongly incarcerated in one, or a spooky (often old, sometimes abandoned but haunted by ghosts) asylum filled with crazy people. Asylums are scary because they are filled with crazy people, and our protagonists don’t belong in them because they are sane, healthy, ‘normal,’ not people who should be wrongfully trapped in among the dangerous, frightening, traumatic mentally ill people.
Never once is the concept of the asylum challenged, or is the larger discussion about institutionalisation and oppression incorporated into the narrative. Members of the mental health community might also argue that some asylums are bad and scary, but for a very different reason. The problem with mental health facilities isn’t that they are filled with people who need treatment, but with the fact that residential institutions have a long and horrific history of patient abuse, experimental ‘treatments’ amounting to little more than torture, and a host of other problems. Historically, asylums were used as a tool to suppress and confine people, and today, some are used for much the same purpose, right down to purposefully overmedicating people to keep them compliant. Victims of sexual assault, physical abuse, and other indignities in asylums are often prevented from reporting, or mocked when they try to report.
These are horror stories, but they aren’t the horror stories we usually see when it comes to talking about mental health facilities in YA. Instead, these facilities are cast in simple terms: they’re okay for crazy people, but not for ‘everyone else.’ This idea is common with the handling of mental illness and disability in general, that treatment as a second class is acceptable for ‘them’ because it’s simply part of how the system works and it always has been. Thus, YA rarely challenges the fundamental assumption that institutionalisation is an acceptable and productive way of dealing with mental illness and mentally ill people; it doesn’t explore the warehousing and torment of human beings that occurs in long-term facilities.
When we see positive, mental illness-centered depictions of institutions, it’s usually inpatient hospital wards in issue books where people are sent for ED or suicide attempt recovery. While both depictions are vitally needed, they need to be balanced with the fact that psychiatricisation and institutionalisation have been used as abusive tools against not just mentally ill people, but also women and people of colour, for centuries. When I see asylums promoted as a positive good (and authors failing to distinguish between, for example, a highly ethical inpatient ward in a modern hospital and a long-term residential care facility), I see yet another reminder that society believes mentally ill people are best when locked up, hidden away from public view, ‘in treatment,’ no matter what that ‘treatment’ might look like.
How can authors avoid these tropes, and others associated with mental illness? Obviously, research, research, research, and interacting directly with members of the mentally ill community, including those with the specific diagnoses being depicted, such as anxiety disorders. It’s critical to talk to more than one person, as well, because mental illnesses are highly variable, and diagnostic creep means two people with the same diagnosis may have radically different symptoms, just as two people with very similar symptoms might have totally different diagnoses. And remember that even someone with a well-managed mental illness has bad days, because sometimes, disability really sucks.
Want to avoid problems with characters who mistake the onset of supernatural powers for mental illness? Think carefully about what you’re saying, how you’re saying it, and how you’re interacting with the character. Talk to people about their onsets of mental illness and the emotions that swirled around them, so you can depict your character’s fear, uncertainty, and nerves accurately, but avoid falling into the trap of suggesting that developing a mental illness is a negative thing. Explore how people define ‘normality’ through the depiction of your character, and ask yourself: how awesome are superpowers, really?
Are there days when your character has trouble functioning because of her superpowers? When she’s frustrated because she feels like she can’t manage them? Instead of inadvertently turning superpowers into a bright, shiny alternative to disability, make them come at a cost; not only will you avoid some painful disability tropes, you’ll also make your book more engaging by raising the stakes and creating more tension for the character.
Planning to include a mental health facility in your book? Do. Your. Homework. Talk to people who have been institutionalised about the care they received, where they received it, and their experiences in the mental health system. Someone who was on suicide watch for two days in a hospital has a very different story from someone who was on an adolescent psychiatric ward for several weeks or months. Someone who stayed at a residential facility (or who lives in one) for an extended period of time has yet another experience to narrate.
Psychiatric facilities are as diverse as snowflakes, running the gamut from those that provide patients with maximum support for developing coping tools and techniques, managing their mental illnesses, and living independently, to abusive nightmares that are everything you imagined and worse. If you’re depicting one, don’t forget about the other, and don’t fall into the trap of thinking that all institutions are horrific dungeons of abuse or fairylands of supportive staff, and never forget the long and complex history of psychiatric facilities.
Above all, remember that being crazy is not a bad thing. Don’t attribute negative or undesirable behaviours to mental illness, or excuse a character’s unacceptable behaviours to mental health diagnoses. Like other disabilities, mental illness should be value-neutral: it’s a trait some people have and other people do not, and we all interact with it in very different ways.
Emma Crees is 32 and lives in Oxfordshire, UK. A life long wheelchair user she’s passionate about all things disability and can often be found online ranting about this. If she’s not ranting about disability she’s probably talking about books or writing. All of this and more is on her blog, A Writer In A Wheelchair, or on her twitter account @FunkyFairy22. When Emma isn’t online she can often be found knitting, sailing or volunteering.
Courtney Gilfillian lives, writes, and works in New York City. She is constantly on the hunt for a good cocktail, the best pancakes in the city, and most of all a good book. Find her on Twitter at @whitegirlbkcvrs and at her blog about diversity in YA lit.
s.e. smith is a writer, agitator, and commentator based in Northern California, with a journalistic focus on social issues, particularly gender, prison reform, disability rights, environmental justice, queerness, class, and the intersections thereof, with a special interest in rural subjects. International publication credits include work for the Sydney Morning Herald, The Guardian, and AlterNet, among many other news outlets and magazines. smith’s writing on representations of disability in science fiction and fantasy was recently featured in The WisCon Chronicles, Volume 7. Assisted by cats Loki and Leila, smith lives in Fort Bragg, California. You can follow s.e. on Twitter, ou personal site, Goodreads, and lots of other exciting places online.
A lifelong Amsterdammer, 
Disability in Kidlit 