Social Justice and Mental Health: Accessibility to Treatment in YA Literature, a guest post by Alyssa Chrisman

Today we are honored to present to you a Mental Health in YA Literature guest post that looks at the accessibility to treatment in YA literature. You can read all the #MHYALit posts here or by clicking on the tag below.

When I was 12-years-old, I went to therapy for the first time. Seventh grade is a notoriously tumultuous year, and although I hardly remember the sessions now, I believe they were helpful in a way I didn’t quite understand then. As I have aged, I have weaved in and out of multiple types of mental health treatment as needed. Even in moments where it seemed like recovery was not possible, books like Ned Vizzini’s It’s Kind of a Funny Story inspired me to speak up and ask for help. Now that I am an adult studying YAL, I have immense gratitude for the positive impact books like that had on my life and am an advocate for diverse YA books featuring mental health topics. As Teen Librarian Toolbox’s 2016 #MHYAL (Mental Health in Young Adult Literature) project illustrates, issues of mental health are prevalent in YAL, especially in recent publications. Most mental illnesses are represented somewhere within this body of texts, but one important aspect is often overlooked: teenage accessibility to affordable and quality care. I was, and am, lucky to have access to mental health treatment through affordable medication and quality therapists, yet that is not the case for many Americans. By considering the intersectionality of mental health and social justice in quality YAL texts, practitioners can help teens think critically about issues affecting their worlds.

Recently, I completed a thesis on representations of obsessive-compulsive disorder (OCD) in YAL. I found that most of the protagonists in these texts are privileged in some way. They often have supportive families (at least by the end of the novel) and appear to be in the middle-upper class. Because of these privileges, the protagonists of most of these novels are able to receive the medical care they need in the form of therapy, medication, and even hospitalization. Unfortunately and unsurprisingly, the protagonists in these texts are also racially privileged through their whiteness. While mental illness affects people across all genders, races, ages, and class levels equally, a recent study showed that “young people in general aren’t likely to see mental health specialists. But the numbers fell further when racial and ethnic backgrounds were factored in. About 5.7 percent of white children and young adults were likely to see a mental health specialist in a given year, compared with about 2.3 percent for black or Hispanic young people” (Luthra). Young adults of oppressed racial and class backgrounds have multiple factors working against them when trying to receive adequate psychological care. They have issues that affect all minors, such as getting parental or adult support, but they also have to overcome systemic problems more likely to negatively affect them, such as a lack of quality health insurance coverage and a high cost of care. By only featuring characters who are white, are economically advantaged, and have a fair amount of parental support, YAL as a whole is not providing literature that accurately represents many teenagers’ lives and is missing out on a significant opportunity.

I believe that mental health representation in YAL is critical, and practitioners who work with young readers should make these texts accessible. However, I argue that practitioners, especially librarians and teachers, also have a responsibility to recognize aspects of privilege within the texts they suggest and to identify what may be lacking. Mental health representation is important, but a person is never just their mental illness. Intersectionality is realistic, and the protagonist’s race, sexuality, and class can affect them just as much as their mental illness or other disability. By looking at what types of identities are lacking in this YAL, we can construct our conversations with teenagers in more meaningful ways. Recognizing a lack of class issues in these novels can help teenagers understand social justice in the context of mental health. I recommend pairing two novels, both featuring protagonists with OCD, together to open up discussion of these issues: Matt de la Peña’s Ball Don’t Lie (2005) and Tamara Ireland Stone’s Every Last Word (2015). Warning: plot spoilers ahead!

Ball Don’t Lie is written in third-person and tells the story of Sticky, a white teenager in the foster system, who spends his days at school, playing basketball at the local community center, and with his girlfriend, An-thu. A diagnosis of OCD (nor a suspicion of its existence) is not mentioned at all in the novel itself. However, readers familiar with OCD can assume that Sticky’s repetitive actions, such as unplugging and replugging his headphones until it feels just right, would be interpreted as compulsions by a medical professional (de la Peña 231). Most importantly, “obsessive-compulsive disorder” is the second tag for the book, alleviating readers from the inappropriate job of having to diagnose Sticky by doing it for us. At the climax of the novel, Sticky’s compulsions result in him getting shot in the hand. He wants to get An-thu a piece of jewelry for her birthday, but he cannot afford it. Although he initially intends to steal it from the store, he decides to steal money from a person on the street instead. When he starts compulsively counting the four hundred dollars over and over, “he freezes. He can’t move. He hasn’t counted right. He hasn’t stacked the bills right. He hasn’t done anything the way it needs to be done, and his body won’t let him move on to the next step” (258).  He continues to count, and the person he robbed catches up to him and shoots him in the hand. He is hospitalized for his injury, but his compulsions go unnoticed and untreated. The reason for this is not explicitly stated, but an assumption could be made that Sticky’s lack of adequate adult support, as well as his lack of class privilege and impoverished community, contribute. Sticky has a happy ending when he physically recovers from the injury, but it is difficult not to imagine these compulsions continuing to affect him as he transitions to playing basketball for a university.

Sam, the protagonist of Every Last Word, tells her story in first person and has been diagnosed with OCD prior to the start of the novel. She takes medication and has a therapist, a prominent character in the book. From the beginning, it is evident that she also has support from her mother. In the prologue, Sam is cutting flowers with her friends when she starts to worry that she may cut one of her friends with the scissors, a type of obsession that is manifested in some people with OCD. She escapes to the kitchen where her mother helps her work through the obsession, all while keeping what is happening private from Sam’s friends. Once Sam has calmed down, her mom assures her that she loves her and says, “Whatever you’re thinking, it’s okay. It doesn’t mean anything about you. Got it? Now tell me.” Sam thinks, “The two of us have been here before. It hasn’t happened in a long time, not like this, but Mom slips right into her assigned role as if it’s second nature. She’s well trained” (7). Sam’s mom then leads Sam through exposure therapy by having her hold a pair of scissors. In the author’s note, Stone reveals: “While there are hints in the text itself, it is important to me that readers understand that prior to this scene, (1) Sue [Sam’s therapist] has led Sam through exposure therapy sessions in her office, (2) Sue has formally trained Sam’s mother, so she can provide the 24/7 support Sam might require, and (3) Sue and Sam’s mother operate as a team and are in constant communication about managing Sam’s disorder” (357). Interestingly, Sam’s family appears very little throughout the rest of the novel (although her therapist plays a larger role). However, this interaction between Sam and her mom in the prologue, as well as the additional information provided in the author’s note, shows that Sam’s mom is positioned as a character who loves Sam and gives her the tools and experiences she needs to recover safely. This type of support system between parent and therapist is ideal for a young adult working through the struggles of OCD. Sam is privileged in that she has accessibility to quality care in multiple aspects of her life, which greatly contributes to her recovery.

These two protagonists lead very different lives. Sam has the support of her mother, while Sticky has lived in several foster homes and currently lives with a family who sees him simply as a means of gaining income. Throughout the novel, Sam’s therapist supports her, but Sticky does not receive help—in fact, he is never even diagnosed with OCD. This lack of care is particularly frustrating for readers who hope that he will get help when he is hospitalized for his injuries, but his mental illness is overlooked, potentially a result of his class status. Very few YA novels about mental health discuss issues of class, and even fewer include protagonists from diverse races. As a person who has personally benefited from multiple types of treatment at various stages of my life—and as a person who simply cares about the well being of teenagers— I believe that all people suffering from mental illness should have such an opportunity for recovery. Looking at Ball Don’t Lie and Every Last Word together can help teenagers better understand how social justice issues impact teenagers with mental illness and hopefully even inspire youth-led campaigns and activism for the cause.

What do you think? Are there any other books you would recommend pairing together? Is there an exemplar YA novel that illustrates how class, race, etc. can affect mental health treatment? Leave a comment below!

Works Cited

De la Peña, Matt. Ball Don’t Lie. Ember, 2005.

Luthra, Shefali. “Race, Ethnicity Affect Kids’ Access to Mental Health Care, Study Finds.” Kaiser Health News, 12 Aug. 2016, http://khn.org/news/race-ethnicity-affect- kids-access-to-mental-health-care-study/

Stone, Tamara Ireland. Every Last Word. Hyperion, 2015.

Meet Our Guest Blogger

Alyssa Chrisman is a 26-year-old living in Columbus, OH. A former secondary English teacher in Memphis, she just received a M.A. in Teaching and Learning from the Ohio State University and is about to start their Ph.D. program in Literature for Children and Young Adults. When she is not doing schoolwork, she is probably spending time with her fiancé and three dogs. Sometimes she updates her Twitter and blog: @radwarriorgirl/(http://www.radwarriorgirl.com).

About the Books

Ball Don’t Lie by Matt da le Pena

Newbery Award-winning author Matt de la Pena’s Ball Don’t Lie about basketball “is a must-read.” [The Bulletin]

Sticky is a beat-around-the-head foster kid with nowhere to call home but the street, and an outer shell so tough that no one will take him in. He started out life so far behind the pack that the finish line seems nearly unreachable. He’s a white boy living and playing in a world where he doesn’t seem to belong.
But Sticky can ball. And basketball might just be his ticket out . . . if he can only realize that he doesn’t have to be the person everyone else expects him to be.
Matt de la Peña’s breakout urban masterpiece, Ball Don’t Lie takes place where the street and the court meet and where a boy can be anything if he puts his mind to it.

[STAR] “[An] inspiring story. Sticky is a true original, and de la Peña has skillfully brought him to life.”-School Library Journal, Starred

“Riveting…Teens will be strongly affected by the unforgettable, distinctly male voice; the thrilling, unusually detailed basketball action; and the questions about race, love, self-worth, and what it means to build a life without advantages.”-Booklist

“Stunningly realistic, this book will hook older readers, especially urban teen males.”-VOYA

“The characters live and breath…This is a must-read.“-The Bulletin

“De la Peña does an excellent job of combining the streets with the sport. Gritty and mesmerizing.“-Kirkus Reviews

“I have never before seen blacktop ball depicted so well. In this novel, you will find its flash, its power, and its elegance without chains. This is powerful stuff.”-Antawn Jamison, forward for the Los Angeles Clippers

“From the very first sentence, this book grabbed me and didn’t let go. The deeper I got into it, the more I felt like Sticky’s story was my story. His heart, his handle, the guys in the gym, his potential pitfalls, his dreams. All of it. In a weird sense, this is my life.”-Grayson Boucher (“The Professor”) of tha AND 1 Mix Tape Tour

“Truly authentic in its examination of both the game I love and the invariable missteps toward manhood. You cannot fail to be moved by the eloquence and truth of this story.“-Rick Fox, former forward for the Los Angeles Lakers

An ALA Best Book for Young Adults

An ALA Quick Pick for Reluctant Readers

(Ember, 2005)

Every Last Word by Tamara Ireland Stone

If you could read my mind, you wouldn’t be smiling.

Samantha McAllister looks just like the rest of the popular girls in her junior class. But hidden beneath the straightened hair and expertly applied makeup is a secret that her friends would never understand: Sam has Purely-Obsessional OCD and is consumed by a stream of dark thoughts and worries that she can’t turn off.

Second-guessing every move, thought, and word makes daily life a struggle, and it doesn’t help that her lifelong friends will turn toxic at the first sign of a wrong outfit, wrong lunch, or wrong crush. Yet Sam knows she’d be truly crazy to leave the protection of the most popular girls in school. So when Sam meets Caroline, she has to keep her new friend with a refreshing sense of humor and no style a secret, right up there with Sam’s weekly visits to her psychiatrist.

Caroline introduces Sam to Poet’s Corner, a hidden room and a tight-knit group of misfits who have been ignored by the school at large. Sam is drawn to them immediately, especially a guitar-playing guy with a talent for verse, and starts to discover a whole new side of herself. Slowly, she begins to feel more “normal” than she ever has as part of the popular crowd . . . until she finds a new reason to question her sanity and all she holds dear. (Disney Hyperion, 2015)

Filed under: #MHYALit, #SJYALit