Mental Health in Children’s Literature FAQ

What exactly is mental illness? 

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.”[1] Environment is a big risk factor for children, as both acute and chronic trauma suffered early can lead to mental illness later in life.[2]

Are there books for children that deal with mental health issues?

More and more outstanding picture books, middle-grade and young adult novels that deal accurately and responsibly with mental health conditions have come out in the last two decades (up from almost zero).

But the number of books for younger readers that deal with mental health is minuscule compared to the prevalence of mental illness in all of our lives.

Why so few? 

One word: Stigma. The negative attitudes, prejudice, fear, and silence that surround the subject.

The many aspects of and the different forms these illnesses take are shrouded in misinformation and misunderstanding.

Stigma exacerbates suffering tremendously. It leads to isolation, negative and destructive ways of coping, and death. Mental health is still difficult to discuss at best, and in some communities remains taboo. The pandemic has significantly worsened mental illness and suicide statistics.[3] The need for more books dealing accurately and responsibly with the problem is urgent.

Why does mental illness suffer from such stigma?

·      It’s invisible.

·      There’s so much about the function of the brain that we didn’t understand until recently. Misinformation and misunderstanding still abound.

·      Cultural issues are at play. For example, in the west, suicides were outlawed in the 2nd century CE by the Christian Church, and eventually harshly punished by medieval European governments (in response to high numbers of them).[4] We haven’t shaken that.

·      We are taught from a very early age to fear and isolate the mentally ill[5]. Studies have shown that at least half of characters acknowledged as mentally ill in popular media in the US are shown hurting or killing others, or in cartoons or content for the young are played as ridiculous or for laughs.

Why is the need urgent for more stories for younger readers that include mental illness?

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[6] 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.[7]

Young people are further affected as 50% of mental illnesses manifest by the age of 14, and 75% by age 24.[8]

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.[9]

Who should write about characters with mental illness?

 Working backward from the goal of wide representation and normalization of mental illness in thousands of books for young readers, the need for stories that deal with any aspect of this subject accurately and responsibly is so urgent that anyone who is interested in telling them, should—as long as the writer gets it right.

How do I get it right?

·      Research is critical. Accurate information is widely available online at the National Alliance on Mental Illness (NAMI), the National Institute for Mental Health (NIMH), American Foundation for Suicide Prevention (AFSP), The Child Mind Institute, The Trevor Project, and the Centers for Disease Control (CDC), to name but a few.

·      Ask expert readers to vet your manuscript, including those who deal with the illness depicted, and those who treat it.

·      If a writer can draw on personal experience of coping with their own mental illness or that of a loved one, all the better.

·      Avoid the many negative tropes and stereotypes (see below)

·      Ultimately show characters (young people especially) seeking and receiving support from family or friends, and importantly, from professionals

·      Show characters following treatment plans and coping successfully

For anyone, but especially the young, the right book at the right time can help normalize what likely feels shameful and overwhelming. It helps diminish stigma – every story out there does. It can model and encourage a reader to reach out for support—because mostly, people don’t. 

We as storytellers are striving to offer a young reader who is searching for understanding, direction, and hope—let alone a reason to live—a realistic but optimistic story about a character dealing with mental illness themselves or in their family.

Points to consider for responsibly creating a compelling mentally ill character:

·      First, you may want to ask yourself why you want to write about mental illness. What do you want your reader to understand, learn, or remember about MI after reading your book? 

·      Is the outcome hopeful—but realistic?

·      Is the mental illness acknowledged with the proper diagnosis and nomenclature?

·      What aspects and challenges (emotional, mental, and physical) of mental illness are part of the character’s motivation?

·      What about self-destructive behaviors/choices/relationships with other characters?

 For main characters with mental illness:

·      What aspects of mental illness interfere with what the MC wants? What must change so the MC can get what they want?

·      Is seeking support from friends, trusted adults, siblings, parents, teachers, etc. part of the storyline?

·      Is obtaining professional help and the journey toward recovery or optimum coping part of the storyline?

What should I avoid when writing about mental illness for young readers?

With young readers especially, writers’ responsibilities must go further. While the perfect mental illness book for young readers has possibly not been written, numerous erroneous stereotypes, false generalizations, and poor representations persist in fiction and popular culture. These include:

·      Romanticizing or sensationalizing suicide, including graphic details of an attempt, or worse, instructions

·      Mental illness as a sign of moral weakness, a sin, or some personal choice

·      Mental illness as a result of character flaws or poor parenting (abusive parenting can lead to mental illness, but good parenting cannot protect a child from it as so many of the causes are not within parents’ control)[10]

·      That a person can think positively or make lifestyle choices that will completely erase their mental illness

·      Conversely, that mental illness is incurable or guarantees a poor outcome

·      That mentally ill people are violent and dangerous (dangerous, violent people are sometimes mentally ill)

·      Love alone can cure mental illness

·      Meds don’t work (finding the right medications can be a long and/or difficult process, and there can be unpleasant side-effects, but medication can improve symptoms and help return sufferers to function)

·      Mentally ill people are treated against their will (If someone is perceived as a danger to themselves or others, coercion can enter the equation, but treatment without the cooperation and participation of the patient not only doesn’t work but causes trauma[11])

·      Romanticizing mental illness as a gift that brings creativity and quirkiness, i.e. avoid the manic-pixie-dream girl/boy, beautiful, tragic, rebel, non-conformist trope

·      Pejorative descriptors like “cracked,” “bonkers,” “loony,” “batty,” going “ape,” etc. are good evidence of the fear and stigma with which we’re programmed from childhood. It wouldn’t occur to most of us to call someone with heart disease or diabetes names or to compare them to animals. In a Time Magazine special on Mental Health[12], David Bjerklie cited studies that have shown that at least half of characters acknowledged as mentally ill in popular media in the US are shown hurting or killing others, or in cartoons or content for the young are played as ridiculous or for laughs.

Through the power of the story, writers can help eradicate stigma by showing that, like physical illness, mental illness is a normal part of life and can be treated and coped with successfully.

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18-year-old suicide prevention worker Delilah’s terminally ill aunt challenges Del’s ideas about life and death

[1] NAMI: National Alliance on Mental Illness. Mental Health by the Numbers. Retrieved from  https://www.nami.org/mhstats, February 16, 2021

[2] Mock, Steven E. and Arai, Susan M. “Childhood Trauma and Chronic Illness in Adulthood: Mental Health and Socio-Economic Status as Explanatory Factors and Buffers.” Frontiers in Psychology. US National Library of Medicine National Institutes of Health. 2010;1;246. Published online 2011, Jan 31. retrieved from  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3153850/

[3] Mclernon, Lianna Matt. Center for Infectious Disease Research and Policy (CIDRAP). “Depression and Anxiety Doubled in Children, Pandemic Study Says.” Retrieved from https://www.cidrap.umn.edu/news-perspective/2021/08/depression-and-anxiety-doubled-children-pandemic-study-says. August 9, 2021.

[4]Hecht, Jennifer Michael. Stay. New Haven. Yale University Press. 2013. p 61

[5] Bjerklie, David. “Finding the Right Words,” Time Magazine, special Mental Health Issue 2019, p.12.

[6]  National Alliance on Mental Illness (NAMI). “Mental Health by the Numbers.” Retrieved from https://www.nami.org/mhstats, February 16, 2021.

[7] Mclernon, Lianna Matt. Center for Infectious Disease Research and Policy (CIDRAP). Ibid.

[8] Ibid.

[9] Kann L, McManus T, Harris W.A., et al., Youth Risk Behavior Survey, United States, 2017. Surveillance Summaries, Centers for Disease Control and Prevention (CDC) U.S. Department of Health and Human Services, Atlanta: June 15, 2018. Vol 67, No. 8. P. 24

[10] “Myths and Stereotypes About Those With Mental Disorders.” Centennial Mental Health Center of Colorado, Crisis Services. 2019. Retrieved from https://www.centennialmhc.org/wp-content/uploads/2017/12/Myths-and-Stereotypes-about-Those-with-MH-Disorders.pdf

[11] Trauma Within The Psychiatric Setting: A Preliminary Empirical Report. (2003). Administration and Policy in Mental Health, 30(5), 453-460. Retrieved from http://www.psychrights.org/Articles/PsychiatricTrauma.pdf June 1, 2019

[12] Bjerklie, David. “Finding the Right Words,” Ibid.