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text 2016-10-18 03:48
Responsibly Handling Mental Health in YA Literature
Challenger Deep - Neal Shusterman
Every Last Word - Tamara Ireland Stone

Last weekend my husband and I attended NerdCon: Stories in Minneapolis. The first session I went to was titled "Mental Health in Young Adult Literature," and it was presented by Amanda MacGregor with Teen Librarian Toolbox -- a GREAT resource for those working in teen services or anyone who cares about YA lit. (This session made me miss my days as a teen services librarian so much.)


MacGregor talked a lot about how common mental illness is among teens (and the population in general -- up to 25 percent of us will experience mental illness firsthand in our lives) and the importance of its presence in teen literature to show teens who have mental health struggles that they are not alone, and to foster greater compassion in those who don't struggle personally. She stressed that it's important that YA lit neither stigmatize nor romanticize mental illness, and that it show that help is possible. A work of fiction may be the first time a teen encounters someone who has a mind that works the same way as their own.


MacGregor shared her own lifelong struggle with anxiety, and she shared writing from YA authors who had written about mental illness, many of whom had personal experience with the mental health issues faced by their characters.


I agreed with MacGregor about the importance of portraying mental illness in a sensitive way when writing for young audiences, and I found myself examining my middle-grade novel through that lens.


Authors often talk about writing the book that they wished they'd had when they were young. I did the same, and much of what my protagonist, Maddy, goes through, I also experienced at her age. That includes my first brush with depression.


I struggled with depression throughout my adolescence, encountering it for the first time when I was about 10 years old -- from there it would come and go in waves, hitting its apex when I was 16; I finally found relief when I was prescribed antidepressants to treat my chronic migraines.


My novel opens with Maddy's suicide attempt; later in the book she experiments with self-harm. She is also the victim of bullying, to which, I would argue, depression is a natural response. She is never clinically diagnosed -- I have never received a clinical diagnosis, either. She does encounter the concept of mental illness through her father, who falls into a depression after he loses his job. Because his depression interferes with his ability to contribute fully as a parent, Maddy's mother pushes him to get help, and he does. So Maddy is aware that depression exists, and also that help exists for it. She even wonders briefly if she (and her mother) should get treatment. But she never sets foot in a therapist's office, and she finds other ways to heal.


I have no doubt that adolescents struggling with mental illness fall through the cracks all the time. Part of it is that we just expect teenagers to be "moody" or "difficult." As an adult or a parent, I'm sure it's difficult to discern when a teenager's struggles are a natural result of the seismic hormonal and social changes of that age, and when they signify an underlying chemical issue that should be professionally or medically treated. And often, teens themselves do not have the vocabulary to name what they are experiencing -- or the agency to ask for help.


In light of MacGregor's discussion, I find myself questioning whether it is irresponsible to portray mental illness without explicitly naming it in books aimed at children. Part of the challenge is that mental illness exists on a spectrum and is somewhat subjective, despite the existence of diagnostic questionnaires and the DSM-V. Although I, as the author, can diagnose depression in my main character, a reader could argue, based on the events of the story, that she has schizophrenia and/or dissociative identity disorder. I don't agree with either of those diagnoses, but I certainly wouldn't try to talk a reader out of that interpretation.


So the state of Maddy's mental health, while described in some detail in the book, is never named. This wasn't a decision I made consciously; and now that I have become more conscious of it, I'm resistant to changing it. Primarily this is because, unlike books such as Challenger Deep or Every Last Word, my novel is not ABOUT mental illness. Some of the characters in it are afflicted, just like some of the population is. Up until this point, I've always felt that what's important is for young readers to recognize themselves in the feelings and experiences of a book's protagonist -- not necessarily that they have names for all those experiences.


But I'm having trouble thinking of similar books for young people that portray mental illness without explicitly naming it. It seems like characters in YA novels are either diagnosed with a named mental illness before or within the course of the story, or they are assumed to be mentally healthy. Does the genre have room for middle ground? And if it does, do you know of books that occupy that space?



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text 2016-10-13 02:53
Reading progress update: I've read 95%.
Challenger Deep - Michael Curran-Dorsano,Neal Shusterman

'There are many things I don't understand, but here is one thing that I know. There is no such thing as the correct diagnosis. There are only symptoms, and catchphrases for various collections of symptoms. Schizophrenia, Schizoaffective, Bipolar I, Bipolar II, major depression, psychotic depression, obsessive compulsive, and on, and on. The labels mean nothing, because no two cases are ever exactly alike. Everyone presents differently, and responds to meds differently and no prognosis can truly be predicted. We are, however, creatures of containment. We want all things in life packed into boxes that we can label. But just because we have the ability to label it, doesn't mean we really know what's in the box. It's kind of like religion. It gives us comfort to believe we have defined something that is, by its very nature, indefinable.


As to whether or not we've gotten it right, well, it's all a matter of faith.'

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review 2016-09-22 03:53
Challenger Deep
Challenger Deep - Neal Shusterman

This is one of those books that people either seem to love or hate. When I told the Internet I was reading Challenger Deep, I got a lot of mixed reactions. Some people said the book is weird, boring, and confusing; others said it’s brilliant. I was a little hesitant to start reading, but after I finished it, I decided I’m firmly in the “love” camp.


Caden is a boy who lives in two worlds. He’s trying to function in the real world, but his thoughts are aboard an imaginary ship that’s heading for Challenger Deep. Eventually, Caden ends up in a hospital where doctors fight to control his ship-themed hallucinations.


If you’re interested in books about mental illness, then this is a must-read. It completely thwarts the stereotypes typically seen in YA illness books:


Love isn’t magic. Challenger Deep shows that illnesses can’t be cured with love. Caden’s family loves him, but he’s still sick. He finds a girl who he’s kind of interested in, but he’s still sick. Unlike in a lot of YA books, love doesn’t magically fix his problems.


“There are times I feel like I'm the kid screaming at the bottom of the well, and my dog runs off to pee on trees instead of getting help.” – Challenger Deep


Doctors aren’t magic. There is still a lot to learn about treating mental illnesses. Doctors make mistakes and educated guesses. Sometimes it’s not even clear what illness a person has. This book shows doctors trying and failing to figure out how to make Caden better.


Medicine isn’t magic. Sometimes, a sick person can’t just swallow a pill and instantly get better. Many types of medication need to build up in a person’s body for weeks before anybody even knows if the medicine is working. If it’s not working, the medicine needs to be changed. Switching medications can cause many nasty side-effects. Challenger Deep doesn’t shy away from showing all that unpleasantness.


“They all think medicine should be magic, and they become mad at me when it's not.” – Challenger Deep 


Mental illnesses aren’t sexy. Many YA books have that “depressed, angry bad boy” character. That character shouldn’t be a sex-symbol. He should get help before he hurts himself or somebody else. In Challenger Deep, there’s nothing sexy about Caden’s depressed behavior.


“Dead kids are put on pedestals, but mentally ill kids get hidden under the rug.” – Challenger Deep


Endings aren’t always perfect. Sometimes illnesses go away. Sometimes they don’t. Sometimes they go away for a while and then come back. Caden’s story might not have a happy ending. 


Tragic backstories aren’t required. There’s a stereotype in books (and in real life) that mental illnesses are caused by something traumatic that happened in a person’s past. A lot of mental illnesses are caused by chemical imbalances. A person can be born with a chemical imbalance or develop one later in life. Caden doesn’t have a tragic backstory. He’s just a sick kid.  


Obviously, there is a lot this book does right, but I still have a few issues with it. It took me a long time to get interested in the story. I think I was over halfway through it before I found myself wanting to pick it up. The story switches back and forth between Caden’s ship hallucination and his real life, but it doesn’t feel like much is happening in either of those places. The hallucination is vividly bizarre, but it isn’t “real,” so there’s not much suspense there. Caden spends most of his real life wandering around, hallucinating. There isn’t much suspense in that, either. I felt like I was just sitting around, waiting for something to happen in the plot.


The story becomes a lot more interesting when the connections between the hallucinations and Caden’s real world start showing up. I enjoyed trying to spot the connections before they were revealed. I also really admire the way the author moves between the hallucinations and Caden’s real life. I reread parts of the book just to find out how he manages those transitions so smoothly. It’s impressive.


Also—this isn’t a criticism of the book—but I wondered how Caden’s family could afford to keep him in a hospital for nine weeks. Can you imagine how expensive that would be? Either they’re rich, or they have the greatest insurance in the history of insurance. Nine weeks in a hospital! Can people really afford that?


Anyway, I can see why this book is getting so much attention from readers and award committees. It’s a gritty depiction of mental illness, and it’s definitely well-written and unusual.

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review 2016-02-22 05:58
Challenger Deep
Challenger Deep - Neal Shusterman

Caden is a 15 year old boy whose high school friends notice starts to act strange. Caden is the artist aboard a ship bound for the Marianas Trench. Caden lies about joining the track team. Caden is torn between loyalty to the captain and mutiny.


I upped this books rating from a 4 to a 4.5 after I learned the story behind this book and saw the art that is in the physical book (I listened to this on audio, like I do most things). I really wish that when you are listening to an audiobook there was a way to get any of the art, images, ect. that are in the physical book, or at least a note that those things exist so know to go looking for them.


This was a surprising book to me. I listened to it and honestly had no idea what was going on at first, I felt like I was going crazy listening to this kids story. I got the anxiety and nervous feelings listening to it and while it was clear that the things he was thinking and feeling where really off base, Shusterman did a really good job of writing it.  


Once I sorted what was going on I was really interested to see where this was going to go.  Somethings that didn't totally work for me had to deal with the narration (there were a few clunky/messy narration sections) and there was a "love interest" that didn't really work smoothly for me.


So the story behind the story I guess could be spoilery for the plot line of the book so if that's something that you don't want to know then I'd skip the rest of this but I don't think it is because I think it's more about the journey with this book than the plot line but at any rate I'll throw it behind a spoiler tag just in case. Obviously I'd recommend this book and was very impressed with it.

Shusterman's son started showing signs of mental illness as a teen and ended up needing to be hospitalized because he couldn't differentiate between what was happening in his delusions and real life. At one point Brendan told Neal “Sometimes it feels like I’m at the bottom of the ocean screaming at the top of my lungs and no one can hear me” and that is Neal came up with the story for Challenger deep.  Brendan worked closely with Neal in telling this story and the art work in the book is from the time that Brendan was in the thick of the mental break he was having.  I wasn't sure how accurate and honest this story was which made me skeptical about the story, it was well written but I wasn't sure about it.  When I found out about the Shuterman's personal connection to this story the more I liked it because it answered the question about the accuracy.

(spoiler show)
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review SPOILER ALERT! 2015-09-03 20:10
Challenger Deep
Challenger Deep - Neal Shusterman

***Note: this review assumes that you've read the book.***


One-sentence summary: One of the best young-adult novels I've read so far this year, if not the best.


CHALLENGER DEEP is impressive. The beauty of it--the masterfulness, for me--is in how accurate it is to mental illness while also being poetic--it's a novel, through and through, and takes exactly the right liberties that fiction should. In other hands, trying for "poetry" sometimes saccharine-izes and paradoxically belittles illness. CHALLENGER DEEP is brutal, while also being beautiful. The earliest chapters before the hospital are also especially strong in depicting Caden's un- and under-medicated decline.  

Depiction of mental illness. I'm not an expert in schizophrenia, but I suspect the way Mr. Shusterman chose to portray Caden's brain turning fantasy into reality is probably where the poetry (rather than strict medical accuracy) comes in. The parallels between Caden's delusions and the real world (the parrot being the doctor, for instance) had a very "narrative" structure, and I'm sure most delusions are more chaotic and would seem confusing to us. By definition they make sense and feel real to the person who is sick, but would be barely recognizable if non-schizophrenics could really see them. But since schizophrenics believe their hallucinatory thoughts do map into the real world, the narrative may be a closer approximation for "healthy" readers, rather than trying to represent what really goes on in Caden's head. 
What was great:
The Navigator's word associations were so powerful, and I suspect spot on: the fluid move from one thought to the other, and finding deep meaning in both the process and the final thought. Also, Hal's unraveling into parchment was exquisitely written.
I loved the way Mr. Shusterman separated the two stories--Caden's "real life" and his hallucinatory life--and then let them bleed into each other toward the end.
I thought that Caden shooting the parrot dead-on was incredibly dramatic and such a shocking moment in the book (because, obviously, we're rooting for the doctor).
Open-ended, bittersweet endings are my favorites. The end was designed to show us that you can't really cure mental illness, you can only manage it. Realism is probably also why Caden's friend Calli really stays out of touch, rather than showing up in some circular way at the end. 
What didn't work as well for me:
I thought there were two or three moments of Mr. Shusterman too obviously speaking through Caden, for example: "There is no such thing as a 'correct' diagnosis. There are only symptoms and catch phrases for various collections of symptoms."
And does that last quotation also explain why the word "schizophrenia" wasn't actually used in the text at all (correct me if I'm wrong)? It seems common for young-adult authors not to name their characters' mental illness, and I wonder if that's to give them more license to play with the facts, or to excuse inconsistencies. 
The real-life Captain felt a little too insignificant to have morphed into such a vital part of Caden's delusions. When we figured out Dr. Poirot was the Parrot, I was hoping that the Captain was simply the embodiment of Caden's illness (which he ultimately is), so I was a little disappointed to have a one-to-one mapping for the Captain, too. I talked myself out of that disappointment by wondering whether many schizophrenics might report having a small event like that in their childhood that they later identify as a pivotal moment. (Caden talks about this somewhat by saying that once you identify mental illness, you begin to look back on thought processes in your past that seemed fanciful or fantastical and wonder whether they were the first sign.) 
When Caden descends into Challenger Deep, what is happening in the real world to him? Clearly, the Captain (i.e. Caden's ill brain) wants to tempt him completely into a non-functional state, even to tempt him into death. But unexpectedly for the reader, Caden's visit to Challenger Deep--the lowest he can go--is somehow a turnaround moment for him. It seems to become the road to recovery because Poirot/Parrot--despite being just a featherless cadaver [i.e. a rejected advisor in real life]--breaks through to him in that moment. Yet I didn't think it was clear why Poirot was able to break through. If it all depends on the chocolate coins--Caden's recognition that they're from his childhood, and thus can't be "real" under the ocean--is that a powerful enough fact to pull him through to reality? It seems to tie in with a previous scene: Caden asks Poirot whether his mother, who is waiting in the visiting room, has a heel broken off her shoe. Poirot commends him for using reality checks to overrule his brain about what is not-real. I think the chocolate coins are meant to resonate with that--they are a proof of non-reality. But why Caden let the dead parrot "in" at that moment wasn't clear: is Mr. Shusterman intentionally showing us that improvement in health sometimes depends solely on luck? If so, I suppose that might fit in well with his message that recovering from serious mental illness is unpredictable. 
Hal's suicide was maybe just a little cliche. It's probably necessary in a book set in a hospital to show someone not making it--it wouldn't have been realistic otherwise. But it too conveniently precipitates changes in Caden's own situation (the firing of the swabbie, the new group counselor, the scolding of Poirot by the administration), and Caden's own falling apart. A smaller effect of Hal's suicide--i.e. forcing Caden to commit to this institution rather than move to another one--is, however, a somewhat interesting, non-cliche moment. 
The ending was awkward, with one last appearance of the Captain. I appreciate that Caden's story is open-ended, and I like the message that illness will always be a struggle, but I'm not sure I wanted to see the evidence of Caden's fragility via yet another hallucination of the Captain, in public, while he's with his family. I loved the way Caden seemed physically weak when he got home. I recall feeling that way after getting out of the hospital, or after a really bad flu. You're on the recovering end, as if you're back from a kind of death, and there's a feeble sort of joy in your new freedom, but you still feel like the world is too bright and strong for you. I thought Mr. Shusterman captured that well. Thus, returning to the Captain was somehow not as poetic a metaphor as it was in the rest of the book--it became an object, a device to tell us Caden's peace was fragile.  
Audiobook comments: 
The narration was a bit sloppy in the audiobook. The narrator, Michael Curran-Dorsano, is an actor, and tries to be impressive, but the overall result feels over-the-top, dramatically, and workman-like, technically. For instance, he recorded the whole book saying "Calliope" incorrectly, and then when the editor dropped in the corrections, they missed half of them. Mr. Curran-Dorsano mispronounced several other words. It also made no sense that many characters (the swabbie, the Navigator) had English accents when they became their "real-life" counterparts. Unless, I guess, we're to think Caden hears their voices that way because of his illness.
I hear there are illustrations in the print version of this book, drawn by Mr. Shusterman's son (who has schizophrenia). I'll have to sneak into a bookstore to look at them. But let me take this moment to beg publishers everywhere: when a book has illustrations, make them available online to audiobook listeners. Surely we have that technology, via an online access code or something.


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