Holding on to Zoe: A Psychtember Review

Patient: Holding on to Zoe by George Ella Lyon

Presentation (from Goodreads):  
"After sixteen-year-old Jules has her baby, Zoe, it doesn’t matter anymore that her mother thinks she’s a drama queen, or that her father left them years ago, or even that Zoe’s father is gone, too. She and her baby make a family now; she doesn’t need anyone else in the world except Zoe. Though it's tough being a new mom, balancing Zoe’s needs with working at the Toyota factory and thinking about how to finish school, Jules is sure she’ll figure it out. Still, she wonders, why can’t anyone be happy for her and Zoe? And why does her mom refuse to believe that Zoe's real?"

*Note: there are huge spoilers discussed in the Axis 4 section of this review, so if you wish to avoid spoilers don't read that part!

Assessment:

Axis 1. Characters

There's just a small cast of characters in this book, with the focus primarily on Jules. If you like unreliable narrators, you'll probably like Jules, because she's about as unreliable as they get. We get such a skewed viewpoint from Jules that we don't know exactly what's true and what's not — although this would have been even more the case, and thus more mystifying and unsettling, if the back cover description didn't give so much away. 

Jules' mom is the complete opposite of helpful, and deserves to be in the running for the Most Annoying and Neglectful Mom of the Year. She keeps pushing Jules when her daughter is obviously having trouble, and she never believes her, which frustrated the heck out of me. Really, it's depressing that she just doesn't seem to care that much about Jules.

 

Axis 2. Premise/plot

This is a short, character-driven book. It's almost like a character study of someone who develops psychosis— their reactions, behaviour, mindset — written for the YA crowd. As I mentioned above, I think the back of the book gives away too much of the plot, and it would have been more surprising if I had known less about it going in.

Axis 3. Writing Style

The writing is simple and minimalist, bringing to mind the bare-boned structure of a play. It flips back and forth between the present and the past (doing so without warning, which is a little confusing).

Axis 4. Psychological Accuracy

There are MAJOR spoilers here (sorry, it's pretty much impossible to avoid them and still assess this book's psychological accuracy!). You have been warned.

The "teen girl gets pregnant and wants to keep the baby" storyline has been done many times before, but the way Jules reacts is different than what we usually see. In her case, the conditions (trauma in the past, father gone, mother as a poor support system) are right for pregnancy to act as a trigger for psychosis. It's a little unnerving that someone can have such a completely different take on reality than most of us, but I had to feel bad for her because she wants a baby so badly that she basically won't let anything else enter her head. While I found it difficult to feel close to her, the fact that she's delusional is not alienating; the reader will not have trouble hoping that Jules will get help. Jules' voice sounds very young for her age — more like 13 or 14 than 16 — but this might be due in part to her mental state; it certainly works to convey her naivete and obvious need for help.   

It's told in 1st-person POV, so the reader is placed fully in Jules' mind, and it becomes obvious how her perception of her environment has been contorted to reflect this inner reality she's crafted, so that everything makes sense within this delusion of hers. She displays the symptoms of hallucination (she sees a bunch of socks tied together as a baby) and delusion (she believes she has a baby), and her level of social functioning has certainly declined as well. Jules also shows a few signs of atypical cognitive functioning — she seems to talk back and forth with herself, and she sometimes uses word association. These are perhaps indicative of thought disorder (which can be a symptom of schizophrenia), although they're not a defining feature of her presentation. Depending on how long she has been having trouble, she would probably be diagnosed with either schizophreniform disorder (more than a month but less than 6 months) or schizophrenia (over 6 months). It's difficult to tell how long she's been exhibiting symptoms since the story jumps around a bit in time. I suspect the most likely subtype Jules would fall under would be undifferentiated schizophrenia; she's a little bit edgy about how other people view Zoe, but I don't think it's enough to qualify her for paranoid subtype.

As for the therapy, I'm not certain which theoretical orientation Emma uses. She asks a lot of questions, and uses some unusual techniques to connect with Jules, but almost seems to operate from a psychodynamic understanding in some respects — the significance she places on memories, for example. I didn't buy the "breakthrough" that Jules has; the unlocking of her memories and subsequent destruction of her delusion happens too quickly and easily to be believable. 

That said, the actual explanation for her developing psychosis — that she was sexually abused in childhood — is plausible, as there does seem to be a connection between the two. I suspect we're meant to take a Freudian interpretation of it: Zoe representing Jules' "inner child" who was abused, and Jules now wanting to protect that little girl. I'm very dubious, however, about the sudden disappearance of Jules' delusion from nothing more than retrieval of repressed memories. "Recovered" memories are a tricky business, seeing as therapists can influence clients to "remember" something that never actually happened. In any case, I would suspect a longer relationship with the therapist would be needed before Jules felt comfortable enough to let herself access these memories. While it's a good sign that Emma is able to create a positive, trusting relationship with Jules, the whole thing still happens rather quickly.

Furthermore, I'd like to better understand the role the medication played here. There are a few brief mentions of pills Jules takes (she believes they're vitamin pills) but I'd really like to know more details. Anti-psychotics are one of the primary methods of treatment for psychosis, and yet they seem to provide Jules with very little benefit. Jules' recovery is quite obviously attributed to the memory retrieval, but in real life I suspect the anti-psychotics would be far more effective.

Validity Score: How psychologically accurate was Holding on to Zoe?

Patient shares symptoms with: Without Tess by Marcella Pixley

Patient's statement:

I will never let anything bad happen to Zoe. No one will hurt or scare her; she'll never be hungry, afraid, or alone. Not while I'm alive. I sat in that day care one whole day watching everything Mrs. Jamieson did before I agreed to leave Zoe there. I know what she's fed, how often she's changed, what they do at nap time. I know Allie and Mary Jane and Glenda, who also work there, and they know I'm paying attention. There's a lot in this world that would gobble little girls up. Dark places in every neighborhood. Most parents don't see, but I see. That's my job. 

Diagnosis: 3.5 shooting stars.

For more information about schizophrenia, see here.

Disclaimer: I received this book as an ARC for review from the publisher. 

This book counts toward my goal for the Just Contemporary reading challenge.