September 25, 2012

Perfect Escape: A Psychtember Review

Patient: Perfect Escape by Jennifer Brown

Presentation (from Goodreads): Kendra has always felt overshadowed by her older brother, Grayson, whose OCD forces him to live a life of carefully coordinated routines. The only way Kendra can stand out next to Grayson is to be perfect, and she has perfection down to an art -- until a cheating scandal threatens her flawless reputation.
Behind the wheel of her car, with Grayson asleep beside her, Kendra decides to drive away from it all -- with enough distance, maybe she'll be able to figure everything out. But eventually, Kendra must stop running and come to terms with herself, her brother, and her past.
With undeniable grace and humor, acclaimed author Jennifer Brown explores OCD, the pressure for perfection, and the emotional highs and lows of a complex sibling relationship.

Axis 1. Characters

Kendra: Honestly, I found her pretty annoying through most of the book — not so much in terms of personality (although she does act kind of sanctimonious, like she knows best), but more in terms of the choices she makes, some of which are obviously poor decisions. For instance, going on this very unplanned roadtrip and worrying her parents like crazy. That made me mad, because it's so inconsiderate; I wanted her to think about other people for once! She's quite self-centered, and even towards the end she's not really thinking about what they'd be going through. Sure, she's in contact with them periodically (and rather sporadically), but she hardly gives them any information at all. I rather suspect this sort of perspective is fairly common in teens though, where they can't stretch their minds beyond their own little bubble to try to think about what their parents might be feeling.

In Kendra's defense, by the end she does think about what it would be like to be someone else — specifically, Grayson — and she finally takes in what he's saying. I'm glad she at last came to a certain realization (spoiler, highlight to read: that she can't "fix" her brother and shouldn't really be trying, that she was creating a "shadow" for him as well, and that she hadn't really thought about how it must feel for Grayson), but it took a long time! For all the pondering she does — and yes, she can be very reflective, spending a lot of time thinking about Grayson's and her motivations and behaviour, etc. — the girl is quite dense in some ways. Plus, oddly enough despite all this personal reflection, she also makes these rash decisions that seem like she's not really thinking things through at all!

I also wish we'd gotten more insight into Kendra's problems in striving for perfection. She recognizes why she does it, but I would have liked to have better understood how a certain plot got started (spoiler: the cheating storyline. As it is, it seemed like a subplot thrown in there to show that Kendra wasn't perfect, and just didn't seem that well-formed. I felt like we were missing something.)

In some ways, Kendra's very immature, but in her personal analysis she can be too mature for her age sometimes. Her level of insight is a bit too deep to be believable for a teen. 

Grayson: Jennifer Brown does quite a good job of portraying an individual with serious obsessive-compulsive disorder (OCD). It's difficult to discuss Grayson without talking about all of the psychological aspects, so an in-depth look at his character is below, on Axis 4.  

Kendra and Grayson: It's refreshing to see such an involved brother/sister relationship; it's unusual for that to be the focal point of the story in YA. Obviously in some ways Kendra and Grayson don't understand each other very well, and with Grayson being in and out of treatment they haven't seen that much of each other. When they were younger, though, they had a fairly healthy relationship, and it's good to watch them trying to renew that towards the end. There's also a bit of interesting role reversal going on, since the older brother is the one with a mental disorder; this changes the dynamic of a traditional older brother/younger sister relationship. 

Rena: I'm not sure how I feel about the addition of Rena (and Bo) to the big picture, since they seemed stuck in there more just to flesh out the cast than to have a storyline in their own right. However, I did like Rena as a person, and she makes a good contrast to Kendra — in some ways they're similar, in others quite different. Rena's a stranger, and has no history with Grayson, so she can treat him differently than Kendra does. Her role as a teen mom reflects the theme of responsibility, which ties into other aspects of Kendra's life. I must say, though, that Rena's and Bo's story could have used some more resolution; I was still curious about how things turned out for them by the end.

Axis 2. Premise/plot

The pacing of this book is really, really molasses-like slow. At least until the final few chapters, when everything comes to an emotional head. When they first start out on the road trip, there's a little bit of momentum, but then there's a huge chunk in the middle where frankly, not much happens. They meet Rena, they wander around, they stay at crummy motels, they swim in a stream, and Kendra tries to cure her brother's OCD. There's also a fair bit of repetition in Kendra's introspective analysis of herself and her brother. It would be good if she could actually accurately analyze herself, but it takes her a while. Basically, I like the idea of the premise here, but not the execution.

I thought there should have been more exciting plot points happening — after all, it's a road trip! But this is probably the worst road trip I've read about. The emotional stress that the characters are undergoing means that no one is really having any fun for most of it, and that means the reader isn't either. Basically, it's a depressing road trip. 

I wish we'd seen what happened once they returned home, both in terms of the fall-out from Kendra's past transgressions (spoiler: the cheating-on-exams fiasco) and in terms of Grayson's next steps. It would have been nice to have gotten some indication that he would be returning to therapy/treatment. He obviously has trouble functioning in some situations due to his anxiety disorders, and that's something he should get help for, particularly as it's affecting the rest of his family. The family dynamic is complicated, but we don't really get to see much of the parents, unfortunately. I hope that Kendra and Grayson tell their parents what they told each other, because while they try pretty hard to be good parents, they're not going to know everything going through their kids' minds.

There's no central romance, and while I do like a romantic plotline in my books, I think a romance would have been out of place here. It would have hijacked the whole storyline involving Grayson's OCD and his relationship with Kendra, and that is obviously the heart of this book. Not all YA books need a romance, but a lot have them, and it's kind of gutsy of Jennifer Brown to write a YA without one. (On the other hand, it might have moved the plot along a little faster!)

As for the Zoe subplot, I enjoyed the final climactic scene where Kendra defends her brother; it was nice to see her finally stand up for him, because in her own head she does a lot of blaming him and being ashamed of him. I also liked how this storyline was resolved — it's different and a little unexpected. Spoiler: it was somehow rewarding to see that Kendra wasn't so attached to Zoe and their history of friendship that she was willing to let bygones be bygones. Kendra makes the choice to dissolve the friendship, and I appreciated that she doesn't act like the perfect friend.  
Axis 3. Writing Style

I didn't think the writing style was anything really special. It's somewhat repetitive, and while the quality of the writing is pretty good, the style itself is fairly generic. It's easy to read, though, and towards the end the drama is handled quite well.

I would have welcomed some more description of the places they go (minus the motels — we're told enough about those). I know that the road trip isn't really the point of the story, but more detailed description of the scenery might have been nice. 

The dialogue is authentic for the most part, and the emotions the characters display are quite realistic. This is especially true for the interactions between Kendra and Grayson. Jennifer Brown does a good job of getting into the head of an individual whose brother has OCD, and exploring the different layers of emotion that would accompany someone who has to deal with all the consequences that come from living with him. Even when Kendra and Grayson have a "heart-to-heart," the author doesn't go over-the-top into super sappy. Really, the last couple of chapters were some of the best because all of the emotions are finally coming out after having been damped down by both characters.

Axis 4. Psychological Accuracy

For someone trying to understand classic OCD, and what it's like to live with a family member with a serious form of it, I think this would be a good portrayal to read. Grayson displays several symptoms of OCD as well as what I suspect is generalized anxiety disorder (GAD). We're told that he struggles with anxiety disorders and depression in addition to his OCD, but we're never told the specifics. I'm not so sure about the depression; he has a pretty low mood generally, so perhaps he is dysthymic, but I don't know that he qualifies for major depressive disorder.

His anxiety disorder symptoms are numerous. For starters, counting and arranging are compulsions for him, making me inclined to say that he has a symmetry subtype of OCD. Grayson also struggles with germs, so he may have the contamination subtype as well (it's difficult to say if his issues with germs are GAD, OCD, or both). Grayson has a variety of compulsions he performs — counting the number of steps he takes, counting rocks, counting numbers out loud, having one rock in each pocket, and others.

Some of Grayson's OCD behaviours make a certain sense to him. For instance, he believes he needs to quit counting on an even number to keep people safe ("He told me a year ago that if he stopped counting on an odd number, even accidentally, it meant that someone he loved would die"), which is typical of OCD. However, even Grayson himself doesn't know why he does certain actions. For instance, Kendra at one point asks him why he starts arranging rocks on the car dash; his response is a simple, "I don't know...It felt like I needed to." This "just right" feeling is fairly common in individuals with OCD. Kendra also raises the interesting point that Grayson can develop a new obsession or an old one can return, which I think is true of many individuals with OCD.

His worries — about dying of disease, danger in crossing overpasses, natural disasters — seem to fit with GAD. The focus here is definitely more on his OCD, though, since that is the more obvious issue he is dealing with. I wish we'd seen more of his other anxiety disorders separate from the OCD, but obviously in someone co-morbid for two or more anxiety disorders, there will be some entangling of the disorders. There's overlap and interaction going on, so you can't tease them apart from each other fully. That's actually illustrated quite well here in that you can't exactly separate Grayson's OCD from his GAD (and whatever else he might have), and there are obviously certain themes that cross disorders. For example, his concerns about germs seem to crop up in both in his OCD and GAD symptoms. Still, it would have been helpful to have been given a standard psychological explanation for his other anxiety disorders. Kendra mentions that he "what-ifs" and catastrophizes, which are definitely associated with GAD, but we're not privy to much detail.

Grayson also presents with a symptom that I wasn't aware was associated with OCD, but apparently can be: a throat-clearing tic. I did a little bit of research and there is an overlap in patients diagnosed with Tourette's syndrome who have OCD symptoms, and vice-versa. In fact, it looks like certain researchers have designated a specific set of symptoms "Tourettic OCD." I'm not sure that Grayson would fulfill the requirements for full-blown Tourette's syndrome, but his throat-clearing tic (and perhaps his need to tap) might qualify him for "Tourettic OCD" in addition to classic OCD. Since we're not reading the book from Grayson's perspective, we don't really know what sensations or cognitions he's experiencing, so it's difficult to say if some of his behaviours fall more into the "tic" category or the "compulsion" one.

Occasionally he'll also have an emotional/mental meltdown, which I suspect would be considered a panic attack. I think in Grayson's case these panic attacks are more strongly related to his GAD symptoms, although he also gets flustered and anxious when his compulsive rituals are interrupted.

One can't really separate Grayson from his symptoms, since they're a large part of who he is at this point in his life. However, we are shown that he has a great personal interest in rocks — and unlike his sister Kendra, who calls him a "rock junkie" at one point, I don't think that aspect of Grayson is really part of his OCD or other symptoms. Yes, he likes to count rocks, but I think the obsessive-compulsive aspect there is the counting more than it is the rocks. After all, sometimes he just counts numbers on their own, or the steps he takes. I wish this distinction had been made clearer.

Also, it should be noted that Kendra really shouldn't be trying to treat her brother.  She has no credentials or training, and doesn't even fully understand what exposure therapy is. Plus, her personal connection to him makes things even more complicated. There are just so many ways in which it could go wrong — and Jennifer Brown shows us this. It's good to see, though, that Grayson has a sense of responsibility about his own disorder and recognizes that he needs his medication.

Validity Score: How psychologically accurate was Perfect Escape?

Axis 5. Miscellaneous

Personally, I found Bitter End (which I reviewed for Psychtember last year) more gripping. Perfect Escape just doesn't have as much driving it, giving it momentum.

Patient shares symptoms with: Compulsion by Heidi Ayarbe, A Scary Scene in a Scary Movie by Matt Blackstone, Lexapros and Cons by Aaron Karo

Patient's statement:

"I couldn't count how many times I'd watched Grayson do this. When I was little, I used to wait until he was finished and then run up beside him and brush my hand through the lines just to mess them up. It made him cry and his face always got beet-red and I thought it was funny. But by the time we were ten and thirteen and he was spending sometimes four hours a day lining up his coins and pulling out wads of his own hair in frustration because he couldn't get them perfect, it wasn't funny anymore. I spent a lot of those nights sitting next to him with a ruler in my hand, helping him move coins such minuscule degrees I couldn't even see the movement. Is this good, Grayson? Does this make you happy?"

Diagnosis: 3 shooting stars. (This is my rating for the story overall, not specifically the psychological aspect.)

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

This book counts towards my goal for the 2012 Just Contemporary reading challenge

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