Clean: Guest Review

I'm pleased to welcome Small Review to the blog today for a guest review of Clean by Amy Reed!

Clean by Amy Reed 
Release Date: August 9, 2011 
Publisher: Simon Pulse 
Pages: 288 
Received: ARC from publisher  
Rating: 3 out of 5 stars  
Goodreads Page 

Summary

From Goodreads: Olivia, Kelly, Christopher, Jason, and Eva have one thing in common: They’re addicts. Addicts who have hit rock bottom and been stuck together in rehab to face their problems, face sobriety, and face themselves. None of them wants to be there. None of them wants to confront the truths about their pasts. But they’ll all have to deal with themselves and one another if they want to learn how to live. Because when you get that high, there’s nowhere to go but down, down, down.

 

Review

Do you see any sparkles here??
 

Nope, not a sparkle in sight and, really, this is so NOT my genre. So why in the world was I reading this book? I really don't know. Nostalgia? Ten years ago I would have loved this book. Maybe the cover? Something about it is eye-catching (though I don't know who that girl is supposed to be). Whatever the reason, I downloaded it and opened it up with the intention of reading a few pages to give it a shot.  

Before I knew it, I had read half the book. And then I read the other half. Clean is compulsively readable. It's broken up into three different types of chapters: larger sections narrated by either Christopher or Kelly (why only these two? I have no idea); small, paragraph-long first-person narratives of each of the characters; and group therapy sessions that read like a transcript for a play. Each type is relatively short and easy to blitz through. 

Still, even though I found Clean to be extremely readable, I didn't exactly like it. Like I said, it's just not my genre anymore. It was depressing (obviously, they're all drug addicts with family sob stories that led to their addictions) and left me feeling absolutely horrible afterwards. I guess that's a sign that Amy Reed did a good job in conveying the feelings of depressed, drug-addicted, family-issued teens, so points for that.  

But, bleh, I feel like I need to go read a book about rainbows and puppy dogs and maybe even Santa Claus just to help turn my frown upside down when I was done. 

Multiple narrators
 

The multiple narration really helped move the book along by breaking everything up into easy to read sections, but I don't think it was as successful as it could have been. With the exception of Eva, none of the voices were very distinct. Their stories were distinct and so it was easy to tell who was speaking given the subject they were speaking about, but their manner of speech was really very similar. 

I also don't feel like I really got to know any of the characters. Maybe this is the nature of the book, but while I know the intimate details of their histories and their issues now, I don't feel like I know who they are as people, which is sort of funny considering all of the mantras about people being more than just their issues or diagnosis. Not in this book.  

Instead of creating individuals that can really come alive off the page, the characters come across as generic collections of issues and mouthpieces for the associated feelings that typically go along with those issues. Some of the secondary characters were also extreme groan-inducing stereotypes. Though I prefer realistic characters that feel alive, I can see how this would be an effective tactic for a book like this. Readers who are going through similar situations will likely find it very easy to relate to and project themselves onto these characters.  
 

Will it punch you in the gut?

Yep, it probably will. Because even if the characters are little more than vectors for their issues, they are stunningly accurate vectors. Amy Reed clearly captures the feelings that teens going through those situations feel in a way that is searingly honest and incredibly effective. 

This is much less a book about drug use as it is a look at the psychological motivations and feelings of a person in these various situations. Drugs aren't really talked about all that much and the book never really goes into any details about the physical feelings and effects of drug use. 

While perhaps Amy Reed's teens are a little more in touch with their feelings and motivations than a real teen would be, this makes her book all the more useful for real teens searching for a source to help them understand their feelings. Clean reads very much like a psychologist's notes outlining exactly what the characters (and people in similar situations) are feeling and why they feel what they feel and do what they do. 

From a psychological standpoint, Clean gets full marks. The issues, motivations, and feelings touched on are spot on and make psychological sense. Halfway through the book the parents make an appearance, and their actions as well as their impact on their children are equally realistic (with the exception of the over the top stereotypes).

Bottom line
 

This isn't my genre, so I didn't love it. I felt depressed and wrung out after reading it, especially given the open ending that offers only a little hope. Readers who do enjoy books like this will probably love Clean as it is a solid addition to the genre. 

It should come as no surprise, but this book includes numerous references to drug use, sex (hetero and homosexual), rape, teen pregnancy, drinking, physical abuse, eating disorders, and cursing.   

Explanation of rating system: Star Rating Key 

 

Do you have any questions about Clean that I haven't addressed?  Feel free to ask in the comments!

Thanks for sharing your thoughts on Clean, Small! 


You can find Small on her Young Adult and Middle Grade book blog Small Review. She holds a BA in psychology with concentrations in psychoanalysis, behaviorism, and clinical psychology. She has worked with young adults in various in-patient and out-patient settings. She is still trying to find a behaviorism schedule that will encourage her to exercise daily (using chocolate as a reward apparently undermines the process).
 

Clean: A Psychtember Review

Patient: Clean by Amy Reed

Presentation:  

Olivia, Kelly, Christopher, Jason, and Eva have one thing in common: They’re addicts. Addicts who have hit rock bottom and been stuck together in rehab to face their problems, face sobriety, and face themselves. None of them wants to be there. None of them wants to confront the truths about their pasts. But they’ll all have to deal with themselves and one another if they want to learn how to live. Because when you get that high, there’s nowhere to go but down, down, down.

Assessment:

Axis 1. Characters


Since Clean stars five main characters, it takes a little bit to figure out who's who in the cast of characters and get a handle on what each character is like. Kelly and Christopher are the two teens telling the story, but we get excerpts from the other three perspectives throughout. Of course, more page time is devoted to Kelly and Christopher, so we get to know those two the best. 

Kelly, Christopher, and Olivia all come across as complex, multi-dimensional individuals, with rather unexpected stories of how they became addicted and ended up in rehab. I felt the closest to Kelly; her observations about the others were at times entertaining, at others heartfelt, and it was easy to connect with her way of viewing the world. I couldn't relate as well to Christopher, and found his voice somewhat inauthentic for a teenage guy. Both Kelly and Christopher wax introspective and thoughtful at times, with some of their insights seeming a bit too advanced for their age; occasionally it feels like an adult voice slips in here. With Kelly I could buy it most of the time — once we get past a bit of a shallow exterior, she actually seems like a smart girl who has just developed some very bad methods of coping with her emotions and problems. However, I found the mature nature of some of Christopher's reflections a bit too unbelievable.

Olivia fascinated me the most; there's more going on with her than just an addiction to diet pills, and I would have loved seeing the issues she's facing in greater depth. I don't feel like I really understood her mindset, but I certainly wanted to know more about her. Jason was a more stereotypical character for this setting — a "tough guy," with a "tough guy" father who clearly wields the power in their home — but even though his story is simpler compared to some of the others, it's still rewarding to see him learning and changing. It was Eva, actually, that I felt I couldn't really pin down or understand. She writes her "personal essay" excerpts in third person and her style is dramatically vague; apart from the neglect her father shows her, we aren't really told a lot more of her story.

Axis 2. Premise/plot


I liked the premise of a rehab facility bringing together different individuals and forcing them to interact. However, the method of showing the group therapy sessions using a screenplay format removed some of the potential chemistry between characters for me as a reader. Somehow, without all the body language, the group dynamic wasn't quite there, and the quick back-and-forth between characters with no intermittent description made it more difficult to visualize the scene and keep track of who was speaking.


Now, this book is all about the characters, so don't go into it expecting a riveting, action-filled storyline. If books about individuals coming to personal realizations are your thing, though, then Clean's for you. Addiction's always been one of the areas in mental health that particularly interested me, so I enjoyed discovering how these five teens had gotten to the low point they're at. However, one of the strengths of Clean is that it isn't just about the addictions. There are a lot of themes touched on — family pressures, sex, friendship, bullying — and many shared emotions: fear, regret, guilt, need.

Axis 3. Writing Style

Having five main characters — whose viewpoints we see in one way or another — is ambitious, but Amy Reed pulls it off quite well here. The format is an unconventional one; typical first-person narratives are combined with excerpts from "personal essays," a "drug and alcohol questionnaire" and conversations written in screenplay style. As mentioned above, though, we don't get to know all of the characters on the same level.


In terms of pacing, like most character-driven books it's quite slow-moving, and I felt that it dragged a little in the middle. Many of the scenes or excerpts are very similar, making it feel repetitive at times. I also found that the dialogue really varied for me, between being quite authentic (lots of swearing in here, which many teens are prone to) and sounding somewhat cliched and/or unrealistic as the teens underwent their personal revelations.


Axis 4. Psychological Accuracy

I appreciated the variety of types of addictions covered in Clean. Hard drugs, "soft" drugs, alcohol, diet pills...it runs the gamut (although no gambling addictions, unfortunately). The different ways in which each teen got hooked on a particular substance demonstrate how anyone can become an addict, serving to dispel the misconception that it's due to a lack of willpower or some other personality "flaw." The emotional aspects of addiction are portrayed quite well, but I was surprised not to see more of the physical signs. There isn't much mention of withdrawal symptoms, which I'd expect to appear in at least one or two of the main characters. I thought they would be experiencing more cravings, although I suppose it depends on how long they've been sober (and they are admittedly receiving some medications while they're in rehab.) Kelly does show signs of genuine craving, for "a line, a shot, pills, anything to leave this world for somewhere upside down." Still, the emphasis appears to be more on causes and effects of addiction than the actual in-the-moment experience of it.


My more significant area of contention is with how Olivia's mental health problems outside of her addiction are handled. At one point she's referred to by Kelly as "the anorexic girl with OCD," yet most of her behaviour does not indicate obsessive-compulsive disorder. She likes to arrange her shoes in a row and alphabetize her books, she's very concerned about getting all of her homework done, she's a big fan of organization and lists, and most importantly, she is constantly striving to be perfect. To me, these scream obsessive-compulsive personality disorder (OCPD), *not* OCD. Yet I don't believe OCPD is actually even mentioned by name at any point. These are two different disorders and it always frustrates me when I see them getting confused, so I am going to lay them out here (most of the information is from my Abnormal Psychology textbook, but I also used this website)

OCD:

• Involves obsessive thoughts followed by compulsive behaviour to neutralize them
• The obsessions cause anxiety, making the OCD ego-dystonic
• The treatment is typically medication and/or CBT (exposure and response prevention)

OCPD:

• Involves a pattern of fixation on order, perfection & control
• Symptoms can include extreme perfectionism, reluctance to delegate, overconscientiousness, miserliness, rigidity and stubbornness
• There are no specific obsessions or compulsions
• The individual does not find the OCPD distressing, making it ego-syntonic
• There has not been a lot of research done into treatment

It's worth noting that there has been discussion of including both of these disorders on an "obsessive-compulsive spectrum" but at the moment, in the current DSM (Diagnostic and Statistical Manual of Mental Disorders), they are categorized entirely separately. (In fact, in the proposal for the updated DSM-V, OCPD is still being included with the other personality disorders.)


Now, anorexia can be comorbid with either of these disorders (according to The Writer's Guide to Psychology), and my university abnormal psychology textbook cites a 20% overlap of OCPD patients who also have an OCD diagnosis. So theoretically, Olivia could have both, in addition to her eating disorder and addiction. However, not only do I find this to be rather a lot of disorders in one character (the interactions between them would be extremely intricate), but I also don't think Olivia demonstrates much evidence for OCD. There's one mention that she seems to have trouble with germs (at the bowling alley), which I feel was thrown in there in an attempt to demonstrate OCD. Perhaps the shoe- or book-arranging could be signs of OCD, if she actually had obsessions about numbers or symmetry. But the glimpses we get of Olivia's perspective don't suggest these kinds of unwanted thoughts and compulsions.


And yet, we're told by Christopher that she's taking medication for OCD which seems to have helped decrease her "crazy organizing." It's possible that both Kelly and Christopher are misinformed or have gotten confused, but really, Olivia's true problems should eventually be cleared up. While a bit more happens with Olivia's eating disorder by the end (in fact, I learned something new about anorexia!), the OCD/OCPD confusion is not dealt with.


Group therapy has been shown to be effective in helping to treating substance abuse, so that's in line with the facts. But I found the counselor Shirley to be rather changeable in mood and attitude. She'd be compassionate one moment, then she'd switch to "tough love," or try to relate to the teens, and even sometimes came off as sarcastic and condescending. The scenes we usually see Shirley in are written in the screenplay style, so we don't get any hints of her body language or tone, making her more difficult to understand. Perhaps her therapeutical orientation is eclectic, using a mix of therapy styles; I'm not familiar enough with rehab therapy to assess how accurate her approach was. However, to me she embodied several different versions of what people think of when they picture an addictions counselor (e.g. from movies or TV) — more a mash-up of various therapist stereotypes/representations than wholly her own person.

Validity Score: How psychologically accurate was Clean?

Axis 5. Miscellaneous

I enjoyed the humour that came through some of the character's perspectives, usually in the form of acerbic remarks and observations about other individuals in the program. It provided a lightness to balance the more serious nature of the teens' pasts and present situation.


And I liked the ending, it actually had me tearing up a tiny bit because it really captured the journey the characters have gone on. 

Patient's statement:

I think the idea is that if we realize we're not completely to blame, then maybe we'll start believing there's some good left in us after all, and maybe that will make us want to get sober. I mean, nobody just becomes a drug addict for no reason, right? Nobody just decides they're going to be totally lame and lose control and get bad grades and make their parents hate them. I get it, but it's just not going to work for me. All it does is make me feel worse, because now it's just that much more obvious that there's no excuse for why I turned out the way I did. No one ever abused me. No one in my family is an alcoholic. Nothing traumatic ever happened to me. The truth is, my parents are the nicest people in the world and I keep breaking their hearts for no reason.

Diagnosis: 3.5 shooting stars. Despite some of the inaccuracies, I did enjoy getting to know the characters and watching them change.

Note: There is some mature language and content in this one, so I wouldn't recommend it for the younger set.


For resources on addiction, go here.

For my interview with Amy Reed, and a giveaway, go here!

Psychtember Interview with Amy Reed

Amy Reed is dropping by for a Psychtember interview! She's the author of the YA novels Beautiful, Clean, and the upcoming Crazy.

Here's the synopsis for the recently released Clean:

 

Olivia, Kelly, Christopher, Jason, and Eva have one thing in common: They’re addicts. Addicts who have hit rock bottom and been stuck together in rehab to face their problems, face sobriety, and face themselves. None of them wants to be there. None of them wants to confront the truths about their pasts. But they’ll all have to deal with themselves and one another if they want to learn how to live. Because when you get that high, there’s nowhere to go but down, down, down.

And a bit about Amy:

Amy Reed was born and raised in and around Seattle, where she attended a total of eight schools by the time she was eighteen. Constant moving taught her to be restless, and being an only child made her imagination do funny things. After a brief stint at Reed College (no relation), she moved to San Francisco and spent the next several years serving coffee and getting into trouble. She eventually graduated from film school, promptly decided she wanted nothing to do with filmmaking, returned to her original and impractical love of writing, and earned her MFA from New College of California. Amy currently lives in Oakland, California.


Her short work has been published in journals such as Kitchen Sink, Contrary, and Fiction. Her first Young Adult novel BEAUTIFUL was released in the Fall of 2009 (Simon Pulse/Simon & Schuster).   Her second YA novel CLEAN has been described as “The Breakfast Club in rehab,” and releases July 19, 2011.

And now the interview!

1.)   Clean features 5 main characters, each with their own specific addictions and stories of their journey to rehab. What kind of research did you have to do to make each teen’s background believable? Do you have a personal connection to one character in particular?

Apart from some basic technical research about anorexia (for Olivia) and autism (for Kelly’s sisters), I didn’t have to do much research for the girls. I had a very deep personal connection to all three of them--their feelings were so familiar, it didn’t take much effort to really try to think like them and understand the motivations for their actions. The boys were much harder, however. I wouldn’t say they required research, but it was more of a challenge to try to understand where they came from and why they turned out the way they did. For Christopher, I really wanted to understand how such a stereotypically “good” kid could get turned on to drugs, and I realized quickly he had a big secret that was like poison to him, and he’d never start to recover until he came to terms with it. Jason was definitely the hardest character to write. I wanted to understand what made a sexist, homophobic bully; I wanted to find the humanity inside the kind of guy I always hated as a teenager. I came to understand that he was mirroring what he grew up seeing, that his concepts of strength and weakness were skewed by a very abusive home. None of this took research really. It’s just a matter of trying with all your heart to imagine what it’s like to walk in someone else’s shoes.

2.)   While the reader is exposed to all of the teens’ viewpoints through excerpts from items like personal essays, a good part of the story is told through two of the main characters’ perspectives: Kelly and Christopher. Why did you choose these two? How do you think the effect of Clean might have changed if, for instance, Jason and Olivia were telling the story instead?

You know, I’m not really sure why I picked Kelly and Christopher. At first, the five voices were going to be equal, but my agent and I decided it would make more sense to focus on one or two. I don’t remember the thought process that went into choosing. So much of writing is based on instinct rather than logic. In retrospect, I’m glad I picked them. I think they’re the most likeable characters out of the five, so it might have made it easier for the reader to relate to them despite the difficult and possibly alienating subject matter. If it had been Olivia and Jason, I don’t know if I could have kept the reader’s attention long enough to discover their redeeming qualities.

3.)   Olivia’s problems are more complicated than just an addiction, yet she is at the rehab clinic for weeks before it becomes dramatically apparent that she needs more help than they can give. Why do you think this fact was able to slip by all of the staff working there? Would you say this is a common occurrence at a facility like the rehab clinic they attend? If so, what suggestions would you make to the staff so that cases like Olivia’s are caught more quickly?

That’s a tough question. Of course, I can’t speak for all rehab clinics or make any blanket statements about their successes and failures with things like this. But I do know that many, many addicts and alcoholics have a dual-diagnosis with depression, bipolar disorder, eating disorders, PTSD, and countless mental illnesses. Alcohol and drug abuse often start as a way to self-medicate untreated mental illness. I know many people for whom this is the case, and their struggle with addiction has always been, and will always be, intertwined with these other issues. My guess is that it’s common for both parents and professionals to only see the addiction at first. It is often the loudest problem, with the most obvious physical and social side-effects. Eating disorders and mental illnesses share so many of the same indicators with addiction; they may look identical to an outsider. A drug rehab counselor is trained to treat addiction, so that is what they’re looking for, and in the process of focusing on that, they may lose sight of other possible problems, although I think professionals in this area are becoming increasingly sensitive and knowledgeable about dual-diagnoses and treatments. In Olivia’s case, her deeper problems were both exacerbated and masked by her addiction--amphetamine use often comes with weight loss and obsessive-compulsive behavior. Withdrawal from alcohol and many drugs looks a lot like depression, so counselors may only see a low mood as a temporary side-effect. The key, I think, is long-term treatment.  After the initial phase of acute withdrawal, professionals will be better able to determine what behavior is temporary and what is longer lasting and needs its own treatment.

4.)   Shirley, their group counselor, is another significant character, but we don’t see any sections from her perspective. If Shirley had to write a “personal essay” too, what do you think one of the excerpts would say?

Shirley has battled her own demons, for sure, and she had to suffer far more years of hell than the kids she treats. That’s part of why she’s so tough on them, I think. She doesn’t want them to take their treatment for granted because she lost so many years of her own life to her alcoholism. She didn’t grow up in a family that had the money to send her to rehab, or even cared enough to notice that anything was wrong. This may be surprising, but when I think of her as a teenager, I think of her as being a lot like Kelly. I think she was beautiful and sad and wild, and she had no one to set boundaries for her.

5.)   For some reason, Jason’s dad, Christopher’s mom, Shirley, and “Compulsive Liar” are all coming over to your place for dinner. What happens?

Oh wow, what a nightmare! Well, I think Compulsive Liar would be going through everyone’s purses and coat pockets when the adults aren’t looking. Christopher’s mom would be very uncomfortable and nervous. She’d be asking for Christopher, wanting desperately to go back home to the comfort of her familiar surroundings. But the drama would really be centered on Jason’s dad and Shirley. He would be trying to bully everyone, making offensive remarks about Christopher’s mom, trying to hold court and intimidate everyone. But Shirley wouldn’t let him, of course. She’d fight right back. Outside of the professional environment, she wouldn’t have to be as diplomatic as she was on Family Day, so she’d probably take great pleasure in belittling him in front of everyone.

6.)   I see you’re now working on Crazy, another YA book involving mental health issues. How have the writing experiences of these three books differed? Has it become easier to write these kinds of stories as you’ve progressed?

Yes, CRAZY is actually totally done and scheduled to release next summer. This book definitely took a lot more research than BEAUTIFUL and CLEAN. I did a lot of reading about bipolar disorder symptoms and treatment, some of it very clinical and academic, some of it very personal. I talked to friends with bipolar disorder. I talked to friends who had been to psych wards. Research was a huge part of this book, while it wasn’t so much with the other two. They were all very different writing experiences. I wrote much of Beautiful while in an MFA program; it was half raw emotion, half meticulous workshop revision. Clean was like writing a collage, and I often used scissors and tape to physically find the structure. Crazy was part research project, part character study, and part love letter.

Thanks so much for these thoughtful answers, Amy! I'll definitely be keeping an eye out for Crazy when it hits stores :)