Psychtember Interview with Trish Doller (and Giveaway!))

I'm excited to have Trish Doller on the blog today for an interview about her debut YA novel Something Like Normal!

First, a bit about Trish and the book:

"I've been a writer as long as I've been able to write, but I didn't make a conscious decision to "be" a writer until fairly recently. For that you should probably be thankful.

I was born in Germany, grew up in Ohio, went to college at Ohio State University, got married to someone really great, bounced from Maine to Michigan and back to Ohio for awhile. Now I live in Florida with my two mostly grown kids, two dogs, and a pirate. For real.

I've worked as a morning radio personality, a newspaper reporter, and spent all my summers in college working at an amusement park. There I gained valuable life skills, including counting money really fast, directing traffic, jumping off a moving train, and making cheese-on-a-stick. Also, I can still welcome you to Frontier Town. Ask me sometime.

These days I work as a bookseller at a Very Big Bookstore. And I write." (from her website)

"When Travis returns home from a stint in Afghanistan, his parents are splitting up, his brother’s stolen his girlfriend and his car, and he’s haunted by nightmares of his best friend’s death. It’s not until Travis runs into Harper, a girl he’s had a rocky relationship with since middle school, that life actually starts looking up. And as he and Harper see more of each other, he begins to pick his way through the minefield of family problems and post-traumatic stress to the possibility of a life that might resemble normal again. Travis’s dry sense of humor, and incredible sense of honor, make him an irresistible and eminently lovable hero." (from Goodreads)

And now for the questions...

1.) In addition to some traditional symptoms of post-traumatic stress disorder, Travis also experiences a more unusual symptom — hallucinations. Psychosis is not currently one of the diagnostic criteria for PTSD (according to the DSM-IV), but has certainly been known to occur in conjunction with it. Why did you choose to give Travis this symptom? In particular, how do you feel Travis' hallucinations of Charlie affect the reader's understanding of his character and behaviour?

When I first imagined SOMETHING LIKE NORMAL, I planned for Travis to be physically wounded. He was missing a leg. But the logistics of getting him from point A to point B in every scene became overwhelming, and I started brainstorming ways to manage this. Then I read the memoir of a Marine's experience with PTSD (Soft Spots: A Marine's Memoir of Combat and Post Traumatic Stress Disorder by Clint Van Winkle) and I realized that not all wounds are physical. I think Travis' hallucinations--my cues for which came from Clint's personal experiences--bring the reader a better understanding of what Charlie meant to Travis and how his guilt keeps Charlie alive.

2.) Harper's presence obviously helps to calm Travis down and relieve his anxiety on more than one occasion. How important do you think social support is for individuals struggling with PTSD? What benefits would you say it provides that medication or therapy do not? Are there any ways you feel friends or family might unintentionally hinder an individual's recovery?

I think the underlying message I've received from people suffering from PTSD is that it's part of their lives but not their whole lives. They may need medication and therapy, but the social support goes a long way in helping them feel "normal." There is a scene in SOMETHING LIKE NORMAL in which Travis spends a day fishing with his friends and enjoying time with Harper, and he feels the closest to good that he's felt in a long time. While I'm not an expert, it seems logical that spending time with supportive friends and engaging in positive activities would work well in concert with medication and therapy. And again, while I'm not widely studied on PTSD, I would venture that trying to force an individual suffering from PTSD to talk about before he or she is ready would be unhelpful, even if well-meant.

3.) Travis and Kevlar both exhibit difficulty in re-adapting to life in the US, but they demonstrate this in different ways. Do you think one of them has healthier coping mechanisms? In the long-term, who do you think will be more successful in overcoming their psychological distress?  

I worry that Kevlar's problem avoidance and adrenalin addiction could be a collision course for disaster. I haven't really attempted to look into his future, but reading stories about soldiers with similar coping mechanisms seem to end with the individual developing more problems or ending in death. While I'd like to think that Travis is on the better road to recovery, I left him very deliberately at the end of SOMETHING LIKE NORMAL. He's acknowledged his problems and sought help, but what happens when he returns to Afghanistan? As an infantry Marine, it's unlikely he'd continue treatment while in-country, so we can only hope that the support group he's developed (his mom, Harper, Charlie's mother) and his therapy journal, will be a strong enough foundation to carry him through. That said, I think he's more likely to succeed than Kevlar.

4.) The stigma of mental illness in the Marines is briefly touched on in Something Like Normal. How large a factor would you say this attitude played in Travis' reluctance to seek professional help? In what ways would you suggest the system be changed to better accommodate veterans dealing with mental health issues?

I asked a former Marine what advice he would give to an active duty Marine who recognizes he has a problem, but fears seeking mental health treatment within the organization and his advice was to do it privately through a non-military professional and pay out of pocket. Stay off the radar. While he was speaking from his own experience, I'd be willing to bet it's a pretty clear window on the stigma of seeking help within the system. I'm not sure the answer, but I've read a lot of stories about going to the VA and coming out with pills. And while I think medication can be helpful, I think getting individual (or even group) therapy helps. I know some Marine vets get together to have beers and talk, and I feel like talking is the key. Primarily with people who understand or have been there.

5.) Your next YA novel, All That Was Lost, involves a girl whose mother has bipolar disorder. Can you give us a sneak peek of what we can look forward to?

In ALL THAT WAS LOST, Callie's mother suffers from borderline personality disorder, but--like the PTSD in SOMETHING LKE NORMAL--I approach the subject with a light hand. Callie is dealing with many issues when her story begins and her mother is just one of them. While her life is not unaffected by her mother's illness, the story is primarily about family and the meaning of home. Here's a short snippet from the beginning of the story, when Callie is still with her mother and does not yet fully understand that her mother even suffers from a disorder:

I wonder what set her off this time. It could have been something the man in the leather jacket said. It’s as if she hears things at a different frequency, the way a dog picks up sounds the rest of us miss. Or maybe she hears something that isn’t really there at all. Either way, when she’s ready to go, there is no arguing. There is only leaving.

Thanks very much for these thoughtful answers to my questions, Trish! I'll be keeping an eye out for All That Was Lost come 2013 :)

Trish has generously offered up a copy of Something Like Normal for a giveaway!

The rules:

- Entrants must be 13 years or older.

- Open internationally

- One entry per person

- Following and tweeting are not necessary but always appreciated!

- Ends Sept 30, at 11:59 pm EST.

- Winner will be selected randomly and contacted by e-mail

To enter, please fill in THIS FORM. Comments are awesome but do not count as entries.

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.

Coming To Terms With Psychology Terms

Casual misuse of psychology terminology really irritates me. I'm sure it must be the same for any field of specialization, but I think we see more incorrect use of words related to psychology in books, just because human behaviour is such an important part of characterizations and stories generally.

So, I'm going to list a few terms here and their correct meanings, so that the next time you read them you'll be able to spot them and go, "Aha! This author so totally didn't do their research here."

Psychopathic: describing someone who is a psychopath — an individual with a number of distinctive characteristics, including limited emotional capacity, manipulative tendencies, and an absence of guilt or empathy. As in, "The psychiatrist testified that the serial killer was psychopathic." Not to be confused with psychotic. Helpful pop culture example: Dexter.

Psychotic: referring to an individual who experiences a disconnect with reality, in the form of either auditory and/or visual hallucinations, delusions, catatonia, or a thought disorder (in other words, psychosis). As in, "Sally admitted she saw chartreuse flamingoes doing the hula, and the therapist realized that Sally was psychotic." Disorders which may have psychosis as a symptom include schizophrenia, bipolar disorder and depression, and substance abuse can also result in psychosis.

Schizophrenic: describing an individual with schizophrenia — a mental disorder characterized by a combination of symptoms that may include psychosis, personality/behavioural change, and difficulties with social, emotional and cognitive functioning. There are five subtypes of schizophrenia recognized by the DSM (Diagnostic and Statistical Manual of Mental Disorders)-IV: paranoid, catatonic, disorganized, undifferentiated, and residual. Helpful pop culture example: John Nash from A Beautiful Mind.

Dissociative identity disorder: a rare mental illness characterized by two or more identities present within one individual (sometimes termed "alters"). The cause is still not well-understood, although there may be a connection to trauma experienced. This used to be called split, dual, or multiple personality disorder, but the DSM-IV term is dissociative identity disorder. People sometimes confuse this one with schizophrenia, but they are two very different disorders. Helpful pop culture example: Gollum/Smeagol from Lord of the Rings.

Obsessive-compulsive disorder: one type of anxiety disorder that involves obsessions (cognitions) the individual does not want to have, followed by behaviour or mental acts the individual feels compelled to perform to rid themselves of the anxiety brought on by the obsession. I see the term "OCD" thrown around so frequently that you'd think half the population had it, but you can't claim that you have OCD just because you have a particular quirk or obsession. There are specific diagnostic criteria that must be met, just like any other disorder. Not to be confused with obsessive-compulsive personality disorder. Helpful pop culture example: the guidance counselor, Emma, from Glee.

Obsessive-compulsive personality disorder: unlike OCD, this is a personality disorder, not an anxiety disorder. Someone with OCPD has a general preoccupation with perfectionism, order, and control; symptoms include: extreme attention to detail and regulations, rigidity of personal views, dislike of delegating tasks to others, and excessive devotion to work. Unlike OCD, which is ego-dystonic (incompatible with the individual's self-concept, making it unwanted), people with OCPD do not find their symptoms problematic (making it ego-syntonic). Helpful pop culture example: Monica from Friends (admittedly, she's never diagnosed with it, but I suspect she at least has a tendency to OCPD).

Asperger's: a syndrome on the autism spectrum characterized by difficulties with interacting socially, and specific behavioural patterns. This is another term that gets tossed around pretty casually, but once again this is diagnosable; it can't be declared just because someone is quirky, geeky, or anti-social. Helpful pop culture examples: Brennan from Bones and Sheldon from The Big Bang Theory (Sheldon's is unconfirmed, but much of his behaviour is certainly indicative of Asperger's syndrome).
 

Subconscious: in essence, a word made up by pop psychology. If you're talking about Freudian theory, please do not use this term as it is incorrect. For more info see this Wikipedia article.

Unconscious: Freud's term for the part of the mind that is wholly outside of our own awareness. This, the preconscious, and the conscious make up the mind in Freudian theory.

Hope this helps the next time you stumble across a psych term you're not sure about while reading! I know I've only touched on a few here, though, so psychology aficionados: which terms do you find being misused in YA (or other books)?

Without Tess: Review (and Giveaway!)

Patient: Without Tess by Marcella Pixley

Presentation:  

Tess and Lizzie are sisters, sisters as close as can be, who share a secret world filled with selkies, flying horses, and a girl who can transform into a wolf  in the middle of the night. But when Lizzie is ready to grow up, Tess clings to their fantasies. As Tess sinks deeper and deeper into her delusions, she decides that she can’t live in the real world any longer and leaves Lizzie and her family forever. Now, years later, Lizzie is in high school and struggling to understand what happened to her sister. With the help of a school psychologist and Tess’s battered journal, Lizzie searches for a way to finally let Tess go. (from Goodreads)

Assessment:

Axis 1. Characters

At the heart of Without Tess is a very complicated relationship between sisters. As they grow up, it's clear that Tess, the older sister, is the leader; she's admired and looked up to — perhaps too blindly and unfailingly — by her younger sister. But it becomes apparent as the story unfolds that something is very wrong with Tess, and the fantasy world that she's concocted in her own head is often more real to her than anything else. Lizzie desperately wants to please Tess, going along with her sister's games and even sometimes believing in them, but Tess' demands become bizarre and unreasonable.

I'm a younger sister, and I'm also quite down-to-earth, so of the two sisters I definitely felt a stronger connection to and understanding of Lizzie (it also helps that it's told from her perspective!) Generally speaking, bonds between sisters are often fraught with sibling rivalry, but nonetheless can prove very solid when they need to be. With Lizzie and Tess, there's definitely some jealousy simmering under the surface on Lizzie's side. Tess is often praised for her creativity and fanciful imagination, and it's obvious at the start that Lizzie wishes she were more like her sister. But as Tess starts eating up more of her parents' attention, envy turns to resentment. Nevertheless, Lizzie sticks by Tess, and Tess — in her own unusual way — tries to do the same for Lizzie, at least for a while.

Their parents really don't play much of a role in the book, at least until towards the end. In fact, the inattentiveness of the parents to what is happening with Tess is really incredible. It takes until  Tess isn't eating anything (a result of one of her delusions) before they finally figure out that she needs help.

Axis 2. Premise/plot

I found the plot very slow-moving — I was often tempted to skim, but I resisted the urge — although it picks up a little as everyone grows more and more concerned about Tess' mental well-being. The plot points are really there more to demonstrate aspects of the characters than anything else — and that they do well. Tess' behaviour indicates that something just isn't quite right, but it's done in a subtle way that makes it all the more unnerving. It isn't loud or showy; instead it creeps up on you. And Pixley gets points for writing about a rare disorder that doesn't get much attention. Schizophrenia typically begins in the late teens or early twenties, so a YA novel about childhood-onset schizophrenia (which is what Tess seems to present with) is certainly unusual.


The ending of Without Tess disappointed me, though. It just seemed to drop into cliche and sappy, losing the nuanced and complex emotions that were so well-done in the rest of the novel. While it is certainly valid to show how sharing one's fears with someone else can help to dissipate them, Lizzie's reaction when she finally confronts her feelings about her sister's death seemed too typical and simple, given how incredibly complicated her relationship with Tess was. Lizzie's emotional transformation happened too quickly for my liking. I also had a hard time swallowing the depth of emotional expression in Niccolo's response, as it just didn't seem authentic for a teenage guy. Overall the scene came off to me as an "easy fix" to her problems, and ended up feeling a bit anti-climactic.

Axis 3. Writing Style

The narrative flip-flops between past and present — the present where Tess is dead, and the past where we can see Tess' problems escalate. For most of the way through, the past sections are prefaced by a poem of Tess', which helped to keep me on track with the time frame switches. I also thought that this technique worked well, for the most part, to illustrate the striking difference between the Lizzie of the present and Lizzie of the past.


The writing style of Without Tess is quite literary, and it's clear right from the start that the quality is high. Marcella Pixley does a wonderful job with creating atmosphere — she evokes those hot, lazy days of summer in the countryside so well. In turn, the contrast between the picturesque atmosphere and the events surrounding Tess and Lizzie is quietly disturbing. I do wish I knew a bit more about the setting in terms of place and time; the sections written in the past had a bit of an old-fashioned feel for me, but the present-time ones felt more modern.

Axis 4. Psychological Accuracy

"Fast Facts" about childhood-onset schizophrenia: Did You Know?

• It's much rarer than adult-onset schizophrenia, but the criteria for diagnosis are very similar
• Symptoms appear less suddenly than adult-onset, but they are 20-30 times more severe (according to this LA Times article)
• It may be confused with autism, Asperger's, or bipolar disorder, as there are some overlapping symptoms
• The hallucinations and delusions become more complex as the child gets older

- information from here, here and here

Since the story's told from Lizzie's perspective, we don't really see inside Tess' mind (though we do get glimpses through her poems). But her behaviour, viewed externally, demonstrates that inside her head she has created a fantastical world of her own, which she frequently becomes wholly absorbed in. She's most certainly delusional; I'm less sure about hallucinations, although she does refer to "Merlin" as though he's someone she actually talks to. I'd also say her social skills are indeed impaired (as evidenced by her inability to interact with anyone outside of her sister, really), which is typical of children with schizophrenia.


I really enjoyed the interactions between Lizzie and her school psychologist. Although it isn't named, I'm quite sure the style of therapy is person-centered therapy, based on Carl Rogers' work. Therapists who use this humanistic approach try to help the individual help themselves towards personal growth and self-actualization. It was great to see the school psychologist using some general techniques of this type — for instance, bouncing her questions back at her. He's also wise to her inclination to use humour to deflect from really getting at her emotions, and he's not afraid to acknowledge this.


It's interesting to see him honouring the agreement of confidentiality — even though he knows that she's been passing off her sister Tess' poems as her own, he does not take this fact to her teacher. However, he does encourage her to start writing her own poems.

Validity Score: How psychologically accurate was Without Tess?

Axis 5. Miscellaneous

I loved the final poem in the book — it was the perfect way to end it.

Patient's statement:

I wish I were like Tess. She knows how to be certain about things. She doesn’t keep herself up at night wondering if she said or did the right thing. She just believes. For Tess the world makes sense. Everything that happens contains a secret meaning. A white butterfly means good luck. A sand dollar means watch your step. A warm wind means Merlin is whispering. Nothing means anything to me. When I see a seagull, it doesn’t tell me anything. The sun hurts my eyes. And even these waves are just waves after half an hour of floating, naked and cold.

Diagnosis: 3.5 shooting stars

For more information about childhood-onset schizophrenia, see here.

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

And now, the moment you've all been waiting for...the giveaway! Macmillan has generously offered up a copy of Without Tess.

The rules:

- US/Canada only (as per publisher's request)

- Entrants must be 13 years or older.

- One entry per person.

- Following and tweeting are not required, but always much appreciated.

- Winner will be selected randomly and contacted by e-mail for their address, which will then be passed on to the publisher, who'll ship out the prize.

- Ends Oct. 17 at 11:59 pm EDT. 

This contest is now closed.