September 27, 2011

Without Tess: Review (and Giveaway!)

Patient: Without Tess by Marcella Pixley

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)


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.


  1. I don't think I've ever read a book about childhood-onset schizophrenia. Despite the lackluster second half, I'm really interested on how the author addresses the mental health issue. Thanks for the great giveaway!

  2. I watched a doc about kids with schizophrenia and it was disturbing to say the least. Reading from Tess's perspective would've been quite an experience but I'm sure witnessing her actions from her sister's view is just as powerful. Definitely interested in reading this one. Great review Danya, and thanks for the giveaway :)

  3. I'm really loving this event you're doing! It's so fascinating. I've been really excited to read this book. It seems like these sort of psychological reads move slower sometimes, but they're also a lot more unnerving. The idea of childhood-onset schizophrenia is terrifying. 30 times more severe than adult?! Wow. I'm definitely intrigued to read this one. Thanks for the great, thoughtful review and giveaway!

  4. Wow, what a great analysis! I especially appreciate the validity score.

  5. Wow. This one sounds awesome. I haven't read many (if any, now that I think about it) books dealing with Schizophrenia, but this one sounds fascinating. Somehow, I totally missed that this was about mental illness. I'll DEFINITELY be adding it to my read pile now!

    Awesome review Danya!


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