Hello writers, it’s Wednesday again, and that means we are talking about the ins and outs of industry, publishing, and craft. Today, we are shifting the conversation to a big picture topic, something that remains a push and pull struggle in the industry: the stigma and representation surrounding mental illness in fiction. May is Mental Health Awareness Month, and as the month draws to a close amid the tapering pandemic and reopening efforts, we are still unfolding the full impact this year has had on the conversation surrounding mental health as a whole. The events of this year have brought the realities of mental health, social isolation, and the struggle of mental well being into sharper focus, and shone a light on painfully obvious gaps in our health care systems. The conversation is shifting, opening, and as it does, we need to continue to strip the stigma from mental illness.
What is the Stigma to Mental Illness?
“The single most important barrier to overcome in the community is the stigma and associated discrimination towards persons suffering from mental and behavioral disorders.” - The World Health Organisation
A stigma is the negative connotation given to mental illness. When stigma is tied to social interaction it can exacerbate feelings of isolation and hinder a person from getting the help they need for fear of judgement, rejection, and discrimination. Instead of treatment, patients are left with feelings of shame and blame; they feel the need to hide that part of themselves and disregard their own feelings.
Stigma over mental health, unfortunately continues to pervade our society, where an openness around one’s mental illness continues to impact securing employment, housing, and so many facets of our lives. With decades of mental illness being sensationalized and misrepresented in media, the shift to true #ownvoices representation is a painfully slow one. Mental Health is another facet of the overarching issues of diversity that we must continue to strive for in all forms of media, because the root of stigma is a lack of knowledge.
When you only see sensationalized or straight up inaccurate representations of mental illness, you don’t know the illness's truth.
A Brief History of Discourse
Mental Health has come a long way from being referred to as the coverall term ‘madness’. There was an almost enamored mindset with ‘madness’ during the Victorian era, where science and medicine were still entangled with pseudo-science. Oddly enough, the ‘madness’ of King George III in the late 1700’s made the exploration of mental health fashionable in the medical community, while on the literary side, poets like Tennyson began to probe into the feel of 'madness'. Keep in mind, the field of psychology didn’t come to fruition until the early twentieth century. In the 1800’s most mental illnesses were broken down to two states: mania and melancholia. Mania was the umbrella term to represent the more violent tendencies of mental illness, while Melancholia represented more depressive orders. ‘Madness’ was meant to cover the full spectrum of behaviors, a catch all term that is obviously highly problematic when you attempt to apply catch all treatments, that is, if madness was treated at all and those afflicted weren’t simply placed in asylums.
By the mid 1800’s the term ‘psychiatry’ was coined to describe the medical treatment of disabling mental conditions. The medical community also began to link ‘madness’ as possibly hereditary, though accurate diagnosis and treatments were still a long way off. On the literary side, Tennyson’s Maude in 1855 took a crack at ‘shedding light on the darkness’. Tennyson’s treatment of the character in his poem was to seek reasons for the ‘madness’. His eventual conclusion is that the protagonist succumbed to the madness of love (which is still portrayed in pop culture today. Thanks Tennyson.) and this madness is a temporary one: the poem ends with the protagonist claiming it was 'but a dream' and wakes with 'higher aims'.
The idea that ‘madness is temporary’ has been particularly and detrimentally pervasive, presenting the false idea that mental illness can be ‘cured’ rather than managed.
Gilman’s The Yellow Wallpaper in 1896 is held up as another early example of mental illness in literature, but the protagonist’s madness, born of paranoid delusion and spousal mental abuse, is also treated as temporary. Over time, many authors have attempted to assign reasons or causes for their character’s ‘madness’. The reality is, mental illness defies causal relationships and there are no simple solutions.
The twentieth century saw the discourse shift into more complex treatments and attempts to understand mental illness. However, the ongoing mindset of this discourse was that these therapies would lead to an absolute cure, from the lobotomies of the 1930s, to the electroshock therapy of the 1950s, to even the modern psychology and therapy techniques of the 1990s. The ultimate negative impact of this mindset was reflected in literature, from Ken Kesey’s One Flew Over the Cuckoo’s Nest, to Susannah Kaysen’s memoir Girl, Interrupted, (a novel of the 1990s) which portrayed the fear, aggression, and societal stigma experienced by asylum patients. Asylums were seen as a place ‘to get better’, and even today, we as a society struggle to understand that mental illness is not something that can be magically cured.
The Conversation Continues
"According to the National Alliance on Mental Illness, 19.1% (47.6 million) of U.S. adults experienced mental illness in 2018. Mental disorders touched the lives of 1 in 5 U.S. adults across all demographics, with instances more prevalent among the LGBTQ+ community. Despite efforts to increase awareness, suicide remains the second leading cause of death among people aged 10–34." - Dani Lee Collins, The Importance of Portraying Mental Illness in Fiction
This is a staggering statistic. In the past couple decades, literature has made great strides in opening the conversation surrounding mental illness, especially, in the YA genre. Young Adult novels speak directly to the most vulnerable population of mental illness, at a time in their lives where symptoms often begin to present. As YA also has a huge reading market of adults, it serves a dual purpose speaking to adult readers who never found their voice. What has made the stories of the last decade all the more poignant is the offering of #ownvoices and presenting characters and story lines that don’t revolve around mental illness as a plot device, but create plots with characters who have mental illness, an important and necessary distinction.
Representation matters. It matters when a reader can connect themselves to a character and see mental illness as part of a person, as part of themselves; that mental illness can be lived with and managed in everyday life. It matters when a reader can see mental illness is not all that defines them.
The push for true, accurate, and honest representation must continue. Today, a site like Buzzfeed can pull together a list of 21 YA books that portray mental illness, which is notable when every single title on this list is from the last five years, including a large percentage from 2020 alone. The discourse is shifting and we, as an industry collective of authors, agents, and publishers, need to continue to push this conversation forward until we’ve fully shredded the stigmas surrounding mental illness.