Trigger warnings: self-harm, eating disorders, psychosis.
Overall 3/5 stars. This book was okay. Not bad, but not great. In terms of being mental health fiction, there’s a lot that this book tries to do (and does) well, but also areas where it falls short.
What it gets right: There is an emphasis on de-stigmatizing mental health (comparing it to a broken bone, emphasizing that it doesn’t mean she’s a bad person, etc). The first-person narration helps us feel the confusion and the inability to discern reality from illusion. Additionally, the author tries to promote the idea that people with mental illness are more likely to hurt themselves than others. Having a protagonist with psychosis is not common (most mental health books tackle anxiety and depression) and this helps psychosis feel less nebulous.
What I wish was different: The description of eating disorders, as an ED researcher, made me cringe. “Bulimia” is not the same as purging/vomiting and “anorexia” is not the same as restricting. You can have bulimia and restrict what you eat (very common) and/or anorexia and vomit (purge subtype)– the main difference is body weight, not the ways you keep your weight down.
Additionally, there are plot holes. Hannah’s very toxic relationship with her parents is not addressed. Especially with the doctor knowing this, she would not have let Hannah leave without family therapy and/or at least addressing it in individual therapy. I would have liked for there to be more tension/higher stakes overall– or something that made me want to keep reading more than I did. The inpatient care representation wasn’t accurate in ways that were frustrating– I’ve never heard of an inpatient center that uses books or bathing as “rewards”, nor any that prohibit outside books. This is especially true since lack of self care is a hallmark symptom of schizophrenia, and not something treatment facilities would promote. There was no group therapy (most inpatient centers have this) or any kind of other therapeutic activities like exercise or yoga.
I’m not sure I liked Hannah. In terms of making a compelling, not-likable protagonist, I think the author does a good job. However, in portraying psychosis, this further perpetuates the idea that those with mental illness aren’t likable (not the author’s intent, I’m fairly sure, but it comes across that way). Similarly, while Hannah says she’s more likely to hurt herself than others, this doesn’t feel genuine in her actions (the number of times she has hurt friends, potentially in deadly ways, vs Hannah’s one outbreak where she hurts her arm).
Overall, I think this book means well, and tackles really important themes. The unreliable narrator is well-executed. However, in terms of the mental health aspect, there are unrealistic, and sometimes untrue, aspects that take away from the story.