Warning: this is a very long review. No tl;dr here. Let's do this.
Have you ever read a book that made you feel physically ill? And I don't mean ugly-crying or any sort of higher emotional reaction. I mean a sucker punch to the lizard brain: that weird, deep core that controls your gut.
I finished Sad Perfect a few weeks ago, but I couldn't write about it directly afterward. I had to pack it away somewhere in my brain, in a dark corner. This is a really weird reaction on my part. 99% of the time, if I do not enjoy a book, I will let you know right away. I will gif it up and post it and revel in the cathartic release of my emotions. But when I finished this book, I felt like someone had reached down my throat, scooped out my stomach and left me hollow inside. I felt angry and exhausted. Because here we go again with mental illness and self-harm portrayal.
All of the reviews I've seen, so far, have been overwhelmingly positive. This is the part where I waltz in and sprinkle my own particular brand of cranky dissatisfaction on everything like evil fairy dust.
I really wanted to like this. I did. But the overwrought narration, combined with a perfect-boy-cures-mental-illness arc, saddened me. The portrayal of treatment for self-harm may scare some teens away from seeking help.
Sad Perfect is told in second-person style narration. This is always tricky, and the only YA novel I've really enjoyed that was done in second-person was Anna Carey's Blackbird (which I know most critics and other bloggers didn't love, so... I suppose you'll have to take that as it stands). My issue with the use of second-person "you" in Sad Perfect is that the narrative would have had better flow if the author had switched to third-person. Conceptually, I get the idea that the reader is supposed to feel what the protagonist feels, et cetera. But some scenes get ... squicky. Like when Pea, the protagonist, and her boyfriend Ben, make out. I don't really want to be told what I/Pea am feeling. Especially when it comes to the sexytimes.
Apart from the narrative structure, my biggest problem with the book was the portrayal of Pea's relationship with Ben and how it "saves" her from her eating disorder. Pea (not her real name because tee-hee you are the protagonist second-person, remember???), has ARFID (Avoidant/Restrictive Food Intake Disorder). The DSM-V placed ARFID under the eating disorder umbrella, but it's separate from anorexia or bulimia. Someone with ARFID is sensitive to textures, smells, mouthfeel, or memories associated with certain foods. While anorexia and bulimia form a vicious circle with a person's body image, ARFID is more about the physical act of eating being highly unpleasant.
Pea has co-morbid anxiety and depression because of the stress of her inability to eat or feel comfortable in social situations where food is involved, so she takes an anti-depressant. This is demonized by Pea, which is also an automatic NOPE from me. I don't mean that everyone who is depressed or anxious or prone to panic disorder must be on meds all the time. Some people can do therapy. But think of it this way: depression means that your brain isn't working right. It doesn't have the right amount of chemicals to make you feel ... not depressed. So by adding the chemicals back in, or restricting how the chemicals are reintigrated into your body, you can attempt to achieve a sort of chemical homeostasis, which will in turn make you feel more mentally stable. There's this whole stigma that meds make you fuzzy or blunt Who You Really Are or keep you from really feeling things.
You know something? The intensity of my feelings when I'm severely depressed is not something I'd wish on anyone. It's like a tidal wave--inescapable and unstoppable. It's like having knives embedded in your heart, and with every beat, they impale you again and again and again. And there's nothing you can do. The feelings are so intense that I long for some sort of soothing relief.
While the novel begins discussing Pea's diagnosis, frustration with her body leads Pea to start cutting herself with a safety pin. Eventually, someone tips off the school that she's self-harming and Pea, desperate, says that the monster inside of her wants her dead. For her safety, she's sent to inpatient.
Okay, here's the deal: I know that not all mental hospitals or wards in the U.S. are great places. Some of them are probably pretty awful. But the description of St. Joe's, the ward that Pea is sent to, is so over-the-top awful that I expected Nurse Ratched to come out with a cattle prod. It smells, it's dirty, the doctors are mean, the food is bad, and there's a subtle insinuation that no one there cares if a patient commits suicide. Let me give you some examples of Pea's description of St. Joe's (again, not final copy, but you get the idea):
"You don't talk to your parents on the way to the 'hospital' as they call it, although you know it's the Crazy House."
One of the nurses tells Pea " 'Stopping your medication might explain some of your erratic behavior.' You decide you don't like this lady at all." Nurse Janet is also "the devil" for telling Pea not to have sex while she's in hospital.
" 'I have some very sad news,' your brand-new therapist, Dr. Lawrey, announces. 'Malik committed suicide last night.' ... You can't believe that this has happened. That you're here because people are worried you're a suicide risk and you're in a place where kids can do the job right under the noses of the people who are supposed to be protecting them."
When she freaks out because she can't call her mom outside of phone hours, Pea gets physical and is chastised by Dr. Winthrop, the head of the hospital. Winthrop threatens "consequences" if there is "one more episode like what you pulled out there."
"You've got to start digging deep. You know you don't belong in the psych ward. Starling, Savara, and Chad seem like good people, but you're pretty sure they've been damaged by circumstances beyond their control, and they need more help than you do." ORLY You are a special snowflake who doesn't "need" mental treatment, but they do, because your cutting is ha-ha just a fad! but they are dealing with drugs and suicidal ideation? Pea. No.
No one bothers to put Pea on any meds at the hospital becuase they are too evil to figure out how to do that. Or, too stupid. Whatever. Both of those things, I guess. The author really pulls out all the stops in demonizing treatment, too.
When Pea attacks another patient (who is chubby and therefore evil--as opposed to the funny chubby stereotype) for stealing her letter from Ben, she's put in solitary. She vomits but no one cleans it up. She sits in her own filth for a night. Then her parents come and save her from this evil institution where teens are tortured and left to wallow in their own excreta. And somehow they just ... take her home.
I think that rules vary state-to-state, but it seems that Pea is a voluntary patient (i.e. her parents agreed to have her admitted--she was not chaptered or court-mandated to stay at the treatment facility). The way the narrative goes, her parents come back to check on her, find her in her own excreta, yell at the doctors, and take her home. Generally, if a patient wants to leave, they have to write a three-day letter (giving the hospital three business days to consider the request for discharge). If you leave AMA (against medical advice), your insurance probably won't cover your stay. I completely understand that Pea's family is protecting her from the abusive staff at St. Joe's and the unacceptable conditions, but the author's portrayal of these aspects of hospitalization concerns me.
Are there bad nurses and doctors and hospitals? Yep. Going to psychiatric inpatient care is not like going on vacation. Some places are private and well-funded, others are over-crowded and insenstive to patients' needs. While I understand that the author may be calling out this area of healthcare (which, let's face it, is just a giant dumpster fire), I am more concerned about the harm that this relentlessly negative portrayal may cause to teen readers. A teen reading this who perhaps has suicidal ideation or has been self-harming will be less inclined than ever to seek treatment. It's a scared-straight type of narrative, only teens should never be scared away from seeking help.
I'm biased, I know. My little brother was hospitalized twice. He was a danger to himself and my parents weren't able to keep him from doing harm. He has bipolar. The safest place to get you off of meds and onto new ones is in the hosptial. I won't sugar-coat it and say that he loved going there--he didn't. He cried. He missed us. He was scared because he was away from his family. But my mom and dad could not take him off of meds by themselves. They couldn't be hurt anymore. They needed help--my brother needed help.
I understand how he felt, at least a little. When I was hospitalized for a med interaction, I was suicidal. All I wanted to do was leave. They were calling the psychologist, my family, anyone and everyone. I was completely hysterical. I felt trapped and terrified and all I wanted to do was go home. What I didn't realize at the time, though, was that I needed to be there. My liver had almost shut down and my blood pressure was basically at the level of a dead person. You're generally not rational when you're in these situations. Which is part of why you need help.
So when Pea gets out, she decides to get better. Wow, I wish I had that luxury. You think that I don't think every single day about how I wish I weren't depressed? About how I wish that every time my phone rings or my inbox pings that I wouldn't have an anxiety attack, running through all of the awful things that could happen? You think that at the age of 25, I wanted to cry on my way to work every day because I truly felt that things would just be better if I were dead? Sure, I would have loved to "decide" that I wasn't going to think that way anymore. But that's not how mental illness works. No.
The other part of Pea's "recovery" that had me furious is her belief that Ben's love will save her.
She tells him, " 'Maybe I don't need therapy,' you say. 'Maybe I just need you to tell me what to do?' 'If only it were that easy,' he agrees." What? You want to live your life by having your boyfriend tell you how to act? Wow. Real empowering there. While Pea is in the hospital, she calls Ben, and he tells her that he loves her. This is her reaction:
"They are like magic words and you literally feel the monster shrivel inside of you. The power of the words, of having somone important love you and being able to love that someone back, it's not like it angers the monster into a rage, but it diminishes his power. It makes him seriously crumble a bit. You're taking away his power by loving and being loved. You're discovering this. That love can overpower the monster."So, I guess only romantic love can overpower depression, anxiety, self-loathing, and an ED. Being loved by your family doesn't count. But having a boyfriend--hey, that solves everything! Plus, after being in the hospital and being away from Ben (BEN!!!), Pea just decidees that she won't cut anymore. " 'No more, Dad. That was just some crazy stuff. I can't explain it. But I don't want to do it anymore. I promise.' " Which is ... good ... that Pea doesn't want to self-harm, but also makes her cutting sound like it's no big deal. Eh, yeah, I do that when I'm sad, but I can stop whenever I want. Whenever anyone says they can stop whenever they want, you know they're not to be trusted. And I don't trust Pea, but the adults and mental health professionals in her life do.
It all boils down to this: as an author, you have a responsibility toward the teens for whom you are writing. Be a good role model. They are going to look up to you whether you want them to or not. So in your writing, it's your job to make sure that you are factual, that you are compassionate, and that you provide healthy examples of how to act, not hyped-up scary tactics or the message that you can fix your own brain. I don't want teens to read this and think that as long as they find a boyfriend or a girlfriend, their depression or anxiety or OCD or self-harm or ED will go away, blasted into oblivion by the power of love. That's not how it works, and it is irresponsible for Sad Perfect to present this as a path to recovery.