Spoilers ahead My review mentions some of the problematic aspects without spoilers.

“If nothing’s real, then what does it matter? You live here. Doesn’t that make it real enough?”

There’s so little YA featuring schizophrenia I was excited to read Made You Up by Francesca Zappia (Greenwillow Books, 2015). It’s garnered lots of love since its publication last year including shortlisting for the Inky Award 2016. I found misunderstanding of schizophrenia and psychiatric care and use of the sensational aspects we see so often in books and media. Zappia does a disservice to real people and their real problems and fears caused by their schizophrenia.

I have family and friends with schizophrenia. (One friend killed himself due to long term refusal of treatment.) As with any mental illness, no two people have the exact same experience. Schizophrenia can cause untold problems, but it does not define a person and they can live as happily as anyone else.

Alex experienced her first hallucination when she was seven which is uncommon. The Freeing of the Lobsters is a prologue and being the first thing I read, it jarred. I really wanted to like Made You Up, so I kept reading. Child-onset schizophrenia causes developmental delays before psychotic symptons. Alex’s mother would surely have noticed this before the lobster incident, although her parenting skills were questionable.

“He’d come right out of my delusions, but here he was. He straddled the line between my world and everyone else’s, and I didn’t like it.”

Zappia uses the terms hallucination and delusion interchangeably, they are not. Blue Eyes came out of Alex’s hallucination, her delusions are that communists are out to get her. I laughed a lot at Alex’s hallucinations, but the lived experiences of people with schizophrenia are not fodder for comedy, unless they choose to tell their stories #OwnVoices

“Kids funneled from their cars to the school, ignoring the men in black suits and red ties who stood at even intervals along the school’s roof. I should have known public school would have some weird security.”

I discussed the problems with Miles’ mom’s psychiatric care in my review. The same institutionalization trope is used when Alex’s mom threatens her with hospital. In an interview about her motivations for writing Alex, Zappia discusses the importance of medication and family support. The book has inaccuracies about meds and appalling family interactions. Therapeutic interactions are non-existent. The only time we hear about Alex’s psychiatrist is when Alex’s mom phones her. These phone calls never lead to Dr Graves talking to Alex.

I thought I got bored of Made You Up due to the length, but it was more likely Zappia’s use of the sensational (and less common) symptoms of schizophrenia to further her story. Alex never experiences negative symptoms. And where are the auditory hallucinations (hearing voices) that are most common in schizophrenia? I got a shock when Alex found out Charlie was a hallucination. This was a clever plot twist but I’ve read it before (The Basic Eight by Daniel Handler).

I’ve known friends with schizophrenia to name a voice after a real person they care about, but Charlie is more than a voice in the book. Alex has a cherished photo album dedicated to her sister and the two often hug.

“Some people, for instance, experience non-verbal thoughts, images and visions, tastes, smells and touch. All with no physical cause and all sensations they did not call into being themselves.” – Hearing Voices Network

This description could be Charlie, but it’s less common than auditory hallucinations. The more usual experience of schizophrenia wouldn’t make as sensational a twist, but it’s the default portrayal in books and media.

Alex being told Charlie isn’t real and accepting this immediately (to the extent Charlie disappears from her photo album) is unrealistic. A friend of mine often asks if I can read her thoughts. I tell her I can’t, but this doesn’t stop her asking.

When I read that real Charlie died four years ago, I thought it was the perfect traumatic event to trigger Alex’s schizophrenia, and cement hallucination Charlie in her mind. Zappia doesn’t know enough about schizophrenia to use that idea.

I read a review of Made You Up on Good Reads by Clementine, who’s training to be a psychologist. She lists many of the same problems I had with Made You Up linked to psychiatric reasoning: symptoms, meds, hospitals, parenting. Clementine mentions Alex’s age: 7 is unusually young for a psychotic episode and 13 is young to be diagnosed. Boys often have a younger onset than girls (late teens as opposed to early adult), but I have a friend who was diagnosed as a teenager. This was after her second psychotic episode and a family history of schizophrenia.

I think these problems override praise for the book. A bad rendering doesn’t improve on not enough depiction of schizophrenia in YA. My brain glossed over many of the inaccuracies, other readers won’t know what’s inaccurate. Made You Up has good points but contributes to further misunderstanding schizophrenia.

I’m reminded of my reaction to The Pause by John Larkin. I was flabbergasted at award shortlisting for The Pause when the psychiatric downfalls were glaringly obvious to me. Does the good cancel out the bad? Not so much. Is it really hard to convince people of the problems in a book they love? Yes.

If reading this has triggered difficult thoughts or emotions and you need to talk to someone right now contact:

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Further Reading

  1. Mental Health America Psychosis (Schizophrenia) in Children.
  2. American Psychiatric Association What’s the Difference Between a Delusion and a Hallucination?
  3. Deinstitutionalization of People with Mental Illness: Causes and Consequences by Daniel Yohanna Journal of Ethics (2013) vol.15, no.10.
  4. Mayo Clinic Schizophrenia: Symptoms.
  5. Auditory Hallucinations in Psychiatric Illness Psychiatric Times (2010)
  6. Hearing Voices Network A Practical Guide to Coping with Voices.
  7. National Health Service Schizophrenia: Causes.
  8. HealthDirect: MindHealthConnect Schizophrenia.
  9. National Alliance on Mental Illness Schizophrenia.