Book Discussion: Does Mental Health Rep Have to Be Positive?

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In discussions about diversity in books, mental health rep isn’t often brough up. If it is, it’s only in reference to books about mental health. That’s because mental health is often difficult to incorporate in a way more obvious aspects of diversity aren’t. Oftentimes, if a book is going to address mental health, it is ostensibly about mental health.

But today I want to discuss whether said mental health representation needs to be positive. I don’t mean good— all representation should be researched and written well. I mean hopeful. Does every story about someone with a mental illness have to include them getting help and following the road to recovery?

The novel that brought this line of thinking to mind is A Little Life by Hanya Yanagihara.


I just finished this book a few days ago and was left with a lot of negative feelings regarding the way mental illness— namely, self-harm and PTSD— was handled in this story.

The character Jude St. Francis has lived through a lot of trauma, especially as a child. As a result, he is left with (undiagnosed) PTSD, negative self-talk, and a lifelong struggle with self-harm. Now, this in and of itself isn’t a problem. Though I find Jude’s life story reads almost like trauma porn, the fact remains that there are real people who have lived lives like Jude’s and have gone through similar struggles.

No, the problem is that throughout the entire novel Jude refuses to get help. As someone who’s dealt with mental health issues for basically my entire life and who has been seeing mental health professionals for all that time, I found Jude’s refusal to do anything about his problems frustrating.

Maybe I’m coming from a place of privilege here. After all, I’ve been fortunate and haven’t gone through any of the terrible things Jude has to endure. My personal method of self-harm (which I haven’t done in years) was something that didn’t leave permanent marks. Maybe I just don’t understand.

And yet, I just don’t think that’s my issue. Because I’m mad at Jude’s loved ones too. His best friend Willem, his adoptive parents Harold and Julia, his friend and doctor Andy, and so many more people. They allow Jude to continue on this way, when they know the right thing to do is to have him committed. But they refuse because they’re afraid of losing the relationship.

Ordinarily, I’d say it’s not fair to hold others accountable for one person’s choices. You can’t force someone to get help when they don’t want it. But when someone is suffering as much as Jude, I think it’s the least you can do. Had they done more, had they had him committed, he would’ve been angry at first. But as he healed, he would eventually have realized they were right.

But again, maybe I’m wrong. After all, Jude’s family and friends always reinforce how amazing they think he is and how much they love him. Andy does his best to monitor Jude’s self-harm and health. Maybe they are just doing their best. So why don’t I buy that?

Well, there comes a point later in the novel when Willem realizes he can’t fix Jude and that he shouldn’t try. And yes, you can’t “fix” someone who’s mentally ill. They’re not broken, just sick. But this moral culminates in such a weird way, with Jude only trying to curb his self-harming for Willem’s sake, but not doing anything to treat the root cause. Jude is still very, very sick.

But the very worst part is that this book gives you hope and then takes it away. Just when you think things are going to turn around for Jude, the narrative pulls the rug out from under you.


Jude hits his lowest low toward the end of the book. He doesn’t try to kill himself, but he stops eating in the hopes that he’ll die. His family and friends stage and intervention (finally) and force him to get help.

Jude goes to therapy, but doesn’t participate. However, after a few more incidents, he finally decides to open up to his therapist and agrees to keep going. This is such a huge turning point for Jude, one that made me really happy.

Then, in the very last chapter, we find out he still kills himself in the end. And I felt hopeless all over again. This conclusion reinforces that Jude can’t be “fixed” in the worst way.


I was very unhappy with what this story had to say about mental health and trauma. But does that mean Yanagihara was wrong to write Jude’s story this way? After all, as I said before, real people have had experiences like Jude’s. Not everyone’s mental health journey ends positively. Not everyone gets help. Can’t writers tell those stories too?

Yes, yes they can. Should they? I wish they wouldn’t. Mental illness is already stigmatized so much. Do we have to tell readers that people with those mental illnesses are doomed? Can’t we been seen working through our trauma and negative self-talk? Can’t we have hope too?

On the other hand, there are plenty of mental health books that do show improvement and growth. These books give us the positive representation we need. So why can’t there be other books that only explore the ugly, hopeless side of mental health?

Ultimately, I don’t have an answer to this question. I only know how Jude’s story in A Little Life made me feel. I hated that he wouldn’t get help. I hated that his trauma was allowed to dictate the rest of his life. I hated that Yanagihara gave me false hope. I felt frustrated and angry and sad and hopeless. I felt like I was told some people can’t find happiness or wellness, when I know in my heart that’s not true. And I think that Yanagihara should’ve cared more about the people she is— intentionally or not— representing.

How do you feel about mental health rep in books? Do you think these stories should end on a positive note? Do you agree or disagree with my interpretation of A Little Life? Let’s continue this discussion in the comments!



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