Estimated read time: 8-9 minutes
UTAH COUNTY — "When the problem's in your head, no one can carry it but you."
Though spoken by a fictional character in a brand new young adult novel written by Utah author Erin Stewart, these words illustrate the very real battle many teens face today: anxiety disorder.
"The Words We Keep" is a novel centering on 16-year-old Lily Larkin — the perfect student, the perfect daughter and all-around perfectionist who is desperately trying to keep her life together months after her older sister ended up in rehab following a mental health crisis. As she works toward breaking a record on the track team, getting a scholarship to UC Berkeley, and not giving her dad any more reason to worry about another daughter, she experiences relentless abuse from the voices in her head telling her she isn't enough.
Her sister may be the one with the bipolar disorder diagnosis, but Lily's fear of following her path and further stressing out their father keeps her from identifying her own mental health struggles, which only makes things worse.
Stewart, who has suffered from anxiety disorder most of her life, didn't initially want to write a novel about anxiety. But as she gave it more thought, she realized it was a book that needed to be written.
Growing up, "anxiety" wasn't the buzzword it is now, so Stewart didn't have a name for the incessant thoughts in her head telling her she needed to be more than she was. She figured it was just her personality. When she decided to write "The Words We Keep," she wanted to write a character who thought her anxiety was a flaw instead of an illness she had to live with, but who learns what it truly is and to face it, confront it and own it.
"I feel like in my life, once I did that, I was able to separate myself from those thoughts and to see them as not me but a part of me instead of defining me," Stewart said. "And I wanted to write a book where kids who are struggling like I was with anxiety can see that: one, they're not alone, that there's lots of people that have these thoughts every day and are living healthy, wonderful lives with them; and two, that the best thing they can do is to speak up and to get the help that they deserve."
Lynne Sill, chief operating officer for The OCD & Anxiety Treatment Center, believes that "The Words We Keep" would be beneficial for teens with anxiety to read because it could help them relate to the characters and might hopefully help them spark a conversation with someone about what they're feeling.
"That's what we are so hoping for — and we love that there is more attention right now to mental health, whether that is in media through Simone Biles … or books like this — is that it starts conversations and it leads people to have a little bit of hope to getting more help," Sill said.
Throughout the text, many of the thoughts in Lily's head are crossed out on the page, demonstrating how her war of demeaning words is inside her head, whereas on the surface she's a logophile and all-star English student.
If we can realize that there's lots of people going through it, then we can get help — but we can also just get camaraderie and friendship and comfort that we need.
"I feel like people with anxiety have a lot of things they're not saying, and it feels like we're constantly self-censoring so that people don't know what's going on in our heads and the thoughts that we're having … and we kind of keep those to ourselves," Stewart said.
Because Lily knows she's viewed as Miss Perfect, she is horrified at the thought of anyone knowing what's going on inside her head. The shame propels her into a downward spiral of isolation. But Micah, who is no stranger to depression himself, recognizes the warning signs and becomes a sort of mentor to her as she navigates finding acceptance.
"I think the biggest problem with anxiety and depression, or any mental health issue, is that if we feel that we're the only one having it, we're going to push away from everyone … until we're all alone in it," Stewart said. "And if we can realize that there's lots of people going through it, then we can get help — but we can also just get camaraderie and friendship and comfort that we need."
According to the National Alliance on Mental Illness, 1 in 5 Utahns experienced a mental illness in the last year.
Stewart believes that dealing with a global pandemic, and specifically the isolation that has come from it has contributed to mental health issues for some people.
"We heal together. We heal each other. We heal in groups as a society, and we need each other for that," she said.
Sill said anxiety pushes people into avoidance, and the COVID-19 pandemic allowed avoidance, as evidenced by quarantining and mask-wearing.
"In a lot of ways, for people with anxiety, it felt good. But then when you had to reenter the real world again, and as we started to come out of quarantine and even started to take off our masks, that was exponentially harder for people with anxiety disorders," Sill said.
She added that one positive aspect of mental health and the pandemic is that it provided unprecedented opportunities for people to receive treatment virtually through telehealth, which The OCD & Anxiety Treatment Center learned was just as effective as in-person treatment.
Some people may wonder if the chaos of today's world or what the current rising generation faces cause more anxiety than in past generations. Leah Jaramillo, executive director of The OCD & Anxiety Treatment Center, said it is not necessarily today's current outside circumstances that are causing the anxiety, but rather how each of us as human beings processes our experiences.
"I get really concerned sometimes that we look just at generations and say, 'This must be what's causing the anxiety,'" Jaramillo said. "What we're missing … is this idea that it's causing anxiety because they're human beings — and anxiety is a mental health condition — not because of what's just happening in society, but because it's attacking a human being. It's creating a human being to feel as if they cannot manage threats that are present in their world. And every time I've tried to assume that I know what those threats are, I've been proven wrong over and over again."
We love that there is more attention right now to mental health, whether that is in media through Simone Biles … or books like this — is that it starts conversations and it leads people to have a little bit of hope to getting more help.
–Lynne Sill, chief operating officer for The OCD & Anxiety Treatment Center
"The Words We Keep" protagonist Lily is not just dealing with feeling anxiety. She is dealing with anxiety disorder, and Stewart said it's important to note the difference. Lily's anxiety disorder inhibits her daily ability to function.
Sill said a key way to identify when your child may be dealing with an anxiety disorder is if they show less interest in activities they once loved.
Jaramillo said what plagues the parents she meets is that they don't know if their child's behavior is normal for their age or abnormal.
"Parents go through a lot of questioning and a lot of doubt themselves, and I would just say to them: If you have a question just ask a professional," Jaramillo said. "Don't ... worry about having the right answer. Just begin the conversation, and then those answers will come out."
In the book, Lily has a loving father and stepmother whom Stewart says are both trying their best. But when Lily's dad says things about her being such a perfect daughter, it's triggering for her and her perfectionism. Stewart said the best thing she believes parents of those struggling with mental health issues can do for their children is to be aware of them and what they're going through and to be present with them. She thinks the worst thing parents can do is shy away from these conversations with their children.
Stewart shares the fact that she takes medicine and goes to doctor's appointments for her anxiety disorder with her own three children. She doesn't want it to be a stigma in their family, and she wants them to know they can talk to her if they struggle similarly.
"I think people would be surprised if everyone were a little more open (about) how much people are dealing with mental health all the time," she said.
Sill said people often feel like they need to "fix" things for their loved one who is suffering from a mental health disorder, but they really just need to be there to support them, listen to them and love them. She said loved ones can let the mental health professionals be the ones to guide the mental health journey.
Stewart specifically wanted her main character to be dealing with anxiety disorder because she wanted to show the battle was in her head and her outward symptoms may not be obvious.
"I think all of my characters … that are struggling with these mental health disorders are actually beautiful, wonderful fully rounded people outside of these disorders," she said. "They are not these things. They have these things, but they are not these things."
The book contains themes of anxiety, depression, self-harm, bipolar and suicidal ideation. However, it does not glamorize these diagnoses and instead offers a hopeful approach to receiving help and rallying for people who struggle. Stewart said she wanted the book to be hopeful.
The Words We Keep, published by Penguin Random House affiliate Delacorte Press, came out March 15. It can be purchased anywhere books are sold.
Resources for those struggling with mental health in Utah:
- Youth Mental Health First Aid
- National Suicide Prevention Lifeline 1-800-273-TALK
- Salt Lake County Crisis Services including Mobile Crisis Outreach Teams 801-587-3000
- Trevor Project Hotline for LGBTQ teens 1-866-488-7386
- Utah Suicide Prevention Coalition
- NAMI Utah