I dug into Turtles All the Way Down, the latest best-selling YA novel by John Green, both to catch a fun read and check out the portrayal of Aza, the main character of the story who we’re led (indirectly) to believe has a diagnosis of OCD. I went in expecting a heavily biomedical explanation of the obsessive thoughts, doubts, and anxiety Aza experiences. At first, I was surprised. Green, who has revealed that he is himself diagnosed with OCD, never explicitly states Aza’s character has “OCD.” He has verified in interviews that the character is intended to have the disorder but had he not, it wouldn’t have been hard to guess.

We’re led into Aza’s “thought spirals” on the complexities of her internal microbiome, her resulting anxiety, and her attempts to cope by using physical compulsions. Anyone who shares these experiences is likely to have some “Yess!” moments of recognition. I was excited to see the book do something we’re not often not allowed to do with OCD in a cognitive behavioral therapy-dominated world. It explores the central existential aspects of obsessive-compulsive anxiety. Aza grapples with bigger questions, trying to determine what makes one a person, where her identity comes from, and if a changing microbiome is evidence that she may never have been a truly autonomous being to begin with.

Remarkably, Aza’s psychiatrist goes on this journey with her, always seeming to have some wisdom to impart or classic literature to quote in the process. In its portrayal of mental health services is where the book most departs from reality. Psychiatrists, which Dr. Singh is portrayed as, rarely offer more than prescriptions and diagnosis, let alone the kind of compassionate philosophical banter we see in the book. At one point, she even visits Aza’s supposedly middle-class home twice weekly, an unheard of service in the real mental health world.

The book’s description promises a mystery which it delivers in part, but it’s diluted by Aza’s inattention and preoccupation with teenage and obsessive pursuits. This may well have been Green’s point, though, as the story delivers the message that Aza’s obsessive anxiety hasn’t, in fact, made her a stereotypically astute mastermind detective. Aza is often understandably distressed by her experience of obsessive doubts and sometimes expresses the idea that things don’t and won’t get better. My greatest concern reading was that this might be the message teens take away, an understandable message coming from a teenaged narrator but one lacking in perspective.

Unfortunately, the book’s refreshing beginning fades as the story progresses into Aza’s worsening anxiety which drives her to more extreme compulsions. As the book goes on and Aza’s problems become more visible to others, she gets more than support and an explanation of her distress. She comes away with the powerful message that she is ill. Perhaps analogous to the real world in that when one is most desperate, hurt and in need of answers, one answer stands out in a society that sees psychological suffering as parallel to physical disease.

That answer is what Aza believes, and it is the answer the novel drives home to the reader. Though the story never once uses the word “disorder,” which may be more accurate, it uses descriptions of “sickness” and “disease.” The portrayal of these experiences was, in the end, what I expected. An accurate and engaging description, but steeped in the dominant unquestioned framework of illness. Toward the end, in something like a prologue, the narrator writes “I know that girl would go on, she would grow up, have children and love them, that despite loving them she would get too sick to care for them, be hospitalized, get better, and then get sick again.” I had hoped for a final opportunity for Green to offer a more expansive and hopeful perspective than Aza’s 16-year old pessimism, but that opportunity was missed and the story wrapped up in a deterministic declaration of the character’s chronic illness.

This isn’t the book that’s going to change the conversation on mental health, nor had I hoped it to be. Green himself adheres to a traditional view of mental illness and it was expected to find this perspective at the foundation of his writing on emotional distress. The book does, however, offer an accurate and even humorous portrayal of obsessive-compulsive experiences. Read it, enjoy it, and maybe even use it to begin conversations on the existential nature of Aza’s anxiety and the impact of the powerful pathologizing message Aza is given by the adults in her life.

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