Without going into too much detail (you really should take the time to read this book yourself, and have some tissues handy when you do), Ingrid lost her ability to enjoy her life. She lost her hope. She wanted to hurt. And despite having many, many good things in her life--a dear friend, a loving family, a crush on a boy who kinda-maybe-possibly liked her back, and an amazing artistic gift--Ingrid destroyed herself.
Hold Still illustrates the devastating aftermath of suicide, but it also shows how insidious depression can be. Caitlin didn't know how much her friend was suffering. In fact, Caitlin admits that, at times, she found Ingrid annoying. At times, when Ingrid was silent and sad, Caitlin left her alone because she didn't know what to do or say.
The prevalence of depressive disorders in adolescents is about 11%. Yep, more than 1 in 10 teenagers, at some point in their young lives, meet criteria for this type of mood disorder. But that's all teenagers--girls and boys together. In girls, the number is 15%.
Suicidal thinking (or recurrent thoughts of death) is one of the symptoms of depression. One study of depressed teens found that 10% attempted suicide over the course of the study--and all of them were receiving treatment. Some other symptoms of depression:
- Depressed mood, including feeling sad or empty. And this isn't just occasionally--it's most of the time. In children and adolescents, it might look different--more irritability than sadness. Keep that in mind, both in real life, and if you're writing a depressed YA character.
- Diminished interest or pleasure in daily activities. And again--this is almost ALL activities, nearly EVERY DAY.
- Loss of energy
- Sleep problems (either trouble sleeping or sleeping too much) and weight loss
- Feelings of worthlessness
- Reduced ability to concentrate or make decisions
Now, Caitlin herself shows some of the symptoms listed above over the course of the story, so is she depressed? Well, no. And here's why: there's another condition that better explains her symptoms. It's called Bereavement. In other words, she's grieving, pure and simple.
Anyone looking for the latest information on treating depression in adolescents can look here. Research is ongoing, but what we know right now is that combination treatment--BOTH medication AND psychotherapy--is most effective. More effective than meds or therapy alone. We also know that long-term maintenance treatment is crucial for teens because they are very vulnerable to relapse.
There's no real mystery about what killed Ingrid. It's one of the things I love about this book. Ms. LaCour has written a story where there's no particular person or event to blame. No villain. No bullying. No trauma. Ingrid died of her illness. Although many survive and conquer depression, sometimes this disease is fatal.
What renders Hold Still beautiful is that simplicity: it is riveting and heartrending and uplifting, but it's not painted up or overdramatized or convenient. And it's not about depression. It's about what it's like to lose a friend, someone you love, and to rebuild your life--and your identity--without that person. It's real life, heightened by the writing and the voice, the attention to detail, the idiosyncratic subtleties, the quiet, brutal tragedy of Ingrid's death, and the strength of Caitlin's love and loyalty to Ingrid and her memory.