Friday, December 17, 2010

Hold Still: Losing A Friend To Depression

Nina LaCour's Hold Still is the story of Caitlin, a girl who has lost her best friend, Ingrid, to suicide. When the story begins, Ingrid is already dead. However, she is a major character in this book--as is her disease: depression. As the book unfolds, Ingrid's suffering is palpable, even though all we have of her is Caitlin's memories, photographs (both girls are very serious about photography, and it's a major part of the book) and Ingrid's own words, left behind in her journal.

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
Based on Caitlin's recollections and Ingrid's own words, it appears that Ingrid showed at least five of those symptoms (including the suicidal ideation). There are, of course, other criteria for specific depressive disorders, which you can find here if you're interested.

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.


  1. I'm now adding this book to my TBR pile. And thanks for the warning. I cry easily.

  2. Great post. I have this on my maybe read pile but I may have to move it up now after reading your glowing review. It sounds so interesting. I lost a dear friend to suicide a few years ago, so stories like this hit a bit close to home, but there are a few dealing with suicide that I've wanted to read. I've heard this one is very well done.

  3. interesting post, and I remember being a teen and later a HS teacher--this is a very relevant topic. Tough one. Thanks!

    Merry Christmas~

  4. Okay, you are steadily becoming one of my fave bloggers. :) As an undergrad, I majored in creative writing and minored in psychology, so your posts have definitely resonated with me.

  5. Stina and Jennifer--good! I hope you enjoy it.

    LTM--yes, depression affects so many people. Not just those who experience it, but those who love or care for them as well.

    Pam--thank you SO much! I'm so glad!

  6. Great review and thank you for bringing up the realities of teen depression. It's a difficult topic but so important to discuss out in the open.

  7. Very difficult topic, but so important.

  8. it is really hard to know what to say when someone is depressed like that... sometimes i think it's best just to listen and care- even if you don't know the "right" thing to say, letting them know that they are important to you can really help. right?
    depression and suicide are very real issues that shouldn't be skirted and sugar-coated. but sometimes, i wonder if the reason they aren't talked about very often is that there aren't really words for emotions that intense. you can try to capture them, but the words seem to fall short... or maybe that's just me. but that's one of the reasons i loved your post about the actions- fidgets.
    you already convinced me to add this book to my tbr pile with your other post! but this review makes me more excited to find it... after the holidays! :)
    thanks for the informational post!... again! :)

  9. Such an important issue. Having worked in a forensic mortuary, I have seen far too many suicide victims. For me, they were the most upsetting cases - even above the murders and car accidents. On average we had around 2 suicides per day - a rate which people find really surprising when I tell them. These are deaths that, in most cases, are not a result of the actions of those around them. They are deaths that are the result of inaction, and therefore, they can be prevented.
    There isn't enough support out there for people suffering from depression. At the very least, our governments should be increasing initiatives to raise awareness so that people can recognise the symptoms of depression, and know exactly where to find help.
    Thanks so much for this post, Sarah. It sounds like a truly moving book. I'll add it to my tbr list.