Graphic Medicine Novels: How I Made It to Eighteen

Stacy has recently graduated high school. She’s living independently but is far from thriving. A deepening depression soon results in a mental break—Stacy punches a glass window, severely injuring herself. Shortly thereafter, she voluntarily admits herself to an inpatient psychiatric facility. At Golden Meadows, Stacy meets other young people who have various mental illnesses. While she does make some friends, she keeps the hospital staff at arm’s length. As the book progresses, Stacy opens up a bit more, first in family therapy with her mother and then with the hospital staff. The book concludes with Stacy admitting that she is still grappling with bulimia. This act of vulnerability shifts Stacy’s perspective on getting help as she firmly commits herself to getting well.

How I Made It to Eighteen is primarily composed of panel-style illustrations that document Stacy’s experiences at Golden Meadows. The artwork is highly minimalistic, absent of shading and featuring occasional black fill. Dividing up this content is commentary from Stacy’s friends, who respond to a question about her (such as, “Did you realize Stacy was depressed?” (p. 18), as well as notes from the Golden Meadows staff. It should be noted that the text is very small, especially on pages featuring Stacy’s friends.

While How I Made It to Eighteen does touch on several mental illnesses, including anxiety and eating disorders, the primary focus is on depression. Evidence that Stacy is experiencing a severe episode of depression is widespread. First and foremost is her general discontentment. She explains: “Gradually I stopped being happy with anything. I don’t know why” (p.12). She admits to suffering from severe insomnia. Her episode with the window, as well as treatment notes from hospital staff, indicate that Stacy experiences suicidal ideation. The author deftly reveals her lack of appetite by showing a very small amount of food spooned onto her plate in the cafeteria. There is also evidence that she experiences low self-esteem, with staff remarking, “she is so fearful of rejection that she beats everyone to the punch by various turnoffs including hostility and sarcasm” (p. 53).

One of the humanistic revelations that stands out is seen in Stacy’s cold and callous exterior. It is not uncommon for individuals who experience depression—or any mental illness, for that matter—to hide their internal struggle from the world. Stacy describes her rationale for her icy disposition: “It’s important to project strength and togetherness. Otherwise, people will sense you’re weak and walk all over you” (p. 61). Sadly, patients who portray that sort of independent confidence often find themselves overlooked by other people who could be partners in their treatment.

Undoubtedly, this book will speak to many individuals who share experiences like Stacy’s. Young adults may find aspects of her story particularly relatable, such as the conflict she experiences with her mother or her ongoing issues related to body image. Others may struggle with the fact that many of the issues presented in the book are never fully resolved. To truly digest the book, readers must be comfortable with that sort of ambiguity.