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Growing Up With Anxiety and OCD in "Turtles All the Way Down"

A young adult novel offers readers alternative scripts for living with mental illness.

Key points

  • The typical coming-of-age story and therapeutic plot generally move the protagonist toward resolution, or "cure," of a conflict.
  • This narrative energy toward "cure" can influence young people's understanding of living with and experiencing mental illness.
  • John Green's novel, "Turtles All the Way Down," offers one alternative script that de-emphasizes "cure."
Kiarash Mansouri/Unsplash
Kiarash Mansouri/Unsplash

The classic coming-of-age story, the bildungsroman, is one that we turn to in order to find connection and self-awareness during our teenage years. Classics like Salinger’s Catcher in the Rye and Lee’s To Kill a Mockingbird are widely read in high schools, while newer titles like Hosseini’s The Kite Runner and Thomas’s The Hate U Give have made their way onto teens' shelves and high schools’ curricular lists. In a general sense, the narrative arc of a bildungsroman follows the growth and development of the protagonist, who transforms from a naive, inexperienced youth into a mature, self-aware adult. There is an impetus toward growth and resolution. For coming-of-age stories that grapple with a protagonist’s mental health, another narrative arc comes into play: the therapeutic plot, which focuses on the movement from cause to crisis to cure. Both the bildungsroman and therapeutic plot can have an impetus toward resolution and “cure” of conflict. It is important to pay attention to these narrative arcs given the growing numbers of young people who are experiencing high rates of clinical-level anxiety and depression.

What do the bildungsroman and therapeutic plot have in common?

The bildungsroman and plot of pathology share a similar narrative energy toward the resolution of conflict, or crisis. The narrative arc of a bildungsroman typically involves the following stages:

  1. Introduction: The protagonist is introduced and their childhood or youth is portrayed.
  2. Initiation: The protagonist encounters a significant event or experience that triggers their personal growth and development.
  3. Development: The protagonist undergoes a process of learning, self-discovery, and personal transformation. They may face challenges, conflicts, and obstacles that they must overcome to grow and mature.
  4. Crisis: The protagonist faces a major crisis or turning point that tests their newfound maturity and resilience.
  5. Resolution: The protagonist resolves the crisis and achieves a new level of understanding, self-awareness, and maturity. They may have a sense of closure and resolution to the conflicts they faced.

Erika Wright anatomizes the ever-present “disease-cure model,” or therapeutic plot, as consisting of a linear movement along the “familiar narrative arc of prelude, crisis, cure” (6). Within this narrative model, the “prelude” serves as an inaugural period of physical and mental health when the catalyst for illness is introduced. The middle stage (crisis) narrates the illness, which becomes “a problem to solve” for the doctor and an “obstacle to overcome” for the patient (Wright 5). The final state, or cure, is a period of recovery wherein a person has purged and gains health as a reward (Wright 5). Fashioning illness as a state to overcome and a problem to solve provides narrative energy and the trajectory toward a cure.

How does John Green's novel weigh in on this narrative?

In his 2017 YA novel, Turtles All the Way Down, John Green tells the coming-of-age story of 16-year-old Aza who, like Green himself, has anxiety and OCD. During a session with her therapist, Dr. Singh, Aza gives an explicit voice to the therapeutic plot: “I wanted to tell her that I was getting better because that was supposed to be the narrative of illness. It was a hurdle you jumped over or a battle you won. Illness is a story told in the past tense” (Green 85).

Aza also worries about how taking a pill–in her case, Lexapro–might affect her personality. She struggles with the idea that “taking a pill to become myself was wrong” (70) and uneasily shares: “If taking a pill makes you different, like, if it changes the way-down you…Who’s deciding what me means…? It’s like I have this demon inside of me, and I want it gone, but the idea of removing it via pill is…I don’t know…weird. But a lot of days I get over that because I do really hate the demon” (88).

Green’s novel is not anti-cure or even anti-treatment. As Aza notes, she wanted to be able to tell her doctor that she was getting better. She wants the “demon” to go away. However, the novel gives readers experiencing mental health concerns the message that it is okay if you do not find a quick fix. That it is okay to be wary of some treatment or prescription changing a part of what makes you “you.” That it is okay that some days are better than others. In short: that it is okay.

What new "script" does Turtles All the Way Down offer readers?

This ability for coming-of-age novels, so often garnering the narrative energy of resolution, to offer space for connection and reassurance around mental health is so important in our moment. According to Tori DeAngelis, “[a]bout 11.6 percent of kids had anxiety in 2012, up 20 percent from 2007. But during the pandemic, those numbers nearly doubled, such that 20.5 percent of youth worldwide now struggle with anxiety symptoms, according to a meta-analysis of 29 studies” (1). Narrators like Aza, though frustrating as a model in other ways—such as her inability or unwillingness to draw healthy boundaries for toxic friends—help to normalize anxiety by providing a realistic portrayal of the experience and its impact on daily life.

At the close of the novel, the reader discovers that Aza has told readers her story of her past, but Green makes a point to not leave her OCD and anxiety in the past. Aza shares: “I know that girl would go on, that 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 know a shrink would say, Write it down, how you got here” (Green 285).

Aza’s coming-of-age does not mean defeating and maturing past her obstacle. Bucking the classic bildungsroman and therapeutic plot, Aza “find[s] a path toward a rich and fulfilling life without experiencing some miracle cure” (296). Aza shows young readers that mental illness is real; that it is not just a stage to outgrow; that it is okay to want and need help; that mental illness is not a personal failure.

This is for my ENGL240 students, with whom I have had the pleasure of reading and discussing Turtles this semester.


DeAngelis, Tori. “Anxiety among Kids Is on the Rise. Wider Access to CBT May Provide Needed Solutions.” Monitor on Psychology, American Psychological Association, 1 Oct. 2022,

Green, John. Turtles All the Way Down. Penguin Books, 2019.

Wright, Erika. Reading for Health: Medical Narratives and the Nineteenth-Century Novel. Ohio University Press, 2016.

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