More and More Children Are Feeling Anxious. This Graphic Novelist Is Trying to Help.

When you’ve been in psychotherapy for as long as I have, you end up talking to your therapists from time to time about writers — Freud and Kierkegaard, let’s say, or Brené Brown and Tara Brach — whose insights might, or so you hope, have relevance to your treatment. But no writer have I pushed more fervidly on a therapist than Raina Telgemeier.

“Look at this,” I said to my psychologist a few weeks ago, thrusting some splayed-open pages of Telgemaier’s new book under his nose so urgently that he leaned back in his chair and looked a bit alarmed. “Now, read these three pages,” I said, flipping ahead. “Amazing, isn’t it?”

Though her name might conjure an image of a Teutonic psychotherapist or Kierkegaard scholar, Telgemaier is neither a psychologist nor a philosopher but rather, as nearly every American girl who has passed through elementary school in the last decade knows, a graphic novelist who writes about the social travails and family dynamics of early adolescence. Since 2010, when she overcame the prognostications of shortsighted publishing executives who claimed girls wouldn’t buy comics, she has seen one book after another propelled to the top of the best-seller lists by her avid young fans, who show up by the thousands for her appearances. Telgemaier is like the Beatles, or maybe the J. K. Rowling, of graphic novels.

What drove me to share Telgemaier’s latest book, GUTS (Scholastic, 224 pp., $24.99; ages 8 and up), with my therapist was not her rendering of the social ecology of fourth grade — though her skill at that puts her in the rarefied company of writers like Judy Blume and Beverly Cleary — but rather the accuracy and vividness with which she conveys the phenomenology of anxiety. No other book I have read on the subject — and to say I have read a lot of them is an understatement — has captured with such brilliant economy and psychological acuity what a severe phobia or panic attack is like. So spot on is her portrayal that I wondered if Telgemaier had somehow taken up residence in my amygdala.

But Telgemaier is simply drawing on — and drawing — her own experience. “Guts” is a memoir, the third she’s published, after “Smile”and “Sister.” (She’s also written two works of original graphic fiction — “Drama” and “Ghosts” — and illustrated several books for the Baby-Sitters Club graphic novel series.) In “Guts,” a series of events propels Raina, already struggling with the sometimes nerve-racking challenges of navigating fourth grade, into a full-blown anxiety disorder, which begins to take over her life.

One reason the shock of recognition was so strong for me is that fourth-grade Raina’s main phobia happens to be the main one I struggled with as a boy (and still struggle with as an adult) — emetophobia, the pathological fear of vomiting. What’s more, the secondary anxieties and associated symptoms — debilitating phobia of germs and fears around food, intense stage fright, the indignities of a nervous, irritable bowel — that beset young Raina are the same ones I endured at that age. (These fears and symptoms commonly cluster together.) Scene after scene rang true to me; the familiarity was almost painful — in places almost a form of exposure therapy. When I was a child (and not only when I was a child), anxiety generally — and the fear of vomiting in particular — felt like a peculiar and embarrassing affliction, and I tried to hide it from my peers, out of shame and fear of stigmatization, going to great lengths to conceal my weekly visits to a psychotherapist. Raina at first endeavors to do the same.

In all three of Telgemeier’s memoirs, Raina contends with the abiding stresses of sibling rivalry and parental discord and mean girls at school. But whereas in those earlier books anxiety is merely a subtheme, an element of Raina’s personality that sometimes figures into the story, in “Guts” it is the force that drives the plot. That Telgemaier is only now, in her third memoir, telling the story of her childhood anxiety straight on could be because it took her a while to gin up the courage to write about this particular set of vulnerabilities. Or it could be because she perceived that we’ve reached a moment when a book like this could be very helpful to her audience.

Children are struggling. Over the last decade, cases of anxiety disorder in young people have increased by 20 percent or more. Rates of suicide and suicidal thinking have risen sharply among young people of all ages — including, horrifyingly, children under 11. Scholars debate why this is happening — plausible culprits include social media, video gaming, helicopter parenting, school shootings and lockdown drills, overweening college pressure, and both the over- and under-prescribing of medication, among other things — but the fact of steadily rising numbers of children with anxiety and depression is hard to dispute.

Telgemeier is not, in a book aimed at third to eighth graders, out to solve the mystery of this rise or limn its sociological roots. What she does do, in keeping with the mode of her previous books, is provide a remarkably well-rendered and accessible first-person account of what it’s like to experience clinical anxiety as a 10-year-old girl — which, I can say with authority, is also pretty much what it’s like to experience clinical anxiety as a 10-year-old boy.

Though Telgemeier’s drawing style owes more to the exaggerated caricatures of newspaper comic strips — the bright colors and the simple features — than to the straight realism or stylized grittiness of graphic novels aimed at older readers, her images convey emotional depth and resonance that belie their cartoony aesthetic. Telegemeier has said that she modeled her early comic strips after Bill Watterson’s “Calvin & Hobbes,” where moments of antic silliness give way suddenly to moments of emotional profundity, and Lynn Johnston’s “For Better or for Worse,” where the day-to-day accretion of domestic detail and psychological portraiture yields an effect that is almost novelistic. Those influences are still evident. If Judy Blume wrote graphic novels, this is what they would look like.

In a few deft panels early in “Guts,” Telgemeier illustrates the moment when young Raina’s phobia first fully breaks through. It is the only sequence of three consecutive full-page panels in the book. Few words of narration appear on these pages (“I didn’t puke. But the thought that I might … was worse than if I actually had”); the images do the work. In the first panel, Raina, enveloped by a sickly green, suffers acute nausea that leaves her shaking and sweating on the bathroom floor. In the second, Raina is clinging to the floor tiles by her fingertips, trying to keep from falling into an abyss. In the third, she loses her grip with a cry, plunging back into her actual bathroom, where she lies quaking in a fetal curl as her parents look on in bewilderment; she has fallen into a new and terrifying existence. It is simple, frightening and psychologically realistic.

As viscerally rendered as Raina’s plunge into phobic misery is, her climb out of it, with the assistance of a kindly therapist named Lauren who helps her understand that she can survive even the worst of her anxiety, feels gratifyingly and realistically hopeful; the reader exhales with Raina as she begins both to transcend the worst of her anxiety and to rise above the pettiness and misunderstanding that beset fourth-grade social relations.

Could this book not merely entertain kids, but actually help the struggling ones with their anxiety? “Guts” captures with remarkable concision and accuracy, and without ever going outside of 10-year-old Raina’s perspective, some of the theoretical concepts and applied techniques that underlie treatment of anxiety. But what will reverberate in the trembling psyches of anxious kids is the recognition that they are not alone in their suffering. Watching Raina endure something like what they may be going through, and then partly triumph over it, provides solace and consolation and possibly hope. I suspect that if I’d read it when I was 10, my perspective on my own anxious adolescent misery would have been helpfully enlarged by the recognition of my own struggles in Raina’s.

“Guts” is dedicated to “anyone who feels afraid.” For anyone that includes, this book’s warmth, humanity and humor — it ends with a sonorous and well-earned fart — provides a balm more soul-soothing than any pill.

Scott Stossel is the national editor of The Atlantic and the author of “My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind.”

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