Holding on to Zoe

The "teen girl gets pregnant and wants to keep the baby" storyline has been done many times before, but the way Jules reacts is different than what we usually see. In her case, the conditions (trauma in the past, father gone, mother as a poor support system) are right for pregnancy to act as a trigger for psychosis. It's a little unnerving that someone can have such a completely different take on reality than most of us, but I had to feel bad for her because she wants a baby so badly that she basically won't let anything else enter her head. While I found it difficult to feel close to her, the fact that she's delusional is not alienating; the reader will not have trouble hoping that Jules will get help. Jules' voice sounds very young for
her age — more like 13 or 14 than 16 — but this might be due in part to
her mental state; it certainly works to convey her naivete and obvious need for help.   


It's told in 1st-person POV, so the reader is placed fully in Jules' mind, and it becomes obvious how her perception of her environment has been contorted to reflect this inner reality she's crafted, so that everything makes sense within this delusion of hers. She displays the symptoms of hallucination (she sees a bunch of socks tied together as a baby) and delusion (she believes she has a baby), and her level of social functioning has certainly declined as well. Jules also shows a few signs of atypical cognitive functioning — she seems to talk back and forth with herself, and she sometimes uses word association. These are perhaps indicative of thought disorder (which can be a symptom of schizophrenia), although they're not a defining feature of her presentation. Depending on how long she has been having trouble, she would probably be diagnosed with either schizophreniform disorder (more than a month but less than 6 months) or schizophrenia (over 6 months). It's difficult to tell how long she's been exhibiting symptoms since the story jumps around a bit in time. I suspect the most likely subtype Jules would fall under would be undifferentiated schizophrenia; she's a little bit edgy about how other people view Zoe, but I don't think it's enough to qualify her for paranoid subtype.

As for the therapy, I'm not certain which theoretical orientation Emma uses. She asks a lot of questions, and uses some unusual techniques to connect with Jules, but almost seems to operate from a psychodynamic understanding in some respects — the significance she places on memories, for example. I didn't buy the "breakthrough" that Jules has; the unlocking of her memories and subsequent destruction of her delusion happens too quickly and easily to be believable. 


That said, the actual explanation for her developing psychosis — that she was sexually abused in childhood — is plausible, as there does seem to be a connection between the two. I suspect we're meant to take a Freudian interpretation of it: Zoe representing Jules' "inner child" who was abused, and Jules now wanting to protect that little girl. I'm very dubious, however, about the sudden disappearance of Jules' delusion from nothing more than retrieval of repressed memories. "Recovered" memories are a tricky business, seeing as therapists can influence clients to "remember" something that never actually happened. In any case, I would suspect a longer relationship with the therapist would be needed before Jules felt comfortable enough to let herself access these memories. While it's a good sign that Emma is able to create a positive, trusting relationship with Jules, the whole thing still happens rather quickly.


Furthermore, I'd like to better understand the role the medication played here. There are a few brief mentions of pills Jules takes (she believes they're vitamin pills) but I'd really like to know more details. Anti-psychotics are one of the primary methods of treatment for psychosis, and yet they seem to provide Jules with very little benefit. Jules' recovery is quite obviously attributed to the memory retrieval, but in real life I suspect the anti-psychotics would be far more effective.