Please Stop Smiling: Removing the Stigma of Schizophrenia

In recent years, more and more children’s books have populated the shelves that are meant to bring social and emotional awareness and better understanding to taboo topics. In Richard Carlson Jr.’s book, Please Stop Smiling, the young writer alludes to some of his most trying times as a child living with a brother with paranoid schizophrenia. Because the book is written by an author with the disease himself, and illustrated by his autistic brother, Kevin Carlson, who is driven to better himself as well as others through the arts and mental health awareness, Please Stop Smiling has a different impact on its audience. Since diagnosed individuals, as well as the disease itself, are so often misunderstood and misrepresented, exposure to schizophrenia can be troubling and even frightening. This book attempts to make acceptance and understanding of this illness more accessible to children, families, and educators, and promotes positive social and emotional development, as well as a healthy environment for everyone involved.

Please Stop Smiling mainly targets young children, particularly those exposed to family members with paranoid schizophrenia, as opposed to those experiencing the illness firsthand. Like many children’s books geared towards awareness and recognition of difficult topics, Carlson’s book makes his story accessible through perspective and voice. The passage, “Sebastian had made fun out of Jose’s older brother, Alejandro. What Sebastian had said was not even true, it was just mean. Alejandro had a mental illness called paranoid schizophrenia” (Carlson 3), is a perfect example of how Carlson productively appeals to his audience. After two short pages of playful and character introductions, the narrative transitions to an all-too-relatable scenario of one child teasing another for being different, or in this case, José’s brother being different. Then, the second sentence from this passage reflects the common and justified response of defending oneself but defending the victim, Alejandro. When children, and most people, are taunted about a loved one, it is a personal offense, that is why this statement really draws the attention and interest of the reader—it appeals to past emotions that every person has experienced. Then, the next sentence follows with the fittingly abrupt statement that Alejandro suffers from one of the most stigmatized diseases in western culture, paranoid schizophrenia.

By both appealing to the mentality of the target audience, and discussing the topic unabashedly, Carlson develops a perspective and voice that is loving yet afraid, empathetic yet not completely understanding. In another passage, Carlson sincerely illustrates Sebastian’s discomfort with the illness when he explains that Alejandro’s illness is very strange and Sebastian, and even frightening. Thus, when he makes fun of Alejandro and distances himself from the situation, it makes “the whole thing a little less scary” (5). The effect is a relatable and honest voice that, though José’s character is young and naive, he still has emotional authority beyond the other characters that promotes healthy attitudes and behaviors. José displays excellent prosocial behavior when he risks his friendship with Sebastian and stands up for his brother when Sebastian speaks ill of Alejandro.

Throughout the story, José defends his brother and approaches conflict with kindness, comfort, encouragement, and sympathy. This is particularly evident during the narratives of Alejandro smiling and laughing at the imaginary voices he hears. Though Carlson enlightens the reader about the disease when he lightly discusses Alejandro’s symptoms, they are from the perspective of a young boy. The American Academy of Child & Adolescent Psychology (AACAP) explains the phenomenon of hearing voices and experiencing hallucinations: “Psychotic disorders in children, while not common, are serious and severely interfere with a child’s thinking and functioning. Children who are psychotic often appear confused and agitated. They also may have disorganized speech, thinking, emotional reactions, and behavior, sometimes accompanied by hallucinations or delusions (a fixed, false and often bizarre belief).” This statement supports all of José’s descriptions of Alejandro’s behaviors and their effect on him and his family as a young man. Please Stop Smiling frequently repeats the fact that Alejandro’s illness makes him delusional, and unaware that he does, in fact, have a disease. AACAP explains that delusions, such as Alejandro believing that his mind actually powerful in that he can control other’s minds, which is why he hears voices, are a common manifestation of both early-onset and adult schizophrenia. From the perspective of a 10-year-old little brother, Carlson playfully and elegantly explains this manifestation of illness and his family’s support in Alejandro’s long road of recovery through the honest voice of his protagonist.

Toward the end of the book, Carlson begins to resolve his story, concluding that, after spending many years seeing a psychiatrist, trying medication, and attending therapy, Alejandro eventually gained control of his illness and mental health, which, of course, made him and his family much happier and comfortable. However, with all of the prosocial behavior, friendship development, and fostering of healthy attitudes, there is little to no mention of the boys’ family direct involvement in Alejandro’s healing process. According to S. Pilling et al., “[f]amily therapy, in particular single-family therapy, ha[s] clear preventative effects on the outcomes of psychotic relapse and readmission” (Pilling, et al ). At no point does the story mention family therapy or their parents seeking any sort of professional counseling, which is critical to the positive development of schizophrenic individuals, especially children and young adults. Though this book has a positive effect on the immediate target audience – young children – the effects do not permeate as far as they could. One glaring concept in which this story is deficient, though productive, inspiring, and informative in its own right, is that it does not address educators or parents. These are the people that often have a large amount of control in cultivating positive attitudes toward treatment, rehabilitation, and enforcing the continuance of healthy behavior.

Family therapy is known to be effective in any type of situation that inflicts the family at large with intense stress, loss or grief, conflict inside or outside of the family, or anger. The goal of this type of therapy is cultivate community, understanding, and trust within familial circles, and it is meant to bring members closer together. Nearly every mental health profession will suggest family therapy sessions in addition to individual sessions to promote collective safe and healthy practices that bring everyone involved closer to effective treatment and recovery.

Carlson’s story of the effect of Alejandro’s ailment on his little brother, José, gently explores the process of treatment, and the hardships one may experience through the process of experiencing symptom, diagnosis, education, and recovery. As mentioned, Alejandro’s family seeks the help of a psychiatrist for his individual sessions. At one point, Alejandro’s progress towards goo mental health management becomes stagnant when he lies to his therapist about the voices he hears and the other symptoms he experiences, leading the therapist to believe he had improved. Carlson makes a big point of explaining the negative repercussions Alejandro experiences by lying, and reinforces prosocial behavior and healthy attitudes about trust and emotional understanding.

Carlson also discusses the positive effects of the use of medication, and how it helped Alejandro manage his life, and continue his education as a veterinarian. This is also a very important point because children are often exposed to prescribed medications for mental illnesses, but the reason or understanding of their effects are rarely discussed in children’s literature. On page 33, Carlson writes, “Alejandro eventually recovered many years later, although he wasn’t cured. Still he felt a lot better inside. He still had to take medication and see a psychiatrist ever few months to stay well.” It is important that Carlson discusses the healing process, and the positive effects of therapy and medication for Alejandro because this also a scary aspect for children. Though the immediate effects of a family member’s schizophrenic symptoms can be disturbing, worrisome, and confusing, they often overshadow the equally daunting and frightening idea of seeking the right road to recovery. Because this aspect is less immediate, children are less exposed to this side of mental illness, the positive growth side. This section of the story reinforces the commonly held idea that medication and therapy must go hand-in-hand. “Psychiatric medication should not be used alone. The use of medication should be based on a comprehensive psychiatric evaluation and be one part of a comprehensive treatment plan” (AACAP). Carlson’s book, Please Stop Smiling manages to discuss psychotherapy in an almost objective way, by telling it from the perspective of a 10-year-old little brother. There are few pieces of children’s literature that bring such blatant points and concerns to the table, and make the information available to young readers.

Though the book may disclude the important point of family therapy and educator awareness, Please Stop Smiling sheds an informative and positive light on the topic of paranoid schizophrenia and how to manage familial relationships and friendships during hardship. The only thing that might improve the story would be additional illustrations and the mention of family therapy, with and emphasis on quality family communication. Overall, however, Richard Carlson’s story reveals a child’s experience and concerns about mental illness, making it much less scary and intimidating for children. By doing do, parents may see that their children have a better understanding and might better include young children in the healing process. Through the honest voice of a young boy, Please Stop Smiling promotes healthy and positive behavior, good emotional and social development of friendship, and fostering healthy attitudes.

References

American Academy of Child and Adolescent Psychiatry. (2012). Hearing voices and seeing things. Facts for Families, (102), 1-2.

American Academy of Child and Adolescent Psychiatry. (2012). Psychiatric Medication for Children and Adolescents Pat 1 – How medications are used. Facts for Families, (12), 1-

Pilling, S., Bebbington, P., KUIPERS, E., GARETY, P., GEDDES, J., ORBACH, G., & MORGAN, C. (2002). Psychological treatments in schizophrenia: I. meta-analysis of family intervention and cognitive behaviour therapy. Psychological Medicine, 773-782. doi: 10.1017}S0033291702005895