Throughout the book, psychiatric treatment is often part of the background. Some characters have participated in repeated, redundant interviews in mental health facilities, or psychotherapy that has proved ineffectual in addressing their angst. But many are depicted with a unique self-destructive bent, their interactions with clinicians or school counselors shaded by a wall of resistance. Their coping strategies are recognizably maladaptive: oppositionalism, resignation, or purposeful suppression. Some alleviate pain with intoxicants, self-mutilation, or violence. When offered help, they dissemble and withhold. They divert and trivialize. Their helpers aren't given a clue.