Every Last Word (35 page)

I
became interested in writing a story about a teen with Obsessive Compulsive Disorder (OCD) when a close family friend was diagnosed four
years ago, at age twelve. I sympathized with and related to her battle with insomnia, her struggles to interpret her friends’ words and actions, and her challenges to control a stream of
negative, often terrifying thoughts she simply couldn’t turn off.

I knew she wasn’t alone. I wanted to learn more about this disorder and to understand what it was like to live inside her mind. She was eager to share her experience, and I was honored
when she agreed to work with me on this novel.

Over the last two years, I’ve done extensive research on OCD and what some refer to as Purely Obsessional or “Pure-O” OCD, where the emphasis is more on internal thoughts and
images than external compulsions. I’ve learned that many professionals consider the term a bit of a misnomer—compulsions are still part of the disorder, they’re simply easier to
hide—but many people with OCD use “Pure-O” to differentiate an obsession with their
thoughts
from the better-known external behaviors, like ritualized hand washing or lock
checking.

I have read hundreds of blogs written by adults and teens, detailing what it’s like to live with OCD and Pure-O. I have pored over articles and medical journals filled with exhaustive
information about treatments and medications. I’ve consulted closely with four mental-health professionals to be sure this work of fiction portrays an accurate account of OCD, while also
demonstrating the value of a strong patient-therapist relationship. It has been enlightening, inspiring, and heartbreaking.

During my research, I became especially interested in exposure therapy, a subset of Cognitive Behavioral Therapy (CBT). I found it empowering, and wove it into the story when Sam’s mother
hands her a pair of scissors to prove that she won’t
act
on her invasive, fearful thoughts. While there are hints in the text itself, it is important to me that readers understand that
prior to this scene, (1) Sue has led Sam through exposure therapy sessions in her office, (2) Sue has formally trained Sam’s mother, so she can provide the 24/7 support Sam might require, and
(3) Sue and Sam’s mother operate as a team and are in constant communication about managing Sam’s disorder. My professional resources have confirmed that, while it is atypical to
perform exposure therapy outside a controlled office environment or to involve a parent in this process, it is certainly something they have employed under ideal circumstances. However, a
professional therapist
always
oversees and is closely involved in any CBT treatment.

CBT can be emotionally and physically intense, with sessions spanning weeks or months. Afterward, practitioners may transition back to traditional “talk therapy,” which is what Sue
and Sam engage in through the majority of the novel.

While this is work of fiction, the relationship between Sue and Sam in many ways mirrors the relationship between the real-life teen who inspired this story and her therapist for the last four
years. Throughout the process of writing this novel, I’ve become even more moved by their connection, and I’ve gained a whole new level of respect for mental health professionals,
especially those who work closely with teens.

If you or someone you know is struggling with OCD, anxiety, depression, or any other mental-health concern, I strongly encourage you to seek out your
own
Sue. S/he is real and out there,
waiting, eager, and able to help. Here are a few reputable places to begin: www.sfbacct.com; www.teenmentalhealth.org; www.beyondocd.org/just-for-teens; and www.kids.iocdf.org.

I want to close with an update on the girl who originally inspired this story. “C” is now sixteen. I can’t get her to swim, but she has started writing poetry, and while she
doesn’t share it broadly, she finds writing extremely therapeutic. She’s found true friends who make her feel good about herself, and she’s even found her very own AJ. Recently,
she decided that she’s brave enough to go away to college, where she plans to study psychology and become a therapist herself someday. I am proud of her, beyond words.

W
riting this novel taught me that I need to be braver with my words, and part of that meant sharing the story with other people long before
it felt comfortable to do so. I’m grateful to the many individuals who helped me bring
Every Last Word
to life and made it a much better book in the process, including:

The mental-health professionals who provided guidance and insight on this project. It’s been such a privilege to work with Dr. Michael Tompkins, Ph.D.; Dr. Marianna Eraklis, M.D.; and
Karen Blesius Rhodes, LCSW. I’m also grateful to my mother-in-law, Rebecca Stone, who deeply understands the workings of the human brain and graciously shared her knowledge along the way.

Everyone at Hyperion, but especially: my editor, Emily Meehan, for her valuable editorial direction and for being such a vocal advocate for this story; Julie Moody, for all her insightful
feedback along the way; Stephanie Lurie, Suzanne Murphy, Dina Sherman, and Seale Ballenger, for their tireless support and enthusiasm; Elke Villa, Andrew Sansone, and Holly Nagel, for marketing
this book with heart and creativity; my publicist, Jamie Baker, for
all
she does (also, for not pulling me away from “The Raven” that day); and Whitney Manger, for designing such
a strikingly simple yet beautiful cover that celebrates the power of words. I’m lucky to work with such talented, passionate, and genuinely fun people.

Lisa Yoskowitz, my first editor, who believed in Sam and her story from the very beginning, and cared so deeply about every last word (see what I did there?). She always seemed to know what I
was trying to say, even when I didn’t quite know myself, and I will be forever grateful for her encouragement, coaching, and friendship.

Caryn Wiseman, for understanding what I needed this book to be, reading
many
drafts (often on short notice), and helping me improve it at every turn. I’m fortunate to call her my
agent
and
my friend. Also, huge thanks to her extended team—my foreign rights agent, Taryn Fagerness, and film agent, Michelle Weiner—who represent my stories with such
dedication.

The members of GetLit.org for inspiring me with their brave and powerful voices, and to all the teen poetry organizations around the country for giving young adults a stage so their words can be
heard.

The courageous teens who openly share their personal experiences with OCD, anxiety, depression, and other disorders in an effort to raise awareness and offer support. I’ve learned so much
from them (and from the example they set).

The many friends who generously shared their talents and expertise, including Joe Rut, for writing beautiful songs and letting me borrow his words; Andrea Hegarty, for teaching me the finer
points of butterfly and competitive swimming; Claire Peña, for sharing my obsession with music and lyrics; Shona McCarthy, for spotting the little things that mattered a lot; Laura Wiseman,
for crying at all the right parts; Lorin Oberweger, for helping me pull Sam to the surface; Arnold Shapiro, time-travel fan turned friend, for providing episodes from his MTV series,
If You
Really Knew Me
and
Surviving High School
to help with my research; fellow authors Elle Cosimano, Stephanie Perkins, and Veronica Rossi, for reading early drafts and giving such solid
feedback; Carrolyn Leary, for coffee talks about mental health and much more; and finally, my forever friend Stacy Peña, who understood how special this story was to me long before I put a
single word on paper. She hugged me hard and told me to write it, and because of her, here it is. These are not just my friends; these are my Poets.

My son, Aidan, who shaped this story in unexpected ways and opened my eyes in the process, and my daughter, Lauren, who isn’t afraid to speak her mind but always does it with kindness.
They are many wonderful things, but mostly, they’re
good people
. I couldn’t be prouder of who they are.

Michael, who helps me be brave and just plain
gets
me. When Sam tells AJ she’s going to go write, he says, “Have fun.” That line is for my husband, because that’s
what he says to me before I disappear into my imaginary world. It’s such a small thing, but those two little words carry the weight of his love and support, while subtly reminding me why I
write books. It’s no wonder this guy is at the heart of every love story I tell.

And finally, C, my muse and friend: Thank you for letting me in. For you, I have so many words, but in honor of Sam, I’ll keep it to three: I love you.

TAMARA IRELAND STONE
(
www.TamaraIrelandStone.com
) is the author of
Time After Time
and
Time Between Us
,
which Melissa Marr praised as a “beautifully written, unique love story,” and has been published in over twenty countries. A former Silicon Valley marketing executive, Tamara enjoys
skiing, hiking, and spending time with her husband and two children. She lives just outside of San Francisco.