The challenge of writing about some types of mental illness is to explain the kind of pain and despair that have no obvious cause.Christoph Hetzmannseder / Getty

Editor's Note: If you are having thoughts of suicide, please know that you are not alone. If you are in danger of acting on suicidal thoughts, call 911. For support and resources, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text 741-741 for the Crisis Text Line.

In the hours before her second suicide attempt, Juliet, the eponymous teenage protagonist of Juliet Escoria’s new novel, starts “doing the thing where I removed myself from myself.” As if floating outside her own body, she sees herself as a too-skinny girl with tangled hair, beset by hallucinatory demons, whose expression is “so flat … that she might as well have been dead.” The vision leads Juliet to conclude, temporarily, that there is no hope for this girl to go on living. She even implies that killing this version of herself would be an act of mercy. “She looked so lost,” Juliet explains. “I felt so sorry for her.”

The moment—one of extreme alienation and extreme empathy—captures the challenge of writing about some types of mental illness, of making legible the kind of pain and despair that have no obvious cause. In Juliet the Maniac, Escoria interrupts the main first-person narrative with archival documents and flash-forwards that allow her to recount Juliet’s struggles with bipolar disorder from a slight remove. The effect is destabilizing, but also comprehensive: Readers are immersed in the girl’s state of mind, but can also see what her experience looks like from the outside.

Rabbits for Food, by Binnie Kirshenbaum, shows a similar split in perspective. The novel follows a writer named Bunny who, while hospitalized for severe depression, composes a fictionalized account of her experiences, telling her own story in the third person as if watching herself from a safe distance. Kirshenbaum breaks up this restrained narrative with prompts from Bunny’s therapeutic writing workshop, revealing a more complete and sometimes contradictory picture of a woman who’s struggling to rationalize what’s happened to her. For both Bunny and Juliet, dissociation is a symptom of and a coping mechanism for the mood disorders that alter their emotions and behavior. Escoria and Kirshenbaum structure their novels to reproduce this feeling, interweaving different perspectives and timelines to illustrate how mental illness can attack a person’s sense of self.

In Escoria’s novel, Juliet’s fear that she is becoming a different person is one of the defining features of her bipolar disorder. At 15, Juliet is a confident and high-achieving, if rebellious, student. As her symptoms get worse—“an army of shadows” presses against her chest and prevents her from speaking, words in her textbooks appear to disintegrate before her eyes—she feels as if her old self is being replaced by someone she doesn’t recognize. “Her name was Juliet,” she thinks. “She was the daughter of Helen and Robert. She was no genius. She was just crazy.” When she wakes up in a hospital room after her first suicide attempt, her guilt over hurting her parents is overwhelming; she feels that she has “mutated from their daughter into a monster.” And even as an adult, Juliet reflects in a “letter from the future,” she can’t reconcile her own identity with the girl who tried to kill herself: “Who is that girl in that story? That is some other girl. I do not own her, or know her, but she both owns and knows me.”

Understanding and exorcising this other, wounded self is the implicit purpose of Juliet the Maniac, which is structured as if the adult Juliet is compiling a case report on her own breakdown. The story—which begins just before Juliet’s first symptoms appear and continues through her treatment at a boarding school for troubled teenagers—is told in short, first-person vignettes. Interspersed among these flashes of memory and introspection, however, are clinical documents that provide a tether to Juliet’s external reality.

“A fact sheet from the future” on the side effects of antidepressants in adolescents suggests a cause for the suicidal feelings that, in the present, seem to come out of nowhere. “Patient logs” from the Redwood Trails boarding school track the passage of time in terms of Juliet’s evolving symptoms and growing list of medications. Images of doctors’ evaluations and Juliet’s own handwritten notes appear throughout the text as if photocopied onto the pages, along with captions (“Luke Letter (final: copy, made for personal records), January 2000”) that mark them as artifacts to be examined. The contrast between these insertions and the narrated passages is jarring; it forces the reader to move between deeply interior and distant views of Juliet’s life, each of which seems to call the other’s accuracy into question.

Rabbits for Food has a similar, though less immediately apparent, frame in which a protagonist takes stock of the factors that have affected her mental health. The novel begins in the first person, partway into Bunny’s stay at a psychiatric ward, then flashes back to a third-person account of how she came to be there. The third-person passages are Bunny’s own writing: a novelized version of her illness and treatment. Her responses to prompts from the creative-writing therapy group that she reluctantly attends are also woven throughout. They appear as diary entries that reveal some of the most painful and formative moments of her life, but eventually shift into the second person as Bunny distances herself from her own revelations.

This structure of interruption and doubling back—with some passages reproduced almost identically, though from a different perspective—is disorienting but appropriate. One symptom of Bunny’s depression, her narrator explains early on, is short-term memory loss that amounts to a kind of narrative breakdown: “She finds she can describe a scene, but the connective tissue needed to tell a story becomes white space, like lines skipped on the page.” Accordingly, the chapters of her story become shorter and more fragmented around moments of emotional extremity, and Kirshenbaum withholds the key event precipitating Bunny’s depression until late in the book.

Bunny, like Juliet, struggles with self-loathing and alienation as a result of her illness; she experiences this less as a division of her identity, however, than as an urge toward self-erasure. In depression, she loses her appetite and becomes “insubstantial, a manifestation of the wish to disappear.” When she can’t bring herself to attempt suicide, she runs her passport and driver’s license through a paper shredder, and then isn’t sure how to respond when her husband comes home and asks her, “Are you here?” Bunny embraces the image of herself as “a person who is not easy to like”—language that adopts the perspective of an outside observer, just as her third-person narration does. This description makes it easier for Bunny to see herself as a character—and easier, in turn, to see her suffering as fiction, to say to herself, as she does at the hospital, “This is not real, this can’t be real.”

Bunny’s attitude could be read as denial. And yet, to the extent that mental illness challenges a person’s most closely held certainties, there’s a measure of healing in creating a narrative, in deciding what is true. The distancing tactics that Kirshenbaum and Escoria use to structure their stories—Bunny’s manuscript and writing prompts, Juliet’s patient logs and letters—communicate the characters’ feelings of isolation and disruption. These framing devices also provide Bunny and Juliet with a buffer from events that might otherwise be too painful to face. In treating their circumstances as fiction, they regain some of the autonomy they’ve lost.

We want to hear what you think about this article. Submit a letter to the editor or write to letters@theatlantic.com.