44 pages • 1 hour read
Freida McFaddenWard D
Fiction | Novel | Adult | Published in 2023A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.
Themes
Mental Health Diagnoses and Their Impact on Patients
Content Warning: This section of the guide discusses stigmatizing tropes that connect mental health conditions to criminal behavior, which Ward D portrays.
Amy’s friend Jade was diagnosed with hereditary Bipolar I when they were 16, after an incident with their math teacher, Mr. Riordan. Amy ran from the situation and visited Jade after she was admitted to Ward D, the latter being furious at having been betrayed. This incident left Amy afraid of Ward D, but as she is assigned to the locked psychiatric ward through her medical school, she is forced to confront her trauma. While the situation is uncomfortable, her fear threatens to become bias throughout the night. Jade’s diagnosis was not unexpected since her mother, whom she killed, also had the same mental health condition, which likely exacerbated her abuse of Jade. However, Jade struggles to find proper treatment because her doctors cannot find the right combination of medication to control her symptoms. She also dislikes her pills because they make her feel sluggish and cause weight gain. This combination of issues has caused her to lack self-control, leading to multiple hospitalizations and legal problems.
Besides Jade, there are multiple patients in Ward D who experience various forms of schizophrenia. This mental health condition causes patients to hear voices that encourage them to act impulsively, often violently. However, this is not always the case. Miguel believes he is the son of God, while Spider-Dan’s nickname stems from his belief that he is Spider-Man. By contrast, Jade’s boyfriend Damon, an isolated patient, has a complicated type of schizophrenia that includes a mood disorder, making it especially difficult for him to receive proper treatment. Will, though later revealed to be faking his symptoms, is diagnosed with paranoid schizophrenia. While schizophrenia does pose challenges, regardless of severity, the novel treads the line between depicting these challenges and demonizing them. While Miguel and Spider-Dan are depicted as harmless, simply experiencing different realities than that of most people, Jade and Damon are borderline demonized for their diagnoses. People are not their diagnoses, but it can be difficult the parse the two, as people like Jade and Damon could very well be malicious people, with their diagnoses exacerbating their preexisting impulses. Amy’s constant fear also treads this line: While her trauma and exhaustion play a part in her discomfort, she seems to assume the worst when it comes to mental health conditions, despite their range in severity.
Amy’s fear could also read as discomfort with herself: At 16, she saw a hallucination of a young girl who often encouraged her to act out of character. Ever since, she’s questioned her mental health, but keeps this suspicion to herself for fear of ruining her “perfect” persona. Her mother never suspected anything because by contrast, Jade’s issues were always out in the open. Amy eventually learns Jade slipped a hallucinogen into her peach iced teas in the past, but she continues to see the young girl in the Epilogue. She likely has schizophrenia but is able to control her impulses, choosing if and when to listen to her inner voice. However, there is danger to her keeping her concerns to herself yet again.
Friendship Becoming Adversity
Amy and Jade have been friends since kindergarten, this relationship playing an important role in Amy’s childhood and enduring fear of Ward D. As she enters Ward D as an adult, she looks back on her past and remembers how Jade’s behavior changed when they were 16: The once studious Jade became erratic and volatile, stealing and spending more time with troublemakers than Amy (including her eventual boyfriend, her mother’s drug dealer Damon). Even before this escalation, Jade seemed to take the lead in their relationship. Amy recalls visiting her in Ward D after a particular incident, and the latter, feeling betrayed and abandoned, threatened to kill her. This incident, the source of Jade’s grudge, isn’t revealed until later in the novel: Amy informed her mother that Jade tortured their math teacher, Mr. Riordan, in an attempt to hide her theft of a test. Out of a twisted sense of solidarity, Jade pushed Amy to kill Mr. Riordan, but she refused and ran away. This behavior led to Jade’s formal diagnosis, the teenager having inherited Bipolar I from her mother, and effectively ended the girls’ friendship.
While Amy and Jade’s relationship began as friendship, it became twisted in their separation, a weight that both women carry and attempt to use to resolve the past. Jade wants to kill Amy for ruining her life rather than partaking in murder, while Amy uses Jade to excuse her fear of psychiatry and Ward D, when she truly fears it because she believes herself to have schizophrenia. However, upon their reunion, the girls act civil, albeit petty, rather than vicious. They find themselves returning to routine, discussing romance as if they were never separated. In hindsight, Jade likely remained civil to literally keep Amy in the dark regarding her and Damon’s plan. There is nothing healthy about Amy and Jade’s friendship at the end of the novel, even with Amy’s guilt over not intervening in Jade’s life sooner. Like her guilt over Cameron, this guilt eventually wavers. With their second parting, Amy and Jade are left as two women who know too much about each other to simply forget their connection—even if they no longer desire it.
By contrast, Amy’s friendship with her roommate Gabby, while given little attention, is straightforward. Gabby agrees to drive Amy to and from Ward D, and Amy sends a lighthearted text to her about Dr. Beck during her shift—which inadvertently saves her life, as she quickly realizes “Dr. Beck” (Damon) is an imposter. When all is said and done, Amy keeps what happened in Ward D a secret, her and Gabby’s final scene being them eating Cameron’s Ring Dings. While straightforward, this friendship could read as falling short of the highs of Amy’s friendship with Jade—at least, before Jade’s symptoms worsened. A healthy friendship with low stakes would do Amy good, but like her other relationships, she continues to keep her emotions and secrets close to her chest. She is not obligated to share everything about herself, but, as her and Gabby’s friendship is depicted in the novel, it seems cordial if lacking depth.
Fear of Knowing Oneself
Amy thinks she knows herself, suspecting she has schizophrenia because when she was 16, she began to see a young girl who often tells her to act out of character. This girl encourages her to shoplift, cheat, and kill—to do so for the sake of pleasure or survival, the two sometimes becoming one. She seems to be Amy’s impulsive subconscious, a part of her who says things Amy herself is afraid to say. Amy’s experience with this hallucination is hidden throughout much of the novel, only appearing in the open when she remembers past appearances of the girl; Jade corroborates these appearances, as she assumed they were the result of her spiking Amy’s peach iced teas in the past. However, unbeknownst to the reader, the girl aids Amy’s defense against Jade: She reminds Amy that she possesses a steel knitting needle in her pocket. Thus, Amy’s denial of the girl’s presence is her denial of her mental health condition—as this challenges her otherwise “perfect” persona. She links her hallucinations to schizophrenia and simply chooses to ignore them, but without a proper diagnosis, this is not a given.
Likewise, Jade also struggles to know herself: She is aware of her mother’s hereditary Bipolar I, but blames her violence on everyone but herself. She doesn’t want to admit to having a mental health condition, which makes it difficult for her to take advice and medication. This reluctance to understand her mental health inhibits her care, with her instead trying to escape her physical imprisonment. Both Amy and Jade’s inner conflicts speak to the stigmatization of mental health as a whole, as mental health conditions such as schizophrenia and bipolar disorder are challenging, but don’t make people lesser in any way. However, due to real and fictional misunderstandings and misrepresentations of mental health, people like Amy and Jade are conditioned to feel afraid or ashamed of themselves—which often discourages them from seeking professional help.
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