I struggled to write this review. Not because “Juliet the Maniac” is undeserving of praise. But how to honor the glimmering beauty of its teenage voice, sharpened by pain, without amplifying the siren calls of self-harm and suicidal ideation that fell over author Juliet Escoria during the onset of bipolar disorder, which she fictionalized for her debut novel?

“I no longer slept. It was so loud all the time. Each day I was assaulted by ringings and whispers, my heart pounding out the center of the chaos like a metronome, the order of the days splintering, popping apart.” In “Juliet the Maniac,” Escoria chooses autofiction — memoir framed through fiction — to deliver titled, lyric fragments of the fraught adolescence of her namesake narrator Juliet, “some random girl, a stranger … I do not own her, or know her, but she both owns and knows me.”

Escoria mines her early years for their truths, made more urgent by Juliet’s headlong bipolar impulse toward sex, drugs and self-destruction. The unsteady orbit of her disintegrating psyche plays out in treacherous episodes of mania and paranoia that intensify, leaving devastation in their wake as she bounces from high school to high school, trying to find an environment she can tolerate.

Describing her symptoms with estranged glamour — “I would have been alarmed but everything was glistening and pulsing and alive” — Escoria depicts Juliet’s descent into self-harm with ruthless precision. Juliet cuts herself to refocus away from her emotional torment and toward physical pain, even while suffering a prescribed, numbing fog. Her checkered medication history is a chronicle of psychiatry’s steep, ongoing learning curve, evidenced by her suicide attempt scant weeks after transitioning to a new antidepressant, a perilous time for juvenile patients.

Escoria interrupts Juliet’s trials and “seemingly endless, remorseless” guilt with earned wisdom in letters from an older, authorial narrator. Her sustained consideration of this troubled version of herself becomes a form of kindness and self-care when seen through the lens of Simone Weil’s definition of attention as the “purest form of generosity.”

In “Juliet the Maniac,” written half a lifetime after Escoria’s dangerous adolescence, the need to find reasons to live is tinged with powerful helplessness that ricochets between Juliet, her parents and the reader. What to tell a frantic teenager “who couldn’t stand the simple act of being herself,” teetering on medications in a haphazard and heavy rotation, desiring “to be a void, not a person?”

Few words suffice.

There is nothing lyric about waking up intubated in a hospital bed. Nothing lyric about keeping a razor handy. Nothing lyric about the contagions of cutting and suicide.

And yet suicide is a philosophical lodestone worthy of a literary lineage that extends to Greco-Roman times, magnetizing the greatest thinkers of many centuries, including Albert Camus, who believed it “the fundamental question,” Johann Wolfgang von Goethe, who called suicide “an event of human nature” that “in every epoch must be discussed anew,” and William Shakespeare, who portrayed an unlikely reconciliation through dual suicide in “Romeo and Juliet.”

Literatures of mental illness and self-harm reveal our common drive to devise solutions to the trauma of living. Of special note in the recent canon are Miriam Toews’ “All My Puny Sorrows” and Kathleen Glasgow’s “Girl in Pieces,” whose cover and form presaged “Juliet the Maniac.”

Below a photo of Escoria’s December 1998 hospital bracelet, dated to when she was 15, she writes, “There are so many things to learn after an attempted suicide. Here is one: the most embarrassing feeling in the world is waking up in the hospital after a botched attempt.” Escoria survived, saddled with the shock of what Sylvia Plath deemed a “theatrical/ Comeback in broad day/ To the same place, the same face.”

Steeped in the inglorious impulses of youth, with bright aches in her skin and a repeatedly emptied stomach, Juliet fakes her way toward a real recovery during months of involuntary inpatient treatment in group homes, plane rides away from her grieving parents. There, she meets teenagers capable of lasting ruin and staff members fleeing crimes and their own demons. Among them are institutional allies and friends who cycle through these fraught places with cruel rapidity, arriving and departing with unexplained, rumored drama. “We were told nothing. I wasn’t even allowed to write her. And just like that, my best friend was gone. Just like that, I was alone.”

Grappling with sobriety, psychic isolation and the companionship of aggressors, Juliet pretends to believe in the worth of her own life, which she threatens at unheralded moments after quotidian conflicts. Ambivalence kills.

Exploring despair and its relief in poetry (“Witch Hunt”), short stories (“Black Cloud”), essays and short videos, Escoria’s work provokes both recoil and re-examination of what we deem safe to discuss. Silence does not protect those who are suffering. Writing coaxed Escoria toward fragile truths whose strengths have grown with each telling. “You’re sensitive. And that means extra pain, extra loneliness, extra sadness,” a night shift attendant tells her. “But it also means extra joy.”

Escoria endured to adulthood and accessed her vitality in unflagging prose, a gift to any reader who has ever lost control, sighted a horizon and began moving toward it. Our private reckonings, in their complex formulations, are as fascinating, repulsive and affirming as her fractured narrative of self-harm and eventual healing, “the pale shoots deepening into a rich green as they widened and grew.”

Novels that consider the unflinching question of whether to die often bend toward showing us how to live. To read “Juliet the Maniac” is to confront our shared faith in the flawed logic of life’s meaning, and by so doing, become worthier of our humanity.

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Young is the author of “Subduction,” a novel forthcoming from Red Hen Press on April 14, 2020.

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