Sonia Patel writes from her experience as a first-generation Indian American born in New York and raised in Hawaii. Her YA novels include Rani Patel in Full Effect, Jaya and Rasa: A Love Story, and the forthcoming Gita Desai Is Not Here to Shut Up. Patel is also a child, adolescent, and adult psychiatrist with more than 20 years of experience. Here, she reflects on the need for YA fiction that realistically portrays the horrors of incest and sexual abuse, like the kind she survived as a child.

At age 40, I blew up my perfect life with a series of poor decisions that hurt those I loved the most. Shame-ridden and on the brink of honor-suicide, I assigned myself the homework I often recommended to my patients: I picked up a pen and a notebook and began reflecting and journaling. I filled up the notebook, then another one. Words poured out onto the lined pages—words I couldn’t yet speak.

It turned out those words were how I taught myself, for the first time, the language to conceptualize the chronic incest and emotional invalidation I’d endured growing up. Though disconcerting, the delay in my awareness made sense when I considered the multitude of ways my developing brain and body had adapted—hardwired symptoms—to survive and submit, and that many of the childhood incest survivors I treated in my psychiatry practice had also not been able to acknowledge the harm done to them until they’d hit some sort of rock bottom in their third or fourth decade of life.

I began to wonder: what if I’d read my notebooks when I was a teenager? Back then, I was constantly reading all kinds of books and magazines, but I’d never come across words like my recently penned ones. If I had, would I have seen myself reflected on the pages and felt less alone? Would I have been able to acknowledge that there wasn’t something wrong with me but that something wrong was being done to me and allowed to be done to me?

Yes and yes! It occurred to me: perhaps the answers would also be yes for other young survivors if they had access to such words.

I spent the next 10 years shaping and stringing all the words in my notebooks—along with the common experiences of some of my incest survivor patients—into three YA novels: Rani Patel In Full Effect, Jaya & Rasa: A Love Story, and the forthcoming Gita Desai Is Not Here to Shut Up.

To accurately represent the long-term fallout of chronic incest—a completely different beast than the fallout of circumscribed sexual assault—it was paramount that I write the survivor characters and their stories as messy and inconvenient. The survivors could not be completely self-aware, even at the end of the story, nor could their characters be fully developed. They had to make poor decisions over and over again. They could not form deep connections with others their age, only the beginnings of such connections. All of these purposeful and authentic depictions were how I translated into words the structural and functional damage that chronic incest and emotional invalidation inflict on the brains and bodies of survivors.

Although there are a few other realistic YA books about incest and its fallout, such as Push by Sapphire and Identical by Ellen Hopkins, a dearth remains. Why? Because, let’s be honest, no one really wants to go there. The word alone makes people flinch and tight-lipped. Not only must young survivors endure the chronic sexual abuse, but they must also adapt to being threatened, manipulated, groomed, and gaslit by the perpetrators and blamed, shamed, and emotionally invalidated by the surrounding family system. Furthermore, society deems circumscribed childhood sexual abuse by strangers more appropriate to discuss than chronic sexual abuse by kin or trusted adults. Thus, the painful and future-destroying realities of childhood incest, for the most part, remain locked away from the collective consciousness.

Incest exists and flourishes because of the secrets, denial, and silence finagled by perpetrators and enabled by surrounding family systems and society. Alarming CDC research reveals that 1 in 4 girls and 1 in 13 boys in the United States experience sexual abuse before they turn 18, and 91% of that sexual abuse is perpetrated by a family member or someone known and trusted by the child or child’s family—incest. Furthermore, a DOJ report indicates that most sexual abuse of children occurs in a residence, typically that of the victim or perpetrator—84% for children under age 12, and 71% for children aged 12 to 17.

In my psychiatric work with incest survivors, acknowledgement of the truth is always the first step on the healing journey. And since incest is perpetuated by the lack of acknowledgement, survivors reading realistic YA books on the subject might find within the pages their first and only validation of harm and suffering. It’s possible that they could then transform the validation into acknowledgement of the harm done to them and their own suffering. It’s also possible that any reader of these books might begin to understand the agonizing silent language of incest survivors—poor decision-making and suffering.

We as caring adults must work against society’s incest-denial by writing, publishing, and making accessible more realistic YA novels on the subject. Such realistic YA fiction can be the powerful voice for survivors until they find and learn to use their own.

Gita Desai Is Not Here to Shut Up by Sonia Patel. Dial, $19.99 Sept. 10 ISBN 978-0-5934-6318-5