The BookBrowse Review

Published May 15, 2019

ISSN: 1930-0018

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The Place Between Breaths
The Place Between Breaths
by An Na

Paperback (26 Mar 2019), 192 pages.
Publisher: Atheneum Books
ISBN-13: 9781481422260

From master storyteller and Printz Award–winning author An Na comes a dark, intensely moving story of a girl desperately determined to find a cure for the illness that swept her mother away, and could possibly destroy her own life as well.

Sixteen-year-old Grace is in a race against time - and in a race for her life - even if she doesn't realize it yet…

She is smart, responsible, and contending with more than what most teens ever should. Her mother struggled with schizophrenia for years until, one day, she simply disappeared - fleeing in fear that she was going to hurt those she cared about most. Ever since, Grace's father has worked as a recruiter at one of the leading labs dedicated to studying the disease, trying to lure the world's top scientists to the faculty to find a cure, hoping against hope it can happen in time to help his wife if she is ever found. But this makes him distant. Consumed.

Grace, in turn, does her part, interning at the lab in the gene sequencing department daring to believe that one day they might make a breakthrough…and one day they do. Grace stumbles upon a string of code that could be the key. But something inside of Grace has started to unravel. Could her discovery just be a cruel side effect of the disease that might be taking hold of her? And can she even tell the difference?

Unflinchingly brave, An Na has created a mesmerizing story with twists and turns that reveal jaw-dropping insights into the mind of someone struggling with schizophrenia.


There are many versions of a story. Many sides and lenses that can distort, change, illuminate what is seen and unseen. What is heard and unheard. What is felt and unfelt. In the end, truth is but a facet of a diamond, a spark of ray from the sun, a forget-me-not flower seen from the eyes of a bee. What lives and breathes as reality is a perception, so who is to say what is possible and impossible?

Call it fate or simply coincidence, but the shorter version of how I found you begins like this. There was a dark speck on the side of the barren winter road that grew larger and larger as I drove closer. Expanding from a dot to a stone to a tree stump until I screeched to a halt. A few dozen feet away from a headless coat turtle-shelled on top of the snow. Both of my hands released the steering wheel and coned over my mouth. Was it a body? There was no movement. I slowly opened the door and stepped out. Had someone frozen and died overnight? It wouldn't have been the first time that something like that happened around here. I took a step forward, and then another, the fragile crack of ice and gravel rippling through me. My breath misted before my face.

A head emerged.

I shouted in fright. "You scared the hell out of me!" A large vapor cloud formed as I exhaled long and slow.

Your disheveled black hair framed your face, petite, round. It was hard to tell how old you were, but something about your eyes told me you were older than you looked.

Slowly unfurling each limb as though in pain, you stood up.

I walked forward in relief.

"You looked like a dead body."

Your brows gathered as you lifted and dropped your shoulders before bowing your head slightly. "Sorry."

Then a brief wave of your hand and you started walking down the side of the road.

"Do you need a ride?" I called to your back. You stopped. "I'm on my way to town," I said.

You gazed back, your eyes roaming my face before you turned and kept walking down the long cold road. Away from me.

* * *

That is the short version of how we met. You didn't tell me then why you were so tired that you had to rest hiding inside your coat by the side of the road, but since then, after meeting again, you have shared a few of your truths. The longer story of us is like the horizon. We can only know what we see, and all that we wish we could understand is beyond vision.

Excerpted from The Place Between Breaths by An Na. Copyright © 2018 by An Na. Excerpted by permission of Atheneum Books. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

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Please be aware that this discussion guide may contain spoilers!

  1. As the novel begins, An Na suggests that perception is reality. "What lives and breathes as reality is a perception, so who is to say what is possible and impossible?" What does Na mean by this? Who is the narrator of this chapter? To whom is the narrator speaking?
  2. The Place Between Breaths is a narrative told from many points of view. With Grace as a first-person narrator, what are some things readers discover or understand especially well about her? Yet, because of her first-person viewpoint, what are some things Grace cannot understand or share with readers? How do the chapters written in second- and third-person narratives affect the unfolding of the story? Discuss.
  3. An Na describes the place between breaths as "Not death. Not life. A limbo state of existence . . . the middle place that exists between breaths, in that pause, that slight breathlessness before an exhale and an inhale. Between the crest and the valley. Where the path always meanders cliffside." How would you describe this in your own words?
  4. There is evidence in Grace's childhood and adolescence of her emerging schizophrenia. Discuss the symptoms of nausea, dizziness, obsessive counting, disorientation, and lapse of memory she experiences. What other symptoms are increasingly in evidence?
  5. Consider your reactions to Grace. Did your thoughts and feelings change as you read the story? In what ways? For what reasons? Compare your reactions with reactions other characters in the novel have toward Grace.
  6. Grace moved many times in order for her father to pursue his dream of bringing about a cure for schizophrenia and reuniting their family. What feelings did Grace have about her many moves? How did it impact her life? Has your family ever had to move? What feelings did you have? Were they similar to the feelings Grace experienced? If so, in what ways?
  7. Consider Grace's coping strategies to protect herself from the anxiety of confronting her own fears. Do you think these strategies were beneficial to her? Do you think her responses to her illness were aspects of the illness itself? What parts do defensiveness, denial, displacement, and repression play in Grace's attempts to cope with the increasing frequency of her symptoms, including hallucinations and delusions? Could she be asking for help, and if so, from whom?
  8. In thinking about Grace's father's approach to her illness, how does he demonstrate his love and concern? In what ways was this inadequate to her well-being? What could he have done differently? What significance does his faith in seemingly unrealistic hopes and goals have on Grace throughout her life?
  9. Will wonders, "I don't know what is worse, having so much hope only to have it crushed, or not to hope at all." Dr. Mendelson asks, "'What is faith but blind hope?'" Grace believes, "Fate is but an encrypted code of genes. Your chromosomes a map of the future that cannot be changed." Passages like these debate between Fates and faith, reflecting the way science often converges on the spiritual. Genetics can show Grace a diagnosis and associated fate, but does that mean she can't keep hope in sight and fight her disease, reaching for a different outcome? Think about the following passage: "What choices are truly our own verses what has been handed down through your Fates? . . . The idea that only one truth can exist is not a truth, I would say. Fates have been known to change. With faith." Can science and faith truly co-exist? Do you believe in free will? A higher power? Is Grace's life worth the fight?
  10. What role do secondary adults play in Grace's life? Are they portrayed realistically? Consider Dr. Mendelson and Stephanie. How could Grace have involved these adults to possibly improve her situation? How might they have contributed more effectively to her well-being?
  11. During Grace's first encounter with Will at the centrifuge machine, what is revealed about her? What is significant about this? How does Will react to her? What do Grace and Will need from each other, and is Grace capable of providing it? What role does Will play in Grace's life? How does this relationship change throughout the novel?
  12. Why do you think the author chose not to share the circumstances of Grace's father's death with the reader? Are the circumstances and time frame unclear for a reason? Discuss.
  13. Why do you suppose the author used the four seasons as chapter titles? Did you discern a pattern? How might the changing seasons mirror the cycles of generations inheriting and experiencing the same disease? How do the changes in seasons affect the point of views of the story? Can you determine who is speaking in each section?
  14. Consider the setting with particular regard to images of unrelenting winter frosts, bleak and isolated gray-clouded landscapes, and a cold, dark, and unwelcoming house full of incessant noises. These images stunningly reflect the inner life of schizophrenia. What other symbolism is evident in the setting of this novel? When and where is it most evident?
  15. Grace is haunted by childhood memories of her mother's illness and struggles with the knowledge that she is genetically prone to schizophrenia as well. What is the difference between understanding one's past and coming to terms with it? Discuss.
  16. Grace's father tells her, "'I can't find a cure, but I can find the scientists who will.'" Is there one thing you're passionate about that you would devote your life to accomplishing, or dedicate yourself to finding someone who could accomplish it? What would that be? Why?
  17. Were you surprised to learn the truth about Grace's friend Hannah? What did Hannah represent? Why could Grace make choices for Hannah, but not for herself? Why might Grace have trouble separating her identity from her mother's, from her situation, from her disease?
  18. What is your opinion of the conflicting choices Grace's parents present to her in her hallucinations as she attempts to take the potassium cyanide? Discuss.
  19. Will believes his sister Sarah did not make a conscious choice to end her life. Whether from schizophrenia or from suicide, he says there is no difference: the choice was not hers. He asks Grace, "'How is that a true choice when she's not even in control of her mind? The voices told her she wasn't worth it. They told her to do it.'" Do you agree or disagree with Will? What is your reasoning?
  20. Before reading this book, what thoughts or images did the word schizophrenia bring to mind? What insights into mental illness have you taken from Grace's journey? Is there another character's emotional journey you relate to in this story? Whose? In what ways? How might your future thoughts or actions differ as a result of reading this book?
  21. How did you feel about The Place Between Breaths immediately after you finished reading it? Explain why you felt this way. Imagine Grace's life several years into her future. What do you envision for her? What would you suggest as an epilogue to this novel?
  22. By the end of the novel, all of the seasons change, and the past becomes the future. This leads to alternate possibilities in re-reading the novel. By shifting the seasons, the novel can be read differently, as a story of Grace with her child rather than Grace and her mother. Try going back to the mother-daughter baking sections of the novel, and reading them as if indeed the mother is Grace, and the child is Grace's child; in other words, as if those sections were the future rather than the past. How do you imagine the story unfolding if that were the shift, if the story spun from that type of timing?

Suggested Extension Activities

  1. Further explore the symptoms and treatment of mental illness by reading Charles Cozic's Teenage Mental Illness. Cozic provides an overview of mental illness, especially as it relates to teens. Discuss as a class how Grace would relate to this book, and whether it adequately describes some of Grace's symptoms. Discuss the differences between reading a textual description about symptoms of mental illness and seeing them firsthand.
  2. Grace believes genetics "is like magic, but real." Genetics is the study of genes and heredity in living organisms, a field of biology that relates to other life sciences including information systems. Genetics has led the way to a number of subfields, including epigenetics, which is the study of changes in gene function that do not involve changes in the DNA sequence.

    Explore the fields of genetics and epigenetics with regard to current research and career opportunities. A suggested source is a podcast called "Epigenetics and the Biology of Belief—With Dr. Bruce Lipton," found at Discover why your genes don't control your destiny, and the latest science from epigenetics.
  3. Grace's mother believed that "The Fates were no minor gods." According to Greek mythology, the Moirai (referred to in English as the Fates) have the power to decide man's destiny. Grace believed she "would beat down the wings of the Fates again. And again. And again." Research the role of the three Fates in Greek mythology. What is the role of the Fates in this novel? Why do you think people like to believe in a greater power?
  4. Among the hundreds of medical researchers at Genentium, the author has portrayed women scientists in key roles. Explore the roles of women in science in the twenty-first century by learning about the structure and data from science-related organizations such as NASA, American Institute of Biological Sciences, American Association for the Advancement of Science, and National Academies of Sciences, Engineering, and Medicine. See if you can find essays from women about their experiences working in scientific fields, such as this article in Science Magazine: Compile your findings and discuss what you've learned with the group.
  5. Write a letter to one of the characters. What would you say? What would you want him or her to know? What advice would you give them? What questions would you ask?
  6. The scene in Grace's kitchen where she is attempting to take the potassium cyanide has intense psychological and emotional richness for stage or screen. With a small group of friends or students, act out this scene. Include Grace, her father, Hannah, and Will's phone call. How would you direct this scene in order to convey the intensity, the hallucinations, and the terrifying struggle between Grace's choices?


Unless otherwise stated, this discussion guide is reprinted with the permission of Atheneum Books. Any page references refer to a USA edition of the book, usually the trade paperback version, and may vary in other editions.

An Na's lyrical, intense novel merges subject and structure in an immersive and compassionate portrayal of life with mental illness.

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Grace King seems like a young woman with a bright, even shining future. The daughter of a successful doctor who left his practice to lead recruitment efforts for a biomedical lab, Grace seems destined to follow in his footsteps. Even though she's only in high school, she has (entirely on her own merits) landed a competitive internship at the lab where her father works. Even if much of her responsibility involves sitting in the hallway babysitting centrifuges, Grace is surrounded by the brilliant, passionate researchers her father has gathered, people dedicated to finding genetic causes and effective therapies for illnesses that plague mind and body. Observant and creative, resilient and independent, Grace seems poised to take her place among them someday.

But secretly, Grace has doubts and fears. The driving force behind her father's ambition and her own scientific interests is the desire to find a cure for Grace's mother, who suffered from schizophrenia throughout Grace's early childhood and ultimately disappeared when Grace was five. Grace remembers her mother's vulnerability, her own anxieties, and even moments of abject terror when her mother's illness was at its peak. Grace's father, an optimist, has faith that a cure is possible; Grace is more pragmatic, and fears that even if a therapy were found, it would be too late for her mom. What's more, Grace has begun to hear the same terrifying train whistle that once terrified her mother - even though there are no train tracks anywhere near home or the lab.

An Na's novel has an innovative, even clever, structure, one that elegantly, and at times unnervingly, mirrors the feelings of disorientation, the breakdown between reality and visions, that can haunt a person with schizophrenia. Linked to seasons of the year – representing past, present, and future - and utilizing varying narrative voices and verb tense, chapters overlap and at times collide with one another, as Grace - and, by extension, the reader - grows increasingly unmoored from everything she thought she knew. Some readers may grow unsettled or frustrated by this approach, but thoughtful and patient readers will recognize and appreciate this inventive and empathic approach.

That's not to say that A Place Between Breaths resembles a protracted writing exercise; far from it. The novel is both lyrical in its language and compassionate in its emotion, as the author draws readers into Grace's world - and beyond their preconceptions about what it means to contend with mental illness. It can also be read as an extended meditation on the interwoven themes of faith and hope. "What is faith but the belief in your chosen religion?" Grace's mentor asks her. "What is faith but blind hope? Do you have faith in science? History? How many times has it all been proven wrong?" This emphasis on faith and hope is what propels the reader - and, one hopes, Grace - to a place beyond despair. An Na leaves many questions open-ended at the close of this slim but surprisingly suspenseful novel, leaving readers to ponder and discuss what might be next for Grace - and to harbor their own hopes for her future.

Reviewed by Norah Piehl

Kirkus Reviews
Starred Review. Thoughtful readers who appreciate literary fiction will find much to savor in this lyrical novel suffused with beauty and terror.

Publishers Weekly
Starred Review. Intense...Readers will feel Grace's tension viscerally, as she weighs hope against despair.

School Library Journal
Starred Review. A slim but demanding and haunting novel for readers of Beth Kephart's One Stolen Thing or John Green's Turtles All the Way Down. Grades 9 and up.

Starred Review. Like the fog and confusion that accompany Grace's episodes, nothing is cleanly delineated, and the reader is left wondering about Grace and seeking answers long after the story has ended.

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Schizophrenia-focused Labs and Research Centers

Like the lab where Grace and her father work in An Na's The Place Between Breaths, scientists around the world are hard at work researching the causes of schizophrenia and investigating potential cures. Here are a few of the labs and research centers that include schizophrenia as one of their primary areas of inquiry:

Duke Schizophrenia Research Group
The Schizophrenia Research Group at Duke University in Durham, NC, focuses on the mechanisms of cognitive deficits in patients with schizophrenia. Research utilizes imaging technologies and studies metabolites, cognitive neuroscience, and the links between genetics and a patient's response to pharmaceutical therapies. The group partners with another research group in Singapore to study a cross-cultural patient population.

Johns Hopkins Schizophrenia Center
Part of Baltimore's Johns Hopkins Medicine, the Hopkins Schizophrenia Center provides clinical care for schizophrenia patients and also brings together researchers from several different clinical specialties to study schizophrenia. The Center's interdisciplinary research approach is also international, as they focus on global health initiatives and international collaborations.

Stanley Center for Psychiatric Research at Broad Institute
This center, part of the joint MIT-Harvard Broad Institute in Cambridge, Massachusetts, was founded in 2007 by philanthropists Ted and Vada Stanley. The lab's research focuses on DNA mapping and sequencing techniques and has amassed the world's largest collection of DNA samples for psychiatric research, including studies in ADHD, bipolar disorder, and schizophrenia.

By Norah Piehl

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