A Reading Group Guide to

The Place Between Breaths

By An Na

About the Book

A senior in high school, Grace King spends her afternoons as an intern at Genentium, a leading-edge genetics research lab. Both Grace and her father, a recruiter for the top scientists in the field of genetics, are looking for breakthroughs in treatment and a miracle cure for schizophrenia, the disease that destroyed Grace’s mother’s life and lured her away from their family and home. Grace and her father work with uncertain hope toward her mother’s return and recovery, and for their family to be whole once more. In the lab, Grace has a role, a function, a purpose; it is a place of comfort for her until there is nowhere she can go to escape the terrifying manifestations of what may be her mother’s illness, and she loses the capacity to distinguish between reality and illusion. Reluctantly, Grace learns to accept the support and encouragement of Will, an esteemed researcher with a familial history of schizophrenia. Shifting viewpoints and non-linear time lines create a complex, bewildering narrative that keeps the reader off-balance—but not as off-balance as Grace. Is hope for her recovery just a four-letter word?

Discussion Questions

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?

Beyond the Book: Suggested Extension Activities

1. Further explore the symptoms and treatment of mental illness by reading Charles Cozic’s Teenage Mental Illness (Compact Research Series). 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 http://theshawnstevensonmodel.com/epigenetics/. 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: http://www.sciencemag.org/careers/2018/02/celebrating-women-science. Compile your findings and discuss what you’ve learned with the class.

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?

This guide was prepared in 2018 by Judith Clifton, Educational and Youth Literary Consultant, Chatham, MA.

This guide has been provided by Simon & Schuster for classroom, library, and reading group use. It may be reproduced in its entirety or excerpted for these purposes.