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John Green’s new book is not a quirky sad romance. It’s an existential teenage scream.

Turtles All the Way Down by John Green Dutton Books for Young Readers

John Green is popularly perceived as “the sad teen book guy.” He writes books about quirky sad teenagers who fall in love and then die, goes the general pop culture osmosis understanding in a post-The Fault in Our Stars world, and then the teenagers who read the books get sad too, and it’s all extremely adolescent and self-indulgent.

What can get lost in that image, though, is the fact that Green is a genuinely good writer for teens. He hooks himself into the questions that consume adolescence — Who am I? What is my purpose? Am I a disgusting monster, or the single most important being in the universe? — and worries through them with the kind of single-minded intensity that would do a teenager proud.

It’s true that Green’s books are about teenagers, that they’re often sad, and that they can be self-indulgent — but they’re self-indulgent in their sadness in the way that teenagers are self-indulgent about their own adolescent angst: innocently, as if they are unaware there could be another way to feel.

In his new book Turtles All the Way Down, out this Tuesday, Green turns his single-minded intensity to the question of what it is like to be a teenager struggling with an anxiety disorder and obsessive-compulsive disorder. The result is deeply claustrophobic and resolutely unromanticized: Green’s signature whimsy pops up from time to time in his characters’ conversations, but his depiction of mental illness focuses on the sheer monotonous grind of it. It’s less a sweet love ballad than it is a scream.

The power of Turtles All the Way Down lies in its main character’s inner monologue

Aza is 16 years old, and she is obsessed with a cut on her finger. She got into the habit of slicing open the skin on her middle finger with her thumbnail as a way of reminding herself that she is real and she exists, and she has done it so often that now she has a callus there, which she opens and reopens throughout the day.

An open wound, she knows, can get infected. It’s important that she sanitize the cut. It’s important that she change the bandage regularly. It’s important that she drain the wound. Was that pus or sweat that came out last time? She should drain it again. If she doesn’t, she’ll get infected with microbes.

But she’s already infected with microbes. Her body is teeming with bacteria — in her gut, in her sweat — and they are always there, making up her body. And they can affect her thoughts. And if her thoughts are affected by bacteria, then are they really hers? And if her thoughts aren’t hers, who is she? Does she have a self? Is she even real?

Which brings her back to the beginning of the cycle, so she opens up the cut again.

Aza’s obsessive inner monologue is the meat of Turtles All the Way Down. The story is told in a tight first-person perspective — or it is until Aza’s intrusive thoughts become so overwhelming that she splits into other perspectives — so that the reader is always trapped inside Aza’s head, where she’s unable to redirect her thoughts away from the same destructive cycle. When she’s kissing the quirky-John-Green-hero boy she likes, she’s obsessed with the idea that the microbes on his tongue are infecting her body. When she’s trying to hang out with her best friend, she keeps getting distracted by the idea that she needs to clean the cut on her hand again.

Aza’s anxiety is clearly a personal story for Green, who’s struggled with anxiety for most of his life. After the runaway success of The Fault in Our Stars and the movie it became, he found it so hard to write a follow-up that he went off his medication and fell into an anxiety spiral. (Worry not for the impressionable youths; one of the things Aza learns over the course of Turtles All the Way Down is that taking your medication can help you.) So Aza’s story accordingly feels real, and exhausting, and authentic. She does not get all the way better. The quirky cute boy does not save her. Her mental illness is not romantic; it is scary and boring, and sometimes it annoys her friends. What’s important is that she manages to make her way through life regardless.

The whole thing is elevated by Green’s knack for an observation that nails a universal truth of high school. One boy, says Aza’s friend, is “in that vast boy middle,” where 99 percent of boys live, where “if you could dress and hygiene them properly, and make them stand up straight and listen to you and not be dumbasses, they’d be totally acceptable.” Aza and her friend spend all their after-school time at an Applebee’s, eating their way through a coupon book, exactly the way teenagers in a crappy midsize city do with limited funds and limited free time.

Green’s observations do occasionally veer off into the kind of faux profundity that his detractors like to make fun of. Aza and her love interest spend a lot of time looking at the stars and having that conversation about how when you’re looking at the night sky you’re actually looking into the past that fictional teenagers have been having for at least 70 years or so; there’s a lot of quoting of angsty teen-penned poetry (“You don’t know a father’s weight / Until it’s lifted”).

But those moments aren’t so much cringe-inducing as they are endearing: They are straight from the earnest teenage heart of Turtles All the Way Down, which is feeling so very many things. And if it’s a little myopic in its focus — well, isn’t that another one of the universal bugs of adolescence?

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