Hanya Yanagihara’s 2015 novel A Little Life has had an ongoing impact on readers. Across booktok, for example, there are videos of readers reacting by shedding copious tears whilst reading the text. Fan art has generated around it, primarily because of the friendships depicted, but also due to the book’s tragic nature, given the focus in the story on self-harm and mental illness and the ultimate suicide of the protagonist. In 2023, a theatrical adaptation was shown in London, raising questions over what can be depicted and how when it comes to mental illness. The response to the play has been mixed, with some reviewers arguing it renders the audience as ‘mirrors’ to ‘reflect the passive pain of witnessing’ (Akbar, A Little Life review – James Norton’s sexually abused lawyer is spared no misery. The Guardian, April 5, 2023). This chapter uses the example of A Little Life to think through what authenticity looks like when it comes to mental illness. How can a personal, subjective, and psychological experience by understood and mediated? Arguably, the idea of authenticity is faulty, but it is increasingly used by younger readers to denote an emotional connection with a text. If this is the case, does one medium offer a more authentic portrayal? In the case of the (unwell) mind being the focus, can it only resort to stereotypes or an exploitative approach to mental anguish that relies on excessive mediation through the text of the body? Ultimately, this chapter argues that the contemporary approach to authenticity falls flat in a text like A Little Life, which is constructed inauthentically, reducing any text associated with it to the parameters of its medium.