At age seventeen, my son "Alex" lost his ability to finish a whole sentence or get even a half night's sleep, or face the other kids at school. The doctors who examined him at UCLA Neuropsychiatric Institute told me he should stay for a month so they could make a proper diagnosis and stabilize what they called his psychotic symptoms.
Having raised two athletic sons I'd been in an emergency room with each of them more than once, but I can't imagine any two words coming from the mouth of a doctor putting more terror into the heart of a mother than "psychotic symptoms." But what I was about to learn would open my eyes to much more.
After I had signed the necessary forms and Alex settled in to his room in the adolescent ward, I tearfully sat down with the psychiatrist on duty (who I'll call "Dr. C") for what she described as a "simple family health interview. With a sheaf of papers on her lap, Dr. C then methodically began to ask me about the health and causes of death of every member of my immediate family going back three generations.
I quickly caught on that unlike the more common version of this exercise Dr. C was fishing not for evidence of heart disease or cancer in the family, but for any mental illnesses suffered by Alex's blood relatives, including those now living and gone. Once I understood our purpose, I was able to quickly dispense with my ex-husband's family and the maternal side of mine -- all seemingly devoid of any mental health issues. After that, the conversation became difficult, the memories more painful.
"Any deaths among your siblings?" Dr. C asked.
"My younger sister Rita was a heroin addict," I began. "She was in and out of jail and rehab for most of her life."
"Cardiac arrest was how her death certificate read."
"And your father?" Dr. C asked.
"Dad was an alcoholic," I began. "He smoked three packs of cigarettes a day and died of lung cancer at 46."
I didn't, couldn't look at her. I exhaled, thinking that at least now the worst was over.
"And your paternal grandfather?" she asked.
"I'm almost sure that Grandpa Michael got hit by a train," I said, but it was as if someone else was speaking; I felt disconnected from the words and their possible meaning. "My mother said it was an accident."
Dr. C stopped scribbling and looked me in the eye. "Has it ever occurred to you that your grandfather's remaining on the railroad track may have been an intentional act?"
"No, never," I said, stunned by her question. "I mean, not until you just asked me."
I didn't say that, even as a child, I suspected there was something wrong with my mother's story. Every night, when we all climbed in the car to pick up Dad at the train station, I could feel the platform shaking long before I saw the engine peek around the bend. How come Grandpa didn't know a train was coming soon enough to get off the tracks? But I didn't ask that question aloud, not then or at any other time.
That's the tricky part about family secrets. Their contents don't have to be secret at all; as long as everyone agrees not to see or speak about what's actually hiding in plain sight--like Grandpa's likely suicide.
That morning at UCLA was the first time I'd ever considered that this grandfather who I'd never met could have taken his own life, or the implication that follows from it: that there was mental illness in my family's past. Of course, at the time I didn't know that 80 percent of suicides have a severe mental illness. Or that the heavy drinking done by several troubled members of my family was probably an attempt to self-medicate for severe depression, perhaps even bipolar disorder in the cases of my grandfather and sister.
I also learned that, like depression, antisocial behavior runs in families. This means that if certain men (or women) in your family had a tendency to drink heavily, get into car accidents or fights and land in jail -- behaviors that were common in my family tree -- they may have suffered from what is now called "antisocial disorder," a heritable mental illness.
Why does any of this matter? Long-term studies (looking at three and four generations in families) have shown that boys with early conduct problems (refusal to follow authority, cruelty or extreme aggression as a young child) are at a much higher risk for developing adult antisocial disorder and psychosis in young adulthood.
Research also shows that the more close relatives a person has with depression, addictions, antisocial behavior or anxiety, the more likely he is to have one or more of these conditions and acquire it at a much younger age -- often before puberty.
After nearly losing my son Alex to an illness that apparently had been lying in wait in his family history, I've come to believe that those of us who survive such a family legacy relatively intact have a special responsibility to break this wall of silence. Secrets can stay secret for many generations. The trouble comes when your beloved grandson or granddaughter begins to display disturbing symptoms and your adult son or daughter has no idea that certain behaviors or full blown disorders can be traced back one, two or three generations.
The information unearthed from my family mental health history -- especially after I acquired a context with which to interpret it -- became critical for my decision-making around Alex's treatment for the disease that Dr. C ultimately diagnosed as schizophrenia. Alex benefitted by going for treatment at a time (1998) when the concept of "early intervention" for the first symptoms of the psychosis that can lead to schizophrenia had just taken hold. After three years spent in psychotherapy and taking a brief course of antipsychotic medication, Alex was able to return to school and ultimately complete his education at a prestigious art college.
Early intervention and treatment such as Alex's often depends on practitioners having a full knowledge of the affected person's family mental health history. Without it they are at an enormous disadvantage when they attempt to interpret symptoms and make a diagnosis or a recommendation about treatment. As internationally recognized psychologist and pioneer in family studies Dr. Terrie Moffitt writes in the forward to my memoir A Lethal Inheritance, "Family history can make the difference between 'treat now' or 'wait and see.' "
Learning about my family history and watching Alex get better also finally persuaded me to take antidepressants for my own lifelong untreated major depression. It then helped me to recognize and treat my younger son's depression and anxiety disorder -- without making him wait the three decades that I had taken to finally act on what was ailing me. I'm happy to say both my sons are thriving today, as is their mother.
Put simply, knowing the size and type of genetic load you carry, including any mental disorders and addictions in your family's past can be life-saving for your children and grandchildren. Given the fragmented state of today's mental health care system, with so many people lacking adequate insurance coverage for basic let alone quality mental health services, we need to become more informed about our own risks and use this knowledge to advocate for our own mental health needs as well as the needs of those we love.
Victoria Costellois an Emmy Award-winning science writer with articles on psychology and neuroscience appearing in Scientific American Mind and Brain World, and blog posts on PsychCentral.com, Yahoo Health & Wellness and her own MentalHealthMomBlog. With the Mental Health Association of San Francisco, Costello is a speaker and state and federal advocate working to improve the mental health of youth and families. Her latest book A Lethal Inheritance, A Mother Uncovers the Science Behind Three Generations of Mental Illness, is just out from Prometheus Books.
Follow Victoria Costello on Twitter: www.twitter.com/VCpsych