Was Grandpa's Accident Actually a Suicide?

The central thesis of an important new book, A Lethal Inheritance: A Mother Uncovers the Science behind Three Generations of Mental Illness, is that the answer to this and other similarly painful questions about family history are critical to the mental health of future generations.The author, Victoria Costello, is a science journalist and mother of two sons diagnosed with serious mental illness, one schizophrenia and the other major depression, in their late adolescence.

As her own survival mechanism kicks in the face of such devastating circumstances, Costello explores the skeletons in her own closet, while using her considerable skill as a investigative reporter to weave her personal story with the last several decades of mental health research at the interface of psychiatry and genetics. Costello learns that her sons are the fourth generation of serious mental illness that has been previously been shrouded in secret. Capturing this well-recognized phenomenon of of intergenerational transmission of trauma and mental illness, she writes:

I've come to think that whoever is denied their rightful place in a family's collective memories will possess the hearts and minds of those left behind, unless and until he is acknowledged.

I found the book to be hopeful and refreshing, essential reading for parents, professionals and policy makers. In my behavioral pediatrics practice it is not uncommon for me to see a young child for "ADHD" evaluation who is described by parents in highly negative terms. As the "identified patient" he may have already been placed on medication by other clinicians. However, when parents are given the time and space to be heard by a person who is interested but not judgmental, they often reveal a history of family mental illness and significant trauma that has been kept secret for years, sometimes for generations. This information is essential for the family members suffering from mental illness who may now seek treatment. Equally importantly, when the child is released from carrying the burden of these secrets, her "true self," in the words of pediatrician turned psychoanalyst D.W. Winnicott, is free to emerge. This is the kind of honest family exploration Costello is advocating for. She writes:

I argue in this book that this stance of silence and secrecy is no longer a viable option, least of all for parents of young children in a family with a pattern of mental illness and addiction. Secrets can cause harm and even kill.

Costello takes on the highly charged question of "blame," She is in an excellent position to address this issue, as she took responsibility for her own lifelong struggle with depression and alcohol abuse in her journey to help her sons. She says:

If it's beginning to sound like I'm getting dangerously close to the historical tendency to blame parents for the psychological ills of a child, my answer is that to a certain degree, I am. In so far as I believe we've gone too far in the direction of "blaming" biochemistry and not taking responsibility for our own roles in shaping the health of our children's brains, I think we have to back up and reconsider. I'm advocating transparency and taking of greater responsibility by everyone-parents, extended family members, mental health practitioners, and our larger communities, including corporate healthcare and government-administered services-for the mental health of our children and future leaders.

She goes on to say that this translates into giving parents more support. Heading off the objection that "we cant afford it,"she offers stark numbers to depict the economic implications to failing to do so.

If we reduce the proportion of young people who become mentally ill by even one quarter, that would mean about 3.8 million saved each year from what can turn into a lifelong and expensive struggle. How expensive? The National Academies estimates that the total economic cost of mental disorders just among Americans under twenty-five was $247 billion in 2007.

Costello has a judicious approach to the contentious issue of psychiatric medication , showing how medication in the face of severe psychiatric illness may at times be essential not only for daily functioning but also for accessing other forms of help, such as insight oriented psychotherapy.

Costello does not address the issue of psychiatric medication in young children, but her view is implied in advocating for prevention. Starting as early as infancy, effective treatment for postpartum depression can give parents the opportunity to promote a child's health brain development, even in the face of a strong genetic vulnerability. She writes:

I've learned that although we're each born with with inherited liabilities and assets, throughout our lives, our minds become largely what we make of them. Put simply, nurture can trump nature. In some cases, it can turn even an inherited liability into a possibility-yes-an asset.

Costello vividly captures her own childhood experience which was "typically middle class."

But the visceral experience of growing up in my family consisted of thousands of moments of bone-chilling fear with no adult to help me cope.

In the concluding chapter, Costello outlines the top ten things a parent can do to safeguard a child's mental health. Costello is arguing that we as a society must work to support parent-child relationships. Every child should have the opportunity to grow up with an adult who can provide safety and security in the face of fear and stress. She advocates for a "fundamental shift in our orientation from doing things for our children to being there for them and us." Costello's recovery and the current successes of her two sons offer heartwarming evidence for the wisdom of this approach.