The Most Misunderstood Mental Illness
Where does schizophrenia come from? From mother-blaming to microbiology, inside the perilous search
“Schizophrenia is a disease of theories,” the psychiatric historian Edward Shorter once told me — and the twentieth century produced easily hundreds of them. To some, insanity is little more than a quirk of brain chemistry, a dial to be fiddled with pharmaceutically; to others, it’s a metaphor for something else — something bigger, more profound, about the way we all comprehend the world. But the nature of madness and how to grapple with it has stumped absolutely everyone, despite the endless procession of people who are convinced that they — they alone! — have cracked the case.
For a writer, the subject of mental illness can be both intimidating and irresistible. Next week, Anchor Books is publishing the paperback edition of Hidden Valley Road, my nonfiction medical mystery and family saga of the Galvins, a large mid-century Colorado family with twelve children, six of whom were diagnosed with schizophrenia, and who, together, presented researchers with a once-in-a-lifetime chance to understand what could be the world’s most misunderstood disease.
Since Hidden Valley Road was published, I’ve heard from countless families touched by severe mental illness, all applauding this family’s decision to come forward despite the stigma schizophrenia still carries today. While this has been intensely gratifying to hear, it’s only made the questions surrounding the family’s experiences seem more urgent. This family suffered greatly even as they became research subjects for scientists. And while their story offers a shadow history of mental illness research in the twentieth century, including all the conflicting theories and compromised ideologies and wrongheaded remedies, it’s also true that the Galvins had been trying to make sense of their experiences long before they decided to be interviewed. The book presented a chance — a hail Mary, maybe, but still, a chance — to find meaning where there seemed to be nothing but chaos. In the book itself, you can see how that search was, at least in part, answered by science, and how the Galvins played a crucial role in breakthroughs that others will no doubt benefit from in the future.
But science could never answer all their questions. This is a family, after all — fourteen people with fourteen different stories to tell, each one informed by his or her own specific traumas and sense of loss. And so the question that carried me through most of the writing of Hidden Valley Road was, which stories are the ones best help us understand, to take meaning from the most haywire of circumstances?
The one about unspeakable abuses, physical and sexual?
About a murder-suicide, covered up at first by scandalized parents trying to protect their children?
About two sisters, helping each other survive their family, only to diverge from one another?
About a profession that (incorrectly, and scandalously so) blamed mothers for mental illness, sending the Galvins and countless other families into the shadows?
About a mental health system that is a system in name only, offering little more than warehousing and, at times, what seem like the most inhumane possible treatments?
About a pharmaceutical industry that, despite amazing steps forward in treatments for bipolar disorder, anxiety, and depression, has left people with schizophrenia with treatments that do little more than muffle the symptoms — essentially the same drugs the Galvin brothers took, back when the Beatles topped the charts?
What I found when I got to know the Galvins was more surprising than any one of these stories — and, against all expectations, more fulfilling. In this space, I’ll be sharing more of what I’ve learned from the Galvins and from those who have studied and cared for them. And I’ll try to show how what seems like such an impossible, unsolvable mystery might actually contain splinters of light, of hope.
One of the more eye-opening aspects of researching Hidden Valley Road was the chance to travel back in time and see just how little we’ve always known, and how wrong we’ve often been. The more I read, the more I saw how the same arguments about what schizophrenia was and what caused it kept coming back again, generation after generation — even today.
For those looking even a little carefully over the years, it was plain to see that madness sometimes ran in families (the most conspicuous examples involving royalty). The paradox is that schizophrenia does not appear to be passed directly from parent to child. It took until the turn of the twentieth century for scientists and doctors to start talking about insanity as something biological. Then came Sigmund Freud, who proclaimed that the illness wasn’t biological at all, but something acquired from one’s childhood — not nature, but nurture. In the century since then, there have remained two separate camps in psychiatry: Those who see schizophrenia as an intractable biological illness, and those who, like Freud, see it as a manifestation of a tortured mind.
For the length of the twentieth century — through the years that six of Don and Mimi Galvin’s twelve children took ill — the biologists preaching nature and the therapists extolling nurture were at loggerheads, going after one another at conferences and hospitals and the pages of academic journals. By the time the Galvin boys came of age, the field was splitting open and dividing and subdividing almost like a cell. Some said the problem was biochemical, others neurological, others genetic, still others environmental or viral or bacterial. All the while, the truth about what schizophrenia was — what caused it, and what might alleviate it — has remained locked away, inside the people with the condition.
The theories didn’t stop with Freud. By the middle of the century we encountered our first glimpses of the anti-psychiatry movement — a wave of therapists and others rejected traditional assumptions about insanity almost completely out of hand. In the 1950s, Jean-Paul Sartre had argued that delusions were just a radical way of embracing the world of imagination over “the existing mediocrity.” In 1959, the iconoclastic Scottish psychiatrist R. D. Laing, influenced heavily by Sartre and other existentialists, made the case that schizophrenia was an act of self-preservation by a wounded soul (better to turn oneself into a stone, he once said, than to be turned into a stone by someone else). And in 1961, the godfather of anti-psychiatry, Thomas Szasz, published his most famous book, The Myth of Mental Illness, in which he declared that insanity was a concept wielded by the powerful against the disenfranchised — a step in the ghettoization and dehumanization of a whole segment of society that thinks differently.
A year later, in 1962, anti-psychiatry crossed over into the mainstream with a juggernaut of a novel that treated the brutality of a state-run mental hospital as a metaphor for social control and authoritarian oppression. One Flew Over the Cuckoo’s Nest was the story of Randle Patrick “Mac” McMurphy, a low-level criminal and free-spirited renegade who fights a war of wits inside of an insane asylum, only to be crushed by the malevolent forces of authority (as personified by Nurse Ratched). Even before it became a movie, Cuckoo’s Nest became one of the foundation myths for the counterculture, as romantic, in its way, and as powerful as Easy Rider and Bonnie and Clyde — a perfect way to explain the way the world was working right now and expose everything that had flattened out the culture of the previous generation. Anti-psychiatry lives with us to this day, most recently in pop-culture fare like Ryan Murphy and Netflix’s Ratched, which is, of course, a prequel-of-sorts to Cuckoo’s Nest.
Anti-psychiatry was a seductive idea for some of the Galvins, and remains so. But the theory that affected the family most negatively was one that seemed to directly target the parents. Beginning in the late 1940s, psychoanalysts became smitten with the theory of the “schizophrenogenic mother,” coined by the therapist Frieda Fromm-Reichmann (the basis for the miracle-working therapist in the influential schizophrenia novel I Never Promised You a Rose Garden), in which mothers trapped their children in neurotic loops of submission and confusion and resentment until finally some of them retreated from the world. When, in 1960, Alfred Hitchcock’s Psycho placed the blame for the most famous delusional homicidal maniac of cinema, Norman Bates, squarely on the shoulders of his dead mother, it made all the sense in the world.
Mimi Galvin never could have predicted how terribly this trend in psychotherapy would end up working against her. The Galvin boys took ill in the 1960s and 1970s, the era of institutionalization and shock therapy, the debates between psychotherapy versus medication, and the needle-in-a-haystack search for genetic markers for the disease. There was nothing generic about how they each experienced the illness: Donald, Jim, Brian, Joseph, Matthew, and Peter each suffered differently, requiring differing treatments and a panoply of shifting diagnoses, and prompting conflicting theories about the nature of schizophrenia. But a shocking number of doctors went out of their way to suggest that the mother, Mimi, was to blame, as if she’d caused the disease by something she did or did not do.
Much of Hidden Valley Road is about how, once the study of genetics took center stage, a handful of bold researchers tried to find those secrets in the biology of the Galvin family. Their breakthroughs have been exciting to see, for the family and for everyone. But the great revelation while writing this book (and once it was published, during the public-health crisis that has threatened us all) was how, despite the many hardships the Galvins faced, I found their story especially meaningful — almost as a model for how to find your way when life seems like nothing more than a crisis, and hope is in desperately short supply.
Don’t get me wrong: The pandemic has been a unique challenge for everyone. But I believe the Galvin family has a lot to teach us about weathering tragedy. Their story is about people who find themselves traumatized and find ways to work through it.
It’s about finding the humanity in the moments that threaten to strip that humanity away.
It’s about refusing to shut down, refusing to turn inward.
Despite everything this family went through, I really do think it’s about hope.
In future columns, I’ll be searching for glimpses of that sense of hope, visiting with people with unique and varied perspectives. Some appeared briefly in the pages of Hidden Valley Road. Others I’ve met — virtually, of course — in the past year, since the book was published. Some are parents, some are scientists, some are pharmaceutical executives, some are historians. There may even be a Galvin family member or two, returning to the conversation.
I hope you’ll join us.
Hidden Valley Road: Inside the Mind of an American Family—an Oprah’s Book Club selection and #1 New York Times best-seller—is available in paperback on March 2 from Anchor Books.