email page print pageAll Topic Reviews
12 and HoldingA Guide to Asperger SyndromeA Lethal InheritanceA Mother's Courage: Talking Back to AutismA Parent's Guide to Asperger Syndrome and High-Functioning AutismA Special EducationA Toss Of The DiceA Tribe ApartA User Guide to the GF/CF Diet for Autism, Asperger Syndrome and AD/HDA Walk in the Rain With a BrainABC of Eating DisordersADD-Friendly Ways to Organize Your LifeADHD Grown UpADHD in the Schools: Assessment and Intervention StrategiesADHD NationAdolescence and Body ImageAdolescent DepressionAggression and Antisocial Behavior in Children and AdolescentsAll Alone in the UniverseAlpha GirlsAmericaAnother PlanetAntisocial Behavior in Children and AdolescentsAsperger Syndrome and Your ChildAsperger Syndrome, Adolescence, and IdentityAsperger's and GirlsAssessment of Childhood DisordersAttention Deficit DisorderAttention-Deficit Hyperactivity DisorderAttention-Deficit/Hyperactivity DisorderAutism - The Eighth Colour of the RainbowAutism and MeAutism's False ProphetsAutistic Spectrum DisordersBad GirlBeen There, Done That? DO THIS!Before I DieBetween Two WorldsBeyond AppearanceBig Mouth & Ugly GirlBipolar ChildrenBipolar Disorder in Childhood and Early AdolescenceBipolar DisordersBipolar KidsBlackwell Handbook of Childhood Cognitive DevelopmentBody Image, Eating Disorders, and ObesityBody Image, Eating Disorders, and Obesity in YouthBoy AloneBrain-Based Therapy with Children and AdolescentsBreaking PointBreathing UnderwaterBringing Up ParentsBullying and TeasingBullying PreventionBut I Love HimCan't Eat, Won't EatCaring for a Child with AutismCatalystChild and Adolescent PsychiatryChild and Adolescent Psychological DisordersChild and Adolescent PsychopathologyChild NeuropsychologyChild Well-BeingChildren and SexualityChildren Changed by TraumaChildren with Emerald EyesChildren with Sexual Behavior ProblemsChildren, Sexuality and SexualizationChildren’s Dreaming and the Development of Consciousness City of OneCommunication Issues In Autism And Asperger SyndromeConcepts of NormalityConcise Guide to Child and Adolescent PsychiatryConquering the Beast WithinConsuming KidsContesting ChildhoodCount Us InCrackedCrossesCutCyber-Safe Kids, Cyber-Savvy TeensDamageDemystifying the Autistic ExperienceDescartes' BabyDilemmas of DesireDirtyDisconnected KidsDoing SchoolDon't Bother Me Mom--I'm Learning!Don't Pick On MeDying to Be ThinEarly Intervention Programs and PoliciesEating an ArtichokeEducating Children With AutismEight Stories UpElijah's CupEmerald City BluesEmotional and Behavioral Problems of Young ChildrenEpilepticEthical Dilemmas in PediatricsEvery Girl Tells a StoryExiting NirvanaExploiting ChildhoodEye ContactFacing BipolarFamily HistoryFast GirlsForever YoungFreaks, Geeks and Asperger SyndromeFreewillFrictionGirl CultureGirl in the MirrorGirlfightingGirlhoodGirlWiseHandbook of Evidence-Based Therapies for Children and AdolescentsHandbook of Preschool Mental HealthHealing ADDHelping Children Cope With Disasters and TerrorismHelping Hyperactive KidsHelping Parents, Youth, and Teachers Understand Medications for Behavioral and Emotional ProblemsHelping Students Overcome Depression and AnxietyHelping Teens Who CutHollow KidsHope's BoyHow Infants Know MindsHow to Keep Your Teenager Out of Trouble and What to Do If You Can'tHurry Down SunshineI Am Not Joey PigzaIdentifying Hyperactive ChildrenIf Your Adolescent Has an Eating DisorderIn the Company of CraziesIncorporating Social Goals in the ClassroomIntegrated YogaIntrusive ParentingIssues for Families, Schools and CommunitiesJake RileyJoey Pigza Loses ControlJoey Pigza Swallowed the KeyJuvenile-Onset SchizophreniaKim: Empty InsideLearning and Behavior Problems in Asperger SyndromeLearning Disorders and Disorders of the Self in Children and AdolescentsLearning Outside the Lines Let Kids Be KidsLiberation's ChildrenLife As We Know ItLisa, Bright and DarkLook Me in the EyeLoserLove and SexLove That DogMad at SchoolMaking ADD WorkMaking American BoysManicMastering Anger and AggressionMaverick MindMedicating ChildrenMind FieldsMind to MindMommy I'm Still in HereMore Than a LabelMy Flesh and BloodMyths of ChildhoodNew Hope for Children and Teens with Bipolar DisorderNew Look at ADHD: Inhibition, Time, and Self-ControlNo Child Left DifferentNo Two AlikeNon-Drug Treatments for ADHDNot Much Just Chillin'NurtureShockOdd Girl OutOdd Girl Speaks OutOne Hot SecondOne in ThirteenOphelia SpeaksOphelia's MomOur Journey Through High Functioning Autism and Asperger SyndromeOut of the WoodsOvercoming ADHDOvercoming School AnxietyParenting a Child Who Has Intense EmotionsParenting Children With ADHDParenting Your Out-Of-Control TeenagerPediatric PsychopharmacologyPediatric PsychopharmacologyPediatric PsychopharmacologyPeople with HyperactivityPhobic and Anxiety Disorders in Children and AdolescentsPINSPlease Don't Label My ChildPraising Boys WellPraising Girls WellProblem Child or Quirky Kid?Problem GirlsPsychotherapy for Children and AdolescentsPsychotherapy with Children and AdolescentsPurgeRaising a Moody ChildRaising BlazeRaising Generation RxRaising Resilient ChildrenReady or Not, Here Life ComesReclaiming Our ChildrenRedressing the EmperorReducing Adolescent RiskRemembering Our ChildhoodResilience in ChildrenRethinking ADHDReweaving the Autistic TapestryRitalin is Not the Answer Action GuideRitalin NationRunning on RitalinRunning with ScissorsRutter's Child and Adolescent PsychiatrySeeing EzraSex and the American TeenagerSex, Therapy, and KidsSexting and Young PeopleSexual Teens, Sexual MediaShort Term 12Should I Medicate My Child?SmashedSnapshots of AutismSongs Without WordsSophie Spikey Has a Very Big ProblemSpeakStaying Connected to Your TeenagerStick FigureStraight Talk about Psychiatric Medications for KidsStraight Talk about Psychological Testing for KidsStraight Talk about Your Child's Mental HealthStrange SonStudent DepressionSuicidal Behavior in Children and AdolescentsSurvival Strategies for Parenting Children with Bipolar DisorderSurviving OpheliaTaking Charge of ADHD, Revised EditionTaming the Troublesome ChildTemple GrandinThe American Psychiatric Publishing Textbook Of Child And Adolescent PsychiatryThe Anti-Romantic ChildThe Bipolar ChildThe Boy Who Loved Too MuchThe Boy Who Loved WindowsThe Boy Who Was Raised as a DogThe Buffalo TreeThe Bully Action GuideThe Bully, the Bullied, and the BystanderThe Burn JournalsThe Color of AbsenceThe Curious Incident of the Dog in the Night-TimeThe Depressed ChildThe Developing MindThe Dragons of AutismThe Einstein SyndromeThe EpidemicThe Evolution of ChildhoodThe Explosive ChildThe Eyes of van GoghThe Fasting GirlThe Field of the DogsThe Flight of a DoveThe Hidden Gifts of the Introverted ChildThe Horse BoyThe Identity TrapThe Inner World of a Suicidal YouthThe Inside Story on Teen GirlsThe Kindness of StrangersThe Last Normal ChildThe Little MonsterThe Medicated ChildThe Myth of LazinessThe New Gay TeenagerThe Nurture AssumptionThe OASIS Guide to Asperger SyndromeThe Other ParentThe Perversion of YouthThe Philosophy of AutismThe Psychoanalytic Study of the ChildThe Real Truth About Teens and SexThe Ride TogetherThe Rise and Fall of the American TeenagerThe Science of ADHDThe Sex Lives of TeenagersThe Survival Guide for Kids With LD*The Unhappy ChildThen Again, Maybe I Won'tTherapy with ChildrenThings I Have to Tell YouThings Tom LikesThrough the Glass WallThumbsuckerTotally WiredTouching Spirit BearTrauma in the Lives of ChildrenTreating ADHD and Comorbid DisordersTreatment of Childhood DisordersTwistedUnder the Wolf, Under the DogUnhappy TeenagersUnstrange MindsWastedWe've Got IssuesWeather Reports from the Autism FrontWhat about the KidsWhat in the World Are Your Kids Doing Online?What Works for Whom?What Would Joey Do?What's Happening to My Body? Book for BoysWhat's Happening to My Body? Book for GirlsWhat's Happening to Tom?When Nothing Matters AnymoreWhen Your Child Has an Eating DisorderWhose America?Why Don't Students Like SchoolWill's ChoiceWinnicott On the ChildWorried All the TimeYou Hear MeYoung Minds in Social WorldsYoung People and Mental HealthYour Child, Bully or Victim?
A couple of recent memoirs have focused on the author's quest to discover and chronicle a family history of mental illness, but I do not know of any that focus on the science behind this legacy with such meticulousness and precision as does Victoria Costello's new book, A Lethal Inheritance: A Mother Uncovers The Science Behind Three Generations of Mental Illness.
It's a tall order to do justice to several generations' psychic suffering while also explaining the pertinent scientific studies, but Costello does as promised. The end product is an impressive compendium, part family history, part memoir, part journalistic explication of the relevant research, and part anguished attempt to understand how Costello could have stood by while first one teenage son and then the other degenerated into mental illness.
Costello frames the book in the form of a psychic and spiritual quest spurred by her older son's confinement, at 18, to a "kiddie psych ward" when he suffers a psychotic break and is diagnosed with paranoid schizophrenia after several years of slow but obvious deterioration. Desensitized by her own lifelong depression, heavy drinking and impressive capacity for denial, Costello has managed to mistake her son's delinquency and drug use for adolescent rebellion, rather than the "negative," early signs of schizophrenia. His hospitalization forces her to confront not only the severity of his illness, but her own undiagnosed depression. After undergoing medication treatment, she begins searching for causes for their shared dysfunction.
What she finds is a heavy incidence of "genetic loading" that has greatly increased her own and her sons' risk of mental illness (her younger son is diagnosed with depression several years after his brother's schizophrenia diagnosis). Defying the common impulse to let family secrets lie, Costello begins excavating the past, reevaluating her father's alcoholism, her sister's drug abuse and probable undiagnosed bipolar disorder, her paternal grandfather's depression, drinking and likely suicide.
Unlike other memoirists who have chronicled their family histories of mental illness, however, Costello is not content to assume that what afflicts one generation must transmit, in some mysterious and unaccountable way, to the next. The chronology is a bit muddled, as are her exact reasons for delving so fiercely into the science (writing a book on the topic may have been a factor), but the upshot is that Costello examines large, carefully conducted longitudinal studies of the familial transmission of mental illness and presents them in great detail. She focuses in particular on those involving schizophrenia, perhaps because these are among the most rigorous and extensive compared to those on mood disorders, and perhaps because she is particularly tormented by her older son's suffering. In any case, her discussion of the studies is exhaustive, detailed, almost clinical.
Beginning her research, Costello had assumed that DNA was destiny, that one was stuck with the genetic cards one was dealt. Her thinking evolved, however, as did the science, over the decade that she investigated the subject, and she provides a fascinating look into some of the mitigating environmental factors that can both worsen and improve a child's chances of developing mental illness in the face of an increased genetic risk. Among them, in the case of psychotic illness, are heavy marijuana use during adolescence. But as her older son's story demonstrates, this presents something of a chicken-or-the-egg problem for parents and doctors trying to parse causes of an individual child's illness through the lens of hindsight. Troubled youths like her son who are already beginning to deteriorate are already more likely to abuse drugs; in a sad twist, however, if they carry increased risk of schizophrenia, they are now increasing their risk further several times over if they use narcotics.
Costello's discussion of the flurry of research into treating "pre-psychosis" is especially detailed and timely, and obviously a topic near to her heart, given her older son's experience. She provides a measured account of the continuing controversy over the use of antipsychotic medications in young people who have not yet begun to exhibit signs of full-blown psychosis, but wisely notes that tailored cognitive-behavioral therapy and other measures are also part of treatment programs, and that even low doses of medication have shown effectiveness in preliminary studies.
Costello makes a convincing case that knowing one's family history is key to deciding how aggressively to intervene in a child's or teenager's illness -- whether to interpret dysfunction as a passing phase or as a sign of more deterioration to come. She notes, shockingly, that although taking a family history is standard in many areas of physical medicine, it is not a feature of psychiatric diagnostics, despite ample evidence that family history determines everything from course of illness to response to treatments (on this last point I would have welcomed more extensive discussion).
Of course, family secrets remain just that -- secrets -- and patients' knowledge remains hampered by how well they can put together the missing pieces. Once they have gathered the information they can, what patients and doctors choose to do with it remains a judgment call, made in the context of other clinical factors. Still, Costello argues wisely, and with ample evidence as back-up, that it is safer and wiser to be armed with more information than less.
© 2012 Kaitlin Bell Barnett
Kaitlin Bell Barnett is a journalist and blogger based in Brooklyn. Her first book, Dosed: The Medication Generation Grows Up, comes out in April from Beacon Press. It examines the experiences of young adults who came of age taking psychiatric meds.