by Laura Fraser, best-selling memoirist and memoir teacher
Victoria Costello took a memoir writing class with me a few years ago at the San Francisco Writers' Grotto, and I was so impressed with her fearlessness, writing about the touchy subject of mental illness in her family. I believed that using her science background to investigate that history, along with her personal story, would make a great read and important contribution to the field--and I am delighted that A Lethal Inheritance has turned out to be all that, and more.
1. Laura: I was so fascinated with your book about the heritability of mental illness. When your son, Alex, started having serious mental problems, you began looking back into your family history to find out whether mental illness ran in the family. How does knowing about a family history of mental illness change the way you deal with the illness in the present?
Victoria: I didn’t start this memoir with the idea of going back three generations. In fact, I resisted it, much the same way we avoid thinking about mental illness or possible suicides in family members who are no longer living; we think of such things as “dirty laundry,” better left in the past. I only decided to go there after my sons started developing psychological problems and I looked into the science and found patterns and links between different mental disorders and even addictions in prior generations that can predict psychological disorders for their children and grandchildren.
2. Laura: There's always been a huge stigma associated with mental illness. I was very taken with how frank you were about the mental illness in your family. Was it difficult to write about mental illness in your family, and admit to your own history of depression?
Victoria: Sharing intimate, often embarrassing experiences became the only honest way for me to tell this story. I couldn’t exactly strip everyone else bare and leave myself out of it, especially after discovering that my untreated depression had raised my sons’ risks for the conditions that they did eventually develop. The guilt was nearly overpowering. One way to deal with it was to tell all, beginning with my own stuff.
3. Laura: Aside from heredity, how do you think mental illness is influenced by the culture we grow up in? Is mental illness viewed the same way in different countries? Does it express itself differently?
Victoria: According to research I’ve seen from Brazil, China and many other countries, the prevalences of mental disorders are virtually the same worldwide--in other words, these are not Western exports, although triggers for certain disorders may differ. In parts of Africa, for example, trauma from war, poverty, famine and forced migration have raised risk levels for youth psychosis and depression. The same factors produced higher levels of schizophrenia in other cultures in the past, such as Ireland during the great migrations of the 19th century. The fact that science is now providing visual evidence of biomarkers, for example MRI images showing that people with schizophrenia and bipolar literally have smaller, shrunken brains, will finally help get the culture through denial and misguided notions that mental illness is somehow "less real" than other sicknesses.
4. Laura: At one point in the book, you say, "although we're each born with inherited liabilities and assets, throughout our lives, our minds become largely what we make of them." If you know you have a family history of mental illness, what are some steps you can take to prevent it from becoming full-blown? How can we use our minds to overcome, prevent, or manage mental illness?
Victoria: I discovered that the brain is very plastic; meaning it gets reshaped throughout our lives by positive and negative experiences alike, everything from friendships and diet to psychotherapy and psychiatric medications. By knowing your family history, you can intervene sooner and even prevent mental illness. It turns out that adult children and grandchildren of people with bipolar disorder are at a much higher risk for ADHD and mood disorders like depression, earlier in life. If they develop attention problems in childhood, these children are much more likely to develop bipolar disorder in adolescence. So, in this case, a parent could learn the signs and monitor her children much more closely. If more serious symptoms develop, she would seek a mental health intervention. The earlier it’s done, the less invasive it has to be, meaning individual or family therapy alone may be sufficient instead of the child taking medications.
5. Laura: What were the special challenges of interweaving science with your memoir?
Victoria: It was a tough process, and required many drafts over several years. The trick for me was finding the most relevant science and the right size chunks of it to interweave with each personal thread I wrote. In one chapter, I tell how the theory of self-medication that arose in the 1970s shed light on why people like my sister Rita could become hooked on heroin by the tender age of sixteen. I share this piece of science in the same sequence that I relate what it was like to watch helplessly as Rita spiraled down from depression into a life of addiction. Fortunately, there are some inspiring models of how to do this elegantly from authors like Joan Didion (The Year of Magical Thinking and Blue Nights) and Andrew Solomon (Noonday Demon, An Atlas of Depression) where they manage to reveal what anyone would consider the most personal and often worst experiences of their lives and yet impart information that is relatable and helpful to others.
As readers we realize that others have been there before us, and this is both a comfort and of practical help. For anyone who wants to read an excerpt and find out more about the book or family mental illness, please visit: http://www.alethalinheritance.com
Laura Fraser is the NYT-bestselling author of An Italian Affair and the recent sequel, All Over the