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Book Reviews   |    
West of Then: A Mother, a Daughter, and a Journey Past Paradise
Reviewed by Harriet P. Lefley
Psychiatric Services 2006; doi: 10.1176/appi.ps.57.5.728
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by Tara Bray Smith; New York, Simon and Schuster, 2004, 319 pages, $24

Dr. Lefley is professor in the department of psychiatry and behavioral sciences at the University of Miami Miller School of Medicine.

The memoir West of Then is about the ripple effects of a heroin-addicted mother on her daughter's life. Tara, a New Yorker, returns to her native Hawaii to seek her mother in a city park where homeless junkies live. It is one of many such scenes. Abandoned by her mother, Karen, and remanded to the custody of her father and stepmother at the age of seven, Tara continues the search and the approach-avoidant dance that punctuates her life and her mother's life. Across the years, Karen reaches out and then disappears, and their reunion is impeded either by shame or by drug-induced oblivion. She rarely has a phone, and her addresses are temporary. She moves from man to man and from dilapidated housing to street to shelter, the parameters of her life defined by accessibility of drugs.

Beautiful, personable, and born into a once-wealthy, old Hawaiian family, Karen could lead a life of privilege. Instead she descends to the bottom of the underclass. She has three daughters with different fathers, steals, probably prostitutes, and is flighty and irresponsible, but she is also helpful to people who are needful or sick. She still manifests remnants of the qualities that made her children love her when they were young. The author's primary positive relationship is with her stepmother, Debbie, but the pull of the once-adored biological mother remains.

The book is a portrait of emotional damage and resilience, which like many human characteristics can be captured only weakly in empirical data. A prevailing theme is the agony of hope. Tara describes her family's cyclical experience, common in mental illness and substance abuse, of curvilinear progress and raised and dashed expectations. There is almost a fear of remission because of the need to believe in and the known inevitability of another piercing disappointment.

The book is written in a style of choppy memories that zigzag across time. Many pages are devoted to Hawaiian history, which provides a social context of promiscuity, substance abuse, illnesses brought by Western sailors, and culture loss reinforced by missionary prohibitions. Despite a caring father and stepmother and orderly childrearing from an early age, Tara leads a purposeless, party girl existence. Her mission seems to be reuniting with her damaged mother in order to clarify her own inchoate life. She leaves her job, apartment, and a nascent romance in New York in order to find and heal the damaged mother. In a series of heartbreaking events, it becomes clear that the mother cannot be healed by a daughter's devotion.

This true story is about addiction, and the familial experience is all hereā€”the self-destructive behavior of a loved one, the constraints of the system, the family's search for help, and their final acceptance of reality while still clinging to hope. It is not a new story, but some elements will be edifying to clinicians who work with children or adults who suffer from rescue fantasies or from fused identity with impaired parents.

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