First-person accounts by people with mental illness or histories of institutional treatment have not been very common, and personal accounts by family members of such individuals have been even more scarce (1). Perhaps that is because for decades, especially for women, the only more stigmatizing place to be than a psychiatric setting was jail (2).
However, since the 1980s we have seen a slowly growing literature by women who are daughters of mentally ill mothers (3,4,5,6,7,8). Except for Shields' memoir (3), few of these accounts have been in book form. This review evaluates three recent books by women who are struggling to understand the life and times of their mentally ill mothers and the ways in which their mothers' mental illness affected their own lives.
In Daughter of the Queen of Sheba, Jacki Lyden has produced an engaging, beautifully written memoir of a daughter growing up with a severely mentally ill mother. The mother's disabling psychiatric symptoms began when she was 34 years old and Jacki Lyden was 12, and the mother's diagnosis of bipolar affective disorder was not made for decades thereafter. Lyden, the oldest of three girls, centers her memoir on the relationship between herself and her mother, but includes the roles played by each of her two sisters and her grandmother. While the memoir focuses on the women's interactions, not insignificant parts are played by Lyden's father and stepfather, the latter of whom psychologically and physically abused her.
Besides highlighting the struggle between a daughter and a mentally ill mother, Daughter of the Queen of Sheba is educational on a range of issues, the substance of which may be familiar to professional audiences, but the mood and tone probably much less so. Lyden describes the symptoms and consequences of mental illness vividly. For example, she writes, "Mania eats up slumber, grabs at repose, and shakes the body awake for dances, for plots, for a carousel of tales that spin on the mind's gimbals."
Describing periods of communicating with her mother, Lyden writes, "I want them selfishly, all her words, all these utterances that would seem so Lewis Carroll if only they belonged to him and not to my mother." In describing the respite that mental illness and active psychiatric symptoms could mean for her mother, Lyden indicates, "If in her well life, my mother was a struggling waitress, why then, in her mentally ill life, she wasn't. No sirree bob. She was a slick business woman, a jet-setter, a princess with a growing empire."
Another area that Lyden sensitively portrays from the family's perspective is the interface between a family with a mentally ill member and the law. "The law of Wisconsin which governed our lives stated that not until my mother became an absolute threat to the life of herself or others could we commit her," Lyden decries. "And so each time we waited and agonized, watching as her money drained away, committing acts that would have mortified her had she been well. We tried to compile evidence, planning for the moment when she was a significant threat but not so significant that someone was hurt, or hurt only mildly. Which was a trick for us in itself." Both how the family must perform these tricks and the agony that family members go through to accomplish this end are themes that occur throughout Daughter of the Queen of Sheba.
Lyden often uses simile and metaphor to portray her mother or the calamitous brouhaha of the dyad of daughter and mentally ill mother. For example, "I knew my sisters and I were growing up like bumper cars in an arcade—the brakes applied harshly and erratically here and no brakes or direction at all there, and all the time spinning around and hitting the edges." Or, "I see the harm that mother and daughter skirted in a manner both oblivious and flirtatious, like coquettes performing before troops in the field."
One of the more interesting aspects of the book is how Lyden is trapped by her mother into making life choices that would probably have been very different were she not the daughter of a mentally ill mother, and how she repeats this legacy again and again. Lyden writes, "In a way I felt I had been run over by my choices in life."
Lyden's book is also a testimonial to her mother—to the strength and courage of a woman with serious mental illness who sometimes struggles with as many as three jobs when she is symptom free, knowing that she will plummet again into a land that is both fantasy and fantastic. Lyden's mother knows, too, that in that land she will be a woman whose behaviors, demeanor, and garb are totally alien to wage-earning middle America. Her creativity and her manias are breathtaking; her ascent or descent (depending on whose perspective) to sanity has elements of pathos and redemption. And the book is a testimonial to the strength and fortitude of children of those with chronic mental illness, that they can survive such turmoil and can, despite their scars, fulfill themselves while contributing to others.
Daughter of the Queen of Sheba is a first-rate personal account—in fact it's better than first rate. Readers are fortunate that Lyden heeded her grandmother's philosophy: "Life, she believed, was not something you stood and thought about. It was something you threw yourself into, like a vat."
Throw yourself into this book, be you mental health professional, family member, or person with a chronic mental illness. Reading Daughter of the Queen of Sheba is like traveling down a scenic byway—you may not see all the hills and valleys that you pass by, but you will be better for the trip.
Judith Hillman Paterson's Sweet Mystery, subtitled A Southern Memoir of Family Alcoholism, Mental Illness, and Recovery, is both more than it should have been and less than it might have been. Paterson portrays a multigenerational Southern family in such rich detail that the reader is hard pressed to keep track of the cast of characters and is distracted from her main theme of the effects of alcoholism and mental illness on a family.
Paterson comes from a family with "the heritage that combines monumental ambition with a depressive gene (sometimes manic, sometimes not) that runs… as deep as any mineral runs in the earth." Although Paterson herself appears to be one of the lesser sufferers of dysphoria in this extended family, her father, mother, two sisters, and brother all appear to have a virulent form of the disorder.
Paterson herself held at bay the memories of her childhood, through activities, higher education, a career, and denial. The memories were subsequently triggered, despite her conscious desires, when it became her task to clean out the family home after the death of her father and stepmother. This memoir portrays what she ultimately does recall.
The book is most powerful when Paterson describes the impact her parents' drinking had on her. However, it is sometimes difficult to ascertain when she is reporting memories of her actual insights as a young child and when she is reporting adult perceptions of what a young girl might have felt.
For example, Paterson writes, "I am very young when I start to believe that the happiness and fate of our family depend on whether or not my parents drink, and only a little older when I start thinking my behavior has something to do with whether they do or they don't." Or, "I understand for the first time that there is no pleasure that cannot be destroyed by my mother's behavior." Or, "I started toward him [her father], expecting him to pick me up. Instead, he turns his head and turns away as if repelled by the sight of me. Suddenly I sense that, for all mother's apparent weakness, there has been some secret strength of hers that had held us together."
The greatest pathos of Paterson's story is how the needs of the four children were repeatedly ignored by most of the adults in their lives. The children were able to make some attachments, and by Paterson's description these attachments probably saved her from the fate that befell so many in her family. Paterson writes movingly, "I realize how angry (and how despairing) I was and what little recourse I had over the things that happened to me that year and how unmindful everyone was of the feelings of four children battling the death of their mother and the emotional collapse of their father."
While Sweet Mystery starts in the present, it spends very little time there before moving both to Paterson's memories and to the research that she needed to write her book. She never explains what implications the time between her first and her tenth year—the focus of this memoir—had for her own life as wife and mother. She does say that her own marriage, like the first marriages of all her father's children, failed. She does tell us that she has children of her own and that her own children sometimes evoke memories of her childhood. Unfortunately, we do not learn more than that.
Paterson tells the reader that Sweet Mystery "is the story of what came back to me of a childhood and a time in which the joys and the sorrows were so mixed that it was not possible for one to come back without the other. And this book is the [note calling for help] finally written, not only for the suffering that was mine, but for all who suffer in childhood and think, as I did, that the pain of forgetting is less than the pain of remembering. For without the remembering, no matter how painful, we have no life to call our own."
This message is an important one. Paterson's memoir does not entirely succeed in bringing that message home to its readers, but it is a courageous attempt well worth reading.
My Mother's Keeper, subtitled A Daughter's Memoir of Growing Up in the Shadow of Schizophrenia, is written by Tara Elgin Holley, with a prologue and epilogue by her journalist husband, Joe Holley. It is a 50-year account of an extended family's struggle with one member's schizophrenia.
Tara Elgin Holley, born in 1951, experienced her mother's first psychiatric commitment in August 1955. Holley moved in with her aunt in 1956 and with her great aunt the next year, and she had no contact with her mother between the time she was six and 11 years old.
Holley grew up in a somewhat eccentric family. Her maternal grandparents were Christian Scientists who lost two children and one grandchild, partly due to their refusal to use standard naturopathic medicine. The maternal grandmother is described as "wonderful," but, the author says, "Much of the time she was in her own ethereal world. She was evasive, cloudy, and deeply devout—sometimes charmingly so, sometimes annoyingly. I imagined her floating through life, her feet hardly touching the ground."
Holley's mother, Dawn, was a budding professional singer who, at least for her extended family, had the aura of celebrity. Because Holley had little or no contact with her mother for several years, until she was an emancipated young adult, she depends heavily on her extended family's memories for information about her mother's deterioration during the first ten to 15 years of her illness. During this phase, Holley is not the "my mother's keeper" of the title. She is, however, always growing up in the "shadow of schizophrenia," as her mother's absence and the information she overhears about her are repeatedly intertwined with her own struggle for identity.
The author's sources of information sometimes seem confused, and Holley occasionally lapses into reporting material as if it were her own recollections when, more likely, she had heard it from others. In fact, she says at one point about her picture of her mother, "Some of it has been confirmed, some is imagined, and some I guess I'll never know for sure."
The second half of the book does describe Holley's efforts to be her "mother's keeper." Although Dawn has three sisters, it falls to Holley to be the caretaker, or at least the overseer, of her mother's well-being. Two of the major conflicts in any family's struggle to meet the needs of a relative with serious mental illness are reflected in the book.
The first is the conflict about roles that emerges when family members must jettison more traditional cross-generational expectations. For example, parents of adult children with schizophrenia must remain caretakers of, or at least advocates for, their children for years or decades longer than normally expected. In Holley's case, roles are reversed, and the daughter must become the mother's caretaker.
Holley is perpetually confronted with her lifelong conflict of wanting, but never having, a mother who could in fact be a mother. For example, Holley writes, "I didn't want to be her mother. I was 18 years old, and I considered myself oh so independent and mature, but still I wanted a mommy." Or, "Dawn was a child, it seemed; I was her keeper. We both found it humiliating."
The second conflict is the struggle between long-term hospital care and the autonomy, or presumed autonomy, that occurs when a seriously ill person lives outside an institutional setting. With Holley and her mother, this struggle came down to whether Dawn should live in the safer environment of a hospital or community residence or on the streets. For most of her life, Dawn clearly preferred the streets and would register her vote both orally and through escapes. Holley went back and forth on this issue. At one point she writes, "The street, with its dirt and danger, was preferable to the death-in-life of a mental hospital or the routine and responsibilities of a halfway house. My mother was a street person."
My Mother's Keeper has several weaknesses. It can, itself, be stigmatizing of schizophrenia, particularly through its repetitive use of the word "schizophrenic" as a noun to describe someone with a schizophrenic disorder. The book can also stereotype and generalize about individuals with schizophrenia with statements like "All schizophrenics go through cycles."
The book also romanticizes Dawn, which actually weakens the book. Holley and her writing can be overly maudlin and sentimental. When Holley chooses to intrude didactic material—much better left to her husband's prologue and epilogue—she distracts from her story and does not consistently provide accurate information.
But all in all, My Mother's Keeper will prove particularly useful to extended families who have a member with schizophrenia and to others who are interested in chronic mental illness and its effects on families. Beyond that, the book may prove helpful to any family with a parent with a chronic illness by providing a view of how long-term illness impacts children. Professionals doing family therapy may find it useful to share sections of the book with patients in such situations.
Finally, for policy makers at all levels, My Mother's Keeper is a very good representation of the fact that the care and treatment of schizophrenia throughout the second half of the 20th century has been, and remains, a complex battle of competing interests. While some interests are attended to, and others totally ignored, the needs and wishes of individuals with schizophrenia and their families all too often get lost.
These three accounts adroitly advance the growing literature on what it means to be an adult child of a mother with serious mental illness. The loss and the yearning of the offspring are quite profound. How different is this loss from the loss of a parent through death early in a child's life? As Harris (9) points out in her book by the same title, the latter is "the loss that is forever."
From Lyden's, Paterson's, and Holley's points of view, their loss is also forever. But through much of their lives, they held on to their hope for something more from their parent, which was most often repeatedly denied. If these things are in some way quantifiable, is that a greater loss than forever?
Dr. Geller is professor of psychiatry and director of public-sector psychiatry at the University of Massachusetts Medical Center in Worcester.