This is a great article on the website “Real Clear Science” compiling the evidence to respond to those who fall on the overmedication of kids argument to deny the existence of this disorder:
This is a great article on the website “Real Clear Science” compiling the evidence to respond to those who fall on the overmedication of kids argument to deny the existence of this disorder:
By Edward Brown Illustrations: Margot Koch
Missing Links Press Reviewed Jan/2014 (Releasing April 2014)
A few pages into this “Zen cautionary tale,”, the dramatic stakes are set high and our attention is arrested when its main character, Edward, barely manages to extricate a piggy hand-puppet from the jaws of a neighborhood feline – just as the interloping cat tries to slink out Edward’s side door.
We soon learn that Edward is a revered, Northern California spiritual master and teacher who, on this day, is preparing to drive a few hours south to give a talk.
In “real life” he is known as Edward Brown, the equally revered Zen Buddhist teacher and author of the beloved Tassajara cook books.
So begins Brown’s intimate, revelatory and often LOL funny novella, which is enhanced by the knowing illustrations of Margot Koch and released this month by San Francisco’s Missing Links Press.
Readers are as grateful as the piggy puppet, named Ponce, when Edward keeps him at his side for the rest of this gently taut adventure tale, complete with a mid-life love story, a near-tragic climax and an emotionally and spiritually rich dénouement. The book’s heart center belongs to the rescued pig puppet. As narrator, Ponce adeptly moves between the voice of Ed’s wounded child-self to that of the grown up Edward – who in turn shows up alternately as Edward the venerable Zen master or “Eddiebear” (Ed’s childhood nickname) — the flawed human being for whom centeredness or masteries of any kind are moving targets.
When Ponce speaks as the young Edward, whose abandonment issues stem from having lost his mother at the tender age of three, Brown makes us feel how that loss formed him and still fuels the 60-something’s foibles and frustrations, as in this scene when Ponce expresses Ed’s satisfaction when Margot compliments his cooking:
This pleased Edward quite a bit because if she liked his cooking enough Edward supposed that she wouldn’t leave, and that would be a good thing not to be abandoned, though, of course, he’d have to keep on cooking.
Brown uses this juicy biographical material to dole out more than pop psych. Ponce’s insights run deep and wide, too, as when he muses on the challenge Zen Ed faces “teaching enlightenment to people not especially interested in waking up”
Even in relationship it seemed that people often aimed to not relate. They’d say, “I like your act, do you like mine, too? You do your act with me, and I’ll do my act with you. Okay? Is it a deal?” Let’s get together and not actually meet, shall we?”
Oh my, I thought, as I brought the book into my lap for a moment of uncomfortable self-reflection.
To provide comic relief from such truth-telling, narrator Ponce is also charged with regularly tossing Ed off his pedestal. Here, in preparation for the appearance in Santa Cruz, Ponce watches impatiently as “the master” carefully selects, folds and packs his proper Zen wardrobe, including the mandatory “white jiban, beige komono, dark brown obi, and a handsome stick,” noting:
Check, check check, if you were going to be a Zen person, it was important to be masterful and nothing says masterful like fine robes. Unfortunately Edwards’ were getting to be threadbare, especially if you looked closely, so everyone knew that he was over the hill just like his robes, a teacher that some conceded, ‘might be good for beginners.’
For me, there was identification and surprise in Ed’s Woody Allen-esque “meltdown” as he multitasks himself into distraction on his way out the door. As I try to insert meditation into my morning routine – before the coffee, Tweets, and Facebook postings that typically launch me into the work day — I have flashed more than once on one of the book’s most reassuring messages: that we are all beginners.
For Edward, the character, a lack of mindfulness could take a serious toll as he begins the drive to Santa Cruz. A jammed Marin commute brings about a chain of events that force him to confront his own mortality, and highlight his shortcomings as a friend and protector to Ponce (who is, after all, the abandoned Eddiebear).
And yet, all may not be lost. Despite Ponce’s immediate, terrifying predicament, seemingly abandoned by Edward and stuck in a dark, cold place, our piggy puppet discovers that by changing his perspective, by looking “from the center of the sparkle,” there is a glimmer of light and promise of another, perhaps more enduring rescue.
Mindfulness and Mental Health
I recommend Ed Brown’s By All Means to anyone – teens and up — seeking inspiration for a more mindful, less stressful life.
More germane to the mental health community, I believe By All Means can provide valuable comfort and support to anyone struggling with a mental disorder — in themselves and/or a loved one. Writing from the perspective of someone with lifelong depression, and as a parent to an adult child with depression, I can attest that those of us who are dealing with the symptoms of a mental disorder face one daily, constant, and fundamental task: to manage our minds; and, when pulled away by scary, negative thoughts, to step back from the precipice of hopelessness and despair that can engulf us.
Like Eddiebear and Ponce, we each carry emotional wounds into adulthood – wounds that can make dealing with difficult symptoms, and thoughts, all the tougher. But, like the characters in this honest and insight-packed book, we absolutely can acquire and commit to a set of practices – call them spiritual or therapeutic, it doesn’t really matter – that will help us find a way out.
As a beginning student of mindfulness and meditation, I am struck by the similarities between the techniques I’m learning to gently tell my mind “get back to you later” while attempting to focus simply on my breath, and those I’ve been given in cognitive behavioral therapy to manage negative self-messages and obsessive thoughts. In both cases, the primary technique used is to observe without making negative self-judgments; in other words, to practice kindness with ourselves.
So I recommend this book as one way to gain new perspective and help that process. . As always, I also suggest you talk to a friend or a mental health practitioner if you are having a tough time.
From “60 Minutes,” CBS Television, January 26th, 2014
Creigh Deeds: There’s just a lack of equity in the way we as a society, and certainly as a government and insurance industry, medical industry, with the way we look at mental health issues.
Scott Pelley: Don’t want to fund it. Don’t want to talk about it. Don’t want to see it.
Creigh Deeds: Absolutely. That– that’s exactly right. But the reality is, it’s everywhere.
If inadequate access to mental healthcare in the US is a disease, and I would argue that it can certainly be seen that way in terms of the toll it has taken on American society, then medical school did next to nothing to prepare me to understand its causes; or, to deal with them. After 15 years of treating thousands of patients with psychiatric disorders, I have long struggled to concisely understand and articulate the confluence of factors that determine why my patients do (or do not) have access to mental healthcare.
Recently, whilst watching 60 minutes all that changed. From the story of a young man named Gus Deeds, a clear and concise picture emerged of cause and effect, depicting the factors that largely determine whether a patient in need of mental health care is likely to receive that care.
In this segment, Scott Pelley interviewed Virginia State Senator, Creigh Deeds, about his son Gus, who was 24 years old and had been living with serious mental illness. His struggle culminated, last November, in a tragic ending. The Deeds’ predicament with their son was echoed by other family members of mentally ill children and adults who were also interviewed for this segment.
I was deeply saddened and perturbed by the story and although I had never met any of the people involved and had no inside knowledge of the situation, Senator Deed’s narrative was all too familiar to my ears as a litany of causes for an avoidable tragedy : inadequate mental health resources; resistance to care by the patient; additional obstacles presented by insurance companies, and fragmented treatment options.
Watching the interview, my head reverberated with all the questions I had asked myself when attempting to provide care for patients with serious mental illness.
These were the types of questions that plagued me during the earlier days of my career. Why am I not able to stop them falling through the cracks in the system? Why do I have to spend so much time persuading insurance companies to pay for their basic care? What am I doing wrong? What can I do better? Why does the opinion of their loved ones not seem to count?
The causes behind inadequate access to mental health care in the US must be described with a terminology not taught in medical school. They hail from different worlds than the one in which I was trained: the worlds of law, healthcare policy, sociology and the insurance industry.
Gus Deeds and Craig Deeds, 2009
If this situation is going to change, the Gus Deeds story provides a tragic, teachable moment for all Americans.
Here are 3 key lessons we can all learn from what happened to the Deeds family.
#1 Despite reforms, mental health care services are inadequate or nonexistent to large segments of American Society
Access to mental healthcare starts with the premise that, if services are available and there is an adequate supply of services, then the opportunity to obtain health care exists, and a population may ‘have access’ to services. Unfortunately, this assumption of adequate supply cannot be made with regards to services provided by mental health professionals. There is a shortage of mental health professionals in the United States, And the situation is particularly dire in rural and underserved parts of the Nation. Add to this the fact thatfunding for community resources such as inpatient psychiatric beds and long-term behavioral health facilities has been shrinking for decades and it is not hard to imagine why the issue of access has become problematic for many who are in urgent need of psychiatric attention.
# 2. Because of stigma and denial surrounding mental illness, patients who most need care don’t always seek it
Stigma can be societal and manifest as discrimination towards people with mental health problems. A response from one of the other parents interviewed by Pelley, says it all: When Pelley asked her what the difference between being the mother of a child who has mental illness and the mother of a child who might have heart disease or cancer was, she answered with one word. Sympathy.Predisposing factors such as patient race, age, and health beliefs also influence an individual’s decision to access mental healthcare. Specifically, in the case of those living with serious mental illness, it is not uncommon for the patient to deny that he/she is ill and, therefore, think that they do not need help or medical treatment, i.e. they choose not to access mental healthcare. This denial brings with it a layer of complexity to interactions between mental health professionals and the patients they serve for, unlike many other illnesses, our patients may hide or not fully disclose essential aspects of his/her symptoms for fear of the consequences of such disclosures.
Another layer of complication is that federal and state laws, surrounding the involuntary hospitalization of individuals with mental illness, whilst designed to protect patient’s rights, often leave loved ones and mental health professionals who understand the patient and their illness with no voice, and minimal sway and influence over decisions that get made in courts. This situation emphasizes why it is so important that mental health professionals have the necessary time to carefully evaluate patients; be able to provide them with the continuity of care they need so that they can, eventually, develop a trusting relationship with their patient. Often, it is through this trust that some aspects of denial can be challenged to ensure a better outcome for the patient. And this brings us to the next lesson
#3. Current insurance policies create barriers to patient access and encourage providers to offer reductionist mental health care services
The issues surrounding access to mental healthcare are further compounded by discriminatory, and often illegal, barriers to mental health and addiction services imposed by the health insurance industry. One of the most consistentdebates that have raged in the psychiatric community, since the advent of managed care, has surrounded such insurance company policies and procedures.
Professional organizations have argued (successfully) that such policies appear to be designed to encourage psychiatrists to provide services that are reductionistic (as they are less time consuming and hence less expensive) and discourage approaches or treatments that: take more time; preserve continuity of care and build trust between patient and the professional caring for them. Americans with mental health disorders have been routinely discriminated against when they are required to pay higher copayments, allowed fewer doctor visits or days in the hospital, or made to pay higher deductibles than those that apply to other medical illnesses.
Whilst the signing of the 2008 Paul Wellstone and Pete Domenici Mental Health Parity Act has been viewed as breakthrough legislation to combat this discrimination it is important to note that the Act does not require employers to offer mental health or substance use disorder benefits, only that IF they are offered they must be offered on par with medical/surgical benefits. From 2014, under the Affordable Care Act, new individual and small group plans in and outside of the mandated insurances will be required to offer coverage. Barriers to the effective implementation of such requirements remain to be seen.
If a picture (in this case a 20 minute segment of TV news reporting) is worth a 1,000 words (in this case a 5,000 research or sober policy document) then this 60 minutes segment is that picture. I would encourage anyone with an interest in mental healthcare to watch it.
This work, unless otherwise expressly stated, is licensed under a Creative Commons Attribution 3.0 Unported License.
Shaili Jain, MD serves as a psychiatrist at the Veterans Affairs Palo Alto Health Care System, is a researcher affiliated with the National Center for Posttraumatic Stress Disorder and a Clinical Assistant Professor affiliated with the Department of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine. Her medical essays and commentary have appeared in the New England Journal of Medicine, the Journal of the American Medical Association, public radio and elsewhere. The views expressed are those of the author and do not necessarily reflect the official policy or position of the Department of Veterans Affairs or the United States Government.
I’ve republished a Speaking of Medicine (PLOS Medicine) blog post I think you’ll find of great interest. In it, Sara Gorman explains the risks of increasing stigma and discouraging treatment, compared to other evidence-based screening factors, e.g. a record of domestic violence to deter gun violence.
In the aftermath of the mass shooting earlier this year in Newtown, Connecticut, debates have been raging in the U.S. about what steps to take to prevent such tragedies in the future. In particular, policy officials and the public alike have been pondering whether more stringent controls on potential gun buyers and gun owners with mental illness should be implemented and what these controls might look like. Shortly after the Newtown shootings, Senator elect Marco Rubio called for guns to be “kept out of the hands of the mentally ill.” In a more extreme statement, the National Rifle Association (NRA) suggested an “active national database of the mentally ill.” A recent study by researchers at the John Hopkins Bloomberg School of Public Health found striking similarities in the opinions of gun-owners and non-gun-owners when it came to restricting the ability of people with mental illness to own guns. 85% of all respondents to the survey supported requiring states to report people to national background-check systems who are prohibited from owning guns because of a history of being involuntarily committed or being declared mentally incompetent by a court. Most respondents, whether gun-owners or non-gun-owners, were resistant to allowing people with mental illness to own guns. Clearly, the provision of tight restrictions on potential gun owners with mental illness is an unusual arena in which gun-owners and non-gun-owners can agree.
There is no question that guns pose a potentially serious problem for people with mental illness. Some forms of mental illness can be associated with heightened potential for violence, but, more importantly, the risk for successful suicide among depressed persons with guns is much higher than the risk for those without guns. Nevertheless, are gun control efforts that require the names of people with mental illness to be kept in a national database such a good idea?
The truth is, we have to be much more careful about gun control efforts that have the potential to target people with mental illness. There are two main reasons to approach these kinds of laws with a healthy dose of caution: one reason is that gun control efforts focusing on mental illness have the potential to exacerbate public stigma about the potential violence associated with mental disorders; the second reason is that gun laws that in particular involve collecting the names of people with mental illness in national databases have the potential to deter people from seeking the care they may desperately need.
Ample evidence has suggested that stigma and discrimination against people with mental illness is often correlated with perceptions that people with mental illness are inherently violent. People who believe that mental illness is associated with violence are more likely to condone forced legal action and coerced treatment of people with mental illness and may feel that victimizing and bullying people with mental illness is in some way justified. The idea that mental illness and violence are closely related is quite common. A 2006 national survey found that 60% of Americans believed that people with schizophrenia were likely to act violently toward another individual. Even so, research has repeatedly established that psychiatric disorders do not make people more likely to act in a violent manner. Gun laws targeting people with mental illness are likely to worsen the perception that mental illness and violence go hand in hand, and, as a result, stigma and discrimination are likely to be exacerbated.
Gun laws targeting people with mental illness may in some instances save lives. Successful suicides, or even suicide attempts, might be avoided, for instance. On the other hand, in addition to perpetuating a stigmatizing belief that people with mental illness are dangerous, gun laws that focus on people with mental illness might involve measures that deter people from seeking psychiatric care. If people are afraid that the government and other parties will have access to their confidential mental health information, they may be much more reluctant to seek help in the first place. In the end, this kind of deterrence could cause more harm than good, not to mention that increased stigma and discrimination also often lead to a decrease in help-seeking behaviors.
It is true that the U.S. mental health system is in need of reform and that strategies to detect people in danger of hurting themselves or others earlier are desperately needed. Even so, it is difficult even for mental health professionals to predict the future violence potential of their patients. Furthermore, it is not only misguided but also potentially harmful to focus gun control efforts on people with psychiatric disorders. What’s more, these kinds of efforts will probably make very little difference in the homicide rate in the U.S. It would be more worth our while to focus gun control efforts not on mental illness per se but perhaps more importantly on alcohol abuse. The association between alcohol abuse and gun violence is convincing. As a result, in Pennsylvania, for example, people who have been convicted of more than three drunk driving offenses may not purchase a gun. Keeping guns out of bars and other drinking establishments is also probably a wise move. Doing background checks fordomestic violence is also a useful measure in reducing gun violence in the home. As the U.S. reconsiders gun control legislation, it is important to recognize that some measures might do more harm than good. Paying closer attention to scientific evidence and remaining focused on the most effective strategies for targeting those most likely to commit violent acts must be the strategy going forward.
I just tried a new online tool from Mental Health America called “How’s Your Mood Today?” that can help you evaluate whether things you’re thinking, doing, or feeling may in fact be symptoms of one of these four, perhaps not yet diagnosed, mental disorders.
Because of the continuing stigma about mental illness, one of the hardest things for many of us is to seek help for bonafide symptoms of depression, and anxiety — or one of the other two less-common disorders, PTSD or Bipolar Disorder. Here’s a simple way to find out if some bothersome or distressing symptoms you may be experiencing add up to a possible mental health disorder for which you should seek help — right away!
Before recommending it to you I tried it myself. After filling out the quick multiple choice questionnaire (truly took 90 sec) with answers that described the me of 12 years ago — before I began using antidepressants to treat my (lifelong) depression and anxiety disorder –I found the (instant assessment) that popped up to be very accurate. It described me as someone displaying symptoms of moderate depression and therefore in need of professional evaluation and possible treatment. One thing I like very much in this test is its emphasis on identifying symptoms that interfere with some aspect of your life.
If you haven’t yet found the courage and/or financial resources to actually go to a clinic or public mental health department for such a screening, taking this test would be a solid first step to give you a better idea of how serious your symptoms are right now.
Here’s how MHA describes the tool:
Mental Health America provides the only online test that screens for depression, bipolar disorder, PTSD and anxiety. The innovative online mood-screening tool is offered in partnership with M3 which created this medically proven checklist for mental health well-being.
Visitors simply need to click on the box in the upper right corner of the Mental Health America home page labeled “How’s Your Mood Today” to start the three-minute self-assessment process. The customized assessment provides a score that a person can then share with his or her physician and monitor over time.
Among the most popular things I offer on this Mental Health Mom blog are the self and family member psych tests (on the top bar). This new test is worth doing and it’s free. Here again is the link: http://bit.ly/XVa3mS
The following came today from one of our PLOS Bloggers, Seth Mnookin, whose book, The Panic Virus chronicles the rise of the antivaccine movement, including its celebrity spokesperson du jour, Jenny McCarthy. In the book, and his recent blog posts, Mnookin profiles McCarthy and recounts how the antivaxx message has scared parents out of getting proper immunizations for babies and young children — in the process posing a grave threat to kids’ health; one that has already resulted in pertussis and measles outbreaks in the US and UK.
Needless to say, giving McCarthy a daily TV platform such as The View to spew such misinformation is a BAD IDEA. A petition to get ABC to reverse its Jenny McCarthy hiring is circulating and can be found here: http://www.change.org/petitions/abc-s-the-view-just-say-no-to-adding-jenny-mccarthy-to-the-view
Although Seth addresses his post to other science and health journalists, its message is equally relevant to today’s parents.
The shameless and lamentable decision on the part of ABC to hire Jenny McCarthy as one of its co-hosts for the daytime talk show The View has, once again, brought the topic of vaccines and autism into the news. Fortunately, the spineless “on the one hand, on the other hand” reporting that characterized this debate for so many years has, for the most part, been replaced by an almost universal acknowledgment that vaccines are a safe, life-saving public health intervention — and that there is not now and never has been the smallest shred of evidence showing a causal link between any vaccine and autism.
As someone who’s been reporting on and writing about this issue for five years, I know how confusing it all can be — and anti-vaccine activists (like McCarthy orRFK Jr.) take advantage of this confusion by moving the goalposts, throwing up smokescreens, and generally doing whatever they can to obfuscate the reality of the situation. (When there aren’t any facts on your side, your only hope is to create enough distractions so that the public forgets what the real issue was in the first place.)
Which is why I get a little nuts when I see well-meaning journalists who are attempting to grapple seriously with the issue make basic mistakes. Take thisLos Angeles Times story titled “Jenny McCarthy on ‘View’: A new forum for discredited autism theories.” After running through the sorry history of charlatan/opportunist Andrew Wakefield’s efforts to scare people into thinking the measles-mumps-rubella (MMR) vaccine could cause autism, the author writes (the emphasis, obviously, is mine):
Subsequent efforts to replicate Wakefield’s findings failed. But vaccination rates began a steep decline anyway, and a new generation of parent activists — skeptics of the biomedical industry’s claim on their children — was born. Meanwhile, the findings spurred additional research, which suggested that the specific culprit in the MMR vaccine was the widely used preservative thimerosol.
I’ll say this as clearly as I can: The MMR vaccine does not and never didcontained thimerosal. (This mistake is made so often that the FDA has included it as one of it’s FAQ’s about thimerosal.) It’s a small, niggling point in this larger debate — but when the anti-vaccine movement’s entire tactic is to blur reality, it’s crucially important that those of us dedicated to uncovering and reporting the truth make sure we get every last detail right.
HIGHLY RECOMMENDED… Here is Seth Mnookin’s four part series on McCarthy and her antivaxx movement:
A meta-analysis published in PLOS Medicine establishes irrefutably that psychotherapy — and various forms of it –are effective treatment for depression. And these studies looked at the effects of psychotherapy alone — without antidepressants. This is very important in that some people, either temporarily, e.g. pregnant women, or permanently cannot or choose not to take antidepressants. The take away: YOU HAVE CHOICES!
Here’s the news…
From mental health practitioner, Adriana Barry’s blog account:
May 28, 2013 ? Treatments for depression that don’t involve antidepressant drugs but rather focus on different forms of talking therapy (referred to as psychotherapeutic interventions) are all beneficial, with no one form of therapy being better than the others, according to a study by international researchers published in this week’s PLOS Medicine.
Read the whole post:
Another news article from Science Daily on the same study:
Read the whole study:
I’m pleased to share this new review of my book written by Sandeep Gautam on his blog, The Mouse Trap:
Today, i.e. 15th may 2013 is being celebrated asa mental health blog day by APA and in the spirit of the day I am posting a review of ‘A Lethal Inheritance’ by Victoria Costello. It is a book chronicling how ‘ a mother uncovers the science behind three generations of mental illness‘ and is an apt topic for the day highlighting the importance of public education and discourse about the topic of mental health. this blog pots and book review is a homage to all the people who silently suffer from mental illness, most of the time undiagnosed, or even after diagnosis kept under warps due to associated stigma, and their family members who face the burden of not just care-giving but the counterproductive and unnecessary guilt that many of them either by themselves feel or are made to feel by indirect societal gestures.
Let me also take this opportunity to apologize to Prometheus Books and Victoria : the book had come out a year ago and I was sent a review copy promptly, but could not review it earlier. Better late than never!
The book, as the subtitle reveals, revolves around three generations of Victoria’s family (this book is autobiographical) : her two sons Alex and Sammy, which have their own mental health challenges and the unraveling of one of them: a first time encounter with a psychotic experience which could be quite disconcerting for everyone involved: leads her on on her journey to trace the roots of this malady affecting her family and also on a scientific pilgrimage where she continues to search for reasons, symptoms and preventive measures for the various mental health conditions afflicting her family’s three generations.
If the third generation is her sons, the second generation comprises of her and her sister Rita. While she struggles with undiagnosed/ untreated depression for most of her life, her sister is found struggling with serious substance dependence and addiction- which in the end cost her her life.
The first generation consist of an Irish immigrant grandpa in USA, whose claim to family fame, is that nobody wants to talk about his death: a purported accident where he feel asleep /drunk on the railroads and died. Now Victoria is a journalist and a good investigative journalist at that. Not satisfied with the account her mother has narrated to her, she undertakes an investigation of her own that leads to surprising discoveries like the fact that her grandpa had dies seven months before hew mother was born , rather than afterwards as believed. Also that his official death transcript reads as died from accidental drowning in a lake, thus casting doubts over the real conditions surrounding his death and also raising a question, could we ever really know if someone had committed suicide or died accidentally even if the incident was of yesterday and not many years before. The fact that his grandpa was an alcoholic, an immigrant laborer most probably facing economic stress and suffering from some mental illness, and likely committed suicide, based on the guilt/ disgust and many other emotions it aroused in his relatives (wife , daughter etc) points to the various ways genes (Irish inheritance) and environmental factors come together to wreak havoc.
The book is large part sensitive narration of one’s own story, some part thrilling investigative journalism and remaining parts informed scientific documentation of symptoms, risk factors, early signs, preventive measures and genes-environment interplay in the making and unmaking of mental health. While the scientific facts are up-to-date, they wont be path breaking as this is not mostly a scientific book- its value lies more in a first hand account of how a family deals with mental health issues and how there are common genetic risk factors that manifest in various forms- from a teen having conduct problems and eventually psychosis, to an adult in the grips of substance use and addiction, to a mother fighting and feigning at the same time that she does not suffer from depression, to a long dead grandpa who was alcoholic and probably committed suicide, to traces of violence in other relatives.
The book is also important as it highlights that mental illness and genetic risk does not respect diagnostic boundaries- from depression to conduct disorders to substance use to psychosis – all manifest in the same family tree and were perhaps myriad manifestations of a same common inheritance.
My recommendations; read it, read it as a piece of fiction , as an autobiographical account; as an educative opportunity to know more about mental illness and risk factors or just to get a first hand experiential account of what it meas to live under the weight of a lethal inheritance- read it whichever way you like, but you are bound to come out with an enhanced and more nuanced perspective that would be richer for having read this .