"Have you had any serious health conditions?" asked my son's psychiatrist Dr. C.
I had just brought Alex to UCLA's Neuropsychiatric Institute to find out why, over the course of the prior twelve months, he'd lost the ability to finish a coherent sentence, wear shoes, sleep through the night, or face the other kids at school. (Later, I would learn the term "psychotic break" to describe his frightening transformation which had begun at age 16.)
"No, none." I answered.
"All right," she said. "Shall we go on to your siblings?"
I was giving Dr. C a family mental health history, after she explained its importance in coming up with a proper diagnosis for Alex's strange behaviors. We were apparently trying to track down the most likely culprit among several candidates in my family's past who might have passed a fatal flaw to Alex.
I didn't expect to have to talk about myself.
I'd just told Dr. C that I was forty-three year old single mother of two sons; and that I worked as a freelance TV writer. I'd also told her I was in fine health. Of course I didn't say I'd been depressed for as long as I could remember. Nor did I mention my drinking. I'd always worked around it, hadn't I?
I flashed on the debris I'd left at home after staying up all night waiting for word of Alex's whereabouts and then rushing to get him to the hospital first thing that morning. The empty bottle of cheap chardonnay on my coffee table; the expensive concealer I'd used to cover the dark circles under my eyes left on the sink; the flinty smile still imprinted on the bathroom mirror, the one I'd practiced in hopes it would disguise my pain when I delivered my first-born son to this state-of-the-art kiddie psyche ward.
"Do you think I might be depressed?" I asked her timidly.
"Without a thorough interview," Dr. C began. "I can't diagnose you."
Of course, stupid me. She's not going to want to mix it up here.
She then continued. "But I do see indications . . . certainly with your family history. If you would like a referral-"
"No, not yet," I interrupted.
We moved on to the next possible suspect in the three generation family portrait of undiagnosed and untreated mental disorders, addictions and one likely suicide that I would go on to paint. Alex, carrying such a heavy genetic load, made worse by smoking a lot of pot and taking speed in the months before his hospitalization, had put himself in a category mental health researchers now call "ultra-high risk." Knowing all this about him, Dr. C was able to make an important and ultimately successful treatment decision—to intervene immediately, prescribing Alex antipsychotic medication and regular psychotherapy in order to stop his progression from early psychosis to full blown schizophrenia.
My Part in the "Family Illness"
Another six months would pass after Alex's stay at UCLA before I was ready to deal with my own deadly dance with depression and addiction. By then I was broke, alone, and drinking—more. I had no job and no health insurance, so my only option was to go to the nearest public mental health clinic—where they take everyone, no questions asked, and where, it turns out, very good care can be gotten.
"There's no question you have dual depression," the balding middle-age psychiatrist I call Dr. B told me after a five minute conversation.
"Can you explain that?" I asked him.
"The mild depression you've had since late childhood. As you get older, you're having longer episodes of severe major depression, which your alcohol intake is only making worse. The crisis with your son has pushed you into the severe episodes you're dealing with now."
Dr. B nailed what was wrong with me in an astonishingly short time. Still, getting a diagnosis for something that has always been part of you-as well as the defining characteristic of your whole family-is a truly strange experience. Omnipresent depression doesn't feel like a symptom, it becomes a personality trait, and that's why most people with it don't get treatment. In my twenties, when I acquired enough perspective to see that other peoples' days and nights were not filled with the chaos and despair that mine were, I started going to psychotherapists. But I always felt that my therapist and I were cleaning up the messes I'd made in my life without touching on their common cause.
Talk Therapy + Medication = Recovery
Obviously, talk therapy alone hadn't worked for me. People who speak negatively about antidepressants often complain that they mask your deeper issues and treat only symptoms. As if this is a bad thing. When I hear this line of argument, as I still frequently do, I detect in it the message that depressed people are getting off too easy, presumably by skipping over the hard stuff in life with the help of a drug. My belief is that those who believe this have never experienced true clinical depression. Otherwise they'd get it.
I became a poster child for the benefits of antidepressants. Within a year, my income tripled. I moved from Los Angeles to my present home in San Francisco, leaving behind the last of my unavailable (read married) boyfriends and years of underemployment in the chaotic TV business. Doing a brief run of therapy again-this time while on medication-helped me make room for some new ways of thinking and behaving: like having an expectation that I would be liked; hell, just doing my taxes or the dinner dishes on time. I plan to stay on antidepressant medication for the rest of my life. The data on getting off them after lifelong major depression is not good. Most people relapse and have another episode of major depression within a year-and I don't plan to be one of them.
Guilt, My Last Addiction
Having helped Alex get back on track (in college and on his own) and after pulling myself out of depression and into sobriety, for the longest time, I still faced a baffling and intractable problem. It seemed that neither medication nor therapy could banish the guilt I still felt over my prior poor performance as a mother. Knowing that I'd stayed in that depressed state until Alex (and his younger brother) reached adolescence-in the process raising their risks for the mental disorders that did develop-filled me with bouts of debilitating regret-for which I could find no remedy.
The answer came only two years ago when I let go of the façade of "normalcy" I still clung to and began telling my story of family mental illness and addiction publicly. That, in turn, led me to make a professional U-turn wherein I quit trying to write the next great American novel in order to write a memoir where I could share the valuable lessons I'd learned on my road to recovery. I also became a full-time mental health care advocate, working with the Mental Health Association of San Francisco to combat stigma and share the good news about early intervention and prevention. My book A Lethal Inheritance, A Mother Uncovers the Science Behind Three Generations of Mental Illness  will be available in January of 2012.
In summary, I've learned three important lessons on my journey through mental illness. First, that I've done things in the wrong order. If we, as parents, get treatment for our own psychological or addiction issues, our children will suffer far less mental illness. If they're already struggling with a mental health challenge, we'll be of much greater help to them. That leads to my second discovery: intervening sooner for a mental health problem is better than picking up the pieces later — for everyone. Lastly, I've learned that although we're each born with inherited liabilities and assets, throughout our lives our minds become largely what we make of them. Put simply, nurture can trump nature. So if fixing mom first isn't possible, then the next best thing is getting help together—as a family.
Once we get these three things, the game has changed, and we're living in the prevention model of mental wellness where healthy minds rule.