Far from the Tree: Parents, Children, and the Search for Identity

by Andrew Solomon

There is no such thing as reproduction. When two people decide to have a baby, they engage in an act of production, and the widespread use of the word reproduction for this activity, with its implication that two people are but braiding themselves together, is at best a euphemism to comfort prospective parents before they get in over their heads.

Though many of us take pride in how different we are from our parents, we are endlessly sad at how different our children are from us.

Because of the transmission of identity from one generation to the next, most children share at least some traits with their parents. These are vertical identities.

Often, however, someone has an inherent or acquired trait that is foreign to his or her parents and must therefore acquire identity from a peer group. This is a horizontal identity.

Many parents experience their child’s horizontal identity as an affront.

Whereas families tend to reinforce vertical identities from earliest childhood, many will oppose horizontal ones. Vertical identities are usually respected as identities; horizontal ones are often treated as flaws.

Many vertical identities make people uncomfortable, and yet we do not attempt to homogenize them.

The timeworn adage says that the apple doesn’t fall far from the tree, meaning that a child resembles his or her parents; these children are apples that have fallen elsewhere—some a couple of orchards away, some on the other side of the world.

My mother didn’t want me to be gay because she thought it wouldn’t be the happiest course for me, but equally, she didn’t like the image of herself as the mother of a gay son. The problem wasn’t that she wanted to control my life—although she did, like most parents, genuinely believe that her way of being happy was the best way of being happy. The problem was that she wanted to control her life, and it was her life as the mother of a homosexual that she wished to alter. Unfortunately, there was no way for her to fix her problem without involving me.

Treating an identity as an illness invites real illness to make a braver stand.

Freud posits that any declaration of love masks some degree of odium, any hatred at least a trace of adoration.

Nevertheless, it is easier for parents to tolerate the syndromes assigned to nature than those thought to result from nurture, because guilt is reduced for the former category.

self-acceptance—a universal struggle we negotiate partly through the minds of others.

The culture is likewise a metaphor for our parents: our quest for high esteem in the larger world is only a sophisticated manifestation of our primal wish for parental love. The triangulation can be dizzying.

The philosopher Philip Kitcher has referred to genetic screening as “laissez-faire eugenics.”

Her aloneness reflects a disjunction between her own perception—that being blind is an identity—and her husband’s—that it is an illness.

Reinhold Niebuhr’s Serenity Prayer, which is a tenet of the recovery movement: “Father, give us courage to change what must be altered, serenity to accept what cannot be helped, and the insight to know the one from the other.”

Recent academic work suggests that people who know their condition to be irreversible are happier than those who believe their condition may be ameliorated. In such cases, ironically, hope may be the cornerstone of misery.

Fixing is the illness model; acceptance is the identity model; which way any family goes reflects their assumptions and resources.

If you banish the dragons, you banish the heroes—and

empathy is “successfully guessing what another person is feeling.”

One popular principle is mindblindness, an inability to recognize how another person’s thoughts differ from one’s own. A child is shown a candy package and asked what he thinks it contains. He thinks it contains candy. It is opened and he is shown that it contains a pencil instead. He is then asked what another child will think when shown the closed package. Nonautistic children expect the other child to be duped just as they were. Autistic children expect the child to know the package has a pencil in it. A number of recent imaging studies have demonstrated that mirror neurons, usually activated when a person either performs or observes an action, fire in autistic subjects only when they themselves are doing something and remain mute when they are observing someone else.

A study conducted at Yale found that in adults with autism or Asperger’s, the region of the brain activated during face processing corresponded to the region activated in nonautistic subjects during object processing. Autistic people with fixations, however, may recognize those in the area where most people register faces. So one autistic boy had the same region in his brain light up for his mother as for a teacup. But he was enthralled by Japanese Digimon characters, and when he saw those, the area where most of us process our intimate connections suddenly flashed on.

Autism is associated with underconnectivity between hemispheres and an overabundance of local connections; the neuronal pruning that helps the average brain avoid overload does not appear to occur in autism. Many autistic children are born with smaller heads than the norm, but by six to fourteen months, many have larger heads than the norm. The brains of autistic children are often enlarged by 10 or 15 percent, a condition that appears to resolve as the children grow. The human brain consists of grey matter, where thought is generated, and white matter, which conveys that thought from one area to another. In autism, inflammation has been observed in areas of the brain that produce white matter; too much is produced too soon, creating terrible noise,

It seems likely that autism is a blanket term. Autistic behavior may prove to be a symptom of a variety of causes, much as epilepsy can be caused by a genetic defect in brain structure, a head injury, an infection, a tumor, or a stroke; or as dementia may be the result of Alzheimer’s, cerebrovascular degeneration, Huntington’s, or Parkinson’s.

While traits such as eye color or Down syndrome are always shared by identical twins, many other characteristics are not shared absolutely, and the correlation for autism is the highest for any cognitive disorder—higher than for schizophrenia, depression, or obsessive-compulsive disorder.

there are strong genetic factors in autism, but that genes alone do not explain all instances of the condition.

Autism is a catchall category for an unexplained constellation of symptoms.

The Cambridge autism researcher Simon Baron-Cohen postulates that women are empathizers, hardwired to understand others, while men are systemizers, hardwired to organize factual and mechanical information. Autism, in this view, is an overexpression of cognitive masculinity—short on empathy and long on systems.

Given that more androgens circulate in utero during pregnancy with a boy, a smaller excess would tip a male fetus into autism than would tip a female. This may be a partial explanation for why autism occurs twice as often in males as in females.

Approximately one-third of autistic people have at least one psychiatric diagnosis in addition to autism, compared to 10 percent of the general population, but they frequently don’t get treatment for these complicating factors. One in five suffers from clinical depression, and about 18 percent from anxiety.

The innumerable questionnaires and inventories, seldom fully sufficient for diagnosis, include the Autism Behavior Checklist (ABC), the Childhood Autism Rating Scale (CARS), the popular Checklist for Autism in Toddlers (CHAT), the seven-hour-long Diagnostic Interview for Social and Communication Disorders (DISCO), the Autism Diagnostic Interview–Revised (ADI-R), and the highly regarded Autism Diagnostic Observation Scale–Generic (ADOS-G). It’s hard to find a consistent instrument that applies to both people who speak and those who are nonverbal.

Some researchers have questioned whether such regression results from loss of function, or whether apparent early sociability in infancy may rely on different brain regions than more mature sociability. Researchers have estimated that between 20 and 50 percent of autism cases involve regression.

In The Cherry Orchard, Chekhov said, “When many remedies are proposed for a disease, that means the disease is incurable.”

“You want to be appreciated for doing something other people want,”

abortion question is emblematic of the tension between identity and illness models.

The trauma of Down syndrome is that it is present prenatally and can therefore undermine the early stages of bonding. The challenge of autism is that it sets in or is detected in the toddler years, and so transfigures the child to whom parents have already bonded. The shock of schizophrenia is that it manifests in late adolescence or early adulthood, and parents must accept that the child they have known and loved for more than a decade may be irrevocably lost, even as that child looks much the same as ever.

Most famously, the schizophrenic disappears into an alternative world of voices that he erroneously perceives to be external; these internally generated relationships become far more real and important than any interaction with the authentically outside world. The voices are usually cruel and often encourage bizarre and inappropriate behavior. The person who hears them is commonly terrified and almost always paranoid.

Though many schizophrenics become curiously attached to their delusions, the fading of the nondelusional world puts them in loneliness beyond all reckoning, a fixed residence on a noxious private planet they can never leave, and where they can receive no visitors.

Few things could be worse than perceiving your dreams as true.

Psychosis is a gross disturbance in an individual’s ability to distinguish self from reality. For schizophrenics, the membrane between imagination and reality is so porous that having an idea and having an experience are not particularly different. In the earlier stages of illness, schizophrenics often have symptoms of depression, because psychosis itself is distressing and because of the desperate nature of schizophrenic thought. This is the time of greatest suicide risk. In later stages, emotional capacity altogether is reduced, and people may seem vacant and emotionless.

The usual course for the condition, however, is that it unfolds through five predictable stages. It is asymptomatic until puberty in the premorbid phase, though recent research points to delays in walking and talking, more isolated play, poor school performance, social anxiety, and poor verbal short-term memory. This is followed by a prodromal phase, which lasts for four years on average, in which positive symptoms begin gradually to appear. The adolescent or young adult in this phase experiences changes in cognition, perception, volition, and motor function; has strange thoughts flash across his mind; struggles to understand whether illogical beliefs are true; and becomes suspicious and wary. Some people who will develop schizophrenia seem curiously detached from the real world even in childhood and gradually slip into psychosis. Most appear to have a dramatic break, sometimes in reaction to trauma and sometimes with no obvious trigger, in which they are suddenly transformed beyond recognition. This marks entry into the psychotic phase, with the onset of hallucinations or bizarre delusions, including delusions of control, thought insertion, thought broadcasting, and thought withdrawal. This usually occurs between ages fifteen and thirty and lasts for about two years. No one has yet been able to discover what maturational event triggers psychosis. There are three primary possibilities. One is that the teenage rush of hormones changes gene expression in the brain. The secon...

Schizophrenia, like autism, is a blanket term. Eugen Bleuler, who coined the word in 1908, actually referred to schizophrenias. In 1972, the eminent neurologist Frederick Plum famously said, “Schizophrenia is the graveyard of neuropathologists,” meaning that no one had understood or would understand its etiology. We now understand more of schizophrenia than we do of autism. It is unclear whether schizophrenia should be subtyped according to biology (genotype) or behavior (phenotype).

The brain is composed of grey matter, made of cell bodies; white matter, the axons that connect the cell bodies and create synapses; and ventricles, fluid-containing spaces that allow for circulation of the cerebrospinal fluid. When you lose brain tissue, you have bigger ventricles, and a cardinal feature of schizophrenia is enlargement of the lateral ventricles. While autism is characterized by an overabundance of synaptic connectivity, schizophrenia is marked by a dearth of it. People with schizophrenia also have fewer dendritic spines, which form synapses, and fewer interneurons, a type of brain cell that regulates mental activity. The positive symptoms of schizophrenia appear to be tied to abnormalities in the temporal lobe, where auditory and emotional perception are located. The negative symptoms appear to be tied to damage to the frontal and prefrontal lobes, where cognition and attention are based.

Genetic vulnerability to schizophrenia is subject to precipitating traumas, including variations in the uterine environment. Obstetrical, labor, and delivery complications are bad for a developing fetal brain, and schizophrenia patients are more likely to have a history of them. Maternal infections such as rubella and influenza during pregnancy also increase risk; the high rate of winter births of people who develop schizophrenia is probably linked to increased second-trimester maternal viral infections. Stressful events during pregnancy have been correlated with schizophrenia; the rate is higher, for example, for children of women who lived through a military invasion while carrying, or whose spouses died during their pregnancies.

Scientists have proposed that prenatal stress results in the release of hormones that disturb fetal neurodevelopment; stress can activate the mother’s dopamine system, and that may dysregulate the fetus’s. Postnatal events such as a head trauma in early childhood increase the risk of developing schizophrenia. Lifetime stress plays a role, too; the risk is particularly high among immigrants who go from underdeveloped settings to cities—people confronting exponential unfamiliarity. The most consistent postuterine environmental factor associated with a worsening of psychotic symptoms is the abuse of recreational drugs, including alcohol, methamphetamines, hallucinogens, cocaine, and marijuana, particularly in adolescence.

In schizophrenia, some gene-environment combination causes the neurotransmitters dopamine, glutamate, norepinephrine, serotonin, and GABA to become dysregulated, leading to excess activity in one dopamine pathway. This induces psychosis and other positive symptoms.

Experts have devised a menu of symptoms that indicate the prodromal stage: suspiciousness; unusual, magical, or bizarre thinking; extreme changes in behavior patterns; decreased functioning; inability to go to school or function at a job. Confusingly, many of these are also symptoms of ordinary adolescence.

biological treatment to address positive symptoms, and psychosocial methods to ameliorate negative and cognitive symptoms.

“I don’t believe in normality,” Winston said. “It’s just an averaging of extremes.”