Hidden Valley Road: Inside the Mind of an American Family

by Robert Kolker

One of the consequences of surviving schizophrenia for fifty years is that sooner or later, the cure becomes as damaging as the disease.

For a family, schizophrenia is, primarily, a felt experience, as if the foundation of the family is permanently tilted in the direction of the sick family member. Even if just one child has schizophrenia, everything about the internal logic of that family changes.

For more than a century, researchers have understood that one of the biggest risk factors for schizophrenia is heritability. The paradox is that schizophrenia does not appear to be passed directly from parent to child.

“LINDSAY” MARY CHRISTINE GALVIN RAUCH born in Colorado Springs, Colorado, on October 5, 1965 married Rick Rauch; son Jack, daughter Kate

That air of mystery would work to Don’s advantage for much of his life. From the

very start, it was as if Mimi belonged to him, while he belonged to everyone.

Schizophrenia is not about multiple personalities. It is about walling oneself off from consciousness, first slowly and then all at once, until you are no longer accessing anything that others accept as real.

His grades were average, eventually earning him a spot at Colorado State, not the more selective University of Colorado.

Schizophrenia, he concluded, simply can’t be imposed or inflicted on someone who is not genetically predisposed to develop the condition.

schizophrenia could be caused by not just one gene but a chorus of many genes, working in tandem with, or perhaps activated by, various environmental factors.

Gottesman and Shields’s theory became known as the “diathesis-stress hypothesis”—nature, activated by nurture.

What if the problem with schizophrenia patients wasn’t that they lacked the ability to respond to so much stimuli, but that they lacked the ability not to? What if their brains weren’t overloaded, but lacked inhibition—forced to reckon with everything that was coming their way, every second of every day?

The only real, unambiguous beneficiary of drugs, of course, were pharmaceutical companies—all of which were still developing variations of the same original drug, Thorazine, that had been developed back in the 1950s. Then again, their very efficacy had seemed to stifle innovation. Why was it that every new drug brought to market had been either a version of neuroleptics like Thorazine or atypical neuroleptics like clozapine—with no disrupting third class of drug to spur forward progress?

Here was the real reason, he thought, why big pharma could afford to be fickle about finding new drugs for schizophrenia—why decades come and go without anyone even finding new drug targets. These patients, he realized, can’t advocate for themselves.

“The metaphor I use is that years ago, clinicians used to look at ‘fever’ as one disease,” said John McGrath, an epidemiologist with Australia’s Queensland Centre for Mental Health Research and one of the world’s authorities on quantifying populations of mentally ill people. “Then they split it into different types of fevers. And then they realized it’s just a nonspecific reaction to various illnesses. Psychosis is just what the brain does when it’s not working very well.”