While You Were Out: An Intimate Family Portrait of Mental Illness in an Era of Silence

by Meg Kissinger

Holmer was hardly in a position to manage Danny’s care. He had his own mental health to tend. To no one’s surprise, Holmer had been diagnosed with bipolar disorder a few months after my mother died.

The court psychiatrists who examined Danny concluded that he was not competent to help in his own defense. Danny was delusional and paranoid, they said. He was not dangerous enough to be committed, but he should be required to be in treatment and take medication so that he could be restored to competency.

Maybe the medication cleared away the cobwebs in Danny’s head, giving him a clarity and insight that he couldn’t have before. Danny went into great detail in his letter about what it was like for him to have bipolar illness and how people need to understand that it is a sickness, not a choice. “Only love and understanding can conquer this disease,” he wrote. The more I thought about this, the more I began to worry. The tone was off. This seemed to me to be too drastic of a change in attitude. All this talk about sinfulness was making me nervous. There was a kind of finality to the way Danny worded his letter that made me uncomfortable. He sounded like someone who just came out of a stupor, taken inventory of his life, and realized that he screwed it up beyond repair. He was saying goodbye, but before he left, he wanted to leave a legacy, a kind of prescription for how to help others. Only love and understanding can conquer this disease.

Our family language of wisecracks and one-liners had been our way of keeping us all from panicking, to distract us from the truth that we were scared out of our minds. We used humor as a kind of Band-Aid, to keep the fear and anger from infecting us. But wounds also need fresh air and sunlight to heal, and we still weren’t ready to sit down as a group and thoughtfully consider what was happening. We were simply in survival mode.

He thought readers would be interested to know how a family copes with the trauma of suicide twice. Are you out of your damn mind? I told Don. How could I possibly write about something so painful? Why would anyone want to take advice from people stupid enough to let this happen twice? We were losers, as far as I was concerned. To lose one sibling is a tragedy, I said, paraphrasing the old Oscar Wilde quote. To lose two looks like carelessness. Besides, Danny was hardly a sympathetic character. I’m sure plenty of people remembered his role in the hate mail case and thought Danny had gotten exactly what he deserved.

But this is what suicide does. It deprives families of their primal need to grieve fully. The shame of how they died overshadows them. We don’t talk about people we love who end their own lives in the same way that we would if they had died of leukemia or had been killed in a skiing accident. It’s an especially lonely kind of grief.

in the ten years since then, Holmer saw how people with mental illness are discriminated against, how family and friends get burned out, and how hard it is for people to get care. He knew this was a scandal worth exposing. He had come a long way from if anyone asks, this was an accident.

I quickly picked up on a universal theme: People are frantic to get care for their family members suffering from mental illness. They didn’t know whom to call. They were either too embarrassed to talk to anyone about it or they couldn’t find anyone who would listen. So, they watched, day after day, while a little bit more of the person they loved disappeared before their eyes. They were confused, angry, and frustrated. But, mostly, they were terrified.

Only love and understanding can conquer this disease. As far as I was concerned, Danny summed up everything you need to know in those eight little words. If you love someone, you will try to understand them. You won’t turn away.

More than one-third of all people with serious mental illness don’t get treatment.

A person with serious mental illness is ten times more likely to be incarcerated than hospitalized. Jails and prisons have become the nation’s de facto mental health hospital system.

I discovered how my family’s struggles were eerily intertwined with pivotal moments in the history of America’s fractured mental health system. We Kissingers had come of age just as failed federal reforms were ushering hundreds of thousands of the sickest patients out of institutions and onto the streets. In the name of civil liberty, we traded one outrage—the warehousing of our sickest psychiatric patients in conditions unfit for animals—for another, deserting them to suffer alone.

The quality of public mental health care depended largely on which zip code you lived in.

The credit cards were coming due, and then what? How is it not stealing to be borrowing money you know you don’t have and never will? The hypocrisy of the Church Lady and her husband spending money they did not have disgusted me, and I had a hard time hiding it.

She says that you have inappropriate feelings toward your father. Wow. So, there it was. Inappropriate feelings toward your father. I was so stunned I didn’t know what to say. I wasn’t going to dignify her accusations with a comment. I suppose I should have seen it coming. What did I expect? She was angry at how Holmer would call me panicking about the prospect of them having to sell their house to pay the bills. They were both embarrassed they’d gotten themselves into this jam. It was easier to gaslight me than own up to their own reckless acts. Jake and Mary Kay came up for the family gathering instead. My relationship with my father would never be the same.

I’d been so rattled after our family photos ended up in boxes at the rummage sale and Holmer’s wife’s ugly accusations that I was quick to tears, angry, and confused. All that unresolved trauma was catching up to me.

Holmer, who once petitioned to keep a group home out of our neighborhood for fear of what it might do to property values, was now relieved that Jake had some place to live, transitional as it may be.

Holmer and his wife never did move out of the condo, nor did they ever go to visit Jake at his new place. A few of his wife’s children chipped in and bought the condo, relieving them of all that debt. They let Holmer and his wife stay there for free. Their financial troubles, however, were far from over. Even after their reverse mortgage funds dried up, they kept traveling and buying fresh flowers, getting regular manicures and pedicures, and putting it all on one credit card after another. Their debts kept climbing.

The city’s building inspection manager told me that it was not unusual to find hungry tenants begging outside of the buildings where they lived because their landlords took their disability checks and did not leave them with enough to fill their stomachs.

Of all the godforsaken buildings that I traipsed through over those months of our reporting—often with photographer Kris Wentz-Graf in tow

It wasn’t enough to just tell sad stories of people who’d been injured in some way. You had to follow the money, reveal conflicts of interest, expose the culprits, and hold them to account.

I sent an email to all my siblings and Holmer’s wife’s children, telling them what had happened and how unacceptable this was. We need a game plan, I said. Clearly, these people do not know how to manage their money. What if we came up with a budget for them and between all of us kids, we could cover whatever else they needed. Who’s in? A few of my siblings were on board, but I never heard back from any of Holmer’s wife’s children. Three weeks later, Holmer and his wife paid Jake back the money they owed him.

The pregnant woman’s guardian had asked that the patient be put on birth control injections when she was admitted the previous July, but for some reason the hospital staff did not do that. The guardian was furious about how the hospital had botched her client’s case. The attack happened that same day that the woman was admitted, but she was not given a pregnancy test for nearly two months. Even then, the guardian was not told of the pregnancy for several more weeks, so abortion was no longer an option. All the while, hospital staff continued to give the woman three highly potent antipsychotics a day, medication that might have harmed her developing fetus.

The director said he and his staff consciously decided to house men and women on the same ward, even knowing the risks to the female patients. Sexual assaults in mixed-gender wards, he said, were a “trade-off” for more violent assaults that would happen in all-male psychiatric units. The idea of a sexual assault as an acceptable trade-off was too much for people to bear. The director was fired the day after our story appeared.

Complicating matters, Wisconsin’s law requires a police officer—not a doctor—to initiate emergency mental health care even if the patient is willing to be treated. Police are not mental health care providers, nor do they want to be. Some underestimate the danger; others are too quick to reach for the handcuffs and taser guns.

Data I got from open records requests showed that one of every three people who were brought to the psychiatric hospital for emergency care were released and returned within ninety days.

I was now learning, making life better for people with serious mental illness is not as simple as shaming others into providing housing, more doctors, better medications. If the change is going to be real and sustained, you can’t just badger people into being better, more loving and accepting. You have to find a way to get them to see those who suffer as their brothers and sisters in need of our embrace, not strangers to be shunned. It’s what Danny was trying to tell me in the letter he sent me the week before he died. Only love and understanding can conquer this disease.

As with Holmer’s ashes and the family pictures that had been schlepped to the rummage sale years earlier, the crude disposal of my mother’s family belongings felt like another kick in the gut, like the things we valued were little more than garbage.

The immortal words of Marion G. Harmon kept ringing in my ears as I set out to investigate our family’s story: “Everything happens for a reason. Sometimes, the reason is that you’re stupid and make bad decisions.”

Our goal was for me to not become overwhelmed by any of my usual reactions: sadness, anger, fear, regret, and—God help me—more shame. I’d been taking emotional shortcuts for more than a half century—steam-cleaning, beer drinking, and smart-assing my way through one trauma after another. But I was learning that you can’t fast-forward through grief or read a CliffsNotes version of your life and expect to make peace with it. As I revisited old memories, I allowed my new feelings to surface and hang around long enough to acknowledge and try to reconcile.

Nancy, despite having tried to kill herself less than three hours earlier, was now being supervised by a child not old enough to babysit by Illinois law.

Such a seemingly reckless decision should not be considered in a vacuum. The empty vodka bottles that my mother stashed in the back of her closet in the year after Nancy died are testimony to how guilty she must have felt about leaving that day. I couldn’t judge her any harsher than she’d already judged herself. If I was going to move on, I’d need to find a way to forgive my mother, just as she had forgiven me for my many faults and misdeeds over the years. She was so much more than this one tragic decision.

Secrets can strangle relationships.

I remembered what a cheerleader he had been for me and for all of us. Whenever one of us stumbled—a lost job, a kid in trouble at school, a fizzled romance—Holmer would call to recite his favorite saying: It’s okay to be disappointed, but don’t get discouraged.

The more time I took to consider the trauma we had all been through, the easier I understood that two seemingly contradictory truths can exist simultaneously. My parents could be warm and loving but also reckless and flawed. Our family life could have been happy despite the tragedies. People are a lot more complicated and nuanced than I had given them credit for.

How differently would Danny’s life have turned out if he had just admitted to doing this stupid, cruel act when he was eighteen years old, asked for forgiveness, and accepted his punishment? Instead, he spent years trying to cover it up or make increasingly thin excuses for it. Danny’s inability to reconcile with his past had stunted his emotional growth and robbed him of any chance to be happy. He’d lost everything he had—his job, a few romances, his ability to live independently, even his best childhood friends.

“We didn’t do much therapy in those days,” she said. “We just gave the patients lots of medication and let them sleep. You’d be surprised by how often that’s all they needed.”

Then she asked me if I knew the joke about the difference between mental patients and psychiatrists. (Answer: The doctors have the keys.)

When someone dies suddenly, especially if it’s by suicide, you don’t get to grieve them in the same way that you do for someone who’s lived a full life or battled a long illness. You might strain to recall an amusing anecdote or two, but to assuage the guilt or dull the shock, you constantly remind yourself how sick they were and that they are much better off now that they are dead.

You can’t find peace without properly grieving, and we—or at least I—had not allowed ourselves to sit with our sadness, to acknowledge the sorrow of these two beautiful people dying so young.

I’d always considered my family to be joyful and fun to be around, despite our tragedies. Now, here was validation.

For a family once scattered and torn apart by mental illness, we’ve grown quite tribal, very protective. We’re back piling on top of each other in a virtual game of Teddy Bear, our old playroom family classic.

Several years ago, we got excited about the research into the MTHFR gene mutation (which we called the “Motherfucker gene”) associated with depression and anxiety. A few of us have been tested and found to have the mutation. But this is far from an explanation of how or even if the gene causes mental illness. It certainly does not offer a cure.

When family gets involved in the treatment, the patient is more likely to have a better mood, a richer quality of life, enhanced work performance, and reduced substance use.

I asked each of them what advice they would offer families that have lost someone to suicide. They all stressed the need for counseling. “Try for family therapy, but if you get resistance, get help for yourself,” Mary Kay said.

Jake warned that it might take a while for therapy or self-help groups to work. “Go even if they don’t make you feel better at first,” Jake said. “Give them a chance to work.” Ever the practical thinker, Jake added this shiny pearl of wisdom: “Have a good picture of the person who died.”

avoidance “only works for so long.” Ultimately, she turned to therapy to help understand her feelings about what went on in our house “and I am still working through it.” She reminded people who have been through the suicide of someone they love to remember that it is not your fault. “Keep taking care of yourself and speak frankly about it.”

“The less stigma there is in talking about it, the healthier we will be,”

Everyone agreed that living with someone in the throes of severe mental illness is difficult. Billy advised being as patient and understanding as possible but warned, “Mental illness can be mean and ugly.” Walk away when it gets too rough, if you can. “Don’t allow the person to abuse you,” he said. “You just have to play zone defense and contain it” as best as you are able. Having a sense of humor is helpful, too, Billy said. “Not to be flippant or dismissive...

Find a way to carve out some place where you can be at peace, Molly said. She has relied heavily on ...