The famed Berkeley sociologist Erving Goffman coined the term courtesy stigma to signify society’s strong tendency to degrade anyone associated with a stigmatized individual or group. Sardonically, Goffman contended that if society rebukes and stigmatizes a certain class of people, it’s only common courtesy to denigrate those individuals affiliated with that group. Think of the relative of a leper—or someone, in the eighteenth or early nineteenth century, who aided a slave in the South. Such people were total outcasts in the mainstream societies of their day. Currently, family members of those with serious mental disorder bear the huge brunt of courtesy stigma: How much closer can you get than being related to someone carrying that kind of taint?
Even more, throughout much of the twentieth century the professions of psychology and psychiatry directly blamed family members, especially parents, for causing mental illness in their offspring. Autism was linked to “refrigerator” parents who provided no emotional bonding; schizophrenia resulted from “schizophrenegenic mothers,” whose hostile and dependency-promoting styles drove their children to madness. Spouses, siblings, and offspring were part of the ongoing curse. Any consideration of biological vulnerability—including the clear findings that genetic risk is formidable for conditions like schizophrenia, bipolar illness, attention deficit hyperactivity disorder (ADHD), and autism—was discounted.
Regarding courtesy stigma, families encounter considerable objective burden linked to their relative’s mental illness, including time taken off work and expenses for obtaining help, which all too often promote economic deprivation and major stress. Yet families also describe, quite vividly, what’s called subjective burden, linked to the shame and humiliation about the entire issue, including heroic efforts to keep things secret. As costly as objective burden can be, most families report that subjective burden—the discomfort and anxiety over admitting the very presence of family mental illness—takes a far larger toll.
As the wife of a man who periodically went mad back in the silent 1950s, Mom lived each day in the deep chasm of courtesy stigma. The psychiatric profession didn’t listen to her or value her insights in the least, and family support was completely off the radar of available mental health interventions. Rightfully, Mom felt that if anyone came to know the truth, our family would be shunned for carrying a “moral flaw,” the ultimate in unfitness. Any social standing we had would have evaporated.
Courtesy stigma isn’t just for relatives. Think of the entire mental health profession, including psychologists, psychiatrists, and social workers—those individuals entrusted with the care of people with mental disorders—along with scientists who investigate causes and treatments. Bluntly, the unspoken view is that all such individuals spend their lives dealing with crazy people. In fact, people working in mental health fields encounter low status and even ridicule. Clinical psychologists are at the bottom of the totem pole of status among other psychologists; psychiatry is widely known to be an undesirable residency following medical school. Funding levels for mental health remain lower than those for physical disorders—that is, “real” illnesses. Stigma, self-stigma, and courtesy stigma fuel a crippling vicious cycle of defeat and despair, with shattering consequences for everyone touched by mental illness.
*
In a sudden burst, I grew several inches in seventh grade. First base was an increasingly good position in baseball, as I could reach off-target throws from the infielders. During the late spring we had a doubleheader on a bright Saturday morning. Sally was at a friend’s; Mom and Dad brought lawn chairs to watch. By noon, the heat was rising up in waves from the dusty infield. Even with my cap pulled tight around my head, I had to squint. Jogging in between innings, I stopped, blinked, and saw it in front of my eyes: A pinpoint of light, turning into a zigzag and then a lightning bolt blocking the right half of the sky. Fast-orbiting lights, bright as a thousand flashbulbs, pulsed outside my eyeballs. I reached up to cover my eyes.
“Steve, what’s the matter?” Mom said, rushing over.
“I can’t see anything,” I said back, fighting panic. “How can I make it stop?”
Dad told my coach I was sick and went for the car. Half of my vision was now covered by a yellow-gold blizzard. During the drive home the lights mysteriously faded, but the pain soon started on the other side of my head, deep in the temple, like the tip of a sword piercing my skull. If I moved a millimeter, the throbbing got worse.
Mystified and half paralyzed, I limped to bed. When Mom came in, her whisper sounded like a cannon shot. The trickles of light at the edges of my nightshade looked as bright as stadium lights. A few hours later, I rose up despite the crushing pain, feeling as though I’d swallowed a gallon of bilge. I barely made it to the bathroom. Retching over the toilet, I threw up explosively—juice, water, bile, who knows what. Panting, I sat on the floor tiles. Getting up to a wobbly standing position, I flushed the toilet, lightly brushed my teeth, and noted that the pain in my left temple had let up slightly. I slowly hoisted myself back into bed.
Sometime during the night I woke up from a deep sleep, parched. Walking gingerly to the bathroom, hardly believing I felt almost normal again, I dared drink only a few sips of water before going back to bed. The next thing I knew it was morning, the air radiant. Famished, I went downstairs, the poison inside me somehow purged. Food hadn’t tasted that good in months. It was as though I lived in two universes, one full of inexplicable pain and the other an exalted reprieve. Dad said I’d undoubtedly had my first migraine, just like he used to get as a teen. Just like Virgil Sr. and all the boys in the Hinshaw family. Just like Sally, about to begin hers. I was now linked to my relatives by pain.
*
After dinner, the whole family sometimes talked about Mom’s and Dad’s past lives. “How did you meet?” Sally and I asked them when we were pre-teens.
“On a blind date,” Mom answered. We didn’t yet know the term. Did you pretend to be blind? “It’s when two people who don’t know each other meet for the first time,” Mom replied patiently. “Friends of mine at OSU knew Dad, who was teaching in philosophy, and wanted the two of us to get together. We ended up falling in love.”
We peered at the wedding photo album, dated June 12, 1950. It was hard to believe that Mom looked so formal in her white gown. Dad seemed impossibly young in his tuxedo. Mom explained that they drove out West for their honeymoon, ending up in Pasadena. It was her first auto trip across the nation. Years later, in a private conversation when I was grown, she elaborated on meeting the five brothers and their families. “It was incredible,” she said. “As soon as they’d sat down for a meal, they talked over one another at the dining room table, vying for position, trying to one-up the rest. Virgil Sr. and Nettella glowed over their brood. Who knew the most about world events, politics, history, science? We wives could hardly get a word in edgewise.” Such a competitive male bastion—bonded by religion and academics—fueled Dad’s intellectual fires.
During the family discussion, Mom added: “We made another trip in 1952 when I was first pregnant with you, Steve, seeing all the California relatives again.”
“But there was a tragedy,” Dad continued. The first night of their drive up the coast to San Francisco, a message awaited them at the front desk of their hotel. Dad’s father had been in a car accident outside Bakersfield. Given his age of 76, he’d employed a driver. Yet a drunk driver had come across the road and hit the back of the car, killing my grandfather instantly. Sally and I were silent.
“We got in the car and drove through the mountains,” Dad continued. “I had to identify the body.” I pictured Dad at the coroner’s office, exhausted and grim. Familiar with irony by now, I couldn’t believe how my Prohibitionist grandfather had died.
That fall, following their honeymoon—and following the loss of his father—Dad escalated into mania, the first time Mom encountered an episode. He wasn’t hospitalized when I was born, Mom told me later, but it was a close call.
Sally and I asked what it
was like when we were little. “You were so adorable,” Mom said. “All those bottles, boiling in the kitchen back on Wyandotte Road. But it was worth every minute.” Looking at photos, I saw one of me, a baby in the arms of my strong, shirtless Dad, squinting in the bright sunlight. Little did I know that Dad was floridly psychotic a few months later, as Mom’s pregnancy with Sally was coming to a close, requiring hospitalization out in California during a severe bout when she was born in February of 1954.
Mom gave birth to both Sally and me essentially alone.
“Here’s something you used to do when you were small,” Dad said. “You liked to pull my books off the shelves. Your favorite was my leather-bound dictionary, with embossed pages, a gift from my father. You would grab a page and just rip it out, a huge smile on your face. You loved the feel of those thin onionskin pages.”
I remembered that dictionary. When closed, the edges of its pages displayed a light gold tint between the covers. But had I really been that destructive as a toddler? Dad said he’d been tempted to punish me but realized that this was my way of exploring books. Because any punishment might thwart my desire to read, he took the book from my hands and placed it out of reach.
“Never,” he repeated, “did I wish to diminish your love of books.”
What if Dad had been manic or seriously depressed during such times? Would he have been outraged and screamed at me? Instead, while in his normal state—the “euthymic” period in between manias and depressions, as it’s formally called—he favored me with his patience and forbearance. What predicts when a person with bipolar disorder flies into mania or sinks into depression? Despite decades of research, it’s extremely hard to gauge. There’s a major genetic vulnerability to bipolar illness, but life stresses can trigger particular episodes. Patterns are specific to each individual. That Dad was in his right mind much of the time undoubtedly saved the family. But the stark contrast between his moods silently colored every interaction in our home.
*
Girls were on my mind like never before. Back in fourth grade, I stared at blond-haired Mary Ann, feeling strange sensations all through my body. Now in junior high school I felt that way just about every day. Would I ever feel connected with a girl and tell her about my feelings, if I could only figure them out myself? The mixture of longing and fear was overpowering.
On Saturday afternoons in the winter, I wandered through the shopping mall amid the freezing air, cars searching for spaces amidst piles of slush, the sky darkening by late afternoon. I was searching for a ring that I might give to some girl, if only I might get up the nerve. Inside a store, displays held jade-like rings that caught my eye. But when the saleslady asked if I wanted to see one, I looked away, my face scarlet. My longing stayed locked inside. What would I say to any girl about who I really was?
In fact, I was saying as little as possible to myself. Staying busy, striving for success in school and sports, and keeping my focus removed the temptation to actually feel. It was far better, I calculated, to keep things in.
When I was in eighth grade, one evening Dad and I sat down in the kitchen to watch The CBS Evening News with Walter Cronkite. Dad often had a bourbon and Coke or some other drink during pre-dinner hours. “It’s the common man’s religious experience,” he would say of his cocktail, though I’d never seen him drink more than two. What insights did the alcohol provide him?
Watching the news was a highlight of Dad’s day. He loved Cronkite. One of the lead stories that night was about a recent increase in gasoline prices throughout the country, a couple of cents per gallon. But Dad glared at the set like a cobra ready to pounce, a strange gleam in his eyes.
“It’s outrageous!” he snarled at the screen.
“What is?” I asked, hoping he’d bring it down a notch.
“Those prices are criminal,” he retorted. “Riots have broken out over far less than this. Class warfare won’t be far behind!” He was incensed, his moral outrage palpable. “History will prove me right,” he continued, holding a menacing edge in his voice.
Come on, I told him, but only in my mind: We aren’t heading toward a class war over an issue as trivial as this. For a moment, I felt older and more mature than my own dad. I was actually embarrassed by him. At least no friends of mine were over, I thought with relief. What would they make of a father so silly, immature, and overemotional?
Should I say something? But the edge in his look, as he stared down the television monitor, warned me to hold my tongue. I murmured something about how the price increase wasn’t all that much but he was utterly dismissive. His tone of assured superiority gripped me like an alien force.
During a rare glimpse, like this one, into my father’s early signs of mania, the biggest shock was the contrast with his usual demeanor and tone. I flashed on the scene at the Willard seven years before but quickly shut it out. During the next commercial, I made an excuse to leave. At school, I started bearing down even harder. Some days the pencil lead nearly snapped underneath my fingertips.
The fog of forgetting has blotted out my recall of how far he escalated after that scene. By that time, it’s conceivable that his doctors had increased the dosage of Mellaril—a newer cousin of Thorazine, an antipsychotic medication that can reduce delusional thinking and paranoia—and kept him home. Remember, I was a collaborator: I actively sought to block out key memories.
A year later, all of us were in the living room, reading magazines or various parts of the Sunday paper. The phone rang and Mom got up to answer in the kitchen. As she talked her voice rose and fell but I couldn’t make out any specific words. She hurried back in and told Dad, with a concerned look, that his brother Bob was on the line from California. Dad walked quickly into his study, closed the sliding door, and didn’t emerge for half an hour. Finally, he padded slowly back. With a slumped posture, he started to speak, then paused. Finally, he cleared his throat.
“Well, that was quite a long conversation with my dear brother Bob. There is troubling news. As you know, his work is as a psychiatrist, sitting all day and talking with patients. With this sedentary life, one of his legs began hurting. Gangrene soon set in.” Dad concluded by saying that Bob needed to have his leg amputated to save his life.
Mom’s eyes were wide, Sally’s too. Amputated? A vague suspicion descended over my shoulders. An amputation caused by too much sitting? As hyper-rational as Dad sounded about his talk with Uncle Bob, I couldn’t quite believe what I’d heard.
Or perhaps I could. I’d learned to accept what was placed in front of me. Questioning things, inviting in the unknown, seemed far too risky. A few weeks later Dad said that Bob had received his artificial leg, which seemed to be working fine. I was relieved. But that initial morning, I witnessed the erection of barricades, a wall against the truth. What else was hidden?
When I was still in junior high, Dad started talking with me about history. It was sure to be another lesson. “Do you ever think,” he asked me, “that full understanding of a person’s life history would reveal the underlying reasons for his behavior?” He continued. “Take Hitler. If we knew his full past, would we understand his actions?” Finishing his thought, he wondered specifically: “Is to know all to forgive all?”
I nodded halfheartedly, but my gut reaction was that this was way too soft. How could pure evil be forgiven if we simply knew the person’s past? But the bigger question was why Dad was so possessed by good and bad. His obsession with Hitler was complete. He recounted that a million people at once, completely captivated, would stand in the plazas of German cities, listening to Hitler’s speeches. Watching TV documentaries together, Dad and I stared at the Führer’s animated gestures as he harangued the throngs. A nation idolized him, but repression, purges, war, and unfathomable extermination were close behind. Dad couldn’t seem to get these images out of his mind. At that point in my life, I had no idea how far his obsession had taken him when he was 16.
On a frigid night before Christmas, Dad and I drove to deliver g
ifts to a family who’d done housework for us years earlier, an African American family on the other side of Columbus. Shivering, we rang their doorbell. After inviting us in to their overheated apartment, they seemed incredibly grateful that we’d come by. The interchange was warm and upbeat. But I felt sick with shame over how much I took for granted every day.
Driving home, as the heater blasted in the front seat while streetlights provided an amber tint to the ice-covered streets, Dad began speaking.
“Steve, we must discuss civil rights and the history of oppression in this country. Black people have been denied fundamental rights for far too long.” He brought up Gandhi, Martin Luther King, and separate drinking fountains and lunch counters in the South. As the bitter wind blew outside the frosted windows, I lamented how little I ever really thought about oppression. Yet if Dad was so attuned to these issues, why didn’t he seem to do much about them? Much of his life took place while sitting in his study, everything filtered through his mind. There was no mistaking his passion, but where was his action?
And where was mine? What was it that held me down and locked me in? Pure and simple, it was fear. But at that point, I didn’t know what I was afraid of.
*
I first heard the sound through our screen doors on a mid-August morning, three weeks before I was to start high school as a tenth grader. In a rhythmic chant, a hundred voices in the distance barked out hoarsely: “One-two-three-four; one-two-three-four.” At first puzzled, I quickly placed it: The football team had started their initial morning of two-a-day practices, counting off for calisthenics. I walked outside to gaze through a crack in the wooden fence bordering our back yard. Across the street the entire squad was arrayed on the fields, wearing white practice uniforms with gold helmets.
Another Kind of Madness Page 11