If you’ve had a close family member diagnosed with a serious physical or mental condition, you may be concerned that you will suffer the same condition, that you “have the gene”.
James Longman, chief international correspondent at TV channel ABC News, was so intent on finding out his own health “heritability” that he applied for access to his deceased father’s medical records and spoke to his old friends, doctors and National Health Service (NHS) caretakers.
In The Inherited Mind, Longman tells how he learnt as a nine-year-old at boarding school that his father had died. He had been diagnosed with schizophrenia and had been receiving treatment under the NHS for many years. Longman only learnt in his teens that his father had taken his own life. A painter, he had set fire to his London flat and leapt through the window.
Longman relates how his mother had troubles of her own, battling alcoholism and anxiety. She burdens her son with some of her concerns and he grows up hearing about her fear that he may have inherited his father’s mental health issues. “‘You mustn’t end up like your father, darling,’ was repeated at every available opportunity,” he says. “She was obsessed with making sure I turned out like her and escaped whatever inevitable darkness was creeping in from the other side of the family.”
It’s only when he has an intense depressive episode of his own, and finds himself sitting on a pavement contemplating walking into the traffic, that he begins to think seriously about whether and in what ways his father’s condition and life experiences may have affected him. “Was this chaos instilled in me as a child or does it go further back?” he wonders.
Compounding the situation is that he knows his paternal grandfather also committed suicide, shooting himself in his shed. Longman’s father had told him that his father had timed it so that his wife would be out and his son would find him. So, for this family, the trauma runs deep.
With the journalist’s nose for what makes a good story, Longman proposed a programme to the BBC about the heritability of mental illness. He finds making the film cathartic and liberating in some ways, and it gives him a clearer picture of his father.
Long conversation
For this book he does wide-ranging research on the effects of genetics on mental illness. Perhaps due to his training as a journalist but also an innate writing talent, Longman tells the story in a relatable and engaging way. A strength of the telling is that he admits he has limits when it comes to science, so he has to break down the research and make it understandable. This makes it understandable for readers who may not be up on science and especially genetics. It’s his journey ultimately but as a reader you feel included as he looks at all the angles and issues around “the inherited mind”.
Longman believes that GPs don’t ask their patients enough about their family history of mental health. He acknowledges the misunderstandings around conditions such as schizophrenia, bipolar disorder and clinical depression, and sets about clearing up some of the confusion that can lead to prejudice and a lack of care for sufferers. The book becomes a long conversation with the many actors in the mental health field, from research to treatment.
A large focus is genetics, so he applies to the NHS for his father’s medical records. As someone living in SA, where many people are treated privately and state resources are patchy, I found it amazing that he was then presented with 140 pages of meticulous records and notes. In his father’s psychiatric history going back to the 1960s, he finds that he had been committed to psychiatric care in 1976 and received electroshock therapy.
Still, it must be unsettling to be confronted with information like this about a loved one and it’s testament to Longman’s courage and tenacity that he perseveres with his research. Passion and perhaps even a modicum of obsession would be needed to drive a project like this, and he does come across as obsessed in his quest to not leave any stone unturned in his effort to understand his father’s mental illness and to share that knowledge.
His father, as flawed as he was — he was not a hands-on dad either and lived separately soon after young James’s birth — is a hero figure for the writer, especially in comparison to his mother, who, he says “has a natural affinity for histrionics”. But one also has to sympathise with the mother, having to shoulder the responsibility of raising a child alone while also managing a partner with schizophrenia.
The book becomes something of a treatise on mental illness, exploring especially the conditions of schizophrenia, bipolar and depression and looking at the factors that surround them from both a nature and nurture perspective. Longman also provides many pictures of himself and all the protagonists, making this first and foremost a memoir but one that also contains important research on mental illness.
Looking at schizophrenia from the nature perspective, he says it was Jung who took the disease out of the mind and placed it in the body, as he was the first to understand it as a biological process and not simply a “thought illness”. The later work of research psychologist David Rosenthal with quadruplets at the US’s National Institute of Mental Health placed the aetiology of schizophrenia in the nurture zone, though not necessarily in the sense of a direct parent-to-child transmission. Rather, Rosenthal said the disease “wanders and meanders through families” but he was firm in that the condition could not be imposed on someone who was not genetically predisposed.
Genetic variants
In the middle parts of the book, Longman becomes so involved with the research around the genetic causes of mental illness that I had the feeling he was overemphasising it and ignoring or at least diminishing the well-known effects that environment has, and especially adverse childhood experiences. He visits the Centre for the Study of Genetic Mental Illness at Kings College London, and cites research that found that whereas depression was 40% heritable, schizophrenia and bipolar were more genetic, at between 70% and 80%.
As developments in genetic technology advance so does the work of researchers looking to identify the potential genetic variants that increase the risk of developing illness. Longman cites Prof Cathryn Lewis at Kings College London, who says that doctors have known for at least 20 years that there is a genetic component to depression, but only in the past four or five years have they been able to define which genetic variants — which “snips” — are common in people with mental illnesses.
However, “it’s clear that there is no single variant that has a major effect,” says Lewis, unlike Huntington’s disease, for example, or cystic fibrosis. “There is nothing like that in depression. You cannot say you have the gene for depression.” Instead, depression is a polygenetic disorder in that multiple genes are involved, leading Longman to wonder whether the variants that caused his father’s schizophrenia could be responsible for his own depression.
If it all sounds a bit fatalistic and contrived, he emphatically makes the point that “there is nothing uncontroversial about the study of genetics in relation to mental illness”. Dr John Read at the University of East London states that mental illness is more due to childhood trauma, and therefore psychotherapy is a preferable treatment to drugs. But Lewis outlined how genetics and environment interact, it is not one or the other.
More information about his father comes from Lizzie, his equally nonconformist girlfriend at art school. Her emails open up “a whole new world of understanding for me”, he writes. His father was something of a freethinking hippie.
Lizzie also gives him an insight into the possible influence of the intense meditation that was part of his life with the Transcendental Meditation movement “and how in trying to access his subconscious, he might have unleashed his genetic predisposition to schizophrenia”.
Another Liz, this time one of his father’s caretakers in the NHS, gives him further insights and reassures Longman that is father loved him and wanted to see him. And as much as John Longman was a trendy Notting Hill hippie he could also be withdrawn and prone to introspection.
Finally, Longman wonders whether his father’s illness was also precipitated by being pushed into roles he could not cope with, especially that of being a husband and father. It seems that in John Longman there was the perfect storm of a genetic predisposition to schizophrenia, adverse childhood experiences, and difficulties coping with the responsibilities of fatherhood. Sympathetically and intelligently explored in his son’s book, his dilemma can be instructive for us.
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