Well, this one has been chillin' on my TBR shelf for years now, waiting for its moment. I was really feeling a sort of narrative nonfiction, a la Patrick Radden Keefe (Empire of Pain, Rogues), and during a month in which I led quite a few Mental Health First Aid trainings with work, this felt like exactly the right mix of my current professional vibes and my reading mood. As always, I listened to the audiobook - my absolute preferred way to intake nonfiction works. 

 

From 1945 to 1965, Mimi and Don Galvin had no less than 12 children. By the mid 70s, six of them had been diagnosed with schizophrenia. In this book, Robert Kolker weaves together the story of the Galvin family, the history of mental health and mental illness care, and specifically the evolution of thought surrounding schizophrenia (causes, treatment, etc.) through the eyes of this family's experiences and their contributions to the National Institute of Mental Health's studies. 

 

This was truly a fascinating read. The research, both into the greater world of mental illness and into the Galvin family directly, through access to medical records and in conversation with members of the Galvin family and (close) friends, was clearly well detailed and thorough. It truly was in line with the works by Radden Keefe that I mentioned above, if slightly more narratively dense. Kolker really delved deeply into this family, and we got to see in so much detail and clarity the way that each child dealt with and responded to and came to terms with (or not) this childhood environment. And for each, we watched as questions of nature vs nurture were asked and played out, affecting not just their mental health as far as schizophrenia is concerned, but also more generally, with how they made choices for the rest of their lives too (both those diagnosed and those who were caregivers). As far as the industry aspects, the discourse around that same question of nature vs nurture in an academic/medical setting was so interesting to read, and felt more immediate when communicated alongside the Galvins' stories. I learned so much, and also had my heart broken over and over watching "money-making capacity" be the largest influence in the pharma (and sometimes overall medical) industry, as opposed to the benefit and betterment and care of patients as people. And even when the person, the patient, was centered, the best knowledge/efforts were often still not enough. 

 

On the whole, the one dynamic that I felt like was missing was a little more reflection on socioeconomic and racial aspects. How these same choices and situations faced by the Galvins might have/did look differently for those living with less privilege, *especially* considering how many laws and rules these boys broke growing up (and not just “basic” ones). I mean, I understand how much the diagnoses played a role in that behavior, but there is no way that interactions with law enforcement would have looked the same for BIPOC, queer or less socially connected people. With how deeply the rest of the medical knowledge and time period environment was considered, not having (really any) acknowledgement of privilege was noticeable. At the same time, I do want to say: what a necessary general indictment of mental health services, that even with all those intangible privileges, these sick people came into contact with law enforcement so often as their only contact with state “assistance” and response, when they really needed medical care (and don’t even get me started on what that “medical care” looked like when they finally got it). 

 

A final thought... I really appreciated the sensitive and understanding look at the human costs of all this on each family member - acknowledging that their choices were all the best ones they knew how to or were empowered to make - under the circumstances - for their own survival. There is a beautiful and equally necessary kindness and compassion and humane-ness in that method of "telling" this story, that not all (not even most) people dealing with or caring for those with mental illness get. What an engaging reading experience. 

 

“Life is merely the permanent roots your family knots around you.”