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When Mental Illness is a Family Affair: Q&A with Victoria Costello

In A Lethal Inheritance: A Mother Discovers the Science Behind Three Generations of Mental Illness, science journalist Victoria Costello weaves the stories of her family’s mental illness with significant studies on genetics, early intervention and evidence-based treatment.

When Costello’s oldest son is diagnosed with paranoid schizophrenia, she traces her family’s history of mental illness and makes some surprising discoveries — such as her grandfather’s well-guarded suicide.

A Lethal Inheritance is a must-read for anyone who’s been touched by mental illness, especially parents who feel helpless and hopeless. Costello shatters the myth that mental illness is a death sentence, along with countless other misconceptions.

She also recounts how she and her sons coped with their mental illness and achieved full recovery. And she does an excellent job of simplifying complex concepts and informing readers of the newest research.

In the book, Costello shares three powerful lessons she’s learned “on [her] journey through mental illness.” First, she admits to doing things in the wrong order, such as not seeking treatment for her own depression. She writes, “If we, as parents, get treatment for our own psychological or addiction issues, our children will suffer far fewer mental illness.”

Second, she learns that it’s important to intervene early with mental illness rather than “picking up the pieces later.” And third, she learns that “…although we’re each born with inherited liabilities and assets, throughout our lives, our minds become largely what we make of them. Put simply, nurture can trump nature.

Below, Costello reveals other lessons as she explains what inspired her to write A Lethal Inheritance, the signs of mental illness caregivers should watch out for, how mental illness can be prevented and much more.

Check out Costello’s website for more information on A Lethal Inheritance.

Q: What inspired you to write A Lethal Inheritance?

A: The initial inspiration for writing this book came in 1998 when my then 18-year-old son Alex had a psychotic break, along with his subsequent treatment and recovery from a diagnosis of paranoid schizophrenia.

Facing Alex’s crisis forced me to take a hard look at my own lifelong, untreated depression. It spurred me to dig into my family history where I found a trail of hidden mental disorders and addictions.

Dealing with all of this became a decade-long journey: beginning in the psych emergency room with Alex and concluding with a trip to my father’s ancestral family farm in Western Ireland where I made emotional peace with this family legacy.

Over the course of this decade, I used research skills I’d acquired in my work as a journalist to explore the science of mental illness. Since many things I learned helped me and my sons personally find our way to recovery, I felt I had to share this information with others.

In the end, our family’s experiences served as a case study to help readers understand that mental health problems such as ours are common, and, most importantly, treatable and preventable.

Q: In your book you mention the early signs of mental illness that you missed in your son Alex. Even as a baby, you write that he seemed different. What signs can parents watch for?

A: Some of the early signs resemble those linked to autism, for which parents are already told to monitor their toddlers and preschool children. Newer research is now establishing the existence of signals that can indicate a higher risk for schizophrenia — particularly if the child also has a family history of a psychotic illness such as schizophrenia and some types of bipolar disorder or suicide.

Some developmental signs include sitting, walking and talking later. The child may also have a preference for solitary play at 4 — usually a very sociable age — something that was very true of Alex.

In an older child, social withdrawal, anxiety, antisocial behavior and acts of self-harm are also associated with a higher risk.

There are also risk factors for schizophrenia in genetically vulnerable children over which parents can have at least some control, such as maternal malnutrition and depression; bullying and child maltreatment; and cannabis smoking by adolescents. No one or two of these signs should be seen as red flags. Only in combination do they merit parental concern.

Q: You talk about the importance of knowing your family’s mental health history. Why is this so critical?

A: Even after I started putting the personal and the scientific pieces of this story together, I didn’t initially have the intention of going back three generations and looking deeply into my family mental health history. In fact, I resisted it.

Like most people I thought of our family’s troubled past—so much depression and alcoholism, my sister’s drug use, and at least one likely suicide by a grandfather that had always been represented as a tragic accident—as “dirty laundry,” better left covered up.

However, when I looked at the connections researchers were finding between different mental disorders and addictions that appear in successive generations of families like mine—and then took into account my depression and the depression and anxiety disorder that arose in my youngest son—I found patterns that helped me understand why we were are such high risk for these disorders.

I could also see that we were an example of the finding that as these disorders remain untreated in families, they grow more severe with each passing generation. I knew this type of information could help other parents know their children’s risks and possibly even avert these disorders before they took hold.

Q: The individuals in your family who also struggled with mental illness were called “weak” or “no good.” Unfortunately, even though there’s more information and education today, our society still tends to think the same way. Why do you think there’s so much stigma surrounding mental illness?

A: There are many reasons why stigma is still so strong. One is the outmoded belief that a diagnosis of schizophrenia is akin to a “death sentence.” This refusal to see that many people with a severe mental disorder can reach sustained recovery, along with the parallel reality that those with initial symptoms can be treated so they don’t have to progress to a full-blown state, seems intransigent within society and, sadly, even in psychiatry.

I’ve come to think that one of the better ways out of this stuck place we seem to find ourselves in is for us all to recognize that mental illness exists along a spectrum of severity, and, on the less severe end of the spectrum, mental illness is actually a nearly universal experience.

Only when symptoms such as paranoia or social withdrawal begin to make a person’s life unworkable would they need mental health treatment. In this model, perhaps, we could begin to deal with cognitive or emotional disturbances as we do a “physical illness”—encouraging people to get treated as soon as symptoms develop and not wait until after the disease has had months or years to reshape their brains and behavior for the worse.

Q: You write that in many cases mental illness can be prevented. How so?

A: To prevent mental illness you must know your genetic risks for a particular disorder based on your unique family history. If you know there’s a history of depression, or bipolar disorder, you can look for early symptoms connected with those disorders.

For example, ADHD appears more often in offspring of parents and grandparents with bipolar. With that history you might look at a child’s attention problems or signs of hyperactivity differently. If they continue or grow worse, you would consider intervention. Initially, that might mean targeted parent education to show you how to step in and calm a hyper or irritated child, or both of you might go for parent-child interaction therapy.

Prevention, with or without a family history, also means taking concerted “neuroprotective” actions such as consciously building family emotional resilience by doing more talking and playing together, honoring differences of temperament and interests in your children, and building true self-esteem by rewarding their efforts over performance.

Q: Anything else you’d like readers to know about your book or mental illness in general?  

A Lethal Inheritance: A Mother Discovers the Science Behind Three Generations of Mental IllnessA: After Alex received a diagnosis of schizophrenia at age 18, I was given the message by his doctors that Alex’s prognosis was bleak; his life would now be about symptom management and repeated hospitalizations.

Being the stubborn type, I refused to accept it. Now there has been a decade-long track record showing the positive results of early interventions such as Alex received. Had we waited the conventional six months or more for his symptoms to take hold, I don’t think Alex would have recovered as fully as he fortunately has today.

In order for others like him to have this option, I think parents should get informed about issues such as the pending revisions of the DSM-5 that would allow and encourage early treatment of conditions such as psychosis, ADHD, bipolar disorder—not to start kids or teenagers on medication, but to begin a therapeutic process that acknowledges the suffering that young people are experiencing and parents are seeing, and allows for the right treatment choices for that individual and family to be available just as they would for any other illness.


In addition to being an Emmy Award-winning science writer, Victoria Costello also is a board member of the MHA of San Francisco. She speaks to parents and mental health providers about preventing mental illness in at-risk families, and resources for achieving mental wellness. Costello writes about the latest research on child and adolescent mental health at her excellent blog

When Mental Illness is a Family Affair: Q&A with Victoria Costello

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Margarita Tartakovsky, M.S.

Margarita Tartakovsky, M.S. is an Associate Editor and regular contributor at Psych Central. Her Master's degree is in clinical psychology from Texas A&M University. In addition to writing about mental disorders, she blogs regularly about body and self-image issues on her Psych Central blog, Weightless.

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APA Reference
Tartakovsky, M. (2018). When Mental Illness is a Family Affair: Q&A with Victoria Costello. Psych Central. Retrieved on October 27, 2020, from
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Last updated: 8 Jul 2018 (Originally: 1 Mar 2012)
Last reviewed: By a member of our scientific advisory board on 8 Jul 2018
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