Verified by 
Key points
- Good parenting cannot prevent serious mental illnesses like mood disorders, substance use disorders, and schizophrenia.
- Guilt and shame prevent many parents from advocating for better services for their kids.
- Families affected by serious mental illness can help others by sharing their story, if they're comfortable doing so.
Do you want to know the big secret about serious mental illness, the number one thing that most parenting “experts” and “gurus” won’t tell you? Are you ready? Here you go: It can happen to anyone.
The most patient, present, organized, and authoritative parent in the world cannot prevent illnesses like depression, bipolar disorder, schizophrenia, eating disorders, or anxiety from taking hold of their child. Next time you read about a young person experiencing delusions, attempting suicide, or being committed involuntarily to a psychiatric treatment facility, I don’t want you to think, that would never happen to my kid. I want you to think, there but for the grace of God go I.
I don’t write that to scare you, though the fact of it is terrifying. I write it because there are legions of experts who promise that if you follow their program, buy their book, or pay for their advice, then your child will grow up to be hardworking, empathetic, intelligent, thin, and especially, especially, especially not mentally ill.
I understand how seductive these claims are, but they are 99 percent fiction. Though there is exciting research suggesting that preventing some major mental illnesses may be possible, these solutions are mostly not in the realm of individual parenting approaches. Promising strategies include reducing fetal exposure to environmental toxins, drugs, and alcohol during pregnancy; preventing obstetric complications and premature birth; addressing the factors that lead to child abuse and neglect; ensuring that young children who experience anxiety and social skill deficits receive timely evidence-based intervention; and implementing legal policies that keep addictive and mind-altering substances away from developing brains.
I can’t control my children’s personalities or whether they experience mental illness, and neither can you. That may be upsetting to contemplate. But the opposing belief—the theory that you can and should prevent mental illness in your children—is impossible and leads to unnecessary judgment and pain.
It’s particularly hurtful to the parents who attend my Tuesday night support group. Each of these attendees has an adolescent or young adult child with a psychotic disorder. They are mostly pleasant, normal people—no different from you and me, other than that they have crossed the Rubicon into the “mental health system,” which is for the most part a non-system of emergency rooms, hospital psychiatric units, day programs, outpatient treatment, psychiatric medications, and taking it one day at a time. They didn’t cause their children to experience major mental illness, and they didn’t fail to prevent it.
I have worked in the “mental health system” in various capacities for eighteen years, but I can’t really defend it. At one point, my office telephone number forwarded to my cell phone, so even when I was driving my kids to school or shopping for groceries, I got a lot of random calls from people dialing desperately through a long list of numbers.
They were usually shocked if I picked up, and would say something like “You’re the eleventh person I’ve called today! My nephew is pacing around and mumbling to himself. Last time he acted like that he tried to kill himself four days later! Can you help him? Just so you know, I’m not rich. No one will answer my messages. The last psychiatrist apparently quit her job four months ago, and we didn’t realize until his prescription ran out.”
Unfortunately, my answer to most of these people was that I couldn’t help much; my own clinic time and caseload are limited so that I can write, supervise trainees, and conduct research. I would try to listen, offer a reflection or two (“you’ve been through a lot” or “I can hear how stressful this process has been”), and recommend a person or clinic that might be able to provide what they are seeking.
I admit, though, I was often shaken by these fleeting contacts. In their randomness, they suggested that for everyone who dials my line, there were dozens, hundreds, or thousands more with similar circumstances.
I know that my writing risks scaring the uninitiated. I understand the importance of reducing the stigma associated with mental health treatment.
Let me assure you that my colleagues are wonderful, smart, altruistic people who are doing their best. We have effective interventions for many conditions, and even scary-sounding treatments like electroconvulsive therapy and antipsychotic medications are usually delivered with compassion, competence, and precision.
Researchers are constantly pursuing innovations to improve the outcomes of both biomedical and psychological therapies. This is very exciting. But sugarcoating the basic situation on the ground, which is that regular people often cannot find acceptable or timely psychiatric treatment, serves no one.
If I am describing a situation that is familiar to you, I encourage you to make some noise about it. Hopefully, I’ve made a compelling argument that your child’s struggles are not your fault, and you have nothing to be ashamed of.
Cancer used to carry such a stigma that doctors often withheld the diagnosis from their patients, and families never uttered the word aloud. Now entire sports leagues wear pink shoes in homage to Breast Cancer Awareness Month. It took brave human beings telling their own stories to create that change in our culture.
Mental illness can happen in any family; perhaps you've read this far because it's impacted yours. Consider sharing your story about the hurdles you faced when trying to get care for your family member with your friends, your insurance company, and your representatives at every level of government. Of course, you must consider your loved one’s privacy; ask them what aspects of their experiences you can reveal. But you shouldn’t be afraid to say what you know, which is that your family deserves better.
Excerpted from The School of Hard Talks: How to Have Real Conversations with Your (Almost Grown) Kids by permission of Sasquatch Books, an imprint of Penguin Random House.
