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by Stephen P. Hinshaw
Cambridge University Press, 2002
Review by Elizabeth Donaldson, Ph.D. on Jul 6th 2004

The Years of Silence are Past

The Years of Silence Are Past: My Father's Life with Bipolar Disorder opens with a disturbing episode.  As his two young children sleep, Virgil Hinshaw, a philosophy professor at Ohio State University, watches television with his wife.  When a female singer takes center stage, he is convinced that her lyrics are communicating important personal messages to him.  Although it is late at night, he decides to drive 100 miles to Columbus, Ohio, where the broadcast is based, in order to speak with her.  Fearing for the safety of her husband, imagining his arrest or death in a traffic accident, his frantic wife accompanies him.  They speed toward the broadcast studio, which is fortunately closed when they arrive.  Even though Virgil Hinshaw is becoming increasingly excited and agitated, his wife manages to convince him to return home.  When they return hours later, the worried mother looks in on her two unattended children: they are still safe and sleeping soundly, oblivious to the nightmarish domestic drama unfolding around them.

Stephen Hinshaw is one of those sleeping children, and this book is a way of recuperating these lost moments of his past and the hidden experience of his father's illness.  This particular incident occurred when Hinshaw was only three and a half, yet it is emblematic of much of his childhood and adolescence.  His father repeatedly disappears and returns: his family rarely talks about where he has gone or why.

These "years of silence" end (more or less) when Hinshaw is 18 and gives his father a copy of R.D. Laing's The Divided Self.  This gift begins a series of conversations with his father that lasts 25 years, until his father's complex Parkinson's illness, dementia, and death.  Much of the content of this book is derived from these conversations as well as from his father's notes, interviews with other family members, and Hinshaw's own professional knowledge of mental illness.  "Hearing my father recount his story to me profoundly changed and deepened my own life," Hinshaw writes, "undoubtedly influencing my choice of career as a clinical psychologist and professor" (5).  Hinshaw is currently a professor of psychology at University of California, Berkeley, and was a former student of Kay Redfield Jamison, a psychiatrist who is well known for her compelling first-person account of bipolar disorder, An Unquiet Mind, and other influential texts on the subject.

One of the more interesting aspects of Stephen Hinshaw's story is his continuing effort to use his developing professional expertise to help his father.  As his father describes the course of his illness over the years, Hinshaw begins to question his father's past diagnosis (schizophrenia) and his current pharmaceutical treatments (Mellaril).  As a result of Hinshaw's intervention, his father is finally correctly diagnosed with bipolar disorder and receives lithium for the first time.  Lithium, Hinshaw writes, "made him feel safe in ways that he had never experienced before" (122).  This new, more accurate, diagnosis also helped his father to better understand his illness and to alleviate some of the guilt he had associated with his symptoms: "he had longed, for much of his lifetime, to have a physical illness to which he could attribute his episodes, anything tangible that he could pinpoint as a cause of his experiences, anything other than the feeling that it was all in his mind" (143).  It is no small achievement on Hinshaw's part that the new diagnosis of bipolar disorder, its recognizable, familiar symptoms, and its well-established genetic basis provided his father with this peace of mind.  Many readers unschooled in the history of psychiatry will also benefit from Hinshaw's explanation of American doctors' tendency to over-diagnose schizophrenia in the past and from his concise history of the diagnosis and treatment of bipolar disorder.

Hinshaw's involvement in his father's treatment is not, however, an unqualified success story.  During one of his father's depressed periods, he suggests adding an antidepressant to "supplement his lithium" (130).  Hinshaw's father immediately experiences frightening side effects, including disorientation and reduced eyesight.  "My attempt at involvement," Hinshaw writes, "had clearly backfired. . . . I was extremely reluctant to suggest medication changes again" (131).  Hinshaw's experience here reveals the risks inherent in taking an active role in a family member's health decisions, and it also reveals the intense pressures a person in this position faces.  Like many other high-achieving children of people with mental illness, Hinshaw experiences a "kind of survivor guilt," which both compels him to play the role of caretaker and plagues him with the sense that he can never do enough to solve his family's problems (199).  (David Karp's The Burden of Sympathy: How Families Cope with Mental Illness provides an in-depth examination of survivor guilt and other issues confronting children and siblings of people with mental illness.)

Hinshaw is very forthcoming about his father's childhood experiences and how the family dynamics of his youth might have affected the course of his illness as an adult.  Hinshaw's father, Virgil, was the son of a prominent leader in the temperance movement who married a former missionary after the death of Virgil's mother.  Virgil's relationship with his stepmother was especially fraught and often abusive.  Her method of disciplining him consisted of brutal strappings and "lengthy" enemas (29).  As an adult, Virgil himself reflected upon this childhood abuse and its formative effects on his personality.  Stephen Hinshaw notes also how the images and themes of his father's childhood seemed to resurface during his manic episodes.  For example, before his stepmother would whip him, she would speak in Spanish to him, requesting that he bare his buttocks.  As an adult, Virgil's manic speech would incorporate his knowledge of Spanish, a tell-tale sign that he was becoming increasingly agitated (54).   As Hinshaw concludes: "the parenting he received profoundly shaped his self-image, influencing the ways in which he later interpreted many life events, including his hospitalizations.  A large part of him believed that he was to blame for his episodes and punitive treatments, perhaps related to some moral weakness.  Indeed, he seems to have been awaiting and anticipating punitive consequences throughout his life" (169).

Hinshaw's candor in revealing these intimate details of his father's childhood is not, however, sustained at the same level throughout this narrative.  It is ironic that The Years of Silence Are Past remains relatively silent about the family dynamics of Stephen Hinshaw's own childhood.  (The title of the book, by the way, comes from a rather cryptic phrase that appears without explanation in one of his father's notebooks.)  There are, of course, several good reasons for this silence.  Hinshaw states, "throughout my childhood I was not aware that my father had any kind of mental illness" (63).  Hinshaw's parents were advised by doctors to keep the illness hidden from the children, a fairly common recommendation at the time.  This prescribed silence might be charitably viewed as a way of protecting children from the social stigma surrounding mental illness.  However, while this silence circumvents a public recognition of the problem, it also reinforces the notion that mental illness is too terrible and shameful to discuss.  Yet perhaps the most important factor influencing the sense of silence in this book is Hinshaw's mother.  Hinshaw writes:

My mother's perspective is crucial to my father's story, but I have tried to respect her understandable desire for privacy.  Living with a partner or spouse with serious mental disorder can be confounding, exhausting, and even terrifying, especially when secrecy, shame, and lack of professional assistance are the norm, as was the case throughout much of my parents' lives.  My mother was the foundation of the family for decades, as the following words make clear.  Although there is another set of stories and issues about the rest of my family that I could recount, this work is primarily my father's story.  (8)

This untold set of stories and issues still lingers in the background, as one of Hinshaw's passing comments about his sister makes clear: "Sally has told me that she does not have the same kinds of warm childhood memories of my father as I do" (64).

Despite these remaining silences, or perhaps even because of them, Hinshaw has written a book that is a welcome addition to the growing bibliography of books by people diagnosed with mental illness and their family members.  Hinshaw writes in the introduction, "The more that such issues are talked about openly, the better, because the cloak of secrecy that still surrounds these problems may come to be replaced by openness and compassion" (6).  Even though the "years of silence" about mental illness may not be completely in the past, Hinshaw's book is a successful attempt to give voice to some of these all-too-often muted experiences.


© 2004 Elizabeth Donaldson


Elizabeth Donaldson, English/Interdisciplinary Studies, New York Institute of Technology