Finding Meaning in My Mother's Madness.

My beloved mother, who died in a psychiatric hospital several years ago, struggled with manic-depressive psychosis most of her life. I have often asked myself existential questions such as, "Did my mom's mental illness have meaning or purpose? Can I find or create significance and value out of the disorder of her disorder? What good, if any, has emerged from Ma's suffering?"

I imagine others have asked similar questions about their loved ones', their own, or their patients' mental disorders. I want to share with you several stories about myself and some of my friends and colleagues which help provide me with answers to these questions. I hope these autobiographical anecdotes might help others to develop their own answers.

A few years ago I had the honor of serving on the board of directors of the Alliance for the Mentally Ill of Vermont (AMI-VT), an advocacy group in my home state. An issue high on our legislative agenda was parity in insurance coverage for mental disorders. We were--and still are--working toward ensuring that mental illnesses, such as schizophrenia, bipolar disorder (the technical term for manic depression), and autism are not discriminated against in insurance by having higher copayments and lower caps on coverage than other illnesses like heart disease and cancer.

One year, for our annual statewide meeting, we invited as our keynote speaker a legislator who had introduced a parity bill in her state and nurtured it through her state house to become law. The evening before her keynote address, this legislator--Susan--met with the AMI-VT board to discuss the nuts and bolts of passing a parity bill. Following this work session, an impromptu party developed, and over a glass of wine (that turned into several), she and I got to talking about how we each became active in the mental-health movement. It turned out that both of our mothers were afflicted with severe, treatment-resistant cases of manic depression. As we exchanged "war stories" about our experiences as children and adolescents growing up in families deeply touched by mental illness, and then as adults attempting to care for and help our mentally ill mothers, we grew closer to each other in a way I think is unique to those who have endured similar difficult experiences.

For example, we both commented on positive ways in which our mothers had influenced our lives. Both of us had become active in mental-health issues and were arduously advocating on behalf of people with serious mental illnesses because of our experiences with our moms and their disorders. In this way we were both giving meaning to our mothers' "madness" and to our own lives. I imagine many others--professionals, family members, and patients alike--find and create meaning, significance, and value in similar ways. I personally experience this meaning deeply. It helps me to feel closer to my mother and to come to grips with her mental illness. It also helps me to answer existential questions about life and about myself. In fact, part of the motivation for this article derives from the desire to add purpose and meaning to my mom's suffering and the suffering of others. This search for meaning and desire to create purpose helps assuage my gnawing feelings that the mentally ill suffer in vain.

Liz was another woman at the annual meeting. Her sister has schizophrenia. One way that Liz added meaning and purpose to her sister's suffering was by serving as the first executive director of AMI-VT.

In the case of Liz's sister, traditional treatments for schizophrenia--such as anti-psychotic medications--weren't particularly effective. This, unfortunately, is all too often the case with severe and persistent mental illnesses. However, homeopathic remedies appeared to have helped and, as Liz and her family believe, even cured the woman for awhile. As a result of what she perceives as the miracle of homeopathy for her sister, Liz began to study it seriously, took courses and workshops on it, and developed her own practice in homeopathic treatment. In this way--by engaging in activities that feel good, right, and important to her because of her experiences with her mentally ill sister--Liz is able to extract something positive out of her sister's suffering. Eventually, Liz gave up her position with AMI-VT to pursue homeopathy full time.

I, "similarly but different" (in the immortal words of Yogi Berra), became a clinical psychologist and a professor of psychology in large part because I grew up in the penumbra of my mother's mental illness. I first enrolled in psychology courses in college in an attempt to understand what was happening to my mom. Then I went on to become a mental-health professional, pushed in part by a desire to help others like my mother and their families and, perhaps, to help my own mother and family, as well as myself.

Now years after my mother's untimely death, my clinical and academic work in psychology continue to be extremely salient in ways that give meaning and purpose to my mother's suffering, to the havoc her madness wrought on my family, and to my own life. As Viktor Frankl, a psychiatrist and a Holocaust camp survivor, states in Man's Search for Meaning: "We must never forget that we may also find meaning in life even when confronted with a hopeless situation, when facing a fate that cannot be changed."

When she returned home from the annual meeting, Susan set me up on a blind date with Carol, her best friend and a colleague from her state legislature. I found out later that, because she met me through the AMI-VT, she was hoping and fantasizing that, through her matchmaking, something positive would indirectly come out of our moms' mental illnesses. We take what life deals us and make the best we can out of it.

During the course of our first date, Carol and I discussed our mutual friend, since she was the only thing we knew at that time that we had in common. Carol commented on how Susan had turned the hardship of her mother's mental illness into a passionate mission. She observed that, largely because of Susan's willingness and ability to bear witness to her mother's and family's trials and tribulations, Susan was extremely effective in educating her legislative colleagues about mental illness and the plight of the mentally ill. This, in Carol's view, was one of the main reasons that the mental-illness parity bill had passed in her state. It struck me that Carol, someone who doesn't have a family member with mental illness, understood and appreciated that her friend was attempting to create some good out of her experiences. To quote Frankl again, Susan was "transforming personal tragedy into triumph," turning her family's predicament with mental illness into human achievement.

Over dinner, I asked Carol if there was anything she'd like to know about me. She thought hard for a moment and then stunned me by asking, "Are you an alcoholic?" The first thought that flashed through my mind was that Carol was asking this because she knew my mother had manic depression and she thought there was somehow a link between it and alcoholism. Perhaps sensing my perplexed unease, Carol went on to explain that some people close to her have wrestled with alcoholism and she "didn't want to go through that again."

I replied that I was far from being an alcoholic and then explained how my mother's mental illness had influenced my use of and attitudes toward alcohol and illicit drugs. Over the years, as I all too slowly come to know myself better, I have discovered that I am extremely sensitive--perhaps oversensitive--to seeing someone even just a little out of control while drinking. If a friend or family member even talks with slurred speech or walks with an unsteady gait it pushes my buttons. I have a deep emotional reaction. For example, whenever I saw my ex-wife get even a little tipsy while we were married I would accuse her of drinking too much and, after several instances, of being an alcoholic. A close friend of mine, meaning to be helpful, confided to me that I was overreacting.

In my own psychotherapy I have gradually come to understand that experiencing someone close to me even a little out of control subconsciously reminds me of my mother out of control when I was a child, for example during one of her manic or psychotically depressed episodes. Such incidents stir me deeply in ways difficult to put into words. I feel a complex combination of fear, helplessness, lack of control, disorder, chaos, anger, sadness, and grief. I get stirred up, anxious, uneasy, and uncomfortable. What's more, I sense that as a child I felt much the same way when I was, for example, awakened by my mother singing --yelling, actually--Broadway show tunes throughout the night. I still vividly remember the exact words and can hear my mom bellowing them. Indeed, my earliest memories--from about age three--are of what I now realize were my mother's manic episodes: for example, my father yanking the telephone cord out of the wall to prevent my mom from phoning relatives and friends all across the country at all hours of the night.

Perhaps it is no wonder then that I don't like to be around people who I think are losing control, be it through drinking or using drugs. For years I tried to avoid such situations without even realizing it. I am still uncomfortable at parties where people get drunk. Furthermore, I don't like to feel myself losing control. I therefore stay closely attuned to my internal state when I drink and stop as soon as I feel the alcohol is affecting me.

After getting drunk on my eighteenth birthday (the legal drinking age back then) and finding that I didn't like the feeling--I didn't yet know why--I drank hardly at all throughout college. However, like many college students in the late 1960s and early 1970s, I did smoke marijuana. I'll also admit that I experimented some with cocaine, with "magic mushrooms" twice, and once with LSD. I didn't like the "shrooms" or the LSD;I now realize that's probably because I felt out of control, perhaps even psychotic-like, while under their influence. With hindsight I realize that I probably more often smoked pot because it didn't make me feel out of control.

However, soon after I learned in a course during my senior year of college that some of the same neurochemicals that are involved in mental disorders are also affected by such recreational drugs as marijuana, cocaine, and LSD, I stopped my experimentation. I vividly remember sitting next to my brother in a biology class--we both attended the same university--and breaking out in a sweat during a lecture on neurotransmitter, their role in mental disorders, and the effects of recreational drugs on them. I was dazed by the realization that, due to genes I might have inherited from my mom, my own neurotransmitter system might be genetically predisposed to malfunction in a way that contributes to mental disorders. When I learned that recreational drugs alter these very same neurotransmitters I, quite frankly, got scared. I distinctly remember asking myself, "Why tempt fate by purposely messing with these biochemicals?"

I have expressed these opinions to relatives, friends, and others who are biologically related to someone with a major mental illness. For example, I explain my decision not to use recreational drugs to students in courses I teach for family members of the mentally ill. I personally like my behavior and attitude toward alcohol and other drugs. I'm not saying that these are right for everybody--only that they work for me. Thus, my mom's psychosis has, perhaps ironically, helped me become a more mentally healthy person. During my last visit with her before she died, my mom told me she felt guilty about not being a "good mother" to my brother and me. I told her that in many ways her struggle and suffering had made me a better person. I hope she believed me, at least to some extent, and that it eased her suffering a bit.

One last thought about illicit drugs. I have heard many family members, including some of my closest friends, blame such drugs as LSD, ecstasy, and cocaine for their loved one's mental illness. To a large extent, their conclusion makes sense. Typically, someone who appears perfectly normal into late adolescence or early adulthood has her or his first bout of psychosis shortly after experimenting with a recreational drug like LSD. It is no wonder why people think the drug caused the mental disorder. However, I believe the situation is more complex. Many people who develop a mental disorder soon after using an illicit drug most likely have a biological predisposition toward developing the disorder (diathesis is the technical term for such a predisposition). The drug alters the person's neurochemicals, serving as a trigger for the disorder. In other words, the drug precipitates the underlying diathesis to surface and emerge as a mental disorder. In this sense, the drug use is, in fact, a proximal cause of the mental illness but, in my opinion, it doesn't tell the whole story.

If I, for example, developed a mental disorder during my experimentation with drugs during college, could we say that these drugs caused my mental illness? In a direct sense, yes. But this simple answer neglects the role also played by the genes for mental illness that I might have inherited from my mother.

So much for my first date with Carol. The rest, as they say, is history. Several years later we were married. Susan performed the wedding. In her remarks, she touchingly explained how bringing Carol and me together had added meaning and significance to her mom's mental illness. We do, indeed, sometimes find silver linings in what carl be the darkest clouds. I felt exactly the same way--it is very likely that Susan and I, and hence Carol and I, never would have met if not for Susan's and my mother's mental illnesses. Their suffering did make a difference in some positive ways.

At the rehearsal dinner the evening before our wedding, with many of my mom's relatives present, Carol proposed "a toast to Marc's mom, without whom none of this would have been possible." I broke down "uncontrollably" and was happy to do so. Carol was correct in so many ways, some less obvious than others. In addition to bringing me into this world, giving me the gift of life, and raising me, my mom and her bouts with madness helped bring about, to a large extent, my success in both my professional life and my life in the community. I'm proud of my work as a clinical psychologist and a professor, of my service on the board of directors of the community mental health center in my county, and of my advocacy for the mentally ill. I doubt that I would have achieved all of this had it not been for my mom's and my family's struggles with her madness.

Perhaps one of the greatest things to come out of all this was the scholarship Carol and I endowed in my mother's name. We suggested to those intending to give us wedding gifts that they instead make a contribution to the Rosalin Lieberman Riess Scholarship Fund. The following is a letter I wrote several months ago to the first recipient of this award:

   It is my heartfelt honor and pleasure to inform you that you are the
   recipient of the Rosalin Lieberman Memorial Prize for 2000.

   This prize was established by the family and friends of Rosalin Lieberman
   Riess, a woman who struggled with a severe and persistent mental illness
   for much of her life, and died prematurely in a psychiatric hospital. To
   honor her memory, the prize bearing her name is awarded to the graduating
   senior who shows the greatest promise to contribute to treatment and
   research that will improve the lives of people struggling with mental
   disorders.

   It especially warms my heart ... that you are the first recipient of this
   award. What a wonderful tribute to my mother! I'm sure she would be proud
   and delighted to know that a student who performed a top-quality senior
   honors thesis on mental disorders under my supervision and is going on to a
   career in clinical psychology is the first winner of the prize created in
   her memory.

   On behalf of the members of the Psychology Department, my family, and
   Middlebury College, I wish you all the best.

Presenting this award at Middlebury's 2000 graduation ceremony was one of the proudest moments of my life. It is awe-inspiring to realize that a positive legacy resulting from my mother's madness is being passed on to subsequent generations.

I love you, Mom, and I miss you dearly.

Marc Riess is a professor and former chair of the psychology department at Middlebury College in Vermont, where he teaches courses in abnormal psychology and researches mental illness and the family. He has served on the board of directors of the Alliance for the Mentally Ill of Vermont and the Counseling Service of Addison County. His forthcoming book is Tearing Us Apart: Eating Disorders and the Family.