Book Review: Hidden Valley Road: Inside the Mind of an American Family.

Robert Kolker. Quercus Publications, April 2020. 362 pages, Price: ₹362/- (kindle edition), ISBN978-0-385-54376-7.

How to cite this article: Chahal S, Deep R. Robert Kolker, Hidden Valley Road: Inside the Mind of an American Family, Quercus Publications, April 2020. 362 pages, Price: ₹362/- (kindle edition), ISBN978-0-385-54376-7. Indian J Psychol Med. 2021;XX: 1–2.

Robert Kolker, a journalist and critically acclaimed author, has come up with this intriguing, real-life family narrative of the Galvin family and their contributions to research studies, which shall undoubtedly evoke the interest of mental health professionals.

The Galvin family had 12 children, of which six boys eventually develop schizophrenia in their late teens. The book cover shows the Galvin family in their happier times, and the book title refers to their Hidden Valley Road house in Colorado, which stood a witness to their lives.

The book is based on extensive interviews with family members (including 90-year-old matriarch, Mimi), their relatives, personal diaries, and records retrieved from multiple hospitalizations at various facilities. The author also attempted to gain insight into the research contributions of the family by interviewing two prominent researchers who engaged with the family over the years. These included Dr Lynn DeLisi, the geneticist, and Dr Robert Freedman, well-known for his sensory gating theory in schizophrenia.

Recently, Dr DeLisi re-analyzed her original genetic materials gathered from nine multiplex families (i.e., families with two or more biologically related members having the same complex genetic disorder) in the 1980s, using newer techniques after the advent of genome sequencing, which led to the discovery of the SHANK-2 mutation on chromosome 11, a finding published in her 2016 paper in “Molecular Psychiatry” journal. This mutation was detected in all samples collected from Galvin boys and their mother, but not their father. The author has discussed the significance of these findings in a lucid, simplistic manner, including their significance and limitations in a broader context.

The book also forms a commentary on the parallel scientific developments in the field of psychiatry from the past century till the present. The author has retained a narrative style and refrains from taking judgmental stances in favor or against a member of the family, leaving it up to the readers to make their conclusions.

The book’s prologue gives a window to the felt experiences of the youngest sibling growing up in a family with six elder brothers having schizophrenia, who felt that “the foundation of a family is permanently tilted in the direction of sick family member.” The book is broadly divided into 3 parts, with a total of 45 brief chapters.

The first part of the book begins with the marriage of Don Galvin, a serving officer, with Mimi, a perfectionist housewife with finer interests in life. The couple went on to have a dozen children between 1945 and 1965, against everyone’s advice. As her elder sons (Donald, Jim) begin to display symptoms of psychosis, Mimi recalls that her disciplinarian, “controlling” parenting style was blamed in an era of “schizophrenogenic mothers” hypothesis. Heralded by a mild prodrome of social withdrawal in some, the illness is preceded by heavy drug abuse, sexual abuse, and neglect in childhood of most of these boys.

Some children suffered sexual abuse from an elder sibling (Jim) and a local priest whom Mimi had befriended. The first part of the book also describes the sudden murder-suicide by their son (Brian), whose antipsychotic prescriptions were found after he murdered his girlfriend and died of suicide. The patriarch of the family, Don, suffered an incapacitating stroke, which made him dependent on his wife who was already struggling with other ill sons.

The second part of the book begins with a shift of gears to the life and career path of Dr Lynn DeLisi and her emphasis on a need to return to multiplex families for research. Dr Freedman looks back to reminisce his research works in which the Galvins had participated. This part also delves into how mental illness affected the lives of each member of the family, whether sick or well. There was a suboptimal response to multiple psychotropic drugs, with two siblings dying from a possible neuroleptic malignant syndrome.

The third part of the book looks from the perspective of the younger sisters who try to come to terms with their family’s past and assume a more supportive role after their mother’s death in 2017. Uncertainty over the genetic risk in the next generation is also an issue of some anxiety. The book ends as Mary’s grown-up daughter Kate (grand-daughter of the Galvin couple) has joined as an intern at Dr Freedman’s laboratory, working at the same lab where genetic material from her own extended family was analyzed long ago.

The book carries many complex themes such as mental illness, substance use, suicide, violence, treatment resistance, fatal complications with drugs, sexual abuse, dysfunction in family dynamics, caregiver burden, stigma, and genetic counselling. Overall, the book makes a good, leisurely read, engaging readers from literary and academic perspectives. We often read the published papers as an end-product, but this book forms a useful companion to know the humanistic stories behind some of those published papers.