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by Victoria Costello
Prometheus Books, 2012
Review by Lynne Trevisan on May 22nd 2013

A Lethal Inheritance

After learning one of her sons has schizophrenia, author Victoria Costello begins a ten-year journey to learn about a variety of mental illness diagnoses and the steps people can take to address the impact the disease(s) have on their lives.  In the book, Costello details the heartbreaking and terrifying experiences a family experiences when a mental illness occurs.  She identifies a long line of family members who had mental illness and how the problems were ignored, how the family acted as if nothing was wrong -- generation after generation, the coping mechanisms exhibited by the family such as alcoholism, drug abuse, and suicide, and the generational lessons that come from ignoring serious problems. 

Costello states that she believes the tragedies that occurred in her family could have been avoided.  This author believes those tragedies were a symptom of health professionals of the time not understanding mental health or mental illness.  Researchers today can point to brain structure changes and chemical changes within the body as a cause or effect of mental illness because we have technology and case histories.  Costello's book goes into detail about the different methods used to diagnose mental health issues now.  This knowledge has come about through years of experimental tests and treatments as well as technological advances to determine which were the most effective on people with a specific group of symptoms.  In the early days of the developing mental health field, those who were seriously ill were institutionalized and many endured horrific treatments, such as frontal lobe lobotomies, sexual sterilization, and electric shock therapy, in the name of research.  The medications available at the time were preliminary and often had a profound, negative effect on the patient's ability to function; even the most basic self-care activities were impossible to perform because the medications were so powerful. 

Today, through decades of research and better understanding of the different types of mental illness and their impact on a person's life, there is still a significant amount of stigmatism for this condition.  The language of mental illness in the past was derogatory; words like "mania, melancholy, hysteria, religious enthusiasm, hypochondria, vapors,….madness, insanity, and lunacy" and crazed were used to describe mental illness (Ingram, 1992, p. 15).  Even now, when someone says they have a mental health diagnosis, there are long-term and deep preconceived notions about the conditions.  Family and friends quietly leave without mentioning why they are distancing themselves.  Employers are often unwilling to hire or continue the employment of someone who openly states they have a mental health condition, no matter if the condition will interfere with the work of the employee.  Insurance companies refuse to provide coverage for psychiatric visits or medications because they are expensive.  The barriers are big and found at every turn.

The book has a chapter called "Preventing Mental Illness."  This author wonders if "Mitigating Mental Illness" might be a better way of viewing the many conditions that fall under the umbrella.  Costello recommends that women get prenatal mental health care, especially in the first trimester of pregnancy if there is a family history of illness, in order to decrease the stress on the mother and the child (2012, p. 213). Decreasing the mother's stress decreases the amount of stress hormones that cross the placenta to the fetus.

There's now no doubt that physical abuse and bullying and ingesting cannabis can do great damage to a genetically vulnerable prepubescent child.  We understand that conduct problems in early childhood and adolescence can lead to antisocial adults and raise the risk for psychosis.  There's also convincing science to show us that if aggressive and antisocial behavior starts in a young elementary-school-age boy, he's at highest risk.  Further, we know where we live and the quality of children's' schools can also impact one's risk for psychosis.  Finally, we are very aware that the level of chaos in our household and the presence of untreated adult psychiatric problems can also negatively affect any child's mental health -- but particularly that of a child carrying a higher genetic risk (Costello, 2012, p. 213).

There are clearly steps parents and the village of people who help in raising a child, such as extended family, neighbors, teachers, doctors, etcetera, can take to decrease the stress on the child.  This author believes Costello's recommendation of controlling the chaos in daily life is one of the most important factors in the mental health of everyone.   We can act together to look for signs of mental illness.  Parents can be honest and accepting of someone else's suggestion and, for the sake of the child, follow through with testing if the signs are truly there.  As Costello states, the earlier the intervention, and the healthier the parents are, the better the odds are for the child being able to grow up as a mentally healthy person. 

One thing is clear, becoming mentally healthy, mitigating mental illness for a child, and maintaining mental health is a long and challenging process.  It takes a lot of work and dedication.  Costello recommends addressing the issues early in the process.   She also recommends addressing all of the family's issues because it is rarely a single family member's problem.  Most families have a dark secret of mental illness; the chapters describing her family's illness are examples in nearly all families and can be used to help shed light on the problem.  Costello shows us how to become honest about the disease within the family and take the steps to help future generations. 

This author recommends the book for professionals and para-professionals who see patients or clients who have mental illness as well as the layperson who has their own challenges or family challenges with mental illness.  The book offers a level of understanding and insight to the trials of life when someone lives with mental illness that is rarely applicable to both professionals and the layperson.  It is an easy read and very relatable to everyone. 



Costello, V. (2012). A lethal inheritance. Amherst, NY: Prometheus Books.

Ingram, A. (1992). Chapter 2: The history of silence. In, Madhouse of Language.  Ipswich, MA: Taylor & Francis Ltd.


© 2013 Lynne Trevisan


Lynne Trevisan, College of Health, Human Services, and Science, Ashford University