Mental Illness in the Family: A Review of 'While You Were Out' 

One of eight children, Meg Kissinger grew up in Chicagoland at the “height of the baby boom.” Three members of her family attempted suicide—two successfully; five, including both parents, had a serious mental illness. Kissinger worked for many years as an investigative reporter for the Milwaukee Journal-Sentinel, exposing the failings of our nation’s mental healthcare system. But of late, she has trained her attention more on norms than policy. In her new book, While You Were Out, Kissinger explores how families respond to mental illness and criticizes the once-pervasive culture of “silence” around it. She also argues for a more therapeutic culture in America. 

Mental illness within the family context is a rich subject.  Think: Robert Kolker’s Hidden Valley Road (2020), Miriam Feldman’s He Came in With it (2020), Ron Powers’s No One Cares about Crazy People (2017), and Pete Earley’s Crazy (2006). There are two main reasons for this richness.

First, mental illness tends to concentrate in certain families. That’s per folk wisdom and academic research. For the general adult population in America, the rate of serious mental illness runs at around 5 percent; in clan Kissinger, it ran at 50 percent. Members of such families anxiously scrutinize all low moods for signs of major depression and sometimes wonder whether they “might be doomed by our genetics.” Before their wedding, Kissinger’s mother warned her father that she had been receiving mental health treatment and indicated that she would understand if he therefore wanted to back out. 

Second, mental illness asks much more from families than other medical conditions. She writes: “For every person with severe mental illness, there are dozens of others whose lives are upended by their disease.” The suicide of Kissinger’s older sister, and then of her younger brother, touch off long-lasting bouts of guilt and blame over who could have prevented them. During her youth, Kissinger, like many with a mentally ill sibling, resented how her sister’s recurrent crises absorbed everyone’s attention and hampered her own flourishing: “Life was a lot calmer when she was far away.” Her sister once threatened her with a steak knife. At what point, in caring for a loved one who refuses treatment—who refuses even to acknowledge his or her illness—should a family devolve responsibility to a government agency, however imperfect that option may seem? 

But While You Were Out is not written in a minor key. To this day, the Kissingers are a happy family, enviably full of affection and levity. Whether or not mental illness-related tragedy could be said to have brought the Kissingers closer, it certainly did not break them. Their closeness appears to be a function of their numbers. Though it’s not exactly Kissinger’s intention to debate fertility rates, her book makes a certain case for the virtues of very large families, particularly when mental illness is in the picture. Being so many growing up, Kissinger and her siblings had no choice but to come together. “My mother couldn’t be the source of all our emotional nourishment,” she explains. “It wasn’t possible. There were too many of us. We’d have to look to each other or elsewhere for that.” By necessity, bonds developed in childhood that endured across the decades.  

What happens to mentally-ill adults upon the death of their parents on whom they depend? (Both Kissinger parents died of natural causes, though the mother did attempt suicide.) The surviving adult Kissinger siblings assume and share that burden for one of their brothers (afflicted with major depression and anxiety but who does not commit suicide) more effectively than many smaller families can do. Over the latter decades of the twentieth century, government shifted the locus of mental healthcare from mental institutions to “the community”—which really meant the family. Concurrently, average family size declined. While You Were Out suggests that those two developments worked at cross purposes. 

While You Were Out also raises questions about the implications of cancel culture and the mentally ill. Kissinger’s doomed younger brother gained notoriety in the early 1980s over his participation in a hate crime incident. Kissinger found his actions appalling but remained loyal to her brother. There seems little doubt that the “shame storm” that descended on him, a private citizen—which included media coverage by prominent outlets—contributed significantly to his decline. Americans with untreated serious mental illness can often be heard voicing bigoted sentiments. They commit hate crimes at a disproportionate rate. This behavior stands as a major obstacle to their integration into ordinary society. But figuring out how to reprimand and correct bigotry, for a schizophrenic adult, is easier said than done. The all-out push for a more tolerant society aims at benefitting Americans with mental disabilities. It also may pose risks to them.  

Across the generational divide, this family was united by their penchant for substance abuse. Kissinger’s parents were heavy drinkers, and a number of the siblings got swept up in the Sixties-era normalization of street drug use. Substance abuse is not exactly presented as the cause of the mental illness they suffered, since the symptoms of which, for some family members, persisted even after they became sober. But it is responsible for psychological deterioration, inflicting far more harm than the “silence” and “stigma” the book targets in the conclusion. Were we all to become more passionately therapeutic about our “issues” than the Baby Boomers, would that help confront America’s ongoing crisis of untreated serious mental illness? Maybe. But what would really help is if we could do more to stigmatize drug and alcohol addiction. 

Stephen Eide is a senior fellow at the Manhattan Institute.