Book Description
The story of a midcentury family with twelve children, six diagnosed with schizophrenia, who became a cornerstone of schizophrenia research.
If You Just Remember One Thing
Schizophrenia is a complex neurodevelopmental disorder with genetic roots rather than being caused by parenting, with re... More
Bullet Point Summary and Quotes
- Mimi and Don Galvin married young, just before Don's deployment in World War II. Don initially had ambitions in politics, but struggled, and ultimately joined the newly formed Air Force.
- Mimi and Don had twelve children. In 1963, the Galvin family moved into a new house on Hidden Valley Road in Colorado, where the new Air Force was being established.
- The boys had troubling behaviors, but the parents mostly assumed it was typical teenager behavior:
- The two eldest, Donald and Jim, often had real physical fights.
- Jim was expelled from school for sneaking into an Air Force jet.
- Donald violently smashed dishes once.
- Donald received severe burns after jumping into a bonfire.
- After a tumultuous relationship ended, Donald's behavior worsened, eventually leading to a subsequent health center visit for a cat bite. Donald disclosed multiple self-destructive acts, including suicide attempts. He also admitted to killing a cat but couldn't explain his actions.
- The psychiatrist diagnosed Donald with a βpossible schizophrenic reaction.β
- Schizophrenia, a term first used in 1908, was controversial and poorly defined at the time (1952 DSM had a three-page definition).
- At home, Donald exhibited clear symptoms -- delusions about the CIA, shouting about being shot at.
- At the time, the "schizophrenogenic mother" theory was prevalent, which blamed mothers (whether overly affectionate or unaffectionate) for causing schizophrenia.
- Mental institutions at the time used disturbing treatments, including shock therapy, solitary confinement, physical restraints, and heavy tranquilizers.
- Mimi and Don didn't want to commit Donald to a psychiatric facility because of fear of shame and mistreatment.
- Donald continued his education and psychiatric visits, eventually marrying Jean in 1967.
- Jim married Kathy in 1968 and had a son, but soon displayed troubling symptoms including violent behaviors (towards himself and Kathy) and strange actions (hearing voices, turning stove burners on and off). When Kathy reported Jim's behavior to his parents, they were dismissive and failed to mention Donald's similar symptoms.
- After a fight, Donald followed Jean and expressed intent to kill her, leading Jean to decide to leave. Donald then tried to poison himself and Jean with cyanide tablets. Jean alerted the police and Donald was arrested for attempted suicide and homicide, then briefly committed to a hospital in Pueblo.
- Donald was released with medical prescriptions and then returned home. He continued to exhibit bizarre behavior (e.g., moving furniture outside, lying naked reciting Bible verses).
- Margaret and Mary, the youngest Galvin sisters, sought respite at Jim's house when Donald moved back in, but Jim molested them when drunk. Unsure of what to do, the sisters delayed telling Mimi about Jim's abuse for years.
- In 1973, Brian, the fourth oldest son, and his girlfriend Noni were found dead. Police concluded Brian shot Noni with a .22 caliber rifle before killing himself after their breakup. Brian had been prescribed an antipsychotic before his death.
- In 1975, Don suffered a stroke, leaving him hospitalized for six months and permanently altered. Peter, the youngest brother, was present during the stroke.
- Peter was deeply affected by Don's stroke, soon exhibiting erratic behavior like speaking gibberish, being violent, and bedwetting.
- Joe, another brother, confided to Peter's therapist about experiencing similar symptoms, fearing he might be next.
- Mimi finally confided in family friend Nancy Gary, who offered to take in Margaret.
- Mary escaped Hidden Valley Road to attend ninth grade at Hotchkiss, a boarding school in Connecticut, where she adopted the name Lindsay to start anew.
- Matt, another brother, visited Margaret, but he stripped naked and smashed a vase he had gifted to the Garys. Matt became the fifth Galvin to go to the Pueblo hospital.
- At Pueblo, the treatment essentially was drugs that had severe side effects like seizures, making the treatment's value questionable.
- In 1982, Joe also became ill.
- By the late 1970s, scientific research was shifting toward a biological understanding of schizophrenia rather than parent blaming.
- Neuropsychiatrist Richard Wyatt found that individuals with schizophrenia had more cerebrospinal fluid in brain ventricles near the amygdala and hippocampus -- regions tied to awareness. His study also revealed that larger ventricles correlated with reduced effectiveness of neuroleptic drugs.
- Schizophrenia likely results from a combination of genetic and environmental factors.
- Psychiatrist Lynn DeLisi, who believed that studying families like the Galvins could help identify genetic markers for schizophrenia, began collecting genetic data in 1984.
- Mimi provided blood samples from her family members to DeLisi. DeLisi's findings confirmed earlier research about enlarged ventricles in schizophrenia patients.
- In 1987, Daniel Weinberger claimed schizophrenia as a developmental disorder, suggesting genetic abnormalities are present from birth but symptoms only appear when the brain fully matures.
- Researcher Robert Freedman studied sensory gating/processing. He discovered that people with schizophrenia respond to repeated stimuli equally as if it's the first time, unlike others who show reduced responses.
- "To these researchers, those triggers -- anything from everyday heartbreak, to chronic poverty, to traumatic child abuse -- didn't cause schizophrenia as much as provide 'an opportunity for vulnerability to germinate into disorder.' And that vulnerability, many thought, was really an issue with 'sensory gating,' or the brain's ability (or inability) to correctly process incoming information. A sensory gating disorder was the most common explanation for the schizophrenia experienced by John Nash -- the Nobel Laureate mathematician depicted in A Beautiful Mind -- who was able to detect patterns no one else could, and yet also was prone to delusions and visions of beings who were out to get him. Both of those aspects of Nash's personality were said to be products of the same hypersensitivity."
- Freedman conducted tests on the Galvin family. He used tissue samples to pinpoint the biological basis of sensory gating to the Ι7 receptor (alpha-7 nicotinic receptor) in the brain, which relies on acetylcholine for neuron communication. People with schizophrenia have roughly half the normal amount of Ι7 receptors.
- Freedman discovered that nicotine could temporarily enhance acetylcholine activity and improve symptoms, but the effects were short-lived. He also found that the drug DMXBA was even more effective at improving symptoms, but pharmaceutical companies didn't develop it because its patent was expiring and it required multiple daily doses.
- Freedman found that choline, a widely available nutrient, could activate the CHRNA7 gene to produce Ι7 receptors, leading to efforts to include choline in prenatal vitamins. Preliminary results have been positive.
- Jim and Joe both died at 53 years old due to heart issues related to their medication.
- Pfizer bought Parke-Davis, the company that was funding DeLisi's research, and cancelled her research. DeLisi later partnered with neurobiologist Stefan McDonough at Amagen to resume the research.
- DeLisi and McDonough continued to study the Galvin family DNA, which led to their identification of a mutation in the gene that encodes proteins that enable synapse communication (SHANK 2).
- DeLisi and McDonough's 2016 study suggested that SHANK1, SHANK2, and SHANK3 genes are linked to a spectrum of mental illnesses (e.g., autism, bipolar).
- Psychiatrist Thomas Insel redefined schizophrenia as a collection of neurodevelopmental disorders rather than a single disease. John McGrath compared psychosis to fever, describing it as a symptom and not a disease, like how a fever is not a disease but a reaction to various illnesses.
- In 2016, DeLisi revisited the Galvin family, finding that Lindsay (Mary) had become the family's primary caretaker.
- Don died in 2003 and Mimi died in 2017.
- βHer mother had always insisted, defensively, that the illness was genetic, and in a way, Mimi was right. Biology is destiny, to a point; that can't be denied. But Lindsay understood now how we are more than just our genes. We are, in some way, a product of the people who surround us -- the people we're forced to grow up with, and the people we choose to be with later.β
- While the family's biological samples continue to be used for schizophrenia research, progress in developing
better treatments has been slow.
- βThe market for new schizophrenia drugs remains sluggish. Antipsychotic drugs require expensive and risky testing, even in the early trials, where rats are no substitute for humans.β
- "The National Institute of Mental Health spends only $4.3 million on fetal prevention research, all of it for studies in mice, from its yearly $1.4 billion budget. Yet half of young school shooters have symptoms of developing schizophrenia.β
- In 2017, Kate, Lindsay's daughter, began working as an intern for Freedman.
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