John Whyte, MD, MPH: Welcome to the WebMD Health Discovered podcast. I'm Dr John Whyte, WebMD's Chief Medical Officer. When it comes to mental illness, especially schizophrenia and depression, there's always that question: what role does genetics play? I'd argue there's another important question: what does the mental health journey look like? 

Today, my guest has a new book on these topics. James Longman is an award-winning journalist and is currently the chief international correspondent for ABC News. His book is called The Inherited Mind, a story of family, hope, and the genetics of mental illness.

Welcome to the WebMD Health Discovered Podcast, James. 

James Longman: Thank you so much for having me. 

Whyte: I have to tell you that our entire team at the WebMD Health Discovered podcast has loved your book. Our listeners and people who come to our site are very interested in mental health and understand the connection between physical health and mental health. So, I have to ask you, what inspired you to write about this generational impact of mental health? 

Longman: Well, it's something that's been hanging over my family for a very long time. Questions around my father's schizophrenia were never truly answered when I was growing up. When I started to get my first bouts of depression and when I started to recover, I really wanted to ask the question, where did this come from? Was this in me? Was it written in my code? Or was this something that I was going to go through because of the history that my family had gone through? 

My father had schizophrenia. He ended his life when I was nine. His brother also had schizophrenia. My grandfather ended his life, and my mother deals with clinical depression. And so all of these dynamics were at play in my life, but as anyone with a history of this will know in their family and anyone listening, there's so much shame attached to these issues that no one really tells you about it. So I wanted, first and foremost, to really go on a journey to find out what happened. And with clarity about what happened, I could make sense of my own life.

Whyte: Now, were you aware of it at the time? You tell us now about your father's mental illness, your uncle's mental illness. Were people calling it that then or when you were discovering it as you looked back and as you examined your own journey, how did that all play out? 

Longman: He died when I was nine. And then I think it was sometime in my teenage years, and I don't remember when exactly it was, but my relationship with my mother broke down fairly substantially. I'm an only child. It was just my mum and me. My parents separated when I was a kid. And so I was told in a fight with my mother that my father had ended his life. Years later, after coming out of a depressive episode, and at the time being a journalist, having started my career working at the BBC at the time, I decided to do a documentary on him and the genetics of mental illness. At that time, I was also told that his father had ended his life. So, really, it was like a 26-year process of me discovering my family history and my father's own history. It was a long time. 

Whyte: What was the emotional impact on you at the time that you learned how you thought your father died and how he actually died? 

Longman: It was devastating, honestly. I knew something had happened, and I couldn't put my finger on it, but there was always so much secrecy. I had a close relationship with my grandmother (his mother), and I'd go to her home in the English countryside. She lived in a cottage in a little village in Somerset. But she didn't talk about him very much. And I always wanted to ask questions, but it felt like something had happened, and I wasn't meant to know. So, finding out that he had ended his life in the way that he did, I found it very sad, but also, it was this information which really, in my family, we weren't really meant to talk about too much. And if we did talk about it, it was always laden with enormous amounts of emotion and trauma and anger. I think, being a journalist, what I wanted to do was try to reattach some facts to his life rather than emotionally laden recollections and all the hysteria that comes with these sorts of events.

Whyte: You have this wonderful discussion about your concern about a “Longman curse,” the fear that your father's and your grandfather's struggles and your uncle's might be passed down to you. And you talk about this concern about this intergenerational impact. People don't often think about that early on, or at least it's not the first thing they think about. How did you come to that idea, and where are you today in terms of the impact? Would you still call it a curse?

Longman: Well, my mother came up with the phrase “the Longman curse.” She said from a very young age, your father's family was damaged. It's my job to look after you. I have to make sure that you escape the Longman curse. So it would always explain to me, as a way of basically blaming his family and also her way of showing me that she really was the only way that I was going to avoid this curse, so to speak.

So again, people listening to this may have had suicide in their family. They will perhaps recognize feelings of blame that come with that, People feeling angry at the deceased for it. I think my mother felt that way. So she really wanted me to know that following her example was the only way I was going to avoid this.

Do I still think of it as a curse now? Absolutely not. I've made sense of the genetics. I've understood that, actually, I probably do have a genetic predisposition to serious mental illness. I have come to understand that my mother actually saved me from what could have become schizophrenia because I didn't know about his illness. I was quite simply shielded from it from a young age. Whilst I've dealt with the trauma of his death and, in a sense, the kind of intergenerational trauma repeating itself in my life, becoming depressed, so to speak, I also think that I've been able to build my own life, my own family I've been able to look ahead, look forward and realize that even if you come from a family like mine, it doesn't mean that you can't build something brilliant going forward. 

Whyte: How did she save you? 

Longman: Quite simply, I was sent to school from the age of eight until I was 18, so I didn't see his illness up close. I wasn't around it. I didn't see her response to his illness up close. She became an alcoholic, and my relationship with her was destroyed, but I think she almost sacrificed her relationship with me by sending me away in order to keep me away from deeper illness. So what the book, I hope, does is at the beginning, you see that I probably blame my mum in some respect for the way that she handled it and the alcohol that took over and the fact that our relationship broke down, but by the end of the book what you hopefully see is a woman who did her very best to keep her son safe.

Whyte: You have so many good points in the book that I want listeners to hear about. You mentioned earlier about how the issue of knowing about your father and grandfather, but that came later. Many people don't know whether their parents suffer from mental illness, particularly issues like schizophrenia, because, as you point out, there is still this stigma. So your book talks a little bit about that. Actually, it talks a lot about it. I wanted to hear from you about what you've learned from your research and what might be some of the best ways to combat this stigma. 

Longman: Well, look, I mean, I speak to a lot of people who have these conditions for the book, and I very much wanted to hear from them about how they feel and what they would like. One of the foundational truths of the book is there is a difference between mental health and mental illness. And we all talk a lot about mental health, which is great. People will be listening to this. They probably have mental health days. They're told to speak about it more at work with their friends and their family. That's brilliant. We all have mental health because we've all got bodies. We've all got brains. We don't all necessarily have severe and enduring mental illness, but we will know people in our lives who have it. We will have come across them. If you are in a big city in America right now, you will have seen people on the street, likely with a significant mental illness. So the number one thing I want people to get from the book is to lead with compassion when it comes to these sorts of illnesses and not to judge and to not immediately believe that the person is dangerous or threatening to you.

Someone with schizophrenia does not have multiple personalities. They don't become a different person when they're in psychosis. And you know, there was one amazing woman from New York who said to me the thing about severe mental illness is that crisis is public, but wellness is private. You never hear about all the people who are doing amazing things in the world. The person with schizophrenia who gets up. Goes to work and stays with friends in the evening. 

Look, there is a tremendous spectrum, right? And there are people who are functioning, and they go out, and they do what they've got to do in their lives. There are people who need constant round-the-clock medical intervention and medical care. But understand that everybody deserves to have a fulfilling life, and people with these illnesses have dreams, just like the rest of us, and they should be encouraged to live them. I talked to a lot of people who have these experiences who showed me how support inside a family is just so important, and actually cutting people off who have these illnesses just makes them worse.

Whyte: And that's a very important point. You talk about your struggles with depression. You mentioned it in the book. You mentioned it during our conversation, and you often talk to groups of people. What's the initial reaction when they hear that? You've been having these challenges at times because here you are, we'll look at it and say you're a successful journalist, you're the chief international correspondent, you're at a big famous brand, you're on TV all the time, you're traveling the world, you're talking about your family on social media, you know, how could you be depressed. How could you be suffering from these feelings? Do you hear that from people? Are they shocked that you're talking about this?

Longman: I think you're right. It's funny, but appearances, as we all know, are very deceiving. Literally, everybody you meet will have had feelings of some description, whether they are induced by stress or whether they are deeper genetic predispositions that are being activated. It doesn't really matter. They will have had them. So, yeah, there are times when people can be surprised. I feel like speaking about it, you get such an extraordinary reaction from people. And the more you speak, the more you get some really amazing responses. And, writing the book, I've been quite open about my life, which means that people who don't know me at all have been reading it. And then if they see me, they open with not, Hello. My name is…  

I was in a studio in New York the other week and the sound recordist was putting my microphone on and he leaned over very quietly. And he said, James, my son has schizophrenia. I'm almost bankrupt because I've been paying for him to stay in a hotel. I don't really know what he does in the room, but I just go to the door, listen in, talk to him through the door, and then leave. And then he said, I've never told anyone else that he came to me with it because he felt because he'd read that little story and he, but he feels in his workplace and his friendship group that it's not something that he can really talk about. But hopefully, reading the book has given him permission to do that. Everyone is going through something.

Whyte: How does being a journalist impact the way you write about a personal story? At first, you think, hmm, they don't seem exactly like they should go together. You're a journalist doing this objective reporting. And in this book, you're talking about your own journey. Right? You're talking about other people's journey, and then you're investigating it, and you even open with your international experience in Syria, which is quite an exciting opening. How do you reconcile all of that? 

Longman: It was tough. I wanted it to be fundamentally useful to people. I mean, I just thought, well, I'm not Beyonce. I'm 38 years old. Why would I write a memoir? I wanted to tell the story of my family but also explain that there's some extraordinary science out there. Right now, there are people all around the world doing amazing work to discover what is happening to us on a genetic level, what our biologies can teach us about how our genetics are not necessarily a prison about the world of epigenetics and how that, and how that pertains to mental illness and most importantly, examples of how people have gone through something awful and have come out the other side. So, I had to make sure that I was writing something that was, yes, personal but also useful. 

You're a doctor. I'm about as far away from being any kind of medical professional as you can get. I am not a scientist. I didn't even pass math. I'm so bad at all these things. So the idea of the book was to discover something with the reader to show you that this stuff can be useful and try and break it down, as I would do any other part of my work. 

Whyte: You're doing this investigation, you're talking to experts, and you're trying to synthesize it for the reader. And as you said, you talk about genetics and epigenetics, which is really, in some ways—kind of the classic nature versus nurture debate. I wanted you to talk to our audience as you do in the book about how you see this evolving our understanding. And also, I'd love for you to point out something that our listeners might find surprising from the research that you've done. 

Longman: Anyone who looks into nature versus nurture, the idea of our genes versus our environment, will understand the 60/40 equation, meaning that we are made up of 60 percent environment, 40 percent genetics, and that is often the way most of these things are described to people in mental illness, it's described as being 60/40.

But that suggests that it's just a simple equation: one plus one equals mental illness. I wanted to try to explain that it's actually how our environment and our genetics combine, what the interplay is like, and how our environments activate our genetics that is really important. The world of epigenetics is fascinating because epigenetics is how your genes are activated by your environment, and it's essentially like dimmer switches. You can turn your genes up, and you can turn them down again, which gives people and has given me tremendous hope. 

I did some work on the idea of inherited trauma. I looked at studies on Holocaust survivors and how children of those Holocaust survivors themselves were experiencing traumas that their parents had. And that work actually really fascinatingly, again, looked at epigenetic changes. But Rachel Yehuda, who pioneered it, says you can inherit trauma, you can also inherit healing. So if I lead a good and happy life, I can give my children not just a good environment, all the kind of holistic things that people understand, but on a biological level, I can give them the epigenetic markers that will mean that they are better equipped to deal with whatever predisposition. 

A surprising thing for me from the book is that we think of schizophrenia, for example, as being all in the mind. It's a mental illness. We think of these things as just affecting the brain. There have been discoveries of the genes that code for schizophrenia. They sit on chromosome 6. Chromosome 6 is where our bodily immunity is coded. So we might start to believe and understand schizophrenia as being not just a mental illness but also an autoimmune illness, a little bit like lupus or MS, where it's an auto-intoxication of the body. It's not just all in the mind or all in the body. It's how the body and the mind interact. And I find all this science absolutely fascinating. 

Whyte: Did that surprise you? Were you aware of that beforehand, or did your research kind of teach you this? You described it very well. 

Longman: My research taught me this. I was trying very carefully not to be oversimplistic in these explanations, but there's a brilliant book by Edward Bullmore called The Inflamed Mind, and he talks a lot about the gut-brain axis. So there's a lot of stuff we can do at the moment to reduce inflammation. We used to talk about inflammation as being a good thing to fight disease. Well, people realize that chronic information is a bad thing. He cites studies of people with inflamed brains who deal with depression. A big study was done in Denmark. But crucially, why all this is interesting is because it means that, particularly when you talk about inflammation in the gut, where I didn't realize that 90 percent of all serotonin, which we think about serotonin as being a chemical in the brain, is made in the gut. You, therefore, have so much more agency over your life than you realize. And so much more agency over. all of your genetic predispositions, whatever they might be. Reading this stuff and then trying to put it into understandable chapters in the book, hopefully, was brilliant for me.

Whyte: Well, the gut is our second brain. There's lots of discussion about that. It goes to your point that then we can break this cycle of trauma, the cycle of the impact of inherited mental health disorders. You talk about that. So, what are some of the practical steps that listeners could take to break this cycle? To promote resilience?

Longman: Well, the first thing is they should be much more open with family members about how they're feeling and the history that's been hanging over their families. A lot of people have secrets in their families that they do not want to go near. I think that will help a considerable amount. I'm not talking about generalities here. It genuinely does help if you talk to your close ones about how you're feeling and your concerns about your life. You will be a healthier person if you do that. 

I do talk a little bit about some of the stuff that I do to keep myself healthy and happy. Now, the book is not intended to be a self-help book. I'm not a scientist. I've looked at the work of David Sinclair at Harvard University, who's talked a lot about lifespan and how reversing biological age can reduce your likelihood of getting a disease. And so, for me, I train. I know that working out and training is good for me. I know that I'm a morning person, so I know that for two hours every morning, I have to do something to be active; otherwise, my day will not be as good. I try and fast. It doesn't go so well, but 16 hours a day is the optimum. And that can be incredibly good for generating the kinds of proteins that he talks about. It is really good for generating these longevity genes that he talks about.

So, these are some of the things that I do. Going and doing a CrossFit class is not going to change my life in one minute, but developing habits that I'm going to keep for a lifetime is the thing that's going to change it. Knowing yourself. Knowing what keeps you happy. Knowing what keeps you healthy. Rangan Chatterjee is a British doctor who's just written a book called Make Change That Lasts, and he talks about how there's so much knowledge in the world, there are more health podcasts than there have ever been, there are more books, there's more self-help literature out there than ever before, and yet I think we feel like we're not healthy. We don't know how to activate the changes in our life that are going to last. And he says the first thing you've got to do is really know yourself before you start trying to take on knowledge from everybody else. And I thought that was very, very pressing. 

Whyte: I loved the story that you discussed earlier about how a sound person confided in you, and you were the first person he ever spoke to. How can society help support families? What do we need to be doing? 

Longman: I think a big part of this was how care for the mentally ill was restructured over many decades. In Britain, we had a system of care in the community, which I think followed a New York model from the 1970s, which took care out of hospitals and put it in the community. And it said that we didn't want to have these big institutions anymore, where people just get locked away for years, that we want them to try to be more a part of a community, able to kind of live in the world a little bit. Over successive governments in Britain anyway, I can't speak for the United States, but in Britain, funding has dried up. And what was once considered necessary, subsequent governments believe they're luxuries. My father had, and researching his life and his treatment, I believed because he ended his life, that he didn't, he wasn't well looked after. I was wrong. He had an incredible amount of care. He actually was better cared for in the 1990s than he would have been cared for today. That's what his doctor told me. He had a day hospital he could go to. He could go and see his doctor within 24 hours to get medications prescribed to him. He could go to a day art center where there were art activities, which he found very helpful. And he had a social worker that he would see 4 times a week. All of that was provided by the state. None of that exists. Now, if you have a mental illness in Britain, you have to go to a centralized hospital. It's a very clinical environment. And there isn't that kind of community support network.

So, I think focusing on trying to get our politicians to care about these issues has to be the priority. And to listen to what people with these illnesses have to say about how they live their lives. 

One of the most touching things I heard from doing the book was a man called Alex. His mother, Monica, has schizophrenia. She hasn't been medicated for 20 years. She's got serious paranoid schizophrenia, but she hadn't had any medication. Now, I'm not advocating for people to come off their meds, but just listen to this anecdote. She has delusions all the time. And she had this one delusion, which she would not let go that she had been given an apartment in Copenhagen by the emperor of Japan. They said to her, do you think maybe this is one of your delusions? She said, no, no, it's absolutely true. She wouldn't let it go. She was getting very hyped up about it. So Alex's sister said, okay, I'll take you to Copenhagen. We'll look for the apartment. They spent a weekend there, but they obviously didn't find it. They came back to the UK. She was devastated. They sat around with her. They loved her back to life. And then she had a moment of insight where she said, maybe that was my illness.

And then every subsequent delusion she has had, the family is able to say to her, do you think this was like that? Do you think you're having another one of these moments? And sometimes it works, and sometimes it doesn't. There's elasticity in how her condition is understood. And yes, that requires resources. It requires a huge amount of privilege. It requires time and energy from a family that loves her. But she's able to have insight because they give her that latitude.

Obviously, that's not going to work for everyone who has schizophrenia, but it's an example of how love and compassion are really important in the treatment of these illnesses.

Whyte: You used an extraordinary phrase that I hadn't heard before. You said loved her back to life, and I never heard that. You can understand what that means, and everyone won't be able to do that, especially in times of crisis, but it's something that we need to come back to. I want to end with. What's your message? What's your take-home point for folks reading this book? What do you want them to know? If it's only one or two things, James, what should they leave it with? 

Longman: I want them to know that if they're feeling alone, if they're feeling like nothing matters, and that everything that they're feeling is inevitable, those feelings are not real. That's your mind telling you that. That's the feeling of depression when I get it. It is a feeling that this was always gonna happen, and there was nothing I could do to change it. There are so many people out in the world right now working on all kinds of different ways to make you feel better. The science of mental illness is making leaps and bounds, not just to help better provide medications, because we're going to end up in a world, for example. Where we're going to have antidepressants tailored to our genetic code, which will mean that it's not just going to be trial and error with these pills. Someday soon we're going to have skin samples that are going to be able to better understand what a person needs on a genetic level. So I want them to know that there are people out there doing the work to make your life better.

I also want them to know that they need to invest time and energy in the people who love them because that, really, for me, in writing this book, has been the message from absolutely everybody I've spoken to. Community is the way to get through these issues. 

Whyte: It's an extraordinary book, and I encourage our listeners to read it. The Inherited Mind, A Story of Family, Hope, and the Genetics of Mental Illness. James, I want to thank you so much for joining me today. 

Longman: Thank you so much, what a privilege. 

Whyte: And I want to thank all of our listeners. Please take a moment to follow, rate, and review this podcast on your favorite listening platform. If you'd like to send me an email about the topics you're interested in or questions for future guests, please send me a note at [email protected]. This is Dr John Whyte for the WebMD Health Discovered podcast.

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