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Crossposted with permission from palabra and Voices of Monterey Bay

My sister was 21 years old when she dropped acid for the first time. She had just graduated college and was celebrating with a few friends. Before this experience, she'd tried hallucinogens that tend to be less intense, like psilocybin, and had always described the experiences as profound.

“But was it fun?” I would ask.

“You should try it,” she replied.

I always knew hallucinogens weren't for me. I suffered from panic attacks long before I knew what they were; the last thing I needed was to try a drug that would keep me high and out of control for eight hours at a time.

The night my sister first tripped on acid, she suffered a psychotic break and was admitted to a hospital under a 5150 hold, a 72-hour observation period for mentally distressed individuals. She was eventually released to my mother, a predominantly Spanish-speaking immigrant who was handed pamphlets by the hospital nursing staff. The pamphlets were written in English, using words like “psychosis,” “schizophrenia” and “bipolar disorder.” She shelved them on the kitchen counter next to the utility bills and parking tickets.

This all happened 22 years ago, and one thing has stayed certain ever since: my family's mental health issues and illnesses did not start and have not stopped with my sister.

We may not have known much about it at the time, but the clues were there: my paternal grandmother, mi abuela, spent eight hours a day praying the rosary in the corner of her home, and my paternal aunt, mi tía, used to climb trees and not come down for hours, sometimes days. These were among the odd stories I heard about my family as a kid.

Before phrases like “mental health” and “diagnosis” were part of my vernacular, I understood that some people in my family were just odd, que eran curiosos. It wasn't until receiving an undergraduate degree in psychology that I learned how your family’s mental health history can be related to your own mental health.

I hope that conversations around microdosing (taking a minor dose of a substance in order to experience the benefit from its physiological action) or any other form of experimentation with hallucinogens include stories like mine — stories about mental disorders that run in families as thick as mi abuela's capirotada. Stories that include how my sister’s genetic disposition made her vulnerable to acid. Or, how her schizophrenia — maybe — could have been triggered that night she tried acid.

Illustration for palabra by Jon Williams

Illustration for palabra by Jon Williams

STRANGER ANGEL

My sister's psychotic break included an attempt to jump out of a moving car while on the Bay Bridge between Oakland and San Francisco. I was 20 years old at the time. While I understood that what had happened was serious, I had no idea what a drug-induced psychotic break meant, much less the later diagnosis of schizophrenia.

After being released from the hospital, my sister was sent to live with our mother in Watsonville. At the time, our mom was grieving the loss of our father (her husband of nearly 30 years), who died in a tragic car accident a few years prior. When my sister was sent to live with her, our mom rarely left her bedroom and no longer cooked—a significant change for any Mexican mom. Looking back on it, she could have been diagnosed as clinically depressed, although she never sought help. Because of her level of depression, I thought my mother’s care would be obstructive for my sister. So, I drove to Watsonville to bring my sister to my San Francisco studio, where I would save her. On the drive back to the city, she rocked back and forth. She sang songs under her breath, over the songs playing on the radio. She was physically shaking, and when I asked what was wrong, she told me about all the wrongs in the world. She spoke in run-on sentences, sometimes putting together thoughts and occasionally stopping to moan.

I was scared but I really believed I could help her and that San Francisco was a better place for her to be. I kept driving and hoped that whatever had just happened to her would end soon and that she would return to normal. Even as I type this today, I still have that hope.

Once we got to my apartment, I put her duffel bag down and made dinner. She continued to rock back and forth, and I tried not to panic. I called our four other sisters for advice, but none of us knew what to do. If they agreed on one thing, it was that my sister’s prospects were better with me than with our mom.

The next day, I went to work in Oakland. I gave her my last $5 bill and told her about the burrito spot down the street. She was still rocking back and forth when I left.

Around noon that day, a stranger called the radio station where I worked as a receptionist and addressed me by name. He said he had “found” my sister. I remember wondering if this was a radio station prank call — it wasn't. My sister had wandered from my studio in San Francisco’s Mission area to the Financial District.

This random person had had a conversation with her and recognized her as being in distress; he knew enough about the situation to call me and to keep her safe until I could get to them. When I arrived, he knew what to say. He had a list of phone numbers and facilities for “people like her.”

What are the chances this stranger would have the exact information we needed? When I got to him and my sister, I was confused and in shock. So much so that I didn't thank him or even ask his name.

HOPING AGAINST HOPE

I wish I could say that 22 years later, she is now back to normal. The truth is that this disease has shaped our family dynamic, and our adult lives. It's been 22 years of dread: dreading the phone call about an altercation with police or finding out that she's hurt someone or herself. From her suicide attempts to hospital stays, to three months in prison and two years’ probation, we all experienced it by proxy. All the while, we wished our family had talked about drug use and mental illnesses so we could have been better prepared. All the while, we wished that keeping secrets wasn’t a cultural proclivity.

In our home, secrets were crucial to keeping our family together. Secrets — about immigration status, financial need, physical health, mental health, alcoholism and domestic abuse — weren't just kept because of pride or shame. Those secrets were key to our livelihood.

Some of the phrases common in our house were, tú no digas nada, calladita, ellos no necesitan saber, con la boca cerrada. Keeping secrets from extended family members, teachers, friends and from our church community was confusing — but necessary.

When my sister got sick, her doctor asked questions that we didn’t know how to answer. “Does schizophrenia run in your family?” “Is anyone in your family bipolar?” “Does anyone have a borderline personality, or does anyone suffer from depression?” We didn’t have answers because we’d never asked these questions of ourselves.

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Of course, I don’t blame my family for not having an open dialogue about these mental health illnesses. Not being able to work legally in a country, to seek medical attention or to have access to health insurance creates, in a way, the foundation of life at home for entire communities of immigrants. Add a language barrier and you have the perfect example of why communities like ours don’t seek help.

Here are some of the questions I wish I had asked when I heard stories about my family as a kid, “¿Cómo es que mi abuela rezaba el rosario ocho horas al día?" “¿Cuándo se enfermó mi tía?” These questions came too late, of course, and hearing the answers was just as tragic as my sister's current inability to grasp her own time and space.

However, perhaps the bigger question is, if we had asked those questions and if we knew the real answers to those questions, would my sister have stayed away from psychedelics? And even if she had, would she have still suffered a psychotic break?

The debate on this question is varied. For example, one study published by PLOS ONE, Psychedelics and Mental Health: A Population Study, concluded, "We did not find use of psychedelics to be an independent risk factor for mental health problems." The debate, and my skepticism, is about dependent risk factors, such as mental illness as a genetic trait. It reminds me that "correlation does not equal causation." In other words, people in the study did not suffer prolonged mental illness after trying psychedelics, but that does not mean that the people in this study were all mentally sound. Some, I assume, did experience negative mental illness from having a bad trip, for instance; it was just not lasting. And if any mental illness persisted, it can't be concretely traced to the use of psychedelics.

"The design of our study does not allow conclusions about causality," Teri S. Krebs, the lead author of the study, wrote in an email to Shots, a health news publication with NPR. "However, there is a lack of evidence that psychedelics cause lasting mental health problems."

Was my sister going to suffer a psychotic break even if she hadn’t tried acid? According to the above study, yes. According to Dr. Erica Zelfand, a naturopathic physician from Portland, Oregon, psychedelics is just one of many possible triggers.

“Extended periods of sleep deprivation, major stressors such as the death of a loved one, and childbirth in women can all trigger manic states,” she wrote in a report published by Psychedelic Support. “Drugs, too, can bring on mania. This includes both pharmaceutical medications, like some antidepressant drugs, as well as psychedelics. It’s for this reason that those with a personal history or a strong family history of Bipolar 1 or psychosis (like schizophrenia) are advised to avoid using psychedelics altogether or, at least from a harm reduction standpoint, to use very high levels of caution when taking substances like LSD, psilocybin, and ayahuasca.”

In my opinion, it's a risk – a risk that, according to the PLOS ONE study, more than 30 million people have taken. Thirty million people in the U.S. have used LSD, psilocybin, or mescaline. A staggering number. I would like to see the demographic statistics of those 30 million people. How many are unhoused? How many hold steady jobs? How many of the participants have family members with mental illness?

Illustration for palabra by Jon Williams

Illustration for palabra by Jon Williams

OPTIONS FOR FAMILIES LIKE OURS

What are the options for families like ours? Those options include hoping my sister will take her meds and will be aware enough not to confront police officers. Conservatorship would be an ideal option for our family because it would appoint us as legal protectors over my sister’s affairs. We would have rights over decisions related to her financial needs, medical needs, and basic needs of her daily life. It is a confusing and lengthy legal process that varies state by state. It is something that we’ve tried to attain, with roadblocks at every turn, primarily because my sister would have to agree to it, which is something that she has refused to do in the last 22 years.

Beyond that, the collateral impacts in the family — separate mental illnesses affected by the stresses of a sibling’s schizophrenia — must be managed. Other family members suffer from conditions like depression, mood swings, bipolar disorder and manic tendencies. When my own diagnosis of generalized anxiety was described by a therapist, I felt seen. In the past 22 years, we’ve learned to manage and separate these experiences from our sister’s sickness, always noting that her diagnosis could trigger and heighten our own.

The mental illness in our family is on a continuum. It's all connected because we're family.

One of the resources given to me by the stranger in San Francisco who picked up my sister was information about the National Alliance on Mental Illness. At the time, its website was formatted like a blog. I asked about mental health treatments and whether the medication she was on would cause permanent damage to her physically.

What I found was community. I remember reading stories from other families in the same situation. NAMI, for me, created a community outside of the silence within my immediate family.

HEALTHCARE AND #FREEBRITNEY

When thinking about my sister and our family conundrum, I can’t help but think about Britney Spears and the #FreeBritney movement. Like my sister, Britney Spears is an adult, capable of making decisions about her career and adult life. Unlike my sister, Britney Spears has an entire culture of support rooting for her to get off lithium. A whole culture just learned about conservatorship because of Britney Spears' case and a Netflix special.

I hope the reasons for Spears' conservatorship don't resemble the reasons my family have attempted to attain it for my sister. I hope that she has recovered from whatever mental illness she suffers from. I know lithium and conservatorship aren't taken lightly. They aren't forced upon anyone who isn't severely ill.

Someone asked if I felt like the mental health system had failed my sister. No, it hasn't. Mental health services and programs vary in different states and counties. Sure, it can be more accessible, and it should be free, but resources do exist. More importantly, those services don't matter if my sister does not agree to participate. Without conservatorship, she can hop on a plane and end up in Europe, and none of us can do a thing about it.

GENETIC PREDISPOSITION

As I understand it, we're made up of chromosomes passed down in the birth lottery. Chronic illnesses, cancers and whether you can roll your tongue can be traced partly to your genetic code. And while things like diabetes can be managed, schizophrenia and its treatment are a lot more complicated.

My goal as an advocate for mental health awareness is to have a broader dialogue about genetic predispositions in our families. I hope there are more studies about links between hallucinogens and mental disorders. Also, I hope communities that lean into silence, like mine, will find a space to ask hard questions.

How else will we know what our genetic predisposition carries if not by asking what is in our genetic predisposition? Who is chronically sick in your family, and from what? It's an important question when your doctor is curious about your risk for diabetes, just as it should be before you try the latest trend in microdosing. ¿Quién tiene diabetes? ¿Quién tiene problemas de salud mental? ¿En cuál lado de la familia? ¿Se murió mi tío? ¿De qué?

POSTSCRIPT

I began to write this article after my family and I entered my sister into the national database for missing persons. Last night, she called me after three months of silence. She wanted to talk about poetry as if no time had elapsed. She didn’t say where she had been, or why her phone number stopped working. She simply spoke about the nuance of a stanza and the quirky way poetry is heightened by punctuation. I encouraged her to write her work on paper and she agreed. She has been inspired to start a blog, where she will share her experiences with mental illness, specifically with a schizophrenia diagnosis. I took the opportunity to tell her that I was working on this article and that I would be sharing the story of the night she got sick. At first, she didn’t think anyone would care, so I reminded her that that was exactly why we needed to share this story. People care and people need to know they’re not alone. She agreed, and immediately began sharing poems for her upcoming blog. I was reminded of how smart she is and about the tragedy of her situation.

For now, we’re happy she’s back and we hope that she stays.

More information about the National Alliance on Mental Illness can be found here. Local affiliate information about NAMI Monterey County is here and the Santa Cruz chapter is here.