Hidden Valley Road tells the fascinating but tragic true story of the Galvin family from Colarado. The parents Don and Mimi were both born in 1924 and were married in 1944. The births of their 12 children followed in quick succession between 1945 and 1960, with 10 boys coming first, followed by 2 girls. Remarkably, six of the sons would go on to develop schizophrenia, with devastating consequences for each of them and for the entire family.

The Galvins were initially the epitome of the American dream, being upwardly mobile, hard-working, educated and ambitious. Don had an accomplished military career. Local newspaper articles celebrated Mimi for raising their huge family with apparent ease and success. It was a picture of domestic harmony. But as with some seemingly happy stories, all was not quite as it seemed, and then it got much worse.

If a work of fiction contained murder, suicide, rape, incest, infidelity, extreme violence and severe mental illness all under the roof of one household it might be dismissed for going too far, but when it is all contained in a true story it is in equal parts compelling, shocking, distressing and ultimately uplifting.

Sometimes, the more perfect the outward façade of a person or family the more likely it is that they are compensating for darker secrets and perceived failings. Such was the case with the Galvins. While the marriage of Mimi and Don was less than perfect the main story begins with the perceived failings of Mimi as a mother, how her efforts to present the perfect family belied a more chaotic, dysfunctional and often violent reality. Here we get front row seats to the devastating effect of the then new and entirely spurious theory of the schizophrenogenic mother.

The story builds flawlessly, never missing a beat or detail. The reader is never lost as it charts the course of this family. In fact, to help orientate the reader, Kolker employs a useful device throughout. At the beginning of each chapter he lists the entire family and highlights in bold those individuals who will be featured in that particular chapter. He therefore moves up and down the family, highlighting in detail their individual stories and how their experiences are ultimately intertwined.

Books like this are sometimes written to be primarily voyeuristic, with equal parts sensationalism, exaggeration and misplaced outrage (often at the expense of psychiatry), but not in this case. Hidden Valley Road provides a fair and measured account of the difficulties faced by all who were impacted. The failings and triumphs of family members and psychiatry alike are dealt with by using a compassionate understanding of the limitations of both people and science. Therefore, Kolker does not try and apportion blame but rather goes to great lengths to understand and explain the actions, words and intent of the people portrayed in this story.

Intertwined with the personal narratives are two more stories that will possibly be of equal interest. Firstly there is the tale of psychiatric treatment. As the decades progress we are given a front row seat to the changing treatments for major psychotic disorders, the personalities behind competing treatments and the inevitable conflicts between them. We see the rise and fall of fads and charlatans until a treatment regime that is most familiar to us now rises from the debris.

In parallel to the story of treatment is the race to discover the possible biological cause of schizophrenia. The decades long search by researchers for a genetic cause dovetails with the story of the Galvins on a number of occasions as the family themselves become a source of hope that a cause can be found. Indeed the Galvin family’s own unique genetic code has been used in many of the foundational genetic studies in schizophrenia. We are introduced to these pioneers and their research as they visit the Galvins in their home or when the Galvins journey to their laboratories with hopes that their contributions will give rise to a cure to the disease that has laid waste to their family.

The stories of the Galvin family members unaffected by mental illness are equally well represented, illustrating the often overlooked but very significant impact of major mental illness on families and carers. Kolker therefore gives us a reminder that it is ultimately families and not psychiatrists who look after people with schizophrenia.

Kolker spent 10 years exhaustively researching this story. Every living member of the Galvin family was interviewed. The candor of their testament is startling and humbling. The famed schizophrenia researchers whose stories intertwined with the Galvins were nearly all interviewed. Ultimately, because of his detailed history taking and scientific research, Kolker’s understanding of schizophrenia is truly impressive. He manages to tell a complex story with an ease and clarity that makes it accessible and useful for both the general public, for anyone with an interest in mental illness and for anyone who works with patients and their families and carers.

While it is generally a riveting read, at times detail on family interactions seemed to drag and seemed to be included to prove the undoubtedly herculean research effort involved in producing this book. However, this is a very minor criticism of what is undoubtedly an excellent book.

This may be the psychiatrist in us but we would have liked more detail on the course of symptoms of the brothers and their at times changing diagnoses. However, Kolker’s description of symptoms and behaviours is truly impressive, highlighting the often changing nature of schizophrenia presentations.

Mental healthcare professionals from all disciplines and at all levels of training and experience are likely to benefit greatly from reading this book and we highly recommend it as an educational resource. Readers will learn from Kolker the importance of detailed history taking, careful descriptions of mental state and behaviour and the importance of describing and interpreting family dynamics.