While You Were Out: An Intimate Family Portrait of Mental Illness in an Era of Silence

“So, she acquiesced, taking her chances that this marriage, beginning on the shakiest of grounds, might somehow turn out all right.”

Assuming Jean’s point of view, Kissinger explores her mother’s troubled life—the result, in part, of her sometimes volatile and often unstable marriage with Holmer. While they were deeply committed to one another, Jean and Holmer both had mental illnesses that affected their relationship with each other and with their children.

“Tigers! Sister knew about the tigers. What did she know about my mother? I was starving for answers. Where was my mother? Why did she leave us? When was she coming home? She was coming home again, wasn’t she?”

When Kissinger writes about her early years, she captures the panic and confusion she often felt when she was young and did not understand what was happening around her; here, a series of unanswered questions create a tone of escalating panic. Her mother’s unexplained disappearances and the resulting trauma for the children illustrate the dangers of concealing pain.

“The Holmer of that era seemed to all the world like he held the keys to the kingdom in his back pocket, and, if you were lucky, he’d let you in, too. His go-go can-do spirit intoxicated nearly everyone he met, particularly his customers.”

Throughout her memoir, Kissinger describes each member of her family in succinct detail, both celebrating their strengths and acknowledging their flaws. Holmer was a charismatic and charming man, who despite his often-violent moods, captured the hearts of everyone he knew. Kissinger draws on a classic cliché to emphasize Holmer’s persistent optimism and hardy spirit, developing his character in a well-rounded way that reminds the reader that he was more than just his mental illness.

“I remember hearing Grandma snore in the next room while her false teeth soaked in a glass on the bathroom sink. Or do I? This sounds like a cartoon. These flourishes are a little too tidy. It can’t really have happened that way. But, as I strain to fill in the blanks, that’s the way I remember it.”

Kissinger acknowledges the ambiguity of memory, admitting that her memories of parts of her life, particularly those parts that were difficult and confusing, could be foggy or skewed at times. She wrestles with memory’s unreliability, questioning a memory that seems “too tidy” to be real. Ironically, in doing so she adds to her credibility by admitting she may be wrong.

“My mother began viewing us with increasing dread, as if sensing that something awful was heading our way and there wasn’t a damn thing she could do to stop it. In time, we each gave her plenty of reasons to despair.”

Kissinger explores her mother’s perspective during Kissinger’s own childhood, describing the brushes with death that she and each of her siblings experienced in the early years of unsupervised play. Jean’s attitude, as Kissinger interprets it, foreshadows the future tragedies she and her siblings will face. She also struggles with the fact that her mother knew there were problems but did nothing, demonstrating once again the dangers of concealing pain.

“If I had my way, I would have preserved us all in amber at that sweet spot of 1970 with the jazz of our family life thumping throughout the house.”

In a single sentence, Kissinger uses two metaphors that provide imagery and a poetic expression of the way she feels about her family and those precious early years. She uses the image of preserving the period in amber as a way of indicating her wish to keep it forever the same, while the reference to their family life as “jazz” indicates both its complex energy and its unpredictability. Even as a child, she feared what would happen when the family started to break apart as she and her siblings grew up.

“There are only so many empty chambers before the one with the bullet fires.”

In reflecting on the years that led up to Nancy’s suicide, Kissinger recalls all the incidents that could have resulted in the death of herself or one of her siblings but by sheer luck did not. With the reference to a gun’s empty chambers and one bullet, she connects the situation to Russian Roulette, a game of chance in which all but one bullet is removed from a gun, and the participants take turns pointing the gun at their heads and firing. The metaphor illustrates both the inevitability of an eventual tragedy and the random nature of who would end up being the victim.

“Well, shit, Nancy said and closed her eyes again. Then she started to cry, not because she nearly died but because she didn’t.”

Kissinger’s brutal honesty in retelling her family’s history is most evident in her descriptions of Nancy’s mental illness and eventual suicide. After learning about the dangers of concealing pain, and how it can damage a person and a family, Kissinger resolved to tell these events exactly as they occurred and to stay true to the harsh reality of Nancy’s mental state.

“My thoughts were racing, too. What should I wish for? That she survives yet again or that she is finally out of her misery? These last five years had been especially tortuous for Nancy. She seemed so sick, like an end-stage cancer patient growing weaker each day.”

Kissinger compares Nancy’s mental illness to cancer to illustrate its severity: No matter what treatment she received or how her needs were met, Nancy was on a course that had only one possible direction and outcome. In part, this was because of a lack of proper care, and in part because the family refused to address the true reality of the situation. The comparison also speaks to Kissinger’s project of Humanizing Mental Illness and Improving Care, as physical illnesses like cancer are not typically subject to the same stigmas as mental illnesses.

“The truth was a lot less Holy Bible and a lot more holy shit.”

Throughout the memoir, Kissinger’s edgy and off-beat attitude comes through in side comments like these. Her dark sense of humor, something that her whole family shares, is especially evident in her commentary on the way her sister’s casket had to be unearthed and reburied due to a burial error. These moments of humor, however dark, offer an opportunity to step outside the emotionally fraught history of her family.

“I wasn’t Nancy. I was different. Yes, I was emotional, and I felt things intensely. But that didn’t mean I was destined to end up like she did. If I could take on these authority figures, challenge the status quo, arm wrestle a radio announcer, and stand up to a misogynistic army officer, I could get past a ‘case of the blues.’”

As Kissinger grew up and found the inner strength to reflect on her past and her fears, she realized that she did not need to go down the same path as her sister, even though they were from the same family. Here, she reminds herself of what she has accomplished, her sense of resolve, and her persistence in fighting against what she considers wrong and knows she can overcome whatever else may come her way. She also recognizes that although family history may have played a part in her sister’s mental health condition, it doesn’t mean that she is destined for the same outcome.

“I’m pretty sure we didn’t have a full deck of cards in the house, a metaphor lost on no one.”

Throughout the memoir, Kissinger uses well-known clichés, adding relatability and humor to dark and difficult subject matter. In this case, she refers to the common idiom of someone with mental illness as “not playing with a full deck.” Although she takes the issue of mental illness very seriously, she also uses humor to address challenging topics.

“From the look of terror in Danny’s eyes as we exited the church, I could see then that he would never shake off the shame of his cruel hoax, not that day, not ever.”

Kissinger foreshadows Danny’s slow deterioration, which she feels began when he began harassing a Jewish man. Danny grew paranoid about the negative media attention and stopped leaving home, and while she loved him, she was never able to help him. This is one of the primary reasons why Kissinger stresses the need to humanize mental illness, as she believes Danny’s story, as presented by the media, didn’t represent his true, complex humanity.

“If she wasn’t thinking clearly, why hadn’t the doctors and nurses paid more attention to her? Steroids are known to increase the likelihood of suicide, especially for patients like my mother, with a history of depression and anxiety. They should have been watching her more carefully.”

During the mid-20th century, psychiatric care was undergoing a massive transformation and was still fraught with problems like a lack of quality care and patient neglect. In this quote, Kissinger reveals her outrage at the treatment her mother received during these years. This issue, and her personal connection to it, is one of the reasons she has devoted her professional life to writing about the importance of humanizing mental illness and improving care in mental health facilities.

“The three of us stood there in a kind of a glow. We felt no anxiety, no tension or sorrow. Just peace, like we had been midwives, ushering our mother gently out of one world and into another.”

Kissinger describes the peace surrounding the moment of Jean’s death. Because she and her sisters were together and Jean was in a calm state, her mother was able to die surrounded by love and comfort. Because of her family’s belief in an afterlife, saying goodbye to Jean was less painful, seen as a transition and not an end.

“Danny was searching for a way to explain his behavior that he thought would make him more sympathetic. He grew up watching Nancy and Jake and my mother suffer from their depression and anxiety, and he was frantically trying to come up with an alternate explanation for what was happening to him.”

Like Kissinger, Danny also feared that he was like Nancy, but to a more severe and debilitating extent. Although Danny was diagnosed with bipolar disorder, he denied having it and insisted that his problems were the result of a diabetic issue instead. Although frustrated by Danny’s avoidance, Kissinger understood it because she had the same fears.

“Why are people with serious mental illness so misunderstood, and how can we treat them better?”

Throughout her journalism career, Kissinger used her Loss and Hardship as Vessels for Purpose that catalyzed her exploration of mental health by driving her to ask important questions and spread awareness. In both her own family and those she met during her investigation, Kissinger discovered that people with severe mental illnesses are stigmatized, mistreated, and ignored. Her own experience motivated her in her mission to destigmatize mental health discussions in the hopes of humanizing mental illness and improving care.

“As I traveled across the country, I discovered how my family’s struggles were eerily intertwined with pivotal moments in the history of America’s fractured mental health system.”

Over the course of her work on this memoir, Kissinger realized that her family’s experiences and the tragedies that they went through were not exclusive to her family nor caused solely by internal forces. Instead, larger societal issues, including a lack of adequate funding and attention toward mental health, also played a major role. By contextualizing her own very personal story in the larger picture of “America’s fractured mental health system,” she makes her story more universal, one that could apply to many families.

“Here were hundreds of the county’s most vulnerable people living in dirty, dangerous hovels, ignored by city and county workers alike.”

Long after the fact, Kissinger is still haunted by the horrors she discovered while investigating the state of mental health care in Milwaukee. The dehumanization of people with mental illnesses remains a significant social issue with devastating ramifications. Her journalistic endeavors, as well as her memoir, are an attempt at humanizing mental illness and improving care.

“I was on the journalistic roll of my life, doing what Danny had challenged me to do—putting human faces on mental illness and daring people to look away.”

Kissinger’s belief in humanizing mental illness and improving care comes from her own experiences and those of her family. She highlights the role of her personal life and family in her investigation by referring specifically to Danny, who had “challenged” her to do it. She also explains her approach, in which she is “daring people to look away,” indicating a confrontational model that forces society to face the terrible results of the shame, fear, and stigmatization of people with mental illness.

“With both of our parents now dead, my siblings and I knew that we would need to make an extra effort to stay connected.”

After Jean and Holmer’s deaths, Kissinger and her siblings came together like they never had before. They realized that they could no longer rely on Holmer to take care of Jake or on their mother’s comforting presence. However, she also shows a continued sense of them as a family, a collective, with the word “we” and with the indication that they all recognized the need for “extra effort” and were willing to make it.

“No one wants to be held behind a locked door or forced to take medication that makes you groggy. But when should a person’s right to autonomy yield to their safety or the safety of others? These are not easy questions to answer, if there are any answers at all.”

In thinking about her brother Jake, whose depression worsened after Danny and later Holmer’s deaths, Kissinger considers the double-edged sword of personal autonomy and the safety of others. She emphasizes the severity of the required treatment with specific examples of freedoms taken away but then balances it against the issue of the safety of the patient and those around them. She highlights the difficulty of this balance through this example and her struggle to answer these difficult questions.

“Then there was the real gut punchers: Had we done enough to help each other? Do you ever worry that we might be doomed by our genetics? What trauma or mental illnesses might we have passed along to the next generation?”

While writing her memoir, Kissinger had difficult conversations with her siblings about their past and about the effects that growing up with mental illness had on each of them. Even though they have healed, there are lingering fears and burdens, like worrying about future generations and about the possibility of how their own mental states will change with age. Their family legacy also involves a grave and unavoidable sense of responsibility, and Kissinger knows this better than anyone.