“My doctor says I have the most extreme version of psychiatric diagnoses.”

That’s how I put it. Bipolar Type 1, with psychoses. I say it at the bar, over coffee, on a walk. Openly. Directly. For years.

What happens next is almost always the same: people start talking. “My brother has that too.” “My aunt was in the clinic for years.” “In our family, no one talks about that.” Sometimes they want to unload. Sometimes they want to understand. Often both.

85 percent of people with a bipolar diagnosis say, according to a 2025 Bipolar UK survey, that stigma has led them to think less of themselves. Experts in Austria therefore call stigma the “second illness.” But the first wall usually stands within — self-stigma. Angelika Klug, chair of HPE Austria, puts it clearly: the greatest concern is that those affected and their families stop devaluing themselves because there is a mental illness in the family.

I try to do my part. With openness. With my story.

What Families Actually Pass Down

For a long time I believed mental illness just “happened.” Research paints a clearer picture.

The largest genetic study on bipolar disorder (Psychiatric Genomics Consortium, published in Nature, January 2025) compared the genomes of over 2.9 million people. Result: 298 regions in the genome increase the risk for bipolar disorder. The genetic share of the risk of developing the condition is 60 to 80 percent. There is therefore a massive biological component — but it consists of hundreds of small variants that every person carries. Whether this leads to illness also depends on life circumstances: stress, trauma, loss, the quality of early childhood attachments.

What is inherited is a vulnerability. And alongside that comes what families pass on — often unconsciously, often unintentionally.

Neuroscientist Rachel Yehuda (Icahn School of Medicine, Mount Sinai) described in World Psychiatry in 2018 how traumatic experiences can have effects across generations — through epigenetic mechanisms, through attachment patterns, through what is spoken and what is silenced in families. Transgenerational transmission is now a widely researched phenomenon: traumatized parents often struggle to give their children the very security and safety they themselves needed most.

Most gave the best they could. That deserves respect.

Silence as a Social Project

In many families there is mental illness on both sides, across generations. Depression, psychosis, addiction. People know — somehow. But it’s rarely talked about.

This is more than a family problem. This society has trained itself to be silent.

In Austria, there is an additional layer. The platform kriegsenkel.at — Austria’s first platform for war grandchildren — names a taboo subject: the transgenerational psychological consequences of National Socialism and the Second World War. The war children (born 1930–1945) learned to keep their emotions locked away. Eight to ten percent of this generation suffer from post-traumatic stress disorders — many of them unrecognized for a lifetime. The war grandchildren (born 1955–1975) grew up with parents who suppressed all emotion, who carried enormous existential anxiety, and who therefore remained distant from their own children.

Kriegsenkel.at notes: the topic is only slowly entering Austria’s collective consciousness. And they name what remains unspoken in many Austrian families to this day: complicity, perpetration, and the suffering that followed for all involved.

The shame around this became a social project. The grandparents stayed silent, so the parents stay silent. The parents stayed silent, so the children believe: that’s just how it is. The Austrian Ministry of Health (GÖG, 2023) describes self-stigmatization as one of the greatest obstacles to healing. Evaluations absorbed early sit deep — and only change when someone opens their mouth.

A line from the SRF research documentary on transgenerational transmission sums it up: “It is a grave misconception to assume that silence protects the next generation.”

Speaking protects. Silence passes it on.

When Children Carry Their Parents

The DGBS (German Bipolar Disorder Association) describes what happens when parents are mentally ill and children observe the behavior without being able to make sense of it: children assume that the parent is angry or sad because they themselves did something wrong. This leads to what is called parentification — children take on a role that gives them responsibility while simultaneously overwhelming them.

The DGBS writes: With active engagement with the illness and open communication within the family, the taboo around parental illness and children’s loyalty conflicts can be countered. With school-age children, strategies for dealing with stigmatizing behavior from others should be developed.

That is the core. Talk. Name it. Give it context. For the children. For the parents. For everyone.

What Openness Triggers

Dr. Gabriele Schöck, a physician who is herself affected by bipolar disorder and head of the DGBS division “Professionals with Personal Experience,” writes about shame: the “lid” on shameful secrecy blocks self-acceptance and therefore healing. Shame is changeable — but through contact with others. In the group, she describes, participants move in “collective nakedness” — and suddenly it becomes clear that the stories of shame belong to the medical history, not the person.

The DGBS describes the experience of many people when they come out: in most cases, when the topic comes up, you hear “Oh yes, my brother / my niece / a friend has that too.” The world is full of people living with mental illness — in their own families, among their friends, within themselves. It’s rarely talked about.

I experience this constantly. When I say openly what I have, a door opens. Sometimes out of curiosity, sometimes out of compassion, sometimes because someone finally finds a space where their own story fits.

The Shadow Side of Openness

This must be said: openness is not a cure-all. And it can also reinforce stigma.

There are people who, from the moment of the disclosure, read everything through the diagnosis lens. You’re angry — “he’s bipolar.” You’re enthusiastic — “he’s manic.” You have an opinion — “he can’t help it.” The diagnosis becomes the filter through which everything runs, and the person behind it disappears.

There is the excuse — my own, honestly. Moments when the diagnosis has to serve as explanation for behavior that simply required taking responsibility. And there is the other person who holds back, thinking: “Better not challenge him.” Both are stigma. Just from the inside rather than the outside.

And there is the projected lens. For years I was convinced that family, colleagues, and friends saw me through the diagnosis. I assumed they reduced me to it. Until I asked. The answer was: “We know you as we know you, including your quirks. That’s fine.”

The stigma was mine. I had put it onto these people.

Openness without responsibility can reinforce stigma rather than reduce it. I spent a long time in the victim role — the diagnosis as identity, as an explanation for everything, as a shield. The way out was experience, step by step. Today I stand at around eight out of ten on the scale between victim and responsibility. I believe the goal is neither one nor the other. The goal is the middle. Peace.

What We Can Do Together

In Austria there are structures for this work. HPE (Help for Relatives of People with Mental Illness) offers counseling, self-help groups, and the project “veRRückter Kindheit” for children of parents with mental illness. The association omnibus in Bregenz is a platform by and for people on the path to mental wellness — with peer counseling on equal footing. The Austrian Ministry of Health’s expert group on destigmatization presented over 100 recommendations in 2025.

And then there is the simplest and hardest thing of all: talking about it. In the family circle. Over coffee. At the bar. At the kitchen table. With your own children, age-appropriately and honestly.

We are the product of history — and every conversation about it continues to write that history.

By René Jochum and Claude (Anthropic). License: CC-BY-4.0.