Author Grace Cho on Her Mother Developing Schizophrenia at Age 45

Author Grace Cho on Her Mother Developing Schizophrenia at Age 45

Author Grace Cho Shares Her Mother's Story of Developing Schizophrenia at 45: 'I Was Terrified'
The sociology professor hopes her experience with her mother's mental illness, told in her memoir Tastes Like War, will contribute to the push for better treatments
By
Sandra Sobieraj Westfall

Published on January 27, 2022 

PHOTO: MARY KANG


A few years back, College of Staten Island sociology professor Grace Cho approached her mid-40s with trepidation.


Her late mother Koonja had been 45 years old when she began exhibiting symptoms of schizophrenia — paranoia, withdrawal, hallucinations — and, given the role of genetics in mental illness, "I was very worried as I was going through peri-menopause because I was aware that that's when it happened for my mom," Cho, now 51, says in an interview for the new issue of PEOPLE.


"One night, I had this incredibly vivid dream that I was hallucinating and that I said to myself in the dream, 'Oh my God, it's happening now, it's happening to me.' And I woke up in a cold sweat. I was terrified."


"I'm past that point now, and so I'm no longer vulnerable and I don't worry anymore. But there were a couple of years when I did wonder if I might start to experience [schizophrenia]."


Cho, whose memoir Tastes Like War is about her reckoning with Koonja's illness and the social factors that left her vulnerable and the stigma that kept her from treatment for so long, was a 2021 National Book Award finalist that she hopes will help other mothers and daughters.



"We know now that, with schizophrenia, there is a secondary peak in onset among women that usually coincides with peri-menopause," says Cho.


"And there's been a lot more research in the last 10 or 15 years that looks at social risk factors and argues that schizophrenia is a social disease, as much as it is a biological disease. There are a number of things where I wonder how my mother could have been helped had we known all of this then."

Early Trauma, and Trying to Fit In

Koonja was Korean, born under Japan's imperial rule and system of forced labor. By age 9, she was a war refugee who survived starvation, Cho says. And in 1971, Koonja was the 31-year-old bride of Grace's father, a merchant marine, when she arrived in the United States from Busan, South Korea, with Cho and Cho's older brother. The family settled in rural, predominantly white Chehalis, Washington.


As a young girl, Cho knew her mother to be "talented, daring and vivacious" in a place where Cho recalls her family facing racial harassment — offensive racial slurs and bullies who taunted by pulling their eyelids into slants. Koonja insisted on speaking only English, which she taught herself from the dictionary, and on learning to bake a perfect apple pie, Cho says. "There was a time when my mother believed she'd be able to melt into the homogeneity of my father's hometown."

Grace Cho and her mother Koonja in Busan, South Korea in 1971. COURTESY GRACE CHO

Koonja was so intent on giving her children every advantage at school that, when Cho started kindergarten, her mother began an annual tradition of throwing a posh cocktail party for the entire school faculty.


"The crowd was thoroughly intoxicated," Cho writes in Tastes Like War. "She had dazzled my current teachers and principals—as well as my future teachers and principals—with a generous supply of food and drink, served with a dash of flirtation ... my mother's magnanimity, her delicious food, her seductive charm."


Then in 1986, when Cho was 15, Koonja began lashing out at the neighbors she once courted with cocktails and pie.


"She'd say they were following her, persecuting her. One day she was dressed up, nervous but excited. She said people were spreading rumors that the governor was my brother's real father, and she was going to meet him so he could clear our name," Cho recalls.


"That's when I knew there was something wrong."

Service Dog Chases Away Hallucinations for Woman with Schizophrenia: 'Life Seems Possible'


Cho says she scoured her high school library's psychology textbooks for the diagnostic term for what she was then seeing in her mom—paranoia, withdrawal and arguments with invisible people—but her family didn't want to hear it. "My father was angry I thought my mother had schizophrenia," Cho says.


Cho fared no better when she looked for help at a local mental health clinic. Because psychiatry at the time understood schizophrenia to present in men in their late teens or early 20s, and women in their 20s and 30s, a counselor at the clinic presumed Koonja had already gone untreated for years, telling Cho: "It's too late. Maybe if you had caught it earlier we might have been able to treat it."

Grace Cho and her mother Koonja at Cho's high school graduation in 1989. COURTESY GRACE CHO

Lessons Learned

Cho says Koonja was finally diagnosed and began treatment in 1993. She died of a heart attack in 2008 at the age of 66. And Cho, whose doctoral dissertation at CUNY Graduate Center was on the long-term trauma of the Korean War and U.S. military presence on Korea's women, has wondered ever since how the ghosts of her mother's early life may have contributed to her illness — and also held the keys to treating it.


"Nowadays we talk about trauma-informed therapy, but I'd never heard that term until pretty recently. I think there were a number of things that could have helped my mother. But as far as preventing her schizophrenia, I don't know. It's a question for me, rather than an answer," Cho says.


Dr. Susan Kornstein, a psychiatry professor at Virginia Commonwealth University School of Medicine, says childhood trauma and sexual abuse as well as "social exclusion, isolation and discrimination are risk factors for schizophrenia, which is thought to involve both biological and psychosocial factors."

"And there is research showing that rates are higher among immigrants," Dr. Kornstein says.


That more recent understanding of risk factors was at play when Cho worried about her own possibility of developing schizophrenia. "I talked myself through it by saying my life has been so different from my mom's. I've had so many privileges and comforts that she didn't have, so that a lot of those traumas that are part of the social risk factors don't apply to me."


Cho also looked toward promising developments in the use of estrogen therapy to treat schizophrenia.

Grace Cho (at home in Brooklyn, N.Y. Jan. 16) shows her son Felix (right) and stepdaughter Bella the bracelet her mother gave her as an infant and the jewelry box she brought from Korea. MARY KANG
---

As Dr. Kornstein explains: "Estrogen exerts neuroprotective effects against psychosis. This could explain the lower incidence of schizophrenia in women of reproductive age and the increased incidence in middle-aged women as estrogen levels decrease during the menopause transition."


The link between estrogen levels and psychosis is also observed in some women with schizophrenia who show a worsening of psychotic symptoms around menstruation as well as during the postpartum period, both of which are times when estrogen levels decline, Dr. Kornstein adds.


Estrogen therapy shows promise as an adjunctive treatment to antipsychotic medications for post-menopausal women, the doctor says, but more research is needed.

Author Esmé Weijun Wang On Living With Schizoaffective Disorder


All of this, Cho says, helped mitigate her terror when she awoke from her nightmare in that cold sweat.


"Because I'm very knowledgeable about schizophrenia now, I knew how to talk to my family about getting help for me. And I said to my husband, 'If you start to notice any of these signs, I want you to insist that I see a doctor.' And I said, 'I want to try estrogen treatments immediately.' "


She's also learning to make peace with what psychiatry didn't know when her mother needed it most. "It could have changed my mother's life. My mom could have had a much better outcome because it took so many years for her to get to a place where she was less troubled, and that was only towards the end."


"I still have moments of han — that Korean sense of unresolved grief and injustice," Cho says. "But that's not necessarily a bad thing because it's been the underlying force in my work towards social justice."

====