“Prodigals” is a Uniquely Appalachian Story of Mental Illness, Loss, and Grief

In the Biblical parable of the prodigal son, a son asks his father for an early inheritance, leaves home, and quickly spends it all on “riotous living.” Destitute, the son resolves to return home, where he figures he might beg his father for a job. Instead, much to his surprise, the prodigal son is met with joy and abundance. “Let us celebrate with a feast,” the son’s father says, “because this son of mine was dead and has come to life again.” 

For Sarah Beth Childers, author of memoir-in-essays, Prodigals: A Sister’s Memoir of Appalachia and Loss, this parable wasn’t as much a lesson as it was a reflection of her reality; her brother, Joshua, who died by suicide at the age of twenty-two, was, in life, the embodiment of a prodigal son. The symptoms of Joshua’s severe mental illness meant that he often left home, leaving his family to wonder when—or if—he would return, and what state of mind he might be in when he did. 

In Prodigals, Childers captures an angle of the prodigal son story that is undertold: what it is like to be the one waiting for a return. As Joshua grows older and begins to make decisions for himself about his well being, Childers raises important points about agency when seeking or refusing medical intervention and about the ways that historic beliefs about mental illness have seeped shame into the present. She writes movingly about the difficulties of obtaining meaningful and compassionate care for mental health in the U.S., a thread complicated by her family’s generations-long tenure in Appalachia, a place where distrust in modern medicine runs deep. 

Childers and I talked by Zoom about writing out of stereotypes, intersections between faith and healing, and what it looks like to seek closure for an impossible grief. 

Jacqueline Alnes: You write about how you don’t want to feed harmful stereotypes about Appalachia but that you also felt pulled to tell your story of your upbringing there, which, in some ways, does intersect with those stereotypes. What was navigating that tension like? 

Sarah Beth Childers: That tension was everywhere. I had to have the freedom to tell my story, so I had to just say out loud that I have a fear it reinforces stereotypes but also know that there are ways it doesn’t fit. I talked a few days ago to a writer named Kami Ahrens who edited The Foxfire Book of Appalachian Women. She wrote about trying to move past the stereotype of “poor, white, and stubborn,” and I was like, well, that’s me and my family. I had to think about what is Appalachian that you would think of my family, like that desire to leave twinned with the desire to stay. And then I had to think about things that are inevitably Appalachian in a sad way, like not having access to medical care because we were in the middle of nowhere, a resistance to medical care because of historical trauma around medicine and also not having access to it, and intense religious faith. 

Human beings themselves, though, defy stereotypes. My mom was a fundamentalist but also a feminist —she’s absolutely for women’s rights and for women’s role in the church and marriages. If you were just to think of a stereotype of a fundamentalist, intense, Christian mother, that would not be what you think. There are some little things that were me pushing back against stereotypes. Both of my parents had college degrees, we were lower-middle class but we were hyper-aware of class stratification. 

JA: Appalachia feels like a difficult place to write about because there is such a charged expectation around it, it seems.

SBC: It is. I have a student, who’s a really great student, who’s now in a PhD program, and she’s an Appalachian writer who grew up queer, and upper-middle class with professor parents and someone on her thesis committee was like “add more broken down cars and dirt and bring in the stereotypes” and she just had this look on her face, like that would be fake. It would be like someone from Michigan trying to write about it. There is this expectation, and this Appalachian aesthetic, which I remember learning about through photography. It’s the landscape in the background and a zoomed in emphasis on dirt, which I realize I totally do. It’s an Appalachian way of looking, which is interesting. 

JA: You were raised attending a fundamentalist Christian school. In ways, this upbringing seems like it meant you felt isolated at times, but in that isolation you drew near to your siblings. And clearly, from the beautiful way you interpret the story of the prodigal son—as a metaphor for your own relationship with your brother, in the riotous joy that you think the son must have felt at times—religion might have also offered a way for you to narrativize really complex relationships.  How did the story of the prodigal son help you to reckon with loss? 

SBC: I went to church with my mother-in-law and the pastor was preaching about the prodigal son and I took it personally, as if he was talking about my brother. It felt too close to home. My mom had always talked about Joshua as the prodigal son and that’s literally the way my family coped. It seems like it’s a metaphor, but it really isn’t. “My brother has gone to the feet of the Father” was said in a literal way. The metaphor was thinking about the prodigal son at home and thinking about riotous living in different ways, both with “riotous” as in terrible and as in happy. That definitely helped me cope and helped me process.

The elder son in the parable ends in this very grumpy, unsettled way, I adore that. There are so many Bible stories or parables that end this way, like Jonah, sitting on a hill, raging at God and being grumpy about this dead plant. I love how angry people often are. It’s not this joy feeling at the end of stories. You don’t know, for example, if the prodigal son’s older brother is ever going to talk to his father again or his brother; it seems like he might just leave. It helped capture the grumpiness I felt in my grief and the very collective grieving I felt with my family, but also this isolation in that I was grieving in a slightly different way. 

A thing that was also helpful was looking at mental illness portrayed in the Bible, like the demon possession. Of course, it is literal demon possession in the Bible, but the way they describe the people sounds so much like severe mental health disorders. It was interesting to read medieval accounts of mental illness and how they were treated as demon possessions, probably because of how it was portrayed in the Bible, and then thinking about these stereotypes around invisible disabilities. Every day was a prodigal son day when my brother was having trouble; it was like he left us and would come back, leave us and come back, and we never knew how fully he would come back. Having that cultural language to map that onto was really helpful. 

JA: When I think about the story of the prodigal son, I so often only really consider the titular character. But, in your essays, you ask us to think more closely about who is left behind waiting for the son to return, and what it looks like to be among those hoping for the son’s safe return. When your brother was young, you wanted to be there to fill his every need, but as you got older you realized you had to separate yourself in some ways, while still wanting to care for him.

SBC: That was really painful. I would have moments where I would try to step in and fix things for him before realizing it wasn’t possible. When Joshua was in college, he had this roommate who stole from him, so Joshua called me and told me how awful it was. I told him I’d call the RA, because changing rooms is something that happens all the time. We can fix this. But he was like, Sarah Beth, I think he’s starting to like me. I realized that sometimes there’s nothing you can do, especially when people are growing up and getting their own agency. There were cultural forces that he couldn’t do anything about but there were things he did choose. Like he was living in Huntington and decided to smoke weed instead of talking to people about his mental health. I mean, he was a kid; you can’t blame him for it—I don’t blame him for it. There’s a grief of people growing up, like your little sibling who you’ve infantilized becoming a complex human being, and realizing there are problems you can’t fix.

JA: Mental health and the stigma around receiving help can be fraught in any situation, in any place, and in any family, but you write so movingly about how your home in Appalachia, in particular, meant that options felt limited. Would you mind sharing a little bit of your perception of how place—and the history of place—intersects with beliefs about healing?

SBC: In a shorter term way, I was thinking about how, like probably every family, the generations of mine tend to repeat what happened. My great grandmother was given up for adoption at three years old and taken as a farmhand. She had to make biscuits for farmers at three years old. It’s difficult for me to think about that life for her. My Granny, even though they had left that situation, felt from a very young age that she had to take care of herself, so she got married at thirteen to get out of the house. My Granny had paranoid schizophrenia. The way that ended up being best to cope with her was to give her space. She didn’t want to take medicine and the only option was to institutionalize her, which was not going to be a good situation. My mom fought to keep her out of there and take care of her at home. My mom had to be a committee for her so she could get signed up for disability and get to take her ex-husband’s retirement money so she could live comfortably in this little house. What was most comfortable for everyone was for her to live alone in a little house; she would have been miserable around other people. She needed her routine—waking up at 4am, reading romance novels, making clothes for us, and smoking her cigarettes. She just needed groceries brought to her and her bills paid. There was that. We grew up with this grandmother who might, when we showed up, literally push us out the door or scream at us, or greet us really warmly. She was so funny—funny in a way that nobody else was funny. She would talk about anything and she had whiskey and a gun. She would have us watch a dirty movie to learn about life. If she was happy, every line was a joke. We had seen how mental illness could be coped with: hide it, give the person space, and hope it will get better.

With Joshua, especially because of the stigma, for my mom, it was a lot of these things: hoping if he got closer to God it would go away, and thinking, what if he outgrows this and gets better? Obviously it did not get better. We had so many fears: What if he goes to prison? What if he kills someone? Him going to the Father was better than that, in some ways. No one was happy he died by suicide, but it was such a hard situation that there were worse alternatives, almost.

JA: It’s a story that highlights the impossibility of being mentally ill in this country. It’s so difficult to find a space where someone would want to go live and be and be treated. The lack of care in Appalachia and the way you highlight the heightened rates of suicide in Appalachia in your book, mental illness or not, was really sobering to read. 

SBC: Something that was healing to realize is how pervasive it is in the culture and almost how inevitable almost that he would die that way, especially with the particular illness he had, where the suicide rate is so high. And then, being in Appalachia where the suicide rate is even higher, it just felt like, what else could have occurred? Is there a point in feeling guilt or figuring this out? I feel like part of my book was figuring out that there is truly no one to blame—certainly not him, certainly not my family. It’s just so hard. It feels like it’s so much bigger than us. Hundreds of years of culture contributed. 

JA: With grief, so often you want this idea of ending or closure that never comes. In the Prodigal Son parable, there is this sense of jubilance when he returns and everyone is whole, for at least a little while. Reading your story, it seems like you’ve arrived in a different place than you were years ago, but there’s not a real sense of closure, which makes sense. What advice would you offer to people searching for that closure or seeking to understand who they are now?

SBC: In terms of suicide, specifically, it is definitely about letting go of the guilt, which is a hard part of the process. There are these immediate things, right after you lose the person unexpectedly, especially someone who chose to leave you, that happen, like a movie would come out or a song would come out and I would be like, if only he had known about this coming, would he have stayed for a week? Fortunately, your brain quits doing that, because it’s so exhausting. 

Talking to other people and seeing that you can make it past it is meaningful. There was this kid who only knew Joshua a little bit, but his brother had died in a horrible car wreck five years before that and he came to the funeral just basically to say, look at me, I am alive. It was such a gift, and I remember thinking that. My sister had seen him years later, randomly, through a window while walking to school, and he was dancing while cooking. She realized: he’s okay. 

To me, there are things that feel like higher forms of grief: you can lose much more of your family, there are wars, and there are worse things that can happen to you. For my parents, losing a child is worse. I hate to rank grief. I think about in War and Peace when Pierre thinks about having painful shoes when he was rich was almost as bad as the real things happening to him now, just because of how much he changed as a person. You can never judge people on what they’re going through and how bad it is for him.

JA: The grief you were in prompted you to seek care for yourself, where you accepted medication while still holding onto your faith. 

SBC: I had this very specific kind of depression when my brother died. It was severe. It wasn’t the first time I experienced it. I talked about, in my first book, being in love with this man on the internet, which happens to a humiliating number of people. It was such a source of shame. I had written him these long emails and broken myself over him, but had never met him. He only lived fifteen minutes away and I remember reading Sense and Sensibility and reading about how Willoughby is always hiding in shop windows, trying to get away from Marianne. I thought he must have been doing that to me. I had a severe bout of mental health issues at that time, and had I taken Prozac or something I probably would have bounced back from it faster. Like I did when my brother died, I got super thin, lashed out at people, and hurt my relationships with people. I had this particular trauma-induced depression, where it’s not something I cope with on a daily basis, but a bout of it was induced. When my brother died, it triggered it. The shock of it drains all of your serotonin, and learning about the science behind grief helped me. I really had to build my stores back up with the medication. I did think at the time, maybe if my brother had tried medication, maybe it would have helped something. And I thought: I have to try. I want to live. I couldn’t live and I want to live. I developed the tools to deal with my own grief-induced depression and now I know there are things I have to do personally to survive, and I know that I will. 

JA: What did you take from writing this book or what do you hope others take from reading it? 

SBC: In books about suicide, I find that there’s often a little blame-iness, which I think comes from a similar feeling to what I had at first, which was that I had to figure this out. There is no one factor. It’s so much bigger than that. You have to go back to history, to place. Was healthcare available? Would they have been stigmatized if they said they needed care? You have to go back to deep that blaming yourself and other people is not useful. Experiencing the freedom of that is something I hope people can take away.