- Email: [email protected]
Divided Minds: Twin Sisters and Their Journey Through Schizophrenia
BOOK REVIEWS
of devastating illness. To readers who do claim religious and/or spiritual belief or practice, she models the use of spiritual and theological tools for expression of the countless emotions and challenges to faith that psychiatrically ill patients and their families encounter. Such tools include sacred writings, prayer, and communities of faith to which they belong. Although Greene-McCreight is writing openly from her own faith tradition, she does so in such a way that readers from other world faith traditions can appreciate the principles she is sharing and translate those into their own personal religious and spiritual backgrounds, current practices, and communities. No single reader will agree with everything the author writes in this book. Indeed, as an Episcopal clergywoman myself, I understand some of the scriptural, theological, and pastoral issues a bit differently, and as a child and adolescent psychiatrist, I would not conceptualize and explain some of the psychiatric and medical topics in the same ways. But these points are not the purpose or the gifts of this book. For clinicians caring for patients and their families, this is an autobiographical piece of one person_s experience, unique and tremendously helpful because it captures an individual_s heart and soul as few works have, and gives us a portrait of her spiritual and religious being that is too often overlooked or underappreciated in the psychiatric world. Mary Lynn Dell, M.D., M.T.S., Th.M. Department of Psychiatry and Behavioral Sciences Emory University School of Medicine Atlanta DOI: 10.1097/chi.0b013e318040b28a
Disclosure: The author has no financial relationships to disclose.
Divided Minds: Twin Sisters and Their Journey Through Schizophrenia. By Pamela Spiro Wagner and Carolyn S. Spiro. New York: St. Martin_s Press, 2005, 318 pp., $24.95 (hardcover), $14.95 (softcover). Divided Minds launches readers in a time machine through the lives of identical twins, only one of whom develops schizophrenia. Far from the Maudsley study and the usual scholarly fare pondering endophenotypes and epigenetics in monozygotic twins discordant for schizophrenia, this frequently poetic book is written in the format of a memoir. It highlights the discordant talents, liabilities, and struggles of these Ivy LeagueYeducated New England twins. The prologue is preceded by a Latin overture: Dum Spiro, Spero (While I breathe, I hope). The state motto of
J. AM. ACAD. CH ILD ADOLESC. PSYCH IATRY, 46:6, JUNE 2007
my native South Carolina, in this context it seems to imply a pairing of the classically antithetical notions of schizophrenia and hope. Is it the hope of Pamela, the talented and magnetic twin who has her first psychotic episode at age 11? Is it the hope of Carolyn, the more average twin who exceeds expectations to become a psychiatrist and dancer? Should it be the hope of the public, with their confusion and stigmas about mental illness? Or is it our hope, we who labor with schizophrenia every day, burdened with our own confusion and biases? Book One hurtles us back to 1958 and the twins_ sixth birthday, when they compete to wear the blue paper birthday crown. Pamela will long resent Carolyn for stealing her rightful crown. But Carolyn will never feel as special as Pamela, even in the throes of the latter_s schizophrenia. We travel through their development, meeting milestones in Pamela_s illness. In 1963, Pamela_s teacher recognizes her outstanding writing, but her themes are dark and murderous. Soon comes President Kennedy_s assassination, or what she calls Bthe last Friday of my childhood[ (p. 28). The assassination triggers her first psychotic episode, replete with paranoia, flights of ideas, clang associations, and auditory hallucinations. By junior high, her self-care declines. Carolyn scolds her: BLookIPeople don_t know we_re twins. If you_re filthy, they_ll think you_re me[ (p. 55). The alternating memoir is organized by months and seasons into bite-sized vignettes. The earlier sections read like diary entries, chronicling the emergence of schizophrenia in an individual and in a family. Unfortunately, the device becomes somewhat tedious by the time the sisters enter adolescence. This is largely due to Carolyn_s bland entries, but mitigated by Pamela_s more evocative imagery and sound. Cleverly, their writing develops with age. Themes and tone further diverge as Pamela_s disease wears on. The alternating of the sisters_ voices becomes more frequent and the book more engaging as life stretches and gnaws at their connection. The twins_ account is frank and spares no one. This is especially true as Pamela recalls the abuses of prior caregivers and her father. They become the casualties of her boundaryless writing. Yet she struggles with blaming herself the most: BI blame myself for all that has happened to me, knowing at the same time that I would never blame others. They are sick; I am weak-willed and evil[ (p. 243, italics in the original). Pamela allows us an inside-out view of her delusions, rage, even catatonia. She manages this with the command of a journalist, the craft of a poet, and the fullness of the person who lived it. Not entirely surprising, given that she graduated magna cum laude from Brown and is an award-winning writer; but then there is her deteriorating illness to make it all ironic and wonderful.
781
Copyright @ 2007 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited.
BOOK REVIEWS
Carolyn is the Harvard-trained psychiatrist and ballroom dancer, the pride of her father after Pamela becomes ill. Carolyn is insightful and candid throughout the book. Her writing effectively conjures the voice of the burdened caretaker, the everyman. She speaks of all the errands, thwarted efforts, phone calls, and harried driving to emergencies. She alternates between rescue fantasies and sadistic thoughts, between hating the disease and hating Pamela: BMust I always be the one to know, to help, to suffer, to bear?II am trapped between wanting freedom from you and wanting you[ (p. 310). Carolyn lives in the shadow of her twin, Bthe brilliant, creative one, the smarter, more special version of me[ (pp. 268Y269). She remains envious despite Pamela_s disease and also because of it. She speaks of schizophrenia as the ally, having Bopened a door for me[ (p. 312), but also as the crippling, inconvenient enemy. Carolyn finds her voice near the end, articulating the essence of her struggle as Pamela_s twin. She receives a call from Pamela in the hospital. Pamela describes command auditory hallucinations to kill herself by burning all her flesh. Carolyn_s description of her own subsequent dream marks her best writing. Why should this be? Is it because the dream occurred during the actual writing of the book and raw images were not softened by recall bias? Has she merely channeled Pamela_s unbounded artistry during an intimate flood of connection? Or, through dreaming, does she loose herself from sibling rivalry long enough to honestly examine it? The result is rousing prose that expresses Carolyn_s sense of invasion and conquering by her twin. Divided Minds compellingly conveys the complexities of both these lives genetically entwined with schizophrenia. But in the end, are we left hopeful? The epilogue, a denouement a` la Hollywood drama and Shakespearean comedy, seeks to tidy up the final scenes of madness and merging. Pamela nearly apologizes for her recent decompensations. Both sisters describe a resolution between Pamela and her father. Carolyn has found Catholicism, a belief in a benevolent universe, and states her hope is enough Bfor now[ (p. 312). Pamela is just trying to live Bin the nowInot overly attached to the possibilities of tomorrow,[ but admits she has found that life Bis not easy to letIgo[ (p. 316). Dum Spiro, Spero. While I breathe, I hope. For now, I believe this refers to hope, not in the form of a cure for schizophrenia, but the possibility of poetic transcendence for those living with it. The proof is in the words of the Spiro twins, as they breathe hope onto the pages of their joint venture. Erica G. Ahlert-Smith, M.D. Department of Psychiatry and Behavioral Sciences, Youth Division Medical University of South Carolina Charleston
782
Disclosure: The author has no financial relationships to disclose.
Divided Minds: Twin Sisters and Their Journey Through Schizophrenia. By Pamela Spiro Wagner and Carolyn S. Spiro. New York: St. Martin_s Press, 2005, 318 pp., $24.95 (hardcover), $14.95 (softcover). Beginning in the 1940s with Franz Josef Kallman, mental health researchers have examined the relationship between control groups of twins and twins with schizophrenia, generating much important information. This research, however, is protected by squadrons of premorbids and discordances, a wall of genetics, and by the occasional metabonomic, loci-endophenotype, and mother-baby unit. So there is something wonderful about the new treatment of the topic by the jointly written biographical account Divided Minds: Twin Sisters and Their Journey Through Schizophrenia, as though a laboratory beagle hound had been set free from his cage to race through a meadow, baying. In fact, a remarkable aspect of this book has to do with baying, or at least voices. There are, of course, the frightening voices of Pam_s illness (Pam is a writer with schizophrenia) and their distant shadows in Carolyn (a psychiatrist), the twin sisters who coauthored this book. There are also other voices of the sisters that are distinct, but constantly bleeding into one another. These voices range from childlike (BEvery time we pick up kids, the bus farts black stinky clouds[ [p. 16]), to lyrical (BThe cut-glass sky, the sparkling white of the slope so pure and wondrous[ [p. 41]) to mad (BI am a seeker, I have sought and now I see. That is, I see; I am seeking truth and seeing it, which is Holy-See-ing, a sacred pun, meaning I_d been given a nod of approval from the Vatican, the Vat-I-Can. I can see that I am at sea, that I will get Cs in all my classes, the gentlewoman_s Cs[ [p. 104]). All of these voices speak with complete authenticity, which makes this book alive and exciting to read. Of the myriad voices here, the only one that is hollow is the voice of Carolyn_s professional distance. This is understandable. She explains the need for it: BMake damned sure no one mistakes me for the patient. I_m the sister, the good sister, the married-with-two-kids-psychiatrist-and-dancer sister[ (p. 272). Her tone is the authentic voice here and speaks of torment and fear; of things that psychiatrists rarely commit to paper. Again, this is wonderfully different from the usual tone of clinical detachment. The authenticity of the voices may be painful for those who know schizophrenia intimately. Their unbridled freedom opens wounds that are then left that way. After all, Ba beagle has a loud baying cry [that] can be disturbing to family and neighbors[ (dogbreedinfo.com, 1998). In addition, an
J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 46:6, JUNE 2007
Copyright @ 2007 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited.
of devastating illness. To readers who do claim religious and/or spiritual belief or practice, she models the use of spiritual and theological tools for expression of the countless emotions and challenges to faith that psychiatrically ill patients and their families encounter. Such tools include sacred writings, prayer, and communities of faith to which they belong. Although Greene-McCreight is writing openly from her own faith tradition, she does so in such a way that readers from other world faith traditions can appreciate the principles she is sharing and translate those into their own personal religious and spiritual backgrounds, current practices, and communities. No single reader will agree with everything the author writes in this book. Indeed, as an Episcopal clergywoman myself, I understand some of the scriptural, theological, and pastoral issues a bit differently, and as a child and adolescent psychiatrist, I would not conceptualize and explain some of the psychiatric and medical topics in the same ways. But these points are not the purpose or the gifts of this book. For clinicians caring for patients and their families, this is an autobiographical piece of one person_s experience, unique and tremendously helpful because it captures an individual_s heart and soul as few works have, and gives us a portrait of her spiritual and religious being that is too often overlooked or underappreciated in the psychiatric world. Mary Lynn Dell, M.D., M.T.S., Th.M. Department of Psychiatry and Behavioral Sciences Emory University School of Medicine Atlanta DOI: 10.1097/chi.0b013e318040b28a
Disclosure: The author has no financial relationships to disclose.
Divided Minds: Twin Sisters and Their Journey Through Schizophrenia. By Pamela Spiro Wagner and Carolyn S. Spiro. New York: St. Martin_s Press, 2005, 318 pp., $24.95 (hardcover), $14.95 (softcover). Divided Minds launches readers in a time machine through the lives of identical twins, only one of whom develops schizophrenia. Far from the Maudsley study and the usual scholarly fare pondering endophenotypes and epigenetics in monozygotic twins discordant for schizophrenia, this frequently poetic book is written in the format of a memoir. It highlights the discordant talents, liabilities, and struggles of these Ivy LeagueYeducated New England twins. The prologue is preceded by a Latin overture: Dum Spiro, Spero (While I breathe, I hope). The state motto of
J. AM. ACAD. CH ILD ADOLESC. PSYCH IATRY, 46:6, JUNE 2007
my native South Carolina, in this context it seems to imply a pairing of the classically antithetical notions of schizophrenia and hope. Is it the hope of Pamela, the talented and magnetic twin who has her first psychotic episode at age 11? Is it the hope of Carolyn, the more average twin who exceeds expectations to become a psychiatrist and dancer? Should it be the hope of the public, with their confusion and stigmas about mental illness? Or is it our hope, we who labor with schizophrenia every day, burdened with our own confusion and biases? Book One hurtles us back to 1958 and the twins_ sixth birthday, when they compete to wear the blue paper birthday crown. Pamela will long resent Carolyn for stealing her rightful crown. But Carolyn will never feel as special as Pamela, even in the throes of the latter_s schizophrenia. We travel through their development, meeting milestones in Pamela_s illness. In 1963, Pamela_s teacher recognizes her outstanding writing, but her themes are dark and murderous. Soon comes President Kennedy_s assassination, or what she calls Bthe last Friday of my childhood[ (p. 28). The assassination triggers her first psychotic episode, replete with paranoia, flights of ideas, clang associations, and auditory hallucinations. By junior high, her self-care declines. Carolyn scolds her: BLookIPeople don_t know we_re twins. If you_re filthy, they_ll think you_re me[ (p. 55). The alternating memoir is organized by months and seasons into bite-sized vignettes. The earlier sections read like diary entries, chronicling the emergence of schizophrenia in an individual and in a family. Unfortunately, the device becomes somewhat tedious by the time the sisters enter adolescence. This is largely due to Carolyn_s bland entries, but mitigated by Pamela_s more evocative imagery and sound. Cleverly, their writing develops with age. Themes and tone further diverge as Pamela_s disease wears on. The alternating of the sisters_ voices becomes more frequent and the book more engaging as life stretches and gnaws at their connection. The twins_ account is frank and spares no one. This is especially true as Pamela recalls the abuses of prior caregivers and her father. They become the casualties of her boundaryless writing. Yet she struggles with blaming herself the most: BI blame myself for all that has happened to me, knowing at the same time that I would never blame others. They are sick; I am weak-willed and evil[ (p. 243, italics in the original). Pamela allows us an inside-out view of her delusions, rage, even catatonia. She manages this with the command of a journalist, the craft of a poet, and the fullness of the person who lived it. Not entirely surprising, given that she graduated magna cum laude from Brown and is an award-winning writer; but then there is her deteriorating illness to make it all ironic and wonderful.
781
Copyright @ 2007 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited.
BOOK REVIEWS
Carolyn is the Harvard-trained psychiatrist and ballroom dancer, the pride of her father after Pamela becomes ill. Carolyn is insightful and candid throughout the book. Her writing effectively conjures the voice of the burdened caretaker, the everyman. She speaks of all the errands, thwarted efforts, phone calls, and harried driving to emergencies. She alternates between rescue fantasies and sadistic thoughts, between hating the disease and hating Pamela: BMust I always be the one to know, to help, to suffer, to bear?II am trapped between wanting freedom from you and wanting you[ (p. 310). Carolyn lives in the shadow of her twin, Bthe brilliant, creative one, the smarter, more special version of me[ (pp. 268Y269). She remains envious despite Pamela_s disease and also because of it. She speaks of schizophrenia as the ally, having Bopened a door for me[ (p. 312), but also as the crippling, inconvenient enemy. Carolyn finds her voice near the end, articulating the essence of her struggle as Pamela_s twin. She receives a call from Pamela in the hospital. Pamela describes command auditory hallucinations to kill herself by burning all her flesh. Carolyn_s description of her own subsequent dream marks her best writing. Why should this be? Is it because the dream occurred during the actual writing of the book and raw images were not softened by recall bias? Has she merely channeled Pamela_s unbounded artistry during an intimate flood of connection? Or, through dreaming, does she loose herself from sibling rivalry long enough to honestly examine it? The result is rousing prose that expresses Carolyn_s sense of invasion and conquering by her twin. Divided Minds compellingly conveys the complexities of both these lives genetically entwined with schizophrenia. But in the end, are we left hopeful? The epilogue, a denouement a` la Hollywood drama and Shakespearean comedy, seeks to tidy up the final scenes of madness and merging. Pamela nearly apologizes for her recent decompensations. Both sisters describe a resolution between Pamela and her father. Carolyn has found Catholicism, a belief in a benevolent universe, and states her hope is enough Bfor now[ (p. 312). Pamela is just trying to live Bin the nowInot overly attached to the possibilities of tomorrow,[ but admits she has found that life Bis not easy to letIgo[ (p. 316). Dum Spiro, Spero. While I breathe, I hope. For now, I believe this refers to hope, not in the form of a cure for schizophrenia, but the possibility of poetic transcendence for those living with it. The proof is in the words of the Spiro twins, as they breathe hope onto the pages of their joint venture. Erica G. Ahlert-Smith, M.D. Department of Psychiatry and Behavioral Sciences, Youth Division Medical University of South Carolina Charleston
782
Disclosure: The author has no financial relationships to disclose.
Divided Minds: Twin Sisters and Their Journey Through Schizophrenia. By Pamela Spiro Wagner and Carolyn S. Spiro. New York: St. Martin_s Press, 2005, 318 pp., $24.95 (hardcover), $14.95 (softcover). Beginning in the 1940s with Franz Josef Kallman, mental health researchers have examined the relationship between control groups of twins and twins with schizophrenia, generating much important information. This research, however, is protected by squadrons of premorbids and discordances, a wall of genetics, and by the occasional metabonomic, loci-endophenotype, and mother-baby unit. So there is something wonderful about the new treatment of the topic by the jointly written biographical account Divided Minds: Twin Sisters and Their Journey Through Schizophrenia, as though a laboratory beagle hound had been set free from his cage to race through a meadow, baying. In fact, a remarkable aspect of this book has to do with baying, or at least voices. There are, of course, the frightening voices of Pam_s illness (Pam is a writer with schizophrenia) and their distant shadows in Carolyn (a psychiatrist), the twin sisters who coauthored this book. There are also other voices of the sisters that are distinct, but constantly bleeding into one another. These voices range from childlike (BEvery time we pick up kids, the bus farts black stinky clouds[ [p. 16]), to lyrical (BThe cut-glass sky, the sparkling white of the slope so pure and wondrous[ [p. 41]) to mad (BI am a seeker, I have sought and now I see. That is, I see; I am seeking truth and seeing it, which is Holy-See-ing, a sacred pun, meaning I_d been given a nod of approval from the Vatican, the Vat-I-Can. I can see that I am at sea, that I will get Cs in all my classes, the gentlewoman_s Cs[ [p. 104]). All of these voices speak with complete authenticity, which makes this book alive and exciting to read. Of the myriad voices here, the only one that is hollow is the voice of Carolyn_s professional distance. This is understandable. She explains the need for it: BMake damned sure no one mistakes me for the patient. I_m the sister, the good sister, the married-with-two-kids-psychiatrist-and-dancer sister[ (p. 272). Her tone is the authentic voice here and speaks of torment and fear; of things that psychiatrists rarely commit to paper. Again, this is wonderfully different from the usual tone of clinical detachment. The authenticity of the voices may be painful for those who know schizophrenia intimately. Their unbridled freedom opens wounds that are then left that way. After all, Ba beagle has a loud baying cry [that] can be disturbing to family and neighbors[ (dogbreedinfo.com, 1998). In addition, an
J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 46:6, JUNE 2007
Copyright @ 2007 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited.