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NORTHEAST COVER
STORY
Twin
Realities
 The Sisters Were
Identical, Until The Voices Began.
December 14, 2003
By
Kathleen Megan
The thing about twins is they invite comparison. Even
though they may look identical, one usually has the edge -- a
little more confidence, a quicker smile, perhaps a bit more
talent.
As babies and little girls, Pam Wagner and
Carolyn Spiro were like that. They danced and acted and held
promise that delighted their parents. They loved it when
people mixed them up. They were a tight club of
two.
And then in adolescence, Pam, the one with the
edge, lost touch with her own mind. Life became confusing and
the twins's lives took separate paths, diverging and then
intersecting repeatedly, as they once again do now. Pam is a
poet and Carolyn a psychiatrist. In midlife, they've come
together to write a book, to try to capture their story for
the benefit of others, and also for themselves.
Their
story is a tale of the inseparable bond of sisters, of twins,
and their struggle when their lives became anything but
identical.
• • •
When you enter Pam's apartment
you can't escape the photo test: two adorable baby girls,
ribbons in downy hair, one gazing intently, the other
head-tilted, tentative. Both bright-eyed, identical. Which is
which? Which is Pammy and which is her twin,
Lynnie?
You can't tell. Is that thoughtful tilt a
Lynnie trait? The more focused expression Pammy's? Impossible
to say, so you guess and you guess wrong.
And you
wonder, was the die already cast at so young an age? Were they
already - though indistinguishable on the outside - so very
divergent on the inside? The seed of illness, perhaps, already
planted; the roles of caretaker and cared-for so early
ordained. You try to reconcile these photos - these identical
babies and later, mirror-image school girls - with all you see
a half-century later.
So very different are they now.
How do they live with this, the undoing of their twinhood?
And, how has their family, so accomplished and talented, coped
with the slap of fate? That one became psychotic, the other a
psychiatrist. Pam catches you staring at the beguiling babies.
"You know," she says, "I was well once."
The Hospital, June
Pam
seems frightened, lying in her hospital bed, with the covers
pulled up almost to her eyes. Her dark glasses, she believes,
protect her from evil influences, while also shielding
innocent people from her. The burn on her forehead - which she
has seared with cigarettes - is a fierce pink. "The devil's
mark," she calls it, and hopes it warns people
away.
Her sister, Carolyn, composed and caring, perches
on a chair at the foot of the bed and they talk about why Pam
has landed in the psychiatric unit again. The voices are back
- the voices that never really disappear despite the myriad
medications.
The voices have been telling her she's no
good, she's fat, she should burn herself, should kill
herself.
"Why don't you say, `Go f--- yourself, I'm not
going to do anything you tell me to do'?" asks
Carolyn.
"I feel like I deserve it." Pam says. "The
carping, the yelling, as soon as they start with `Burn, baby,
burn' - that's the point of no return."
Twins. For more
than 50 years, their lives have been as inextricably linked as
they have been drastically different. That's part of what
concerns Pam about this story and about the book she and
Carolyn are writing about their lives: No matter how you try
to avoid it, twins invite comparison, contrast,
juxtaposition.
Pam is nervous that their lives will be
reduced to this: the good twin and the evil twin. That's how
she often sees it.
Carolyn Spiro - Lynnie to her family
- is the twin who went to Harvard Medical School, got married,
had two children. She is the psychiatrist in Wilton and is a
dedicated ballet and ballroom dancer.
She has
strawberry blond hair, stylish clothes, eloquence, sensitivity
and humor. She has a good relationship with both her parents
and is now divorced.
Most important, in Pam's eyes, she
is absolutely reed-thin. She is the good twin.
Pamela
Spiro Wagner is the twin who went off to Brown University,
brilliant and promising, but became depressed, suicidal,
psychotic during her freshman year. She has been in and out of
hospitals for much of her adult life - diagnosed with
schizoaffective disorder, a mix of schizophrenia and what has
been known as manic depression.
Even so, she graduated
Phi Beta Kappa, completed more than a year of medical school,
writes prize-winning poetry and essays, and lives in a
high-rise in Wethersfield. She is the twin who hasn't spoken
to her father in years, her illness wedged between
them.
When she is feeling well - and often even when
she's not - she is witty, acerbic, insightful. She has
shoulder-length dark graying hair, and often hides herself
beneath roomy thrift-store purchases and floppy
hats.
For seven years, she has been on a drug called
Zyprexa that has done more than any other medication to free
her of voices and enable her to write, read and think. But the
drug comes with a side effect that would be troublesome for
anyone, but is excruciating for Pam. It has added dozens of
pounds to her once tiny body, the body she has wished would
vanish.
She fears people will see her as the fat twin,
the evil twin.
Only a few months ago, Pam was convinced
that the 70 or so pounds she had gained were, if not
acceptable, at least a bearable price for sanity. But the
extra weight is proving too great a burden.
That's why
she has landed in the hospital again. She has been tinkering
with her medications hoping she might lose weight. But
instead, the voices returned, calling her "Fatso! Pig!
Lardass!" and goading her into harming herself.
"Why
would you think that anybody would have a right to tell you to
hurt yourself?" asks Carolyn.
Pam answers, "Because
they are very authoritative in some ways ... I feel that I
will be gotten back at if I pull anything."
"You do it
to yourself," asks Carolyn, "because you know the
consequences?"
"Absolutely," Pam answers. "I don't know
that there's ever been a time when they said, `Burn, baby,
burn,' when I haven't actually done it."
The
conversation turns to the clothes Carolyn has brought for Pam
- tunic tops and pants. Pam may be unable to ignore the
disparaging voices, but she doesn't forget the
niceties.
She rolls out of bed to try the clothes on
and suddenly they are sisters anywhere. She thanks Carolyn and
says the colors are just right - dark shades, not red or pink.
She slips them on and loves the shirts, but the pants, alas.
They are capris and Pam is not a capris sort of person.
Carolyn promises to exchange them.
Then Pam says that
she is convinced the nurses and aides are out to get her,
planning her demise.
"You should have heard me last
night," she says, back on the bed, but sitting up straighter.
She was tied down and fought back the only way she could. She
yelled every obscenity she knew: "Bitch, prick, mother- ...
"
"They came in and said, `If you don't quiet down ...
if you don't quiet down ... "
"What?" asks
Carolyn.
"They're going to kill me?" Pam asks, with a
twinkle in her eye. "Unfortunately, it's never as funny when
it's happening. When it's happening, it's not
funny."
"I'm aware of this," says Carolyn. "I have seen
you."
"Not when I'm tied down, you haven't."
| Twin Beginnings Our first word,
after `mama' was `we,' which meant `I': we weren't
merely similar and separate: we were, we knew, one.
-From "Solo for Two," by Pamela Spiro Wagner
| Ever since the beginning,
Carolyn and Pam say, it has been as if they have occupied one
space in the universe. They
weren't two beings stuck
together. No, it was as if they had one place and therefore
had to divide up the territory.
And from the start - as
with many twins - it was somehow important that Pammy was the
older and slightly bigger twin. Older by minutes. Bigger by 6
ounces.
Such family folklore can shape expectations,
can set the stage for what is to come.
In this case,
Pammy was "the smart one," the golden girl who wasn't quite
sure herself why she always got A's. She was the one for whom
her parents had the highest hopes, the one her father called
his "most intellectual child."
Both girls were shy, but
Pammy was the leader and Lynnie would hide behind her. She
would push Pammy ahead of her into the room when her parents
had guests. At nursery school, where the theory was that the
girls should not be in the same class, Pammy was put in the
class with the slightly older kids.
As Lynnie viewed
it, Pammy won every award imaginable: She was an excellent
writer, musician, artist.
Lynnie saw herself in
cutthroat competition with Pammy, while Pammy had no idea that
Lynnie lived in awe of her. All she experienced was simply
being twins and being the best at whatever she
tried.
On an exam, Pam might get 99.99 while Lynnie got
99.98. "Of course that meant that she was second rate in my
family," said Pam. "`Lynnie, you're just no good - forget it.
You're all washed up. You only got 99.98
percent.'"
Carolyn says now, "I idolized her,
obviously, but I also got to hide behind her: Everything was
expected of her, and as far as I knew, not too much was
expected of me."
Still, the girls loved being twins.
They loved wearing the same clothes and having people mix them
up. But sometime around middle school, things
shifted.
When Everything
Changed, November 1963
When you peel back
all the layers, layer after layer, when you finally get back
to the reason Pammy feels like poison, the reason she feels
unworthy, the reason she feels the voices are right, you find
yourself back at President Kennedy's death.
The girls
were 11 when the "strangeness" began for Pammy, when she first
heard the voices, and when Lynnie got so mad at her sister's
odd behavior.
For Pammy, John F. Kennedy was more movie
star than president. When his son Patrick died, she wrote a
poem about it and mailed it to the White House. She received a
form letter back, but it had President Kennedy's signature and
Pammy showed it all over the neighborhood. The White House
knew Pammy Spiro.
She was in art class when her
teacher, dabbing her eyes with a tissue, told them. "Girls ...
There's bad news. President Kennedy has been shot. In
Dallas."
"Yeah, sure," Pammy thought. This was an
adult's idea of a joke, though she didn't quite get it.
Nothing that bad could happen to JFK.
But when Pammy
began to see that this was no joke, she felt herself sinking
into a different reality. A realm of heightened sensitivity
where the world shimmered and everything took on a vibration
of signi-ficance.
As she left art, turning to go down a
hallway back to her regular classroom, the principal's voice
came over the intercom announcing that President Kennedy was
dead. Her knees buckled and it seemed people were whispering
her name, like they did on the television show
"Password."
When she got back to her classroom, she
started crying and couldn't stop. She began to understand that
the scary voices were blaming her. Saying that she had killed
Kennedy. Not that she had actually pulled the trigger, but
that she was responsible. She couldn't disagree.
Her
teacher tried to calm Pammy and finally called her mother,
Marian Spiro, who came to take her home.
All weekend,
Pammy cried. She couldn't tell anyone what was wrong - that
she was to blame - and no one could understand. Often her
emotions were bigger or different from others. Excessive, her
family would say. They would say she was pulling "a Sarah
Bernhardt."
Lynnie grew steadily more irritated with
her sister. "So the president died. Presidents are old.
Presidents die - what's the big deal?" is how Lynnie remembers
her feelings. She knew Pammy was just scheming to get
attention. Didn't Pammy already have ALL the
attention?
Marian says now, "It was very surprising
that [Pam would] be so upset ... but watching Pam overreact
was not a new thing."
All weekend Pammy heard the
voices blaming her. When Jack Ruby killed Lee Harvey Oswald,
she thought, OK, they killed the wrong person. "They killed
the trigger man, trigger man, trigger man," the voices
said.
She had no idea why she'd done it or how she'd
done it. But she knew that in some way, the blame would be
laid at her door, as she would say later, "like the butterfly
who flaps its wings in Peking and starts a storm in
LA."
That was when she first felt like poison, when she
wanted to disappear, when she wanted to take up as little
space as possible until she died.
Writing Partners, Last
Winter
As soon as Carolyn enters Pam's tiny
one-bedroom apartment, the banter starts.
"You stole my
spinning wheel!" Pam accuses her. It's a ritual that Pam,
especially, enjoys. "Every time we meet, the first thing we do
is fight over the spinning wheel."
"What about this
carpet?" asks Carolyn, pointing to a small Oriental rug on the
floor.
"Mommy gave it to me from Turkey," says Pam.
"But I didn't get a thing when my parents moved out of our
childhood home."
"What did I get?" Carolyn
asks.
"Well, you got whatever you
wanted."
"Well, I don't know that I got anything of
mine."
"But you could have."
Pam is in fine
spirits today, and Carolyn, too. It's not always easy for the
sisters to work together. There are times when Carolyn's
schedule won't permit it, times when Pam's illness is talking.
And even when both are available, the process of dredging up
the sediment of their lives can be painful.
Often they
rely on e-mail or phone, but today they lean over each other's
manuscripts. Pam is in the dark green velvet-soft recliner
that dominates her living room, a kind of command central with
coffee and Carltons balanced on the arm; Carolyn folds herself
into a fold-up rocking chair.
Several years ago, Pam
wrote her autobiography and sent chapters to nationally known
Virginia psychiatrist E. Fuller Torrey for his opinion. Torrey
knew of Pam's sister and suggested that it would be far more
powerful to include Carolyn's perspective as well. Early this
year the sisters got a contract from St. Martin's Press and a
deadline: Jan. 1. They hope their book, which they have
tentatively titled, "Solo for Two," will help people
understand mental illness.
So Carolyn has been writing
and Pam has been rewriting. Each chapter is divided between
their life stories, but Carolyn is planning to include some
expert information about mental illness - she is, after all, a
psychiatrist.
"Actually, that would weaken your chapter
when you include all that stuff," says Pam, the expert on
writing. "I can show you how and why. It slows down the action
every time you interject an editorial comment."
Carolyn
suggests that Pam can also write as an expert on the patient's
point of view. "You know how psychiatrists used to say: `Well,
she's refusing to take her medication,' like `she doesn't want
to get better.' They don't say: `It causes this intolerable
grogginess - and no wonder she doesn't want to take
it.'"
The sisters dive into their reading, and Carolyn
reaches the part where Pam writes about how hard she tried to
be happy when her twin got into Harvard. Instantly, Carolyn
dissolves into tears.
"No, no, no, you can't," Pam
commands.
"I can't?"
"You said to be honest,"
says Pam. "All right, now STOP it. Your nose is getting
red."
"But it's true," says Carolyn. "You know, I'm not
hurt. I'm moved. It's true, this whole thing about me going to
Harvard Medical School."
"What about it?
"Just
how painful it was," Carolyn replies. "To tell you, to want
you to know, but to know that I would hurt you."
"But
you didn't hurt me," Pam says.
This doesn't stop
Carolyn's tears, and Pam looks concerned. "I'm OK, you're not
hurting me," Carolyn tells her. "My crying is not because you
hurt me. My crying is because I'm remembering."
Pam
leans back into command central and covers her face with
Carolyn's manuscript. "Geez," she asks, "How can you be a
freaking psychiatrist?"
"I don't know. I cry," says
Carolyn.
"You do?"
"Oh yeah."
"Geez," Pam
sighs.
"Stop covering your face," Carolyn
instructs.
"I'm afraid I'm making you feel bad," says
Pam from beneath the manuscript.
"You're making me feel
bad," Carolyn says, "because you're writing well enough to
make me cry."
Growing up a
Spiro
If Marian Spiro had stopped after the
twins, she might have doubted the existence of "a mother's
instincts."
Pammy and Lynnie were collicky and hard to
soothe. It seemed to the young mother - far from home on an
Army base in Washington state - that as soon as she calmed one
down, the other would kick up.
Marian and Howard had
met in the late '40s at Harvard University; she was a
technician in the lab where he was doing medical
research.
A Fall River, Mass., native with a Mayflower
Pilgrim in her lineage, Marian, then 21, was strong-minded
though shy.
Howard Spiro (pronounced SPY-ro), 25, whose
father was a Lithuanian immigrant and lawyer, grew up in
Newton, Mass., and had excelled: He went to Harvard College
and on to Harvard Medical School.
At first, Marian was
irritated by Howard. She found him bossy - how dare he tell
her the Friday after Thanksgiving was a workday? "It's not a
workday for me because I'm going home," she
announced.
But the fireworks between them had more to
do with attraction than aversion. They married in 1951. He
joined the Army and they moved to Tacoma, Wash., where the
twins were born on Nov. 17, 1952.
Two years later,
Phil, dubbed Chipper, arrived. And then in three years Martha
came. By then the family had moved to Connecticut and Howard
was teaching at Yale School of Medicine.
Marian found
it far easier to mother her younger children. She was more
likely to talk to them one to one. And they were more likely
to come to her with their troubles.
Pam and Lynnie
turned to each other for comfort. It was difficult for Marian
to bond individually with them because they were such a
twosome. It was always: Chipper, Martha and "the
girls."
Carolyn says now, "No question, our mother felt
left out, pushed out, kept out."
During those early
years, Marian was a stay-at-home mom with diverse interests -
all of which she shared with her children.
She taught
them basketball, tennis, swimming, sailing. She took a geology
course, and led her children on walks to help them identify
mica or shale.
When Lynnie didn't care for reading,
Marian could understand why. What's interesting about Dick,
Jane and Sally? So Marian wrote stories that would pique
Lynnie's interest, and put up a ballet bar and mirrors in the
cellar when the girls took dance. She built them a small stage
in a bedroom for their dramas.
At Yale, Howard was
acquiring prestige and success. He was writing what would
become the textbook on gastroenterology for many
years.
Howard loved his tiny flock, insisting when they
were small that they be kept awake until he got home from the
office. To him, Pammy and Chipper were the ones with the most
promise; later they would say they could never do well enough
to please him. Lynnie was more timid, more likely to cry.
Martha, the youngest, was the most easygoing. Pam's interests
ran most parallel to her father's: literature, history,
religion.
Often, Howard would gather his children on
his lap to tell them Bible stories and Greek myths. The
stories were sometimes frightening - particularly one of the
Greek myths. Pam thought her father was talking about her:
"Pam-dora's Box."
Fall from
Grace, Mid-1960s
When Pam gets to junior
high, she is scared of everything: the cool ninth-graders, the
gossipy girls, the social scene.
There is also the
"strangeness," the feeling that she is evil.
She wants
to talk to Lynnie, or maybe to her mother, but she doesn't
know where to begin, how to tell them she feels "something's
odd - within," words she would find much later in an Emily
Dickinson poem. But the truth is that, even if someone had
asked her what was wrong, she would have snapped, "Leave me
alone!"
How can she tell anyone about this sense she's
had for a while, that she isn't going to make it? A
premonition that she'll never be the sort of grown-up who
marries, has kids, holds a job. She is fearful and anxious and
clings to Lynnie. She knows this annoys Lynnie - because Pam
is supposed to be the one Lynnie leans on. Not the
reverse.
Lynnie looks down the junior high hallway and
admits to herself: Pammy looks weird. She squishes up against
the wall, her arms hanging awkwardly by her side. Her hair is
greasy, her clothes mismatched.
Always, in the past,
Lynnie has felt flattered when people confused her with Pam.
In fact, she has half-wondered why a boy would ever like her,
if he could be with Pam. Pam was a version of her, only one
step better.
Now Lynnie doesn't want to be associated
with Pammy. "Why don't you wash your hair? It's dirty," she
would say.
"But I washed it last week," Pam would tell
her. She'd wonder to herself, "How do you know it's dirty?
What is dirty hair?" and "How did Lynnie know so much about
makeup and boys?"
Pammy's grades begin to slump.
Concerned, Howard and Marian offer the girls a chance for
private school. Both girls apply to Day Prospect Hill School
in New Haven.
Pammy is delighted with the offer. The
classes are smaller, the girls don't wear makeup. No one has
to take a shower after gym. Lynnie scarcely considers it - if
there are no boys, she's not interested.
About the age
of 13, the girls begin to eat less and less. First Lynnie, who
is copying a friend. Then Pammy joins in to keep up with
Lynnie, but also for darker reasons related to Kennedy's death
and her wish to disappear. By not eating, she hopes to be "one
with the wind" or "a pair of ears on the
wall."
Sisterly competition takes over. If Pammy has
half an apple, Lynnie wants a quarter. The girls eat so many
carrots - and so little of anything else - that their skin
takes on a yellowish cast.
Dinners are nightmares.
While everyone else tries to enjoy their meal, Pammy and
Lynnie eat a quarter of a graham cracker and a half a carrot
stick.
Inevitably, an argument breaks out. No one
remembers exactly why. Looking back, it seems to Pam and
Carolyn that their father believed they were eating so little
just to annoy him. Often, Howard would make a comment that
would send the twins storming from the table. Marian would
leave the table angrily, tearfully.
Eventually, only
Phil and Martha would be left. "We'd be wondering where
everyone went," says Martha. The younger siblings would finish
their meal quietly and play table football with a
matchbook.
Everyone in the family remembers this time
as turbulent. "I'd say in some ways we were worse, in some
ways we were better than the average '60s dysfunctional
family," says Phil.
The understanding of anorexia was
limited then, and it doesn't occur to anyone to get help for
the girls. Marian said she and Howard were simply hoping it
would pass. "We blamed Twiggy." Thin was very in.
As
the girls lose weight, Marian is worried, particularly about
Pammy. She is becoming more and more withdrawn while Lynnie is
growing more socially adept. The girls at Day Prospect are
calling Pammy "zombie" because she avoids eye contact and
looks zoned out.
When Pam refuses to serve hors
d'oeuvres at her parents' parties, her father scolds her.
"Stop this nonsense," he says.
Years later, Marian will
wonder if that shyness was an early symptom of Pammy's
illness. She also wonders, if Pammy hadn't been a twin, would
mother and daughter have talked more? Would she have
understood what was going on in her daughter's
mind?
Reclaiming a
Mind
There is a sparkle of glee in Pam's eye
as she opens the door to her 12th-floor apartment on a wintry
day last February and pulls out her latest project.
She
has enlarged and laminated copies of The Nation cover - the
one with George Bush pictured as MAD magazine's Alfred E.
Newman with a pin on his lapel that exhorts: "Worry." And, she
has purchased a few dart guns.
"Would you like a set?"
she asks. They are for target practice.
It's only
relatively recently that Pam - a fierce critic of Bush and his
war plans - has been well enough to have political opinions.
It's because of Zyprexa, she says. Before then, she could
barely read at all, let alone maintain an interest in
politics.
The most she could do was read poetry -
because it was short - and occasionally write it because she
could get down the skeleton of a poem in one
sitting.
"It really has given me back a life that I
thought was lost to me forever," Pam wrote in an e-mail. "Just
the notion that I can get up in the morning and EXPECT that I
should be able to read and write rather than wonder if I
shall."
For Pam, writing has long been "the life's
breath. ... When I get a poem right, it feels like the top has
come off a champagne bottle. It's just this incredible,
bubbly, fizzy sensation of just: Wow!"
She first
noticed that she could read again when she picked up a copy of
The Nation. "Hey, this is good," she told the librarian. She
would have figured she'd be a "lefty," but her eyes used to
glaze over when anyone talked politics. Since then, Pam says,
"I am gorging. It is like the movie `The Awakening,' it really
is."
Her friend Joe, who lives two floors down from her
and is visiting this morning, agrees that she was a different
person before Zyprexa. "Yeah, you were struggling with your
poetry and everything was difficult," he said.
The
evidence of this breakthrough is everywhere in the tiny
apartment: the shelves filled with poetry, literature, history
and mythology, and the floor piled with copies of Scientific
American, The New Yorker, The Atlantic Monthly and other
magazines. She has educational tapes in physics and economics
and a huge collection of videos ranging in topic from "La
Bohème" to plant life. Affixed to her curtain rods are
pull-down maps: the world, the Mideast.
This is clearly
home to a formidable, eclectic intellect.
Pam feels the
medication has also made a difference in her relationship with
Joe, who asked that his last name not be used.
A decade
ago, Joe met Pam when they were patients at Hartford Hospital.
Pam was doing a lot of angry screaming at the time and Joe, a
truly gentle man, admired her spirit. He thought: "That's the
girl I want to meet."
A Cornell-educated engineer, Joe
also has schizophrenia, but not as severely as Pam. Every
morning he can, he comes up to Pam's place for their ritual:
watching "Dr. Phil." He is more friend than
boyfriend.
Pam and Joe's illnesses are very different.
Pam is far more often psychotic and subject to mood swings.
Unlike Joe, she has been self-destructive: Her mottled arms
bear witness to the times that she has burned herself with
cigarettes or cut her wrists. She has tried suicide, just a
year ago almost managing to hang herself. Only the thought of
Carolyn stopped her.
"I think schizophrenia is a
wastebasket label," Pam said, "for things they don't know how
to define."
Her health is further complicated with
narcolepsy - the sleeping disorder- and a case of Lyme disease
that affected her neurologically.
Pam needs help with
the little tasks of daily living. While she won the 2002 BBC
World Service Poetry Competition, she has trouble getting the
dishes washed, the laundry done, picking up the mail. Simply
brushing her teeth or taking a shower can be overwhelmingly
difficult.
To help her take her medication, she has a
nurse who comes twice daily; an occupational therapist helps
her devise plans to get chores done. A housekeeper comes when
she can get one.
Joe and Pam also have very different
ideas about the roots of their illness. Joe tends to talk
about who did what to him, while Pam sees it as her
psychiatrist, Dr. Mary O'Malley of Fairfield,
does.
"She says, `Pam, you think this way because your
amygdala or something is firing off a message to be afraid,'"
says Pam. "`We need to get this under control because your
brain is sending off the wrong message.'
"She just
neatly, you know, separates the illness from the person. And
doesn't blame me and so I can't stand it when Joe wants to say
this person's to blame and that person's to blame because if
they are to blame, so am I!
"The only thing I've ever
blamed my parents for at all is for rejecting me because I was
ill - not because of the illness."
On Pam's suggestion,
O'Malley vastly increased her dosage of Zyprexa a couple of
months ago. The voices have been quieter since then, and most
significantly, she doesn't now have the urge to go off the
medication - despite her weight gain.
"I take it simply
because I realize I need it. No matter how fat it has made me.
Fat is just fat. But insanity, psychosis, is
unbearable."
But then Pam moves into her bedroom to
watch "Dr. Phil." And there, above her bed, is a canopy: a
metallic blanket and tinfoil. The silvery cocoon protects her
from the mind readers, the CIA, the deadly radiation. But
wasn't she talking about Bush and foreign policy and war in
Iraq?
Pam's fantasies remain part of her reality, even
when she seems so lucid. As she explains it, when she is well,
she is able to put various paranoid beliefs "on the shelf,"
but on some deep level, she still holds them.
So though
she has been well and productive lately, the tinfoil stays
up.
And though she realizes, when she really thinks
about it, that she didn't kill Kennedy, the feeling that she
is evil remains.
Dancing
through Mid-Life
Carolyn and her boyfriend,
Tim Pritchett, are caught up in an intense discussion with
their dance teacher, Terri Boucher. At their last competition,
a couple had hindered their performance by crowding
them.
"You two need more competitive experience - as
frequently as possible," Boucher tells them.
Tim also
needs a new tuxedo - custom-ordered from the West Coast or
England. The world of ballroom dancing is acutely
appearance-aware.
"He did not look as nice as I knew he
was dancing," says Carolyn, smiling at him.
"You have
to dress and dance like you want first place - not like you've
just come to participate," says Boucher.
But enough
with the talking, Carolyn says. "Hey, Tim, we can talk or we
can choreograph!" At $30 each an hour, they start
dancing.
Tall, blond and with ramrod posture, Tim
sweeps Carolyn into a head-snapping tango under the watchful
eye of their teacher. In a T-shirt and black spandex capris,
very thin but also very strong, Carolyn dances with the
suppleness of a much younger woman.
The pair found each
other through ballroom dancing. Tim said there were lots of
possible partners, but that Carolyn was the only one who
wanted to work as hard as he did.
The art fosters
closeness between them, but can also strain. To dance
smoothly, Carolyn must be moving backward just as Tim steps
forward. The steps are exacting and tempers can flare if one
partner isn't there for the other.
"A couple can dance
only as well as the weakest partner," Carolyn
explains.
They take ballroom dancing on Sundays and
Mondays - alternating weekly between Brookfield with Boucher
and a teacher in Maryland near Tim's home. About every month
or two, they compete in a weekend contest - usually somewhere
between Boston and Washington, D.C.
Besides ballroom,
Carolyn sandwiches five ballet lessons a week between therapy
sessions, often sponging off to rush the quarter-mile from
ballet studio to office.
She'll finish at the office by
3 and get home the same time her son, Jeremy, 16, returns from
high school. Her daughter, Allie, 20, is a New York University
student studying in Prague.
While Carolyn's routine may
seem exhausting to the average person, it has helped her
navigate difficult middle years.
Three years ago,
Carolyn ended her troubled marriage of 18 years. That meant
leaving a four-bedroom colonial with a swimming pool and an
office across the breezeway. She now lives in a condominium
near Wilton Center.
When Carolyn met Tim two years ago,
she found in him not only a dance partner, but an introduction
to his religion, Catholicism. Raised a Unitarian, Carolyn had
always felt left out. Her Catholic friends had First Communion
and Jesus and Mary and heaven - what did Unitarians get? Not
much, certainly no answers to her questions about
God.
This discovery of the church has marked her
midlife - which seemed to be about things falling apart - with
the sense of a new beginning. (She was baptized last Easter.)
She calls it a "wonderful blessing" and says that even if she
and Tim were to part ways, she would remain a
Catholic.
Her parents, siblings and kids are a bit
puzzled by her conversion, but Pam says, "I think it's amazing
what it's done for her ... She's a nicer
person."
Carolyn says religion is something she's done
for herself. "So much of my life had to do with what Pam was
or wasn't."
Sominex and Sleep,
1971
On a dismal day in January, Pam buys a
large bottle of Sominex. Her plan is to take a few every day,
just to stay asleep, out of pain.
She and Lynnie are
freshmen at Brown University. They didn't set out to go to
college together, but neither got into her first-choice school
- Hampshire for Pam and Wesleyan for Lynnie. Brown was No. 2
for both.
They arrive at Brown eager to establish their
own lives - especially Lynnie. As part of her new image, she
has discarded "Lynnie" for "Carolyn." The girls are put in the
same dorm but have their own friends.
However, since
September, the strangeness has been growing in Pam. She thinks
the pharmacist at the local drugstore is watching her, and
aiming his radiation at her. She'll walk blocks out of the way
to avoid him. She believes that when her roommate wears a red
sweater, she and her friends are plotting against Pam. Should
she let them know she's aware of the plot, she wonders, or is
it safer to pretend she doesn't know?
Carolyn is aware
that Pam is becoming more bizarre. When Pam goes down to the
lounge to read, she doesn't just sit on the couch or a chair.
She moves a wing chair behind a wide drape and sits there
hidden.
Pam arrives with her Sominex back at the dorm,
where she sees her roommate. They argue and Pam, feeling as if
she's lost her last friend, takes the entire
bottle.
She leaves the bottle open and empty. Beside it
is a note: "I've taken a few too many pills." She writes that
she'll probably sleep them off, "but just in case, I'll be in
the downstairs lounge."
She heads down the winding dorm
stairs and suddenly, there is Lynnie coming up. She takes one
look at Pam and knows her sister isn't right.
Pam hands
her sister her room key and tells her she might want to check
out the note she's left there. Carolyn hurries to her sister's
room, finds the note. She grabs Pam's jacket and darts down to
the lounge. She finds Pam behind the drape and tells her,
"We're going to the infirmary."
The nurse gives Pam
ipecac, but Pam is convinced she's going to die. She keeps
telling the nurse to get Carolyn out of there. "I didn't want
Lynnie to see me dead," Pam says now. "I didn't want that to
be her last sight of me."
And Carolyn wants to leave.
With Pam delivered to the infirmary, her job is done. When the
nurse tells her to go back to the dorm, she does. She isn't
really worried. She trusts that Pam will be fine. She doesn't
call her parents. The nurses do. The next day, she doesn't
check on Pam or visit. Years later, she wonders at her seeming
unconcern, while also understanding it.
"I had a life.
I had a boyfriend," she says. "I wanted the grown-ups to take
care of her now."
Psychiatry
and Blame, 1971
When Howard arrives at the
Brown infirmary after Pam's overdose, he finds her much worse
than he expected. She is clearly psychotic. He sobs when he
sees her, but in her confused state Pam thinks he is
laughing.
He takes Pam to Yale-New Haven Hospital -
which is at the tail end of a benighted era. It is a time when
psychiatrists talk about the "schizophrenogenic mother" - the
mother who causes her child's psychosis. No one mentions
schizophrenia to the Spiros - they don't want to label. To
Howard and Marian, the blame seems to be directed at them,
particularly Howard. Pam has been so angry at him.
This
drives Howard away. He has some experience with mental illness
- an aunt suffered with it. Now, he is upset with the
psychiatric system and with Pam. "To be blamed for your own
illness is bad enough," Howard says years later. "To be blamed
for your daughter's illness ..."
Marian, who never
trusted psychiatrists to begin with - she grew up believing
that they chose their specialty because of their own problems
- has her doubts confirmed. The psychiatrists can't seem to
help her daughter, her husband, her or the rest of her
family.
With no mention of schizophrenia or of any
serious mental illness, Marian is convinced that this is just
a setback for Pam, a stumbling block on the road to adulthood.
Both parents are hoping Pam will get through this and back to
Brown soon.
But as the weeks in the hospital turn into
months for Pam, Carolyn is flourishing back at Brown. Marian
doesn't call her with worrisome updates about Pam. She doesn't
demand that Carolyn show up for family therapy sessions at
Yale. She lets Carolyn live her life - something for which
Carolyn will be forever grateful.
Martha, in the eighth
grade, is far more caught up in the family maelstrom. "I
learned that the world is a dark place for some folks," Martha
says now, "and my role was to try to make it a better place
for people."
Often, Martha, now a nurse practitioner
living with her two children in Northampton, Mass., was the
one who comforted her mother when Marian would return from the
hospital in tears.
Phil, then a junior in high school,
remembers being baffled by Pam's suicide attempt and thinking
that she was acting up on purpose. "I experienced it as
irritating," he says, "and we had to go to these silly family
meetings and I just wanted everybody to be OK." Phil, who is
also a psychiatrist now, lives with his wife and two daughters
in North Carolina.
If someone had explained that his
sister was seriously ill, he says, he might have reacted
differently. As it was, he says, with his parents' attention
diverted, he had more freedom than he should have
had.
After five months in the hospital, Pam recovers
enough to return to school, but decides instead to transfer to
Kirkland College. Later, she'll return to Brown, but by then,
Carolyn will have left for Sarah Lawrence.
During this
time, the sisters phone each other occasionally - mostly to
check on schedules. Neither wants to be home when the other
is. Pam is functioning, but not well.
Both young women
need their own space now. Especially Carolyn. Now that Pam is
ill - now that it seems as if she won't be able to lead the
life always expected for her - a door has opened for Carolyn.
Once so consumed by dance, she suddenly finds herself
intrigued by pre-med.
"Hey, there's someone else who's
smart in the world," she remembers thinking. "I'll be the
person Pammy isn't able to be."
UConn Med School,
1978
Pam is sitting on the examining table
at UConn when the doctor notices her arms. The scarring from
all the burning and cutting is obvious. The doctor doesn't ask
Pam where the scars came from. She simply observes, "You must
be in a lot of pain."
A decade after her suicide
attempt at Brown, Pam is making a go at the life that had not
seemed possible. She is a student at the University of
Connecticut School of Medicine.
But it's not going
well. She can't look anyone in the eye, she feels as if she'll
be electrocuted if she touches anyone. The voices have been
telling her to hurt herself and she has.
That she was
admitted to the medical school - despite a second
hospitalization and many ups and downs - is remarkable.
Through it all, she tended to her academic life, graduating
with honors from Brown in 1975. The medical admissions people
told her they were willing to take a risk on her because her
verbal scores were so high.
Carolyn, now at Harvard
Medical School, is happy for Pam, but also worried. Howard and
Marian are hoping that perhaps, finally, Pam's life will
straighten out.
For years, Pam's relationship with her
father has been poor, but her illness has driven them farther
apart. She feels that he sees it as a rebellion against him -
that somehow she is acting sick to provoke him.
Because
of her anger at her father, Pam has recently changed her name.
No longer is she Pamela Spiro. She tells a judge in New Haven
that she wants to change to her mother's maiden name - Wagner
- because, with her father and sister, there will be too many
Dr. Spiros. But whether there will ever be a Dr. Pamela Wagner
is doubtful now.
A minor health problem has brought her
to the doctor and her secret is revealed. She is referred to a
psychiatrist who gives her medication, but her troubles soon
overtake her.
On the night before she is to give a
physical to another medical student, she can't sleep. How can
she give someone a physical if she can't touch them? In the
morning, she marches into the dean's office and demands: "Get
me out of here!"
Ousting the
Ogre, March
Pam is standing on the scale
backward with her hands covering her eyes in O'Malley's office
in Fairfield.
"Don't tell me anything, don't tell me
anything, DON'T TELL ME ANYTHING!" says Pam. The scale belongs
to Pam, but she leaves it in O'Malley's office because she
can't bear having it at home.
Her midwinter resolve to
stay on the Zyprexa and endure the extra weight has now melted
with the snow.
She can no longer go on being fat. Since
she can't cut out Zyprexa, she's decided to cut out food. For
several days now, she has been drinking only soup and coffee.
O'Malley has decided to get a baseline on her weight - to see
if she's actually gaining or losing.
O'Malley checks
the scale and Pam pleads: "Don't even tell me." And when
O'Malley is done, "Take it away, take it away, take it
away."
"Let me ask you, Pam, what do you think you
weigh?"
Pam doesn't know and doesn't want to
know.
"Is it too scary?" asks
O'Malley.
"Yes."
O'Malley tells her that her
heaviness has nothing to do with being evil or lazy. "It's not
that you lack discipline. It's different from someone who is
just casual about their weight," O'Malley tells
her.
"No one is casual about their weight," Pam
retorts.
"Lots of people don't pay attention to their
bodies - believe it or not. But for you, it doesn't seem
possible because it's such an important thing."
"Yes,
because it's making me evil."
"No."
"Yes, it's
making me fat and it's making me take up too much space in the
world. It's making me into the ogre that ate
Manhattan."
"No it's just making you heavier. All those
other things are your add-ons. Zyprexa is helping you to
function. Being heavier does not make you evil. It does not
make you the ogre that ate Manhattan. It does not make you
poison."
Pam pulls the brim of her black derby down
over her eyes and folds her arms close to her.
"No one
in the world - certainly I don't - feels that you're evil for
having gained weight, but, Pam, that's your belief. ... Are
you hearing voices commenting about
that?"
"Yes."
"Do you talk back?
"Yes,"
Pam says. "I'll have a conversation with them and then
realize: What the HELL am I doing?"
"That's awful, Pam.
You know you didn't ask for this, Pam. You really didn't. And
the voices are your illness."
Pam says that maybe it
was seeing Lynnie recently - so slender - that made her feel
worse about her own weight gain. O'Malley urges her to think
logically.
"Lynnie isn't on Zyprexa and she does a lot
of dancing. She works at her weight and she works at her
body," says O'Malley. "She isn't thin because she's good or
perfect."
Twins Undone,
1983
When Carolyn looks back, the time she
probably most longed for Pam to be well was when her daughter,
Allie, was born, in 1983.
Carolyn had called Pam soon
after the birth, wishing her sister could hop in the car and
visit, but the news left Pam in tears. "She thought Allie
replaced her," is how Carolyn remembers it. "But a daughter
doesn't replace a twin. How could she think that?"
Pam
remembers it differently. "I was crying because Lynnie had
everything, including a daughter, which was what I desperately
wanted: a daughter. It was never anything I could even begin
to have.
"It was the icing on the cake ... It was just
a really difficult thing for me to accept that my chance had
come and gone and would never come again."
Carolyn is
left wishing her twin were there. Isn't this the promise of
twin-ness? A life-long duet of shared birthdays, of having
someone just like you beside you for each milestone. A mirror
in which you see yourself reflected.
Pam looks in the
mirror and sees all that might have been: a doctor, wife, now
a mother. Carolyn looks in the mirror and wonders: Why Pammy,
why not me?
The milestones they should have shared are
pushing up between them. Carolyn's wedding - Pam wasn't there.
Every step forward for Carolyn takes her farther from Pam,
every gain for Carolyn illuminates Pam's
losses.
Carolyn and Pam believe they are identical
twins, but have never wanted to take the genetic test to know
for certain. If one sibling has schizophrenia, there is a 10
percent to 15 percent chance the other will. If one identical
twin has it, the chance the other will rises to 40 percent to
50 percent.
Like hypertension or coronary heart
disease, schizophrenia seems genetically predisposed, but
genes alone do not determine who gets it. What activates the
disorder in one twin and not another is unknown. The catalyst
could be insufficient nutrition, a virus or other factors that
might intrude as early as in the womb or later, during
childhood. Like many diseases, there is a time-release
element. The disease doesn't usually surface until the late
teens or 20s.
When imaging is done on the brain of the
twin with schizophrenia, abnormalities are apparent. The well
twin's brain usually does not share those anomalies but may
not be completely normal either. Not much research has been
done on the topic, but often it seems that the well twin - and
other close relatives of people with schizophrenia - are
likely to experience milder forms of dysfunction: attention
deficit disorder, depression or simply
eccentricities.
Carolyn never worried about developing
schizophrenia, but it did cross her mind to worry about having
children. If she were an identical twin, she would have the
same chance of having children with schizophrenia as Pam would
have: 15 percent. For ordinary siblings of someone with
schizophrenia, the chance is much smaller, 2 percent to 5
percent.
Soon after Allie's arrival, Pam declines and
is hospitalized. Both sisters believe it is because of the
birth. Aunt Pam won't be able to visit for several
months.
Free Fall, About
1990
It's not until Carolyn walks into Pam's
triple-decker in the South End of Hartford that she truly
realizes how poorly her twin is doing. The place is
overflowing with garbage, dirty laundry, plates filled with
moldy food, old cat litter.
After Pam dropped out of
medical school, she has been in and out of hospitals. Her life
has been in a kind of free fall. Carolyn has been in phone
contact with Pam but hasn't seen her much. No one in the
family really understands what's happened to
her.
Marian has felt caught in the middle. For years,
she felt Howard acted as if Pam's illness was voluntary.
Marian knows it
irritates him if she sees Pam. She
feels she is being forced to choose between her husband and
her daughter. She also is working full time now as a high
school teacher. With these impediments, Marian sees Pam, but
perhaps not as often as she might.
Neither Phil nor
Martha has seen her much either. For them, it's partly the
natural pulling away from family and leaving home for college
and career. Phil hadn't been that close to Pam growing up and
with her illness, he says now, "She was difficult to be
with."
For Martha, it is about the heartbreak and
confusion of seeing her sister so ill. Pam would tell her the
police were monitoring her mind, and ask for Martha's help. "I
didn't know anything to do," Martha says.
Now a unit
chief at the Yale Psychiatric Institute, Carolyn drives up
from New Haven and finds Pam hearing voices, cursing at them,
rambling on about the "radiation" and the "five people" who
are after her.
Carolyn puts her in her car and drives
her to Cambridge, Mass., to see one of Harvard's most esteemed
professors. After a 10-minute exam, the professor's words are
cold and detached.
"Your sister is a chronic paranoid
schizophrenic. There's not much else to do," he
says.
Carolyn is shocked at his
callousness.
A Shrink with
Insight
Almost 15 years later, Carolyn sits
on her couch in her elegant, spare living room - with a
friend's orginial artwork on the walls and the coveted
spinning wheel nearby.
While her Harvard professor's
diagnosis of Pam was unquestionably correct, his assessment of
her life prospects was overly harsh and angers Carolyn to this
day.
If there is anything she has learned from her work
as a psychiatrist and her lifetime as Pam's sister, it is that
there is far more to a patient than a diagnosis. "From my
point of view, I'm not just dealing with depression and
anxiety: I'm dealing with a person who's experiencing this
illness or that condition.
"The person who says: `I'm
the devil' - that's obviously not the whole
story."
Through her experience with Pam, Carolyn knows
about the importance of involving a patient's family in their
care. She talks scathingly of the era when parents - her own
parents - were blamed for a child's
illness.
"Unfortunately, I think my profession has done
significant damage ... around this issue," says Carolyn.
"There's no question that families contribute in positive and
negative ways to pyschiatric illness, but they don't cause
schizophrenia."
Of her father's reaction to Pam's
illness, she says, "He was terrorized beyond coping to see his
firstborn this way."
Carolyn also makes it a point to
listen to her patients and make their care a collaborative
effort.
"When a patient comes in and says she is
gaining weight on a medication, I'm not inclined to argue,"
Carolyn says. "It's not whether the issue is right or wrong,
it's can we do anything about it?"
Carolyn also knows -
personally - how much the right medication helps. Since
childhood, she has found it difficult to sit still and read or
study. Often, she daydreamed or even drifted off to sleep. For
years as a young adult, she ignored the problem. It was the
way the world was divided: If Pammy was sick, then Carolyn had
to be well. Her attitude was: "Hey, I'm OK, I can handle
it."
But a few years ago, Carolyn decided to see a
psychiatrist. She wanted to write and she was having trouble
concentrating. She was diagnosed with the "inattentive" form
of attention deficit disorder and was prescribed medication.
She says it helps her writing and her focus in dance. It's
also given her a shade more understanding of Pam and her
patients.
When she is asked why she became a
psychiatrist, Carolyn says it wasn't because of Pam, at least
not consciously. She didn't know how sick Pam was when she
made the decision. Rather, it was because she found it
fascinating.
(Her father tried to talk her out of it.
Psychiatrists were not "RD's" - real doctors - in his mind,
Carolyn says, but she was hooked.)
Carolyn was at first
hesitant to get involved in Pam's care - not wanting to "blur
boundaries" or step on professional toes. But she came to see
that she could really help Pam and has been instrumental in
linking her to excellent care - which Pam
appreciates.
"I mean look, you are singlehandedly
responsible for everything - I mean everything good in the
past 10 years," Pam told Carolyn one afternoon. "You rescued
me."
Often people ask Carolyn how she can stand to
listen to people's troubles all day, but she has learned to
keep a certain distance from her patients. She also knows to
take a break from Pam.
"I don't have to live with her
illness," she says. "I am able to hang up the phone, shut the
door, drive away."
A Visit
from Mom, June
The visit starts out happily
enough. Pam is showing her mother the life-size llama she's
made out of bubble wrap, mailing tubes and papier-mâché.
Marian, who loves crafts and has a well-stocked wood shop, is
amused and interested.
The Dalai Lama has been in the
news, and Pam jokes that her creation is called "Dolly the
Llama."
"Guess what I used for the legs?" Pam asks her
mom. Marian hesitates and Pam tells her: upside down TV
tables.
Lately, Pam's energy has been running high. She
still has trouble carrying out the small tasks of life -
whether brushing her teeth or doing dishes. But she has plenty
of energy for her artwork.
Now, she is midway in the
creation of a religious triptych - which she wants to give to
Carolyn - and is logging long hours on her llama.
While
her enthusiasm for her work is catching, her energy is
beginning to have a manic edge.
When the conversation
with her mother turns to her father, Pam's intensity grows.
She has tried to reconcile with him, written him letters, but
she hasn't gotten anywhere.
"I don't understand why you
stand up for him - a man who has treated your daughter this
way for 30 years," Pammy shouts.
"He was wrong, Pammy,
there's no excuse for his behavior," Marian
says.
Lately, Marian has been making a more concerted
effort to see Pam. While Howard still does not see his
daughter, he no longer makes it uncomfortable for Marian to do
so. However, Marian sometimes hesitates because "if she's
doing well, I'm afraid I'll rock the boat and if she's not,
I'm afraid she'll rock mine ..."
Phil and Martha are
also a more regular part of Pam's life. Whenever Phil's family
visits from North Carolina, they see Pam. Like her mother,
Martha can feel overwhelmed when Pam's illness flares. She
prefers it if she has something concrete to do - cleaning
Pam's apartment - when she comes to visit.
Pam starts
to wonder aloud whether she'll go to her father's funeral and
then tells her mother, "I will because I'll want to comfort
you. I'm not going to your funeral because I don't want to
comfort him."
"I really don't want to talk about this,"
Marian says. She adds that perhaps she should go out and check
on her dog, Procyon, named for Orion's puppy, in the
car.
"Please don't go! Please don't go!" Pammy begs. "I
didn't mean to embarrass you. I love you!"
Marian stays
and the visit is salvaged. Later, Pam says her mother is a
wonderful woman who has grown greatly in recent years.
Although Pam has spent much of her life angry at her father -
she files his books in the Holocaust section on her shelf -
it's clear she would like to have him in her life.
She
doesn't need an apology she says. Just talking about The
Nation together would suffice.
It's little surprise
when Pam is hospitalized again. She has been manic and easily
irritated, and recently has fiddled with her medications,
hoping to lose weight.
Carolyn is going to visit Pam
and her apprehensions spill out. As a psychiatrist, Carolyn
knows she should be used to visiting psych wards, but when she
visits Pam, she comes as a sister. The sister who is
OK.
Seeing Pammy, her idol, in two hospital johnnies
behind the sunglasses - worn to protect her from evil - is
always a shock. "Can you imagine gaining all that weight?" she
asks. "It's so unfair - the whole thing."
And there are
the burns on Pam's forehead and arms. "It's like those are my
arms. How can you scar my arms?"
Harder to understand
is why having Pammy in the hospital - Pammy sick again -
prompts Carolyn's ancient feelings, the fossilized permanent
sense of always being second best. All the discussion over
Pammy, with Pammy, the talk of her brilliance. "She's a
colorful paperback and I'm the staid leatherbound classic on
the shelf. I feel like the ordinary colors standing next to a
rainbow."
If she tells this to anyone, they are, of
course, startled. And when Carolyn sees Pam in the hospital,
sees how little she has, she feels ashamed.
"I started
out feeling the universe is divided and then - Geez, I've
gotten 95 percent of it.
"I don't blame myself, but it
is true that because Pammy got sick, I got a life. Maybe it's
true that I would have a life anyway, but it would have been
different ... I didn't make her ill, but I profited by her
illness."
Fireworks,
July
From the moment Carolyn enters Pam's
apartment, Pam seems on edge and irritable. She has been out
of the hospital for a few weeks now, but isn't quite stable.
Neither the fasting she did nor the juggling of medications
has reduced her weight, and she is deeply frustrated by
this.
She doesn't want to see people who knew her at
100 pounds. "I know what their first thoughts are: `Holy shit,
is that Pam?' They don't know why, they only know, `holy
shit,' and I can't exactly go up to everyone and say, `This
isn't really me.'"
The sisters begin work on their book
when the discussion turns to Pam's use of her old
autobiographical manuscript as the framework for their new
book. In the past, the sisters have agreed that their book
should be a new creation - not simply Pam's manuscript with
Carolyn's add-ons.
No one seems angry until Pam tells
Carolyn, "What makes you angry is when I talk about having
written a book before!"
Carolyn, who wasn't upset, but
is starting to heat up, asks, "Is this THAT book or is this a
DIFFERENT book?"
"This is THAT book with your parts put
in," Pam says.
This ignites Carolyn, who abandons her
role as sisterly shrink for pure sister: "That's what I
figured. That this is really about you."
Pam pulls her
black straw hat down low over her eyes and folds her arms.
Shutdown. Carolyn turns away, her eyes glistening, and walks
into the kitchen muttering expletives.
Carolyn calls
from the kitchen: "I don't understand ... What do you
want?"
Pam explodes, "YOU WANT ME NEVER TO HAVE
LIVED!!"
"Oh, I see. I see," Carolyn replies. "It's all
or nothing. It's either you're alive or I'm alive. Is that
what it is?"
Pam: "According to you."
Carolyn:
"This has been my dilemma. I have to go into the f---ing
background so that YOU can be alive."
"No, Lynnie," Pam
says, "who's been in the background?"
"I've been in the
background my entire life - it doesn't matter what I do,"
Carolyn says. "Martha talks about you. Chipper talks about
you. Mommy and Daddy talk about you."
"They don't talk
to ME!" Pam says.
"Yeah, they talk to me about you,"
Carolyn says.
There are a few more exchanges, a long
pause and then, somehow, calm is restored.
"Anyway,"
Carolyn asks, "you want to talk about writing?"
"Yes,"
Pam replies. "I want to talk about writing."
Back in the Hospital,
September
Pam is in seclusion, lying on a
mattress on the hospital floor wrapped in a sheet spattered
with drops of blood from the cuts on her forehead. Scribbled
on the wall above her is her own graffiti: Kill me. I'm sorry.
The Ogre that Ate Manhattan Must Die.
Carolyn comes in
and sits down beside her. Pam, pale and irritable, peers out
from under the sheet. "I apologize that I didn't have
something sharper," Pam says, referring to the piece of
plastic she used to cut herself. "I found the sharpest thing I
could."
Recently, O'Malley agreed to let Pam replace
the Zyprexa with another anti-psychotic. During that
transition, her mind became sort of chemically stuck:
catatonic. She was aware of what was happening around her, but
could not speak and could move only with help.
The
doctors considered electroshock to jolt her out of it, but
Carolyn said no, fearing that it might affect Pam's memory.
What's a memoir without a memory?
Eventually,
medication brought Pam back, but voices are still telling her
to kill herself. The doctors put Pam back on Zyprexa, but when
she's released she goes off it again. Soon she's
rehospitalized.
Tired and
Discouraged
It's not often, but on this
October day Carolyn is downcast. Though rationally she knows
that Pam doesn't decide to have a setback, part of her feels
as if she does.
This is how it always seems to go,
Carolyn says. Pam starts to get better. Carolyn starts to
relax. "Oh, good, I can have a regular relationship. I can go
back to my fantasy. Everything is going to be OK and then I
hear from her or someone else: No, something else has
happened.
"Part of me wants to get angry and tell her
to think about me for once in her life," says Carolyn. Often,
Carolyn has used this rationale when talking to Pam about
suicide. "You can't kill yourself," she'll say. "Because if
you kill yourself, you're killing me."
It is an
argument Pam has listened to in the past, but now she is
obsessed with a presence - a visual hallucination - that is so
strong that she can't be released from the hospital until it
is extinguished. When she looks at the biohazardous material
stickers on waste containers, she sees the face of a
frightening man with a mustache. She calls him the
"Bio-Haz-Mat Man" and says she can't ignore his command to
hurt herself.
"I keep thinking I should be able to
reason her out of it," Carolyn says, knowing as she says it
that it isn't possible.
Where the man has come from, no
one is sure. Perhaps he is the result of her switch to another
anti-psychotic that doesn't seem quite as
effective.
Pam has voluntarily agreed to try
electroshock therapy, to try to zap "Mr. Bio-Haz-Mat" out of
her thoughts. Carolyn is concerned about this, but says, "At
least it won't put on weight."
The First Dr. Spiro,
October
There is a knock at the front door
of his New Haven townhouse and Dr. Howard Spiro jumps up. With
white hair and a goatee, he is distinguished at 79. Who could
it be, he wonders. He isn't expecting anyone just
now.
He opens the door and a man with dark curly hair
is there. Oh, you want the newspapers, Howard says. He hands
them over and reminds his caller that he'll be abroad for
three weeks.
It's the young man Howard has been helping
out. He is the son of a colleague. A young man with
schizophrenia who doesn't get along with his own father very
well. Often it is this way with mental illness. The disease
exhausts and splits families in ways other illnesses
don't.
So Howard has stepped in, has lunch with him,
tries to help him.
"It's useful to me to help him,"
Howard says, after shutting the door. "It gives me a chance to
feel that I'm helping someone."
So why can't Howard
talk to his own daughter? Why hasn't he had a real
relationship with Pam for decades?
"This is making me
very uncomfortable," he says. But these are questions that
gnaw at every member of the Spiro family; everyone would like
to see a peace of some sort between father and
daughter.
A few months ago, Howard said that his
retreat from Pam began at the beginning, when he drove her
from Brown to Yale and realized, then, that she had
schizophrenia.
As a doctor, he knew it was an illness
that could consume not only her, but the entire family. "To
myself I've used the word `encapsulate,'" he says, "so that it
doesn't too much affect the way everybody lives. It may sound
hard-hearted, but you have to understand, I knew it was a
lifetime illness."
Could he explain why he hasn't
reopened communication since then? Howard said his feelings
would remain secret. "It's not helpful to get into it. I would
like to draw a veil over it. It was self-protection, but
denial is a pretty good thing."
But Howard's account is
not consistent with Marian's. Marian says neither of them saw
how serious Pam's condition was. If they had, they would have
reacted differently. They would have treated Pammy as a person
with a devastating lifelong illness, rather than as a child
who was passing through a troublesome adolescence. If they had
understood the seriousness, Marian says, Howard wouldn't have
treated Pam as if she could snap out of it at
will.
Howard nods now and says that Marian is also
right. He did feel - on an emotional level - that Pam had some
control over the illness. That somehow her illness was a
rebellion against him, even though he also understood that the
illness is biochemical.
He says that a year or so ago,
he thought he and Pam were moving toward a kind of
rapprochement, but then there was an angry call from
her.
"I'm clearly woven into her psychosis. I was the
center of her aggressions as far as I could
see."
Marian and Carolyn have told him that they too
have been the target of Pam's ire, but that often it is not
Pam talking; it's the disease. Howard understands that, but
"the reality is I get attacked."
Howard says that if he
had been treated differently by Yale doctors way back in the
'70s, if he hadn't felt blamed for Pam's illness, family
history may have gone differently. "Both of us [his wife and
him] would not have suffered so much. It left us with the
feeling that the family was responsible. If the family was
responsible, then we could cure her.
"I didn't know
what to do. I felt absolutely powerless and
paralyzed."
Howard says he is grateful to Carolyn and
to his wife for taking care of Pam when he could not. "I owe
it [to them] for complete protection from the depredations of
the disease. I believe Lynnie has extraordinary strength to
function as a psychiatrist, to be aware of the genetic
influence and parallels and the dangers of having a twin with
schizophrenia, the risks of having children.
"I had my
work - work is a great panacea," but "my wife and Lynnie are
the heroines."
Howard says he is convinced that the
twins have a "mystical connection." He likens them to the twin
stars, Castor and Pollux, "continually circling each other,
continually influencing each other."
If he wasn't their
father, he would like to write about them, he says. "Write a
story about hope," he suggests. "That Lynnie has not lost her
hope and Pam has not lost her hope. Leave out the anger and
the sorrow. Focus on the heroines."
But what about the
question. Will he see Pam again?
He doesn't
know.
Pam-dora's Box,
October
Pam is worried that her memory is
deteriorating. She has had six electroshock
treatments.
She has taken to keeping a list of what's
important: her name, her doctors' names, that she is writing a
book and will be in a Northeast magazine story.
Today,
Carolyn has come to visit, bringing chocolate chip muffins,
fruit salad, scones and sticky buns.
"I don't remember
anything," Pam says.
"Do you remember that I am
Martha?" Carolyn asks with a wry smile.
"Martha - who's
that?" answers Pam, deadpan.
"Your memory will come
back," Carolyn tells her "but this gives me license. I can
tell you anything I want."
"You can say you brought me
scones and fruit and muffins."
The conversation turns
to weight, as it so often does. Carolyn tells Pam she looks as
if she's lost 30 or 40 pounds. "Just from being in here?" asks
Pam.
"And from not being on the Zyprexa," Carolyn tells
her. It has been an unusually onerous last few months for Pam.
While fluctuations are routine, she had never been catatonic
for so long, she's never needed electroshock.
But this
news that she has lost weight brings a fresh smile to her
face. "That makes it all worthwhile," she says.
Carolyn
sighs and asks Pam if she's still seeing the Bio-Haz-Mat Man.
"Do you actually see him as real as I am?"
"Almost as
real as you - yeah," says Pam.
Pam says an occupational
therapist has given her an oversized silver Altoids box and
suggested that she catch "Mr. Bio-Haz-Mat in that
box."
"The problem is, he won't go in there," Pam says,
seemingly serious. "If I caught him, I could just chop him up
and put him in there ... Will you help me get the guy into the
box?"
"How can I? I don't see him," Carolyn asks. "Can
you see him?"
"No, he's not there," Pam replies, and
then she ponders, "I wonder if I already got him in the
box."
Carolyn suggests she go get the box in her room,
which Pam does, and then confides: "I can't believe this is
happening. If this were a movie, I'd say this isn't how people
with schizophrenia behave."
Pam returns and Carolyn
points to a slight bulge in the box and says, "This is a real
Pam-dora's Box."
"I feel like he's in there," Pam says.
"I need to tape it up and make sure he's in there. How did I
get him there? Promise you won't open it."
"Me? Open
this?" asks Carolyn. "Nothing I'd like better than to have
this guy locked up. We're talking multiple boxes, chains,
bicycle locks ..."
"You won't untape it, just to see if
it's real?"
"Pammy, I want you better," Carolyn tells
her. "I'm the one who wants you to get out of here!"
As
if suddenly remembering, Pam asks, "So we can write a
book?"
Carolyn: "You forgot?"
Pam: "I forgot,
but now I remember."
51st
Birthday, Nov. 17
It's the twins' birthday,
and each is marking the day in her own way.
Pam is OK
about being 51. She is glad to be out of the hospital, happy
to be home. Ever since she put the Bio-Haz-Mat man in the box,
he hasn't returned. In fact, she's been hearing no voices,
seeing no hallucinations.
It's tempting to ask
questions. Did the electroshock help put him in the box? Does
she actually believe he's locked in the box or was it a mental
device or metaphor? But asking might undo the magic of this
remedy.
The burns on Pam's forehead have healed,
leaving a scar that's barely noticeable. Soon after her
arrival home, Pam took down the baby photos and gave them to
Carolyn. At first, Carolyn was concerned. "Does this mean
you're intending not to be around?" she asked. No it
didn't.
"She wanted them and I didn't need them," Pam
says today. She's left up the schoolgirl photos.
Her
apartment is immaculate. Martha visited a few days ago and
cleaned it up. A visiting nurse suggests covering up the
tinfoil with fabric. Pam thanks her for "the fashion
tip."
Pam's memory - except for parts of her
hospitalization - has returned and she is back to writing and
editing. She is hoping to stay well.
A birthday is a
victory for her. "I'm happy to have made it. It's another
milestone. I might not have made it this far ... Why would I
want to go back to so many years of misery?"
The signs
of aging don't concern her, either. "I like my wrinkles, I
like the drooping jowls. They don't bother me in the
least."
Carolyn has been less fond of birthdays,
particularly last year's. She considers visiting Pam on their
birthday. Pam is ready to work and the two could edit side by
side, but ultimately she decides not to. She has a two-hour
ballroom lesson with Tim and then two hours more of practice,
and it's dreary and raining.
Pam is not surprised: "I
know she's avoiding her birthday. She thinks I'll make
something of it - and I will, little as it is."
As Pam
settles down in her recliner with a large mug of tea, the
phone rings.
It's Carolyn, singing into the phone:
"Happy birthday to me, Happy birthday to you ..."
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UTILITIES |
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Eemie
(MICHAEL MCANDREWS)
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