The Sisters Were Identical, Until The Voices Began.
By Kathleen Megan
December 14 2003
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
• • •
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.
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
The Hospital, June
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
"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.
has strawberry blond hair, stylish clothes, eloquence, sensitivity and humor.
She has a good relationship with both her parents and is now
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.
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
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
"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
"You do it to yourself," asks Carolyn, "because you know the
"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
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
"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.
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.
folklore can shape expectations, can set the stage for what is to
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
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
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
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.
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.
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."
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
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.
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
Marian says now, "It was very surprising that [Pam would] be
so upset ... but watching Pam overreact was not a new thing."
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
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.
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.
you got whatever you wanted."
"Well, I don't know that I got anything of
"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
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, you can't," Pam commands.
"You said to be honest,"
says Pam. "All right, now STOP it. Your nose is getting red."
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."
"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,"
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
"Stop covering your face," Carolyn instructs.
I'm making you feel bad," says Pam from beneath the manuscript.
making me feel bad," Carolyn says, "because you're writing well enough to make
Growing up a Spiro
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
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.
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.
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,
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
She taught them basketball, tennis, swimming, sailing. She took
a geology course, and led her children on walks to help them identify mica or
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
At Yale, Howard was acquiring prestige and success. He was
writing what would become the textbook on gastroenterology for many
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.
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.
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
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.
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.
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.
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.
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."
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
Pam feels the medication has also made a difference in her
relationship with Joe, who asked that his last name not be used.
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."
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
"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
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
"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
"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
"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."
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
"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
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?
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.
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
"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
"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
But enough with the talking, Carolyn says. "Hey, Tim, we can
talk or we can choreograph!" At $30 each an hour, they start
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.
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.
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
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.
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,
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
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.
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
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.
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
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
"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
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.
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
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
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
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
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
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
"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."
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
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
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
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
"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
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
Pam doesn't know and doesn't want to know.
"Is it too
scary?" asks O'Malley.
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
"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
"Yes, because it's making me evil."
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.
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
"Do you talk back?
"Yes," Pam says.
"I'll have a conversation with them and then realize: What the HELL am I
"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
When Carolyn looks back, the time she probably most
longed for Pam to be well was when her daughter, Allie, was born, in
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
"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
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
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
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
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
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
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
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
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.
is a chronic paranoid schizophrenic. There's not much else to do," he
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
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
"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
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
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
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.
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
"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.
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,
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
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.
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
"I don't understand why you stand up for him - a man who has
treated your daughter this way for 30 years," Pammy shouts.
wrong, Pammy, there's no excuse for his behavior," Marian says.
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
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."
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
"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?"
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
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
"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."
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.
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
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.
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?"
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.
calls from the kitchen: "I don't understand ... What do you want?"
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
"No, Lynnie," Pam says, "who's been in the
"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
"Yeah, they talk to me about you," Carolyn says.
There are a
few more exchanges, a long pause and then, somehow, calm is
"Anyway," Carolyn asks, "you want to talk about
"Yes," Pam replies. "I want to talk about
Back in the Hospital,
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
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?
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.
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
"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
"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.
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.
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,
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
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
So Howard has stepped in, has lunch with him, tries to help
"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."
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.
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
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
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."
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
"I didn't know what to do. I felt absolutely powerless and
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
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
But what about the question. Will he see Pam
He doesn't know.
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.
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,
"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
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
"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."
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."
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."
this?" asks Carolyn. "Nothing I'd like better than to have this guy locked up.
We're talking multiple boxes, chains, bicycle locks ..."
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?"
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
"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."
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
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
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
As Pam settles down in her recliner with a large mug of tea, the
It's Carolyn, singing into the phone: "Happy birthday to me,
Happy birthday to you ..."