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Submitted Literature

Divided Minds: Twin Sisters and Their Journey Through Schizophrenia

By Pamela Spiro Wagner & Spiro, Carolyn S.

Review

Divided Minds is an autobiography told through the alternating perspectives of identical twins Pamela, who has a diagnosis of schizophrenia and struggles with psychotic symptoms from a young age, and Carolyn, who becomes a psychiatrist. This book is unique within the realms of autobiographical accounts of mental illness. It seamlessly blends harrowing accounts of acute periods of illness alongside the intricacies of the relationship between the two sisters. Pamela’s account of psychosis and schizophrenia does not shy away from the horror and fear that she experiences:

 

‘On New Year’s Day I wake in University Hospital to the scream of air raid sirens. When I hear the call for evacuation, my legs turn to jelly, giving way to a sudden loss of muscle tone that’s common in narcolepsy. I collapse on the floor, a helpless heap. Someone sneers in disgust and tells the others to ignore me, they’re leaving me behind.

I hear the noise of passing feet, see light and shadows going by my door, then murmuring as patients are herded toward a hidden exit. Some laughter, whispering, strange thumps and clattering. Finally nothing, just silence.  

Faintly but growing louder each second, a high-pitched whine saws its way into my skull with a Doppler intensity. Approaching missiles – ICBMs. Or is it only a fly? Guns pound. Or is it only my heartbeat? My head is throbbing. The pulse in my neck resounds like ocean combers crashing on the rocks.

Why have they left me behind? Is it some kind of joke? A test? A mistake, a bad dream? There has to be an explanation... something.

The noise grows louder and louder, enlarging inside my head until a tangible dazzling fills me, its substance taking up all the space in the room, filling me with sudden understanding bright and hard as diamond: Aah, so it’s an experiment! Of course! Everything is being recorded by hidden cameras. This conclusion, horrible though it seems, consoles me; a malevolent world that follows rules of any sort is easier to bear than the cruel unpredictability of a so-called benign one.’ (p. 260-261)  

 

Nor does it sugar coat her relationships with other family members, friends and various professionals, or the dilemmas she faces with taking medication which enables her symptoms to recede but which takes as much, if not more, from her sense of self and ability to lead a satisfying life than it gives back. During one hospitalisation, punitive and brutal ‘therapeutic’ methods are detailed, familial and medical interventions clash while Pamela, terrified and largely mute, must survive towards, and post, discharge from hospital:

 

‘In any event, after four months, I am still mostly mute and unable to interact, and I remain on one of the lowest status levels. My parents ask for a consultation with an outside psychiatrist, Dr. Saul. He’s a tall, white-bearded man who holds the door for me and smiles in a gentle way that makes me like him. We go on walks; he seems to understand that it is too hard for me to talk or to look at him. His voice is soft and kind. He’s not sarcastic like the other doctors. After six visits I come to trust him.

Then he recommends long-term hospitalization and my parents explode. Not caring who hears, my father shouts, “Behave like a normal human being! Do you want to be institutionalized?

Dr Saul also recommends a switch from an antidepressant to an antipsychotic medication. This is finally effective. I begin talking and rise in status. I am even elected head of the patient government.

Discharged a month later to a halfway house, I get a job at a local hospital pushing wheelchairs and stretchers. Despite the lip service given to “follow up”, within a week I have no doctor, no medication, no future.’ (p. 139-140)     

 

The account is frank and honest, from both sides of the story – Pamela’s experiences are terrifying and her survival admirable, and Carolyn is refreshingly open in her frustrations with fulfilling the carer and sister role, and how these coincide and conflict with her medical training. Here we can see the pain of hearing distressing experiences and dangerous plans from an unwell twin:

 

‘ “They told me something about a plan.”

“Damn it! I told them not to.” She sounds more worn out than angry now. “I knew you’d only worry.”

“You were right. So?”

“What’d they tell you?”

Not much. Confidentiality. They said I needed to ask you.”

“It wouldn’t help if you knew. You’d only get upset, and there’s nothing you can do to stop it.” She pauses and then adds, “It’s his plan, really. He’s worked everything out.”

“He?”

“You know, the hazmat man. He’s mad that I told the staff, because now they’re watching me twenty-four/seven.”

“He’s telling you to kill yourself? That’s the plan?”

“No, it’s not suicidal.” She stops. I wait. She goes on carefully, “I know what you’re thinking, but the plan isn’t lethal. He’s assured me of that-”

I interrupt her. “That’s supposed to make me feel better? It won’t kill you -”

“There are safeguards...”

“So what? I should be happy it’d only maim or disfigure you? And that’s okay? I’m sick of it. How can you do this to me?”

“Lynnie, I don’t want to do it.” There is something eerily genuine in this offering. Cold, I pull the blankets over me. Pammy’s quiet now. Finally, she continues. “I called Dr. Haas, and she phoned the unit to make sure I don’t get out.”

“Why?”

“Because I have to do what he tells me! Every day he reminds me of the plan. He has given me specific instructions. He won’t let it kill me, but it would set things back for a while-”

“Set things back?” She’s right; I don’t want to know the details of her plan if there is nothing I can do but wait. I don’t like suspense in any form. At movies, I close my eyes at scary scenes to avoid any visual memory able to roam around in my brain at night. I don’t like to watch reruns of the Olympic skating events even when I already know the outcome.

But of course she tells me anyway, delusions about the man, the little red dancing hazmat man, his orders, his demands. He matters. I don’t. She has no idea of the agony of insomnia this causes me, with nightmares destroying what little sleep I can steal.’ (p. 305)

 

The carer role – and not only the role of carer, but as ‘expert’ carer – and the details of Pamela’s periods of illness and treatment, as well as recovery and residual symptoms, are given equal weighting in this moving text – a rarity within this subgenre. In this respect, this book is a vital read for individuals who have been through, or are going through, periods of mental illness, their carers, family and friends and – crucially – psychiatric professionals who would undoubtedly gain insight and, hopefully, empathy from the perspectives in this book.

Key Themes:

  • Autobiography
  • Carer Issues
  • Schizophrenia

Reference: Pamela Spiro, Wagner & Spiro, Carolyn S.. 2005. Divided Minds: Twin Sisters and Their Journey Through Schizophrenia. St Martins Press, 2005

Reviewer

- Charley Baker
Date Review Submitted: Saturday 11th September 2010