Psychiatrist Carolyn Spiro, M.D., was sleeping in the on-call room at
Massachusetts Mental Health Center in Boston one night in 1981 when an urgent
call came from a nurse working at the state psychiatric hospital in
It wasn't one of Spiro's patients who'd been admitted, but her twin sister,
Like many twins, the two shared many of the same attributes and life
experiences: dark eyes and slight builds, quick intellects, undergraduate
years at Brown University, and even admission into medical school.
But after Spiro made her way to the hospital, where her sister was frozen
in a catatonic stance with one arm extended into the air, the similarities
between them seemed to fall away. "This can't be my twin," Spiro
remembered thinking at the time.
In a recent interview with Psychiatric News, Spiro said that
although she knew her sister had emotional problems and engaged in
self-injurious behavior, she had denied any possibility that Wagner had
serious mental illness. "Psychiatrists use the same defense mechanisms
that others do," she noted. "I defended against the realization
that a family member was actually suffering from the same illness I treated on
the very wards where I learned how to be a psychiatrist," said
As twins growing up in New England, Carolyn (left) and Pamela Spiro had
unremarkable childhoods. Pamela began to experience the first symptoms of
schizophrenia in early adolescence. Courtesy of Carolyn Spiro, M.D.
The truth could no longer be avoided when hospital staff told Spiro that
her sister had schizophrenia.
Spiro said it was difficult to know how to behave during the trip to the
"I knew I was there to support Pammy as my sister, but I didn't know
what to do with the part of myself that had been on call in a very similar
hospital the night before and taking care of patients just like her,"
Carolyn Spiro, M.D. (left), and Pamela Spiro Wagner sign copies of the
book they co-wrote, Divided Minds, at the West Hartford, Conn., Town
Hall in August of last year. Courtesy of Carolyn Spiro, M.D.
As it turned out, Wagner ended up hospitalized because she had stopped
taking her antipsychotic medications; she required multiple hospitalizations
over the next two decades.
"All those drugs made me feel horrible—dull and
dead—everything I didn't want to be if I was going to write
poetry," Wagner told Psychiatric News. When she went off her
medications, she'd be in "seventh heaven," she recalled,"
until the paranoia and obsessions hit."
Over the years, Wagner wrote poetry and award-winning articles pertaining
to mental health. In addition, she wrote a memoir about her experiences with
mental illness and treatment, which would later be integrated into Divided
Minds, a book the sisters wrote together between 2000 and 2003.
St. Martin's Press published the book last year.
The book tells the story from the alternating perspectives of Wagner and
Spiro as they recount their lives and sometimes profoundly different
experiences of certain events.
For instance, when the twins were in the sixth grade and President Kennedy
was assassinated, Spiro felt shocked, as did many of her peers. Wagner,
however, became crippled by terror and felt that she was to blame for the
tragedy. "I believed that I killed Kennedy," she said.
As the twins matured, their relationship became characterized in part by
rivalry as they struggled to distinguish themselves from one another.
"If Pammy did something first, I always felt like she owned
it," Spiro said. "I was doomed to be in the position of
imitator." Spiro never blamed her sister for being in front, she
explained. "It was my fault that wherever I looked, I saw her
Though Wagner was plagued by increasingly threatening auditory
hallucinations throughout high school, she excelled academically and managed
to keep the psychosis a secret, even from her sister.
When the twins began attending Brown University, Wagner became increasingly
isolated and spent a great deal of energy trying to seek refuge from the
voices and nonsensical thoughts that flooded her mind. She swallowed a bottle
of sleeping pills in her freshman year and was hospitalized.
Though both Wagner and Spiro attended medical school, Wagner dropped out in
her second year.
Spiro explained that when her sister became ill, "she left the door
open for me, and when I walked through, the horizon was clear." By this
she meant that when Wagner became incapacitated by mental illness, Spiro was
free of the rivalry that existed between them. "I began to try new
things because I no longer assumed that I would fail," she said.
Spiro embarked upon a career in psychiatry, which she believes is the"
most fascinating area of medicine," but also admitted that her
sister's illness gave her "an excuse to be a psychiatrist." She is
now in private practice in Wilton, Conn.
Over the past several years, Wagner has found a successful combination of
medications and has been "coping and doing well," she said.
Wagner remarked that writing the book has brought them closer together, and
though they were "perfectly attuned to one another" toward the end
of the writing process, the going was sometimes rough.
"Pam was in and out of the hospital more times than I can
count," Spiro said. "I was carting notes and manuscripts back and
forth to a number of different hospitals around the state."
During this time, Spiro was having her own difficulties. "I was going
through a divorce, but Pam was still able to be emotionally supportive,"
Since the book's release, Spiro and Wagner have been traveling around the
country to share their experiences at book signings and meetings of the
National Alliance on Mental Illness. "Our main message is that mental
illness should not be pushed into the closet," said Spiro. "We
encourage people to seek treatment and know that there is hope for
Spiro noted that their speaking engagements have opened up new worlds for
Before the book tour, Wagner had never spent a night in a hotel and had
seldom dined in restaurants. "Here is this incredibly bright woman who
reads everything and knows a lot from books, but hasn't experienced a lot of
things," remarked Spiro.
Though public speaking can be a daunting task for anyone, Wagner said that
it is "absolutely worth it to stand in front of crowds and speak if I
can help people like me hang onto hope for a better tomorrow—to put one
foot ahead of the other and keep walking." ▪