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Book Reviews   |    
Divided Minds: Twin Sisters and Their Journey Through Schizophrenia
Reviewed by Margo Lauterbach
Psychiatric Services 2006; doi:
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by Pamela Spiro Wagner and Carolyn S. Spiro, M.D.; New York, St. Martin's Press, 2005, 318 pages, $24.95

Dr. Lauterbach is a psychiatry resident at the University of Massachusetts Medical School in Worcester.

The book Divided Minds, by Pamela Spiro Wagner and Carolyn S. Spiro, M.D., is an autobiographical account of these twins: they are identical twins but clearly different from birth. Their chapters are eloquently written, with each twin narrating her experience through significant life events, some parallel and others strikingly disparate. Beneath jealousy, pleas for attention, resentment, and competition lies a loving story of sisterly connection only twins could truly understand and experience. The two struggle throughout life to form unique and distinct identities, both with and without the other. Their obvious difference is psychiatric: Pamela is given a diagnoses of schizophrenia, and Carolyn becomes a psychiatrist. They both understand the illness. Pamela has first-hand experience from early in life, while Carolyn, as a loved one and eventually a mental health professional, is a witness to such severe mental illness. At times heart-wrenching, this unique book is an honest portrayal of their battles, with each other and with the illness that has affected their lives and the lives of so many people around them.

Pamela Spiro Wagner, the dominant twin, is the first-born high-achiever, gifted at everything. She overshadows Carolyn throughout their youth, and both of them know and feel this. Through adolescence though, the early signs of Pamela's illness become apparent, at least to herself. She hints at her psychopathology throughout the diary: a sleep disorder, an eating disorder, and a psychotic disorder. As her illness worsens, she slips into the shadow of Carolyn's well-rounded achievements and everything slowly changes for her. They both end up at Brown University as undergraduates, but academic accomplishments and sociability soon become challenging for Pamela. Rifts form in her relationships, and daily living becomes wrought with symptoms of her illness. She eventually starts medical school too but drops out during her second year as the disease takes its toll. Side effects, isolation, noncompliance, suicidal thoughts, and hallucinations guide Pamela's fragile mental states and numerous hospitalizations. However, her strong character and excellence become evident in her award-winning poetry and writing, a hobby and skill not taken by schizophrenia. Throughout her gripping life story, Carolyn remains a constant figure of hope in Pamela's life, for better or worse, even when the medications fail.

Carolyn S. Spiro, M.D., also known as "Lynnie" during her early years, has a clear path for success once her sister becomes ill. No longer second to Pamela, Carolyn grows to be a psychiatrist, a wife, and a mother. But her sister is not left behind, because Carolyn receives phone calls from state hospitals informing her of her sister's deteriorations. Her career in psychiatry becomes highlighted by the patient in her family. Although her marriage ends and she faces her own life conflicts, Pamela, despite schizophrenia and all of its destruction, remains a constant figure of hope in Carolyn's life. Alone and together, Carolyn and Pamela are both remarkable women who carve out identities for themselves beyond psychiatry. Although divided by circumstances and life events, their message is a unified one of hope and strength poignantly weaved into their fascinating story about their twinship.

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