Divided Minds

1. The Unbreakable Yet Strained Twin Bond

Most people don’t understand how hard it is to make the effort with other people when you’ve always had so easy a connection with your twin.

Profound connection. Identical twins Pamela and Carolyn (Lynnie) share an intense, almost telepathic bond from childhood, often sensing each other's thoughts and feelings. This deep connection provides comfort and understanding but also creates challenges in forming relationships outside their pair. Their world is initially defined by "we," making individual identity development complex.

Competition and resentment. Despite their closeness, rivalry is a constant undercurrent. From vying for a birthday crown in first grade to competing over academic achievements and even thinness, the sisters measure themselves against each other. This competition, sometimes subtle and sometimes overt, strains their relationship, particularly as their lives diverge dramatically.

Mutual dependence and distance. As adults, their bond persists, often mediated by phone calls when face-to-face interaction becomes difficult due to Pamela's illness and the emotional toll on Carolyn. They rely on each other for support and understanding, yet also create distance to forge individual lives, a necessary but painful process.

2. Early Shadows of a Divided Mind

I knew it, I knew it, didn’t I? And I did nothing. I killed him, I killed him.

Childhood anxieties. Even in early childhood, Pamela exhibits signs of distress and unusual thought patterns, such as her intense reaction to wearing the "boys' crown" or her morbid writing assignments in sixth grade. These early behaviors hint at an underlying vulnerability that goes beyond typical childhood fears or sibling rivalry.

Magical thinking and guilt. The assassination of President Kennedy becomes a pivotal, traumatic event for Pamela, leading to a profound sense of personal responsibility and guilt. She believes her thoughts or inaction caused his death, demonstrating a breakdown in reality testing and the emergence of delusional thinking at a young age.

Sensory distortions. Alongside her disturbing thoughts, Pamela experiences sensory distortions, hearing whispers and seeing things others don't. These early hallucinations and paranoias, though not fully understood at the time, are precursors to the more severe symptoms that will manifest later, marking the beginning of her "divided mind."

3. Trauma's Deepening Impact

I am drowning, unable to get enough air before I go under.

Compounding stressors. Significant events like the JFK assassination and a severe ski accident in childhood seem to exacerbate Pamela's underlying vulnerability. The ski accident, resulting in a broken leg and prolonged isolation, coincides with increased emotional distance from her twin and a growing preference for solitude.

Parental criticism. The father's harsh criticism and inability to express affection deeply wound Pamela, reinforcing her feelings of inadequacy and worthlessness. His public shaming and dismissal of her emotions contribute to her withdrawal and difficulty trusting others, particularly authority figures.

Internalizing blame. Pamela internalizes external events and criticisms, believing she is inherently evil or responsible for negative outcomes. This self-blame fuels her distress and makes it difficult for her to seek or accept help, as she feels deserving of punishment rather than support.

4. Divergent Paths in Young Adulthood

I am on the verge of freedom, I’ve always thought of myself as part of Pammy, limited by her but safe.

Seeking independence. College represents a crucial turning point as Carolyn actively seeks to establish her own identity, separate from Pamela. She changes her name, pursues different academic and social interests, and consciously limits time spent with her twin, recognizing the need to break free from their codependent dynamic.

Academic and social success. Carolyn thrives in the college environment, forming new friendships, exploring relationships, and excelling academically and in dance. Her journey is one of self-discovery and growing confidence, contrasting sharply with Pamela's increasing struggles.

Pamela's decline. While Carolyn flourishes, Pamela's mental health deteriorates significantly during her freshman year. She becomes withdrawn, experiences intense paranoia and hallucinations, and attempts suicide. This period marks the onset of severe, overt symptoms that derail her academic path and necessitate hospitalization.

5. Descent into Psychosis and Hospitalization

I am convinced he feels only contempt for me. I am already being dressed down by voices he can’t hear but with which I am sure he would fully agree.

Hallucinations and delusions. Pamela's experiences escalate to persistent auditory hallucinations (voices), visual distortions, and complex delusional systems involving conspiracies, surveillance, and personal responsibility for major events. These symptoms profoundly distort her perception of reality and make daily functioning impossible.

Repeated hospitalizations. The severity of her illness leads to frequent and prolonged hospital stays. These admissions are often triggered by crises, such as suicide attempts, inability to care for herself, or escalating paranoia and agitation, highlighting the chronic and debilitating nature of her condition.

Catatonia and self-harm. At her worst, Pamela experiences catatonic states, becoming mute and immobile. She also engages in self-harm, such as cutting or burning herself, as a way to cope with emotional numbness or the torment of the voices, demonstrating the extreme distress caused by her illness.

6. Navigating the Complex Mental Healthcare System

Psychiatrists are supposed to help people. He only seems to care about my parents.

Challenging interactions. Pamela's experiences with mental health professionals are often fraught with difficulty. She encounters doctors who are dismissive, overly confrontational, or seem more concerned with her parents' distress than her own suffering, leading to mistrust and resistance to treatment.

Misdiagnosis and ineffective treatment. Early in her illness, Pamela's condition is not consistently or correctly diagnosed, and initial treatments are often ineffective or have debilitating side effects. This period of trial and error prolongs her suffering and contributes to her skepticism about the medical system.

Stigma and judgment. Pamela faces stigma and judgment from some staff members and even family, who may attribute her symptoms to willfulness or character flaws rather than a severe illness. This lack of understanding and compassion exacerbates her feelings of isolation and shame.

7. The Search for Effective Treatment and Stability

I think you can get well too, but you’ve got to take the medication.

Medication challenges. Finding effective medication is a long and difficult process for Pamela. She experiences severe side effects from various antipsychotics, including sedation, weight gain, and movement disorders, which make her reluctant to take them consistently despite their potential benefits in reducing psychotic symptoms.

Therapeutic relationships. Positive relationships with therapists, like Dr. Ginzer and later Dr. Siobhan, prove crucial. These therapists offer empathy, validation, and a willingness to listen to her experiences without judgment, fostering trust and encouraging her engagement in treatment, even when symptoms persist.

Periods of stability. Despite the chronic nature of her illness, Pamela experiences periods of relative stability and improved functioning, often linked to finding a medication regimen that provides some relief and having consistent support from professionals and family. These periods allow her to pursue her interests and maintain a degree of independence.

8. Finding Purpose and Identity Amidst Illness

Now, at last, there is something of value in my life. Poetry... is something to live for.

The power of writing. Amidst the chaos of her illness, writing, particularly poetry, becomes a vital lifeline for Pamela. It provides a means of expression, a connection to a different reality, and eventually, a source of validation and purpose outside of her illness.

Recognition and validation. Winning poetry awards and having her work published provides significant external validation for Pamela's intellect and talent, challenging the narrative of deterioration and hopelessness often associated with her diagnosis. This recognition boosts her self-worth and motivates her to continue writing.

Maintaining interests. Despite the debilitating effects of schizophrenia, Pamela maintains intellectual curiosity and artistic interests, such as reading, art, and music. These pursuits offer moments of escape, engagement, and a sense of continuity with the person she was before the full onset of her illness.

9. The Enduring Impact on Family and Self

Her life has fallen apart and if I cared—

Family strain. Pamela's illness places immense strain on her family, particularly her parents and siblings. They struggle to understand and cope with her symptoms, navigate the healthcare system, and balance their own lives with the demands of her care, leading to emotional exhaustion and sometimes fractured relationships.

Carolyn's guilt and responsibility. As the "well" twin and later a psychiatrist, Carolyn grapples with complex feelings of guilt, responsibility, and helplessness regarding Pamela's illness. She feels compelled to help but also resents the burden and the way it impacts her own life and sense of self.

Redefining identity. Both sisters are forced to redefine their identities in the shadow of schizophrenia. Pamela must find a way to live with a chronic illness that fundamentally alters her perception and functioning, while Carolyn must reconcile her identity as a successful professional and "normal" twin with the reality of her sister's profound suffering.

10. A Sister's Perspective: From Twin to Psychiatrist

I’m a fucking psychiatrist, for God’s sake. I know Pammy better than she does.

Influence on career choice. Carolyn's path to becoming a psychiatrist is deeply intertwined with Pamela's illness. Witnessing her sister's struggles and the shortcomings of the mental healthcare system likely influences her decision to enter the field, seeking to understand and potentially help others like Pamela.

Professional and personal conflict. As a psychiatrist, Carolyn faces the unique challenge of being both a family member and a professional observer of her sister's illness. This dual role creates tension, as her personal knowledge and emotional connection sometimes conflict with professional boundaries and the perspectives of other clinicians.

Advocacy and understanding. Carolyn becomes an advocate for her sister, challenging diagnoses and treatment approaches she believes are inadequate or harmful. Her journey highlights the importance of family perspective and the need for empathy and individualized care within the mental healthcare system, informed by her personal experience and professional expertise.

Last updated: May 9, 2025