CHAPTER 9
1964
National Institute of Mental Health, Washington, D.C.
On a spring day during the Great Depression, in a bustling town somewhere in America, a squabbling, unhappy married couple welcomed into the world four identical girls—quadruplets. The press rushed to cover the story of the births, and the parents, whose resources were severely limited, allowed one of the local newspapers to hold a contest to name the four sisters. They also fielded offers of sponsorships from local dairies eager to use the girls to sell milk, and charged admission to visitors hoping to catch a glimpse of the babies at home.
Money did not solve the family’s problems. One of the daughters had a psychotic break when she was twenty-two. The others followed, one after another. By the time they were twenty-three, all four sisters were diagnosed with schizophrenia. And in the early weeks of 1955, these four women—quadruplet sisters, twenty-five years old with identical DNA—were referred to the National Institute of Mental Health in Washington, D.C.
The psychiatrists at NIMH understood the rare opportunity that these sisters presented. By their calculations, quadruplets with schizophrenia were likely to occur only once in every 1.5 billion births. They entered the care of David Rosenthal, a psychologist and researcher at NIMH who, thanks in part to the quadruplets, would go on to become one of the century’s most prominent schizophrenia researchers focused on the genetics of the illness.
The sisters stayed at NIMH for three years and Rosenthal and his team of two dozen researchers studied them for five more, protecting their privacy with pseudonyms. They gave them the last name Genain, from a Greek phrase meaning dire birth, and first names starting with letters corresponding to the acronym NIMH: Nora, Iris, Myra, and Hester. The city they lived in was never disclosed, and their parents became known as Henry and Gertrude. And in 1964, the year that the Galvins were settling into their new home on Hidden Valley Road, Rosenthal published The Genain Quadruplets, a six-hundred-page study of familial schizophrenia that would become a classic of the genre—a case study that, with its scrupulously nuanced take on the nature-nurture question, became every bit as consequential to the study of schizophrenia, it was said at the time, as the case of Daniel Paul Schreber.
* * *
—
BY THE TIME the Genain sisters came to NIMH, the search for a physical or genetic marker for schizophrenia had fallen out of vogue in psychoanalytic circles—out-argued, it seemed, by a new generation of therapists, Frieda Fromm-Reichmann among them. But in a separate silo—university laboratories and hospitals out of reach of the psychotherapists—neurologists and geneticists spent the 1950s and 1960s continuing the search for a biological marker for schizophrenia. The gold standard in such work was the study of twins. There could be no better way, it seemed, to test the hereditary strength of any condition than by seeing how many identical twins share the illness and then comparing that to the rates of disease in fraternal twins. Researchers in Europe and America conducted and published many major twin studies of this sort, starting with Emil Kraepelin in 1918 and continuing with others in 1928, 1946, and 1953. Each of these studies offered data showing a hereditary element existed, even if the numbers weren’t overpowering. And each time, the response from psychoanalysts was more or less the same: How do you know the disease wasn’t passed through families because the family environment was what caused the disease? How do you know it wasn’t their mothers?
At NIMH, David Rosenthal believed right away that the very existence of quadruplets with a shared mental illness could settle this argument once and for all. “When one first learns that the quadruplets are both monozygotic and schizophrenic,” wrote Rosenthal, “one can hardly help but wonder what further proof…anyone would want to have.” But he also knew it was not that simple. In his writings about the case, he noted that many psychotherapists, including some of his own colleagues at NIMH, were unpersuaded. The parents of the Genain sisters presumably treated each girl pretty much the same: They dressed them alike, sent them to the same schools, set them up with the same friends. It would be every bit as likely, they argued, that these girls all had schizophrenia because the parents brought them all up the same way.
Rosenthal and his colleagues went to work collecting a family history of the Genains and found at least one instance of mental illness. The sisters’ paternal grandmother had apparently had a nervous breakdown as a teenager, experiencing symptoms that one NIMH caseworker believed sounded like paranoid schizophrenia. But genetics only tells part of the story of any identical sibling, and the Genain sisters indeed were, in certain respects, different from one another. Nora was the firstborn and sort of the spokesperson for the group, the best piano player with the highest IQ, though she was given to tantrums. Iris, meanwhile, was described as “vacuous,” but helpful around the house and a skilled beautician, while Hester was quiet, sober and retiring, “unkempt,” as Rosenthal described her, “in a cinderella-by-the-fire fashion.” Myra had a more “sparkling” personality, but paradoxically something about her affect seemed flat, as if she was playing the part of a person and not sure exactly how to do it. From an early age, the girls’ mother had tried to separate Nora and Myra from Iris and Hester because she thought that Nora and Myra were brighter than the other two, whom she called “duller.”
Then came the question of their home life. The more the researchers learned, the stranger it seemed—first peculiar, then appalling. Both parents were abusive. The father drank, had affairs, and was said to have molested two of the daughters. When the mother, for her part, discovered two of the girls engaged in mutual masturbation, she put them in restraints at night, gave them sedatives, and eventually forced them both to undergo female circumcision. In the view of the NIMH researchers, Gertrude was the same sort of mother that Frieda Fromm-Reichmann and Gregory Bateson had described—so controlling and anxious that her daughters had to have been traumatized by her in some way. “It is easy to see that the longer her family remained sickly and unwell, the more prolonged would be her gratifications,” Rosenthal wrote. “Her house was her hospital.”
In the end, nothing about the Genains’ childhoods had been close to normal—not their schooling, and certainly not their sexual development. Even Rosenthal compared the experiences of these girls to the “extreme situation” concept developed by the Holocaust survivor and trauma theorist Bruno Bettelheim, in which one finds oneself overpowered by an inescapable situation, unprotected, never out of jeopardy. “Almost from the moment the quads were brought home from the hospital, an atmosphere of fear, suspicion and distrust of the outside world permeated the house,” Rosenthal wrote. “The blinds were drawn, a fence erected, and the guns kept at the ready, with Mr. Genain patrolling….The dread of kidnapping was constantly with them….Threat was everywhere.”
The nature of their childhoods seemed to corrupt the experiment. Certainly the researchers at NIMH would have had a more compelling nature-nurture experiment if the Genains had been a little more like, say, the Galvins—a more mainstream, middle-class family.