Quadruplets With Schizophrenia? Researchers Were Confounded.

GIRLS AND THEIR MONSTERS: The Genain Quadruplets and the Making of Madness in America, by Audrey Clare Farley

Sixty years ago, a psychologist at the National Institute of Mental Health named David Rosenthal published a famous but now largely forgotten study of four sisters with schizophrenia, quadruplets born to Carl and Sadie Morlok in 1930. The Morlok quadruplets — renamed Genain in the scientific literature — had grown up in the same house, and come from the same fertilized egg, but did not appear to have the same version of the disease.

As Audrey Clare Farley explains in “Girls and Their Monsters,” this circumstance afforded Rosenthal a rare opportunity to investigate the tangled influences of heredity and environment — at a time when nature and nurture were spoken of more as mutually exclusive principles than contributors to a complex whole.

Farley, who has written widely on culture and medicine, gives a fascinating glimpse of N.I.M.H.’s clinic in Bethesda, Md., where the four young women spent three years in the mid-1950s. The patient-subjects were tested, studied and given therapy in a sort of living laboratory where the nurses took notes on social interactions, and where “a beauty shop, newsstand and retail store, which were frequented by researchers, clinicians and patients alike,” served “both investigative and therapeutic purposes.” Farley makes rich use of clinical records and the material gathered by N.I.M.H. researchers dispatched to interview neighbors, teachers, classmates and relatives of the quadruplets.

The Quadruplets Research Committee that Rosenthal oversaw included psychologists, psychoanalysts, social workers, sociologists and a geneticist. Gathering up the committee’s disparate findings, Rosenthal published “The Genain Quadruplets: A Case Study and Theoretical Analysis of Heredity and Environment in Schizophrenia” in 1963, when psychiatry itself was at a crossroads, and President Kennedy had called for the replacement of state hospitals with community care.

That hopeful policy’s ill-fated implementation reflected the divided nature of a discipline torn between the narrow specificity of emerging brain science and American psychoanalysts unencumbered by empirical evidence, who attributed schizophrenia to “double-binding” mothers and pathogenic social structurers crying out for systemic remedies.

The researchers considered both of the sisters’ parents to be mentally ill, though Carl, who persuaded his wife to marry him by threatening suicide, and bit her cheek with savage violence the first time they had sex, was far more unstable. He was also deeply paranoid, like his own, possibly schizophrenic mother, who had tried to abort him the day he was born, and who expressed the opinion that it would be best if the quadruplets died.

The violence and dysfunction Farley describes is gothically sordid, painful to read about and entirely believable. Abused by their irrational father — who had banged their heads together when they were babies, and squeezed their breasts to see how they would react on dates as they grew — and tormented by their own burgeoning delusions, they had all been diagnosed with schizophrenia, and several had been hospitalized, by the time they were in their early 20s, and invited into N.I.M.H.’s clinic.

But as the fairy-tale title suggests, “Girls and Their Monsters” is more concerned with the mythic and metaphorical than the medical. Farley’s subtitle replaces schizophrenia, heredity and environment with “the Making of Modern Madness,” evoking Thomas Szasz’ “The Manufacture of Madness,” which likened psychiatry to the Spanish Inquisition, and Michel Foucault’s theory of mental illness as a socially constructed tool of state power.

“For all their contributions to scientific literature,” Farley writes in her preface, “the N.I.M.H. researchers will leave some part of the story untold.” What they missed, in the author’s opinion, was the emblematic nature of the Morloks’ suffering. “If the quadruplets’ home was a mire of threats,” she writes, “so was the wider society in which they lived.”

Translating the Genains back into the Morloks, Farley transforms them again, turning their “house of horrors” into a microcosm of a pathogenic society, and the abused and psychotic quadruplets into avatars resisting “the American family and other institutions” that exploited them.

The challenge for the reader, and for psychiatry, is that emblematic importance, much like untreated mental illness, can be more mask than illumination. The more metaphorical people become, the less they can be seen as actual people who might, for example, require medical care.

The genetic and environmental dichotomy Rosenthal grappled with was largely a false one, resolved at the molecular level where everything becomes a chemical effect whatever its cause. That is not the case with the poles Farley wants to join.

“The quadruplets were formed in a world gone mad,” she writes, echoing the psychiatrist R.D. Laing. “Some, like Laing, might have said this fact disproved their own diagnoses, as if only people or worlds could be pathological — as if only medical scientists or social theorists could speak with authority about madness. But was it possible that both camps had something to say about the realms of pain and distress that consumed the four women?”

Certainly, both camps had something to say; antipsychiatry in the 1960s was in many ways an aspect of psychiatry itself, advanced by psychoanalysts who, trained to apply mythology in the name of medicine, were in a very good position to critique their discipline’s shortcoming.

But there came a time when those who thought schizophrenia was a sane response to a mad world, a higher form of consciousness, or a myth, had nothing to offer people suffering from an actual illness — much as Laing himself had no advice to give when his own daughter became psychotic. Psychiatry learned the hard way that treating society like a sick organism that had to be healed in order to help ailing individuals was a brutal betrayal of the people who most needed care. Rosenthal’s speculation that trauma in the birth canal, experienced by each quadruplet differently, contributed to the variations in their illness holds up better than the malign effects of a world gone mad.

In an almost throwaway sentence, Farley mentions that the sisters received no “hard drugs” while at N.I.M.H.’s clinic, “which would corrupt the studies.” It was only afterward, when they entered state hospitals, that they were given antipsychotic medication, to which follow-up studies attributed their long-term stabilization.

“Could it be,” the author asks, “that the thing society called mental illness was far too heterogeneous for any single discipline to describe it?” The challenge of reviewing this book is in explaining that Farley’s questions are already answers: She has translated serious mental illness into social theory from the start.

If schizophrenia was “the thing society called mental illness” rather than an organic brain disease, and if symptoms were “realms of pain” rather than delusions, then perhaps one discipline was as good as another. Giving social theorists the same authority as medical scientists to speak about mental illness suggests that social theory might itself be a kind of medicine, despite requiring no laboratory tests, while making medical science more like an alternative narrative.

Farley’s own book contains the evidence of past disasters that argue against the experiment. So do the social theories she brings to this story — especially when she writes about Nazis, Jews and whiteness, as when she explains that the Jewish feminists in the late 1970s, who accused Freud of covering up incest, simultaneously conspired to “de-Judaize” him out of “ethno-racial” self-interest. They did this to help themselves, other Jews and the father of psychoanalysis “disappear into whiteness” — even though Freud died in 1939 after narrowly escaping from Nazis who considered his ideas as ineluctably Jewish as his genes, regarding him as a pathogenic danger to a society they saw as an organism, which is why they murdered four of his sisters.

All of this is excruciatingly incompatible not merely with science, but with Farley’s ability, at her best, to tell a story or evoke a character like Rosenthal, a mediating figure who threw out the eugenic bathwater but kept the biological baby. A caring practitioner as well as a researcher, he maintained his connection to the quadruplets long after they had left his care, and “always found time to listen” when they called.

Farley describes with compassion Rosenthal’s dawning discovery that he was developing Alzheimer’s disease. And though she has described the stark poverty of his childhood, his experiences in World War II and his postwar frustration hunting for a house when many neighborhoods were closed to Jews, she does not suggest that trauma or a biased society was responsible for the terrible disease erasing his gentle personality. The tragedy of his illness was that it has no cure, something which will come only from the painstaking work of research, trial and error.

Jonathan Rosen is the author, most recently, of “The Best Minds: A Story of Friendship, Madness, and the Tragedy of Good Intentions.”

GIRLS AND THEIR MONSTERS: The Genain Quadruplets and the Making of Madness in America | By Audrey Clare Farley | 291 pp. | Grand Central | $29

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