Twins

Bethany squirms uncomfortably in the chair across from me. She’s a slender, attractive woman, her blonde hair pulled back into a pony tail accentuating her high cheek bones and large blue eyes. I’d guess her to be in her late twenties to early thirties.

“It’s hard to start,” she says. “I guess that’s because I feel guilty. My sister, Heather just got engaged. He’s a great guy. An attorney, sweet, caring. He’s crazy about her. But all I can think of is, why her, why her and not me. I forgot to say, we’re twins. Identical. I mean we look identical. But that’s where it ends. She’s smarter than me or at least she did better in school. She was way more popular. She always got the cool guys. I just stumble along through life.”

“Sounds hard to always be comparing yourself negatively to your sister.”

“I come by it honestly. My whole family does it, especially my mother.”

I flash on the memory of patient who years ago told me about giving birth to identical twins and feeling an immediate connection to the first twin that she didn’t experience with the second. Did Bethany’s mother have a similar experience with her twins that has shaped Bethany and Heather’s experience in the world? An unanswerable question, but an interesting one nonetheless.

“That must be painful.”

“I guess, but I suppose I’ve gotten used to it. I’ve always been shier than Heather, more introverted. I like to draw. I like art. That’s sort of what I do. I work in a design studio that sells lots of art. Although I work mainly in the back. I’m not the greatest sales person. I try, but it’s hard for me.”

“And do you show your own work?”

She shakes her head. “People tell me I’m good enough. But it feels so exposing. And the idea of marketing myself feels overwhelming.”

“Tell me about your family, Bethany.”

“Well, I have an older brother who’s been out of the house for a long time. And then there’s me and my sister and my parents. They’re all very social, outgoing people. They have lots of friends, go to parties, invite people over. I have friends too. I don’t want you to think I’m a total recluse. But we’re different. We sit around and talk, go to the movies, sometimes go to museums.”

“Sounds pretty rewarding. Why is what you do with your friends less valuable than what your parents or sister do?”

She shrugs. “I don’t know. I guess because my mother always seems so disapproving of me. I don’t have enough fun. I don’t wear make-up. I don’t get my hair done. She always wants me to be doing something different than what I’m doing.”

“Has that always been true?”

“Always. I remember when I was little. My friends and I would sit around the house drawing, or playing school, or making up stories and my mother would be telling me to go outside, to ride my bike, to go swimming. Whatever I was doing she wanted me to do something else.”

“Did that ever make you angry, Bethany?”

“Sometimes. But mostly it just made me feel bad about myself. Like what’s wrong with me? Why aren’t I more like Heather?”  

“Did your mother ever praise you for your art? Did she ever listen to the stories you and your friends made up?”

“Never. Or at least not that I remember.”

“What just happened there, Bethany? First you said ‘never’ and then you quickly changed it to ‘not that I remember.’”

“Well, I was only a kid. I could have forgotten.”

“Or maybe it’s hard for you to think anything negative about your mother, like it wasn’t fair of her not to praise you for your strengths, just as she praised Heather for hers.”

“I was about to say, I didn’t have any strengths, but I know that’s not true. I really am a good artist. But my strengths weren’t important in my family.”

“You know, Bethany, when children aren’t valued, it’s very hard for them to think that it’s their parent’s problem for being unable to cherish them. They’re much more likely to feel it’s their fault and if only they could change, then their mother or father would love them.”

“I definitely feel that. I always wanted to be like Heather.”

“Well, I’ve only just met you, but it seems to me you have lots of wonderful qualities, qualities that would be loved and valued in many families. Maybe we can help you to learn to value yourself and give up on trying to win the approval of a mother who can’t seem to appreciate you for who you are. It’s really her loss, but I know you’re a long way from feeling that.”    

“A long way.”

“I know. But we’ve just begun our work.”

Failure to Thrive

“I’ve decided to write a book,” Karen announces at the beginning of her of session. Dressed in casual jeans, no make-up with her hair pulled back in a ponytail, Karen looks younger than her 48 years.

Although her declaration leads me to think, ‘Oh no, not another idea that goes nowhere,’ I take a more supportive approach. “In art history?” I ask, Karen’s area of specialty.

“I don’t know. I haven’t decided yet. I have to do something. I can’t go on just being Dr. Thomas Hartfield’s wife. It’s too boring. I don’t want to have to get all dressed up and hang out at the club playing bridge, gossiping with the women.”

“Weren’t you recently talking about wanting to open an art gallery?”

“Yes. I still think that’s a good idea, but I don’t know, there’d have to be so many people involved, people I’d have to manage. It seems overwhelming. Writing is something I can do on my own, at my own time, in my own space.

“Of course, I haven’t written anything since I was in college. I was pretty good back then. I think I considered majoring in English. But then again I thought about majoring in lots of things. I’m not even sure how I ended up with a major in art history. I guess because I hung around college for so long and had so many credits, they told me it was time for me to graduate and art history was it.”

“So it seems, Karen, we’re back to talking about how difficult it is for you to make a decision and to carry a plan through to fruition.”

She sighs. “You don’t think I’d write that book do you?”

“Well, I don’t have a crystal ball, but when you say that you don’t  know what you want to write about, it seems you could get stuck right there. I’d be concerned you could think endlessly about what you did or didn’t want to write and never be able to move beyond that point.”

“How did you know what you wanted to write?” Karen asks me.

I don’t introduce my book into my therapy sessions, but many patients Google me and find it online. Now I wonder if there’s some relationship between my book and Karen’s sudden interest in writing. “Before I answer that question, Karen, can I ask you how you feel about my having written a book?”

“Envious. You were able to follow through and do it. But maybe also inspired, like if you can write a book maybe I can too.” She hesitates.

“What just happened there?”

“Nothing. I guess I got anxious. There are so many choices. I don’t know how anyone ever decides on one path over another. I don’t know how you pick. I don’t know how you pick one and give up the others. So how did you decide what to write about?”

I wonder about Karen’s anxiety. Does she worry I’d feel angry or vindictive if she wrote a book? Does making one choice over others bring up fear of loss? Keeping these questions in mind, I answer Karen. “I felt compelled to write about my relationship with my late husband. I think there’s often an emotional press in writing; you have something you have to say. It’s like being in therapy. It’s sharing a vital part of yourself that you want to be known.”    

“Do you think I don’t want to be known?”

“That’s a very interesting question. What do you think?”

“Well declaring myself, taking path A rather than path B would be a way of being more known.”

I’m silent, intrigued by Karen’s train of thought.

“But why wouldn’t I want to be known?”

“I was just asking myself the same thing.”

Silence.

“Weird. The words, ‘You’re a moving target’ just went through my head.” Pause. “Who did I think would shoot me?”

I wonder if it’s me, but I remain silent.

“My oldest sister for sure. She was horribly jealous of me. I was the pretty one, although I made myself as unattractive as possible until she left for college. She’d cut up my clothes, steal all my panties. One time she even cut off part of my hair in the middle of the night.”

“That’s called abuse, Karen,” I say, surprised by this revelation I had not previously heard.

“You think?”

“Definitely. What did your parents do?”

“I don’t know. I don’t remember telling them. Maybe I did. Maybe they said we had to work it out. That part of my childhood is a bit fuzzy.” Pause. “Do you think this is relevant?”

“I definitely think this is relevant, Karen. We have to stop now, but we definitely need to spend more time understanding how your sister affected your life.”

Life and Death

Naomi looks weary and haggard. She looks as if she has spent countless nights in a hospital besides her 85 year old mother with stage IV ovarian cancer which is indeed the case.

“I had to come in and see you today. I had to steal an hour for myself. I’m not even sure the last time I took a shower. Good thing the girls are self-sufficient. Although my husband’s been great. No complaints there.” Pause. “But now there’s my brother. I don’t know if he thinks he’s the knight in shining armor, but he’s decided he’s going to save our mother. By prayer.  As long as I don’t ‘kill her’ in the meantime. Does he actually think I don’t want her to live? I’ve spent years of my life trying to keep her alive; years trying to make sure she had the best quality of life. But she’s dying. She doesn’t even know who we are any more. It’s enough. It’s enough already.”

Internally I flinch at my patient’s words: “It’s enough already.”  Those were the same words my late husband spoke when he decided that he had tried everything possible to halt the progression of his cancer and that he was ready to let go. I would, of course, respect his wishes, but the finality of the words took my breath away. Steeped in remembering, I struggle to bring myself back to Naomi’s current reality.

“Your mother never made her final wishes known?” I ask.

“No, she didn’t. Every time I tried to bring it up, she’d change the subject. She couldn’t tolerate dealing with the reality of her own death. Well, you know how my mother was, never wanting to deal with reality, her head always in the sand.”

“So now you and your brother disagree about what to do.”

“That’s putting it mildly.”

“And you’re angry.”

“Yes, I am. I’m almost too tired to be angry, but I am. I’m not sure when he got so high and mighty religious and it’s not like I’m talking about killing Mom, just withdrawing treatment and allowing her to go peacefully. You’d think his God would welcome that.”    

    

Did you and your brother ever see eye to eye?”

“As children we were very close. I was like his second mother. But then he moved away and I stayed put and I gave my parents grandchildren which he never did. I guess that made me the favored child.”

“So maybe he’s fighting for favored child status now?”

“A bit late, isn’t it?”

“Perhaps not psychologically.”

“Yeah, I know what you mean. So you think I should be more understanding of my brother?”

I flash on an incident that occurred when my beloved grandfather died and the samovar that had always been promised to me was taken by my uncle, the less-favored child. “Being more understanding doesn’t mean you’ll be any more comfortable with what your brother is doing. I guess I’m concerned that this battle with your brother is going to divert you from grieving for your mother.”

“That’s true. Right now I’m more involved with feeling angry with my brother than dealing with my mother’s death. And it’s only a question of time before she dies, regardless of what we do or don’t do.”

“So how do you feel about her death?”

“Sad. But it’s time. And I have no regrets. I’ve been a good daughter. There’s no unfinished business between Mom and me. Hmm. I wonder if that’s what’s missing between her and my brother. I wonder if he still has unfinished business.”

“That’s a good insight, Naomi.”    

“But I’m not sure he knows it. And I have no idea how I’d talk to him about it.” Pause. “But you know what I said about it only being a matter of time until she dies anyway. Maybe I should listen to myself. Maybe it doesn’t matter all that much what we do. Death will do what’s it’s going to do, regardless.”

“I’m impressed, Naomi. That’s certainly taking yourself out of the fight with your brother.”

“The only problem will be if she lingers too long and suffers.”

“Yes, that would be a problem.”

“But maybe I can just wait and see what happens and try to opt out of fighting with my brother.”

“Sounds like a good plan.”