Archive for April 29, 2014

The Unspeakable

How do I know you?   By what you say, or by what you do not say?  It takes patience and a persistent curiosity—or a sharp scriptwriter—to notice what a person avoids talking about.   In drama a character is often revealed by the way she struggles with the unspeakable—a stutter, a pregnant pause, an abrupt shift of topic.   We can’t miss these cues.  Her dodge grabs our attention as much or more than her spoken words.

And the meaning of one person’s  dodge depends so much on the context of the moment:  the needs of the speaker and the listener, the timing, the rules of the society about discretion and candor for a particular topic.  Taboo topics may simply reflect social conventions, or they may reveal fascinating aspects of character: the military veteran who can’t talk about his war experiences, the workaholic who won’t talk about his work, the declining diabetic who professes ignorance about diabetes.

My fascination with secrets played a part in my attraction to medicine and later to psychiatry, with its privileged access to the inner worlds of others.   I like to think that psychotherapy works in part by helping people learn to speak the unspeakable, to understand their fragmented narrative well enough to retell it in a way that serves them better.

In my family our rules about what was okay to talk about were laid out with clarity by our mother, who monitored our speech, grammar, and content with the discipline of a Victorian schoolmistress.   Among our taboo topics were the peculiarities of our Aunt Pauline, whom we all called Aunt Paun, our mother’s eldest sister.   By the time my siblings and cousins and I knew her in the 1950s and ’60s, she was a heavy woman in her forties, already with streaks of grey, who lived with our grandmother.  Aunt Paun was allowed at specified times to join us when we visited Grandma Reed.  Aunt Paun sat in her designated chair, spoke only rarely, always in an airy and insubstantial voice, her gaze wandering around the room.  I don’t remember her calling any of us by name.  She ate ice cream with us, but ate it in slow motion, seemed to do everything in slow motion.  She could cross-stitch with dexterity, but the line of her lipstick was often uneven, and she worked her tongue at her lips in a way that made it hard not to stare.  Grandma, as scrupulous about comportment as our own mother, sometimes chastised Aunt Paun as though she were our age, making us think Aunt Paun had just misbehaved, though her misbehaviors were a mystery to us.  Then Aunt Paun would disappear upstairs without a word.

Among us 15 young cousins, Aunt Paun was an enigma for which we had no name and no story.  In all our games and skits and mischief we cousins steered clear of Aunt Paun, without ever receiving an explicit taboo.  We learned early not to mock or make fun of her, and not to ask about her.

I was in medical school before I heard the word schizophrenia associated with Aunt Paun.  Schizophrenia was the unspeakable word.  One day, after I’d expressed to my mother my budding fascination with psychiatry, she told me of Aunt Paun’s sudden transformation in 1935 from a stellar college freshman at Bryn Mawr to a helplessly disorganized psychotic girl of 18, who could not care for herself.   Grandma  searched year after year for some treatment to relieve Paun’s relentless rantings and unpredictable behaviors.  Fifteen years passed before partial-relief came in the 1950s with the availability of thorazine and later other antipsychotic medications.  Then more than now, severe mental illness wrapped itself in layers of secrecy, in proportion to the ignorance and shame surrounding it.  The unspeakable nature of this daily struggle defined the limits of circulation for my aunt and my grandmother, who chose to keep her daughter with her in her house, after multiple hospitalizations and ineffective  treatments,  rather than turn her over to the long-term asylums of the day.  Only rarely did either of them leave the house for most of the next thirty years.

This family secret leaked out selectively over the years to those who needed to know: doctors, caretakers, close friends of the family.   But many cousins of my generation have remained in the dark about the specifics of her illness and her treatments.  Vague generalities have protected this secret from becoming too vivid for most of us, even though, more than any other single factor, the demands of Aunt Paun’s schizophrenia dictated the daily life of our grandmother for over thirty years.   You can’t begin to appreciate the character of this mother, who lost her mother in childbirth, her husband at 32, and her son at 36, without wrapping your mind around her choice to harbor and nurture her psychotic daughter, day and night for three decades, to the exclusion of many of her other interests, and to keep quiet about it.

We often hold on to our private truths for reasons that become more compelling than the avoidance of the trouble that might come with disclosure.  For our extended Reed family, keeping the silence about Aunt Paun became an unspoken bond.  Similar taboos applied to families with cancer in those days; more recently the taboo has been AIDS.  We didn’t know much about what we were guarding, but it mattered to us that we had something and someone worth guarding.

Aunt Paun’s been dead for over forty years, but the enigma of Aunt Paun, though no longer a secret, remains a family tie among my Reed cousins. We inherited this family secret, and now it’s one of the unspeakables we can talk about.  How’s that for patience?