In an era in which headlines proclaim on a regular basis that scientists have found the “genetic basis” of schizophrenia or some other “mental illness,” this seems like a good time to look back on the most celebrated case history in psychiatric genetics, that of the Genain quadruplets. Like the story of the Kallikak family, the sad and sordid tale of the Genain sisters was intended to illustrate the primacy of heredity. Instead, it ended up revealing much more about its chroniclers than about its intended subjects.
Siblings Under a Microscope
The Genain sisters were a set of four identical quadruplets. Born in 1930, all four were diagnosed with schizophrenia in their early twenties and brought to the National Institutes of Health for three years of intensive study: interviews, Rorschach tests, galvanic skin-response tests, electroencephalography, doll play, and god knows what else. Their story is told in the book The Genain Quadruplets: A Case Study and Theoretical Analysis of Heredity and Environment in Schizophrenia,1 edited by David Rosenthal, a research psychologist at the National Institute of Mental Health. Twenty-five different researchers contributed to that volume, including psychiatrists, psychologists, social workers, a geneticist, a sociologist, a statistician, a social science analyst, a physiologist, and a handwriting analyst. It’s a massive tome, over six hundred pages in length.
The name Genain is a pseudonym taken from the Greek words genos and ainos, and literally means “dire birth.” The parents were identified by the pseudonyms Henry and Gertrude, and the four sisters as Nora, Iris, Myra, and Hester. (Note that the initial letters of their pseudonyms spell out the abbreviation for National Institute of Mental Health.)
The book begins with the story of their lives. And it’s all right there in black and white — 125 pages littered with tales of abuse that began literally when the girls were in the cradle and their father knocked their heads together “to keep them from crying” and continued right up to the time the family was taken to the NIH: physical abuse, sexual abuse, emotional abuse.
A Fear-Ridden Home Life
Henry kept his wife and daughters in line with threats to murder them, and nobody doubted he was capable of such an act. He quite likely was involved in the killing of another man, and for the rest of his life he would wake up screaming from nightmares of murder, demand his gun, and search the house for intruders. He once fired that gun at his wife, later claiming that he had thought she was a burglar. He missed, although he did put a hole in her nightgown.
The girls were never allowed to play with other children after school — not even their own cousins — and they grew up socially isolated. They were tormented by boys who would knock their books out of their hands, throw food at them, and push them down the stairs. People who knew the sisters described them as passive, timid, and unusually quiet, and the home atmosphere as “fear-ridden.”
During the girls’ sixth year, Gertrude decided to leave her husband and saw a lawyer about getting a divorce. Henry promised to mend his ways. Later, he told her, “If you leave me, I will find you wherever you go, and I will kill you.”
One of the sisters, Hester, was a favorite target for her father’s anger. He became obsessed with trying to prevent her from masturbating, and he would punish her severely for this behavior: beating her, holding her head underwater, even pouring carbolic acid on her vulva.
Hester began engaging in sex acts with her sister Iris, so the family doctor ordered surgical mutilations of the genitals for both of them. When Hester broke her stitches in the hospital, he threatened to “fix her now” and prescribed sedatives to her and her sister. He also instructed Gertrude to tie the girls’ hands at night.
Henry insisted on watching his daughters as they were undressing or changing their sanitary pads. He would grab their breasts or buttocks, explaining to his wife that he was testing to see how they would react when they went on dates — dates they were never allowed to go on.
A Father’s Malign Neglect
During all this time, the local newspapers were running puff pieces portraying the Genains as the ideal American family. One account referred to the family patriarch, a constable, as “jolly Henry, Daddy of 4-of-a-kind.”
All of the sisters were raped or sexually assaulted — Hester as a child, the other three as young women. And what about their father? What did this tough guy — with his badge and gun, and obsession with his daughters’ virginity — do about any of this?
His daughter Nora, for example, was sexually assaulted in the municipal building where both she and her father worked. When she told him, he sneered, “Just shut your mouth and go back to work.”
By this time Henry was downing 16 bottles of beer a day, and during these drunken binges, his daughter Hester was tasked with cleaning up the vomit in the sink. She also had the job of cleaning out her father’s smelly spittoon every day. Once he chipped her tooth after becoming angry at her and kicked a frying pan out of her hand.
One by one, all the Genain sisters suffered nervous breakdowns, and at least two of them were hospitalized and subjected to dozens of sessions of electroshock “therapy.” The doctors attributed their problems to menstrual difficulties or excessive masturbation — anything except abuse.
Shortly after the whole family was taken to the NIH, Henry attacked his wife and tried to strangle her. The staff restrained him and placed him in a straitjacket. He died soon after from complications of obesity and Type II diabetes. His obituary eulogized him as “a conscientious public official with a splendid reputation.”
In 1981, the sisters were brought back to the NIH for more testing,2 and fifteen years later, NIH researchers visited the sisters’ hometown for still more testing.3 By then, David Rosenthal had retired, and he died the following year.4
Only one of the sisters, Myra, had anything approximating a normal life. She was the only one to receive any post-secondary education (two years at business school), the only one to have a career, the only one to marry, and the only one to have children. She is also the one who had the least exposure to neuroleptic medication.
Myra and her husband had two children together, although their marriage later ended in divorce. One of her two sons died of AIDS contracted from a blood transfusion in 1996. The surviving son was by then married himself, with a son of his own. That son reluctantly gave a blood sample to the NIH researchers, although he refused to participate in any psychological testing or to allow the researchers any access to his own son. The researchers characterized him as “generally suspicious and mistrustful,” and he voiced the opinion that he did not see any good at all coming to his mother or his aunts from their participation in the study.
“Myra” is the only one of the sisters still living. She has even written a book, under her real name,5 describing what it was like growing up as a member of a famous set of quadruplets. She skips over the goriest details, although she does acknowledge that her father was abusive and controlling.
So what is the lesson to be learned from the Genains’ lives? None of the relentless testing performed by the NIH researchers brought humanity one inch closer to understanding the etiology of schizophrenia or of devising a cure.
In the meantime, a mountain of empirical studies has accumulated showing that schizophrenia and other “mental illnesses” are likely caused by sexual abuse, physical abuse, emotional abuse, and every other category of adverse childhood experience.6 The correlation is robust, reliable, and dose-dependent. It cuts across income brackets, ethnic identities, and national boundaries. It has been demonstrated again and again in case-control studies,7 cross-sectional studies,8 and prospective cohort studies.9
In plain English, bad things happen — and they can drive you crazy.
At the same time, the new science of genome-wide association studies have enabled researchers to go over the human genome with a fine-toothed comb, and guess what? Despite breathless news reports, they have yet to find any gene for schizophrenia, and for a very simple reason: No such gene exists.
How could it? It is a meaningless diagnostic label with no known biological cause, no consistent symptom, and no common outcome. According to the Diagnostic and Statistical Manual of Mental Disorders, two individuals can share a diagnosis of schizophrenia and yet have no symptoms in common.
The story of the Genain sisters has long been cited as evidence proving something about the supposed hereditary nature of schizophrenia. As recently as 2017, Allan F. Mirsky, one of the 25 authors of the original volume as well as the principal investigator in the follow-up studies, wrote: “This phenomenon added to the accumulating database on the genetic basis of the disorder.”10 But exactly what it added is not clear. It’s not as if there existed a control group of four other genetically identical sisters who had not been subjected to years of abuse.
More importantly, neither Rosenthal nor Mirsky nor any of the other researchers involved in these studies ever asked the obvious question: Who wouldn’t fall apart after surviving that horror show of a childhood?
- David Rosenthal et al., The Genain Quadruplets: A Case Study and Theoretical Analysis of Heredity and Environment in Schizophrenia (New York: Basic Books, 1963). ↩
- Lynn DeLisi et al., “The Genain Quadruplets 25 Years Later: A Diagnostic and Biochemical Followup,” Psychiatry Research, 13, no. 1 (September 1984): 59-76; Allan F. Mirsky et al., “The Genain Quadruplets: Psychological Studies,” Psychiatry Research, 13, no. 1 (September 1984): 77-93. ↩
- Allan F. Mirsky et al., “A 39-Year Followup of the Genain Quadruplets,” Schizophrenia Bulletin, 26, no. 3 (2000): 699-708. ↩
- Anonymous, “David Rosenthal, 77, Genetics Researcher” New York Times, March 1, 1996. ↩
- Out of respect for her privacy I have elected not to reveal her true identity. ↩
- John Read, Richard P. Bentall, and Roar Fosse, “Time to Abandon the Bio-Bio-Bio Model of Psychosis: Exploring the Epigenetic and Psychological Mechanisms That Lead to Psychotic Symptoms,” Epidemiology and Psychiatric Services 18, no. 4 (October-December 2009): 299-310; Lucia Sideli et al., “Do Child Abuse and Maltreatment Increase Risk of Schizophrenia?” Psychiatry Investigation 9, no. 2 (June 2012): 87-99; Filippo Varese et al., “Childhood Adversities Increase the Risk of Psychosis: A Meta-Analysis of Patient-Control, Prospective, and Cross-Sectional Studies,” Schizophrenia Bulletin 38, no. 4 (June 2012): 661-671; T. Bailey et al., “Childhood Trauma is Associated with Severity of Hallucinations and Delusions in Psychotic Disorders: A Systematic Review and Meta-Analysis,” Schizophrenia Bulletin 44, no. 4 (August 20, 2018): 1111-1122. ↩
- M.C. Cutajar et al., “Schizophrenia and Other Psychotic Disorders in a Cohort of Sexually Abused Children,” Archives of General Psychiatry 67, no. 11 (November 2010): 1114-1119. ↩
- Mark Shevlin et al., “Cumulative Traumas and Psychosis: An Analysis of the National Comorbidity Survey and the British Psychiatric Morbidity Survey,” Schizophrenia Bulletin 34, no. 1 (January 2008): 193-199. ↩
- S. Fennig et al., “Life Events and Suicidality in Adolescents with Schizophrenia,” European Child and Adolescent Psychiatry 14, no. 8 (December 2005): 454-460. ↩
- Allan F. Mirsky et al., “The Genain Quadruplets,” in SAGE Encyclopedia of Abnormal and Clinical Psychology, ed. Amy Wenzel, (SAGE Publishing), 1521. ↩