Three Identical Strangers - The Reluctant Psychoanalyst watches a movie about experimenting with identity

Documentaries are not generally my thing in movies, but this week we have watched two – Free Solo – because the idea of man against nature was compelling – and then Three Identical Strangers – a movie that will be discussed at our local psychoanalytic institute without a screening there (we recently watched and then discussed Medea).

This film – intended to be dark – starts out on a light and high note.  There is an interview with a charming middle aged man who is remembering going off to a community college, but his reception there is almost dream-like.  He is met by people he has never seen before who are excited to see him – attractive women come up to him and kiss him and say that it is good to see him again – but they are calling him by the wrong name.  Finally an individual says to him that you look exactly like my roommate from last year – they call the roommate – and it turns out that both of these young men were born on the same date and both of them have been adopted.  They drive to connect with each other – and it is love at first sight – they have found a long lost twin they did not know and they roll around like puppies as they connect with a person who is a mirror image of themselves.

This odd happenstance makes the news and then things get even odder because it turns out they have a third identical twin – also adopted – also born on the same date.  Identical triplets.  How is this possible?  Identical twins occur when a fertilized egg in the womb divides and, instead of staying together, splits and two individuals with identical genetic material grow in the womb.  In this case, after having split once, one of the split off twins splits again – and three individuals with identical genetic material are now growing together in the same womb (though actually this happened twice - their fourth brother died at birth). 

Researchers love identical twins (and triplets is a bonus).  There is a long and rich literature that looks at what is inherited and what comes about as a result of the environment to try to tease apart the nature/nurture questions that we have about our human condition.  Identical twins that have been separated at birth and placed in two separate families – generally because of adoption – are particularly rich sources of such research because the similarities between them, sometimes uncanny similarities – can be attributed to some kind of genetic predisposition.  So we wonder whether such things as liking plaid versus plain shirts can be traced to our genes.  In a more controlled fashion, identical twins are used to study the inheritance of predispositions to certain disorders – and if your identical twin is diagnosed with bipolar disorder or schizophrenia (whether you are raised together or apart), you are much more likely to be diagnosed with that disorder as well than if, for instance, a twin that was from a separate egg and sperm combination – a fraternal twin – is diagnosed.

But that lurks in the background of the first part of this film.  In the beginning, the brothers reunite, they become minor celebrities – they go on talk shows – they fall in love with each other – and are attracted to similar women.  They are the toast of New York – and in early eighties New York, they get into Studio 54, hang out with celebrities and live the high life.  As they realize that they have something they can cash in on, they go into business together.  They open a restaurant where they are the main attraction and, in addition to the food, what attracts people to the place is the party atmosphere.  Each of the boys was adopted by a Jewish family through a Jewish adoption agency, and raised Jewish; in the restaurant they essentially put on a Bar Mitzvah party every night that everyone is invited to.  And people come to be included and have fun and the brothers do a million dollars in business in the first year.

But then things begin to get dark.  As one of the relatives points out, the boys did not grow up together.  They didn’t learn how to resolve differences between them.  They came together and looked at the similarities.  It was only over time that they began to see and to have to confront the differences (The reluctant wife and I noted that this is true of marriages as well – the similarities draw us together – and it is only after we have committed to each other that the differences seem to emerge – and to suddenly have more weight than we ever expected them to).  One of the brothers – the one who was interviewed first – decided to leave the business.  The second brother weighs in about how difficult this was on the third brother – and it is only then that we realize that the third brother – the most fun loving one of all – has not been interviewed in the present day.

Well – spoiler alert – he wasn’t interviewed because, in the wake of his brother leaving the business, he went home one day after work and killed himself.  Ouch.  The film takes on a decidedly different tone.   No longer light and airy and fun, we are now feeling the loss – and we begin to try to figure out what happened.

A million years ago, when I was in training, one of my wise supervisors, Fred Shectman, convened a meeting to do a psychological autopsy after a patient that we had worked with as a team committed suicide.   I had done the psychological testing of the patient.  I am embarrassed to admit that I did not remember him – in my defense it had been six months and I had tested many people during that time – but I did remember what Fred said at the beginning of the meeting.  He said that, in the wake of a suicide, we (meaning anyone who was involved in the suicide - treaters, family members, and friends) look to manage our feelings of guilt and blame – and that we can move back and forth between the two - assuaging the one by feeling the other - I am not to blame, I am not guilty - you are and, vice versa, you are not to blame, it is I who feel guilty about what I did or failed to do.

This film can, I think, be understood against that backdrop.  The question that was lingering took center stage – why had these boys been separated at birth?  The parents had gone to the agency when they found out about the separation (after the boys were reunited) and had confronted the director and others there.  The agency responded that they were concerned that the boys would not be adoptable as a package.  All three sets of parents said they would have adopted all three if they had known.  The agency stuck with their story – but one of the parents – going back to find an umbrella they had left in the meeting – found the people they had been meeting with drinking champagne and talking as if they had just ducked a bullet.

To make a long story short, the agency – a very well respected and powerful agency – was conducting research.  The boys had been intentionally placed in three very different homes – each of the families had earlier adopted a girl from the same agency – and now the boys were being placed in an upper class home, a middle class home, and blue collar home.  Why?  Well this becomes a mystery that the film tries to track down.  No results of the study have been published.  Why?  The data from the study have been sealed in a library at Yale.  Why?  We begin to look towards the researchers as the bad guys.  The central researcher, the director of the Freudian Archives, is now dead, but there is an investigative reporter who had tried to get the answers out of him when he was alive but failed.  Two research assistants are interviewed – one who might have been more aware of the design and one who did the follow up testing – he want into the boys homes and did psychological testing and observation on them on a regular basis.  From the first we get a sense of the research atmosphere – from the second we find that there are likely additional twin pairs that have not yet found each other (though a few have done so).  Ultimately there were 6 or 7 pairs, including the triplets, which were in the study.

What is going on here?  My guess is that this was a study to look at whether the environment – the different homes – was more influential on the intellectual and emotional development of these kids or whether the genes were predictive.  There is a period of time in the movie where there is a focus on the mental stability of the mother of the boys and there is some speculation that it is a study about the heritability of a mental illness.  While I think this is a possible research question, I think that the instability of the mother – she is tracked down by the boys who notice that she can drink them under the table – is based largely on her drinking.  This is too small a sample to have a solid study looking at the inheritability of mental illness – in my opinion.  But it is mysterious about the records being sealed and the air of secrecy about the design.

What is more poignant is the discovery that the three boys were kept together for the first six months of their lives and then separated – they would have been pre-verbal and couldn’t speak about the sense of being apart – but at least two of them would bang their heads as a means of soothing themselves when they were young.  Were they trying to communicate that they missed their brothers?  Were they more inconsolable for having lost brothers – something that might have had a distinct attachment code over and above the maternal attachment?  Hard to know.  The book is that object permanence – the sense that this person is different from that – comes on-line at nine months – but I think there is room to wonder about what being a triplet and then an only may have felt like on a visceral level for a kid who was six months old.

The movie shifts its sights and focuses on the father of the man who killed himself.  The father is portrayed as being a strict disciplinarian and distant.  And he was the father of the most outgoing boy.  Was there a fundamental mismatch between them?  The most outgoing of the fathers took all of the boys under his wing when they were reunited and the outgoing son connected most with him, and was the loss of that connection – when that father died – too much for the outgoing son to bear?  Who is guilty and who is to blame?

As haunting as these questions are, the movie keeps coming back to the mystery of the research.  What were those researchers interested in?  But a funny thing happens – as people are painting the researchers as villains they subtly and not so subtly end up asking the researcher's questions.  They wonder whether the difficulties that the adolescent boys had were genetic – or were they caused by the separation – or by the conflict with parents who weren’t a good match.  They marshal evidence to support their positions – pointing to when this occurred or how that emerged – or how something was mirrored in all three boys even before they knew each other.  The conclusions they reach – and these are smart people who know these kids well – are less interesting to me than that the family members – and we in the audience – are asking the very questions that it is likely the experimenters were interested in knowing.

Was it harmful to have separated these boys and the twins and to do that because of research interests?  Sure.  Shouldn’t the parents at least have known of the existence of the twin/triplets?  Absolutely.  And shouldn’t the parent’s permission have been sought to experiment on the boys?  Of course.  Would the parents have consented?  Perhaps not.  And that might have been a very good thing for the boys.  But the questions still would have been there.  What is causing the similarities in these individuals – and what is causing the differences?

Btw, I don't mean to be minimizing the ethical breeches that researchers - especially by today's standards - committed.  But I think that in fifty years we may well wonder about the "informed consent" that we engage in today.  How, our future selves may wonder, could we have consented, or been asked to consent, to whatever we consent to?  We do experiments because we don't know the outcome of the experiment - if we knew with certainty that the outcome would be positive - we wouldn't need to ask permission.  Even when something has been "proven" safe - say a psychoactive medication - do we really know that to be true?  If we start taking a medication that turns out to be a lifetime medication two years after it has been invented - we cannot know what the lifetime impact of taking that medication will be - no one has done it.  But I digress...  

We can’t know whether something as traumatic as the suicide would have been prevented – or if something worse would have been caused by raising the boys together.  But the questions would still have been asked.  We want to know what leads us to become who we are.  Is biology destiny?  And more than that – I think (and Heinz Kohut thought it long before I did) that there is something deeply intriguing about discovering a doppelganger – a twin – out there in the universe.  Wouldn’t it be interesting to look into another’s eyes and see your own reflected?  Wouldn't it be good to know what of our identity was in our genes - what was determined by our environment - and what was the result of the choices we ourselves made?  I don't think these questions can be definitively answered, but the existence of twins allows us to get as close as we can to these very tantalizing questions - questions that are tantalizing enough that we might not think about the best interests of those we are studying because we are so caught up in the possibility that we might be able to address questions that are unanswerable...

I will report back in January after the discussion of the film on additional perspectives that others have taken…


So: Postscript:  If I went to the meeting in January, I don't remember it.  I think it was rescheduled and I couldn't attend, but today I read an interesting article in the Journal of the American Medical Association (JAMA) about the ethics of this case.  It is available (at press time 7/18/19) at:  https://jamanetwork.com/journals/jama/fullarticle/2737146.  The thesis of the article is that the movie got some of the facts wrong about the ethics of the case.  First of all, the decision to split the boys (and in the case of some of the twins) girls up was not made by the researchers.  It was made by the agency.  And the decision was based on "wisdom" of the day - twins developed language late (probably because they developed their own language and didn't need to learn the adults), they didn't get as much attention form each parent (there are two to look after rather than one), and they get connected to their twin in ways that may impair their becoming their own person.  So it was the agency that decided to separate them - "for their own good".  The researchers saw this as an opportunity - they did not create the experimental separation - they just measure the impact.

One of the concerns was that the records were sealed - none of the data have been published.  The reason for this, according to the article, had to do with confidentiality of the records and the decision of the researchers to protect the privacy of those who unwittingly participated in the study vs. publishing the results of their work.  They decided, based on the small numbers, that any description could be traced to individuals and that would have violated their right to privacy.  So the records were not sealed to protect the researchers, but to protect the participants.

The authors of the article conclude - as did I - that it is problematic to judge the actions of those in the past based on current standards.  We would currently see the benefits - as well as the costs - of keeping twins and triplets together.  We would currently inform the families of what was being done.  Some of the participants in the study have now accessed their records as the privacy laws have changed and they can now do that.  This does not mean, however, that researchers can access the sealed materials yet.  By the time they can, I'm not sure how much interest there will be in the data - the instruments that they used will be unknown to current researchers and the group will still be so small that it will be hard to know whether the results are caused by nature, nurture or chance.

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