CHAPTER 7

Superhuman

When I was at boarding school, sent away during the war as a little boy, I had a sense of imprisonment and powerlessness, and I longed for movement and power, ease of movement and superhuman power.

—Oliver Sacks, On the Move

No one knows I’m here,” Elizabeth said. The no ones she was referring to turned out to be her fellow medical residents at the nearby university hospital where she was working toward a joint medical and law degree, the MD/JD. “People would see it as a weakness, you know, needing help from a shrink.” That day, and all the days that would follow over a period of more than three years, Elizabeth cried almost every moment she was in my office. Her tears were the barely noticeable kind, sort of seeping from her eyes and collecting every few minutes at the overhang of her jawline where she wiped them away with the backs of her hands. In all of the hours we spent together, Elizabeth never once reached for a tissue, as if she wanted to be as self-sufficient as possible.

“I came here because I think I’m not human. It’s like I don’t have feelings,” Elizabeth confided early on.

I pointed out that her tears suggested otherwise.

“I don’t know why I’m crying,” she said, seeming embarrassed and disconcerted by this inability to control her tears. “I never cry outside of here.”

Then, after many sessions, came this: “Last night I read this article online. It was called ‘I Am Adam Lanza’s Mother.’ You know, Adam Lanza was the Sandy Hook shooter, and the article was written by this woman who wasn’t really his mother but she felt like she could have been. Because her son was really out of control and it was all about how hard it is to be a parent of a kid like that, never knowing what he’ll do next or, you know, how to handle him.”

Elizabeth sniffed and wiped some tears away.

“And you know what I thought to myself when I read it?” she asked me quite directly. “That I am Adam Lanza’s sister. I mean, my brother didn’t shoot anybody, but he was just like the kid in this article. Why doesn’t anybody ever write about that?”

Elizabeth’s brother Henry was a special-needs child though no one knew quite what his special needs were or how to meet them. As long as Elizabeth could remember, her parents had driven her brother to specialists and hospitals, some hundreds of miles away, for a better diagnosis in the hope of a better treatment. Intermittent explosive disorder. Autism spectrum disorder. Sensory integration disorder. Pediatric bipolar disorder. Tourette’s syndrome. With every new label there was hope that something might tame the wild tantrums in public and the violent outbursts at home that resulted in broken dishes and even broken bones.

Elizabeth’s parents’ efforts to help Henry were nothing less than valiant. Her mother gave up her career and dedicated nearly all of her waking hours—and many hours when she surely would have liked to have been sleeping—to Henry’s care. On weekdays, she homeschooled him and accompanied him to a parade of appointments: speech therapy, social skills training, occupational therapy, physical therapy, tutoring, psychiatry, play therapy. On weekends, she traveled to conferences to hear the latest thinking on developmental disorders. Sometimes Elizabeth’s mother and father fought about how to handle Henry; her father did not want the squeaky wheel to get all of the grease whereas her mother said she saw no other way. Henry’s mother usually won.

As the family was busied with Henry’s special needs, Elizabeth grew up with no memory of having even the most ordinary needs of her own. She was an easy baby, so much so it was thought she, too, might have some developmental difficulties, given the way she sat in a playpen for hours without crying or calling for anyone. It was only when a third child came along—a baby girl—that Elizabeth came to life. Elizabeth and her younger sister grew up side by side, playing and talking out of the way of their older brother. Elizabeth credited her sister with being the best part of her childhood, and now her closest friend, and it seems that was what her parents hoped for all along.

When a relative questioned Elizabeth’s parents about why they had had a third child when they were so overextended with Henry, Elizabeth overheard this in quiet tones: Her sister had been born so Elizabeth would not be alone in caring for Henry when both parents were gone. Elizabeth and her sister were going to need to get Henry through adulthood together. Feeling protected and sacrificed at the same time, Elizabeth had always wanted to talk to her sister about what she heard but did not have the heart to tell her the news: that she had been born to serve.

Once when Elizabeth and her sister played too long outside, Elizabeth came in sick with heatstroke. “Mommmmm!” she called out before collapsing on the bathroom floor. Her mother yelled back from upstairs as she managed one of Henry’s fits: “I need you not to need me right now!” It is said that siblings find niches, different from one another, so as not to compete for the same resources or the same spot in the family. Elizabeth stripped to her underwear and splayed out on her stomach like a starfish, her torso and her cheek cooling on the tile floor. If Henry’s niche was having special needs, then Elizabeth’s niche would be having no needs at all.

There are countless ways to be a special-needs child. The term special needs is a shortened way of saying that one has special health care needs. It is an umbrella term intended to cover any chronic physical, developmental, behavioral, or emotional condition that requires medical, mental health, or educational services beyond those that are commonly a part of growing up. Such conditions most commonly include learning disabilities, attention-deficit/hyperactivity disorder, mood disorders such as depression and bipolar disorder, anxiety disorders, autism spectrum disorders, behavioral disorders, developmental disorders, arthritis or other joint problems, intellectual disabilities, cerebral palsy, speech problems, tic disorders, asthma, diabetes, severe allergies, seizure disorders, hearing or vision impairments, and brain injuries. This is a long list but not an exhaustive one. Any condition that necessitates special services would qualify. Many special-needs children meet criteria for more than one condition—or, like Elizabeth’s brother, they struggle with behaviors and symptoms that do not fit neatly into a diagnostic box at all.

According to the National Survey of Children with Special Health Care Needs, a representative sampling of tens of thousands of households across the nation, about 13 to 20 percent of boys and girls under the age of eighteen—or between ten and fifteen million children—have special needs. While boys are somewhat more likely to have childhood health problems than girls, special-needs children are roughly equally likely to be found in all income brackets. Advances in medical treatments mean that countless children who might once have died from their conditions—or who might have been institutionalized because of them—now are more likely to live at home where their parents attempt to meet their special needs. Most of these special-needs children share a house, or even a bedroom, with at least one sibling.

It is important to be clear that two-thirds of special-needs children are not impacted much by their conditions, and neither are their families; their special needs are few. But about one-third have conditions that greatly affect their day-to-day lives and those of their parents and their brothers and sisters. Kids who have special needs often cannot just be kids. They may be unable to run and play and learn alongside others their age. Finances and marriages may be strained under the weight of constant caregiving, and often parents must work less, or stop working, in order to give their children what they need. It may be difficult for families to enjoy good times together, or to go out in public without receiving pitying looks or sympathetic smiles. Additionally, these struggles are often not temporary: Many special-needs children have conditions that will stretch far into their adult years.

Although there are many ways to be a special-needs child, the so-called typically developing siblings of special-needs children sometimes look a lot alike, and they can be anything but typical. Aptly known to some as “supersiblings,” these brothers and sisters may compensate for their loved ones’ disordered development with their own precocious development. Younger siblings may act like older siblings and older siblings may take on the role of little parents as they step up and help out with cooking, chores, and childcare. Mature beyond their years, supersiblings are often recognized by others as “little adults” or “old souls.” “What would we do without you?” parents say. When their special-needs siblings cannot be flexible, these siblings take the backseat in the car and in the home.

Because children with special needs are rising in number, the challenges their parents face are beginning to gain prominence—as seen in the op-ed “I Am Adam Lanza’s Mother”—but the siblings of special-needs children are a largely unrecognized, underserved group. Compared with their brothers and sisters, supersiblings are overlooked not just in the home but in the research as well, and only very recently have clinicians and families begun to recognize that the siblings of special-needs children are a special population themselves.

There are special benefits and costs that go along with having a special-needs sibling. Growing up a few feet away from a loved one with a chronic illness or disability can offer unique opportunities for personal growth, and consequently many supersiblings become more responsible and competent than their peers. Living with a sibling who is different can foster tolerance, empathy, compassion, and patience. Knowing that someone you love may never be well—and may even die—puts other childhood problems in perspective. Their childhood experiences can result in distinct skills, and many supersiblings take their talents and strengths and become valedictorians, class presidents, physicians, community leaders, and sports heroes. Young golf great Jordan Spieth credits much of his maturity and groundedness to having a younger sister with a neurological disorder. She is, he says, “the best thing that ever happened to our family.”

Elizabeth’s story is only one story, of course, and it is one that can be more difficult to talk about. It is a story about how, even though boys and girls may love their special-needs siblings, life can be hard for them, too. Supersiblings like Elizabeth may worry about whether they themselves might one day have their brothers’ or sisters’ problems, or give birth to children who do. They may feel embarrassed about the ways that their special-needs siblings are conspicuously different, and then feel they have betrayed their siblings in their hearts and minds. They may feel resentful about unequal treatment in the family as their siblings receive praise for everyday tasks while their own outsize accomplishments are simply expected, and then feel bad about lapsing into petty jealousy. They may feel burdened by the prospect of having to care for their siblings one day, and then feel ashamed for being selfish. Supersiblings often keep these feelings to themselves, and about half struggle with their own problems, such as depression, anxiety, substance abuse, or eating disorders, at some time during their lives, although friends and family may never know it.

Growing up in England, world-renowned neurologist and author Oliver Sacks had a brother who was diagnosed with schizophrenia as a teen. In late adulthood, Sacks wrote openly about his childhood ambivalence: “I became terrified of him, for him. What would happen to Michael, and would something similar happen to me too?” Like many children who live with adversity, Sacks coped by distancing himself from the problems in his home: “I set up my own [science] lab in the house, and closed the doors, closed my ears, against Michael’s madness. It was not that I was indifferent to Michael; I felt a passionate sympathy for him, but I had to keep a distance also, create my own world of science so that I would not be swept into the chaos, the madness, the seduction, of his.”

Later, Sacks recognized that his relocation to practice medicine in the United States was a move “partly to get away from my tragic, hopeless, mismanaged brother.” Becoming a neurologist was, he said, a way to understand and master the brain, the organ that had devastated his brother and his family. There was, however, no quick or simple resolution. Sacks struggled with a secret drug addiction for four years in his late twenties and early thirties, and decades later he wrote of guilt that would never leave him: “I could, I should, have been more loving, more supportive… and the shame of this—the feeling that I was a bad brother, not available to him when he was in such need—is still hot within me sixty years later.”

When the world looks at supersiblings like Oliver Sacks, or like Elizabeth, it sees, from the outside, an apparently seamless adaptation to their special circumstances. What the world often does not see—or cannot see—is a complicated mix of love, hate, protectiveness, embarrassment, guilt, anger, resentment, frustration, fear, and exhaustion. Like their special-needs brothers and sisters, what many supersiblings yearn for most is the average and expectable. They, too, want a life that is all their own, unaffected by illness. They wish they could enjoy an everyday relationship with their brother or sister, one that allows for rivalry and name-calling. They long for permission to have ordinary feelings and needs and milestones of their own. They would like to just be normal and even flawed themselves, but too often these supersiblings feel they cannot be normal, they need to be supernormal. They cannot be human, they must be superhuman.

In 1969, when Oprah Winfrey was fifteen years old, a special guest speaker visited her high school. In an hour that would change her life, the Reverend Jesse Jackson delivered what Winfrey described as “the speech of a lifetime” in which he gave the students this challenge and solution to discrimination: “Excellence is the best deterrent to racism. Therefore, be excellent.” That evening, Winfrey went home and made a poster of these ten words to live by, and the poster remained taped to her mirror through college.

Excellence, it turns out, is the best deterrent to any form of discrimination based on difference, and Elizabeth knew—it seems instinctively—that the best way to protect Henry, herself, and her family from sideways glances and unfair treatment was to excel. To err may be human, but Elizabeth was exceedingly careful never to make mistakes of any kind.

Henry could not be left home alone, and no babysitter could handle him, so wherever Elizabeth’s mother went, Henry went, too. Henry hated errands, and the grocery store most of all, with its bright lights and cold temperatures. He had trouble controlling his eating, and because he could eat a box of Little Debbies or Crunch Berries in one sitting, his mother was not supposed to buy them. Some kids might fuss or cry in the store for sugar cereals or sweet snacks, but Henry had what his doctors had begun to call, for lack of a better term, blind rages. He shook his mother’s big, metal shopping cart with his arms and kicked her with his feet and, while most other shoppers pretended to casually look away, he hissed and spit at those who dared to stare. Once, a store manager asked them to leave: “What am I supposed to do with my child while I buy food for us to eat?” Elizabeth’s mother asked imploringly in response as Elizabeth wished she might sink into the floor.

When Elizabeth was young and Henry misbehaved in the grocery store, she would sneak away to an empty aisle and, looking carefully in both directions, reach into her shirt and pull out a necklace she kept tucked there. Raising her arms high up above her head, she was Oh Mighty Isis, pretending to swirl the clouds as she took control of the world. By the time she was in middle school, she attempted to transform stares and glares from strangers by using the only real power she had: being very, very good. She ran and fetched items for her mother so they could move quickly and efficiently through the store. From the outside, Elizabeth and her mother might have looked like frantic contestants on some strange game show, but on the inside, they felt like they were running for their lives. To skip the candy in the checkout line, Elizabeth’s mother diverted Henry to the car while Elizabeth stacked items on the conveyor belt in an orderly fashion—fruits with fruits, frozen foods with frozen foods, boxes with boxes, dairy with dairy—before she laid down her mother’s credit card and her sister pushed the cart out to the parking lot. Elizabeth’s mother might have had one very troubled child, but she had a model child, too.

Perhaps similarly to how Oprah Winfrey aimed to succeed as a black woman in a white man’s world, Elizabeth felt she needed to be excellent, too. She had a vague and constant feeling that she had something to prove or offset. Day after day, school offered countless opportunities to do so. In the mornings, she walked quickly up the front stairs of the school and greeted her principal cheerfully—“Hi, Mrs. Miller!” She pretended not to notice Henry, who—now being “mainstreamed”—came out of the car like a giant piece of taffy, stretching and resisting against the guiding arms of his mother and the assistant principal. In the classroom, Elizabeth took comfort in the perfection of 100s, only to have Henry’s shouts from the hallways sometimes pierce her world.

In one school talent show, Elizabeth hammered out a flawless minuet by Bach, and she did so with her cheeks flaming red, not because she was anxious about performing on stage but because she was angry. She heard Henry laugh out loud when she came on stage, and then Elizabeth’s father ushered him out of the auditorium as she played. As she sat at the piano moving her fingers up and down the keys with poise, she also imagined herself screaming at her mother from the stage—“Couldn’t he have stayed with a babysitter just once?” Later that night, when Elizabeth was sullen and she complained that Henry had ruined the night for her, her mother scolded her: “For God’s sake, Elizabeth. You just had this great experience that Henry will never have. He can’t control himself. You’re lucky you can!”

Many supernormals seem to have some kind of secret weapon. “Lord yes, she had the stuff from the beginning,” remembered an early teacher of novelist Alice Walker. “A lot of children passed my way, but Alice Walker was the smartest one I ever had.” Or as biographer Carl Sandburg said about young Abraham Lincoln, who attended school only sparsely and sporadically: “Abe made books tell him more than they told other people.” That secret weapon is not always book smarts, of course, and Andy Warhol remembered being noticed at a young age for his artistic skill: “The teachers liked me. They said something like I had natural talent. Or unnatural talent.” Not every supernormal will go on to be a famous novelist or artist or politician, and not every supernormal need have some prodigious talent. A secret weapon that a great many supernormals do have, however, is a natural—or unnatural—ability to control themselves.

Self-control is the ability to direct one’s own thoughts, feelings, and behavior, usually as a way to better adapt to the world. A sort of catchall word for how well we resist temptation, delay gratification, regulate our emotions, and work toward what we want, self-control is how we obey rules, follow directions, check emotions, cooperate with others, exercise consistently, eat healthily, keep promises, save money, get to work on time, and work hard. As noted by Sigmund Freud almost a hundred years ago, the ability of the individual to be in charge of herself—for reason to be stronger than passion, for the individual to bend to society, for the ego to be stronger than the id—has long been one of the hallmarks of civilization.

Now we know that self-control does not come from the ego per se; it comes from the prefrontal cortex. The human brain develops, and has evolved, from back to front and from bottom to top. The most primitive parts of the brain are buried deep at the bottom and the back of the brain, and these areas function automatically: The brain stem regulates heartbeat, breathing, and sleep without any effort on our part, for example, and the amygdala triggers fight-or-flight responses reflexively. The prefrontal cortex is literally and figuratively the most top and forward part of the brain. Located just behind the forehead, this is where our most advanced, forward thinking takes place. This is the part of the brain that provides “top-down” regulation of the amygdala, quieting our impulsive, emotional reactions and replacing those with conscious, intentional actions. The prefrontal cortex is where the executive functions reside, self-control being chief among them.

The most often cited illustration of self-control is the now famous “Marshmallow Test,” developed by psychologist Walter Mischel in the 1960s. In a classic set of studies, Mischel examined whether preschool children could resist eating one marshmallow right away in favor of waiting twenty minutes for the reward of getting to eat two. Not surprisingly, some gobbled up the single marshmallow in an instant, others tried to wait the twenty minutes but failed, and still others were able to hold out for the reward of two goodies. What was intended to be a snapshot of individual differences in children’s ability to delay gratification became a long-running study of development, and over the years the predictive validity of the Marshmallow Test has turned out to be nothing less than astonishing. Those preschoolers who had enough self-control to wait for the reward of two marshmallows went on to have higher SAT scores, better coping skills, higher educational attainment, higher self-worth, and less drug use in adulthood.

In the decades that have passed since Mischel’s preschoolers faced off with those marshmallows, other scientists have shown self-control to be pretty much all upside. In a 2012 meta-analysis that combined results from over one hundred studies and more than thirty thousand subjects, self-control was associated with better outcomes in school, work, love, and health. From early education through higher education, self-control means better attendance, more time spent studying, less time spent watching television, and higher grades and standardized test scores; self-control has even shown itself to be a better predictor of academic success than IQ.

Those with more self-control are at an advantage outside the classroom as well. They have better relationships and tend to be popular, at least in part because they are good at overriding their own desires and attending to the needs and wishes of others. Greater self-control is associated with better performance in sports, too, as it makes it possible for athletes to dedicate themselves to regular practice, and to keep calm and excel under pressure. And self-control helps us not only say yes to the work that is required in life but also to say no to destructive behaviors that might get in our way. As a result, those with greater self-control are less likely to struggle with impulse-control problems such as violence, anger, delinquency, and binge eating or drinking.

Self-control may even tell us something about why some who experience trauma go on to develop post-traumatic stress disorder (PTSD) while others do not. Brain imaging studies suggest that in the face of overwhelming experiences, those who develop PTSD show less activity and connectivity in the prefrontal cortex compared with those who have also experienced trauma but do not develop PTSD. This suggests that, at least in part, PTSD may be the result of inadequate “top-down” control of the amygdala, such that fight-or-flight reactions run amok. Indeed, one aspect of treatment for PTSD involves teaching greater control over one’s thoughts, feelings, and behaviors. One of the defining features of PTSD is feeling overwhelmed and helpless as the result of trauma, and self-control allows us to feel in charge of ourselves and our lives even if we are unable to control some of the things that happen to us.

The predictive power of self-control is so strong that it is comparable to that of intelligence and socioeconomic status, yet, importantly, it is not the same as either of these. This means that self-control is a place of possibility, a way that even without being the smartest or the most privileged, the resilient child still has an opportunity to excel. To be sure, as the study of Mischel’s preschoolers suggests, some people start off with more self-control than others, and those who have more will likely do better in life. (Elizabeth’s mother was partially right: Elizabeth was fortunate to have more self-control than her brother.) Self-control is not simply an inborn gift, however, available to the “haves” but out of reach of the “have-nots.” Self-control can be built through practice and challenge, and those who battle adversity in their homes or neighborhoods are awash with practice and challenge. Every day there are opportunities to hold their tongues with troubled siblings, to choke back their tears in the presence of bullies, to tiptoe around the moods of an alcoholic, to avoid dangerous blocks on the walk home, and to work diligently toward the goal of getting out. Supernormals probably come into this world with at least their fair share of self-control—likely they would have passed the Marshmallow Test easily—yet one cannot underestimate the impact of being immersed in an environment where, day after day, one must continuously control how one thinks and feels and acts.

By adulthood, many supernormals attribute their survival and their success to their special ability to control their days and, therefore, their destinies. Indeed, those who transcend difficult circumstances often do so in part through self-control and self-direction. In the Kauai Longitudinal Study—the study in which a diverse cohort of infants in Hawaii were followed through midlife—the men and women who outperformed their disadvantaged beginnings were those who, by adolescence, believed in their own effectiveness, in their ability to overcome whatever obstacles lay ahead. In a different study, this one of nearly three thousand adults, aged twenty-five to seventy-four, a lack of parental support in childhood was associated with chronic mental and physical health conditions in adulthood, but it was those who felt in control of themselves and their lives who fared well.

Known for their amazing ability to put their executive functions to work, supernormals can be like “little executives” in their controlled and directed approach to life. They set goals and make posters for themselves—“Be excellent!”—and they do this knowing that being excellent comes not just from having some prodigious raw materials but also—or perhaps even more—from being willing and able to put those raw materials to work. Though Elizabeth never would have admitted it to others, she secretly felt something like omnipotent. She felt she could do anything she set her mind to as long as she chose wisely—which, of course, she typically did. “I don’t understand failure,” she said. “If you want to do something badly enough, you make it happen.”

Because Elizabeth and her sister were “the lucky ones,” they were not allowed to have complaints about their brother, nor did it seem they were allowed to have the whole range of human emotions. “In our family, it went beyond, ‘If you can’t say anything nice, don’t say anything at all,’” Elizabeth recalls. “It was, ‘If you can’t feel anything nice, don’t feel anything at all.’” Elizabeth was not sure what she felt anyway. As difficult as it is to have thoughts or feelings about a problem that no one wants to talk about, it is even more difficult to have thoughts or feelings about a problem no one can talk about because no one knows what it is. “Never having a clear diagnosis, it was hard to hold Henry accountable for anything,” Elizabeth recalls. “Sometimes he would be just fine and then other times watch out. But whatever it was, he couldn’t help it so I was told I could not have feelings about it.”

Anger. Sadness. Fear. Those feelings were off limits. The sisters were told to be “better than that” and “above all that,” so many hours at home were spent rising above being human. Like at the dinner table, when Henry taunted Elizabeth—“My classes are harder than yours, you know”—typical sibling rivalry might have resulted in some back-and-forth bickering that would have gradually ruined dinner for everyone. Instead, when Elizabeth said casually, playfully, “No, mine are harder, actually,” dinner was ruined in an instant when Henry threw his plate at her. When Elizabeth dove down under the table and began to crawl out of the room, her mother commanded, “Get back up here! You’re not going anywhere. You are going to sit right here and apologize to your brother.”

Or like when, as teenagers, Henry charged Elizabeth with a butcher knife and her father called 911. After the police officers left with her brother in the backseat of their cruiser, Elizabeth and her sister collected the “sharps” in the house—the knives, the scissors, the screwdrivers—and hid them away in a shoe box. Later, on the solemn drive to the police station, Elizabeth’s mother asked Elizabeth what she would like to do: “You could press charges but then he’ll have a record… or we could put Henry in a hospital for a while . . .”

“If he goes to a hospital, will he ever be able to get a job?” Elizabeth asked, saddled with worry and responsibility for her brother’s future.

“Yes, honey,” Elizabeth’s mother said. “No one will ever know.”

“Then I guess he should go to a hospital,” Elizabeth said.

Remembering that car ride years later, Elizabeth flashed a sardonic smile and quipped, “He wanted to murder me but I wasn’t allowed to want to murder him.”

By the time Elizabeth left for college, she was gifted at what trauma expert Bessel van der Kolk calls “dealing but not feeling.” She took seven classes a semester, served as a residence adviser in the dorms, made the dean’s list, and waited tables twenty hours a week. This might sound implausible or even impossible, but owing at least in part to her very capable prefrontal cortex, Elizabeth had always been able to do more than most others her age. Each semester, she needed special permission from a dean to take on her inordinately heavy load, and in this semiannual perfunctory meeting, her cheery disposition and color-coded planner spoke for themselves. No one knew, nor did Elizabeth herself think much of the fact, that she routinely drank as many as ten cups of coffee a day and slept as little as four or five hours a night. She often failed to notice when she was hungry.

Next she headed for law and medical school, where she played off her ready knowledge of the psychiatric drugs Henry had taken over the years, as well as her knowledge of the legal system: “How do you know all this stuff, Elizabeth?” her fellow students wanted to know. Elizabeth’s achievements clearly differentiated her from her brother: If he was going to be stuck at home as a patient, then she was going to get somewhere as a doctor; if he was going to sit in the back of a police car, then she was going to have a law degree. Besides, as she watched her parents argue about the credit card debt that was piling up over Henry, Elizabeth now understood the full force of what she had once heard her mother confide to her aunt: One day, she and her sister were going to need to be able to support him. Elizabeth’s family could not afford for her not to do well.

Yet as she excelled, Elizabeth instinctively knew to whisper about her accolades—summa cum laude, graduate school admission, selection as chief resident—or simply not to speak of them at all. She cringed when her accomplishments were mentioned in front of her brother, and the entire family took a collective, silent gasp when, in public, some well-meaning stranger inadvertently shone a light on the discrepancies between the siblings: “And what about you, young man? Are you in graduate school, too?” Elizabeth felt a heavy sense of culpability, that whatever was good for her was bad for her brother. She returned home less and less as the message she received from her parents shifted from “Your honor roll mention is upsetting your brother” to “Your existence is upsetting your brother.”

Supernormals like Elizabeth live with an excruciating double bind: Their families need them to be well and do well, yet they are often left to feel bad about their own health and accomplishments. Their celebrations may be muted or nonexistent, and their achievements can be a source of pain or anger or sadness for those they have worked so hard to protect. While many supernormals do not feel entitled to their most primal human emotions, they may feel awash with a more sophisticated feeling: guilt. Guilt is a social, moral feeling that arises in the context of a relationship between two people. It surfaces when we feel we have behaved in ways that are damaging toward another, or when we see inequities in a group—especially in a group of family members. Guilt resides in the prefrontal cortex and is closely related to self-control—“I live in my goddamn prefrontal cortex!” Elizabeth would bemoan in sessions—and its evolutionary purpose is to promote fairness. Guilt prods us to even things out.

For most supernormals, though, life is not, and may never be, fair. Many live alongside brothers or sisters or mothers or fathers who struggle with problems they do not have and cannot fix. Though Elizabeth felt somehow responsible for Henry’s unhappiness, she had done nothing wrong except get the longer end of the neurodevelopmental stick. The more she tried to “even things out” for her family by being good and helpful—by being supernormal and superhuman—the more she outstripped her brother and made him feel bad. Other than sabotaging her own success, which would only burden her parents more, there was nothing Elizabeth could do to make their lives more equitable.

Guilt is not adaptive when it cannot lead to some sort of repair, and indeed a meta-analysis that examined the results of over one hundred studies and more than twenty thousand subjects found that feeling responsible for events one cannot control is related to depression, a problem that Elizabeth was struggling with privately in therapy. “I don’t feel like I am allowed to be really depressed or have a breakdown or anything because I’m the lucky one,” she said. “But I don’t feel like I am allowed to be happy, either.”

When Elizabeth was set to graduate with her MD/JD, in lieu of gifts from her parents, she asked for one thing: that the day be about her. With some guilt, she requested that her mother and sister come alone, that Henry be left behind with her father, so she could enjoy her achievement. When the two women rang the bell at Elizabeth’s apartment only just in time to dash to the ceremony, her mother reluctantly admitted that one of Henry’s appointments that morning had run long. In a rare display of anger, Elizabeth shrieked, “I asked for one thing for graduation! I just wanted one day to be about me. You couldn’t go one day without putting Henry first? He had to have an appointment today?”

“Henry is back in the hospital,” her mother said icily.

Flooded with guilt, Elizabeth was trumped again.

“Just buck up and we’ll have a good day,” her mother continued. “That’s what you always do. That’s what you’ve always been so good at.”

Unable to acknowledge her suffering, Elizabeth’s parents simply could not afford—financially, logistically, or emotionally—to have more than one child with needs. Unable to understand her parents’ bind, Elizabeth uncharacteristically pushed further for an explanation: “Why do you always put Henry ahead of me?” she shrieked some more.

After several rounds of denials, Elizabeth’s mother said something that maybe she did not mean, or that maybe she did not mean to say: “You’re an animal lover, Elizabeth,” she exhaled, exasperated. “Let’s say you have two little dogs. One dog is cute and cuddly and everybody runs over to it and wants to pet it and play with it. The other dog growls and snaps at people and no one wants to go near it. If you have to put one dog out on the street it’s going to be the cute one because you know somebody is going to come along and pick it up.”