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Mary was sitting in her usual chair off to a side of the day room. She had the look of someone who has spent many years sitting in rooms just like this one in other psychiatric facilities. Her hair was long, gray, and unkempt. Her sweatpants fit tightly over her big belly. Her sweatshirt did not quite match the pants, and it was stained where food had spilled down her chest. She did not talk much, but she saw everything and knew a lot. One day I was walking through the day room and felt her eyes follow me. She commented favorably on my appearance, and when I thanked her, she added that I “should use a little lipstick.” A week or so went by and I was hurrying through that same day room when Mary reviewed my appearance and complimented me again. “Well, I remembered to wear lipstick.” “Yes,” she replied, “now you need to improve the shade.”

My grandmother, Minna, knew a lot about self-adornment. For her, matching clothes to shoes was no big deal—just a starting point. She could match a suit with gloves, a handbag, a scarf, and jewelry as well. She wore a fair amount of makeup, and I cannot remember now, but I’ll bet that her lipstick and nail polish were always the right shade for her unnaturally blond hair and fair skin. She did not have to “remember” to put on lipstick when leaving the house, as I do. It was just part of her. When the family gathered at our grandparents’ house three times a year, we always dressed up. When my sister, my cousins, and I reached a certain age, Minna would compliment us on how we looked, then add, “You would look so much nicer with just a little lipstick.” She might have said it only once or twice to each of us—it is hard to know exactly—but it became our joke. There was only one other comment we could count on from her, and that was in response to any news of a boy in our lives. Her immediate and only question was, “Is he Jewish?”

Those two responses, “You could use a little lipstick” and “Is he Jewish?” sum up the education the girls in the family received from our grandmother. We, of course, just laughed, since we were teenagers in the sixties, when we were learning so many other things about ourselves and the world that felt more important than marrying well. But the Jewish issue was no laughing matter for Minna. The relationships with her family members and her social standing in the Jewish community were the underpinnings of her identity. Minna was born at the turn of the century into a large family of Russian Jewish immigrants. She grew up poor and became wealthy. She achieved where she could—not in the ways of her granddaughters—but in the circumscribed roles permitted in the synagogue, fund-raising organizations, and the Jewish country club. Always striving for assimilation, her cultural identity was her reference point. When I walk into a professional meeting, I automatically count to myself the number of women in the room. Others do the same thing with race. Minna walked into a restaurant and would note aloud the numbers of Jews.

When she got older, Minna began to lose her mind. It was not like Mary’s problem, which was more obvious. Minna just became forgetful—first about little things, like any older person, then the big things. I did not realize how bad it was until one day when I was just finishing my training as a psychiatrist. We were at the wedding of a cousin. The setting was a house on a riverbank and the day was beautiful. I sat on a couch with my grandmother, whom I hadn’t seen in a while. She looked as well put together as usual, and she chatted pleasantly with me. She asked me where I was living now. Even though I had been in the same place for 4 years, it was a reasonable question, given her age and the frequent moves of her nine grandchildren. “I live in New York now,” I said patiently. “Oh,” she replied, “maybe that is where I know you from.”

That was bad, but not compared with what came later that day. I introduced her to the man I knew I would marry. I told her he was my boyfriend and added in a partly mocking and partly proud tone, “And guess what? He’s Jewish!” “That’s nice,” she said sweetly. “Are you?”

Neither Mary nor Minna had an education like mine. I learned about the arts and science and was taught that professional achievement alongside of marriage and family is what makes a woman happy. They knew all kinds of other womanly things that were never part of my training. Mary’s mind now played tricks on her much of the time. Although she could not help spilling food on herself, she knew that she did not want to look like that. Somewhere along the way she had learned the lessons of the art of dress and makeup and could tell that my mind was devoid of that knowledge. Minna’s mind was lost in a different way. Unaware of her memory problems, she eventually found the world to be confusing and frightening. She hid her jewelry and, when unable to find it later, would accuse others of stealing. Yet, as the inner workings of her brain began to scramble, her outside facade was remarkably intact.

I wonder what it will look like if I lose my mind. Whether I will start to hear voices, like Mary, or forget who my grandchildren are, like Minna, I hope there will be some core of my self that shines through. In the meantime I’ll try to grow and develop in the ways I can. I may never get the part about matching shades, but at least I’ll try to remember to wear a little lipstick.

Presented at Yale University, Feb. 16, 1996. Address correspondence and reprint requests to Dr. Steiner, Department of Psychiatry, Yale University, 34 Park St., New Haven, CT 06519; [email protected] (e-mail). Accepted for publication February 2008 (doi: 10.1176/appi.ajp.2008.08010124).The author thanks John Strauss, M.D., and the late Malcolm Bowers, Jr., M.D., for their comments.