Sybil

[LibraryLady]

Shortly after I graduated from high school, I read a book by Flora Reta Schreiber called Sybil. Many of you are probably familiar with it. It tells the story of a young art student in New York in the 1950s and 60s who, with the help of a loving and sympathetic psychiatrist, discovers that she has 16 separate personalities. After years of therapy and nurturing from the doctor, she is able to fuse these disparate personalities into a new and whole person and go on to live a fulfilling life.

Along the way, Sybil is forced to recover the memories of horrific physical, psychological, and sexual abuse at the hands of her schizophrenic mother. Her aloof father manages not to notice the broken bones and other symptoms. Her narrow and strict religion discourages seeking psychological help. The small Wisconsin town in which she was raised is bound around with small town values that hide other dark secrets.

I was wowed by the book. I even read it again a few years later and began to notice some odd things about it. It seemed a little contrived with the second reading. But still, I was impressed with the story.

A movie was made with Sally Field and Joanne Woodward, an impressive cast, but they changed the story a lot, and it didn’t really capture me the way the book had. After that, I really didn’t think about it much.

As I grew older, as we all know, I developed a skeptical perspective and did a lot of reading about false memories and other abuses by some therapists, trained and not.

A couple of nights ago, when I watched a remake of the story with Tammy Blanchard and Jessica Lange, which stayed a little closer to the book, but added a feminist perspective with the doctor, Cornelia Wilbur, fighting with a male colleague who dismissed Sybil’s problems as hysteria and “women’s issues.”

It made me wonder just how much of this story held water. As it turns out, not a hell of a lot. And, in spite of that, it has had a profound impact on the practice of psychiatry in the United States.

The male colleague dismissed as a “skeptic” and chauvinist (yes they used the word skeptic in the second movie) turns out to be a doctor Herbert Spiegel. Here’s what he had to say in an interview in 1997. In this quote, he’s discussing why Sybil was diagnosed with MPD:

Quote:

I think they were both angry with me because I refused to collaborate with them on the book. Wilbur had decided she was going to make the Sybil case into a book, because she couldn't get it published in professional journals. So she engaged Schreiber, who was a professional writer, and they both came to see me to ask me if I wanted to be a coauthor with them. That was the original proposal: since I had all this information about the case, would I join in with them? We didn't spell out the fine print, because we didn't even get to the big print. I said, "Hmm. That's interesting." I had a lot of stuff to show them. But toward the end of our discussion, they said they would be calling her a "multiple personality." I said, "But she's not a multiple personality!" I think she was a wonderful hysterical patient with role confusion, which is typical of high hysterics. It was hysteria. Back in those days, Multiple Personality Disorder was not yet in the DSM. To me, a multiple personality meant you had to have an "alter" -- that is, a distinct alternate personality -- that was enduring, assuming control over the person for a considerable period of time, and that there was an amnesia barrier between one alter and another, as in the case, reported by William James, of Ansel Bourne, an American who forgot his identity and developed a second personality.

You’ll notice that reputable medical journals would not publish Schreiber’s and Wilbur’s articles on the case.

Wilbur taped her sessions with Sybil, whose real name was Shirley Mason, and some of those tapes were turned over to Robert Rieber of the John Jay College of Criminal Justice. He didn’t actually listen closely to them for many years, but when he did, he was shocked to discover that they revealed a deception. Wilbur had actually suggested the different personalities to Sybil and named them herself. This was confirmed by the patient when she saw Spiegel and asked him, “Would you like me to be Helen?” explaining that Dr. Wilbur had named her different moods and difficulties.

This is a long post but it has an important point. After Sybil was published in 1973, the diagnoses of Multiple Personality Disorder increased dramatically, with patients informing their doctors that they had MPD and the doctors accepting that diagnosis. Most of these patients cited the story of Sybil which was on the New York Times bestseller list and had an extremely wide readership. It became an accepted diagnosis on the basis of a book that was not true.

How many of Sybil’s horrific memories were false and induced by Dr. Wilbur’s hypnosis and use of sodium pentothal is impossible to say. All three protagonists in the story, Shirley Mason, Cornelia Wilbur, and Flora Schreiber are dead. It must be said that the three women remained very close until their respective deaths and that Mason found a secure and loving friendship which helped her live her life. The doctor and the writer were not pure villains. But their eagerness to write a bestseller has created a whole category of illness which is probably much more rare than believed or might not even truly exist.

A cautionary tale.

[fuelair]

Neither the first nor last time this kind of thing will happen. Sadly.

[Jeff Corey]

I think the book and the film The Three Faces of Eve(1957) was more influential in jumpstarting this bogus diagnosis.

[alfaniner]

I wonder if Roseanne is still claiming multiple personalities? (It could be the only explanation for the last season of her show -- yikes.)

[Roma]

I spoke with Herbert Spiegel several years ago when I was suing a psychiatrist for causing me to have iatrogenically induced MPD. Spiegel is a warm and kind person who sees MPD therapy as the quackery that it is. For more information on the fraud of the Sybil case and MPD woo please go to this site:

http://www.fmsfonline.org/sybil.html

[Professor Yaffle]

That some (or even most) cases of MPD (now known as DID - dissociative identity disorder) may have been iatriogenically created is probably true, but it doesn't necessarily follow that therapists create all cases and therefore the disorder is bogus. I haven't looked at the literature for a long time, but at the time I studied it, there seemed to be some evidence of a "real" disorder.

Quote:

Why some people develop DID is not entirely understood, but they frequently report having experienced severe physical and sexual abuse, especially during childhood. Though the accuracy of such accounts is disputed, they are often confirmed by objective evidence. Individuals with DID may also have post-traumatic symptoms (nightmares, flashbacks, and startle responses) or Post-Traumatic Stress Disorder. Several studies suggest that DID is more common among close biological relatives of persons who also have the disorder than in the general population. As this once rarely reported disorder has grown more common, the diagnosis has become controversial. Some believe that because DID patients are highly suggestible, their symptoms are at least partly iatrogenic— that is, prompted by their therapists' probing. Brain imaging studies, however, have corroborated identity transitions.

http://www.psychologytoday.com/conditions/did.html

It's one of those areas where debate is very polarised, and I'm afraid I'm not up on current literature enough to say what the current weight of the evidence points to.

[sleepy_lioness]

I have an amateur interest in this area. Books putting the "iatrogenic" theory, which I personally think has the overwhelming evidential support, include Richard Webster's Why Freud was Wrong; Ofshe and Watters, Making Monsters: False Memories, Psychotherapy and Sexual Hysteria and their Therapy's Delusions. Also Elaine Showalter's Hystories has a chapter on DID/MPD, and Frederick Crews discusses it extensively including in The Memory Wars: Freud's Legacy in Dispute. For me the definitive discussion has been the excellent recent book by psychiatrist PR McHugh, Try to Remember: Psychiatry's Clash over Meaning, Memory and Mind. I think Elizabeth Loftus's books on false memory also tackle the subject.

There is a wealth of evidence which shows that this 'disorder' only appears after prolonged therapy in which the therapist continuously calls forth, refines and gives attention to 'alter' personalities and it disappears within days or weeks of a change of therapeutic regime to one in which the 'alters' are ignored and the person's feelings and realities focussed on instead (McHugh's book details his experiences in this regard). Also, McHugh points out that 'dissociation' is not actually defined in psychiatry and means little more concrete than 'forgot', 'went a bit vague', or similar. To believe in DID or MPD, as it originally was, you need to believe in Freudian-style repression whereby whole aspects of the self, indeed, whole personalities, have real concrete existence and are repressed into the 'unconscious' (another Freudian term with no evidential backup), ready to explode into consciousness at any point. From modern neurology and psychiatry we know that the brain simply doesn't work like that.

[Dancing David]

Um it was a diagnosis that did not have a cluster of symptoms that were coherent.

i have met people who are disassociative for many reasons, most of them nuerological others substance abuse.

It wa sthe last flight of a neo-Freudian abstracted diagnosis without merit.

It is less popular amongst psychiatriasts than it is in the myriad of people who like the diagnosis.

Professor Yaffle, What are "personality changes", I think that is less likely than that article would suggest. When i am anxious, irritable or under compulsion I am very different than when I am not.

This sia terible set of criteria:

Quote:

Diagnostic criteria for 300.14 Dissociative Identity Disorder
(cautionary statement)
A. The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).

B. At least two of these identities or personality states recurrently take control of the person's behavior.

C. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.

D. The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during Alcohol Intoxication) or a general medical condition (e.g., complex partial seizures). Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play.

The first two criteria are so vague as to be sueless, unlike the things like insominia, depressive symptoms which may seem vague to layman (but are not) these are unable to be consistently applied across the diagnosis. i assume that under the DSM-V it will be revised.

And please note the rule outs, there should be a rule out for PTSD, behaviorally the effects of PTSD would meet most of criteria 1 and 2. And substance abuse is an immedeat rule out.

[Dancing David]

http://www.currentpsychiatry.com/art...?AID=7303&UID=

I think is a rather common feeling amongst psychiatrists.

[LibraryLady]

This is really good. I'm getting more reading to do! Thanks for the recommendations.

[Baby Nemesis]

From the book Even From a Broken Web by Bill O'Hanlon and Bob Bertolino:

Quote:

We have touched on the idea that therapists' models of therapy can dominate the clients' experience in a sometimes intrusive and unhelpful way. Nowhere is this danger more apparent than in the treatment of multiple personality, or what is now called Dissociative Identity Disorder (American Psychiatric Association, 1994). For years, multiple personality disorder (MPD) was rarely diagnosed. True cases of MPD were often missed or misdiagnosed. Recently, the situation has reversed. MPD is now an epidemic (North, Ryall, Ricci, & Wetzel, 1993)- Colin Ross (1989), a well-known expert on MPD writes, "Within a span of ten years, we may evolve from extreme underdiagnosis of MPD to a situation in which the major problem is false positive diagnosis." Prior to 1944, a total of 76 cases of multiple personality disorder had been reported in the psychiatric literature (Taylor & Martin, 1944). Because they were so rare and dramatic, most cases were probably written up. By 1970, 14 more cases had been reported, 6 of which were by one clinician, making for a total of 90 cases, almost all of which were in North America (Aldridge-Morris, 1989). By 1986, it was estimated that 6,000 cases of MPD had been diagnosed in North America (Aldridge-Morris, 1989; Coons, 1986; Ross, 1989). In 1986, Frank Putnam wrote, "More cases of MPD have been reported within the last five years than in the preceding two centuries." In addition, the average number of personalities "discovered" has risen from 2 from 1840 until 1944 to 25 in 1990. The maximum number of personalities reported has risen from 3 in 1850 to over 300 in 1990 (and still rising) (North et al., 1993). What is happening here? Perhaps there were cases of multiplicity
that clinicians missed in previous decades. But 6,000 of them (now, it is surely many more than 6,000, but the number is hard to ascertain)? And since some cases were discovered and treated, how come those early pioneers did not discover 300 personalities in their cases? They used hypnosis and they clearly believed in the possibility of multiple personalities.

What is operating here, in our opinion, is "theory countertransference"
(Hubble & O'Hanlon, 1992). This is our name for the phenomenon that happens when a therapist unwittingly imposes his or her theory on the client and becomes convinced that the data arose spontaneously from the client. ...

Here's an account by a psychologist of how she used to do therapy that she now believes was harmful because it induced false memories of abuse in clients, and how such things were sometimes the catalyst to diagnoses of multiple personality disorder: "First of All, Do No Harm" - A Recovered Memory Therapist Recants

And here's an account of someone who therapy convinced she had MPD, but who later realised that wasn't true at all and who went on to sue her therapist.

They give an idea of the kinds of things that can go on.

[sleepy_lioness]

Just to add to the bibliography, there's some excellent sources listed here:

http://www.fmsfonline.org/mpddid.html

I particularly liked this article:

http://www.csicop.org/si/9805/witch.html

[LibraryLady]

I'm going to re-read Sybil now. Should be interesting with this new point of view.

[I Ratant]

Sweet Thang can switch instantly from "normal" to 12-year-old spoiled brat and back again, without needing a new identity. She's borderline BPD.
I'd go along with therapist-induced condition for the MPD examples I've read about.

[NoZed Avenger]

Originally Posted by LibraryLady

A cautionary tale.

Interesting and well-written summary.

Thanks. I always meant to go back and find out more about that story after learning more about the claimed MPD diagnosis.

[Wolrab]

I can see the arguments for continued inclusion of Dissociative Identity Disorder into the DSM V.
"DID!"
"DID not!"
"DID"
"DID not"....

[Subduction Zone]

I knew a person who used to use meth. When she was on that stuff she would sometimes take on "alternate personalities" or whatever you want to call them. They were not any more intelligent than her regular self. One of her personalities "thought" she was very intelligent, but she was no more so than her regular personality. She was just much MUCH more sure of herself. Now that she is not on it anymore she does not go into periods where she seems ruled by these personalities, but she can still do the voices. From my observation, and I am definitely not a psychologist, she just used these personalities as an escape from responsibility. They could say the things she wanted to say but normally would not. She knew of them, they were not a surprise to her as the character's of the movie were to Sibyl.

[Dancing David]

Originally Posted by I Ratant

Sweet Thang can switch instantly from "normal" to 12-year-old spoiled brat and back again, without needing a new identity. She's borderline BPD.
I'd go along with therapist-induced condition for the MPD examples I've read about.

Well then there is another issue there.

Um, how to put this, personality disorders are labels for general categories of behavior under stress.

However each one has specific rule outs that are totaly ignored.

Take BPD, it is not to be diagnosed in the precense of almost any axis I symptomolgy. Doctors and clinicians routinely ignore this. Most BPD have PTSD, anxiety, hypomania and substance abuse disorders. these are automatic rule outs for BPD, yet it gets disgnosed all the time.


I am having a hard time finding the verbatim section on BPD, co-morbidity is allowed for some disorders. But there are rule outs that are totally ignored.

[LibraryLady]

I think I Ratant is referring to normal 12 year old behavior. Perhaps I'm wrong.

[Dancing David]

Most likely, I am addressing the fact theat the label BPD is often overused.

[Roma]

I heard some one say that if you took all of the characteristics of a typical healthy teenageer it would qualify for inclusion in the DSM as a mental illness.

As a mom of a teen I say they are completely crazy but not mentally ill.

[Dancing David]

Originally Posted by Roma Hart

I heard some one say that if you took all of the characteristics of a typical healthy teenageer it would qualify for inclusion in the DSM as a mental illness.

As a mom of a teen I say they are completely crazy but not mentally ill.

Yeah right, this is argument by appeal to unknown authority who is using an appeal to emotion.

No, a typical teen ager would not qualify as a DSM diagnosis, are you anti-mental health treatment or making a joke.

As stated before the problem comes when lay people read the criteria but do not know what words like 'significant' mean in the context of the criteria. They also don't have a clue as to what 'pairment in functioning' means especially a 'significan' or 'substabtial' one.

[Roma]

Originally Posted by Dancing David

No, a typical teen ager would not qualify as a DSM diagnosis, are you anti-mental health treatment or making a joke.

A little of both.

I'm not anti-health treatment but there are some people who worry too much about what is completely normal behavior in kids.

Sure there are a very few teens who really do need psychiatric intervetion but otherwise moods swings are normal in teens.

[Dancing David]

The isseu is the parents, there are normal things and then there is the MI issue. It is normal for a teenagers to have 'mood swings' but that is different from the 'mood swings' in bipolar disorder. And while it is normal for teens to be gloomy, despondent and/or frustrated. If the feelings of saddness last more than thirty days...well depression?

But I agree the issue is parents, they overdominate their teens, they rag on their teens, they set unclear boundaries and unclear expectations, they abuse them verbally and emotionally.

Then they wonder why their teen is pissed off.

By the time your child has become a teen they are past the 'teaching' phase and in the 'learning from cosequences phase'. So parents set limits and enforce consequence, but lecturing goes in one ear and out the other.

[Baby Nemesis]

Originally Posted by Roma Hart

I heard some one say that if you took all of the characteristics of a typical healthy teenageer it would qualify for inclusion in the DSM as a mental illness.

As a mom of a teen I say they are completely crazy but not mentally ill.

Hehe.

Some psychology books on prejudice tell the story of an experiment that was done in the summer of 1954, where two groups of 11-year-old middle-class boys were invited to a summer camp. The experiment was meant to investigate the effects of competitiveness and co-operation. The place the experiment took place was called Robbers Cave.

Each group spent the first week going hiking and swimming together and doing other enjoyable activities, so they became friends. They gave themselves group names and printed them on their caps and T-shirts. Neither group knew of the others' existence at that point.

But then they were introduced to each other, in an atmosphere of competition. Football and other sporting events were arranged between them. The winning team of each event was given points. A trophy and medals were promised to the overall winners of the games.

Almost overnight, the groups turned into hostile enemies, and their rivalry escalated into a series of battles. Group flags were burned, cabins were ransacked, and a food fight that was like a riot erupted in their mess hall.

Bear in mind that these boys had before always been considered well-adjusted and decent. They weren't street gang members. But the man who planned the experiment commented that a naive observer would have thought the boys were "wicked, disturbed and vicious".

That just shows how people can behave in more extreme ways than usual under different types of pressures. Perhaps one reason people can be more argumentative than they normally would be on the Internet is that people tend to express opinions they wouldn't in ordinary conversation, so the provocation is greater.

As the stories about the development of multiple personality disorder that were told in the articles I linked to before illustrate, people can go from coping with life fairly well to neurotics who can't seem to cope at all under the wrong type of therapy.

(The story about the boys in the experiment has a happy ending. It was difficult to bring the groups together in friendship for a while. First, the organisers tried saying nice things about each group to the other, but that didn't work. Then, they brought the two groups together under relaxed, non-competitive circumstances, but that didn't work either. What did finally work was giving the two groups things to do together where they had to co-operate with each other to achieve goals they both wanted to achieve. For instance, the experimentors arranged for the camp truck to break down, and both groups were needed to pull it up a steep hill. Those activities worked wonders. At the end of their time there, the two groups were so friendly they wanted to travel home on the same bus.)

[Gord_in_Toronto]

Originally Posted by Baby Nemesis

Hehe.

Some psychology books on prejudice tell the story of an experiment that was done in the summer of 1954, where two groups of 11-year-old middle-class boys were invited to a summer camp. The experiment was meant to investigate the effects of competitiveness and co-operation. The place the experiment took place was called Robbers Cave.

<snip>

Thanks B N.

I'll add this to the area of my brain where I store things that illustrate, "This is the Way the World Works". An elegant experiment.

I did Google for more details and if, anyone else is interested, I found them here:
http://www.age-of-the-sage.org/psych...xperiment.html

[Elizabeth I]

Originally Posted by Roma Hart

I heard some one say that if you took all of the characteristics of a typical healthy teenageer it would qualify for inclusion in the DSM as a mental illness.

As a mom of a teen I say they are completely crazy but not mentally ill.

Actually, I've always said adolescence/late teen-age is a 10-year-long case of schizophrenia.

[LibraryLady]

Originally Posted by Elizabeth I

Actually, I've always said adolescence/late teen-age is a 10-year-long case of schizophrenia.

I remember it as being more bi-polar.

[Dancing David]

Schizophrenia, no. Characterized by delusions, hallucinations and thought disorders.

Bipolar disorder, no. Characterized by depression, mania or hypo mania. Mood swings take months to change and manifest.



Adolesence is a biologically driven process, it most resembles an anxiety disorder.
Obsessive thoughts, compulsions, social anxiety.

[TraneWreck]

Originally Posted by Dancing David

Schizophrenia, no. Characterized by delusions, hallucinations and thought disorders.

Bipolar disorder, no. Characterized by depression, mania or hypo mania. Mood swings take months to change and manifest.



Adolesence is a biologically driven process, it most resembles an anxiety disorder.
Obsessive thoughts, compulsions, social anxiety.

What is the DSM diagnosis for a malnourished sense of irony?

[Dancing David]

Humor should be accompanied by smilies that denote it is humor. Part of the general cultural stigma of mental illness is the nyth that mental illness doesn't exist. the second part of it is the misapplication of terms.

"Teenagers could be said to have heart disease because they suffer emotionally', "Teenagers could be said to have cancer...", nope you don't hear those statements, just the ones about mental illness.

[pipelineaudio]

Originally Posted by Dancing David

No, a typical teen ager would not qualify as a DSM diagnosis, are you anti-mental health treatment or making a joke.

He or she would, however, qualify as on the autistic spectrum if using the DSM

[billw]

If you haven't already, check out The Minds of Billy Milligan by Daniel Keyes

http://en.wikipedia.org/wiki/The_Min...Billy_Milligan

http://www.dispatch.com/content/stor...1_EV89AGB.html

[Buckaroo]

They're currently talking about the Sybil case on Science Friday -- mere hours after I first saw this thread. Maybe Jung was on to something...