Sybil

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A new book, 'Sybil Exposed' claims that the famous case was a fraud, started by an emotionally needy woman who wanted more attention from her psychiatrist. I had read the book, and I, and everyone I knew, believed every word of it. How many psychiatrists have made how many serious mis-diagnoses that have ruined how many lives?

I heard it was more like she was having some issues due to abuse, but that the multiple personalities where exagerated in the book that was written.

Dear Sweetleaf, this new book claims that there was no abuse, that the psychiatrist was willing to believe and encourage these fantasies because she was making a name for herself, and that Flora Reta Schreiber was aware to a large degree that there were serious questions, but that her motivation was fame and money. The original book was so hard for me to read; everyone I knew read it and was very upset by it....Sylkat

I am always somewhat skeptical of armchair diagnosticians.

Certainly Herbert Spiegel and Cornelia Wilbur famously disagreed on diagnosis, but I don't think that either Schreiber or Nathan have added to the medical understanding of Shirley Mason.

Psychiatry is one of the most difficult branches of medicine to practice because, unlike many other disciplines, there are very few empirical bases to evaluate a patient other than the patient's own narrative. I can measure a patient's pulse and blood pressure. I can count a patient's lymphocytes. I can measure a patient's serum glucose. But a psychiatrist can't look inside a patient's mind and see the truth of the patient's description of experiences.

Was Mason deliberately exaggerating her symptoms? Did Wilbur accept these at face value, or did she positively encourage these exaggerations? On the other hand, was Mason being essentially accurate in her descriptions and was Spiegel being uncritically dismissive? We cannot truly know the answer to these questions, we can only speculate based on our interpretation of other material.

So, was Mason misdiagnosed? Possibly so. Was Wilbur guilty of a professional misconduct? Possibly so. But I am not in the least sure that any of us are in a position to make those evaluations.

Dear Visagrunt, What do you feel should have been done ? Should other psychiatrists have been consulted? Should she have been sent to someone else? How could the patient's welfare best have been protected? Her life became very pressured, and I understand that she died pretty much a recluse.... Sylkat

My approach to medicine is that I am a resource for the patient's use. I bring my education, my experience and my skill to the relationship, but it is the patient, ultimately, who makes the decisions.

As I said, psychiatry is challenged, but even in this field, patients can be encouraged to take control of their own care. We obviously must be mindful of an individual patient's capacity to make meaningful, informed decisions. There are, after all, some people who, with the best will in the world, will never be able to take responsible decisions for themselves.

My preferred approach (and I emphasize, I'm not a psychiatrist) would be to bring the patient to an awareness of her own condition, the limitations that it places upon her and the options that she has for going forward. But this is my 21st century view of things, and we are half a century away from this patient-doctor relationship. In the 1950's the physician gave the orders and the patient disobeyed at her peril.

The worst part of all is that Mason did have something very wrong with her and needed help. It's looking like her real illness was never diagnosed and if not, then she was never treated appropriately. It SEEMS that the doctor and author got rich and famous as a result, though....Sylkat