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Book review: The sordid story of Sybil

Article in Australasian Psychiatry · August 2012

DOI: 10.1177/1039856212447969 · Source: PubMed

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Book reviews
placebo). Parker’s pursuit and
research into melancholia and a
framework for understanding and
responding to non-melancholic
depression have led his group to
adopt a pattern-analytic or proto-
typic approach. The importance of
making this distinction is that
melancholic depression has a poor
response to placebo, does not
respond to psychotherapy alone
and is more likely to respond to
biological treatments. Not all
antidepressants are equally effec-
tive in melancholic depression.
Broad spectrum antidepressants
such as tricyclics are more likely
to be effective than narrow spec-
trum antidepressants such as SSRIs.
The manifestations of melancholia
may also change with age. Parker’s
‘alternate model’ for classifying
and managing non-melancholic
depression involves a skilled clini-
cian formulating the stressors
and personality interdependencies
to generate an individualised set of
biological, social and psychological
treatment strategies. Psychiatrists,
trainees, general practitioners and
suffers of depression will enjoy this
section of the book because, as
Parker notes with the Chinese adage,
‘The beginning of wisdom is calling
things by their right name’.
In the third part of the book, Parker
reflects on being a clinical psychia-
trist. He sees developing compe-
tence as an important ingredient, but
also, because psychiatry is essentially
about human connections, psychia-
trists should possess the ability to
‘prescribe themselves’. Parker recog-
nised early that he had a talent for
pattern recognition. In the last part of
the book, he returns to consideration
of how a good clinical psychiatrist
thinks. A capacity for pattern analy-
sis, a sound knowledge base, applica-
tion of logic and a modicum of
common sense is Parker’s recipe for
what Montgomery calls the ‘practi-
cal reasoning’3 required to be a good
clinician. This he considers the best
equipment for dealing with the fuzzi-
ness of diagnostic conditions and
treatment options. As Montgomery
says: ‘experts reason not by methodo-
logical inference but holographically’.
A Piece of My Mind is a book for those
thinking about a career in psychi-
atry and a courageously candid
and reflective personal chronicle of
an accomplished academic leader.
Finally, the book contains a vehe-
ment piece of mind from a man well
qualified to see an era of unenlight-
enment in relation to the classifica-
tion of the disease of depression.
References
1. Ellard J. ‘The music of psychiatry’. Austral N Z J Psy-
chiatry 1985; 19: 156–157.
2. Parker G. Parental Overprotection. New York: Grune and
Stratton, 1983.
3. Montgomery K. How Doctors Think. Oxford: Oxford Uni-
versity Press, 2006.
Nick O’Connor
Sydney, NSW
DOI: 10.1177/1039856212449675
The sordid story of Sybil
Review of Debbie Nathan. Sybil
Exposed. The Extraordinary Story
Behind the Famous Multiple
Personality Case. Free Press, 2011
For many people, the phenomenon
of Multiple Personality Disorder
(MPD) started with the 1973 publi-
cation of the book Sybil by Flora
Rheta Schreiber.1 In the book, the
author described a woman who pos-
sessed 16 different personalities as a
result of appalling abuse in her early
youth by her mother, who suffered
from schizophrenia. Sybil, who had
no control over her various person-
alities, was rescued by the valiant
efforts of her psychoanalyst, Dr
Cornelia Wilbur, who, after years of
analysis, succeeded in getting the
warring personalities to cohere into
a single entity that allowed Sybil to
lead a normal life. It was described
by many, not least by Wilbur, as the
most famous psychiatric case since
Freud’s Anna O.
The book was not just a sensation,
but sparked a phenomenon. MPD
became the cause du jour among psy-
chiatrists, psychologists, intellectuals
and the public.2 Thousands of people
were diagnosed – or diagnosed them-
selves – with MPD.3 They became
regular features on talk shows such as
Geraldo, Sally Jessy Raphael, Springer
and Oprah. The author and Dr
Wilbur often appeared on television
to promote their book. Wilbur
became an avid proselytiser for MPD,
achieving her goal when it became
listed in the Diagnostic and statistical
manual of mental disorders, third edi-
tion (DSM-111) in 1980.
But the mystery remained: who was
the woman known as Sybil in the
book? In fact, the answer was there
for those who chose to look. In 1997,
Mikkel Borch-Jacobsen, a French lit-
erature scholar, interviewed Dr
Herbert Spiegel, a psychiatrist with
extensive experience in hypnosis.
He had looked after Sybil for a brief
period when Wilbur was not availa-
ble. She had told him that the per-
sonalities were not real and she only
put them on to please Dr Wilbur.
Spiegel, taken aback, pointed out
that she did not display any of the
characteristics of hysterical patients
who dissociated. Later, Wilbur asked
him to cooperate in writing the
book, but he refused. The interview,
published in the New York Review of
Books, attracted little attention.4
The rest of the world had to wait
until 2011 when Debbie Nathan
published Sybil Exposed. Nathan
had gone through Wilbur’s archive
at a law college and interviewed
everyone still living who could have
been involved in the case, includ-
ing people in Sybil’s home town.
She shows that Wilbur, Mason and
Schreiber perpetuated a fraud, pro-
viding a 1958 letter by Mason con-
fessing to making up the multiples
for attention and excitement.
Wilbur, following in Freud’s foot-
steps, simply dismissed this as a
‘major defensive manoeuver’ to
derail the therapy.
And what a world of deception and
delusion Nathan revealed. The real
Sybil was Shirley Ardell Mason, born
in Dodge Centre, a small town in
Minnesota. Mason’s parents were
devout Seventh Day Adventists. An
only child, she had difficulties from
an early age and would retreat from
her parents’ fundamentalist exhorta-
tions by treating her doll collection
353

as if they were real. As a young adult,
she wanted to do medicine and
showed a talent for painting and
drawing. However, her studies were
dogged by a series of complaints,
including anorexia, stomach cramps,
sinusitis, headaches, tingling in the
limbs, spatial disorientation and
confusion. She first saw Wilbur, then
working as a neuropsychiatrist at
Omaha, for treatment in 1945. Early
in her career, Wilbur had been influ-
enced by a psychiatrist who was
interested in MPD and she was
regarded as a miracle worker with
cases of hysteria. She did so well that
Mason felt she had made a recovery
and was able to lead a normal life for
the next nine years.
Wilbur was now practising as a psy-
choanalyst in New York. Mason
started seeing her again, toppling
into a course of therapeutic calumny
that was to destroy any capacity she
had to lead a normal life. Wilbur,
determined to expose the hidden
memories of childhood abuse, would
pump her full of barbiturates, sup-
plemented by amphetamines, for
abreaction. She made Mason com-
pletely dependent on her. She took
over her life, seeing her day and
night, supporting her financially,
even having her stay at her home.
This feckless interference was disas-
trous for Mason. She became a help-
less drug addict, living from one
shot to the next, doing little more
than stagger from her bed to the ses-
sions with Wilbur. When she was
injected, the wild babblings that
emerged were as much the product
of drug-induced delirium as inven-
tive fantasies driven by the fear that
her therapist would abandon her.
Wilbur, who was obsessed by the
case, found journalist Freda Flora
Rheta Schreiber, who had an indif-
ferent career to date and was desper-
ate for a big hit. But once she took
on the assignment, Schreiber found
the story so full of holes she consid-
ered backing out. Wilbur prevailed
on her, coming up with more stories
to convince her of the veracity of the
case. Mason, too, would provide
exaggerated accounts until Schreiber
became convinced. In any event, the
354
version that became the book was
wildly sensational, and even Wilbur
agreed that it was much more of a
work of fiction. By then it didn’t
matter – the book was to consume
the lives of the three participants.
Despite being hidden under the
name of Sybil, Mason was easily
identified by those who knew her,
especially in her home town, and
this put an end to any chances she
had of resuming a normal life.
Wilbur feuded with her collabora-
tors and launched a campaign to
nominate herself for the Nobel Prize.
Of her devoted male protégés at the
University of Kentucky, half would
eventually be accused of having sex
with their patients. Her involvement
with Mason seemed to go well
beyond a need to use her as a spring-
board to fame. By the end of her life,
she and Mason virtually lived
together and were described as being
like a married couple. As would be
expected, there were many tensions
between the two and Wilbur eventu-
ally only left her a small amount in
her will.
Schreiber scarcely did any better.
Under pressure to produce another
best seller – she ran through the
money quickly – she ended up writ-
ing about a jailed sexual killer with
whom she was besotted, thereby
reprising the Wilbur–Mason axis
and went to her death in the thrall
of her passion for him.
Once it came out, Sybil became not
just a success but a cultural phenom-
enon. Where there had only been
less than a hundred cases described
in the literature in the previous hun-
dred years, usually with one or two
extra personalities, the number of
reported cases escalated dramati-
cally. If the lay and the medical press
was accepted, there were thousands
upon thousands of cases every-
where. In addition, these cases had
many more personalities, the bracket
creep (to quote Richard McNally)
went from tens to hundreds and
even thousands in some cases. MPD
turned up in all sorts of places; sym-
pathetic judges exonerated some
MPD cases from conviction on the
Australasian Psychiatry 20(4)
grounds that they could not control
their alters’ behaviour.
The MPD epidemic segued into a new
phenomenon: the false (or recov-
ered) memory syndrome (FMS). This
had emerged in response to a rising
awareness of childhood abuse and
feminist groups raising consciousness
about rape. It was driven by a simplis-
tic conception of Freudian theory
that all abuse would be repressed and
only emerge as physical or behav-
ioural symptoms. Once the repressed
memories were revealed – and the use
of checklists was common – the pur-
ported victims were instructed to
confront their abuser and cut all ties
with their family.
Before long, there was a conjunction
of egregious socially driven epidem-
ics: FMS, MPD and, most bizarre of
all, Satanic Ritual Abuse.5 This
morphed into a particular late-20th
century version, namely Alien
Abduction. Into this scenario came
John Mack, a Harvard psychiatrist
who wrote a book claiming that his
patients were justified in their claims
and nearly got himself expelled from
the university. It didn’t matter;
Harvard psychologist Richard
McNally examined the cases and
showed that they had all experienced
sleep paralysis,6 a condition described
for over 3000 years, its content mark-
edly influenced by cultural mores. It
was the story of Sybil all over, played
out in a thousand different ways. But
there were legal consequences and,
starting with the USA, a string of
false convictions based on scientifi-
cally dubious evidence, leading to
appalling travesties of justice.
Something had to give. For many,
the turning point occurred when for-
mer patients of abuse therapists,
such as Bennett Braun, began to sue
for damage and courts threw out
cases based on repressed memory
evidence. But historians will focus
on a series of articles in the respected
New York Review of Books in 1993 and
1994 by respected literary critic
Frederick Crews. Formerly a Freudian
devotee, Crews recanted his early
work. He wrote a two-part article,
‘The Revenge of the Repressed’,
on the egregious self-help manual,
 Book reviews
The Courage to Heal, and the account
by Charlotte Prozan Krause of a
patient who had recovered memories
of sexual abuse during 15 years of
analysis. Crews cut the books to shreds
in the most elegant manner and all
hell broke loose.7 He was more than
able to rebut the outraged letters from
the repressed memory lobby and revi-
sionist articles began to appear in the
journals. Among the authors were
August Piper, Harrison Pope and
Harold Merskey, who did an able job
of demounting the shibboleths.
Just when the FMS dust was starting
to settle, Roy Meadow, a paediatri-
cian in England who had written his
thesis on Munchausen’s Syndrome
by Proxy, was sent by the courts to
examine women suspected of killing
their children. Despite the fact that
he had no training in adult psychia-
try, the courts were happy to accept
his opinion on their culpability.
Once again, medicine was over-
extending its mandate and the result
was a legal and social catastrophe.
There is no doubting the findings of
Nathan’s research. By the end of the
book, no one can retain any doubt of
the extent of Wilbur’s mendacity and
appalling misconduct. But, when all
is said and done, what was it that
made Shirley so unwell and drove her
into the clutches of Wilbur?
View publication stats
Her parents, being devout Seventh
Day Adventists, did not let her eat
meat. Those periods of her life when
she was coping always occurred
after she had, for various reasons,
been given injections of Vitamin
B12. Shirley Mason, in short, had
pernicious anaemia, a condition
which can produce all the physical
and psychological symptoms she had.
But Mason was quite unaware of this
and, believing that it was Wilbur’s
therapy that had given her nine years
of health, sought her again in New
York. Mason lived out the rest of her
life as Wilbur’s semi-slave, cooking her
meals and nursing her on her death-
bed. If only she had sought other help.
Nathan’s work cannot be faulted,
although the feminist explanation
for Wilbur and Schreiber’s behaviour
is superficial and unconvincing. The
importance of this book cannot
be understated. The American
Psychological Association recom-
mends that Shirley Mason’s case
should no longer be cited as a ‘clas-
sic example’ of MPD.8
The implication of psychiatry’s role
in facilitating pseudo-epidemics that
arise in times of moral panic has not
been fully realised and nor have the
correct lessons been drawn. FMS,
MPD and SRA have come and gone;
who is to say what will be next? In
the words of Harold Merskey, analys-
ing the cascade of MPD cases:
When the intellectual faculties
are only slightly loosened, there
is no end to the developments
that will occur.
It could not be put any better.
References
1. Schreiber RF. Sybil. New York: Warner, 1973.
2. Harris B. Sybil. Science 2011; 334: 312.
3. Pendergrast M. Victims of memory: sex abuse accusa-
tions and shattered lives. Hineburg, VT: Upper Access
Books, 1996, p.153.
4. Spiegel H and Borch-Jacobsen M. Sybil - the making of
a disease: an interview with Dr. Herbert Spiegel. New
York, NY: New York Rev Books 1997; 44.
5 Rieber RW. Hypnosis, false memory and multiple
personality: a trinity of affinity. Hist Psychiatr 1999; 10:
3–11.
6. McNally RJ, Lasko NB, Clancy SA, et al. Psychophysi-
ological responding during script-driven imagery in
people reporting abduction by space aliens. Psychol Sci
2004; 15: 493-497.
7. Crews FC. The memory wars: Freud’s legacy in dispute.
New York, NY: New York Rev Books 1995.
8. Lawrence M. Review of bifurcation of the self: the his-
tory and theory of dissociation and its disorders. Am J
Clin Hypn 2010; 50: 273–283.
Robert M Kaplan
New South Wales, Australia
DOI: 10.1177/1039856212447969
355