Monday, November 28, 2011

The Center Cannot Hold: My Journey Through Madness by Elyn R. Saks


For anyone, Elyn Saks’s accomplishments would be impressive: multiple degrees from distinguished schools including Vanderbilt, Oxford University, and Yale Law School, plus a PhD in psychoanalysis; four books published and many articles; and important awards, including the MacArthur “genius grant.” Saks did all this while suffering from paranoid schizophrenia. Her story is nothing short of astonishing.

Saks’s descriptions of her delusions and crazy behavior are fascinating and sad. She alarms people by asking “Have you ever killed anyone?” or saying “You are the devil. You are trying to kill me. I am evil. I’ve killed you three times today. I can do it again.” At times she is floridly psychotic, even forcibly committed and put in restraints. (This leaves such an impression that she’s devoted a good part of her professional life to examining issues of consent with mental patients.)

As Saks explains it, the fundamental characteristic of schizophrenia is confusion between what’s real and what’s not, like the feeling when you wake up from a nightmare and aren’t sure yet if it’s over. As crazy as her delusions sound, it takes many years for Saks to accept that they are delusions, not the same things everyone else thinks but doesn’t say. She figures they just have better self-control than she does.

In fact, Saks is amazingly self-controlled, strong, and self-disciplined. She can maintain order and sanity in her life, and being immersed in the work she loves helps keep her sane. Ironically, though—and to me this is one of the most interesting themes in the book—her refusal to surrender keeps her sicker longer. Even when she can be persuaded to take antipsychotic drugs at all, for years she lowers the dose at the first opportunity, despite many, many experiences of getting better at higher doses. After much she work, she can finally accept that yes, she is schizophrenic, and yes, she needs meds.

Slowly, and with the help of talk therapy, Saks does find balance in her life, even meeting someone to love who loves her back. She’s married now, and has good friends too, and that made me want to stand up and cheer. She’s never going to be not schizophrenic, but she has a way to live with it now, and I’m so glad for her.

Monday, November 21, 2011

Sybil Exposed: The Extraordinary Story Behind the Famous Multiple Personality Case by Debbie Nathan (2011)



I was 10, in the summer of 1974, when I first read Sybil, utterly fascinated and horrified. (My mother told me to skip the abuse sections, but of course I didn’t.) I re-read it many times over in years to come, and anything else I could find about multiple-personality disorder. As nearly everyone did, I accepted uncritically Flora Rheta Schreiber’s account of Sybil’s illness and recovery under Dr. Cornelia Wilbur. The story made beautifully dramatic sense: A severely abused child who is also intelligent, sensitive, and creative could unconsciously save herself from being destroyed by trauma. She could split herself into separate personalities with separate memories and life experiences, each personality having a role in remembering certain events, expressing forbidden feelings, and otherwise protecting the core self. Through emotional confrontations with the repressed past, and with the help of a caring therapist, the patient could integrate into one whole, healthy person.

Except that’s not what happened, as journalist Debbie Nathan explains in Sybil Exposed. The exposé here is not really of Sybil herself (real name: Shirley Mason), but of  “Sybil” the created product. (There was even talk, after the book’s success, of a Sybil board game, T-shirt, dolls.) Nathan lays bare how, in their different ways, Wilbur, Schreiber, and Mason each needed and contributed to the MPD narrative. Both Wilbur and Schreiber had reputations to make. Wilbur had been wanting an MPD patient; it was a rare diagnosis, a fascinating one, and she felt she could help. Schreiber was tired of writing fluff pieces for women’s magazines and needed a juicy yet serious subject. Mason desperately wanted love and attention, and her diagnosis guaranteed lots of that. Especially when Wilbur started shooting her up with truth serum in hours-long sessions several times a week, demanding to know who had hurt Shirley.

Besides the Pentothal, other drugs Wilbur prescribed include Seconal, Demerol, Dexamyl, Miltown, Edrisal, and Thorazine. She also made house calls, sometimes to inject Pentothal, sometimes with a portable electroshock box:
Connie would carry her apparatus to Shirley’s apartment and climb in bed with her. She would clamp the paddles to Shirley’s temples, twirl the dials, press the buttons. Shirley’s body would arch and crash with convulsions . . . . Connie was relentless, administering Pentothal round the clock.
Of course, we know now that “truth serum” is more likely to produce rambling flights of fancy, but Wilbur was convinced that every word was gospel. When Mason finally wrote a long letter to her doctor saying she had been lying because she’d been distraught and didn’t even know how she came up with these terrible accusations about her mother, Wilbur called it a defensive maneuver. Wilbur cued her intelligent, suggestible, and needy young patient until she got what she wanted, and rewarded her with hugs, gifts, and money, sometimes paying her rent, getting her jobs, sometimes living with her, going on vacations with her, and other shocking boundary violations that would never be accepted today.

Nathan makes depressingly clear that poor Shirley Mason was made far worse by Wilbur’s treatment. She did need help. Since childhood, she’d been troubled, unhappy, and anxious. Artistically gifted, she was burdened by her parents’ extremely strict Seventh-Day Adventist beliefs, which forbade imaginative play, fictional stories, and art done in non-realistic colors. A lonely only child, she invented imaginary playmates; this too was a sin, but she couldn’t stop herself from escaping into pretend adventures with Vicky and Sam. Sometimes she became so involved she couldn’t remember what was real and what was fantasy. By the time she started seeing Wilbur regularly, Mason had had a lifetime of dreaming up other selves and imagining heroic adventures.

Schreiber never mentions this in the book. Nor does she mention that no one in Mason’s tiny hometown, where everyone knows everyone, could corroborate the savage abuse described in Sybil. Yes, Mattie (“Hattie” in the book) was a bit nervous and strange, and when depressed would ignore her daughter. But no one had a story about her wandering around the neighborhood defecating on people’s lawns. Not a single rumor about the teenage lesbian orgy in the woods Sybil supposedly witnessed. Dodge Center doesn’t even have woods. Although the TV movie claims that doctor’s records validate scars from sexual abuse, no such records were found.

Near the end of the book, we learn that Wilbur mentions in passing that one reason Mason was always so tired is that she had pernicious anemia. The symptoms? Exactly those Mason went into treatment for, including depression, anxiety, headaches, mood swings, hallucinations, and confusion about identity. If she’d just taken some vitamin B12, instead of having MPD iatrogenically produced through powerful, addictive drugs and a dangerously enmeshed psychiatrist, she could most likely have lived a much happier, healthier, more independent life. Schreiber and Wilbur made their careers on her. Mason died nearly penniless. If she’d been willing to sell her paintings as Sybil, she’d have had plenty to live on. But she refused.

As for why, besides inherent fascination, Sybil became a huge bestseller and introduced a new psychiatric diagnosis, Nathan says it’s about female identity after the sexual revolution and how the book was published during a time in history when women were experiencing fragmented selves, needing to integrate their roles as wife, mother, professional, and so on. Maybe; Mason wouldn't be the first woman to be wrongly diagnosed because a woman's symptoms must indicate hysteria. I don’t think you have to look that far, though. The idea that the one who is supposed to love you best is actually a frightening monster out to get you has its own inherent fascination—one that doesn’t need a push from historical currents. After all, I had no role confusion at age 10, and I was agog. It’s ironic that the story of monster disguised as helper winds up being true after all, although the monster is named Doctor, not Mother.