Sybil and Dissociative Disorder

Introduction

The movie Sybil, starring Joanne Woodward and Sally Field, was released in 1976 as a two-night television movie event. The movie is loosely based on the biography of Shirley Ardell Mason and her intensive psychotherapy work with Dr. Cornelia Wilbur. The story depicts the story of a young woman, so brutally traumatized by abuse in her youth that her mind dissociates into sixteen distinct personalities. Dr. Cornelia Wilbur is the psychologist who works through the seemingly difficult problems of 'Sybil' to discover the multiple personalities lurking beneath the surface. With Dr. Wilbur's help, Sybil is able to reconnect her many alternate personalities (Sybil, 2006). In the movie, this is emphasized with a moment in which Sybil embraces herself and whispers, "I Love You".

While the movie Sybil was based on a the biography by Flora Rheta Schreiber, describing the care of a Kentucky substitute art teacher by the name of Shirley Ardell Mason, it is a highly emotionally charged movie and uses graphic scenes to grasp the watcher. It is a fictionalized narrative account where the screenwriter and director took great liberties with the original written work. Furthermore, there is much to be said about the 'debunking' of Sybil over the years. In 1998, Robert Reiber, a noted psychologist, reviewed the original audio tapes of Dr. Wilbur and 'Sybil' and believed that much of the multiple personality disorder presented was directly influenced by suggestions from Dr. Wilbur during her sessions (Swales, 1998).

Despite the exaggerations and possible malfeasance on the part of the psychologist, the movie is still a standard depiction of dissociative disorder in adults. Most Americans have seen the movie at one time and 'Sybil' has become part of our lexicon used to reference someone who acts as if they have multiple personalities. This movie and the associated images have become the standard by which the average American views dissociative disorder and therefore must be examined to determine whether the portrayal was an accurate interpretation of post-traumatic dissociation.

This paper will also provide a detailed review of the journal article, Childhood Trauma and Perceived Parental Dysfunction in the Etiology of Dissociative Symptoms in Psychiatric Patients as researched by Draijer and Langeland (1999). This journal article is a research paper on the etiology of the dissociative disorder with specific emphasis on the relation to trauma. In their research, they found that while trauma-related dissociation is common, there is also neglect-related dissociation in adults. They assert that this indicates a need for change in the treatment of object relations and attachments when psychiatrists treat adults with dissociative disorder.

Sybil Dorsett is a young woman with serious issues in the movie "Sybil". It is quite clear that the focus of the psychological aspect of this film is on the title character. This becomes overtly evident after a scene in which the young woman, played by Sally Field, is found by her psychiatrist, played by Joanne Woodward, huddled beneath a piano with the apparent mannerisms and behaviors of a young child. The psychiatrist develops a theory that Sybil is suffering from multiple personality disorder and, though way over her head, decides to help treat her with the eventual goal of integration of personalities.

Sybil is clearly a disturbed individual displaying five distinct personalities throughout most of the film. These personalities include a mothering and suicidal young woman by the name of Mary, an ambitious and outgoing woman named Vicky, an exceptionally combative and self-assertive girl named Peggy Lou, an athletic young boy named Mike and an remarkably young and traumatized Sybil Ann. Each personality deals with issues that the main personality (Sybil) cannot handle or couldn't handle in the past.

According to the DSM-IV, Dissociative Identity Disorder can be diagnosed with four features. These are:

• The patient demonstrates at least two distinct personality states or identities. Each of these identities has its own, relatively lasting pattern of sensing, thinking about and relating to self and the environment.
• At least two of these personalities repeatedly assume control of the patient's behavior
• Common forgetfulness cannot explain the patient's extensive inability to remember important personal information.
• This behavior is not directly caused by substance abuse or by any general medical condition. (Dissociative Identity Disorder, 2003)

The differential diagnosis for dissociative identity disorder includes ruling out post-traumatic stress disorder, substance abuse or alcohol blackouts, or complex partial seizures (Dissociative Identity Disorder, 2003).

In the case of Sybil, she clearly demonstrates at least two (and up to sixteen by the end of the film) distinct identities. At least five of these identities regularly vie for control of the persona and manifest with significant features unique to the personality being displayed. This includes the thumb sucking demonstrated by the young Sybil Ann. When these various personalities exhibit themselves, they take complete control of the patient, Sybil, and control her reactions in relation to their own unique personalities. This demonstrates the first two qualifications for the DSM-IV diagnostic criteria.

Sybil clearly has lost memories that do not correspond to the typical forgetfulness experienced by most people. She regularly has missing blocks of time and, in one case, claims to have woken up one morning and realized she had missed the entire sixth grade. This is clearly not a normal absent mind but rather one with significant time lapses and blackout periods. While it is not overtly stated in the movie, it is clear that substance abuse is not an issue with Sybil. The periods of shifting personalities seem to correlate to triggers of color, music or sound and are in no way related to alcohol or drug intake.

The DSM-IV links associated features with dissociative identity disorder as trauma, depression, mood swings, suicidal tendencies, sleep disorders, panic attacks, phobias and alcohol and drug abuse (Dissociative Identity Disorder, 2003). Sybil presents with depression and mood swings in the film and seeks psychiatric counsel due to the concerns this has raised in her life. She has a history of violent trauma inflicted by a cruel mother which is vividly depicted in the film. While many of the other features are not overtly displayed within the film, the clear picture is presented of a woman at wits end and looking for help in a desperate situation.

The etiology of dissociative disorder is often attributed to a patient's experience of extreme mistreatment, often at the hands of a nurturer, and a complete lack of nurturing experience from the parent or caregiver (Dissociative Identity Disorder, 2005). Sybil's recurrent flashbacks to her childhood clearly demonstrate this etiology in her case. She was repeatedly abused in cruel and tortuous ways by her mother. The movie portrays a mother who is nearly maniacal in her desire to find new ways to harm her child. In one situation, Sybil is hung from a rope while her mom delivers an enema to the poor girl. The lone moments with her grandmother, where Sybil does feel cared for and nurtured, are seemingly few and plainly not enough to overcome the damage of her mother's abuse.

The ability of a person to dissociate is considered key in a person's ability to develop the disorder. A person's dissociative capacity is their ability to separate their own memories or perceptions (and obviously their actual identity) from their own awareness (Dissociative Identity Disorder, 2005). This is most common in children due the lack of unified identity in early childhood. In normal childhood development, various sources combine and have input on the child's identity which slowly defines into a unified sense of self. In children with severe and constant abuse, the parts that would normally blend remain disconnected. It is likely a protective behavior to keep different aspects of personality into different compartments in order to deal with the ever-changing situation around them. This allows them to retreat into these compartments and view their 'self' as separate individuals. In this way, they can feel empathy for the 'other person' being injured without having to personalize the experience. It is often the case that dissociative children develop new and unique identities at each developmental phase (Dissociative Identity Disorder, 2005). This is evidenced in the movie by the varying ages of development of Sybil's multiple identities. While Sally Ann is very young, likely in her preschool age, Peggy strength and seeming sense of self is clearly evidence of a higher development level. The forming of alternate gender identities is thought to be related to the sex roles imparted upon children (Dissociative Identity Disorder, 2005). In Sybil's case, Mike was likely created as an athletic and robust male to give the identity strength and the male role of dominance in society, particularly in the time period in which Sybil was raised.

Another proposed etiology for dissociative identity disorder has its basis in neurobiology and the Orbitalfrontal cortex. The OFC function is to control distracting information that deters from goal seeking behavior. The OFC continually monitors the internal and external environment and is responsible for attachment processes. The primary neurotransmitters of the OFC are norepinephrine and dopamine. These chemicals are responsible for attention, movement, and emotion. In combination with other brain structures, the OFC responds to emotionally significant stimuli and enjoyment of social interactions. The myelination of the OFC occurs between ten and twelve months of age in conjunction with attachment behavior. It is completely myelinated by age twelve years with significant formation between ages six to nine. It is hypothesized that the OFC's function of protection from distraction that would interfere with goal directed behavior lets the brain separate the input from outside stimuli that would challenge the beliefs or basic attachments of the child (Forrest, 2001). In other words, a child who has formed attachment to a parent or caregiver must protect themselves from the negative input of that person's abuse on them. If they acknowledge the severity of the abuse, then this is inconsistent with the attachments that the OFC has helped form. This would undo or severely restrict this attachment and so the OFC chooses to ignore it. However, the input is still being received and must be processed in some way. To make this all work, the brain segments the information into a state of identity without the formed attachments. In Sybil's case, the abuse was ongoing, severe, and at the hands of a caregiver. It is quite likely that if this neurobiological etiology is accurate, Sybil's mind would have to segment to avoid the incongruous input of abuse in relation to attachment. This would also explain the significant number of personalities since the abuse continued throughout the myelination periods of ages six to nine years. Each assault was going against the attachment and therefore must be segmented to a created or new identity.

Research done by Darijer and Langeland (1999) demonstrated that neglect in childhood is as traumatizing, in relation to dissociation, as trauma in early childhood. The study consisted of 160 willing participants were assessed for psychosis and schizophrenia in relation to dissociation. Dissociation was measured by the Dissociative Experiences Scale. All participants were adult patients admitted to a general psychiatric hospital over an eighteen month period. They found that severity of dissociative symptoms was related to the reports of sexual and physical abuse. The most significant association was found to be between severe sexual abuse and dissociation. The combination of physical and sexual abuse produced the most substantial number of dissociative incidents. However, extremely high scores of dissociation were reported in patients who reported having mothers that were heavy drinkers and therefore dysfunctional parents. They confirmed previous studies indicating that victimization, in the form of physical or sexual abuse, is the strongest predictor of dissociative behavior in adult life. In conjunction, they discovered that maternal dysfunction was the third highest predictor of dissociation. This may due to cofactors of abuse and neglect or may be an independent predictor of DID. This may indicate that the lack of nurturing received from maternal units contributes to DID as well as actual abuse. The researchers conclude that this subset of etiology could lead to new cooperative treatments that combine attachment therapy along with post-traumatic therapy (Draijer & Langeland, 1999).

Draijer and Langeland's research has little relation to the dissociative behavior exhibited by Sybil (1999). While her mother was obviously physically abusive in the movie, her neglect was not demonstrated. It may be possible that neglect also affected Sybil's development of DID but it was not portrayed in the movie. It is likely that this relationship between maternal neglect and dissociation lies in the combination of maternal neglect in conjunction with abuse.

Whether intentional or not, the movie Sybil presented distinct messages about multiple personality disorder (dissociative identity disorder) that continue to this day. In general, the movie does do an excellent job of portraying the horrors that many dissociative patients have endured in their childhood. The graphic scenes are difficult to watch, but are necessary to fully portray the viciousness of the abuse that occurred and places it in relation to the reasons behind the development of DID. The constant psychotherapy that Sybil must undergo is directly in line with the recommended treatment for people with dissociation. However, the ability to integrate the identities into a congruous whole is shown over a relatively short period of time. The integration process often is extensive and rarely complete. Furthermore, the movie clearly leaves off the ability of poor psychotherapy (particularly under hypnosis) to elicit memories and personalities from a non-dissociative but highly suggestible person. In relation to the time frame of the movie and the lack of review of Dr. Wilbur's tapes by other psychiatrists, this is understandable. Overall, I believe the movie gives a positive view of a woman struggling with her past as well as her illness and fighting her way back to mental health.

Conclusion

The movie Sybil was groundbreaking for its 1976 debut; it established a person to identify with a confusing and troubling mental disorder. The portrayal of the disorder was accurate inasmuch the script related the author's narrative of the book. The multigenerational degradation of the original story of Shirley Mason nearly guarantees that the movie version of Sybil is exceptionally more dynamic and exploitive than the Shirley's own experience. The movie did a fair job in presenting the nearly fluid movement from one personality to another and the characteristic behavior associated with each identity. It was clear while watching the movie which personality was presenting and what distinct characteristics they possessed. The overall etiology of dissociative identity disorder clearly indicates that if Sybil's recalled memories are correct, she would be an ideal candidate for the development of the disease. She suffered from abuse at an early age, lasting longer than one year and lack of nurturing from her mother. All of these are distinct etiological features of the disorder. The movie portrayed the signs and symptoms of the disorder clearly and followed the DSM-IV guidelines well. However, the information that has gained light since the broadcast, and particularly since the deaths of all involved, have cast great doubt on the validity of Shirley's diagnosis. Sybil is a great movie to understand what multiple personality disorder looks like, but lacks in many clear details and is definitely not a completely factual account of Shirley Mason's life.

References

(2003, July 17). Dissociative Identity Disorder. Retrieved November 15, 2006, from Psychnet-UK Web site: http://www.psychnet-uk.com/dsm_iv/dissociative_identity_disorder.htm

(2005, Nov 1). Dissociative Identity Disorder. Retrieved November 14, 2006, from Merck Health Web site: http://www.merck.com/mmpe/sec15/ch197/ch197e.html

(2006). Sybil. Retrieved November 19, 2006, from Internet Movie Database Web site: http://www.imdb.com/title/tt0075296/maindetails

Babbin, J. (Producer), & Petrie, D. (Director). (1976). Sybil [Motion picture]. United States: Lorimar Productions in conjunction with National Broadcasting Company (NBC).

Draijer, N., & Langeland, W. (1999). Childhood trauma and perceived parental dysfunction in the etiology of dissociative symptoms in psychiatric inpatients. Am J Psychiatry. 156:3, 379-385.

Forrest, K.A. (2001).Toward an etiology of dissociative identity disorder: a neurodevelopmental approach. Consciousness and Cognition. 10, 259-293.

Swales, P. (1998, Aug 16). Was 'Sybil' really a multiple personality? Retrieved November 17, 2006, from Astraea's Web Web site: http://www.astraeasweb.net/plural/sybilbogus.html