Thursday, October 16, 2008

It's Not Bipolar

Here is a story sure to delight all those who read it (1). It's about a teacher named Suzy Bass. The beginning of the article summarizes what you'll read about, "This popular teacher told students and friends she was going to die. What no one knew: She'd feigned chemo nausea, shaved her own head and was never actually sick at all." This is called Munchausen syndrome (also known as Factitious Disorder in the DSM-IV).

Here are the following diagnostic criteria:

A) The intentional production of physical or psychological signs or symptoms

B) The motivation for the behavior is to assume the sick role

C) External incentive for behavior (e.g., economic gain) are absent

There are three subtypes: predominantly psychological signs and symptoms; predominantly physical signs and symptoms; and of course combined psychological and physical signs and symptoms.

The reason I chose to write this post is not to highlight a really cool disorder, but rather, to show how bad mental health treatment really is.

Ms. Bass' story begins when she "told her parents that she'd been having breathing problems and persistent colds. Then one day she broke the news: She'd been diagnosed with non-Hodgkins lymphoma, an often deadly form of blood cancer. 'I went with her to chemo on more than one occasion,' says her father, who recalls sitting in the waiting room and watching Bass sign in and walk back to the treatment area."

Eventually, she was exposed...again, "Staffers from a school in Dallas, Georgia--where Bass once taught--had contacted him (the principal of her most recent employer) to expose what they claimed was Bass's latest deception. An employee googled her former colleague to see what had become of her; she found the Knoxville News Sentinel article about the prom fund-raiser (which was in her honor). Bass, the callers warned Hutchinson, had pretended to be a cancer patient during her tenure at their school--and at yet another one in Alabama."

People with this disorder not only go to great lengths to produce signs and symptoms, but they also go to great lengths to conceal the their deception, especially when exposed as frauds, "A week after getting exposed, Bass pulled down her Facebook account, changed her phone number and disappeared."

It is also common to move from location to another, thus allowing them to continue with their charade, "She was at Paulding County for about a year and a half when the Basses got a call that their daughter had passed out at school. A few weeks later, Bass called with a worrisome update: A mammogram had detected a tumor. Soon after, she announced that it was stage II ductal carcinoma."

Her parents even commented that, "she looked sick and appeared to have radiation burns under her arms." Once she was exposed again, the cycle repeated itself, "This time she told her parents that enemies at Tanner High had tried to sabotage her career and that she indeed had breast cancer, it had just gone into remission. A little more than a year later, Bass left for Knoxville."

Bass also exhibited another core characteristic of Munchausen syndrome called pseudologia fantastica (another cool name). This is the fancy term for pathological lying, people who lie for no apparent or rational reason, "Bass acknowledges that there were other lies she'd told friends and colleagues. She once pretended she had a fiancé who died on 9/11, that she'd played basketball at Florida State University and that she'd starred in the North American tour of Mamma Mia!"

Here is the part where it gets disturbing, "Once she left Knoxville, Bass admitted herself into an Alabama psychiatric ward and she told doctors she no longer wanted to live. There, she was diagnosed with bipolar, anxiety and obsessive-compulsive disorders." I know what you're thinking, she didn't tell the doctors about faking cancer. Actually, she did, "currently Bass's counselors have not diagnosed her with Munchausen syndrome and say they are primarily focused on treating her bipolar disorder, but add that her diagnostic review is not yet complete." They know her history, yet they truly believe that she has three serious psychiatric disorders. And they are treating her when the diagnostic review is not complete.

Here is the length this woman went to fake cancer, "she'd shaved her head...she was telling people the end was near..." Moreoever, "Bass had forged a doctor's name on a certificate of disability that she gave Paulding's associate superintendent" and "after spending hours researching cancer on the Internet, Bass learned to draw convincing-looking radiation dots on her neck with a permanent marker (doctors tattoo patients so they know where to line up the radiation machine every day). She would also roll up a bath towel, stretch it between her hands and rub it back and forth against her neck as fast as she could to give herself 'radiation burns.' She shaved her own head with a razor and made herself throw up from chemotherapy 'nausea' in school bathrooms. And all those times her father accompanied her to chemo treatments? After walking through the waiting room door, Bass would meet up with an actual cancer patient--a friend she met at church--and keep her company during her chemotherapy." Her doctors supposedly know all of this, yet they are concerned with treating her bipolar disorder.

Here is what her primary care provider said, "It is certainly possible that given her diagnosis of bipolar disorder, Suzy could have truly believed she had cancer, says Marvin Kalachman, a licensed physician assistant who has treated patients for more than 30 years. He prescribes and monitors Bass's medication under the supervision of a medical doctor." WTF!? Okay I have to break that down part by part.

"given her diagnosis of bipolar disorder." He is assuming that the diagnosis is legit. Cancer can actually be tested for, bipolar disorder can't. Yet, he's certain about her diagnosis. Refer again to the diagnostic criteria for Factitious disorder, "The intentional production of physical or psychological signs or symptoms." You see, psychological signs and symptoms are faked too. Would it not cross you're mind to consider that she might be faking bipolar disorder. No where in this entire article is it mentioned that she experiences manic symptoms. The woman who wrote this article (someone who actually has cancer) said this, "Speaking with a thick Southern accent, she sounded calm and polite, even funny. I could see why so many people had adored her. When she told me about a recent session with her mental health counselor, she joked, 'They charge $90 for 20 minutes and I'm the crazy one?'" Clearly this chick is not depressed either.

"...says Marvin Kalachman, a licensed physician assistant who has treated patients for more than 30 years." Her primary is not even a doctor. Who cares if he's treated patients for 30 years. If they're not psychiatric patients, that means nothing.

"He prescribes and monitors Bass's medication under the supervision of a medical doctor." Okay, unless that medical doctor is a psychiatrist, these two have no business treating this woman. None. Nada. Zip.

However, not all hope is lost. There are some people who are actually trained in this stuff, "Marc Feldman, M.D., a world-renowned psychiatrist, has treated more than 100 women who have faked serious illness. Though he has never met Bass, he believes he has her diagnosis: Munchausen syndrome, a psychological disorder in which someone feigns or self-induces illness to get attention and sympathy." This is someone who should be treating Ms. Bass, not Tweedledee and Tweedledum.

At present, "Bass is currently unemployed, a medical recommendation. 'My counselors don't even want me saying Welcome to Wal-Mart. Here's your buggy,'  she says with a laugh. Bass hopes, though, that her determination will propel her through treatment to a more healthy, happy life. 'I'm working to get past the guilt I feel and move past the mistakes I've made. I'm sick and I'm working on it every day,' she says. 'And I can assure you of one thing. If I can at all control this, it will never happen again." Too late, it already has.


Anonymous said...

When all you have is a hammer, everything looks like a nail. And the mental health system is loaded with hammers that need nails to bang on.

Anonymous said...

"They know her history, yet they truly believe that she has three serious psychiatric disorders. And they are treating her when the diagnostic review is not complete."

Well to be fair, she could be bipolar. There's nothing to stop you really being bipolar and also making up having cancer. I admit it seems rather dubious, but we haven't met this patient. You can't give a diagnosis without meeting someone.

Anonymous said...

Well, my mother is bipolar and it seems during the maniac phase she fakes many illnesses and sympthoms. I can truly understand that the priority is treating BPD!!


Anonymous said...

Actually one of the first priorities in treating Munchausen's is evaluating the patient for underlying psychiatric illness which might be fueling the behavior.

Most patients with Munchausen's do have underlying oar comorbid disorders - typically severe personality disorders - but also mood and anxiety disorders are quite prevalent. Obviously the Munchausen's should make the psychiatrist circumspect in evaluating the patient's own report of psychiatric symptoms and history, but I would imagine that the psychiatrists in question have taken that into account.

Munchausen's and any associated personality disorder almost certainly require psychotherapy, but psychotherapy is going to be far more effective if any underlying bipolar illness is under control.

Janet said...

Kalachman has mainly treated psych patients, but not properly. He's more of the treat 'em and street 'em without even caring kind.