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In a review of Debbie Nathan’s book, Sybil Exposed, psychologist Carol Tavris1 noted a health condition in the famous patient that produced symptoms easily attributed to mental illness.  Sybil, whose real name was Shirley Mason, became the subject of a 1973 best-selling book about multiple personality disorder. Though many factors contributed to Mason’s troubles, thorough research by the author points to pernicious anemia as one potential cause of many of Mason’s symptoms.

Tavris points out that pernicious anemia can cause symptoms such as “fatigue, social withdrawal, anxiety, hallucinations, muscle pains, confusion about identity, distorted memories, and changes in personality.” Apparently, doctors missed the significance of the disease’s symptoms in their patient diagnosed with mental illness.

Treatment for anemia might not have provided a complete cure for Mason’s emotional and mental distress, but physicians would have had a more accurate psychological picture to work from.  Though Mason’s diagnosis and treatment took place over 30 years ago, the same diagnostic confusion occurs today.  According to a recent news article2 by Melinda Beck, up to 25% of today’s mental health issues are caused by medical disorders.

Though many primary care physicians will recommend diagnostic work before referring a patient to a psychiatrist, the number of possible physical disorders that wreak havoc on the mind can challenge doctors who are often pressed for time.  Considering the complexity of the human body and the astounding number of diagnoses and medications, an element of confusion should not come as a surprise.

During diagnosis, doctors and patients need to consider the following:

  • Past (and present) activities which could affect mental health include multiple concussions from sports, substance abuse, steroid usage, travel to other countries, and exposure to ticks (hunting, camping, and hiking).
  • Hallucinations, a symptom of schizophrenia, can also result from substance abuse, epilepsy, brain tumors, and narcolepsy.  The same conditions can produce psychosis, as can steroids, stroke, and venereal disease.
  • Depression can accompany Lyme disease, lupus, underactive thyroid, sleep disorders, low levels of folate or vitamin B-12 or D, hormonal changes, and the use of many prescription medications. (Pernicious anemia, referred to above, causes “an inability to process vitamin B-12.”)

An incorrect psychiatric diagnosis can lead to years of ineffective treatment if the problem is actually a medical condition.  Beck states that “more than 100 medical disorders can masquerade as psychological conditions or contribute to them.”

As a patient or as an advocate for a family member who faces symptoms of depression or schizophrenia, your insistence on a thorough medical review and discussion of past activities could prove worthwhile.  Your request for in-depth testing and examination might lead to a better treatment plan than you or your doctor first considered.  I think Shirley Mason would have agreed.

[The following site http://psychoticdisorders.wordpress.com/bmj-best-practice-assessment-of-psychosis/ carries a thorough list of potential causes of psychosis. The site originated after the October 2009 airing of the PBS program “MINDS ON THE EDGE: Facing Mental Illness.”³]

Sources:
1http://online.wsj.com/article/SB10001424052970204524604576609350972680560.html

2http://online.wsj.com/article/SB10001424053111904480904576496271983911668.html

³ http://www.mindsontheedge.org/about/program/

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