It's worth reviewing an old story because wrong is forever.

Suzy Bass, a math teacher at a private high school, had breast cancer:

Because Bass had recently moved to Knoxville and was single, two Webb staffers--Julieanne Pope, 43, and Terri Ward, 51--became her part-time caregivers. "I left my cell phone on my nightstand every night in case she needed anything," says Ward, the dean of faculty.... When Bass was too sick to teach, they'd cover her classes. And they kept a steady stream of casseroles and smoothies going to her condo. "We'd visit and she'd be shaking, pale and so sick," says Pope, Webb's technology coordinator. At school Bass would cover her head--bald from chemotherapy--with a knit cap, and limp from the tumor in her foot.

Except she didn't: she made it all up.

Listening to Bass detail the outrageous lengths she went to over the years to fake her symptoms is chilling.... Bass learned to draw convincing-looking radiation dots on her neck with a permanent marker... 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.

She did it for years, at multiple schools, with everyone, including her parents.

Why?  Not for the money-- she didn't ask for any disability pay/leave.  So?

II.

I wish this was a joke: the article first suggests it's bipolar disorder.

Despite all that effort and time Bass spent learning how to appear sick, she claims that every time she feigned having cancer, she truly believed she was ill. "In my mind, I didn't lie to anybody," she says.

Could someone honestly believe she is dying while actively lying about it? That's part of the puzzle Bass's counseling team is attempting to piece together. "It is certainly possible that given her diagnosis of bipolar disorder, Suzy could have truly believed she had cancer," says Marvin Kalachman [who is treating her.]

Note the construction of his explanation: the "known" quantity is "she has bipolar" and because of that, it is assumed she could believe her lies.  But in reality, we don't know she has bipolar and we certainly don't know that she actually believes her lies.  We only know that she lied.  But he's accepted her story and given her an alibi.

This is the real danger of the overdiagnosis of mental illness: it prevents any further analysis  of the symptoms.  The debate from this point on will be about whether she has bipolar, not whether her symptoms-- in this case believing her lies-- are real.

I don't have to wait long for an example, here's the next paragraph:

"It's possible for a bipolar patient to experience delusions lasting days or weeks during an episode, Dr. McInnis [professor of psychiatry at the University of Michigan and a leading expert on bipolar disorder] explains. In Bass's case, however, she went to great lengths to fake symptoms--not a hallmark of bipolar delusions, he notes.

He is correcting the diagnosis: bipolar delusions don't look like this.  "Delusions," as in "she believes them."

III.

Fortunately, the article abandons bipolar as an explanation (though not as her diagnosis), and instead turns to something that is even more wrong:

Marc Feldman, M.D., a world-renowned psychiatrist, has treated more than 100 women who have faked serious illness... he believes he has her diagnosis: Munchausen syndrome, a psychological disorder in which someone feigns or self-induces illness to get attention and sympathy...these people know that they are lying, but typically don't know why they're compelled to do so. 

You'll be tempted to disagree with me: "this sounds exactly like what she has."

And, he says, a diagnosis of bipolar disorder does not rule out Munchausen syndrome. Currently Bass's counselors have not diagnosed her with Munchausen syndrome and say they are primarily focused on treating her bipolar disorder

The problem with the article's and the doctors' assessments is that they are being fooled by the content of her lies and not the form.  Because the focus of the article is cancer, because she's faking a medical illness, the explanation must be some other medical (psychiatric) illness.

What everyone does agree on is that this is a woman who will need help for a long, long time.

"I feel sorry that she's sick, but I don't want her to do it to anyone else."

"I just wish we'd found the right doctor for her 15 years ago."

Bass is currently unemployed, a medical recommendation.  "... I'm sick and I'm working on it every day," she says.

If she had lied for monetary gain, no one would assume it's a psychiatric condition, but because the gain is non-financial, she must be ill.  That's because in America, only crazy people do things for no money.

IV.

The content of her lies suggests Munchausen's; if this was accurate, you'd worry about this:

But if Bass herself can't promise that one of these days she won't suddenly start faking breast cancer, melanoma or some other disease, how do I know she won't? How does anyone?

Because she "fakes medical illness for sympathy" the reflex is to focus on the words "medical illness," but where you should focus is on "for sympathy."  Munchausen's doesn't predict what was in retrospect obvious to her students-- she lied about everything.

List of things said by Suzy Bass most of us believed...

Had Breast Cancer...Lie
Worked for NASA...Lie
Played basketball for Florida State...Lie
Got hit by a tornado...twice....Lie
Good friends with Archie Manning...Lie
Had dinner with Vince Young, Mike Vick, and T.O....Lie
Wrote 3 textbooks....Lie
Name is Suzy Bass...Possibly a lie

Oddly, the Glamour article misses a lie that was right in front of them:

In the fall of 2005, the school nominated Bass for the prestigious Disney Teacher of the Year Award. "[Bass] may be the finest teacher/inspiration I have ever been associated with in 32 years of education," Jim Gottwald, the Paulding County principal told the Athens State University newsletter.

The actual quote is "Dr. Bass."

Meanwhile, it lists some lies Bass herself revealed, but doesn't recognize their importance:

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! "What I did was wrong, and I'm willing to stand up and admit that," Bass says, "but it doesn't change that my intent was never to hurt anyone. Never. I'm not that kind of person."

 
The point here is that the faking of cancer is completely incidental to her life's narrative, what is important is the faking.  She faked cancer because, simply, it worked very well.  If she could have gotten sympathy and esteem and identity from faking being a basketball pro, then the article would be called "She Said She Played For The Celtics-- But She Lied!" and it would have appeared in Sports Illustrated.

V.

"So you think everyone is a narcissist?"  No, but when you see elements of it, you can make some predictions.

Before everyone goes bananas, I am not judging Suzy Bass-- I'm not saying she is a good person or bad person.  "Narcissist" isn't synonymous with "jerk"-- I'm using all of these terms to describe what I see, and make predictions about the future in order to help her and others like her.

The worst thing that can happen to a narcissist is a narcissistic injury-- in which their desired, constructed identity is revealed to be invented.  In her case, it was literally fake, not just psychologically fake. 

What happens in narcissistic injuries?  Rage and violence.  But, as a woman with limited targets for rage, it gets turned inwards: depression, suicide.

In 1995, when she was found not to have Hodgkin's disease she went into a psych hospital for several weeks.  And, eventually, she had to move-- new location, new relationship, maybe even a new "identity"-- but for sure you don't stay put, exposed to everyone.

At her second job in Dallas, GA, where she was found to be faking stage II ductal breast cancer, she was able to get away and find refuge at her parents house-- where her parents still believed she had cancer.  Identity intact.

She eventually went to Knoxville, where she got the math teacher job and ultimately was exposed again, this time also to her parents.  Now no solace anywhere.  

Once she left Knoxville, Bass admitted herself into an Alabama psychiatric ward and she told doctors she no longer wanted to live.

The Munchausen is wrong, not because it's formally wrong but because it is incomplete, in the same way as saying "it's a thirst disorder" when it's diabetes.   If people are watching for "medical lies" as a clue to her condition they will inevitably miss the next set of non-medical lies and, importantly, the suicide attempt that is likely to result if those are exposed.

The problem isn't that this is a woman faking medical illnesses.  The problem is that this is a  ghost, and it's faking an identity.  There are a lot of Suzy Basses out there.

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http://twitter.com/thelastpsych