Fake Patients in Need of Real Help

by Robert Fulford
The dark fascination of Munchausen Syndrome grows out of its peculiar status as both
a warped form of folk narrative and an insoluble medical mystery. We've all heard about
lonely people who flagrantly waste health care resources by showing up at hospitals with
fictitious symptoms, at first puzzling and then enraging the doctors. We know that some of
them exhibit a truly vicious tendency, Munchausen Syndrome by proxy, which means
attracting medical attention by making their children appear sick or even causing them to be
become sick.
We assume this happens because the pseudo-patients want attention and yearn for
control over their lives. They have discovered the power of skilful storytelling and the force
of a clever lie.
But that doesn't begin to explain the most amazing aspect of Munchausen, the
spectacular mental energy and long-range determination demonstrated by many in the Munch
Bunch (the nickname Britain gives its national registry of suspected Munchausen patients).
Consider their extraordinary patience, their hidden creativity, the endless hours studying
symptoms.
Some years ago Wendy Scott, a working-class woman from Scotland, became the
Munchausen queen of the world. She managed over 12 years to get herself hospitalized 800
times in several countries. Her abdomen carried dozens of scars, evidence of the occasions
when she persuaded surgeons to operate. The lines connecting her imagination and ego were
snarled, but not snarled enough to hamper her ingenuity.
What finally broke her pattern was acquiring a kitten. She realized that if she were
hospitalized again, no one would look after it.
Apparently that brought her to her senses, and soon she was running a Munchausen
support group. Eventually she developed real colon cancer, but doctors viewed her with such
suspicion that she didn't get treated until it was too late.
People like her, loony as they may be, are the true contrarians of this era. While many
of us work desperately hard to stay out of hospital, the Munch Bunch lie to get admitted.
Surgery they consider a major bonus.
Karl Friedrich Hieronymus Munchhausen (1720-1797) was a German baron who
served with the Russian army and spent his retirement lying about his exploits. He entered
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medical textbooks in 1951, when Richard Asher, a British doctor, gave his name (with
spelling changed) to medical trickery.
In The Lancet, Asher described a syndrome most doctors had seen: "Like the famous
Baron von Munchausen, the persons affected have always travelled widely; and their
stories ... are both dramatic and untruthful." Ever since, medicine has been trying to deal with
Munchausen. But apparently it continues to spread.
Marc D. Feldman, an Alabama psychiatrist who has made it his specialty, puts together
in Playing Sick? (Routledge) a collection of stories about Munchausen and related conditions,
which he groups under the term "disease forgery." He argues that patients exhibiting
Munchausen behaviour deserve the help rather than the disdain of psychiatrists. These are
patients and pretenders. He's had some clinical success, but he acknowledges that it's hard to
treat people for a condition they don't think they have.
By the end of Playing Sick? we know Munchausen is even more complicated than we
imagined. One patient tells Feldman, "The first time I saw a therapist, I don't know why but I
began to act out having multiple personality disorder." Over time she developed 12 different
personalities and couldn't figure out how to bring her story under control. Another patient
reported that when she actually became sick it was hard to remember that she wasn't just
working another scam.
Feldman, introducing us to on-line Munchausen, describes a young man who signed
on to a Usenet group for migraine sufferers. He described at great length his long struggle
with migraines, also his haemophilia and his seizure disorder, also his drunken stepfather and
his blind mother. Still, he was getting good marks in fourth year of medical school and paying
for his medication by working nights as a drummer in bar. Finding this all a bit much, other
members of the group began gently questioning him. When they asked what medical school
he was attending, he denounced them for unkindness -- and vanished.
That's what usually happens when a Munchausen patient is exposed.
And that's one of two reasons why (as Feldman notes) this subject remains little
understood. The other reason is that there's no lobby promoting research, as there is for AIDS,
breast cancer and many other conditions.
Patients are in no position to demand help, since their main interest is in denying that
they could possibly have any such illness.