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16 March 2015

Munchausen syndrome: why people fake illness

Cybershrink investigates why some people invent elaborate symptoms and demand treatment for imaginary ills.

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Though largely unspoken, there are certain accepted rules about being sick. If you feel unwell, you are expected to consult an appropriate doctor or other health professional for advice.  You are supposed to be frank and honest and tell them what’s troubling you and follow their advice and treatment.

Breaking the rules

You are also expected to do your best to get better. In return, you’re allowed to assume the rights and privileges of being sick: you may be allowed time off work, school, or household chores; other people are expected to be pleasant and sympathetic towards you; and help you if needed. Generally, these arrangements work pretty well.

But there is a condition where people flagrantly break these rules. They carefully lie to their doctor, elaborately faking an illness they really don’t have, while seeking treatment they don’t need. They try to prolong the process, but if they find they’ve been spotted, they usually beat a hasty retreat, and try again elsewhere.

This behaviour has been around for a long time, but wasn’t formally named until a British doctor, Richard Asher, described this in a brilliant article, and called it the Munchausen syndrome, after the fictional German Baron, famous for telling elaborate untrue stories.

Asher’s children added to his fame.  His eldest son, Peter, formed a successful pop duo Peter & Gordon, and his daughter Jane, still working as a well known British actress who rose to fame when her boyfriend, Paul McCartney, lived with the family for a time in their home above Richard’s consulting rooms in Wimpole Street. Richard also alerted us to psychiatric conditions arising from thyroid gland malfunction, and wrote a highly influential paper against the fashion of keeping people in bed for long periods: The Dangers of Going to Bed.

Read: Effects of prolonged bed rest

A patient with Munchausen syndrome fakes a serious medical condition, generally one that will be irresistible to the doctor and will require time to investigate: something like abdominal pain, or bloodstained urine, or vomiting blood.

Usually they specialise in one clinical problem, though some have a whole repertoire, so they can switch if their initial offer doesn’t cause sufficient interest or alarm. Not only will they learn all facts relevant to the range of possible causes of their presenting problem, but they may devise supporting documents, even intricately faking blood and urine test results where possible.

A rapid disappearing act

They may even carry a hidden bottle of animal blood they can swallow so as to be able to produce dramatically bloody vomit, or sneakily add to their urine sample to stain it with blood, or otherwise use a pin to scrape the lining of their urethra if they’re being watched too closely.  

People with Munchausen syndrome are fascinating, and their motives remain a puzzle. Though they’re intent on persuading doctors and hospitals to treat them for the condition they have chosen to depict, they have no desire to accept treatment for what is truly wrong with them. Usually, when they realise that they have been “caught out”, they do a rapid disappearing act, only to try their luck somewhere else.

They travel widely, and tell dramatic stories, cleverly distracting the doctor from noticing flaws in their clinical performance, and endearing themselves. One older man I saw, his abdomen covered in elaborate scars from the many needless operations he had persuaded surgeons to perform on him, explained each one with a vivid tale of his exploits in World War II. 

Read: Lies, lies, all lies

A good story can also subtly hamper proper investigation. One man arrived at the casualty ward very late at night, and asked if he could speak discretely to the on-call psychiatrist. He claimed to be suffering from very severe depression, but told me he was a defecting member of the I.R.A., planning to co-operate with the authorities against his former terrorist colleagues.  He asked me to arrange his admission to a different mental hospital, as he claimed some of our staff were working with members of his I.R.A. cell.

His description of his depression was ordinary and convincing, but his dramatic story bothered me. Ordinarily, the distant hospital would accept our diagnosis and concentrate on treatment plans, but after arranging his transfer, I called the specialist in charge there, and explained my concerns, asking them to check the genuineness of his complaints more carefully than usual. Within a couple of days they noticed that his behaviour, when he thought he was unobserved, was jolly and cheerful. When they questioned his behaviour, he disappeared from the hospital within an hour.

'An exaggeration'

Paul, another professional patient, told a heart-rending tale of how after many struggles he had married his childhood sweetheart, only to discover to his horror that she had died in bed beside him on the night of their honeymoon of a terrible cancer she had kept secret from him. The nurses were rapt and weepy.

After investigating the matter carefully, I sat quietly with him and explained that I had discovered that the young woman had not died at all. “Ah, yes,” he said, “That was an exaggeration.” Indeed, I persisted, he had never actually been married, and there had been no such girl. He shrugged. That, too, had been “an exaggeration”.

I explained that the kidney infections he claimed were similarly non-existent, and his urine was sterile and not infected.  More shrugs. Uniquely, he stayed in treatment with me for some months to explore what might actually be the source of his problems, and if there were better ways he could deal with them.

Read: Liars take longer to respond online

I think this was not because he was deeply motivated to change his habits, but he was intrigued to find out more about how I had checked his stories, perhaps so that he could improve his chances of escaping detection in future.

But this did enable me to explore and understand more about this curious way of life. He was an orphan and had been brought up in institutions, feeling unsafe when expected to take charge of his own life. He felt safe in an institution and scared when alone in the outside world.

More kindness when ill

As a young child he had witnessed the grave illnesses of his parents, and noticed how kind and supportive everyone was when they were ill.  Even when in childcare, he was impressed with how much more kindness and care he received when he was ill. 

Such people seem to feel they are owed more sympathy and assistance than they routinely receive, and try to find ways to collect this debt. Unpleasant investigations, tests, and operations are not enjoyable, but they may find these an acceptable price to pay for getting attention and feeling cared for. It may be an imperfect technique, but if it seems to work, they will repeat it, and it can become a habit.

Read: Lies lovers tell

Paul illustrated this perfectly when he told me angrily about a time when he had a girl-friend who was on holiday with her family in a more distant town some hours away from him, and he decided to travel there by bus to spend a weekend with her.  He grumbled that it had all gone wrong, and looked really angry. When I asked what had happened, he said he had boarded the bus and set off. “And?” I asked. “And at lunchtime the bloody bus stopped for people to have a meal,” he said, “right opposite the local hospital!” 

He was furious that this had proved irresistible, and before he could control the urge, he had walked into the hospital, told his usual story, and been admitted for investigation. By the time he came to his senses, the bus had left.

Munchausen is a fascinating condition, but it depends on the availability of a good National Health Service or widespread health insurance, so the person can move freely between hospitals or otherwise move on to a new caregiver when their subterfuge has been discovered at their last source of care. 

But even without such resources, it can be practiced by people who exaggerate their symptoms, or prolong their treatment, so as to remain in hospital. Obviously there can be many reasons why someone may not get well when expected to do so – but sometimes they really have no interest in “being well”.  

Read more:

Why we lie

Is Renee Zellweger lying about plastic surgery?

How to spot a liar

Image: Psychiatrist and patient from Shutterstock  

Professor MA Simpson is Health24's CyberShrink. A South African psychiatrist, he qualified in medicine and in psychiatry in Britain. He has been a senior academic, researcher, and Professor in several countries. Read more of his columns.

 
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