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
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
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
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
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
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.
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
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
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”.
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.