MEDICAL MATTERS:Online dreamers follow in Munchausen's path, writes MUIRIS HOUSTON
‘HERE IS described a common syndrome which most doctors have seen, but about which little has been written. Like the famous Baron von Munchausen, the persons affected have always travelled widely; and their stories, like those attributed to him, are both dramatic and untruthful.”
This Dr Richard Asher’s opening statement in his classical description of Munchausen’s syndrome published in The Lancet in 1951. The syndrome is an extreme form of factitious disorder, in which a person fabricates physical signs and symptoms and/or psychiatric ones with no apparent motivation other than to adopt the role of being a patient.
Munchausen’s probably accounts for fewer than 10 per cent of all factitious disorders seen in a hospital setting. To make the diagnosis the following features must be present: simulated illness, pathological lying and wandering from place to place.
Asher’s nomenclature is based on the true story of Baron von Munchausen, a German cavalry captain who lived in the 18th century. He was renowned for his fabulous anecdotes about his life and adventures, some of which were subsequently published as Baron Munchausen’s Narrative of his Marvellous Travels and Campaigns in Russia.
Munchausen by Proxy is a related condition in which a care-giver fabricates signs and symptoms in another person, usually children in their charge. They often report breathing problems in toddlers, and diarrhoea and vomiting in older children.
Patients diagnosed with this condition often have an underlying personality disorder. Now called factitious disorder by proxy, it occurs when a person manufactures an illness in someone close to them in order to gain attention or emotional support.
The latest manifestation of the syndrome is Munchausen by internet. Coined by Dr Marc Feldman, a clinical professor of psychiatry at the University of Alabama, the term describes a growing number of people who pretend to suffer illnesses in order to get sympathy from online support groups.
A 40-year-old mother posted for months on an ovarian cancer website until her 17-year-old daughter came online to announce the news of her mother’s death. However the daughter then developed ovarian cancer and continued to seek support. But when the daughter’s boyfriend announced that she, too, had died, the fake was rumbled.
Feldman has described some of the behaviour patterns common to people with Munchausen by Internet (MBI): the length and severity of the fictitious ailment conflicts with the person’s activities and behaviour; a terrible prognosis is interspersed with miraculous recovery; when other forum members begin to lose interest, the user announces the illness has now affected a family member; and when members of the support group reach out to offer to visit and offer more personal support, this is deflected with sometimes bizarre excuses why further contact isn’t possible.
The scam is never about money. But those who are duped and offer genuine support often spend a huge amount of time online. When the deception is revealed, forum members who offered support are left to reflect on the wasted time that could have been given to their own families. Some describe feeling “violated” by the experience.
One of the most notorious cases of MBI occurred on a website called Connected Moms. An Australian woman calling herself Mandy said she had been diagnosed with leukaemia, not long after her husband had left her and their two children. She then reported how chemotherapy caused her to have a stroke, which required some weeks in intensive care. Members of the online community supported her through three years of medical ups and downs before she confessed.
Feldman reckons people with MBI lack social skills and simply want attention and sympathy. But as so few come forward, it may be some time yet before psychiatry can finally offer a deeper explanation for this latest spin-off from the Baron’s original exploits.