ILLUSTRATION BY NICOLE XU
Meet five Munchausen patients who went to desperate lengths to fake illness.
Marc Feldman has spent more than 25 years studying fakes, but the bespectacled Alabama-based psychiatrist still vividly recalls the woman who introduced him to what became his life’s work. It was in the early 1990s, when he was a newly minted psychiatrist, shortly after completing his residency at Duke University. His department chair asked him to see a patient he calls “Anna,” who was suffering from an unusual psychological disorder.
The woman sitting in the brightly lit exam room was emaciated, and her gaunt body was virtually devoid of flesh with an ill-fitting brown wig sitting on her shaved head. She was in her 30s and had been employed in a position of some responsibility. Anna’s alarming appearance was presumably the result of several grueling rounds of chemotherapy for her metastatic breast cancer, which had sucked about 60 pounds off her frail frame and caused her hair to fall out.
Except that it was all a lie. For nearly two years, Anna had pretended to be sick: She copied the cancer symptoms of an acquaintance, starved herself to shed weight, and shaved her head to mimic the appearance of undergoing treatment. In a case report, Feldman and his co-author Rodrigo Escalona noted that Anna refused social invitations, fearing her vigilance would falter and she’d give the ruse away by acting “too well.”
The words that came tearfully tumbling out to explain what motivated her to fabricate such an elaborate ruse had a certain twisted logic. A few years before, her fiancé had abruptly ended their engagement, which left her feeling abandoned and betrayed. Soon after, she told coworkers about her “breast cancer diagnosis” and that her prognosis was grim. Their outpouring of sympathy filled the profound emptiness in her life, which had become more pronounced after her broken engagement. Their warmth and concern prompted her to join a cancer support group, where she quickly established a network of close friends, even though it had been difficult for her to form deep relationships.
But her deception was discovered when the leader of the support group, in a routine review of her medical chart, found out Anna had never seen the oncologist she claimed had treated her. Confronted with the truth, she confessed—and was promptly fired when she told her irate employer. Distraught, Anna realized she needed help, which is how she ended up in a psychiatric ward diagnosed with Munchausen syndrome, a condition in which people feign illness or make themselves sick.
Because of easy medical access online, Munchausen syndrome is now more common than it’s ever been.
“I didn’t know anything about Munchausen, I didn’t even know the term,” Feldman says. “These stories and lives are jaw-dropping; it’s almost impossible to get bored.” He has since become perhaps the world’s leading expert on Munchausen syndrome, and has written four books on these great pretenders, most recently Playing Sick? Untangling the Web of Munchausen. Over the years, the soft-spoken physician has treated numerous patients and received hundreds of letters and emails from people suffering from or victimized by this little understood disorder.
Only about 1 percent of hospitalized patients are fakers, according to estimates by the Cleveland Clinic, although that would translate to hundreds of thousands of cases in the United States alone, given that hospitals treat more than 35 million people a year. Feldman suspects the true number is higher because physicians often don’t realize they’re being duped, especially since “patients” hop from one doctor to another to avoid exposure. “Doctors often do know, but don’t confront the patient for fear of the consequences,” he says. They worry about being sued for malpractice or defamation or being bad-mouthed as insensitive, so they try to protect themselves by referring patients elsewhere.
More recently, Feldman has worked with people suffering from what he calls Munchausen by Internet. “It used to be that people had to go from emergency room to emergency room, they would have to study up on illness and try to appear authentic when they were faking,” he says. “Now all you have to do is sit at home in your pajamas and click into a support group and make up a story.” Because of this, Feldman suspects Munchausen syndrome is now “more common than it’s ever been.”
The term Munchausen syndrome was coined by psychiatrists in 1951, after Baron von Munchausen, a German soldier who told fanciful tales about his adventures. It’s not the same as hypochondria, because hypochondriacs truly believe they’re sick. Munchausen patients know they’re lying and often go to extraordinary lengths to fabricate symptoms, such as injecting themselves with bacteria or household cleansers, or undergoing serious surgeries and other procedures that can cause permanent injury.
The impulses that drive people to concoct these elaborate ruses are, in many ways, perverse extensions of the craving for attention and affirmation. “Many patients with Munchausen syndrome pretend to be ill because they feel this is the only way anyone will pay attention to them,” Feldman says. “They believe that having an illness will make them feel special. Patients who are diagnosed with Munchausen syndrome are almost always found to be struggling with something—perhaps depression or a traumatic childhood. They need help. But for whatever reason, they cannot admit this to others and so they use illness as an excuse to reach out for emotional support.”…