Munchausen by Internet
November 23, 2012 8:13 PM Subscribe

Why would someone want to fake a serious illness on the Internet? Valerie, a cancer survivor, decided to blog about her experience with cancer. While blogging, she interacted with three women who faked illnesses to get attention or had what is referred to as "Munchausen by Internet." As a result, Valerie lost money and friendships, gained a troll, and shut down her blog. Here is a list of clues for the detection of false Internet illness claims.
posted by Four-Eyed Girl (131 comments total) 41 users marked this as a favorite

Recently on Metafilter, relevant to the topic.
posted by zadcat at 8:19 PM on November 23, 2012 [3 favorites]

Mefites are the hipsters of detecting false Internet illness claims. We did it before it was cool.
posted by tzikeh at 8:26 PM on November 23, 2012 [14 favorites]

Fascinating. Thanks.
posted by chinston at 8:41 PM on November 23, 2012

I'd include fake suicide stunts, such as the one that recently happened here, in this phenomenon.
posted by orange swan at 8:45 PM on November 23, 2012

There was a fake suicide stunt on Metafilter? What happened!?

Man, I'm so out of it...
posted by suburbanbeatnik at 8:46 PM on November 23, 2012 [1 favorite]

Faking illnesses is one of those things that just makes me scratch my head. I get it in cases where people are scamming money, but when they just want the attention? Weird.
posted by Forktine at 8:52 PM on November 23, 2012

This goes back a long ways.

In the mid nineties, there was Paul "Voss" Hinds. I think you can still find much of that in usenet archives.

Another faker that I was more personally involved with was KenJr, and his fake B17. The basic idea was that this guy played WWII flight sims because his dad flew 56 missions in a B17. That was unheard of, but OK. Then he went on to claim that he had bought and restored the very same B17 his dad flew. And then it was bad photoshops of other people's aircraft and this and that, and pretty soon he got outed and it all fell apart.

Some people just gotta make shit up. I just don't get it.
posted by Pogo_Fuzzybutt at 8:53 PM on November 23, 2012 [6 favorites]

Stuff like this just makes me sick.

seriously, I'm really sick from it. give me attention and money!
posted by davejay at 8:54 PM on November 23, 2012 [13 favorites]

There was a fake suicide stunt on Metafilter? What happened!?

If you poke around on MetaTalk a bit you'll find the information.

I'd rather it not all be churned up again in this thread. It sucked.
posted by hippybear at 9:04 PM on November 23, 2012 [43 favorites]

Yeah faking being an authority on something, or being a navy seal, or rich is one thing. That makes sense to me. Faking being sick makes less sense, I suppose you get an enormous amount of sympathy and attention you might not ordinarily get. I guess people feel neglected and alone, they are willing to go to great lengths to receive love and attention.
posted by Ad hominem at 9:05 PM on November 23, 2012 [1 favorite]

What I don't understand is the push to make Munchausen's by Internet a separate diagnosis. By proxy, sure-- that's clearly a different action, making other people actually sick. But just pretending with oneself, via a different medium? Seems like the same disorder, just without committing to it enough to actually try to scam medical professionals-- just caring, gullible people online. (Sort of like the difference between a racist forum troll and an IRL skinhead.)

(Some of this stems from my worry about the DSM-V exploding with new, focused diagnoses that sophomore psychology majors are going to diagnose themselves with while taking abnormal psych.)
posted by supercres at 9:13 PM on November 23, 2012 [16 favorites]

There are also the fake 9/11 survivors, feeding off the sympathy: the woman who claimed to have lost her fiance, and the fireman (although that one wasn't done on the internet).
posted by eye of newt at 9:16 PM on November 23, 2012 [1 favorite]

To clarify: in these articles, there's a recurring theme of, "This person is suffering from Munchausen's by Internet, which isn't recognized in the DSM-IV..." Well no, but normal Munchausen's is. The Internet just makes everything easier.
posted by supercres at 9:18 PM on November 23, 2012 [1 favorite]

That article was such a huge bundle of crazy, I don't even know what to think now.

While I am by no means qualified to judge in these matters, I do agree that "Munchausen by Internet" should probably just be included under the original diagnosis.

I also think that internet trolling of the sort described in the article should maybe be included on its own, somewhere around the anti-social part of the personality disorder axis. I've had people tell me that they do it "just to get a rise out of people," as though it's some kind of harmless fun. I now respond by asking them if they literally get pleasure from making other people feel bad, because that seems kind of psychotic. I think it is a distinct phenomenon in that perceptions of anonymity and license are key components in its manifestation, and where the person in question might not display these behaviors in other contexts.

It is certainly easier to do on the internet. I do know one or two people who behave in this manner in actual face-to-face situations with other people. They tend to get into fights, and it does not always go well for them.
posted by TheWhiteSkull at 9:31 PM on November 23, 2012 [10 favorites]

As I understand it, just saying you have a disease, without faking symptoms or trying to get "treatment" for the supposed condition, doesn't rise to the level of textbook Munchausen's. So there's nothing "in the book" that properly fits, even though the connection is clear.
posted by Holy Zarquon's Singing Fish at 9:35 PM on November 23, 2012 [1 favorite]

Valerie seems a bit like a complicit victim in this article. Spending money on these women, choosing to go see one over being with her grandfather when he died -- these were her decisions as a grown woman. She didn't have to create a Flickr feed to prove she was ill to a bunch of strangers on the internet. She seems to have a healthy dose of the dramatic herself, it's not terribly surprising that she ended up in this situation three times. You have to be willing to engage with the drama to be caught up in the drama.
posted by Felicity Rilke at 9:40 PM on November 23, 2012 [7 favorites]

Valerie discovered Munchausen by internet after harnessing the power of internet search engines to research "crazy bitches who fake cancer."

"crazy bitches who fake cancer" is the name of my new...nothing. I'm too depressed to even finish a lame trope.
posted by 445supermag at 9:54 PM on November 23, 2012

Felicity Rilke, it wasn't Valerie who went to see Alex instead of her grandfather. From the article:

Gabby's grandfather passed away weeks later. "I never got the chance to say good-bye to my grandfather," Gabby says. "She knew my grandfather was dying, and she begged me to see her instead."

I also think that going through something as emotionally intense as cancer probably tweaks your radar for bullshit a little bit.
posted by guster4lovers at 9:58 PM on November 23, 2012 [3 favorites]

I now respond by asking them if they literally get pleasure from making other people feel bad, because that seems kind of psychotic.

It would be great if metafilter could be a bastion of refuge from the widespread misuse of psychological terms. Someone suffering from psychosis is out of touch with consensual reality. Think hallucinations and delusions. Psychosis does not imply sadism or even lack of compassion.
posted by parrot_person at 10:26 PM on November 23, 2012 [29 favorites]

My mistake, misread that bit. But as someone going through cancer and who's been involved in online communities surrounding this for almost 10 years, I can say that my radar for bullshit has remained intact, if not heightened.
posted by Felicity Rilke at 10:29 PM on November 23, 2012 [1 favorite]

Faking illnesses is one of those things that just makes me scratch my head. I get it in cases where people are scamming money, but when they just want the attention?

I'll tell you why, it's pretty straightforward, and as someone with a chronic illness I know both )a how you are treated when you are really sick, and b) I worried for a long time about being a 'faker' of one description or another.

(Most) People are nice to you when you're sick. They're not just nice to you like, being generous etc. They're nice to you, like telling you what a nice person you are, how brave you are, how great you are.

Normal standards don't apply; people cut you a lot of slack about stuff - so in some ways life is actually a lot easier for you, and people are telling you how much braver and amazing you are! You are, in some ways, encouraged to put yourself first, to be selfish, that it's the right thing to do and you are a good person for doing it.

But. But there's a bit of a "cry wolf" situation to it as well. Once your illness has become normalised, a lot of that special treatment will dry up, or at least pass uncommented so it's just a part of you and dealing with you. If you want that validation, you need to up the ante. And it doesn't take much upping before you are in faking-your-own-death territory cause there's nothing left.

This is not to gloss over a) the bad parts of being genuinely really sick, and b) the dickheads that are completely horrible about your illness. However, I can see that for people with very low self-esteem, plagued by self-doubt, they would find that treatment tremendously attractive and validating, and it would be very hard to replicate those feelings in other way.
posted by smoke at 10:37 PM on November 23, 2012 [60 favorites]

I've experienced this first-hand.

I think it's good and important that this phenomenon becomes more widely known. I also think it's a mistake to assume that one can easily identify someone exhibiting Münchausen by proxy. Instead of a stranger on the internet claiming a sudden and disasterous illness, imagine someone you've known for years. A friend, whom you trust. Now imagine it starts small. A car accident here, a diagnostic scare there. It seems like nothing more than a string of bad luck. Only somehow it just gets worse and worse. Wouldn't you want to be there for your friend? Provide the comfort and support and sympathy they need? Of course you would. Like any decent person.

I'm as cynical as they come, but I fell for it. I overlooked the pieces that didn't quite fit because I cared and I wanted to help. I don't regret doing so. The alternative is so much worse.

These people exist, and they'll take a little bit of your faith in humanity if you let them. Don't. Give them the pity they deserve and be done with it. Move on, and don't look back.
posted by dephlogisticated at 11:28 PM on November 23, 2012 [12 favorites]

I'll tell you why, it's pretty straightforward, and as someone with a chronic illness I know both )a how you are treated when you are really sick, and b) I worried for a long time about being a 'faker' of one description or another.

I've been reflecting on this recently, as my husband and I announced to the world (i.e., Facebook) that I'm pregnant.

And the reason I'm reflecting: I am treated differently now. Everyone wants to know how I'm feeling. Everyone compliments how good I look. Bad moods are chalked up to hormones. If there are people around who know I'm pregnant, I carry nothing -- packages and groceries get swept out of my hands, or out of my reach before I can grab them myself. If I touch my hip at all, someone's asking me if my back hurts and if I want their seat.

As a bit of an introvert, I find all the attention and hand-waving of any bump in my personality mildly annoying. But I can also see how the attention could be addictive, and why some women fake pregnancies, and by extension, why other people fake illness. It's a chance to be "special", and all you have to do is say a few words: "I'm pregnant." or "I have cancer."

(Not that I am conflating pregnancy with truly life-altering illnesses. Apologies to those who are ill if this reads so. I am saying that this is the proxy by which I feel I understand all this better.)

Personally, I can't wait till the process is done and I can go back to being me. Me with a kid (and I know that will make me different), but me all the same.
posted by offalark at 11:29 PM on November 23, 2012 [29 favorites]

I have experienced this first hand with someone IRL. It is horrifying and monstrous. That's really all I wanted to say, and that I try to not let it make me jaded and suspicious.
posted by OnTheLastCastle at 11:49 PM on November 23, 2012 [2 favorites]

The whole fake suicide/illness/whatever on the internet thing was kind of interesting back when Jay Stile did it. I used to read StileProject daily, and I was actually there seeing that when it happened, and it was a very... strange experience. I was worried about him, but not angry, mostly happy when I found out it was fake. It fit his persona, I guess.

But that one time was enough. As "interesting internet experiment", it's been done. Doing it now is just being an asshole.
posted by Joakim Ziegler at 12:15 AM on November 24, 2012

I don't want to worry anybody, but I have an uncle at Nintendo who has a rare cancer-suicide-wealth disorder, his house burned down, he lost his job, and I am going to inherit a jet airplane that can fly into space. He was great, and now I'm a rich military hero, but it is a family tragedy, and it is genetic. Whatever you can donate to help, well, I would appreciate it a lot. We all would. :(
posted by TwelveTwo at 12:55 AM on November 24, 2012 [16 favorites]

I just realized there's a MBI on a forum I frequent. The guy is constantly in deep shit for mental and physical health reasons and he even fakes an account from his "mom" to corroborate. Not someone I pay a lot of attention to; he pops up mainly to announce yet another crisis.
posted by telstar at 1:12 AM on November 24, 2012

Crikey, all the posts and no one even questions the poster.

Is she REALLY four eyed, or is it a plea for attention?

Enquiring minds blah blah blah...
posted by Samizdata at 1:56 AM on November 24, 2012 [2 favorites]

dephlogisticated: "I also think it's a mistake to assume that one can easily identify someone exhibiting Münchausen by proxy. Instead of a stranger on the internet claiming a sudden and disasterous illness, imagine someone you've known for years. A friend, whom you trust. Now imagine it starts small. A car accident here, a diagnostic scare there. It seems like nothing more than a string of bad luck."

This seems like a slightly inappropriate place to be a pedant, but Münchausen by proxy actually involves making someone else in your care sick, for the attention. Typically it will be an abusive mother making children suffer (poisoning to cause symptoms, for example) so they can get attention. It is a whole other level of evil.
posted by idiopath at 2:18 AM on November 24, 2012 [21 favorites]

The blog belonging to the person called "Kate" in the article from The Stranger can be found here. Apparently she shared the login details with a real-life friend, "L", who immediately locked "Kate" (actually called Cara) out of the blog to keep her from deleting the whole thing once the truth was revealed. I'm fairly sure "L" is also "Gabby" from The Stranger article.

Kate/Cara seems to have finally and completely outed herself by posting photos of her cat visiting the ICU ward where she was supposedly near death and in-and-out of consciousness.
posted by cilantro at 2:42 AM on November 24, 2012 [3 favorites]

Munchausen by proxy server.
posted by spitbull at 2:47 AM on November 24, 2012 [50 favorites]

idiopath is correct but doesn't look so well.
posted by hal9k at 2:47 AM on November 24, 2012 [6 favorites]

What I don't understand is the push to make Munchausen's by Internet a separate diagnosis.

It does seem a bit like those cases where if a murderer sent an email about it their crime becomes an 'internet slaying' in the media.

However, I think there is a difference here in that "standard" Munchausen's typically involves seeking medical attention, whereas here it's the attention of actual sufferers and perhaps the general public which is courted. Actual medical investigation is the last thing these people want. While the internet may not be essential it does play a key role in facilitating this kind of thing, which possibly justifies the label.

Maybe, in fact, we shouldn't call it Munchausen's, but e-malingering or support group infiltration or something.
posted by Segundus at 3:19 AM on November 24, 2012 [3 favorites]

"Compulsive lying" works fine. This is perfectly consistent with people who spin elaborate falshoods for attention and money. The medical angle is incidental to the pattern. It could be any sob story or tall tale.
posted by clarknova at 3:29 AM on November 24, 2012 [13 favorites]

This is perfectly consistent with people who spin elaborate falshoods for attention. Cor!
posted by Mblue at 3:36 AM on November 24, 2012 [2 favorites]

From the article: She wanted to keep her family abreast of her treatment

Punchausen by Internet.
posted by Rykey at 3:51 AM on November 24, 2012 [5 favorites]

As someone who has multiple chronic illnesses, this just makes me feel icky. Why would anyone want this horror that I live with, I ask myself.

Some say, oh, everyone is nice to you when you are sick. And that just makes me even more confused. Surely, nice is not how I would describe the experience Ive had with most people. They are uncomprehending at best, rude and cruel most often, and abusive and unfeeling at worst. There is always the assumption that I am faking it, exaggerating it, seeking attention, making things up. It took me nearly a year to force a doctor to diagnose my arthritis at sixteen, even with family history and xrays. It took me 15+ years to get the "sinus" trouble and "poor dental hygiene" diagnosed correctly as Trigeminal Neuralgia. Panic attacks so bad I couldn't leave the house at one point? Clearly, the theatrics of a young woman seeking attention, clearly.

The last time I was in the ER, in the bed next to mine there was a man who was perhaps in his late 30s. He was insistant that something was wrong with his leg, an issue I surmised he'd been in with the week before. Despite an X-Ray and pain medication, he was back, demanding, over and over, an MRI of his leg. The doctor, the same who was dealing with me, kept telling him that there was nothing wrong, in a tone I recognized as reserved for frequent flyers of an ER who are attention seekers. He wanted that test, no matter what. I could not, laying in the bed next to him, being IV fed pain medications and muscle relaxers to try to unknot the horror of a cramp in my jaw muscles that had made my right eye unable to focus, understand what he thought it would accomplish.

I realized something, then, that I think might explain this behavior. There are some people who, as children, when they are sick they receive affection and attention. There are others (like me, I suppose) who were always met with suspicion (Why dont you want to go to school today?) or rejection (You aren't that sick! No, you may not go to the bathroom, no matter how sick you feel! Sit down!). I wonder if somewhere along the way, the first type might be the process which creates individuals like this through some pathological response. And I wonder, if it is a cycle then that produces those who reject illness as serious, who see all as fakers. And that, I suppose... eventually creates whatever I am.
posted by strixus at 3:51 AM on November 24, 2012 [28 favorites]

My bad on the use of "psychotic". However, it does not change my opinion of people who troll others on the internet for the purposes of "getting a rise out of them."
posted by TheWhiteSkull at 3:56 AM on November 24, 2012 [1 favorite]

I had a scare relatively recently that ALS might be on the cards for me. I'm having a lot of problems. It led me to an ALS forum. Watching the trolls there is horrible. I also have a close friend with terminal cancer. I could list the procedures, surgeries and treatments she's been through.

The idea that someone would actively engage in this sort of foolery is abhorrent. It would have to be someone with a mental illness, expressed or otherwise.
posted by michswiss at 4:56 AM on November 24, 2012 [2 favorites]

If lying on the internet is an effective outlet for Munchhausen by proxy sufferers then more power to them. I'd rather be lied to than have them poisoning their kid, which is what usually happens.
posted by subtle_squid at 5:01 AM on November 24, 2012 [1 favorite]

I try to have some compassion for anyone who is obviously unwell, but it is difficult in this case. I've seen death by cancer in one parent, and I've seen another beat it. Pretending to have it is obscene.
posted by thelonius at 5:03 AM on November 24, 2012

I thought the phrase "Munchausen by Internet" was just a slang term coined somewhere else on the Internet. Kind of like "ceiling cat" I suspect that people in medical circles don't actually differentiate if it's internet-based Munchausen's.
posted by EmpressCallipygos at 5:21 AM on November 24, 2012

They are the real vampires.
posted by seanmpuckett at 5:21 AM on November 24, 2012 [1 favorite]

There are some people who, as children, when they are sick they receive affection and attention.

Yes there are. When they later develop serial illnesses that doctors can find no physical manifestations of, it's not necessarily "faking." They may be experiencing real physical pain, or whatever the symptoms are. Is that still Munchausen's?

I made the terrible mistake of marrying a person like that. It became a progressively horrible nightmare. She was able to go much farther along her crazy path because she's a licensed "mental-health professional." Changing doctors repeatedly. Self-sought electroshock therapy. Very public accusations that I was not being supportive of her in her imaginary illness (at a large meeting of a support group for that illness, with me present.) It took a lot to get the various doctors to tell her it was all in her head, at which point, she'd go doctor-shopping. Her therapist tried unsuccessfully to stop seeing her. So far as I know, the woman's still at it.
posted by Kirth Gerson at 5:24 AM on November 24, 2012 [6 favorites]

Ah. And now that I read the article I see that a doctor is trying to get Munchausen's by Internet classified AS a distinct thing.

....Sorry for the screw up, see I have this weird purple spot on my toe and it's just distracting me, especially since yesterday when it started speaking to me in Aramaic....do you think it could be anything?
posted by EmpressCallipygos at 5:26 AM on November 24, 2012 [2 favorites]

Because this.
posted by Space_Lady at 5:29 AM on November 24, 2012

Yes there are. When they later develop serial illnesses that doctors can find no physical manifestations of, it's not necessarily "faking." They may be experiencing real physical pain, or whatever the symptoms are. Is that still Munchausen's?

Yeah, I get the sense many Fibromyalgia case are some mix of depression and Munchausen's
posted by crayz at 5:38 AM on November 24, 2012 [1 favorite]

The doctor, the same who was dealing with me, kept telling him that there was nothing wrong, in a tone I recognized as reserved for frequent flyers of an ER who are attention seekers.

As another take on this, I have chronic pain that sometimes leaves me screaming and writhing. It's from a spinal cord injury. Changes in weather especially fuck me up. Doctors prescribed opiates; it didn't help, and I'd end up in the ER. My charts were flagged or whatever because DRUG ADDICT. I had one doctor tell me it was all in my head. Now I just smoke a lot of weed but I still end up screaming and writhing. I was totally a frequent flyer, but boy was I not faking.

On the other hand, the hands-down weirdest wheelchair comment I got was when I was like flying down a hill (I can go quite quickly sometimes) en route to catch a bus and this chick said, "I wish I was in a wheelchair. I hate walking. No offense!"

These folks who fake their illnesses are straight-up mentally ill. Feel bad for them. AND LEGALIZE WEED IT'S TOO EXPENSIVE AND COPPING IT IN A WHEELCHAIR IS A DRAG KTXBYE
posted by angrycat at 5:38 AM on November 24, 2012 [26 favorites]

This seems like a slightly inappropriate place to be a pedant, but Münchausen by proxy actually involves making someone else in your care sick, for the attention. Typically it will be an abusive mother making children suffer (poisoning to cause symptoms, for example) so they can get attention. It is a whole other level of evil.

"Fun" fact: Eminem's abusive mother had Munchausen by proxy, which at least partially explains some of Em's massive issues. Nasty thing to put someone through.
posted by Sticherbeast at 5:44 AM on November 24, 2012 [3 favorites]

strixus, your faker was probably there for the pain meds, which is a whole other level of this stuff. Well known ER type, probably an opiate addiction.

I would distinguish real grifters -- malingerers who fake illness to get money, stuff, or time off work, let's say -- from the psychotic (in the clinical sense) fakers seeking attention or addicts seeking drugs. And beyond that it is important to distinguish many other forms of psychosomatic illness from true factitous disorders. Many people who believe they are sick physically even when they are not objectively so are nonetheless not intending to deceive anyone, other than perhaps themselves.
posted by spitbull at 5:47 AM on November 24, 2012

Also, I have always wondered about what seem to me to be the obvious connections between factitous disorders like Munchausen Syndrome and Borderline Personality disorders.
posted by spitbull at 5:49 AM on November 24, 2012 [5 favorites]

I am with strixus---I want to know where all these "super nice to sick people" folks are hiding, so I can ask them to make me a cake and mulch my roses!

There is literally nothing good about being sick in my opinion. It fucking sucks. I am sorry for anyone whose life is so unsatisfying to them that they would rather emulate mine. I would gladly switch with them if I could.

This crankiness brought to you by a night of vomiting into a wastebasket. So glamourous! So brave!
posted by Sidhedevil at 6:00 AM on November 24, 2012 [16 favorites]

Smoke wrote what I might have written. This stuff always makes me think about the two years when we were engaged in a custody fight with our youngest child's birthfather. For those two years, people did extraordinarily kind things for us all the time--two different families even gave us $1000 each, out of the blue, to help with lawyer bills. If I needed to talk, even the busiest of my friends would drop everything to listen to me ramble and fret my way through it one more time. Even my parents were nice to me, which was unprecedented.

And then we won in the appeals court. And there was definitely this period of adjustment back to being just regular folks, entitled to only the regular sort of attention. It was an easy adjustment for us--we were so happy!--but I was aware of the shift happening. And I could imagine someone who felt like an outsider watching us during those two years, seeing us get that huge outpouring of love and both emotional and material support, and thinking, "Why them and not me? How can I get that, too?"
posted by not that girl at 6:02 AM on November 24, 2012 [8 favorites]

I'm as cynical as they come, but I fell for it. I overlooked the pieces that didn't quite fit because I cared and I wanted to help. I don't regret doing so. The alternative is so much worse.

I've seen variations on this comment, starting with the Kaycee Nicole takedown back in the day -- and it continues to baffle me: "the alternative is so much worse" -- worse than what??

I'm assuming that the "alternative" would be not caring and wanting to help. But how is that worse, particularly when it means that you wouldn't have been duped? And just because you don't care and want to help in one scenario by no means indicates that you'll be emotionally uninterested in every other scenario.

I see in this attitude a rather scary belief that it's better to risk one's own emotional equilibrium by being tricked by fakers, than to ever be perceived (by oneself or others) as uncaring.
posted by gsh at 6:04 AM on November 24, 2012 [13 favorites]

Jesus, yes, what gsh said.

Everything everyone did for Kaycee Nicole could have been done for a stranger at the closest hospice. And would have helped someone who was truly dying, not perpetuated someone's cycle of dysfunction.
posted by Sidhedevil at 6:13 AM on November 24, 2012 [7 favorites]

I see in this attitude a rather scary belief that it's better to risk one's own emotional equilibrium by being tricked by fakers, than to ever be perceived (by oneself or others) as uncaring.

Who hasn't had the parable of the Good Samaritan drilled into them while attending Sunday school?
posted by Melismata at 6:28 AM on November 24, 2012 [2 favorites]

I'm assuming that the "alternative" would be not caring and wanting to help. But how is that worse, particularly when it means that you wouldn't have been duped? And just because you don't care and want to help in one scenario by no means indicates that you'll be emotionally uninterested in every other scenario.

I suspect that the "alternative" they are talking about is not "not being duped" but "being so habitually uncaring that when a friend says 'I have been diagnosed with cancer' you say 'tough shit, but what does that have to do with me?'"

You seem to be assuming that there must have been something about these scenarios that was or should have been a sure giveaway that they were not worth your emotional energy. But I suspect that good and caring people will pretty much always respond to a declaration by a friend that they've been diagnosed with a grave disease by "caring" and "wanting to help." There would have to be some pretty weird history between you for your response to be "oh yeah? Show me some medical documentation or I'm out of here!"
posted by yoink at 6:29 AM on November 24, 2012 [18 favorites]

that's why, as imperfect as they are sometimes, we have medical professionals
for reals, I'm seeing a whole lot of hate against clearly mentally ill people when -- yes, if it is a parent poisoning their kid, fuck, horrible evil, even if it is a byproduct of mental illness. but when it comes down to somebody wanting sympathy -- they're ill, just in a different way, and as horrible as it would be to have cancer, I am not seeing the horror in being exposed to the fact that sometimes people have fucked-up minds.

I'm not a big fan of taking examples of fucked-up minds and talking about how they are vampires and what not. Especially when the harm that results from their fucked-up minds could be avoided by not engaging with them. Because we have medical professionals to engage with them.
posted by angrycat at 6:47 AM on November 24, 2012 [8 favorites]

When I was in university there was this girl Lisa that I knew who was told she was getting a new roommate. New roommate comes and also happens to be named Lisa. Turns out both Lisas had boyfriends named Ryan, both were the youngest of three with older brothers the same ages, each with a parent that had died in a car crash, and... each being born on the same day!

Turns out the new Lisa was in fact Jennifer, aka "Jennifer the compulsive liar". That was my very first, "What the fucking fuck?!" moment with these kinds of people.
posted by dobbs at 6:48 AM on November 24, 2012 [17 favorites]

the psychotic (in the clinical sense) fakers seeking attention or addicts seeking drugs

Another pedant attack: still no. The stigma against actual disorders with chronic psychosis (namely, schizophrenia) is so great that this word gets attached to almost any mental illness. Stamping out the stigma is harder with proliferation of mis-usage.

These people would only be psychotic if they actually thought they were ill. (Or drug-induced hallucinations, or BPD with delusional thought, e.g.) They don't; they knowingly manipulate others for their own benefit. It's closer to sociopathy, if anything, though that word gets thrown around a little too freely as well.
posted by supercres at 6:51 AM on November 24, 2012 [7 favorites]

I had a short period when I was not working much, a bit isolated from family & friends but had a couple regular appointments, a optometrist spent a long period helping me adjust to contacts. At one point I had the observation that I was really looking forward to the appointments and when they ended I had a strong sense of loss. Really spooked me. but also gave me a strong empathy for folks that had little else in their lives. Very sad article, we should not allow this but should have sympathy.
posted by sammyo at 6:54 AM on November 24, 2012 [8 favorites]

I get it in cases where people are scamming money, but when they just want the attention?

loneliness can be a mutherf***er.
posted by philip-random at 7:48 AM on November 24, 2012 [9 favorites]

Also, I have always wondered about what seem to me to be the obvious connections between factitous disorders like Munchausen Syndrome and Borderline Personality disorders.

spitbull, they are both considered personality disorders, and thus are indeed closely related; it's just that Munchausen can manifest distinctively without the broader etiology of BPD. In practice, very often the general personality disorders will have comorbid conditions.
posted by dhartung at 8:00 AM on November 24, 2012 [5 favorites]

I think "the alternative" is "but what if I don't believe them and it turns out that they weren't faking it and then I have to live with the fact that I blew off someone who really WAS suffering from cancer".

Precisely. I do not want to be mugged, yet I walk alone at night sometimes; I do not want to be attacked by bears, but I will hike in the woods. The alternative is safe, but cowardly.

I feel a hideous pity for these people, a sense that if my life had been unhappier I might have tried to become one of them. Although I can't find it now, I first read about Munchausen's syndrome in an article about a woman in Scotland. Her first name might have been Dorothy, I'm not sure. She grew up in an absolute emotional moonscape, not physically neglected but entirely ignored and very near the poverty line, a picturesquely bleak UK 1940s childhood. When she got appendicitis as a child and was admitted into the hospital for several days, it was the most care, kindness and affection she had ever experienced.

She later admitted that she had spent the rest of her life chasing that one certain source of attention. In the end, she paid full price for it; when she became genuinely ill in her old age, no doctor would believe her. She died in great pain.
posted by Countess Elena at 8:02 AM on November 24, 2012 [13 favorites]

However, it does not change my opinion of people who troll others on the internet for the purposes of "getting a rise out of them."

People who stir shit just to see the results, who go out of their way to pointlessly and senselessly lie just to see if they can rope you in, who go through their lives serially pretending to be nice to people they don't actually like just to see if they'll fall for it . . . are completely incomprehensible to me though they seem to teeter on the brink of sociopathy.

At least the fake-sick (or other fake-life-drama) people do it out of some sort of psychic need rather than for shits and giggles. Anyhow, it's quite possible to be cautious and self-protective while still being empathetic and caring toward others.
posted by FelliniBlank at 8:09 AM on November 24, 2012 [2 favorites]

Just for everyone's reference, so you can have actual facts to discuss, the DSM criteria for most of the various disorders mentioned above:

***
Factitious Disorder

A. Intentional production or feigning of physical or psychological signs or symptoms.

B. The motivation for the behavior is to assume the sick role.

C. External incentives for the behavior (such as economic gain, avoiding legal responsibility, or improving physical well-being, as in Malingering) are absent.

Code based on type:

300.16 With Predominantly Psychological Signs and Symptoms: if psychological signs and symptoms predominate in the clinical presentation
300.19 With Predominantly Physical Signs and Symptoms: if physical signs and symptoms predominate in the clinical presentation
300.19 With Combined Psychological and Physical Signs and Symptoms: if both psychological and physical signs and symptoms are present but neither predominates in the clinical presentation

(Munchausen Syndrome and Munchausen Syndrome by Proxy are not separate diagnoses in the DSM-IV-TR or ICD-10. A patient would have to meet the criteria for Factitious Disorder.)

***
Malingering

Producing false or grossly exaggerated physical or psychological symptoms, motivated by external incentives such as avoiding military duty, avoiding work, obtaining financial compensation, evading criminal prosecution, or obtaining drugs. These may represent adaptive behavior.

(Malingering is a V-code, which means it's not a mental illness but may be a "focus of clinical attention.")

***

Somatization Disorder

A. A history of many physical complaints beginning before age 30 years that occur over a period of several years and result in treatment being sought or significant impairment in social, occupational, or other important areas of functioning.

B. Each of the following criteria must have been met, with individual symptoms occurring at any time during the course of the disturbance:

(1) four pain symptoms: a history of pain related to at least four different sites or functions (e.g., head, abdomen, back, joints, extremities, chest, rectum, during menstruation, during sexual intercourse, or during urination)
(2) two gastrointestinal symptoms: a history of at least two gastrointestinal symptoms other than pain (e.g., nausea, bloating, vomiting other than during pregnancy, diarrhea, or intolerance of several different foods)
(3) one sexual symptom: a history of at least one sexual or reproductive symptom other than pain (e.g., sexual indifference, erectile or ejaculatory dysfunction, irregular menses, excessive menstrual bleeding, vomiting throughout pregnancy)
(4) one pseudoneurological symptom: a history of at least one symptom or deficit suggesting a neurological condition not limited to pain (conversion symptoms such as impaired coordination or balance, paralysis or localized weakness, difficulty swallowing or lump in throat, aphonia, urinary retention, hallucinations, loss of touch or pain sensation, double vision, blindness, deafness, seizures; dissociative symptoms such as amnesia; or loss of consciousness other than fainting)

C. Either (1) or (2):

(1) after appropriate investigation, each of the symptoms in Criterion B cannot be fully explained by a known general medical condition or the direct effects of a substance (e.g., a drug of abuse, a medication)
(2) when there is a related general medical condition, the physical complaints or resulting social or occupational impairment are in excess of what would be expected from the history, physical examination, or laboratory findings

D. The symptoms are not intentionally feigned or produced (as in Factitious Disorder or Malingering).

***

Conversion Disorder

A. One or more symptoms or deficits affecting voluntary motor or sensory function that suggest a neurological or other general medical condition.

B. Psychological factors are judged to be associated with the symptom or deficit because the initiation or exacerbation of the symptom or deficit is preceded by conflicts or other stressors.

C. The symptom or deficit is not intentionally produced or feigned (as in Factitious Disorder or Malingering).

D. The symptom or deficit cannot, after appropriate investigation, be fully explained by a general medical condition, or by the direct effects of asubstance, or as a culturally sanctioned behavior or experience.

E. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.

F. The symptom or deficit is not limited to pain or sexual dysfunction, does not occur exclusively during the course of Somatization Disorder, and is not better accounted for by another mental disorder.

Specify type of symptom or deficit:

With Motor Symptom or Deficit
With Sensory Symptom or Deficit
With Seizures or Convulsions
With Mixed Presentation

***

All criteria copied from BehaveNet's DSM-TR-IV defintions. Bits in parentheses are mine.
posted by jaguar at 8:15 AM on November 24, 2012 [17 favorites]

Munchausen is not a personality disorder. It is a subset of Factitious Disorder.
posted by jaguar at 8:18 AM on November 24, 2012 [1 favorite]

I missed one that also might be relevent:

***

Pain Disorder

A. Pain in one or more anatomical sites is the predominant focus of the clinical presentation and is of sufficient severity to warrant clinical attention.

B. The pain causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. Psychological factors are judged to have an important role in the onset, severity, exacerbation, or maintenance of the pain.

D. The symptom or deficit is not intentionally produced or feigned (as in Factitious Disorder or Malingering).

E. The pain is not better accounted for by a Mood, Anxiety, or Psychotic Disorder and does not meet criteria for Dyspareunia.

Code as follows:

307.80 Pain Disorder Associated With Psychological Factors: psychological factors are judged to have the major role in the onset, severity, exacerbation, or maintenance of the pain. (If a general medical condition is present, it does not have a major role in the onset, severity, exacerbation, or maintenance of the pain.) This type of Pain Disorder is not diagnosed if criteria are also met for Somatization Disorder.

Specify if:

Acute: duration of less than 6 months
Chronic: duration of 6 months or longer

307.89 Pain Disorder Associated With Both Psychological Factors and a General Medical Condition: both psychological factors and a general medical condition are judged to have important roles in the onset, severity, exacerbation, or maintenance of the pain. The associated general medical condition or anatomical site of the pain (see below) is coded on Axis III.

Specify if:

Acute: duration of less than 6 months
Chronic: duration of 6 months or longer
Note: The following is not considered to be a mental disorder and is included here to facilitate differential diagnosis.

Pain Disorder Associated With a General Medical Condition: a general medical condition has a major role in the onset, aeverity, exacerbation, or maintenance of the pain. (If psychological factors are present, they are not judged to have a major role in the onset, severity, exacerbation, or maintenance of the pain.) The diagnostic code for the pain is selected based on the associated general medical condition if one has been established or on the anatomical location of the pain if the underlying general medical condition is not yet clearly established--for example, low back (724.2), sciatic (724.3), pelvic (625.9), headache (784.0), facial (784.0), chest (786.50), joint (719.4), bone (733.90), abdominal (789.0), breast (611.71), renal (788.0), ear (388.70), eye (379.91), throat (784.1), tooth (525.9), and urinary (788.0).

***
posted by jaguar at 8:21 AM on November 24, 2012 [4 favorites]

Basically, Factitious Disorder and Malingering are intentional lies; patients know they are making them up.

In Somatoform Disorders (like Conversion Disorder, Pain Disorder, and Somatization Disorder), patients are truly experiencing physical pain or disorders, but the cause is psychological rather than physical.
posted by jaguar at 8:25 AM on November 24, 2012 [6 favorites]

Sorry, gonna respond to being pedant-attacked: it seems to me some forms of "I'm sick but no one believes me" are in fact delusional psychosis. A simple example is formication (the sensation of bugs or other organisms crawling all over you) in opiate withdrawal. The word "psychosis" is not as precise as all that, any more than "sociopath." But even in a clinical setting, psychotic delusions of illness are a thing.
posted by spitbull at 9:05 AM on November 24, 2012 [1 favorite]

Also, "knowing" you are making something up /= "intentional" lying, necessarily. There are degrees of agency and self-delusion in many of these cases. Accusing someone who has BPD of being a malingering liar is probably not all that helpful if the goal is to convince that person that they are (mentally) ill.
posted by spitbull at 9:07 AM on November 24, 2012

Oh, and I now see supercres included "drug induced hallucinations," so we're on the same page. My point is only that there are forms of "faking" illness that are delusionally psychotic, not that factitous or somatization disorders are a priori examples of psychosis. I mean specifically things like "delusional parisitosis," which is actually incredibly common.
posted by spitbull at 9:10 AM on November 24, 2012

I wonder how many sick people fake wellness, say on dating sites.
posted by StickyCarpet at 9:30 AM on November 24, 2012 [5 favorites]

I'm seeing a whole lot of hate against clearly mentally ill people

I was thinking the same thing. That these people are to be avoided, no question. But unlike trolls there is seldom any evidence that they set out to harm anyone or had mercenary purposes. There is something very wrong in their lives and probably in their psyche as well. For me that engenders nothing but pity.
posted by Tell Me No Lies at 9:46 AM on November 24, 2012

Another pedant attack: still no. The stigma against actual disorders with chronic psychosis (namely, schizophrenia) is so great that this word gets attached to almost any mental illness. Stamping out the stigma is harder with proliferation of mis-usage.

Pedant Counterattack: the word is being used correctly according to the dictionary.
posted by Tell Me No Lies at 9:51 AM on November 24, 2012 [1 favorite]

I am with strixus---I want to know where all these "super nice to sick people" folks are hiding, so I can ask them to make me a cake and mulch my roses!

Count me in with you. Total strangers snarl "You don't LOOK sick!" when they "catch" me using the handicapped stall in public restrooms or if I'm moving too slowly for their taste in the grocery store. Well, no shit. Most of the time, people with RA look perfectly healthy, even when we're stiff and in pain. You don't see us when we LOOK sick, because when it's THAT bad, we can't even get the fuck out of bed.

Ugh, people.
posted by MissySedai at 9:56 AM on November 24, 2012 [20 favorites]

the word is being used correctly according to the dictionary.

Doesn't mean it's not a symptom of a very real problem for a surprisingly large segment of the adult population.
posted by supercres at 10:20 AM on November 24, 2012

Despite an X-Ray and pain medication, he was back, demanding, over and over, an MRI of his leg. The doctor, the same who was dealing with me, kept telling him that there was nothing wrong, in a tone I recognized as reserved for frequent flyers of an ER who are attention seekers. He wanted that test, no matter what.

I'd just like to say, how do you know he wasn't actually sure something was wrong with him? Same could be said of you, just looking at you or other pain sufferers, most don't show up to the eye or on MRIs. Remember the story not long ago about the woman with the dead tapeworm in her brain? She kept demanding that she knew something was wrong, but doctors kept dismissing her until one found it. Another woman had constant horrible leg pain, her doctors kept dismissing, just like the guy above, after moving to a new city, she got a new doctor, they found a large tumor on her main leg nerve in her hip, not in the leg where the other doctors were looking.

Basically, quit judging others without knowing the whole story, even if those who fake it for attention are bad.
posted by usagizero at 10:24 AM on November 24, 2012 [17 favorites]

I wonder how many sick people fake wellness, say on dating sites.

I'm seeing a whole lot of hate against clearly mentally ill people

These two go hand in hand. People seem to think that mental illness is a sign that you did something bad, or are a bad person no matter what. Want to make yourself basically un-datable? Put something in your profile about a mental issue you have.

Heck, even doctors treat you differently. I walk into a new doctors office, and they start out seeming to be sincere about helping my issues, then they open my file and get to my mental issues, and then it's quite a different story. They stop listening, don't even bother looking closely at what i'm there for, and just prescribe something that does nothing to help.
posted by usagizero at 10:31 AM on November 24, 2012 [8 favorites]

StickyCarpet, it isn't faking for those of us who are ill to choose to leave that information off our profiles. I mean, it's not like I'm writing that I am so healthy and there is absolutely nothing wrong with me, nosiree, and thus faking health. And there is an aspect of faking illness (especially in the cases illustrated in this article) that is linked to an underlying mental health issue -- it isn't a sign of mental instability for me to not announce that I have cancer on my dating profile.
posted by Felicity Rilke at 10:32 AM on November 24, 2012 [3 favorites]

I belong to a group of women who became friends because we were part of a "buddy board" for women who had babies due in October 2006. For some reason, our group really gelled, and we're still close today, though membership has waned a bit.

As is inevitable when you have a large group of pregnant women, some of us had things go badly in our pregnancies. A couple of our members gave birth quite early -- 28, 29 weeks-- had had long, intense, grueling stays in the NICU. One of those women (whose 29-week daughter ended up perfectly healthy) later became pregnant again, with identical twin boys; after a panic-inducing week where they desperately tried to stop her early labor, she delivered the babies at 23w3d, which is too early to live without a miracle.

The whole board went into overdrive. We raised a thousand dollars to put on a gift card for her to deal with the inevitable petty costs that are involved in a long-term hospital stay; we arranged to have dinner delivered to the family for a month. We wept and we prayed right along with her, and we all sobbed when, at three days old, it became apparent that her sons could not overcome the complications of their prematurity and were removed from life support to pass away in her arms.

The twist in this case was that it was all completely true. We had known her for years, she had met a couple of people on the board, there were pictures of her whole family in her profile, herself and her husband with their daughter. She took calls from group members in the hospital, the kind where you call and ask to be transferred to $NAME's room and they transfer you in. There were a thousand kinds of confirmation for her story; she even had her medical records sent from the hospital to another group member who is a reproductive endocrinologist.

All the details that are normally vague in an MBI case were completely firm and verifiable here. But I still had that vague unease, that "wait what if I'm being scammed?" And I did verify stuff; I called the hospital from the number on their web site, not just from the number she gave us, etc. I wish I didn't have to feel that distrust, particularly not from someone I really thought of as a friend, but I did.

(as for the sympathy vs. anger for people with chronic illnesses? Here's the difference; you get sympathy for illnesses that make you get thin and die, or that affect your children. You don't get sympathy for illnesses that compromise your mobility, or cause fatigue or pain, but aren't fatal, particularly not if they lead to weight gain. No, that's not 100%, but it is true enough to be disgusting.)
posted by KathrynT at 10:33 AM on November 24, 2012 [40 favorites]

I also think the women written about who were faking their illnesses deserve some compassion -- maybe even the same level of compassion they earned from being "actually" sick. They are still women who are ill, just not in a way that is easily understood, or in the way they indicated. I don't like the way this article creates a victim/victimizer dichotomy between the women who were "really" ill and the women who were "faking" it.
posted by Felicity Rilke at 10:37 AM on November 24, 2012 [1 favorite]

Doesn't mean it's not a symptom of a very real problem for a surprisingly large segment of the adult population.

Agreed, it's just that common usage often varies from clinical definitions. Including my favorite hobby-horse "depression".
posted by Tell Me No Lies at 10:37 AM on November 24, 2012

I was peripherally involved in such a case, years ago - unpleasant, I'll skip the details which are much like the above.

I saw Ferris Bueller's Day Off recently, and I found the character completely unpleasant. The fact that Bueller is faking a serious illness for sympathy, and that the town is running fund-raising activities for him as a result, made me feel quite disgusted. I kept expecting that this would come out, and he'd be shamed, but this doesn't happen during the movie.

I can't understand why that movie is so popular - don't people see what an awful person he is, and once it comes out that he was never sick, why the town will never again come together to help a person who really is sick?
posted by lupus_yonderboy at 11:03 AM on November 24, 2012 [10 favorites]

Wow. I hadn't thought about Kaycee Nicole in a long time. That was a trip down the 2001 internet rabbit hole. That particular scam was so pervasive, I remember seeing references to it on multiple blogs and message boards back then. I feel like I need a "where are they now?" epilog.
posted by vibrotronica at 11:57 AM on November 24, 2012

I knew several people who faked a variety of aspects of their lives.
Several fake Viet-Nam vets, a couple people who faked major illness, and one I who I still am not sure if she was spying on me or what. She was huge drama. She probably always will be.
I think it is important as a parent to deal with your children from a place of truth.
My kids weren't told about Santa Clause, the Easter Bunny or the Tooth Fairy. End result, kids who didn't lie or fake illnesses. I allowed my kids the occasional 'Get Out Of School Free Card'
I didn't have to deal with fake illnesses.
Maybe there is something wrong in society that is pushing people to fake stuff.
I too have chronic issues and want to know where are the 'nice people'?
Arthritis, Migraine, IBS, and if the lot decide to hit all at once, it's bad. No one awfully cares.
posted by Katjusa Roquette at 12:10 PM on November 24, 2012 [1 favorite]

lupus_yonderboy: I can't understand why that movie is so popular - don't people see what an awful person he is, and once it comes out that he was never sick, why the town will never again come together to help a person who really is sick?

Agreed. It's a bit of a derail but the whole basis for that film is Ferris' sociopathy. He also feeds on Cameron's low self-esteem, taking advantage of the shy, uncool kid's grateful, hero-worshipping friendship. That Cameron takes the fall for them both when Ferris pushed him hard is depicted as some kind of moment of maturity just made me wince. Maturity would have been saying "I'm done with you."
posted by George_Spiggott at 12:24 PM on November 24, 2012 [9 favorites]

(as for the sympathy vs. anger for people with chronic illnesses? Here's the difference; you get sympathy for illnesses that make you get thin and die, or that affect your children. You don't get sympathy for illnesses that compromise your mobility, or cause fatigue or pain, but aren't fatal, particularly not if they lead to weight gain. No, that's not 100%, but it is true enough to be disgusting.)

I agree but think it can be simplified to 'People have sympathy for illnesses that they have some understanding of.'

For most people who aren't medical students or who have not happened to have personal experience with a disease, most diseases are apprehended in the most vague and general way. Cancer, as far as how it specifically works, is surely as wildly misunderstood by the general population as any other disease, but most people are clear (no doubt mostly thanks to movies and TV, fwiw) on the fact that cancer kills people all the damned time, and even when it doesn't it makes them lose their hair and their weight. This makes it easy for people to know that they should be nice to cancer patients, and the symptoms of chemotherapy are often plain to see even to someone with minimal medical knowledge.

People don't react to some other kinds of diseases because they don't have any idea how to recognize them or what risks, treatments or symptoms they entail. Also, people are wary about offering sympathy to people who might not want sympathy for their condition--people who would prefer to forget about it and move on and not be perceived as abnormal.

Some people probably have bias or disdain for certain kinds of sicknesses/medical conditions, but I think most people just don't know how to act around someone who suffers from a condition that they don't have any understanding of and choose the course of safety from embarrassment at making the wrong gesture, which is the course of making no gesture or a simple, neutral perfunctory one.

People who are angry at people with illnesses are people who are unhappy (often, depressed or anxious people) in a way that a hospital stay or a surgical procedure can't fix. Society often views unhappiness as a problem that the sufferer should be able to fix him/herself if only they could just be a little more confident and just take charge of their life a little more. This can make one jaded and even jealous of folks with less nebulous conditions who have really 'earned' their sympathy in a way that is obvious to everyone, and whose conditions are not seen as personal issues that require self-discipline but as life-threatening emergencies that demand unilateral and powerful medical responses. This is obviously distorted thinking.
posted by TheRedArmy at 12:46 PM on November 24, 2012 [5 favorites]

I know someone who went through a major, devastating life event and everyone was, of course, super nice and solicitous to her. Work gave her a leave of absence, friends dropped everything to spend time with her, hugged her, cooked for her, took her out of town every weekend, sat up with her while she drank wine and cried, took care of her chores and pets, gave her money, her doctor gave her a generous prescription for Xanax, we all brushed off any subsequent drunken Xanax-induced shenanigans because she was having a hard time, gave her more money, took care of more chores for her, excused more acting out..... uh oh. Within a few months she had morphed into a black hole of need, need and more need. I don't know what was missing in her life before but she will now do ANYTHING to keep the outpouring of sympathy and help coming her way. In her mind she deserves it. I can see how faking illness achieves the same result for people who just have a bottomless void of need hidden inside.

One time I called her out, privately and fairly nicely, on a big very provable and obvious lie and she apologized and I thought she might finally see herself a bit more clearly. She then spent the next 8 hours or so (until 4am) sending me dozens of increasingly revisionist text messages until she had worked herself back into a worldview where she was the victim and she didn't understand how I could accuse her and didn't "deserve my hostility". Reading them all in order was like going down the rabbit hole of her thought process and it was scary.
posted by fshgrl at 12:48 PM on November 24, 2012 [7 favorites]

Also, I have always wondered about what seem to me to be the obvious connections between factitous disorders like Munchausen Syndrome and Borderline Personality disorders.

Honestly, not that much similarity. Both have aspects of attention seeking, but that's about all they have in common.

People with Borderline Personality Disorders have a skewed view of the world from commonly shared reality, which includes difficulty telling between oneself and the ones around one in terms of emotional responses. It does tend to be dramatic, but it's a drama which includes lots of people and playing people off against each other (which is why BPD is one of those diagnosis where the entire care-team needs to be on the same page). BPD does tend to be overdiagnosed in women with "big" personalities, but the undisputable cases are pretty difficult to miss - we've had a couple go through my office and have a couple less disruptive/threatening individuals still on various caseloads (the words no care provider ever wants to hear: "You're the best X I've ever had." RUN! RUN!).

Munchausen is an attention-seeking mental illness, but effectively through self-abuse. It's about making oneself visible through unhealthy means, and with Munchausen by Proxy you might have a psychological conflation of the person and their victim, but it's about eliciting sympathy and love, not manipulating groups of people against each other to get what you want. Personally, I think Munchausen by Internet will probably make it into the DSM eventually, though likely with a different name (Munchausen via Medium, perhaps) and I think it shares many of the characteristics with standard Munchausen and Munchausen by Proxy.

One thing to keep in mind is that all of the personality disorders are related to wholesale distortion of the personality of the person - which means their perception, their cognitive biases, their self-reflective capabilities, how they relate to others, etc... It is a wholesale sort of thing and relatively rare, and tends to have abuse or neglect comorbidity. Munchausen is a partial disorder, meaning it's entirely likely other aspects of the person's personality are (and indeed have to be, since they are effectively accessing services and sympathy) healthy in relation to their community standards and commonly shared reality.
posted by Deoridhe at 12:55 PM on November 24, 2012 [6 favorites]

Hmm, as someone recently diagnosed with a truly rare form of breast cancer but a really fantastic, longterm prognosis, I'm just getting started with trying to figure out people's responses. So far, people have seem to be all over the place, from the guys I work with who were freaked out because I got the diagnosis over the phone while in a very very public situation with them at my elbow, to the people who want to pooh pooh the radiation treatments I'm about to start to the many representatives of the breast-cancer industry who hovers about, offering me advice, concern and inviting me into their endless activities.

I found myself whining a little to the doctor last week that some people seemed unconcerned but had to admit that I'd worked hard to play down the significance of the diagnosis so I am not perceived as a sick woman. One of the reasons is that within a space of about three months, I was diagnosed with first a heart problem, totally controllable by meds, and then the cancer. Both are a complete reversal of how I see myself, that is, someone who has never had a major illness. So it's going to be interesting, to put it mildly, to see how this all plays out.
posted by etaoin at 12:57 PM on November 24, 2012 [2 favorites]

spitbull, they are both considered personality disorders, and thus are indeed closely related; it's just that Munchausen can manifest distinctively without the broader etiology of BPD. In practice, very often the general personality disorders will have comorbid conditions.

Munchausen is a facticious disorder, 300.16 (primarily psychological), 300.19 (primarily physical), 300.19 (mixed), 300.19 (Not Otherwise Specified). The term "Munchausen" isn't actually in the DSM-IV, and the chances of it being added for the DSM-IVR are remote. Facticious Disorder by Proxy is listed in the for further study area, and the perpetrator would be diagnosed with 300.19 NOS. My guess is Munchausen by Internet would also be 300.19 NOS.

Personality Disorders are the 301.* range, from 301.0 (Paranoid Personality Disorder) to 301.9 (Personality Disorder NOS).

Borderline Personality Disorder is 301.83 and specifies it as a "pervasive pattern of instability of interpersonal relationdhips, self-image, and affects, and marked impulsivity that begins by early adulthood and is present in a variety of contexts". Facticious disorder is not listed as any of the common co-occuring Axis-I disorders.

Breaking out the DSM is fun!
posted by Deoridhe at 1:10 PM on November 24, 2012 [1 favorite]

Yeah, I get the sense many Fibromyalgia case are some mix of depression and Munchausen's
posted by crayz

First of all, epony and all that.

Second, your statement may be true about some people who have been diagnosed with fibro but certainly not all. I was diagnosed with fibro and I am not happy about it. I am not depressed or lethargic, or sleeping all the time. I AM in pain and the doctors cannot figure it out so I got the fibro diagnosis. Yay. I KNOW that there is something else going on. Also, I haven't told anyone, not even my parents about the diagnosis because of attitudes like yours.

Time and science will hopefully sort all of this out. Until then I guess I will have to figure out how to tell my dog why I put his leash away. No walkies for either of us. Constant pain has become the new normal. I don't even bring it up anymore. And when I do I am treated like a pill seeker by my doctor. Double Yay.
posted by futz at 2:05 PM on November 24, 2012 [16 favorites]

Who hasn't had the parable of the Good Samaritan drilled into them while attending Sunday school?

Me?

I'm Jewish.
posted by asterix at 2:24 PM on November 24, 2012 [4 favorites]

The thing about the Good Samaritan is that there are verifiably dying strangers right near you, wherever you are right now, whom you can help. There are verifiably terribly sick strangers, right near you, wherever you are right now, whom you can help. There are verifiably destitute strangers right near you, wherever you are right now, whom you can help.

What bugs the shit out of me about viral fraud phenomena like Kaycee Nicole or Baby April Rose is that people get such a high out of being part of the current compassion fad. Which the exploitative hoaxsters rely on. Somehow J.T. Leroy's fake post-traumatic stress disorder was more fun to care about than the pain of real survivors of child sexual abuse. The fake childhood cancer of the fake Warrior Eli was more engaging than the kids in the local cancer wards.
posted by Sidhedevil at 2:57 PM on November 24, 2012 [15 favorites]

I kind of agree with sidhedevil. Jumping on the bandwagon on the internet is a cheap emotional thrill. All you have to do is push a few buttons and read and you can work yourself up into any emotional state you want: arousal, pity, sympathy, happiness. It's ultimately pretty selfish. People who actually go out and volunteer and spend the time, money and gas to physically be present in a cancer ward or at a homeless shelter are doing it, not just reading about it.
posted by fshgrl at 3:40 PM on November 24, 2012 [5 favorites]

I'm bookmarking this thread for important clues when I need to malinger.
posted by telstar at 3:42 PM on November 24, 2012 [5 favorites]

I too used to know someone who claimed a serious illness --- in her case, she frequently used it to excuse everything from showing up late to work to screwing up what little work she did do. She told us she had "Limes disease", insisting she got it when she was bitten on the butt by mosquitos while peeing overboard from a riverboat in Ethiopia..... other than the fact that you can only get Lyme disease from ticks in the US, and it was named after my home town (let's hear it for East Lyme, Ct.!) and it is most certainly not spelled 'Limes'..... well, as I say: other than all that, oh yeah, really believable......

(Well, all that plus the fact that she also insisted her father was the US Ambassador to France at the time, when I could have sworn the US Ambassador was named Pamela Harriman.....)
posted by easily confused at 4:06 PM on November 24, 2012 [2 favorites]

It depends what's put in front of you, doesn't it? There was a time when almost everyone I knew either had cancer or had a relative with cancer, and everything at all times was always about cancer. Not a day went by without an email about cancer, a CaringBridge post, a sponsored skydive, an announcement of a funeral or viewing, and just cancer, cancer, and more cancer, all cancer, all the time, cancer cancer cancer cancer cancer cancer cancer cancer cancer cancer cancer, and when it's devoured everyone I ever knew it will come for me too. Basically, cancer is what life's all about.

I've had a break from that for a little while, except for several prayer requests a day from people I know only over the Internet. I can handle that, and I don't give it a whole lot of thought, especially because I don't enjoy thinking about it. The idea that I'm getting some emotional satisfaction out of it, or that I have a duty to seek out and minister to grievously ill total strangers in person, is bizarre. It's surely only a matter of time before yet another person I already know gets cancer, and why wouldn't I save my energy for when that happens?

Out of all these people, I did know one who I'm fairly sure was malingering by proxy - not inducing symptoms as far as I know, because there actually was a real illness behind it. But on top of that there were tales she was telling that simply were not believable, and had to have been false or at least grossly exaggerated. She was almost charmingly transparent about what she hoped to gain by it (improvements to her living situation and reduction in her work schedule) and very very likely was strongly motivated by the tremendous amount of emotional support and admiration that was poured out to her by the community. I saw no reason to think she wasn't lying with full awareness that she was lying. She was a very malicious person under the surface, too, and I personally witnessed her trying to do serious harm to someone she envied.

In her case the lies were really obvious to me, and should have been obvious to almost anyone - but not to the community/fan club that was her main support system. Most of the people in that group were very dishonest and/or disturbed themselves, and they maybe didn't so much believe her as they claimed, so much as support her out of loyalty to her as a group member. Sort of like the Mafia.

I've seen this on the Internet, too, and basically there were small details of the story that didn't really hang together, or rang false, but nothing conclusive on its own. There might have been an element of financial gain, and the same person turned out, in a separate operation, to be running a support group targeting a section of the population known for their gullibility. If that person were simply deluded I have to wonder why they would target that group in preference to, say, ex-heavyweight boxing steroid ragers in recovery. In the case of the group I actually belonged to, that got trolled, compassion is supposed to be an important part of what that group is known for, so I think the main point may have been "ha ha fuck you and your so-called compassion! compassion is for suckers!!!1!!!" or something like that. It broke down after some members attempted to visit the "patient" IRL and reported their experiences.

Really, I think someone who does this only on the Internet must be less likely to be delusional, otherwise why bother to hide behind a fake persona and make up corroborating evidence? In real life the stakes are a lot higher and the effort much greater. You'd have to at least be highly motivated to try it in the first place, whatever the motivation actually was. To try it on the Internet, all the motivation you'd need would be high levels of boredom and malice.
posted by tel3path at 4:48 PM on November 24, 2012

There is literally nothing good about being sick in my opinion. It fucking sucks. I am sorry for anyone whose life is so unsatisfying to them that they would rather emulate mine. I would gladly switch with them if I could.

Being sick really does suck. But that's the thing: these people aren't really sick! They never actually vomit up blood, or feel weak, or get yelled at for going to slow at the supermarket, or deal with any of the negative aspects of being sick. The "illness" is never an intrusive element in their lives, because they can turn it off and back on again whenever they want. Their 'illness' is something that they wholly control, having the shape they want, the effects they desire, and nothing else. If you're really sick and someone's an ass to you about it, it hurts you... But if you're not really sick and someone's an ass to you? You just move on to find yourself another mark. They've got for themselves this cozy little space, where they can get all the sympathy and kindness without having to experience the pain, fear, or other unpleasantness.

I can't read about cases like this without feeling just so sad for the people who would do such a horrible, despicable thing. They must be so lonely, so twisted up with need.
posted by meese at 4:49 PM on November 24, 2012 [7 favorites]

Tell Me No Lies: if by "common usage" you mean "lots of people use this term incorrectly", then yeah. Otherwise: Try a real dictionary, not dictionary.com with its "loose" (by its own account) definitions.

Psychotic has a particular meaning, and if we allow people to use words to mean anything they damn well please, then words have no meaning at all. I'm of the mind that words should have actual, you know, meanings, so that we can per chance communicate with one another.

If words mean nothing in particular, or whatever a given person wants them to mean, well then all I can say is nirblegee nipnap on the snookums.

There are certain terms from psychology--"schizophrenic" is another one--that are very commonly misused. It matters. It's not pedantic to correct these misuses. The more these words are misused, the more people get the wrong idea of what a given diagnosis actually entails. Many people now think that schizophrenics, for example, have dissociative identity disorder (aka multiple personality disorder), because people so commonly use the term "schizophrenic" to imply a split personality. So when someone who has seen this term so commonly misused that they don't actually know the real meaning finds out that a friend or loved one is diagnosed as schizophrenic, they have all sorts of incorrect ideas about how that person must feel and behave. People also commonly toss around "schizophrenic" or "psychotic" in a glib way, much like some people proclaim about anything they don't like: "that's soooo gay!". It trivializes the actual state of being gay or of having schizophrenia or psychosis.

So anyway, the people profiled in this article who hoodwinked Valerie are almost certainly not psychotic. There is absolutely nothing in this account that even suggests that they are. In fact, the article discusses the motives behind Munchausen by Internet, and specifically states that the goal is to "fool medical professionals into treating them, while cultivating as much attention and sympathy as possible". These people know they aren't sick, but are trying to deceive others into believing they are. That's very much not psychotic.
posted by parrot_person at 5:05 PM on November 24, 2012 [5 favorites]

I observed a case of "pseuicide" on a fanfiction mailing list back in the late 90's. The girl in question claimed to have dropped a bottle of ether and fainted, and then woke up with terminal lung damage with symptoms oddly similar to the way "consumption" is described in old romance novels. At various points, her "sister", "mother", "friend", and "doctor" took the time to post to the list with paeans to her bravery and essential goodness, all, of course, written in her own voice, complete with literary tics. A few people got kicked off the list for being "mean" for even gently pointing out the obvious holes in her story. It was utterly baffling watching people gathering money, making tribute websites, and generally buying into the falsehood.
posted by Karmakaze at 5:19 PM on November 24, 2012 [3 favorites]

I wonder why they didn't write fanfic about gathering money and making tribute websites instead? Because it must have been a fanfic experience for at least some of them.
posted by tel3path at 6:06 PM on November 24, 2012 [2 favorites]

I suppose everybody's pretending on some level anyway - there's a fairly large element of not being able to fool an honest person that involves the audience reaction as well...which is quite interesting.
posted by sgt.serenity at 7:03 PM on November 24, 2012 [1 favorite]

I've been chronically ill and disabled all my life because I suffered from a neurological form of cancer, a neuroblastoma, as a child. For most of my life, I've been faced by either suspicion ("You don't LOOK disabled") or ignorance (such as my college friends failing to visit me when I was emergency hospitalized for three days 1/4 of a mile from campus). When I read cases like this, there's a part of me that wants to learn from these people what their trick is. How do they get this kind of support-not financial, but certainly emotional? That's what would really help me to know. I suppose part of the issue is when you are genuinely ill, you aren't sitting around figuring out how best to get the response you want, you're too busy trying to struggle to get your medications refilled or rushing to the doctor for yet ANOTHER totally upsetting visit your doctor for even more painful tests. (That would be me this week.)
posted by miss-lapin at 7:26 PM on November 24, 2012 [7 favorites]

Yeah, I get the sense many Fibromyalgia case are some mix of depression and Munchausen's
posted by crayz
How do you get that "sense"? I have had fibromyalgia for 35 years- longer than it has had a name. I spent many years being told it was " all in my head" before going on recent medications which help with the pain. I don't think accusing fibro sufferers of Munchausen is very helpful, unless you have some type of medical connection that may have lead you to this "sense" ?
posted by Isadorady at 7:28 PM on November 24, 2012 [8 favorites]

Yeah. People with fibromyalgia have MORE than enough to deal with without yet another random internet stranger telling them they are just "making it up" or trying to get attention.

I'll weigh in as yet another person with a chronic illness but with no outward signs that it's incredibly hard to put up with people constantly questioning you, doubting you, judging you. So I understand the anger at people who fake serious illness, but like others, I can't imagine wanting my life/illness. Do you really want to be in pain, literally, all the time? Do you want to have to explain why you keep dropping the whiteboard markers, or accidentally bump into students? Do you want to lose feeling in your fingers and hands when you move your neck wrong, or even better, lose circulation in your fingers and watch them turn blue every time it drops below 50 degrees F?

Because seriously, I'll trade you. I'm more than happy to have your perfect health and you can have my Lupus.

And I have complete sympathy for Valerie. I am sad that this happened to her at a time when she deserved to have friends who would care for her and love her, rather than use her and manipulate her emotions.
posted by guster4lovers at 8:31 PM on November 24, 2012 [4 favorites]

The answer to how healthy people get support is, of course, that they can arrange their fake illness drama timing for maximum impact..say, right when one of their support people has their own distracting issues bammo, time to get a sudden bad diagnosis or start having episodes or what have you. I have seen it in action. It is not pretty. The person in question is genuinely mentally disturbed but still very capable of manipulating others to get what they need.
posted by emjaybee at 9:55 PM on November 24, 2012 [2 favorites]

People are fake because they want acceptance and cannot or will not change in order to get it.
posted by Brian B. at 10:00 PM on November 24, 2012 [1 favorite]

Deoridhe, I have a sense of the DSM but I do not own a copy. I had to go by the ICD-10 classifications, in which factitious disorder is actually classified under the same broad rubric of "disorders of adult personality or behaviour". I did not mean to imply they were the same thing, only that they are clinically related.

The term "Munchausen" isn't actually in the DSM-IV, and the chances of it being added for the DSM-IVR are remote.

Well, yeah, no kidding. I think the larger direction is to get away from the misleading associations of such dubbings.

My guess is Munchausen by Internet would also be 300.19 NOS.

As far as I'm concerned, I don't see any reason it would actually gain a separate diagnosis. It's just a pop culture term.

Facticious disorder is not listed as any of the common co-occuring Axis-I disorders.

Well, it's listed as a comorbid condition elsewhere than the DSM (of which I do not own a copy). The book Somatoform and Factitious Disorders (Review of Psychiatry, Volume 20) {is that a textbook?} states that BPD "has been most consistently reported in Munchausen syndrome and factitious disorder as a whole" sourced to a paper, and also states that DSM-IV-TR allows for concurrent diagnoses.

If your point was that they should not be confused or muddily applied against each other (hey! you got BPD in my FD!), well, I would agree there. I think therapeutically they are both at least on the same continent. I would definitely say that you explained their crucial differences well.

As to this:
Tell Me No Lies: if by "common usage" you mean "lots of people use this term incorrectly", then yeah. Otherwise: Try a real dictionary, not dictionary.com with its "loose" (by its own account) definitions.

Psychotic has a particular meaning, and if we allow people to use words to mean anything they damn well please, then words have no meaning at all

I think the point is not that we need to abolish the misuse of psychotic by the larger public (so that it doesn't appear in dictionary.com -- which by the way is licensed from sources including Random House and Harper Collins, in case you thought it was crowdsourced or something) but that we should avoid such glib usage here in a thread where we're trying to speak intelligently about a psychiatric condition. Yes, it exists and likely will continue to exist as a colloquialism, but here we should at least try to be more careful, in the larger goal of a more productive discussion.
posted by dhartung at 10:23 PM on November 24, 2012

"How do they get this kind of support-not financial, but certainly emotional? That's what would really help me to know."

By being the healthy kind of sick. People who are fake sick can reward your emotional support by feeling a little better, spending lots of time sending a nice e-mail to thank you for your support, etc. People who are real sick are blowing off thank-you notes because they're too tired to type, feel worse because they're getting worse, and are short-tempered and cranky because they're really sick, not just acting. (Obviously not all the time, but you take my point.) People who are having Munchausen's by Internet are putting all of their energy into cultivating these relationships. People who are sick are putting energy into coping with illness, not complex interpersonal relationships.

"for reals, I'm seeing a whole lot of hate against clearly mentally ill people when -- yes, if it is a parent poisoning their kid, fuck, horrible evil, even if it is a byproduct of mental illness. but when it comes down to somebody wanting sympathy -- they're ill, just in a different way, and as horrible as it would be to have cancer, I am not seeing the horror in being exposed to the fact that sometimes people have fucked-up minds."

It is possible to feel a lot of compassion and sympathy for someone with Munchausen's, while still condemning their behavior. You can understand why someone is screwed up and feel bad about it, while still think they're acting like a stupid jerk. (I feel like alcoholism is the paradigmatic case -- you can recognize it as a disease and have tons of sympathy for the person with alcoholism, but still be really angry about their drinking behavior.)

And being lied to by someone you trust or care about hurts and makes people angry. That's a normal human response. Lies are painful. Even if they don't affect reality in some way, people are hurt when lies are exposed simply because of the lies.

"I saw Ferris Bueller's Day Off recently, and I found the character completely unpleasant. The fact that Bueller is faking a serious illness for sympathy, and that the town is running fund-raising activities for him as a result, made me feel quite disgusted. "

I think you missed a plot point. Ferris fakes a stomach virus to stay home from school; he only lies to his mom (and dad, I guess, but mostly mom). The gossip chain being all, "OMG Ferris is dying!" and starting the fundraiser to save him from death is actually meant to reflect and parody the way teenaged gossip exaggerates and dramatizes things. Ferris has nothing to do with that.
posted by Eyebrows McGee at 10:58 PM on November 24, 2012 [15 favorites]

Yeah, I get the sense many Fibromyalgia case are some mix of depression and Munchausen's
posted by crayz

This is one of the horrible consequences of malingerers. I am a scientist and I believe Fibro is real, because I've read the large peer reviewed genetic studies on it, and the putative mechanisms match the syndrome. However, those mechanisms are unseen. People who have it, especially women, get a lot of grief about how they're faking.

I had a chronic pain disease a while back, and I'm no faker. I searched around for 10 years to get it treated, seeing lots of docs who didn't believe me. Once they opened me up, I had pervasive internal disease. Once I got surgery, I felt better and never brought it up again (except on forums like this occasionally when I'm looking back and peeved about the experience).

It's a shame though, because yeah, those few attention-seeking work-shirking malingerers are bound to choose an unseen mysterious disease if they want to fake something. It's harder to fake cancer or an amputation. That makes things worse for people who really do suffer from poorly understood diseases. I think people should be sensitive about making comments like the above.

(One doctor offered me antidepressants a while back for my chronic pain, and I wanted to fucking tear his eyes out. My pain was so bad that I literally vomited and went pale from it. I remember all these tricks I had, like counting ceiling tiles and saying the alphabet backwards, to try to get my attention off the pain. What an asshole that guy was.)
posted by kellybird at 11:53 PM on November 24, 2012 [12 favorites]

Because seriously, I'll trade you. I'm more than happy to have your perfect health and you can have my Lupus.

Is it really so hard to understand? Imagine you're a perfectly healthy person who would like the day off work. You call in and say 'sorry I'm sick', but you're not actually sick. You're also not thinking 'gee I wish I was really throwing up like I just told my boss!'. You're thinking 'sweet now I get the benefit of a day off!'.

Now switch in 'the day off work' for 'people leaving blog comments telling you how much they care about you and that they hope you're ok'.
posted by jacalata at 1:27 AM on November 25, 2012

It's a shame though, because yeah, those few attention-seeking work-shirking malingerers are bound to choose an unseen mysterious disease if they want to fake something.

Hypochondriacs end up there too via process of elimination. They're not faking or work-shirking, they're just sure that something undiagnosable is wrong with them.

Thankfully diagnostic tools are catching up with Fibromyalgia which should help lift the stigma from it, but there are plenty of poorly understood syndromes waiting to take its place.
posted by Tell Me No Lies at 8:57 AM on November 25, 2012

kellybird, I'm so sorry for the horrible health care experiences you've had. That is shitty, and you deserved so much better.

I do want to say, though, that pain specialists often prescribe antidepressants to people with chronic pain, not because they think the patient has a somatiform disorder, but because many antidepressants do have clinically validated off-label uses for treating pain. (As do some drugs originally created for seizure disorders.)

That doctor may have just been an asswaffle, but I wouldn't want other readers of the thread to automatically associate "prescribes a med usually used as an antidepressant" with "thinks I am somatizing".
posted by Sidhedevil at 11:07 AM on November 25, 2012 [2 favorites]

angrycat: My charts were flagged or whatever because DRUG ADDICT. I had one doctor tell me it was all in my head. Now I just smoke a lot of weed but I still end up screaming and writhing. I was totally a frequent flyer, but boy was I not faking.

man, i get really angry when I hear about situations like yours. I don't specifically know that you're reliable, but I've known enough people who were in real pain and got flagged as drug-seekers or malingerers because people abuse trust to get attention or drugs. my mom was so resistant to taking pain meds that I swear it hastened her death, due to the stress from constant pain, and a big part of that was that as a former nurse, she was frightened of being perceived as a drug-seeker or attention-seeker. I have a good friend with fibro and know her well enough to know how painful it is for her to even admit she's having a problem -- yet she was forced out of a job because they were convinced she was a malingerer. Another good old friend has a very embarrassing but very real lower-intestinal issue, caused by a botched coccyx-repair surgery, that for more than 30 years he couldn't get anyone to believe until he took a photo, because he'd been flagged as a frequent-flyer after being surreptitiously examined by a psychiatrist.

It all just pisses me off. Sorry, I'll stop ranting now.
posted by lodurr at 11:31 AM on November 25, 2012

(One doctor offered me antidepressants a while back for my chronic pain, and I wanted to fucking tear his eyes out.

I'm sorry you had such bad experiences, but FWIW I have lived with chronic pain most of my adult life, having had a non-stop headache for nearly 20 years now. My neurologist had me try Effexor, an antidepressant, last year. It has been miraculous for my pain.
posted by not that girl at 12:57 PM on November 25, 2012

I would also like to add to the chorus of those pointing out that certain types of antidepressants are well established treatments for chronic pain. I don't want to speculate on what your specific doctor was trying to do by offering you a Rx for an antidepressant, but when I offer that type of medication to a chronic pain sufferer it's certainly not because I think their pain isn't real.
posted by thelaze at 1:40 PM on November 25, 2012

I think one of the undercurrents of this discussion, though, is a tendency in the US (and likely other Western Cultures) to view most psychological disorders (and medical disorders we don't understand) as "all in your head" meaning "you can stop it any time" as opposed to a variety of coping techniques for a wide variety of unhealthy and abusive circumstances which sometimes calcify and remain even if the person's circumstances become healthier. The need for attention is a human need, and to be healthy all humans need it - the rise in "attention seeking" behavior in teenagers, for example, is discussed as if it were a problem with the teenagers, when actually it's a problem with the adults around them for not giving enough attention; the reason for insulting people and ignoring them for attention seeking behavior is because it's easier for the person doing the dismissal, not because it actually helps the person being ignored.

Likewise, a lot of the dismissal of people with drug seeking behavior both ignores that there are real, undiagnosed pain disorders causing suffering, and that people who seek drug-induced pain relief for non-physical reasons actually need treatment, attention, and service not dismissal. Drug "addicts" (addicts in quotes, because we don't really understand psychological addiction, and physical addiction is relatively rare) are usually treating real, persistent, overwhelming psychological pain which is unaddressed in any other way. Gabor Mate in his book "In the Realm of Hungry Ghosts" goes into detail about the pain of detachment and suffering which drives the most extreme drug addicts (he works at the only legal injection site in Canada and struggles with addiction himself).

Unfortunately, the culture I personally live in, and which I suspect a lot of people live in, views people through the veil of their fiscal worth and "work" ability (where work is imperfectly defined, since someone sitting at a desk yelling at people is often doing more "work" than someone working twelve hours cleaning houses based on how much they are paid). People who are "riff raff" or "losers", people who are "addicts" and "homeless", people who are ill or weak and so can't contribute financially, are viewed as leeches on society, as outside of society and thus feeding off of it, rather than as integral and important simply for being alive and people. The whole nonsense redefining benefits as "entitlements" is part of this - the connotation of entitlement is that what is given is not deserved.

I don't live in a society where people are treated as if they have the right to food, clothing, a home, and healthcare simply due to being a person. I live in a society where we wage a "war on drugs" with innumerable social and financial costs that no politician can go against because then they would be viewed as "soft on crime", and where "they're just doing it for attention" is a common dismissal of suffering.
posted by Deoridhe at 1:53 PM on November 25, 2012 [12 favorites]

So ... is it possible to fake Munchausen by Internet?
posted by sour cream at 2:34 PM on November 25, 2012

jaguar: " B. The motivation for the behavior is to assume the sick role. "

In medicine it's useful to distinguish between "Primary Gain" (ie, the psychological benefit from assuming the sick role, usually assumed to be non-conscious process) and "Secondary Gain" (ie, getting material benefit from assuming the sick role, usually assumed to be a conscious process). Across a spectrum of people with similar diseases, some will derive more primary gain from their disease than others and this differential response by individuals to similar diseases creates the illness response. Some people do their best to shrug off or minimise their diseasess, chronic or acute, whereas others just kind of throw themselves into them, becoming identified by them to a sometimes impressive degree.

Secondary gain is usually identified with "malingering", where people feign a disease for material benefit.

Where it gets interesting is when you do have the interplay of primary gain with a personality disorder that's quite cognitively distorting, such as borderline. During episodes of stress-related instability that manifest as micropsychosis or dissociation, it's entirely possible that a person's ability to perceive and respond to symptoms can become grossly disordered. In fact, it's the rapid waxing and waning of these symptoms that's a dead giveaway when you're doing an exam, including the psychiatric symptoms such as "voices" or paranoia, trauma memories or goal-planning. So why do some people do this "Munchausen" thing? I think that at least some of it is similar to how some people with personality disorders present rapid, disjointed and frankly bizarre (at least, by "Axis 1" criteria) symptoms. And some of it is more-or-less conscious, for secondary gain.
posted by meehawl at 3:00 PM on November 25, 2012 [2 favorites]

FWIW, looking at this in terms of primary and secondary gain, I've known drug seekers, both first and second hand, who appeared to derive negative primary benefit from seeking a fix through medical means. ("It wasn't worth it" was how one person described it to me, where that concept of 'worthitness' rolled up costs in time, shame, guilt, etc..) In the cases I knew about, they tried it either only once or used it as a desperate last resort. So I think most 'frequent flyer' drug-seekers are probably getting significant primary gain from the experience, or they wouldn't do it that way. There are simpler ways to get drugs.
posted by lodurr at 3:26 PM on November 25, 2012

I think less severe versions of Munchhausen's are more common than we realize. I'm thinking of my sister who's been using her GI issues to get sympathy for most of her life. She just somehow never got around to going to the doctor about it, never kept a food diary to try and get to the bottom of it, just whined endlessly and got endless sympathy from her friends about it for years. You'd think someone in as much distress as she seemed to be in would try and find a solution, but no. For her, it's part of her self-image as a tragic victim, so I think she enjoys it on some level. For somebody who's a drama queen already, this kind of stuff fits right into that.
posted by WorkingMyWayHome at 9:44 PM on November 25, 2012

I could swear there is a person suffering "M by I" on an internet forum specific to one of my conditions. It's amazing the number of complaints and issues that crop up with her on almost a daily basis. Many of the community rally around her, extolling her to go to Mayo or fire her current doctors or lamenting the struggle she faces with young children, an under caring husband and a dominant mom.

I've suggested she seek out counselling at least to help prioritise where and how she spends her energy while getting through some health issues. Nope, not even acknowledged.

Maybe it's just her way of coping with daily life, but I've always felt it was overly dramatised.
posted by michswiss at 11:09 PM on November 25, 2012

I realized something, then, that I think might explain this behavior. There are some people who, as children, when they are sick they receive affection and attention. There are others (like me, I suppose) who were always met with suspicion (Why dont you want to go to school today?) or rejection (You aren't that sick! No, you may not go to the bathroom, no matter how sick you feel! Sit down!).

I remember how Arthur addressed this in the Chicken Pox episode. I always thought of as a cautionary tale for treating children too specially when they get sick -- especially to the point of ignoring your not-sick kids.
posted by Leucistic Cuttlefish at 1:11 AM on November 26, 2012 [1 favorite]

In many cases, fibromyalgia is a diagnosis for "I have no idea why you have these symptoms, feel like crap, and have no other measurable diagnosis." So, many people who are in denial about depression, or whatever, will get it as a diagnosis of convenience. And, yes, many people will maximize any illness, minor, major, in-between, or will invent illness as a way to avoid coping with being over-whelmed or depressed.

The thing is, mental illness has a physical manifestation. Mental illness, depression, personality disorders, etc., are real, and have a massive effect on how any individual lives. Those people need treatment and help. But they may be told "just cheer up" and "it's just depression," etc. There's lots of compassion for physical illness, not as much for mental illness. The cost of not treating mental illness, and of having a culture that doesn't build community is so high.

I'm a middle-aged woman with some measurable and some non-measurable symptoms, but blood tests for diagnoses are negative, and some docs want to slap on a label. I miss being healthy. My work environment has the opposite reaction to what's described here: you're not healthy & energetic? You suck. Go away. The doctor with whom I had a history, and who helped me get some treatment, moved away. I'm struggling to stay employed, and it means that work is pretty much all I do. There's not much energy left for having a life, because having health insurance is critical.

tl;dr - we need a better mental health care system.
posted by theora55 at 7:09 AM on November 26, 2012 [1 favorite]

Deoridhe, thanks for the explanation on borderline personality disorder---the 'borderline" always makes me think it's not serious, that it's 'almost' a problem. My misunderstanding, of course, of how the word is used.

No prob. The "borderline" is actually a hold on from older ways of classifying mental illnesses; it was consider the "borderline" between neurosis and psychosis. We don't really divide things that way anymore (though the concepts of neurosis and psychosis remain) but the term has carried on because it is a fairly consistent cluster of symptoms that is very difficult to sum up easily (my running theory is that it's an attachment disorder, but I'm not sure that's common).

As a basic rule, all Personality Disorders are exponentially more difficult than other mental illnesses because of their sheer all-pervasiveness. Usually the goal is to manage the symptoms rather than affect a cure. I'm a bleeding heart progressive, so of course I hold out hope, but I will say the intensity level gets ramped up a lot; I've said before I'm much more used to schizophrenia, but I find the intensity and ...I guess the best word is insularity of personality disorders fascinating (my other "favorite" disorder is Dissociative Identity Disorder, which is another pervasive, mythologically rich mental illness; "favorite" in quotes because someone having it is a representation of an unbelievable amount of suffering, and so my loyalties are always divided since my fascination is underpinned by the desire to extinguish that which I am fascinated by).

Part of why people in the field like me get antsy about Internet Diagnosis, though, is that even with repeated, in-person experience with another human, Diagnosing a Mental Illness is a fraught, difficult, and questionable thing. The original concept of the DSM was that you would be able to diagnose anyone in an hour sitting, but I've recently had an experience with a client which made clear to me that we often see what we want to see, and multiple clinicians can miss basic information and thus miss-diagnose.

Noting inconsistencies, making decisions about the people one wants to expend time on, finding patterns - all very valid. I would actually encourage people to develop the ability to express friendly skepticism - often the image of a skeptic is someone dismissive, cold, or even insulting toward what they are skeptical about, but there is a way to say simply and warmly, "this doesn't seem to fit for me" without making a value judgement on the other person.

I currently have someone in my sphere of acquaintance where the pieces are not fitting together correctly, so I'm choosing to be friendly, warm, but to not get tugged emotionally in; I offer friendly and brief support, but I don't ask them endlessly how they're doing, get fired up for legal action (though I did mention Adult Protective Services as a resource), etc... I couldn't, and wouldn't, diagnose this person with anything, though; I'm just choosing where my energy and attention goes. When we're having fun and chatting, my attention and energy is there. When the conversation becomes a list of trials and tribulations, I'm suddenly distracted. I have friends who I put energy into cheering up when they're sad, but they're people I got to know before I started hearing about their woes; we were already friends and didn't become friends through their suffering. I personally think this is one way to protect yourself without becoming hard and cruel, but I do have a skewed perspective because of my job.
posted by Deoridhe at 4:44 PM on November 26, 2012 [3 favorites]

dhartung: "Deoridhe, I have a sense of the DSM but I do not own a copy."

If anyone wants a copy of the DSM IV you can download it here.

You'll need 7zip to open the multi-part archive.
posted by clarknova at 1:04 AM on November 29, 2012

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