A real term for faking it

Patients with dramatic tales of maladies that turned out to be made-up occasionally came to the Central Middlesex Hospital in England, where Richard Asher was a senior physician in the late 1940s. Asher wasn’t the first to notice such patients -- but he was the first to bring them to the medical community’s attention and give their common condition a name: Munchausen’s syndrome.

-- Elena Conis

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From the late 1800s through the early 1900s, a handful of European doctors wrote of otherwise healthy patients who turned up at hospitals with faked diseases or who seemed addicted to surgical procedures.

But Asher was the first to coin an accepted medical term for such patients, which he did in a widely read 1951 article for the medical journal Lancet.

“Like the famous Baron von Munchausen,” Asher wrote, “the persons affected have always traveled widely; and their stories, like those attributed to him, are both dramatic and untruthful.”

Munchausen, an 18th century German military officer, was notorious for his outrageous tales of adventure, though he didn’t lie about his health. He is said to have once claimed to save a ship of English prisoners of war by fashioning himself a pair of wings and flying the prisoners to freedom -- in just half an hour.

Asher wrote that Munchausen’s syndrome patients often fought with doctors and nurses who questioned their accounts, went from hospital to hospital with their “falsehoods” and often had a “wallet or handbag stuffed with hospital attendance cards, insurance claim forms, and litigious correspondence.” They all, according to Asher, wanted one thing: attention.

One of Asher’s patients claimed to have been torpedoed in the abdomen while in the Navy and then held as a prisoner of war -- only for doctors to later find he had been in another nearby hospital when he claimed to have been at sea.

Asher’s article encouraged other doctors to share stories of patients who made themselves sick by deliberately eating contaminated foods, injecting themselves with drugs or feces, or stabbing themselves.

Others (with presumably weaker stomachs) carried animal blood, urine or organs into the emergency room, claiming them as their own.

In 1977, British pediatrician Roy Meadow added a new type of Munchausen’s syndrome to the books: Munchausen’s syndrome by proxy. Meadow reported, also in Lancet, on mothers who faked or induced illness in their children. He wrote of one mother who poisoned her infant with salt. The syndrome, he argued, applied to anyone who induced or faked symptoms in someone under their care.

Today, the term Munchausen’s syndrome is being written out of medical and psychological reference texts in favor of the more general term factitious disorder. (Munchausen, after all, never had the syndrome himself.) People with the disorder have been distinguished from malingerers (people who fake illnesses for drugs or money) and hypochondriacs (who aren’t sick but believe they are). And many, doctors now know, suffer from mental illness.

But Munchausen’s syndrome patients still puzzle doctors far and wide: The cause of their syndrome, doctors agree, is not entirely clear.