What causes Munchausen syndrome?
There are several theories to explain the complex problems of the Munchausen patient. An easy one to understand relates to learning "illness behavior" at an early age. Some Munchausen patients have what I call the Dudley Moore syndrome. As a child, Dudley had a limp and was teased unmercifully by other children. Once when he was in the hospital, a nurse gave him a goodnight kiss. Many years later Moore said, "That kiss was probably the first taste of real, unqualified, uncomplicated affection I had ever had. In many ways my entire life is based on recapturing that single moment of affection." Moore, who was born with a clubfoot, was not suffering from Munchausen syndrome, but Munchausen patients frequently share his longing for the type of care and attention one receives in a hospital.
What are some of the favorite tricks of Munchausen patients?
There are two kinds of tricks. The first is illness illusion, where the patient imitates or feigns various maladies. In these cases, patients with acting ability might simulate seizures, accidents or cardiac emergencies. One common problem they will feign is kidney stones because they're very painful and the doctor is expected to give narcotic medication.
And the second kind of trick?
It's called illness abuse. A patient involved in illness abuse may have injected himself with a toxic substance, taken harmful medications or withdrawn blood to a dangerous level. This can, in fact, lead to serious illness, even death.
What kind of toxic substances might they inject?
Saliva, human feces, milk or blood. One man injected himself with parrot feces because exotic birds carry dangerous diseases. Whether illusion or abuse, because of laboratory tests, the patient is assured several days in the hospital with lots of attention. Some Munchausen patients actually undergo unnecessary surgery, and believe it or not, they don't mind.
Are there other dramatic manifestations?
There is one interesting group of people who draw their own blood. One Munchausen patient, known as "the Baron," obtained blood by piercing his urethra with a pin. He would lie in a pool of his own blood, always in close proximity to a hospital.
Who is the most colorful character in Munchausen syndrome history?
Leo Lamphere wins the prize. He was a 260-lb. merchant seaman and self-professed circus weight-lifter and professional wrestler known as "the Indiana Cyclone" who harassed hospitals from Canada to Louisiana and from Maine to Oregon between 1943 and 1977. Lamphere would draw blood from his veins with a syringe and swallow it. Then he'd burst into an emergency room, coughing up the ingested blood and splattering himself and everything nearby. He is thought to have died in New York City in the late '70s, but that has never been verified.
How common is it for Munchausen patients to create fictitious personas?
Very. For example, there is a group of patients who make themselves out to be war heroes with post-traumatic stress disorders when actually some of them weren't even in the service. Similarly there are patients who come to emergency rooms with tales about the tragic death of a spouse or child. This is known as feigned bereavement.
Are children of Munchausen syndrome affected?
Yes, often in a tragic way. Some parents give their children medications or poisons and then bring them to the hospital to make the physician figure out what's going on. This is Munchausen syndrome by proxy. Children themselves seldom suffer from the syndrome because they lack the medical sophistication to pull it off.
Since Munchausen patients cry wolf so often, are genuine medical problems sometimes overlooked?
Yes. Occasionally physicians mistakenly believe the Munchausen disorder is entirely faked. One patient's chest pain complaints were largely ignored due to his history. Even after coronary angiography revealed vessel disease, the results were disputed because of his Munchausen diagnosis. But in fact all three vessels were seriously diseased and a bypass operation was performed.
What tips you off that a patient has the syndrome?
Often it's the patient's facile use of medical terminology. Munchausen patients have a lot of knowledge about medical procedures. Sometimes it comes out inadvertently and sometimes they flaunt it.
Who was the most unusual Munchausen patient you ever treated?
Because this particular person impersonated military heroes, I called him Major Munchausen. I was familiar with him because there had been several articles written about his impersonations as an oceanographer working for Jacques Cousteau, a minister of the Church of Scotland, a professor of psychology from Nicaragua, a Boeing corporation executive and a nuclear physicist—to name but a few. By his own account he had 47 operations, and one look at his "gridiron" abdomen would be enough to convince anyone that this particular claim was true.
How did you meet him?
One day he came into the emergency room here claiming to have cardiac pains. The doctors suspected something was wrong because the symptoms did not match his complaints, i.e., he was not perspiring. They called me, and I went down and interviewed him. Immediately I recognized him. He said he was a Strategic Air Command pilot. I asked him if he had also told people that he'd worked with Jacques Cousteau, and his eyes got wide. Then I asked him if he'd told people he'd worked as a nuclear physicist, and he was quite startled. I told him I was familiar with him and that for me he was an important person. He was very pleased that I acknowledged his Munchausen mastery.
Can Munchausen syndrome be treated?
Munchausen patients are notoriously difficult to treat, partly because they travel from place to place and run away from caretakers. They up and go, against medical advice, because they want to remain in the sick role.
With The Adventures of Baron Munchausen playing in theaters across the nation this spring, many Americans are having their first introduction to the 18th-century German baron who was a famous teller of extremely tall tales. Most moviegoers are unaware, though, that he gave his name to a bizarre condition that afflicts from 4,000 to 12,000 Americans and costs the U.S. taxpayers as much as $40 million a year. Sufferers from Munchausen syndrome, so named by an English doctor in 1951, "go from hospital to hospital, inventing fantastic tales of illness or accidents to get the medical attention they crave, "says Dr. Loren Pankratz, one of the foremost experts on the disorder. Pankratz, 49, an associate professor of medical psychology and psychiatry at the Oregon Health Sciences University, spoke to correspondent Susan Hauser about the syndrome and some of the dozens of sufferers whose tales he has heard.