Curing Fake Patients

Patient or Pretender: Inside the Strange World of Factitious Disorders by Marc D. Feldman '80, DMS '84 and Charles V. Ford with Toni Reinhold (John Wiley & Sons, Inc., 1994)

Playing sick may be the most common, and harmless, childhood illness. Ferris Bueller did it to get himself a day off in Chicago. But he was a rank amateur compared to the people described in a new book co-authored by Marc Feldman, a University of Alabama psychiatrist. Feldman's patients feign illness so well that the deception becomes a dangerous disease in itself one that requires a specialized treatment described in the book. You don't have to be a doctor yourself to be drawn into this account of the lengths to which people will go to benefit emotionally from pretending to be ill.

Why do grownups pretend to be sick? Feldman says they may be after some TLC, the safety of a hospital setting, the pleasure of being the center of attention, or a sense of power that comes from stumping the medical community. So strong are these cravings that people will actually take poison, bleed themselves until they are anemic, induce fevers, infect wounds, even feign cancer. In the full- blown factitious disorder Munchausen syndrome, patients move from one doctor and hospital after another when their deceptions are in danger of discovery. (The syndrome is named for the legendary eighteenth-century liar Baron Karl Friedrich Hieronymus von Munchausen. The label is somewhat of a bad rap; he himself never pretended to be sick.) Much more insidious are the abusive conditions called Munchausen by Proxy and Munchausen by Adult Proxy, in which an adult induces illness in a child or another adult to gain sympathy and support as the caregiver.

Strangely, between a third and a half of all factitial patients are themselves nurses and other healthcare professionals a case of healers unable to help themselves.