May 7, 1996
"If we take license in insisting that every Nazi was a criminal--worse yet, denying him his claim that he has evidence to clear his blighted name--is there a "syndrome" or a model that fits the Opposition?
I would like to propose the Munchousen Syndrome, based on a well-known psychiatric disorder. It describes the Professional Sufferer.
The diagnostic label comes from a German nobleman who lived two hundred years ago--Baron Karl Friedrich Hieronymous Freiherr von Münchhausen-a cavalry officer who kept a century engrossed with his amazing tales.
Here's what this raconteur par excellence could do:
- He could jump on a cannon call, spy on the enemy, jump back on yet another cannon ball, and tell the troops what he discovered.
- He had a dog that ran his feet to stumps and then flipped over, using a spare set attached to his back.
- In a snowstorm, he tied his horse to what he thought was a convenient post. When he woke up the next day, he saw the snow had melted overnight and his poor horse was hanging from a church steeple.
- Once he laid bait with small pieces of bacon tied to a string. Hiding himself behind shrubs, he watched how a flock of geese snapped up the slippery bait from each other after it passed through their intestines, only to fly in formation, having strung themselves up in a pattern.
Munchousen "patients" exist. This form of mental illness-the need to tell tall tales and watch how others swallow them and then "fly in formation"-belongs to the "factitious" classification.
Factitious means "not real, genuine or natural." It is a chronic form of mental illness that is held to be volitional in that the patient is fully in control; he knows what he is doing. It is involuntary in that the patient cannot stop.
Some people are important for what they do; a Munchousen defines his "worth" by what was done to him. Munchousens are in need of sympathy. All of their illnesses have a compulsive quality. They know how to pester and wallow. The stories of their maladies won't quit.
The aim is to become a lifelong charity.
Toward that end, behaviors appear deliberate and purposeful. Munchousens are very smart people. Physicians know such "patients" make intelligent decisions as to timing and concealment. Munchousens have a working vocabulary of their illnesses and are well-stocked with "facts," limited only by the person's medical knowledge, sophistication and imagination.
On the surface, a Munchousen's symptoms may look like malingering but should not to be confused with malingering. A genuine malingerer has good reasons to want to appear to be sick. He may try to avoid the draft or jury duty, or maybe he just feels he needs an extra holiday. A Munchousen needs to be coddled.
His "illness" may be a total fabrication or partial fabrication, or an aggrandizement of a legitimate but relatively minor pain. The goal is to be hospitalized so someone will take care of him.
Therefore, Munchousens are not above helping their "symptoms" along in such a way as not to be likely discovered. Some patients will spit into their urine to distort the laboratory findings. Others may prick their finger to show blood in their stools. Not infrequently, there is fairly serious self-mutilation.
Munchousen yarns are intriguing to the listener; besides, they bring amazing dividends. They grow more elaborate with each presentation. Imagination runs at a fever pitch. A Munchousen knows how to suffer. He does so with gusto and flair.
Paradoxically, Munchousen symptoms become aggravated when a Munchousen thinks he is being observed. He can't refrain from simulating yet another illness with even wilder symptoms than the one he just "survived"-even if the danger of discovery is known.
Most Munchousens are highly suggestible. Once they have checked into Emergency, they grab hold of additional symptoms the examiner may mention in passing. Almost all of them suffer from memory loss, hallucinations, dissociate and conversion problems. A Munchousen presents with great dramatic genius, but will become vague and inconsistent when questioned on detail. One diagnostic cue is a specific Munchousan habit called "vorbeireden"--meaning they are skilled in "talking past the point." They will give approximate answers, engage in "near misses," or flood the listener in rapid and disjointed speech. As one physician explained this strange phenomenon:
"Asked when Santa comes, they'll tell you, Halloween's. They'll tell you with the straightest face that eight times eight is sixty three."
Sometimes, this can be self-defeating. Because of their compulsive need to beseech sympathy, Munchousens have great difficulty forming lasting relationships. They don't have many friends. The staff will notice that not many people visit.
This only proves the patient's point he is rejected by society and therefore needs more pampering.
Other normal interpersonal interaction is frequently impaired. Hence, a Munchousen patient has difficulty maintaining steady employment.
Hospitalization soon becomes a way of life and a magnificent obsession. Munchousens claim their particular suffering gives them the required emotional insights, and they will challenge a professional who tells them otherwise. Negativistic and uncooperative, a Munchousen will often cause havoc on a ward by non-compliance with hospital rules. When the hospital staff becomes suspicious, the patient turns strident and often abusive.
Genuine Munchousen patients have fall-back positions.
One such defense is that the person who discovered the deception must be sick.
Another tactic is character assassination, or a challenge to professional competence. When confronted with undeniable evidence, the patient threatens litigation, starts arguing excessively and loudly that his ailment is real and suspicions of fakery unfounded.
When all his options have run out, a Munchousen will discharge himself in haste, heading for yet another hospital, repeating his charade. He knows that it is dangerous, but he will keep recycling the same story of his enormous suffering and hope that it still works.
This search for attention takes Munchousens from city to city in search of yet another hospital and yet another sympathetic ear, sometimes to foreign countries and even continents.
Some professionals feel the disorder is common but rarely recognized. Others feel the disorder is over-reported because the same patients appear at different hospitals, using different names and sometimes fake IDs, thus artificially boosting the count.
Tellingly, the Munchousen Syndrome is a disorder that can only be inferred by a skilled outside observer but cannot be diagnosed by conventional means. Diagnosis is arrived at by exclusion of all other factors.
Sadly, Munchousens are incurable. Much has been tried, but nothing seems to work. Said one frustrated doctor, as documented in a classic reference book: "Perhaps the only defense the system has against a Munchousen is to tattoo his belly."
Ingrid
Thought for the Day:
"Are we geese flying in formation?"