For the most part, we diligently avoid the topic of illness, and this is understandable: it is natural to be afraid of illness. But among us there are those who pretend to be sick and willingly tell others about terrible “diagnoses”. What drives them?
This spring saw the release of the first season of Pretense, a film based on a true story about how Dee Dee Blanchard convinced Gypsy’s daughter Rose Blanchard that she was suffering from several diseases, including cancer. The ending of the non-fictional story is tragic: Gypsy persuaded her boyfriend to kill her mother. For the crime, the young man received a life sentence, and Gypsy was sentenced to 10 years in prison.
The series and the Blanchard trial, which was widely covered by the American and world media, drew public attention to the topic of feigning disorders (a diagnosis officially recognized by the American Psychiatric Association). They are divided into several types. More common is the simulation of one’s own diseases or Munchausen’s syndrome: a person convinces others that he allegedly suffers from a severe physical or mental illness. There is another variety – the delegated Munchausen syndrome shown in the series “Pretense”. In this case, one person, most often a parent or caregiver, simulates the illness of another, usually a child.
Why are some people willing to pretend that they suffer from serious illnesses? There may be several reasons.
Lying as a consequence of a mental disorder
Although factitious disorder is a fairly rare diagnosis, cases occur in many countries. “It is believed that approximately 1% of hospital patients suffer from feigning disorder. They cause more problems for the health care system than we think,” says psychiatrist Mark Feldman, an expert in feigning disorders and author of the book I Want to Die to Get Ill.
Those suffering from Munchausen’s syndrome often behave in such a way that they are actually considered sick. They make doctor appointments, talk about an illness or injury, go to group therapy, or discuss fictitious problems with friends. For the book, Feldman interviewed dozens of people with Munchausen syndrome, many of whom described the desire to fake as an addiction or an obsession. They so want to attract attention and arouse pity that they are unable to resist this temptation.
Delegated Munchausen syndrome is often found in “martyrs”: a caring parent longs to receive praise and sympathy from others.
Simulators have found a way to overcome the isolation and indifference of others
Some make up a fictitious illness to gain a sense of control over the situation. For those who have an underdeveloped self, this is a very pleasant feeling: the role of the patient gives them clear goals to follow. For example, they may lie in the hospital for long periods or (increasingly, according to Feldman) spend hours on the Internet looking for information on ways to treat a non-existent disease.
Simulators are different from hypochondriacs – anxious individuals who constantly suspect that they have some kind of disease: they actually know that they are healthy. Most often, they are forced to lie by the desire to receive the attention and sympathy of others. “One day they discovered this unhealthy way to satisfy their emotional needs and have continued to stick to it ever since,” explains Mark Feldman.
These people often suffer from personality disorders and have unhealthy thought and behavior patterns. “A personality disorder is a tendency to satisfy one’s needs in unhealthy ways. Simulators have found a way to overcome their isolation and the indifference of others, ”explains the psychiatrist.
They often claim to have cancer. One of the first simulators observed by Mark Feldman was a 35-year-old woman who claimed to be suffering from terminal brain cancer. The psychiatrists were able to help her.
Selfish motives
If a person pretends to have cancer, this does not mean that he has mental problems. They exaggerate the severity of the disease, often for selfish purposes: to get prescription drugs, financial assistance, or to get out of trouble.
“Psychologists and psychiatrists happen to come across such cases, but the simulation of an illness for selfish purposes is not a mental disorder. Often the reason becomes clear if you know the life circumstances of the simulator – for example, that he has financial problems, ”says Mark Feldman.
Recently, cases of fraud on the Internet have become more frequent: people pretend to be seriously ill and collect money for treatment. Take, for example, Bella Gibson, who claimed to have cured brain cancer with a special diet, raised money ostensibly for charity, and in 2015 created a brand of “healing” products. Later it turned out that she feigned illness, and appropriated the collected money.
Even if the malingerer is driven by selfish motives, he can still enjoy caring
“Many fall for the tricks of scammers, because they are well versed in the skills of emotional manipulation. Their stories touch us to the core and evoke strong emotions. It is difficult to remain indifferent to a cancer patient, ”says Connecticut psychologist Marni Amsell. But even if the simulator is driven by selfish motives, he can still be pleased with the care and attention of others. “Almost all of us are flattered by increased attention, and malingerers know how to get it,” explains Amsellem.
Can feigning disorder be cured?
It is not easy to treat a person with a pathological tendency to simulate. Those suffering from Munchausen syndrome and similar disorders usually see doctors only for a fictitious illness, and not for mental problems. However, psychotherapy and behavioral therapy can be effective in helping the patient review and change unhealthy thought and behavior patterns.
Mark Feldman believes that in many cases, Factitious Disorder is better treated as an addiction, especially in those patients who experience euphoria when they manage to deceive someone. They become addicted to this feeling and find it difficult to stop, although they destroy life with constant lies.
Feldman is convinced that the methods developed for the treatment of addictions can help many chronic malingerers as well. He happened to meet several patients who independently compiled a therapy program and were able to get rid of the obsessive desire to pretend to be sick with its help.