Munchausen by Internet Breeds a Generation of Fakers

Over nearly three years, from 1998 to 2000, a woman—let's call her Anna—posted to an online support group for people with mental illness. To the larger circle of readers, she acted mostly as friendly counselor. But to a select few, she e-mailed stories of escalating catastrophes. Her husband and two children had perished in a plane crash, she wrote. As a kid, her father had molested her, and she had suffered multiple personality disorder. Finally, she told her trusted—and trusting—confidants that she had just been diagnosed with leukemia.

Gwen Grabb, a psychotherapy intern and mother of three in Los Angeles, says the group believed Anna because she took on the role of helping others, revealing her own difficulties much later, and to an intimate audience. "She was very bright," recalls Grabb. "She was very supportive and kind. One day, she started telling me about `the crash,' what they found in the black box, how you could hear her daughter screaming. I had known her a year. I believed her."

But as the tales became more elaborate and grotesque, Grabb grew suspicious. Along with another group member—Pam Cohen, a bereavement counselor in the Mid-Atlantic region—she did some research and discovered Anna was making it up. It was a shock to all, but worse than that to Cohen. "It is like an emotional rape," she says. People may have been upset over the online life and fatal cancer of the fictional Kaycee, whose creator admitted last month she'd invented the high school character for expressive purposes. But that was geared to a general audience, however easily suckered. Pretenders like Anna hurt a much more vulnerable group—folks who may be seriously ill and are seeking help.

The Internet was made for such fakers, says Dr. Marc D. Feldman, a psychiatrist at the University of Alabama at Birmingham and an expert on Munchausen syndrome and factitious disorder. People like these, he explains, suffer from a form of Munchausen, a condition in which they either feign illness or victimization, or actually induce illness or injury in order to gain sympathy and become the center of attention. With another variation, Munchausen by proxy, caretakers seek these rewards by making their charges sick. Cyberspace has added a new twist—one Feldman labels Munchausen by Internet.

To credibly represent themselves as ill—often with obscure and dramatic maladies—Munchausen sufferers often study medical literature, and even go so far as to poison themselves to simulate particular symptoms. "On the Internet," Feldman explains, "it's very easy to fake. All you have to do is click and you go to another disease site. You can become an expert on anything in 30 minutes by visiting Google." By the time Feldman published his article "Munchausen by Internet" in the Southern Medical Journal in July of last year, he'd already studied over 20 cases of cyberMunch. "The incidence is increasing rapidly," he reports.

Feldman runs his own site, and provides a link to another started this year by Cohen, Victims of Factitious Liars). Cohen says the people who congregate at her site feel betrayed, but they understand the fakers are seriously troubled.

The irony in these Munchausen cases is that those pretending to be ill really are sick, but they rarely go to the right kind of doctor. When confronted on the Web, they often disappear. In person, they may show some contrition even though they resist treatment. One of Dr. Feldman's first Munchausen patients was a profoundly depressed young woman who was feigning terminal breast cancer. He hospitalized her and successfully treated her with psychotherapy and drugs. "We tell them we'll give them treatment for their emotional illness," Feldman explains, "that they don't need to be ill to see a doctor anymore."

Getting them proper treatment could prevent a lot of harm. Off-line, by some estimates, people with Munchausen and similar disorders consume as much as $20 billion annually in unnecessary medical procedures. Those taken in by online Munchausen sufferers are often homebound. For them, the Internet is a lifeline to the outside world. "To discover that their love and nurturing have been misdirected is like being taunted with their own illness," Feldman says. "It's devastating."

Diane Hamilton, a librarian in Cape May, New Jersey, and a migraine sufferer, brought one such case to Dr. Feldman's attention. From 1998 to 1999, a visitor posted to a long-standing migraine support group on Usenet. He claimed to be a 15-year-old medical student. Not only did he have migraines, he said, but he also had a seizure disorder and hemophilia.

At first he won great love and approval from the group. Then his stories become more and more incredible. His mother was deaf and his father was alcoholic and abusive. He had to skateboard three miles a day to get the bus to medical school, and he had a nightclub job as a drummer. When group members began to question his stories more and more aggressively, his "mother" signed on to say how their doubt might plunge the boy into another episode of depression. Finally, as he was met with increasing skepticism, both the "teen" and his "mother" disappeared from the site, having victimized a vulnerable group..

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