Cybersickness

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..

"Some of them had such bad migraines they had to be on Social Security disability," says Hamilton. "Others had them from head traumas from accidents. Many had been on drugs for years with no relief."

After their encounter with the fake poster, the group never recovered. It split into factions of believers and doubters, its spirit of trust and caring broken.

An even more bizarre case involved the 1997 duping of a Web-based fan club for the musical Rent. Many of the members had met while waiting on line for tickets in New York, and for them the club became a support network. Catherine Skidmore, a 26-year-old technology consultant in New York, was one of those taken in a student claiming to suffer from a fatal liver and nerve disease.

"She showed up once with an IV shunt taped in her arm," Skidmore recalled. "And she'd go to the cast members and try to get sympathy." In this way, the woman was able to meet and have dinner with Rent stars Anthony Rapp and Gwen Stewart. When she returned to Chicago, the group started getting e-mail from a "friend" of the woman's. The messages were full of medical jargon and day-by-day accounts of the "sick" person's condition as she slipped into a coma. "I had lost a friend who didn't tell me she was dying," says Skidmore. "So I wrote to her and said I didn't want her to be alone."

Skidmore and others in the group prayed, sent messages, and bought tickets to fly to Chicago. But whenever they were about to leave, the friend, who refused to give the name of the hospital, would write that Rachel had miraculously recovered.

Eventually, these Lazarus-like revivals aroused suspicion. Group members uncovered the hoax by calling all the hospitals in Chicago. Rapp's boyfriend, Josh Safran, was one of the fraud detectors. "I can't believe the lengths she went to. Her e-mails were very medically proficient. And everybody's lives were so messed up. It was total drama." Although Safran was skeptical early on, he hesitated to mention his doubts. "If she turned out to be sick after this, we were horrible people."

The people who perpetrate these hoaxes don't usually consider the ways they're harming others. One former Munchausen patient, a 40-year-old computer technician on the West Coast, used to hurt herself and pretend she'd been the victim of an attack or accident. "I called them 'scenarios,'" she explains. "When I'd do something to attract the paramedics and police, I got an adrenaline rush. I believe I got addicted to it. At the time, it didn't occur to me I was hurting anyone but myself."

For those who do not want to be victimized by such folks, however sick they may or may not be, Dr. Feldman has developed a series of cues for online detection. Some warning signs are posts that copy textbook material or other online sites verbatim, and a series of dramatic declines followed by miraculous recoveries. Be suspicious when the person makes fantastic claims, he says, resists telephone contact, or complains that the group is not supportive enough. Be very suspicious if a "friend" or family member posts for the sick person—displaying the same writing style and spelling errors.

The treatment for the support-group fakers is psychotherapy. The treatment for their victims is...another support group. Victims of Factitious Liars already has 42 members who post regularly about their own victimization and brainstorm about how to get publicity and funding to treat Munchausen. Cohen and Grabb are hoping to make a documentary on the Munchausen phenomenon and have recently received a substantial contribution from an individual donor.

Paradoxically, one of the issues Cohen and Grabb must confront is that a member on their own site could be lying. "Look for inconsistencies in the story over time," Cohen advises her group. "If you become suspicious, e-mail me and let me know. For the most part, we have to take what people say at face value. But let's all be aware that we could get used and get emotionally attached to someone who is an online liar."

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