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Care seeking syndrome
MOST PEOPLE may no be familiar with this syndrome. The Munchausen Syndrome takes its name from Baron Karl Friedrich Hieronymus Frieherr von Munchausen, a German cavalry officer, who was known as a tremendous liar. Patients with this syndrome dramatically present very plausible symptoms and histories and receive care, in some cases even surgery. They fake physical signs of illness and abnormal laboratory findings.
In most cases, patients are seen to confuse themselves with strange association of ideas, colourings of supernatural notions and beliefs. With proper delineation, it would become clear that this phenomenon is a chronic addiction to invalidism, that it is neither sophisticated nor rare and is deliberately simulated by the patients in order to secure attention and care from others. This kind of illness is invariably found in individuals with hysterical traits, whose special craving is for sympathy and concern and for crazy participation in the high drama that hospitals may provide.
The Münchausen Syndrome is generally seen in patients with pathological lying tendencies, who frequent hospitals complaining of symptoms of gastrointestinal problems and inducing unhesitatingly unsuspecting surgeons to operate on them. These patients may show operation scars on their abdomen and report melodramatic accounts of their previous surgical interventions. This is only one variety of hysterical swindling.
Among the simulated illness are pyrexias (fevers) of unknown origin, haemorrhages, which may bring haemoglobin down to dangerous levels, acute gastrointestinal emergencies, coetaneous artefacts, or deeper wounds, which become infected and necessitate amputation of the limb, multiple abscesses exposed for relief incisions and more rarely neurological disorders like fainting spells and pseudo-seizures.
Some of the tricks used include swallowing blood then entering an emergency room and throwing up, pricking a finger and putting blood into a urine sample and injecting insulin to drop their blood sugar. Some go so far as to swallow fishhooks and nails.
The blend of conscious and unconscious mechanisms in the development of morbid condition of hysterical symptoms is peculiar and may be illustrated by a reported case. A middle-aged woman with a succession of physical illness, successfully simulated all of them, spread over a period of more than 25 years. The conditions for which she received investigations and treatment included multiple haemorrhages, gastrointestinal problems, pyrexia of unknown origin, suspected hyperthyroidism, multiple abscesses, septic arthritis of several joints and protracted pharyngospasms. In the course of her last admission to the hospital, there were found in her locker, innumerable syringes of various sizes and needles, catheters, textbooks of medicine and hundreds of tablets of various kinds including thyroid extracts. Unfortunately, she was the child of cold and remote medical parents, with marital disharmony with both largely absorbed in their own work. Incidentally, one day, the parents asked her, when she was a child, what she would like to be when grown up and the child's instantaneous answer was "A patient".
Almost 50 per cent of those with this syndrome are subject to drug abuse and may have borderline personality disorder which starts during early adulthood, but may begin during childhood.
This woman's story gives us some impression of the immense variety of hysterical manifestations. It is a point of interest, how much this type of manifestation has varied during the course of human history from age to age, from the hysterical fits to driving away of devils of the prehistoric era, the pilgrimages of the flagellants of the Middle Ages, communal psychoses affecting primitive communities as were seen in the witch-haunts of the 17th century (e.g., Salem Witches), down to the ages of neurasthenics. The prevalence of a disposition to hysteria probably remains unaltered through the centuries, but its manifestation is responsive to the "Zeitgeist" (the spirit of the age) and above all to the preoccupation, interests and theories of the medical professionals from time to time.
C. P. SOMASUNDARAM
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