Mstang, if it was a staph infection just beginning, by now it would be even more painful and much redder, probably already showing signs of pus formation. I threw that in just in case, and because the treatment for it is practical and not pleasant if there really is no problem; but the treatment also won't do any harm (unlike taking antibiotics when they're not really needed). I'm glad he hasn't got it; sorry if he's still trying to play on it.
Star, that neighbour of yours sounds more like a Munchhausen's case. A hypochondriac is generally a fairly normal person who is AFRAID they are ill; they're always worrying, "It could be this; it could be that." But they can be reassured, they usually will jump at the chance to see the doctor, because this is a genuine belief. This isn't primarily attention-seeking behaviour, it's genuine concern for their health.
A Munchhausen's case, on the other hand, wants EVERYONE ELSE to think they are ill, and they do it for attention. Generally they know, at some level, that they're not sick. But they will go to sometimes extreme lengths to try to convince other people that there is something serious wrong with them. They also can get very aggressive and angry with the medical profession for failing to diagnose what is wrong; doctors are "incompetent, uncaring" and any attempt by a doctor to say that there is nothing wrong and they should see a psychiatrist - Munchhausen's patients will get extremely angry and almost always refuse psychiatric help.
A classic finding in Munchhausen's is lack of continuity of care. They keep changing doctors because they keep getting found out. Once a doctor gets suspicious, the patient moves on. Eventually the patient has to lie, more and more, about their identity, their history, everything, in order to maintain the lie. And they know it's a lie.
A hypochondriac will read medical textbooks in order to examine the symptoms they believe they have. A Munchhausen's case will read medical textbooks more secretly, in order to get their story straight and to be able to manufacture the symptoms of the disease they have chosen to 'have'.
A hypochondriac has no reason to hide anything. A Munchhausen's patient has to hide their knowledge or have a way of explaining it, because knowing they're being dishonest about it, they are generally paranoid about people getting suspicious.
When I first left home at 17 to go to uni, I could have been described as a hypochondriac. I was anxious about every little symptom, often going to the doctor (free clinic) for the slightest little thing. I felt a fraud, especially as I was leaving, always embarrassed to find the symptoms which had been worrying me always seemed to disappear by the time the doctor was ready to see me. Looking back, my symptoms could well have been connected to a combination of my own extreme naievety about life and the world, plus living on my own meant my diet wasn't as good as it should have been and I wasn't looking after myself properly. I later became seriously ill which gave me a benchmark by which to measure all future feelings of not being well. What helped me most was understanding of my anxiety and being gently reassured that my symptoms had been carefully considered and I was really OK.
I have also had a lot to do with a woman who was Munchhausen's. Another woman I knew very well over quite a number of years was, I believe, likely to have been Munchhausen's by proxy. But I won't talk abut her, that was too tragic.
The woman who was Munchhausen's, I'll call her Marie, I first encountered through my volunteer work on a telephone counselling and information service. Initially, I was the only person on the service, so I got Marie ringing me up A LOT. I also met her many times at various seminars run by the organisation.
Marie's tone of voice could at times whine, wheedle, cajole and then suddenly turn vicious. Unpredictable and increasingly, scary.
One day she complained to me that she had lost the subsidised taxi service for people with mobility problems. I offered to support her appeal by writing a letter for her (or rather, she bullied me until I agreed).
"So, for this letter, it will help if you tell me exactly what your diagnosis is."
Marie began a long list which included diabetes, epilepsy, rheumatoid arthritis, food sensitivities, multiple allergies, heart problems and chronic fatigue syndrome. I was meticulous about this list and read it back to her for confirmation.
I sent the letter off, she rang me a week later to thank me, she had got the subsidised taxi service reinstated.
She had been complaining about the retirement home she was living in (despite still being too young). They were refusing to give her the vitamin injections prescribed by her doctor. She told me the name of her doctor, it had changed again. I actually dropped in to visit her one day while I was in the area; she was out so I talked to the matron of the place hoping to plead Marie's case to her, ask for more compassion for Marie. In her turn the matron described a few incidents to me, such as the time (while the taxi service was unavailable to her) Marie asked to be driven to the railway station. Marie was using two quad sticks for walking. The matron had to carefully ease Marie down onto the seat, Marie groaning in pain all the time, stack the quad sticks on the spare seat and then drive gently to the station. At the station Marie's train was already in - she didn't wait to be helped out but almost jumped out of the car, grabbing her quad sticks and RAN for the train, quad sticks under her arm! The matron said, "I don't like being taken advantage of."
Marie rang me later that afternoon, abusive. "How dare you spy on me? How dare you come round looking for me? I was at the doctor's, I'll have you know, I was NOT out somewhere partying, I was SICK! What were you hoping to prove?"
I placated her, told her I had wanted to visit to ask if she wanted a lift to the next seminar. Marie's mood changed instantly, to sweet as pie.
This was the pattern. I was exhausted and began screening my calls. One day a few months later she rang and was telling me, "My doctor told me yesterday, that I have diabetes."
A flicker of memory. While she talked I checked my notes, found the letter she had almost dictated to me which listed her (then) diagnoses. "Marie, you told me three months ago that you already had diabetes."
Whoops. She screamed at me. "NO, I NEVER! Why would I say such a thing when I didn't have it? I only got diagnosed yesterday!"
I didn't say any more, there was no point. She was adamant that she had never said that she had diabetes.
That was when I did some digging and learned about Munchhausen's. The more I learned, the more I used her regular calls to me to probe. It was fascinating. In all the time she had talked to (at) me, she had never said a word about her past. Nothing about what sort of job she used to do, what she had studied, where she had lived, if she had ever married or had kids - nothing. Her past did not exist. And if I tried to ask about her medical history she would get vague, or she would find ways to change the subject.
One hallmark of a serious long-term Munchhausen's is a history of numerous past abdominal exploratory surgeries. Of course she wasn't going to tell me, so one day when she was complaining of abdominal pain I said to her, "You know Marie - you could have adhesions."
I could hear her ears prick up. "What are adhesions?"
"It's scar tissue, where bits of muscle and other things get stuck together as scar tissue develops, usually after abdominal surgery. But you would have to have had abdominal surgery to get adhesions."
I had done it. She rattled off a long list of abdominal surgeries, including a lot of exploratory laparotomies. No time frame, but a long list.
Another time she was asking me about my health. Now, she NEVER wanted to know about other people so I was curious. She pumped me for exact detail of my symptoms. How did it feel? How did the pain first start? How could I describe it?
I told her. I suspected what she was up to but I told her anyway. I also had told her that my constellation of symptoms plus the conditions which had triggered it all was considered very rare. Who knows? That may have been what made her curious.
A week later I was giving her a lift to a seminar. A neighbour of mine, male, came too. She was all over him like a rash, all night. Looking back I think she thought he and I were "an item" (no way!). But also, as we drove, she wouldn't stop talking. I was tired and trying to cope with city traffic, almost crashing the car as her voice changed from wheedle to tirade mid-sentence. Then I almost crashed the car again, as she began to describe her newest symptoms. Word for word, it was my description of my nerve pain, the description she had pumped me for a week earlier!
Utterly bizarre.
At every stop, when Marie had to get out of my car or back in, she needed my neighbour to carefully lift her into her seat or carefully lift her out. She had to be helped with her seat belt. She was also discussing the specialist which she and I both shared - "A lovely man. Did you know, the last time I saw him, he gave me a big hug and told me I was his favourite patient!" she confided. I had months earlier heard the same thing, and learned that if I hinted to any friendship with our specialist she would fly into a rage. Once I had said, "He's like that with everyone," and she screamed at me that I was lying. She really seemed to get off only on medical attention. She was clearly competing with me, she had only acquired the quad sticks after she saw me using my canada crutches a year earlier.
At the seminar, Marie kept interrupting the guest speaker with personal questions. Instead of making general questions, she had to ask specifically about her own symptoms. It was bizarre and embarrassing.
Later we dropped her off at her retirement home. She was on fire, had enjoyed a wonderful evening, in her eyes clearly the sickest person present but to us looked as healthy as an ox. My neighbour walked her to her room. Marie almost flew up the stairs, quad sticks not touching the ground, except for when she 'remembered' she was disabled. As he pushed open the door to her room, he told me later, she grabbed him and kissed him - tongue and all. He was in shock, all the way home from there he kept saying, "She kissed me - yuk!" and wanting to drag his tongue on the tarmac.
Marie was a sad case, she had no concept of love or affection unless it came in a white coat holding a hypodermic. The kindest thing the matron could do for Marie was to give her the vitamin injection the doctor ordered.
BY sheer fluke I did eventually find out about Marie's past. A woman who shops around for doctors also shops around for other organisations to lean on and to leech. My close friend was associated with another organisation which had Marie in their number at one time. She had a different batch of medical problems back then but also had a young daughter who was always sick (according to Marie) but the doctors often could find nothing wrong. Then another contact a few years later reported encountering Marie, but no sign of a daughter or any hint one had ever existed.
The final contact I had with Marie was when our specialist had successfully referred her to a psychiatrist colleague of his (who was doing more than just psychiatry). She rang me excitedly to tell me that he had diagnosed her with "chronic somatisation syndrome." It sounded so rare, so important, she was thrilled.
I quietly looked it up. It meant that she had been faking disability for so long that she had actually developed functional disability.
Marie openly declared she was ill, but she also was a skilled faker. She must have realised, at some level, that she was making it up, but for her she needed to be ill in order to get the only attention in the world that she could value. Anyone else with health problems was a potential rival and had to be undercut or outclassed (hence her attempt to copy me). Any hint that you were on to her and she would get vicious. I know if I had persisted in accusing her of faking, she would have vanished and started over again somewhere else.
Munchhausen's patients will often make themselves sick if they must, to get medical attention. A Munchhausen's by proxy will make other people sick, in order to get attention (often as the hero rescuing others, or the desperate but angelic parent with the suffering child). If they can they will just fake it, but if they have to cause themselves harm they will. Their entire life revolves around getting attention for medical problems.
A hypochondriac wants to be well but is afraid he is not. A hypochondriac will seek medical attention in order to get well.
A Munchhausen's patient's sole purpose is to acquire medical attention, not to get well but for its own sake. But it is never enough, it is a craving that can never be satisfied. And the resentment when they see someone else getting what they consider to be more medical attention - they will behave like jealous two year olds.
Some are stupid, like Marie. Some are very smart and much cleverer at covering their tracks, like the other woman I mentioned in passing. I lost contact with her years ago, when she knew I was on to her. Anyone who ever seemed remotely critical of her was cut not only from her personal contacts, but from her cronies as well. She is a charismatic and powerful person who was able to sustain her own credibility by removing anyone who didn't consistently believe in her and champion her cause.
They often feature Munchhausen's on TV medical shows. Just as when they feature autism or ADHD, I can pick it - every time. It's become a family joke.
Marg
