Bioethics Discussion Blog: Munchausen by Internet: Should We Believe Everything Our Visitors Tell Us Here?

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Saturday, June 09, 2012

Munchausen by Internet: Should We Believe Everything Our Visitors Tell Us Here?

On many of the threads on my blog, my visitors describe their own medical conditions and their experiences with the disease and with their healthcare providers. Probably more common, of course, are visitors to online chat or websites which deal with and provide support for specific illnesses and encourage discussion.  The general personal anonymity of the postings encourage free discussion of one's described illness and experience.  Often there may be a outpouring of sympathy by the other participants to the site. Unfortunately, it has been discovered and documented that these personal narratives of one's illness are fabricated by the writer for their own psychological reasons. And this condition has been named: "Munchhausen by Internet". An excellent description  of this behavior is described in the Wikipedia presentation "Munchhausen by Internet" from which the following portions are copied below. Go to the Wikipedia link and read the entire article including noting the resources. What do you see as the ethical implications of such behavior on the internet and the effect of such made-up life experiences might have on large numbers of innocent but ill visitors struggling with their own concerns? ..Maurice.



Münchausen by Internet is a pattern of behavior in which Internet users seek attention by feigning illnesses in online venues such as chat roomsmessage boards, and Internet Relay Chat(IRC). It has been described in medical literature as a manifestation of factitious disorder or factitious disorder by proxy.[1] Reports of users who deceive Internet forum participants by portraying themselves as gravely ill or as victims of violence first appeared in the 1990s due to the relative newness of Internet communications. The pattern was identified in 1998 by psychiatrist Marc Feldman, who created the term "Münchausen by Internet" in 2000. It is not included in the fourth revision of the Diagnostic and Statistical Manual of Mental Disorders(DSM-IV-TR).
The development of factitious disorders in online venues is made easier by the availability of medical literature on the Internet, the anonymous and malleable nature of online identities, and the existence of communication forums established for the sole purpose of giving support to members facing significant health or psychological problems. Several high-profile cases have demonstrated behavior patterns which are common among those who pose as gravely ill, victims of violence, or whose deaths are announced to online forums. The virtual communities that were created to give support, as well as general non-medical communities, often express genuine sympathy and grief for the purported victims. When fabrications are suspected or confirmed, the ensuing discussion can create schisms in online communities, destroying some and altering the trusting nature of individual members in others.
The term "Münchausen by Internet" was first used in an article published in the Southern Medical Journal written by Marc Feldman in 2000. Feldman, a clinical professor of psychiatry at theUniversity of Alabama at Birmingham, gave a name to the phenomenon in 2000, but he co-authored an article on the topic two years earlier in the Western Journal of Medicine, using the description "virtual factitious disorder".[2] Factitious disorders are described in the Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR (DSM) as psychological disorders involving the production of non-existent physical or psychological ailments to earn sympathy. These illnesses are feigned not for monetary gain or to avoid inconvenient situations, but to attract compassion or to control others.[3] Chronic manifestation of factitious disorder is often called Münchausen syndrome, after a book about the exaggerated accounts of the adventures of Baron Münchhausen, a German cavalry officer in the Russian Army, that was written by Rudolf Erich Raspe.[4] When another person's symptoms are caused, such as a child or an elderly parent's, it is called factitious disorder by proxy, or Münchausen syndrome by proxy.[5]
Feldman noted that the advent of online support groups, combined with access to vast stores of medical information, were being abused by individuals seeking to gain sympathy by relating a series of harrowing medical or psychological problems that defy comprehension.[1] Communication forums specializing in medical or psychological recovery were established to give lay users support in navigating often confusing and frustrating medical processes and bureaucracy. Communities often formed on those forums, with the goal of sharing information to help other members. Medical websites also became common, giving lay users access to literature in a way that was accessible to those without specific medical training. As Internet communication grew in popularity, users began to forgo the doctors and hospitals often consulted for medical advice. Frequenting virtual communities that have experience with a medical problem, Feldman notes, is easier than going through the physical pain or illness that would be necessary before visiting a doctor to get the attention sought. By pretending to be gravely ill, Internet users can gain sympathy from a group whose sole reason for existence is support. Health care professionals, with their limited time, greater medical knowledge, and tendency to be more skeptical in their diagnoses, may be less likely to provide that support.[1][6][7]People who demonstrate factitious disorders often claim to have physical ailments or be recovering from the consequences of stalkingvictimizationharassment, and sexual abuse. Several behaviors present themselves to suggest factors beyond genuine problems. After studying 21 cases of deception, Feldman listed the following common behavior patterns in people who exhibited Münchausen by Internet:
  • Medical literature from websites or textbooks is often duplicated or discussed in great detail.
  • The length and severity of purported physical ailments conflicts with user behavior. Feldman uses the example of someone posting in considerable detail about being in septic shock, when such a possibility is extremely unlikely.
  • Symptoms of ailments may be exaggerated as they correspond to a user's misunderstanding of the nature of an illness.
  • Grave situations and increasingly critical prognoses are interspersed with "miraculous" recoveries.
  • A user's posts eventually reveal contradictory information or claims that are implausible: for example, other users of a forum may find that a user has been divulging contradictory information about occurrence or length of hospital visits.
  • When attention and sympathy decreases to focus on other members of the group, a user may announce that other dire events have transpired, including the illness or death of a close family member.
  • When faced with insufficient expressions of attention or sympathy, a forum member claims this as a cause that symptoms worsen or do not improve.
  • A user resists contact beyond the Internet, by telephone or personal visit, often claiming bizarre reasons for not being able to accept such contact.
  • Further emergencies are described with inappropriate happiness, designed to garner immediate reactions.
  • Other forum members post on behalf of a user, exhibiting identical writing styles, spelling errors, and language idiosyncrasies, suggesting that the user has created fictitious identities to move the conversation in their direction.[1]



8 Comments:

At Sunday, June 10, 2012 3:59:00 AM, Anonymous Anonymous said...

People are deceptive in every situation imaginable, for all sorts of reasons - from the white lie re. "Does this dress make my butt look fat?" to extremely serious and hurtful lies. I don't find this particularly different, or surprising.
The internet makes all sorts of deception easier - from Nigerian scammers to this.
I think people that spend that much time on their Munchausen by Internet probably have some sort of psychological disorder, and are more sick than "evil". It'd be too much bother, and not enough reward, for someone psychologically healthy.
Does it hurt people, and cause damage to internet communities? Sure. Lies hurt people in all sorts of situations.
I think perhaps part of the bigger problem is people being too invested in online communities. To me, if you're online, you're generally not "real" until I have contact with you in some other form. It's hard to maintain that detachment sometimes however, especially for some people, so I don't know what the answer is.
TAM

 
At Sunday, June 10, 2012 9:50:00 AM, Anonymous Anonymous said...

Another disorder to consider is
Munchausen internet by proxy.This
is an even more serious disorder
whereby we believe there is something wrong with our computer
internet service when in fact it is perfectly fine.

PT

 
At Sunday, June 10, 2012 10:17:00 AM, Blogger Maurice Bernstein, M.D. said...

PT, wrong! or maybe I misread what you intended to express. The use of the diagnostic term Munchausen whether direct or by proxy is to describe the behavior of an individual who demonstrates an intent to deceive rather than simply expressing an mistaken belief. The deception is an attempt to attain a goal. ..Maurice.

 
At Sunday, June 10, 2012 1:41:00 PM, Anonymous Anonymous said...

But Maurice

Munchausen by proxy is an
exaggeration or fabrication of
illness by a primary caretaker.
Based on that definition
I am suggesting there is something
wrong with my computer or internet
service.It seems to be working
perfectly fine,but perhaps there
is something wrong.

PT

 
At Sunday, June 10, 2012 4:34:00 PM, Blogger Maurice Bernstein, M.D. said...

PT, I would say the usual use of the term "Munchausen by Proxy" is as follows:"Munchausen syndrome by proxy (MSP), a type of factitious disorder, is a mental illness in which a person acts as if an individual he or she is caring for has a physical or mental illness when the person is not really sick."(Cleveland Clinic )

The proxy subject is a cared for human or animal and not an object. Further, the intent of the exaggerator or fabricator is to obtain self-satisfaction for the consequences of an intended deception.

Again, this syndrome has nothing to do with the person's belief since the person is aware that the subject is healthy. It has to do with the person's intent to create an illusion of sickness in another by carrying out some action or actions upon the other.

PT, with regard to your example, I really don't think computer repair or internet service providers really have experienced such proxy behavior of a customer and I am not sure to what customer benefit but I suppose any bizarre human behavior is possible.

And now back to the main issue: the effect within the internet of visitors expressing lies about their medical condition, treatments and outcomes for their own benefit.
For example, how about spammers who would love to get internet folks to believe that a certain product makes for a healthier life, weight loss or an extra-long penis? A little detailing of the "personal experience" but without identification that this is just an advertisement would certainly be one example of "Munchausen by Internet." But one doesn't have to be a spammer for financial gain but simply an individual who feels "uncared for" and wants others to deliver some sympathy for what the individual has allegedly undergone.
Yet, these individual's lies, may undermine the true educational and even therapeutic value of a internet discussion site. ..Maurice.

 
At Sunday, June 10, 2012 10:19:00 PM, Anonymous Anonymous said...

I doubt when Baron Munchhausen's behavior was
first described, no one ever imagined this syndrome
as being expressed through a device such as the
Internet. In fact, classic munchausen is always exhibited
to medical personel, repeatedly. The driving force being
a need for attention with an underlying cause of depression.
Fairly hard to achieve these goals through the
Internet. I believe what Dr Feldman has described is
simply a tool for drama whores to further express themselves to a more receptive crowd. My humor
was directed at by proxy, a person authorized to act
for another, dosen't say it has to be a human being.

PT

 
At Sunday, June 24, 2012 10:21:00 AM, Anonymous Kim Robinson said...

What is fascinating, are the new psychiatric maladies spawned by the advent of Internet, with a plethora of on line support groups and medical literature. In my view, the only absolutely credible medical advice is from a "live flesh" physician with verified credentials. We see both the seeking and giving of medical advice by strangers, on the Internet, which abuses the role of support groups for those who are genuinely physically or mentally ill. I administer two cancer patient education communities, mainly choosing to do so, so someone who has "Munchausen's by Internet" doesn't distort content. I don't give any advice as a lay person, as I am unqualified to do so. However, many unqualified people give advice that comes perilously close to practising medicine. It seems nothing can be done about this on the Internet, which is a perilous ethical precipice. Advice is not verified by any qualified medical professional, which may have a harmful outcome. Do no harm.

 
At Wednesday, July 11, 2012 11:47:00 PM, Anonymous MC said...

As TAM said, yes lies will hurt people. And yes, it's unethical and immoral to pretend to have an illness and then give out advice. But people need to take responsibility for their actions. Caveat emptor - buyer beware. If you choose to take a laypersons advice, and not research it thoroughly via various forms, then you have to take responsibility for this. Ditto taking a medical professionals advice without doing any personal research. Humans should remember they are not sheep, and don't have to mindlessly follow the flock.

 

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