Post No.: 0834
Furrywisepuppy says:
Munchausen syndrome or factitious disorder imposed on self is where one feigns illness or trauma in order to draw attention, sympathy or support from others onto oneself. It’s not always due to malingering, or faking symptoms for some kind of personal gain, like an insurance claim.
Munchausen by Internet is a more specific term describing when someone feigns their illness or trauma on online forums or social media; perhaps to attract sympathy, followers and fame, money and gifts (in which case it’d be a case of malingering). Even if their illnesses aren’t faked then they may be exaggerated and milked for attention. Whether someone truly has a chronic health condition or not, some social media influencers almost compete to show who’s suffering more, partly to gain more attention and partly to show those who accuse them of malingering that they’re not.
But trying to differentiate the real from the fake is sometimes tricky. We shouldn’t jump to conclusions to tar everybody with the same brush. It’s also the case that if someone will go to such lengths to actually harm themselves e.g. by abusing laxatives or diuretics, in order to ‘prove’ that they’re ill then that itself is evidence of a disorder – it mightn’t be the disorder they’re trying to fake but something certainly isn’t mentally right with them. One must feel quite desperate or insecure about oneself to go that far to seek a support network. And if they find the attention and receiving messages of support addictive then that’s an addictive behaviour.
Munchausen syndrome by proxy, where a caregiver appears to falsify illnesses in a person under their care, can be a form of abuse, or alternatively due to reading something online and being genuinely fearful that the person under their care has certain symptoms and thus ‘playing it safe’ by seeing a doctor about it. Whatever the case – truly fabricating or inducing illnesses is rare.
There’s still much for medical scientists to need to better grasp – including regarding functional neurological disorders or conversion disorders, which are disorders where a person apparently exhibits physical symptoms like blindness, loss of memory, fatigue, movement problems, seizures, paralysis or other neurologic symptoms that cannot be explained by a medical evaluation. We know though that seeing, for example, involves far more than the eyes and optic nerves, hence people with healthy eyes can still suffer from visual agnosia, where someone can fail to recognise visually presented objects despite them being right in front of them. The processing of signals and perception ultimately happens inside the brain. It’s akin to a software problem even though the hardware is fine, such as your TV hardware works fine but the streaming software trying to connect to it is faulty, resulting in no or jittery pictures on the screen. Therefore it isn’t always a case of malingering or faking symptoms for some other gain.
They tend to appear in response to psychological distress. They could be triggered by a past emotional or traumatic experience. Some symptoms can even appear to be contagious, maybe somewhat like a laugh or yawn, in some contexts, and lead to a mass psychogenic illness or mass hysteria. This is where a cohesive group of people will exhibit symptoms of illness like, for instance, Tourette syndrome-like tics (which might be brought about by anxieties, along with, in part, being exposed to social media content that includes people with tics?) all without any apparent plausible organic basis like a virus.
From the other direction – physical diseases, like some autoimmune diseases that attack the brain, can directly cause mental health problems. Well with all diseases or injuries, mental and physical health are intrinsically bi-directionally connected.
Too many who don’t experience a particular problem though arrogantly assume that a problem must be easy to overcome, maybe because of the naïve assumption that everything is a simple choice. Or there may be presumptions that ‘yeah I’ve had what you have right now and it was no problem for me’ – when what they had wasn’t what you have at all. Or there’s the bias of believing that ‘if I cannot figure out what you have myself then (because I believe I know everything) you must be making your symptoms up, malingering or being a hypochondriac’! The too common immodesty of believing that ‘one has a higher-than-most pain threshold hence other people must be just weak, pretending or malingering if they claim to be suffering from chronic pain’, despite one having not experienced a similar situation oneself, also plays a key role.
It’s perhaps similarly related to the cockiness expressed by some, who’ve never ever spent a day in prison, who think that prison is cushy. Or who’ve never been caught in the direct middle of a major disaster yet wonder why other people panic, scream and run around like headless chickens. And other such examples.
Because of our collective lack of sufficient understanding regarding how the brain and body works – diagnosing many health problems through questionnaires and self-reported answers is the only way to go. But then patients are sometimes accused of entering false responses. Not being believed is the worst feeling. It totally compounds the symptoms of your genuine core ailment by attacking your mental health (too). Post No.: 0822 covered this in more depth.
It’s not just the time, the stress, being accused of malingering or of course the direct symptoms of the condition itself – some people spend a lot of their own money trying tests or potential treatments to diagnose and cure their unknown or undiagnosed conditions.
A person’s fussy eating habits might be due to parosmia symptoms that affect their sense of smell, which is important in assessing flavours. Irritable bowel syndrome (IBS) is still not fully understood. Similar symptoms can have different possible causes but this doesn’t mean that these symptoms are necessarily made up. Our mental states are even negatively affected by physical hunger or tiredness, never mind anything more deep or serious.
And just because, say, a treatment like gradually exposing someone with social anxiety to social situations works to reduce their social anxiety levels, it doesn’t necessarily mean feeling constantly socially anxious was that person’s fault for being so reclusive in the past. Some people find it more difficult to do what others find more natural or easy to do. So a ‘neurotypical’ person might argue that they’re not socially anxious only because they’re always out socialising hence it’s other people’s own fault if they’re socially anxious if they don’t go out much – but others might argue that they’re not out socialising only because they’re socially anxious, and it’s a vicious cycle that’s difficult to get out of.
Long COVID or Post-COVID syndrome also highlighted that if you’re ill, the best immediate thing to do is to take things easy rather than plough on as if there’s nothing wrong. It showed us that, in this case, a regimented programme of trying to build up a Long COVID sufferer’s fitness too hastily won’t rehabilitate them at all – they need to pace themselves within their physical capacity limits rather than push it; although breathing training is still helpful and recommended. That’s the current advice as of publishing this post.
No doctor knows everything. A doctor would be overweening to believe that he/she does because not even the entire medical community knows everything. There are known unknowns like with how to best treat Long COVID, as well as the unknown unknowns like future pathogens. New genetic mutations and environmental pathogens are evolving constantly. Well if the entire world of doctors combined knew everything about diseases and medicine, there’d be at least cures for all diseases at present. COVID-19 would’ve been predicted and prevented too! For all these reasons, any hubris in personally thinking that one can know everything about any patient after a curt assessment, to be able to say they’re definitely faking their symptoms or malingering just by looking at them, would mayhap indicate one’s naivety.
But bad doctors, laypeople or those who know just a little but not enough frequently make snap judgements to suspect that someone is malingering or exaggerating their symptoms. Meanwhile, specialist mental health professionals will ask a lot more questions and conduct extensive tests before coming to a conclusion. Even when good doctors do suspect malingering, they’ll understand that they must explore the deeper reasons why because it could reveal past traumas i.e. what fears or insecurities are making someone wish to fake being ill? Are they avoiding school because of bullying? Have they been raised without resilience? If someone is a pathological liar then that’s a real medical condition called mythomania or pseudologia fantastica too!
Historically, certain illnesses might’ve been brushed off as psychosomatic or hysteria – but now we understand that even if a problem is psychological and to do with the brain, it doesn’t make the problem less real. Something ‘medically unexplained’ might be explainable in the future when medical science advances – it’s just unfortunate that some people are born too soon with the problems they have e.g. born too soon to understand and treat the congenital disease they have. It’s like if you were born centuries ago and have a disease or disorder that wasn’t understood back then but is understood now, then you might’ve been regarded as cursed, possessed, put in a circus or freak show, burned at the stake or perhaps fetishised or worshipped for your abnormality. It’s therefore not too hard to imagine that in the far future people will look back at the naïve understanding of even the best minds of today when it comes to psychological and/or rare physical conditions.
It’s proper however that doctors should apply Bayes’ rule when making diagnoses i.e. not assume the symptoms are due to an exotic disease rather than a more common one that appears to fit the description, at the first furry consultation anyway.
We likewise need to most consider the base rate for the most relevant subgroup a particular case belongs to if that information is available e.g. if we have more fine-grained data on black and female patients, and the patient before us is regarded as black and female, then we should base her prior odds on the data for black and female patients rather than on the data for the broader population as a whole. It’s like how many people out of a hundred are likely to die from a bee sting? Then comparing this with how many people out of a hundred are likely to die from a bee sting if they’ve just been stung by a bee? Then comparing this with how many people out of a hundred are likely to die from a bee sting if they’ve just been stung by a bee and they know they have a bee sting allergy? Neglecting base rates is a problem when we assume we’re individually exceptional and don’t face the same prior odds as everyone else in our group.
Yet doctors should also understand that some of their patients, out of the hundreds they come across, will statistically have rare diseases hence these patients shouldn’t be perpetually doubted if they say that the prescribed treatments aren’t solving their symptoms.
The time-honoured tradition of receiving a second opinion from a different doctor shows us that doctors hardly always agree with each other. Any differing opinions for the same patients logically mean that doctors cannot all always be right. A second independent opinion here is somewhat like repeating a drug test with an imperfect sensitivity and specificity – it’ll improve the diagnostic accuracy tremendously. You may need to push your doctor to enable you to try new, but still sensible, tests or possible treatments. Or if you’re not getting anywhere with your usual doctor then seeing a different doctor and having to explain things all over again can be annoying but can offer renewed fluffy hope. And sometimes that’s all we want.
Woof.
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