A Great Pretender Now Faces the Truth of Illness
by Denise Grady
The New York Times, July 20, 1999:D5.
"To begin with, it was just something I did when I needed someone
to care about me," she said, speaking with the burr of her native
"Then it became something I had to do. It was as if something took
me over. I just had to be in hospital. I had to."
Miss Scott, who is visiting the United States from her home in London,
says she has not faked her way into a hospital in 20 years. She is
50, with streaks of gray in her hair and deep creases in her face
that make her look older than she is. This time, she belongs in the
hospital, because she is genuinely, gravely ill.
But her past still qualifies as one of the most severe examples ever
known of Munchausen syndrome, a rare psychiatric condition in which
people feign illness or make themselves sick because they crave medical
attention. By her own count, she became a patient at more than 600
hospitals, sometimes being released from one in the morning and getting
herself admitted to another by nightfall. Her portrayals of agonizing
stomach problems were so convincing that many doctors resorted to
surgery to help her, and she underwent 42 operations, nearly all
of them unnecessary. Her abdomen is criss-crossed with scars, leading
a doctor who examined her recently to comment that she looked as
if she had lost a duel with Zorro.
"She is the most extreme case I've ever heard of," said Dr.
Marc Feldman, vice chairman of the department of psychiatry at the University
of Alabama at Birmingham, and coauthor of "Patient or Pretender:
Inside the Strange World of Factitious Disorders"
(John Wiley & Sons, 1994), about people who feign illness or induce
it in themselves. "When it comes to number of hospitalizations and
number of countries, I've never heard of someone even close." Considering
all the surgery and complications she has had, he added, it is remarkable
that she survived.
Miss Scott also stands out, he said, because she recovered from Munchausen
syndrome, which many doctors consider untreatable, and because she
is willing to speak openly about behavior that most patients are
too ashamed even to admit. Few doctors have had the chance to talk
to Munchausen patients about the condition, because they generally
flee when they are found out. Dr. Feldman said that among patients
who seek treatment for the syndrome, psychotherapy can sometimes
Given Miss Scott's phenomenal career as a liar, Dr. Feldman acknowledged
that she might be pulling his leg. But, he said, he did not really
think so. Her psychiatrist in England had confirmed the broad outlines
of her history, though not every hospital admission, and Dr. Feldman
said he had come to like and trust Miss Scott, and to believe that
her goal in revealing herself was to help others.
There have always been people who faked illness for one reason or another,
and for centuries doctors have known about such phony ailments, called
factitious disorders. In 1951 a group of factitious disorders was
named for Baron Karl Friedrich Hieronymus von Munchausen, a war hero
who traveled around Germany in the 18th century, telling tall stories
about his exploits. Medically, the name refers to people who wander
from one hospital to the next, telling tall stories about their illnesses
and seeking unnecessary treatment.
The syndrome differs from hypochondria, which is not a factitious disorder:
hypochondriacs think they are sick, whereas Munchausen patients know
they are not. And it is not the same as the factitious disorder malingering,
because malingerers play sick to get out of work, obtain drugs or
collect insurance, while Munchausen patients are in it strictly for
Munchausen syndrome is rare. Of all patients in the hospital, only 1
percent of those on whom psychiatrists are asked to consult have
factitious disorders, Dr. Feldman said, and 10 percent of those have
Some people with the syndrome, like Miss Scott, simply make up stories
and act out symptoms. Several have caused commercial flights to make
unscheduled landings so they could be rushed to hospitals for emergency
Others go to extraordinary lengths to make themselves ill. They bleed
themselves, take laxatives, inject saliva or feces to cause infections
or secretly take powerful drugs like insulin that they do not need.
They have hidden syringes under their mattresses, dangled them outside
hospital windows on string or slipped them into the hems of their
clothing. Dr. Feldman said he encountered a patient who had introduced
drain cleaner into her bladder, where it did so much damage that
the bladder had to removed. Another, described in his book, injected
yeast and cornstarch into her veins to make herself sick, but the
substances formed lumps that lodged in her lungs and killed her.
Psychiatrists say that Munchausen patients long for attention, nurturing,
care and concern, and do not know how to find them in healthy ways.
Some patients may also be a bit sadistic, Dr. Feldman said, and take
"duping delight" in tricking others, especially doctors.
"Doctors hate being played for fools," he said, adding that
many despise Munchausen patients, for manipulating them, wasting their
time and making them appear incompetent. Dealing with such patients,
many doctors feel they cannot win: if they withhold treatment, the patient
may sue, but if they offer treatment and it turns out to have been unnecessary,
the patient may still sue.
"Probably no other diagnosis is viewed as so contemptible," Dr.
But Miss Scott said: "I never intended to make doctors look stupid.
I just wanted to be in hospital."
Her childhood, like that of many Munchausen patients, was rough, to say
the least. She was sexually abused, she said, and her mother was
distant and unaffectionate. She repeatedly ran away from home. One
of her few pleasant experiences was having her appendix out, when
she was about 16.
"A nurse would come in the morning and plump up the pillows and
say, 'How are you today, Wendy?'" Miss Scott recalled. "It
was just little things like that, asking how was your pain, how was your
No one had ever shown her so much kindness or concern.
Soon after, she left home and took various jobs at a dairy, a bakery,
a spinning mill and a potato farm. Then she became a hotel maid,
"cleaning up everybody else's muck and being expected to act cheerful
24 hours a day," she said. The work was hard, depressing and lonely.
It seemed to her that no one in the world cared about her.
One day, she made believe she had a stomachache and went to the nearest
hospital. "I thought, somebody will care," she said.
She spent several days there being tended to. "It recharged my batteries,"
Over the next year or so, she tried the tactic a few more times, at different
hospitals. It worked, and soon she was spending all her time hitchhiking
from town to town, trying to get into the hospital.
She was not close to anyone during those years. "I didn't have friends,"
she said. "I didn't want anybody. If I had friends, they might find
out what I was doing."
Eventually, doctors began suggesting exploratory operations to find out
what was wrong with her. She did not want surgery, she said, but
went along with it because it meant that she would be allowed to
spend more time in the hospital. She knew that what she was doing
was wrong, she said, but she could not make herself stop.
But she found that the people who had treated her so kindly could turn
very nasty indeed when they figured out what she was up to. One surgeon
stormed up to her bed, scolded her in front of the rest of the ward
and ordered her to get out. At a few hospitals, employees snapped
her picture to warn others about her.
Like most Munchausen patients, she simply ran away whenever she was caught.
A few times she fled with stitches still in place, and removed them
herself later. Twice, she was jailed, charged with stealing lodging
and food by checking into the hospital needlessly.
Looking back, she said, she might have asked for psychiatric help, if
somebody had said, "I know what you're doing but I don't know
But, she said, "It was always approached in a confrontational way.
The barriers go up."
After 12 years, two things finally helped her recover. The first was
an operation that went wrong, and left her ill and suffering from
severe infections and complications that took her months to recover
"I realized that if I kept doing this, I might die,"she said.
The second step in her recovery was a kitten, left to her by someone
in a shelter she was living in. She realized that if she went into
the hospital, no one would take care of it.
Two and a half years ago, she contacted Dr. Feldman, who has a Web site
about Munchausen syndrome (www.munchausen.com), and offered to participate
in any studies he might be conducting. But Dr. Feldman thought she
might be able to help other patients, and he put her in touch with
them by E-mail.
"A number said she made a decisive difference," he said. "Not
so much what she said, but that nobody's case is as severe as hers and
yet she recovered."
But now she has become a painful example of what can happen to a person
who is labeled as having cried wolf. She lives in London, and, even
though she has not lied about her health for 20 years, her notorious
record has made it difficult for her to get doctors there to take
her seriously when she is truly sick. Although she had suffered abdominal
pain and other symptoms for a year and a half, few tests were ordered
and no diagnosis was made in London. On a visit to the United States,
she called Dr. Feldman, who urged her to come to Birmingham, where
doctors discovered a large mass in her intestine that required immediate
Last Friday, Miss Scott learned what the surgeons had found: a malignant
tumor, too large to remove. The news came as a shock, and she wept.
She wondered bitterly what her outlook might have been had British
doctors paid attention to her when she first described her symptoms.
"Once you've been branded," she said, "it's like you've
got it written across your forehead: 'Not to be trusted. Munchausen.'"
She was frightened. "I'm not really ready to die yet," she
said. "There are too many things I want to do." She had hoped
to fly first class sometime, to see New Zealand, to drive her car down
the open road once again.
Now, she said: "I suppose I wonder what the future holds. I wonder
if there is any future."