Munchausen by Internet in the Doula Community
Dr Kathryn Newns, Clinical Psychologist
There is an individual described who contacts a Doula – by text or telephone – saying that they are in labour and are alone. The doula then supports this person through labour. The baby is born, apparently with congenital problems not conducive to life. The Doula will then continue to support this woman, throughout the next few days, weeks, months and sometimes even years. In the face of multiple crises, or refusal of the person to show the baby on a video-call, or inconsistencies in the stories given, eventually, the Doula becomes suspicious and once they pull at a loose thread, this unravels the whole fabrication. The perpetrator sometimes has several of these fabricated stories going on at the same time. This person seems to have become more prolific over the last few weeks with COVID 19 lockdown.
The Doulas involved in these hoaxes often feel emotionally disturbed by what has happened. Others may be surprised that such a deception could occur in the first place. There is a need to consider why someone might engage in this behaviour, how to potentially detect someone misleading in this way, and how to cope if you have been deceived.
Munchausen by Internet
Fictitious disorder is the feigning (or exaggerating, aggravating or self-inducing) of a disease in order to assume the role of a sick person. With it comes attention, nurturing and caring from others. When this is done online it could be considered a form of “Munchausen by Internet” (a term coined by Doctor Mark Feldman in 2000) and while these fabricators usually use online forums and apps such as Instagram, rather than targeting professionals, such as Doulas specifically, Feldman (in personal communication, April 2020) notes that the case described within the Doula community would fit this profile. Those with Munchausen by Internet do not seek financial gain from their behaviour, rather attention and nurturing. It is viewed as a mental disorder, but is simultaneously considered misbehaviour that the person actively chooses to engage in. This makes it different from mental illnesses such as depression, bipolar disorder, and schizophrenia. (Feldman, personal correspondence, 2020)
We do not know exactly why people with Munchausen by Internet engage in this behaviour, as they seldom come forward. We also do not know how common this is, as the ruse is not always discovered, and those which are unveiled might only represent a small minority. Access to the internet allows perpetrators to research in detail and convincingly fabricate or induce illnesses.
It seems likely that, in many cases, those with Munchausen by Internet crave sympathy, support and caring attention, as this was missing from their own childhood. There is also an apparent need to control others, likely because they do not feel that they have control over things that happen to them. Of course, it is difficult to be certain as to the motivations of an individual that we have not met, and we should apply these more general theories of background and incentive with caution.
From those they have studied, Cunningham and Feldman (2010) are of the opinion that the perpetrators are “troubled people who were having difficulty obtaining comfort and support”. They note that prior to the internet these people may have drained resources from the healthcare system.
There are hundreds of stories of people fabricating illnesses, and even deaths, online. These are detailed on forums, newspaper articles and in academic articles. Here are just a few some examples:
- “Limeybean” (described in Kleeman, 2011) who pretended, via Livejournal, to have an untreatable form of tuberculosis, and went so far as to fake her own death, only to later resurrect her account and “come clean” that it had all been a lie.
- “Glenda” met Frank in an internet chat room and chatted off-forum. There were claims of an assault (“reported” to Frank by “Glenda’s father”); long but inconsistent descriptions of a history of abuse; descriptions of further assaults; resistance of “Glenda’s father” to speak to Frank by telephone. The writing style of the father and an ex-boyfriend, mirrored Glenda’s. In the evidence of continuous crises, eventually Frank realised that he had been manipulated into expending vast amounts of energy and sympathy. Feldman (2000) observes that even with this knowledge, Frank still talks online to Glenda from time to time.
- Jeanette Navarro (described Kleeman, 2011) told her forum (via a “friend) that she was in a coma, and was so intoxicated by the care she received online that she continued to lie, answering up to 50 emails a day and spending 15-20 hours online focusing on her fabrication. She ended up inventing 5 different characters (internet vernacular refers to these invented personae as “sock puppets”) to embellish and sustain the deception. She told the Guardian in 2011 that she found managing the lies exhausting, and had post-it notes around her computer to remind her of who she had told what lie to. She eventually felt guilty and confessed to the 200 people she had been deceiving.
- Drew and Gina, a brother and sister (described in Cunningham and Feldman, 2011) worked to mislead someone called Elizabeth for no financial gain, just time and attention. It is this case which seems most similar to the one that the Doula community are experiencing – one individual was targeted as opposed to an online community or forum. The two conjured up tragic stories including Drew’s testicular cancer, childhood abuse, his girlfriend’s cancer, miscarriage, parental illness and parental death. Eventually Gina called to say Drew had taken his own life. There then came a series of “sock puppets” that Elizabeth was “introduced” to. The hoax continued for over 6 months. Drew and Gina’s family apparently realised what they were doing and sought treatment for them.
- There is also a case in the USA of a woman who has, for many years now, preyed on couples seeking to adopt, described in many articles, including Palas (2019, 2002). She contacts couples via the internet, using Instagram or similar, and either tells them that she is pregnant and wanting to put her baby up for adoption. She sends photos of her pregnancy, often with a partner in the picture. She speaks to couples by phone and text. Eventually the baby is born, prematurely, and photos of the baby are sent. She will then suddenly, after months of contact and the promise that this newborn will be the couple’s baby, she blocks them. Sometimes the couples go so far as to fly to the hospital where she says she and the baby are, only to be told that there is no such person, no such baby. This person was unveiled by a BBC journalist as being someone called Gabby, she had scammed hundreds, possibly thousands, of families, for no financial gain. The same journalist followed her up in February 2020 and spoke to her father. It appears that Gabby cannot have her own children due to heart problems. She went onto the Dr Phil show in America. She was offered therapy. However, despite that, she has not stopped. She told Pallas, the journalist, “I was in a dark spot and I wanted attention and someone to talk to,”
Reactions of those who have been misled
People who have been misled by these individuals feel “violated” and, for those who befriended them there is grief amongst the anger. The couples in the adoption scams find it hard to trust any other offers of adoption and describe a feeling of bereavement. Feldman (2000) also notes individuals who have been misled may fantasize about or attempting to arrange a face-to-face confrontation. They may also feel afraid that the deceiver may misuse personal information that has been volunteered.
These are normal feelings, and it would not be unusual for someone who has been offering care and support to a person who it transpires is not real to feel a wide variety of emotions. Self-care is important, and speaking to a supervisor or mentor is strongly recommended, as well as possibly seeking professional psychological support.
Clues to the detection of fictitious internet claims
Feldman has formulated some clues as to how to spot if someone is making false claims of illness online:
- The length, frequency, and duration of the posts do not match the claimed severity of the illness (e.g., a detailed post from someone claiming to be in septic shock).
- The posts consistently duplicate material in other posts, in textbooks, or on health-related Web sites.
- The characteristics of the supposed illness and its treatment emerge as caricatures based upon the individual’s misconceptions.
- Near-fatal exacerbations of illness alternate with miraculous recoveries.
- Personal claims are fantastic, contradicted by later posts, or disproved (e.g., a call to the hospital reveals that there is no such patient).
- There are continual dramatic events in the person’s life, especially when other group members have become the focus of attention (e.g., as interest in one person started to wane in her group, she announced that her mother had just been diagnosed as terminally ill as well).
- The individual complains that other group members are not sufficiently supportive and warns that this insensitivity is undermining his or her health.
- The individual resists telephone contact, sometimes offering odd justifications (e.g., it would be so upsetting as to cause a medical catastrophe, or the telephone lines in the building do not permit incoming calls) or making threats (e.g., he or she will run away if called).
- There is feigned blitheness about crises (e.g., a cardiac arrest or assault) that will predictably attract immediate attention.
- Others ostensibly posting on behalf of the individual (e.g., family members) have identical patterns of writing, such as grammatical errors, misspellings, and stylistic idiosyncrasies.
- Posted photographs appear manipulated or are determined to have been taken from other websites or posts.
- The individual provides the names of doctors, “experts,” and healthcare facilities that cannot be confirmed or simply do not exist.
- The timelines of purported events do not make sense, individually or in aggregate.
From the point of view of those within the Doula community, someone misleading you may continually refuse to introduce you to their baby. It would be prudent to be wary if you do not see a video or picture of the baby, or if you do, it is not “gritty” and “real” (as a quickly taken photo may be) but rather something that could be from Instagram. There should be no reason why a baby cannot be shown to you “live” on Zoom/Facetime etc.
People with Munchausen by Internet appear to target those who are empathic; supporters who are genuinely caring and sympathetic. When we are unable to meet someone face to face to verify what they are telling us, it is of utmost importance to balance empathy and compassion with circumspection and caution.
Munchausen by Internet is far more common than we probably realise, and it is very easy to be misled especially given the amount of medical information at people’s fingertips. More and more frequently (especially currently, during social distancing) people are seeking online or “virtual” support from professionals. When it is found that someone has misled us, there are understandable feelings of betrayal, as well as sometimes feelings of grief and anger. Self-compassion is crucial; it is important to acknowledge how you feel and seek support when necessary. Approach yourself as you would others, with empathy and kindness.
To read the story of one doula who was duped in this way, visit the blog of Verina Henchy.
Cunningham, J.M., & Feldman, M.D. 2010 Munchausen by Internet: Current Perspectives and Three New Cases. Psychosomatics. 52:2 185-189
Feldman, M.D. Munchausen by internet: detecting factitious illness and crisis on the internet. Southern Medical Journal. 93:7 669-672
Feldman, M.D. 2012. Munchausen by internet can be bad for your health forum. The Guardian. https://www.theguardian.com/commentisfree/2012/oct/19/munchausen-by-internet-health-support-sites
Kleeman, J. 2011. Sick note: faking illness online. The Guardian.
Pallas, N. 2019. The fake baby Instagram adoption scam. BBC News Stories https://www.bbc.co.uk/news/stories-49425794
Palas, N 2020. She pretends to have a baby for adoption 0 can she ever stop? BBC News. BBC News https://www.bbc.co.uk/news/stories-50644595
Pulman, A., & Taylor, J. 2012. Munchausen by internet: Current research and future directions. Journal of Medical Internet Research, 14(4), E115.