sick sad world

on munchausen by internet in the time of covid

A few months ago, amid the rhythm of my favorite pandemic-era repetitive thought loops (what trauma-based behaviors am I developing now that will last the rest of my life that I don't even notice? I wish I could remember the exact date I last saw my family!), a new one started to stand out from the chatter: wow, I bet this is a field day for the Munchausen by Internet crowd.

I'd go back and forth on it, walking the thought back as soon as I had it. Munchausen by Internet is a confusing and slippery beast, a contemporary iteration of the larger disorder of Munchausen and Munchausen by proxy. On the one hand, COVID is a dream Munchausen illness to work with: its symptoms are broad-ranging, inconsistent and constantly being updated; people can be asymptomatic when first infected but still experience extreme and chronic symptoms later on; the fact of long-term isolation means it's easier than ever to carry out an online illness campaign without needing to mirror it in person.

On the other, our collective experience of the pandemic seems to pretty publicly invalidate some of the basic premises of people who engage in MbI behaviors - to the extent that they have conscious beliefs and hopes that guide them, I suppose. To get specific, this is the most helpful Munchausen by Internet explanation I've found, from a doula hub:

"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)... 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)"

My difficulty with this dumb pandemic mystery box I've assigned myself is that while COVID and its attendant illnesses are easier to fake than ever — and a breeze to kill off when the story gets too complicated, as authors of MbI narratives often need to do — clearly "attention, nurturing and caring from others" is in incredibly short supply right now. It speaks to a catch-22 that's always been at the heart of MbI and related factitious disorders; the illnesses and disabilities they pretend to develop are in real life a gateway to institutional abuse, systemic ableism and failure, not care or nurture. This has always been the case, but the pandemic has made this incredibly evident to even the most clueless of able-bodied people. I was lucky to get to speak with Johanna Hedva back in August, and have been thinking a lot about one thing they told me:

"When it was first starting in March, my dear friend, Constantina Zavitsanos, who’s part of my crip fam, was like, “the world is gonna get a little more crip right now.” I think some of us were hopeful about it, in this way of having seen the experience of becoming crip affect people in a way that I haven’t really seen anything else do. It won’t have a lasting change on everybody, for sure — I think the other thing about the blast radius of disability is that it’s when ableism, internalized ableism, is the strongest. The world’s ableism is really fucking strong right now in a way that’s pretty unbearable."

That mushroom cloud of ableism is over all of us now, much like the pandemic, although of course with extremely uneven intensity and consequences. I don't know anyone with real COVID-related illnesses who's receiving appropriate "attention, nurture and care" right now, even the most privileged of us; people in my life are having to beg and borrow for basic accommodations from workplaces and plead with doctors to believe them about chronic symptoms. Even (currently) healthy people are caught in the blowback of the blast radius Hedva describes; forced to work in person for non-essential jobs they can't afford to quit, denied hazard pay for even union jobs, and using internal resources they don't have to both work full time and care for loved ones and children. What care or sympathy could anyone hope to gain right now?

And yet they do; or at least something like it. Documentation of MbI, especially while it's ongoing, is difficult; "proving" it is a thorny ethical problem — it calls for balancing zeal for exposing harmful people with the very real possibility that you could be accusing a bewildered and very ill person of deceit. Even so, it's recorded as rearing its head at least a few times over the past ten months. Most famous was not actually an incidence of Munchausen by Internet, but the semi-related phenomenon of catfishing: a white woman who created a bisexual Indigenous science professor as a persona on Twitter, and then dramatically killed her with a COVID diagnosis as a way to exit the con — compounding the harm of doing public Indigenous raceplay with capitalizing on the devastating impact the pandemic has had on actual Indigenous communities. A hospital in India reported a patient who fabricated both high-risk pre-existing conditions and COVID exposures to insist he be admitted for an inpatient quarantine, using knowledge of both the risk to people with underlying heart conditions and testing imperfection to make his stay as long as possible.

The most interesting case I found in researching this isn't actually a false COVID diagnosis, but is from the abovementioned doula community: they describe "an individual... 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." They mention cryptically that "This person seems to have become more prolific over the last few weeks with COVID 19 lockdown," with little elaboration. The portrait it paints is striking and grisly: people similar to catfisher BethAnn McLaughlin above, alone in lockdown and convincing themselves what they're doing isn't harming anyone, relieved to have someone on the other end of the line and drawing out the tragic story that keeps them there as long as they can, no matter how much secondary traumatic stress it causes the care provider.

In thinking about what psychological needs MbI (inappropriately) meets, I found myself thinking less about the usual presentations of the disorder (or the various, say, House episodes inspired by it) and more about sick lit: the pulpy genre of fiction crystallized in Lurlene McDaniels' work that romanticizes extreme or terminal illness, especially among young and beautiful people in love with each other and doomed to have their romances ended by premature death; they have titles like SIX MONTHS TO LIVE and DON'T DIE, MY LOVE. Subtle! They are, as many have pointed out better than me, distressing and impressively ableist as far as depictions of actual illness or disability; love, devotion and connection in a world with illness and disability looks like destigmatizing needs and limitations, prioritizing care and accommodation, and making space for access intimacy, not romanticizing or overlaying tragedy onto the realities of illness.

That's exactly the project I think Munchausen by Internet is trying to accomplish, though: the tragic romance of a Lurlene McDaniels novel, a way to become the protagonist in an unforgettable story. The love offered to a tragically doomed sick lit hero(ine) is, to paraphrase your favorite sad gay poet, "larger than the usual romantic love - it's like a religion." The desire to be on the receiving end of that kind of love is understandable - and the misdirection of sick lit is that the inciting element isn't illness, it's ~tragedy~. It's an emotional phenomenon that doesn't map well onto real life human dynamics; it makes up the difference between care and pity.

But it explains why we aren't necessarily seeing a noticeable uptick in fictitious COVID diagnoses, an illness that our dominant cultural narratives have worked hard to convince us is not a big deal/not something we can do anything about/something we deserve if it happens to us/maybe not even real at all — but are, I suspect, experiencing some upswell that we may not even be able to detect in the realm of other factitious tragedy claims (what's sadder than giving birth alone in a pandemic and losing the baby?). People are lonely; as almost everything I'm subscribed to and every set of holistic horoscopes reminds me, "no one is getting what they need right now." I keep telling my friends when we're frustrated that dysfunctional and inconvenient dynamics keep showing up even at the worst of times that everything is very close to the surface right now; all of our most self-destructive and least desirable instincts are right under our skin. The 2010 article on MbI in Psychosomatics theorizes that it presents in "troubled people who [are] having difficulty obtaining comfort and support"; unfortunately for the foreseeable future this seems like... all of us? There are so many ways to be unwell; hard to know what to do lately besides pray for as many of them as possible to be alleviated.