Doctor Munchausen I Presume!

Editorial note:  As Britain descends into an orgy of handwringing about the abuse of vulnerable people, this is the first of several posts to tackle the issue

In 2000 when I gave a lecture on Psychopharmacology and the Government of the Self at the invitation of the University of Toronto, I ran into a problem. In the public domain our shared difficulties were because of this lecture. In fact, the difficulties stemmed from a member of the Establishment – Charlie Nemeroff – who put the frighteners on the U of T about hiring Healy.

The psychopharmacology establishment in the face of adverse effects from drugs is the same as the medical establishment in the face of treatment related adverse effects is the same as the British establishment in the face of allegations of paedophilia and child abuse is the same as the Vatican in the face of allegations of abuse.

It’s about power. We have it – you don’t. Get lost.

There is maybe a difference in that it could be argued that academics are just middle men these days rather than holders of real power – but sometimes the less power the more vicious and nasty the abuse.

Psychopharmacology and the Government of the Self

The lecture had twenty-six slides, of which all bar one were images. It can be accessed HERE.

The main point was that the face of medicine was changing.

At the heart of this change was the fact that drug development now went through clinical trial programs and the data from these trials were now hidden. Because of this we were in an increasing darkness about the hazards of treatment. Not just specific hazards but the very idea that there might be hazards was being lost. There was no way to keep a check on things. This was a call for access to clinical trial data long before AllTrials or Tamiflu were heard of.

The lecture was widely misreported as Healy said SSRIs cause suicide. The message was that I believe SSRIs cause suicide, you in the audience likely don’t – the difference stems from the fact that you haven’t seen and cannot get to see what I have seen.

Against this background conflict of interest was an issue of growing importance – we were increasingly dependent on the people we might turn to if things went wrong – the police in the case of abuse, bishops in case of clerical abuse, academics in the case of pharmacological abuse – or perhaps members of a Hospital or Health Board.

As a way to illustrate the point, one of the 26 images used was that of Harold Shipman. Shipman was a doctor whose case was then dominating the headlines of British and world medical care. He had murdered hundreds of his patients, mostly women. There seemed to be some gain in terms of getting their wills altered so he was given money, but no-one believed this was enough to explain what had happened. He seemed to enjoy it.


We were I said creating conditions in which Shipmans could flourish.

From Hero To Villain

Baron von Munchausen was a real life eighteenth century German, a colorful character who traveled widely and developed a reputation for tall tales. There was nothing wrong with his health – physical or mental. But he has posthumously been done in.

In 1951, a British doctor describing three cases of patients who were feigning illnesses behind the smokescreen of colorful stories suggested describing this condition as Munchausen’s Syndrome.  The patients were thought to be trying to pass themselves off as ill in order to gain attention or sympathy. The Baron, as a result, is probably now thought by most people who hear of Munchausen’s Syndrome as someone who was mentally ill.

In the mid-1970s a new disorder emerged – Munchausen’s Syndrome by Proxy. In this case parents were thought to be making their children ill, in some cases close to killing them, in order to gain medical attention.

Proxy Munchausen’s has given rise to huge controversy. There was a rush to label parents in cases doctors found difficult as sufferers. Some of the parents fought back and won. The reputations of several leading doctors who had branded parents injudiciously were destroyed.

Everyone agrees that the original syndrome is pretty rare and the proxy variant is even rarer – I may have seen one convincing case of the proxy syndrome in my career.

The Dynamics of Abuse

But just as Tall Tales take on a life of their own, the idea of Munchausen’s syndrome has penetrated deep into healthcare. It seems to shape shift as it goes. Mental health workers now faced with an awkward patient protesting that the treatment they are on is not suiting bizarrely describe these “awkward” people as suffering from Munchausen’s, with an awkward mother complaining about the treatment her son is being put on being labeled Munchausen’s by Proxy .

This is exactly the opposite to the original syndrome. In this case people with a real illness, who are being given a very real second problem, are being termed fantasists. Why?

With all abuse, dynamics come into play. In the case of priests, or Britain’s most famous abuser Sir Jimmy Saville, the sheen of good works makes it almost impossible for others aside from the victim to see the dark side. It’s just difficult to hold two contradictory things in our mind at the same time.

In medicine, blaming the patient or a relative is the perfect way to hide the identity of the real abuser – the doctor.

Doctor Munchausen is not an uncommon figure. He or she is the one who gives you illnesses which they then feed off.  There is one – likely several – working in every hospital in the land – from Bangor in Wales through to Sydney in New South Wales, from Seattle to Dr Nemeroff’s new stomping ground in Miami, from Vancouver to Halifax, from Belo Horizonte where the dream died to Buenos Aires where Jorge Mario Bergoglio comes from. Europe is stuffed full of them from Helsinki through Berlin to Lisboa.

The Mechanism of Abuse

The mechanism of abuse is very PC – a prescribing cascade. When a problem develops on treatment you are put on more of the same treatment or further drugs are added in to treat the original problem and unless you have a lucky escape or have extraordinary courage, the abuse keeps going until you are dead. Doctors who abuse are concealed by the fact they are doing even more of what good doctors do than their colleagues.

Caught like a child in the soft fleshy hands of a priest, it’s almost impossible to escape. No-one will believe you – not the doctors’ colleagues, not the management of a Hospital, especially if the abuser is one of them, not any of the regulatory bodies in health nor the government.

It’s difficult to know whether the mental health system is worse than the rest of healthcare. Here the abuser has the power to forcibly detain a perfectly normal person in hospital who might for instance be suffering a very clear physical reaction to treatment and threaten them with shock therapy. One Flew Over the Cuckoo’s Nest is not something that happened back then – it happens today and will happen tomorrow and tomorrow and tomorrow in mental healthcare but typically with antipsychotics rather than ECT.

There seems to be no protection. This can happen in hospital settings where the boss may have once have been responsible for making sure that vulnerable patients are not abused by the Mental Health Act. Once a person with this kind of background swaps sides and becomes part of the system and it’s a case of stopping a person who sits across the table from them from abusing someone, they seem unable to do it. The abusers are Welt-Meisters – Masters of their little Universes.

Descent into Hell

Following Shipman, there was an orgy of efforts to make sure this couldn’t happen again. British doctors now have to be revalidated, regulatory bodies have more teeth, the checks are ever more thorough. But all this does is to penalize the good doctor without in any way stopping or deterring the most profound abuse. The abuser is now in fact even more protected by a battery of boxes ticked and forms filled – if it is to survive, the system cannot let them be fingered as abusive.

Last week, following revelations of pedophile rings operating at the highest echelons of British society, Britain began its descent into another orgy of hand-wringing – how do we stop the powerful doing these things.

The place on this earth where there is the greatest mismatch in power between two people is when doctors meet patients. The easiest place on this earth for an abuser to flourish is in a doctor’s office. Have a look there.

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  1. Great piece, wonderfully written, an “insider” take, incisive, shocking and to the point. It made me laugh, how true it is. Thanks, Chrys

  2. Measure for Measure says:

    Against this background it is vastly troubling that Baroness Butler-Sloss, who has been called in by David Cameron to head the inquiry into child abuse, presided for a great time in the family courts where the MSbP theories of Meadow and Southall flourished. Those who call upon her to stand down because of her family and political affiliations, while insisting that she has hitherto a blemishless record, ignore the fact that most of her judicial career was conducted in secrecy, and is quite beyond scrutiny apart the known pervasive influence of unsound and corrupt theories.

  3. What an excellent article and observation. One which I know from the inside out being a sufferer of the neuro-immune disease ME for the last 44 years.

    I found this paragraph particularly apposite: “The mechanism of abuse is very PC – a prescribing cascade. When a problem develops on treatment you are put on more of the same treatment or further drugs are added in to treat the original problem and unless you have a lucky escape or have extraordinary courage the abuse keeps going until you are dead. Doctors who abuse are concealed by the fact they are doing even more of what good doctors do than their colleagues. ”

    I had a very bad ‘relapse within a relapse’ in 2004 (I had already succumbed to being ‘housebound’ in 1994). I was clearly physically very unwell. My temperature control had completely konked out (it has not recovered fully to this day) and the sensations that accompanied it were very unwelcome. Unfortunately this was seen, not as a problem of the nervous system at all, but as a psychiatric malady.. ‘catastrophising’, ‘somatising’ etc etc. Stupidly, having refused any sort of antidepressant medication in the preceding decades I agreed to try an antidepressant as I felt so incredibly ill and nothing else was on offer. One single tablet of Venlafaxine left me hallucinating and I took no more..except it also made me very depressed and tearful and so I was brought into the hub of what you describe as the ‘prescribing cascade’. I was put on and taken off all manner of drugs over the course of that year (all psyche drugs..nothing to deal with the underlying pathology at all!) : very many SSRIs and SNRIs and benzodiazapines etc. I was bedridden for all of that year.. just squirming with hideous extrapyramidal dystonic movements, akathisia and deepening suicidal depression. Yet one tiny bit of my mind still knew I wasn’t actually a depressive.. I knew the drugs were doing this to me..killing me slowly. It was my family who stopped the rot. Just said ‘enough’ more drugs and instead of deferring to my local doctors my family sourced the wonderful ‘Ashton Protocol’ from many nights of Googling and trawling online forums. Despite following that gentle protocol I felt as though I was living in a hellish Kafka-esque nightmare in trying to get off the last of the drugs..but I was right..without the drugs I wasn’t in the least depressed. I was still very unwell however..but to this day no one has tried to address that. I wonder why?
    To be frank I know why: because the disease I have is deemed not even really ‘psychiatric’ but this new fangled ‘somatising / multiple unexplained symptoms’ rubbish. Prof Simon Wessely heads up the school of thought that dismisses a serious neuro-immune disease which has a wealth of research to show problematic pathology and yet because he and his little coterie are given a little bit of power, they can and do abuse us through lack of care (biomedical research is not publicly funded in the UK because of their influence) , inappropriate care ( the NICE Guideline which is unfit for purpose was clearly designed by those who support that paradigm) and for some, actual hands on abuse where people with the disease are sectioned to locked psychiatric wards and forced to complete Graded Exercise schedules etc..). It would be wonderful if you, Dr Healy might look at this particular population, not least because it links very neatly into the theme of this article AND so many people with this disease are mis-prescribed SSRIs and other psyche drugs and often made much more unwell through that sort of prescribing. For interest you may like to read:

    Of course for me the story doesn’t end there. Ten years on and I’m still very very ill with this disease. Neuropathic pain has been added to the list of symptoms I suffer. Along with that I now have a medical history which says I suffer ‘depression’ and yet this is completely untrue. I have suffered very very severe iatrogenic harm, which manifested as severe suicidal depression caused by the prescribing cascade. But for ever more I will be deemed as having a psychiatric disease…although I suppose that is moot in as much as I suspect my primary care team to have already presumed that my diagnosis of ME is much the same!

  4. Johanna says:

    Not a bad column for Bastille Day! At least half the time, I’m sure, Dr. Munchhausen is convinced what he’s doing is for your own good … but I bet a lot of peasants heard that from the landed aristocracy too.

    • David_Healy says:

      How appropriate that its Bastille Day – when stormed as I remember it the most conspicuous person found residing inside was the Marquis de Sade.

  5. Thank you. I enjoyed reading this.

    “The easiest place on this earth for an abuser to flourish is in a doctor’s office. Have a look there.”

    One of the challenges then is how to make the doctor’s office safer for the patient (without the doctor feeling insecure). We need to find ways to help shift the attitudes of doctors and patients. Education for doctors alone will not solve this concern. How can we prepare patients better for consultations with their G.P/Consultant? Of course such interventions are likely to accompany a financial cost. The challenge is making it cost effective. I wonder if it would make a difference if a mental health nurse/advocate/peer support worker was present at every consultation, or if we had CCTV/audiotapes in the clinic rooms with patient permission. We need to find ways to better inform patients. In doing so we open up the opportunities to change the doctor/patient relationship. Using digital media perhaps is one way forward. Reach out and connect to patients before they attend, in doing so we can help develop the knowledge and assertiveness skills of the patient (video links/facebook pages etc). We could even have situations where the patient can communicate with a carer/advocate/other professional using technology during the doctor consultation, to help inform their decision making whilst hearing the expertise of the doctor…..What a wonderful world it could be!


  6. Thank you David. I read this today after reassuring my new GP that I am well able to read and question the information related to the various treatment options for what ails me (in my case autoimmune vasculitis or Wegener’s but, Mr Wegener was a nazi doctor so better not mention his name) and that I rather she would communicate with me than lecture or worse, dole out her treatment in silent condescension. She smiled and shook my hand. There is hope.

  7. Dear Healy, Let us not forget Genene Jones as we also remember Harold Shipman.

    Nurse Jones was transferred (Vatican Style) from the hospital where she was making children sick (digoxin, herapin, …), in order to revive them, to another hospital where she then played the same role. Hero Nurse Jones was better at making children sick than at the reviving process. She killed an untold number along the way (the high estimate is 40+). The transferring hospital, who initially caught her red-handed, did so as an act of litigation prevention.

    Welcome to Vatican Hospital, a Nurse Priest will be with you and with your children shortly. Indoctrination is down the hall.

  8. Steve Hawkins says:

    Hi David,

    Had heard of you, but not come across your blog, so this piece comes as an excellent introduction; all the more so, because I had already come, independently, to the conclusion that most of the psychiatrists I have met with, and those who are the most prominent figureheads of the profession, are themselves guilty of MBP. The most obvious example of this is mentioned above. Whole reputations are won, as a reward for the activity of projecting psychiatric illnesses–that are only opinions after all–on to people who have no power to resist. Once a pronouncement–amounting to defamation, or libel–has been made, the unfortunate branded person, is ruined for life. Electronic media make it impossible to stop the maldiagnosis from propagating ahead of the patient, wherever he or she goes in the health system, and there is an effective denial of service to the unworthy from then on.

    I fully concur with R Cox, and have, myself, spent 3 1/2 years in mental health units after being sectioned for the alleged and unprovable crime of ‘hypochondria’. There is no way to shake off this label, because every effort you make to do so ‘proves’–in the blinded eyes of the health service–your hypochondria. The NHS Choices website, goes even further, by saying you are a hypochondriac both if you go frequently to the doctor AND if you hardly ever go (Not going means your fear for your health has made you too scared to go!).

    After plying me with antipsychotics for the 6 months period of the section–the drugs greatly reducing my capacity to read and think straight enough to do crosswords, sudoku etc–I refused any more. Like R Cox, I also found that SSRIs and SNRIs made me hallucinate–particularly around mealtimes–, so I refused any more of those as well. There was no question of me being either depressed or anxious: other than what was caused by the torture of this mistreatment while the real, and steadily worsening physical illness was being ignored. The despair that this situation creates, simply cannot be described: the psychological torture of the progressively physically ill, is the most despicable act of cruelty. Yet it comes from those whose motto is: ‘Do no harm.’

    I do hope, Dr Healy, that you will pursue this further, because it really is killing people. I was, eventually ‘discharged’ in a bedridden state, only to be hospitalised a week later with clots on my lungs. Even this was blamed on me, for not exercising: even though it had been my inability to exercise that had made me seek help from the doctors in the first place, when I was still just able to get about! They neglected and abused me into a bed-bound state, and still I cannot get my illness investigated because I have been traduced and branded for my whole life. (On top of this there is the widespread perception that, by definition, the chronically ill have lasted this long, so they can wait forever at the back of the queue!)

  9. Another insightful and articulate post Dr. Healy.

    Having once had my Seroxat side effects laughed at by my doctor, I know only too well how dangerous that unequal power-paradigm between Doctor and Patient can be..

    Thank you for being courageous and brave Dr Healy…

  10. Measure for Measure says:

    We haven’t got very far from Susanna and the Elders.

    Commenting on the Butler-Sloss business yesterday I did not pay tribute to the importance of this article. Since biblical times and no doubt beyond there has always been a usually unequal contest of truth and lies between the abuser and the abused. David has put his finger on the precise function of Munchausen Syndrome and its variant Munchausen Syndrome by Proxy or Fabricated Illness in the modern world – a diagnosis which is as whimsical in many/most cases as declaring someone to be a witch by certain infallible tests (we recall that Butler-Sloss supported the Cleveland paediatricians who found evidence of paedophilia absolutely everywhere by performing an obscene test on children – but of course the accused were only ordinary citizens).

    The reality is that these are just ways in which the social order asserts itself dressed in pseudo-scientific garb.

    And, of course, the tale of Susanna has generally been assigned to the Apocrypha.


    “Why does Healy even add the MD after his name?” 14th 09.34

    I am so glad we have our very own Mr. Right and that we don’t have to put up with squabbles as vapid as this…

  12. anonymous says:

    A doctor became very annoyed with me when I refused to be bullied into saying that I had particular symptoms, which I did not. This annoyed her because she couldn’t then make her preferred diagnosis. She told me that I must have these symptoms, because it said so on the computer.

    I later found out that she had described a “difficult consultation” in the medical notes and said that I lacked insight.

    How does a patient fight against this kind of thing?

    The point is that we shouldn’t have to.

    • It seems to me and many others I have spoken to, that doctors raison d’etre has been entirely forgotten, by them. They seem to think they exist solely for their own benefit and we as patients are an inconvenient nuisance. If every patient simply approached a doctor as they would a mechanic, they exist for our benefit alone and to put things the patient is the one in the ‘driving seat’ so to speak, then things might change…..
      At what point in Med School do med students have the ‘I am God’ lecture I wonder?

  13. I think Doctors should have training sessions on how to listen to and respond to patients’ needs on a regular basis throughout their practice. I think a lot seem to have forgotten they are there for the patient and not just to be listened to by the patient. They do not have a divine right.

  14. Dr. Healy describes my reality again.

    I am but a misfortuned patient, of such debilitating diagnoses as panic anxiety and depression. From one misfortuned day, back in the 1990’s, that I recieved that diagnose I was also instantly transferred into a person of low degree.
    From that day on, I was in the mercy of my doctor.
    I respected and listened to him, for long over a decade, because he is a doctor.
    I was brought up that way, a certain degree of respect was automatic along with such a fancy title as ‘doctor’. (Psychiatrist)

    Today I know he is just an ordinary human, with a title, who has also been mislead. Mislead by Big Pharma into not caring for each and every individual patient he meets. Mislead into thinking that even though I as a patient need help, should also be thankful for ANY help, even that that ruins me.

    No one likes to remove his hat in the precence of an authority that no longer posesses any authority, really.

  15. I had a pain management specialist tell me where I was feeling pain – when I was not feeling it in the areas he poked with his fingers.

    He was wanting to diagnose me with fybromyalgia, when what I have is vast nerve damage from a spinal surgery gone wrong.

    This doctor just happened to be involved in a clinical trial using Cynbalta. The condition being studied? Fibromyaliga!

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