The Cyber Effect (34 page)

But that won't deter some people from searching and searching, almost as if they are hoping to find something to worry about.

Hungry Joe became anxious if he didn't have missions to fly. He had become addicted to the adrenaline rush, and he missed the anxiety and drama when it was gone. In the absence of that excitement, he looked for other things to worry about, and his alphabetical list of maladies and disorders provided it.

Moving along my continuum of health anxiety, we wind up on familiar ground,
hypochondria
—clearly the condition that Heller meant for Hungry Joe. Once upon a time in recent history, there was a genuine disorder called
hypochondriasis
. It referred to a situation in which individuals were inordinately preoccupied with their own health—or rather their poor health. I say “was” because the
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
(DSM-5) made
a number of sweeping changes. About 75 percent of what we previously called
hypochondria
is now subsumed into a new diagnostic concept called
somatic symptom disorder
, and the remaining 25 percent is considered
illness anxiety disorder
.

Losing an official diagnosis and description may cause anxiety in its own right. Many people become quite attached to their diagnostic labels and don't appreciate watching their illnesses classified away. In the interest of clarity, please forgive me if I just use the good old-fashioned term
hypochondria
, as it is popularly understood. All the literature that I will refer to, written over the past hundred years or so, uses that term.

What are hypochondriacs really like? They have a general preoccupation with health that is distracting and life-altering—and they are sure there is something seriously wrong with them. Rather than consciously faking their symptoms (like some other disorders, which I will get to soon), hypochondriacs can have authentic physical symptoms and changes in the body that cannot be traced to a cause other than the mind. Family members may roll their eyes—“Guess what kind of cancer Mom thinks she has now?”—but in many cases, Mom truly feels
the pain, numbness, tingling, or tightness that she persistently complains about.

Fed by a great deal of anxiety and imagination, hypochondriacs have a deeply held belief that small symptoms and physical glitches are signs of a serious and probably fatal condition, but have trouble supplying a precise description of their symptoms. They are amateur medical experts, avid readers of health newsletters, medical studies, medical magazines, and books about medical topics. They repeatedly seek medical advice and make frequent visits to the doctor's office, but their
anxiety and concern aren't abated by a doctor's reassurances that they are fine. In fact, they are likely to be disappointed when no actual physical problem is found. This only escalates their ruminations about an undiagnosed disease.

Another trait of the hypochondriac is a distrust of the medical profession—and a subconscious wish to undermine the authority of the doctor. The patient knows best. When a doctor can't seem to find a problem—and therefore no cure—the hypochondriac will move on to a new doctor. The hiring and firing of many physicians in an unreasonably short period of time is another indication of the condition.

You'd be hard-pressed to find many doctors who enjoy their time with these difficult patients. Some doctors regard people with health anxiety as nuisances who take up space and time that could be devoted to truly sick people in need of care. And when the day finally comes when a doctor gives a patient the news that they do have a diagnosable condition, and it's called somatic symptom disorder or hypochondriasis, this only leads to more frustration and upset, often causing a sufferer to become even more focused on health. This would be the time to seek the help of a psychotherapist, but I'm afraid that rarely occurs.

Hypochondria is found in 4 to 9 percent of the population, a figure that had been stable across studies for decades prior to the introduction and widespread use of the Internet. The condition appears equally among women and men, and seems to run in families, either due to a genetic predisposition for the disorder or behavior learned from their home environment. Like most individuals with these types of disorders,
and not surprisingly, the hypochondriac experiences
a wide range of emotional difficulties in life—often having trouble with impulsiveness, neurotic tendencies, and hyper-self-consciousness. There is usually an accompanying anxiety disorder or depression.

Prior to the introduction of the Internet, your good, old-fashioned hypochondriac had to painstakingly thumb through great tomes such as
Gray's Anatomy
—1,217 pages of obscure convoluted medical text—to provoke new ideas and fuel their anxiety. Now the obvious place for these frustrated folks is the Internet. You can find them hanging out in medical chat rooms, discussing their rare illnesses in forums, and logging on to intuitive diagnostic websites—where algorithms lead them, click by click, through the experience of being diagnosed with the same simplicity that prompts the general computer user through the installation of a new piece of software. (More on these “diagnostic” sites later.) Now all that information, and a great deal more, is available with the click of the keyboard, and about as hard to resist for the hypochondriac as Internet porn is for the pornography addict.

So what is the motive for anyone to engage in online medical search? My own research in this area found that many people are simply curious, like acquiring new knowledge, and enjoy the feeling of empowerment—which gives them confidence to challenge medical authorities and professionals. Others could not afford the cost and time involved in the medical consultation process. Another interesting piece of the motive puzzle: One researcher found that the
average length of a consultation with a family practitioner is about eight minutes, but the “super-knowledgeable” patient who comes prepared with his search printouts tends to take up more of a physician's time. This is an interesting gain for the attention-seeking patient in the era of overworked physicians with a cattle run of patients: more face time with the doctor and value for your money.

Psychosomatic-type behavior is highly complex and often associated with impulsivity, which itself is associated with addictive behaviors. Intermittent reinforcement, as discussed in
chapter 2
, could also be a motivation for the cyberchondriac, as the Web symptom crawl becomes a form of lottery ticket that occasionally delivers a rewarding result.

Farther along the continuum, we finally arrive at
conversion disorders
, a category that represents some of the more extreme manifestations of chronic illness. In common parlance, these are “hysterical” conditions, which used to go by such names as “hysterical blindness” and “hysterical paralysis.” Now renamed
functional neurological symptom disorder
, Munchausen syndrome, as it was originally known, is a psychiatric condition in which patients deliberately produce or falsify symptoms or signs of illness for the principal purpose of assuming the sick role.

Munchausen itself has a colorful background. Back in the eighteenth century, Baron Karl Friedrich Hieronymus Freiherr von Munchausen was a mercenary during the Russian wars of Peter II against the Turks. In retirement he became something of a curiosity—and renowned for telling tales of his adventures, often “over a bottle.” In 1785, when Munchausen was still living, a scholar-turned-thief named Rudolf Erich Raspe published a book called
Baron Munchausen Narrative of his Marvellous Travels and Campaigns in Russia
, which made the most of the Baron's outlandish stories. A huge success, the book forever associated the name Munchausen with wild falsehoods. This led a British doctor, Richard Asher, to refer to patients who fabricated dramatic illnesses as
suffering from “Munchausen syndrome” in 1951. And later, a pediatrician, Roy Meadow, borrowed the term to describe those who fabricated or induced sickness in others (usually their children) as suffering from “
Munchausen syndrome by proxy” in 1977. Since then, there have been controversies about diagnosis and expert testimony, and a
proliferation of various conditions that were once just called Munchausen by proxy.

People with a Munchausen-type syndrome,
also known as “hospital addicts” in the U.K., are a much rarer bird than hypochondriacs, but they share a few traits, one being an antagonistic relationship with members of the medical profession. Like hypochondriacs, they also tend to be highly knowledgeable about symptoms, medical treatments, and care. As Laura Criddle, a critical care nursing specialist, relates in her article “Monsters in the Closet,” quite often the Munchausen syndrome individual
develops the condition after hospitalization for a true
illness and then begins to lie pathologically about made-up maladies. They seem to be gratified emotionally by fooling doctors, and enjoy having a deceptive relationship with them.

When the syndrome takes a different name, Munchausen by proxy, it is rarer still—and the motivation changes. The individual with the syndrome (most often a mother, in 93 percent of the cases) uses another person (usually the mother's child) in order to work out a disturbed scenario with medical experts. Dr. Meadow, who gave the behavior its name, described one mother who mixed her own blood into her baby's urine sample in order to fake illness. Another mother poisoned her toddler with table salt.

One of the most famous cases of MSbP, as it's called in the clinical journals, is that of Kathy Bush, a Florida woman whose twelve-year-old daughter, Jennifer, endured two hundred hospitalizations, forty surgical procedures, multiple poisonings, and treatment for dozens of serious and suspicious infections over the course of her childhood. After Kathy Bush was arrested in 1999, the girl was sent to live in foster care out of state, where she received medical care and improved. Later, she was reunited with her mother and denied abuse had taken place.

It's a form of child abuse, but unlike a parent or caregiver who cruelly harms children by lashing out in anger and frustration, the Munchausen by proxy mothers are motivated by an insatiable need for social attention and recognition. They become emotionally rewarded by their ability to fool people, to receive praise and sympathy, and to be perceived as being embroiled in something important. Of course, there are sometimes secondary gains or motives—subsidized housing, welfare, free medications, and financial aid. But the big driving factor seems to be a desire to be seen as an angel, a rescuer—a stoic caretaker of a chronically sick child. It becomes the mother's identity.

Technology has the power to exacerbate a factitious disorder—when a person deliberately feigns or exaggerates having an illness. It doesn't require a huge imagination to see what happens when you mix a disturbed individual who likes to fake illness with the richness and plausibility of information now available online—or the communities that gather there. As long ago as 2000, Dr. Marc Feldman, a psychiatrist in
Birmingham, Alabama, who specializes in factitious disorders, coined the terms
virtual factitious disorder
and
Munchausen by Internet
to describe those who use the Web to aid their deception and masquerade. (Feldman himself runs a Munchausen website, where members of the cyber-public can report new suspicious cases.) Some specialists have even made the case that Munchausen by Internet is a natural
evolution of the original condition—a more efficient and rewarding environment for the patient's deceptions. Think about it. Logically the sympathy of hundreds of people online is far more powerful than sympathy from one person in a white coat. And rather than deceiving a small circle of friends, neighbors, and medical professionals, they can fool potentially millions.

A shocking example of Munchausen by Internet was perpetrated by a blogger, David Rose (a.k.a. Dave on Wheels), who described himself to his virtual audience as a profoundly deaf cerebral palsy victim and quadriplegic living in Los Angeles. Over a period of four years, between 2008 and 2012, he inspired a growing fan base of followers on Twitter and Facebook with his funny asides and heartbreaking story, which he said he wrote using a Tobii computer that followed the movements of his eyeballs. As he garnered more and more attention, Kim Kardashian and other celebrities began retweeting Dave's sad musings and bravely uplifting one-liners. Then, out of the blue, his “sister” Nichole posted the stunning news of Dave's death from pneumonia on his Facebook wall. This unbearable end to the Dave on Wheels saga drove thousands to leave “RIP” comments on his page while continuing to share his poignant story with others online. One die-hard fan even booked a flight to L.A. to attend Dave's funeral, prompting a confession from “Nichole Rose” that Dave was a fictional character, a persona invented to “inspire people to love and live a better life.”

What drives an individual to such lengths of pathological lying and stagecraft is likely true mental illness—not just the desire to create an Internet hoax or cute joke. And in spite of Munchausen sufferers' need for sympathy, it's pretty hard to muster much of it for people who enjoy manipulating and fooling others, or the Munchausen by proxy individuals who abuse their children for emotional gain. This isn't usually
the case in
cyberchondria by proxy
, the condition we'll get to next, which is quite often the result of good intentions gone very wrong.

The
Sydney Morning Herald
told the story of a devoted son who was worried about his father, a seventy-year-old man who complained of body aches and jaw pain when he chewed. He had been diagnosed with temporal arteritis, an inflammation of the vessels that supply blood to the brain and head, and was taking a number of medications.