During the infrequent slow days on the psychiatry consultation service, the boredom sometimes leads me to muse about subjects that can be challenging to wrap my brain around. Boredom can be enhanced in my temporary office while my old one is being worked on in the process of building the new Children’s Hospital here.
It’s a little on the small side. The advantage is the printer, which I didn’t have in my old office. I’ll be camping here living out of boxes for the next 4 weeks–more or less. I won’t be bored for long and I’m reminded of a recent story about someone who is suing his former boss for causing job conditions leading to a new condition called bore out, a sort of inverse of burnout I take it.
It sounds fictitious to me, or maybe it’s factitious. Possibly it’s example of a fictitious factitious condition, which reminds me of our recent Psychosomatic Medicine Interest Group Meeting a couple of days ago. Dr. Darbie Little-Cooper, a senior in the Family-Medicine and Psychiatry combined residency program talked about the weird idea of Factitious Delirium. Can you fake delirium? And why? You remember Darbie; she’s one of the Three Consulteers.
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Anyway, her presentation drew quite a crowd and the discussion provoked a lot of thought about the nature of delirium and the nature of factitious disorder. Darbie and I doubt that delirium can be faked, but the whole discussion reminded me of the story of a patient named Norman U. Senchbau. You may know this one because Norman was the subject of a case report published in the New England Journal of Medicine (NEJM) in 1980. He appeared in the ER claiming to have factitious Munchausen’s syndrome. For example, he claimed to have gridiron abdomen from the scars of multiple unnecessary surgeries. The problem was they washed off with soap and water.
The story was a hoax although to be fair, readers could have figured that out by looking closely at the patient’s name. It’s an anagram of Baron Munchausen. You could get away with publishing stuff like that in the NEJM back then. Factitious disorder expert Marc Feldman gently chided the authors years later, pointing out that the story was so convincing that it was still being cited seriously.
It would be pretty tough to dissemble delirium, given the well-validated screening tools we have and which Darbie described. And she included a video about delirium with people acting like they’re delirious. It shows you how hard it is to fake it.