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In 1785 the obscure minor German author Rudolf Erich Raspe appropriated the name of a minor historical figure, Baron Hieronymus Karl Freidrich von Münchhausen (1720-1797), anglicized it by dropping an umlaut and an aitch, and published, in English, The Original Travels of Baron Munchausen. An instant best-seller and on its seventh edition by 1793, the book delighted both adults and
children for generations to come with its tall tales about the Baron's fictitious adventures and escapades.
In 1951 the mythical Baron acquired further posthumous fame when a British physician, Dr. Asher, invented a new medical disorder, the Munchausen syndrome, to apply to patients who fabricate physical symptoms and illnesses and seek multiple examinations, tests, hospitalizations, and surgical procedures. It was old wine in a new bottle, for it referred to the vexatious problem of genuine versus counterfeit medical disorders. Through the ages, fabricators of tall medical tales have been branded with such pejorative diagnostic labels as hypochondria, hysteria, and malingering applied to the bothersome behavior of patients posing as “really sick” while being shameless poseurs. Such patients repeatedly acted the part of “hospital hoboes,” hounding respectable doctors, who were, in turn, mightily vexed by such shameless conduct. The latest DSM-IV of the American Psychiatric Association has a chapter on “factitious disorders,” whose chief diagnostic criterion “A. intentional production or feigning of physical or psychological signs or symptoms” (p. 474; italics added). The Manual contrasts malingering symptoms intended to overcome a problem in living (e.g., playing sick to avoid jury duty) with factitious disorder, which is devoid “of external incentives for the behavior” and therefore “always implies psychopathology” (p. 471). These are confusing definitions that immediately beg a number of questions.
Even though an intent to deceive is present in both, there is a major confusion here bet