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Playing Patient, Playing Doctor: Munchausen Syndrome, Clinical S/M, and Ruptures of Medical Power

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Abstract

This article deploys sadomasochism as a framework for understanding medical practice on an institutional level. By examining the case of the factitious illness Munchausen syndrome, this article analyzes the operations of power in the doctor-patient relationship through the trope of role-playing. Because Munchausen syndrome causes a disruption to the dyadic relationship between physicians and patients, a lens of sadomasochism highlights dynamics of power in medical practice that are often obscured in everyday practice. Specifically, this article illustrates how classification and diagnosis are concrete manifestations of the mobilization of medical power.

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Notes

  1. Heym, “The Imposter Patient,” 160.

  2. This observation comes from my review (Fisher 2002) of all the medical literature on Munchausen syndrome from 1951 (the year of the appearance of the original article) to 2000 (578 total publications).

  3. Chancer, Sadomasochism in Everyday Life, 2. Subsequent references to this work appear in the text.

  4. See, for example, RR Linden et al., Against Sadomasochism and M Thompson, Leatherfolk.

  5. Chancer is very careful to point out that sadomasochism is not inherently gendered. That is to say, she stresses that patriarchy has influenced the gendering of institutional hierarchies, not that essential differences between men and women have caused this division.

  6. Starr, The Social Transformation of American Medicine.

  7. Illich, Medical Nemesis, 22.

  8. Nash, “Problems of Deception,” 141.

  9. See B Good and M-JD Good, “Learning Medicine” and C Amirault, “Pseudologica Fantastica.”

  10. Young, Presence in the Flesh.

  11. See H Mandel and H Spiro, When Doctors Get Sick and EE Rosenbaum, A Taste of My Own Medicine.

  12. Schiebinger, Has Feminism Changed Science?

  13. Gramsci, Prison Notebooks.

  14. See both M Foucault, Discipline and Punish and The History of Sexuality: Volume I.

  15. Chancer uses the term “conditions” here to describe the responses from those in power to those challenging their authority.

  16. Hess, Evaluating Alternative Cancer Therapies.

  17. Hess, Selecting Technology, Science, and Medicine.

  18. Haddy, et al., “Munchausen's Syndrome,” 197.

  19. Fisher, Sociopatholigizing Patients.

  20. Asher, “Munchausen's Syndrome,” 339.

  21. See, for example, Haddy, et al.; DO Quest and SE Hyler, “Neurosurgical Munchausen's Syndrome”; DJ Vail, “Munchausen Returns.”

  22. Spiro, “Chronic Factitious Illness,” 574.

  23. See, for example, TP Duffy, “The Red Baron” and S Vaisrub, “Editorial: The Immortal Baron.”

  24. Kass, “Identification of Persons with Munchausen's Syndrome,” 197.

  25. Baudrilliard, Simulacra and Simulation, 3.

  26. MacKendrick, Counterpleasures.

  27. Quest and Hyler, 413.

  28. Hart, Between the Body and the Flesh.

  29. Sale and Kalucy, Munchausen's Syndrome, 525.

  30. Manolis and Sanjana, “Cardiopathia Fantastica,” 528.

  31. CA Pallis and AN Bamji, “McIlroy Was Here,” 973, 974, 975.

  32. AN Bamji and CA Pallis, “McIlroy, the Media, and the Macabre,” 641-2.

  33. Other examples of this detective work can be found in Le Coz et al. 1997 and in Asher 1951.

  34. Ilich, 117.

  35. GC Bowker and SL Star 1999.

  36. DJ Vail, “Munchausen Returns,” 320.

  37. Spiro, 577.

  38. Case Records of the Massachusetts General Hospital, 113.

  39. RW Moore and K Ullman, “The Doctor's Thorn,” 123.

  40. See E Frankel, “Munchausen's Syndrome”; JEH Stretton, “Munchausen's Syndrome”; B Williams, “Munchausen's Syndrome”; P Wingate, “Munchausen's Syndrome.”

  41. AM Karnik, et al., “A Unique Case,” 701.

  42. T Nadelson, “The Munchausen Spectrum,” 175.

  43. JO Cavenar and AA Maltbie, “Munchausen's Syndrome,” 349-50.

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Authors and Affiliations

  1. Assistant Professor, Women & Gender Studies, Consortium for Science, Policy & Outcomes, Arizona State University, P.O. Box 873404, Tempe, AZ, 85287-3404, USA

    Jill A. Fisher

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  1. Jill A. Fisher
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Fisher, J.A. Playing Patient, Playing Doctor: Munchausen Syndrome, Clinical S/M, and Ruptures of Medical Power. J Med Humanit 27, 135–149 (2006). https://doi.org/10.1007/s10912-006-9014-9

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