Sunday, 20 January 2013

When Service Users Seek to Deceive Part II

Borrowed from the excellent Little People Blog
Warning: this post may contain triggers for abuse.
During the more than 20 years that I have been based in a CMHT, I have worked with literally hundreds of women and men who have been the victims of childhood sexual abuse, rape and domestic violence.
One of the greatest fears that abuse survivors have when they disclose their abuse is that they will not be believed. That is one of the reasons why, as a matter of basic practice, I always believe what service users tell me. After all, I often tell them, why would anyone want to make up those sorts of stories?
I also often say to those people that out of the hundreds whose stories I have heard, there has only ever been one who did not tell the truth.
Trudy was 25 years old when I first met her. She already had a considerable psychiatric history, including depression, anxiety, and bulimia, and had recently had a spell as an inpatient. She also had dependency problems with amphetamines and other drugs. As a result of all this, she had split up from her husband, and he had got custody of their two children.
When I assessed her, she told me, without going into any detail, that at the age of 16 she had gone to live with an older man whom she described as a gangster. While she lived with him, she was terrorised by him, and had to endure nameless sadistic practices, until she had eventually managed to escape his clutches and move to another part of the country.
Through copious tears, she described a range of symptoms of post traumatic stress disorder, including nightmares, flashbacks and intrusive thoughts and memories.
She decided that she needed to disclose the details of the abuse she had suffered at the hands of this man.
However, she was very avoidant. She would cancel appointments, or forget to come, or find other reasons why she could not attend. This pattern continued for over two years, with far more cancellations and DNA’s than actual sessions.
When we actually did have a session, she would frequently become so distressed and tearful that she was unable to speak.
Eventually, we devised a plan in which Trudy would write about specific incidents at home, and she would then bring the printed account to the session. I would then read it through, and it became possible for her to begin to debrief these events. His abuse of her, according to these exceptionally graphic and lurid accounts, was almost unimaginably sadistic. It was not surprising that she had been traumatised by this relationship, and that she now found it so hard to deal with it.
However, she reported that things were gradually improving as a result of these sessions. The trouble was, we would have one or two good sessions, then there would be a series of cancellations or no shows.
During this time Trudy had a number of acute psychiatric admissions. Various sorts of medication were tried, with little success. At the time, the CMHT did not have a clinical psychologist, but a psychologist from another team showed me how to practice EMDR (Eye Movement Desensitisation and Reprocessing), a technique in which the subject recalls a traumatic event while the therapist moves a pen or other object from left to right in front of their eyes. The technique is supposed to disconnect the emotion from the event, and hence to reduce the traumatic recall.
I tried this technique with Trudy, with quite remarkable results. She reported an improvement in her emotional response immediately. We therefore did several sessions, and the improvement continued.
Trudy worked hard to regain control over her life. She stopped abusing amphetamines. She started to do volunteer work, she went on a diving course, she began to address her weight problem, and on our last session she told me she was planning to take an HGV course. She was discharged from the CMHT.
It was very gratifying to see the change in Trudy, and to feel that I had in some way helped her.
Then a few months later, she unexpectedly turned up at the CMHT asking to see me urgently.
I took her into an interview room. She presented in a way I had never seen her before. She seemed agitated, but also almost elated.
“Masked AMHP,” she said to me, “There’s something I need to tell you. You know all that stuff I told you about, about that relationship? None of it was true. I made it all up. None of it happened. And when I went into hospital? I just pretended to have those symptoms.”
I didn’t know quite how to respond. I didn’t know quite how I felt. How could she have deceived me so well? And not just me – how could she have pulled the wool over the eyes of all the inpatient nursing staff and psychiatrists?
“Why do you think I did that?” she asked me imploringly. “Why did I make all that stuff up?” She seemed desperately eager for my response.
"Well,” I said at last. “There is a mental disorder called Munchausen’s Syndrome. That is when someone pretends to have an illness, and feigns the symptoms, and often convinces medics that they are really ill. It’s more usually about physical illness. Such people often end up having many operations and courses of treatment.”
“I see,” she said, as if this was a remarkable revelation. “That sounds like me, doesn’t it?”
“Then there’s Munchausen by proxy, where a parent pretends their child is ill, or even feeds them poison to make them ill, and then seeks medical help.”
Her eyes lit up.
“But I used to do that!”
“What?” I said.
“I pretended that my son was having epileptic fits. He had all sorts of tests, he was even admitted to hospital for a while. He was on medication. Of course, there was nothing really wrong with him.”
These revelations were even more difficult to process. Although her children were no longer in her custody, I knew I would have to report what she had told me to Children’s Services.
“You need to help me,” she continued. “I need help. You see, even though the other stuff wasn’t true, what is true is that my Dad sexually abused me when I was a little girl.”
“What was the nature of the abuse?” I asked her.
“I can’t actually remember anything. But I know he abused me, and I need help.” But her presentation was incongruent with what she was saying. Her eyes were wide. They glittered. She was excited.
“We can’t do any more today,” I told her. “You were discharged from us months ago. You’ll have to get your GP to refer you again.”
However, she moved out of the area shortly afterwards. I never saw her again.


  1. These two linked posts have been interesting. Big and bold of you to discuss what could be seen as failures in practice. Thanks.

    Any chance of a companion post on 'When Psychiatrists try it on?'

  2. I suppose to say those things and go through all that she must be mentally ill, maybe she just liked all the attention and fuss it created?