Perspectives in Biology and Medicine

VARIETIES OF IMPOSTURE LLOYD A. WELLS* Introduction Imposture—the attempt to make others believe that one is someone other than himself or herself or fills a role for which he is not in fact qualified—has long fascinated some psychiatrists. Johannes Weyer, the "father" of modern psychiatry, published an account of an impostor in 1577 [1, pp. 209-212], and several such accounts were published in the sixteenth and seventeenth centuries. In recent decades, however, imposture has had a surprisingly small bibliography. "Great impostors" who fool others regarding a variety ofjobs and roles are rare, but lesser impostors are common, and the occasional fantasy of becoming an impostor is probably ubiquitous. Becoming someone else, however briefly, probably is an early coping mechanism which, in children, can be reparative [2]. Failures, large and small, in adult life can perhaps reactivate such fantasies and deeds. Ekstein and Friedman have called attention to the relationships among acting out, play, and playacting, and these are relevant to the event of imposture [3]. In this paper I shall examine some "partial" forms of imposture, compare them with the full-blown syndromes, and relate them to some specific psychiatric disorders. In the syndrome of the "great impostor," a person assumes many roles, often socially exalted ones such as priest, physician, and tycoon— all without credentials. Often such persons are remarkably successful in their imposture and perform well in the roles to which they assign themselves . A classic case was described in 1925 by Karl Abraham [4]. He described a man who was a quasi-successful impostor during and after World War I; he eventually stopped these behaviors following marriage to a much older woman who was a maternal figure for him. Abraham saw the syndrome as rooted in the Oedipus complex. Unfortunately no *Associate professor of psychiatry, Mayo Medical School, Rochester, Minnesota 55901.© 1986 by The University of Chicago. AU rights reserved. 003 1 -5982/86/2904-0502$0 1 .00 588 I Lloyd A. Wells ¦ Varieties ofImposture follow-up on this patient was available, so whether his marriage was a cure for further successful imposture is unknown. Certainly great impostors have existed for at least several centuries. George Psalmonogar convinced reputable people that he was the representative of Formosa to Great Britain, and the case of Frederick Demarra in this country achieved considerable renown and notoriety. Phyllis Greenacre felt that persons who were impostors had several basic problems, including an unresolved Oedipal complex, defects in the sense of identity and superego, and what she termed an "infarction" in reality testing [5,6]. She felt that impostors often had a polymorphously perverse sexual orientation and a need for an audience as they acted out various components of the family romance. She also noted that the mothers of future impostors were often ambivalent about them and that their relationships with the patients were marked by watchfulness, guilt, anxiety, and great pride. Imposture for gain is probably far more common that some other forms of imposture. Again, the psychiatric literature on this form of imposture is sparse. People who consciously plan imposture for financial gain are much more likely to come to the attention of the police and judicial system than to that of the psychiatric profession. Miinchhausen's syndrome, although a rare entity, has inspired a great many contributions to the literature. Patients with this syndrome make a profession out of fooling physicians, going from hospital to hospital simulating serious physical illnesses and often receiving heroic treatments and, ultimately, bona fide iatrogenic disease. Related syndromes include chronic factitial illness, malingering, and compensation neurosis. The patient with chronic factitial illness usually lacks the flamboyant pattern of hospital peregrination that the patient with Miinchhausen 's syndrome has. The patient who is a malingerer is usually consciously feigning illness for financial gain, and the patient with compensation neurosis is usually simulating illness at a largely unconscious level, with primary gain of relief of anxiety and secondary gain of financial compensation. In both Miinchhausen's syndrome and chronic factitial illness, while there may be elements of symptom gain, and although the patient is consciously simulating disease, he is compulsively driven to do this for reasons that remain obscure to him—and...