[Michelle Gray writes for National Lampoon! and is the editor and a contributing writer for In Cold Blog]
It's hard for a rational individual to fathom harming a child, let alone their own child. It's even harder to comprehend callous premeditated actions conducted for the sole purpose of causing a child to appear chronically ill and suffer through needless medical procedures and surgeries, or even death. Yet, that is exactly what takes place when the form of child abuse is Munchausen by Proxy.
A perpetrator of Munchausen by proxy is often times referred to as having a "mental illness." They are described as being driven by an uncontrollable compulsion to make their children sick in order to gratify their own personal desire for attention. Attention that might take shape in the form of sympathy from family, friends and co-workers or perhaps by being perceived as a strong dedicated mother - a champion fighter for the chronically ill child.
Dr. Marc Feldman, Clinical Professor of Psychiatry at the University of Alabama, Tuscaloosa, is an international expert on Munchausen Syndrome by proxy (MBP). It is his position that Munchausen by proxy is not a mental illness. It is, instead, a behavior that is driven not by compulsion, but is instead carried out by choice.
"Munchausen by proxy, isn't really an illness, as I see it. It as a form of child abuse, not something a perpetrator suffers from. In the same way that a mother doesn't have shaken baby syndrome, a mother doesn't have Munchausen by Proxy.
"Some people with Munchausen syndrome [not to be confused with MBP] do say that they feel a compulsion to lie, whether about illness or other things. But this doesn't rise to the level of an irresistible impulse" says Dr. Feldman.
So, what is the difference between having the mental illness called Munchausen Syndrome and perpetrating the abuse known as Munchausen by proxy?
The easy answer is individuals with Munchausen Syndrome want to be unwell and will feign or exaggerate illness in themselves so that they may garner attention by assuming the sick role. Munchausen Syndrome itself is a form of Factitious Disorder which is a mental illness. Factitious Disorder is characterized by "the feigning, exaggerating, or self-inducing of physical or psychological signs and symptoms to assume the sick role." Munchausen Syndrome boils down to "chronic and severe factitious disorder," faking it to the nth degree, so to speak.
The form of child abuse called Munchausen syndrome by proxy involves a parent or caretaker convincing the medical community that the child in their care is suffering from a chronic and debilitating illness. The abuser is usually a mother and the victim is usually their child, often times preverbal. The behavior is driven by the abuser's self-gratifying need for attention.
Perpetrators of Munchausen by proxy have been found suffocating their children, poisoning them, injecting foreign matter into their child's intravenous tubing - quite frequently a mixture of water and fecal matter - fabricating symptoms, starving them, putting drops of blood in their urine samples, effecting unnecessary surgeries such as shunts, colostomy bags, G-buttons and implants to control non-existent seizures. That’s the short list.
How is it possible that the medical community could be easily fooled into believing that a child who is not actually sick is suffering from a chronic illness? According to Dr. Feldman the answer would seem to lie within the way the medical community is taught their profession in med. school.
"Physicians are taught nothing about medical deception in medical school or residency" Says Dr. Feldman. "Doctors are taught [correctly] that the best clue to what is going on with a patient is what the patient and family have to say about it and that we must form an alliance. We are not taught ever to doubt what is being said. It doesn't surprise me that doctors can not only be gullible but also wind up being, as one author put it, 'professional participants' in MBP maltreatment."
In addition to not questioning the honesty of the patient, or in the case of Munchausen by proxy the patient's mother, it has also been found that even though medical professionals never witnessed the symptoms being expressed by some MBP mothers regarding their child, nor having test results that substantiate the mother's allegations, surgical procedures have been preformed regardless.
Munchausen by proxy perpetrators will frequently doctor shop. If there is suspicion of MBP the perpetrator will move on to a new doctor, clinic or hospital. The moving, and in some cases complete geographic relocation, makes it difficult for a new treating physician to do anything other than believe the litany of symptoms being provided by the MBP abuser. Their training tells them that they must believe.
Trying to rationalize in one's own mind that Munchausen by proxy is not an actual mental illness can be difficult, to say the least. Not only does one have to ask themselves what kind of sane person would intentionally induce debilitating illness in their child, causing needless surgeries, invasive medical procedures and unneeded medications, just so that their psychological need for attention can be quelled. It also seems to beg the question that if Munchausen syndrome itself is a mental illness than how can a component of it not also be a mental illness? Dr. Feldman explains it like this: "If someone kills himself/herself, we assume that they are depressed and/or substance dependent or that they have some other mental disorder. We assume they are mentally ill, and that assumption is usually valid. But if someone kills someone else, we don't assume they're mentally ill--we prosecute them. The same holds true for Factitious Disorder, Munchausen Syndrome and Munchausen by proxy. If someone sickens himself/herself, it's a mental illness. But if they sicken someone else, it's not. That's my opinion, anyway, but some in the field do sharply disagree, and consider factitious disorder by proxy to be a mental illness like any other. The debates about this can get heated."
The debate as to whether Munchausen by proxy is a real phenomenon or simply a witch hunt perpetrated by over zealous medical professionals and untrained social service workers is ongoing. While there is little doubt that there have been individuals who have been wrongly accused of being Munchausen by proxy abusers there is also plenty of video taped evidence to demonstrate that this form of child abuse does exist. To deny its existence altogether is, I think, to be intellectually dishonest with not only one's self, but to also be dishonest with the public and the medical and social services community - not to mention victims who know through their own experience that Munchausen by proxy is very real.
According to Dr. Feldman, "It has been estimated by one researcher that there are around 1,200 new cases each year in the U.S., but that statistic makes a lot of assumptions that might not all be true. MBP is a form of abuse/neglect that is bathed in secrecy and I have the feeling that most--yes, most--cases are never identified."
With the medical profession being so willing to do invasive procedures at the behest of a Munchausen mom when test results don't necessarily support the symptoms described, I don't find it at all surprising that MBP cases would likely be under-reported. In fact, I would imagine the deaths associated with MBP are also underreported. Says Dr. Feldman, "it has been estimated that 9-10 percent of MBP victims eventually die, either as a direct result of the abuse or the iatrogenic complications caused by misdirected treatment efforts."
When will the torture and death of a child as a result of deliberate medical malfeasance on the part of a parent be considered significant enough for a decision to be made that this form of child abuse is worthy of study? "Very little formal research into MBP has ever been performed and government and private foundations in the U.S. have never contributed a dime in grant monies for these issues," says Dr. Feldman.
There is an unjustifiable lack of research into the phenomenon of Munchausen by proxy maltreatment. As a result the medical community is ill-informed, social services programs are ill-informed, and the public is ill-informed. Because of the lack of information victims of Munchausen by proxy will continue to suffer and die, and parents of real chronically ill children will be wrongly accused. There is no lesser of two evils here, neither should be considered a better option than the other. Children should not suffer because bureaucrats are afraid of the consequences of wrongly accusing parents of MBP and parents with real chronically ill children need to be at their side, and their children need them there.
The lack of research and information has created a poorly educated community on how to effectively handle and recognize this type of abuse. Continued failure to adequately study and address Munchausen by proxy is not going to make this form of abuse go away, and it certainly isn't going to save anyone's child.
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