When Mommy Fakes It: Guest Blog by Michelle Gray

June 28, 2008

[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.

Photo Credit: www.freeimages.co.uk

Please note that Investigation Discovery does not necessarily endorse any of the views expressed by guest bloggers and Investigation Discovery is not responsible for the information contained in guest posts.

Comments

[Maureen]

Good article Michelle! We've seen this on MySpace, the
Munchausen Moms that continually send out bulletins about their sick child. At first many are drawn to it but after awhile when the Mom starts complaining that they are being turned away from hosptitals and doctors aren't returning their calls, etc., etc., ........ makes you wonder!

I think one thing though that you didn't touch on was some parents' fears, usually Mom's, who fear that they will misread symptoms and not get their child medical help in time. Munchausen may have to do with attention and abuse but is there a term for those that just fear not getting help in time and so bring their children to the doctors constantly for every little thing?

Maureen

[Mike Schuler]

Excellent article. I could be wrong, but I think another factor is the medical industry's willingness to perform tests, x-rays, and examinations as often as possible, in order to bill for them. At least that has been my impression when I go to the doctor.

Doctors who suspect MBP should be allowed to order the child's immediate hospitalization and separation from the suspect caretaker. I know of local cases where a child's life would have been saved. In one case, the foster parent was depriving the child of water and food, and telling the school teachers that he had a drinking disorder, and to not let him drink any water because he will drink water out of mud puddles or the toilet. The teachers followed the foster parent's orders, and the child died of severe dehydration.

[christy]

very interesting and really sad :(

[Amy]

Child abuse in any form is tragic. However, there have been cases where doctors suspected abuse because they lacked other explanations but sadly for mother and child, it turned out that there was a real underlying malady. www.munchausenmovie.com tells of several such cases.

[Michelle Gray]

Amy, I'm wondering if you actually read this post of if you are here on an agenda from MAMA? Your comment actually seems to be more for the purpose of pointing towards a propaganda movie made by an organization who insists that MBP does not exist. I think if you had actually read this article you would have noticed that I did address the issue of individuals who were wrongly accused of being MBP abusers. I am wondering if you just have the word Munchausen on your Google email alerts and pop in and drop your movie link willy-nilly without reading the articles in question because that is certainly how it appears to me right now.

For those who are not aware, there is an organization in which the members allege to be falsely accused MBP perps. While I have no doubt that some probably are victims of false accusations, as I mentioned in this post, I also believe that MAMA harbors MBP perpetrators and allows them a safe haven and the ability to scream about being victimized when the truth of the matter is that they, themselves, are the ones who are the victimizers.

[Dawn]

I do believe that there are children out there who are victims of MSBP, but I know first hand that MANY parents of children with chronic illnesses, such as Mitochondrial disorders, are falsely accused. My children and I have all be diagnosed with this chronic illness and I lost my middle child in 2006 to this horrific disease.

One year later, when receiving treatment for my youngest child at our local hospital (the only hospital we have ever used) I followed the Patient Bill of Rights and filed a complaint against the hospital, doctors and nurses for what I considered negligant care. Two weeks later I was accused of Munchausen Syndrome by Proxy.

The accusing doctor never met me, interviewed me, never met my child,never examined my child or her medical records. Based soley on this accusation, my child was removed from my care.

Though I have spent thousands of dollars on experts in their fields to combat this accusation, no one cares. The top MSBP expert in the country did a full forensic evaluation of the medical records and interviewed me for over 10 hours. He found no evidence of MSBP.

A top Mitochondrial expert in turn has done the same and concluded that we DO all suffer from Mitochondrial Disorder and that in no way is this a case of MSBP.

My daughter suffers from a chronic illness and is not being treated for it. The accusing hospital and doctors need to believe that she does not have it and refuse to treat her for it, or they admit fault.

This has torn my life apart. My child has been ripped away from her home, her family, friends, school and medical treatment that she needs.

If only a full investigation had been done before the accusation this would not have happened. False accusations are running rampant in the world of Mito and Metabolic disoders because pediatricians cannot understand the issues related and don't want to take the time to research and learn. They make the same amount of money with an easy patient as they do a complicated one. Maybe "doctor shopping" happends because doctors continually pass these families off to "experts" so they do not have to deal with it. I never took my child to a doctor I wasn't told to take her to by another doctor. Never went to any other hospital for care. Used the same pharmacy. If you don't follow the doctor's recommendations, you are at risk to being negligant.

How do surgeries, xrays, testing and all other invasive issues go on? Do parent's order these to be done? NO. Where is the culpability to the doctors who ordered the tests, performed the surgeries, gave the prescriptions. They were tricked by mom? Is that there defense. That is scary, isn't it?

One Mitochondrial expert has stated that he has treated over 20 families with Mito who have gone through accusations before coming to him. This is just one doctor.

So maybe before we just assume that all parents accused of MSBP are guilty (to protect the child), how many are not, and how many children are now at risk becasue they have lost the right to be properly cared for by a parent, who now have no rights in their care?

The medical community can say that sometimes someone may get falsely accused in the name of protecting children, but those children sometimes die. Who are you really protecting?

[Amy]

I did read the article and am sorry if I didn't acknowledge your acknowledgement of those wrongly accused. I do think it should be noted that there is controversy over the very existence of the behavior/mental illness because its founder, Dr. Roy Meadow, has been discredited. There are many sites that debate this subject, www.msbp.com, www.munchausenmovie.com, etc and I think that your article has added to this issue. Thanks.

[Michelle Gray]

Quite frankly, it doesn't matter to me if it is or is not a mental illness. It is still a devastating form of abuse and there is not enough information on it because there has been very little done in the way of research. These facts do not change based on whether the perpetrator is mentally ill or not. These facts stand on their own. These facts do not change based on whether or not Meadows has issues (Dr. Feldman certainly doesn't have any and he is most definitely an expert on the subject.) MBP IS abuse and it IS a devastating and torturous form of it.

The reason that there are false accusations is because there has not been enough research done to make sure that adequate information is available. I don't see how anyone can argue that there needs to be more done to study MBP. Do you two not realize that studying the phenomenon would help address the knee jerk reaction and false accusations? Or is the only course of action to try and insinuate that MBP doesn't exist? Head, meet sand.

Let me save some time and bandwidth by saying that I am a Munchausen by proxy victim. It's impossible to tell me that MBP doesn't exist because I am living proof that it does. My life was devastated and destroyed due to MBP. I am sorry people are wrongly accused, however, I sure wish someone would have tried to save me. What was done to me was cruel, evil and heartless. I was destroyed by MBP in every way a person can be destroyed.

I am angry that there hasn't been enough research done. I am angry that as a victim of this type of abuse there is no where that I can turn for support. I'm angry that there has only been one study done with victims of MBP. I'm angry that groups like MAMA can't step forward and encourage research. I find it interesting that those who complain about the wrong accusations never seem to include a plea for more research. Why is that?

[MAMA = Moms Against Munchausen Allegations/Accusations]

[Michelle Gray]

By the way, for the record, Roy Meadow was not discredited. He unintentionally gave one bit of inaccurate information during a single trial, and the MAMA folks ran with it, constantly repeating the claim that he has been "discredited" (the word they always use).

[Dawn]

My very first statement was,

"I do believe that there are children out there who are victims of MSBP, but I know first hand that MANY parents of children with chronic illnesses, such as Mitochondrial disorders, are falsely accused."

This indicates that my head if definately not burried in the sand.

Secondly, I have been living in the hell of a false accusation for well over 7 months, so again, no head burried here.

I have missed Christmas, birthdays and Easter with my child. Every day I get a dose of reality. I am truly sorry that you were a victim of MSBP, but now I am a victim of a false accusation of MSBP. Can you imagine a parent not even being allowed to tell her child that she loves them, or kissing their child goodnight because she happened to have pissed off or questioned the wrong doctor? How about a brother not being allowed to see his sister, what could he possibly be accused of?

I strongly believe that education of physicians, nurses, social workers and teachers of the TRUE signs of MSBP is important(if anyone can agree what they really are). They also need to learn first hand what making a false accusation can do to a family. Lives are destroyed when nothing is done to help a child, as are when a doctor jumps the gun and falsely accuses someone.

I am not associated with MAMA, though I have visited their site. If false accusations were not prevalent as they indicate, their site would cease to exist.

Why am I not our there fighting daily to educate the public on MSBP?; because I am out there daily trying to fight to get my child back.

I cannot even get a newspaper reporter or TV station to talk with me because one person with an MD at the end of their name made the accusation. Well, then he must be right. We all know that doctors never lie or make mistakes.

Every person involved in this situation, be it a victim of abuse or a victim of a false allegation suffers as no one should have to. Why is it that any victim is worse off than another. This is not a war against each other, but a war against ignorance.

[Star LaBranche]

Great article, Michelle. Out of all of the crimes one can commit this issue has always saddened me. I'm so sorry for all that's happened to you. I hope that your work in raising awareness for this issue will help kids who are or have been victimized by this.

[Todd]

I have suspected this very thing often in my small town. I wonder how often it is overlooked, unexpected or even avoided. A can of worms than few want to open.

A passionate that I hope to see continue.

[Compassrose]

You might as well call this child abuse by proxy because the child it subjected to unnecessary medical exams and treatments that can be painful and can forever warp a child's sense of well being and undermine their ability to judge their own health. They have to learn how to be healthy having been told all their life they have a debilitating illness or devastating disease. These parents don't physically abuse their own children -- they let the medical profession do their dirty work for them. Sadly, when a caregiver designs to lie -- be it about a child's health or their day to day living conditions -- the child will suffer because unless you can sort through the deception, people will take a caregiver's words to be factual. Doctors, teachers, CPS, anyone that attempts to provide protection to a child can be stymied by manipulating and deceitful caregivers. It would seem research would benefit everyone from the children that suffers at the hands of their guardians, to the medical profession that must sort truth from fiction, and to the truthful parents whose child suffers from an unusual and little known disease.

Mike, good news and bad news, it would take a note from a doctor before a guardian could deny a child food, water, or normal activities at school, but that wouldn't help if they manage to get a doctor to believe their lies.