"On the plains of Oklahoma, with a windshield sunset in your eyes like a watercolor painted sky, you'd think heavens doors have opened."
Fly Over States

Monday, October 27, 2008

Munchausen's Syndrome by Proxy

Have you ever heard of Munchausen's Syndrome by Proxy? Here is an article that touches on it. I can't say I agree with all that it says but it is pretty much on point, seems to me.

In a nutshell, MSP generally involves a caregiver - in most cases the mother - who makes a child sick or fabricates symptoms in the child so that the poor thing endures medical procedures. Sometimes, the incentive appears to be that the caregiver enjoys the praise heaped upon her when she "saves" her child (mouth to mouth, quickly getting them to the doctor, that sort of thing). Some just seem to be addicted to the drama that comes with being in a medical crisis or being the parent of a seriously ill child. I have also seen some parents who seem motivated for tangible reasons - one mother milked the public and governmental agencies for all sorts of assistance, including housekeeping services based on claims that she was too exhausted from caring for a "special needs" child to cook and clean.

When I first went into the Guardian ad litem business, I'd heard of MSP but assumed it was so rare that I would probably never see a case.

Would that have been so.

Perhaps it is just the luck of the draw, but I have had a number of cases specifically deemed by the court to involve MSP. I get one or two cases a year. I have had a number of other cases that have elements of MSP but for reasons specific to each, there was no official "finding" by either a court or Child Protective Services.

A common fact pattern in MSP cases is for the mother to suffocate a young, pre verbal child. Then she resuscitates him/her and is hailed as a hero for being quick thinking and decisive. In the beginning, there is no clear cut medical reason for the child passing out. Alternatively, the doctors come up with a working hypothesis and the parent now has a name for the alleged malady. The mother continues this behavior for a year or two. Once the child gets old enough to tell what is going on, the mother switches to a younger, pre-verbal child. Now she claims some sort of genetic disposition to "passing out" exists in her offspring. Some of these mothers have one or more children who, tragically, die of SIDS. Ominously, many are outside the age range you'd expect when SIDS is involved. There may be questions raised but a lot of times they get away with it. And they'd completely get away with it if they'd stop.

I've have several of my parents get caught when they were filmed in the hospital placing a pillow over the child's face. (After the death of one of the mothers, one of the children who we never knew had been a "target" described how she would put a plastic bag over his head and force him to pass out). In each of these cases, the doctors have deliberately admitted the child to the hospital to a special room with cameras to monitor the parent after the doctor became suspicious. There must be an element of compulsion in some if a parent would risk getting caught in the hospital.

A second common fact pattern that I've seen are children who allegedly have reflux. The mother insists they can't keep anything down. I am horrified at the number of low weight children who, when I first meet them, have had a G-tube installed so that their dear, dear overworked mother can feed them intravenously. These mothers also tend to insist that their child has allergies and are prone to infections. Some of the kids I've worked with are so messed up that they aren't even walking. Lab work and cameras have shown the mother injecting all kinds of nasty things in the child. It is sickening. Even in the absence of lab work or candid camera shots, separating the child from his mother has resulted in miraculous recoveries.

A third common fact pattern are children who suffer mysterious seizures. I've had cases where the mothers were actually injecting the children with insulin and the lab work came back showing the children were full of non natural insulin in their system.

In each case, the mother is sweet, gentle, eager to please. There is not a snarly bone in her body. She will look at you with gentle eyes, feign confusion and beg you to help her child. In every case that I have worked with, the more I review the medical records, the more horrified I get. Repeatedly, I've had cases where the mother claims the the seizures began after a car wreck or a near drowning (in one case, both). Once you start to track it down, you usually discover that the alleged symptoms began before the alleged precipitating event.

In most of the more significant cases I have personally dealt with, there have been other dead children. Their deaths have typically been attributed to SIDS or a car wreck or some bizarre allergic reaction. It is not until subsequent children start displaying similar symptoms that someone, a doctor usually, starts looking back and asking questions.

Doctors find themselves in a tough spot. With nonverbal children, doctors typically rely upon the reports of a child's caregiver and will assume their reports are correct or mostly correct. Imagine the position a doctor finds himself/herself, to have needlessly put an infant through a serious, invasive procedure. What doctor wouldn't want to believe that his actions were the right ones? I have seen a few doctors who dig in and don't want to admit they were duped. Most, however, when shown the facts, are pretty candid that they relied on the mother's reports in making their medical decisions. They aren't happy about it but their tend to be honest.

MSP is not a mental illness although the manner in which it is discussed sometimes makes it sound like it is. No, the experts describe MSP as a behavior or a type of abuse. One way to think about it is to compare it to sexual abuse. Sexual abuse is not a mental illness - but sometimes it can be the result of a mental illness. Not all the time, however - sometimes, the perpetrator is just twisted.

Experience has taught me that these things happen. My research has taught me that this is not a new phenomenon. Some of these mothers strike me as flat out crazy in a sneaky sort of way. I get all that. What I DON'T get, is how in my cases, the fathers can look the other way. To a man, they have been in complete denial. Even when faced with the evidence and the likelihood that they are going to lose their surviving children, they tend to steadfastly stand by their woman and believe it is all a mistake. His family despairs that he will ever see the light. I've seen fathers who watch their children go into foster care rather than face reality. I have seen them listen to expert witnesses who describe in meticulous detail how a particular child was injected with insulin and the husband/father still simply sits in denial.

A related fact pattern I've seen are women who seem addicted to going to the doctor, themselves. They have ovarian cysts. They sprain their ankles. They have migraines. Their allergies are out of control. Their pregnancies are nightmares. When Junior comes along, sure enough, she has him in the emergency room several times a month. These mothers aren't exactly lying about symptoms, and they aren't taking steps to make their children sick. They are, however, addicted to hospitals and will use any excuse to get their child there. Their kids never have a cold. They have pneumonia. Their children never have a 24 hour bug - they have e coli poisoning. The doctor may throw out some possibilities about what is ailing their child and the mother will swear to anyone who will listen that they think her child "probably" has cancer. They may call their boyfriend at work, their mother, their boss or their best friend, crying, for sympathy. I don't know if these are women displaying a mild case of MCP or they are just attention needing, in general.

At the end of the day, even if she is not doing anything to make him sick, Mom is sitting in the emergency room with a half smile on her face as everyone pays attention to HER. Her little one sits next to her, terrified that he is about to get another shot or poked or prodded or experimented on to find out what could possible be wrong with him.

There are no gurantees that something minor won't turn into some thing major. All the same, it is a fortunate child whose mother's first line of defense is chicken soup, a cool washrag and a cuddle while her Little Darling sleeps off a bug, safe in her own bed.


Sherry said...

I do not understand how you do what you do. God bless you.

Years ago I worked as a secretary in a probation office. A young man was on probation for killing his wife...he walked in while she was beating their extremely young son...something he already suspected was going on...but there was always an excuse about the bruises. His greatest fear of the future was the day his son was old enough that he would have to tell him what happened.

Penny said...

Sherry, that is horrible. Are they really sure that the wife was beating the child? Killing the mother seems pretty excessive (boy, was that an understatement on my part?). Did he say why he didn't just separate the two of them?

Owens Family Adventures said...

Words just fail me.

Anonymous said...

Thank you for opening my eyes again, Penny.

I can see where your hobbies must help keep you sane.