Munchausen Syndrome by Proxy

"He slides his blade across my taut muscle like a bow to a violin. Please don't do this to me. He has broken the seal of my body. Blood flows from the slit and rushes; staining, screaming across the cool white sheet. My mother is making it up. I flop my head side to side, panting. Please don't do this to me. I look down; blood flows out of me, red races across the field of white. Is this me? My leg? My blood? The doctor threads his wire toward the incision in my thigh. My mother is making it up. My legs are moving, curling away. Don't let it touch me, get the wire out, get it out! What happened to you? You were being such a good patient. I'm struggling to my lazy elbows, they fold like cheap cards. My arm wire jerks with me......The doctor halts his wire, staring calmly into my eyes from behind his mask. Quick, get her sedated; she's ruining the test......Stick. Injection. Sedation. Calm. Enough to last me another twelve years. (Gregory, J. p.127)

This is Julie Gregory's account of a surgery that her mother forced her to have in order to find a problem that did not exist. Julie was abused by her mother throughout her life by social deprivation, nutritional and medical neglect, physical and emotional abuse, and Munchausen's by Proxy, a form of child abuse in which her mother would repeatedly take Julie to the doctor because of symptoms that were either completely fabricated, or intentionally caused by her mother. The phenomenon is unimaginable to most parents. Parents spend most of their time trying to keep their children out of harm's way, not trying to convince other's that their child is hurt, or ill. However, Julie's mother would keep her out of school to see specialists, force her to have unnecessary surgery, and shove pills down her throat, all while staying completely attentive to her, seeming like the ideal doting mother. (Gregory, J.)

What is Munchausen's by proxy, what causes it, and what is the proper response when confronted with a family with children suffering from this disorder? Munchausen's by Proxy is a very serious, and bizarre form of abuse which can be better understood by looking at the most common situations surrounding the abuse, individual cases of MBP, diagnosis' and the proper response to a family suffering from MBP.

Munchausen's Syndrome was considered solely an adult psychological disorder until the 1970's, labeling a mental disorder in which adults consciously create symptoms in themselves in order to gain attention from the medical community. It was originally named by a London physician, Richard Asher, after Baron Karl von Munchhausen's, a soldier who was known for his tall tales and wildly made up stores. (Bartol, C. p226) The term Munchausen's Syndrome by Proxy was coined by an English Psychologist, Dr. Roy Meadows, a professor of pediatrics at the University of Leeds in England. He was later knighted for his work on the subject (Feldman, M. p124). The word 'Syndrome' was dropped from the title because of the implication that the symptoms were biological, and unable to be controlled. Munchausen's by Proxy is defined as "a form of child abuse in which a parent (almost always the mother), or guardian, consistently and chronically subjects a child to medical attention without any 'true' medical condition or symptoms being present, either falsified or directly caused by the parent."(Feldman p226). The words 'by proxy' are what distinguishes this form of child abuse from the adult mental disorder, alluding to the parents "dominating influence" in the symptoms being present and stressed, and revisits the fact that the false medical information is being directed onto someone other than the person reporting the symptoms. Munchausen's by Proxy (MBP) is legally considered child

abuse, falling under the definition laid out by the Federal Child Abuse Prevention and Treatment Act of 1974., which states that child abuse is: " the physical or mental injury, sexual abuse, negligent treatment, or maltreatment of a child under the age of 18 by a person who is responsible for the child's welfare under the circumstances which indicate that the child's health or welfare is harmed or threatened hereby." ( Bartol, C. p122).

MBP is fully punishable by the law as child abuse because it is not considered a mental disorder. Though there are usually mental issues that tag along with MBP, MBP itself is seen as a set of events that has been chosen to be acted out by the perpetrator. This is explained using an example of someone who commits suicide by shooting themselves in the head with a gun; most would agree that the person in question was definitely suffering from some sort of mental disorder. However, if the same person shot someone else in the head; while it is true that the person could easily be suffering from a mental disorder, only the fact that they shot and killed someone, doesn't conclusively point to the presence of any mental dysfunction (Feldman p. 122).

It should be understood that though the most common relationship in MBP is a mother/child relationship, but there are cases in which the 'proxy' is another adult, and elderly person, and even sometimes an animal. Such was the case in Israel in 1980. A thirty four year old man drugged his wife's coffee with sleeping pills. When she had passed out from the medication he took a syringe, and injected her body with gasoline which after sometime created abscesses in her skin and her body. While she was suffering, her husband stayed by her side night and day feigning concern. She died from the medical condition that he had caused. Three years later, he hired a nanny to care for his children. After some time, he proposed to her. When

she refused, he drugged her coffee in the same way that he had drugged his wife, and when she had passed out, he injected her body with gasoline into her breast, neck and buttocks. The woman went in and had "extensive" lab tests done and it was discovered what he had done. He was then brought to trial, and sentenced to forty six years in prison for the murder of his wife, and assault to the nanny. He became publicly known is Israel as "The Gasoline Injector". (Feldman p.135)

There are some traits that are frequently fabricated when MBP is involved, these include apnea, or respiratory arrest, seizures, blood or bacteria in the urine, fevers, which has been known to happen by the mother putting her own menstrual blood into the urine specimen, continuous diarrhea, bloody stools, vomiting by use of ipecac, or extreme amounts of salt, anti depressants to induce a coma, and even cardiac arrest. (U.S. Department of Justice) Some physicians believe