Munchausen By Proxy Syndrome

This is one of those times that I sat down to research a case and it became something entirely different than I expected and in turn this will be different than I think any blog that I have done before.  You will hear about a few cases throughout but the majority of the discussion will be about this "syndrome." So often in the stories that I tell you, the reader, are left to decide if the person whom has been deemed responsible for a crime is the actual perpetrator.  From time to time I have done cases in which you have had to decide if a crime was even committed.  Undoubtedly the first question you will have to ask yourself is if Munchausen By Proxy is a real syndrome.  The answer to this question may be one thing at the beginning and by the end you may be thinking another way or at least asking more questions, at least that is what I hope because that is what I have come to do myself.  The more I learned about many of the situations in which Munchausen's has been alleged the more I wondered how I was not at some time accused of it myself considering how it is often diagnosed.  But once again, here I go ahead of myself.

So when I initial sat down to pick a case to go through I began by searching the case of Philip Patrick.  He was an 11 month old boy who had died at Vanderbilt University Hospital in Nashville Tennessee in 1996.  I remember seeing an episode of one of the news documentary shows about the case at some point but as far as the Internet went there really was not an extreme amount about his actual case.  The reason is likely probably because unlike so many of the cases I discuss here there were not any kind of real court proceedings.  In the end the allegations against Philip's mother, Julie were dropped and unproven. However, this case is often referred to when speaking of Munchausen By Proxy (here on out known as MBPS) as well as the Patrick's are now huge advocates against MBPS and have created an organization called MAMA: Mothers Against Munchausen Accusations.  I do want to state that you will hear some things that the MAMA website concludes and states but I want to be clear that although this was the case in which I began my search I did not visit this particular website until near the end of my research.  I state this so that it does not seem as if I took the information from there and looked to have it collaborated elsewhere. By the time I went to that site I was already armed with a lot of information about MBPS. I also want to be clear that the website duly notes that child abuse is never okay, nor do they in ANY way advocate for child abusers which is what the diagnoses of MBPS alleges.   In the case of Julie Patrick, her son had been born with multiple birth defects and issues.  The Patrick's lived in Mississippi but had going to Vanderbilt to medical treatment for Philip.  According to Julie a gastro doctor who had spoken to her for less than 30 minutes decided that Julie suffered from MBPS and made a call to Child Protective Services.  Julie goes on to claim that this was the first MBPS case (since at least then it was rarely alleged) the CPS worker had seen and she seemed more than willing to take full advantage of the situation.  Whether either of those allegations are true we only have Julie's word on that, but somehow as a mother I doubt they are false. At any rate Julie and her husband Mark were promptly forbidden contact with their son due to the allegations.  Within a month Philip died before Julie could prove her innocence. I know that Julie and Mark sued the hospital and those involved if for nothing else the mental anguish they caused but I am sure for much more. Again, I was able to get little information on the specifics of the case but if you read the information at the MAMA website you tend to believe little to nothing was done.  It is pointed out there that in cases such as these doctors "hide" behind what are called The Good Faith Laws.  Doctors, nurses and anyone in a position to care for children are required by law to make a report if and when they suspect abuse.  The theory behind it is that it will be investigated and determined one way or another and a child is saved from an abusive situation. So despite any outcome of any investigation, that may or may not be done as long as a professional claims they did it in "good faith" for the well being of the child it is pretty easy to get away with it.  The MAMA website also points out that CPS workers will then often hide behind the doctor claiming that they were only taking the word of a "professional."  So in the end a doctor can say "I thought it would be looked into and investigated" and those in charge of investigating it simply say "well, the doctor is smarter than I am and they thought it was abuse" and everyone goes home happy.  Well, those that just saved their careers that is, the families are often shattered.  

So what exactly is MBPS?  When was it all but "discovered"? And is it truly recognized as a "syndrome" or disorder?  Well some of these answers depends on who you ask but let's start with the first question.  MBPS has been described as a situation in which an adult caregiver, be it mother, father, foster parent...etc, to a child exaggerates or fabricates medical illness in the child for the attention and sympathy of others.  More often than not the alleged perpetrator is the mother of the child, or at least the adult female.  A study was done and it was state that father's only make up about 6% of MBPS cases and even still MBPS is considered to be a rare condition.  Some say that MBPS is a mental illness; some say it is not.  I think the important part to remember or keep in mind is that the American Medical Association does not recognize it nor does the American Psychiatric Association.  In some cases it is not even called Munchausen but called a "Factitious disorder imposed on another" and even still not truly even recognized completely.  In layman terms it is when a parent or guardian either lies or creates symptoms in a child in order to seek attention from the medical community or sympathy from friends or community.  

So who came up with this and decided it was "a thing."  Well that was a man by the name of Roy Meadow who in 1977 coined the term (although it started out named something else) while he was a Professor of Pediatrics in England.  After a few name changes it was settled on Munchausen ... the By Proxy was added later as an extension.  In the 1800's there was a man by the name of Baron VonMunchausen and apparently he was known to tell tall tales per se about his travels and his life.  It was said he did this because he liked the attention that it gave him.  So in essence someone would have Munchausen (NOT MBP) if they were to lie about themselves or create their own illness for the attention or sympathy.  The "by proxy" was added when it was decided that someone was harming someone else in order for them to gain attention.  When giving the description of this "disorder" it is almost exclusively defined as being the caretaker or guardian of a child although there was a small line saying that there have been doctors and nurses sometimes who fall in this category but it is said so offhandedly it is nearly missed.  Theoretically however using the description an adult child or any adult caretaker taking care of an elderly parent would qualify but we do not call that MBPS, we call that elder abuse.  Chew on that for a moment.

Now, although Meadow came to his conclusion of a diagnosis in 1977 it was not until the 1990's that he became really known for his 'discovery' and it appears that he was considered to be an expert obviously in the field. You know, that happens when you invent something and have not gotten the word completely out and he was apparently finding this "rare" disorder everywhere and testifying as a witness at trials throughout England.  Of course word had made it to other places, including the U.S. but Meadow was the leader!  Of course, as with any diagnosis there was a criteria that had to be met to qualify, and as with any disorder apparently not all symptoms had to be met necessarily.  But, that being said the standard criteria became the following:

1. The child had multiple medical issues that did not seem to respond to traditional or any treatment.
2. The symptoms would seem to disappear when the suspected caregiver was not present for a period of time or only appear when they were present.
3. The parent, or caregiver insists that something is wrong despite nothing being found and does not seem relieved when nothing can be found.
4. The parent or caregiver seems knowledgeable or fascinated by the medical profession.
5. The parent or caregiver is either overly supportive of the doctor or overly demanding of them.

Yeah... I have to admit that I did not quite understand that last one either.  For myself personally as a mother who has been known to become irate when her child is sick or in the hospital I find these things vague at most.  Aside from the fact that my children never had what I would consider "multiple medical issues" I have probably fallen into each of these things at least once when dealing with the medical community and my children.  I mean how many times have you taken your child to the doctor complaining that they have ran a fever or acted funny or did this or that and then you get them to the doctor and all seems fine? I think that has happened to us all as parents at least once.  When my youngest son was born it took them 3 days to figure out what was wrong with them before they figured out he had pneumonia.  I was not a happy mother when it came first to them not being able to figure out what was wrong and secondly by that particular hospitals lack of communication with me especially when I too was still a patient and nearby.  There was a notation put in his file that he had a "hostile mother."  At any rate Meadow's was "the man" throughout the 1990's and of course his new syndrome was getting it's fair share of publicity through cases and even movies made about fictional cases.... and then his career came crashing down and his reputation went with it.  

Meadow's biggest case as far as contributing to his downfall was the case of Sally Clark.  She had been a lawyer at one point.  In 1999 she was convicted for the murders of two of her infant sons.  The first had died when he was 11 weeks old, her second child died at the age of 8 weeks old.  In both cases Sally was home alone with the children and had claimed to have found them unconscious. Many experts claimed the deaths were "natural" meaning possibly SIDS although some later claimed the other child likely had a breathing disorder that contributed to his death. It seems at some point the prosecution was planning to claim "shaken baby syndrome," another controversial diagnosis but decided to settle on smothering and they brought in Meadow to testify about MBPS. Meadow testified that the odds of a person having more than one unexpected infant death in a family was 1 in 73 million.  He would claim that her motive was the fact that she had given up her career as a lawyer and resented the children for that.  Of course that lead away from the fact that he himself had claimed that MBPS was caused by a need of attention and sympathy.. but oh well, he was the leader and knew what he was doing... right??  Sally Clark would be convicted in 1999.  So it would seem that the jury thought he knew what he was doing.  Not so fast because despite being the 'fearless' leader and presumably knowing all there was to know not just on MBPS but his new specialty it seems became on infant deaths in which he disputed dozens of SIDS cases in which he claimed murder had occurred some new statistics, obviously not conducted my Meadow started coming in.  The new statistics were way off from the ones Roy Meadow had testified to because they actually accounted for things like actual medical issues and genetics.  One has to wonder if Meadow had not gotten such a big head in his career if he actually conducted any research anymore or just decided people would buy whatever he was selling, because really, they did for a long time.  Evidence was presented showing Meadow's information was "misleading and erroneous" and in 2003 Sally Clark was released from prison.  Because of the Clark case and a few others, a review was made into nearly all of the cases in which Meadow had been involved and in 2005 he was found guilty of "serious professional misconduct" and was sanctioned, unable, at least for the time being to practice medicine. It seems that he appealed the case and the judgment was set aside (it wasn't a criminal case so it wasn't 'overturned' as we say) and he was able to go back to practice but by then many of the cases he had been involved with had been overturned and women were exonerated. Meadow, by all accounts was done.  However, not only had the harm been done to the families directly affected by Meadow, more was to come.

By the time Meadow was discredited MBPS had been around for nearly 30 years technically although still never an official medical diagnosis and Meadow was far from the only doctor claiming to being proficient in the field despite the fact surely all their initial training or ideas had come from him.  I should point out that while the AMA and the APA still were not, and are not recognizing, this as a legitimate "syndrome" it was still the doctors that were studying this. Which if you look at it on the surface that is fine but as you dig deeper you have to have a few questions especially when it comes to court issues because when you bring in MBPS it is an all new ballgame.

We often see people who are on trial who will claim they are mentally ill or they suffer from a mental illness such as schizophrenia, bi-polar disorder or any number of personality disorders. You have experts who testify in courts to these things.  Generally it is the defense side that pulls in the first experts to discuss these things about the defendant and sure the State will have their own experts but they are almost always to dispute the defense experts leaving you with two opposing sides once more.  And although  MBPS is not fully recognized as I have said many times already those who do recognize it generally consider it to be a mental illness and yet you do not have defense attorney's bringing this up... it is the prosecutors.  Why? Because it's not something that can necessarily be defended I suppose.  When issues relating to MBPS are brought into court they are not used as a defense they are used to be accusatory.  I take issue with this as it is like talking out both sides of ones mouth, or cherry picking as we call it. Those who claim to be proficient in the study of MBPS claim it is a mental illness, yet in cases of other mental illness you do not hear prosecutors standing up and saying "The defendant is bi-polar and therefore is guilty of this crime and you should convict."  No, they are standing up fighting against the fact that someone is bi-polar because it is considered to be a mental illness and they may lose their case.  So why are we allowing prosecutors to use this as a basis for charges?  Why are we even hearing those words in a court of law? 

Someone can obviously be mentally ill and suffer from issues and not be guilty of a crime.  For example, my husband suffers from bi-polar disorder.  That does not mean that just because he suffers from that he is guilty of a crime, it would obviously have to be proven.  The difference here is that to accuse someone of MBPS means a crime has been committed.  In order to accuse someone of MBPS there has to be some area of proof that they have deliberately harmed or put a child in harms way.  So MBPS IS the crime if you listen to the courts.

In 2004 Australia passed a law dismissing MBPS to be used in courts.  Australia, and now apparently the UK have said that it is up to a jury to decide whether a crime has been committed.  The US has not made it that far.  We still see cases in the news.  In fact, just this past fall a woman was convicted of this in my area, although I find it very interesting that I can find no information on it on the Internet, even a local website that carries news articles despite the fact the local new called it a Munchausen case.  Not long ago I blogged about the case of Lacey Spears who was convicted in 2015 for the death of her son Garnett. While the term MBPS was not used in the trial it was used to the media prior to the trial by the prosecutors.  In the same respect while they did not use the term they did use the reasons (attention and sympathy) behind MBPS in court as their motive.  Seeing as I did the blog on Lacey Spears based solely on that case without looking into MBPS I went back and skimmed through that one a bit to see what my thoughts were.  I find it interesting that while I did think she was likely guilty based on numerous things even then I questioned the testimony of the doctors who testified at her trial.  The MAMA website points something out that I have to agree with.  It seems that we (and by we I mean the public and the courts) have allowed doctors and even social workers to testify and make judgments about MBPS, even those without supposed training. In Julie Patrick's case the doctor in which who called CPS was apparently the one who mentioned MBPS to the social worker and he was a gastroenterology. He was not likely a doctor in which had any real training in MBPS, if there are any. Remember again, it is not truly considered an actual disorder so it is unlikely that doctors are given much, if any, paid training into the issues and more likely that if the doctor suspected Julie may have been harming Philip he just threw out the diagnosis.  I mean we all know that parents who "knowingly" harm their children suffer from this... right? Another thing that was pointed out on the site is why does it have to have a name?  Why do we have to label it? That answer may be a bit simpler.  We all know that prosecutors are not required to give a motive to a crime, but we all also know that jury's want one and MBPS is an answer.  It is an answer, and it is an answer that jury's understand, at least at some level. You do not hear MBPS when an adult child abuses their elderly parent, yet the same motive. And doctors do not get up on the stand and testify that an adult child abused their parent for sympathy and attention. Yet they do so when it comes to a parent.  Of course these doctors can testify like everyone else on how someone acted or the actions that they saw, but doctors are being allowed to say these parents are doing these things for attention and sympathy.  

As a parent I have seen my fair share of doctors who have been less than professional, to put it mildly. I have often said that the medical profession is guess work in a white coat.  I have been lucky enough that my children did not suffer from multiple diseases or issues but I have been in situations where I know the doctor clearly had no answer to what was wrong and made one up. My oldest child was, and still is at 25 years old, an accident waiting to happen. When he was little I swear he could not walk through a doorway without banging his head. I did not always take him to the ER obviously but it always seemed the following day he would run a high fever which would concern me and I often would take him to be examined then.  It never seemed to fail that the doctors would diagnose him with an ear infection and prescribe an antibiotic. After one particular incident I had taken him just after he had hit his head and he was examined (ears too) and sent home.  The following day he was very lethargic and I could barely keep him awake or eat, and he once again had a fever.  After testing and three doses of medication to bring down the fever once again the doctors decided he had ear infections and prescribed an antibiotic.  I got them to admit that it was possible he had a concussion and that it may have been mild enough to not show up on tests.  I never filled the prescription because I knew his ears were fine.  A few days later his doctor confirmed this at a check up.  My point is that a doctor will do whatever it takes to shut you up as a parent.  Parents do not like to hear nothing is wrong when clearly they know there is something wrong.  We expect those with education in the field to have an answer, and yes, that is our fault because sometimes there is no answer, especially in minor issues. However, when those issues involve things like breathing, eating or digestive issues we know there is an answer somewhere and we expect someone to find it.  We do not expect every doctor to know everything but we do expect them to find us someone who can give us answers. And yet, that attitude and that behavior can open a parent up to being accused of having MBPS.  

Let me be clear in saying that I do believe there are parents out there that do intentionally harm their children, and probably for the reasons behind MBPS... attention and sympathy.  There are parents out there who do abuse and kill their children and there is absolutely no excuse for this but for the guidelines given to "diagnose" MBPS to be so broad it would be easy to see every parent on the planet qualifying, especially those with chronically ill children. As a parent we are supposed to fight for our children and most of those who have had a parent accused of MBPS are toddlers and infants (the average age is 4), children who cannot speak for themselves so their parent, generally the mother, is their advocate.  

I guess this blog kind of turned into more of a rant than an actual story on a case or even on the issue of MBPS but in the same respect if it gets you as a reader thinking then it has done it's job.