Monday, February 20, 2006

Munchausen Syndrome by Proxy

As background to the following discussion, please see:

I am saddened, profoundly saddened, that Munchausen Syndrome by Proxy (MSBP) has been "discredited" because of the cases of medical practitioners who allegedly misused the diagnosis.

I do not know why Sir Roy Meadow has been discredited personally and instead of being called the discoverer of this syndrome is being slurred as "the inventor of this label/diagnosis". I think he should be hailed for having given a name to a phenomenon that, without being named, is very difficult to recognize as a syndrome of child abuse.

Almost 25 years ago I befriended a woman who had one daughter at the time, or rather, she befriended me - desperately. She was a needy and dependent personality, but I was new in Israel and her obvious admiration of me and the open house she provided me with was pleasant and convenient in lieu of a real family. She seemed to need to be needed and didn't seem to care if a good deal of being used was involved.

Her daughter, whom I loved, was a "sickly" child and she was always attentively attending to the girl's various, rather obscure and oddly symptomless, illnesses. At first I thought this woman a very dedicated and concerned mother. After a while I began to see that something was amiss, but I did not know how to define what exactly. I began to joke with her that she a hypochondriac for her daughter. Her husband did not smile when I made these jokes.

After a few years she has a boy, then another child...five in all.
All of her children were "sickly". Their obviously imaginary illnesses ran the gamut from the mild cold to chronic illnesses and emergency medical conditions that required immediate attention. She was constantly running with them from one health clinic to another (perhaps as they caught on to her she moved on?) and calling ambulances in the middle of the night. There was no name for what she was doing to her children in those days and all I ever heard of was plain old vanilla hypochondria. Evidently, that was also the case with the child welfare workers too. Israel has excellent child welfare mechanisms in place for rescuing children at risk, but no one had a name for this type of personality disorder and child abuse at the time.

The last time I saw her she invited me over to her place. We were living in different cities at the time. When I got there no one was at home. I spotted a pharmacy across the street. I walked over to the pharmacy and, not at all surprisingly, there she was with the kids. "How did you know where to find me?", she laughed knowing the answer. She was always plying the kids with OTCs and getting them prescription drugs from unsuspecting doctors and administering those as well. This time she was buying Flagyl. I knew Flagyl was dangerous so I opened my mouth and said: "Flagyl is dangerous (I don't recall that we knew it is carcinogenic at the time, but we did know that it is risky to take). Why are you giving the kids Flagyl?" The little one said: "Mom says I have worms" and rolled his eyes signaling that he knew he didn't. I choked back the tears.

I never went back there. I couldn't. It hurt too much to see what the kids were going through in that house. She called me to invite me to the wedding of her oldest, my favorite of her children. I couldn't attend. Too many memories of her having been hurt as a child would have flooded my memory. My friend said something unclear about a social worker helping the family and about the little ones being in boarding schools. I understood that child welfare had intervened. I heaved a very deep sigh of relief.

My conscience bothers me to this day. Had I known the words Munchausen Syndrome by Proxy, I would have reported her to the authorities. I would have demanded that they look into the case if they ignored it for lack of knowing how to handle it. If they didn't know what MSBP is, I would have sent them information. I didn't know what MSBP was and those kids suffered terribly until someone learned about the syndrome and acted on it.

I am filled with sorrow that MSBP had been "discredited". How typical of the West to throw out the baby with the bathwater on the lark of a trend. MSBP was probably the "darling" of the psychological world at one time. Now it's the ugly stepdaughter. How typical. Dammit!

I am certain that more children will suffer because of real MSBP than due to medical malpractice using MSBP as a cover.

Doreen Ellen Bell-Dotan, Tzfat, Israel