Munchausen Syndrome by Proxy: The Wrong Way to Punish Your Child
Munchausen Syndrome is classified as a factitious order, meaning one who is subject to this condition propagates lies. In Munchausen Syndrome specifically, "patients" fabricate evidence to suggest that they are suffering from some sort of sickness when they are completely healthy in an attempt to satisfy a need for attention and emotional fulfillment. This differs from hypochondria in that the "sufferers" are not afraid of having an illness; instead, they manufacture it to receive the attention of a caregiver or doctor. The implication of Munchausen Syndrome by Proxy or MSP (which falls within the family of Munchausen Syndrome), then, is much more disturbing. Individuals who suffer from this complex attempt to derive emotional fulfillment from diseases they fabricate in others (hence the "Proxy"). Those who are recipients of this treatment are usually children.
Munchausen Syndrome is named after Baron von Munchausen, a German Officer who lived during the 1700's and frequently told tall tales of his exploits. Its causes are not well known, but both the parent syndrome and the by proxy disorder are thought to originate from early childhood psychological trauma or abuse. True incidences of both syndromes are rare, and over-attribution has become a recent problem (see http://www.msbp.com/ for some heated opinions in this regard).
In the 1990's, Munchausen Syndrome by Proxy had reached the attention of the FBI and popular consciousness. The syndrome has been featured in a number of popular films, including The Sixth Sense (1999), Yes Man (2008), and one of the first: A Child's Cry for Help (1994). In most appearances in the media, examples of Munchausen by Proxy are typified by mothers attempting to poison their children in order to receive attention from medical professionals. This is appropriate, because the vast majority of MBP cases have been perpetrated by mothers harming their children. Most of the rest have occurred from female caregivers harming children, while only a few have occurred at the hands of fathers. Reasoning for this is not entirely known, but if child abuse is one cause, it could be that women are more likely to internalize that abuse and reciprocate it later upon their children. It could also be that our current societal construct dictates that women are more often encouraged to seek help and support from others than men. Ideas such as these are only conjecture.
Typically, Munchausen by Proxy Syndrome has a few key indicators. Usually, a mother or other guardian will appear in a hospital with a child who has a strange and inconsistent condition. The mother will appear very concerned about the child's health and often even exhibit some extensive medical knowledge. If the child's condition returns to normal, then the mother will usually resort to a new tactic to make sure her child receives continued treatment. All of these signs can be easily mistaken for any number of concerned parents, but the easiest signals to decipher can occur during an examination of the child's medical records. Typically, a parent or guardian will move hospitals once their act is discovered, and the records will show frequent movement if examined carefully. If the child's symptoms often mysteriously disappear and reappear, or change and become non-typical, then these could be signs that the mother is keeping the child in a sick condition. Also, if the mother is observed tampering with medical equipment, this is another likely sign that Munchausen by Proxy Syndrome is in play.
One reason that so little is known about MBP is because of the nature of the disease. There are a number of characteristics that make Munchausen by Proxy Syndrome difficult to detect and study, including:
Perpetrators have a tendency to stop harming the patient if they believe they are being observed
Mothers or guardians will often move hospitals if their act is discovered
Sufferers of the disease try variable tactics to make their children appear sick
Sufferers also possess natural, extreme concern for their child, which is paradoxical and confusing
Perpetrators have been known to inject poisonous and disgusting substances into IVs including arsenic and feces, tamper with or disable medical equipment, and otherwise hamper the diagnosis process and confound medical staff. A handful of cases have resulted in the death of children, although guilty individuals are often caught due to the attention-seeking nature of the disease. Pictured are some engravings of Baron von Munchausen's fictitious exploits. The one at top is difficult to distinguish, but it pictures the baron on his voyage to Africa being pulled through the water by a team of horses.