Friday, September 03, 2004

Calling the police on your own child: Another form of Munchausen Syndrome by proxy

Remember the famous story about the mom in Florida who was all loving and caring to her poor dear sick child? While this child was in and out of hospitals and enduring exploratory surgery, the mom was always so saintly and comforting. "What a good parent," the medical professionals all said. Until one day a nurse caught this perfect parent placing fecal matter in her child's IV.

"Why did you do it?" she was asked.

"I wanted the attention."

Recently, I think that I have had the unfortunate experience of running across another case of Munchausen Syndrome by proxy. A15-year-old boy that we know has a father who is a psychologist. And this boy has been in and out of mental hospitals, desert boot camps and mental health facilities all his life. He has been kidnapped by so-called "transporters" in the middle of the night and dragged off to the Utah badlands to be starved and force-marched "for his own good." He has been shipped off to half-way houses for juvenile delinquents and recovering drug addicts. And he has been going to shrinks since he was three.

This is a sweet child who doesn't use drugs, isn't sexually active, doesn't drink, can play sonatas on the piano and has a great sense of humor. What gives?

Two years ago, this boy made friends with my daughter. Immediately the boy's father started calling me and telling me how screwed up his child was. "You don't know his history," he'd say. "He spends too much time hiding in his room, is afraid to go to school and often runs away." The actuality of the child belied everything the father told me. I just didn't understand.

One day last week, young Jordan ran away -- again. "My father called the police on me!" he said. Meanwhile, the police officer involved in the incident called my house and told me that the father had done this sort of thing before. Many times. "The kid seems normal to me," said the officer.

I didn't know what to do. I sent Jordan back home. That was the law. Then we planned to go on a vacation. We were going to New York City! But Jordan ran again. The father started calling me again. "Has Jordan showed up yet?" At 3 am, Jordan finally showed up. He begged us not to send him back. Then the father started calling me and calling me and calling me and telling me in his most professional voice that, "We need to sit down and talk." At first I wanted to work with Jordan's father. After all, he was a psychologist. And he had such good arguments too. "You just don't know Jordan like I know him. He is a sick kid. He needs help!"

Then Jordan ran to another house but the father's calls kept coming to us. After several days of almost hourly calls at all hours, I began to feel like the father was stalking us. Finally we left for our trip, but he kept calling me and my daughter, even in New York. Then Jordan called me at our hotel. "I am in your house. My father is outside and he has the house surrounded by police! I'm so scared! What should I do?" Finally Jordan voluntarily gave himself up to the police.

Although I was thinking that probably this wasn't as severe a case as when the police in Milwaukee gave the Laotian boy back to Jeffery Dahmer because Dahmer was a smooth-talking man with a very good story, that's the way I felt when the police gave Jordan back to the father.

We have not heard from Jordan since -- except for one small phone call in the middle of the night when Jordan sadly told my daughter that he wanted to commit suicide. We talked him out of it but for how long?

It was then that I finally had the realization. This father had Munchausen Syndrome by proxy! And he was blossoming under all the excitement and attention that he was getting -- from me, from child psychologists but especially from the police. Sirens, uniforms, badges and everything! But perhaps the ultimate attention he craves will come only when, at Jordan's funeral, he will be the ultimate center of attention -- comforted by his friends as they as they say to him, "You poor man! What you went through! We realize what a wonderful father you were. We know that you did all that you could."

Is there ANYTHING that anybody can do to help Jordan? I myself feel so helpless. I feel like I am in way over my head.

PS: My daughter just got an e-mail from Jordan. It said, "My father has done it again. A new set of transporters have just arrived. They are letting me send this to you before they take me off to another boot camp program. Goodbye." My daughter is in tears.

Syndrome by Proxy (MSP)
Munchausen's Syndrome refers to a psychiatric disorder where patients pretend to have illnesses, and therefore are subjected to many medical tests and surgical procedures. Of course, these would never have been performed if the patient had not tried to fabricate them. However, the most notorious patients have often had dozens of surgical procedures for factitious (false) symptoms. Thus, this is a form of self-mutilation.
Munchausen's Syndrome by Proxy (MSP) is a parenting disorder where parents, usually the mother, fabricate symptoms in their children, thus subjecting the child to unnecessary medical tests and/or surgical procedures. In some cases, the parents also inflict injury and can kill their children in the process. MSP is not rare in Apnea Programs. Apnea is the perfect disorder for MSP, because infants appear normal between episodes. Therefore, a parent can bring her baby to a medical facility, fabricate a history of an apparent life threatening event, and the baby will be admitted, many tests performed, sometimes even surgery (such as tracheostomomies) are performed. MSP parents can be quite good at this, often switching from doctor to doctor so that it is difficult for one individual to put it all together. There have been documented cases of MSP in apnea clinics. However, these are much rare than "true" infant apnea.
There is a profile of a parent who is likely to cause MSP. They are usually the mothers. They are often health professionals, especially nurses and respiratory therapists. They often are very friendly with health professionals and cooperative with medical procedures. They appear quite concerned about their child, and are sometimes described as overly concerned. Some psychiatrists believe that this is an attention-seeking behavior. Obviously, not all health professionals who are nice to deal with have MSP.
I would think that MSP is more likely a problem in Apnea programs than it is in babies who have died from SIDS. The diagnosis of MSP is difficult to make. Pediatricians are uncomfortable even suspecting someone of MSP. After all, in training, pediatricians are trained to listen to parents' histories of their children and to believe them. Confirmation of the diagnosis is very difficult. Covert video-surveillance has been used in some settings, but a court order is often required to do this without the parent's knowledge. When the diagnosis is made, the baby must usually be placed in protective custody and psychotherapy is used on the parents.
I hope this helps. Thank you.
Thomas G. Keens, M.D.Childrens Hospital Los Angeles
Munchausen's Syndrome is the condition we name when a person makes himself ill purposely often to get the attention and friendship of medical personnel. For example, a person that secretly injects himself with his own germs into the blood stream to make themselves sick and needs to be hospitalized on a regular basis will often see the same medical staff who feel sorry for this person with this strange disease. This person and the staff become friendly. However, after this happens three or more times, people become suspicious and catch the person doing this to himself. Sometimes people will die from making themselves ill. Once someone who has Munchausen's Syndrome is identified, psychological and psychiatric intervention is necessary.
Now, Munchausen by proxy is when a parent makes their child ill on a recurrent basis. This is child abuse. These infants will usually come to medical attention with the complaint of stopping breathing (apnea) with a color change. If this complaint from the parent is not taken seriously, the parent will often make the infant more ill before they see the doctor. Frequently, the infant is brought into the emergency room by ambulance after getting resuscitated by the paramedics. It is true that sometimes these babies do not survive the damage induced by the parent (usually only one parent is inducing the injury and the other is unaware). If there is no autopsy or death scene investigation, these infants can wrongly be labeled as SIDS. This is not often the case.
Most often, the infant will have recurrent episodes of this "illness" and seek medical attention with the same complaint. Doctors are aware of this Syndrome and are looking for this type of pattern. There may also be signs from the parent or a type of attitude that go along with this type of abuse.
In its worst form Munchausen's by proxy results in the death or permanent damage of the child. In one case in upstate NY, the Hoyte family had 5 recurrent deaths in the children that were thought to be SIDS. Now, years later, the mother confessed to the murders. These deaths were thought to be SIDS at the time, but now would have undergone more careful investigation by both the police and the pathologist.
Because of these crazy people, when there is more than one SIDS death in a family, doctors become more concerned with the welfare of the new siblings. These infants will frequently undergo testing to look for medical problems and be placed on monitors at home. The family is looked at with some suspicion as well.
JDDeCristofaro, MDSUNY @ Stony Brook, NY