Saturday, June 21, 2014

Munchausen's Syndrome by Proxy Is Alive and Well

Baron Munchausen was a fellow who just loved to tell tall tales and I'm sure that made him a rather charming dinner party guest. After all, these dinners can be pretty dull unless you have a few people who will make everyone laugh and he could do it in spades. Because of his ability as a raconteur of imagined adventures, his name was given to a rather unpleasant psychiatric syndrome known as Munchausen Syndrome.

The characteristics of the syndrome are basically far-fetched medical maladies which someone fabricates in order to get attention. Some of them go to extraordinary lengths to keep getting the attention they crave and, for some unkind medical personnel, they are known by the rather characteristic name of "zipper stomach" or something like that. Of course, there are other code words the professionals use and one of them is "FLK" for "funny looking kid" or "PIA" for "pain in the ass." If you see it on a chart, now you know what it means. Those with the zipper notation are usually seen as fakers who are going to try to get an unnecessary surgery or treatment and it's doctor beware time.

The syndrome is bad enough for everyone, but when it comes to a child and it's Munchausen's Syndrome by Proxy, it is truly a cruel case. Children have been brought to the point of near death by parents (usually the mother) or caregivers who seek to be seen as kindly angels caring for a sick child who never seems to get well. There have been cases where parents have contaminated IV lines, put blood in diapers, practically suffocated the child and worse. Most of the time, the children survive, but sometimes they don't and then it becomes a matter of who is able to document that it was an unnatural death and a case of homicide. Hospital security cameras are extremely helpful in this regard as are set-ups in the home or another medical facility such as a rehab center.

Although there are people who perpetrate this suffering on a child, everyone involved has to be extremely careful. No one wants to arrest a grieving mother, parent, guardian, medical professional or anyone else wrongly. It's not so easy to prove and it can cause an incredible amount of suffering.

I first came across it at a seminar I attended in the mid 1990s and was so surprised that I didn't know about it that I decided to research it and write an article. The article, with an MD co-author, was published in Postgraduate Medicine (sorry I don't have the reference available). The article must have been meant to be published because shortly after it appeared there was a legal case on Long Island where a mother was accused of MSP while caring for her child. Over the next year or so, the topic received quite a bit of press thanks to the on-going trials on Long Island, Florida, Canada, Arizona and just about any state you can name. One little girl had been hospitalized 200 times and had 40 surgeries.

MSP isn't confined to children, however, and there have been cases of wives being slowly poisoned or otherwise medically compromised by husbands who are obsessively possessive, fathers on children and wives on husbands. As you can see, it's usually a family affair.

The symptoms range is so wide that no one can point a finger to one medical condition that sets off alarms, but there are clues. Usually, coordination of hospital ER reports helps and so does an indication that someone has been taken to many different physicians and not treated by one consistently. There are also illnesses that should clear up with medication, but don't and which are often replaced with symptoms of another medical disorder.

The case is so challenging and the caregiver so attentive and helpful that the actual perpetrator doesn't appear like one at all. They are just a devoted parent or spouse who does everything they can to make the work of the medical staff a bit easier. For this reason, they are often left alone with the patient and this is the most dangerous time. Hospital cameras have caught mothers holding pillows over a child's head or putting contaminants in food they feed to the patient.  The staff, in fact, without this kind of evidence to the contrary, believes they are in the presence of an "angel" who always helps, always visits all day and may even want to sleep over to care for the patient.

It is a psychiatric disorder and a serious one. Treatment is absolutely essential but it must be with someone well-versed in the disorder and its treatment. These are clever people usually with a good understanding of medicine and medical procedures and they are very good at covering up their tracks.

Are we beginning to see another case in the headlines now? Take a look and see if there might be something that catches your eye. I think there may be one.