Munchausen by Proxy-The Deadly Game

By Schreier, Herbert A.; Libow, Judith A. | The Saturday Evening Post, July/August 1996 | Go to article overview

Munchausen by Proxy-The Deadly Game


Schreier, Herbert A., Libow, Judith A., The Saturday Evening Post


The national spotlight is focused on the little-known Munchausen by proxy syndrome, where the protective role of motherhood conceals a bizarre portrait of child abuse.

After 22 months of unsuccessful diagnostic procedures in a hospital setting in England to determine the cause of a baby's breathing problem, staff concealed a video camera in the baby's hospital room, and a policewoman and a nurse jointly monitored the scene. The following events occurred:

Sixteen hours after the onset of video monitoring, the child was asleep in his cubicle with only his mother in attendance. She moved the chair away from the cot and lowered the cot sides. She then placed a soft garment (a T-shirt) on the bedding close to the child's face. Five minutes later she placed the garment over his nose and mouth and forced his head onto the mattress. He awoke immediately and struggled violently. After ten seconds the policewoman alerted the nurses who went into the cubicle. . . . In this first episode the woman police officer had intervened prematurely [by legal standards] because of her own distress at what she had seen. She decided to continue surveillance. Twenty minutes later, when the child was asleep on his side and the mother was again alone in the cubicle, she placed him in a supine position with his face upright and tucked his arms under the bedding. Ten minutes later she again applied the garment to his nose and mouth and forced his head onto the mattress. The child struggled violently. Forty-two seconds later the nursing staff were alerted by the police and went into the cubicle. . . . The mother claimed that he had woken screaming and that she was comforting him.

What Is Munchausen by Proxy Syndrome?

This case is a classic example of Munchausen by proxy syndrome (MBPS). These patients, usually mothers, systematically fabricate information about their children's health or intentionally make their children gravely ill. The children usually require extensive medical attention, often entailing serious and dangerous invasive medical procedures, surgeries, intravenous medicines, or multiple x-rays. Well versed in medical conditions, MBPS parents will seemingly stop at nothing to gain access to doctors and the inner circle of care in hospitals. Often they seek more general recognition of, or public adulation for, their devoted caretaking of a sick child. Sometimes the MBPS parent's interventions or the medical responses prompted by her fabrications result in the death of the child. We know, based on parents' own admissions as well as observations of some of these incidents taped by hidden cameras, that the mother's behavior is calculated and is performed calmly and carefully. These mothers are generally not psychotic and not in a dissociative state when they harm their children. When confronted by physicians who suspect they are inducing illness, or even when confronted by documented proof of their abuse, MBPS mothers tend to deny vigorously and persistently their role in harming the child. Some mothers even deny abuse years after conviction in court, and others only gradually come to acknowledge their role over the course of many years.

The name Munchausen by proxy syndrome was coined from the adult "Munchausen syndrome" because it seemed to mimic the adult disorder of illness fabrication but involved the use of a child as a type of proxy, or substitute, for the adult's own body. Unfortunately, the similarity in names of the two disorders has engendered considerable confusion about the relationship between the adult factitious disorder and the "by-proxy" syndrome. The name "Munchausen syndrome by proxy," still widely in use, makes the unwarranted assumption that the proxy syndrome is simply a variant of the adult disorder. We have chosen to use the term "Munchausen by proxy syndrome" to clearly distinguish it as a separate entity from Munchausen syndrome. While some patients share symptoms of both disorders, in fact there seem to be distinct differences in behavior for the two syndromes. …

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