Do you remember the scene in Sixth Sense when Cole attends a family party and meets a young girl who gives him a videotape showing her mother poisoning her with household cleaner? This scene was one of the first depictions of Munchausen by proxy disorder on film. Since then, the media has provided many reenactments of the symptoms associated with this disorder, supplying us with multiple examples of how a disorder that mostly affects women can result in accidental death and serial murder.
Some experts believe that the growing portrayal of this disorder on TV suggests a rise in public anxiety around motherhood and women in the workforce – as the media’s depictions detail the other side of human behavior: the side where our desires outweigh the safety of others. The side where mothers are not perfect. Whether or not this is true, the belief process behind this necessitates a look into the underlying mechanisms of this disorder and how it correlates to observations around societal standards. However, in order to do this, we must first understand Munchausen Syndrome by proxy and its sister disorder: ‘Munchausen Syndrome,’ also known as Factitious disorder.
Munchausen Syndrome/Factitious Disorder: Imposed on Self
Munchausen syndrome (or factitious disorder, Latin for artificial) is a psychiatric condition in which individuals feign physical or mental illness, sometimes through intentional harm to themselves. Individuals with this disorder “assume the sick role to receive the associated care and attention from others in order to cope with their emotional or psychological distress.” According to Baylor University Medical Center, self-infliction of the disease is a conscious act, but the underlying motivation is typically unconscious.
Theories for the underlying cause of this disorder are largely based on speculation, with no large-scale studies to confirm their accuracy. Experts believe the behaviors presented by this disorder are a result of maladaptive responses to childhood life events – with 60% of those diagnosed with this disorder having suffered a major childhood illness and this population, as a total, being much more likely to have experienced a difficult or traumatic childhood. “The instability of their childhood reflects in these individuals experiencing a lack of control over their lives. Hence patients fabricate symptoms and their medical histories, which allows them to feel a sense of control over an aspect of their lives. The role of an ill patient also provides these individuals with a sense of identity”, details Drs. Jafferany and Khalid in their 2018 CME Article, Psychological Aspects of Factitious Disorder. There’s also a strong association between individuals with factitious disorder and those with personality disorders (as the development of a personality disorder is often the result of an unstable childhood environment).
“Healthy relationships with caregivers are important for child development,” states Drs. Jafferany and Khalid. “If there are problems in these relationships, children may seek to satisfy their innate need for caregiver attention by exhibiting illness behaviors. In this way, children can satisfy their need for comfort and protection through the attention of healthcare providers who—through completing the duties of their jobs—act as substitute caregivers. These abnormal illness behaviors may extend into adolescence and adulthood. In this way, abnormal illness behaviors may affect the next generation either indirectly—if children model their own behavior after the parent with a history of factitious disorder—or directly if the parent abuses the child by forcing him or her to assume the patient role.”
There are other suggestions for the mechanisms behind the behaviors associated with this disorder (besides the affection one receives from portraying the sick role), such as the disorder being a type of behavioral addiction that causes individuals to have an uncontrollable urge to maintain the sick role and, conversely, a desire to overcome their dependence.
Other theories for the onset of this disorder include:
- Seeking and maintaining relationships.
- Enjoying being cared for by others.
- Coping with stressful life events or a lack of identity.
- A sense of accomplishment in duping physicians.
Since many individuals with this disorder experienced an unstable childhood, it must be noted that research has demonstrated that adults who experienced abuse or neglect as children are more likely to become abusers themselves. Therefore, individuals who develop factitious disorder in childhood to cope with abuse or neglect may be more likely to become abusers as adults. Through this process of the abused becoming abusers, the offspring of adults who coped with childhood abuse through factitious disorder may be at higher risk of becoming victims of factitious disorder imposed on another (also called Munchausen syndrome by proxy). A great example of this is the case of the Angel of Death, Beverly Allitt.
Allitt was known for wearing bandages when she didn’t have any wounds to cover, frequent visits to the hospital when she wasn’t sick, and physically harming herself for attention and sympathy. Allegedly, she forced a doctor to remove her appendix, although there was nothing wrong with it, and had gone as far as to use glass shards and hammers to inflict injury on herself. Once pretending to be sick and injuring herself was no longer enough, she began harming others to get the attention she craved...
Factitious Disorder by proxy/Munchausen Syndrome by proxy: Imposed on Others
In 2017, Dr. Gail Saltz, Associate Professor of Psychiatry at NY Presbyterian Hospital, told Bustle Magazine that “Munchausen syndrome by proxy (MSBP) is an often-undetected mental illness and form of abuse in which a caregiver ‘fabricates an illness or injury or induces an illness or injury upon someone in their care (most often their child) for the purpose of being a victim by association and getting medical attention and care from others.’” The individual enjoys the attention and sympathy that they receive from having a sick child as well as the praise for being such a devoted parent. Saltz noted that someone with the disorder – historically diagnosed predominately among women – can also victimize elderly or disabled persons in their care. In extreme cases, the person with the disorder will cause an individual to become sick, often with dire and sometimes fatal consequences.
There are 2.5 million cases of child abuse reported annually in the United States. It’s estimated that 1,000 of those cases involve MSBP. A 2017 study looking at nearly 800 published cases of MSBP found that about 95% of the time, the victim’s abuser was their mother.
Mothers have been found to be perpetrators of MSBP more often because women are more likely to be the primary caregivers to their children, providing them with the opportunity to carry out the abuse undetected, states Dr. Marc Feldman, a psychiatrist at the University of Alabama and author of Playing Sick? Untangling the Web of Munchausen Syndrome, Munchausen by Proxy, Malingering, and Factitious Disorder. “It’s not considered weird for mothers to bring their child for healthcare interventions. They can get away with it for longer and sometimes indefinitely.” Feldman found in his research that in many families in which MSBP cases are diagnosed, traditional values along gendered lines — where fathers are breadwinners and mothers handle childcare — are upheld tightly. He’s also seen several examples of the condition in families where fathers are oblivious to what’s going on between their wives and their children.
“People love horror movies, and people love medical mysteries,” states Feldman. “These cases combine both.”
It’s hard to forget Patricia Clarkson’s Adora mixing a cocktail of poisoned milk to give to her daughters in Sharp Objects, much like the image of Patricia Arquette’s Dee Dee forcing King’s Gypsy to use a feeding tube she doesn’t need in The Act. Elizabeth Podnieks, professor of English at Ryerson University, whose research has centered on motherhood and pop culture, recently suggested to TIME Magazine that the rise of the portrayal of MSBP complicates a longtime dichotomy that figures mothers as either bad or good, but nothing in between. Using the disorder to tell stories allows viewers to look at characters who take on “two sides of the same coin” (TIME, 2019).
“We have a woman who’s trying to make her child sick. The child is then, therefore, in desperate need of a mother’s care, allowing her to showcase that she’s the embodiment of the maternal figure that women are expected to be,” states Podnieks. In Podneiks’ view, the concept of intensive mothering, in which the mother holds primarily responsible for child-rearing and adheres to a lifestyle that totally revolves around the child, has taken root as more and more women join the workforce – putting extra pressure on working mothers to maintain unrealistic standards of parenting. According to Feldman, in the few cases in which mothers acknowledged being the perpetrators of abuse, they said it was because they wanted attention, sympathy, care, and concern. “They felt anonymous in their daily lives and unappreciated as mothers. After sickening their children, these women shift identities from that of an invisible mother to an admirable caregiver of a sick child whose illness eludes diagnosis,” continues Feldman.
Although we now may understand why and how the disorder becomes present in so many women, Feldman wants to ensure we remember that Munchausen by proxy “is a form of abuse, just like sexual abuse, physical abuse, and emotional abuse – it’s just a variant.” Most Munchausen mothers often have a history of abuse and a longtime pattern of using maladaptive methods to meet their needs.
Unfortunately, there is no cure for Munchausen or Munchausen by proxy. It’s caused by trauma and ultimately is a disorder that uses the trauma to produce even more trauma The main way to treat it is through the use of psychotherapy – such as cognitive behavioral therapy – to change the person’s thinking and behavior. Family therapy may also be utilized to help ensure that family members are aware of what’s occurring and can intervene as much as possible.
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