Munchausen by Proxy

Munchausen By Proxy

Jeffrey L. Lange

Post University

INTRODUCTION

        There is no greater form of abuse, even child abuse than Munchausen by Proxy.  While it is a rare form of child abuse, children are still made ill by the person that loves them and cares for them the most.  This horrible form of abuse can result in a child becoming ill, suffering, or even death (Weintraub, 2007).  The theory is that the caregiver of a child seeks a reparative relationship feeling that in their own childhood they were not a valued member of their family.  This person then turns into the perfect caregiver by medically “taking care” of their child or children to gain attention from the physician (Weintraub, 2007).  Many cases go unrecognized because these care givers will jump to different physicians.

        There is still a great debate as to whether Munchausen by Proxy (MBP) even exists.  The reason being that there is no true empirical studies that are controlled and blinded.  Sometimes caregivers are accused due to the acuity of illness a child may have and the caregivers demand for certain medical treatment.  Not to mention there tends to be a vast over diagnosis of MBP (Weintraub, 2007). MBP made a first appearance in 1977 and is an important issues that impacts social workers, child protective service workers, psychiatrists, psychologists, and other health and safety workers providing care to others.

IMPACTS ON SOCIETY

Health Services Workers

        Munchausen by Proxy can be difficult for those working in the health professions such as social workers to psychologists.  Most of these professions work from a point of view of strengths their clients have and not weaknesses (Cullen, n.d.).  Since caretakers perpetrating MBP are knowledgeable about the medical field, are attentive and loving towards the victim, and are fully invested in the care of the child, most health professionals would consider these strengths to help a child heal.  Most parents or caregivers do not present with other psychotic or mental health features, but rather as model people (Cullen, n.d.).  It makes it tricky to make a diagnosis or recognize what is going on, especially since children have small voices or do not know what is being done to them, they cannot say much on the matter.

        It is also a concern for those in the health services fields because it is not only the young that can be victims.  Spouses or even elderly can suffer from such abuse like MBP (Cullen, n.d.).  Media and movies tend to focus on the children as they are the most helpless, but so are the elderly or even adults who are suffering and cannot speak up for themselves.  

First Responders

        Munchausen by Proxy can also be troublesome for first responders such as police who part of abuse investigations.  When suspicion starts to mount on the caregivers, medical records are seized on the victims and police being to interrogate.  For example the Wilfred family from Georgia where Leslie Wilfred was under investigation after she alleged that her stepson Nathan was threating the family with a knife and child protective services were called.  The investigator on the case was Officer Brettel (Grush, 2013).  Upon further digging and siege of medical records, Brettel found there to more going on with the family.

        Leslie stated twins she was carrying were still born at 5-months, however; the urns she ordered for the twins were purchased five days before the stated still-births according to seizure of her computer after a search warrant was issued (Grush, 2013).  Additionally, the doctor Leslie told police that delivered the premature babies did not exist anywhere.  This was just the icing on the cake for this particular investigation.  

        Officer Brettel decided to investigate further into Munchausen by Proxy once he learned more of the reality of the situation in regards to Leslie Wilfred.  Since it is hard to prove guilt when it comes to MBP, it took investigators more than two years to before Leslie plead guilty (Grush, 2013).  It takes time and patience to collect the correct and most effective evidence when police and forensic pathologists are trying to prove this form of abuse is at play.

Training of Workers

        Louisa J. Lasher runs the only forensic service that is entirely devoted to investigating

cases of MBP.  She is a former child protection worker from Georgia who people turn to for training caseworkers in recognizing the signs of MBP (Weintraub, 2007).  She works with workers in dozens of states across America.  Lasher also is called as an expert witness all over the country every month.  She has the market cornered on investigation techniques when MBP is in question (Weintraub, 2007).

        It is also hard for victims to speak out against their abusers.  Sometimes if the victims indicate they know what is going on, the perpetrators make threats toward them.  Threats such as death can keep victims silent until something happens to change the situation and the victims are removed from the caregivers.

Recognition and Diagnosis

        In the fourth-edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) published by the American Psychiatric Association in 1994 put in “facetious disorder by proxy (FDP)”.  It was described as a psychiatric illness of the perpetrator whose victims had fabricated illnesses (Grace & Jagannathan, 2015).  Even in the new DSM-5 (APA, 2013), there is Factitious Disorder Imposed on Self of Factitious Disorder Imposed on Another with specifier on the number of episodes: single or recurrent.