Is Munchausen Syndrome killing children?


Announcer: Welcome to Stuff Mom Never Told You from howstuffworks.com.

Cristen: Hello, and welcome to the podcast. I'm Cristen.

Molly: I'm Molly.

Cristen: So, Molly, I want you to be honest with me right now.

Molly: Okay. I'm always honest with you, Cristen.

Cristen: Have you ever faked sick to get out of work?

Molly: That's so mean, Cristen. So mean.

Cristen: Just put Molly on the spot.

Molly: No, I have never faked sick to get out of work.

Cristen: That's so good of you. I have. I'm not gonna lie. Every now and then, we fake sick to get out of work or get out of school. I dare someone to e-mail me to say they have never faked an illness before because I think that you're lying. But the reason why I'm thinking about this is because, I don't know about you, but sometimes when I was a kid when I would fake sick I would also enjoy the attention that I would get from it. That meant mom would make her famous homemade chicken noodle soup and I would get to watch movies. It was kind of awesome.

Molly: Yeah. I always got beverages with straws when I was sick.

Cristen: Oh, the straws.

Molly: Because my mom said that it helped you to drink from a straw when you're sick. Now that I'm older I see how that's not the best medical advice, but it really seemed to work when I was little.

Cristen: But straws are still great. But faking sick every now and then, everybody does it. If you pathologically fake sick in order to get all of those straws and chicken noodle soup, you might have a case of Munchausen.

Molly: Yes. Now, this is, I think, one of the strangest things I've ever come across, Cristen. It's called a fictitious disorder, which means that people purposely exaggerate, invent, or even cause disease symptoms within themselves. Now, it's not being hypochondriac. You don't just hear about an illness and think you have it. It's more some people, we were reading about this on the Internet, inject urine into their blood or blood into urine to mess with their samples. Some people might take laxatives, so that they have a lot of gastrointestinal symptoms. It's, basically, faking so sick that you need to go to a doctor or you get a lot of attention from all of the people around you.

Cristen: Right. It should also be distinguished from Malingering, which is when people pretend to be sick for financial gain or to get out of work. Munchausen is all about the attention. This isn't something that you'll find in the DSM. It's not recognized with a formal diagnosis by the American Psychiatric Association. It is highly controversial because A) It's hard to get someone with Munchausen to admit that they are faking, and B) It happens a lot with mothers and children. Which we'll get into very soon.

Molly: Right. Real quick before we get into the mother part, which is why we're talking about it on our podcast. Some of the risks that researchers think might lead to a case of Munchausen Syndrome include a history of abuse in some form, a serious illness during childhood, a relative who is seriously ill or died, poor self-esteem, or some sort of personality disorder. This form of trauma, let's say, leads you to crave attention later in life, so that you will do awful things to yourself. One of the symptoms was agreeing to undergo medical tests even if they're really painful and invasive because who would want to put themselves through that. They're saying that that's how badly you crave attention that you would be like, yes, sign me up for that spinal tap. Beyond just a normal desire to get well.

Cristen: This was first identified in 1951 by the British physician Richard Asher who basically noticed this band of wanderers who would trek from hospital to hospital just to fake all of these illnesses.

Molly: Hospital hobo's.

Cristen: A band of hospital hobo's. He wrote about the condition in the medical journal of the Lancet and he named it after a colorful fellow named Baron Karl Friedrich Munchausen who was a German officer who served in the Russian cavalry in repeated military campaigns against the Turks and he became very well known for his grandiose story telling.

Molly: You can never believe a word the guy said.

Cristen: Don't believe a Munchausen.

Molly: So that's why if someone comes in and they're complaining of a sore throat and you've all ready treated them ten times for really wacky things in the past, that's sort of where the name came from. Now, we've got Asher in 1951, but then in 1977 a British pediatrician named Roy Meadow identifies mothers who are causing or fabricating their children's illness, so it's called Munchausen Syndrome by Proxy. The mothers use their children as proxy's to get the attention from a doctor and, also, from the loved ones that will naturally gather around when you've got a sick child.

Cristen: Just, for example, in one case, he found out about a 6-year-old girl named Kay who had been admitted to the hospital 12 times for a urinary tract infection and it had been treated with eight different antibiotics. None of which took. Then he found out that Kay's mother altered her urine samples to make it appear as if the child were sick.

Molly: Quite bizarre. He found one parent who had essentially poisoned their child with salt. It just sounds awful. I think if you're any reasonable person you would never believe that a mother would do that to their own children. When Meadow brought this up, no one did. So he had this colleague named David Southall who videotaped a lot of these suspects of having this syndrome without them knowing. So the most damning tape they found was there was this woman who smothered her baby, that's what the videotape caught, and then it showed her running out and grabbing the doctors and saying my baby can't breath. The videotape was like, well, because you smothered it. That was what helped cement this diagnosis of Munchausen by Proxy.

Cristen: Then Southall and Meadow really dedicated themselves to rooting out as many of these Munchausen by Proxy, or MBP, cases as they could. They would examine patient records, use statistics, use secret video surveillance, and also something called a separation test to see if a sick child is removed from the mother, see if they somehow mysteriously get better again. They would try to identify these potential perpetrators and then testify against them in court. As a result, over a number of following years, hundreds of mothers were forcibly removed from their children because these medical experts said that they were intentionally making their children sick.

Molly: Now, one of the most prominent cases that Meadow testified in was the case of Attorney Sally Clark who lost two children to Sudden Infant Death Syndrome. One of the weird things that's attributed to Meadow is this thing called Meadows Law. He said that if you have one case of Sudden Infant Death Syndrome that's a tragedy. If you have two in the same family, that's suspicious. If you have three, that's murder unless the parent can prove otherwise. He also really made this impact in the UK of tying SIDS to Munchausen. Now, this happens to Sally Clark. Two of her children die and Meadow testifies that the chance of two such deaths in the same family is 73,000,000:1. Clark is convicted of murder and sentenced to life in jail. Now, the tricky thing is that Meadow's math was off.

Cristen: It was way off.

Molly: Way off. The actual odds of this are 200:1. So he had statistical societies writing him in, writing the courts and talking about what a miscarriage of justice this was. The correct odds of this, it's actually 200:1. Okay. So he's got statistical societies writing him, writing the courts, saying this is such a miscarriage of justice. His entire research essentially collapses because people are like this guy is just making up numbers. How do you get from 200:1 to 73,000,000:1?

Cristen: Right. And not to mention that Southall, his old colleague, the videotape friend, happy colleague, ended up accusing Sally Clark's husband of smothering one of his sons just because of random behavior that he saw on the tape. He lost all of his credibility as well.

Molly: Some of those early videotaped cases, it came out later that the woman was essentially disturbed because this is more than just a mental illness. This is a calculated decision that women make to harm their child in order to get attention. It's not - there was really a separation in some of the stuff we read about other mental disorders you might ascribe to these women. This largely discredited Meadow in the UK. I'll be interested to see if we have any British listeners out there who can remember Meadow and what the perception of him is today. Now, the tale of Sally Clark is a really sad story. She was released from jail, as w ere many of the people that Meadow testified against. However, she died, likely of suicide, in 2007.

Cristen: Yeah. They said that she, first of all, never got over the death of her two sons. Then on top of that, she was completely vilified for supposedly murdering them. Even after she won her appeal, after having spent a few years in jail, it was just the psychological toll was just too much. This is one of the reasons why Munchausen by Proxy is so controversial because, first of all, it's kind of taking this claim of meddling mothers who are actually just crazed and attention starved and separating them from their children and throwing them in jail when, in fact, their children might actually be sick. There are some warning signs out there that something might actually be going on.

Molly: Right. I think when we were researching this what struck me was there are essentially an equal number of people who are saying it's over diagnosed and an equal number of people saying it's under diagnosed. Thanks to Meadow's hysteria, there are people saying it happens all of the time and others are saying this is really rare.

Cristen: Yeah. Because just for a contrast to Sally Clark, I think that we could, and an interesting example to look at here in the US, would be the case of a Florida mother named Kathy Bush. Her daughter Jennifer spent 640 days in the hospital, undergoing 40 operations, including the removal of her gallbladder, appendix, and parts of her intestine from ages 2 through 9. She became a tireless advocate for a chronically ill child, even appearing with Hillary Clinton back in the day, in her quest for healthcare reform. Then she was later convicted for making her daughter sick by infecting her feeding tubes and giving her damaging drugs in 1999. On the one hand, we've got Sally Clark and then we have Kathy Bush. What do you even look for? Where do you draw the line between just a concerned mother with a sick child and someone who is actually doing something?

Molly: All right. So let's talk about some of the things that doctors look for and, again, this isn't gonna wrap things up for anyone because so many of these symptoms are pretty contradictory. All right. So let's go over some of the warning signs that a doctor may consider when he's got a child that he just can't cure. This child keeps coming in, has repeated and unexplained illnesses that never seem to get better, the symptoms only occur when the mother is present. Now, this will get tricky because if your child is sick, why would you leave it? The mother is probably going to be present a large percentage of the time. If the mother appears to know a lot about medicine, that will tip people off because if they know that, oh, if I do this to the feeding tube then it will harm them this way. They know a lot about how to hurt a kid, but also in the age of the Internet a lot of people just know how things work. If you hear your kid is sick, then you might come to the excellent website howstuffworks.com and find out everything you can know about it. So, again, some of these symptoms just seem so possibly confusing and -

Cristen: And possibly like good parenting.

Molly: Exactly. That's why it gets so controversial. Now, this is one that might help you get to the heart of it. Although the mother stays with the child all of the time while he or she is in the hospital and tends to him or her well, she might not appear as concerned about the child's well being as the healthcare professionals who are providing treatment.

Cristen: So, basically, she is more attentive to the healthcare professionals and getting their attention than necessarily the attention that they're giving to the child. That's something that we'll talk about in a minute is this odd psychological attachment to doctors.

Molly: Also, willingness to be in the hospital. Willingness to say, hey, like we were talking about earlier, give the kid a spinal tap. He needs them. Especially if you're doing it, doctor.

Cristen: Let's say that this kind of stuff is going on and you do actually have a woman - because we keep saying women. What is it, 85 percent of the time it's the mother. So the six primary categories of abuse are usually just inventing the symptoms, tampering with test results to encourage a diagnosis, deliberately not providing the child with nutrients it needs to get better, triggering symptoms, using a low toxicity poison, such as a laxative. A lot of these cases see mother's will give their children diarrhea medicine or stuff that will make them throw up.

Molly: Ipecac.

Cristen: Using a high toxicity poison on a child, such as using insulin to induce hypoglycemia, and then making the child lose consciousness by deliberately smothering him or her. On top of that, we have the most commonly fabricated symptoms, including fits, fainting, apnea, hyperactivity, asthma, vomiting, diarrhea, allergy, and rashes.

Molly: I think that there is - obviously, if the mother brings the kid into the hospital and says last night my kid had a temperature, but then the kid shows up without the temperature, you would believe the mother who said her kid happened to have a temperature, right?

Cristen: Um hm.

Molly: So that's how a symptom can be faked, just to give you an example of how that could happen.

Cristen: Yeah.

Molly: Which is part of why diagnosing is, again, hard because of the separation test. We were talking about this earlier. If they separate the kid from the mother and then it stops throwing up because the mother is not around to give the kid ipecac anymore, then people are like, oh, that must be the mother giving the kid ipecac, but sometimes just when treatment stops, symptoms like that go away. We read one example of a woman who her child was going through this really extreme treatment and when the doctors were like, oh, I don't think these kids are that sick, we're gonna stop the treatment, their symptoms went away, but it was just a result of the treatment and not necessarily the mother's doing.

Cristen: I think that this would also be a good time to point out that this is a very rarely diagnosed condition. I think in the UK, a lot of this happens in the UK we've discovered, anyway, there are about 50 cases per year. But the question is, Molly, for those 50 cases per year, why on earth would these mothers intentionally hurt their children because this isn't just physical abuse. It's a whole different kind of abuse because it's so much tied to this idea of needing the attention from these healthcare workers.

Molly: Right. These women seem to have this need to just interact with a doctor in a way that's not confrontational. It's why a woman might choose to do Munchausen by Proxy as opposed to just faking illness in herself. There was a lot of talk in one article we read about how being the mother of a sick kid allows you to be kind of the ideal mother. You are obviously concerned about your kid's well being because you're there in the hospital and you've got a person whose job it is to pay attention to you and to help you and so they were saying that some women just crave that approval and interaction with a pillar of society, as doctors are.

Cristen: If I may quote Herbert Schreier and his book Hurting For Love, these mothers are just seeking a reparative relationship because they felt they weren't valued in their family of origin. Now, Schreier also goes on to discuss the erotomaniacal pursuit of this fictive phallic power that these women have, so -

Molly: Well, he says that in a lot of instances you find a missing father. So that like people who - like the symptoms we ran down of Munchausen earlier, people have these traumas in their past and somehow being in a place that is designed to make you well, they think there is some link of these people going, trying to find this wellness cure for some deep, dark past hurt. There are plenty of people who do have really troubled childhoods who don't grow up and put salt in their kids food.

Cristen: These kind of allegations are so controversial because a lot of times it's just going to boil down to disagreements between mothers and healthcare workers, between what is best for their children. Also, in a day and age when, like you said, if you think that you have a collection of symptoms that might be some kind of illness or disorder, you can go online to howstuffworks.com or to something like WebMD and put everything in and diagnose yourself with, say, colon cancer. It just kind of gets in your head and it might lead you to getting into these heated debates with doctors and demanding tests and insisting that you do have something. It was interesting in one article, it pointed out that if fathers were doing the same type of thing they would just say - they would actually praise them and say, oh, what an involved parent he is. But with mothers they're saying, wow, this meddling mother really needs to go home.

Molly: So it's very interesting. I don't know if I would be able to spot a case of a meddling mother versus a possible Munchausen mother. They do say that Munchausen mothers, once the kid dies, obviously you don't want that to be the time you can figure out a case of it, but they have no remorse and at the funeral they usually seem kind of excited about it. They're reveling in all of this attention. They're probably talking more to the doctor than they are to family members. And if you remember the scene from the Sixth Sense, one of the dead people that Haley Joel Osment sees is this girl who was poisoned by her mother and Haley Joel Osment sees the mother at the funeral and they're all ready whispering in the background like, oh, now she has another sick child. So it can be a deadly cycle. Because they don't show any remorse or admitting that they did any wrong, that's why they'll try and separate the child and usually not give them back. There's usually very little hope for reconciliation once you've had an allegation of Munchausen thrown against you.

Cristen: Now, because these allegations are so harmful and can easily result in social services stepping and taking the child away from them, some mothers are actively lobbying against it even being allowed to happen. For instance, we found this organization MAMA is the acronym and it's Mother's Against Munchausen by Proxy Allegations. They say our mission is to stop the assault on innocent parents from Munchausen by Proxy allegations and to reveal the ulterior motives of the accusers, to prevent the broad label from being used in a court of law, and hold accountable any phys ician who acts as judge and jury. As a mother, and I think that I can say this not being one -

Molly: You're not a mother.

Cristen: I'm not a mother, but I think that I can put myself in their shoes for a minute and imagine maybe as an aunt, okay, let's say. If I am any more protective of my child than I am of my niece and nephews, then Lord only knows what kind of hell I would raise if I thought that my child was in some kind of physical danger. I can see kind of both sides of it. Doctors want to make sure that they're doing the best for the children, so do mothers and there certainly can be a conflict interest there at some point.

Molly: But doctors do need to step in and stop cases of child abuse, which I think is - I mean, that's essentially what Munchausen is, so that's why it's gonna be controversial for a while to come I think.

Cristen: Yeah. I think it is also, too, worth noting that it is extremely rare. Yes.

Molly: According to some people. That's the thing. Over diagnosed or under diagnosed, we don't know. We'd love to hear what you guys think about this. Our e-mail address is momstuff@howstuffworks.com. We have a few listener e-mails to read. I'll start with one that's not signed. This is about the what constitutes an eating disorder podcast. The listener writes, I suffered from bulimia on and off for ten years. At times the binge, purge cycle consumed my life so much that I abandoned friends and other fun experiences in order to preserve my disorder. During the worst of it, in high school, no one ever called me out on my abnormal behavior or relationship with food and simultaneously it was my biggest fear that someone would. However, now, I would suggest to anyone that suspects a friend suffers from bulimia to let her or him know that you support him or her and love them no matter what and that if they need someone to discuss any challenges with you are there with non-judgmental ears. Eventually in college, I had friends I could talk about my problems with and have been totally 100 percent binge, purge free for two and a half years. I think many people over simplify eating disorders when actually they are symptoms of deeper issues that will only heal by being acknowledged, so don't be afraid to say something.

Cristen: All right. Well, I've got an e-mail here in regard to the same podcast and this is from Hannah and she says I was totally astonished that you skipped over the very important point of self-esteem. For most women with eating disorders, especially young women, this is a huge factor. For high school girls with anorexia and bulimia, poor self-image is often the reason they start to starve themselves or vomit up all of their food. From there, it progresses to a legitimate brain disorder, but it often starts as choice. I, myself, am in high school and I can tell you that many, many girls feel overwhelmed and completely without control over their lives. This is usually how destructive behaviors, like cutting, eating disorders, or drug use, begin as a desperate attempt to exercise control over whatever aspects of their lives they can and diffuse emotional pain. Regarding your advice, I tried several times to tell a friend with an eating disorder about my concern and it didn't help. No offense, but it probably wouldn't be very helpful in other cases either. Telling someone that you love and care about them and want them to be healthy is definitely a good idea because it helps them know that you're there for them and that you're not judging them, but I don't think it would ever make them stop their disorder outright. It might even give them a rush of power that they can keep doing what they're doing and you can't do anything about it. Now, as I said, it's largely about control. I think that even if it costs you your friendship, the most important step you can take is to get the problem out into the open. So thank you, Hannah.

Molly: All right. So if you want to send us an e-mail it's momstuff@howstuffworks.com. During the week, we've got a blog called HowToStuff and we have an article, if you would like to read more about the Munchausen Syndrome and Munchausen Syndrome by Proxy, head on over to howstuffworks.com.

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