What Is Münchausen Syndrome By Proxy and Why Are Parents Losing Custody Because Of It?

Münchausen syndrome by proxy.

It sounds dire. And for parents of sick children who have yet to receive a diagnosis from their medical care providers, it can be.

But it’s not the illness their children have.

It’s what their children’s doctors think the parents have.  And if the doctors and nurses in charge of your child’s care think you have it, prepare for a custody battle.

What Is Münchausen Syndrome By Proxy?

Münchausen (MSbP – sometimes erroneously referred to as MBPS) was named for Baron Hieronymous Carl Friedrich von Münchhausen, a rather colorful individual known for making up wild stories about his various “adventures.”

Like the related illness, Münchausen, MSbP is said to involve psychologically-motivated actions of triggering or causing medical symptoms in order to obtain desired attention. Both are considered mental illnesses.

Whereas in Münchausen, the person with the illness makes himself appear to be sick (or actually makes himself sick), in MSbP, the person with the illness makes another person sick, or appear to be sick, in order to obtain attention from medical professionals and others.

Typically, the target of the individual said to have the illness is the person’s infant or young child.

The origins of the term and the illness itself are in question. Many believe both were basically created in a 1977 paper by a British pediatrician, Roy Meadow. Regardless of whether he was the first to use the term, Meadow’s reputation in this area grew to prominence in the last decades of the 20^th century, but has since been severely questioned.

Those questions resulted in professional misconduct proceedings against him which dragged on extensively in the U.K. but ultimately resulted in a ruling striking his credentials being reversed, although the criticism against him stood.

Meadow had also testified as an expert at a number of abuse trials in the U.K. and was even knighted for his work. Based on his testimony, several parents were convicted of abuse in cases where their infant children died suddenly and without warning (Sudden Infant Death Syndrome, or “cot death” as it’s called in the U.K.). After Meadow’s work began to be questioned, many of those convictions were reversed.

The MSbP “Profile”

While MSbP sounds perfectly valid – and we’d certainly want to protect children from such sick parents – there are a number of troubling issues stemming from this diagnosis.

One of the main problems: the profile for the illness itself. Read for yourself – these are, according to the medical and psychology professions, a few of the hallmark indicators of MSbP:

• A child with one or multiple medical issues and who doesn’t respond as anticipated to medical treatment, or with a medical issue that progresses unusually in a puzzling or unexplained way.
• A parent who understands medical terminology and concepts, who seems to be interested in the medical details of her child’s case, seems to enjoy being in the hospital and shows an interest in other patients.
• A highly attentive parent who is reluctant to leave their child's side and who themselves seem to require constant attention.
• A parent who appears to be unusually calm in the face of serious difficulties in their child's medical course while being highly supportive and encouraging of the physician, or one who is angry, devalues staff, and demands further intervention, more procedures, second opinions, and transfers to other more sophisticated facilities.

There are other indicators, of course, but in many cases, these four indicators alone have triggered suspicions in medical staff who used them as the basis for reporting those suspicions to authorities.

A Failure of Logic and of Compassion

Let’s take a critical look at these indicators again.

A child with one or multiple medical issues and who doesn’t respond as anticipated to medical treatment: If the medical professionals do not understand your child’s illness, have improperly diagnosed it, or failed to diagnose a co-existing condition, your child will almost certainly fail to “respond as anticipated to medical treatment.”

Does that mean you, as her parent, have MSbP?

A parent who understands medical terminology and concepts, who seems to be interested in the medical details of her child’s case…: Whenever a child becomes chronically ill, almost certainly this prompts her parents to buckle down and educate themselves on the child’s condition and medical terminology, in order to communicate more effectively with their child’s doctors and in order to provide better care themselves.

Does that mean these parents have MSbP?

A parent who … seems to enjoy being in the hospital and shows an interest in other patients: If your natural orientation and mood as a person is one of compassion, stoicism, and optimism, you too might appear to a casual observer to “enjoy” being where you are. Of course you don’t enjoy it – you’re heartsick and worried to distraction. You just happen to be the kind of person who feels compelled to put on a brave face. You might also strive to remind yourself to show interest and compassion for others around you, too, to avoid becoming too self-absorbed.

Do any of these behaviors mean you have MSbP?

A highly attentive parent who is reluctant to leave their child's side and who themselves seem to require constant attention: Of all the indicators for MSbP, this one strikes most thinking, rational people as absurd.

What parent of a chronically sick child wouldn’t be reluctant to leave their child’s side? What parent of a chronically sick child wouldn’t need some help and support during that crisis?

Does that mean that parent has MSbP?

A parent who appears to be unusually calm in the face of serious difficulties in their child's medical course while being highly supportive and encouraging of the physician, or a parent who is angry, devalues staff, and demands further intervention, more procedures, second opinions, and transfers to other more sophisticated facilities: Here’s the “damned if you do, damned if you don’t” Catch-22 of MSbP indicators. You can either support your child’s medical care providers and try to remain calm, or you can lash out, give voice to your frustration and demand better answers for your child’s care.

Either way, the medical staff could decide you have MSbP.

In a future post, we’ll look at a few ways in which MSbP has been approached by the legal system in the U.S. and in the U.K.