Defending A Parent Accused of Munchausen by Proxy
Munchausen syndrome is a ‘sexy’ diagnosis and allegation. While the term only entered legal and medical vocabulary in the mid-1970s, it has become rather in-vogue. Hollywood made it popular in movies such as The Sixth Sense and with television shows such as ER and The X-files. Even Eminem used his chops to sing about his childhood plagued with “…going through public housing systems, victim of Munchausen syndrome. My whole life I was made to believe I was sick when I wasn’t….”
What is Munchausen Syndrome?
Let me give credit to the Cleveland Clinic for this answer:
“Munchausen syndrome is a type of factitious disorder, or mental illness, in which a person repeatedly acts as if he or she has a physical or mental disorder when, in truth, he or she has caused the symptoms. People with factitious disorders act this way because of an inner need to be seen as ill or injured, not to achieve a concrete benefit, such as financial gain. They are even willing to undergo painful or risky tests and operations in order to get the sympathy and special attention given to people who are truly ill. Some will secretively injure themselves to cause signs like blood in the urine or cyanosis of a limb. Munchausen syndrome is a mental illness associated with severe emotional difficulties.”
Or…in layman’s terms…people perceive or fabricate their own illness, or others (usually their children) for reasons related to their mental health.
What does Munchausen by proxy (to another, typically their child) look like:
- Child hospitalized or seen by medical providers of unusual and unexplained symptoms
- Those symptoms seem to only be present when the caregiver is around
- Symptoms do not comport with anticipated test results
- Symptomology seems to worsen with parent and improve while the child is hospitalized or under supervised medical care
- In dramatic instances there are chemicals in a patient’s system
- The parent works in the healthcare field often with Extensive understanding of medical terminology.
- Parent is eager to have medical testing and procedures performed on the child
- The parent goes doctor and hospital “shopping” for care and opinions
It is important to understand how these cases come about. Usually a report of MBP comes through a medical provider who has surmised that the medical records do not match the level of treatment and testing that the child has overcome. Perhaps the report comes from a pediatric specialist, such as a Gastroenterologist in the hospital, who is wondering why the parent has been referred for a procedure when nothing was found the last time a similar procedure occurred. The parent presents as ‘too eager’ for the child to be put under general anesthesia and the Doctor surmises that the problem is the parent’s, not the patient’s. The doctor will then be under an obligation to report the suspected abuse pursuant to Arizona’s Mandatory Reporting Statute.
CPS must then intervene and conduct their investigation. If they are told by a physician (and probably the hospital social worker) that they suspect Munchausen’s, it is likely a TCN (Temporary Custody Notice) will be served and the child will be placed in CPS care while the matter proceeds to Court.
CPS will then consult with an expert on Munchausen’s. Often the Department will look out of state for an expert and frequently relies on providers from the University of California, Los Angles (UCLA). It is usually recommended that the only way to tell if a parent is fabricating is to separate the child from the parent and see if the condition improves. Of course this means that the child will be removed from the home and placed in foster care. Some psychologists believe that the child cannot be placed with a relative, despite Arizona’s kinship priority statute (A.R.S. 8-514.03) as somehow they too may be duped into believing that the ‘fabricated’ condition exists.
Defending parents in these cases is challenging as there is no unified mental health consensus as to the diagnosis/treatment of the disorder. The State’s expert will no doubt discredit every medical decision made by the parent. Engaging quality experts on Munchausen by proxy and possibly other medical professions is critical.