Disordered Mother or Disordered Diagnosis: Munchausen Syndrome by Proxy
by David Allison & Mark Roberts

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Foreword by Attorney Tom Ryan

In Hans Christian Andersen's classic tale of The Emperor's New Clothes, two charlatans come to the Emperor's city, posing as weavers of such fine fabrics that only the truly intelligent can see them. The charlatans are hired by the Emperor, and in exchange they will receive gold and silk to weave the fabric. The ruse is simple enough: appeal to the intellectual vanity of the Emperor and his court. Each member of the Emperor's court in turn is sent to the charlatans’ room to check on the progress of the fabric. Each returns to the Emperor "bedazzled" by the beauty of the fabric. No one in the Emperor's court wants to appear dim-witted and admit that there is no fabric to be seen. The ruse is complete on the day the Emperor is to show off his new clothes. There in the dressing room stands the naked Emperor, with his court and the charlatans, each gushing over the beautiful colors and textures of the nonexistent fabric. Although the Emperor can see that he is entirely naked, he too refuses to admit that there is no fabric to be seen. It takes the clear-minded honesty of a child to point out the nakedness of the Emperor.

I have often used this tale in closing arguments, because of the many wonderful parallels that exist between it and Munchausen by Proxy Syndrome. Since 1991, I have spent nearly 4,000 hours counseling, litigating, and defending these cases nationwide. I have consulted with the most preeminent medical scholars in the fields of genetics, microbiology, immunology, neurology, infectious disease, gastroenterology, psychiatry and more, only to find that the allegations against the mothers were as threadbare as the Emperor's new clothes. As a result of my work I have successfully reunited five families and have helped dozens of other attorneys nationwide do the same. In each of these cases, a child was taken from his or her mother because someone claimed that the mother "suffered" from Munchausen by Proxy Syndrome.

The essence of this "disorder," as described by the "hired gun" experts, seems to be that the mother medically maltreats her child to gain the attention or approval of doctors. The reasons given by these experts as to why a mother would do this smacks of misogyny, or as I like to call it in court, pure unadulterated "mommy bashing." The reasons testified to range from "women are much more manipulative than men" to "women have become enamored with doctors as saviors, through the medium of daytime and nighttime medical soap dramas." Keep in mind that these "hired gun" experts are also professors of medicine in our nation's medical schools.

The problem is that the "hired gun" experts cannot agree on what to call this "disorder," much less agree on how to define it. These experts have alternately referred to this "disorder" as "Munchausen Syndrome by Proxy," "Munchausen by Proxy Syndrome," "Munchausen by Proxy," and 'Factitious Disorder by Proxy." Each of these labels carries with it a vastly different definition, each more vague and equivocal than the next. Is this a mental health disorder residing within the mother? Or is it a description of an act of medical abuse of the child? Who gets the label, the mother or the child? There are many other important questions left begging for answers. Unfortunately, the relevant medical community cannot even agree on what the answers to these questions are.

The profile used to identify "perpetrators" of this disorder is equally pusillanimous. For example, one characteristic that consistently makes the lists of the "hired gun" experts is that the mother is convincing in her denial of the allegations. How is this predictive of anything? One can easily imagine a truly innocent mother testifying sincerely and convincingly about her innocence, only to have the judge check off one more element of the profile as having been met. Of course, if she is nervous about testifying in court and appears less than convincing, that will be counted against her as well. It is like the old childhood ruse of "Heads I Win. Tails you lose."

The literature on Munchausen by Proxy Syndrome is replete with warnings that only those doctors and scientists who are well versed in the supposed permutations of this "disorder" can see it. In support of this dire warning, no less an expert than Herbert Schreier, M.D. cautions, in his book, Hurting for Love, how, during an interview of a mother accused of MBPS, he was once almost duped into believing that she was innocent. It was not until Dr. Schreier left the interview and had his faith reaffirmed by other knowledgeable doctors that he realized what was going on. With this type of dire warning coming from experts, it is no wonder that social workers, police, and eventually judges themselves get pulled into the ruse. Just as in The Emperor’s New Clothes, nobody wants to admit that he or she just does not see "it." By the time a MBPS case gets to the judge, it is replete with dubious experts, social workers, detectives, and nervous treating physicians who by now have all jumped on the "Munchausen Bandwagon.' Unless the mother is fabulously wealthy, she will be no match for the unlimited resources of the state, and her family will be destroyed.

With all this "evidence" amassed against a mother, few judges would be willing to admit that they just do not see this esoteric "disorder." In one case I am aware of, the trial judge acknowledged in her findings that she did not see Munchausen by Proxy Syndrome; however, she went on to enter the finding anyway. The judge's reasoning was that the state had provided her with more experts on the subject than the mother did. Indeed, some courts have held that all that is needed for a finding of Munchausen by Proxy Syndrome is a chronically ill child with baffling symptoms and a mother who fits the "profile" (see In re Jessica Z, 135 Misc.2d 250, 515 N.Y.S.2d 370 [N.Y. 1987]). In Jessica Z the court unbelievably applied the tort doctrine of res ipsa loquitur (literally "the thing speaks for itself"). This doctrine is used in personal injury cases where there are no eyewitnesses to an injury-producing event. This doctrine further requires the defendant to have exclusive control over the thing or instrument that causes injury. Lastly, this doctrine holds that no other possible explanation can exist, except that the defendant must have been negligent in the control of the object. To have any viability, the application of res ipsa loquitur in the Munchausen by Proxy Syndrome setting would require the mother to have exclusive control over the child at all times. The application of res ipsa loquitur fails to take into consideration the doctors, nurses, therapists, technicians, fathers, grandparents, aunts, uncles, stepbrothers, and others who come into frequent, regular contact with the sick child.

Making sense of all this nonsense has been difficult until now. David Allison and Mark Roberts have done a masterful job of analyzing the historical context of Munchausen by Proxy Syndrome. They expertly guide the reader through the development of witchcraft and hysteria as precursors to the modern-day Munchausen by Proxy Syndrome. The authors deftly show how fear, prejudice, and distrust of women have been defined, classified, and codified into societal acceptance by the very institutions that have the most to gain from the exclusion of women. This is especially true of in the field of medicine. According to a recent study (1997) the majority of all health care decisions in the United States are made by women. Given the rapid advancement of managed health care in the last 10 years, health care Professionals and their payors (read that as insurance companies) are "incentivized" to remove any woman who is perceived as overutilizing the system.

Allison and Roberts are at their best in this book, when they bring the bright hot light of their critical thinking to bear on Schreier and Libow's work, Hurting for Love. Allison and Roberts point out, with tremendous insight, the internal inconsistencies, the lack of scientific support, and the sheer reification of supposed facts in Schreier and Libow's work. If society is going to take effective steps to eradicate child abuse, it needs something much more substantial than Hurting for Love before it steps in and destroys a family. Allison and Roberts's work set forth in this book is Exhibit "A" of that fact.

What Allison and Roberts have done here is not just fire a warning shot across the bow of the "Good Ship Munchausen." Indeed, they have fired an Exocet missile right into its midsection.

Thomas M. Ryan, Esq.
Chandler, Arizona

ISBN 0-88163-290-2 LP:  $39.95 1998 336pp.
Analytic Press 101 West Street, Hillsdale, NJ 07642 Phone 201)358-9477

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