Biology 202
2004 Second Web Paper
On Serendip

Although Munchausen By Proxy was first described less than thirty years ago by Dr. Roy Meadow(1) it has garnered much press in recent years with appearences in "The Sixth Sense" and "Law and Order" and high profile court cases such as that of Kathy Bush. But what exactly is Munchausen By Proxy and why does it occur? How could something that destroys our image of a mother exist in society?

"MBP is sometimes called Munchausen Syndrome by Proxy, Munchausen by Proxy Syndrome, or Factitious Disorder by Proxy. All of these terms apply to a well-established variant of maltreatment (abuse and/or neglect) in which caregivers deliberately feign or produce ailments in others. The perpetrator deliberately misleads others knowing that there is no reason to believe the victim has an underlying physical and/or psychological-behavioral problem. The signs and symptoms perpetrators falsify or create are usually physical."(2) In 98% of the documented cases the mother is the one with MBP. There are several ways that Munchausen By Proxy in manifested in behavior. Sometime the perpetrator will falsly report that their child has an illness, other times the perpetrator will create evidence of a problem but will conceal their role in it. The perpetrator may also exagerrate a real medical problem that the child has. Finally, the perpetrator may worsen an already existing ailment or cause a problem in the child on purpose.(2) These final two manifestations are the most intrigueing from a behavior point of view because the directly contradict our ideas of maternal instinct.

There is no set profile for MBP. (2) But there are some basic facts that usually apply to MBP perpetrators. Perpetrators usually seem to be "normal" and have loving relationships with their victms. However, MBP perpetrators are usually good at decieving and manipulating people
and may have a history of feigning problems in themselves.(2) They often have a dramatic flair and sometimes falsly accuse others of wrongdoings, if charged with wrongdoing themselves they will vehemintly deny it. "MBP perpetrators do not necessarily have to have extensive health care knowledge or be particularly intelligent. It does not take special knowledge to engage in many kinds of MBP maltreatment."(2) This fact is especially important to remember since many people often dismiss accusations of MBP by saying that Ms. X couldn't possibly outwit a team of doctors. All information reported in this paragraph is preceeded by the word usually or often. There could easily be a MBP perpetrator who posseses none of these characterics or an innocent mother who has all of them.

Munchausen By Proxy is extrememly difficult to diagnose. Each case must be taken by itself and while past information can be useful it should not be used to determine whether MBP is the cause of a child's illness. There is a vary broad range of charasterictics that are attributed to MBP.(3) This can lead to misdiagnosis of MBP in mothers of severly ill children. Even if MBP is suspected it is hard to get physical data to prove it. Sometimes a hidden camera can catch the perpetrator inducing illness but most of the time its just the word of other people against the perpetrator. Kathy Bush was found guilty of aggravated child abuse and put in jail without any definitive evidence.(4) It was her word versus that of her daughters doctors, nurses, and the police. Because Kathy Bush had previously been named mother of the year by Hillary Rodham Clinton the case garnered national attention. MBP perpetrators can vary greatly in their behavior. Another suspected MBP perpetrator is Marie Noes whose 10 babies sucessivly died in the 1940's-1960's.(5) Unlike Kathy Bush who was a doting mother, Marie Noes seemed to have little interest in her children. When one child was in the hospital for 2 monthes she visited only twice.(5) Without delving deeper one would never guess that these two women were perhaps commiting similiar acts. MBP seems to be the only thing they have in common.

Perpetrators of MBP can come from vastly different backrounds. Some are rich, some poor. Some were abused as children, some were not. There is no set of conditions that MBP seems to arise from. Because of this we cannot know what drives these women to do this. Most of the literature says that MBP perpetrators do it so that they can get attention and sympathy from doctors and other medical staff. This is a reasonable conclusion but it leaves unanswered why these women would need attention so desperately that they would harm their children. It is important to note that MBP perpetrators do not seem to possess any sort of homocidal tendancies. Although MBP can lead to the death of the child, that death is often an accident caused by miscalculation of the MBP perpetrator. (2) These women are not looking to rid themselves of their children, the children are merely a means to an end.

How could somebody's need for attention be so great that they would go so far as to harm their own children? We tend to think of maternal behavior as a natural occurance but maybe it is not. Perhaps then maternal behavior is a result of human society. It could be something we percieve that does not have any neurobiological/behavioral foundation. This would make MBP much easier to account for because if there is no beavioral basis then it is not so strange that something like this could occur. MBP shocks us to our core because we cannot imagine a mother harming her innocent children. But what if this is just what society tells us? What if there is nothing in our genes that tells us to nurture our children? Do perpetrators of MBP have a psychological prohlem or do they merely deviate from our societiy's norm?

Since the perpetrators of MBP are so different it is likely that it does not derive from a specific psychological problem. It seems likely that these perpetrators probably have other psychological problems that may contribute towards MBP but mostly they just deviate from what we expect from mothers.

References

1)Basic MBP Information
2)A rich MBP resource
3)General MBP Information
4)News Articles about the Kathy Bush Trial
5)An Article about the Noes Family


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