Munchausen Syndrome by Proxy (MSbP) is a mental health disorder that involves a caretaker causing illness or injury to an individual under his or her care, for example, a child, elderly adult, or physically challenged people. MSBP disorder is relatively rare and its name is credited to Baron von Munchausen, a German dignitary who existed in the 18th-century, and was famous for creating stories of his expeditions to gain attention. The last two initials, B.P. (By Proxy), imply that the parent or care giver is feigning and fabricating symptoms in a child. The problem of MSBP is classified as a form of abuse because the victim is usually vulnerable ("Munchausen Syndrome by Proxy-Topic Overview", 2014). Most cases involving MSBP are associated with small children victims that may become seriously ill and injured, and may die due to the actions of the caregiver. The caregiver in MSBP may lie about the child’s symptoms, change test results to indicate that the child is ill, or physically harm the child to give rise to symptoms. According to specialists, the most common conditions and symptoms fabricated by parents and caregivers with MBPS include allergies, asthma, vomiting, diarrhea, seizures, infections, and failure to thrive ("Munchausen by Proxy Syndrome", n.d.). Children subjected to such kind of abuse and ill-treatment may develop lifelong physical and emotional issues that later become MSBP when these kids become adults.
What Are the Problems Diagnosing This Illness? Is It Confusing With Something Else?
Approximately thirty years of clinical and legal experience have yet to substantiate the definition of Munchausen Syndrome by Proxy, making the disorder one of the most complicated issues especially in children health care (Pankratz, 2006). Due to this controversy, mothers that present the problems of their children in strangely perceived or problematic ways become involved in legal battles that could be resolved clinically. Some experts have tried re-labelling this mental health disorder as Paediatric Condition Falsification but ended up misdirecting the focus onto numerous mistakes and misunderstandings that understate the crucial issues of intentions. Many women (parents) feel fearful due to experts confusing warning signs with diagnostics and also citing retrograded studies instead of focusing on futuristic and optimistic research. Many experts continue to disagree on the appropriate manner to define and confirm MSBP. In most cases, some ‘warning signs’ of MSBP are ascertained, and an irrevocable process of gathering more signs is initiated. According to Pankratz (2006), profiling of mothers is the best step forward in searching for a reasonable response to the child’s symptoms. Sadly, however, many doctors have been associated with more injuries to the children than the parents. These two approaches prompted an investigation into the types of adults handling children and lead to conviction by profiling.
In an alternate perspective, MSBP has been labeled as falsification of pediatric conditions. Rosenberg (1987) defined the disorder as a simulated illness that is consistently presented for medical assessment in which the mother (parent) denies etiology knowledge, and the child’s symptoms subside when the child is separated from the offender. However, Meadow (1995) disputed this claim, stating the Rosenberg conditions were merely warning signs and lacked specificity. The diagnostic measure provided by the DSM was later adopted - DSM-IV (1994) stipulated an abandonment of the Munchausen term for ‘factitious,’ which meant that the symptoms of MSBP are formed outside their natural source. Using DSM-IV to diagnose factitious disorders requires that the mother deliberately produces an illness or its appearance motivated by the desire to shoulder a sick role by proxy (Pankratz, 2006). As a result, factitious disorder by proxy became a perpetrator issue instead of the abused. The major disadvantage with this is that authorities would be led to believe that child abuse could be diagnosed by psychiatrists or assessment of the perpetrating adult could overrule clinical and forensic findings made by individuals that have associated with the child.
What Are The Chances Of Being Prosecuted In This Type Of Case?
The likelihood of being prosecuted in this kind of case are quite slim, given that, in some cases, even video surveillance recordings are not adequate to confirm the case of MSBP. Many ethics-related issues and false accusations arise when prosecuting an MSBP case, for example, the issue of more doctors being the perpetrators instead of the parents or caregivers. Even when armed with videotape surveillance, it is probably that the defense may argue that some of the tapes contain no evidence of MSBP and in some cases, the evidence may be highly subjective and disputable. The final option in prosecuting MSBP cases is the utilization of experts that specialize in this disorder and employing their personal judgment in confirming the diagnosis of MSBP. However, it is quite certain that even the best of all experts are prone to bias and alteration of information. Additionally, there are few specialists in this field of clinical medicine. Therefore, the MSBP experts may lack adequate information on the entirety of the issue in discussion and as a result, provide misleading or insufficient information. Pankratz (2006) states that there have been cases of MSBP experts being confronted and admitting to lacking proper qualifications to make a comprehensive psychiatric diagnosis of the mother or caregiver. To circumvent this hurdle, experts revert to diagnosing the child and re-labelling MSBP as pediatric condition falsification.
What Is The Evidence?
Some of the clues presented for MSBP can be verified by checking children’s medical records for past tests and treatments to ascertain whether the problem is real. Doctors suspect an issue when the child has repeated or unusual illness, with no particular reason tied to it. The body of the child does not improve even with prolonged treatments. Most symptoms appear when the mother or caretaker is with the child, but disappear when the caretaker is not around. The second parent (usually the father) doesn’t indulge in the treatment process of the child even when conditions may be severe. A caregiver may all of a sudden decide to change doctors and make up lies about previous testing and treatment. The standard results of the clinical tests don’t reassure the caregiver, and he or she may be strangely calm and collected when the condition of the child keeps worsening. Usually, the best evidence is the video recording presentable in a court of law. This video recording shows the mother or caregiver abusing the child or mistreating them in some other form that brings harm to the child. Another factual piece of evidence entails the trauma that a child may endure when another child or member of the family has suffered unexplained illness or even death ("Munchausen Syndrome by Proxy-Topic Overview", 2014).
How It Is Investigated
Child protective services, law enforcement authorities and doctors are all involved in the investigation and treatment of MSBP. Even after counseling and other forms of treatment, it is probable that caregivers may repeat this sort of behavior; therefore, members of the community and personal psychiatrists are implored to keep a watchful eye just in case problems arise. When one suspects that MSBP is taking place, they should carefully investigate the involved parties without confronting them; otherwise, that might make the problem worse. The investigating authority may keep a journal of the symptoms of the child and other related effects, talk with a doctor or health specialist that is bound to help, or report his or her concerns to the local child welfare agency anonymously. Furthermore, they can secretly make a video or audio recording of the child abuser and present the evidence in a court of law ("Munchausen by Proxy Syndrome", n.d.). The whole investigation process is tedious and many people neglect the process because they have given thought to minding their business. However, it is upon each and every individual to protect the liberties of our children and prevent their abuse by rogue parents and caretakers. The national constitution protects everyone including young children who are most vulnerable to cases of abuse by their parents and caregivers.
Lessons Learnt
MSBP is a serious condition that victimizes children and causes developmental changes in them, some of which may be long term and detrimental. According to the Kids Health organization, MSBP is a psychiatric problem that may stem from abuse, either physically, mentally, and/or sexually, of the perpetrators when they were children. This kind of child abuse may have come from communities where being sick is a way to get love and attention. Some parents fail to perceive their children as individuals with their own rights because they were raised within similar extremes of being treated inhumanly. However, given that some extreme cases of MSBP have resulted in destructive skeletal changes in limbs, mental retardation, brain damages, and blindness due to abuse by caregivers and parents ("Munchausen by Proxy Syndrome", n.d.), we cannot leave the issue to chance. It is imperative that children understand what is happening to them through sensitization and access to relevant information, to enable them to report cases of abuse to the local children protective agencies. Information sensitization can be achieved in the classroom, library, or through media advertisements on radio and TV. Furthermore, these children can share this information with their friends through networking and institute awareness measures to protect them from abuse. Responsible members of the community are also equally obliged to report cases of child abuse to the relevant authorities and prevent detrimental effects on our future generation. In the case where doctors abuse children more than the parents, stern action should be taken against these medical practitioners, either by the federal health authority of the national government or their supervisors who manage the hospitals. Parents and caregivers that deny abusing their children should be reprimanded and those children removed from their care.
References
Munchausen by Proxy Syndrome. Kidshealth.org. Retrieved 6 May 2016, from http://kidshealth.org/en/parents/munchausen.html#
Munchausen Syndrome by Proxy-Topic Overview. (2014). WebMD. Retrieved 6 May 2016, from http://www.webmd.com/mental-health/tc/munchausen-syndrome-by-proxy-topic-overview
Pankratz, L. (2006). Persistent Problems With the Munchausen Syndrome by Proxy Label. Journal Of The American Academy Of Psychiatry And The Law Online, 34(1), 90-95. Retrieved from http://www.jaapl.org/content/34/1/90.full
