PSYCHOLOGY

Munchausen Syndrome By Proxy

The disorder that creates “angels of death”

A very serious mental clinical disorder that raises many questions is Munchausen Syndrome By Proxy, in which a caregiver artificially causes an illness or injury to another person in his or her care. Usually, the caregiver is a parent or nurse and the other person a child, an adult, or a person with a kind of disability.

There are many cases where mothers suffering from Munchausen Syndrome By Proxy worldwide, after murdering their children, gladly accepted to be examined by a psychiatrist. However, this dangerous syndrome that puts in danger the lives of helpless people, raises many questions.

Mental illness, abuse, or delinquent behavior?

In the international literature, it is known as MBP (Munchausen by Proxy) and was coined by pediatric professor Roy Meadow in 1977 as a form of child abuse. The term was coined to describe two cases in which obvious symptoms of the syndrome were projected on children by their mothers. In other words, the mothers projected on their children their own need to be sick, deliberately causing them symptoms of illness.

In the first case, a mother transferred her blood to the urine sample of her child, who at the age of 6 had undergone a long series of tests and medications. Eventually, it was found that the abnormal specimens were those which at some point in the procedure had been left unattended, in the presence of the mother. She denied any involvement and was forced to see a psychiatrist.

In the second case, a baby suffered from recurrent hypernatremic seizures from the age of 6 weeks and the test results pointed to high sodium levels. After multiple admissions to hospitals, it was found that his examinations were normal, while the seizures took place only at home. Research has shown that the mother forced the fetus to swallow large amounts of salt using a feeding tube, as she was a nurse and was familiar with the use of this kind of medical tool. Eventually, the fetus ended up and the mother committed suicide.

The syndrome is now defined as a “fictitious mental disorder imposed on another” and the result is delinquent behavior. Although MBP now applies to any dependent relationship with a caregiver (he or she may be a nurse with his or her patients), it is interesting to note that the first record was based on a child’s dependent care relationship with his mother (the case mentioned above, where the child was at the age of 6).

What Meadow has left as a legacy — but without his jurisdiction — is a phrase known as Meadow’s law: “A sudden infant death is a tragedy, two raise suspicions but three are murder, unless proven otherwise.”

What is the profile of the perpetrator?

In Criminology, the perpetrators are referred to as “angels of death“. They rarely stop at a single victim. The vast majority (94% -99%) of the perpetrators are mothers. These mothers often have education or interest in the medical field.

They may be practicing a health profession or be well-read in terms of illnesses and their symptoms. Thus, they can deceive even doctors, presenting or causing plausible symptoms.

In any case, the perpetrator has the main and exclusive care of the victim. In other words, the victim is completely dependent on them. They are the “representatives” in what we call Munchausen Syndrome By Proxy. They are responsible for taking care of disabled people (elderly, seriously ill, children, and infants). In this case, usually, the perpetrator practices a paramedical profession e.g. nurse to have access to victims.

Of course, it is possible to be a man, but in almost all cases it’s a woman because the responsibility of care is mainly assigned to a woman. She has often experienced mental disorders in the past, such as depression, personality disorders or she has Munchausen Syndrome herself. She is rather a person with zero self-esteem, who through the “control of life” she forces on her victims, receives the self-esteem she needs.

What drives those who suffer from Munchausen Syndrome By Proxy

There are no motives here that we would expect from a common criminal. The perpetrators are mentally disturbed, so they don’t seek any financial benefit, nor do they make a profit from the death of their victim. The perpetrator appears as a devoted caregiver, as an “angel of mercy”.

They seek the sympathy and positive attention of both the medical staff and those around them who see how much the helpless and their caregiver are tortured. In some cases, the motivation may be to demonstrate their medical knowledge and collect the acceptance and recognition they may have been deprived of.

However, there are cases in which the motivation might be the avoidance of further commitments, as no one will ask a mother devoted to her sick child to take on other responsibilities.

All of them have the feeling that they are doing something good.

How does one end up committing such a terrible thing?

One wonders how someone, especially a mother, dares to repeatedly hurt her own child, much less all of her children. These are rare psychiatric cases that are probably based on the individual’s greatest need to be in control. To hold the control of treatment, health, life, and even death, obviously as a replacement for other parts for which they have lost control.

Scientists are not entirely sure what causes Munchausen Syndrome By Proxy, but they speculate that it is related to problems in the perpetrator’s childhood. Perpetrators usually have trouble coping with stress, have low self-esteem, and feel out of control. They are unwittingly looking for a way to regain control, but also to be accepted, liked by those around them.

The perpetrators don’t see their behavior as harmful. They try to draw others' attention, to gain their acceptance, they want to be needed To achieve this they tend to invent non-existent problems for their victims. Imagine them as persons whose lives acquire meaning by serving others. If they, the “others”, are vulnerable, completely helpless people, this makes them appear even more necessary or “saviors”.

The so-called nurse syndrome, which is often met in people who take care of sick or troubled people, is in the same vein, but quite far from Munchausen Syndrome. In the first case, they get satisfaction by seeing the helpless person being vulnerable. In the second case, they are the cause of the problem

Strange as it may sound, some mothers feel more worthy, more useful, more loved ones if their child needs them forever. How can this happen? Only if their child is constantly sick. Without any rational explanation, they base their own value on their child’s incapability, they feel that this is the meaning of their life.

In the case of mental disorder, the mother’s belief of herself and reality is clearly disturbed, distorted, to the point that she even repeatedly harms her victims, so that they are dependent on her to eternity!

In many cases, the victims are gradually poisoned, as the perpetrator seeks compassion and acceptance at the same time. In this game of provoking pity, acceptance, and control that unfolds in their soul, control at some point takes the first role. By killing their victim they gain complete control of their life. At the same time, the perpetrator becomes almost a victim, a recipient of absolute compassion and the sympathy of those around them.

But then they need to feel needed again, useful, accepted, so they move on to their next victim. The perpetrator is not aware of their actions. This is a mental diversion mechanism, which has been set up to fill essential mental gaps. It’s an artificial edifice, a narrative built on existential anxieties, on mental gaps that no audience shares with reality.

The perpetrators are not paranoid, they live an otherwise normal life, they don’t believe that they are committing something bad, that is, they are not aware of their actions. To feel useful, accepted and savior, they have built their own fairy tale and live in it.

How to identify the perpetrator

• The perpetrator may appear comfortable or even happy in front of doctor announcements for serious disorders.
• They often work in the field of health, due to their increased interest in diseases.
• The victim’s symptoms subside every time the perpetrator moves away from them.
• A child has a recurrent or unusual illness and the reason can not be found.
• The child's health condition does not improve, even after special treatments that should help.
• The other parent is not involved in the child’s treatment, although the child’s condition may be serious.
• Another child in the family had an unexplained illness or death.

Is there remorse? Is there a cure?

What happens when the truth, the crime, is revealed? Can the perpetrator understand what they did? Any revelation belongs to the realm of material reality, which often shares little in common with that of the psychic. The perpetrator can not actually regret it, since the psychic world they have created and in which they live is based on substituents. It is an invention they have composed to be able to communicate with the world and manage their social life.

The perpetrator of Munchausen Syndrome By Proxy has not lost consciousness in the sense defined in psychiatry, but can not accept that they have committed a crime. In their mind, they remain the unfortunate parent, the man-sacrifice, the guardian-angel of their child. They seem to be guided by their irrational thoughts. They live in a lie.

There is no specific treatment for this rare syndrome since its causes still belong in the field of cases. Doctors’ goal should be to eliminate at least the obvious pathological elements, to minimize the chances of recurrence.

Any treatment, however, psychosocial or pharmacological, should target the particular characteristics and needs of the individual, as well as any underlying organic (eg thyroid disease) or mental illness (eg depression, personality disorder, etc.).

Counseling and psychological monitoring could help, but it’s almost certain that the perpetrator will repeat this criminal behavior even after any psychological intervention.

Thank you for reading!

References

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