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Munchausen Syndrome by Proxy

Today is an exciting (and also gruesome) day! I have banded together with the awesome Dr. Lydia Kang and the equally awesome Dr. Laura Diamond to discuss a really fascinating and (I strongly suspect) misunderstood ailment.

Lydia's post is about the medical aspects of Munchausen Syndrome and Laura's post is about the more psychological aspects. You might want to go read their posts to get a little background on this disorder. As for me: hey! I'm a child psychologist, so I am going to tell you all about Munchausen Syndrome by Proxy (MSP).

The basics: A caregiver (often a mother, but it could be a father) either feigns or induces symptoms in the person (often a young child, though it could also be an elderly parent) under her care. The caregiver does this for purely psychological reasons (e.g., not for financial gain).

MSP, which is considered very rare (like, 1 in 50,000), is not a formal disorder listed in the DSM IV, so it would be diagnosed as Factitious Disorder, Not Otherwise Specified (NOS). Factitious Disorder is a mental illness wherein the person feigns either physical OR psychological symptoms with the focus on assuming the "sick role" (not for external reasons like avoiding legal responsibility). MSP is usually considered a form of child abuse.

In MSP, we have a parent making a kid sick, solely for the purposes of gaining sympathy. They appear devoted, dedicated, tireless. They also tend to be really knowledgeable about the kid's symptoms and medical condition and very interested in having positive relationships with the medical professionals caring for the child. Warning signs include:

• Multiple hospitalizations of the child. If the symptoms go away in the hospital, they usually come back when the kid goes home.
• The parent reports the symptoms are getting worse (even when they aren't)
• Reported symptoms don't match the lab tests
• Some evidence of fakery in lab tests (the blood/urine isn't the child's)
• Some evidence of weird chemicals in the lab tests
• Siblings who have died under mysterious medical circumstances
• The parent may have very similar symptoms, or a history of them

Examples:

• Administration of excessive laxatives (or poison) to produce severe diarrhea, vomiting, or other symptoms
• A mysterious skin condition produced by rubbing caustic substances on the child's skin

On a personal note, here's a pet peeve of mine: when professionals toss this label around casually. I find it really upsetting. Because as soon as a professional decides a parent is MSP, it's a recipe for nastiness. I'm not saying that parents don't sometimes contribute to children's conditions, but deciding it's happening with deliberate intention is a different thing entirely.

It's not that MSP doesn't exist, because it does. And it's not like we don't need to pay attention to the psychological processes that are active for a parent caring for a symptomatic child, because we do. But I get concerned when something this big and scary gets raised without very careful consideration of 1) all the other possible explanations for the parent's behavior and the child's symptoms, and 2) a great deal of knowledge about what MSP actually is (and is not--for example, I've heard professionals accuse a mom of MSP because she was desperate to get her kid on disability. That's financial gain, folks, which immediately eliminates MSP).

Parents of kids with rare medical disorders sometimes get accused of MSP, and it makes things so much worse. So. Just a note of caution. There's a lot of controversy about this disorder. For some solid, more detailed general information about MSP, go here.

What do you think of MSP? Horrifying, no? Somehow, I think it's even worse than Munchausen Syndrome, because with MSP, the person is inflicting symptoms on another, more vulnerable person. Now--if you haven't yet, go read Laura's and Lydia's posts!

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Introducing Mr Crazy

Hear that? That's the sound of awkwardness. The sound of many numbers and a lot of letters that we don't need and would rather were scrapped to make way for the important stuff. I'm talking about November. November is hands down the most boring and pointless month of the year for many reasons, which I shall now list:

- It always lacks any exciting events.

- It's nearly the end of the year but not quite.

- It's bloody freezing but refuses to accept the welcome of snow.

- It's the third month of the academic year causing an abundance of 'cbf'itis

- It's the month of dread wherein mock exams are usually done.

- It's just a long 30 day wait until advent calendars can be officially opened. 

Alas, my dear friends, there is only a mere FIVE HOURS  to go before the mighty month of December. I have waited 11 MONTHS for December for one reason and one reason only. Drumroll please, and do be upstanding for the most tremendous event of 2010 and possibly of past centuries...HHHEEEAAATTTTTTTTT!

...what do you mean? Christmas? Who's Christ? Is that pronounced ChrisT like TreyC? Anyway, stop interrupting me with your insignificant affairs and let's go back to this amazingness. It is indeed, finally, slowly approaching those four !!!!!! days. Like a lion advancing on it's delicious prey. Yes, just like that. Then going in for the KILL AND RAVAGING THE BEING IT HAS GRASPED WITHIN ITS PAWS...oh. 

Remember that little thing I went to, I don't know if you'll remember it, it was called THE BEST NIGHT OF MY LIFE feat. DAVINA MCCALL. It might ring a bell. Well I am preparing myself for identical mental happenings, which may include being speechless; giggling; gasping; within self screaming; speaking a language that has yet to be invented, etc etc. 

When I first got my work experience placement at Heat I went ape shit crazy. Proper loony screaming wetting self crazy. Said crazy symptoms lasted for around a week before realisation that I had to wait a whole year set in. So for the past 11 months Mr Crazy has been lurking at the back of my brain quietly snoozing, and at intervals would stir from his slumber and dip a loony toe into my active brain, causing an eye pop or a corner of mouth smile or maybe even (if I was lucky) a short burst of adrenaline. But now, oh now, Mr Crazy is wide awake and has adopted a penchant for divebombing into my frontal lobe and releasing clinically insane adrenaline through my veins and even to my voice box causing an excited MEEEEEP every now and then. 

Now taking Mr Crazy's antics into account, I am worried for the health, safety and sanity for everyone at Heat Towers, because this could go either way...

ONE - I could channel Mr Crazy into the creative and personality part of my brain and put him to good use, proving my experience to be a useful one and coming out of it with pride and knowing I made a good impression on the Heaters and that they enjoyed my company and ambitious and innovative ways.

TWO - Mr Crazy could completely take over and cause me to be a complete and utter wreck for the said four days, making me silent and awkward at some points, or obnoxious and embarrassing at others. I will be a fool and come home every day in tears with paranoia seeping through me and will therefore combust into a small pile of dust on the tube. I'd prefer the former way but let us let fate take its course.

I've waited years for this. Heat is the reason I wanted to become a feffin' journalist for feff's sake. I remember picking up a copy for the first time and buzzing with excitement that a bulb had just been lit in my brain, that I wanted to write stuff. Funny stuff, inspirational stuff, stuff that people would remember. The little man at the local newsagent used to have a fresh copy waiting for me on his desk every Tuesday morning before school. I'd read it in a certain order, passing it around at break and lunch, cutting out parts I wanted to keep. I did my whole GCSE Art final piece on Heat. MY BIRTHDAY CARD WAS HEAT...

Now I have a subscription and launch myself onto my bed every Tuesday, ripping the cellophane and spend devoted hours flicking through the pages. I'm going to BE there in 20 days. Me! There! 20 days! SCREAMFALLSEXPLODESRUNSBANGSBREATHES. I'll be fine right? Yeah. Just fine. Nothing to worry about. *leg jitters, eye twitches* Now if you'll excuse me, I have some patient waiting to do. X

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Themes of This Blog Seen In Newspaper Advice Columns The Game without End Gender Role Division

In Amy Dickinson’s advice columns of 5/29, 6/14 and 6/18/17, and in Carolyn Hax’s column of 6/23/17, the Agony aunts published letters which serve as a good, simple and straightforward illustrations of something that family therapists have called the game without end, described in several previous posts.

Whenever one member of a couple or a family makes a good case for changing the rules by which people in the family operate, other members of the family (or the other member of the couple) get suspicious. The person making the request has always followed the old rules. I mean, they say they want things to be different, but do they really?

So the person making the request gets “tested” to see how sincere their request really is. The others make the requested changes, but do so in an obnoxious or annoying manner. My favorite illustration of this is a situation widely created by rapidly evolving changes in gender role functioning, which the letters that are the subject of the current post clearly illustrate.

Both members of a couple work, but somehow everyone - including the females - has always expected the female to do all or most of the housework due to the rules followed by earlier generations of men and women.  The woman often has treated the kitchen, for example, as her own personal fiefdom in which she is the undisputed boss of how things are supposed to be done.

If she suddenly asks her husband or boyfriend to help clean up and do his share of the cooking, he wonders if she reallywants that - because of her prior attitude and the accompanying behavior, which had been readily and repeatedly observable up to this point.

So, when it’s his turn to clean the kitchen, he does a half-baked job and puts the dishes and pots and pans in all new places, so that his partner cannot find them when it’s her turn to do, say the cooking. Or he does any of numerous other passive-aggressive things that annoy the heck out of her. So she criticizes him unmercifully for his poor performance.

In a sense, she starts criticizing him for doing the very thing she had asked him to do in the first place.

His conclusion: "See, she really didn’t want me to help out after all." I can never understand why he discounts his own behavior in drawing this conclusion, but that is highly typical.

An effective way to handle a game without end so that the rules really can change is described here.

So for those readers to are skeptical, here are some abbreviated letters from the advice columnists:

5/29/17. Dear Amy: I am really tired of my husband asking: “How can I help you?” “What can I do for you?” or “What do you need?”Here’s why this upsets me: If I am cooking dinner for the both of us and he asks, “What can I do for you?” I think, well, you are eating this dinner too, so why not just ask, “What can I do?” Why is he offering to do something “for me”? I get so frustrated that my response is: “…nothing.” When I suggest that he just pitch in, he tells me that I do these household things so much better than he does. 

He seems to want me to need him. I don’t need him. I just want him to initiate the household work on his own. He watches TV while I run around picking up the house or making dinner, and his only response is, “Am I in your way?”...When he finally does something like putting a load in the washer, he needs to announce it like it’s the second coming. What can I do? - — Frustrated!

A response from a man to the above letter: 6/14/17. Dear Amy: I am a man who has been in the same position as “Frustrated’s” husband, who would ask, “What can I do for you?” instead of just taking responsibility for his half of the household chores. I used to be like this. I just didn’t know how to be helpful and I didn’t want to get in the way. Honestly, my wife basically trained me how to take on more responsibility and now we work together. — Reformed (This guy is still letting her be the boss!)

Dear Reformed: I have received a huge response to this letter, and many men echo your statement — they needed some guidance and when they got it, they stepped up.

6/18/17. Above letter, continued. Dear Amy: I understand a lot of men are responding to the letter from “Frustrated!” about her husband’s lack of initiative regarding household chores. In my case, I jump in and do my best, but my efforts are criticized and belittled. It is hardly inspiring me to do more. — Also Frustrated

6/23/17.  Dear Carolyn: I love my partner. He recently moved in... I’m so tired of people who won’t clean up after themselves and leave it until I do it. I made it very clear to my partner before he moved in that it was important to me...But I’m already tired of asking and I’ve been reading about “the mental load.” Like last night: I was stressed and headed to my second job and he asked what he could do to make me feel better (sweet!) so I said, get wrapping paper and a card and wrap your sister’s wedding present. And when I got home later, he had! But. The box was left out instead of recycled, the couple of dishes I used to feed us before I went to work weren’t done, the living room was a mess . . . he just doesn’t see it…— I’m Already Tired