Biology 202
2003 Second Web Paper
On Serendip

"I was looking for a way to get attention to myself, and maybe if I could just do something drastic enough, that someone would see that I needed help"-mother who tried to suffocate her child (1)

Why would any mother try to suffocate her child? Is it not true that:

"A mother's love for her child is like nothing else in the world. It knows no law, no pity, it dares all things and crushes down remorselessly all that stands in its path?" --Agatha Christie.

Mothers, in most cases, are seen as the essential "caregivers" in many societies/ cultures. A novel or textbook, screenplay or script, Hallmark card or holiday, could celebrate "motherhood," and what it entails, at one point in time. The bond of mother and child is shown to be "unbreakable" and we hear stories of mother's lifting cars to save pinned children, essentially sacrificing their lives in order for their children's survival. Growing up, we might hear that being a mother is an "under-appreciated job; and "all the work mothers do whether paid or unpaid - has social and economic values"(1). Mothers can essentially be the shapers of the future society: able to raise children, and possibly even hold down a job, while still being able to cook and clean. Author Ellen Bravo stated, "Only Clark Kent had to be Superman, but every mother has to be Superwoman" (2).

Just recently (about 26 some years ago) physicians began to disagree with Miss Christie's belief that mothers are extraordinary defenders of children. Dr. Roy Meadow coined the term, Munchausen Syndrome by Proxy (MSBP), in 1977, to describe an unusual and bizarre behavior exhibited by parents of extremely "sick" children after observing a mother who had tampered with her child's urine samples (3). Parent(s)/caregiver(s) of a child in MSBP falsify illnesses or fabricate symptoms for children. They will "purposefully inflict pain/harm on another person, usually his/her own child" (4). Not only will the parent inflict pain, they will try to elicit "health problems" in their children through various means, usually undetectable by forensic exams (5). They will suffocate the children, poison them, inject them with feces/urine/insulin, block airways with fingers/hard objects, scrub the child's skin with cleaning solvents and bleaches, or feed children large amounts of sugar or salt (6), (3), (5). The mother (usually the sufferer of Munchausen's and perpetrator of MSBP more than 95% of the cases), or, very rarely, the father, might also feed the child more medication than required, tamper with medical equipment, or swap medicine (7), (8), (6).

Perpetrators can make their deceptions look like plausible and valid medical problems, which doctors will then try to treat:

"The perpetrator can make the a child's emesis, urine, or feces appear bloody by adding their own blood, or paint, or dye, or cocoa. Feeding a child large amounts of salts or sugars can create electrolyte imbalance. Scraping a child's skin with a sharp object or applying irritating solutions, such as oven cleaner, or dyes can cause rashes that will last for days, weeks, or even months. Sedatives, tranquilizers, or the injection of drugs or foreign material can induce neurological symptoms. Only the imaginations of these parent's limit the variety of believable signs and symptoms. The children not only suffer from the parents' actions, but they are also subjected to an extensive array of invasive radiological, medical, and surgical procedures that are unnecessary and painful (9).

Take the case of young Jennifer Bush. Her mother, Kathleen Bush, admitted Jennifer to a hospital on "130 separate occasions" (8),. Jennifer spent "640 days in hospitals" and "underwent approximately 40 surgeries for chronic illnesses such as immune system deficiency, gastrointestinal problems and seizure disorders and needed a feeing tube to eat" (10), (8). The surgeries Jennifer Bush suffered removed not only her gallbladder, but also her entire appendix, and part of her intestines (9).

What did the mother get out of it? Instant fame? Previous First Lady, Hillary Rodham Clinton, did chose Jennifer as the poster child for her campaign on healthcare reform (9), (10). Kathleen Bush was lauded and given the highest praise for her "exemplary devotion" to her little daughter (11). However, the cause could go deeper than attention seeking, especially since MSBP is an unusual form of abuse.

Why is MSBP bizarre? There are basically three unusual facts surrounding MSBP. One- the fact that young children are suffering, even dying, from unknown causes; Two- mothers are the ones behind the child's suffering or eventual death; Three- The mothers are knowingly harming their children and trying to cover up what they are doing from others, even from their spouses.

Young children, more vulnerable than adults and older children, can be susceptible to many diseases. However, if there is a history noted of similar sibling illnesses. Unexplained reasons for death/illness of sibling, more than one or two cases of SIDS in the family, or the doctor being baffled by the patient's symptoms, could suggest that the child's illness could be due to an "unlikely" alternative cause-mothers. This was concluded to be the cause of a child's "sickness" once nurses, spouses, doctors, and other family members noticed that when the mother's left the child, the signs and symptoms of the "illness" would alleviate, or no longer surface. An undercover video recorded by an English doctor, David Southall, confirmed suspicions that some children were actually harmed by their parents. "In all Southall recorded 39 different children over the course of eight years. In the taping, 33 of the 39 children are seen being attacked" (12). If this is true, than one in five "cot deaths," or SIDS, is "actually a murder resulting from a mother with MSBP" (5).

This may be hard to accept for many people since, as stated before, mothers, and parents, in general, are seen to be the "caregivers" and "protectors" of children. For instance: "Few people ask questions, for how many people would dare to think that this wonderful, kind, caring, compassionate person who has devoted all her life to helping others is, in reality, a murderer?" (5). This denial can be linked to societal views. Mothers and parents are placed in high esteem when it comes to the care of children. Therefore, why would a doctor even question the reports made by the parent's of a "sick" child. "Physicians are trained to believe in the medical history given by a caregiver and may not question the facts" (13). On the other hand, if the perpetrator of MSBP is a nurse or doctor, society is taught to trust the people "in the coats and uniforms." We give people in uniform a certain degree of power. Police have the right to enforce the law, and doctors have the right to heal and save the sick. Whether or not they abuse this power can not be controlled by what society deems the "proper" function of a job. People, given the power, may use it or abuse it. As long as one does not get caught, society and others will never know how one is using his/her power. Moreover, all the same, most people trust each other. Doctors trust parents to tell the truth about symptoms/problems and parents trust doctors and nurses to treat and not harm their children.

MSBP violates this societal norm. Mothers, or even fathers, afflicted with MSBP, no longer follow the "traditional" role as caregivers. Instead, they inflict pain and irrational attacks on their own flesh-and-blood. They only seem to get away with it because many parents with MSBP are "highly attentive," "unable to leave the side of the child," while also being "supportive to staff" and involved in the "hospital environment," extremely "close to hospital staff" (14), (15). Thus, on the surface, this parent seems to be a caring and overprotective mother. What the medical staff, spouse, and the family, do not realize is the amount of care this "devoted" individual put into hiding the abuse inflicted on the child and the fabrications created around it.

Why would anyone do this? Causes for MSBP are large and varied. One of the most popular reasoning's behind the disorder could be traced to the mother's own childhood. Most of the mothers with MSBP may have had an "emotionally deprived childhood with a high probability of physical abuse" (9). These mothers could have suffered at the hands of their own parents, causing them to do the same to their children. Another popular reason related to the presence of abuse as a child, is the search for recognition, sympathy, or just "attention," such as Kathleen Bush sought when abusing her daughter Jennifer. These women could be in an unhappy marriage, where the husband is inattentive and distant, or could have depression due to childhood abuse and trauma (7), (16), (4), (6), (15), (9). If the husband is distant, the mother may harm the children to "grab the husband's attention or even [use it] as a method of taking revenge against the husband" (4).

The Munchausen (a separate syndrome in which the individual inflicts pain or falsifies illnesses to gain entry into the hospital) could carry over to the victim abusing his/her child.

A more controversial cause deals with mother's "outwitting doctors"- an authority figure in society. "Some offenders might receive gratification that as they fool the doctors. They derive enjoyment from knowing what is wrong with the child as medical experts remain baffled" (15). The relationship developed by the mother and doctor is strictly "sadistic"-the mother harming the child to get back at the doctor (7). In some cases, the doctor could stand in as the target for the mother's hatred or ambivalence towards her own father (7). If the mother felt that her father "rejected her," leading her to feelings of "psychological abandonment" and "emotional hunger," causing her to fail in "developing a sense of self," the mother might redirect her feeling about her father's treatment of her to a male doctor (7).

All of the "sources/causes" of MSBP, I feel, can be related to power and control.

"The mother may feel hugely empowered, because she knows society is on her side- mothers don't deliberately harm their children in such a way, thus giving her the edge in a social encounter with the doctor and to a certain extent she has gained control over the thoughts and actions of a well educated doctor by 'feeding him lies' and determining the periods of acute illness in the child" (7).

Like any abusive disorder, control and power is a major issue. For anorexics, it is to starve themselves. Bulimics control the amount of food after bingeing by either vomiting, or doing intense exercise. When a child is abused, the first thing they lose is control and power. Their attacker wields all the power and all the control. As we discussed in class, control means a lot to us, whether it is physical or mental. To some people, the fact that we can not control certain aspects/functions of our lives frightens them or makes them feel inadequate (9). Thus, the reality behind this disorder can be seen when examining the actions the mother might take.

In order to cause symptoms in the child, mothers have to physically induce the illnesses." As stated earlier in the paper, they can achieve this in numerous ways (injecting feces, applying cleaning solutions to skin, smothering, etc.). The inducing of "sickness" in a child wields a lot of power and control for the mother (7), (16). She can do whatever she likes with the child. The mother has the ultimate upper hand in how much the child will suffer before she gets caught, or before the child dies. This absolute control over a being results in secondary benefits: attention to the mother, feeling of worth by attentive hospital staff and doctors, recognition for "heroism," revenge, etc. Overall, if the mothers practicing MSBP really were affected by childhood abuse/trauma enough to feel that they are "ignored," then the control/power cause would be the most logical cause for the development of MSBP.

To this date, we do not have enough information to pin one cause onto MSBP. However, I do not think the syndrome can actually be explained by one cause, despite the lack of information. Any disorder, especially mental, can be attributed to several factors and causes. Mother's that perpetuate MSBP that never had any childhood abuse/trauma might be led to harm their child for other reasons: to get back at their husband's for disregarding them, to deal with insecurity by searching for attention and support through hurting their child, depression, the list could go on.

A MSBP victim survivor noted,

"Just as we have been called as a nation to stand together, may we survive to pull each other up to the mountaintop and shout-NO MORE. Our children deserve to be safe, to know and receive unconditional love. This will be our mission and our legacy to the next generation" MB (13).

What is important now is to realize that MSBP DOES exist, despite whatever reason. The potential victims are the defenseless children. By reaching out to the mothers and helping them deal with their problems, or by recognizing the "signs" of MSBP early on, we could potentially prevent more deaths of children (9).

Bibliography

1)Mothers and More Homepage , A non-profit organization site dedicated "to improving the lives of mothers through support, education and advocacy. We address mothers' needs as individuals and members of society, and promote the value of all the work mothers do."

2) CNN.com Homepage, Article by Annelena Lobb on "the market value" of a mother's work

3)Hendrick Health System Homepage, A brief definition and description of Munchausen Syndrome

4)General Health Articles, Brief paper on Munchausen Syndrome

5) Bully Online,Site on Attention Seeking Disorders. Has a section on MSBP

(6)Body Magazine Online, site on women's health and lifestyle.

(7)School of Medicine Papers, Paper by Med student on MSBP, entitled Munchausen Syndrome by Proxy

(8)Court TV Homepage, Site on trials and verdicts

9)Nursing Career Site, Self-Study Module on MSBP for RNs

10)CNN online Homepage, Article on Kathleen Bush case by Susan Candiotti

11)Self Help Magazine, Paper on MSBP by Marc D. Feldman, M.D., entitled, "Parenthood Betrayed The Dilemma of Munchausen Syndrome by Proxy"

12)ABC news online, News OnLine. Article on MSBP.

13)MSBP Survivor Network Site

14)PediatricBulletin, Article on MSBP on Pediatric Bulletin Site

15)Allen Cowling Investigations Homepage, Site on False Allegations. Paper on MSBP.

16)Stranger Box site, Post-Trauma Page. Section on MSBP.


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