Munchausen's Syndrome is a psychiatric disorder in which the patient pretends to have an illness, in order to receive medical tests and treatment, frequently surgical procedures.

On the other hand, Munchausen's by Proxy Syndrome (MSP) differs in that a carer (frequently a parent) will attribute symptoms to those in their care, thereby subjecting them to unnecessary medical tests and/or surgical procedures. In some cases, the carer will also inflict physical injury on the victim to get medical attention. In some recent cases in the UK (notably the nurse Beverley Allitt), the patient is in one of the caring professions.

In order to be effective at obtaining treatment for their charges, sufferers must have some medical knowledge (to be able to come up with convincing symptoms requiring professional attention). Additionally, they will appear to be both friendly and co-operative with health professionals, and concerned for the welfare of those in their care. A common strategy from the MSP sufferer is to describe symptoms of an ailment which is not readily apparent - one such is apnea (a temporary cessation of breathing). Some psychiatrists believe that this is an attention-seeking behavior.

If initial complaints are not taken seriously, the patient may exacerbate the situation by harming their charge - in the case of a parent, by causing some injury in keeping with the described symptoms, or in the case of health professionals, by administering drugs or medication.

As MSP progresses, a pattern may develop of serial visits from parents, which can alert health professionals, but in all too many cases, children and patients have died, effectively at the hands of the MSP sufferer.

Medical professionals are always reluctant to suspect MSP - they are trained and conditioned to believe both to parents and fellow professionals, each of whom should demonstrate a natural concern.

In the case of the Nottingham nurse Beverley Allitt, she was convicted in 1993 of directly causing the deaths of four patients, and injuring nine others. She achieved this by interfering with medical equipment and administering drugs, notably insulin.

In another case in New York, the Hoyte family had 5 recurrent deaths in the children that were thought to be 'cot deaths' (SIDS).

It is also worth noting that the film The Sixth Sense makes reference to MSP, in that one scene showed a mother putting something in her daughter's soup, and funeral goers were overheard to say that "another little one's getting sick". Cole Sear helps out by giving a video tape of the poisoning to the girl's father. Thanks to Chattering Magpie for pointing this out to me.

A tale from a survivor:

Tuesday, June 5, 2001
Had kind of a rough time with my shrink today. He was actually at the point of asking me about termination. I wasn't quite ready for that, and asked if we could just switch to every three weeks. We agreed on this, then I ended up talking about my mom and school and a bunch of shit. I started thinking about this stuff in ways I've never thought of it.

It wasn't until I was writing in my journal about the horrors of school that I thought about the fact that my mom never stood up for me for anything. I was never allowed to get mad, and nobody in her family was either. She could get pissed at me and scream and yell, but I'd catch hell if I even seemed a little pissed off. So she did a fairly good job of training out any of my ability to express anger in any way. I never saw my mom get mad at anyone, except me.

So today I started thinking about the fact that I'm pretty pissed off at her about a lot of things. Namely, the fact that she didn't really take care of me. She didn't stand up for me with things at school, just told me it wouldn't last forever and I just needed to take it. The only way I knew how to get attention was to be sick, and she loved it when I was. I had more tests and procedures and things done to me at an early age than most people have had in their lives. I talk about it sometimes but always in kind of a peripheral way, sort of detached and joking about it.

The truth is that a lot of this shit was pretty close to torture. I mean, real honest physical torture. I was talking to David, my shrink, about school and getting beat up all the time and medical procedures, and I joked that "at least it gave me a very high tolerance for pain." He told me that was really sad, and that people aren't supposed to have high pain tolerances. Then he started talking about torture victims and how the stuff that hurts a lot at first doesn't hurt so much after a while, and that after a long period of increasing pain being inflicted, the things that hurt like hell at first are barely even felt.

This got me real sad. I've had giant tubes shoved up my ass, cameras rammed down my throat multiple times. Giant machines pointed at me and sticky stuff with wires covering my head. I've been given tests for people with bad hearts and had to wear electrodes attached to my body, connected to little walkman things for days at a time.

I've had more needles rammed in my veins drawing blood than I can even remember. Shots beyond number. I've had needles shoved deep in my wrists, probing around for arteries that are hard to find. I've had needles jabbed in the muscles of my thighs and then been told to lift my legs while the doctor moves the needle back and forth.

I spent one Thanksgiving in the hospital on such high does of corticosteroids that I was having psychotic episodes. I didn't sleep for four days, and cried constantly. The reason for me being in the hospital is because the level of steroid they were giving me was dangerously high, and they wanted me someplace where they could resuscitate me if my heart stopped. My nose bled constantly the entire time.

I was in the hospital for Christmas once when I wasn't even sick, and didn't even feel sick. They wanted me as an inpatient because the wanted to make sure I didn't have cancer. Tests all day long every day. Waiting rooms and gurneys and IVs and needles and tubes. This guy sticks shit in your eyes to dilate your pupils and then shines bright lights in them in a dark room. Then go to the next guy who strips you naked while you still can't see yet and starts examining your testicles, saying, "hmm they seem a little small."

And drugs, so many drugs and side effects and drugs to counter side effects from other drugs. At the age of 10 I could swallow 32 pills with a Dixie cup of water. That's sick. What's sicker still is I was proud of it. That was a pretty normal morning dose for me through most of my childhood and teenage years.

I once OD’d on theophyline, which is sold on the street as speed. My doctor gave me another drug that blocks the liver's ability to process theophyline. So, each dose increases the blood level in steps, until you eventually OD. They call it, "becoming toxic." I OD'd when I was in a hospital for some kind of appointment or test or needle probing thing. I started shaking and shivering and throwing up a lot in the waiting room. I was sweating like crazy and my stomach hurt like hell. I hadn't felt well earlier and hadn't eaten breakfast, so it was dry heaves after the first few times. They would have pumped my stomach, but it wouldn't have done any good since it was all in my blood. They gave me lots of charcoal pills to try to suck the stuff out of my blood faster through the intestine. I had to stay overnight for observation while I detoxed, heaving for about 12 hours. I think that most parents would have sued over this, but not my mom. For her, it was just another cool medical story she could put in her scrapbook. Plus, if she had sued, she would have had to find another doctor that would give her scripts for pain killers and muscle relaxants and tranquilizers over and over without asking questions.

If I was sad or upset my mom would give me Vallium or codiene to make me feel better.

I lost three pints of blood once because my IV backed up and it was just siphoning blood out of my body onto the floor. Three pints later a nurse noticed, took it out, and then rammed a new needle into my other arm, which was still bruised from the previous IV that collapsed my vein. This was the last time I screamed because something hurt. I was 11 at the time, and have since had much more painful tests.

Oxygen tents, masks, tubes, breathing machines, and needles, needles, needles. Sitting inside all summer because I'm too sick or drugged out of my gourd to do anything but watch TV or read. Big machines, small machines, wires and sticky stuff and noise...they all make noise and they're all very loud.


Why would someone do this? If I wasn't being carted to a doctor or hospital I was alone at home or listening to my mom on the phone. She'd come home at 7, and then talk to parents of her students until 10 or 11. I put my brother and myself to bed almost every night for a good five years. And the House. The House was a nightmare of broken things, dog hair, dog piss, dog shit, trash, dirt, mice, mouse shit, and noises. The sound of mice squeaking everywhere at night and no way to escape it except blast a fan as loud as it will go. Carpet that isn't even carpet anymore. No way to bring friends over because I'm too embarrassed. My mom guilting me because the house is a mess. My grandfather telling me at the age of 11 that the reason my mom is a mess is because of me.

Why would she do this? My dad didn't want me and my mom took me from one torture chamber to another, all while stuffing chemicals down my throat. Nobody took care of me, nobody looked out for me, and nobody seemed to care. Why wouldn't anyone take care of me? I didn't do anything wrong, I wasn't bad, I was never in trouble. I didn't ask for anything, I didn't want expensive clothes, I didn't want expensive shoes, I didn't demand anything.

For other writings in this vein see Conversations with my wife
(What follows contains references to child abuse. Those who have a sensitivity to such issues may find these disturbing)

My wife works as a Child Therapist and our conversations frequently take the form of hour long tirades about one aspect of her work or another. I try to be supportive and a good listener, but some of the cases she handles can strain one's belief that we all share a common humanity.

Wife (who has not stopped pacing since coming home): I don't believe it. I just don't believe it.

Me: Hard day at work, dear?

W: (glaring) It's not funny! They had no right to inform the family. MbPS is governed by a completely different protocol. We're supposed to meet privately with the GP's and compare medical records with what the mother is saying, before....

M: Excuse me: MB whatsis?

W: Munchausen by Proxy Syndrome, you know...

M: I know about Munchausen Syndrome, where you pretend you have an illness in order to get attention. It was named after the stories of Baron Munchausen by Rudolf Raspe. He used to say...

W: (with deadly patience) MbPS is a clinical term referring to an illness or condition fabricated by someone, usually the mother, and ascribed to the child under her care.

M: Whoa! She tells the doctor her child is sick? Makes it up? What in hell for?

W: (sighs wearily) Oh, all sorts of reasons. Maybe the mother was neglected as a child and likes people feeling sorry for her. Sometimes there's a clear intent to harm. A man and his wife went to jail recently for feeding their infant son salt.

M: Salt?

W: He died of it, after being ill for a long time with symptoms no one could diagnose.

M: (takes the Lord's name in vain) What's this case you're on about now?'

W: Child X has missed therapy two weeks running, the mother says she's not well enough. First it was ME, now she says Child X's whole system is shutting down, she's lost skills and the ability to talk. All this is supposed to be due to a head injury two years ago that no one has heard of up to now.

M: What does Child X say about this?

W: (grimacing) They always support the parent...the alternative is unthinkable to a child.

M: You mean, that the parent is trying to harm them deliberately?

W: (nods) So I did some checking. There was a case four years ago with this family , a teenage boy whose symptoms proved to be fabricated. My colleague at work is our Child Protection Officer and she is willing to make the referral.

M: Referral? To whom?

W: The NSPCC, it's the Government Body for Child Protection.

M: Sounds pretty serious.

W: You bet. First we hold a private meeting with the various people concerned, the Doctors, the School, to see if anything at all jibes with what the mother is saying.

M: So what happened?

W: The meeting? It hasn't happened. Some dickhead at TAF told the mother about it and now she's denying she ever said that Child X was that ill, I must have misinterpreted what she said, she's been under such strain lately worrying about her daughter, yadayadayada. She'll probably pull the kid out of therapy.

M: What are you going to do?

W: Either I back off and wash my hands of it , or I have my colleague make the referral.

M: So....

W: It comes down to this: If I do nothing and something happens to Child X as a least if I try I'll be able to sleep nights.

M: So it's a mitzvah

W: You mean 'No good deed goes unpunished' don't you? I don't think I care anymore. I'm in this for the kids, pure and simple. Is there anything for dinner?

M: I got some some smoked salmon earlier. There's bagels and a couple more eggs.

W: God, I wish you could cook.

M: I thought you married me for my good looks.

W: (managing a smile)That was thirty years ago, in case you hadn't noticed.

M: We can watch the next episode of 'Marco Polo'.

W: (yawning)Works for me.

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