Sunday, 20 March 2011

Sick in the head? Part 2

This is the second in a three part series on Munchausen's syndrome. Part one is here.

So, in Munchausen's syndrome the individual mimics the symptoms of a real medical condition, or actually causes them in themselves. Munchausen's syndrome by proxy is in many ways even harder to understand for the onlooker: here the individual causes illness in others, typically in a child. It is a form of extended child abuse, and the motivation is to assume the sick role by proxy. In some cases the child goes on to develop Munchausen's themselves, to go on getting the attention they received when they were in ill health.

One study showed that in over 90% of cases, the abuser was the mother. In other cases it was another female caregiver. This may be due to females being placed preponderantly in caregiving roles, or to socialisation patterns encouraging women to seek help and sympathy from others.

The term Munchausen's by proxy is thought to have been coined by paediatrician Roy Meadow in 1977. In the late 1990s and early 2000s Meadow testified in several murder cases, some of which resulted in parents being wrongly convicted of murdering their children: there was no doubt that harm had been done to the children, but Meadow commented on motive without evidence, and subsequently the judgements were reversed.
The person with Munchausen's by proxy is typically seen as very helpful in the hospital setting, and is often appreciated by the nursing staff for the care given to his or her child. Their frequent visits make the child accessible to them, and changes in the child's condition occur only when they are there, almost never witnessed by hospital staff.

Readers in the UK may recall the case of Beverley Allitt, labelled the Angel of Death by the media.
Allitt was a State Enrolled Nurse who worked on a children's ward. Over a two-month period she killed four children and injured nine others by injecting them with substances such as potassium chloride, which can stop the heart. She was sentenced to a minimum term of 40 years, which she is serving in a secure hospital. Her motives are not known, but it is thought she may have been suffering from Munchausen's by proxy.

Munchausen's by proxy may be linked to Hero Syndrome, where the individual seeks recognition by creating a desperate situation that they can resolve. The phenomenon has been noted to affect emergency workers such as nurses, police officers, firefighters and ambulance crew. Perhaps Allitt's 13 victims are only the ones we know about, and there were others where she became a "hero" by recognising their desperate illness - the illness she'd caused - in time to save them?
Over these two posts I've looked at Munchausen's syndrome, where an individual mimics illness symptoms or causes harm to themselves, and Munchausen's syndrome by proxy, where an individual causes harm to someone else, usually a child. In the final post of this series, I'll be considering a newly described condition, Munchausen's by internet.

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