Cienna Madrid posted an excellent article on what clinical researcher Marc Feldman has called "Munchausen by internet." Munchausen is a syndrome in which a person fakes illness or trauma, you might say making a life out of it. They may repeatedly seek treatment, feigning symptoms and expending a great deal of effort concocting elaborate, convincing details that become the ongoing focus of relations with others. A related syndrome, Munchausen by proxy, refers to a person who assigns an illness to someone in their care, typically a child. Sometimes they merely report symptoms in the other person, but they may also induce real symptoms, using poisons, for example.
That I'm aware of, I've only seen one case of Munchausen's by proxy. That was in my third year of graduate school and my second year of clinical training. In that case, I was asked to conduct an extensive evaluation of the child involved. As one might expect, there was a great deal of concern about the welfare of the child, though there was no evidence that any physical harm had occurred up to that point. In addition to seeing the child, I interviewed the mother. There was no father in the picture.
The mother struck me as a psychologically primitive woman, not overtly psychotic, but deeply disturbed apart from anything she was reporting about her child. I saw no evidence of higher-order defenses or coping mechanisms and no indication of any self-insight whatsoever. The child was surprisingly emotionally healthy, perhaps owing to the constant involvement of two other caregivers in her life. She spent much of her time with these other caregivers, including many overnight visits. They were not available for interview, but I suspected that they were doing what they could to protect the child from the mother.
After conducting my eval, I met with the psychiatrist, my psychologist-supervisor and a fourth clinician who had already begun seeing mother and child in a therapeutic context. It was decided that we needed to go over the findings with the mother. The therapist would take the lead and I would be present for questions (and I think to serve as bodyguard, though the latter was never stated explicitly). Mother had been perfectly amiable up to that point, but she was nonetheless a bit frightening because she was profoundly mad, though in a way that wasn't technically psychotic or legally insane.
Frankly, I was glad that I wasn't the one who had to figure out how to discuss the findings with the mother. I was also appreciative of the opportunity to see firsthand how a senior clinician might proceed with a person who showed zero capacity for insight into herself, along with what impressed me as an almost life-and-death need to externalize all of her difficulties in the concrete form of physical symptoms in someone else.
We discussed, beforehand, our shared observation that the mother hadn't ever seemed palpably anxious about the child's health problems. In fact, all involved sensed a not-so-subtle enthusiasm with the process of seeing many clinicians. Mother behaved as if she was a colleague, though she had absolutely no clinical background.
Don't get the idea that this was about exposing the mother as a fraud. We regarded the mother as a very troubled woman and the goal was to help her. The hope was that the mother would continue in therapy, but that we could remove the child's alleged illness from the equation.
During the meeting with the mother, the therapist impressed me as confident, tactful and genuinely empathic in her approach. Nonetheless, mother went absolutely berserk as she sensed that she might in some way be considered a patient, as well. It was clear that she regarded her therapy as strictly about collaborating with the therapist to deal with her child's illness, and it was also clear afterward that mother and child would not be returning for follow-up.
Not knowing how the mother would proceed, we called DCFS because we were concerned for the child's safety. Up until then, there had been no concrete harm to the child and she was being monitored at the clinic. As we feared, there was not enough evidence to find child abuse in the case, nor was the child deemed at sufficient risk to remove the child from the home or force monitoring and treatment. Probably a case of a finding that served to ration DCFS oversight responsibility. I have little doubt that after the smoke cleared, mother and child simply moved on to another hospital.