Dr. Patricia Farrell on Medika Life

It’s Time to Reconsider Deadly Munchausen’s Syndrome by Proxy

The little-talked-about or diagnosed syndrome may be more prevalent in healthcare than we know.

Call it what you will, but the psychiatric factitious disorder, one step removed, that causes physical and emotional harm to kids and adults is still primarily known as Munchausen’s Syndrome by Proxy (MPS). Some wish to change the nomenclature to Fabricated or Induced Illness by Carers’ (FIIC), but it’s still a form of child or spouse/relationship/partner abuse by a parent, a spouse, a loved one, or someone caring for the child. I had written a professional article about this several decades ago.

The case is eerily similar to the infamous killings of hospitalized patients by Dr. Michael Swango who was only caught because he missed a plane connection out of the US to go to Asia. Swango isn’t the only killer physician. One, who may have killed dozens in a hospital, fled the country and has never been prosecuted.

The recent horrendous case of Lucy Letby, a neonatal care nurse in a hospital in Great Britain, points up the seriousness and difficulty involved in detecting these cases of infant deaths. Letby has been found guilty of killing at least seven babies and trying to kill six others while they were in hospital care. But many more cases may be uncovered as the investigation into hospitalized babies, at two different hospitals where Letby worked, may reveal a much larger number of murders.

Cleverly, Letby used at least three different methods to kill twins and, in at least one case, at least two triplets. The nurse was viewed by staff as a caring, agreeable young woman who tended to the premies in her care. In fact, she cried, washed, and dressed the dead babies before their grieving parents took them. The British police are now investigating over 30 deaths of infants who may have been victims.

The reason she killed the children is unclear, and Letby has never offered a reason, nor have we ever heard she has MSP. This article, therefore, is not a diagnosis of Letby, but a review of MSP and how potentially close it could be to revealing the disorder that would push some individuals to engage in this type of behavior. However, there are some things that give us pause to consider this diagnosis.

The media has never provided any psychological interviews or diagnoses for Letby, and we can only speculate that she might be motivated by certain pathologies, but this cannot be viewed as solid evidence here. We have no evidence of her motives.

The hospitals where she worked appeared unmoved by physician concerns about the deaths of babies that were on the brink of maintaining their lives. But what are the characteristics of MSP that cause us to wonder if some professionals might diagnose Letby with the disorder?

Munchausen Syndrome by Proxy (MSP) is a complicated and upsetting psychiatric condition in which a caregiver willfully injures another person, frequently a child, in order to portray themselves as a caring caregiver. This disorder, which manifests as a severe distortion of the caregiver’s sense of self, stems from a deep-seated need for control, attention, and affirmation.

MSP patients fake or intentionally cause disease or injury in the victim they are caring for, frequently resulting in pointless treatments such as interventions, hospitalizations, and medical procedures, including multiple surgeries.

Some of the characteristics that have been found to date include their having medical skills or experience, apparent devotion to the child or individual, seeking sympathy and attention, usually forming close associations with medical staff, a need to feel powerful and in control, and not seeing their behavior as harmful but, in some ways, helping the patient to die.

The motivation of the offender is the compassion and attention that they receive from family, friends, and medical professionals while their victims suffer bodily and psychological suffering.

Research and discussion into the psychopathology that underlies MSP are still underway. According to some professionals, people with MSP may also have an underlying personality condition, such as borderline or narcissistic personality disorder, which increases their need for affirmation and attention. Some people suggest that MSP could be linked to unresolved trauma, a history of child abuse, or issues making healthy attachments.

Because MSP is covert and misleading, it is challenging to estimate its incidence rates. Instances are frequently only discovered after healthcare professionals express suspicions or after unusual patterns of diseases or injuries in a victim raise alarm. In Swango’s and Letby’s cases, there were unusual numbers of deaths when either of them were on duty at the hospitals. In Swango’s case, patients with minor illnesses died suddenly.

As MSP is thought to be severely underreported, it is difficult to determine its prevalence with precision. Despite this, it is regarded as a rare illness that affects a relatively small number of caregivers. But MSP cases frequently receive a lot of media coverage when they are found, which can affect people’s perceptions of how frequently they occur.

Typically, children who are completely reliant on their caretakers for care and protection — in particular, newborns and toddlers — are the victims of MSP. The manipulation and violence done to these defenseless victims may have serious and long-lasting physical and psychological repercussions.

Identifying the perpetrator’s acts and safeguarding the victim’s safety are both necessary for dealing with MSP, which presents formidable hurdles. A multidisciplinary strategy for intervention is used, involving professionals from the medical field, mental health specialists, child protection agencies, and the legal system. One usual practice of anyone with MSP is to take their victims to different healthcare providers or hospitals to cover their tracks, but artificial intelligence in medical records might remediate the use of this ruse. Who runs a far-reaching search in the vast medical “cloud” to look for possible crimes?

MSP has a significant and far-reaching impact on victims, notwithstanding the difficulty in pinpointing its actual incidence. Medical, mental health, legal, and protective services must all be involved in the treatment of MSP. Due to the entrenched nature of the condition, MSP treatment is complex and difficult, with a limited chance of recovery. The protection of vulnerable victims’ well-being depends on our ability to recognize and address MSP situations as our awareness of the phenomenon develops.

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Pat Farrell PhD
Pat Farrell PhDhttps://medium.com/@drpatfarrell
I'm a licensed psychologist in NJ/FL and have been in the field for over 30 years serving in most areas of mental health, psychiatry research, consulting, teaching (post-grad), private practice, consultant to WebMD and writing self-help books. Currently, I am concentrating on writing articles and books.


Medika Editor: Mental Health

I'm a licensed psychologist in NJ/FL and have been in the field for over 30 years serving in most areas of mental health, psychiatry research, consulting, teaching (post-grad), private practice, consultant to WebMD and writing self-help books. Currently, I am concentrating on writing articles and books.

Patricia also acts in an editorial capacity for Medika's mental health articles, providing invaluable input on a wide range of mental health issues.

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