The Munchausen Syndrome by Proxy (with Sharp Objects Excerpt)

Recently I read the chilling tale of a murderous mother in Sharp Objects and I was interested to see what I could find regarding the Munchausen syndrome. The Americans had the city of Kansas and the story of the Wizard of Oz (a bit different from the Wizard of Glass). The Germans had The Baron Of Munchausen (1785 book Baron Munchausen’s Narrative of his Marvellous Travels and Campaigns in Russia)

he fictional Baron’s exploits, narrated in the first-person, focus on his impossible achievements as a sportsman, soldier, and traveler, for instance riding on a cannonball, fighting a forty-foot crocodile, and traveling to the Moon. Intentionally comedic, the stories play on the absurdity and inconsistency of Munchausen’s claims, containing an undercurrent of social satire. (Wiki)


Munchausen syndrome

In the medical community, the Munchausen concept has been applied to adults who invent outrageous illnesses (either physical or psychological) to receive medical attention. Adults aged 20-40 years are most likely to develop Munchausen syndrome. Women with knowledge of health care and men with few family relationships are particularly vulnerable to developing this disorder.


This does not mean that the person is doing this on purpose to get attention. The people who experience the Munchausen mental disorder have borderline or antisocial personality symptoms or a grudge against the medical profession and social, or may have had a personal or family history of serious illness or a history of neglect, abuse, or other maltreatment.

In the book Sharp Objects, Camilla’s mother confesses that her own mother was cold.

“You remind me of my mother. Joya. Cold and distant and so, so smug. My mother never loved me, either. And if you girls won’t love me, I won’t love you.”

Due to the chronic nature of the condition, as well as the tendency of sufferers to discontinue treatment, care for individuals with Munchausen syndrome is difficult. They consciously invent the illnesses they carry. No single approach is consistently effective in managing this illness.

Munchausen syndrome by proxy (MSBP)

acfd66839c83443c28d0e09f06970f07The Munchausen by proxy syndrome is a fabrication of illness by a third person that allows the third person, usually the victim’s mother, to assume the role of caregiver and gain attention and sympathy.

Lacey Spears, of Scottsville, Kentucky, 27, found guilty of second-degree murder in January 2014 death of her 5-year-old son, Garnett-Paul Spears whom she was force-feeding salt through his stomach tube.
As Spears moved around the country — Alabama, Florida and eventually New York — she kept friends updated on her son’s frequent hospitalizations with photos and musings on Facebook, Twitter, MySpace and a blog.
“My sweet angel is in the hospital for the 23rd time,” she tweeted in 2009.
Garnett-Paul Spears (left) died in January 2014
Garnett-Paul Spears (left) died in January 2014

The individual enjoys the attention and sympathy that she receives for having a sick child as well as the praise for being such a devoted mother. In the United States, 2.5 million cases of child abuse are reported annually. It’s estimated that1,000 of those cases involve MSBP.

10 Shocking Cases Involving Munchausen Syndrome By Proxy

“Munchausen by Proxy. The caregiver, usually the mother, almost always the mother, makes her child ill to get attention for herself. You got Munchausen, you make yourself sick to get attention. You got MBP, you make your child sick to show what a kind, doting mommy you are. Brothers Grimm, see what I mean? Like something a wicked fairy queen would do. I’m surprised you haven’t heard of it.”
“It sounds familiar,” I said.
“It’s becoming quite a well-known disease. Popular. People love new and creepy. I remember when anorexia hit in the eighties. The more TV movies on it, the more girls starved themselves. You always seemed okay, though. I’m glad.”
“I’m okay, mostly. I have another sister, a girl born after Marian, I worry about.” “You should. Dealing with an MBP mom—it doesn’t pay to be the favorite. You were lucky your mother didn’t take more of an interest in you.

– Sharp Objects

The image of my mother sitting on the edge of my bed, a spoonful of sour-smelling syrup hovering over me. Her medicine always made me feel sicker than before. Weak stomach. Not as bad as Marian’s, but still weak. – Sharp Objects, Gillian Flynn

The person with MSP gains attention by seeking medical help for exaggerated or made-up symptoms of a child in his or her care. As health care providers strive to identify what’s causing the child’s symptoms, the deliberate actions of the mother or caretaker can often make the symptoms worse.
The person with MSP does not seem to be motivated by a desire for any type of material gain. While health care providers are often unable to identify the specific cause of the child’s illness, they may not suspect the mother or caretaker of doing anything to harm the child. In fact the caregiver often appears to be very loving and caring and extremely distraught over her child’s illness.

I am a nurse who has attended Marian Crellin for her tests this week, as well as several previous in-patient stays. I am of the very strong [“very strong” underlined twice] opinion that this child is not sick at all. I believe were it not for her Mother, she would be perfectly healthy. The child exhibits signs of illness after spending time alone with the Mother, even on days when she has felt well up until maternal visits. Mother shows no interest in Marian when she is well, in fact, seems to punish her. Mother holds child only when she is sick or crying. I and several other nurses, who for political reasons choose not to sign their names to my statement, believe strongly the child, as well as her sister, should be removed from the home for further observation. Beverly Van Lumm

People with MSP may create or exaggerate a child’s symptoms in several ways. They may simply lie about symptoms, alter tests (such as contaminating a urine sample), falsify medical records, or they may actually induce symptoms through various means, such as poisoning, suffocating, starving, and causing infection.

The children may or may not know that their parents are doing this on purpose, but in the end, they will be the ones suffering from the ministrations.

I could see her so easily here, sitting cross-legged on that bed, small and sweat dotted, her eyes ringed with purple. Shuffling cards or combing her doll’s hair or coloring angrily. I could hear that sound: a crayon running in hard lines across a paper. Dark scribbles with the crayon pushed so hard it ripped the paper. She looked up at me, breathing hard and shallow.
“I’m tired of dying.”
– Sharp Objects, Gillian Flynn

What Are the Symptoms of Munchausen Syndrome By Proxy?

525446167Certain characteristics are common in a person with MSP, including:

Is a parent or caregiver, usually a mother
May be a health care professional
Is very friendly and cooperative with the health care providers
Appears quite concerned (some may seem overly concerned) about their child
May suffer from Munchausen syndrome (a related disorder in which a person repeatedly acts as if he or she has a physical or mental illness when he or she is not really sick)
Other possible warning signs of MSP include:

The child has a history of many hospitalizations, often with a strange set of symptoms.
Worsening of the child’s symptoms generally is reported by the mother and is not witnessed by the hospital staff.
The child’s reported condition and symptoms do not agree with the results of tests.
There may be more than one unusual illness or death of children in the family.
The child’s condition improves in the hospital, but symptoms recur when the child returns home.
Blood in lab samples may not match the blood of the child.
There may be signs of chemicals in the child’s blood, stool, or urine.

Diagnosing MSP is very difficult because of the dishonesty that is involved. Doctors must rule out any possible physical illness as the cause of the child’s symptoms before a diagnosis of MSP can be made.

If a physical cause of the symptoms is not found, a thorough review of the child’s medical history, as well as a review of the family history and the mother’s medical history (many have Munchausen syndrome themselves) may provide clues to suggest MSP. Remember, it is the adult, not the child, who is diagnosed with MSP.

How Is Munchausen Syndrome By Proxy Treated?

The first concern in MSP is to ensure the safety and protection of any real or potential victims. This may require that the child be placed in the care of another. In fact, managing a case involving MSP often requires a team that includes a social worker, foster care organizations, and law enforcement, as well as doctors.

Successful treatment of people with MSP is difficult because those with the disorder often deny there is a problem. In addition, treatment success is dependent on the person telling the truth, and people with MSP tend to be such accomplished liars that they begin to have trouble telling fact from fiction.

Excerpt – The love and care of a mother – Sharp Objects, Gillian Flynn

Now she was going to tend to me, and I was too weak and desperate to ward her off. I began crying again, unable to stop.
“I feel sick, Momma.”
“I know, baby.”
She stripped the sheet off me, flung it down past my toes in one efficient move, and when I instinctively put my hands across myself, she took them and placed them firmly to my side.
“I have to see what’s wrong, Camille.”
She tilted my jaw from side to side and pulled my lower lip down, like she was inspecting a horse. She raised each of my arms slowly and peered into my armpits, jamming fingers into the hollows, then rubbed my throat to feel for swollen glands. I remembered the drill. She put a hand between my legs, quickly, professionally. It was the best way to feel a temperature, she always said. Then she softly, lightly drew her cool fingers down my legs, and jabbed her thumb directly into the open wound of my smashed ankle. Bright green splashes exploded in front of my eyes, and I automatically tucked my legs beneath me, turned on my side. She used the moment to poke at my head until she hit the smashed-fruit spot on its crown.
“Just another little bit, Camille, and we’ll be all over.” She wet her tissues with alcohol and scrubbed at my ankle until I couldn’t see anything for my tears and snot. Then she wrapped it tight with gauze that she cut with tiny clippers from her cosmetic bag. The wound began bleeding through immediately so the wrapping soon looked like the flag of Japan: pure white with a defiant red circle. Next she tilted my head down with one hand and I felt an urgent tugging at my hair. She was cutting it off around the wound. I began to pull away.
“Don’t you dare, Camille. I’ll cut you. Lie back down and be a good girl.”
She pressed a cool hand on my cheek, holding my head in place against the pillow, and snip snip snip, sawed through a swath of my hair until I felt a release. An eerie exposure to air that my scalp was unused to. I reached back and felt a prickly patch the size of a half dollar on my head. My mother quickly pulled my hand away, tucked it against my side, and began rubbing began sifting through various pillboxes and tubes, finding a square of folded tissue from the bottom, wadded and slightly stained. From its center she produced an electric blue pill.
“One second, sweetheart.”
I could hear her hit the steps urgently, and knew she was heading down to the kitchen. Then those same quick steps back into my room. She had a glass of milk in her hand.
“Here, Camille, drink this with it.”
“What is it ?”
“Medicine. It will prevent infection and clear up any bacteria you got from that food.”
“What is it?” I asked again. My mother’s chest turned a blotchy pink, and her smile began flickering like a candle in a draft. On, off, on, off in the space of a second.
“Camille, I’m your mother, and you’re in my house.”
Glassy pink eyes. I turned away from her and hit another streak of panic. Something bad. Something I’d done.
“Camille. Open.” Soothing voice, coaxing. Nurse began throbbing near my left armpit. I remember being a kid, rejecting all those tablets and medicines, and losing her by doing so.
She reminded me of Amma and her Ecstasy, wheedling, needing me to take what she was offering. To refuse has so many more consequences than submitting. My skin was on fire from where she’d cleaned me, and it felt like that satisfying heat after a cut. I thought of Amma and how content she’d seemed, wrapped in my mother’s arms, fragile and sweaty. I turned back over, let my mother put the pill on my tongue.

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