On Turning Against One of the Pillars of Humanity – Our Mothers.
That afternoon we watched the video by M.A.M.A was the first time I heard of the condition called Munchausen Syndrome by Proxy (MSBP). It was shown in the video how the condition was first described and diagnosed. MSBP was named by Dr. Roy Meadow in 1977 in a journal called Lancet, and is a variant of Munchausen Syndrome, which was named by Sir Richard Asher in 1951 in the British Medical Journal. The name for the condition was taken from the name of Baron Karl Friedrich Hieronymus Freiherr von Munchhausen who lived in the 1700s who purportedly told many fantastic and impossible adventures about himself, which Rudolf Raspe later published as The Surprising Adventures of Baron Munchhausen.
When the condition was described in the video, I was starting to wonder how could have the so-called “authorities” in diagnosing the condition arrived at their conclusions. The cases presented in the documentary video bothered me personally. While it might be true that such condition is really possible I was not convinced with how the mothers in the video were diagnosed. I was eagerly waiting for the criteria with which the “authorities” based their diagnosis. As the video progressed, the experts were not able to present the DSM criteria I was waiting for but the symptoms associated with the condition. When I looked it up in the internet, I realized why there were no established criteria for the disorder. I found out that it is categorized in DSM IV-TR under factitious disorder not otherwise specified. In the absence of a clear-cut criteria, I became skeptic at how they arrived with their diagnosis. This, I learned, is a disorder wherein the caregiver, and in most cases, the mother induces symptoms in her child or children in order for her to gain social approval and admiration for being a responsible and selfless mother thus, abusing her own child in the process of gaining something of pleasurable feeling for herself. But something bothered me. The cases presented in the video could not qualify as MSBP. Dr. Asher himself said that in the diagnosis of the disorder it should first be considered whether the child has a real medical condition as assessed by a medical doctor. With the presence of any medical condition, the possibility of MSBP is cancelled out. But the cases presented in the film tell a different story. The victims in the documentary had been diagnosed with real medical conditions prior to the diagnosis of their mother’s conditions. One of the mothers in that video, Misty Jones allegedly injected her baby with insulin where in fact she had been advised by a nurse in the hospital where she gave birth that her baby should be transferred to a pediatric medical facility because of a medical condition related to insulin regulation. Julie Patrick, another mother diagnosed with the condition was allegedly causing her baby’s condition. Eventually, it became evident in the video that baby Philip Patrick’s improved condition occurred when he was under the care of his mother and when the authorities removed him from her custody his condition deteriorated. Worst, the doctor (the one who took over after his removal from his mother’s custody) of baby Philip gave him a neurolyptic called metoclopromide with the intention of eliminating the symptoms induced by his mother. The drug, though not yet been proven in the court, might have caused baby Philip’s death. I could not help but cry silently in my seat. These neurolyptics according to experts cause seizure-like reactions and a bending of the body and sticking out of the tongue, which indicates pain and discomfort. Baby Philip was showing all these behavior after the alleged administration of the drug. His belly swelled as a side effect of the said drug and one can only guess how much pain the pressure of the swollen internal organs against his thin and delicate skin is causing him!
It all started with a wrong diagnosis brought about by inadequate research and understanding of the condition. It is intriguing enough to know that the basis of the experts’ contentions is taken from a clandestine study in the basement of Bronson Hospital. A hidden camera was installed in one of the walls of the hospital room where mothers are left alone with their babies. But there are a lot of issues surrounding the study. First and foremost, the method Dr. Roy Meadow used in establishing his evidences was unethical. He claimed that he tried to intentionally tie his grandson’s leg to suspend the flow of blood so as to find out whether the hematoma in his patient was induced if it would look like that of his grandson’s. In another situation, he argued that the mother of a child with high concentration of salt in the blood induced the condition. In substantiating his argument he boldly declared that he tried to let the child swallow some salt and he could only do so much since the child could only take a certain amount and therefore the high content of salt in the child’s blood might have been induced. In uttering those words, Dr. Meadow himself indirectly accused himself that he had committed an act against his subjects – his grandson and the child who was an alleged victim of a mother with MSBP. Second, the researcher violated a basic right of his subject to be informed that she is to be included in a study so she might have a choice whether or not to join the study. Granting without accepting the possibility that the quality of the research outcome will be jeopardized with the subjects’ knowledge of the study, there are still several issues, which remain to be considered. Thus the third issue, the number of cameras in the room was not enough to give a full view of what the subjects are doing. One video showed that a mother seemingly choked her baby intentionally. But at second look the action may also be perceived as the mother trying to lift her baby up after choking in bed. Had there been more than one camera strategically placed all over the room, which would yield all possible angles and viewpoints then the assessment of the behavior would have been more precise. Another concern of mine is the fact that there was not enough empirical evidence that would strongly lay the foundation of the said condition. The fact that there is no specific set of DSM criteria for MSBP tells us that the said disorder is still understudied. Yet many mothers are already diagnosed and labeled with MSBP in the absence of these criteria! Another issue lies on what the state is doing for the victims. After being removed from mothers with alleged MSBP, children are sheltered in centers wherein, according to one of the children there, living conditions are not as pleasant as compared with that of their own homes. One child even showed a picture of her and her brother while they were with their mother and compared it to their picture in the shelter, they had become thinner and unhappy.
To sum it up, my greatest concern is on how the diagnosis and interventions are done. In the interviews with the authorities in the diagnosis of MSBP against Julie Patrick, it was evident that they were more concerned with being right in their claims than being right with their diagnosis. The case of baby Philip revealed that his internist had diagnosed a medical condition with which he suggested hospitalization. I would sound biased but I was really raged at how arrogant were those so-called “experts” at defending their misdiagnosis even when confronted with medical records showing that baby Philip had a serious medical condition. Furthermore, the intervention that the state was implementing is not at all helpful. Separating children from a significant other against their will and without pre-counseling prior to the removal of custody from the mother may not be the best option. They can instead give a mandatory order for the mothers to engage into psychotherapy or any form of behavioral modification program while allowing their children to live with their families and assigning a social worker to check on them on frequent but random visits. They can also conduct a counseling program prior to the child/children’s separation from their mother.
Moreover, mothers could not care less when it comes to their children’s safety and security. It pains me to know that their greatest strength -- to care, to nurture -- had been used against them by people whose intentions might not be as bad as the advocates of M.A.M.A would think but are inconsiderate of gender roles and less concerned with a scientific approach to diagnosis. With this video, I have come to appreciate the necessity of having a standard manual like the DSM and further appreciated a transdisciplinary approach to research, which can yield better understanding of the human experience. Together with this is the realization that a researcher has the responsibility to exhaust all possible empirical evidence upholding ethical standards to support his hypothesis before he should attempt to lobby with the government and other groups of stakeholders for policy-making. Only a few of these policy-makers are genuinely motivated to help and better the condition of stakeholders. Most of them would simply take the opportunity of attracting funds, and gaining fame, popularity and support from the public. Moreover, a researcher must be professionally humble enough to accept that he might be wrong if he had drained all possible source of empirical evidence yet could not establish a scientifically logical reasoning that could support his hypothesis. A researcher’s foremost concern should be the welfare of society and the last would be his reputation. But this though is easier said than done. At least then a researcher must always be conscious of his social responsibility. In the case of the proponents of the MSBP, they should have provided practitioners with a much more scientific approach to diagnosing the condition and a strict implementation of the criteria if they intend to help than to exacerbate harm.
