Munchausen Syndrome by Proxy: A Narrative Approach to Explanation

Abstract

Munchausen Syndrome by Proxy (MSBP) is generally categorized as an unusual variant of child abuse, and one where the mother is the usual perpetrator. Explanations of this extraordinary condition focus on characteristic features of the mother and the family. This article attempts to complement these findings with a narrative approach, viewing MSBP as the outcome of a particular human story. A detailed case history is presented and linked to clinical and research findings in an attempt to track the evolution of the behaviour we categorize as MSBP. This view suggests that MSBP is best seen as a process, and one in which the key relationship is between the mother and the child's doctor. Such a view has important implications for the detection and management of this increasingly recognized problem.

Munchausen Syndrome by Proxy: Implications for Professional Practice in Relation to Children's Education

“…Loader and Kelly (1996) describe the case of a boy who, from the age of three, had undergone substantial medical investigation for a history of fits. He had been placed in a special school, to which he went strapped in a wheelchair and wearing a crash helmet.…”

“…Some studies (Adshead & Blugrass, 2005;Gray & Bentovim, 1996) suggest that a mother's experience of unresolved bereavement may be of significance. Loader and Kelly (1996) seek to incorporate clinical and research findings into an explanatory narrative of one case. Any explanatory model needs to account for families where only one of the children is subjected to fabricated or induced illness.…”

Factitious Disorder by Proxy and the Abuse of a Child with Autism

“…Other carers have been involved and health workers have been implicated in several incidents (eg Repper, 1995), including apparently dedicated nurses (Spink, 1994). Loader and Kelly (1996) present a compelling case study narrative approach, indicating that a key antecedent is the relationship between the mother and the child's doctors. In general, however, it is the mother who is the perpetrator in the majority of cases and the father is seldom involved (Pearl, 1995).…”

The child's experience of Munchhausen syndrome by proxy

“…These papers emphasize the abusing parents' own deprivation in childhood and their need for care (Loader and Kelly, 1996;Schreier, 1992). What is less clear is the abusing parent's view of the child, hidden behind the facade of concern; that is, if there is a capacity to see the child as a separate person.…”