Munchausen: Unusual Suspects

Call them the Munchausen mothers. A growing number of women stand accused of deliberately sickening their children for attention from doctors. In an era of patient advocacy and hard-charging moms, there's no end in sight to this hotly contested diagnosis.

By Pamela Weintraub, published on September 01, 2007 - last reviewed on November 15, 2007

Austin Savage was born the youngest of four in Sierra Vista, Arizona, in 2002. He fell ill with pneumonia at one week of age, and landed in a hospital incubator. After he came home, he cried inconsolably, threw up his food, and barely gained weight. "I'd raised three other healthy children," says Kelly Savage, his mother. "I knew something was wrong."

While her husband, Buddy, stayed back in Sierra Vista, Kelly and the kids left for Tucson, where a top-notch medical center could drill down. Soon they found the problem: a case of acid reflux so severe that doctors said Austin must be feeling pain equivalent to a heart attack. So began a marathon of surgery, feeding tubes and special formulas. "It was scary," Savage says.

Then Buddy got a job near a major hospital in Fort Worth, Texas, enabling the family to be together, at last. Little Austin arrived with a mountain of medical records. By then 9 months of age, "he had constant, watery diarrhea and weighed as much as a 3-month-old. You could see every bone in his body," Kelly Savage recalls.

Desperate, the Savages reached out to local doctors, eventually requesting that nutrients be delivered intravenously, despite damage to liver and kidneys that might result. "The doctors had no answers," says Kelly Savage, who worried that her baby might die. One doctor arranged for Austin to enter Fort Worth's famed Cook Children's Hospital in March 2004. Alone in the room with him, Kelly noticed an air bubble blocking his feeding tube, trapping gas in his stomach and preventing formula from getting through. Sensing her baby's pain, she sucked out an ounce of formula and the trapped air bubble beneath. "I planned to replace the ounce later," she states.

But she would never get the chance. Already suspect in the eyes of her new doctor, she'd been placed in a hospital room wired for surveillance, and now her accuser had "proof." Based on the video, the doctor charged, it was clear Kelly was stealing Austin's food, intentionally starving him because she craved the excitement of hospitals. Kelly Savage might have even killed Austin, all in pursuit of a bizarre form of child abuse called Munchausen by proxy (MBP), in which a parent—almost always a mother—exaggerates a child's symptoms or actually induces illness so she can swoop in to the rescue, thereby gaining attention and a special bond with the child's M.D.

That very day child protective services arrived to take Austin and his siblings into custody. In foster care, Austin refused to eat, stayed bloated, and had explosions of diarrhea. Finally the children, even Austin, were allowed to come home only if Kelly stayed away. With Austin's health at the precipice and her family ripped apart, she lived at a hotel and studied medical records, preparing for her day in court. "I swapped with my friends from church. I watched their children and they watched mine so my husband could go to work."

The Savage trial, in May 2004, lasted just two days. After expert witnesses combed through the medical records, dismantling the case against her, Kelly Savage was finally fully exonerated in January 2005. "It was a nightmare," she says. "We were too scared to take any of our children to the doctor until 2006."

A Controversial Syndrome

The very idea of MBP is difficult to grasp. Child abuse, of course, is a sad but well-known occurrence. That some mothers abuse children by poisoning or starving is beyond refute. But in Munchausen by proxy, hundreds of women a year in the U.S. alone are said to knowingly fabricate or induce illness in their children to garner a doctor's love. Whether the physician is male or female doesn't matter, says psychiatrist Herbert A. Schreier of Children's Hospital Oakland in California and co-author, with Judith Libow, of the influential book Hurting for Love. "These mothers are seeking a reparative relationship because they felt they weren't valued in their family of origin," Schreier states. "The mother becomes a 'perfect' mother in a perverse, fantasized relationship with a symbolically powerful physician." This motivation, he believes, is what differentiates MBP from ordinary medical abuse caused by anger, incompetence or neglect.

Given the abundance of accusations on the one hand and the outright strangeness of the syndrome on the other, MBP has become one of the most hotly contested psychiatric diagnoses in the country. On one side of the debate are psychiatrists, psychologists, and plenty of social service agencies who say these cases occur regularly. They route them out when children are absent from school, or where mothers frequently change doctors or move. "Most cases go unrecognized," says University of Alabama psychiatry professor Marc D. Feldman, author of Playing Sick, who's popularized MBP in the medical press. "Perpetrators have borderline personality disorders and maladaptive ways of handling stress," he contends. "They have a hazy sense of identity, and compensate by creating the persona of mother of the year."

On the other side of the argument are wrongly accused mothers and the experts who have analyzed their cases, fighting for them in court. "I have seen mothers accused of MBP simply because physicians disagreed about the medical management of their child," says Portland psychologist Loren Pankratz of Oregon Health & Science University. An authority on the psychology of deception and author of the book Patients Who Deceive, Pankratz calls MBP "vastly overdiagnosed."

"There's virtually no empirical evidence that it exists as a syndrome," states New Hampshire psychologist Eric G. Mart, who has deconstructed the theory in the book Munchausen's Syndrome by Proxy Reconsidered. "Controlled and blinded studies have never been done."