Today, when child protection agencies want to train case workers, they turn to Lasher. With her slide show, videos, and experiential exercises, she's taught thousands of case workers in dozens of states her investigative techniques and views on MBP. When a jurisdiction thinks it's dealing with a perpetrator, they recruit Lasher as expert witness. In a typical week, she fields dozens of e-mails and calls, and during any given month she's flying around the country, testifying in court.
"Because they rarely admit to their acts and deny any wrongdoing, they are generally incurable," Lasher says. "So I've never recommended reunification in a genuine MBP case."
Whether due to extreme stigma or the rarity of the phenomenon, few self-identified victims ever speak out. "They are very vulnerable to public attention since this kind of publicity is typical of the kind of victimization they experienced," explains Harvard psychologist Catherine Ayoub.
Those coming forward, moreover, don't necessarily have tales as neat or paradigmatic as the classic definition of the syndrome might suggest. Bree, now 29, says her mother withheld crucial antibiotics as an infant, causing her to remain perpetually sick. Her health stabilized during childhood, but then, at age 12, it all changed when her mother learned Bree had been named after her father's childhood crush.
From that point on, Bree says, she could taste the sickly sweet flavor of purple gum—it turned out to be the emetic ipecac—in food her mother prepared for her. After such meals Bree suffered uncontrollable vomiting and dehydration, eventually becoming so impaired that she often missed school and was confined to a wheelchair. "It was always worse in March, around Mom's birthday," Bree recalls.
She was almost 18 when doctors found toxic levels of the anti-seizure medicine Depakote in her blood, despite their explicit orders to stop that treatment. The police were called and Bree was carted off to a foster home. "At first I didn't believe it, and I wanted to get back to Mom." But a new, loving family and years of therapy have helped her recover and convinced her of the abuse. "I was never sick after I left Mom," Bree says. Bree's mother appeared to be punishing her for the perceived transgressions of her father, but she also basked in the attention that a sick child conferred on her, Bree says today.
Another survivor, Lauren—not her real name—is now 40. Her violent mother had long beaten her. Then she began giving ipecac and paregoric to Lauren and other children while baby-sitting, regularly causing them to throw up. "I knew what she was doing, and I was furious," says Lauren, "but she said she would kill me if I told." The medical abuse stopped a year later, when a pharmacist refused to refill the prescriptions. "Then the beatings increased," Lauren recalls. Now a clinical social worker, Lauren reflects: "My mother felt she had no family or support, though she did. No matter how much was done for her, it was never enough."
Lauren says that despite all her education and sophisticated understanding of abuse, she remained afraid to speak out until her mother died of a massive heart attack in 2002. "There is fear of not being believed and fear of retaliation by the abuser," she says. Both women now maintain limited contact with their families of origin.
False Allegations
Despite all the theories and prosecutions—despite reports of abuse by children now grown—Munchausen by proxy has never been embraced as a formal diagnosis by the American Psychiatric Association in its diagnostic bible, the DSM-IV. Not yet a proven entity, the syndrome is a theory waiting for research to validate it as real.
Even if Schreier's theories on motivation are eventually borne out in studies, the problem of false accusations will persist. In case after case, families with complex medical histories have been stripped of their children and left to fight for custody in court.
One such mother is Mannie Taimuty-Loomis, whose son, Jonah, had cerebral palsy and was mentally retarded and blind. He died of heart failure at age 3 in 2001. After his death, doctors suggested he'd suffered mitochondrial disease, in which the cell's energy factories malfunction, causing a wide array of ills. Moving on that hunch, they finally diagnosed the condition through a muscle biopsy performed on Jonah's older brother, Ezra, who, like their younger sister Symia, had been sick from birth.
Mannie and her husband, Ron, who was training for the ministry, founded the nonprofit Jonah & the Whale Foundation to help other parents of the chronically ill. They also brought Ezra and Symia to top medical experts, who agreed the children had mitochondrial disease and treated both aggressively. Despite that, they became so ill they too seemed headed toward certain death.
It was a resident at Pittsburgh's Mercy Hospital who blew the whistle in 2004. As the head of an organization for special-needs families, Mannie fit the typical MBP-parent profile, after all, and the resident didn't believe her children were truly sick. Child protective services took little Ezra and Symia, removing the intravenous lines that delivered their nutrients and drugs, stopping the treatment cold. Dramatically—in what could be interpreted as confirmation of MBP—the children (who did have mitochondrial disease) nonetheless began to improve. Yet it hadn't been Mannie who'd lobbied for all that medication, but some of the top doctors in the world.
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