MEDICAL MATTERS:Munchausen syndrome is difficult to diagnose
HOW COULD a mother pretend her son was terminally ill for six years, confine him to a wheelchair and force unnecessary treatments and investigations on him? Parents will be horrified and healthcare professionals mystified at the behaviour of 35-year-old Lisa Hayden-Johnson, a Devon woman jailed for three years last week for the abuse of her son.
She received a wide range of benefits by pretending her child had cystic fibrosis, diabetes and cerebral palsy, and even claimed a free holiday to the Canary Islands from a charity. She was caught out when her son missed a test for his “diabetes”, which she had fabricated by adding sugar to samples of his urine. Sentencing her, the judge described Hayden-Johnson’s behaviour as “cruel, manipulative, perverse, disordered and pitiful”.
Her defence had argued she suffered from a personality disorder similar to Munchausen by Proxy syndrome (MBP). However, the prosecution successfully argued she was primarily motivated by monetary gain, something not usually associated with the illness.
Medical diagnoses are often given eponymous names, usually those of the expert who discovered them. But others have more colourful monikers, such as Munchausen syndrome or its derivative, Munchausen by Proxy.
Dr Richard Asher’s classic description of Munchausen syndrome was published in the Lancet in 1951. The syndrome is an extreme form of facititious disorder, in which a person fabricates physical signs and symptoms and/or psychiatric ones with no apparent motivation other than to adopt the role of being a patient. To make the diagnosis, Asher said the following features must be present: simulated illness, pathological lying and wandering from place to place.
Asher’s nomenclature is based on the true story of Baron von Munchausen, an 18th-century German cavalry captain who was renowned for fabulous anecdotes about his life and adventures.
Munchausen by Proxy is a related condition in which a care-giver fabricates signs and symptoms in another person – usually children in their charge. They often report breathing problems in toddlers, and diarrhoea and vomiting in older children. Patients diagnosed with this condition often have an underlying personality disorder. Now called factitious disorder by proxy it occurs when a person manufactures an illness within someone close to them in order to gain attention or emotional support.
Last July, hospital officials and social workers in Jerusalem suspected abuse when a woman brought her three-year-old son, who weighed only 7kg, for treatment. The mother of five was arrested after hospital cameras caught her disconnecting vital tubes attached to her son. She was diagnosed as suffering from Munchausen by Proxy. However, extreme elements in the ultra-Orthodox community reacted with anger to the woman’s arrest, accusing the authorities of pursuing a “blood libel” against their community.
MBP is a difficult diagnosis. After all, doctors are taught to listen carefully to mothers’ concerns, and in younger children are completely reliant on a history given by parents or guardians. Dr Marc Feldman, an authority on the disease in the US, notes that it takes a huge shift in attitude for a doctor to suspect the story is untrue. Gradually, it may dawn on staff that no treatment works and that the parent wants a constant stream of ever more invasive tests for the child.
Feldman encouraged Julie Gregory, an MBP victim, to tell her story in a book, Sickened. Interestingly, she considers MBP to be a form of abuse and not a psychological illness. Her mother starved her so she would perform "better" in medical tests. And in a clever twist, her mother would fiercely threaten any wavering medic that if her daughter died she would sue him for "every cent you've got".
Meanwhile, Asher paraphrased Churchill when he somewhat unkindly said of patients with Munchausen syndrome: “Never in the history of medicine have so many annoyed so few.”
mhouston@irishtimes.com