Libow, Schreier, & Munchausen by Proxy: Part 7 – Bias and Perversion

In my last post, I focus on the first work of Drs. Judith Libow and Herbert Schreier, which materially began the substantive discourse in the scientific literature about Munchausen Syndrome by Proxy (MSbP). Here, I continue to describe more their early work together.

Selection and Diagnostic Bias

In my last post, I identified Libow & Schreier’s earliest work, “Three forms of factitious illness in children: when is it Munchausen Syndrome by Proxy?” which was published in 1986 in the American Journal of Orthopsychiatry.

The main contribution of this “orthopsychiatry” paper was to bring awareness to MSbP abuse. Although the researchers try to categorize the few perpetrators they met as either “Active Inducers” or “Doctor Addicts”, subsequent literature will show that there is significant overlap between the two, and that many of the “Doctor Addicts” are also secretly “Active Inducers” and vice versa.

Although I couldn’t get the full article, as an epidemiologist, I can assure you that the idea of setting up a subclassification system for MSbP perpetrators based upon a small series of cases from a particular clinic as a Bad Idea™. In epidemiology, this mistake is called a combination of selection bias and diagnostic bias. It is a mistake more commonly made by clinicians than public health people.

These researchers in their landmark article make these two mistakes and come up with a two-pronged classification system for perpetrators. Luckily, this ill-informed system was never used.

The “Perversion” of Mothering

Neither Libow nor Schreier published another scientific article on MSbP until 1992 – six years after their first article. I do not have any insight into why this might have occurred.

In 1992, Dr. Schreier single-authored an article with the title, “The perversion of mothering: Munchausen Syndrome by Proxy”.

I am particularly offended by this title, because it implies the sexual abuse done by some MSbP mothers to their victims by using “perversion” in the title, but actually contradicts the prospects of sexual abuse by the perpetrator in the article. In Dr. Schreier’s article, which the Proxy Project was able to obtain in full text, he defends the use of the word “perversion” as non-sexual:

“The mother becomes a “perfect” mother in a perverse, fantasized relationship with a symbolically powerful physician, in which the harm that she inflicts on her infant is but a by-product of the needs of that relationship. Perversion here does not refer to particular sexual practices, but rather to a nonpsychotic mode of mental function in which the distinction between reality and fantasy is blurred by someone who has difficulty accepting reality despite unpleasant affects and a poorly developed capacity for feeling guilt.”

Are you sure, Dr. Schreier?

With all due respect, Dr. Schreier, my mother was indeed perverse, and attacked me with “particular sexual practices” that are considered pathological and had been published in 1989, several years before you published this article. Worse, these “particular sexual practices” are ONLY seen in MSbP, and are essentially diagnostic of MSbP. As a result, I have had severe vaginismus my entire life. My life was definitely affected by the real-life impacts of this “perverse” mothering.

Shouldn’t you have concentrated on the frank effects of perversion, such as the MSbP-related sexual abuse I and others experienced, rather than your own heavy philosophical soliloquys as comment on the vastness of the human mind? Couldn’t your pontificating on the intricacies of the human condition and cultural concepts of “mothering” have been reserved for psychological conferences, while you focused on public health and saving children from death and torture in your day-to-day work?

I’m just saying.

The Science Evolves

In my next blog post, I begin to talk about the “hey day” of Libow & Schreier’s joint research, which took place in the early 1990s. After that, they seemed to go in separate directions – Libow concentrating more on clinical applications in her writing, while Schreier focused more on the side of healthcare system issues surrounding MSbP. In my mind, this split in direction makes sense, given their backgrounds. I talk about these separate directions also in subsequent blog posts.

Want to know more about the different “biases” in epidemiology?

Here is a laundry list of the biases, the veritable enemy of epidemiologists!

Photograph of geese by Monika Wahi. Photograph of mother with child by Vania Raposo on Pixabay.