Libow, Schreier, & Munchausen by Proxy: Part 14 – A Clinical Fable

In this series of blog posts, I relate the work of Drs. Libow & Schreier, two researchers who published extensively in the scientific literature on Munchausen Syndrome by Proxy (MSbP). Previous blog posts focused on a critique of their work by Dr. Conway Rand, who specifically pointed out their inappropriate use of whimsical language. In this blog post, I describe that they later meet this same criticism as expressed in the literature through a letter to the editor by another scientist, Dr. Carek.

Unicorn with castle

MSbP: A “Clinical Fable” for Our Times

Yes, they really named the article that. They really called the torture that I survived a “clinical fable”.

I wonder what they call would call the recent spate of mass shootings in the United States – a “sociological fairy tale”?

I could not get this article, so I don’t actually know what it’s about. I assume it is similar to the “pediatric challenge” article I discuss in my last post, which is basically an advertisement for their book about MSbP with another unfortunate name, “Hurting for Love”.

Oddly, what is actually way more interesting than their article is a letter to the editor written by Dr. Donald J. Carek at the Medical University of South Carolina about their article.

Dr. Carek’s Take on the “Fable”

Carek starts his letter with a very poetic criticism of the use of Libow & Schreier’s language around MSbP. He bemoans that MSbP is named after Baron Munchausen, a historic storyteller, because that fact causes it to have this fairy tale quality.

He accuses Libow & Schreier of adding “but another layer of mystery and intrigue” to this disorder by using the “clinical fable” title in their work, and points out that their whimsy is actually standing in the way of getting to the bottom of a serious public health and clinical problem. He quotes their actual words as he demonstrates how they characterize the mother as some sort of victim. Then he says:

The sobering finding that 75% of the morbidity in published cases of Munchausen by proxy takes place at the hands of doctors does not alert them to what might be amiss with the involved doctors but directs them back to those imposter mothers who malignantly thwart the doctors’ healing effort.

In other words, Dr. Carek points out that the healthcare system is a necessary collaborator in MSbP abuse, and Libow & Schreier’s bullshit rhetoric is not helping these matters.

A shot in the arm

Given that Dr. Carek is an MD, and likely a pediatrician or a primary care physician who actually sees children outside of psychiatric or psychological setting, he probably takes this very personally. MSbP perpetrators have probably tried to play him and his staff. I believe from his letter that he is frustrated by the lack of insight and lack of evidence-based guidance that has been produced by the Libow & Schreier publication factory – guidance and evidence he actually needs to do his work as a doctor.

He ends with a final paragraph that is just scathing, in my opinion, and I am cheering from the sidelines. First, he calls them out as drama queens…

Frankly, the staunch proponents of Munchausen by proxy syndrome not only tend toward melodrama but also tend to ignore probable contributions to their syndrome by health providers themselves.

… then points out that some of this is the fault of psychologists and psychiatrists (Ahem! Libow & Schreier!) because they don’t notice the psychological cues of the perpetrator …

That is, how about the dogged, but often naive, pursuit of physiological explanations without early attention to psychological cues even though they might be glaring?

He goes on to suggest that they might stop farting around and do something useful, like helping doctors develop better clinical skills so they can identify MSbP perpetrators and intervene. He implies that the job of psychologists and psychiatrists like Libow & Schreier is not to tell fables and fairy tales, but instead to help clinicians who work in primary care understand how to identify and work with MSbP patients like these, so that the physician catches on early and does not allow him or herself to be pulled into being a provider participant in the MSbP abuse.

Ouch! What did Libow & Schreier Think?

Food fights in the scientific literature are always interesting. I’ve been in one myself, but it was mostly friendly fire, which are the best kind. Dr. Carek’s letter was definitely NOT friendly fire.

Dr. Carek’s letter was a succinct four paragraphs. The journal printed a response letter from Libow & Schreier which was about twice as long. I will cover it in my next post.

Are you a published scientist?

If so, what have you published? Has anyone ever written a letter to the editor about it? Share your comments on our blog!

Image of unicorn by Merio. Picture of vaccination by dfuhlert.


One thought on “Libow, Schreier, & Munchausen by Proxy: Part 14 – A Clinical Fable

  1. I feel that the thinking has advanced since this book was written, more abuse victim centered. I think you need to really survey the current literature, to find out where the cutting edge is at today.



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