Libow, Schreier, & Munchausen by Proxy: Part 15 – Reflection on Dr. Carek

In this series of posts, I review the work of clinician-scientists Libow & Schreier, who studied Munchausen Syndrome by Proxy (MSbP), beginning with an initial article and book, followed by several articles and the inevitable critiques.

In my last post, a clinician named Dr. Carek, in a letter to the editors of Journal of the American Academy of Child and Adolescent Psychiatry, questions the “melodramatic” approach taken by Libow & Schreier in one of their articles. He suggests that they instead try to guide clinicians as to improving their clinical skills such that they catch that they are being duped into MSbP behavior. I think he is smart to say this, doing that would not only protect the provider from inadvertently participating in the abuse, but also, to offer an opportunity for early intervention.

Question mark banner

Are Libow & Schreier Perpetrators Themselves?

That, at first, sounds like a mean question. After all, they treated all these kids. But then – isn’t that what MSbP is? Treatment that’s not needed? What if they treated kids in ways that they should not have been treated, and therefore, the kids got sick and died? Wouldn’t that fit the definition, at least in the broadest sense, of a participating provider?

In one of their many case studies which I discuss in a previous blog post, they say they do not know the “ultimate fate” of Kevin, an infant being poisoned by his mother with anticonvulsants. They considered the case “mild” and called it psychological abuse, although toxicologists call it poisoning. If Kevin died, are they at all culpable, since they knew what was going on and didn’t stop it?

I don’t think Dr. Carek was really trying to imply that Libow & Schreier were themselves perpetrators on purpose. And if Libow & Schreier were indeed perpetrators, I don’t think they realized it. Like I’ve said before, I think their intentions were benevolent, and I think Dr. Carek would agree. But I do I think he was fairly calling them out by trying to get them to check their language, and I also think it was fair to inspire them to produce some useful literature that could guide him and his colleagues in primary care.

Regardless of how Dr. Carek’s short letter was meant to be taken by these two, their response, which is twice as long as Dr. Carek’s letter, could be interpreted to be, well, defensive.

Man covered in food

Next up – Food Fight Play by Play

In one corner, we have Drs. Libow & Schreier, well-published and successful mental health practitioners, who have just been wounded by a scathing but factual letter to the editor about a recent article.

In the other corner, we have Dr. Carek, a primary care doctor who wrote the incendiary letter, questioning some of the authors’ scientific approaches and conclusions in their article.

In my next posts, I will describe Libow & Schreier’s response – or should I say, counterattack – to Dr. Carek’s letter.

What do you think about Dr. Carek’s criticism?

Do you think it is fair? Or is it biased? Tell us what you think in a comment on our blog.

Question mark image by Geralt. Image of man covered in food by FAB Awards.

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