In this series of posts, I review the scientific work on the topic of Munchausen Syndrome by Proxy (MSbP) by Drs. Judith Libow and Herbert Schreier, who wrote many articles on the topic, including one that evoked an incendiary response in the literature by another scientist, Dr. Carek.
Round 3 – The Physician is the Melodrama, not Libow & Schreier
In Round 3, Libow & Schreier redirect the use of Dr. Carek’s word “melodrama” away from themselves, and back toward the perpetrator and – you guessed it – the physician:
The melodrama, we fear, is to be found in the mothers’ compulsive playing out of a dangerous script on the bodies of their children, to satisfy their complex needs vis-to-vis the physician.
In a backwards way, they accuse the physician (perhaps represented by Dr. Carek?) of being played by the mom, and that’s what the melodrama is – not their discussions of “fables” and “pediatric challenges” and “ultimate fates” and “hurting for love”.
…Oh, did I mention their book “Hurting for Love” again? That’s because that’s what comes next in their response – a book plug!
But Dr. Carek need only read the chapter on “The Physician and the Imposter” in Hurting for Love (Schreier and Libow, 1993b), which elaborates on the very points he finds lacking.
Notice that everything they publish in the immediate years following their book has a very obvious book plug in it. They don’t just reference it, they actually make sure to say the full title.
Round 4 – We Agree, Dr. Carek – Blame the Physician
In another backwards way, they go on to blame the physician. Hang on! This logic is very convoluted. For your help, I highlight certain words so you can see them more clearly:
It is this intense inward focus by the physician, the self-blame for whatever is going wrong clinically in the case (the kind of doubt doctors and clinicians too frequently do not share with their colleagues), that is transformed into self-doubts. These self-doubts in turn cause otherwise competent doctors to miss or misinterpret obvious clues concerning MBPS behavior. Moreover, there may well be an element of to the self-blame and self-doubt if the physician finds himself fleeing from the demands and needs of an “engulfing” MBPS mother through actual avoidance or the desire to “get rid of” the problem (Schreier and Libow, 1993b, p. 130).
We discuss aspects of physician personality that contribute to their susceptibility to lying and examine aspects of medical training that overemphasize the need for certitude at the expense of greater sensitivity to ambiguity and the broader picture, as well as the paucity of training in interpersonal issues in medicine.
So we find ourselves in agreement with Dr. Carek’s plea for developing greater clinical skills and psychological mindedness in our health care providers.
What? Are they really accusing other clinicians of “getting rid of the problem” when they themselves allowed Kevin to go back to his mother and suffer his “ultimate fate”? Are they really accusing physicians of missing things that they themselves don’t seem to be able to see? And are they accusing Dr. Carek of being one of them, in their own crazy way?
After the Food Fight
After this heated exchange in the literature, Dr. Carek goes on to keep being Dr. Carek, and teaching early identification of MSbP cases as part of his work.
But Drs. Libow and Schreier take slightly different paths. In my next post, I’ll talk about Dr. Schreier’s next directions in MSbP research, and after that, I’ll make a post about Dr. Libow’s next directions.
What Journal Was this Food Fight in?
The Journal of the American Academy of Child and Adolescent Psychiatry. Curious to know what else it publishes? Read about it here.