Libow, Schreier, & Munchausen by Proxy: Part 21 – Food Fight #2

In this series, I examine the body of literature developed by Munchausen Syndrome by Proxy (MSbP) researchers Drs. Judith Libow and Herbert Schreier. In my earlier posts, I discussed their prolific work on the topic, and included a discussion of a food fight they got in with someone who wrote a letter to the editor about their article.

In my last post, I introduce a more recent food fight they get into, which actually starts with the publication of an article about MSbP which is not by Libow & Schreier called, “Beyond Munchausen Syndrome by Proxy: Identification and Treatment of Child Abuse in a Medical Setting” by Dr. John Stirling of the Committee on Child Abuse and Neglect.

Drs. Libow & Schreier (with co-authors) respond with a letter addressing two points. I will cover the first point here, and Dr. Stirling’s response to that point.

Point 1: The Perpetrator’s Motivation not Unimportant

Libow & Schreier (et al.) say that it makes no sense that Stirling says in one place that whatever is “motivating” the parent toward the abuse is not important, and then later, he contradicts himself by saying that the treatment options depend on the “motivation” of the parent, so obviously, the “motivation” must be important.

Next, they point out that “motivation” is in the APSAC Taskforce on MSbP position statement (that Libow & Schreier wrote along with others), suggesting that this is even more evidence that Stirling’s wrong for saying it is unimportant. They put it in such a snotty and passive-aggressive way:

Interested readers should refer to this statement to clarify this seemingly confusing paradox.

In other words, Stirling is confused, and you have to read Libow & Schreier to get the right scoop.

La Tomati

Stirling’s Response to Point 1

First, Stirling repeats the purpose of writing the report was:

  1. to remind pediatricians that medical signs and symptoms can be fabricated or inaccurately reported and
  2. to encourage pediatricians to accept responsibility for making the diagnosis of child abuse that takes place in a medical setting.

He points out that the perpetrator’s “motivation” may be important in deciding how to respond to the perpetrator, but that it’s not important to the diagnosis of severe child abuse and getting the child away and into safety. Even if the parent is accidentally poisoning a child, you still need to get the kid away. He reminds the letter writers:

…it remains most important that whenever a caretaker’s actions harm a child, steps must be taken to protect the child regardless of whether the harm was intended.

Which I think is pretty obvious…

…So What did Libow et al. Actually Mean?

That if we can’t figure out why the parent is harming the child, we should leave the child with the parent? That’s certainly what Libow & Schreier did in an earlier post when they report on a family where a boy they call Kevin was “lost to follow-up” with a mom who was poisoning him with anticonvulsants.

It’s hard to believe they actually mean that – that you shouldn’t do anything until you understand the motivation of the dangerous parent. What if the kid is killed by then? But if that’s not what they mean, it’s equally hard for me to come up with an alternative interpretation of what they meant in their point.

Read my next blog post to see how Stirling responds to Libow & Schreier (et al.)’s second point about his article.

Photo of La Tomatina by flydime. Photo of a man writing by Unsplash.

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