In this long series of posts, I catalogue the writings on Munchausen Syndrome by Proxy (MSbP) by clinician-researchers Drs. Judith Libow and Herbert Schreier. I cover their early work, which includes a book called “Hurting for Love”, and I also cover a food fight they have in the literature with a scientist who attacks some of their points in an article they write.
In my last few posts, I cover a more recent food fight they get in with Dr. John Stirling of the Committee on Child Abuse and Neglect who writes “Beyond Munchausen Syndrome by Proxy: Identification and Treatment of Child Abuse in a Medical Setting”. Libow, Schreier and their colleagues respond with two points about Dr. Stirling’s article. I cover the first point and Dr. Stirling’s counterpoint in my last post, and in this post, I cover the second point.
Point 2: Only a Physician can Diagnose MSbP?
Libow, Schrier, and their co-authors have a problem with the idea “that only a physician can diagnose illness falsification”.
At first thought, they might have a point for two reasons.
- They point out that anyone who witnesses abuse needs to report it, so that doesn’t need a physician.
- And, from my own experience, a lot of psychologists (like Dr. Libow) diagnose depression and other mental health problems, and that doesn’t need a physician.
So why would you need a physician for the actual diagnosis of MSbP? Is Dr. Stirling saying that just because he happens to be a physician?
But these are my reasons for thinking Dr. Libow et al. have a point. Their reasons have to do with more assault on the judgment of the physician:
Why a Physician Might Not be the Best Person to Diagnose MSbP
The basic counterpoint that Libow et al. make is not that others certainly are capable of making a diagnosis. Their counterpoint is actually that the physician (specifically the pediatrician) is getting played by the perpetrator, so the physician is the least correct person to try to make a diagnosis! I have put my own emphasis in their quote so you see how they seem to indict Stirling for suggesting such a thing:
Unlike other forms of child abuse, the unsuspecting pediatrician is frequently a central figure in perpetuating MBP abuse through unnecessary or harmful treatment and in defending the seemingly dedicated and loving parent. Therefore, not only is it important to have others involved who may notice and call attention to this process that often goes on for exceptionally long periods of time, potentially placing the child at grave risk, but it is also important to appreciate the role of all mandated reporters. The key behavior of MBP abusers is a pattern of intentional lying to cause others to treat the child as more ill or impaired than warranted. Professionals other than the primary pediatrician may have more experience detecting MBP, more exposure to the family in a wider range of contexts, or a more objective perspective by virtue of not being the target of the caregiver’s manipulations. There is no advantage in placing the abuse-detection responsibility solely on the shoulders of the person who potentially is being most aggressively misled and manipulated.
So, basically, the doctor is the dumbest one in the group – getting manipulated by the perpetrator into hurting the child – so that person is the least qualified to diagnose MSbP. And the most qualified, I guess, are Libow & Schreier.
Dr. Stirling’s Concise Reply
What they didn’t notice is that Dr. Stirling didn’t mean the treating pediatrician, he meant a medical doctor in general. He points out:
Determining whether the medical care given was harmful or potentially harmful is, ultimately, a medical decision and requires the judgment of a medical professional.
I would have to agree with that one. And, also, I agree with another thing he says in response to them, that I will let stand on its own (with my emphasis):
We are concerned that intervention may focus on the caregiver’s pathology, rather than the harm occurring to the child, and emphasize that if a child is being medically abused, the abuse must first be stopped.
What About Survivors?
Notice that no one seems to talk about what happens to survivors. Do these kids survive and grow up, or just get killed by another health system? If they survive, aren’t they totally messed up as adults? Doesn’t that seem logical?
As much as I object to Dr. Libow’s tone, I’m grateful she wrote the only case series on adult survivors of MSbP, which I will cover in my next post.
Are you a healthcare clinician who has experience with an MSbP patient?
Have you had a patient who is either a perpetrator or a survivor? Let us know how you handled it. What is your advice? Post a comment on our blog!