Libow, Schreier, & Munchausen by Proxy: Part 24 – A Surviving Epidemiologist’s Perspective

In my last 23 posts, I review over 15 works on Munchausen Syndrome by Proxy (MSbP) written by the psychologist-psychiatrist duo Drs. Judith Libow and Dr. Herbert Schreier. In this post, I will provide my opinion as to the take-home messages for an adult survivor of MSbP from their long literature.

What Good was Done by Their Articles?

From my perspective, here is how their line of research helps the Proxy Project and adult survivors of MSbP:

  1. They provide in-depth documentation of cases in a lot of their works, including a lot of background and quotes of what the perpetrator and family actually said. This forensic information is original data and extremely valuable when considering how to prevent this deadly abuse.
  2. They raised the issue in the literature and got people talking about it. Their book, “Hurting for Love”, did a lot to bring awareness to the issue. Since then, there are hundreds of case studies published that physicians identified as MSbP cases which are in the Proxy Project library. This likely would not have happened without all the scientific discourse on the subject initiated by these two researchers.


    Photo by geralt.

More Damage than Good

While I agree they accomplished a few good things, those things were largely negated by the damage they did. I will make a list of the damage:

  1. They set a precedent for sensationalism without public health. As Dr. Carek and Dr. Stirling pointed out, they focus on the perpetrator, not the victims, and they do not provide any practical advice on how to protect the victims.
  2. They set a precedent for clinicians not being held accountable for their role in the child abuse. Typically, when psychologists study serial killers, the criminals have already been convicted and are in jail. Here, these clinicians study serial killers in the act of killing, and then lose track of them. This seems to me like “aiding and abetting” child abuse, but to my knowledge, no healthcare providers have been held accountable for the harm they inflicted on their patients secondary to MSbP perpetration.
  3. They dismiss the perpetrators and do not work them up for conditions known to be common among serial killers, specifically MSbP types. They do not discuss, for example, whether the perpetrator has an anti-social personality disorder. They do not look into whether medical sexual abuse is going on in the family. They do not discuss the role of obsessive-compulsive disorder in perpetrator actions. For all their focus on perpetrators, they really don’t do a good job of psychoanalyzing them. They talk about “fables” and “fates”, and use very colorful language, which I personally find insulting.
  4. They provide no public health recommendations. Unlike Dr. Stirling’s listy article, Libow & Schreier do not provide practical advice on anything – identification, diagnosis, treatment, or epidemiology. Even though their works are titled as if they provide useful information (e.g., “Casebook companion”), I find nothing in their writing helpful in terms of fixing healthcare policy to improve MSbP family identification and outcomes.

eye with reflection

So where does that leave the Proxy Project?

With the severe lack of a patient-centered scientific literature, we are left at square one. We are essentially starting at the beginning, and all we have is these narratives written on historic scientific vellum by poetic philosophers of the human mind.

Ironically, with all their attention to perpetrator “motivation”, we learn very little from Libow & Schreier’s work about why these perpetrators do what they do.

From the Proxy Project perspective, we feel that they do what they do because they were trained that way. Their parents gave them MSbP coping skills, and they used them.

I don’t think this is a very controversial theory, and it’s one that could have been tested by Libow & Schreier had they interviewed their patients in a strategic way. They could have learned how the perpetrator came up with the idea to poison the victim, for example, and why the perpetrator picked what she picked. But due to their unscientific approach to their patients, most of the usefulness of their research to the Proxy Project is lost in time.

In closing

This is the end of my series on the work on the topic of MSbP by Drs. Judith Libow and Herbert Schreier. In my last post, I make a list of all the posts in this series, including a short summary of the post.

Are you interested in child abuse as a public health problem?

Read this article from the American Nurses Association about the topic of child maltreatment as a public health issue.

Image of eye with reflection by Alexas_Fotos.


5 thoughts on “Libow, Schreier, & Munchausen by Proxy: Part 24 – A Surviving Epidemiologist’s Perspective

  1. Hi Nomadic,

    Thanks for all your thoughtful comments (on various pages). I’m sorry, I’ve been so busy lately, I haven’t been able to answer all of them, but I’ll try to get to them all over the next few weeks.

    I’m sorry there is some confusion about my position, but after reading your comment, I realize that I was not clear. First, I believe that all the systems in the US are corrupt (correctional system, healthcare system, school system, higher education system, etc.). But, 1) some are more corrupt than others, and 2) each system has unique features of corruptness. I happen to be an expert on the US healthcare system – not just because I was chewed up and spit out by it my entire childhood – but I’m also a professor of it at a nursing college. So I’m really intimately familiar with that particular set of corruptive features.

    MSbP is a thing people really don’t care about; it’s like one of those genetic diseases that fundraisers try to get you excited about and it doesn’t work. So given my knowledge, I realized there was actual potential that we could devise some public health things and get them into the US healthcare system, and they might actually work to protect some MSbP victims without much fanfare.

    Up to now, the entire MSbP scientific literature is about trying to use some confused conglomeration of the child protection system, the court system, the mental health system, and other systems to deal with MSbP. (Your comment aptly reflects this phenomenon.) For some reason, no one thinks outside that box, and the entire literature says basically that this approach doesn’t work. I’ve noticed in the scientific literature, sometimes entire fields get “stuck on stupid” or “stuck on study design”, where they keep researching the same thing the same way and they get the same confusing results. That happened to this literature, so there really is no public health perspective.

    I just want to try the experiment of whether going at this from a public health approach will get us a little farther. Do murderers and child abusers deserve to be punished? Probably, depending on your value system. Will they be in the US? Probably not. So if we focus instead on protecting the victims and not really caring what happens to the perpetrator otherwise (except maybe getting them treatment), we might get somewhere.

    This is a new thought; we’ll see if it works.


    • Thank your for writing back to me. I know you are busy with your book chapter and all. And thank you for explaining some about what your position is. But I have to say that I am still finding myself rather confused about it.

      And also this software I have not learned how to work, very hard to find where replies are. Glad I found you new one here.

      You know I don’t like the MSbB terminology. I see it as just another non-existent illness.

      All human institutions are corrupt. But to protect children we need to act anyway.

      Parents have a huge emotional investment in finding fault in their children. Often this involves doctors, but now always. I am glad that you are also looking at things like Troubled Teen Industry, and also abuses where the parent may give a bogus medical justification, but where doctors are not involved.

      When you punish the parent, especially by taking their money away, that offsets their reason for the abuse. Usually they are holding their money over the child. ( “Son would have to live in homeless shelter were it not for his meds.” )

      Middle-class parents understand only the Self-Reliance Ethic, and the license this gives them. Have to strike there.


      • Hi Nomadic! Thank you for all your comments, your information, your thoughts, and your encouraging words. I really appreciate it!

        I super apologize for the fact that it is impossible to find the “reply” button on this theme we chose. Someday when we are a rich non-profit (ha!) we will host our own WordPress and I’ll put the reply button in a more obvious place. But for now, while we are poor and is free, it is relatively hidden. Alas!

        Your talk about the “middle-class family” is interesting because you raise the question of where the line is in the continuum between generically messed-up parenting and MSbP. In another comment, you mention a parent who is overly obsessed that their child has a disease, and keeps testing them though all the tests are negative. Your point of “where is the line” in the middle-class family is a good one; we are seeking also “where is the line” between normal botched medical care and MSbP-related malpractice. I think the points you make are that the modern middle-class family may not be all full of MSbP parents, but many have the traits because society has created an environment ripe for that (the way you could say that in a ancient Greece, where women were treated like crap, men raping females was pretty common because the environment was ripe for that). I would agree with that, and also, the healthcare system has evolved in such a way that it is ripe for this kind of abuse. The juxtaposition of them is lethal.

        It’s just that I don’t think I can get much done trying to work on fixing this BS about the “middle-class family” which I hate probably just as much as you do. So, I focus on a different monolithic behemoth of the patriarchy – the US healthcare system.


    • Yes, I also am at a loss for how to properly reply on this system. Glad you recognized what was happening.

      As I see it, all of these problems are caused by the rise of the middle-class family. This is different from anything which has ever before existed, because people have children deliberately.

      In other social arraignments they are just something that, short of religious celibacy, would be impossible to avoid.

      Knowledge of contraception was typically confined to within the temples. And then just with gender politics unfolding as the patriarchal society demands, there will be children.

      Our society, driven by the commercial sector and religion, and this unfolding into politics, romanticizes lots of things. This is extremely harmful and usually at the expense of children.

      And the middle-class lives in Bad Faith, not being willing to accept that it has choices, and instead using children to hide behind.

      Can you outlaw this? I say no. But you can come down with extreme force when there are problems. Always stand with the child and hold the parents accountable. And most of the time this will mean money.

      So the middle-class family was invented as a way to exploit children. I don’t like to talk about “abuse”, as this sounds like it is something aberrational. Exploitation is the norm and the intent. The child is the exploited worker, used to provide a legitimate adult identity for the parents.

      And then I don’t go along with the idea of “dysfunctional families”. They are completely functional, they inflict the harm they are intended to. They are just as functional as the sharp stones and hot coals that Nietzsche wrote about primitive societies using to “breed man”.

      Now sometimes there are for some reason a few families, like maybe 5%, where for some reason there is some sort of outside mitigation, so the harm inflicted is not what it was intended to be.

      But so idotic, those of the Recovery and Therapy camps going around crying, “Oh if only I had grown up in the Good Family, then my life wouldn’t be like this.”

      I’m not saying that they don’t have a right to be angry, they certainly do. But get angry about the right things, and then DO SOMETHING ABOUT IT!

      Don’t just confess on your therapist’s couch, or punch his pillows and scream at them.

      Well to do something, you can’t do it alone, you have to organize, and this means raising political consciousness.

      I don’t know that the medical profession is always excessive. But I have seen first hand pediatricians, the priests of the middle-class family, giving out instructions to mothers, designed to calm the mother down. So she is to use giving medicine to her child in order to calm her own nerves.

      I’m not saying that this is necessarily excessive, but it could be.

      And then some treatments pediatricians advocate, in my view are excessive, like the allergy desensitization injections. This goes on for years and years and can involve as many as 30 doctor visits per year. I say that the cure is worse than the illness. And when you have a parent who signs on to it, it probably is like MbPS, in that the reason is to give their own life meaning, to keep the child ( children ) in tow, and especially to keep the spouse in harness.

      So anyone who gets involved in the affairs of the middle-class family is already in dicey territory.

      And then with Psychotherapists and Psychiatrists, they are treating imaginary illnesses anyway. Any time there is contact with such, it should be overseen by the court and the child should have an appointed attorney.

      Anyway, I’m still trying to understand what your real views are. I am against the middle-class family, and that is universal. But the Medical System is not fully universal. But steering the discontented to therapy and recovery is universal.

      I don’t go along with all the feel good stuff. What I want is to take scalps. What that means is taking people down and being able to brag about it. This is how we restore our social and civil standing.

      Which is better:

      “I spent the last 30 years in recovery and therapy and so now I think I finally have all my anger out of me.”


      “I spent the last 30 years putting parental abusers in prison and taking all their money away from them and putting it in trust for their child. And I’ve also put lots of psychotherapists and psychiatrists out of business. I’ve also organized survivors so that they are now getting a life long education, instead of just having to live under the self-reliance ethic, and having nothing.”

      So I am counting the Pentecostal Daughter Molester as my first scalp.

      See, I am not otherwise a fan of locking people up. So before I got involved, I asked myself, could I follow the example of John Brown in Kansas Territory, and deal with him myself?

      Finally I decided yes, as what he did to his daughters was horrible. And he did it for the purpose of harming them, making them more like himself and the members of his church.

      So not just based on the police report, but if it is supported by credible testimony, then I could take care of him myself.

      But in fact, how it worked out is fantastic. My involvement went on well over two years. But judges, prosecutors, police, and a journalist got educated. And the state is locking him up, because otherwise someone like me would deal with him.

      Do you think Kings and Presidents really have such care for their subjects that they prosecute murder and robbery, and the rape of another man’s wife or daughter without his permission?

      No, they do it because otherwise people would handle the situations themselves, and so the State would lose its claim to power.

      So same here, the State holds its claim to power because it handled a situation so I would not have to.

      So I don’t give out his name, because his name is the same as his daughter’s names. But face to face I never stop talking about the case, about my role in it, and especially about his church’s role in it. Most all of them there have scapegoat children and adult children, and they talk about them just like this guy did.

      I told the DA’s office to look for the animosity, because that had to have started with the parents and it is the rationalization used for abuse.

      So I want more ways to strike, and I want the survivors to organize and take legal and political action. And we the survivors of the middle-class family need to organize and build a work which works differently than by the self-reliance ethic. And we need to set up our own foster care group homes too.



  2. Having a little bit of a hard time following you. Still don’t really understand what your intent is. As I see it, you have to focus first on perpetrators. If you focus on victims, then that is like Psychotherapy and Recovery, and these are just more of the original problem.

    No, we need to focus on perpetrators, and this means parents and doctors. Sometimes it is more one than the other, but no matter what, we need to focus on perpetrators and get criminal convictions and civil judgments, and also change laws to prevent disinheritance of one’s child.

    So do I want Muchausen’s treated like a public health problem? Well yes, as is extremely pervasive, and so it is a public health problem. But does this mean that I want it treated by therapists, and therapists acting on the victim? No of course not. That would be more abuse on top of abuse, the quintessential second rape.

    I think our system should try to provide support to families that are having problems, but this must be with supervision of the court, because the court is the only entity which has actual authority over the parents. And so the child must also be represented by an attorney.

    So to a point support can be given, so long as the child is not be placed at risk, or ever being given “help in recovering.”

    Once it goes beyond that, then it should be police, handcuffs, a jury trial, and then prison. In minor cases we could just confiscate all of the parents’ cash and assets and place them in a trust fund for the child.

    Then as far as the welfare of the child victim, it comes down to a matter of legitimated social identity. A therapist will try to convince you that your problem is simply because you won’t let go of past hurts. This is again, second rape.

    The issue, for anyone who is a Survivor of the Middle-Class Family, is that we lack a legitimated social identity. We are always being challenged, always at risk of being made to feel that we are the problem. And then in the voluntary associations of employment and intimate relationships, we are always at a huge disadvantage.

    So the way we remedy this is by organizing and acting. I don’t mean playing Uncle Tom and courting approval and pity, I mean by going after perpetrators and imposing server consequences.



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