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:
- 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.
- 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.
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:
- 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.
- 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.
- 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.
- 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.
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.
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.