Proxy Project Submits Patient-Centered Book Chapter Draft

Earlier this year, we submitted a proposal for a book chapter in the book  under the working title “Patient Centered Medicine “, ISBN 978­953­51­4982­8. Our proposal was accepted, and we just submitted our draft chapter with the working title, “Patient-Centered Medicine and Prevention of Munchausen Syndrome by Proxy”, or MSbP.

Stylized bookshelf

Chapter Synopsis

The chapter covers the following topics:

  • Understanding the nature of MSbP: This section describes the entity “MSbP” as seen from a patient-centered perspective.
  • How the healthcare system contributes to MSbP morbidity and mortality from a system perspective: This section describes how the healthcare system appears to operate in MSbP cases in ways that contribute to patient and perpetrator morbidity and mortality.
  • How the healthcare system contributes to MSbP morbidity and mortality from an individual perspective: It is generally considered that the healthcare system’s contribution to patient and perpetratory morbidity and mortality in MSbP is due to the innocent actions of those within the system. However, there are important cases where individual providers within the healthcare system are engaged in MSbP behavior; this aspect is covered in this section of the chapter.
  • Recommendations for a patient-centered approach to MSbP in the healthcare system: This section applies the Haddon Matrix as a framework for structuring public health recommendations on how to address MSbP in the healthcare system. It focuses on changes in policies, regulations, and operations in the healthcare system to de-incentivize participation in MSbP behavior and incentivize the immediate intervention into suspected MSbP behavior.

Does our chapter sound boring? Good!

This cat is not entertained.

It provides a nice counterpoint to the drama in the scientific literature that has been much sound and fury, but signified nothing in terms of improving the identification of victims and their immediate protection.

Our Contribution

Our chapter actually makes some solid, workable recommendations that could be built into the system, such as:

  • Supervised collection of laboratory specimen so as to identify if the perpetrator is contaminating the specimen
  • Federal regulation of the troubled teen industry (TTI)
  • Requirement for hospitals to have a protocol of what to do if a provider is suspected of MSbP behavior, with a separate protocol of what to do if a patient or family is suspected of MSbP behavior
  • Education of provider types likely to encounter MSbP behavior (such as adolescent psychiatrists, emergency department personnel and pediatricians) as to red flags indicating MSbP behavior

These might be a long shot, but you can’t reform the system without any concrete, workable reform proposals on the table. I think this is the first one I’ve seen that could actually be implemented.

Next Steps

Our next steps are:

  • Hear back from publisher: To cross our fingers and hope that our chapter is reviewed and accepted for the book. We’ll update you in 6 to 8 weeks when we hear.
  • Share our findings with you: Regardless of the chapter’s acceptance, I plan to have us make a series of blog posts about what the chapter says so you all know. I’ll try to make it less boring for this audience!
  • Follow-up chapter – about “why”: We want to write a follow-up chapter (if the opportunity arises) to describe why we are making these recommendations, and why there have been barriers to intervention in healthcare about MSbP (where there haven’t been with, say, domestic abuse). Kent has written something we hope to publish about “affirmative bias” (assuming that “a mother would never do that”), and Mariel has brought up points about the dysfunction of the healthcare system on other fronts (such as fragmentation) lends itself towards unwitting (or witting) participation in MSbP behavior. C.E. Miller has experience within the healthcare system to inform this discussion, but it simply couldn’t fit in this book chapter, so these concerns needed to be kicked down the road to the next book chapter.
  • More weird science: We also hope to get some journal articles published and go to a scientific conference together. We’ll keep you posted! We can always count on Mariel to take great pictures.

Do you have any topics about MSbP that you think the Proxy Project should explore?

If so, please comment below! We’ll see what we can do.

Images by Alexas_Fotos and Pete Linforth on Pixabay.




6 thoughts on “Proxy Project Submits Patient-Centered Book Chapter Draft

  1. “How the healthcare system contributes to MSbP morbidity and mortality from a system perspective”

    Some in our healthcare system are trying to get ahead of the game make it become a preventer of morbidity and mortality. One of the ways they are doing this is by leaving behind the concept MSbP and instead just looking at it as Medical Child Abuse. At the hospital in Providence Rhode Island you will find some of the leaders.

    And they have also invented the new specialty and department, Child Protection Pediatrics. These doctors are supposed to spot and respond to suspected cases of Medical Child Abuse. Usually the only way to really know is the “separation test”. And sometimes this turns into a full “parent-ectomy”.

    In my view parent(s) could be destroying the health of a child without engaging in poisoning, and even without fooling doctors. They can do it just psychologically.

    But more often, doctors are involved. And of course the worst are psychologists and psychiatrists, because they work in bogus illnesses to start with.



    • Nomadic,

      Wow – you lay out the problem perfectly. They call it Medical Child Abuse now, so they stop looking at the MSbP literature. Next, they don’t notice that providers are involved. So even though I applaud RI for trying to take this on, as long as providers are involved, it’s the fox watching the hen house.

      I live in Boston, so maybe I should contact these RI people and give them our book chapter. It might help them realize they have to look at their own as well as parents. Charity begins at home! Great points.



  2. Monika, I strongly agree with your four above recommendations. And also of this troubled teen industry, in most cases they will be violating mandatory reporting, engaging in child endangerment, and engaging in child abuse themselves. All federal felonies. Lets get these people prosecuted, as well as trying to get new laws.

    I also have my own view of these matters, and perhaps this is a good place to share them.

    I feel that we all must reject all aspects of the mental health system, and even the concept of mental health. We must also reject any and all forms of psychotherapy, recovery, or rehabilitation.

    It is all based on the premise of innate moral defect, as derived from the religious doctrine of original sin.

    And even after reading people’s stories and discussing them, it really is hard to see how anyone could ever end up in the mental health system, or in therapy or recovery, unless it were simply a continuation of childhood familial abuses.

    Our society needs scapegoats, to hold up for public humiliations, in order to maintain discipline in the lower end of the workforce. It used to get these in the immigrants and racial minorities who did low wage labor and slave labor.

    But now in the information age, there is much less need for any type of labor. So using things like substance addiction, developmental disabilities, and mental health, and psychotherapy and recovery, it gets these scapegoats from the middle-class family itself.

    So we must never go along with this, never go along with pity seeking approaches, and especially when faced with something like this Murphy Bill. When we seek pity in therapy and recovery, we are aiding those who advance Social Darwinism and Eugenics.

    We must instead organize and act aggressively to bring abusers to justice, including parents and all types of doctors. No one who has abused their child should ever be allowed to hold on to money or assets. No doctor who markets to parents to help them “fix” their child, should be running around not in custody.

    If we who have survived the middle-class family and its doctors are not willing to act, then we are helping those who promote the bogus sciences of Social Darwinism and Eugenics, as well as guaranteeing that today’s children will be used in the same ways that we were.



    • There is another kind of child abuse, which may or may not properly be considered an MSbP variation.

      This is, when a parent so hates their child, considers the child to be an embarrassment. So this negative attitude is communicated to the child day in, day out. And so in particular, once a child is treated this way, the child will forever be vulnerable to the same sorts of responses from others.

      This may or may not lead to an assessment being made by white coats. If it is made then they may be further abuses in the form of therapists telling the child that they have a defect / difference, but with the help of the therapist they can probably be made passably acceptable to most people most of the time.

      But even with out this assessment and the further abuses, the child will be vulnerable to peer culture abuses. Usually the worst will be school, work place, and especially intimate relationships.

      It particularly shows up in these situations because the child is not like others in the peer group, because the child has not learned to stand up for themselves, and especially because work place and intimate relationships are fully voluntary. So people can reject without giving any reason. And some may find the child’s difference to be completely unacceptable.

      The parent is in part responsible. But the white coats and the people who run the schools are too.

      We just need to build society differently.

      Now the example that I have in mind is that bogus disorder referred to as Autism / Aspergers / ASD.

      As the assessment rate for this bogus disorder has climbed higher and higher, ( 1 in 40 for boys in the US now ) the gender disparity has climbed too. And to me it does seem like it is primarily about a negative mother – child relationship. Though there still could be some temperament difference in the child. And then it is often going to be female school teachers and therapists who react the most negative. And then it will be female rejection in intimate relationships which cements it, along with negative work place situations.

      People become more rigid in negative situations. They have to in order to defend themselves. Only in accepting situations can they gradually open up.

      I don’t know if this should be classified as MSbP, but I feel that it a similar kind of child abuse, looking to find the local of Original Sin in the child.



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