The Fascination Around Munchausen by Proxy and Crimes that Fake Serious Illness

Gypsy Rose Blanchard, a Missouri woman currently serving 10 years in prison for second-degree murder, initially made headlines in June 2015 because she appeared to be missing after the violent death of her mother, Dee Dee. Believed to have a myriad of physical and intellectual disabilities, as well as a cocktail of life-threatening health conditions, Gypsy shocked law-enforcement officials by appearing healthy after she was discovered living with her boyfriend, Nicholas Godejohn.

Dee Dee medically tortured her daughter for years by convincing Gypsy and her doctors that the girl had a variety of severe illnesses, including leukemia, muscular dystrophy and epilepsy.

Gypsy underwent a series of invasive, painful procedures, all of which turned out to be unnecessary. The subsequent media frenzy covering Gypsy's lifelong abuse put a spotlight on cases of what's clinically known as factitious disorder imposed on another (FDIA), or, as it's more colloquially called, Munchausen syndrome by proxy or, simply, Munchausen by proxy.  This condition is characterized by a person faking or exaggerating health problems of someone in their care to gain sympathy and attention. (Munchausen syndrome is when someone fakes or exaggerates their own health problems to gain sympathy and attention.)

More recently, in December 2017, authorities arrested 34-year-old Kaylene Bowen in Dallas and charged her with injury to a child, with serious bodily injury. Bowen, who claimed her 8-year-old son Christopher had cancer and a rare genetic disorder, is accused of unnecessarily having him equipped with a feeding tube that caused painful and nearly fatal blood infections, forcing him to use a wheelchair, trying to get him on a lung transplant list and placing him in hospice care.

After calls from medical providers alerted Child Protective Services (CPS) to Christopher's case, he was discovered to be completely healthy. Like Dee Dee Blanchard, Bowen, who also goes by Bowen-Wright, is believed to suffer from Munchausen by proxy, according to the CPS report on the case. She has denied the allegations against her and, when this story published, was free on bail and awaiting trial.

(Christopher's father, Ryan Crawford—who had been fighting for several years to convince authorities that Bowen was lying about Christopher's health conditions—was granted temporary managing conservatorship of his son in December.)

We spoke with Gayani DeSilva, M.D., a child and adolescent psychiatrist and author, on the  warning signs of Munchausen syndrome and why cases involving the disorder are so horrifyingly fascinating.

What is Munchausen by proxy in a nutshell? What are some of its possible causes?

Munchausen by proxy is a psychiatric disorder characterized by someone, usually a caregiver or parent, who fabricates medical conditions and seeks medical interventions for the person they are caring for. For instance, a mother who gives her child a toxic substance to create symptoms that need medical attention. This is child abuse. People who suffer from Munchausen by proxy are extremely ill people with an overwhelming need for attention. These people are often victims of abuse [themselves].

What are some signs that someone might have Munchausen's by proxy?

Any time a child is taken to the physician repeatedly with vague symptoms that escalate in severity, and when the caregiver or parent pushes for medical interventions, Munchausen by proxy should be considered.

Some parents with Munchausen by proxy will insist on certain medications or procedures—despite the physician advising against it due to the risks being greater than potential benefits, or if the intervention is not appropriate. For instance, a mother who insists that her child take higher than normal doses of Ritalin, despite her child having a dangerously high heart rate whenever she takes Ritalin.

In the case of Gypsy Rose Blanchard, how was Dee Dee able to cover up her actions for so long to friends and medical providers? What kinds of things do parents do to cover their tracks in these cases?

These parents are generally well meaning, and believe their child absolutely needs extreme medical interventions. These parents or caregivers often cause the medical problem, but their medical providers, friends and family only see the symptoms displayed by the child. These medical providers, friends and family unintentionally enable the parent to enact their abuse for a long time.

In addition, many providers value the parent's story over the child's description of her needs. It is an unfortunate cultural bias that undervalues a child's experience and expression of their needs, which paves the way for these ill parents to project their victimization onto their children.

Many parents will create stories about their depth of caring for their child, their helplessness, their inability to fully meet their child's needs. These parents seem like attentive and desperate parents who only want their child to be healthy. However, there are subtle signs, such as the parent seeming to be too eager for medical intervention, insisting on dangerous interventions, the child seeming more depressed and withdrawn and inconsistency in medical signs and symptoms. If the parent presents a "textbook" description of symptoms, or a myriad of symptoms that is confusing and esoteric, Munchausen by proxy should be considered.

What would the long-term psychological effects of infantilization and fabricated illnesses be on someone like Gypsy?

I can imagine that Gypsy had considerable suppressed rage towards her mother and her predicament. Despite external attempts at infantilizing Gypsy, she—and all children—still have psychological drives to mature. Her mother's parenting responsibility was to help her grow up.  Dee Dee did the opposite to Gypsy, and likely created profound and severe psychological conflicts for Gypsy.

While children who are not abused can grow up and develop mature and rational ways of thinking and managing their feelings, children like Gypsy cannot.  Children who are abused—and Munchausen by proxy is a form of horrific abuse—spend nearly all their psychological, spiritual, physical and mental energy and effort trying to survive the abuse. There is no opportunity to mature and engage in normal brain development.

For children like Gypsy, their thinking processes, ability to manage emotions, ability to organize and execute complicated cognitive tasks and ability to even assess situations is expected to be severely compromised.

How do you think Munchausen by proxy contributed to Dee Dee's death and Blanchard's motivations for having her mother killed?

Gypsy likely does not process information or manage her emotions like a person without her trauma would. She may have felt so imprisoned and controlled by her mother, that she could not see any other way out of her situation without killing her mother. Her brain development is likely severely compromised, and thus [she] may only be able to think about how to get out of a bad situation.

Why do you think most parents with Munchausen by proxy tend to be mothers?

I think, as more men take more caretaking roles, we will see more men being diagnosed with Munchausen by proxy. Traditionally, aggressiveness has been the more acceptable projection by men, and women are expected to be nurturing. But roles and expectations are shifting. Munchausen by proxy is abuse and, like other forms of child abuse, stems from an adult's sense of inadequacy.

Why do you think there is such a strong cultural fascination with cases like this?

Parenting is challenging to most people across the globe. Being a parent requires us to be selfless all the time. No longer is the spotlight on the individual, because the priority shifts to the child's needs. Caring for oneself and caring for children is a near universal human experience, and finding a balance is challenging for most of us. Having physical or body problems when stressed, sad, scared or anxious is another universal human experience.

Munchausen syndrome and Munchausen syndrome by proxy are extreme manifestations of not being able to find a balance between self-care and care of others. It's fascinating because we can relate to needing attention and nurturance, and hope to never be so desperate for it that we resort to making up illnesses in our children.