by Proxy: Issues in Diagnosis and Treatment
|| Alex V.
Levin and Mary S. Sheridan
Jossey-Bass Publishers, ©1995
Lexington Books: Jossey-Bass Publishers
350 Sansome St.
San Francisco, CA 94104-1310
Not much is known about the
pattern of behavior subsumed under the label Munchausen Syndrome by
Proxy, which was first
identified and described by Roy Meadows in 1977. This 479-page book is the first attempt at a
systematic review of what is known about this puzzling and highly dangerous form of child abuse.
chapters by a variety of contributors consist mostly of anecdotal accounts, summaries
of clinical observations,
and case studies. This is the way science begins to collect data, understand, and generate hypotheses and
information. The book ends with an 18-page
bibliography and a useful index.
The thrust of this
book is to describe the pattern of behavior in which an adult, almost always a mother,
deceives others by
presenting false claims of illness in a child. This may range from parents simply lying about symptoms the child is
said to have to deliberately and repeatedly killing their children.
In between are
parents who may
deliberately, or as the result of an environmental pressure, make false claims of abuse,
physical or sexual,
by the other parent or another adult. It is clear that the behavior of an adult causing
illness, injury, or emotional harm to a child is a form of child abuse.
It is also likely that the
pathology of the adult is the principal etiological
factor, however, there is little known about the nature, extent, or
origin of the adult pathology.
The book also contains the best thinking up to this point about how to
recognize and treat the problem. Recognition of an adult creating a false illness in a child requires
cooperation of all professionals who may come in contact with the parent, child, and
family. The most significant data may be generated by
an observed difference
in the symptomatology shown by a child when not in the care of the parent and when the parent
is caring for the child. The book addresses the full range of reported symptoms generated in recognized
cases of Munchausen Syndrome by Proxy. There are separate chapters summarizing the known symptoms according to
physical systems, organs, and the psychological effects of false
allegations. The remedy proposed is decisions by multidisciplinary teams
that effectively remove a child from the care of the parent. There is
not a great deal of enthusiasm for reunification of a family when there
has been a child damaged by the adult's machinations.
The prevalence and incidence of Munchausen Syndrome by Proxy is not
known but it is clearly frequent enough and the risks to children high
enough that professionals should entertain this syndrome as a
possibility when confronted by claims of illness or abuse that seem to
be affected by the ability of the complaining parent to be in contact
with the child.
This book should be of value to all professionals who may be in a
position to encounter children whose lives may be dramatically affected
by a parent's pathology.
Reviewed by Ralph Underwager, Institute for Psychological Therapies, Northfield, Minnesota 55057.