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Editorials

Munchausen Syndrome by Proxy

August 2, 2009

A hassidic woman in Jerusalem, a member of the sect Toldot Aharon, which is called in Israeli newspapers “an extremist haredi sect,” is suspected of starving and abusing her three-and-a-half-year-old son. This story makes headlines in Israeli newspapers. The police have claimed that she not only starved her child at home over a period of two years until a point where he weighed seven kilograms but also disconnected his feeding tubes at Hadassah University Hospital. The authorities reached the conclusion that she had Munchausen Syndrome by Proxy. The child apparently made a miraculous recovery as soon as she was barred from his bedside.

Some people in the haredi community have accused Hadassah of “conducting medical experiments” on the boy. An Orthodox Jerusalem psychiatrist, Dr. Ya’acov Weill, evaluated the woman and said that she was not suffering from Munchausen Syndrome by Proxy. It has been reported that Dr. Weill might have had his own axe to grind with Hadassah. Apparently, he worked as a part-time sexologist at Hadassah in the past.

The first case of Munchausen Syndrome was described by British physician Richard Asher in 1951. He was the first to describe a pattern of self-harm, where individuals fabricated histories, signs, and symptoms of illness. Remembering Baron Munchausen, Asher named this condition Munchausen’s Syndrome in his article in The Lancet in February 1951, “Here is described a common syndrome which most doctors have seen, but about which little has been written. Like the famous Baron von Munchausen, the persons affected have always traveled widely; and their stories, like those attributed to him, are both dramatic and untruthful. Accordingly the syndrome is respectfully dedicated to the Baron, and named after him.” Baron Karl Munchausen, an Austrian soldier in the 18th century wrote a book in which he described a military officer who told a lot of lies. The current American Psychiatric Classification, DSM-IV, considers Munchausen’s Syndrome as the most severe and chronic form of factitious disorder consisting of the core elements of recurrent hospitalization, peregrination (traveling), and pseudologia fantastica.

Munchausen Syndrome by Proxy is a rare condition that involves the exaggeration or fabrication of illnesses or symptoms by a primary caretaker. An individual, usually a mother, deliberately makes another person (most often her or his own child) sick or convinces others that the person is sick. In some cases, Munchausen by proxy patients focus on a single child; in some where the parent has a large family, they pick on two or even three children. Possibly, that it isn’t just the attention that’s gained from the “illness” of the child that drives this behavior, but also the satisfaction in being able to deceive individuals that they consider to be more important and powerful than themselves.

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