Too Much In Common

Kathleen Bush and Yvonne Eldridge had a lot in common. First, both cared for children with remarkably complex medical problems: Jennifer Bush suffered from constant intestinal problems, and Eldridge's two foster daughters experienced a host of ailments that left them weak and emaciated. Second, both Bush and Eldridge spent most of their time escorting their sickly girls from doctor to doctor: Jennifer was eventually hospitalized 200 times, and all three children had to undergo surgery to place feeding tubes into their stomachs. And third, both parents received the highest praise for their exemplary devotion to their little charges: Bush was lauded by Hillary Clinton at a 1994 White House rally, while Eldridge was named national "Mother of the Year" in 1988 by Nancy Reagan.

Yet prosecutors now maintain that Kathleen Bush and Yvonne Eldridge shared one more feature, a dark secret only recently exposed to the glare of television shows and newspapers around the world. Bush and Eldridge are accused of having a strange psychiatric ailment called "Munchausen syndrome by proxy" that led them to manufacture the girls' illnesses to meet their own needs for attention and sympathy. Bush is alleged to have deliberately poisoned and infected her daughter, Eldridge to have starved her foster children and reported symptoms that never really existed.

A Web of Deceit

The term "Munchausen syndrome by proxy" (MSBP) was coined around twenty years ago, and hundreds of reports have appeared since then. In most cases, a mother either claims that her child is sick, or she goes even further to actually make the child sick. This "devoted" parent then continually presents the child for medical treatment, all the while denying any knowledge of the origin of the problem--namely, herself. As a result, MSBP victims may undergo extraordinary numbers of lab tests, medication trials, and even surgical procedures that aren't really needed. For example, by the age of eight, Jennifer Bush had had more than 40 operations, including the removal of much of her intestines. Other children have scarcely experienced a day of their young lives without being brought to the doctor's office or confined to the hospital. In the vast majority of cases, the perpetrator is the mother and the victim an infant or toddler.

The web of deceit the caregiver spins can be buttressed by medical signs and symptoms that mislead the most skillful of physicians. Their acting skills can match those of a veteran performer. For instance, the MSBP perpetrator might induce "apnea" (a cessation of breathing) by suffocating her child to the point of unconsciousness, then frantically display the limp child to the hospital or clinic staff as the tears roll down her cheeks. She may secretly place a drop of blood in the child's urine specimen, then appear aghast at lab results that alarm the unsuspecting physicians and nurses. Behind closed doors, she may scrub the child's skin with oven cleaner to cause a baffling blistering rash that lasts for months. Since it may take many years of illness for doctors finally to arrive at the truth, it should not be surprising that this form of child abuse has a mortality rate of nine percent.

Struggling to Understand

Why would anyone do such a thing? That question haunts everyone who encounters MSBP, since few other behaviors so sharply challenge our concept of what "motherhood" is supposed to be all about. Typically, it seems, the MSBP parent is on a misguided mission to feel "special," to garner attention from people--family, friends, and community--as the heroic caretaker of a tragically ill child. Other perpetrators crave a perverse relationship with doctors in which they simultaneously engage and defeat them through their carefully-crafted deceptions. And virtually all have personality disorders that lead them to behave in odd and even destructive ways, especially when they feel under stress.

Protecting the Defenseless

When MSBP is suspected, health care providers are required by law in all fifty states to report their concerns. Since MSBP can be a deadly form of abuse, law enforcement will usually step in to investigate while social service agencies focus on the highest priority of all: ensuring continued protection of the child. Though the media frenzy surround the startling cases of Kathleen Bush and Yvonne Eldridge has already faded away, the rest of us bear the responsibility of continuing to educate ourselves and others about MSBP. Each of us will need to carry the banner for the appropriate recognition of this perplexing phenomenon and, in so doing, help to protect those who are too young to protect themselves.

5/28/98

Marc D. Feldman, M.D. is the co-author of "Patient or Pretender: Inside the Strange World of Factitious Disorders" (1994) and co-editor of "The Spectrum of Factitious Disorders" (1996).