Munchausen Syndrome By Proxy Essay

Abstract
Munchausen Syndrome by proxy is a mental disorder characterized by an individual, usually a mother or caretaker, who creates fictitious symptoms or causes real symptoms either physical or psychological in nature to make it appear as if a child is suffering from an illness. Over the years, there has been much controversy surrounding the definition and diagnosis of Munchausen Syndrome by proxy. Other controversy is directed towards whether it should be described as a disorder, illness or listed as a form of child abuse. This paper will discuss and outline the history of Munchausen Syndrome by proxy and define how it is often used by the many interdisciplinary fields it is often discussed. In addition, a contextual example of Munchausen

Syndrome by proxy in the form of a brief case summary involving Marybeth Tinning will be explored. The circumstances surrounding this case have often resulted in it being referred to as “the worst case in history” of Munchausen Syndrome by proxy.
Keywords: Munchausen Syndrome by proxy, fictitious symptoms, Marybeth Tinning

Munchausen Syndrome by Proxy:
The Marybeth Tinning Case
In 1977, Sir Samuel Roy Meadow was responsible for the increasing acknowledgment and awareness of Munchausen Syndrome by proxy (MSBP).

Sir Meadow, a British pediatrician and professor, became publicly known after publishing academic literature titled “Munchausen Syndrome by Proxy – the hinterland of child abuse.” This article generated extensive attention towards this new phenomenon. The phenomenon, Munchausen Syndrome by proxy, consisted of a mother’s ability to deceive medical personnel by creating a fictitious illness often resulting in unwarranted surgical procedures carried out on the child primarily to meet self gratification (Parnell & Day, 1998). The publication of this literature increased the understanding of MSBP, and created great controversy surrounding the topic including its relative impact on the medical and legal aspects of society. Although Sir Meadow generated publicity on this topic, the term Munchausen syndrome originated in 1951 by Dr. Richard Asher when he identified common factors between many of his patients and the exaggerated storytelling of Baron Karl Friedrich Hieronymous von Munchhausen in the 18th century, who was described to have had “a reputation for colorful raconteur who spun outrageous stories and wandered about the countryside to find audiences” (Gray & Zide,

2008).
Lasher and Sheridan (2004), defines MSBP as “a dangerous kind of maltreatment (abuse and/or neglect) in which caretakers, usually parents, deliberately and repeatedly exaggerates, fabricates, and/or induces a problem or problems in someone who is under their care” (p. 3). MSBP is described as a mental illness and a form of child abuse. In the areas of understanding the mental illness and child abuse aspects, it is important to note both involve a team of specified multidisciplinary professionals selected on a case to case basis to evaluate medical records and generate a plan of action. Based on the circumstances of the case, physicians, social workers, child protection services, law enforcement agencies and legal staffs respectfully, may work together to determine the specified needs of the individual or family involved. These factors are the beginning of understanding the complexity of MSBP. Although MSPB is categorized into four types which may involve physical, psychological or behavioral symptoms, it will be evaluated in a simpler form within this text (Lasher & Sheridan, p. 13). To understand MSBP, it can be looked at from two viewpoints or categories; mental illness followed by child abuse.
The first view point refers to the mental illness of the offending parent where, “women are usually the perpetrators accounting for up to 98 percent of cases” (Feldman, 2004). With those facts, references will be made in the context of mother to child situations. The high percentage is reflective of women fulfilling the majority of unsupervised caretaking of children while statistically; men are less likely to be the primary care giver. Children of both genders are equally at risk; however, infants and toddlers are typically affected due to their inability to communicate vocally (Spitz & Spitz, 2006). MSBP as a mental illness is difficult to diagnose based on “only care providers with specialty training in child abuse are likely to have experienced the level of manipulation and lying evident in MSBP cases” (Parnell & Day, 1998, p. 69). The mother is mentally motivated by the feeling of emotional gratification she receives as a result of the attention she gains from creating exaggerated or fictitious medical symptoms of her child. Gratification is gained through the formulation of lies, alteration of medical tests by self contamination, falsifying medical records or often times inducing conditions by means of and are not limited to starving, poisoning or suffocating the child. The mother may use the illness or death of a child to correct marital issues or gain the attention of media. Often times, the mother make receive gratification as a result of being capable of outwitting medical personnel resulting in gain financial benefits through lawsuits. It is often known for mothers or parents together to seek legal representation and initiate lawsuits against medical facilities and individual medical personnel for allegations of medical malpractice or more severely, the wrongful death of a child.
The second view point refers to offending parent causing multiple forms of child abuse or death. “Over 70 signs, symptoms, and laboratory findings have been associated with MSBP, but the commonly fabricated or induced symptoms include seizures, bleeding, apnea, diarrhea, vomiting, fever, and rash” (Spitz & Spitz, 2006). The aforementioned signs and symptoms are usually repetitive uses as they are common medical complaints of children within various age ranges. Without the review of past medical history of the child or children noting a pattern of medical visits for the same alleged conditions child abuse is unlikely to initially be considered.
In 1982, John Emery, a pediatric pathologist, made a correlation between the then referred to as Sudden Infant Death Syndrome (SIDS) and MSBP. SIDS is defined as “the sudden death of an infant under one year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history” (Willinger et al., 1991 pp. 677-684). Emery found a commonality which suggested infant deaths attributed to SIDS were actually smothered to death (Levin & Sheridan, 1995). His findings caused pandemonium amongst the medical and child care professions due to the inhumane ideal of a mother intentionally causing the death of her child. While Emery had the confessions of many mothers admitting to smothering their children, this alone was insufficient in convincing the medical and child care professionals of the commonality between MSBP and SIDS to increase awareness of its severity and it was disregarded. Shortly thereafter, the discovery of hospital video footage depicting a large quantity of mothers caught in the act of smothering their children contributed to the validation of the possible correlation Emery made efforts to gain attention to previously. MSBP and SIDS remain topics of great debate with regards to how each should be classified when being referred to within different disciplines.
According to the Child Abuse Prevention and Treatment Act (CAPTA) of 2010, MSBP is identified as a form of child abuse. Within text of the CAPTA (2010), specific terms child abuse and neglect are defined as:
…Any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which presents an imminent risk of serious harm. (p. 6)
A parent who caused abuse or neglect to their child by way of MSBP has committed a criminal offense. The legal literature and case law discussing MSBP are limited in number. The first criminal case involving the prosecution of a mother for the offense of MSBP was People v. Phillips in 1981. In this case the California court allowed an expert witness to testify to a mother accused of murdering an adopted child and willfully causing the endangerment of another child, engaged in MSBP. The evidence provided proof of the mother being responsible for adding a sodium compound to the children’s formula resulting in the death of a child. Based on scientific literature and the fact of motive for murder may not be essential but very relevant to a case (Parnell & Day, 1998).
A case known for being the worse case of MSBP involves a woman by the name of Marybeth Tinning. Born Marybeth Roe, on September 11, 1942 in Duanesburg, New York where as a child, she was frequently physically abused by her father. In 1963, she met Mr. Joe Tinning; they married in 1965 and in 1967 their first son was born. Mrs. Tinning maintained modest jobs during this time including employment as a nurse’s aide and later in life, a school bus driver. In 1971, her father died of a sudden heart attack and this was the beginning of several subsequent tragic events for the Tinning family. Tinning gave birth to eight children and adopted one child during the course of her marriage. Between 1972 and 1985, nine of the Tinning children died suddenly without a clear explanation. The third Tinning child, Jennifer, was the first to die and her death was the only death doctors attributed to spinal meningitis; however, all other children cause of deaths were documented by vague medical conditions – SIDS, pneumonia, or a hidden genetic flaws (Bovsun, 2011, para. 6).
During the 14 years of repetitive loss, there was an unspoken suspicion within the community regarding the actual circumstances surrounding the death of these innocent children. For years no one considered the possibility of a stay at home mother to cause the death of her children. During funeral services, Tinning was often seen as detached and happy as she said her final goodbyes to the children. It was often assumed she enjoyed the attention she received and became addicted to the feeling gained during funeral services. Despite the repetitive deaths, Tinning and Joe stood together and tried every effort to build a family through adoption; however, Michael was adopted in 1978, shortly after his birth and died under the care of Tinning at the age of 2 in 1981. In 1985, Tami Lynne was born and 3 ½ months later, she “stopped breathing” and died. An autopsy was conducted and resulted with the discovery of no physical cause being noted as a contributing factor of her death. Again, it appeared to be another documented case of SIDS.
Law enforcement for years monitored the Tinning children deaths; however, Tami Lynne’s death initiated the need to ask Tinning difficult questions. The asking of these questions resulted in an interrogation wherein Tinning admitted to being responsible for causing the death of three children: Timothy, Nathan and Tami Lynne (Bovson, 2011, par. 15). Tinning admitted to smothering the children with a pillow while she was alone with them merely because she considered herself not to be a good mother. Tinning explained in an interview, “after the deaths of [her] other children.. [she] just lost it, became a damaged worthless piece of person and when [her] daughter was young, believed [Tami Lynne] would die so [she] just did it” (Gavin, 2011, par. 2). She also admitted to the attempted murder of husband, Joe by mixing epileptic pills into his cocktail, but was never charged (Gavin, 2011, par. 19). Joe was interviewed and it was determined he was unaware of his wife’s actions, having no involvement in the murders. In the wake of the trials, the bodies of Timothy, Nathan and Tami Lynne were exhumed. Due to severe decomposition of the children, nothing of evidentiary value was discovered to assist with the investigation.
As written by Sir Meadow, “one sudden infant death is a tragedy, two is suspicious and three is murder, until proved otherwise.” On July 17, 1987, Tinning was found guilty of second degree murder and subsequently sentenced to 20 years to life in prison for the murder of Tami Lynne. After twenty-six years confined in the Bedford Hills Correctional Facility, on January 10, 2013, Tinning appeared before her fourth parole hearing at the age of 70 and was denied for the fourth time (Cook, 2013, par. 3). It is important to note in the context of MSPB, Tinning was never diagnosed with a mental illness nor was MSBP used as a defense during her trial. Other than allegations of physical abuse by her father, Tinning lived a normal life as a child and her marital relationship appeared to be normal. Tinning will be available for parole in January 2015.
In conclusion, MSBP is a complex mental illness requiring a multidisciplinary team to accurately detect and diagnose. Without a definitive algorithm supported by medical criteria supported by thorough research, the accurate diagnosis of MSBP will remain one of the most rare and difficult illnesses to diagnose. Marybeth Tinning is only one example of a severe occurrence of MSBP although she was never diagnosed with Munchausen syndrome. As outlined within the Diagnostic Manual of Mental Disorders, a standard reference book for identifying mental illnesses in the United States, it organizes factitious disorders into four main types: psychological symptoms, physical symptoms, both physical and psychological symptoms; and those with no match to any of the three types (Lasher & Sheridan, 2009). MSBP is listed within the fourth category as being physically and psychologically reflective by symptoms an individual experiences. It is essential to understand the diagnoses of MSBP may constitute a form of child abuse and the proper social work services and law enforcement agencies must be contacted as soon as possible. The rarity of MSBP has caused a serious lack in research and further development; however, this sole factor does not exclude its existence.