The sad story of 8-year-old Christopher Bowen is getting some attention on social media. According to an article by the Fort Worth Star-Telegram, the Dallas youngster had 323 doctor’s visits and 13 major surgeries; he was attached to oxygen and a feeding tube and even spent some time in hospice care, treatments and procedures that doctors now believe he didn’t need.
Experts suspect that Christopher was a victim of Munchausen by proxy — also called medical child abuse — where a parent harms a child for attention. His mother has been arrested and charged with causing serious bodily injury to a child, according to news reports. Christopher is now in foster care while his father fights for custody.
Christopher’s story is just the latest case of Munchausen by proxy to come to light. Earlier this year, the HBO documentary film Mommy Dead and Dearest told the story of the years of abuse Gypsy Rose Blancharde suffered at the hands of mother, Dee Dee.
To get more insight about how these cases happen, and why they often continue for years before anyone uncovers the deception, we spoke with Marc Feldman, MD, clinical professor of psychiatry at the University of Alabama in Tuscaloosa. Dr. Feldman has written numerous books on what are called factious disorders and why people fake illness in themselves or their children for gratification and personal gain.
WebMD: Christopher’s father, Ryan Crawford, was interviewed by a Dallas news station, WFAA, and he wondered how doctors could be duped for so long. He said, “How do you do 13 surgeries? How do you do it?” he asked. “How do you do 13 surgeries and not question the fifth surgery? The sixth surgery?”
How do doctors and medical staff end up being unwitting participants for so long?
Feldman: It happens more than you would imagine. We’re taught in medical school that what a patient or family member tells us is the single most important indication of what’s going wrong. We’re not taught to doubt what we’re being told. It takes quite a leap for doctors to even consider that they’re being told falsehoods.
Also, once these cases get rolling, it’s really hard to get them to stop because there may be legitimate medical problems as a result of the surgical interventions or medications the child is on as well as things the mother is doing to the child and those may require medical or surgical interventions.
WebMD: Is it always the mother who harms a child? Do fathers also do this?
Feldman: Studies show that the mother is the perpetrator in 95 percent of cases. In the rest, it is commonly another female caregiver, such as a grandmother or day-care provider. Rarely is it the father.
WebMD: Is this a crime, a mental illness, or maybe both? How do you, as a psychiatrist, understand this behavior?
Feldman: For years and years, we talked about Munchausen by proxy as a form of child abuse in which a caregiver fakes or induces illness in a child because they want attention and gratification. We understood it to be a form of maltreatment, but not a mental illness.
At the same time, we said that if someone made themselves sick in order to get unnecessary treatment, that was a mental illness.
In 2016, the American Psychiatric Association said, in essence, that both are mental illnesses.
Munchausen by proxy is now formally called Factitious Disorder Imposed on Another (FDIOA). I think that’s an unfortunate term. It’s clunky. It also makes it possible for guilty mothers to claim to be the unfortunate victims of mental illness and therefore not responsible for their behavior, when in fact Munchausen by proxy, FDIOA, medical child abuse — pick your term — involves deliberate planning and is not like most other mental illnesses.
I tend to use the term medical child abuse more than any other at this point. I’m of the school that this needs to be understood as abuse, and not, necessarily, as a mental illness. I call them not patients, but perpetrators.
WebMD: You’ve interviewed a lot of people who’ve been charged with this. Why do they do this? How can they do this to an innocent child?
Feldman: That’s a central question that everybody asks because it’s so counterintuitive. We think of mothers as loving and caring. We idealize them. When someone so wantonly ignores their maternal role, it’s very confusing and makes us ask the obvious question: Why?
I’ve talked to a lot of perpetrators, though most of them won’t admit to the abuse, even when you confront them. What these mothers tell me is that they have only a little understanding, themselves, of why they’ve done what they’ve done, even as they engaged in extensive planning to deceive doctors.
I think we can say that most of them are after attention and nurturance and concern that they feel unable to get in any other way. Some of them are depressed or have personality disorders, which simply means they have long-term deficiencies in getting needs met in appropriate ways. They tend to engage in self-defeating behavior. Certainly harming one’s child has the potential to be massively self-defeating.
WebMD: Can this behavior sometimes be fraud? That is, the person doesn’t have a true factitious disorder, but they’re trying to get money or some sort of material benefit?
Feldman: Yes. When someone is feigning, exaggerating or inducing illness in a child and they’re doing it for some tangible gain, such as disability payments, donations or gifts, we call it “malingering by proxy.” That’s not a mental illness; that’s a criminal behavior. What we see in these cases is sometimes a combination, and that may well have happened in the Dallas case, where the mother, primarily is after attention and care, but, secondarily, profits financially.
Sometimes these perpetrators don’t really want to accept donations, but friends say ‘You’ve got to have massive medical bills, let us start a ‘Go Fund Me.’ And it would look funny if the mother said no. It might create suspicions. So they say yes.
WebMD: Do you think this is increasing?
Feldman: Munchausen by proxy is reportable to child protective services, but they don’t keep good statistics. There’s been an estimate that there are about 600 new cases of Munchausen by proxy in the United States each year, but I think that involves a lot of conjecture.
Social media plays an enormous role. In so many of the Munchausen by proxy and even factitious disorder cases where people harm themselves for attention, they’ve created Facebook pages and joined health related support groups and done all they can through the internet to mobilize even more attention. It used to be that Munchausen syndrome or factitious disorder patients had to go from hospital to hospital with excellent acting skills to be able to convince people that they were sick or their child was ill.
Now you can sit in your PJs in your living room and mobilize the same kinds of attention and concern without needing any acting skills at all. All you need is verbal skills. The advent of the internet has probably made this behavior more conspicuous, not less. I think the behavior has become more frequent as the result of social media and the easy access to supportive communities.
WebMD: Is this treatable?
Feldman: I don’t think we have a good grasp of how to break through the wall of denial that these perpetrators manifest. You can show them videotapes that were obtained secretly of them suffocating a child in the hospital or administering a toxic chemical through a bloodline, and they’ll deny they’ve done it. It’s that intractable. When it comes to therapy, you’re disagreeing with the mother about why she’s even in the therapy office, so there’s no opportunity for an alliance that might lead to positive change.
I feel like our primary focus needs to be on prosecution and on the safety of the child. For those mothers who are willing to accept help and admit to the misbehavior, then we can talk seriously about treatment.
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