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Writer's Answer

Virginia T. Sherr, M.D.

ABSTRACT

Reprinted with permission from Medical Hypotheses. 2005;65(5):440–447

May 27, 2005

Preface to the article

By Eric G. Mart, Ph.D., ABPP (Forensic)

Munchausen’s syndrome by proxy (also known as Factitious disorder by proxy) is a diagnosis that lacks scientific validity. Unfortunately, it still occurs for any number of reasons, among which are its uses of psychological profile data with untested reliability and validity, confirmatory bias, and over-inclusiveness of the diagnosis, just to name a few. However, the starting point for making the putative diagnosis rests on a physician’s decision that a possible MSBP victim does not suffer from the disease in question. All discussion about motives, underlying psychopathology and other issues follows from this judgment.

The paper, Munchausen’s Syndrome by Proxy and Lyme Disease: Medical Misogyny or Diagnostic Mystery? makes it clear that there are significant differences of opinion among physicians with regard to the signs, symptoms and medical course of diseases, most notably Lyme disease. Such disagreement assures an inevitability that parents, especially mothers, whose children suffer from this or similar conditions will be placed at risk for allegations of child abuse, particularly in the present atmosphere in which MSBP is the “disease du jour.”

In promulgating a hypothesis that the MSBP label may be mostly about misplacement of responsibility for lack of medically significant diagnoses onto innocent mothers, this article performs an important service for children and their parents who suffer from these conditions

— Eric G. Mart, Ph.D., ABPP (Forensic)

Eric G. Mart, Ph.D., ABPP is a licensed psychologist in private practice treating patients in Manchester, New Hampshire, USA. He is board certified in forensic psychology, is an internationally known expert on Munchausen’s syndrome by proxy, and the author of Munchausen’s Syndrome By Proxy Reconsidered, In his forensic work, Dr. Mart emphasizes investigative techniques based on empirical research and established protocols.

Chronic, tertiary Lyme disease, a vector-borne infection most accurately designated neuroborreliosis, is often misdiagnosed. Infectors of the human brain, Lyme borrelial spirochetes are neurotropic, similar to the spirochetes of syphilis. Symptoms of either disease may be stable and persistent, transient and inconsistent or severe yet fleeting. Characteristics may be incompatible with established knowledge of neurological dermatomes, appearing to conventional medical eyes as anatomically impossible, thus creating confusion for doctors, parents and child patients.

Physicians unfamiliar with Lyme patients’ shifting, seemingly vague, emotional, and/or bizarre-sounding complaints, frequently know little about late-stage spirochetal disease. Consequently, they may accuse mothers of fabricating their children’s symptoms-the so-called Munchausen’s by proxy (MBP) diagnoses.”

Women, following ancient losses of feminine authority in provinces of religion, ethics, and healing-disciplines comprising known fields of early medicine, have been scapegoated throughout history. In the Middle Ages, women considered potentially weak-minded devil’s apprentices became victims of witch-hunts throughout Europe and America. Millions of women were burned alive at the stake.

Modern Medicine’s tendency to trivialize women’s “offbeat” concerns and the fact that today’s hurried physicians of both genders tend to seek easy panaceas, frequently result in the misogyny of mother-devaluation, especially by doctors who are spirochetally naïve. These factors, when involving cases of cryptic neuroborreliosis, may lead to accusations of MBP.

Thousands of children, sick from complex diseases, have been forcibly removed from mothers who insist, contrary to customary evaluations, that their children are ill. The charges against these mothers relate to the idea they believe their children sick to satisfy warped internal agendas of their own. “MBP mothers” are then vilified, frequently jailed and publicly shamed for the “sins” of advocating for their children. In actuality, many such cases involve an unrecognized Lyme borreliosis causation that mothers may insist is valid despite negative tests.

Doctors who have utilized MBP tactics against mothers are likely to be unaware that in advanced borreliosis, seronegativity is often the rule, a principle disagreed upon by its two extant, published, peer-reviewed, Standards of Care. These are guidelines for Lyme disease management--the older system questioning the existence of persistent Lyme and the newer system relying on established clinical criteria.

Mothers must be free to obtain the family’s preferred medical care by choosing between physicians practicing within either system without fear of reprisal. Doctors and mothers together may then explore medical options with renewed mutual respect toward the best interest of children’s health.

DOI information: 10.1016/j.mehy.2005.04.009

Private Practice of Psychiatry,
47 Crescent Drive, Holland, PA 18966–2105, USA
vtsherr@comcast.net

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