Authors of a recent report
do not speculate on variations in time or between cultures, which might give a
clue as to the possible causes.
by Theodore Dalrymple
One of the things that medical practice teaches the observer of
human nature is that no behavior is so bizarre that humans are incapable of it
and will not indulge in it. Indeed, they often seem to take delight in
inventing new forms of destructive and self-destructive conduct to assert their
freedom from the dictates of reason and good sense. I have not been entirely
immune from this tendency myself.
Among the stranger patterns of behavior that doctors encounter is
that of parents, overwhelmingly mothers, who deliberately exaggerate, make up,
or physically induce symptoms in their young children so that they are
investigated, often extensively, by doctors. The first two mothers whom I ever
encountered who did this put blood in their child’s urine and interfered with
thermometers in order to make it appear that their child was suffering from
fever.
An article in a recent edition of the Lancet reviews what
is known about this very odd and dangerous conduct (6 percent of children whose
mothers induce symptoms in them are eventually killed by them, and 25 percent
of them have siblings who have died in suspicious circumstances).
How common is this behavior? The article reviews the various
estimates. In part it is a matter of definition, which is why the estimates
vary between 2 and 89 per 100,000 children. This variation alone suggests a
dimensional rather than a categorical phenomenon. An Italian study found that
0.5 percent of children seen in a pediatric clinics were the victims of
factitious illness reported or induced by their parents. The authors do not
speculate on variations in prevalence in time or between cultures, which might
give a clue as to the possible causes of this conduct. The data are simply
insufficient for them to comment.
Why do mothers do it? Various motives have been suggested, by no
means mutually exclusive. An excessively anxious mother may exaggerate or
fabricate symptoms in order that the doctor pays more attention to the child.
She may wish to have her beliefs about the child’s health confirmed, in some
cases beliefs that are frankly delusional. The mother may wish for attention,
hence needing to dramatize her child’s condition. She may wish to maintain a
pathological closeness to the child and keep it in a state of complete
dependence. Finally, the social security system may provide money for mothers
with sick children.
The mothers are, not surprisingly, usually rather odd. Many of
them have suffered from psychosomatic or factitious illness themselves.
Interestingly, the children of women with psychosomatic disorders attend
pediatric clinics more frequently than do those of mothers with proven physical
disease. To adapt slightly Philip Larkin’s line, “Man hands on misery to man,”
mother hands on misery to child.
Can anything be done, other than to separate mother and child?
Those perpetrators who do not admit to what they have done, minimize it, or
explain it away, remain dangerous. A fifth of perpetrators repeat their acts
even after exposure. Only perpetrators who acknowledge their acts are likely to
desist. One is reminded of the old joke about how many psychiatrists does it
take to change a light-bulb? Answer: one, but the light bulb has to want to
change.
One form of this strange conduct that the authors do not mention
is the induction by mothers of chronic fatigue in their young children. In
severe cases this can lead to a child being bedbound for years without there
being any physiological reason for it – though the fatigue grows with the
resting. A possible reason for this omission was the authors’ wish to avoid the
vituperation, often extremely fierce and sometimes nasty, of what might be
called the Chronic Fatigue Syndrome lobby.
****
Theodore Dalrymple, a physician, is a contributing editor of City Journal
and the Dietrich Weismann Fellow at the Manhattan
Institute. His new book is Second Opinion: A Doctor's Notes from the Inner City.
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