Keeping Faith Read online

  "The majority of victims of Munchausen by Proxy are children. Most often, a mother artificially creates or exaggerates symptoms in a child, and then presents the child for medical care claiming to have no knowledge about the etiology of the problem. The theory of mental-health professionals is that these women do not want to inflict pain on a child, but to indirectly assume the role of the sick person--by getting sympathy from doctors whom they encounter when they bring in the ailing child."

  "Whoa," Metz says. "Let's take this a little more slowly. You're saying that the mother makes her own kid sick, just to get attention?"

  "That's exactly what it boils down to, Mr. Metz. And making a child sick would be the simpler end of the spectrum. Some mothers contaminate urine samples with blood, create leaks in an IV, or suffocate newborns. Munchausen Syndrome by Proxy is considered a form of child abuse, and there's a nine-percent mortality rate."

  "These mothers kill their children?"

  "Sometimes," Dr. Birch says. "Unless they can be stopped."

  "What are some of the ailments produced by these mothers?"

  "Bleeding presents in forty-four percent of MSP cases. Then seizures, forty-two percent. Followed by central-nervous-system depression, apnea, and gastrointestinal disorders. Not to mention psychological symptoms."

  "Can you tell us what might trigger this behavior in a mother?"

  The doctor shifts in his chair. "Remember, this isn't going to happen to ninety-nine percent of mothers--it's not like a flu virus you come down with. These women are disturbed. Often it's triggered by life stressors--marital conflict, divorce. Perpetrators may have a history of being abused themselves, and they often have some exposure to medical communities, so they know the ins and outs and the lingo. They need--no, they crave support and attention. To them, being sick is a way of being loved and cared for."

  "You said psychological symptoms can be produced in a child, too? Can you explain?"

  "By symptoms, I mean hallucinations or delusions; memory loss or amnesia; or conversion symptoms, like pseudoblindness. It's harder to understand how a mother can 'fake' them in a child, but basically it involves the mother selectively reinforcing maladaptive behavior. For example, she may provide tremendous nurturing when the child reports a vivid dream and ignore or harm a child when the child is acting perfectly normal. Eventually, the child will learn to give her mother what she wants, so to speak."

  "Would it make a difference if that child had only one parent living with her?"

  "Absolutely," Birch says. "In fact, it makes parental approval that much more integral."

  "So an alleged vision is something that might be reinforced in MSP?"

  "Yes, although you'd be more likely to find delusions and hallucinations reinforced in a child if the mother has had some personal experience with either delusions or hallucinations."

  "Such as a mother who spent time in a mental institution?"

  Dr. Birch nods. "Entirely consistent."

  "Doctor, what happens if the mother is confronted with her behavior?"

  "Well, they lie and say they're not doing it. In rare cases, the mother may honestly be unaware of her behavior, because she's unconsciously harming the child during a dissociation that occurs as a result of earlier trauma."

  "You mean that you could ask these women flat-out if they're hurting their children, and they'll tell you no?"

  "They'll all tell you no," Birch says. "It's part of the symptomatology for this disorder."

  "So a woman who seems shocked, confused, even righteously angry when confronted with this behavior--a woman with no memory of harming her child--might still have done it?"

  "That's correct."

  "I see," Metz says slowly. "How do you diagnose MSP, Doctor?"

  Dr. Birch sighs. "Carefully, Mr. Metz, and not often enough. Remember, the ones with the presenting symptoms are the children--and they're not going to tell you what's happening, because it's what buys the mother's love. Parents are the primary informants for doctors, who assume their honest report of a child's illness. But most physicians don't make the mental leap and move from trying to diagnose the child to diagnosing the parent.

  "Moreover, these mothers don't exactly have scarlet letters on their chests. They deny harming the child and ironically look rather attentive to the child. One way a health-care provider can be tipped off to MSP is to see a long, complicated medical history. Or a description of symptoms that's almost too textbook. Or, in the case of psychological symptoms, to discover that administering drugs doesn't help a whit...since these children of course are not truly psychotic." Birch leans back. "But the only conclusive way to diagnose MSP is to catch the mother in the act--with video cameras rigged in hospital rooms--or to remove the child from the mother's care. Presumably, if it's Munchausen Syndrome by Proxy, the acute illness will remit once the child is taken away."

  "Doctor, have you seen Faith White?"

  "No, but not for want of trying. I tried to get access to her hospital room three times today but was told she was too ill to speak to me."

  "Have you interviewed Mariah White?"

  "No, I've reviewed information on her institutionalization and her current mental health."

  "Does Mariah White fit the profile of a perpetrator of MSP?"

  "In many ways. The behaviors in her child ensued after a period of great personal stress. Mrs. White has seemed a concerned parent, taking her daughter for psychiatric treatment--which, note, did not respond to drug therapy--and to the emergency room. And perhaps what is most telling, in this case, is the choice of stigmata as a presenting ailment. Bleeding is easy to produce in a victim, yet stigmata are fairly brilliant. It has to be a symptom with a textbook description, because there aren't any chronicled cases. What physician can say that the child's not a stigmatic, when he's never seen one in his life?"

  "Is that all, Doctor?"

  "No. Mrs. White also has a history of mental-health problems. As a result of marital stress, she attempted to commit suicide--and suddenly a hundred doctors and nurses were there for her support. On some level she equates being loved and taken care of with attention from health-care personnel. Which could explain why, when a similar marital stress occurred, she began to make her child sick. Every time she brings Faith in to be treated, Mrs. White herself, by proxy, receives the attention she got seven years ago from doctors and psychiatrists."

  "Could she be hurting her daughter and not know it?" Metz asks.

  The doctor shrugs. "Not having examined her, it's difficult to say. But it's possible. Mrs. White suffered from severe depression before, and the shock of finding her husband involved in another extramarital affair might be enough to cause a dissociative break. Rather than face the pain all over again, she absents herself mentally. It's during these episodes that she feels most neglected, and therefore it's during these episodes that she harms her daughter."

  "What do you imagine would happen if you confronted Mrs. White with this behavior?"

  "She'd flatly deny it. She'd be very upset that I would accuse her of something so heinous. She'd tell me that she loves her daughter and only wants her to be healthy."

  Metz stops at the defense table. "Dr. Birch, as you know, Faith is in the hospital. If her mother were allowed no contact with her for a period of time, what would you expect to happen?"

  The psychiatrist sighs. "I wouldn't be at all surprised to see Faith White bounce back to health."

  December 3, 1999--Late afternoon

  After the court empties, Joan and I are left sitting alone. "What are you going to do now?" she asks.

  "I'm not going to go to the hospital, if that's what you mean."

  "It wasn't. I just...well, I didn't know if you had other plans."

  I smile at her. "I was thinking of going home, taking a hot bath, and then sticking my head in a gas oven."

  "Not funny." She touches my arm. "Do you want me to call Dr. Johansen for you? I'm sure, given the circumstances, he could squeeze you in for an ap