When Sandy Greenhough had to hospitalize one of her three children, the experience was distressing. But the worst was yet to come.
Greenhough was accused of being a "Munchausen mother" who was deliberately causing her 4-year-old son's illness. The accusation, and the resulting legal wranglings, left her family emotionally and financially devastated.
"They make you out to be some kind of monster mom," she said. "That label feels like it's stuck with you for the rest of your life."
But Greenhough, who says her son suffers from several conditions including gastroesophageal reflux disease, was determined to fight back. "I decided that I would no longer play the victim and I would stand up for what I believed," she said. "I knew I was not a monster mom."
Munchausen: Tough Love
Munchausen by proxy describes parents — usually mothers — or other caretakers who intentionally sicken or injure children, then request multiple medical procedures to address the problems they inflict.
The name is derived from Baron von Munchausen, an 18th-century traveler who told grandiose stories of his adventures.
There are a number of different theories regarding the origins of MBP behavior. Some believe the women who sicken their children are seeking attention from medical professionals or affirmation of their roles as good mothers.
But a growing number of accused women are disputing accusations of MBP, claiming allegations of this rare form of abuse have turned into a witch hunt.
They argue that MBP has become a conveniently applied label in cases where doctors can't make a diagnosis, or feel a parent has become too aggressively involved in a child's treatment. In other cases, skeptics say, MBP has been used as a weapon in child custody disputes.
Come to MAMA
To help families facing MBP accusations, Julie Patrick of Byhalia, Miss., founded Mothers Against Munchausen Accusations following the death of her infant son, Philip.
In 1996, officials at Vanderbilt University Medical Center in Nashville, Tenn., suspected Patrick of being a Munchausen mother, she said. One month after the Tennessee Department of Children's Services separated her from Philip, he died from causes related to numerous birth defects including gastrointestinal problems.
"I started the MAMA Web site six months after the death of my son. I promised Philip that I wasn't going to let him die in vain. I didn't want his life to be nothing more than a nightmare," she said.
"And it was a way of finding others [accused of MBP] and to know that you're not alone," Patrick said. "There's a feeling of being totally alone when you face this accusation."
When Greenhough was faced with an accusation of MBP, the British Columbia woman turned to MAMA for information and support. The group helped her get in touch with a lawyer experienced in MBP cases. In the end, she was able to keep her family together.
Videotaped Proof of Abuse
But experts warn that MBP is no imaginary phenomenon.
There are an estimated 1,200 newly recognized cases of MBP a year in the United States. In cases where the abuse goes unchecked, children can be permanently disabled or even killed.
Munchausen investigators say there have been cases in which mothers dose children with medications prescribed by several different doctors, intentionally break their children's bones, or spray oven cleaner on the youngsters' skin to induce a severe rash.
One mother was secretly videotaped in her child's hospital room putting nail polish remover in her daughter's feeding tube.
Because of these horrific examples of child abuse, many are concerned about the growing movement to discredit experts in the field and deny the existence of MBP.
"It's a backlash," said Dr. Marc D. Feldman, a psychiatrist and author of Playing Sick? Untangling the Web of Munchausen Syndrome, Munchausen by Proxy, Malingering, and Factitious Disorder.
"Like child abuse in the 1950s, we thought it didn't exist in the U.S.," he said. "People thought these reports [of child abuse] were coming from overzealous doctors. Now we have the very same phenomenon with Munchausen. History's repeating itself."
Experts also fear that some MAMA members are too extreme.
"They bathe themselves in the language of the religious right," said Feldman. "The time for the backlash came, and now it's time for it to go."
Louisa Lasher, a private forensic specialist and co-author of Munchausen by Proxy: Identification, Intervention, and Case Management, has had her own experiences with MAMA.
"MAMA is largely a hate and discontent group, composed largely of those who say they have been falsely accused of MBP," she said. "A main focus of this group appears to be to destroy MBP experts, and to destroy the idea that this kind of maltreatment exists."
But Patrick vehemently denies that MAMA is out to destroy any experts.
A statement on the group's Web site says, "Our mission is to stop the assault on innocent parents from [MBP] allegations and to reveal the ulterior motives of the accusers … and hold accountable any physician who acts as judge and jury."
MAMA's Web site also acknowledges that cases of actual child abuse do exist and should be investigated when real evidence of abuse exists.
Is There a Munchausen Profile?
Even experts acknowledge MBP is a difficult assessment to make.
"There are many misconceptions regarding MBP. One misconception is that MBP is a mental health diagnosis. It is not," said Lasher.
"Another misconception is that there is some kind of profile — or combination of personal characteristics — that can determine whether or not someone is an MBP perpetrator," she said. "There is no such profile."
The American Psychiatric Association lists MBP only in the appendix of its Diagnostic and Statistical Manual, not in the main body of the manual.
"We refer to it as a form of abuse, not a mental disorder," said Feldman. "There's no test you can do [for MBP]. It requires further study before it's classified as a mental disorder."
Lasher also recognizes that mistakes have been made in confirming cases of MBP. She says one of the inherent difficulties in investigating these cases is their rarity, and cases of MBP require a complex confirmation process.
"MBP maltreatment is a very specialized field," she said. "There are few people in the world, unfortunately, who know how to — and have time to — complete a thorough and objective MBP maltreatment confirmation-disconfirmation process. I am regularly involved in cases where a determination has already been incorrectly made."
Feldman, too, acknowledges there have been false determinations of MBP.
"In 3.5 percent of published cases, the diagnosis of Munchausen was misapplied," he said. "But that means in 96.5 percent of cases, it was accurately applied."