Munchausen Syndrome by Proxy in the Cinema
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María Lucila Merino Marcos J Med Mov 2 (2006): 10-20 JMM Munchausen Syndrome by Proxy in the cinema. From The Sixth Sense (1999) to A Child's Cry for Help (1994) María Lucila Merino Marcos Departamento de Pediatría del Hospital Universitario de Salamanca (Spain) Correspondence: María Lucila Merino Marcos. Hospital Universitario. Paseo de S. Vicente s/n. 37007. Salamanca (Spain). e-mail: [email protected] Received 6 November 2005; accepted 10 December 2005 Summary One form of child abuse that has been included in the script of several films is the Munchausen syndrome by proxy. The plot of A Child's Cry for Help (1994) portrays a clinical case of this syndrome, while in Chakushin ari/ One Missed Call (2003) it underlies the whole plot, and in The Sixth Sense (1999) it is part of the subplot. Keywords: Munchausen's Syndrome by Proxy (MBP), Child Abuse, Child Maltreatment, Paediatric Condition Falsification (PCF), Personality Disorders.. Many rare illnesses form the core or are part resemblance to Munchausen's Syndrome, which of the screenplay of some films1. One of them is involves people (generally adults) who feign or pro- Munchausen's Syndrome by proxy, a form of child duce symptoms in order to gain admission to hospital. abuse. The impact of this syndrome in the cinema is This syndrome was described in 1955 by Richard scarce. Among the films addressing it in some way are Asher, who named it after Baron Von Munchausen, The Sixth Sense (1999) by M. Night Shyamalan, One the great narrator of invented stories4. Both of them Missed Call/ Chakushin ari (2003) by Takashi Miike and are included within the sphere of factitious disorders2, A Child's Cry for Help (1994) by Sandor Stern. Mama/ characterised by the patient or someone close wanting M.A.M.A. (2003) by Nonny de la Peña and A Boy's to give the impression that there is an illness. Life (2003) by Rory Kennedy and Nick Doob are two Munchausen's syndrome by proxy has attracted huge documentaries whose interest also focuses on this professional interest; in 2004 alone twenty-one articles syndrome. appeared in PubMed. Munchausen's Syndrome by Proxy Munchausen's syndrome by proxy involves two players: the child that suffers the abuse and the This is a serious form of child abuse with person who inflicts it. The American Professional high rates of recidivism and a high mortality. Those Society on Abuse of Children has proposed that they involved are people who take care of the abused child, should be diagnosed respectively as a "paediatric con- usually the mother. The perpetrator gives the impres- dition falsification" and a "factitious disorder by sion that the child is ill, pretending that he or she has proxy"1, 2. symptoms, or even provoking them, so that the child must be sent to hospital and undergo diagnostic pro- In most cases the perpetrator is the abused cedures and invasive therapeutic techniques. It child's mother. She (or he) nearly always alone or involves both the abused and the abuser, who is char- cohabits with a partner who is not really relevant in acterised by not gaining any benefit, unless psycholog- the relationship and hence contact with doctors can ical, from the abuse meted out1, 2. replace this absence of affection. Many such perpe- trators have some degree of medical knowledge: they It was described by the British paediatrician may be nurses, clinical assistants or child carers. This Roy Medow in 19773, who gave this name for its circumstance facilitates not only the actual carrying 10 © Ediciones Universidad de Salamanca María Lucila Merino Marcos J Med Mov 2 (2006): 10-20 through the abuse, because they know how it should best of cases, a diagnosis of abuse is given. On aver- be done, but -worse- it allows them to continue their age, the duration of the abuse surpasses one year. tragic actions in hospital, because they gain the confi- Many of these children suffer physical alterations and dence of the staff, who then allow them to take care nearly all are subjected to psychological abuse, with of the child. The apparent dedication they show sequellae many years later1, 6. Among the damage towards their children leads them to gain the medical elicited is that derived from the health personnel's staff's recognition and that of their family, although actions, induced by the symptoms provoked by the when they are not being watched, of course, they can perpetrator1. continue with their dark deeds. Very often they give a thoroughly detailed and complete case history of their The suspicion of abuse obliges a thorough children. Thus, they are undoubtedly psychologically analysis of the child's case history and those of the or psychiatrically disturbed. Indeed, they often have child's siblings, searching for suggestive information. personality disorders: factitious, somatoform, narcis- Special precautions must be taken with the child's sistic, histrionic and/or borderline. Many of them suf- safety and well-being and also as regards the possibil- fer from Munchausen's syndrome or have been vic- ity of future legal demands. Diagnosis is confirmed by tims of Munchausen's syndrome by proxy in their forensic and toxicological analyses, video surveillance childhood. It is hard to know why they carry out this (depending on the legislation of each country) and type of voluntary, deliberate abuse. One reason that with a "separation test" between the two people might induce them to do it is the need to use the child involved, at which moment the symptoms should pre- as a way to draw the attention of doctors and other sumably disappear. For the diagnosis and handling of health staff. Thus, they assume the role of a patient the syndrome, it is essential to have multidisciplinary through another person. Contrary to other types of teams involving doctors, social workers and lawyers1. abuse, in this syndrome the person responsible for the During treatment it is crucial to separate the child abuse does not gain any profit or benefit for him or from the abuser and ensure future psychiatric treat- herself unless it be psychological1, 2, 5. ment of the perpetrator. It should be borne in mind that the latter, once discovered, may commit suicide6; Most children that suffer abuse are less than evidently, the necessary measures must be taken to five years old, and most of them are infants1, 2, prevent this. although even teenagers may be subjected to it5.In most cases, the abuse is directed at two siblings. THE SIXTH SENSE The symptoms aimed at calling the medical Technical details staff's attention can be feigned, deriving from tamper- Title: The Sixth Sense ing with analysis samples (e.g., by adding blood) or, Country: USA more often, they are induced. Examples of the latter Year: 1999 often involve to obstruction of the respiratory tract or Director: M. Night Shyamalan the administration of exogenous substances. These Music: James Newton Howard usually involve drugs (emetics, laxatives, psychoactive Screenwriter: M. Night Shyamalan drugs, hypoglycaemic agents, etc.), but there may also Cast: Bruce Willis, Haley Joel Osment, Toni be other elements, such as cleaning products and flu- Collette, Olivia Williams, Mischa Barton, ids containing microorganisms. Apart from suffoca- Donnie Wahlberg, Peter Tambakis, Jeffrey tion, direct physical abuse has also been used, involv- Zubernis, Bruce Norris, Glenn Fitzgerald, Greg ing lacerations, changes to the diet, etc. The induction Wood, Trevor Morgan and Angelica Torn. of infection is also frequent5, 6. The abused child Color: Color shows atypical symptoms that do not match known ill- Runtime: 107 minutes nesses and the process is either not controlled or Genre: Drama, Thriller when it seems to be controlled unexpected relapses Production Companies: Hollywood Pic- appear2. The clinical manifestations vary; the most fre- tures, Spyglass Entertainment and The quent ones are apnoea, depression of the CNS, con- Kennedy/Marshall Company. vulsions, vomiting, diarrhoea, fever, exanthema, clini- Synopsis: A child psychiatrist takes as a cal allergies and psychiatric symptoms1. The children patient a child who is suffering from the same illness as a patient whom he previously failed may be admitted to hospital several times and be shut- to cure and who committed suicide after tled from hospital to hospital until in the end, in the shooting him. 11 © Ediciones Universidad de Salamanca María Lucila Merino Marcos J Med Mov 2 (2006): 10-20 The Sixth Sense is a film of drama and intrigue where in a subplot, limited to a single sequence, Munchausen's syndrome by Proxy appears. From the cinematographic point of view, this is a good film that succeeds in what it attempts to portray and has "twists" for the spectator. Bruce Willis' acting is excel- lent. The film Malcom Crowe (Bruce Willis) is a child psy- chiatrist who has just received an award in acknowl- edgment of his professional work. The night he receives the prize, a patient Crowe had treated when the former was a child, and whom he failed to cure, enters his house. After the patient reproaches the psy- chiatrist for his earlier failures, he shoots Crowe and then commits suicide. Soon after, we learn that the psychiatrist treats an eight year old child, Cole Sear (Haley Joel Osment), who has the same symptoms; he sees dead people. He becomes obsessed with the child's condition and even neglects his wife and mar- riage until he manages to cure the child. Munchausen's Syndrome by Proxy in The Sixth Sense As mentioned before, this syndrome is simply a subplot in the film. After a young woman's funeral ONE MISSED CALL/ CHAKUSHIN ARI Kyra (Mischa Barton) , Cole goes to his room.