ABSTRACT
Factitious disorder (FD) imposed upon another or factitious disorder by proxy (FDP) is not a newly established idea or recognition of behavior. Some of the earliest described situations associated with FDP date back to the eighteenth century when the German baron Von Munchausen (1720-1797) entertained friends and neighbors with stories, which over the years became more and more exaggerated and finally quite unbelievable.[1]
When the baron, at the age of 74, married a 17-year-old girl, his wedding night was spent alone and it is said that his bride “danced with another.” Shortly thereafter, the baron’s wife gave birth to a son who was named Polle. It was whispered at that time “the life of the Munchausen child will likely be short.” The child died under suspicious circumstances before he reached his first birthday.[2]
Unusual behavioral patterns among young men gained notoriety in the writings of Charcot, who in 1877 described adults who attempted to gain hospitalization and treatment for self-inflicted injuries or falsified medical documentation. The term “mania operative passive” was coined as a result of this recognized condition.[3]
In 1951, Dr. Richard Asher described a similar pattern of abuse whereby people fabricated illness and traveled from doctor to doctor-inventing false stories or illness causation, which led to complex medical investigations and hospital procedures, including surgeries. Asher coined the term Munchausen syndrome and applied it to this behavior.[4]
In 1977, Dr. Roy Meadow, a British pediatrician, described an extreme form of child abuse in which mothers deliberately induced or falsified reported illness in their children and referred to this behavior as Munchausen syndrome by proxy. Meadow described cases of children who were unnecessarily treated for numerous medical problems that were falsified by their mothers.[5]
Dr. Donna Rosenberg bolstered awareness of Munchausen by Proxy (MBP) with the authoring of Web of Deceit in 1987. Dr. Rosenberg’s research included a review of 117 cases of MBP child abuse and provided intuitive foresight into the potential application of MBP within modern medicine.[6]
During the 1990s, a crossover occurred from the medical profession into the criminal justice system for criminally investigated cases involving an FDP (then known as
Munchausen [syndrome] by proxy) factor. The concept of FDP was virtually unknown within criminal justice circles although recognition and documentation of the behavior had been occurring regularly within the medical field up to that point. Confusion surrounded the concept of FDP, and it largely centered on the descriptor that FDP behavior was a syndrome accompanied with a perception of illness and inferred lack of accountability for a person’s actions. Spirited deliberation occurred as members of the criminal justice system sought criminal prosecution when FDP behavior crossed the threshold into specified willful victimization covertly executed through an unknowing third-party delivery system. Munchausen by Proxy (MBP) dropped the term “syndrome” from the official description of behavior. Initial criminal cases of child abuse and child homicide utilizing the mode of FDP provided understanding that FDP is a delivery system of inflicted harm but it is also a confusion factor for juries. FDP was utilized (ineffectively) as a defense within trial as defendants were portrayed as innocent due to their illness. Substantive charges of criminal victimization acts were muddied with the notion that purported mental illness seen within MPB absolved the defendant of accountability. Over time, the choice was to divest a criminal case of the primary inference upon the delivery system (FDP) of the criminal act and try a case based upon the identified crime. What this did was open the door to further use of FDP as a criminal defense, and prosecutors found that although they may have elected to not introduce FDP, they needed to counter prepare for FDP being raised as a criminal defense. Criminal cases involving an FDP factor were always media sensations, and this is accurate today.
