Some folks lie about their symptoms. Since all psychiatric diagnoses are based on historical information, along with a mental status examination, a patient can skillfully convince a doctor that he/she has a particular syndrome. When this process is done to obtain a secondary gain such as federal disability or an insurance settlement, we call this Malingering. When a person does it for unconscious reasons, then we call it factitious disorder. When a parent creates an illness in a child, and then denies that she does this, we call this Munchausen by Proxy; I call it heart-stopping child abuse.
Anna’s eight year old son, Don, has ADHD. Although all psychiatric diagnoses are open to suspicion, Don has problems focusing, problems sitting still, and problems with impulsivity, in all settings: home, friends and school. Anna did not cause Don’s ADHD, but she acts as if Don’s disability has given her a focus (pun intended) that has long been missing in her life. Anna worked as a corporate attorney for ten years before she had Don and her second son Anthony. Her husband, also an attorney, suggested that she stop working to take care of her kids. She, without much thought, agreed. Anna works out, she has friends, but ever since she stopped working, she has felt that a gaping hole in her mental well-being. She had a hard time explaining this feeling to her husband, to her friends and to her family, since to them, Anna’s life was the dream life. She had time to herself; she had time to be there for her kids, her husband and her friends. Anna’s quiet sense of emptiness persisted until Don started having behavior problems at school. Suddenly, Anna was mobilized into action. She needed to mobilize a team to help Don. She needed to investigate the best schools, the best professionals, the best doctors. This “project” as she called it, quickly made her feel like she was using her research skills, her interviewing skills and her management skills.
Anna is not abusing Don; she is helping him. At the same time, she is exhibiting the same characteristics of mothers who are guilty of Munchausen by Proxy. These mothers go from what they perceive to be a mundane existence, to one where they have to deal with doctors, physical therapists, occupational therapists and nurses. Their child is “sick” and no one knows what is wrong with him/her. This puzzle creates a challenge; a secretly needed challenge.
Maybe if we, as a society, recognized the challenges of parenting, the need in some parents, to explore many aspects of their brain in parallel, the need to multi-task, then perhaps we could help parents accept that raising children may not feel like “enough” to keep them satisfied. I wonder if accepting how brains need to be satisfied, mother’s brain and baby’s brain, then maybe we could decrease child abuse. I wonder.