Jonathan Bandler for Journal-News: There has been much reporting that Lacey Spears fits classic profile of someone with Munchausen by proxy. Do you see that? How might Munchausen by Proxy then be used as part of the criminal case? Have you consulted on any Munchausen cases? Munchausen as a disorder seems to be pushed by prosecutors more often than defense. That seems to be counterintuitive as prosecutors generally shy away from anything that would suggest personality disorder or mental defect, correct?
Dr. Welner: Munchausen by Proxy (MBP) is rare and hard to prove. Because it reflects on the parents as perversely selfish, doctors and caregivers are cautious about bringing such suspicions out in the open. This reluctance creates inherent tension with the mandate to protect children from abuse and indeed, death when actions go too far.
I have worked on MBP matters that culminate in death. There is no particularly narrowed profile of the MBP parent, other than primarily female, immature, overwhelmed and identified with health caregivers as a source of psychological support.
MBP is a necessary approach for prosecutors, because most jurors would never be able to relate to a mother doing this to a child. The explanation to a jury that occurs beyond what they can relate to is a necessary part of educating a jury to consider possibilities beyond their own traditional biases. MBP is never useful to the defense, unless it is provided as an alternative to a prosecutor’s charge that a child was killed out of contempt or because the child represented inconvenience (Susan Smith, Casey Anthony). MBP, properly illustrated, might not make a parent’s actions justified or even understandable, but can illustrate how pathetic a parent must be to relate to others in such a pathological manner.
MBP, however, is premeditated, manipulative at its core, and undeniably selfish. With those qualities, it is a powerful argument for guilt if prosecutors can provide the evidence for it.
Personality disorders are usually seen as qualities that a defendant can control. Illness is, rather, something one may not be able to control. Defense arguments that use psychiatry tend to avoid personality disorder explanations unless the alternative is outright criminal defiance or psychopathy. Prosecutors stay away from mental disorders because they prefer to rely upon facts rather than explanations. Unthinkable crimes, however, beget a jury’s need to understand the unthinkable.
What also distinguishes MBP is that it is typically accompanied by a trail of pediatricians, social workers, and nursing staff who save lives, were the most sincere advocates for the child who was a helpless pawn. This is powerful and credible testimony not readily available to any kind of criminal case. No matter how sympathetic an MBP defendant may appear, (remember that this would be someone who fooled medical staff and could therefore fool a jury), at some point the medical testimony, if prosecutors can present it, is likewise a compelling a countervailing impression of guilt.
