One of the things that medical practice teaches the observer of human nature is that no behavior is so bizarre that humans are incapable of it and will not indulge in it. Indeed, they often seem to take delight in inventing new forms of destructive and self-destructive conduct to assert their freedom from the dictates of reason and good sense. I have not been entirely immune from this tendency myself.
Among the stranger patterns of behavior that doctors encounter is that of parents, overwhelmingly mothers, who deliberately exaggerate, make up, or physically induce symptoms in their young children so that they are investigated, often extensively, by doctors. The first two mothers whom I ever encountered who did this put blood in their child’s urine and interfered with thermometers in order to make it appear that their child was suffering from fever.
An article in a recent edition of the Lancet reviews what is known about this very odd and dangerous conduct (6 percent of children whose mothers induce symptoms in them are eventually killed by them, and 25 percent of them have siblings who have died in suspicious circumstances).
How common is this behavior? The article reviews the various estimates. In part it is a matter of definition, which is why the estimates vary between 2 and 89 per 100,000 children. This variation alone suggests a dimensional rather than a categorical phenomenon. An Italian study found that 0.5 percent of children seen in a pediatric clinics were the victims of factitious illness reported or induced by their parents. The authors do not speculate on variations in prevalence in time or between cultures, which might give a clue as to the possible causes of this conduct. The data are simply insufficient for them to comment.
Why do mothers do it? Various motives have been suggested, by no means mutually exclusive. An excessively anxious mother may exaggerate or fabricate symptoms in order that the doctor pays more attention to the child. She may wish to have her beliefs about the child’s health confirmed, in some cases beliefs that are frankly delusional. The mother may wish for attention, hence needing to dramatize her child’s condition. She may wish to maintain a pathological closeness to the child and keep it in a state of complete dependence. Finally, the social security system may provide money for mothers with sick children.
The mothers are, not surprisingly, usually rather odd. Many of them have suffered from psychosomatic or factitious illness themselves. Interestingly, the children of women with psychosomatic disorders attend pediatric clinics more frequently than do those of mothers with proven physical disease. To adapt slightly Philip Larkin’s line, “Man hands on misery to man,” mother hands on misery to child.
Can anything be done, other than to separate mother and child? Those perpetrators who do not admit to what they have done, minimize it, or explain it away, remain dangerous. A fifth of perpetrators repeat their acts even after exposure. Only perpetrators who acknowledge their acts are likely to desist. One is reminded of the old joke about how many psychiatrists does it take to change a light-bulb? Answer: one, but the light bulb has to want to change.
One form of this strange conduct that the authors do not mention is the induction by mothers of chronic fatigue in their young children. In severe cases this can lead to a child being bedbound for years without there being any physiological reason for it – though the fatigue grows with the resting. A possible reason for this omission was the authors’ wish to avoid the vituperation, often extremely fierce and sometimes nasty, of what might be called the Chronic Fatigue Syndrome lobby.