Cynthia Lyda, a San Antonio woman accused of child abuse, could face as much as 212 years in prison if she is convicted of all the charges against her. Part of her defense, however, is that she suffers from an increasingly well-known psychiatric disorder called Munchausen's Syndrome by Proxy (MSP).

Experts say that this is one of the least understood forms of child abuse and least understood forms of mental illness. MSP is a psychiatric disorder which involves caregivers intentionally harming children so that they can bask in the attention they receive for their own caregiving.

The actual incidence of MSP is difficult to determine. There is a good possibility that there is a lot more of it than we know about. Numerous cases once considered to be caused by Sudden Infant Death Syndrome (SIDS), for example, have recently been determined to be caused by caregivers with MSP.

But, there is also the possibility of over reporting, especially with the increased media attention being given to MSP. There are women who say they have been unfairly accused of MSP who have created an organization to call attention to the incidence of false accusations. They claim that it is all too easy for frustrated doctors who can't find the cause of their child's disease, or who wanted to avoid malpractice suits, to throw around the MSP accusation, with virtually no liability.

The traditional position by most health practitioners is that successful treatment is rare.

Psychiatric treatment is usually refused or circumvented, and it is thought that while the deceits and simulations of the perpetrators are conscious, their motivations for seeking such pronounced attention are not.

MSP is an extremely violent form of child abuse, often going on for years before it is detected. The perpetrators are usually very intelligent and resourceful, and are commonly acquainted with sophisticated medical practices. Characteristic in these cases is an early history of emotional and physical abuse of the caregiver, identity problems, intense feelings, inadequate impulse control, a deficient sense of reality, brief psychotic episodes, and unstable interpersonal relationships.

The caregiver basks in the attention given to them. They stay by the sick child's bed day and night, become involved with hospital staff, and sometimes even gain recognition outside the hospital. Kathleen Bush, whose daughter Jennifer, had 200 hospitalizations and 40 surgeries in her first 8 years of life, was lauded by Hillary Clinton in 1994 at a White House rally. Another woman later found to have MSP, Yvonne Eldridge, was named national "Mother of the Year" in 1988 by Nancy Reagan.

The confrontation of an individual with MSP, must be done carefully. Often, when health practitioners start to suspect an individual, the abuse escalates, and therefore the danger to the child

Once these cases come into the courtroom, the question comes down to whether the caregiver should accept responsibility and therefore the full weight of the legal system for such a horrid course of action, or whether MSP is a valid mental illness, which demands a consideration of diminished responsibility.

For further information:

• Consult Parnell, Teresa F. and Deborah O. Day (Eds.) Misunderstood Child Abuse. Sage Publications, 1997.
• "Munchausen's and the Marybeth Davis"  By Rich Lord

Notes:

Dr. Johns has published three books on criminology. She is a Senior Fellow at the Institute for Law and Society at Florida State University, writes newspaper columns for several newspapers across the country, does radio commentaries for an NPR affiliate, and does a radio program on Crime and Society. She can be reached at Lylajean@prodigy.net.