Munchausen By Proxy By Internet

March 10, 2015


Did the Internet Help Cause the Death of a Five Year Old Boy?


Garnett Spears spent much of his short life in and out of hospitals. His mother, Lacey, moved him from town to town and doctor to doctor as he got sicker and sicker with a mysterious illness. Last year, he died at the age of 5. Last week, Lacey was convicted of second-degree murder for his death. Prosecutors alleged that she had been poisoning her son with high doses of sodium through a feeding tube in his stomach, then carting him to the hospital to elicit sympathy from doctors and friends.


In 1951, a British doctor named Richard Alan John Asher coined the term “Munchausen syndrome” to refer to patients who feign or induce illness in themselves for no obvious reason. (It’s distinct from “malingering,” where a person fakes or induces illness for a tangible goal, like convincing a doctor to prescribe a certain medication or securing a favorable court verdict.) By 1977, researchers had identified a new permutation of the syndrome—“Munchausen by proxy”—wherein the subject fakes illness in another person; one of the first recorded cases involved a mother who, like Spears, poisoned her toddler with sodium. But Spears didn’t just poison Garnett; she also tweeted about his illness (@GarnettsMommy), blogged about it (“Garnett’s Journey”), and documented it with photographs posted to MySpace. Some argue that Spears was exhibiting an even newer form of Munchausen than had previously been identified: “Munchausen by proxy by Internet.”


The Diagnostic and Statistical Manual of Mental Disorders—the industry guidebook produced by the American Psychiatric Association—recognizes the Munchausen-like disorders “Factitious Disorder Imposed on Self” and “Factitious Disorder Imposed on Another,” but it includes no specific entry for cases that play out over the Internet. In fact, none of the hundreds of disorders outlined in the DSM reference Internet-specific ailments; the APA does not recognize “Internet Addiction” or “Online Gambling Disorder” or “Internet Gaming Disorder.”


Internet-related behaviors are so new that there’s little scientific consensus on how they fit into established underlying disorders.


Dr. Marc Feldman, a psychiatrist and a leading Munchausen researcher, coined “Munchausen by Internet” in 2000 to refer to cases with an online element. Since then, the term has been popularized by Wikipedians and journalists, inspiring deep dives in the Village Voice, the Stranger, Gawker, and Wired. But in the psychiatric community, the idea of updating the literature with Internet-specific diagnoses is controversial. While some doctors believe that psychiatric classifications need to keep pace with new technologies in order to properly diagnose modern patients, others argue that such “diagnostic inflation” risks stigmatizing novel human behaviors—like spending a lot of time online—instead of focusing on the psychiatric root of the problem. The conflict, in other words, lies between those who believe that the Internet has the power to inspire new disorders affecting the human brain, and those who see it as just a new vehicle for expressing old mental illnesses.

“The Internet is impacting everything in society, and it’s moved so fast that the field of medicine, including psychiatry, is struggling to catch up,” says Jeffrey Lieberman, Chairman of Psychiatry at the Columbia University Medical Center and a former president of the AMA. But at the same time, “we don’t want to call every new fad or cultural change an illness, because there’s little value in pathologizing the great diversity of normal human behavior.”


In 1840, the U.S. census recognized just two categories of mental disorders: “insane” or “idiots.” As medical science progressed, doctors were able to distinguish illnesses more precisely, and as environmental factors shifted, new complications arose: DSM-approved disorders like “Tobacco Use Disorder” and “Caffeine Withdrawal” did not exist before humans started smoking cigarettes and drinking coffee.


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Article courtesy of by Amanda Hess


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