Munchaussen syndrome by proxy (0)

Vahendatud Münchauseni sündroom/Münchauseni sündroom by proxy /Münchausen by proxy sündroom
MSBP on üks laste väärkohtlemise vorm, kus hooldaja vigastab tema hoole all olevat last või nõuab lapsele ohtralt meditsiinilisi teste ja ravi, mille käigus tekib lapsele kahju, olematu, väljamõeldud või liialdatud seisundite tõttu.
MSBP on üks lapse väärkohtlemise vorm, mida esimesena kirjeldas Inglise lastearst Roy Meadow aastal 1977. Sellise nime sai see häire selle sarnasuse tõttu Münchauseni sündroomile, mis on häire, kus inimene tahtlikult tekitab või mõtleb endale välja haigussümptomeid. Rangelt öelduna tähendab MSBP, et inimesel on Münchauseni sündroom ja see psühhopatoloogia avaldub lapse läbi.
Munchaussen syndrome by proxy
Munchausen syndrome by proxy (MSP) is an uncommon disorder first described by Roy Meadow in 1977. It was so named because of its similarity to Mun- chausen syndrome, a factitious disorder in which a person intentionally produces or fabricates physical symptoms in him- or herself .' In MSP the symptoms are intentionally produced o r fabricated in a child by a parent , usually the mother
MSBP is a syndrome in which perpetrators either harm a child in their care or achieve harm through their insistence on medical tests and treatments for non-existent, fabricated or ecacerbated conditions . Abuse may go on for some time, and sometimes this abuse results in the child’s death .
In the strictest terms , Munchausen’s Syndrome by Proxy means that a perpetrator has Munchausen’s syndrome or factitious illness himself /herself and manifests the psychipathology via the child.
Aga kas MSBP on vaimne haigus ja kas kohtul on võimalus tunnistada selliseid vanemaid süüdimatuks/kas kohtul on alust karistust selle võrra kergendada? Vastus on ei. (vaata siin järgi USA, Austraalia ja UK seadusi. Kas nendes riikides on ka vaimne haigus süüdimatuse alus?)
In majority of legal jurisdiction, doctors are only allowed to give evidence in regard to whether the child is being harmed. They are not allowed to give evidence in regard to the motive as it would be prejudicial to the determination of the guilt. Furthermore, It has been specifically established in legal precedents in Australia and the U.K. that Munchausen Syndrome By Proxy does not exist as a medico-legal entity.
About seven years ago, an attorney asked me how much it would cost to assess a mother accused of MSBP. While reviewing the hours I had spent on previous cases , it struck me that I had confirmed the diagnosis of MSBP in only 2 of the 11 cases that I had evaluated up to that time. Two other cases involved tragic deaths, but I considered the Munchausen label inappropriate for them because one mother was mentally retarded and the other harmed her child while in a delirium. Both went to prison , as did another mother for whom I considered MSBP appropriate.
Siin kohal on tähtis see, et kui vanem on vaimselt haige või deliiriumis ja siis teeb oma lapsele haiget, siis ei ole see MSBP.
In a more far-reaching decision , a three-judge panel in the United Kingdom ruled that children , but not parents , can sue those who wrongly conclude they have been the victims of abuse. Considerations barring claims of wrongful diagnosis were swept away by the European Union’s Human Rights Act of 2000.
Kui suuremal osal juhtudest piirduvad sellised juhtumid mitteeluohtlike lapse vigastamisega ühe lapse tapmisega, siis on ka väga ekstreemseis juhtumeid. Ms. Allitt – 13 samaegset eluaegset vangistust. Minimaalne vangistus (mil ta sai aligable for parole ) 30 aastat. Tal olid nii munchhausen kui ka munchhausen by proxy. Tappis palju lapsi. Tema puhul käsitleti seda kui vaimset haigust ja pandi hoopis haiglasse.
Justice Burnton observed that to give a pattern of criminal behaviour a name, namely Munchausen Syndrome by Proxy, „does not of itself lessen the responsivility of the offender . One could say that a multiple rapist exhibits multiple rape syndrome, but that would not of itself lessen his criminal responsibility and should not of itself lead to a lesser sentence“.
Certain characteristics are common in a person with MSP:

• Often is a parent, usually a mmother, but can be the adult child of and elderly patient
  
• Might be a healt care proffesional
  
• Is very friendly and cooperative with the healt care providers
  
• Appears quite concerned (some might seem overly concerned) about the child or designated patient
  
• Might also suffer from Munchausen syndrome (this is a related disorder in which the caregiver repeatedly acts as if he or she has a physical or mental illness when he or she has caused the symptoms.)
  

Other possible warning signs of MSP in children include the following :

• The child has a history of many hospitalizations often with a strange set of symptoms.
  
• Worsening of the child’s symptoms generally is reported by the mother and is not witnessed bu the hospital staff
  
• The child’s reported condition and symptoms do not agree with the results of diagnostic tests.
  
• There might be more than one unusual illness or death of children in the family.
  
• The child’s condition improves in the hospital, but symptoms recur when the child returns home.
  
• Blood in lab samples might not match the blood of the child
  
• There might be signs of chemicals in the child’s blood, stool, or urine.
  

Ray Meadow: my experience of mothers who have abused their children in this way is that the graeat majority do not set out with the purpose of causing their children suffering and harm. In a very strange way, they are able to shut out their minds to the suffering their child is incurring. It is as if the benefit they get personally from their actions completely outwighs and is separate from what the rest of us observe, which is terrible harm and suffering for the child.
Muchausen disorder, named after and infamous Baron von Munchausen (1720-90), a retired mercenary who entertained his weekend estate guests with fabulous tales. But „by proxy“ indicates that individuals are harming or claiming fabricated illness in another, usually a child.
There are four key elements of MSBP commonly referred to in the child-abuse-centered literature ; notably these focus on the impact of the conduct on the child. First, the child’s illness is simulated or produced by a parent, usually the mother, or someone acting in a caregiver role . Second, the child is repeatedly brought forward for medical evaluation and treatment. Third, the perpetrator denies any knowledge of the cause of the illness. Fourth , when the child and the perpetrator are separated, the medical issues cease.
MSBP was formally acknowledged by the American Psychiatric Association in 1994 when it was entered in the Diagnostic and Statistical Manual (DSM-IV) under the general title, Factitious Disorder by Proxy.
Herbert Schreier MD, who is Director of Psychiatry at a California children’s hospital and author of a book on MSBP, observes that MSBP presents „a haunting paradox“ ... (combining) two of society’s most intensely emotional yet diametrically opposed states , „ good mothering“ and „callous child endangerment“, practised simultaneosly by the same peson.
In part because of the difficulties associated with providing a contested psychiatric syndrome in the criminal law contect, „the dominant framework for (legal) action (has been) child protection , not the mental healt of the mother“, althought expert evidence of MSBP is introduced to support legal responsibility.
Finding of „neglect“ or child endagerment, for example, fit more neatly into existing legal frameworks and overcome the need to prove the diagnosis of a parent who is hostile.
MSBP mothers:

• Remaining uncharacteristically calm in view of the victim’s perpexing medical sympoms;
  
• Welcoming medical tests that are painful to the child;
  
• Having an unusually close relationship with the hospital’s medical staff;
  
• Praising medical staff excessively;
  
• Allowing only selected persons close to their children;
  
• Maintaining a high degree of attentiveness to the child;
  
• Having a history of the same type of illness as the child;
  
• Adamantly refusing to accept the suggestion that the diagnosis is nonmedical;
  
• Having previous medical or healtcare experience
  

Siin võib ära märkida, et kuigi võivad tavalised emad ka nende iseloomulike joontega olla, siis siin saab nende joontega vahet teha näiteks sellel, mis olid ema motivatsioonid. Kui on näiteks teada kindlalt, et ema last vigastas, siis Munchausseni sündroomi olemasolu sõltub sellest, kas ema vigastas seda last lapse vigastamiseks mingitel sadistlikel põhjustel või oli see põhjus seotud tähelepanu saamisega.
Should the law address MSBP as just a partivcularly vicious form of child abuse or as a psychiatric disease that prevents the mother from exercising proper judgement... (thus forming ) a mitigating factor in the defendant’s cuplability.
Mother’s reason to do it: ...many having to do with the perpetrator’s own early experiences of traumatic events and disturbed attachment systems. The child’s body is, for the MSBP mother, an extension of her own, yet the links to her own psychic injury are not consciously accessible to her.