Seattle-based author Andrea Dunlop created a podcast that recently caught our attention. “Nobody Should Believe Me” explores Munchausen’s psychological state vicariously. Dunlop spoke to KUOW’s Kim Malcolm about her journey around this little-understood syndrome.
This interview has been edited for clarity.
Kim Malcolm: We’re not going to be able to get close to the full scope of what you present in your series. But let me start by asking you to define Munchausen syndrome for us.
Andrea Dunlop: Munchausen is the best-known name for the clinical diagnosis of factitious disorder, which is when someone exaggerates, invents, or even induces illnesses in themselves for the express purpose of sympathy and attention.
You dive even deeper into that. You watch Munchausen by proxy. How is this different from the larger syndrome?
Munchausen by proxy is really a term for two separate things. One is an underlying psychiatric disorder called factitious disorder imposed on another. The other is the act of medical child abuse. It’s when a parent or caregiver exaggerates, invents, or induces illnesses in a child, again, with that same intrinsic motivation to get attention and sympathy.
What does it look like, Munchausen by proxy?
It really can encompass quite a wide range. We see a lot of premature births and feeding problems that come after that. We see a lot of respiratory problems. Seizures are another thing that comes up. Often seizures that no one else sees except the caregiver who reports them. So really, anything that would be primarily based on a caregiver-to-doctor ratio.
It is truly an alarming and surprising condition to consider. How did you come to create this series and host the show?
I have a personal history with this subject. My sister has been investigated for medical child abuse twice. She was never charged with a crime. I want to make sure to mention it. This first survey took place about 12 years ago, so we have a long history with it. I wrote a novel called “We Came Here to Forget” which came out in 2019. Munchausen by proxy was a subject in that novel.
When I was doing press for this book, I met an amazing expert called Dr. Marc Feldman. He’s someone we interview on the podcast. He introduced me to an incredible group of experts that is part of the American Professional Society on the Abuse of Children (APSAC). They have a proxy Munchausen committee. I met them and I am now a member of this committee. They really do an amazing job on this.
As I was hearing all these incredible, fascinating, heartbreaking stories about these other Munchausen cases by proxy, and really having these in-depth conversations with these experts, and really wanting to find a way to make their work more accessible to the audience, I just thought it would be perfect for a podcast. It was two years ago.
Part of what you explore in this series is the question of how common or rare these cases are, which I know is part of a larger story, but what did you find in your exploration ?
One of the biggest lessons for me from doing this podcast was really the discovery that none of the experts we spoke to think this abuse is rare. They believe it is very rare for him to be caught, and even rarer for there to be a successful criminal conviction. But when it comes to actual abuse, every expert I spoke to was unanimous in saying they don’t think it’s uncommon. They think it’s comparable to other child abuse rates. It was a huge revelation for me.
I wonder what happens to these children. How do we hear about them?
I spoke to a number of adult survivors. The reality is that I don’t think I’ve spoken to a single survivor who has been permanently separated from her abuser, and in most cases she hasn’t been separated from them at all. They usually have memories of a few run-ins with family court at some point, or in one case I know of, a criminal investigation, but overall the victims end up being brought up by their abusers because, again times, convictions in these cases are very rare.
That’s another real focus I wanted to have on the show going forward, that survivors are currently very isolated. Everyone I’ve spoken to who’s involved in one of these cases, whether it’s a family member or a survivor, feels like they’re the only person on Earth to whom this has ever happened. This is something I hope to remedy by bringing some of this to light.
You seem to point out that the systems we have in place to detect and prevent this kind of abuse, self-abuse and child maltreatment, are not up to scratch. Is that your understanding of the situation right now?
Yes. And again, that’s by talking to all those experts who have worked on dozens of cases for decades. I think the understanding of this issue is so minimal in the public sphere and in all systems, like child protection services, like family court—where these cases often end up either at the same time as there is a criminal investigation, or instead of a criminal investigation — like the police departments, really all the systems that we have in place to protect children from abuse.
These people, on the whole, receive no training on this abuse. Often they don’t even have a passing knowledge of what Munchausen is by proxy. They are not able to differentiate themselves. A common misconception is that this is some kind of exotic psychological disorder, and we need to bring in psychologists and diagnose, like with mental illness. And although there is an underlying mental illness that causes people to do this, to abuse their children in this way, child abuse itself is a crime. For something like that, you need proof. He has to go through the criminal courts.
So I think there’s so much confusion about what it is. If it is mental illness, does that mean someone is not guilty of the crime? And the answer, should I say, is no. It’s not something that drives people crazy or criminals crazy. I think improving that knowledge for anyone who interacts with children is crucial, because most of us interact with children on some level.
For someone who is listening, and maybe a bell rings for them about something they are seeing in their family or loved one, where do you start to get resources on this issue?
I would refer people to Munchausensupport.com. This is a resource website that Dr. Marc Feldman and I created with our colleagues at APSAC. This has resources for professionals who work with children and also family members and survivors. It’s also a great place to contact us if you need help.
Listen to the broadcast interview by clicking the play button above.
Listen to an extended version of Kim Malcolm’s interview below: