don’t understand it anyway, so they make lousy witnesses. What is unusual is that most of the fathers of these kids never speak up. They either don’t understand what’s going on, or they don’t want to make waves, so they just lie low and pretend they don’t see it. Your patient’s father is atypical.”
“He says he’s terrified for his child. He doesn’t trust his wife anymore. He says she lies to him.”
“If she has MBP, or factitious disorder imposed on another, you can be damn sure she does. And if you try to pin something on her, she’ll lie more. And everyone will say what a fantastic mother she is. They make sure that everyone knows that about them. They’re the best mothers in the world, except that they’re injuring or killing their kids.”
“Is that what they want? To kill the child?”
“I honestly don’t know. I think sometimes they just go too far, and become too dangerous and it gets out of hand, or maybe they just can’t stop. But some of the victims die, there’s no question of that.”
“How do you stop them? Therapy?”
He smiled wryly at that. “Thank you for your faith in my chosen field. No, therapy has no effect on them. They’re like pedophiles, you can’t stop them or cure them. You have to remove the child, in order to save its life, and their quality of life. You know what your role is in this, don’t you?”
“No, I don’t. That’s why I’m here.”
“If you really believe the mother has Munchausen by proxy, you have to report her to the authorities, in other words, Child Protective Services. It’s your responsibility. You have to write the report and turn her in. It’s confidential, of course, and if you don’t have an airtight case, she’ll wiggle out of it. Most of them do, with righteous indignation. If it keeps happening, they may be able to nail her eventually. But it’s not easy, so you have to be fairly sure.”
“And if I’m not?”
“Then you don’t have a case, and the kid keeps breaking bones and having unneeded surgeries, and hopefully grows up and gets away, or she dies. It’s been a fairly taboo subject for all these years. Essentially, these kids are child abuse victims, to an extreme degree, and it’s often done in a very sophisticated way, by a mother who everyone tells the authorities is a star. I’ve only had one patient who was an MBP victim as a child. He was in pretty bad shape mentally, and eventually committed suicide. It was a sad case. They go after the elderly too, their geriatric parents who can’t defend themselves. They die pretty quickly. Kids are sturdier and more resilient. It’s an ugly business. I hope for your patient’s sake that you’re wrong about this. But at least she has her father on her team. It sounds like he’s alert and watching what’s going on.”
“He is now. But he doesn’t know how to stop her and keep the child safe.”
“He can’t do either one. If she has MBP, he’s got to get the kid away from her, as soon as possible. Whatever he does, she’s going to keep creating situations where the child gets hurt, or sick.”
“My God, it’s awful.” Cathy looked upset, thinking of Jaime with the dog bite on her cheek. She’d had an email from Jane at the end of the day that everything had gone well, and they’d taken care of her chin too. She promised there would be no scar on her cheek, which was why Cathy had sent them there. She had total faith in Jane.
“I’ll look at her file tonight, before I leave for L.A. tomorrow, and I’ll call you in the morning before my flight. What you do after that is up to you. You may have to wait awhile and gather more evidence against her. But while you do, the child is at risk. And if this woman runs a child abuse shelter, you’re going to have a hell of a time nailing her. She’ll smell like a rose in court. What does her father do?”
“He’s a child advocacy lawyer, and he does a lot of pro bono work for her.”
“It’s too bad if this turns out to be true. They sound like good people.”
“They are, which makes this that much harder to believe.”
“Just know that if she has MBP, she’s not a good person, whatever she looks like, or whatever her reputation is. She could kill