What Would Make a Mother Poison Her Child To Death?

Lacey Spears really wanted a baby. For years she’d been serving as an unofficial nanny for her friends’ kids, but nannying just didn’t seem as joyful—or as real—as having a kid of her own. Then, in December 2008, the 26-year-old from Alabama finally got her wish, giving birth to a baby boy she named Garnett.

But on June 17, Spears drew media wrath when she was arrested and charged for the January 23 murder of her son, whom she is alleged to have slowly poisoned to death with an excess of sodium.

According to Spears, the five-year-old boy (whose father was out of the picture) had been sick nearly his entire life, the subject of countless tests, proddings, needles, machines, and hospital stays. In fact, the boy had been rushed to the hospital for an ear infection (he also had blood gushing from his nose) when he was only five days old.

Spears described her son’s ailments as “failure to thrive,” but that now seems purposefully vague—she’d asked doctors to insert a feeding tube for Garnett when he was only nine months old (whether or not he actually needed it is unclear).

The new mom shared photos and chronicled her son’s plight for friends and supporters on Facebook, MySpace, and an infrequently updated blog, where she wrote things like, “Garnett has enjoyed driving his tractor through our neighborhood, playing in the rain, riding his bike for hours, and we spent a few days in the hospital.” She also recounted his ongoing health woes—including his frequent hospital visits—on Twitter, posting, “My Sweet Angel Is In The Hospital For The 23rd Time 🙁 Please Pray He Gets To Come Home Soon…” just weeks before Garnett’s first birthday.

She is pleading not guilty to a charge of murder in the second degree and another charge of manslaughter in the first degree for “acting with a depraved indifference that led to her son’s death,” though she isn’t charged with intentionally killing him. Though the indictment doesn’t specifically name Munchausen by proxy, it does describe a troubling pattern throughout Garnett’s life—a pattern that looks a lot like the maligned and misunderstood condition. The young mother had relocated to Chestnut, New York, in 2012, and had long been moving around with Garnett—from Alabama to Florida to Tennessee. Why she kept fleeing and starting over isn’t totally apparent; was she just a free spirit, or was she was trying to outrun the doctors, hospitals, and other officials she’d dealt with in each town due to Garnett’s chronic ailments?

Munchausen by proxy (MBP)—its name stems from a storybook character, Baron Munchausen, based on an 18th century Prussian cavalry officer, created by Rudolph Erich Raspe—is a condition that, according to the National Institutes of Health, “almost always involves a mother abusing her child by seeking unneeded medical attention for the child” (though there have been reported cases of adult victims as well). People with MBP are 95 percent female, and usually mothers, likely due to the fact that, according to Dr. Marc D. Feldman, an MBP expert and author of the book Playing Sick, women remain the households’ primary caregivers. Caregivers with MBP usually subject their children to a high number of unwarranted diagnostic tests, hospitalizations—even surgery, which Feldman calls “disease forgery.” MBP, and its parent condition, Munchausen syndrome, are fairly rare. They’re considered “factitious disorders,” i.e., conditions in which a person falsely pretends to have a physical or mental illness.

Approximately 1,000 out of 2.5 million cases of child abuse each year are due to MBP. Though the condition was added to 2013’s American Psychiatric Association’s Diagnostic Manual, some professionals, like Feldman, don’t believe it’s a mental illness. Feldman believes MBP suspects knowingly induce illness to vicariously “accrue emotional satisfaction,” and describes it as type of conscious maltreatment—medical child abuse.

“I think it is best to avoid suggesting that perpetrators of medical child abuse are the helpless victims of a mental illness,” says Feldman, “[because this is] potentially reducing their culpability when the cases go to court.”

Louisa Lasher, MBP expert and co-author of Munchausen by Proxy: Identification, Intervention, and Case Management, agrees, saying that one of the biggest misconceptions about the condition is that it can be detected from a mental-health evaluation.

But if it’s not mental illness, what is it? What could compel an otherwise “normal” parent to consciously strive to cause her child pain? The parent generally knows what she’s doing—at least that’s what most experts think—but she’ll often deny it, even in the face of extensive evidence. As Lasher says, MBP suspects consider “their needs … much more important than anyone else’s. They’re using the child as an object to get a need met—whether it’s getting attention in general, or jealousy or revenge.”

Though MBP suspects might be aware of what they’re doing, that doesn’t mean they’re unaware that what they’re doing is wrong. People “do not realize that factitious illness behaviors are typically deeply disturbing to patients themselves, who may feel a kind of compulsion to engage in the behaviors,” says Feldman.

Over time, some suspects become quasi-delusional, convincing themselves that the child is authentically ill. Very few women who recognize their own MBP issues are willing to admit it (even to a therapist, who may be required by law to report her to child-protective services).

Many of these perpetrators initially come off as solid caretakers with an overall positive relationship with their victims. Though they sometimes have “normal” mental-health evaluations and no prior involvement with Child Protective Services, their manipulation skills are well honed and their lies can extend to areas of life beyond their kids. In the case of Lacey Spears, she posted photos of the two kids she nannied—before having Garnett—on MySpace and Facebook, trying to pass them off as her own children. She used captions like “My World My Everything” and “He Completes Me.”

If someone is suspected of medical maltreatment, professionals will carefully review the child’s medical history, looking for oddities or discrepancies. They’ll be scanning for clues of medical deception or falsification; the best way to find this is, obviously, via instances of a child being repeatedly sick for no solid reason (for example, Lacey Spears’ son—and the children she nannied before Garnett was born—all had mysterious, recurrent ear infections while under her care).

“Direct or circumstantial evidence proving a pattern of behavior is what should be used to confirm abuse or neglect of this kind,” wrote Louisa Lasher in a report on the subject. “There simply is no ‘profile’ [of a classic perpetrator].”

There are warning signs, though: If the child’s symptoms don’t improve after repeated medical interventions. If there is more than one ill—or deceased—child in the family. If the child’s health seems to improve in the hospital, but s/he becomes ill again upon his or her return home. And if there are signs of chemicals in the child’s urine, stool, or blood.

Unfortunately, effective treatment options aren’t plentiful when it comes to Munchausen by proxy. Most perpetrators are riding a strong current of denial on the subject, “even if there is incontrovertible evidence, such as videotape of them harming their children in the hospital,” says Feldman.

Successful treatment depends, of course, on the suspect telling the truth, and people with MBP are, by definition, delusional. In the rare circumstance that suspects are willing to get help, psychotherapy is the best approach. “The goal is [for them] to learn to use words rather than abusive actions to get their needs met,” says Feldman. Medications for depression or anxiety can also be useful in some situations.

Such a dramatic, even malicious, need for attention has to stem from somewhere. Though they might not qualify as mentally ill, most MBP perps would qualify as disturbed. In 2005, U.K. researchers interviewed 67 mothers who had been referred by the court system for child maltreatment arising from what they called “abnormal illness behavior.’’ Seven of them were charged with manslaughter. Most of these women (85 percent) described having an “insecure, ambivalent attachment” to both their parents and their own kids. When they were young, these mothers felt their parents were unpredictable—the root of both intense pain (more than 50 percent described being physically or sexually abused as kids themselves) as well as positive feelings like reassurance.

And there’s another thing these suspects tend to have in common: a history of physical illness themselves, or having a Munchausen-afflicted parent who faked symptoms and sought frequent medical attention from doctors and nurses. As kids, they learned that physical illness was the quickest and simplest way to gain attention, while more blatant ways (crying, showing emotional distress) usually went ignored.

It’s been reported that Lacey Spears struggled with anorexia and claimed to be a victim of abuse at home. Some of her friends didn’t believe her stories—some accused her outright of lying. She stayed at her best friend’s house for weeks at a time and cozied up to her friend’s mother, eventually calling multiple unrelated people “mom.”

Dr. Carole Lieberman, a forensic psychiatrist who has not treated Spears but is familiar with the case, speculates that she must have had a highly dysfunctional youth. “She may well have been abused and neglected, causing her to have both a longing for a baby and a need to destroy the baby because of her own self-loathing,” says Lieberman.

Most victims of a parent with Munchausen by proxy are very young—usually under six years old—with the youngest-known victim being a fetus. About 10 percent of MBP victims die, and even more will have long-term physical complications.

Of course, they may have lasting psychological trauma as a result of what they went through, too. Judging by the user posts on this MBP victims’ forum, the effects seem to range from depression to rage to low self-esteem and, naturally, having difficult feelings when it comes to family. One victim, reflecting on her mom’s condition, said “I started to see my mom for who she was … I felt like I was brainwashed … I grew up thinking I was really sick and something was really wrong with me. [Some] part of me also liked being sick because that’s the only time I felt loved.”

Another victim reports feeling rudderless, unsure about who she truly is, without that critical identifier of “Being Sick”: “When people asked me what I was, others were soccer players, cricketers, piano players, etc. Me, I would say with pride, ‘I am a chronic bronchitic.’ It was my identity, it was who I was.”

Some walked away from their families altogether, like “Pebbles,” who writes that severing those ties as an adult was “the best decision I ever made, and I wish I’d made it much, much earlier.” She goes on, “It’s very hard to explain to other people, however … and our society treats families as holy, never to be disrupted. Which is a joke, because frankly I wish I’d grown up in foster care.”

Unfortunately, though, many MBP victims don’t get pulled from their difficult homes and placed in alternate care. “Most child victims remain in their homes with their mothers because the case is never identified as an MBP case,” Feldman says. “Underrecognition is a serious problem.”

When professionals or family members do report a possible MBP case to Child Protective Services—which was done at least once in Lacey Spears’s instance—Feldman believes it’s important to remove the child, at least temporarily. Part of the reason is to see if the kid’s health improves when she or he’s separated from the mother (this is called a separation test). “Research shows that reunification with the abusive parent, at least in the short term, is fraught with danger,” he says.

If the child is removed from the home, it’s also crucial that their medical history accompany them into their next placement, whether that happens via adoption, foster care, or another avenue.

Sadly, Garnett Spears never had the chance to start over in a new home with a mom who wouldn’t hurt him. He fell victim to a bizarre condition that crosses income and socioeconomic lines—one that can happen under our noses, to seemingly “normal” parents you’d never expect. People like Lacey Spears, who’d had plenty of childcare experience and had long fantasized about a baby of her own.

Though we might never understand what sort of urge drove Spears to consciously harm her son, it would be some consolation if the media attention helped to advance awareness—or, even better, change—around the disturbing condition. Even if said change only goes as far as encouraging us to hug the kids in our lives a little harder tonight.