Justina Pelletier: What Is Munchausen Syndrome by Proxy?

Justina Pelletier was 14 years old when she was taken out of her parents' care by Boston Children's Hospital.

As shown in the Peacock documentary The Battle for Justina Pelletier, the hospital was concerned that she had fallen prey to Munchausen syndrome by proxy, a psychological condition in which a child's carer, usually their mother, fakes or induces illness in the child.

It is a form of abuse and gets its name from Munchausen syndrome, a related condition in which people fake sickness in themselves. These conditions are also known as fabricated or factitious disorder.

Dr Marc Feldman, a clinical professor of psychiatry and adjunct professor of psychology at the University of Alabama, is an expert in forms of medical deception. He told Newsweek that Munchausen syndrome by proxy "can be similar to torture when it is severe and the child is subjected to repeated, unwarranted surgeries based on reports from the parent.

"The mortality rate among published reports is 6-9 percent and the children are very often physically and psychologically damaged in ways that might affect them for the rest of their lives."

In the Pelletier case, Justina's parents Lou and Linda Pelletier strongly denied that they had abused her.

They first took the 14-year-old to Boston Children's Hospital in February 2013 when she was complaining of severe stomach pain. She had previously been diagnosed with mitochondrial disease. This rare condition affects the mitochondria, a part of human cells that produces energy. It can cause extreme fatigue, seizures, impaired hearing and vision, and heart defects.

The doctors at the Boston hospital were not convinced of this diagnosis. They believed the girl had a mental condition called somatoform disorder, which causes a person to experience real, physical symptoms as a result of psychological distress.

Eventually, the doctors concluded that it was a case of Munchausen syndrome by proxy—saying Pelletier was being overmedicated by her parents.

The teenager was taken out of her parents' care. For more than a year, from February 2013 to June 2014, she was kept at the Boston hospital and then another facility in Massachusetts. During this period, her parents were forbidden from discussing medical issues with her or with medical professionals from outside the facility.

After a 16-month custody battle, a judge dismissed the child protection case against Lou and Linda Pelletier. The family later filed a medical malpractice lawsuit against the hospital. In 2020, a jury found that the hospital had not been negligent in its care.

In a statement given to Newsweek following the release of the Peacock documentary, Boston Children's Hospital said: "We strive to act in the best interest of every child who comes to us for care, as we did with Justina Pelletier. The jury's decision affirmed what we have always believed: that our clinicians provided Justina high-quality, compassionate care, and acted in the best interest of her health and well-being at all times."

What Is Munchausen Syndrome by Proxy?

Feldman, who has written a book called Dying To Be Ill, explained that Dr Richard Asher coined the term "Munchausen syndrome" in 1951. Asher, a British physician, used the phrase—a reference to the fictional braggart Baron Munchausen—to describe patients who seemed to suffer from dramatic symptoms but were later determined to be faking the whole thing.

In 1977 another British doctor, Sir Roy Meadow, began using the term "Munchausen syndrome by proxy" for cases he identified in which mothers feigned, exaggerated or induced illness in their children.

Feldman said these moms wanted "to garner some form of emotional satisfaction, such as sympathy and attention, that they felt unable to get in other ways. They were deliberately deceptive, not just misguided or overanxious about their children."

Caregivers may lie about illness, falsify lab results or even induce sickness, for example by injecting their child with bacteria.

Statistically, the condition is extremely rare. But Feldman believes many cases go unrecognized. "Instead, the child undergoes years of suffering without any doctor, relative, or friend ever realizing that the mother herself is the reason the child is so sick."

He added: "It is estimated that there are 600 to 1,200 new cases each year in the United States. This makes it uncommon compared to other forms of maltreatment such as sexual abuse, but doctors and others shouldn't be blind to the possibility when risk factors or odd maternal behaviors are present. I say maternal behaviors because 96 percent of perpetrators are the child's mother."

In recent years, the condition has been depicted in a number of movies and TV shows, raising public awareness of it.

Feldman said: "Munchausen syndrome by proxy is usually horrific, and people love horror movies and they love medical mysteries and psychological puzzles. It combines all these elements. It is truly stranger than fiction. Munchausen syndrome by proxy mothers put up the pretense of caring, but are devious and secretive, and those features make for good drama.

"However, Hollywood does tend to feature the most intense stories imaginable and, even while providing useful education, that may mislead the public into thinking all such cases result in death or near-death."