Archive for May, 2014

Meaning, through handling adversity

In the US, parents can get extra attention by having children who are labeled. If you have a gifted child, you can feel good both about what it says about your genes, and about the nurturing things you did that you conveniently think is causal (e.g., breastfeeding, nutrition in general, reading to them, and so on). On the other hand, if you have a kid with special needs you can score a lot of social points by being seen as a strong advocate for your child and handling adversity.

The people who survive some natural disasters or violent acts receive a lot of compassionate attention. The same goes for people who are hospitalized due to injury or disease. Parents of kids who are sick or injured also receive this attention.

The desire for this sort of attention is strong, especially if you haven’t found much meaning in your life in other ways.

By giving people social attention for anything (good or bad), we create a gradient. There will be people who are jealous of the sick or injured (or the people with sick or injured kids), because they want that kind of meaning in their life. They want to be seen as the strong survival or fearless advocate.

Of course, most people will not actually make this happen. Most people will not pretend to have been in one of the towers on 9/11. Most people will not feed their kids or their pets poison. Most people will not fake their own illnesses and hop from one hospital to another. But what if we make it easier for people?

One spectrum disorder leads to another

Suppose there is a disorder that creates serious challenges for the individual and caregivers. Over time, awareness of the disorder increases. Parents are praised for their advocacy and their love for their challenging child.

Now, suppose the DSM committee decides to weaken the criteria, to allow for milder cases of the disorder[1]. Some children legitimately could be considered mild cases, and might benefit from the new criteria. However, this new criteria might be vague enough that many children could qualify, if their parents wanted them to.

Consider a parent who would love the social attention that comes with having a special needs child. Suppose this parent would never feed their child actual poison. Well, the new DSM just gave them a new option. They can make sure their child qualifies as special needs. With their parenting style, they can make sure that their child exhibits more of the characteristics of the disorder than they would have under a different parenting style. That is a type of poison, but one that the person might have an easier time denying to their self.

Essentially, by creating a spectrum disorder, the DSM committee turns Münchausen’s into a spectrum disorder. Parents can figuratively poison their children — receiving the praise for it from unaware peers, while not suffering from the guilt of literally making their children sick.

So far I have intentionally spoken in general terms, because I think it could apply to all kinds of different disorders. But let’s now look at a specific example.

Autism often involves children who have trouble with language, exhibit repetitive behaviors that might even result in self-injury, etc. It would be pretty hard for a parent to make sure their child has these symptoms. Aspergers syndrome, on the other hand, was considered to be on the autism spectrum (until DSM-5) and has much milder characteristics associated with it. If you have an introverted child, it wouldn’t be particularly hard to convince people that they have Aspergers [2].

Consider the following two factors. First, a psychiatrist will often rely heavily on a questionnaire that the parent fills out about the child. If a child makes less eye contact than the average child, occasionally puts their toys in a straight line, or has a favorite topic that they talk about a lot, a parent can easily exaggerate these. Second, the way a person parents can greatly affect the degree to which a child exhibits anti-social behaviors. The belief that the child has a disorder that makes it so they can’t have pro-social behaviors can create exactly the parenting style that leads to more anti-social behaviors. Thus, a parent can do a lot to make sure their child appears to have this disorder. They can do it, this mental Münchausen’s by proxy, without doing anything that feels wrong to the parent. In fact, they might really believe that they are helping the child.

For example, suppose Mary believes that her young child Mike has Aspergers. If he is mean to another person, she might only see what other people did to get him upset. She will send him the message that it was their fault, but encourage him to try and be nicer next time. He will get the message that it is their fault and that he isn’t really capable of being nice. He will also get the message that other people should always be worried about how their actions will affect him, but he shouldn’t bother with thinking about how his action affects others — the opposite of what someone with Aspergers needs. If a child is excused for behavior because the parent perceives them as having Aspergers, they will never learn to think about how others feel; thus, fulfilling the original prophecy.

I have seen this sort of thing quite a few times over the years. If you search Aspergers and Munchausen’s by proxy, you will find all kinds of forums where people are talking about exactly these kinds of cases.

It has even reached popular culture. There is a show called Parenthood in which this exact scenario is the main plot. No matter how bratty the child with A​psergers is, everyone else is expected to apologize to him.  He is made to apologize sometimes, but it is understood he cannot help but be mean to others. Because of this assumption, their approach has always been a “kinder” way to deal with him, a.k.a. excusing his behavior and only giving a polite apology at times because it’s the right thing to do. There is a reward system in place, which is good, but no actual consequence for his actions. This ensures we will never know how severe his social deficits are. By spending all of their time and energy to make the world revolve around him, they never give him a chance to see if is actually capable of better behavior. Some children have severe autism, and it is clear there is nothing anyone can do to make them act in polite ways. However, with the inclusion of Aspergers in the DSM, any child with the slightest disposition to be less kind than their peers can be parented in such a way that they can fit the criteria for Aspergers. ​ This is doing this child a huge disservice. ​By parenting in a way that refuses to allow a child to take at least some responsibility for their actions toward others (and this does not mean passively teaching about facial expressions, which is simply not enough), they are ensuring their child will be disliked, teased (because let’s face it, s/he is always teasing​ others), shunned (who wants a mean kid around?), and so on. Therefore, it is not at all exaggerative to say that this type of parenting is a way of poisoning a child.

Just as some parents with Munchausen’s by proxy​​ compromise their child’s future by weakening their physical health (under the guise of “helping”), ​parents with mental Munchausen’s also compromise their child’s future by weakening the social health of the child. S/he will no doubt suffer serious adverse effects each time s/he tries to have any type of mutually respectful relationship with others.

[1] This is not a criticism of the DSM per se. Many disorders are on a spectrum; mild cases exist. People might benefit from an actual diagnosis. For example, a diagnosis might be needed to have services covered by insurance; a diagnosis might be needed for a child to qualify for special services at school.

[2] This is not to say that most Aspergers diagnoses were just pathologizing introverts or the result of attention-seeking parents. I’m sure many people benefitted from Aspergers being in the DSM. I’m sure many of the cases could truly be thought of as high functioning autism. I am strictly talking about the incentive that is created and the minority of people who take advantage of it.

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