And the seizures?”
“Same thing, I guess. I don’t know, Alex. I really don’t know.”
She squeezed my arm again. “I’ve got no evidence at all and what ill’m
wrong? I need you to be objective. Give Cassie’s mom the benefit of
the doubt-maybe I’m misjudging her. Try to get into her head.”
I promise a miracle, Steph.
“I know. But anything you can do will be helpful. Things could get
really messy with this one.
“Did you tell the mother I’d be consulting?”
She nodded.
“Is she more amenable to a psych consult now?”
“I wouldn’t say amenable, but she agreed. I think I convinced her by
backing away from any suggestion that stress was causing Cassie’s
problems. Far as she’s concerned, I think the seizures are bona fide
organic. But I did press the need for helping Cassie adjust to the
trauma of hospitalization. Told her epilepsy would mean Cassie can
expect to see a lot more of this place and we’re going to have to help
her deal with it. I said you were an expert on medical trauma, might
be able to do some hypnosis thing to relax Cassie during procedures.
That sound reasonable?”
I nodded.
“Meanwhile,” she said, “you can be analyzing the mother. See if she’s
a psychopath.”
“If it is Munchausen by proxy, we may not be looking for a
psychopath.”
“What then? What kind of nut does this to her own kid?”
“No one really knows,” I said. “It’s been a while since I looked at
the literature, but the best guess used to be some kind of mixed
personality disorder. The problem is, documented cases are so rare,
there really isn’t a good data base.”
“It’s still that way, Alex. I looked up sources over at the med school
and came up with very little.”
“I’d like to borrow the articles.”
“I read them there, didn’t check them out,” she said. “But I think I
still have the references written down somewhere. And I think I
remember that mixed personality business-whatever that means.”
“It means we don’t know, so we’re fudging. Part of the problem is that
psychologists and psychiatrists depend on information we get from the
patient. And taking a history from a Munchausen means relying upon a
habitual liar. But the stories they tell, once you expose them, d’
seem to be fairly consistent: early experience with serious physical
illness or trauma, families that overemphasized disease and health,
child abuse, sometimes incest. Leading to very poor selfesteem,
problems with relationships, and a pathological need for attention.
Illness becomes the arena in which they act out that need-that’s why so
many of them enter health professions. But lots of people with those
same histories ~n’t become Munchausens. And the same history applies
both to Munchausens who abuse themselves and the proxies who torment
their kids. In fact, there’s some suggestion that Munchausen-by-proxy’
parents start out as self-abusers and switch, at some point, to using
their kids. But as for why and when that happens, no one knows.”
“Weird,” she said, shaking her head. “It’s like a dance. I feel I’m
waltzing around with her, but she’s leading.”
“Devil’s waltz,” I said.
She shuddered. “I know we’re not talking hard science, Alex, but if
you could just dig your way in there, tell me if you think she’s doing
it.
“Sure. But I am a bit curious why you didn’t call in the hospital
Psych department.
“Never liked the hospital Psych department,” she said. “Too
Freudian.
Hardesty wanted to put everyone on the couch. It’s a moot point,
anyway. There is no Psych department.”
“What do you mean?”
“They were all fired.”
“The whole department? When?”
“Few months ago. Don’t you read your staff newsletter?”
“Not very often.”
“Obviously. Well, Psych’s dissolved. Hardesty’s county contract was
canceled and he never wrote any grants, so there was no financial
backup. The board decided not to pick up the cost.”
“What about Hardesty’s tenure? The others-weren’t Greiler and Pantissa
tenured, too?”
“Probably. But tenure, as it turns out, comes from the med school, not
the hospital. So they’ve still got their titles. Salaries are a whole
other story. Quite a revelation for those of us who thought we had job