Cynthia Lyda, a San Antonio woman accused of child abuse, could face as
much as 212 years in prison if she is convicted of all the charges
against her. Part of her defense, however, is that she suffers from an
increasingly well-known psychiatric disorder called Munchausen's
Syndrome by Proxy (MSP).

Experts say that this is one of the least understood forms of child
abuse and least understood forms of mental illness. MSP is a
psychiatric disorder which involves caregivers intentionally harming
children so that they can bask in the attention they receive for their
own caregiving.

The actual incidence of MSP is difficult to determine. There is a good
possibility that there is a lot more of it than we know about. Numerous
cases once considered to be caused by Sudden Infant Death Syndrome
(SIDS), for example, have recently been determined to be caused by
caregivers with MSP.

But, there is also the possibility of over reporting, especially with
the increased media attention being given to MSP. There are women who
say they have been unfairly accused of MSP who have created an
organization to call attention to the incidence of false accusations.
They claim that it is all too easy for frustrated doctors who can't
find the cause of their child's disease, or who wanted to avoid
malpractice suits, to throw around the MSP accusation, with virtually
no liability.

The traditional position by most health practitioners is that
successful treatment is rare.

Psychiatric treatment is usually refused or circumvented, and it is
thought that while the deceits and simulations of the perpetrators are
conscious, their motivations for seeking such pronounced attention are
not.

MSP is an extremely {*filter*} form of child abuse, often going on for
years before it is detected. The perpetrators are usually very
intelligent and resourceful, and are commonly acquainted with
sophisticated medical practices. Characteristic in these cases is an
early history of emotional and physical abuse of the caregiver,
identity problems, intense feelings, inadequate impulse control, a
deficient sense of reality, brief psychotic episodes, and unstable
interpersonal relationships.

The caregiver basks in the attention given to them. They stay by the
sick child's bed day and night, become involved with hospital staff,
and sometimes even gain recognition outside the hospital. Kathleen
Bush, whose daughter Jennifer, had 200 hospitalizations and 40
surgeries in her first 8 years of life, was lauded by Hillary Clinton
in 1994 at a White House rally. Another woman later found to have MSP,
Yvonne Eldridge, was named national "Mother of the Year" in 1988 by
Nancy Reagan.

The confrontation of an individual with MSP, must be done carefully.
Often, when health practitioners start to suspect an individual, the
abuse escalates, and therefore the danger to the child

Once these cases come into the courtroom, the question comes down to
whether the caregiver should accept responsibility and therefore the
full weight of the legal system for such a horrid course of action, or
whether MSP is a valid mental illness, which demands a consideration of
diminished responsibility.

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