I accidentally stumbled upon this long article by Michelle Dean that tells the absorbing story of an extremely sickly child and her devoted mother that eventually became exposed as a fraud following a murder.

The story discusses the syndrome known as Munchausen by proxy.

Munchausen syndrome was first identified by a British psychiatrist named Richard Asher in 1951. A successor, Roy Meadow, identified Munchausen by proxy in 1977. It has been in the DSM, the diagnostic manual used by psychiatrists, since 1980. (In the latest version, the DSM-V, it goes by the name “factitious disorder,” but for clarity’s sake I’ll stick to the Munchausen nomenclature.) In short, a person with the syndrome either feigns or induces physical and psychological symptoms for no obvious benefit other than attention and sympathy. If the person does this to themselves, it’s plain Munchausen syndrome; when the symptoms are feigned or induced in others, it’s called Munchausen by proxy. The DSM-V recommends distinguishing Munchausen syndrome from what is called “malingering,” that is, faking or inducing symptoms of illness where there is some hope of material benefit. Malingering isn’t considered to be a mental illness. It’s just plain fraud.

While most with the syndrome are mothers, there are also documented cases of fathers doing this to their children, husbands doing this to their wives, nieces doing this to their aunts. And doctors often don’t detect it for months or years. In fact, it’s difficult to say just how prevalent Munchausen is in the general population. By its very nature, it hides in plain sight.

That doctors often miss Munchausen seems counterintuitive, but the doctor-patient relationship is a bond of trust that goes both ways. “As health care providers,” said Caroline Burton, a doctor at the Mayo Clinic in Florida who’s treated cases of Munchausen where the proxy is an adult, “we rely on what a patient tells us.” Even if a doctor suspects his or her patient is lying, there isn’t much incentive to refuse treatment based on the doubt. What if the doctor is wrong and the patient suffers for it? “You have to be careful not to overlook organic disease,” Burton said. “You’ve really gotta go through quite a lot of diagnostic hurdles.”

In the aftermath of the tragedy, all the people who knew the mother and daughter were astonished at how they could have missed all the signs that there was something terribly wrong. Most people are kind and generous and do not want to be suspicious of others and take their stories at face value. This can result in them being manipulated and cheated.

But while this was an extreme case, it is generally true that we have little idea of what goes on in other families and behind the closed doors of their homes and that what is presented to us may be quite different from the reality. We discover this when there is a major crime or scandal but it often happens on much smaller scales.