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?'
