Comparing Media's Misrepresentations of Forensic Psychiatry and Munchausen Syndrome, Study notes of Law

Download Comparing Media's Misrepresentations of Forensic Psychiatry and Munchausen Syndrome and more Study notes Law in PDF only on Docsity! questionable interviewing techniques, cults, and sexual masochism. Both seasons send an erroneous message that if an individual commits a heinous act, mental ill- ness is likely involved. The series does an unclear job of delineating the difference between competence to stand trial and pleading not guilty by reason of insan- ity. Each defendant undergoes a competency to stand trial evaluation, the portrayal of which is quite con- crete. Cora is asked about her mental health history, her understanding of a trial, and whether she has any thoughts of self-harm. She is also asked what, as an adult, she would like to say to her teenage self. Julian is asked about his life in the commune, his under- standing of the murders, and ideas of what happens after death. Detective Ambrose reads about schizo- phrenia (Season 1, Episode 3) and meets with the psy- chiatrist who performed Cora’s evaluation. The psychiatrist states, “She passed, because technically she should pass. She’s lucid, she’s aware of her circum- stances, her judgment isn’t compromised” (Season 1, Episode 3). Detective Ambrose then asks the psychia- trist about the possibility of a song that “drove her to kill” (Season 1, Episode 3). The psychiatrist responds, “It sounds like PTSD psychosis, we see it in combat veterans a lot” (Season 1, Episode 3). Detective Ambrose and the psychiatrist subsequently perform two meditation sessions with Cora to revisit past trau- mas for possible clues about what led Cora to kill. Although not explicitly stated, the show hints at the idea of PTSD, specifically “PTSD psychosis” as a means for self-defense. The judge rules in each case that Cora and Julian would benefit from psychiatric treatment rather than prison, insinuating that their actions were secondary to psychiatric illness. In reality, diversion is rarely an option for someone who com- mits a violent crime. The show’s misperception of psychiatric evalua- tions and boundary violations compounds the misun- derstandings the lay viewer may already have of court proceedings. The show uses jargon in an attempt to establish legitimacy, such as a “730 exam” to describe a competency evaluation. In New York, fitness exami- nations are referred to as “730 examinations” after Criminal Procedure Law Article 730.1 In contrast, the independent evaluating psychiatrist would never actually say, “she passed” (Season 1, Episode 3) or consult with the detective. The show also contributes to a misperception that the psychiatrist and detective are working together to help defendants rather than taking separate, objective, and ideally unbiased approaches. The show then uses the non-DSM-5 term “PTSD psychosis” and the unsupported method of “guided meditation” (Season 1, Episode 4) to extract clues for the case. The same psychiatrist who completed the competency evaluation appears to be the treating psychiatrist in the jail, violating one of the ethics principles of our field. Ethics boundaries are further crossed when Detective Ambrose is allowed to sit in during the meditation sessions. It is made clear that Detective Ambrose is an advocate for the defendant when he states, “I’m on your side” (Season 1, Episode 4). He is seen visiting and calling the defendants outside of work functions and sharing personal information. Although portrayed as admira- ble, these representations distort the realities of police and forensic work. Despite the many misconceptions of forensic psy- chiatry and the law, The Sinner is well acted and an attention-grabbing piece of entertainment. It does adequately reveal the negative impact of trauma, and it challenges viewers’ thinking about how this should affect the disposition of criminal cases. It also allows for a different definition of a “sinner.” If the viewer (even a forensic psychiatrist) can suspend dis belief, just as in other works of fiction, The Sinner can be enjoyed for its dramatic acting and clever storylines despite the inaccuracies and misperceptions of psy- chiatry and the law. Reference 1. N.Y. Crim. Proc. Law § 730 (2019) Disclosures of financial or other potential conflicts of interest: None. Munchausen’s Syndrome by Proxy, Medical Child Abuse, and Darling Rose Gold By Stephanie Wrobel, New York: Berkley, 2020. 320 pp. $26.00. Reviewed by Alyssa Beda, DO, Karen B. Rosenbaum, MD, and Susan Hatters Friedman, MD DOI:10.29158/JAAPL.200058-20 Key words: Munchausen syndrome by proxy; factitious disorder imposed on another; medical child abuse; Darling Rose Gold; fiction Books and Media Volume 48, Number 3, 2020 419 Darling Rose Gold is Stephanie Wrobel’s debut novel, and it appears to be inspired by the case of Gypsy Rose, the medically abused daughter of Dee Dee Blanchard. The book is a fast-paced, easy read with an interesting narrative approach; however, psychia- trist readers may be disappointed with the character- izations. The story is cleverly told through two converging timelines and points of view. Patty Watts, the mother of her darling Rose Gold and adjudicated perpetrator of aggravated child abuse, narrates the story in the present tense. Rose Gold tells her story in the past tense primarily over a period of five years, the length of her mother’s prison sentence, and the time needed to hatch a vindictive and ulti- mately disappointing revenge plot. Eventually these two stories intersect in the present. The story of Dee Dee Blanchard and Gypsy Rose has been sensationalized since Ms. Blanchard’s mur- der at the hands of Gypsy Rose’s internet boyfriend in June 2015. A compelling aspect is that many lay peo- ple felt duped once it became clear that Gypsy Rose Blanchard was actually a healthy adult, and not the sickly child who won free trips to Disney World, a home from Habitat for Humanity, and multiple other perks from her community.1 After it came to light that Gypsy Rose Blanchard may have been abused at the hands of her mother, many still believed she was merely manipulative and not at all a victim.2 These themes were also dramatized in the television mini-se- ries The Act.3 Stephanie Wrobel’s book appealed to this viewpoint, as her protagonist, anti-hero Rose Gold, was presented as a manipulative perpetrator in her own right rather than as an innocent victim. In 1951, Dr. Richard Asher used the name of the eighteenth-century German officer, Baron von Munchausen, who was known for telling dramatic and untruthful stories, to describe an individual’s pattern of self-abuse, known as Munchausen syn- drome.4 Munchausen syndrome by proxy, coined by pediatrician Dr. Roy Meadow in 1977, is now referred to as factitious disorder imposed on another in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. This rare condition involves an individual deliberately either falsifying physical or psychological symptoms, or inducing injury or dis- ease in another person, and presenting the victim to others as ill or injured. Examples of mechanisms include suffocation, poisoning, or falsifying labora- tory results, among many other methods of abuse.5,6 Medical child abuse is the term used by child abuse pediatricians to stress that the primary concern is the child’s victimization, regardless of the psychopathol- ogy of the parent. In the vast majority of cases, mothers are the perpe- trators of medical child abuse.6 In contrast, fathers typ- ically have minimal involvement. InDarling Rose Gold, when Rose Gold’s estranged father, who temporarily came back into her life, realized that she manipulated him, he tried to distance himself from her and told her, “I expect my son to act out . . . but girls are sup- posed to behave” (p 219). Rose Gold says to herself, “I guessed my mom never got that memo” (p 219). The fictional portrayal of Rose Gold shares strik- ing similarities with the true story of Gypsy Rose.7 Besides the obvious use of the name Rose, the novel feeds into the media’s perceptions by cherry-picking attributes of the actual case and blending them into a contrived story of Munchausen syndrome by proxy. The similarities include poor dentition, the secret internet boyfriend (with a twist in the book), obses- sion with Disney princesses (with Rose Gold being “[her] own Prince Eric” (p 297)). In contrast to this fictionalized account, in the excellent memoir, Sickened,8 Julie Gregory tells her own story of a difficult journey after surviving years of medical child abuse at the hands of her mother, who nearly convinced doctors to perform an unnecessary heart procedure on her. Her story explores the seque- lae of medical child abuse and how she does not escape unscathed. She also describes how she does not let it define her or control her behavior in adulthood. As forensic psychiatrists, we are currently some- what limited regarding data about outcomes of medi- cal child abuse victims. Given the concealment of medical child abuse, it is difficult to identify the vic- tims and determine the long-term psychological sequelae. Limited evidence gleaned from the small number of reported cases indicates that some victims may minimize subsequent health problems or medi- cal needs in adulthood, while others may continue to report somatic complaints.9 Rather than depicting a two-dimensional revenge story, the story of tribula- tions and growth in Sickened is a journey worth read- ing about. Ultimately, Darling Rose Gold is disappointing as it further sensationalizes medical child abuse and psy- chiatric diagnoses and deflates true aspects of a well- known case with a trite revenge story. Of note, this is the second popular novel in the last few years to fic- tionalize true-crime events depicted in popular news Books and Media 420 The Journal of the American Academy of Psychiatry and the Law