Munchausen's Syndrome by Proxy, Medical Child Abuse, and Darling Rose Gold

• Munchausen syndrome by proxy
• factitious disorder imposed on another
• medical child abuse
• Darling Rose Gold
• fiction

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, psychiatrist readers may be disappointed with the characterizations. 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 ultimately 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 murder at the hands of Gypsy Rose's internet boyfriend in June 2015. A compelling aspect is that many lay people 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-series 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 syndrome.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 disease in another person, and presenting the victim to others as ill or injured. Examples of mechanisms include suffocation, poisoning, or falsifying laboratory 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 psychopathology of the parent.

In the vast majority of cases, mothers are the perpetrators of medical child abuse.⁶ In contrast, fathers typically have minimal involvement. In Darling 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 supposed 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 striking 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), obsession 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 sequelae 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 somewhat limited regarding data about outcomes of medical child abuse victims. Given the concealment of medical child abuse, it is difficult to identify the victims 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 medical needs in adulthood, while others may continue to report somatic complaints.⁹ Rather than depicting a two-dimensional revenge story, the story of tribulations and growth in Sickened is a journey worth reading about.

Ultimately, Darling Rose Gold is disappointing as it further sensationalizes medical child abuse and psychiatric 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 fictionalize true-crime events depicted in popular news media. For example, the French novel, The Perfect Nanny, by Leila Slimani, is a Roman à Clef (a novel about real-life events with the overlay of fiction) that appears to be based loosely on news stories of a real murder case in New York City in 2012. It is important for forensic psychiatrists to be aware of these stories, as they may distort the views of the lay public (and potential future jurors), and to be aware of novels that purport to be fiction yet appear to be sensationalized portrayals of complex events occurring at the intersection of psychiatry and the law.

• © 2020 American Academy of Psychiatry and the Law