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Updated 19 March 2015

'Munchausen by internet' – mother kills son for attention

Cybershrink comments on a mother, Lacey Spears, who poisoned her son because she enjoyed the attention she received from family, friends, doctors and people on the internet.

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In America, a young mother, Lacey Spears, 26, was found guilty of second-degree murder for killing her son of 5 by salt poisoning. The jury deliberated for three days.  She’ll be sentenced on April 8, facing a maximum sentence of 20 years to life.

'Marvellous mothering'

Although, oddly, Munchausen by proxy syndrome was not mentioned in court, the case dramatically illustrated the nature of this condition. The prosecution told the court she poisoned her boy because she enjoyed the attention she received as the mother of a sick child, craving attention from family, friends, doctors and people on the internet where she published dramatic stories about her son’s illnesses and suffering and her marvellous mothering. 

Garnett-Paul Spears died last year. It’s almost impossible, under normal circumstances, to poison anyone with salt, because it tastes horrible and is an emetic, causing you to vomit. But in some mysterious way, she’d persuaded a surgeon in Alabama to insert a gastric feeding tube into her son’s stomach, even though another hospital had refused her request to do so and had insisted it wasn’t necessary. The procedure isn’t common, and limited to very premature babies or children with other serious illnesses who have severe difficulty swallowing and hence feeding normally. 

Read: How to stop salt from killing you

Somehow she did find the ideal surgeon for her purpose, and the 15-minute procedure was done in 2009 at a Children’s Hospital by a Dr. Chong who estimated he had done 800 to 1,000 such procedures that year. He admitted that he never tried to find the boy’s medical records, and said: "I don't remember him or the mom at all."

There’s no good evidence that Garrett suffered any genuine problem requiring the procedure, but Lacey insisted that he could not eat normally, and would only survive if she provided him with liquid nourishment through the tube. Nurses and others later stated that the boy ate normally whenever he was left in their care. Lacey used the simple plastic tube as a murder weapon, feeding him salt, causing dangerously high sodium levels. Among other harmful effects, this caused brain swelling and death. 

The court saw a video which showed her taking the boy into a hospital bathroom with a connector that would enable her to pour something down his tube, and when they emerged, he looked ill, retching and writhing on his bed.

Equivalent of 69 McDonald’s salt packets

After he died, she asked a friend to go to her apartment to locate a feeding bag which she was to throw away without telling anyone. The bag eventually reached the police and was found to contain the equivalent of 69 McDonald’s salt packets. 

Her defence was very unconvincing. Her lawyer complained, for instance, that the video shown to the jury didn’t show a scene where she put two pairs of socks on the child’s feet, exclaiming: "If she's planning on killing him, why does she care whether his feet are cold?" A naïve question, as her concern had always been to appear to be a very caring mom in public. She even tried to blame the poor child for his own demise. She said he sometimes played with the syringe she used to put food into his tube, so it was possible he had put something into himself other than what she selected.

In and out of hospitals since he was born, Garnett's short, tragic life was marked by frequent moves and more frequent illnesses – vaguely explained problems treated by doctors who usually made decisions based on Spears' version of her son's medical history, without the benefit of his actual medical records, and apparently without asking the boy himself.

Read: Medical records worth more than credit cards on black market

A report says medical authorities in Alabama, where he was born, were concerned about her "emotional stability" and "presumed she suffered from postpartum depression and Munchausen syndrome by proxy." But no appropriate action appears to have been taken.

It’s believed that as he turned 5, she killed him, fearing he would tell people how she was making him sick. It is an especially dangerous time for the child, when they become old enough to be able to tell others about what mommy does. And when the parent is questioned by suspicious staff, the abuse often increases, as the mother wants to prove that the child really is as sick as she has been claiming. She then switches to another doctor or hospital, or to another town, or increases the abuse.

Case closed without any action taken

Spears shows very typical signs of Munchausen by proxy syndrome. She lied even when there was no benefit to doing so, persistently exaggerated his illness, gave an inaccurate medical history and answered questions vaguely and misleadingly.  And she moved, often, not giving any doctor or team enough time to find out what was happening.

A number of doctors challenged the need for the tube, and asked for his past medical records, which she never supplied. At one stage a nurse called the state child protection agency to voice her suspicions, but they never opened a case. Spears moved to Florida, where state investigators described Garnett as an "intermediate risk" for neglect. "Mom smacks the child so he will cry and she can hug on him," it said. But the case was closed without any action being taken, and when she moved north, nobody was aware of her background.

Meanwhile Spears made herself a star of Facebook, MySpace, Twitter and other blog posts, in which she appeared as a loving and devoted Supermom who remained brave as her little boy was in hospital 23 times before his first birthday. She also claimed sympathy as she wrote about the sudden death of Garnett’s father, Blake, a police officer and her “soulmate”, who was killed in a car crash. But there were no pictures of him in her blogs, and not one of her friends had ever met such a man. Yet, the man who is apparently the real father, a garage-door installer, Chris Hill, lived near them in Alabama, but was never even allowed to meet his son. 

Read: Paternity tests in first trimester

One of her blogs was called “Garnett's Journey”, subtitled “Healing takes courage, and we all have courage, even if we have to dig a little to find it.” She milked her growing online audience for attention and sympathy. When her son was declared brain dead, she posted that his "soul is already with the angels”, and when he died, she posted: “Garnett the great journeyed onward today at 10:20 a.m.”  Having documented his suffering in harrowing detail, she even posted pictures of him on life support, and then of his dead body.

Such women find that the amount of sympathy and attention you can receive is greatly multiplied when the child is sick. Now that they can exploit social media, the available audience is multiplied. She portrayed herself as “Wondermom”, skilful and with endless patience, caring for her poor child, always at his bedside, asking her fans to pray for him.

She wanted to harm him

Even after doctors had begun talking with police and gave instructions that she was not to be left alone with the child, she continued to feed him dangerous and eventually lethal amounts of salt.  Even after a doctor confronted her and told her it was “medically impossible” for the boy’s sodium levels to reach such high levels due to illness.

The hospital called the state child-abuse hotline and police became involved, but he died two days later. Five months later she was charged with second-degree murder and manslaughter.

More details emerged during the investigation. She had been heard, in Garnett’s first months of life, saying aloud that she “wanted to harm him”, and on another occasion the child was described as bleeding from his eyes and ears, with no apparent medical explanation.  Her computer showed she had made online searches about the effects of salt on a child.

Read: Are you a salt savvy parent?

Another weird chapter in her history has emerged.  After high school, Lacey worked in daycare for children. For a couple of years before Garnett was born, she cared,  without pay, for another young boy, Jonathan, posting on MySpace online pictures of herself kissing the boy with the title: “A mother’s love is unexplainable.”  She claimed to be his mother. There were dozens of photos of this boy, with comments like "My world, my everything", "He completes me”, “He has the key to my heart” and “Hey there, mommy Lacey”. She took this child to a local church, pretending to be his mother, and was given charity baby supplies.

When the real teen mother discovered this and confronted her, Lacey admitted everything, apologised and said, perhaps revealingly, “I would never to anything to hurt him.”  It seems the episode impressed Lacey not so much with the joys of parenthood, but with how having a child could make you the centre of attention. The real mother recalls that her baby kept getting serious ear infections while Lacey was caring from him, but that these stopped soon after she left.

Lacey showed many signs typical of Munchausen by proxy: The parent is always there when the child’s illness is at its worst. The presence of a feeding tube or chronic intravenous drip is ominous, enabling damaging substances to be easily introduced into the child’s body. She showed the typical pattern of telling dramatic stories that were untrue. The internet makes it easy for people to seek attention and support both from their own blogs, and also from online support groups for the disease that is being simulated.  It’s worthwhile for a doctor to check the web for publications and comments from the patient suspected of this condition.

Babies never existed at all

Only recently have such cases begun being dealt with legally. Last year, a woman in the US state of Georgia was jailed after she pretended to have given birth to premature twins, even holding a memorial service for the babies who had never actually existed at all. She also claimed that her daughter had cancer, and that her son needed a liver transplant. She was convicted of fraud for taking money for their treatment, and also for documented cruelty towards her own children.

Like the old story, The Boy Who Cried Wolf, it becomes hard to believe anything such people say. Lacey talked of having been abused as a child, of having had anorexia and an abortion, but there was no evidence this had ever been true.  Even at high school her friends were so concerned at her spinning lies that they wanted to intervene and confront her. She’d claim she hadn’t eaten for three days, when they remembered seeing her eat a hot dog.

At 14, she announced to friends that she was pregnant, then later claimed she’d had an abortion. When it was pointed out that abortions were not done at the hospital she named, she changed her story and said she’d gone out of state.

It was also discovered that before Jonathan she had helped care for yet another little boy and presented herself to others as that child’s mother, which naturally bothered the real mom.

A nurse told reporters she had no problem feeding Garnett with all types of food, including fried potatoes, and even a McDonald’s hamburger and Happy Meal, though Lacey had insisted he couldn’t keep any food down.

When the man who seems to be Garnett’s real father, Chris Hill, heard that the boy was dying in a distant town, the only way he could try to contact Lacey was by a Facebook friend request. (She had never allowed him to meet the boy.)  He waited for her to respond, and then out of the blue she texted him, admitting that Garnett had been his son, apparently expecting sympathy from him for the death of “our child”. Much later she posted an online update saying: "I will always be Garnett's momma. I will always be a mother. Nothing will ever change that. But who am I today? That I don't know."

Read more:

Munchausen by proxy: getting attention by making someone else sick

Munchausen syndrome: why people fake illness

Social media can feed Munchausen by proxy

Image: Lacey Spears escorted into the courtroom at the Westchester County Courthouse in White Plains, N.Y. (AP Photo/The Journal News, Ricky Flores, File)

Professor MA Simpson is Health24's CyberShrink. A South African psychiatrist, he qualified in medicine and in psychiatry in Britain. He has been a senior academic, researcher, and Professor in several countries. Read more of his columns.

 
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