Early on in Hulu’s newly released film Run, it becomes clear that Diane (played by Sarah Paulson) is intentionally making her child (played by Kiera Allen) ill. She feeds her muscle relaxers meant for a dog and other unknown pills, keeping her imprisoned in their house with limited access to the outside world. While it’s never explicitly stated, it’s apparent that Diane has Munchausen syndrome by proxy, making Run just one more in a long list of movies and TV shows that have turned the mental illness into a plotline in the last several years. The condition featured prominently in The Act; It; Phantom Thread; Everything, Everything; and Sharp Objects as well. But the condition is neither new or exceedingly common. So what’s driving the current pop culture fascination?
Munchausen syndrome by proxy — which is now known as Factitious Disorder Imposed on Another (FDIA), according to the DSM-5 — was first named in 1977. It occurs when a caregiver (97% of the time, the mother) feigns, exaggerates, or induces illness in a child in order to gain some kind of emotional satisfaction. "It's sometimes called medical child abuse, which is more descriptive and really explains what it is," says Marc D. Feldman, MD, the author of Dying To Be Ill: True Stories Of Medical Deception. "It's a serious form of abuse and it may be the most lethal form of abuse." There are an estimated 600 to 1,200 cases in the United States each year, and six to nine percent are fatal.
In 2015, the story of Gypsy Rose Blanchard and her mother Dee Dee caught the nation’s attention. Dee Dee had a severe case of FDIA, and Gypsy Rose conspired to kill her mother as a result of the abuse, then was imprisoned for the crime. This was an unusual case, and indisputably fascinating: Dr. Feldman said it’s the only instance he’s heard of where the victim had the perpetrator murdered. There were news articles about the case, then a Netflix documentary. Finally, came the fictionalized account in the shape of Hulu series The Act.
This fictionalization of disturbing news events is part of a relatively common cycle: For instance, the 2015 thriller Room was inspired by the stories of Josef Fritzl and Ariel Castro, both of whom kidnapped women and kept them imprisoned for years in hidden areas in the men’s homes. The Law and Order franchise regularly bases its episodes on recent news stories. These tales scratch the same itch as true crime podcasts and shows: While we may feel conflicted about our interest in these topics, they allow us to process our feelings about the stories, and think through how we’d act in that situation, says Sarah Walden, PhD, a professor at Baylor University who specializes in women’s rhetoric and motherhood.
Stories about women harming their children, such as Casey Anthony or Andrea Yates, who both murdered their children, tend to receive outsized amounts of media coverage, Dr. Walden says. This fascination with “killer moms” may reveal a tension that exists around how motherhood, and to a larger degree, women, are viewed in society today, says Elizabeth Podnieks, PhD, a professor of English at Ryerson University in Toronto who specializes in motherhood studies. Throughout history, pressure has been placed on mothers to be perfect, nurturing, and self-sacrificing, and coverage of conditions like FDIA radically dismantles that idealized view of maternity, a juxtaposition that people find naturally fascinating, Dr. Podnieks says.
"There’s a relief there for women to see a sort of breakdown of this ideal," Dr. Podnieks says. "There’s something liberating, metaphorically, to say, 'What would happen if I didn’t fulfill these dictates of idealized maternity? It’s a liberation of these myths of the idealized woman." She notes that it's similar to watching any kind of horror film: "After you watch one of these movies, from a mother’s perspective, you can say, ‘Wow I went to the darkest place, and now I’ve come back, and I see my own mothering in context — I’m not that bad of a mother’." She calls it a kind of “psychic release.”
On the other hand, the continuous coverage of a rare mental illness can be read as being reflective of “society’s and culture’s ongoing backlash against women and their power, which is denigrating to women and offensive, frankly," Dr. Podnieks adds.
Setting aside the Blanchard story, it’s no coincidence that FDIA portrayals became more common in the last four years, according to Dr. Walden. “We’ve had this huge conservative turn in the past four years in regard to discussions of women, openly misogynistic language, and a patriarchy that’s explicit instead of implicit,” Dr. Walden says. “I think this idea of fearing women and fearing what women might do in a care taking role is probably largely a result of our political context.”
Power is often associated with our culture’s stereotype of the masculine ideal. Painting women as destructive or dangerous when they’re in positions of power — even if these movies show them having power over just one person, their child — directly plays into our society viewing powerful women as negative.
“To me, it’s another backlash against maternal power and feminist power that we see with more women in positions of power and the rise of right-wing groups and so on,” Dr. Podnieks elaborates. “[There’s] this need to punish women who have power to make them see abhorrent and monstrous for being unfeminine, and so the mother becomes the perfect target. Her power is being seen as an evil, destructive force.”
That said, Dr. Feldman believes that there’s at least one positive outcome of pop culture’s current fascination with FDIA: increased awareness. Dr. Feldman has been studying these medical abuse cases for almost 30 years, and he's always surprised by how ominous they can be. "They take my breath away with the deviousness and potential seriousness," he says. "Death is not a terribly uncommon outcome and I think these TV shows, whether it’s true crime or fictional, have by and large accurately depicted the severity by Munchausen by proxy abuse."
For those concerned that pop culture depictions of the mental illness may prompt copycats, Dr. Feldman says, "Perpetrators have never needed any instructions. They are very enterprising and creative when it comes to sickening their children or pets." He says that his first book, Patient or Pretender: Inside the Strange World of Factitious Disorders, was criticized by some professionals who feared that he had provided an 'instruction manual.'" That's not the case, Dr. Feldman says — in the many years since, he hasn't learned of a single instance in which the patient or perpetrator misused any of his books as a "how-to" guide.
As of now, however, the causes and triggers for FDIA aren’t well understood. Although these cases are rare, Dr. Feldman says that our exposure to them via pop culture could help accelerate research on how to treat the disorder in the future. For now, he says that The American Professional Society on the Abuse of Children is a good resource. “The more it’s highlighted, the more likely it is to be recognized as a public health crisis,” he says. “We don’t know how to really treat the perpetrators. Judges still have never heard of it so they don’t take it seriously. Police departments and child protective services know little to nothing about it.” More awareness means children in the care of someone with FDIA may get help sooner, Dr. Feldman notes. “Any way to educate the public is a good thing.”