These fictionalized interactions provide clues about how Dee Dee Blanchard's past could've contributed to Munchausen by proxy, or "medical child abuse," a situation in which a caretaker feigns, exaggerates, or induces an illness often in their own child. For years, Dee Dee confined her daughter Gypsy to a wheelchair, convinced her she had multiple illnesses, gave her unnecessary medications, and even dressed her and shaved her head so she appeared sick.
On the show, immediately after Gypsy is born, her Grandmamma grabs the baby and criticizes her daughter's lack of parenting skills. While in the hospital, a doctor tells Dee Dee and her mother that Gypsy has "failure to thrive," meaning she's underweight and smaller than she should be. Although the name is alarming, the doctor assures Dee Dee and Emma that infants typically grow out of it, and she'll probably be fine. In another flashback, a young Gypsy falls off of a trampoline while playing with her friends, and she's sent to the hospital. When she returns in a wheelchair, Gypsy tells her mom that she can actually walk, which we can assume is supposed to signal the start of her Munchausen by proxy behavior.
It's hard to discern what actually happened in the case of Dee Dee Blanchard and Gypsy Rose, versus what's part of the new Hulu adaptation's narrative. (For example, people who knew the real family told reporters in 2015 that they recalled seeing Gypsy jump on a trampoline, then pretend to collapse when Dee Dee came outside. But we also know that Dee Dee told Gypsy she had to use a wheelchair because she claimed she had muscular dystrophy.) While we don't know if there was one singular instance that set off Dee Dee's behavior, there are a few things that we know about why certain people become perpetrators of Munchausen by proxy.
Often perpetrators of Munchausen by proxy have experienced abuse or neglect during childhood, Marc D. Feldman, MD, distinguished fellow of the American Psychiatric Association, and author of Dying to be Ill: the Stories of Medical Deception told Refinery29. They may also have other personality disorders, such as borderline, histrionic, or avoidant personality disorders. "The main reasons the mothers behave this way is that they are after attention and concern; they seek to control their child," Dr. Feldman said. In studies, researchers have shown that the majority of women perpetrators of medical abuse grew up with an insecure, ambivalent attachment to their parents, and may have a similar relationship to their own children.
In some cases, perpetrators of Munchausen by proxy may have realized that they could get attention by pretending to be sick growing up, Dr. Feldman told Refinery29. As adults, they may continue this behavior using their children instead. Someone who grew up around a lot of physical illnesses, or who witnessed parents who tried getting attention from doctors, might also exhibit Munchausen by proxy tendencies with their own children. Interestingly, many women who worked as caregivers are often perpetrators of Munchausen by proxy, especially those who have experience being around medicine. We know that Dee Dee had medical training, and in the end of this episode of The Act, we also see her caring for Grandmmama when she's sick.
Abuse of any kind is never okay, but with Munchausen by proxy, it's particularly disturbing. In the Buzzfeed News story about the case that initially made headlines in 2016, the writer points out that, since Dee Dee is deceased, it's impossible to diagnose her with Munchausen by proxy. Now with this Hulu series, it's easy to wonder, had someone picked up on Dee Dee's behavior and red flags, perhaps she and Gypsy Rose would have suffered a different fate.
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