Judge cites Munchausen for leniency in mom's sentence

WHITE PLAINS, N.Y. — While Münchausen by proxy is recognized as a mental illness by the established medical community, jurors deciding the fate of Lacey Spears never heard mention of the illness during her trial.

But when a judge Wednesday sentenced the former Chestnut Ridge, N.Y., woman convicted in March of fatally poisoning her 5-year-old son, Garnett, he cited the disorder as a reason for some leniency.

While the probe into Garnett's death focused on Münchausen by proxy, prosecutors ultimately did not introduce that theory at trial, suggesting they were convinced that the evidence they had was strong enough for a conviction.

"I am appalled, but not truly surprised, that the judge made Münchausen by proxy a mitigating factor in establishing the sentence," said Dr. Marc Feldman, an Alabama psychiatrist and expert in Münchausen.

"Pedophilia is also listed in the official psychiatric nomenclature as a mental disorder," Feldman said. "Would the judge have applied that as a mitigating factor if Lacey Spears had killed Garnett in the context of sexually assaulting him?"

Acting state Supreme Court Justice Robert Neary ordered Spears, 27, to serve 20 years to life in prison — short of the maximum 25 to life for second-degree murder charges.

Not all mental health and legal experts agree about Münchausen by proxy, a condition in which a caregiver — almost always a mother — secretly injures someone, usually a child, to seek attention.

They prefer the term "factitious disorder," in which a person acts as though they or someone they care for has an illness that they don't really have. The Diagnostic and Statistical Manual, the bible of psychiatry, recognized factitious disorders imposed on others as a mental illness for the first time in 2013.

Organizations such as the National Institutes of Health refer to Münchausen by proxy as a "psychiatric disorder," though some experts, including Feldman, disagree.

Spears carefully planned, moving her son from state to state, doctor to doctor, to get treatment for conditions he never had. In the final days of the child's life, his mother sneaked him into a hospital bathroom to deliver a fatal dose of salt through his feeding tube, prosecutors said.

So much planning to avoid detection, Feldman said, means Spears had "not lost contact with reality. She knew what she was doing.

"If she had not been in touch with reality, if she did not know what she was doing, she could not have taken those actions," he said.

Neary pointed to that during sentencing. "This was not a spontaneous or ill-conceived solitary act. It was a serious and orchestrated series of actions that really shock the conscience," he said.

Brenda Bursch, a California psychologist who has treated patients with factitious disorders, is convinced that it is a psychiatric condition.

"I don't have a doubt in my mind that psychopathology is involved," she said.

Patients with a factitious disorder can be helped through psychotherapy, she said, but only if they are willing to admit that they caused harm.

Spears, who did not testify at her trial, was never diagnosed with Münchausen by proxy. She maintained that she was a careful and loving mother to a very sick little boy.

Contributing: Lee Higgins, The (Westchester County, N.Y.) Journal News