To what extent do the parents/guardians of child beauty pageant contestants meet the criteria for Factitious Disorder by Proxy (FDP)? Introduction In the Western society, it has long been argued that child beauty pageant (CBP) is perversive because of its emphasis on sexualising innocent children. Child pageant’s parents tend to be the objects of social criticism and condemnation because they are in a position to encourage and authorise the CBP ideologies.
Sarah Burge from the United Kingdom, who has dramatically ‘made over’ her seven-year-old daughter Poppy, and taken her to compete at the Darling Dolls of American Contest 2012, will be the object of study. The aim of this essay is to provide an assessment of Sarah as a child pageant’s mother, analyse and discuss whether her motivations and behaviours constitute the criteria for Factitious Disorder by Proxy (FDP).
Although atypical, it is argued that Sarah’s behaviours and motivations have met the majority of the FDP criteria, including fabricating pre-pubertal maturity in Poppy and assuming a sick role in Poppy as sexually inadequate by proxy. In addition, this essay will critically analyse whether Sarah’s behaviours were encouraged by a set of intangible motivations, such as her illogical or even pathological demand for power, control, and excitement.
Since FDP assessment takes both sociological and psychodynamic perspectives into consideration, Sarah’s FDP behaviours have implication for her coping with patriarchal suppression and trauma at both social and familial levels. Factitious Disorder by Proxy and child beauty pageant Although atypical, characteristics of Factitious Disorder by Proxy (FDP) suggest its relation to that of a child beauty pageant (CBP). FDP is also known as Munchausen Syndrome by Proxy (Rosenberg, 1987) and Induced Illness by Carers (Parrish & Perman, 2004).
FDP usually involves a caregiver, almost always the mother, who deliberately induces physical or psychological symptoms in her child by proxy (Franzini & Grossberg, 1995, APA, 2000). Inevitably, FDP does not only constitute a mental disorder in the perpetrator, but also appears as child abuse through intentional victimisation. On the other hand, CBP is a competition where parents produce children as objects of “public fascination” (Giroux, 1998, p. 37). Typically, it is a place where mothers of child pageant ‘convert’ their innocent daughters into attractive and mature sexual beings.
The common ground between a FDP perpetrator and a child pageant’s parent is also that both their behaviours have more or less implication for abusing a child by proxy. Although perpetrator of FDP constitutes a condition whereby the child suffers direct harm through the mother’ actions, the potential psychological consequences of CBP (e. g. premature syndrome, depression, behavioural and emotional dysfunctions) also suggest an indirect form of harm (Heltsley & Calhoun, 2003, Lieberman, 2010).
Nonetheless, Lasher and Sheridan (2004) emphasised that the identification of traits congruous with the FDP criteria served only to provoke suspicions, but did not always constitute a profile. The nature of role and the behaviours of child pageant’s mothers may reflect that of a FDP, but this does not automatically mean that they possess this disorder. Diagnosis for FDP is often controversial and complex, involving fundamental dynamics of human behaviours that conventional diagnostic criteria can fail to fully comprehend (Butz, Evans & Webber-Dereszynski, 2009).
Therefore, when assessing whether child pageant’s mothers meet the criteria of FDP, both diagnostic criteria and family dynamics need to be analysed. In Sarah’s case, the actual production of illness in Poppy might not be present. However, it is evident that Poppy was a victim of a society where the human bodies were increasingly problematised and medicalised. The fabrication of maturity First, it is important to assess whether a child pageant’s mother had intentionally produced or feigned physical or psychological symptoms in a child who was dependent on her (APA, 2000).
In this criterion, there are two primary areas of examination: whether there exists a dependable relationship, and whether there is recognisable induced symptoms. In an intuitive sense, pre-school daughters are always dependent on the mothers, although Sigal, Gelkopf and Meadow (1989) found out that there could be a two-way dependency between mothers and daughters. At a CBP context, child pageant is even more dependent on her mother because of situating in a potentially competitive and hostile environment. At a normal circumstance, ypical FDP patients induce symptoms in the child through poisoning, injections, suffocating, or feigning of medical records, and subsequently request for unnecessary medical attention and treatment (Franzini & Grossberg, 1995). Child pageants mothers, however, induce more subtle form of symptoms. Pre-pubescent girls are required to act like and possess the qualities of fashion models by their mothers (Heltsley & Calhoun, 2010). This requirement inevitably involves a number of ‘beauty’ projects to exaggerate sexual qualities on stage.
As is demonstrated in Sarah’s case, she invested ? 15,000 on Poppy’s pageant career, including entrance fees, outfits, cosmetics, modelling courses, and pole-dancing lessons (Pearce, 2012). Poppy’s process of becoming a qualified child pageant, with feminine body shape and sexual attractiveness, was through a series of extravagant makeover and unnecessary training supported by Sarah. More importantly, training a supposedly innocent girl to flirt and pose sexually is a means of inducing and simulating a facade of a sexual being in Poppy.
What Sarah also feigned in Poppy was a social roles as “human capital” that children sociologists had always denied being an appropriate lifestyle for children (Levey, 2009, p. 197). Rather then protecting Poppy from the complicated life of adults, Sarah shaped her into a by-product of social and cultural institutions (Giroux, 1998). Therefore, it is evident that Sarah induced a symptom of prematurity that did not normally occur in pre-school children with healthy physical and mental development. The need for illness Second, is it crucial to assess whether the motivation of the FDP is to simulate a sick role by proxy (APA, 2000).
In this category, it is especially important to examine whether a child pageant’s mother uses her perceived legitimacy and authority to assume a sick role in her pageant child. As demonstrated in her dedication to Poppy’s ‘beauty’ projects, Sarah seemed to assume a sick role in Poppy as being sexually inadequate or imperfect. In a material society where individuals overemphasise the priority of beauty, child pageant’s parents have the tendency to use celebrity images from the media as a normative standard for their children (Lieberman, 2000).
This explains why Sarah gave fake tan to Poppy, encouraged her to do liposuction and breast enhancement, while injecting her other daughter, Hanna, with Botox (Pearce, 2012). Astonishingly, Sarah supported Poppy to thrive in a medical environment where most mainstream mothers found intimidating. Moreover, in a clinical perspective, children failing to meet the standards of the social definition of beauty are considered normal. However, Sarah did not regard this sexual inadequacy as normal and acceptable.
Rather, she was convinced that physical imperfection in a child was a ‘disease’, that required ‘fixing’ through the feigning a sexual facade. More importantly, Sarah was only ensured by her own actions for ‘caring’ if the perceived sick role in Poppy persisted. Both legally and morally, Sarah had a deterministic power over her daughter Poppy. Although Sarah repeatedly claimed that she had never forced any of her pageant’s ideologies on Poppies (Pearce, 2012), Sarah’s persistent pursuit of them meant she was responsible for Poppy’s sexual performance (Levey, 2009).
This behaviour, typically manipulative, only works when the mother is in a position of authority and power. Of course, medical staff would regard Sarah’s behaviours as a deliberate harm to Poppy, rather than saying Poppy was sick because of her normal immaturity. Nonetheless, it is important to note that Sarah was trained in a nursing school before she opened a plastic surgery consultation service (Mirror, 2011). Her perceived expertise and experience provided her with the power to confront and challenge both social and clinical judgement that condemned her (Butz et al. , 2009).
Consequently, Sarah was convinced that she had a legitimate position to pressure Poppy into her own values and beliefs. Since Sarah compulsively and authoritatively regarded gratuitous medical attention as inevitable to Popp’s pageant career, she had already fulfilled the criterion of assuming a sick role in her child by proxy. Intangible motivation and psychological incentives Perhaps the most essential criterion, it is important to assess whether internal incentives outweigh external ones. According to the APA (2000), external incentives for FPD behaviours are absent.
Similarly, many scholars argued that behaviours that are encouraged by an external consequence or tangible gain, such as financial gain and academic achievement, are not categorised in FDP (Hahn, Harper, McDaniel, Siegel, Feldman & Libow, 2001, Parrish & Perman, 2004). However, this ground is inconclusive. In reality, most pageant’s mothers, including Sarah, are motivated by both external and internal gains. If Sarah was ‘solely’ and consciously motivated by the monetary gain from Poppy’s pageant career, her motive was better explained by Malingering by Proxy (Pridmore, 2006).
However, she demonstrated a more complex sense of satisfaction for being a child pageant’s mother. Schreier and Libow (1994) asserted that when external incentives were subordinated to internal incentives, the integrated motivation constituted that of a FPD patient. In fact, one of the most complex aspects of a FDP mother is the internal incentive she earns from controlling and manipulating her child’s physical and psychological self. In particular, Precey (1998) argued that mother is motivated unconsciously by their inner drives and fantasies.
Although Sarah claimed that child pageant was more about raising money for Poppy’s future education and her own charity organisation, than pursuing fame (Pearce, 2012), her motivation did not appear that simplistic. FDP parent, as Welldon (2011) found out, was always trapped in her own unconscious motivation. Put differently, Sarah’s recognition of the external incentives could be interpreted as a form of self-denial and self-deception that repressed and concealed her inner drives.
Apparently, Poppy’s pageant career had helped Sarah, especially her extraordinarily ‘open-minded’ parenting style, to gain fame and popularity across the American. What Sarah also sought to gain was the connection with people, and other pageant’s mothers, who admired her and Poppy. For a FDP mother, her ‘sick’ child is a medium to legitimise her own pathological need for help and attention (Franzini & Grossberg, 1995), although Sarah did not appear to need help at this instance. Poppy, in this phenomenon, constituted what Boocock and Scott (2005, p. 33) called the “passive recipients of adult socialization”.
If the ultimate aim of Sarah is to subtly exploit this fame to fulfil her pathological need for attention and recognition from the media and other social systems, her behaviours already constituted a by-product of her inner drivers. In addition, the underlying theme behind FDP is that the behaviours are motivated by pathological rather than realistic fantasies. Franzini and Grossberg (1995) argued that what drives FPD mother and her behaviours is her paranoia and delusion that her child is seriously ill, and a sociopathic character that enables her to challenge legal and moral systems without feeling guilty or remorseful.
As Sarah felt excessively ‘unique’ in a “characterological sense” (Butz et al. , 2009, p. 35), it could paradoxically imply her insufficient self-worth and a pathological need for power and excitement. Only narcissistic, borderline, and fragile person like Sarah would constitute her identity from caring for an ‘ill’ child, hoping to receive praise and envy from the media and other mothers who recognise her social authorities. Sarah thought high of her ability to manipulate the perceptions of others despite realising her fragmented and contradictory thoughts (Schreier & Libow, 1994).
That is also why FPD perpetrators are vulnerable to criticism and condemnation. When criticised by other pageant’s mothers, Sarah had the tendency to belittle these women as ugly, fat, incompetent and ignorant (Pearce, 2012). While Sarah denied her responsibility and harm on Poppy, she would simultaneously deflect her own pathology to condemners of her behaviours. Rosenberg (1987) described this behaviour as the “distorted” intent of parents with FDP. Although less explicit, Sarah’s motivations could be interpreted as that of a FDP mother.
History of abuse Sigal, Gelkopf and Meadow’s (1989) study on FDP mothers indicated that most of them have a history of being abused. In this sense, previous experience of abuse also has implication for the motivation and behaviours of pageant’s mothers who are characterised as FDP perpetrators. Sarah was once a victim of domestic violence perpetrated by her male partner, resulting in a completely disfigured facial appearance for the subsequent six years, before she had thirty medical procedures to fix it (Mirror, 2011).
Sarah’s history of physical abuse was a justifiable ground for her medical pursuit, but she continued to dramatise her personal history and develop a pathological need for unnecessary plastic surgery. As is realised by her ‘Barbie doll’ make up and her numerous attempts of plastic surgery (Eugenios, 2012), Sarah seems to also assume a ‘sick role’ herself as being imperfect without a facade. According to Feldman, Rosenquist and Bond (1997), the concurrent of FDP and FD is relatively possible. Such fabricated victimisation of Sarah’s own self have implication for her inducing a sick role to Poppy by proxy.
In a psychodynamic perspective, FDP underlies a craving for authority that is an anticipated outgrowth of a society of patriarchy and its continual suppression and victimisation of women (Franzini & Grossberg, 1995, Butz et al. , 2009). Sarah appeared to have such a pathological need to control Poppy’s pageant career and her achievement, in a way exercising her authority to a submissive child as a compensation for patriarchal suppression. Whether Sarah’s FDP behaviours arise from pure mistakes or complex psychoanalytical drives, they should be understood as the defensive mechanism to past trauma.
According to Welldon (2011), the aim of FDP patients is directed toward themselves, their own bodies, or what they perversely constitute as a continuation of themselves, their child. In this sense, Sarah had generalised her personal tragedy to Poppy. By making Poppy to conform to social standards, Sarah was convinced that she was protecting her but not harming her. Especially when the father was emotionally and physically absent, Sarah’s damage on Poppy could also be interpreted as spouse revenge on the father for contributing to a damaged family (Franzini & Grossberg, p. 3). This view also assumes that repressed feelings against family and society were enacted toward the child in abnormal and perverted behaviours. In fact, the psychoanalytical cause of Sarah’s FDP behaviours is not purely the distorted structure of family and society, but also the feelings and emotions behind these institutions. Child as object Finally, FDP mothers who direct toward their children only treat them as an object rather than an individual. Rosenberg (1987) and Polledri (1996) described this abnormality as Disorder of Empathy for the child among FDP mothers.
Although Sarah claimed that she loved Poppy, but assessing her includes finding out what was her repressed feelings at the behind. In her pursuit of compensation, Sarah turned Poppy into a sexual commodity that fulfilled her greed, recklessness, and need for security. All she solely concerned about was her mental achievement, rather than Poppy’s inner strength and personal development. Poppy may solely be an object in which Sarah unlashed her repressed struggle of frustration and indignation.
The implication is that Sarah was never proud of herself as a parent, but was only proud of herself as a beauty consultant who had created a pageant winner. While her profound ambivalence affirmed that she lacked the feelings for being a maternal figure at all, it also implied that she behaved just like a typical FDP mother. Conclusion Undeniably, child beauty pageant represents a problematic stage where parents can indulge their children, while fulfilling their own need for authority and power. This assessment requires the consideration of both sociological and psychodynamic perspectives.
Unlike typical FDP perpetrators, Sarah deliberately induced pre-pubertal maturity on seven-year-old Poppy, when Poppy did not deserve to live in a complex adult world that overemphasises the significance of sexual qualities of women. Sarah was also trapped in a social reality that constantly encouraged individuals to keep up with the celebrity standards of beauty. It was a FDP behaviour for Sarah to assume a sick role as sexually inadequate in Poppy, and then ‘fix’ her with unnecessary makeover and even dangerous medical procedures.
Although external incentives have appeared to be the primary motivation for Sarah’s dedication on Poppy’s pageant career, this has insufficient implication for the whole story. Rather, the fame, attention, power and security that she had gained from controlling and manipulating Poppy’s physical and psychological self have predominantly motivated her. In a psychodynamic point of view, Poppy was only a medium, or an object for Sarah to unlash her repressed frustration for domestic violence and patriarchal suppression.
Although Sarah’s behaviours and motivations have closely met the majority of the FDP criteria, it is not possible to conclusively confirm that Sarah, or other pageant mothers, are FDP perpetrators. Diagnosis of FDP is often complex, involving a significant extend of dynamic variability. In fact, this assessment has a more valid implication; that is, FDP behaviours have become increasingly prevalent among mothers who do not necessarily constitute a physical abuser of children. References American Psychiatric Association, 2000, Diagnostic and statistical manual of mental disorders, 4th edn, e-book, Washington, DC, Statref, viewed 1 Oct 2012, ttp://online. statref. com/Document. aspx? DocID=1&fxId=37&npo=p7&anon=yes&noteId=3898&SessionID=196977CSWPRSOKWD Boocock, S & Scott, K 2005, Kids in Context: The Sociological Study of Children and Childhoods, Rowman and Littlefield, New York. Butz, MR, Evans, FB & Webber-Dereszynski 2009, ‘A practitioner’s complaint and proposed direction: Munchausen Syndrome by Proxy, Factitious Disorder by Proxy, and Fabricated and/or Induced Illness in Children’, Professional Psychology: Research and Practice, vol. 40, no. 1, pp. 31-38.
Eugenios, J 2012, ‘Human Barbie’ defends her plastic surgeries, parenting’, NBC News, 5 Sept 2012, viewed 3 Oct 2012, http://today. msnbc. msn. com/id/47353734/ns/today-today_news/t/human-barbie-defends-her-plastic-surgeries-parenting/#. UG_4KvlrbT0 Feldman, MD, Rosenquist, PB & Bond, JP 1997, ‘Concurrent Factitious Disorder and Factitious Disorder by Proxy: double jeopardy’, General Hospital Psychiatry, vol. 19, no. 1, pp. 24-28. Franzini, LR & Grossberg, JM 1995, ‘Munchausen’s Syndrome by Proxy: the new form of child abuse’, in Eccentric & Bizarre Behaviors, John Wiley & Sons, New York.
Giroux, HA 1998, ‘Nymphet fantasies: child beauty pageant and the politics of innocence’, Social Text 57, vol. 16, no. 4, pp. 31-53. Hahn, LV, Harper, G, McDaniel, SH, Siegel, DM, Feldman, MD & Libow, JA 2001, ‘A case of Factitious Disorder by Proxy: the role of the health-care system, diagnostic dilemmas, and family dynamics’, Harvard Review Psychiatry, vol. 9, pp. 124-135. Heltsley, M & Calhoun, TC 2003, ‘The good mother: neutralization techniques used by pageant mothers’, Deviant Behavior: An Interdisciplinary Journal, vol. 4, no. 2, pp. 81-100. Lasher, L & Sheridan, M 2004, Munchausen by Proxy: identification, intervention and case management, The Haworth Maltreatment and Trauma Press, New York. Levey, H 2009, ‘Pageant princesses and math whizzes: understanding children’s activities as a form of children’s work’, Childhood, vol. 16, no. 2, pp. 195-212. Lieberman, L 2010, ‘Protecting pageant princesses: a call for statutory regulation of child beauty pageants’, Journal of Law and Policy, vol. 18, pp. 739-774.
Mirror 2011, ‘Surgery addict Sarah Burge explains why 100 cosmetic procedures still isn’t enough’, 7 Aug, 2011, viewed 3 Oct 2012, http://www. mirror. co. uk/news/real-life-stories/surgery-addict-sarah-burge-explains-184308 Parrish, M & Perman, J 2004, ‘Munchausen Syndrome by Proxy: some practice implications for social workers’, Child and Adolescent Social Work Journal, vol. 21, no. 2, pp. 137-154. Pearce, D 2012, ‘Does this girl have the worst mum in Britain? ’, The Sun, 25 May 2012, viewed 3 Oct, 2012, http://www. thesun. o. uk/sol/homepage/features/4337082/Does-this-girl-have-worst-mum-in-Britain. html Polledri, P 1996, ‘Munchausen Syndrome by Proxy and perversion of the maternal instinct’, The Journal of Forensic Psychiatry, vol. 7, no. 3, pp. 551-562. Precey, G 1998, ‘Assessment issues in working with mothers who induce illness in their children’, Child and Family Social Work, vol. 3, pp. 227-237. Pridmore, S 2006, Factitious Disorders and Malingering, in Download of Psychiatry, University of Tasmania, viewed 5 Oct 2012, http://eprints. tas. edu. au/287/28/Chapter_23. _Factitious_disorder_and_malingering. pdf Rosenberg, DA 1987, ‘Web of deceit: a literature of Munchausen Syndrome by Proxy’, Child Abuse Neglect, vol. 11, pp. 547–563. Schreier, HA & Libow, JA 1994, ‘Munchausen by proxy symptoms: a modern pediatric challenge’, The Journal of Pediatrics, vol. 125, no. 6, pp. 110-115. Sigal, M, Gelkopf, M & Meadow, RS 1989, ‘Munchausen by Proxy Syndrome: the triad of abuse, self-abuse, and deception’,
