Revisiting Season One: Can They Be Saved?
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Hello, it's Andrea, host of Nobody Should Believe Me. We are in our seventh episode of our revisit to season one, almost at the end. And for today's episode and for our finale, which will be re-airing next week, it's going to be just me in the postscript, just me talking you through

All of the big feelings and thoughts that I had listening to these two final episodes. This first season was such a journey, and we really figured out what the show was going to be and what

Yeah, I have a lot of thoughts to share about this episode in particular when I see you shortly from the future right after the end of this episode. So stay tuned for that. And in the meantime, as always, if you want more from us, you can subscribe to our Patreon or subscribe on Apple Podcasts and you get...

a minimum of two exclusive bonus episodes per month. You also get all episodes early and ad-free. So check us out there if you want more content. This month, we are doing a deep dive on the Justina Pelletier case, which is one that I get asked about a lot. We're doing that with our good friend of the show, Dr. Becks. So that is what is in store for you over there, as well as a huge backlog of exclusive bonus content. In the meantime, here is today's episode, and I will see you soon.

♪

Well, we got a minute. I'm going to buy that truck I've been wanting. Wait, don't you need, like, weeks to shop for a car? I don't. Carvana makes it super convenient to find exactly what I want. Hold up. You're buying a car on your phone? Isn't that more of a laptop thing? You can shop wherever you want. I like to do my research, read reviews, compare models. Plus, Carvana has thousands of options. How'd you decide on that truck? Because I like it. Oh, that is a great reason. Go to Carvana.com to sell your car the convenient way.

Did you know that I have a new book coming out? True Story. And unlike my previous books, this one actually is a true story. The Mother Next Door, Medicine, Deception, and Munchausen by Proxy, which I co-authored with friend of the show, Detective Mike Weber, chronicles three of his most harrowing and impactful cases—

Long-time listeners of the show will have some familiarity with these cases, but I promise you will learn so much more about them, and you'll also just learn so much more about Detective Mike's journey in this arena and also mine. Dr. Mark Feldman, another friend of the show and an esteemed expert in all things Munchausen by proxy, read an early copy, and this is what he had to say about it.

a truly vital, groundbreaking, and riveting contribution to the true crime literature on child abuse. Over the past four decades, I have read just about everything dealing with medical deception, including Munchausen by proxy abuse, and can easily affirm that this immensely readable book is the most important literary work since Professor Roy Meadow coined the Munchausen by proxy term 50 years ago. And if you don't think that that endorsement from that particular man made me cry...

You would be wrong. So the book comes out on February 4th of next year. And now I know what you're thinking. Andrea, why are you talking to me about this right now? February is approximately 100 years from now. We have to do a whole election and whatever else before then.

And I hear you, but I'm telling you this now because as you may know, if you have any other authors in your life, pre-orders are vital to a book's success and will really affect how our publisher positions and supports the book's launch. So if you think you are going to buy this book, doing so now will really help us out. It's available for pre-order in all formats wherever books are sold, and you can find it at a link in the show notes. I hope you will love it, and I appreciate your support.

Before we begin, a quick warning that in this show we discuss child abuse and this content may be difficult for some listeners. If you or anyone you know is a victim or survivor of medical child abuse, please go to MunchausenSupport.com to connect with professionals who can help. People believe their eyes. That's something that actually is so central to this whole issue and to people that experience this is that we do believe the people that we love when they're telling us something.

I'm Andrea Dunlop, and this is Nobody Should Believe Me. At the beginning of this process of doing this podcast, I think I'd convinced myself that I had put the personal stake that I have in this issue behind me in a way that I've now discovered maybe I have not.

Despite my best efforts to completely detach from my sister, there is still a small part of me that can't help but hope that at some point in the future, there might be some sort of reconciliation.

As I was going back and forth with Hope, as I was talking to her family and sort of reliving all of these emotions that I had kind of tucked away for a long time, I almost feel a little foolish that I would have any hope for a reconciliation because of everything that I know. That

That person is still, she's still my sister, but I also sort of don't feel that way. That person sort of is still physically out there, but then in a very meaningful way is not. So much of what you believed that person to be and who you believe that person to be is shown to be an illusion because of the lies that they have told you. And I have needed to no longer be naive about

I thought I had the answer of whether or not people who do have fictitious disorder imposed on another to whether or not they could be treated, and that seemed impossible. And then the deeper I got into this, it seems more possible. I really wanted to go deep on this topic in particular with Dr. Mark Feldman and Dr. Mary Sanders.

When people ask you, is Munchausen by proxy a mental illness, how do you answer that question? I tell them Munchausen by proxy is not a mental illness in itself. It's a form of maltreatment, usually of children. But I also am quick to point out that the American Psychiatric Association says that it's always associated with a mental illness they call factitious disorder imposed on another person.

But I don't want to lose sight at any time of the fact that it's a form of maltreatment because we have a responsibility as healthcare professionals to make reports to Child Protective Services and the police when we see it play out. We wouldn't do that if it were just a mental illness, but we must do that when it involves the exploitation of children.

When it comes to the underlying psychiatric disorder, so factious disorder imposed on another, with what perpetrators get out of it? Why someone would do this? That's a critical point. In Munchausen phenomena, the person is after emotional gratification.

attention, sympathy, care, support that they feel unable to get in any other way. Sometimes they're a bit desperate in their personal lives and certainly harming a child, whether it's yours or somebody else's, is an act of desperation. And when it comes down to a possible cause for it,

We don't know tons about the causes because the perpetrators tend not to make themselves available for study. The denial is really pervasive and persistent.

in these cases and the perpetrators will, in most cases, never admit to what they've done. And if that happens, you have no basis for exploring the behavior with them. That said, it does seem as if many of these perpetrators have a history of making themselves sick. That is, they have a history of factitious disorder imposed on self or Munchausen syndrome. Those are fairly synonymous.

They also seem to have personality disorders that are very severe. That is, they have long-term maladaptive, unhealthy ways of trying to get their needs met.

We've heard a lot of common themes as we've been talking to people about these stories in terms of the behavior patterns. One of them you mentioned, which is the factish disorder imposed on self. So just a long history of inexplicable medical ailments. The other things that have come up a lot are various kinds of fraud, financial and otherwise, and then infidelity. Would the personality disorder element of infidelity

Of this, would that kind of account for some of those other behaviors that don't seem necessarily related to factitious disorders, but are sort of patterns we've really been recognizing? Yeah.

A common underpinning is deceptiveness and impulsivity and poor judgment. And that kind of person is likely to engage in all the kinds of behaviors we're talking about now, whether it's infidelity, lying about aspects of their lives that may not even involve illness in any way.

When it's severe, we call it pseudologia fantastica, which is a Latin term for pathological lying where the person mixes some truth with fiction, which makes for the best lie in a sense. When we see that, we know that we've got an extraordinarily difficult uphill battle to fight to get them to acknowledge that anything they've said is false.

Another pattern that we've seen and that I've seen just in reading about many different cases is that many of these babies

who end up becoming victims of medical child abuse are born premature and in some cases severely premature. And so any baby who's born premature is going to have some issues in the very beginning. You did actually hear from a couple of perpetrators and talk to a couple of perpetrators for your most recent book. And there was a woman that you spoke to for your book who talked about exactly how she felt

created the scenario of having a premature birth. And that has just something that has really stuck with me.

You're right that a common factor among some perpetrators, in fact, many, is that there have been obstetrical complications that led perhaps to a failure of bonding early on. And so sometimes people have said there's no way this could be Munchausen by proxy because the mother has five children.

And it's only the fourth child or the fifth child that anything has happened with. And I look at their backgrounds and find that that fourth or fifth child may well have been one of the examples in which bonding didn't really occur successfully. Or the child is perceived as imperfect.

in some way, and whether it's conscious or unconscious, that child gets victimized by a mother who is dissatisfied at some level with the way things have turned out with that particular child. In other cases, it's every child in the family.

I want to be really clear here that though we're talking about one piece of this behavior, one spot in the timeline of these cases, we are not by any means indicating that people who have complications with their pregnancies or who have premature babies

are in some way more at risk for becoming perpetrators. They're absolutely not. This is a case of we see a high percentage of Munchausen by proxy perpetrators who do this thing, not that there's a higher percentage of people who have this in their lives become these perpetrators. This is yet another scenario that perpetrators who are already midstream with this behavior will exploit perpetrators

that set of circumstances for their own gain, not that people who have that set of circumstances legitimately then go on to do this. So I wanted to be really clear about that causal relationship that we're speculating about here. The reality about Munchausen by proxy is that these behaviors are very deep-seated and they in fact function much like an addiction.

There is a compulsive or addictive quality to gaining attention, even if it's under false pretenses. And that certainly does involve false pretenses, exaggerations and falsification in these cases. That's why I think we've been seeing an explosion of what I've called Munchausen by Internet or Munchausen by proxy by Internet, where a person misbehaves.

They sicken their child in real life, but regardless goes online and milk social media for all it's worth by posting pictures of the child with tubes coming out of every orifice.

We call it medical porn because that's basically what it is, these disturbing photos that are intended to do nothing other than alert friends, family, strangers that this mom needs all the support she can get. As to the question of whether or not perpetrators are treatable, I really wanted to talk to Dr. Mary Sanders because she is one of the foremost experts in the world on that particular part of this subject. ♪

I'm a clinical associate professor at Stanford University Medical School in the Department of Psychiatry. I'm also co-chair of a national committee through APSAC, American Professional Society on the Abuse of Children. And the committee is a multidisciplinary committee that looks at the assessment and treatment of Munchausen by proxy. Are these perpetrators treatable?

Treatment with perpetrators of Munchausen by proxy abuse is very difficult. The important aspect is acknowledgement. And when individuals tend to have what's called an external locus of control, they tend to blame others, not take responsibility, get their needs met indirectly using deception. It's very difficult for them to admit and acknowledge that they've engaged in these behaviors indirectly.

not only to others, but to themselves. Certainly they may face all sorts of reprisals from friends, family, and legally as well. And so there's a lot of reasons not to acknowledge the abusive behaviors. With that said, some have been able to do so.

And it takes a lot of courage for them to be able to do that. When they have, they have then been able to work successfully in treatment. We have had successful cases. We have had cases that we're able to reunify with ongoing support. Are there other things that make this kind of treatment particularly difficult? Yes. A lot of the parents have engaged in their own factitious behaviors and post-unself behaviors.

And I have had some parents that it was very difficult for them to admit that to themselves and to their family. The families were, needless to say, quite surprised and upset and felt betrayed. Also, personality disorders. A lot of parents are diagnosed with personality disorders that are difficult to treat. And especially if the abuse has been severe and life-threatening, for example, non-accidental poisoning or smothering, these are

much more difficult situations in which to work at treatment and reunification. Is that usually the goal of family court, which is where a lot of these cases end up rather than in criminal court, you know, is to reunify the family. That's usually seen as a successful outcome. So I wonder how we should think about whether or not reunification is

should ever be the goal in these cases? And if so, under what conditions? Reunification is a mandate, as you mentioned, of child protective services. And we do want to try to do that if possible, obviously, if it's safe for the child. It is quite a process. The first step is going to be acknowledgement from the perpetrator that the abuse has occurred.

If the spouse is going to reunify, the spouse has to also accept that these behaviors have occurred and recognize that they're going to be an integral part in providing protection and support ongoing. And then the children, too. Basically, we want to be able to have the children informed as well. Then we're at the stage of being able to have a parent inform the child of the abusive behaviors that he or she engaged in.

and be able to set up a extremely important safety situation, usually in which the non-abusing spouse is the one that takes the child to the doctor. The doctors are informed.

We usually request that there be two pediatricians that are informed and they're the gateway to any treatment that the child needs. So there's basically a lot of checks and balances to maintain safety within the family. It takes a lot of energy, a lot of dedication for these families to work toward reunification. It has been successfully done. It is very rare though. If we could hear from you about...

the minds of these perpetrators, what that experience is like for them. How much they understand about what they're doing, whether or not they ever get convinced of their own deceptions. There's a defense mechanism called compartmentalization. One parent told me they were able to take the knowledge they were doing this to their child, actively harming their child, and sort of put it in a little mental drawer and kind of close it.

They knew it was happening, but they could just not pay attention to that information. Like you lose your keys and you know, there they are, you know, so every once in a while they would be reminded that they were engaging in these behaviors.

but they would also be using rationalization and other defense with the idea being that this is helping my child. They're getting these opportunities to meet celebrities or, you know, Make-A-Wish Foundation, Habitat for Humanity, rationalizing that somehow this was actually in their child's best interest.

And I have had parents that did, they said they almost came to believe the illness. And especially, you know, when they were able to convince doctors and then the doctor said, oh yes, your child has this. They were able to kind of suspend reality and come to believe it to some extent themselves. It's not a delusional system, but being able to almost convince themselves, even though they know it's not true.

There is this easy conception when people are looking at these cases to look at these perpetrators as monsters. I really appreciate and think it's extraordinary that people like you can find enough empathy as a way in to helping these women and helping these families. And it's moving for me to think that it's not just completely hopeless.

I've had people tell me that. How can you do this work with these monsters? I've had that word used quite a bit, actually. I think it comes from seeing, experiencing, and acknowledging that we are not defined by our behaviors. We are multi-storied. Certainly, we can all engage in behaviors that don't fit for us. We can engage in behaviors that can be

altered with support and help, especially the parents that I've worked with that were successful. These were very disempowered women. We go back in time and look at their growing up, especially around how do you get attention? How did you get your needs met?

And sometimes in doing that, what we've been able to do is discover almost this story in which they realized they had used deception in their childhood to get attention. And they may have even seen the child that for

pretends to be sick to stay home from school. A number of us have done that, but they may have seen this and been a part of that themselves. And basically that sometimes helped them be able to acknowledge, wow, this is really, I've done this. I've engaged in these behaviors in my life. And now I've taken it to this step where I've presented myself as being ill when I'm not, presented my child as being ill when my child is not. And so sometimes that's where we can get to the acknowledgement if it's not right away.

I really like that you made that connection between the childhood experience of I'm sick and I want to stay home from school and you get taken care of. And I think it's a pretty universal human experience to enjoy being nurtured and taken care of and having a little minute away from life. So I think it's really helpful to bring those comparisons back down to earth a little bit because the more that we can understand life,

how this is an extreme of that feeling that we can relate with, it's helpful to everyone to understand that this is on a continuum rather than a good mother does this and a monstrous mother does that. It's not an all or none, exactly. And there is a pretty big spectrum of these behaviors.

There certainly is a spectrum. With that said, we're also very cognizant that all of this is harmful to children and we do want to keep that in mind. And I think it's especially important because the best way to get these families help is to report the abuse.

Situations in which children may be over-medicalized, brought to the doctor when they may not have a need. That leads to inappropriate treatments that can be harmful, evaluations that can be invasive. All the way to, yes, smothering or use of substances, poisoning, that can certainly put a child at risk for death.

You know, it gets to this question whether we should be looking at Munchausen by proxy perpetrators as criminals to be prosecuted or sick women who need help.

My experience is that both can happen simultaneously, which is difficult. Here you have an individual who either has to plead guilty or not guilty, which means if they're pleading guilty, then they're open to entering into treatment because they're acknowledging. If they're pleading not guilty, then the treatment really can't proceed. What do you think can be done to better protect children from this kind of abuse?

I mentioned APSAC before, American Professional Society on the Abuse of Children. The audience is pediatricians, psychology, psychiatry, social work, judges, attorneys, all of us that are involved in these cases. So the best way to protect is to recognize and report.

I first met Detective Mike Weber at a child abuse conference where he was giving a training about investigating cases of medical child abuse or Munchausen by proxy.

I was so impressed with the depth of his knowledge and how he seems to grasp all of the complexities of this issue. So I really wanted to talk to him about all of the various barriers there are, both cultural and structural, to us making movement on this issue. Yeah, I have been doing this for now over 10 years. And I think what makes me stay doing this

is the fact that no one else will. I just know the consequences of not doing anything. I'd love to have four trained detectives willing to take this on. Trust me, I have the work for them. Currently, that's not out there. We've said many times over the course of this podcast that this is an underreported crime.

By that, we do not mean that it is all mothers, a majority of mothers, or even some significant percentage of mothers that would ever, ever do this. But it does happen. And right now, we're hardly ever catching or prosecuting it.

We're fighting the societal perception of motherhood. That is the task before us in these cases. And I often have said, even before I started doing this, denial is the strongest human emotion. This is hard to wrap your head around. It's hard for police officers, veteran police officers, veteran detectives to wrap their head around. So for regular people to think that their picture of motherhood is going to be disturbed in such a really disturbing manner, it's very hard for them to accept that.

Because if someone becomes, as an adult, so toxic and destructive, there are times when you just don't love them anymore. And I mean, I think that's something like we talked to Paul Pucher about, and that is profound. And then I've watched, you know, various members of my own family go through where it's just like, no, there are actually things that people can do where you're just like,

That bond gets severed and it's enough to do it. I've seen what parents who unconditionally love perpetrators in these situations will do and they become enablers. Like you said, it's like they're dismantling their idea of motherhood. A lot of people really want to hold on to that idea that motherhood is this sacred thing and it will turn flawed human woman into some kind of angel on earth that would never do anything bad.

When I was an investigator with a local DA's office, and we would have trials on other forms of child abuse, not this form, but other forms. The sentences for mothers who committed other forms of abuse were far less than for males. It's just the perception that society has. Partly because you have this axiom.

this behavior of medical child abuse and then right intertwined with it, you have this disorder, a factitious disorder imposed on another and that's where the motive comes in. It's not that we should be saying, this is mental illness, these people are not criminally culpable. Right. But,

If you can't get people to understand factitious disorder imposed on another, they're not going to see the abuse. Right. It's the same thing that we suffered through with pedophilia. Pedophilia has been in the DSM, the Diagnostic and Statistical Manual of Mental Illness, since 1952. So you have that same combination with aggravated sexual assault of a child and pedophilia. You have those overlapping factors.

But what we've come to understand is, okay, well, they may be a pedophile, but guess what? They're still a criminal. And that is the problem that especially family courts are having in these cases, especially when they see an attractive, especially well-to-do mother who they identify with. I'm talking about family court judges. They're maybe in the same social class as they are, and they just don't believe that a mother could do this.

I'd imagine this is really difficult work being a detective on child abuse cases. I mean, do you find yourself getting emotionally invested? In most of my cases, there's been a positive outcome because we haven't got a positive outcome in every case. And the ones that stick with me are the ones where we didn't. Those ones really stick with me and really haunt me, for lack of a better word. You don't get emotionally involved as a detective, but you see the emotional toll they take on others. And that's impactful to you.

As long as I can get the child safe, it's not even necessarily about a conviction of the parent. Unfortunately, in these cases, that's usually the only way you get a child safe is with a criminal conviction. During the investigation, I have to strictly look at the evidence that I have and see if that fits a crime. There's been times where I know that this form of abuse is happening, but it doesn't meet our state law. I can't file a criminal case. I turn my findings over to CPS and hope that they do the right thing.

You know you're not dealing with someone who's like operating by the same playbook that most of the people you're ever going to talk to in your life are. Right.

But I do think it's important to also point out that she knew what she was doing when she was doing it, and she knew it was wrong. So it is important to point out that's the definition of criminal sanity. You, I, Dr. Feldman, pretty much everyone on the committee agrees they are subject to the criminal justice system. But at the same time, you know, it doesn't mean they're not a human being.

Dr. Feldman has said it's an attempt to get their emotional needs met. Does that have any bearing for you on, like, how you would look at these offenders if you're seeing it less as a, like, almost to me that's almost something deeper, right? That it almost hints at, like, this is a much more profound issue.

compulsion than I'm just trying to get people to pay attention to me. I don't know, there's such a negative connotation with attention seeking. I mean, from a legal perspective, from a detective perspective, that would just go to motive. It's gonna just be a very nuanced motive. And whether it's attention or love, it's still basically the same motive. You're doing it for something that's intrinsic.

which is kind of hard for juries to understand. You're not doing it for money. You're not just a horrible person beating your kid. And we can argue about attention or love. You know, attention isn't always public attention. It can also be private attention from a loved one. So to me, those words, as a detective, obviously not a psychologist, those words are pretty interchangeable as far as motive goes.

We're seeing the perpetrators as human beings that do need help, but also should not be in the house with their children and maybe should be behind bars for a while. If you humanize them and you know, like we know with pedophiles now, they can be of any social class, they can be of any social standing, they can be anywhere. If we could somehow get society to understand that about these abusers, we'd have a lot of success.

hopefully we would start catching them sooner, which is better for the abuser and better for the abused. If you catch someone sooner on a mental illness path,

then treatment should be easier. If you catch this behavior earlier, it's going to be easier to get a confession, right? Because what they're confessing to is not nearly as harmful as what they would have done had they continued down that path. In a perfect world, you would have systems set up that would catch this early, and that would obviously benefit both the abused and the abuser.

I find it moving that someone who's in Mike Weber's position can still see the humanity in the perpetrators and understands that for them, it's better if they can be stopped earlier. If they can not get so far down the road where they've done these things that hope has that she now has to live with and that everyone in her family and in her orbit has to live with.

I feel like that's really the spirit that we need on the criminal justice side of stop it early, catch it early before it gets to that point of no return.

There's no way I could ever predict any of these offenders' behaviors because they are so wild sometimes. Even me as a seasoned police detective would never, I mean, I would never imagine that Hope would put pathogens into her kid. But when the path led me there, I looked at it and I investigated it and I confronted her on it and she confessed to it.

Just be open-minded. Approach these cases. Don't be afraid to work. And for supervisors out there, CPS supervisors, police supervisors, if you have a detective or an investigator that has one of these on their caseload, number one, CPS, this isn't going to be done in your magical three-month time limit. That's freaking impossible. Don't try to shoehorn it into that box. Give your investigator time to work her case.

Mike Weber is still working an incredibly intense caseload for the Tarrant County Sheriff's Department. And that's not all he's doing. These days, he is doing trainings all over the country to educate various interdisciplinary groups of professionals about how they can better identify and deal with Munchausen by proxy cases. He is also a member of the

of the American Professional Society on the Abuse of Children's Munchausen by Proxy Committee, along with myself, Dr. Mark Feldman, and Dr. Mary Sanders. In the next five to 10 years, I hope we see what we've already started to see societally and culturally. This has gotten its moment in culture. You know, I kind of keep track of cases around the country, and we're starting to see more and more of these cases.

What I hope is that the committee's effort and my efforts have some little influence on these cases and getting this information out to detectives so they know what to do on these cases and they know what this is when they see it.

As much as this podcast has been a way for me to exercise some of my demons and to follow my curiosity about this topic, the thing I hope for the most is that people will hear this

And it will give them a deeper understanding of something that is a complex issue, but one that I believe is present in our communities in a real way. And that people who've been through it in particular, whether they're survivors, whether they're family members, whether they're perpetrators who are looking for help, will hear this and understand that there are people trying to help.

Meeting the members of this committee has really given me a lot of hope. Not necessarily hope for whatever is going to happen in my own family, but just hope that there are people that are willing to take this complicated issue on. The only way to make kids safer from this abuse is to look at it. And it's hard to look at, and it's hard to hear about.

Because ultimately, it is about children. It's about kids who are powerless, voiceless. And it's also about the people who used to be those kids. If I can make any crack in that awareness that this is a real thing, then this will all have been worth it.

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Did you know that I have a new book coming out? True Story. And unlike my previous books, this one actually is a true story. The Mother Next Door, Medicine, Deception, and Munchausen by Proxy, which I co-authored with friend of the show, Detective Mike Weber, chronicles three of his most harrowing and impactful cases.

Long-time listeners of the show will have some familiarity with these cases, but I promise you will learn so much more about them, and you'll also just learn so much more about Detective Mike's journey in this arena and also mine. Dr. Mark Feldman, another friend of the show and an esteemed expert in all things Munchausen by proxy, read an early copy, and this is what he had to say about it.

A truly vital, groundbreaking, and riveting contribution to the true crime literature on child abuse. Over the past four decades, I have read just about everything dealing with medical deception, including Munchausen by proxy abuse, and can easily affirm that this immensely readable book is the most important literary work since Professor Rory Meadow coined the Munchausen by proxy term 50 years ago.

And if you don't think that that endorsement from that particular man made me cry, you would be wrong. So the book comes out on February 4th of next year. And now I know what you're thinking. Andrea, why are you talking to me about this right now? February is approximately 100 years from now. We have to do a whole election and whatever else before then.

And I hear you, but I'm telling you this now because as you may know, if you have any other authors in your life, pre-orders are vital to a book's success and will really affect how our publisher positions and supports the book's launch. So if you think you are going to buy this book, doing so now will really help us out. It's available for pre-order in all formats wherever books are sold, and you can find it at a link in the show notes. I hope you will love it, and I appreciate your support.

Wow, I got really emotional listening to those last couple of minutes of that recording because, you know, at the time that I was making this show, this was several years ago, it was all recorded before we released it. So I wasn't yet out really in the public sphere talking about this issue in the way that I am now. And...

I had no idea what kind of audience the show would find, how it would resonate with people. And I really am so proud of everything the show has accomplished. And that certainly hasn't been me alone doing that.

I really owe so much to the team that helped me make this show, to the people who really bravely shared these very vulnerable stories from their own lives and trusted me with that.

And the experts who shared their incredible work and their perspectives and just all the people who have really been supporters from the very beginning of the show to the listeners, to all of the people who've reached out to me about the show and shared the show. I mean, this really was incredible.

such a collective effort to get this show out in the world and get it to the people that it could potentially help. And, you know, Munchausen Support, which is the nonprofit that I founded before the show came out, I worked with Dr. Mark Feldman, who I've become really close with, to get that started. And, you know, the first job of that was just getting all of the amazing resources from the professionals of the committee online. And then since then,

We have done some trainings. We've presented at some conferences. And the biggest thing that I'm the most proud of that was really helped along by my incredible colleague and mentor, Bea Yorker, is this support group model, Joe Hope, who's also been on the show a couple of times.

also does a lot of work with Munchausen Support and helps a lot with those support groups in particular. And those have become really active. And I have just heard from so many people. I get messages every single week, almost every day, practically at this point, from people who...

have some personal experience with this, where it happened in their family or they're looking back at a person they used to know and having questions. And I also hear from a lot of survivors. And I started off this project never having met anyone else who'd been through it. And now I know a lot of people in a whole community has really developed around that. And that was really started with my colleagues on the APSAC committee.

It's really incredible to think that, like, yeah, I really had no idea how it would all land. And I think it has accomplished that goal of reaching some people who really needed it. And I'm just really happy that that's happened. And one of the big things that we talk about in this episode of the show is this question that I get asked all the time, probably one of the most common questions and one of the most common points of confusion about this issue of, is this a mental illness?

And we talk about that piece about the underlying psychopathology, but my thoughts on this have evolved really a lot since this episode aired and since I started really digging into this. And...

I think the mental illness question is interesting and it's worth exploring, but I think I have really leaned away from talking about it in those terms because I think that it creates so much confusion around culpability and guilt.

For me, for a long time after becoming estranged from my sister, it felt much more comforting to think that she was in some sense not in her right mind. And that is not quite how I understand it now because of my conversations in particular with Dr. Mark Feldman. And that is one of the first things I really asked him when we were just talking off air, when we were just getting to know each other.

you know, was this question of like, do they understand what they're doing? Are they in some sort of delusional or like fugue state where they just don't understand that they're doing these things and they forget that they've done these things? And, you know, we talked to Dr. Mary Sanders in this episode about that really intense compartmentalization, which is really helpful to sort of understanding how someone could do these things. But I think it's really important for people to

really look at what's happening and not sort of take this more comforting route of thinking like, oh, they don't understand what they're doing or this is a sick woman. And I think that's

That can feel like an emotional escape hatch when you're looking at something so horrible, but I think we really need to fully understand what perpetrators of this abuse are doing and what they are capable of because that's the only way we will take it seriously enough and understand how dangerous they really are to their children in particular, but not just to their children. I mean, I think we've seen in Hopi Abara's case, you know, she poisoned a coworker.

the things that these perpetrators do, it's such a profound disconnect, it's such a profound lack of empathy that it does make them very dangerous. And I think that's really important to take seriously. And I think, well, the mental illness piece and the treatment piece, you know, that we talked to Dr. Mary Sanders for those very small percentage of cases where treatment is a viable option,

worth pursuing, worth talking about how to intervene sooner so that better outcomes can be had for everyone involved, including the perpetrator. But I think we're not at the point where that needs to be the priority. We're at the point where we need to take it seriously as abuse.

And really, really put it starkly in those terms. And so I think my thinking has just really evolved on this. And one of the big questions of the show, you know, that I think we will continue to explore in further seasons, we're definitely going to really dig into this in season four, which features Jordan Hope. They have been a guest on our podcast several other times if you've listened to those seasons, but we'll be getting a lot more into their story. And I know they have such fascinating thoughts to share on the topic of what happens.

justice looks like in these cases? What do we do with perpetrators of this abuse as a society? And these are really complicated questions for me. And I think depending on how you feel about, you know, the criminal justice system, the prison industrial complex, I mean, there's a lot of really complicated questions around this. And what would rehabilitation look like? Is that possible? I think these are some of the biggest questions of, you know, how to look at this abuse for me. And I think it's just something that remains an open question.

And that my feelings continue to shift on this. And I'm not so necessarily interested in punishment, but I think in terms of like protecting the kids should always be the biggest goal and also protecting other people.

Because they're usually female and often appear physically very normal and very harmless, the way that Hope and my sister and many of the other cases I know of appear really not like what you would think of as a criminal, I think we tend to take less seriously how dangerous they really are. So...

More, too, to come on all of that. And I think this first season, which, you know, again, I've said before, I originally thought that maybe this would just be a limited series of eight episodes. And I think, you know, we sort of opened all the big boxes in this first season. We really got to some of what are going to be our central themes and why this show is continued. And there's just so much more to dig into and so much worth exploring. So I will see you next time for the season finale of...

our first season of Nobody Should Believe Me. On the season finale of Nobody Should Believe Me, I will sit down with Hope Ybarra, who spent 10 years in prison for medical child abuse. If you've been listening to this podcast and some of the details sound very familiar to you from your own life or someone that you know, please visit us at munchausensupport.com. We have resources there from some of the top experts in the country, and we can connect you with professionals who can help.

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