BONUS: Unabridged Interview with Bea Yorker
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Only on Netflix, October 18, rated R.

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Hello, it's Andrea. Today we are sharing the unabridged interview with one of my favorite people, Bea Yorker. If you are a longtime listener, you've heard Bea on the show a number of times, and I always love having her on because she has such a depth of expertise about Munchausen by proxy. And it was very special to have her on this season because she also knows Joe very well. Bea

Bea is now the president of Munchausen Support, which is a nonprofit that I founded a couple of years ago, and she is very active in helping survivors and family members. I just admire her so much. So please enjoy my full conversation with Bea Yorker. Hi, I'm Bea Yorker. I'm a retired professor of nursing, criminal justice, and criminalistics at California State University Los Angeles.

And I've had a long academic career that has really focused on child abuse, specifically Munchausen by proxy. And Bea, how did you originally get interested specifically in Munchausen by proxy? What brought you to this part of the field? Oh, I love this story. So I was working in a large pediatric hospital in Atlanta, Georgia.

And I had recently gotten my master's in child and adolescent psychiatric mental health nursing. And I had the privilege of working on the child and adolescent psychiatry consult team. So I was with child psychiatry residents

child psychology, interns, social workers, and there were a couple of us advanced practice nurses. And we would get calls to visit any child or adolescent that had a mental health issue. So we would go to the adolescent unit for gunshot wounds. We would go to the pediatric clinic for kids that tested positive for gonorrhea. We would go to the burn unit because

over half of any burns on a kid under 5 were intentional and abusive burns and as part of that work we also dealt with depression and autism and routine mental health issues but during that time this is between 1981 and 83 we got a case where the chief pediatrician said

I'm thinking this might be Munchausen by proxy. B, here is a Roy Meadows article. Go read this and see if you can sort out if this little kid's ears that keep bleeding is being caused by the mother. It so happened at the same time I was in law school part-time. I was pregnant with my third kid in there. So it was a busy time.

But it turned out it was not Munchausen by proxy. The little boy actually had a rare genetic disorder. So my very first exposure, I was riveted by Roy Meadows article when he talked about the urine specimen in the little girl that the nurse said, you know, we cannot clear up these urinary tract infections.

that if I collect the urine specimen, it comes back clean. If mom collects the urine specimen, it comes back infected. So Dr. Meadow said, "Okay, we'll set this up. We'll have the nurse collect the 6:00 AM specimen and mom collect the 10:00 AM specimen." So they did that and they went down to the lab and sure enough, the 6:00 AM specimen was clean.

and the 10 a.m. specimen was loaded with red blood cells and bacteria. So the lab tech went one step further, and he typed the blood cells in the little girl's urine, and it wasn't the little girl's blood type. The mother had been putting her own menstrual blood in the urine specimens,

to get innumerable tests, antibiotics, hospitalizations, x-rays, invasive procedures on a little four-year-old girl. That fascinated me so much that I learned all I could about it.

And then I paired up with a local pediatrician who had actually come from California, and he had seen some cases in California. And the two of us started writing articles together. That's so interesting. And I wonder about just your mindset at that time, because it strikes me that, you know, like pregnant with your third child, right?

confronting what I think is one of the forms of child abuse that people are the most resistant to believing exists because it's just so horrific to contemplate a mother doing this in such a purposeful fashion. And you did not have that reaction. You had the reaction of, oh, I want to run into that building on fire and just go deeper. And so I wonder, like, have you sort of thought about

Like maybe what that was in you that made you want to know more about this thing that, you know, a lot of people have, you know, end up with sort of interacting with one case and then they never want to see another case as long as they live has been my experience. So, yeah, I wonder if you if you can give us some insight. Yeah.

Yeah. Ever since nursing school, when I knew I really did not want to be a nurse nurse, I wanted to be a child psych nurse. I wanted to do play therapy. I knew I was going to go right to graduate school so that I could do that. I was fascinated by forensic psychology.

I went to Grand Rounds as an undergraduate and heard Dr. Wilbur speak on her book about multiple personality disorder. And she showed videotapes of her patients going into different personalities. And I was like, that's what I want to do when I grow up.

Oh, that's fascinating that you mentioned that piece. So we're talking about Joe this season, and Joe is someone that you and I both know really well. So can you tell me, how did you first meet Joe? I believe through you. And it was at the Munchausen by proxy, APSAC, when you and I first met.

We talked about bringing some survivors' voices to the committee. And Andrea, you were awesome because you were hearing from survivors and you suggested a couple of them. And Joe, and this is during COVID, so this is a virtual meeting, but Joe impressed us all so much with how...

I don't know if there's a word for this, but Joe is unchaotic. And that's exceptional for any survivor of complex trauma because, and most of the survivors of Munchausen by proxy are fairly chaotic. They can hardly tell their story in a straight line. They are

triggered and speechless as they talk about their experience. And then here comes Joe and their story is linear and they're not obviously not being triggered as much as other people that we've heard.

And then they were able to link it to all the higher theories. So, for example, Joe was talking about the body keeps the score and advanced trauma theory right in that meeting and how they were making sense of their experience through that book.

That really struck me as well the very first time that I talked to Joe. And I believe not to take – I don't want to take all the credit for Joe's appearance at the APSAC committee meeting because I think their first point of contact was actually either Detective Mike or Dr. Mark Feldman, two of our other close colleagues on that committee. And I think I started talking to Joe through one of them. But, yes, I think we were all really blown away by –

how much clarity Joe seems to have about their experience and how rare that is. And do you want to talk about some of the factors that contribute to that, like the way that a lot of survivors tell their stories? Because I think it's not, that's not sort of a criticism of other survivors. That's just...

That has so much to do with the way that the psychological abuse affects people's idea of themselves and affects their memories of their basically entire life usually. And so like there's a lot of factors that really contribute to that chaos and that sort of inability to speak about their own lives. Can you talk to sort of what your thoughts are on why people often have that reaction when they're survivors of this abuse?

Sure, because I work with survivors of all different types of abuse, as well as other PTSD. So your physiology takes over when you are recovering from and when you've experienced repeated trauma at a very young age. And when your physiology takes over, sometimes it's really difficult

to keep your mind on a steady flow of thought. It just gets interrupted. And it's because your heart is beating fast or because your mind goes completely blank or you just get flooded with visual images.

or terror even as you're talking. So we just give people a lot of space and this is typical of running any type of support group is you just give people a lot of space. In Joe's case, they were able not only to keep a steady flow of their own thoughts, but

Wow, they have really stepped up to be able to then facilitate and manage a lot of fresh survivors.

who are going through that chaos. Yeah, so let's talk about the work we've been doing together because the three of us work really closely together with Munchausen Support, which is the 501c3 that you are now the president of, because you took over for me, and that is dedicated to serving survivors and family members.

And you really were instrumental in bringing us the peer support model. So can we talk a little bit about what that model is all about and why we hoped it would be a fit for this and sort of how that's, then we'll talk a little bit about how that's all gone because Joe's been such a big part of that. Oh, thank you. I really appreciate the opportunity to talk about support groups as an intervention and

As a nurse, I think support groups is in our DNA. We all learn how to facilitate support groups as undergraduate students. This is not group therapy. This is not therapy. This is not coaching. This is not a workshop. This is simply making people the experts of their own experience and creating a safe space so that they can help each other.

When I revisited my undergraduate psychiatric nursing curriculum in the last few years, teaching undergraduate psych students, I required all of them as part of their, they did an inpatient psych experience, but I also required all of them to attend two community support groups and two 12-step support groups.

And there's a difference in those, but the community support groups are very much what our model is based on, which is having people share some stressful experience with each other. The 12-step model gives us a lot of guidance and the 12-step model

has been around for a long time. It's not so much evidence-based as it is, it's cost-effective, it's tried and true. Judges order people to go to 12-step programs if they're on their third DUI or something. So we know that it's a model that has proven itself when there are a lot of expensive therapeutic modalities that may not be as effective.

But support groups, the community support groups, are for people who are bereaved. For example, I sent my sister, when my brother died of cancer, we all suggested that my sister-in-law join a bereavement support group for other wives who had recently lost their husbands to cancer. And so...

There are support groups for just about everything, including probably for people who believe they've been falsely accused of child abuse.

Nevertheless, that's a whole other. Yeah, no. And I know there are. But yeah. And we do know that there are support groups for rare diseases. And for we know from your work and you and Mark have talked about munchausen by Internet. We know that virtual support groups can be infiltrated.

by people who find that modality

a place where they can get their needs for attention met. So, but the model that we use is that we have ground rules and these are consensus built ground rules by the participants. We spend the first and sometimes the first and third session just reviewing ground rules like confidentiality. Everything said in the group is confidential and shouldn't be repeated.

That particular ground rule has emerged as some of the support group members say, wait a minute, I want to tell my story. I want my identity to be known. And we had three fathers from a support group join us at the APSAC colloquium in Denver this past year because they, for them, their confidentiality was less important

than their ability to tell their story and go on the record and talk about what happened to them. The other ground rule is both Joe and I are mandated reporters. And so we have to let everybody know up front that it will be confidential unless

any member of the group discloses something that gives us concern for danger, harm, imminent threat to either themselves or somebody in their periphery. And in that case, we would have to report.

Yeah, it's so interesting you talking about that sort of question of, you know, folks that have been in the support groups and sort of in that community. And then the idea of sort of telling your story more publicly, either, as you said, at the colloquia that we presented at or at events.

you know, or on the show, because of course I've talked to, you know, a couple of those dads I've talked to on the show. And obviously Joe, Joe is on the show. This, this whole season is about Joe. And that's something I think about a lot because increasingly as the show has gotten bigger, you know, I, I get a lot of people that want to tell their story on the show. And I always sort of think about, you know, mostly I direct people, especially if they're survivors of,

to the support groups and to Joe, who does all of the sort of intake. I mean, that's really one of the interesting things on the behind the scenes here is that, you know, Munchausen Support, the reason I started it was because I had a feeling that once I was out talking about this publicly, I was like, I don't, I feel like the only person on earth who's ever been through this, but I don't think that's true. And I would have, this is what I would have loved to have when I was going through it, you know, 13 years ago was like, just to be able to talk to another person that had been through this would have

been so helpful and that was not there at the time. That was not accessible. I had no way to find other people who'd been through it. And so I actually sat in on the first support group and it was extremely helpful to me. And, um, and Joe was just, Joe was there as well as, as were you with a, with a number of other survivors. And, um,

It really to be able to talk to other people who've been through it. I mean, even as I was doing all the interviews for the first season, talking to other family members, siblings, talking to dads. I mean, that was so healing for me. And so I sort of was was very convinced already of the of the effectiveness of peer support. And I think that that's a different thing entirely than telling it on TV.

a very public sort of open platform, especially one where now, you know, with the podcast, we do have a large number of listeners that a lot of people are going to hear and have opinions about and weigh in and you might get backlash and like all that kind of thing. So now I think one of my, yeah, I sort of, that's a question I ask a lot of like, well, how do I make sure that as, as best I can, I can never make that decision on someone else's behalf, but like, how do I make sure that, um,

How do I do everything to ensure that that person who's trusting me with their story, A, that I just do right by them in telling that story?

you know, help tell it in the most responsible way possible, but also ensure that that person is going to be okay, because that is a really intense process. And I think with Joe, because I know them so well, and also because I know that they have a support system in you and in, you know, some of the other folks from the community, that is one of the reasons that I felt like, okay, I know Joe is going to be okay.

Like, I know that we can sort of collectively take care of them and they have access to resources and they have lots of people looking out for them as we go through this process for whatever intense stuff that it brings up. And I think that's, it's just something I think about a lot about the difference of like,

do you need someone to hear your story or do you need a large number of people to hear your story? And I think both can be valuable. I absolutely think, obviously, that's why I have the show, I obviously think that people hearing these stories can be incredibly valuable, but I also think it can take a huge toll. And we've seen that too. We've both talked to survivors who've

done podcasts or shared their story with the news or something like that. And it's, it's really taken a huge toll. Do you have kind of any thoughts on in sort of sharing your story? I think it's a process of growth. And what I'm so humbled by is that people in the groups, the support group provides a venue for people to heal themselves and each other. And I just stand back

And that, for me, is the reward. That is why I do this work. So what are the reasons for doing a support group specifically for this community? Well, first of all, people feel less isolated and stigmatized when they can meet other people with a similar, very unusual adverse experience.

Support groups empower people to work to solve their own problems. And that's huge. So members can share information. And what we have found is that the members very often share

are the ones to give resources to especially when we're looking at non offending family and one of them has worked with the guardian ad litem one of them has worked through the court system one of them has worked with CBS they bring such diverse and creative ideas to the support groups and for the survivors

Joe did research on, or a literature review, on the effectiveness of support groups before the colloquium. People benefit almost more from giving support to their peers than they do from receiving support from their peers. And that has borne out from the very first group

By the time we're on the fourth, fifth, seventh one, the members are saying, I feel better today. Even though my situation may not be working out for me right now, I feel so much better because I was able to help one of you today. Yeah. And I think, you know,

That might be specifically important, I feel, for survivors of this abuse because it is disempowering in so many ways. I mean, obviously, all abuses to some degree, but I think there's such a thing of like...

When I think about some of the really strong parallels across the survivor experiences that I've heard, that feeling of like, you can't do this. You'll never live a normal life. You're going to die young. You're going to not be able to do X, Y, Z that other people can do. It just really gives people this idea that they're not capable and that they're not going to be able to sort of

contribute to society. I think that's really one of the things that it leaves people with. And that sort of oftentimes the way that they, you know, got their caretakers love and approval was to disempower themselves, right. Was to pretend to be, to go along with the idea that they were sick and they couldn't do things and make a show of that in front of doctors. Cause that's what their parent was telling them they needed to do, or they wouldn't get the help they needed. You know, that's something we hear over and over again. And so I think like for, I,

that makes a lot of sense to me that to be able to not only help themselves, but help others and be sort of of use in that way would be particularly healing for this group.

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And I wonder, you know what, I was just sort of talking about some of the parallels that we've seen across stories. And I think there's, you know, as we're talking about Joe's story and as we talk about all the stories on this show, no survivor is monolith.

But we've also seen that there are some extremely strong parallels to these stories. And I think, as you said, this is a unique adverse experience, right? I mean, I think that was the thing. And I think that's why it's really wonderful to have that group model because you sort of think no one else is going to understand this story. No one else is going to have ever experienced anything like this.

It's just struck me sitting in and also just talking to a number of survivors, like how it is the sort of exact same bizarre story over and over again. I mean, the beats are so similar. Can you talk a little bit about that? Oh, yes. Oh, my gosh. First of all, at the end of the first or second group, all of the members, whether it's survivors, non-offending family, and I do want to talk a little about the sibling support group.

But at the end, they all just, some of them just cry. They just say, I am so relieved to be able to talk to somebody

that gets it. And then they'll tell horror stories. They'll say, yeah, I got into therapy. I went and told my therapist and my therapist was crying because they couldn't handle how horrific what I went through was. And so these people don't need to be holding their therapist's hand or other group members' hands. They need each other to go, yeah, it was that bad.

It was that crazy. Yeah, I mean, that's happened to me as well, just trying to tell friends. And I think that that sort of experience that regardless of whether you're a family member or a non-offending spouse or non-offending parent or survivor, I think especially, obviously, especially it

potent for the survivors. But I think that that experience of not having to sort of make emotional space for the person you're trying to talk to about it and like dealing with their reaction and that reaction being so extreme and all those sort of layers of like disbelief and like, wait, what? What happened? And like that kind of thing. I mean, it makes it really impossible to sort of get any relief from talking about it if you are doing so much to sort of

manage that person's reaction, I guess. And that is the biggest thing I think of being with peers that have been like, no one's going to question you. And I mean, that was a huge revelation for me. The very first time that I met you was when I came to speak to the APSAC committee in San Diego. And I was there to meet everyone. And I told my story. And I'm expecting it to land

shock, which was the only reaction I'd ever had before. And I just was looking around a group of heads going, yeah, mm-hmm, yep, yep, oh, yep, like all the beats. And you're just like, what? What is going on? Like, why do these people know this story? And it's because all the stories sound that crazy. They're all, I mean, there are differences in the extremes, but they all sound crazy.

They're so similar when you've heard a lot of them. And I think what that makes you feel as a person who's gone through it, who's spent a lot of time questioning yourself and probably had the offender gaslight you to some degree or another about, oh, you're not seeing the thing you think you're seeing, is, oh, my experience is real and it's valid. And I'm talking to a group of people who understand that it's real and it's valid. And just that alone, I think, is...

makes it worthwhile. We definitely experience that and that is what is so rewarding. The other thing that's really rewarding for me because everybody asks me

So me, why are you doing this? You know, you're retired. You don't have to work. If you do, you work as an expert, you charge a lot of money and you're doing this for free. And I'm like, this is the reward at the end of my career. I have spent so long

trying to figure out what little way can we do to make it better. Yes, I've had some success stories where we saved kids and gotten victims out. Yes, I've had some very frustrating stories where we haven't been able to save a kid.

But with this, after 10, I commit to 10 sessions. We hold them twice a month for two hours per session. They are virtual. And at the end of 10 sessions, I depart. And before that, I do some termination work on my part. But I ask the group, are you all willing to step up and peer facilitate this? And so far, we've only lost one group.

And that's because some of the group members had such huge successes that they didn't need it anymore. And they had their kids back and they were too busy to go to the support group. Yeah.

Yeah, no, it's really rewarding. So we were just both sort of saying that, oh, these stories have so many of the same beats and you sort of like see the same thing over and over again and that some of these things also are really like red flags that we talk about for this abuse. So can we talk about specifically what are some of the commonalities that you see in these stories? Yeah.

Yes. You've already mentioned one, and that is questioning your own reality. One of the reasons it's chaotic in the first few sessions for people to tell their story is because they second guess everything that they think they might have a visual or an auditory or a physical memory of. They just question it. They just, I'm not sure that's real. I'm not sure that was real. Yeah. So they all question their reality.

then they all also have so much shame. And that's another reason that having peers to talk about this with who can say, yeah, shame is a big part of this. You're ashamed with your peers that your family would have such a dark secret. Andrea, I consider you a sibling in a way.

You're an aunt, but you understand that you went through years of experiencing shame. So that's definitely something. And then there's also one step forward, two steps back, or two steps forward, one step back. There's discouragement when you do peel back another layer and another sort of

remembering with eyes that understand Munchausen by proxy abuse and perpetrators. And then there's regression because the progress you felt that you were making to tackle your life, to go to school, to get your next degree, to have a relationship, to maybe move in with a partner. There's setbacks each time those layers appeal back.

And overall, just we see the growth. You know, especially I do come back and visit usually six months and then a year or however long. I come back and visit the groups and I'm astounded at the growth that we see after they do this work of unpeeling. Yeah, I mean, this all sounds...

very familiar to me. And I think, you know, I'm not, I don't put myself in the same category as the survivors that we talked to, because that's just such an intense, specific experience. But I certainly like have parallels with my own experience, as you said. And I think the sort of, it takes a really long time to reckon with

Who that person is. And if that person is someone that you loved, who is the offender, then it really like I think you grieve that love all the way along. Like you kind of go, OK, like I think a lot of us talk, you know, something that Joe and I talk about a lot is whether or not this person.

should be considered a mental illness of its own, although we recognize that there is a mental illness that underlies the behavior. Like, we are always very clear to say that this is abuse. This is not someone who doesn't have their, you know, is not culpable for a crime because of reasons of insanity and that kind of thing. And I think also because that is sort of like

Not to say that it like exactly lets people off the hook, although sometimes I think it does, but that you sort of like, and I remember in my own journey, and I think this is true for a lot of us, is like that's kind of the first place you go where you think like, oh, they're doing it because they're sick. So I don't have to really like grapple with the level of intentionality that's happening here because I'm sort of going to put it in this bucket.

And I think a lot of people get stuck there. They go, oh, that's a sick person, and they're sort of acting out because they have this illness. And because we know that this is, by and large, not treatable, I mean, I think for some offenders, for the rare offender, they can make progress, and there is a treatment model. We've talked to Dr. Mary Sanders, our mutual friend and colleague, numerous times about that, and that's always something I want to make a little bit of space for. But I think, by and large, this is not a behavior that people –

are held accountable for, that they make themselves accountable for, that they try to get rid of, that they try and make progress on. So that's not going to be what most people are dealing with. And I think, you know, I found that like the more I learned about it, it gave me clarity, but that also added some to my grief because I really had to just

So it's like you sort of I think a lot of us as we go through this kind of really get to a place where we finally find ourselves sitting with what that person has done and that they did it intentionally over a long period of time and that they understood what they were doing the whole time. And that's just a really hard thing to sit with. And so, yeah, that really resonates with me what you're saying about sort of like peeling back

those layers of grief. And I think it's, but it's also important, right? I think like, that's sort of like, the only way out is through. And I think I talked to a lot of people where they're really early in that journey. And that's, that's when I'm like, I don't think I should put you on the show, because I think like that could send you sort of, you know what I mean? And that's why I feel so good about having the support groups as a resource, because it's something to give people in a, in a situation where we know that like,

I mean, I don't think we've ever talked to a survivor that was permanently separated from their abuser, have we? Good question. Not that I can think of right now. I do know that a topic of discussion that comes up frequently is navigating the no contact issue. And our survivors have been so good and give each other so much grace because one,

One in the group might be absolutely vehement. No contact, no contact. Nope, nope, nope, nope. Worst thing for you. At the exact same time, another one is moving back in with their abuser. And that's really hard. But as you mentioned, Andrea, it's sort of like the more you learn about the actual abuse that has occurred and the intentionality and that

so much of it that you might have just sort of said, I'm not sure if that really was abuse. And you start going, no, it really was just the heaviness of that sitting with that. And so the survivors can help each other with that on any given day, there'll be one group that would be really heavy with it and, or one member. And then the other members will kind of step up and nurture that person.

Yeah, that's really beautiful.

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I'm just wondering what kind of research has been done on survivors of Munchausen by proxy abuse as a group? We talk regularly to Kathy Ayou in the APSAC committee meetings.

She's had a database and she's been following cases for many years, and she has more of sort of a medical record algorithm, like sort of looking at demographic data, looking at CPS placement. Did they go to college? Those kinds of things. What you know, how long were they in therapy?

One of the issues we have is human subjects, institutional review board approval to do research with any survivor of abuse. This is a high bar. Okay. I mean, we, all of us interested in child abuse.

have to go through a gazillion safeguards before we can do research on survivors. Yeah. Yeah, I know that's pretty complicated. I mean, I think like one of the...

One of my, I guess, aims with this season is, and why it's sort of personally really resonant for me, is that I have noticed that, and I'm sure this is not unique to this abuse, but I think because this abuse is so severe and because it does encompass often these other types of abuse, right? You talk about the...

what is it, the adverse childhood experiences, the sort of ACEs score, you know, a lot of the folks that we talked to, it's not just this abuse isolated, it's like this abuse and then, you know, their parent was dealing with other, you know, addiction issues or because of the sort of amount of deception in these offenders' lives, there's like all kinds of other chaos and abuse kind of going on in that household. And I fear sometimes that people looking at survivors of Munchausen by proxy will be inclined to give up on them

because they just think, oh, this, what this person's been through, there's no way you could sort of be, you know, be okay or be a sort of have normal relationships or be a contributing member of society or what have you, you know, and I, I,

I that's something I really want to push back on because I think that most survivors, the system is not going to help them adequately. Right. Like I think the stories like Alyssa Weyburn that we covered in season two, which is a story I know you know well. I mean, those are the exception to the rule. It usually does not, you know, community does not usually swoop in and save the child and find themselves in a loving home. So I guess like what would you say to people who

Just, I guess, what do you want to say to people about survivors of this abuse? What are our reasons to be hopeful? So our reasons to be hopeful are the same reasons we have for really any victim of abuse, which is resilience.

we see people who come out of childhood torture situations. And I, I actually equate Munchausen syndrome, my proxy abuse to childhood torture. To me, it's some of the most parallel in terms of understanding the dynamic and the long lasting horrible effects. But we have children who have emerged from childhood torture and they,

If they have just a glimmer of a resilience factor, that means some adult in their life who listened to them, who was there for them on the tough days, who encouraged them. It could be a teacher. It could be somebody at church. It could be a counselor. It could be an older sibling.

but just some other person there. And then there's the concept of dandelions and orchids, a book written by a pediatrician that talks about there are some kids who are very, very sensitive. And even in the most nurturing hothouse of an environment, they will still be sensitive and be stressed and have quirks. And then there are dandelions and they will just plant and grow in the cracks of the sidewalk.

And the hope is that we have a lot of dandelions who were in these horrible situations and we'll find their way out and we'll find resilience factors. Yeah, I love that. And I think Joe is like the dandelionist of the dandelions because I think that's the thing that has...

struck me about Joe kind of over and over again is just their incredible resilience and like determination to be happy and live in the world and help others. And I just, I know you see that as well. And I just, I wonder if you can kind of tell us like from your perspective, what, what makes Joe so special? For me personally, I am so delighted to have Joe.

an academic mentee. I think, and you asked early on about how could I do this work and not just burn out, it's hard work.

The way that I handle dealing with the child abuse is that I went to academia. It's too hard clinically to do this five days a week. I listened to your interviews with Dr. Sally Smith, and she even agreed. She said, look, if child abuse was my 100% job, I couldn't have done it. Thank goodness for pediatrics. And I'm going to say thank goodness for academia. So I am so excited that we have got talent in the next generations here.

who are bringing the next generations to our consciousness. The fact that Joe has such a strong social media and other modern technology presence is educating those of us who grew up in libraries. And I am so pleased that I can help

them understand things like human subjects approval and writing for publication and getting data. In addition to what Joe helps me understand,

with the influencers and what you helped me understand with the influence of podcasting. Yeah. We have a beautiful little generational dialogue with the three of us being, I feel like. But yeah. And like, what are your hopes for Joe as they go forward in their career? My hope for Joe is that they will continue to blossom and find joy on the journey that

I have no preconceived notions. If they want to continue an academic career, awesome. If they want to go into raising goats in the mountains, awesome. Whatever it is, as long as they're finding joy along the path,

which I think is very well in place. I agree with you. I agree with you. You know, be something that we see even within families is that people really experience or sort of view this abuse really differently. And so that can definitely happen, um,

between siblings. So can you talk about, I mean, I think it's always interesting to talk about sibling relationships because you're sort of, you're in the same family, but you're not in the same family because it was happening at a different time, you know? And like, can you talk about kind of how siblings may experience that parent differently? Yes. So the siblings of victims of Munchausen by proxy abuse are

all say how they were divided and split by their abusive mother. The abusive mother did everything they could to pit the children against each other, to keep them hating each other,

Because, heaven forbid, if the siblings got together and shared their experience, it'd be two against mom, right? And so these mothers have like a driven instinct to keep one of the kids from ever really hearing what's going on that's bad from the other.

So splitting, and we know splitting is a function of narcissists and people who abuse in other ways, is keep them separated. And then we hear, because many of them didn't know the term Munchausen by proxy at the time their siblings were being abused...

They just thought that there was torture going on in the house and they would also be abused by the torture. Like many of them will say, yeah, I was locked in a, I was locked in my room. I was just kept in my room. I didn't even realize what all was going on in that hospital room down the hall in our home. I was just locked out. Yeah. Yeah. And I think that, yeah, that, that really resonates. And, um,

Yeah, that sort of keeping, I mean, I think it's like really one of the most profound things about this abuse is like the way that it isolates the victim and like that they really, it seems to me in hearing a lot of these stories that that abuser really ensures that that victim is not going to have a close relationship with anybody else. Yes, good point. And the siblings are aware of that.

Yeah. And I think that the siblings also seems to me like if you, you know, because we see a lot of this with like, you know, if there are two or three kids in the house that like, you know, a pattern I've seen many times is that like, okay, it started a little bit with one or maybe even the oldest didn't get it at all. And then the next one, you know, gets it medium. And then the third one, you know, really is the, you know, their life is in danger, et cetera. That's kind of like the pattern with the Hope Ybarra case. And we've seen that.

through a bunch of sort of sibling cases where it sort of gets worse as time goes on and really escalates every time there's a new child. And obviously the youngest child is always gonna be the most vulnerable because they can't speak or they're smaller, what have you. And so I think you see a lot of that escalation. And then I think for the older siblings who end up maybe not the primary target of the abuse, there's also a ton of neglect, right? Like that kid's just completely forgotten in that household.

Right.

I've become very interested in some of these dads who appear, you sort of have the spectrum of how male partners react to these. And I'm sure this happens in same-sex couples, but I've just, the stories I'm aware of are mostly hetero couples where either the father is present to some degree or the father's completely absent like he was in the Alyssa Weyburn case. And

You sort of see this spectrum, right? On the one hand, you have the Doug Welch's, the George Honeycutt's, the Ryan Crawford's dads that do everything under the sun to protect that child and just will stop at nothing and unfortunately have to go over more hurdles than they should in order to protect the child from abuse usually. And so you have that group and that's a group we're really familiar with because those are the people who will seek out something like a support group for fathers.

And then you have kind of the middle, right? Where the dads are like a little checked out or they have a job that takes them, you know, away or they're just a really passive guy and they sort of definitely don't do as much as they should, but maybe are not sort of strictly to blame. And that's sort of the, you know, even I put like kind of Rod Blanchard of the Gypsy Rose Blanchard case in that story where he was, you know, separated and the abuser really did everything they could to sort of keep him away from her. And so it's sort of like,

yes, he's responsible. Yes, he probably should have done more, but he wasn't sort of collaborating in the abuse. And then I think you have the dads where I put my brother-in-law in this category where they have, it's like you have, this person has been presented with so much evidence over so many years that it's really unforgivable that they haven't acted protectively of their kids. And then, you know,

It kind of in that category slash even a maybe more extreme version of that category is someone like Jack Kowalski, who we talked about last season in the Maya Kowalski case, where when you look at the records, when you look at the evidence in that case, he was participating. He took her to half of her medical appointments. And I think this is where that.

question of, oh, is Munchausen by proxy abuse caused by a mental illness, by like a specific mental illness, it gets really confusing because even this came up in another in that Lehigh, Pennsylvania story where someone said, well, this person said that both of these parents had Munchausen by proxy. Like that could never be true. And you're like, well, yeah, no, but you could have a parent that was also collaborating in the abuse.

by just going along with it or letting the parent do it, right? And like you see, obviously, female partners doing that too with like dads that are sexually abusing their children or what have you. And so I've become really interested in sort of those cases where the dad is playing a bigger role. And I just, I wonder like, I realize this is like a big open question that I just opened, but sort of like, what do you think about

the dads in these situations? So I think the term we're looking for is an enabler. And there's a lot of literature on enablers. I think we look at it as any partner who is so enmeshed that not only do they fit in the, oh, this is awful. I got to get out. Or just the, I can't look at it to even, I don't want to know if it's awful, but then they go, I've looked at it. It's awful. And

and rather than try to deter it, become part of the problem. I don't know what the difference is that some parents cross that line. So the gender dynamics, you and I have talked about this at length, is that caretaking, caregiving is within a feminine domain.

So my other area of research is what I call professional Munchausen by proxy, which is where a healthcare provider or somebody in the helping professions, instead of using their child to get medical attention by creating healthcare crises, they use a dependent in their care. So this could be a home health provider,

What I have studied is mostly in hospitals and in nursing homes. And I have a database of 154 healthcare providers who have been prosecuted for serial murder of patients in their care by injecting them with substances or toxins. And 86% are nurses. And of that 86%, half of the nursing staff

Okay, so this takes me to this is a crime of opportunity, and it's within the caregiving domain. And so...

Mostly because I think of, and maybe this is not true anymore, like, do you know what percentage of nursing, like nursing professionals are male versus female? Yes, 12% of nursing staff are male. So males are significantly overrepresented in the healthcare serial murder database. Wow. And it's because it's a crime of opportunity. It's done within the domain of

of caregiving. And it takes us to that movie, Misery. So it wasn't so much her gender that when James Caan was starting to get better and wanted to get the heck out of the bed and she whacks him and so he can't leave. It was the opportunity. It's whoever is providing the care, the nursing care, the motherly care, the breastfeeding, the primary care.

basically. Wow. So that leads me to think that we could possibly see a shift as these, you know, there's a lot of research to say that like, I guess this is the, wow, this is a real like dark side of this otherwise uplifting statistic that like millennial dads are much more involved in their, you know, in, in their kids care than, than previous generations. And so it would be interesting to see if this

shifts over time as we see who is caring for children shift. Yes. And those are some of the cases that I'm seeing is where it is dads who are equally involved or sometimes primarily involved as the gender dynamics of families evolve in a good way.

And yes, they will munchhausen. They will do medical child abuse. They will get their needs met through over-medicalizing their children and getting that attention. Yeah, that's so fascinating. And I mean, when I think about some of these cases where the evidence shows that the dads have been participating more than others, like-

with Jack Kowalski where he was retired and so he was a lot more involved than maybe your average working dad of that generation. Yeah, that's really fascinating and we will have to have you back on to talk about your serial killer research because that is so interesting. So something you said much earlier in our conversation really stuck in my head when you were talking about working as a nurse very early in your career in the pediatric burn unit and that a full half of those burns were

by. Well, of the under five. Of the under five. Right. So for very young, yes. Because of course, like. For very young kids. For very young children. Yeah. About a third. About a third to a half were inflicted. Yeah. And I think, you know, one of the things that we're up against trying to raise awareness about this form of abuse is that

That there are many people that just don't want to believe that child abuse is as common as the data would suggest it is. And I wonder what you as a longtime child abuse professional want to say about that. Oh, gosh. This is where I have existential angst. I've been thinking about it a lot because the system is broken. The system that would protect kids is not working.

is not a happy ending for most kids. And so I'm not sure we want to, you know, be identifying it anymore unless we can provide a good solution or a good outcome. As we know, it's really society. It's society that has to start saying, we won't tolerate physical abuse. We won't tolerate violence.

emotional abuse of children. We do write laws. We have evolved as a society to at least not treat children worse than animals or at least give them some rights. But I don't think the laws alone have caught or the system that implements the laws is not yet where we want to identify every single case.

Yeah. I was on the board of Prevent Child Abuse America for many years because they say prevent it before it happens.

providing home visitation to childbearing families, especially those in distress or those under stress or those with high ACEs or those that are homeless or those that have, you know, mental illnesses and depression. Home health support where you say to a pregnant family, we're here. When that baby cries in the middle of the night, the baby's not mad at you.

The baby's just uncomfortable. You don't have to be upset with the baby and give coaching on developmental milestones. No, you don't need to potty train your child by the age of eight months. No, you don't need to smack them if they have an accident and wet their pants. That's not good discipline to anticipatory guidance.

through the experience of having an infant and a toddler is the best way to prevent all of this. And as I think about Munchausen by proxy abuse, I'm thinking it's also a good way to prevent maybe over-medicalizing. If you can just say, no, this is normal and calm down the

So illness anxiety that sometimes precedes munchausen by proxy, that might be a good way to prevent that. Yeah. I mean, I, so I actually, I'll have to reach out to you about this later, but I did, I put in a request because I'd like to have someone from Prevent Child Abuse come on the show to talk about exactly what you're talking about, because I think that is a sort of hopeful thing. And, you know, last season we had Dr. Jessica Price, who is a researcher and former CPS investigator on the show to talk about her book.

And she shared that statistic with us that 76% of cases that end up in the system and children that get separated are happening basically because of poverty-adjacent reasons. So not adequate housing, not adequate supplies, whatever. Basically problems that some resources could solve. And-

So then we're only talking about the sort of 24% of cases that are abuse related. And even within those, a lot of those are certainly exacerbated by everything that you were just talking about, by people not getting adequate support, basically. And I mean, both you and I are moms. I've thought many times, I don't think, one of the things that I think is a sort of misperception about

Maybe not medical child abuse. I think it is a little bit different than some of these other things that we're talking about that are sort of can be really exacerbated by anger, frustration, you know, lack of resources, that kind of thing. But I think I think a lot of people.

who are in a more well-supported position would like to believe that it could never be them who loses their temper with their child or never could never be them that sort of does the wrong thing. And I don't think that's true. I don't think that there's quite as hard of a line there as people like to think, because I mean, having a new baby is so stressful. It taxes every resource you have. And if you are not adequately supported, I think that's,

a lot of people would not be the parent that they might otherwise be. And I think that those support systems, and I think, you know, the other thing, like what I think about for parents

medical child abuse. I mean, having seen it in my family where I guess my sister is the darkest version of an orchid, someone who did not come from a difficult upbringing, someone who had every resource and every thing that a person could really want in terms of support and financial support and all that kind of thing and still went on to engage in those behaviors.

But I think what can always help and you know something you said earlier was just like that something that creates resilience is just those adults along the way that reach out to a child, that create a safe space, that make a child feel like they're worthwhile and sort of reinforce that belief that their life is worth something.

really do make a difference and it makes a difference to that survivor even if every other even if sort of every official system fails them along the way like I think one of the things that like I mean I

Yeah, I don't know. I agree with you. I mean, I'm in the middle of an existential crisis myself about it because we always tell people report abuse, report it to the police, report to CPS. And now we're seeing this situation where, oh, and then hope that you don't end up as the villain of a Netflix film and it ruins your life. Good luck out there. You know, like it's very hard to know what to tell people and under this circumstances. But I think what we can tell people is that like.

It's never going to be an effort wasted to like be there for a child and to try and support a child that's going through a rough time because we've seen it. We've seen it time and again where people remember that one teacher, that one friend's parent, like anyone who was kind to them and supported them, like that's the thing that they hold on to forever. Yeah, that's a really good hopeful note. And I do believe that we as a society have made exponential progress in

in a century in terms of our awareness of protecting children. Right. I mean, there was a point where I think it is like to sort of look at the longer scope of things is helpful because right now it feels of course very much to me being very, very in it that we are headed in the wrong direction with our sort of like medical kidnapping panic that we're having. Um,

But yeah, if you look at it like over the span of decades or certainly over 100 years, like it just wasn't the idea of like don't beat your children. Like being a thing was just not even sort of a cultural norm. So at least we have sort of moved in some direction where like, yes, we're still in a lot of denial about how often it happens. But at least that we can mostly agree that it is a bad thing to mistreat your children, which was not always the case.

Exactly. All right. Well, thank you so much, Bea, for giving us so much of your time. It's always a delight to talk to you. I could always talk to you forever. Every year, over 300 businesses start right here in Prince William County. And I'm one of them. I'm Stefano Marzano with Mighty Meals. We deliver healthy, locally sourced, chef-prepared meals right to our customers' doors.

As you may know, we have a little bit

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