Case Files 10: The Psychology of Perpetrators with Dr. Cathy Ayoub

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Hello, it's Andrea.

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So today I'm talking to Dr.

Kathy Yayub from Harvard.

Kathy is a colleague of mine from the American Professional Society on the Abuse of Children, and we had a really fascinating conversation about survivors, perpetrators, and just all of the complex psychological dynamics involved in these cases.

I really appreciated Kathy coming on to share all of her research and her insights.

Thank you for being with me this year and for your support of the show.

I hope that you are getting some rest this holiday time and spending lots of time with those you love and getting a break from it all here at the end of this absolutely bonkers year.

Whatever is coming in 2025, I will be here with you every week and we'll get through it together.

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Well, hi, Kathy.

Hello.

Thank you so much for being with us.

So yeah, if you could just start off by telling us who you are and what you do.

My name is Katherine Ayu, usually called Kathy,

and I'm an associate professor at Harvard Medical School.

And I'm a counseling and consulting psychologist and a nurse practitioner.

So I come at all the work that I do from

my basic interest and work in working with children and their families.

Which of those several jobs that you just listed, which of those was your first entry into this work?

How did you get started in your career?

I actually got started as a nurse practitioner, nurse clinical specialist, and I wanted to work in a hospital with young children and families.

I actually wanted to work with children who were ill.

So I wanted to work with chronically ill children and we moved to Tulsa, Oklahoma for my husband's job many years ago.

And I convinced the director of nursing that I could be the mental health consultant to their pediatrics and obstetrical unit.

And while I was there, I not only worked with chronically ill children, but the chief of pediatrics said to me, Hey, there are these new things we've heard about, and they're called hospital child abuse teams.

How about if you start one along with the other things you're doing?

Because I think we probably see four or five cases a year.

And I said, Well, okay, let me see what I can find out.

And I had the tremendous

luck in working with a couple of great pediatricians who had trained with Dr.

Henry Kemp in Colorado.

But

he was one of the first people who really talked about child abuse and helped get the child abuse legislation through in all 50 states for mandated reporting.

And he really wrote about child abuse first and foremost.

And so I said, okay, very naively, I'll start this child protection team.

And we saw 150 children in the first year and about

200 or more in the second year and realized the other hospitals in town didn't have teams and worked on building those teams.

And so I saw my first case of medical child abuse in Tulsa when I was part of the child abuse team.

And most of that, all of the pediatricians and the nurses were very, really, very willing to have folks on the child abuse team go ahead and, you know,

talk to the parents, understand what happened to the child, and really try to understand

any forms of abuse or neglect we were seeing and whether we should report to child welfare.

For example, except for one case.

And the chief physician who

had really helped start the team and actually circulated, rotated through the team, said, I have a case and I'm not referring it.

And there is a mother here and

her baby almost died because the baby's bottle was full of salt.

And I'm going to handle this case myself and I'm going to work with child protection.

I'm going to work with, you know, referring it and she's very sorry and you're not going to touch this case.

Wow.

And I was really curious.

And I think my curiosity led me to then after I

moved to Boston and went back and went back to school.

In my clinical work, both as a pre-doctoral and post-doctoral I was really interested in working

through the courts and with child protection agencies and hospitals around child abuse neglect.

And I was always curious about this, by then this Munchausen by proxy.

So

what year roughly was that case?

What year did that come up, would you say?

It was in the late 1970s.

Very long ago,

really around the time that Roy Meadows actually wrote the first paper on Munchausen by proxy.

And I found the paper and even tried to say, I wonder if this is what's going on.

And it was just, again,

our whole team was really shut out of the process.

I'm so curious about that dynamic because, yes, my first question, I was sort of doing some quick math in my head.

And I was like, I bet that was around the time that even term came into existence.

And I wonder if that doctor who, so it sounds like the doctor in that case was really trying to protect that mother and was very much

unwittingly, I'm sure, but sort of colluding with her.

And so how did he frame

what had happened?

You know, like he was cutting out your part of the process, but like he sounds like he did report it.

Like what was his conception of what was happening?

Here's, I believe his conception was really that this was a very remorseful mother who had made a big mistake.

And he was very

connected to her.

I mean, that was the other thing that really,

really got my attention because he was so connected to her

that he really needed to, he not only kept us out of the situation, but he really worked with the child protective.

workers to keep them out in a way too.

I'm going to see her.

I'm going to see this baby.

You know, I'm sure this isn't going to happen again.

And he made a lot of assertions

and was incredibly protective around the whole, you know, the whole reporting system.

That's really fascinating.

So that was sort of your entry point then, sounds like, into getting interested in Munchausen by proxy.

Exactly.

That was my entry point.

And then when I went back and

got my doctorate in psychology, I was lucky enough to be both as a pre-doctoral student and then to do a postdoctoral fellowship in child forensics.

And I worked at the Boston Juvenile Court Clinic as part of that experience and also did a lot of work in family court.

And

I was handed a case and they said, well, you're a nurse, you should understand these medical things and you're a psychologist, so you should understand, you know, the mental health issues.

Here's this really unusual case at the Boston Juvenile Court Clinic, this was a court clinic that sits within the juvenile courthouse, and judges would refer to us directly around, you know, any kind of juvenile cases.

But in particular, I was really interested in young children and I was really interested in child abuse neglect.

So they used to give me those cases.

And it was really there at the Boston Juvenile Court Clinic that I began to be the person who ended up seeing these cases.

And we also, at the same time, I did work in family court, and this is through the law and psychiatry service at Massachusetts General Hospital,

which is where I still practice my forensic work, but ended up seeing those cases once they got to court, and then at the same time, doing some work with a number of hospitals about how to set up child protection teams and hospitals.

And these were always what a number of my colleagues call the black holes of child abuse and neglect because there was so much information and it was so complicated.

And to

medical child abuse cases, the Munch Housing cases.

Right.

Are the black hole of, yeah,

I can see that.

I mean, this is really fascinating because I think that sometimes people, and certainly even as I've been digging into this,

I think many of us are surprised at how recent

our recognition of of child abuse, period, is, right?

Munchausen by proxy is its own thing, but even sort of this idea of like the battered child syndrome and the

need for protections for children from abuse is very recent.

Absolutely.

And,

you know, again, I'm old, so I've had the opportunity to really

see this develop.

Again, I remember talking to Dr.

Henry Kemp at the University of Colorado, and he was saying, you know, you're a young thing,

you don't remember when there were no protections for children.

And he worked with Walter Mondale when he was in the Senate and actually

got them to pass legislation that provided federal funds for states that would develop child protection laws.

And what year was that?

That was in the 1960s, because by the time we got to the 1970s, all 50 states had passed child protection laws, and most states had child protection systems that were developed within their states.

However, there were a few states that didn't, and Massachusetts was actually the last state to integrate into their state system child protection services because those services had been provided since the late 1880s by the Centers Centers for Prevention of Child Abuse, the Massachusetts Society for the Prevention of Child Abuse.

So it sounds like previous to this era,

there were sort of patchwork

and maybe efforts to protect children, but not this sort of overall understanding that this is something that needs to be taken really seriously.

Exactly.

So, you know, we're really in a very different place now

than people were in the 1960s as this was really developing and even in the 70s.

But we're still struggling with some of the

same issues and some of the real backlash to protecting children.

Yeah.

If you can just talk us through, like, I, and I always want to make sure in my work that I don't cast aspersions of any kind or sort of make parents of truly chronically ill children nervous.

And of course, those parents do have bad experiences with the medical system plenty of the time, right?

I mean, there are those real problems also.

Munchausen by proxy cases are very distinct from those, I think, but I wonder if you can kind of talk us through, like,

what are some of the things that makes

either parental behavior just the sort of expression of it?

Like, what are some of those things of like, if you take a child that has a genuinely rare medical complexity and put it up against a Munchausen by proxy case, what are the differences between those things?

There are some very distinct differences, but oftentimes healthcare professionals get so wrapped up with,

and I'm going to say mothers because 97%

are moms or are women who are caretakers.

But there are some real distinctions.

Having worked with a lot of families with chronically ill children, it's incredibly anxiety producing.

I mean, there's nothing worse than having your child be ill, particularly chronically ill.

And so, parents are anxious, but what you see by and large is that parents want action and then they're so relieved when the child gets better, or they're very anxious when the child is not getting better, or when they have a chronic life course that the parent often can't control, particularly if the child's quite ill.

What you see in Munch Hus and by proxy is that there is always what I call a yes but.

It's like there's a procedure, the child has the procedure.

Sometimes the parent will often push for a procedure that the doctor may not think is totally necessary.

And the parent comes back and says, yes, but.

My child is still ill or my child has another problem.

If their GI problem was taken care of, now they have seizures.

If they're also having seizures, then they have an immunological problem.

So almost every body's system gets tagged and it just gets worse.

The other thing you see is if providers have time to go back and look at the records, you can almost track

where

different disorders appeared.

So you also see doctor shopping not to try to find a way to have the child get better, but to have somebody validate that the child is ill.

So you have to really look at all those patterns very carefully.

I think I could say almost every parent that I've interviewed with factitious disorder has convinced me at some point in time.

I get taken in to the point where I often have a colleague when I'm doing these forensic interviews where I can do six interviews, 10 interviews, you know, I can spend much more time.

I may have a colleague sit behind me to watch me be taken in oftentimes

because these are very, very convincing people.

Now,

and some of these women present as victims and really want everybody to feel sorry for them.

Some of them are more assertive and

are more intellectual.

You know, I know more about this disease than the doctor.

And, you know, that's also kind of another sign.

It doesn't mean that parents of chronically ill kids aren't going to know a lot about their child's disease, but it almost comes across in a different way.

They don't spend all their waking hours, you know, on the internet looking at rare diseases.

So I hope that's given you

a few characteristics that are really different, but you can see that it's not something that you might know instantaneously, and you have to dig.

And that's one of the things I think that's always interested me is that it's very important to really start out thinking, this is a chronically ill child and really peeling back the onion and then watching and spending some time with the child, really understanding who is this child?

What are they doing?

You know, how do they appear when they're, you know, relaxed or will sit and, you know, be with you, play with you, those kinds of things.

Right.

I mean, I'm fascinated at the way you describe that because, you know, I've had Pjorker on the show a couple of times and she described the exact same experience of just, oh my God, I get roped in every time.

You'll be in a conversation with them and you'll just be like, oh, we've got it all wrong.

And then you sort of like come out of that trance when you look at these other factors, right?

When you look at the evidence.

Yes, exactly.

And it's what a lot of times we talk about it is as there are lots of what we call cognitive distortions with the parents.

It's that you think you're following a logical train of thought, but it gets distorted.

And what you see is that

events that most people would see one way are often described by these mothers in a way that actually moves to make them look like they're more nurturing, more competent, and that they're right about what they're saying.

They also will take a piece of truth and distort it.

So even when I have the opportunity to do psychological testing, which I think is interested in understanding people's personalities.

It certainly doesn't define or identify Munchausen.

But to look at how

oftentimes these women will actually start with a detail and build information, like circle that detail to make it something that it isn't, or they'll take an overall statement and add the details that then change the situation.

So even looking, and I also believe that these women are not all made in in the same cloth, that there are at least three or more different pretty clear groups of women with

different

ways of being and that their prognosis for really being able to change their behavior has something to do with that as well.

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So you were saying that there's

several versions of this type of perpetrator.

If we're talking about sort of like almost a profile, right?

Which has been interesting to be on the show.

You know, I think initially I assumed every perpetrator would be charming, charismatic, very bright, et cetera, because that's what I know.

And then Brittany Phillips, who we covered in the second season, was like the opposite type, right?

A bully.

No one believed her, but she, you know, mostly got away with it nonetheless.

So what have you seen in terms of like when you're talking about, yeah, talk to me about those different sort of groupings of perpetrators and what you said about like which ones may be capable of some kind of treatment and which ones are just not going to, that's not going to be viable for.

There are a number of different ways of talking about perpetrators.

And we actually did what I think is still the largest prospective study, which is only 45 families

of Munch Husband by proxy cases and they all were verified through

one court.

In other words, the judge found that this was true.

Several cases were criminal courts, most often it was juvenile court or family court.

And so we tried to understand what the mothers really looked like.

I've got lots of different information.

We first we looked at their IQs and they were all, you know, some were very high.

And then there were people whose IQs were not that high.

So just want to say, I think, you know, these are, and these were people from multiple walks of life.

So you can look at these moms in a number of different ways.

The person who I think looked at the most carefully, and I think this is so interesting, is Dr.

Southall, who was the pediatrician in the UK who

actually

did surreptitious video surveillance of

children who had unexplained breathing episodes or what we call apparent life-threatening events where kids stop breathing.

And

what he found was that when they analyzed those tapes, all of these individuals were suffocating their children on videotape.

Again, they didn't know they were being videotaped, but

he found three distinct groups.

So one of the ways to think about these moms is how do they act with their children.

And what he found was that there was one group of mothers who had no interaction with their children except to reach into the crib and suffocate them.

So,

no connection, no interaction.

When the nurse came in, they would play with the child, they would change the child, but when they were alone, nothing.

Second group of

mothers

who seemed to engage with their kids in a pretty normal way, and then they'd reach out and suffocate them.

And then a third group

who would pinch their children.

One mother even broke their child's arm.

You know, they were really hurting the child in multiple ways.

That third group of women, I think, are

probably

in the acute situation the most dangerous.

Now, these were all women who were suffocating their children, and that is the most likely form of medical child abuse to be fatal.

And in our study, we found of 45 families, we had a 17% mortality rate.

That is

so high when you think, when you compare to other chronic diseases, for example, the most common cause of death in children is infectious disease.

In the child, one to four,

there's a 10% mortality rate.

In four to 14, there's a 5% mortality rate.

You know, if you're born with a congenital heart condition, you have a 2% mortality rate now.

It used to be 77 in 1990 and now it's gone way down because we know how to treat these children.

So when you think of children with chronic illnesses or even with acute, the most common illnesses that actually lead to serious injury or death in children, much housing by proxy is way up there.

And it's primarily because of the children who are being suffocated.

Although there were also several children in this study who died of chronic intestinal problems because they were just so debilitated.

And I've also seen, sadly, I've seen young adults, 21, 22-year-olds, I get a call from their internus, what can you do?

I think this mother is making this young woman sick or this young man.

And at that point, there are no protections.

Anyway,

they've gotten off the topic there.

No, no, no.

All of this is on the topic.

And I mean, that's really fascinating.

And I'm sort of, as you're talking, I'm sort of triangulating

the various cases into like those three groups.

So the 45 families that you studied, those were not all suffocation cases, right?

Those were a variety of monchasemby proxy cases.

Okay.

They had a variety of different kinds of problems, GI disorders, asthma, mitochondrial disorder, seizures.

I mean, I have a list.

I could even read it off for you.

I think we saw a little bit of everything, poisoning.

We did have some apne or suffocation cases.

And we also had 10% of the cases were cases in which the

illnesses that were being fabricated, exaggerated, or induced were psychological or psychoeducational.

So it was either they were seen in schools or they were being seen by mental health professionals.

So we were able to identify that as a form of victimization as well.

I think medical child abuse is a helpful terminology

for some pieces of it.

But I actually really have come to appreciate sort of just the descriptor of Munchausen by proxy abuse because of exactly what you said.

We see in so many of these cases, even if there are those, you know, really the life-threatening elements are more the poisoning, the suffocation, that kind of thing, the starvation in some cases.

It also extends to this, you know, emotional abuse and psychological abuse and educational abuse.

And it really like, in some cases, it's really only taking place in

those arenas and it's still extremely harmful and leaves lifelong wounds, whether they're physical or not.

Exactly.

And that's my problem with the term medical child abuse.

We tried to craft a term back in 2002.

And I think,

you know, it was too complicated, but it was child abuse by illness falsification.

And what we were, and we really said illness or condition falsification so that it wasn't just physical abuse.

But I think this is still a struggle.

And unfortunately,

you know, the term medical child abuse is

a great one for pediatricians, but it doesn't differentiate the dyadic nature of Munchausen by proxy, which, you know, there's a diagnosis for the parent, there's a diagnosis for the child, and you put them together, and that's Munchausen by proxy.

And unfortunately, in our healthcare system, you can't have a dyadic diagnosis.

Right.

But what is a dyadic diagnosis?

I don't know that one.

I like that.

Anyway,

lots of D's here.

We also talk about Munchausen by proxy as being one of a number of disorders of deception.

And, you know, getting back to these three groups of women and some other things you can think about.

Disorders of deception, as a more global term, are people who fabricate or exaggerate or change their reality.

Or some of them are what we commonly know as pathological liars.

Now, with Munchausen by proxy perpetrators, some of them are very focused on their children, on their children's symptoms.

And in a number of cases, I've had some perpetrators say to me, my child has these physical symptoms, they would never have psychological problems.

Or my child has these psychoeducational problems, and they would never have physical symptoms.

And sometimes there are a combination of both.

I think...

the child's symptomatology also tells you something about actually how many children in the family are going to be targeted.

So that's kind of another issue we can come back to if you're interested.

But then thinking about the perpetrators, they

may also

be evaluated or be

identified based on their

whatever is motivating them to keep this secret or to actually

make an admission.

I've been involved in long-term treatment of a small number number of cases, but significant cases, and had the privilege of actually working with these families for seven or eight years

from the time they were identified to the time that the children were completely reunified.

And it was really quite extraordinary.

And then I've seen several of the families when the children were adults and their siblings.

So that's

been very interesting.

And in those cases, those mothers each said to me, me i happened to be the forensic evaluators for for each of them

and in one case i actually got a full confession which was just extraordinary because it just doesn't happen

but each of these mothers essentially said

i was waiting for someone to find me out why didn't for example there was a woman who was in a hospital here in Boston and her child was getting ready, her four-year-old was getting ready to have surgery to have part of

his pancreas removed because he kept having excessive insulin production.

And no one could figure this out in their hometown, so they came to Boston for evaluation.

And he had these hypoglycemic, you know, low blood sugar episodes,

which were life-threatening, in the hospital.

And the doctor would immediately take blood.

And this is the chief of endocrinology.

And he looked at the findings and he said, this can't be.

The lab is wrong.

Then there was a second episode.

Then there was a third episode.

And he finally said, this has got to be right.

And what he was doing is he could identify that this child was being injected with insulin because the breakdown products for insulin were not present in the child's blood if it had been.

insulin that had been created from the child's pancreas.

So there was, in some sense, a smoking gun.

And he went in and, you know faced the mother and said, this is what's going on with you.

She came back to me and she said, I don't know why, you know, he came in and he told me I did this.

The syringes were in my purse.

I don't know why he didn't come find them.

I don't know why no one looked at me or examined me, you know, or looked for some evidence that I did this because I really wanted to stop and I couldn't stop and I really needed to stop.

And as ashamed as she was, and I helped her walk through telling her husband, which was the hardest thing for her,

she was desperate to stop.

And the women that I've worked with, at least in treatment, and maybe this is just

random, but are women who are almost compulsive about doing this.

They've started to do it, they continue to do it, and then they can't stop.

And so I think that's one group of mothers.

And those were often the mothers that were actually able to interact with their children fairly normally in other ways.

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You know, when you're talking about the sort of three different styles of interacting with the kid, and that's really interesting to think about

This sort of idea that I've always wondered, and I think one of the things that people are the, why people are so disbelieving about this abuse is because if you have kids, especially, but I think for anybody, it's, it's so hard to imagine.

Right.

It's like kids are here.

Right.

Like harming your child, not even because you're having like you're in a rage or like because you're, you know, abusing substances and don't, you know, have lost your, you know, sort of faculties or what have you, but like this deliberate, planned out, orchestrated harming of your children.

It's hard for me to believe that a person who's capable of doing that is really capable of empathy.

And so when you describe someone just sort of going down that road, but also simultaneously having the empathy sounds like to be able to sort of rebuild and get to a better place.

I mean, I, I just like, I almost can't like reconcile that idea.

So what do you think makes that difference where someone, that very small, admittedly, percentage of perpetrators that may be treatable?

I think that they really came from different backgrounds and that they had different, you know, genetic predispositions.

In each of these cases, what I discovered fairly quickly was that these women had experienced significant and severe trauma of their own.

Many of them have been sexually abused within their families.

They had been physically ignored and really mistreated,

although they were designated as the caregivers in their families and they actually took care of their own parents, who oftentimes were abusive to them.

Now, I don't think that's the case with all Munchausen perpetrators, but with this subgroup, I wonder if there isn't extended family trauma that, along with a very strong push to be the caregiver in the family.

And then the third piece is that

I believe that there is often a trigger for these perpetrators.

Some of them really had triggers in adolescence and, you know, began with some issues in adolescence, but they're

often some triggers or some trigger that really pushes them into

this.

Now, there are two other groups, and I think the biggest one are the mothers who really don't do a lot with their children unless they're on stage.

And I think that's a different, you know, because the bond between the child and the parent is really not there from the parent's perspective.

And those are the individuals who have recreated themselves, as my colleague Kirk Schreier says, they are impostering as nurturing parents and that takes up their whole time their whole being and those are the folks who

I think are very very difficult I mean that that's where you're really not you're not going to get admissions and treatment isn't effective without some kind of an admission well without a genuine sustained admission Yeah, there are many cases, Munchausen by proxy.

Many of the cases I've covered,

in fact, almost all all of them I can think of off the top of my head, there was no known history of

abuse as a child.

And I think that makes it even sort of more perplexing.

And again, you know, like Dr.

Mark Feldman and the others sort of described this as a maladaptive coping mechanism.

And I think one of the things that I always try and, you know, remind folks to sort of bring the whole thing down to earth because it does seem so bizarre is like, most of us, I think if we take a moment, can really understand.

that intrinsic reward that you get for being sick or having a sick child, right?

As you said, with this sort of of first profile that you're talking about, if someone was heavily parentified in an abuse situation and put in that caretaker role, that that might sort of become this coping mechanism and this thing that they do and this thing that sort of becomes all twisted up for them.

I mean, what's really fascinating is that it sounds like people who are perpetrating this abuse

because of their own history of abuse

are more treatable than the other variety who is not doing it for those same reasons.

And I'm also assuming with that second group that doesn't have a history of abuse, that's probably where you're more likely to see that pathological lying that spills into other areas.

So the really high rates of excessive infidelity, lying at work,

fraudulent, this, that, and just a million things, you know, because so many of these cases that I, that I look at, you scratch the surface and you're like, oh, this was not the only thing that this person was lying about.

So I'm assuming that that's kind of more common in that second group, too.

Yes, absolutely.

And that you've you've got it.

That

those tend to be the people

who oftentimes have factitious disorder as well as they're involved in factitious disorder, you know,

imposed on another.

They make themselves sick, and those people we may often see some of that develop in adolescence, and they start the behavior of

you know, distorting situations.

And

some of them, in the extreme, I think, then go over into the third group where they tend to really

make all kinds of people ill.

Their spouses, their friends,

they may,

if they're upset with a partner, they may fabricate

domestic violence, is something that we see.

You know, it's only limited by the perpetrator's imagination, just like the forms of

illness are.

Right, just absolute chaos agent on all fronts.

Right.

And it's more than that.

What we found in our study was that about 60%

of the, and these were all women in our study,

60% of them were also fabricating, exaggerating, or inducing illness in themselves.

We did find that a very large number of the women that we evaluated had mixed character disorders or personality disorders.

In other words, they had long-term dysfunctional ways of being and of acting

that they had really, you know, kind of supported for

a number of years.

You know, again, on the extreme where we had women that were

really chronically violent with their children in a number of different ways.

And then they tended to be with other people as well, oftentimes in a very

indirect or subtle way.

But, you know, I'm going to put IPACAC, which makes you vomit, in your applesauce and you're not going to know it's there kind of thing.

Like we saw this with the Hope Yobara case that we covered in the first season, you know, she poisoned a coworker, like that kind of thing.

Yeah.

What else did you learn in this study about, and just what have you observed about like the family dynamics surrounding perpetrators?

So both in like the family of origin, as you said, that's a piece that you look at, and also their family as it is.

So like their marriages, their dynamics with their

extended family, that kind of thing.

Let me start with the current information because I'd love to talk about fathers.

We evaluated mothers and fathers

or partners

in both cases.

And

in terms of thinking about, again, I always did this from thinking about, so how can the child be safe?

How can they be cared for?

And how can they have some permanent placement?

There were really two groups of fathers, were really two family consolations.

There was the two-parent family, and in those situations, almost always the father was enabling the perpetrator.

And there often times were additional maternal family members in particular

that were also supporting mom.

In some cases, there were other maternal family members who were really, really trying to get into the system, grandparents, you know, aunts and uncles, and they couldn't kind of break this

couple

because dad really supported mom.

That was really quite typical.

Those fathers totally stayed out of the health care for their kids.

That's mom's job.

I don't know anything about it, but I totally support her way of thinking.

And

I think of the one case I was involved in a number of years ago where mother was tried criminally and was convicted.

Dad was in the courtroom and he walked out and he said

to the press,

they've just convicted an angel.

So he was firmly connected to her.

There's another very fairly significant group of fathers that are estranged from their partners, either were never married or oftentimes were quickly married and divorced, and they're fighting for their children.

And those

situations show up most often in family court.

And I think there are a couple of us who have probably done more work in family court than a lot of other folks.

And it's almost the hardest to manage those cases in family court because in family court, when you come in for a divorce, the assumption is that both parents are fit.

And so it's often very hard to really demonstrate that this is going on.

And I always think of the case I can talk about, which was a criminal case in Dallas back in 2019

with a...

Trying to remember, the little boy's name was, I probably even have it here, Christopher Bowen.

Oh, yeah,

we spoke to Ryan Crawford on the show.

Yeah.

Yes.

And I actually testified in the sentencing portion of that criminal trial just about what Munchhausen is, what the prognosis is, what the likelihood is that she would, you know, continue to do this.

And,

but that was such an interesting case.

And

I did talk to Ryan afterwards and,

you know, heard more of his story and how he really, really

you know how he was really found in contempt of court and family court trying to present this information

and not surprising yeah and I mean for those fathers who find themselves in that situation who I mean on the one hand I can understand where this gets complicated in the arena of divorce because something that people ask me about constantly and we can address this a bit is like well what about all these false accusations of munchausen by proxy now there aren't there's not really any data that there are.

Yeah, I know we're having the same reaction.

There isn't any data to support that there are a large number of false accusations of munchhousing by proxy happening.

But I think where you might see one is that a dad could throw that out in the context of a contentious divorce, but there wouldn't be any evidence to back it up, right?

So I can see where it feels like a thing someone might throw out

as a way to sort of get custody of kids.

But I, I, number one, I don't know that that happens often.

And obviously, if you were,

if you discovered that your spouse was doing this and did not want to go along with them, did not want to enable them, this almost certainly would end in divorce, right?

Because you're not going to maintain your marriage with that person and watch them torture your children.

So for dads who discover this abuse, I mean, is there any way, like, is it about reporting it sooner so that that's on record while you're still married?

Or, I mean, is there any sort of practical advice?

Because we hear from a lot of people on the show.

I know.

It's really so painful and so tragic.

There are lots of fathers.

And what I always say is: you know, have you filed for divorce?

If that's something you're going to do, you need to make sure that you get a guardian ad litem or

an expert on Munchhausen appointed by the judge

to do an assessment.

A guardian adelaid is really looking at the best interest of the child.

It's the best way in family court to get someone to evaluate both parties, but it has to be somebody who knows something about Munchausen if that's what they're suspecting.

And I have, you know, and I've done probably almost 100 cases in family court, maybe more.

And, you know, some of them have turned out not to be Munchausen.

It's interesting that most of them have,

because I think by the time they get there, there's enough information, but judges need to be convinced.

And unfortunately, I think it's going to take someone to put all the pieces together.

And what they shouldn't do is have someone do one piece and another person do a second piece and another.

person do a third piece and try to put the information together because that's what these perpetrators want.

They want to divide and conquer.

So the kinds of assessments that often happen in family court: well, we'll go have you do a psychological evaluation of both parents.

Well, that's not that helpful.

It is really hard when fathers haven't left, and it's really hard to know what to say to them except to describe what the kids look like and what the perpetrators look like, and have them make their own decisions.

I do think that some of the groups that B.

Yorker is running are absolutely critical.

These partners

feel so lost and so alone.

And the other thing that tends to happen, particularly in those divorce situations, is these mothers never give up.

And that's something I want to make sure I get to say, is that

in thinking about the long term,

They do not give up.

They do not give up when the children turn 18, if they have been, if their rights have been terminated, they're on the doorstep on that child's birthday.

I've seen it over and over and over again.

So when I'm talking to fathers, I'll say, you know, when your child gets ready to turn 18, if they're willing, get a restraining order

for your ex-wife because there's no protection.

And these women are just relentless.

And they come back, they may come back into the situation when rights haven't been terminated five, six, six, seven years later and say, oh, here I am.

I love my child.

I want to do something.

And

if there aren't any legal,

you know, legal protection for these children, adolescents and even young adults,

they get pulled right back into the same kinds of behavior patterns.

I know in addition to studying perpetrators, and I know you don't necessarily have data to publish yet, but you are doing a long-term study on adult survivors.

And I wonder if you can just share with us, you know, even anecdotally, sort of what you've noticed about how this affects, you know, sort of maybe even starting with like, how does this affect children when they're children and being victimized?

And then what are those long-term effects on adult survivors?

We're really hoping to reach out to more adult survivors.

This study started 20 years ago and we had to wait.

We've published some current information on it, but not about the follow-up.

And so I think this is really important.

First of all, when we look at what the children are like, you know, when they're in this situation, one of the things that's really critical is they are very unlikely to acknowledge their abuse until they're separated and safe.

And Judy LeBeau did a study 20 years ago.

She talked to adult survivors.

She literally put an ad in the paper and said you know do you think this might have happened to you and she talked to folks and what she found was that half of them said they didn't they were unsure that they were being abused until they really heard about this as an adult and some perpetrators are very overt and others are much more subtle and so that's one thing about victims is that they're very confused because they're being told that they're feeling things or particularly when illness is being induced that they're feeling things that aren't really there.

So,

you know, we know for example that sexual abuse victims have a lot of difficulty.

They often will not disclose.

Munch husband by proxy victims are even more likely to not disclose.

I had one case

The little girl was seven

and her mother was convicted five years after she was removed.

She could not even think

or say anything about her mother until she actually heard on the news that her mother was convicted.

And then she finally could begin to say, you know, my mother did that to me.

My mother did hurt me.

So once these children are in a safe place, and you know, part of this depends on their ages, but they often then begin to show some signs of behavioral difficulties.

So the other problem is, particularly in a divorce situation, this child, custody changes from mother to father, and all of a sudden, you know, three or four or five months later, father has a child who's got some attachment difficulties, is maybe some oppositionality, maybe is lying,

maybe having some other issues.

I do have one young man in who I've followed.

He was severely abused.

I saw him at seven, I saw him at 12, and actually did some testing.

He went to live with a paternal aunt and uncle.

And

he was very wary,

you know, was superficially happy,

but you couldn't get under the surface.

And when I tested him, he had some psychotic process going on that was traumatically related.

And by the time he was

16 or 17, his paternal uncle and family had,

it was a failed adoption.

Now, I don't know what kind of issues this young man would have had otherwise, but a great deal of it.

And he had a very sadistic mom.

So one of the things that we've actually recommended is that these children have some follow-up before they're 12 or 13 and that someone really work with them during early adolescence to help them understand what happened to them.

Because this not understanding what happened to you leaves you with all of these struggles about what's real, what's not real,

what do I need to do to get attention.

Oftentimes, these children are really seeking a lot of attention.

They got attention for the wrong things from their biological parents, but they think that's the way they need to be.

And so oftentimes they can, if they

go to live with a relative or even go into foster care, they really struggle with building relationships.

And we see this through adulthood too: that

a number of the survivors are just, they're very cautious about building long-term relationships.

You know, we saw a lot of kids with PTSD and a lot of kids with identity problems.

The children who really were were subjected to this form of abuse for a long time

also did sometimes end up fabricating, exaggerating, and inducing their own illness.

And then those are the kids that we saw as adults that are crippled and die in their 20s.

So, yeah, and then there are people who have really struggled and been able to lead good lives and develop strong relationships.

But I think it's something that you always

overcome to think that you had a parent that really saw you as who you weren't.

There are basic, basic issues around identification and also having some control.

I've had a number of young adult victims say to me, I had to learn to take control of my own life because someone controlled everything that I did for so long.

I have no identity because it was just what someone else put on me.

Yeah, I mean, it really seems to me that one of the,

you know, even if someone, even if a parent isn't engaging in things that are as physically dangerous or as life-threatening or or surgeries and that kind of thing, that just this, like, you're really robbing a child of their opportunity to come of age, right?

Because

they're not having normal childhood experiences.

They're not learning to take care of themselves, which is what you're, you know, it's like your whole job as a parent is to prepare someone to go and live in the world.

And then they're just like really in the deepest, most persistent way, not getting the opportunity to do those things.

Exactly.

I'm hoping you can give us a little bit of hope or some direction in this arena that, you know, given that, I mean, unfortunately, as we both know, the likelihood of a victim being separated from their perpetrator in any meaningful way is low.

It's low, even if they are in the best case scenario where they have a father who is protective, right?

Even then, it's a huge challenge, as we know, from cases like Ryan Crawford's and George Honeycutt's and, you know, many of the other dads we've talked to on the phone

on the show.

So given the fact that

many survivors of this abuse are going to end up only confronting it in adulthood, in their 20s, in their 30s, whenever it is that they sort of are able to have that revelation,

what are some things that survivors can look to?

And

what can we all do to make this better, make this world better for survivors, essentially?

I mean, what are some of the keys here to fixing this?

One of the things, at least, that I've heard from survivors is the first thing is they need to understand what happened to them.

So oftentimes, survivors take a journey.

They go back and they talk to the doctor that saw them.

I think of Mary Burke, who was one of the first survivors who came forward.

And she tells a beautiful story about how she went back to the doctor who treated her and said, you know, I want to see my medical records.

You know, I need to tell you, doctor, what happened to me.

You know, my mother actually pulled a hammer out of her bedside table at the same time every day and pounded on my joints.

And that's why they were the way they were.

So

in whatever way, that's certainly not the only way.

But There are a number of ways.

You know, some people like Julie Gregory write a beautiful book.

Some people,

you know, really decide they need to tell their stories in other ways and they need to work with other adults who are victimized.

I think there are probably many, many ways of doing this.

But one is connecting and understanding what really happened because that really breaks through

the whole traumatic consequence of building around building relationships and around

really being able to set your life on a pattern where you really affirm your own identity.

This is what happened to me.

This is what occurred to me.

And here's how I'm going to work through it and beyond it.

So, at least we believe fairly strongly that this needed to happen.

And that if children are out of an abusive situation, that this is something that they really might want to be offered the opportunity to do in adolescence.

To really, here's what happened.

Do you want to see your medical records?

You know, one of the things that

I've really

advocated for is if victims want to see their own records, I'll say, I'd be glad to sit down and go through them with you.

You know, let's figure out what they say.

Some people may not want to do that.

And then the second step is really understanding who is safe and who isn't safe.

And it's very, very hard for

adult victims, their mothers are often very persistent about seeing them, connecting with them, being with them, and that is a lot of energy.

And again, they have to decide what they want to do, how much contact they want to have.

Many of the victims, again, I go back to Judy Lebo's study 20 years ago where she asked victims, well, what happens when you go see your mother?

And most of them said, well, when I go there, she still tries to make me sick.

So when we say this is a persistent disorder,

you know, of the perpetrators, it is.

So

to also help

victims understand

and come to some peace with the notion that this is who this important parent is.

I mean, we usually only have one mother and this is...

this is really problematic.

The other thing that's really helpful for victims is to have people on their side.

Other family,

other

friends, but

family is absolutely critical.

We

saw

about

43% of the children in this study go into foster care.

And their long-term outcomes

About 24% of them went to grandparents, and I believe something like 17% of them went to fathers.

I hope there are more children going to fathers, but it's very hard because these women assault the families in which these children are living, even as they move on to be adults.

And we've had some fathers who have essentially given the children, I have two, who gave the child back to mom.

He said, I just can't deal with this anymore.

She is after me every day.

You know, she's destroying my relationships at work.

She's trying to get me fired.

She's, you know, she's wanting this child.

She's accusing me.

She's filing child abuse reports, etc.

So whoever the caregiver is of the child after they're out of the situation needs support and so does the child.

The adult victims that have struggled the most have been those without family.

And we had 43% of the children that we saw in this study that remained in temporary placements.

So not having a permanent placement with people who care and love you

is critical.

And they were in long-term limbo, and I think that just did irreparable damage.

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Charlie Sheen is an icon of decadence.

I lit the fuse and my life turns into everything it wasn't supposed to be.

He's going the distance.

He was the highest paid TV star of all time.

When it started to change, it was quick.

He kept saying, no, no, no, I'm in the hospital now, but next week I'll be ready for the show.

Now, Charlie's sober.

He's going to tell you the truth.

How do I present this with any class?

I think we're past that, Charlie.

We're past that, yeah.

Somebody call action.

AKA Charlie Sheen, only on Netflix, September 10th.

Such a strong sort of splitting that the perpetrators do that like if you are that person who has quote taken their child um i think something that i've come to understand about

perpetrators of this abuse is

listen if someone will do this to their child there are not limits on this person's behavior and they are going to you know, take everyone down with them.

Like they will keep fighting.

I mean, I just, you see this all the time, right?

They will bankrupt whatever family members are supporting them in court.

They will, I mean, they will just sort of, I remember when I was talking to one of one of the dads who presented with us at the AppSat conference and he made a great,

Brian is his name and he made a great, I wish I could remember it word for word, but he made a great analogy where he's sort of like,

you know, what people don't understand about dealing with someone like this is you're like, it's not like there's someone in your house and you need them to leave.

It's like there's someone in your house and they're threatening to burn it down with you in it and then blame you when the the police get there.

Like it's just this sort of like scorched earth thing that is very pervasive in these cases.

Yes, absolutely.

And it's, it's really so destructive.

So again, I think that for these children as they grow, you know, they need protection from that.

And it's very hard.

to deliver that if you're the adult caregiver for them and you're having to, you know, to try to protect them from all these assaults, so to speak,

the more protection they can get, I think, you know, and really being able to be

seen as well, you know, identified if they do have an illness, you know, for the real extent of that illness.

And then, but, but again, mostly it's

having family, and I think families need to be supported by the system.

What I mean by that is in the situations where we saw successful reunification, and I have to say

I was very

skeptical.

And I think that's the reason that the court kept me involved to provide oversight in these few cases for eight years

because

it was like these kids can't go home unless this is a safe place.

and a healthy place.

But in those situations, I really,

the whole system came together to support this family.

There were paternal grandparents who took the children.

There was a father, in each of the cases, these were two parent families, but the fathers kind of were like, oh my gosh, I can't stay with you unless you get treatment, and I do need to protect my children.

Although that was hard for them.

A lot of the fathers have what I call they have on blinders.

You know, the MAC truck is coming down the road and they're standing in the middle of it and they don't see it.

So helping the father see what's going on is also a critical part of treatment because they then have

the tools to be able to then protect the child.

But extended family is also critical.

And oftentimes extended family is split, which is another real problem.

And then having good caregivers, but I think these cases need to stay in the courts.

That's the only way we had successful treatment.

And I've had other cases that I've asked to stay in the juvenile court system because the mothers were so dangerous.

So, you mean when you say stay in the court?

I mean, have an open court case.

Okay.

I mean,

the young man that I mentioned at 17, who actually was in residential treatment because of his psychiatric problems, he had a guardian analytum appointed by the court, and

the juvenile court judge kept the case open

so that he could make sure that this young man was fine 10 years after he was abused and removed from his mother.

Wow.

And that guardian Adelaidum worked with him for 10 years.

And

he is now living outside of an

a psychiatric institution.

He's doing fairly well.

He has a good job.

and he still sees his guardian Adelaide him.

He's now 27 or 28.

But he literally, at 18,

his mother was on the, and I'm talking very literally, was on the doorstep.

I'm here to see you.

I love you.

And thank goodness there was a restraining order, and he agreed to continue to have his guardian Adelaidum actually appointed to

help him with guardianship through 21.

Wow.

So, I mean, that may be an extreme, but we have to, as a society, come and provide these supports for,

and in other cases, it's been critical in divorce court for these fathers to have the ability to go back to court and say, she's doing it again.

You know, I need some help.

Yeah.

I think there's a real strong theme.

There's a really strong theme in what you're saying here.

And I've wrestled with, not in terms of family members so much, much, but in terms of survivors, especially, is sort of like the importance of before you can do anything to help anyone, you have to see the truth.

You have to really acknowledge what has happened here because there's so much denial in these cases.

And I mean, I think certainly in like splitting the families, it's like you can't, you know, you can't protect a child if you're not acknowledging the fact that they're being abused in the first place.

Like that is then you are enabling the abuse and that is what you're doing.

I think with survivors, it's an interesting question for me because, like, one, one, I've thought of in particular, just as specific, just as a specific example, we covered in season three the Kowalski case, which I'm continuing to follow up on.

And, you know, that survivor, and I

feel very strongly that she is a survivor of mud childhood by proxy abuse, although she does not currently acknowledge that, probably for a lot of obvious reasons.

There's a pending case against the hospital, et cetera.

But I've wondered just personally for

my own self, with, with, you know, regards to Maya Kowalski or someone who's in that situation where,

you know, she is 18 now.

Her mother,

you know, died, sadly, by suicide in 2017.

So her mom has been gone for a long time.

And one of the reasons I felt a little bit conflicted, not enough to not cover it, because this is an extremely important case to many other people and for sort of outcomes overall for child abuse, I think.

But,

you know, is that I sort of wonder, like with someone like Maya Kwalski, is it better for her to live the rest of her life and just believe that her mom was who she believed her to be and believe that her mom didn't do this and believe that her mom was a loving mom?

Or will she not be able to sort of move forward with her life if she doesn't know the truth?

And I don't have an answer to that, but I mean, I think it's a really interesting question because, of course, this is a horrible truth to have to confront.

Exactly.

And I think that's a really good question.

You know, I think

I believe because of what I understand about trauma and what I've studied about trauma is that

when you hold less than truths, it's very difficult to then

take a look at the kind of dysfunctional

ways you have adapted to everyday life.

You have to really

acknowledge this is who I am.

This is why I feel this way.

And my guess is that there are critical periods in our lives, and you know, they vary for a lot of us, but some of them are, you know, when we decide to build a relationship with another adult, you know, when we have children,

there are some critical periods where you really see people fall apart.

They're coming in a new situation, they're transitioning, and all that old stuff just comes forward.

It doesn't go away.

And

so, again, at least it's my understanding that it's really going to be hard to lead a full life and to, in particular, to build

full relationships that are lasting if there's not some understanding

of what you've been through.

I mean, for each of us around our own childhoods,

you know, traumatic or not.

Right.

I mean, that so resonates with me and sort of understanding why you react to things that you do.

And certainly in a much, you know, I'm not a childhood trauma survivor, but I, you know, the impetus for me getting into this work was having my first child, because as you said, that tends to shake a lot of stuff loose.

And for me, that was,

I,

I, you know, I, I suddenly found myself

just

overcome with

sort of processing it in this new way, what had happened in my family and really confronting some of the ways that that had burrowed itself in me that I did not previously recognize and sort of thought, like, you know what, I'm doing pretty great.

I'm doing all right, you know, and then it just kind of takes you down.

And so, I assume, I'd imagine, especially if that's childhood trauma, which obviously sort of implants itself even deeper, and then you can have all those

levels of disassociation with it, that that could just sort of be this monster under the bed for your whole life, unless you sort of drag it out into the light.

And for some people, they

can't bring it out into the light, it stays under the bed, and it really changes,

you know,

some of the ways that they probably could,

you know, build.

In particular, it's about building long-term relationships and

attachments.

And then, you know, then you think of having your own children, you know, some of the most important people out there for us to be attached to and care for and

support to be adults.

And so I...

I would have trouble thinking that she's going to have a very good life.

I mean, my concern is that

the same way with some of, again, the other victims, about 10% of the children in our study, and the number was so low because these were all cases involved in the court already, the children went back to their mothers without any

oversight or treatment.

And those are the children who did the worst.

Yeah, that's almost extraordinary.

Well, not to me, but I think, you know, you sort of think like, oh, how could someone have ended up back with their mother if it went all the way through the courts?

And like you said, this study was very specific to families.

And what I've come to understand is the least likely outcome, right?

Where there is like actually a court decision against the mother.

I mean, certainly from looking at the cases I've looked at, talking to adult survivors, most of them have more of this pattern of like, yeah, my mom was getting, but, you know, she's getting reported all the time.

CPS was there all the time or like this, that, and the other thing happened, or this family member suspected and they got cut out.

But it's like most of them were raised by their abuser right like most most of the time i think that's most survivors we're going to talk to are not going to be placed elsewhere permanently and then as you said when there is another placement there's all kinds of other things that can come up there so it's a it's a difficult situation exactly it you know it's this is i think so important i i just did

actually several months ago a piece at Boston Children's Hospital where I now work with the child protection team, because they kind of wanted to say, what do we do when we get past the diagnosis?

And I wanted to talk about setting up visitation and

access immediately, because if the child's in the hospital, that all gets negotiated with child protection, well, the child's in the hospital, and it's really important.

So part of the question for me, even with those children, when they're diagnosed, is

how much access are they going to continue to have?

And how is this going to be managed?

And

having worked in the child abuse field for a long time, I never thought I would hear myself say parental rights need to be terminated.

I mean, I saw lots of battered child syndrome cases.

both juvenile and sometimes in criminal court.

And, you know, there clearly are times when parents should not be parenting their children.

But in these cases, I don't know what the other alternative is if these perpetrators are not able to modify their behavior.

And even those who were the most willing to be in treatment needed to have the court

fence surround them.

Safeguards.

in order to follow through, particularly initially, even though they made confessions.

they never were full confessions at first.

It took some time to hear more.

Well, and presumably, I mean, from what I understand about, I mean, this is

such a deeply compulsive behavior that even if someone really, even if in those cases where a parent is trying their best and fighting the good fight, they're still going to be fighting those compulsions.

So they need a lot of help and support to be their best as a parent.

I mean, I think we could say that probably across the board, that all parents need help and support to be their best parents, but especially if you're, yeah, especially if you really are struggling with, you know, your own sort of maladaptive tendencies.

So, Kathy, I honestly could talk to you all day.

I hope maybe you will come back on and talk about some of these cases with us, like the Jennifer Bush, or I don't know if you're able to talk about the Justina Pelletier case, that obviously happened in your backyard.

But I want to be mindful of your time.

And so, just one kind of final question,

because this came up in a couple of your papers that I was reading.

Do you think that Munchausen by proxy is extremely rare?

No, no, I don't.

I saw that you had referred to, and it's so funny because I feel like this is one of these sort of Franken pieces of data that has made its way into people who are wishing to cast this as rare.

And I think, you know, as we see this, some of these narratives playing out in, you know, my Kicksenbog's work in sort of Take Care of Maya film and some of the press around that, you know, there's this argument that's made in court, in the media, or what have you, where

munchhousen by proxy is so extraordinarily rare that if a child abuse pediatrician has had more than one case of it, then in their lifetime, then that is proof that that child abuse pediatrician is overzealous and they're making it up and they're looking for cases, et cetera.

Or if that some, you know, a place like Tarrant County that has this higher rate of conviction, oh, there must be, you know, that must be because they are seeing something that's not there because we have this piece of data that it is so rare.

And what it is, I finally realized, and Dr.

Feldman had made a reference to this, and I sort of was like, oh my gosh, this is the smoking gun of the bad piece of data, which is this British study that was on 600 cases of suffocation and non-accidental pointing only.

Yes.

And that there was

suffocation.

Right.

And that, so that is this tiny percentage.

And so that then has been applied to like, oh, this is the instance of Munchausen by proxy overall.

So you looked at this very small, at this point, pretty old study that was just about these two specific, most severe, most, you know, life-threatening, and sort of expanded into this, oh, it's this point.

You know, you see, I see this statistic floating around of this 2.8 out of a thousand or what have you.

And so, can we just like debunk that statistic that people use kind of once and for all here?

Yeah.

Although I'll tell you, I've used that statistic to say, look,

in our study, I believe it was something like 10%,

it's less than that, 10% of the cases were suffocation cases

and 5% were poisoning.

So if those are the numbers you just got from suffocation and poisoning, you're only explaining 15%.

of Munchausen by proxy if you want to think about it by disorder.

And And so we know we must have a lot more out there.

Right.

Because this only accounts, I mean, it's misinterpretation of that study that I think we actually could use to

further the cause.

Thank you.

Yeah.

So it's not that it's a bad study that needs to be debunked necessarily.

It is that it is being used.

It is being, I think, deliberately misinterpreted.

Yeah.

Misused.

Yeah.

Exactly.

It's been, and we really don't know.

I I mean, that's the other thing.

Even in our study, it's a small sample.

So maybe I've got an overrepresentation of kids with GI problems or kids with apnea.

We did, by the way, do a study just on life-threatening events that I'd love to come back and talk about because it was really sobering.

I would love you to come back and talk about that as well.

I'm making my little list to myself of things to have

Kathy back on the document.

You mentioned GI issues, and I mean, those are so common in these cases.

And there was that study

at Seattle Children's that a couple of our colleagues were involved with that looked at cases within that.

And I mean, the prevalence pointed to much higher than what most people, I think, would think.

So I think there's all kinds of reasons, both data and anecdotal, to think this is way more common than most people believe.

I'm just absolutely convinced.

And again, one of the other things that I'm trying to put this under this umbrella of disorders of deception.

And when you kind of step back, for women, we see them, you know,

impostering as nurturers.

And

for men,

they often are either really con artists who are impostering, you know, really to meet their own needs to get material goods and services.

There's another group of people who are really,

and they tend to be men rather than women, who imposter as doctors or lawyers or,

you know, judges.

And those, I've evaluated a couple of those folks.

There's very interesting.

Again, when you kind of look at the larger group of people who imposter, you kind of think about, and then you have the con artists, you know, who really are antisocial, which is what there's a subgroup of these women who are really,

really don't have a conscience.

I mean,

they're really out for themselves in a really powerful way.

Now, there are people in between.

Well, I would really love to have you back on because I think, you know, what you're saying about sort of like the

con artist thing, it's like I look at some of the spouses, actually, like your Lou Pelletiers and your Jack Kowalski is that like when you dig into their history, I'm like, ooh, and then you get both, you get one of them each and you get them in a couple.

Yes.

All all right well if you'll permit we would love to have you back on because these are all things i would really like to dive into

one of my commitments is really to do whatever i can at this point in time to to help people understand

and to to share what i know what i don't know you know kind of what i think and use it as you will but thank you for asking me andrea Oh my goodness.

Well, thank you.

Thank you for thank you for doing it with me.

I really appreciate it.

I think I just, I learned a whole bunch of new things.

And now I have 8 million more questions for you, which is why this whole thing has turned into a podcast because

there's so many layers to it.

You can never believe.

Yeah.

I'm just so glad you're doing it.

I can't tell you.

It's really just, it's so critical.

And I don't know how you.

You know, you can make a half an hour video.

I mean, and that's, that's really important too.

But I think this is something ongoing where you continue to tell the story.

It's just, it's so important.

Yeah, well, thank you so much, Kathy.

I appreciate that.

Nobody Should Believe Me case files is produced and hosted by me, Andrea Dunlop.

Our editor is Greta Stromquist, and our senior producer is Mariah Gossett.

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