Preface
The text that follows is a group of proposals borne from the necessities of clinical practice, informed by the literature, and refined by collegial discussions as well as legal cases across the state of Montana. For those of you who may not be familiar with the geography of this part of the world, it is five hundred rugged miles in any direction to the next major city from Billings, Montana. What that means for a practitioner, such as this author, is that the scope of practice is unusually broad and need for sound services high. Every day and each case is different, demanding in its own way, and often times requires a renewed familiarity with the area of practice as well as its literature. It follows that the referral request is either addressed thoroughly, or many a time these clients will need to travel to Denver, Salt Lake City or Seattle to have her or his needs met. The concept of an Interrelated Multidimensional Diagnosis was derived out of such needs in our state and this author’s inability to find a more useful way to approach these phenomena.
What is an Interrelated Multidimensional Diagnosis? That will be answered in a myriad of ways over the balance of this book. The short version is that this term was meant to define a set of diagnoses that holistically describe interrelated individual and system characteristics. These characteristics, together with subdynamics, cumulatively create a multidimensional pathological dynamic. It will be argued that the pathological dynamic created is known, for example, by the name of one of the three other terms that are the focus of this book: Munchausen’s Syndrome by Proxy, Factitious Disorder by Proxy or Parental Alienation.
These phenomena each describe a pathological dynamic, wherein Munchausen’s Syndrome by Proxy or Factitious Disorder by Proxy is the number one health concern for most child protection agencies, since estimates are that between one-in-ten and one-in-twenty children who carry the diagnosis dies. Meanwhile, the latest estimates are that Parental Alienation here in the United States impacts between twenty-two and forty-four million children, and recent estimates are far higher in other countries.
So, this approach was developed to address a need in my community. This conceptualization of an Interrelated Multidimensional Diagnosis will not answer every problem given the convoluted nature of these phenomena. But, what you may find across the pages of this book are a series of proposals, one proposal after another intended to address the needs and problems related to these phenomena. What is being offered here is admittedly a conceptual leap too. My colleague Dr. Evans and I put it this way in our most recent article (2019, in press):
We recognize that what we are proposing throughout this article may seem radical. Yet, we argue that clinicians have continually wrestled with ways to more fully describe the experiences they have encountered with these sorts of complex multidimensional phenomena. In many cases these clinicians have been dissatisfied with the status quo and struggled to stem the suffering and/or death of the children whom they ultimately serve in medical and legal systems.
What follows in the pages ahead is a journey, and it is my hope that it will prove to be worthy of the reader’s time and attention.
Practitioners and professionals should, I hope, find this an interesting read with multiple vantage points from which to examine these phenomena. There will be conceptual analogies, real-world practice applications and discussions, as well as innovations that include, for example, a new diagnostic approach to each phenomena at the end of Chapters 5 and 6. For those of you who are academics and researchers, there will be plenty of citations, details, and patterns that are repeated over and over by different authors in different parts of this text that clarify some of the remarkable consistencies within the literature on these two diagnostic topics. To start with, heroes and heroines from different disciplines and different fields will be discussed to demonstrate the inherent challenges of articulating novel insights. Do not be alarmed when quantum physics and the structure of DNA are discussed at the outset, since it will also be argued that behavioral scientists, practitioners in healthcare and professionals in law have long been dealing with equally complex phenomena.
Understanding the concept of an Interrelated Multidimensional Diagnosis may sound insurmountable, but there are regular encounters with similar phenomena on a daily basis. Further, the concept is no more difficult to understand than a campfire or, at times perhaps, the workings of an orchestra. On this journey there are awful sounds, such as those that were produced by the Portsmouth Sinfonia, and still thoughts will turn toward understanding what Leonard Bernstein envisioned as art. There will also be examples of how an Interrelated Multidimensional Diagnosis may be revealed in practice early on, both with regard to the matter of Parental Alienation and in cases where there is Factitious Disorder by Proxy.
There are, as stated earlier, some highly technical theory and definition matters that do need attention in Chapter 3. These matters will be intertwined with a progression through the history of Munchausen’s Syndrome by Proxy and Factitious Disorder by Proxy, as well as Parental Alienation, to provide a grounding in each phenomenon. Simultaneously, there will be attention to challenges with naming conventions. These matters will be tackled with a set of novel solutions to the Gordian Knot that these matters have created at present, and even the Platypus Paradox will be offered with a cartoon to illustrate the point.
After these clarifications, it will be time to get down to the nuts and bolts of what an Interrelated Multidimensional Diagnosis is, how it develops, how it is structured, how individuals and systems interact, and how it turns into a pathological dynamic. This phenomenon has interrelationships on multiple dimensions, wherein one dimension builds on the other and under the right circumstances creates a pathological dynamic—a pathological dynamic that punctuates as a new steady state that describes a change in one member of the family system whose behavior creates a change in the whole system.
Once an Interrelated Multidimensional Diagnosis has been defined, the concept will be applied first to Munchausen’s Syndrome by Proxy and Factitious Disorder by Proxy to see if its architecture and dynamics are fitting and explanatory. Parental Alienation will follow, and the literature associated with each phenomenon will be reviewed in detail as each is applied to the psychological surround of these phenomena with background dimensions. These considerations will be followed by individual characteristics and symptoms, systemic interactions and subdynamics, which again under the right conditions create a pathological dynamic. Tables and proofs will be developed from each phenomenon’s literature and research in order to derive a diagnosis and diagnostic process that allows these pathological dynamics to be recognized and studied to the extent that each either conforms to a qualitative description and may be measured against a quantitative cut-off of more probable than not.
These data and literature-rich chapters are followed by a shift back to conceptual matters. In Chapter 7 the journey leads to a discussion of how, despite the fact that the two phenomena under discussion are very different and occur in very different environments, all Interrelated Multidimensional Diagnoses hold a number of characteristics in common. Each also has variable criteria unique to the individuals in the system and the quality of the systems with which they interact. To clarify these matters the role of stress in time and space will be discussed by way of its lasting impact in development stresses, which, coupled with contemporary and situational stresses, amplify the symptoms that create pathological dynamics. Also within that chapter the Interrelated Multidimensional Diagnosis Symbolic Language will be introduced in order to facilitate gathering information from family systems in a fashion consistent with the concepts herein and to create a ready medium with which to converse among colleagues about the structure and functioning of these family systems and the individuals and other systems they interact with.
Chapter 8 then deals with the prospect of intervention and the necessity of follow-through with an active Interrelated Multidimensional Diagnosis. Several aspects of intervention will be described with Factitious Disorder by Proxy and Parental Alienation. These discussions will eventually lead to the necessity for systems change in healthcare and law, as well as change in governmental policies and procedures in order to arrest, intervene and treat Interrelated Multidimensional Diagnosis as a larger societal matter. With these discussions behind us, then, four Interrelated Multidimensional Diagnoses will be proposed for future consideration.
It is this author’s hope that this journey will prove challenging and informative, and that it will promote a new way of considering these phenomena and the families and individuals they impact.
https://www.routledge.com/Parental-Alienation-and-Factitious-Disorder-by-Proxy-Beyond-DSM-5-Interrelated/Butz/p/book/9780367345815