Sickened tells the story of
Julie Gregory’s abuse by her mother and father.  The abuse took many forms,
including verbal insults, beatings, threats of suicide and abandonment, forcing
Julie to hit her foster brothers and sisters, and insisting that she undergo
invasive and painful medical tests and take medical drugs that were not
needed.  That’s not to say that she was a healthy child: she often had
shortness of breath, and she was extremely thin.  Although it isn’t quite clear
what the causes of these problems were, it seems that they were mainly due to
emotional stress and nutritional deficiencies.  However, her account suggests that
her mother had a pathological desire for doctors to find serious medical
problems with her: she was outraged when cardiologists refused to perform
open-heart surgery on her.  Once Julie took a psychology course in college and
learned about the condition of Munchausen by Proxy, in which parents or
caregivers seek out medical care for those in their charge as a way to serve
their own needs even when this does harm, she was clear that it perfectly
described her mother.  

As a memoir, Sickened works
well.  It is quite short, at 244 pages of relatively large print, so it goes
through about twenty years of Gregory’s life quickly.  Gregory is a talented
writer, with a strong ability to write dialog and convey her childhood
feelings.  She shows not only how her parents were manipulative and hurtful,
but also how doctors often collaborated unknowingly with her mother’s abuse,
and how nobody would believe her when she tried to tell them that her mother
was making up her health problems.  It becomes very easy to understand how even
she would go along with her mother’s pathological lying as a way of appeasing
her and avoiding trouble.  Her story also will provide hope and inspiration for
others who have been in similar positions, since it ends with her feeling
confident and with a clear understanding of all she has been through.

However, it is worth noting the
difficult position of someone writing such a memoir.  Gregory tells how she was
abused and forced to lie to doctors as a youth.  She emphasizes her mother’s
lying about her to doctors and the ways that her mother has undermined
Gregory’s credibility more recently when she confronted her about the past. 
Her mother accuses her of making stories up and being an unreliable source
because having been in mental hospital.  Obviously, readers are not in a
position to independently assess the truth of Gregory’s story.  A few medical
documents from her youth are included in the text, maybe to add to the interest
of the book, but possibly also to serve as evidence for the truth of some of
the details.  They are not all easy documents to decipher and of course we have
no proof they are real.  It is hard to know what value to assign them as part
of the narrative.  But as with any memoir, (as opposed to some autobiographies
of well-known people), the reader’s role is not to sit in judgment over the
truth of the story.  Rather, the aim in reading such a book is to gain from the
other person’s life experience.  Nevertheless, it is hard to dismiss the
question from one’s mind when reading Sickened about how reliable
Gregory’s memory is, for the paradoxical reason that if her story is true, it
seems more likely that her experiences would cause her memories to be
distorted.  My point here is not to throw doubt on the truth of the story, but
rather to point out readers of the book are likely to experience an underlying
tension in working out what to make of it all.  As with Augusten Burroughs’ Running
with Scissors, the childhood chronicled makes one wonder how the author
could have avoided growing up herself becoming a chronic liar.  

At the end of the book, Gregory is
determined to stop her mother from carrying out the same abuse on other
children, and this determination is fueled by the fact that her mother
currently has children in her care now.  Readers should go to Gregory’s website
to find updates about her fight to protect children and work to raise the
public consciousness about Munchausen by Proxy.  Her self-appointed task is an
important one, and since her book has been successful, it is likely that she
really will do good.  Gregory deserves praise and admiration for her courage
and persistence in overcoming huge challenges.

Sickened raises questions
that Gregory herself does not attempt to answer.  What safeguards should be in
place to stop parents from getting doctors collusion in medically abusing their
children?  Normally parents have full decision-making power over their children
so long as they are not neglecting or abusing them.  But how are doctors meant
to find out when abuse is taking place, when they are being put in the role of
abusers? Medical practices that are swamped and doctors are generally only able
to spend a short time with young patients, so they have to rely on the
testimony of parents in order to make a diagnosis.  How much effort should be
made to verify the reports of parents about their children?  These are very
difficult questions given the medical system we have at present, especially
since a larger problem is that too few children receive adequate medical
treatment, and often doctors are only too happy to help when parents do bring
problems to their attention. 

Another central question the book
raises is why people who use the medical system as ways to abuse their children
to fulfill their own psychological needs should be classified as having mental
disorders for that specific behavior.  There are two sorts of reasons one might
challenge the categorization.  First, one might argue that it is covered by
more general diagnostic categories such as depression, anxiety, or more likely,
personality disorders.  Given that the actions of Gregory’s mother were
narcissistic, showing no appreciation of the rights of her children, and that
Gregory seemed to need to derive her own feelings of self-worth from taking her
daughter to doctors, to the extent of threatening suicide if her actions were
challenged, it is very tempting to speculate that she would be a prime
candidate for a diagnosis of some kind of personality disorder.  If so, then
what need is there to give the behavior a specific name?  It is worth being
clear, since Gregory does not mention this, that Munchausen by proxy is not in
fact listed in DSM-IV-TR.  Maybe then, the main purpose of giving the
behavior a name is just to help emphasize that such behavior can be symptomatic
of mental disorder.  However, and this is the more radical form of challenge
the categorization, one might question the whole assumption that such behavior
should be seen as a mental disorder of any sort.  This would go with the line of
thought that denies there are any such things as personality disorders, and
argues that the forms of behavior that earn people such labels are much better
seen as moral failings rather than psychological or medical categories. 
Gregory never considers such a view, and indeed her account provides an
argument against it, because it is clear that, for her, coming to see her
mother’s behavior as an example of a particular form of mental disorder was
very helpful to her in coming to really question her mother’s judgment and
actions.  Learning about the psychological syndrome was empowering for her, and
this gives us a pragmatic reason to think it is a helpful category.

Ultimately, Gregory’s book is an
uncomfortable read because of the abuse it chronicles, the emotional tensions
inherent in the text about the author, the questions it raises about how
society should try to prevent such abuse in the future, and the worry that
there are children currently in danger from Gregory’s mother.  Yet even with
that discomfort, or perhaps because of it, Sickened is a compelling work
that readers will remember for a long time. 

Link: http://www.juliegregory.com

© 2005 Christian Perring. All
rights reserved. 

Christian
Perring, Ph.D., is Academic Chair of the Arts & Humanities
Division and Chair of the Philosophy Department at Dowling College, Long Island.
He is also editor of Metapsychology Online Review.  His main
research is on philosophical issues in medicine, psychiatry and psychology.

Categories: Memoirs, Relationships