Bizarre abuser leads in 'Devil's Waltz'

February 15, 1993|By Peter Gorner | Peter Gorner,Chicago Tribune

Gritty and twisted, the latest psychological thriller by Jonathan Kellerman pits his child psychologist-sleuth Alex Delaware against a bizarre personality disorder, Munchausen Syndrome by Proxy.

This is a variant of classic Munchausen's Syndrome, which is characterized by Mr. Kellerman as "hypochondriasis gone mad." Named for Baron von Munchausen, an 18th-century Austrian aristocrat and legendary liar, the syndrome refers to patients who fabricate diseases by mutilating and poisoning themselves.

They manage to get themselves repeatedly tested and medicated needlessly in their mania for attention; some even get cut open on the operating table.

But if Munchausen's is pitiful, masochistic and perplexing, its proxy variant is even more so.

Munchausen's by proxy refers to parents -- mothers, invariably -- who fake illness in their offspring. Such parents either lie about symptoms or make their kids sick, not necessarily to harm them, but to get the attention the adults crave from doctors.

Little is known about the disorder, primarily because in the rare confessions obtained, psychiatrists and psychologists must rely on information supplied by habitual liars. But several hundred cases have been reported in the United States since it was identified in 1977.

All involve children who suffer recurrent, unexplained illnesses -- breathing problems, bleeding disorders, fevers, infections, seizures -- that shift from one organ system to another.

Lab tests fail to explain anything. Parents usually are intelligent,

TC very concerned, and so likable that they often are defended by medical professionals.

Careful examinations, however, have uncovered poisonings by sugar, alcohol, narcotics, expectorants, laxatives, emetics -- even feces and pus -- to create what are known as T "bacteriologically battered babies."

What makes parents behave this way? Family histories often contain early exposure to serious physical illness or trauma, child abuse, sometimes incest. Such experiences presumably lead to poor self-esteem, problems with relationships and perhaps a pathological need for attention. Illness becomes the arena in which patients act out that need.

Author Kellerman, a child psychologist himself, published his first Alex Delaware novel in 1985. Seven more have quickly followed.

His thrillers are filled with mind games, drugged dreams and morbid sexuality. "Devil's Waltz" is set in what he calls the "hinterland of child abuse."

Delaware returns to Western Pediatrics, the Los Angeles hospital at which be began his career, at the behest of a pediatrician and former colleague with a baffling patient. Cassie Jones is an adorable 21-month-old who looks in perfect health, yet repeatedly is brought to the emergency room for a host of symptoms.

Dozens of tests reveal nothing, so Delaware focuses on the family. As he probes into the reasons behind the infant's illness, the tale deepens in richness and complexity.

Cassie's unknown tormentor always seems to be a step ahead '' of Delaware. After a hospital doctor is murdered, the psychologist and his longtime buddy, Det. Milo Sturgis, begin to catch on that the child's fate and growing tensions at the hospital are linked.

Eventually, Delaware pieces together a puzzle of such sickness and depravity that you may forget "Silence of the Lambs."

BOOK REVIEW

Title: "Devil's Waltz"

Author: Jonathan Kellerman

Publisher: Bantam

Length, price: 416 pages, $22.95

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