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Dr. Susan Diamond is delicate as a wren, with large dark eyes and hair swept back in a no-nonsense shoulder-length bob. She's an expert on treating HIV/AIDS, with a thriving practice near Presbyterian Hospital, and her patients describe her as warm and compassionate, a rare doctor who makes house calls and gives out her cell phone number. Colleagues say Diamond is extremely intelligent, a good physician who works hard to stay on the cutting edge of research and treatment of a difficult disease.
She's also a mother of five children. Friends within the Orthodox Jewish community of North Dallas see Diamond as devout, dedicated to raising her children in accordance with God's laws. She keeps a kosher house and doesn't drive on the Sabbath. She lives in the "eruv" area of North Dallas where many Orthodox Jews own homes within walking distance of their synagogues. From 18 minutes before sundown every Friday until sunset the next day, they don't work, drive or do household chores. Only within the eruv are they allowed to push baby strollers and carry prayer books on their way to services.
Most of those patients, friends and colleagues don't understand why, after a bitter divorce battle, Diamond not only lost custody of her children but for months saw them just a few hours in tightly controlled visits at a place designed to host meetings between kids and parents accused of domestic violence, child abuse or neglect. She was allowed to speak to them only about what they were doing at the moment--playing bingo or cards--not how they were doing in school or soccer or Cub Scouts or basketball.
Diamond's life was turned inside out in 1999 when her husband, Rick San Soucie, abruptly announced he wanted a divorce. When he walked out, Diamond, then 44, was five months pregnant with their fifth child.
Raising five children and managing a busy practice was hard enough, but bizarre behavior by her second child, Daniel, created much more stress. Always a difficult child, by age 8, Daniel was acting out in dangerous ways--grabbing knives and chasing family members, threatening to kill himself by jumping in front of a car or over a stair banister, and biting or choking his siblings and other children. (The names of the children have been changed.)
Diamond believed her son was bipolar. But a court-appointed psychiatrist examined Daniel and declared that the problem wasn't the boy; it was his mother.
The doctor believed that Diamond was perpetrating a rare and bizarre kind of deception called Munchausen Syndrome by Proxy (MSBP), in which an adult, almost always a mother, manufactures symptoms in a child in order to get attention or her own way. The psychiatrist concluded that Diamond was lying about what her son was doing and manipulating him to win the custody fight. Several nannies testified that Diamond was some kind of "Mommie Dearest."
A second psychiatrist, Dr. Mark Blotcky, initially rejected that judgment and diagnosed Daniel with bipolar disorder. But after months of wrangling with Diamond over medication and custody issues, Blotcky told a family court judge that Diamond was manifesting Munchausen Syndrome by Proxy and was indeed dangerous to her children's mental and physical health.
Then recently, an independent court-appointed forensic psychiatrist released a report saying that Blotcky's diagnosis was wrong, that Diamond is not perpetrating MSBP.
Her story illustrates the controversy over the MSBP diagnosis, usually seen in cases where a child has physical symptoms that disappear when the mother is removed. More physicians, confronted with problematic cases, are concluding that these women are fabricating or aggravating their children's disorders.
But critics contend that the warning signs of MSBP are so broad they are worthless, based on anecdotal descriptions of the disorder, not rigorous study. One expert in such factitious disorders says that women who are diagnosed with MSBP are often intractable or irritating people who don't fall in line with psychiatrists and other authority figures when it comes to the treatment of their children. "As a result, mothers who are inappropriately concerned about the health of their children or are problematic in other ways have become entangled in legal battles that should have been resolved clinically," says Dr. Loren Pankratz, a clinical professor in the Department of Psychiatry at Oregon Health Sciences University.
There's no doubt that Diamond--furious at her husband for leaving her, frightened by her son's dangerous behavior, frustrated by the family court system--can be a maddening, controlling person. She's made serious errors in judgment and behavior. Some Diamond admits; some she denies.
Once labeled, all of Diamond's actions were seen through the prism of MSBP. The court battle has cost Diamond and her former husband hundreds of thousands of dollars. But a close look at the case shows that in punishing Diamond, the court system also penalized her five children, sentencing them to awkward snatches of time with a mother they all profess to love. That's formative time they'll never get back. And there's plenty of blame to go around.
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