By now, you’ve probably heard coworkers obsesses over the wildest scenes in The Act, Hulu’s new true-crime series. The eight-part show, now streaming, unravels the bizarre story of Gypsy Blanchard who suffered years of abuse under the care of her mother, Dee Dee Blanchard.
Based on a BuzzFeed report by journalist Michelle Dean, the show details the true story of how Dee Dee made her daughter undergo unnecessary medical procedures and take harsh medications to treat conditions Gypsy never had, like muscular dystrophy. Gypsy ultimately discovered Dee Dee’s lies and, with the help of her boyfriend, murdered her mother.
Dean’s BuzzFeed story and The Act document the numerous horrors Gypsy endured: operations to treat supposedly weak eye muscles; salivary gland removal because she drooled; tooth extractions because her teeth were severely decayed either due to medications, malnutrition, or hygiene issues.
Although it’s hard to fathom inflicting this kind of abuse on an innocent child, Dee Dee’s behavior can be attributed to a syndrome commonly called Munchausen by proxy. (The medical name has been changed to “Factitious disorder imposed on another.”)
What is Munchausen by proxy?
Essentially, people with Munchausen syndrome act as if they have specific medical conditions, according to the Cleveland Clinic. Some patients may go to extreme lengths to make themselves sick, such as ingesting fecal matter, explains Dr. Marra G. Ackerman, MD, psychiatrist at NYU Langone Health.
Patients who have Munchausen syndrome by proxy—like Dee Dee Blanchard—fabricate medical conditions in someone they’re caring for, be it a child, spouse, or elderly parent.
The biggest question surrounding this disorder is: “Why?” But Ackerman says the reasons for people developing Munchausen syndrome by proxy are unclear. It’s likely that patients may have had their own rough upbringing.
“Patients who have had traumatic childhoods themselves are more likely to pass it on in various ways to their children,” she says.
Others could have abandonment issues and fear their child will grow up and leave them. Ackerman says people with the disorder often have other mental health conditions, such as anxiety or depression.
“You wouldn’t really see it as a disorder by itself without a comorbid psychiatric illness,” she explains.
The behavior has horrifying effects on people in Gypsy’s position, but Ackerman says it’s not always done maliciously. Some parents may think the only way to get medical care is by concocting severe sometimes in their child.
Of course, there are people who may be doing it to get money or attention, she says. In Gypsy’s case, Dee Dee garnered a free trip to Disneyland, services, and even her house from various charities.
However, not every case of Munchausen syndrome by proxy is as extreme as seen in The Act, says Ackerman. “There’s a spectrum of illness,” Ackerman says.
On the less extreme end, parents may worry excessively about their child’s health and drag them from doctor to doctor for unnecessary tests.
“That’s still disruptive to the life of the child. But it doesn’t reach the level of a severe case where the parent is inducing illness or making the proxy change their behavior or change the way that they dress or look.”
This disorder is still mysterious to clinicians, in part because of its rarity. But diagnosing someone with Munchausen by proxy is challenging since patients tend to doctor shop.
“They sort of go from place to place and even hospital to hospital. That way there’s not a clear paper trail,” says Ackerman.
As Hulu releases new episodes of The Act, we’ll all keep wondering how and why Dee Dee could torment Gypsy for so long. Of course, those questions just can’t be answered.
“It’s really, really complicated,” says Ackerman.