Director Nonny de la Pena, talks about her latest film, MAMA/M.A.M.A., a documentary that follows the lives of three women accused of Munchausen’s Syndrome by Proxy. Munchausen’s is a condition wherein individuals are accused of harming others to gain the attention of others.

Nancy Semin (cinema hybrid): Can you start out with a brief blurb about the film itself?

Nonny de la Pena: The film is about three women who have been accused of Munchausen’s Syndrome by Proxy and essentially what I found was that this is an umbrella diagnosis. It’s a profile that can fit almost anyone, and that way too many innocent women, based on really, the fact that they’re female, this has allowed them to be accused of child abuse, and they’ve gone to prison and had their children stripped from them, and I got involved in this case because of how women were accused of this with their first child, and should they get pregnant again, will have their child stripped from them at birth, based on nothing they had done to that child. It’s a civil liberties issue to me. That is what I was interested in.

But then I had a mother who had been accused with her previous child, got pregnant again, and somebody told Social Services she had broken her water, and she was still about five and a half weeks out from her due date, and it was not true that she had broken her water, but they came with handcuffs and they took her to a hospital, and found out she had not broken her water. They broke her water and induced her labor, and they stripped the baby from her womb, five and a half weeks early. And I thought, “My God, that’s a rather emotional response. What’s going on here?” And I started to find that this is a lot about prejudice over the facts. This was an issue where being an accused child abuser, the accusation was stronger than the facts, and particularly because this is a very medically oriented accusation. If you’re a mom and you have no medical background, which most of these mothers are not, if you’re a lawyer or pubic defender with a medical background, having seen these cases, if you’re a judge and you have no medical background, well of course you’re going to believe whatever the doctor says. But primarily what I found was, one case the mom accused the doctor of malpractice. He came after her with a Munchausen’s charge. Legally, a doctor has to report a child abuse, and therefore in return, the law states you are immediately immune from prosecution. So it’s a really easy out for a doctor or hospital. “Oh no, she’s a Munchausen’s by Proxy case.” So if you’re accused of abuse, the doctor is now immediately protected from the malpractice charge

NS: So you’ve discussed your intent or motivation for making the film, but how did you become aware of the topic? What specifically got you interested in this topic?

ND: My last film was called The Jaundiced Eye and it was about a gay father who was in a small town in Michigan, and he was accused of sexually abusing his son. Based on again, there was no physical evidence. He had supposedly sodomized the child repeatedly with a machete and there was never any cuts or burns or scars or anything. And he was going to get 18 to 35 years in prison. In the making of that film, I had been looking at child abuse issues and I found out about this mom, who was going to have her baby stripped at birth, and I thought, “Well, hang on, that’s interesting.” But I kind of filed it away and after I finished the last film, which is still airing on the Sundance Channel, it has been airing for the last year and a half, I began to research it and I heard about the mom, who had the baby induced. And I became more interested in following this up. And Amy Sommer (the producer) agreed to team up with me again on this project and the more I learned the more passionate about the subject matter I became.

NS: So the distribution for this film is also the Sundance Channel?

ND: No, we don’t have distribution yet. This is our world premiere basically.

NS: Any bites?

ND: The Sundance Channel is here right now. So we’re keeping our fingers crossed, and we’d love for somebody to pick it up.

NS: It seems you had access to perhaps some difficult evidence. Was that a challenge?

ND: A huge challenge! Huge! And then to try and spend those months of learning that I did, and translating to adopt to my film to try and educate as many people as I could without completely go, “Whoa, too much.” There is some people who watch a film, and go, “Whoa, that’s just a little too much.”

NS: How did you get access to confidential documents?

ND Medical records from the parents. Moms gave them to me. And I talked to a lot of doctors. It was really interesting. When I first started making phone calls, and saying “What is Munchausen’s by Proxy?” I had never had more doctors hang up on me. They hung up on me! I called a doctor from the National Institute of Health and he hung up on me: “I don’t get paid to talk to you about this sort of subject.” Boom! I said, “Whoa, I’m a former correspondent for Newsweek. And I have worked on a lot of films, BBC, Channel 4, HBO. I’ve worked on a lot of films in various capacities; this is my second film as director/producer/writer. And I have never been treated that way. And then I also thought, “What the hell is going on here?” This was a very interesting project. So I had to learn a lot. I had to learn about how insulin is made in the body and how you diagnose how somebody has injected insulin in the body or whether it’s been naturally formed. I had to learn about the systems of enzymes. It sounds crazy. I don’t put that in the film, but it’s basically the seven genetic enzymes that are pathways you metabolize drugs. I had to learn about how drugs affect those pathways. I had to educate myself on this stuff. But I found a lot of doctors who would be willing to share with me. You pick up the phone and call somebody up. It was very research-intensive.

NS: So in the press kit you refer to Munchausen’s as a “supposed disorder.” Are you saying you don’t think this is a legitimate disease in any sense of the word?

ND: I think it is an umbrella diagnosis and it will sweep up anybody you want it to, and that child abuse exists, but call it what it is. Call it suffocation. Call it poisoning. Call it whatever you think the mother is doing, call it that, and then produce the evidence. And make it a fair fight because Munchausen’s by Proxy is a slippery slippery slope. A woman just got convicted, and we thought for sure she was going to beat that case, in Spokane, Washington. One of the interesting things the judge said, why he took the child away from her, because she interfered with the doctor’s care, and what did that mean? She was trying to stop the child from having more invasive procedures. So Munchausen’s by Proxy means getting more procedures done from the doctor, and in this case she tried to stop procedures from getting done, because she felt this was more damaging to her child. And yet this mother was accused of having Munchausen’s Syndrome by Proxy. If you are too emotional in the hospital, you have Munchausen’s by Proxy. If you’re not emotional enough you have Munchausen’s Syndrome by Proxy. Honestly. These are the profile guidelines, honestly. So it’s really based on prejudice and emotion, and one of the cases I followed, the doctor really accused this women had never looked at the medical records.

Woodrow Bogucki (cinema hybrid): Are there any dissenting opinions within the medical field about this?

NP: I would say this is the first really hardcore challenge to Munchausen’s Syndrome by Proxy.

WB: It’s widely accepted.

ND: However, the people who are starting to get involved behind me in the film are Dr. William Sears, who is the Dr. Spock of our day. He has seen three of his mothers accused and he is furious. And he is right behind us. We’ve gone to local NOW chapters, they’re really pissed off. They’re speaking out now. We’ve gone to their national chapter, and they said, “You have issue to comment on our behalf.” One of the national reflux organizations is furious. The head of that research organization. A lot of these babies are spitting up, and they give them a particular drug… and they affect the brain the way they do the gut.

NS: And it’s basically causing suffocation?

ND: It causes apnea. It has an effect on the autonomous nervous system, and stops them from breathing and stops their hearts from going. One of the drugs has been pulled [off the market] for causing fatalities.

NS: What’s the drug?

ND: Sisapride or Propulsid and the other drug I get into is metacloprimide or Reglan. The issue is that the American Psychiatric Association has been trying to educate psychiatrists about the non-recognition of the side effects. Have you ever seen someone who is psychotic and they are twitching and jerking, or doing that all that weird stuff? Typically it’s a lasting side effect of the drug, and the drug, with this problem with infants. They started to give this drug to adults with gastrointestinal cases and then they started giving it to infants, but no one has educated the doctors really aggressively about the problem of non-recognition, and I can find in all these medical records. The nurses will write down, “tongue thrashing, back arching, neck arching,” emergency room physicians, same thing. We find this over and over but somehow the doctors are not recognizing the side effects, and then worse than that, a number of the doctors are actually on me for doing research on Sisapride, Propulsid, and they are being paid by drug companies but at the same time they’re going after the moms. Now, is it a cover up? I couldn’t ever possibly say that. All I can say, they are involved with this drug and they weren’t recognizing the side effects. And I have medical records from these doctors in particular where they made accusations and I can find the same problem in these medical records, that these doctors are accusing these women of doing.

NS: So it’s a conflict of interest.

ND: That’s right. Absolutely. One of the doctors said, in the last year, Sisapride, wonderful drug, but watch out because 8 of 20 of my patients in the last year are also Munchausen’s by Proxy cases. When you’re saying nearly half the cases have this disorder, you kind of have to say wow, this guy is seeing what he wants to see, not what’s really happening. So that’s just to give you an idea of some of the research I did get to the point where I am in the film.

NS: So you’re a mother.

ND: And my baby was diagnosed with reflux.

NS: How has motherhood affected or impacted your relationship with the topic?

ND: I got pregnant in the middle of the film. I was five months pregnant; I was shooting in the U.K. I would never do that again. I wouldn’t go off pregnant again. I got hit by a truck [when I was in a car], and went into premature labor and a lot of these babies are premature, and thank God, my labor stopped. I just wouldn’t do it again. But then, extraordinarily, my baby was diagnosed with reflux and… she was teeny tiny. And when the doctor was in the room saying, “Your baby has reflux” I was like, “And so what. I’m not giving my kid any drugs.” And she is now completely fine. So, although there are some extreme causes of reflux where you do have to give some sort of intervention, unfortunately.

I interview Roy Meadow… I was one of the last interviews he would ever give to the press… Meadow is the father of Munchausen’s Syndrome by Proxy. He wrote the first papers on it, and I asked him to describe the side effects of these drugs, and he cannot, and he gets so angry he grabs the microphone and pulls it down off the camera. And the other thing I found that is in the very first paper he did on Munchausen’s by Proxy, he accused a mom of drug poisoning her child. Well, you go to that first paper and he said he could not figure out how the mom was doing it. Twenty grams of salt given by us only raised the level to just above normal. Now how does 20 grams of salt given to a child under a year old, is a potentially fatal amount, and the child dies. But all these years he accused the mom of killing the child, and we believe he has been destroyed in the U.K. because he put a woman in prison for three years, and it turns out, whether he knew or not, I don’t know because he was going around accusing the mom, showing the child had Staph and could have died, and hours later the child did, and it turns out when he was questioned by the defense for all this evidence he was using to testify against the mom, he said his secretary had shredded it all.

NS: So he was hiding evidence?

ND: The pathologist was. Whether Roy Meadow was or not is an interesting question.

NS: So where do we go from here with this? This seems like a powerful tool used by the medical community. How do we counter this? How do we turn the tide?

ND: I think the film has got to [be] out there. That’s my hope.