Munchausen Syndrome by Proxy article

Subj: munchausen syndrome by proxy article


As published in Living Now Australia January 2004
What is munchausen syndrome by proxy?
Munchausen syndrome by proxy (MSBP) is a “diagnosis” used to describe an individual who
purportedly induces or exaggerates illness in a child to gain attention from the medical profession. MSBP
generally involves a mother deliberately making her child sick.
The term was coined by British doctor Sir Roy Meadow in the Lancet medical journal in 1977 to
describe parents, usually mothers, who harm their children in a medical context. The two cases in this
original paper were merely a collection of notes and did not appear to have any scientifically-based
research to underpin Sir Roy’s proposition. Many of Sir Roy’s articles on MSBP have been published in
the journal he himself edited, the Archives of Disease in Childhood.
A Munchausen syndrome by proxy diagnosis lacks scientific validity. It is not a definitive category in
the authoritative DSM IV (1994), only appearing in the appendix.
Parents and professionals should be aware that there are many similar labels to MSBP, which include
the following: somatisation disorder, abnormal illness behaviour, folie a deux, pervasive refusal syndrome,
hysteria, and factitious illness. Often the MSBP label will be combined with other labels. For example, a
mother may be accused of both MSBP and shaken baby syndrome.
It is a recent and extremely controversial diagnosis (Allison and Roberts, 1998). Despite its highly
controversial nature, MSBP is being used extensively in the medical profession, by social services, and in
court.
Dr Hayward-Brown contends that the profiling is extremely prejudicial, inaccurate, paradoxical and
often nonsensical
The prejudice of this MSBP label is so great that a mother’s credibility is completely destroyed. And,
once a child is removed it is virtually impossible for the mother to regain custody.’
It just takes a child protection officer from the Department of Community Services to say the child is
“at risk” and a mother loses her child.
‘The false accusations can happen to any mother or father at any time – it does not discriminate
regarding class or status,’
Mothers accused by over-zealous child protection
by Michael Nott
There are calls for judicial inquiries and the reopening of medical child abuse cases known as
‘Munchausen syndrome by proxy. MSBP originator Sir Roy Meadow is under official investigation by the
British General Medical Council, that registers UK doctors, as a “problem doctor”. He was criticised by
the British Court of Criminal Appeal and accused of giving misleading and contradictory evidence in
courts on the causes and incidence of child abuse.
Jennifer took her young daughter, Sara, who was suffering from a diagnosed illness to hospital as she
feared other critical medical problems. After being assessed by doctors, Sara was given medical treatment
however her mother questioned the doctors on the way they were treating the child.
That is when Jennifer’s nightmare began. She was accused of Munchausen syndrome by proxy
(MSBP) for allegedly causing her child’s illness – the basis of an MSBP “diagnosis”. Doctors called in
child protection officers from the New South Wales Department of Community Services and they took the
child into foster care.
This type of MSBP allegation is not unique. False and misleading MSBP charges are a worldwide
phenomenon with mothers across Australian, England, and the United States being falsely accused.
The New South Wales Department of Community Services does not have figures on MSBP
accusations, describing the number of MSBP cases as “insignificant”. However, one psychiatrist told an
accused mother that she is dealing with 27 families on a weekly basis.
These MSBP accusations, according to Dr Helen Hayward-Brown, occur to mothers whose children
suffer illnesses that cannot be easily diagnosed. ‘Mothers who present their children to hospital are
particularly at risk. This risk is compounded if they raise questions about their child’s treatment.’
Dr Hayward-Brown, a medical sociologist, was awarded her doctorate for investigating false
allegations of Munchausen syndrome by proxy. ‘Children are usually removed from the mother’s care,
often without adequate investigation, and mothers are only allowed minimal supervised contact or no
contact with their children. The prejudice of this MSBP label is so great that a mother’s credibility is
completely destroyed. And, once a child is removed it is virtually impossible for the mother to regain
custody.’
MSBP or Cisapride?
In another MSBP case a mother, Carol, has not had contact with her last baby who was removed shortly
after birth due to previous MSBP allegations. There are question marks over these prior accusations as the
children were prescribed the suspect reflux drug Cisapride. Documentation shows clearly that this drug
exacerbated her first child’s symptoms. Cisapride has been withdrawn in the United States and was banned
in England due to severe adverse reactions, including officially recorded deaths of several children.
However, Cisapride is still available in Australia and is used by the medical profession. The young
daughter of another accused mother was also treated with this drug.
The removal of a baby at birth due to previous MSBP allegations has been found to be a breach of
human rights by the European Court in the case of P, C & S vs. UK. The British Blair Government was
fined and had costs awarded against it totalling around 100,000 pounds. The European Court criticised
doctors and social workers for being “draconian” in their removal of the child.
In the MSBP cases investigated by Dr Hayward-Brown there is little natural justice in the accusations
– official files are falsified or wrong files used, and the medical profession and child protection workers
continually fail to fully investigate why a child has an illness. ‘One of the main predicaments for parents of
children with a difficult to diagnose illness is that the child’s symptoms are trivialised by the medical
professional.’
Alarmingly, one proponent of MSBP, Dr Herbert Schreier, describes MSBP mothers as ‘women who
are not wholly passive in their interactions with the medical profession’.
According to Dr Hayward-Brown, doctors accuse a mother of medical child abuse when they cannot
determine what is causing an illness. They do not consider that drugs such as Cisapride may have been
prescribed for the child, contributing to the medical problems. ‘The whole issue of MSBP has been hidden
away behind the closed walls of the secret Children’s Court that limits public and media access through
potential contempt of court actions.’
Doctors may want to protect themselves or their own incompetence by not fully investigating the
child’s illness. An expert British defence witness in child protection, now in Melbourne, Charles Pragnell,
said the so-called MSBP research conducted by Sir Roy Meadow was not scientifically based and was
merely his own conjecture, speculation and assertions that had questionable origins.
Mr Pragnell’s child protection expertise is backed up through his involvement in the exposure of
numerous false allegations of sexual abuse in Cleveland, England in 1987. ‘With those allegations it was
the over-zealous intervention of social workers that over-rode the rights of children and their families
causing them long-lasting emotional harm.’
He has found MSBP allegations follow threats by parents to report a doctor for negligence or
incompetence and threats to sue a doctor or a hospital. Therefore any retaliatory action by the doctor or
hospital required serious consideration. ‘In this way MSBP very effectively shifts the blame onto the
parents, who then come under scrutiny and investigation by the child protection system,’ Mr Pragnell
observed. He has found that government figures show that 85% of child abuse reports ‘have no substantive
basis’ and these false allegations are made for mistaken, mischievous, malicious or monetary reasons.
British opposition health and social services spokesman, Lord Howe, has called MSBP one of the most
pernicious and ill-founded theories to have gained currency in child care in the past 10 to 15 years. ‘It is a
theory without science. There is no peer-reviewed research to underpin MSBP and it rests on the assertions
of its founder Sir Roy Meadow.’
Concerns over the use of MSBP are also shared by Professor Colin Morley, formerly a paediatric
doctor with the University of Cambridge School of Clinical Medicine in England and now working at the
University of Melbourne. Dr Morley said that MSBP gave no indication of what was happening to a child
and that it was very non-specific and could be mis-interpreted. He said it should be abandoned in favour of
what was happening to the child, as it had become a diagnosis with emotional overtones. Further, as Mr
Pragnell has pointed out, “MSBP children” usually suffer from congenital disorders and birth injuries,
surgical injury, inappropriate medication and other treatments, allergic reactions, vaccine damage,
infections such as Giardia and chronic fatigue syndrome.
Dr Morley is also uneasy that mothers are being told to confess to harming their child because if they
do not confess, they are unlikely to have their child back. ‘That is blackmail and may result in a false
confession.’
MSBP lacks scientific validity
These experts agree that in some cases child abuse may be caused by mothers, but they also assert that the
MSBP accusations are an unsafe and unreasonable practice that fails to address the illness and problems of
the child. Dr Hayward-Brown said that accusing a person of MSBP lacks scientific validity as it was not
recognised as a psychiatric disorder, only appearing in the appendix of the psychiatric Diagnostic and
Statistical Manual of Mental Disorders IVR, as requiring further research. ‘One single mother related the
extraordinary chain of events that labelled her as an injurious MSBP mother, when the medical profession
failed, for 18 months, to discover her son’s chromosomal disorder.’
Dr Hayward-Brown also said that in another case both parents were charged with contempt of court
when they took their daughter to a gastroenterologist, despite the fact that they obtained a diagnosis for her
bowel complaint. ‘If the parent does obtain another diagnosis, some doctors will argue that the diagnosed
illness may co-exist with MSBP. This argument protects professionals from being sued for negligence as
for example, lack of diagnosis delaying treatment, wrongful removal of the child, etc.
‘MSBP is a recent and extremely controversial “diagnosis” that is unreliable as it may exclude genetic
and other factors that may be causing a child’s illness. However, despite its highly controversial nature,
MSBP is being used extensively in the medical profession, by social services, and in court.’
Some doctors could not acknowledge that some illnesses were very hard to diagnose and treat. This is
shown by a report in the British Medical Journal (August 2003) noting that the Court of Appeal for
England and Wales ruled that children can sue the healthcare trusts and local authorities that wrongly
conclude that they have been the victims of abuse. The BMJ cited one of the cases used by the court in its
findings and this was a 6-year-old boy who was said by Professor David Southall of North Staffordshire
Hospital to be a victim of fabricated illness. However, the boy was removed from the at-risk register after
three months when his condition was diagnosed as extensive and severe allergies.
In the UK last October, Dr. Umapati Biswas was found guilty of serious professional misconduct and
was struck off the medical register for making false allegations of child abuse.
In the inquiry into the Cleveland sexual abuse cases, Justice Bulter-Sloss recommended that child
protection workers needed to fully investigate claims made by medical professionals, rather than purely
accepting their opinions.
Dr Hayward-Brown discovered that the names of particular doctors and psychologists keep cropping
up as the ones who accuse mothers of MSBP. ‘They seem to be the ones that are predisposed to accuse
mothers.’ These professionals often know very little about the family, the child and their medical history
and with little first-hand contact, make the MSBP allegation.
A diagnosis is made without seeing the mother or child and by reading selected reports of other
doctors. This is called diagnosis by “immaculate perception”, Dr Hayward-Brown said.
‘Sir Roy Meadow has accused mothers of MSBP by reading selected doctors’ files and child protection
workers’ reports on a child – he does not meet the mother or child. He also provides expert evidence
outside his own speciality. Sir Roy has practiced this form of “diagnosis” in Australian cases.’
‘The MSBP profile used by doctors contain paradoxes that make it very difficult, almost impossible,
for mothers to prove their innocence. For example, being an over-protective parent is part of the MSBP
profile, but so is being a negligent parent,’ Dr Hayward-Brown said.
‘Good mothers are also in trouble. In Heather’s case, in the notification to social services, she was
described as purportedly “a good mother” with numerous and credible references attesting to her fine
mothering skills. Nevertheless she was still accused of MSBP since MSBP mothers are “able to deceive
everybody”.’
Dr Hayward-Brown said the MSBP profile appears to be expanding with the invention of the so-called
“falsification disorder by proxy” (FDP) for mothers who do not fit MSBP profile. ‘Doctors and social
workers are starting to use somatisation and conversion disorders in MSBP allegations, while older children
and disabled and autistic children are being targeted.’
The national child abuse conference in Sydney (November 2003) heard a child protection unit say that
the “anxiety” shown by a mother for her child’s illness could be a “concerning behaviour”. The child
protection units suggested that another MSBP symptom was when parents sought a second or third medical
opinion.
Dr Hayward-Brown contends that the profiling is extremely prejudicial, inaccurate, paradoxical and
often nonsensical. ‘The mothers are presumed to be guilty and it is very difficult for them to prove their
innocence.’ She notes that many parents who have been accused of MSBP and had their children removed
have not had criminal charges of child abuse laid against them. There is no criminal evidence, she
contends. It just takes a child protection officer from the Department of Community Services to say the
child is “at risk” and a mother loses her child. ‘In my view, evidence of child abuse simply does not exist to
convict mothers in a criminal court. Higher courts are dismissing Sir Roy’s theories. Mothers accused of
MSBP are usually too scared to speak out openly against doctors and the Department of Community
Services. They fear contempt of court charges by the Children’s Court that is closed to the public and
media.’
In her years of investigation, Dr Hayward-Brown has been shown evidence of many unethical or
corrupt practices including breaches of social services policies and procedures, refusal to investigate a
medical doctor’s notification that was accepted without qualification and the exclusion of documents
indicating innocence.
She also found that files were tampered with, there was fabrication of evidence, hearsay evidence in
court, intimidation, blackmail, withdrawal of treatment, hospital errors and mismanagement, lack of
knowledge of overseas expertise or lack of expertise in the relevant specialty, and attribution of father’s
comments to the mother.
In one MSBP case, doctors and Department of Community Services used the wrong child’s medical
file – same child’s name but wrong person. And a mother found over 120 false or inaccurate items in her
DOCS files.
In her thesis, Dr Hayward-Brown pointed out that the lack of scientific credibility of the diagnosis
could be seen by outcomes in United States courts, several of which have ruled that the use of the MSBP
diagnosis is not admissible. (These include Martinez v. United States of America, State v. Lumbrera, and
Commonwealth v. Robinson.)
The British General Medical Council has confirmed that both Sir Roy Meadow and Dr David Southall
are under official investigation as “problem doctors”. With these investigations occurring, it is questionable
how doctors can diagnosis MSBP in alleged child abuse cases in “good faith” and how doctors can
continue to use Sir Roy Meadow as one of their principal references in court affidavits when alleging
MSBP.
Previously, Dr Southall was suspended from child protection work for two years during the British
Griffiths Inquiry into his research work and MSBP accusations. The South Australian Supreme Court has
ruled that Dr Southall’s MSBP testimony could only be regarded as a lay person’s opinion, albeit a wellinformed
one as he is a paediatrician.
What about Sir Roy’s Munchausen-syndrome-by-proxy research documents? According to Lord
Howe, when Sir Roy was challenged to produce them, Sir Roy claimed that they had been destroyed. The
legitimacy of the MSBP theory is now undergoing intense scrutiny worldwide for its lack of scientific
integrity, highly questionable support literature in medical journals, and its continuing use by a minority of
members of the medical profession.
Dr Hayward-Brown concludes that there are major and disturbing problems in the procedures and
attitudes of the medical and social service professions in relation to MSBP, and wonders how the medical
profession can prove that a MSBP diagnosis is indeed positive? ‘The false accusations can happen to any
mother or father at any time – it does not discriminate regarding class or status, as has happened in
England. It is a nightmare waiting on the doorsteps on every Australian family if their child becomes ill or
is disabled.’
Note: the names of parents, their children and identifying facts in the case studies have been changed
or altered to protect the parents and children as required by law.
Michael Nott is a former radio and television journalist and a senior media and communications
officer for federal, NSW and Queensland government departments and agencies.