The Munchausen Syndrome by Proxy witch hunt

Consider this. If you are a mother with a young child who has a very difficult-to-diagnose illness, you could find yourself looking down the aggressive barrel of a child protection agency. They could take your child into foster care, and the courts could allow you only very limited supervised contact with your child again, if at all.

There is no evidence that you have caused the child's illness. Often the children at risk are very sick but a parent may have challenged a doctor's medical treatment.

Such a scene is happening in a number of countries, including Australia, Germany, New Zealand, UK and the US. In some cases it is happening without evidence, driven by the speculative, circumstantial and prejudicial, much the same way as the witch hunts of old. It follows on from the Munchausen Syndrome by Proxy (MSBP) theory introduced by British pediatrician, Professor Sir Roy Meadow (Lancet in 1977), also known as "factitious illness", "pediatric falsification disorder" and similar terms.

Named after the 18th century German figure Baron von Münchhausen, famous for his "tall stories", Munchausen Syndrome is where one is alleged to be causing problems in oneself, e.g., self harm, or presenting oneself at hospital too many times. Munchausen Syndrome by Proxy is where one is alleged to be causing problems in another person, usually one's child. In most cases, the mother - as the usual care-giver - is accused. I write as an advocate for mothers accused of Munchausen Syndrome by Proxy.

The MSBP theory has found favour in powerful sections of the medical profession, child protection, academia, law enforcement and the judiciary. According to medical sociologist Dr Helen Hayward-Brown it has become a nightmare waiting on the doorstep of every family with a sick child. Hayward-Brown was awarded her doctorate for investigating false allegations of MSPB, when many of her case studies were based in Australia.

“Ordinary mothers and fathers are being accused of child abuse because their children have an illness that some pediatricians cannot diagnose, or (because) the parents strongly question the doctor over the child's treatment,” she said.

“The parents are refused the opportunity to obtain a second medical opinion as this is labelled ‘doctor shopping’, part of the MSBP child abuse profile - even though doctors are ethically obliged to allow it and it is a patient's right to obtain a second medical opinion. A mother could be doing nothing wrong, other than showing anxiety and care for her child and questioning doctors on the care of her very sick child,” she said. “Before long, she could be accused of child abuse and face criminal charges. It is just like the witch hunts of centuries ago that were based on guesswork.”

MSBP is based on a "profile" or label that allegedly indicates the mother's behaviour. Such a profile includes the mother who shows too much interest in medical procedures, paradoxically taking no interest in the child's medical care, and the mother who passively accepts everything but also seeks attention by going to the media. Hayward-Brown said that generally an accused mother will be told she has little hope of her children being returned unless she confesses to MSBP.

Charles Pragnell, an expert British defence witness in child protection, now based in Melbourne, Australia, said that the labelling of a carer, usually the mother, with child abuse prevents proper investigation. Bringing legal action or making a complaint against a doctor is thereby effectively stopped.

Hayward-Brown said, “The MSBP profile used by doctors contains 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." Child protection agencies often took the view that a mother must be guilty and failed to undertake appropriate investigations.

"It does not matter if it is called a disorder, behaviour or syndrome. It does not matter if it is seen to be psychiatric or pediatric. The outcome is the same," she said.

The legitimacy of the MSBP theory is now undergoing intense scrutiny worldwide. Challengers allege a lack of scientific integrity with highly questionable support literature in medical journals; there is concern that a minority of influential members of the medical profession continue its use. Pragnell made the point that Meadow’s MSBP research had not been subject to peer review.