Munchausen's Syndrome by Proxy

Munchausen's syndrome by proxy (MSP) is a psychological condition claimed to lead to infant- and child-abuse. It was so-named in 1977 by Sir Roy Meadow and is a variant of Munchausen's syndrome, invented and so-named by Sir Richard Asher in 1951. MSP has been diagnosed in many cases of cot death, and about 250 mothers in the UK have been convicted of killing their babies in the last 15 years. Hundreds, perhaps thousands, more have been deprived of their children on the basis of this idea. As a scientist, I am amazed that such a theory is accepted by doctors, since there is scant scientific evidence for it. There is, of course, evidence for SIDS (sudden infant death syndrome), infanticide and the intentional harming of children. It is the diagnosis of MSP to explain these deaths and diseases that must be regarded as not scientifically proved.

I have found two websites with a definition of MSP. The first is that of Dr. Marc Feldman and the second is that of Dr. Huynh.

Dr. Feldman first defines Munchausen's syndrome: "People with factitious [meaning false] disorders feign, exaggerate or actually self-induce illnesses. Their aim? To assume the status of "patient" and thereby to win attention, nurturance and lenience that they feel unable to obtain in any other way." He goes on to define MSP: in the proxy form, someone else is harmed, and the benefits are vicarious.

Dr. Huyhn defines MSP as "the intentional production or feigning of physical or psychological signs ... or symptoms in another person who is under the individual's care, for the purpose of assuming the sick role by proxy."

Both doctors distinguish between Munchausen's and malingering; in the latter condition, the patient creates real or false symptoms of disease in order to obtain social benefits such as disability payments. This is not the real purpose, we are told, of those suffering from Munchausen's. Similarly, in the proxy form, there is [supposed to be] a distinction between the psychological condition of those harming someone in their care in order to get attention and those doing it for money.

Some web-sites include in Munchausen's syndrome those harming themselves to get cash benefits, and in the proxy form, those harming others for the same purpose. I shall not use the terms in this sense.

It is the requirement of intention in these definitions that is difficult to test and impossible to prove. Intention is outside the realm of science, but has a place in legal questions. While I was serving on the jury of a murder trial, the judge explained the difference between murder and manslaughter: to be murder, the accused must have had the intention to kill, or seriously harm, the victim. To convict, we the jury had to conclude beyond reasonable doubt that this intention was there. Similarly, to be guilty of stealing, an accused must have had the intention of permanently depriving the victim of the article taken. To be guilty of fare-dodging, the traveller must have "failed to buy a ticket in advance for the whole journey, with the intention of defrauding the Railway Company" [Bye-law, London Transport]. A new addition to this list is the crime of grooming: paedophiles who groom children on the web with the intention of meeting them and abusing them face 10 years in jail.

The difference between scientific proof and legal proof can be seen in a case of fare-dodging. A former student of physics at Imperial College decided that public transport should be free. He produced a pamphlet advising travellers to travel without any money and without a ticket, and to declare this at the ticket barrier. Provided that you give your correct name and address, you will be let through, he advised; LT will never check up and ask you for the money, as it costs more than it brings in. After he had himself played this trick 150 times or so, he was arrested by the Railway Police and charged with defrauding the railway. At the magistrates' court, he chose to conduct his own case. Because any intention was internal to him, he asserted, the police could not prove that he had broken the bye-law. They just did, replied the magistrate, SIX MONTHS IN PRISON!.

It seems to me that in a cot-death murder trial, doctors who announce that the accused is suffering from MSP are usurping the functions of the jury.

Some of the mothers accused of killing their own children because of MSP have formed their own web-site. They are perplexed that once diagnosed to have the condition, cure is impossible. Feldman says that one case of a cure is documented, though "many doctors consider [it] untreatable". Others say that a cure is difficult. The first step in all proposed cures is [see Huynh] the genuine admission to all the deceptions. This is very similar to the first step needed to cure witchcraft: admit it and denounce your accomplices. Huynh also says that the vast majority of MSP-sufferers deny that they have the syndrome. In slide 45, his site does say, however, that "although many children return to the family and survive, there is no convincing case in the professional literature demonstrating successful treatment". In other words, it is [so far] not possible to find out whether or not the patient still has the syndrome. This admission leads one to the conclusion that it was not possible to determine whether the patient had the "disease" in the first place. It reminds me of a similar question that arose in a debate about psychoanalysis when I was a student: how do analysts verify the claim that in a patient, a weakly developed mechanism for internal repression might fail to sublimate the id into the ego? This caused much merriment among us physical scientists.

More black humour will be found here. See also the Stasi Syndrome

These humourous sites refers to MSP, and also to previous disasters concerning the social services, which are described in the book,

When Salem Came to the Boro' by Stuart Bell, M.P., 1988. Pan Books.

The allusion to Salem concerns the way witches were exposed in Arthur Miller's play "The Crucible", made into a notable film, The Witches of Salem. Namely, children were bullied into denouncing somebody, who was then tortured until confession or death. Confession was the only way to avoid being hanged.

The first disaster hit Leeds, but broke out in worse form in Middlesbrough, Cleveland, whose M.P. Stuart Bell was. Local hospital staff had to allow the paediatritian Dr. Marietta Higgs, and her side-kick Dr. Geoffrey Wyatt, to test children, who were visiting hospital for other reasons, for sexual abuse. Dr. Higgs was this country's foremost practitioner of the "reflex anal dilatation test", a test for possible bug*ery. The test had been announced in 1986 in The Lancet by Dr. Jane Wynne and Dr. Christopher Hobbs. Dr. Wyatt had no experience in diagnosing child abuse, but at least Dr. Higgs was qualified: she had attended a "residential course" on the subject, taught by staff at Leeds. Now, a "residential" course must have been at least two days long, which is plenty of time to master the simple test. The child is undressed, and put on all fours, with the back side facing the doctor. The buttocks are gently parted; if the anus opens, then the child has been the subject of a sexual attack. The argument is, why else would the anus open, if it had not been conditioned to receive some insertion? It turned out that a large proportion of the children in the hospital, boys and girls, tested positive, and as new young patients arrived, about one hundred children were so diagnosed over six weeks, 18 in one weekend alone. Court orders were obtained, prohibiting either parent to see their child, and criminal proceedings against one or both parents were started or threatened. In many cases, the siblings were also taken into care, even in the absence of a positive response to the test. One report mentioned 197 children taken into care. Stuart Bell, the local M.P., was brave enough to try to slow down the flow of bug*ered children, since apart from anything else, there was nowhere to stack them. Moreover, word spread and parents of sick children were afraid to bring them to the hospital. A similar bout of bug*ering was also found Worcester. After causing misery to hundreds of families, eventually Dr. Higgs and her acolytes were forbidden to use this test on children, following the inevitable enquiry.[The Butler-Sloss Cleveland Report]. All the children not already sent for adoption were returned to their parents and no prosecutions took place.

Even after this report, an outbreak of "ritual satanic abuse", made famous by the religious right in USA, was found on the Orkneys; the affair started when someone had complained that the Minister of the Church was holding services "dressed in animal skins". It happened that his B.D. robe had a fur collar, to which the complainant took exception. But by then, the "team" had found that many of the children in the hamlet had tested positive under the anal test. Some never saw their parents again. There were other outbreaks of satanic ritual abuse in Nottingham and Rochdale. Even more recently, the Shieldfield Scandal escalated when the SS appointed a team of four "experts" to overturn a not-guilty verdict of a criminal court; one of those appointed was "expert" in satanic ritual abuse.

How reliable is the test? Google reveals that the test shows positive in the normal child if a stool is present. [ask Google for web-pages on "reflex anal dilatation test"]. Her Worship Dame Elizabeth Lord Justice Butler-Sloss did not commit herself to judging the anal test, which was a scientific and not a legal question; this was wise, since there had been NO EMPIRICAL TEST ON ITS VALIDITY at the time of the B-S report. Nevertheless, she gave a damning report on the procedures and the failures in the system of checks.

The theoretical argument, why else would the anus dilate? reminds me of an encounter that I had with someone who argued that the fruit of the wild flower, London pride, was good for someone suffering a heart attack: "Why else would it be heart-shaped?" I was asked, to which I had no reply.