Sexist Syndrome: Munchausen By Proxy

Have you ever visited a doctor for distressing but subjective symptoms -- maybe headaches or nausea -- and been told the problems would improve if you weren't so anxious/attention-seeking/over-achieving or otherwise emotionally off-balance? Did you think the doctor relied too little on science and too much on his psychic powers, but feel too intimidated to argue because of the embossed diplomas on the walls?

Well, imagine you do argue. No, you say, I'm not crazy, and I want proper care. The physician -- perhaps irritated or frustrated -- could then diagnose Munchausen Syndrome, the feigning of illness to get attention.

Now imagine your child is the sick one. The physician could diagnose Munchausen Syndrome by Proxy (MSBP) and bam, you're accused of faking your child's illness, perhaps even poisoning or beating him to instigate symptoms. While such abusive parents surely and sadly exist, MSBP may be dangerously overdiagnosed, often at the expense of "uppity" women who challenge the male-dominated medical or legal establishments. Studies indicate that doctors tend to take female patients' complaints less seriously than male patients'; presumably this unfortunate trend would apply to a woman's complaints on behalf of her child.

An MSBP diagnosis doesn't necessarily require extreme behavior. The guidelines for diagnosing MSBP include situations that could apply to any concerned parent whose child has a puzzling or treatment-resistant illness. Several of the guidelines devalue a parent's (particularly the mother's) agency and attempt to pigeonhole her into a prescribed, acceptable -- and sometimes contradictory -- range of behavior, with no regard to the extenuating circumstances of her child's illness. For example: "A parent who appears to be unusually calm in the face of serious difficulties in her child’s medical course while being highly supportive and encouraging of the physician, or one who is angry, devalues staff, and demands further intervention, more procedures, second opinions, and transfers to other more sophisticated facilities."

We need to remember that the guidelines' vagueness may help ignorant or unethical doctors and lawyers to use concerned people's (justifiable) fear of child abuse to pad their own pockets and soothe their own egos.

Susan Diamond's dubious MSBP diagnosis in 2005 was shaped by bitter divorce proceedings, a mentally ill son, and his possibly flummoxed and too-proud physician.

Sally Clark was convicted of MSBP and murder because the prosecution said the chances of both her children dying of cot death were 1 in 73 million, a wholly inaccurate statistical interpretation, according to the British Royal Statistical Society (see here the details).

The "expert witness" pediatrician at Clark's trial also happened to be the "godfather" of MSBP theory, who was later chastised for professional misconduct and had his competency discredited.

Shady dealings not only hurt innocent families, but may even prevent real (and rarer) cases of parent-induced illness from being properly recognized amidst the mayhem. Until more honest, unbiased, and thorough research is done, MSBP should be viewed with skepticism and applied with restraint.

For a personal look at the MSBP controversy, see this petition by Rebecca Leigh, who describes having her son taken from her.

Photo credit: a.drian