Munchausen syndrome by proxy
Encyclopedia
Münchausen syndrome by proxy (MSbP) is a label for a pattern of behavior in which care-givers deliberately exaggerate, fabricate, and/or induce physical, psychological, behavioral, and/or mental health problems in others. Other experts classified MSbP as a mental illness. However, the term is not officially recognised in the latest Diagnostic and Statistical Manual, 4th Ed., published by the American Psychiatric Association
. Münchausen by proxy has been described by some as a form of extended child abuse
. The motivation is to assume the sick role by proxy. It involves physical abuse
and medical neglect
.
Some conditions or symptoms that may be faked by the care-giver or parents include failure to thrive
, allergies, asthma, vomiting, diarrhea, seizures and infections. These symptoms are easy to fake because when a child goes into the doctor’s office the adult can simply say that his or her child is experiencing these symptoms. This usually occurs during the preschool years.
Many experts feel this form of ill treatment is driven not only by the attention that the child and parent/caregiver receive because of the diagnostic tests that must be run, but also by the satisfaction of being able to deceive individuals who the abuser feels are more important or powerful than he or she.
Münchausen by Proxy can have many long-term effects on a child. In some cases, children themselves go on to develop Münchausen Syndrome, which is where they are likely to inflict injury upon themselves or fake illnesses. One of the reasons for this is that they seek the attention they received when they were in poor health. They may also inflict injury or sickness upon themselves so that their caregiver/parent will not leave them.
, Münchausen syndrome
was first described by R. Asher in 1951 as when someone invents or exaggerates medical symptoms, sometimes engaging in self-harm
, to gain attention
or sympathy
.
The term "Münchausen syndrome by proxy" was first coined by John Money
and June Faith Werlwas in a 1976 paper titled folie à deux in order to describe the abuse induced and neglect induced symptoms of the syndrome of abuse dwarfism. That same year, Sneed and Bell wrote an article titled The Dauphin of Münchausen: factitious passage of renal stones in a child.
According to other sources, the term Munchausen syndrome by proxy was created by the British pediatrician Roy Meadow
in 1977. It is also known as Meadow's syndrome after him. In 1977 Roy Meadow — then professor of pediatrics
at the University of Leeds
, England
— described the extraordinary behavior of two mothers. According to Meadow, one had poisoned her toddler with excessive quantities of salt. The other had introduced her own blood into her baby's urine sample. He referred to this behavior as Münchausen syndrome
by proxy (MSbP). In 2005 British General Medical Council
(GMC) struck off Meadow from the British Medical Register after he was found to have offered “erroneous” and “misleading” evidence in the Sally Clark
case. Clark was a lawyer
wrongly convicted in 1999 of the murder of her two baby sons, largely on the basis of Meadow's evidence. It emerged later that there was clear evidence of a staphylococcus aureus infection that had spread as far as Clark child’s cerebral spinal fluid. Mrs Clark was released in January 2003 after three judges quashed her convictions in the Court of Appeal in London.
In 1977, Burman and Stevens coined the term "Polle syndrome" which was questioned by Meadow and Th. Lennert in 1984.
The medical community was initially skeptical of MSbP's existence, but it gradually gained acceptance as a recognized condition.. Widely used, the term "Munchausen syndrome by proxy" has led to much confusion in the literature: initially referring to harmful medical care, the appellation "Munchausen syndrome by proxy" was then extended to cases in which the only harm arose from medical neglect or noncompliance or even educational interference.
In 1994, the DSM
, Fourth Edition, labeled the condition under a new category called "factitious disorder by proxy." In 2002, the American Professional Society on the Abuse of Children suggested a new terminology: pediatric condition falsification (PCF) .
patterns that encourage females to seek the sympathy and assistance of others. Neuropsychological
testing of perpetrators has shown either normal results or nonspecific abnormalities.
MSbP may also be attributed to another prevalent socialization pattern, which places females in the primary care-taking role. A psychodynamic model of this kind of maternal abuse exists.
These symptoms may be more prevalent in the parents of those with a learning difficulty or mental incapacity, and as such the apparent patient could in fact be a grown adult.
, the Opposition spokesman on health, accused the professor of inventing a "theory without science" and refusing to produce any real evidence
to prove that Münchausen syndrome by proxy actually exists. It is important to distinguish between the act of harming a child, which can be easily verified (and there are plenty of cases to prove that it happens), and motive, which is much harder to verify and which MSbP tries to explain. For example, a caregiver may wish to harm a child simply out of malice, rather than in order to draw attention and sympathy.
The distinction is often crucial in criminal proceedings, in which the prosecutor must prove both the act and the mental element constituting a crime to establish guilt. In most legal jurisdictions, a doctor can give expert witness
testimony as to whether a child was being harmed but cannot speculate regarding the motive of the caregiver. FII merely refers to the fact that illness is induced or fabricated and does not specifically limit the motives of such acts to a caregiver's need for attention and/or sympathy. There are now more than 2,000 case reports of FII in the professional literature. Reports come from developing countries that include, but are not limited to, Sri Lanka
, Nigeria
, and Oman
. Dr. Meadow was knighted for his work for child protection, though later, his reputation, and consequently the credibility of MSbP, became severely damaged when several convictions of child killing, in which he acted as an expert witness, were overturned.
In 2003, a number of high-profile acquittals brought Meadow's ideas into serious disrepute. Around 250 cases resulting in conviction in which Meadow was an expert witness were reviewed, with few changes. Meadow was investigated by the British
General Medical Council
over evidence he gave as an expert witness for the prosecution in the Sally Clark
trial, where he asserted that the odds of there being two unexplained infant deaths in one family were one in 73 million. That figure was crucial in sending her to jail but was hotly disputed by the Royal Statistical Society
, who wrote to the Lord Chancellor to complain. It was subsequently shown that the true odds were much lower, i. e., there was a much higher possibility of two deaths happening as a chance occurrence. In July 2005, the GMC declared Meadow guilty of "serious professional misconduct", and he was struck off the register for giving "misleading" evidence in the Sally Clark case. At appeal, High Court judge Mr. Justice Collins described this as "irrational" and set it aside. Meadow was involved as a prosecution witness in two other high-profile cases resulting in mothers being imprisoned and subsequently cleared of wrongdoing — those of Trupti Patel
and Angela Cannings
. Collins's judgment raises important points concerning the liability of expert witnesses — his view is that referral to the GMC by the losing side is an unacceptable threat and that only the Court should decide whether its witnesses are seriously deficient and refer them to their professional bodies.
In addition to the controversy surrounding expert witnesses, an article appeared in the forensic literature that detailed legal cases involving controversy surrounding the murder suspect.
The Perri and Lichtenwald article provides a brief review of the research and criminal cases involving Münchausen Syndrome by Proxy in which psychopathic mothers and caregivers were the murderers. This article also briefly describes the importance of gathering behavioral data including observations of the parents who commit the criminal acts and references the 1997 work of Southall, Plunkett, Banks, Falkov, and Samuels.
In a June 2004 appeal
hearing, the Supreme Court
of Queensland, Australia, stated:
The Queensland Supreme Court further ruled that the determination of whether or not a defendant had caused intentional harm to a child was a matter for the jury to decide and not for the determination by expert witnesses:
Principles of law and implications for legal processes that may be deduced from these findings are that:
The Queensland Judgment was adopted into English law in the High Courts of Justice in Case No. WR03C00142 [A County Council v A Mother and A Father and X,Y,Z children] on 18 January 2005 by Mr. Justice Ryder. In his final conclusions regarding Factitious Disorder, Ryder states that:
In his book Playing Sick (2004), Marc Feldman notes that such findings have been in the minority among U.S. and even Australian courts. Pediatricians and other physicians have banded together to oppose limitations on child-abuse professionals whose work includes FII detection. The April 2007 issue of the journal Pediatrics specifically mentions Meadow as an individual who has been inappropriately maligned.
features a band called Münchausen by Proxy, featuring Zooey Deschanel
's character as lead vocalist.
The novel Sickened: The Memoir of a Munchausen by Proxy Childhood by Julie Gregory
details the life of a girl growing up with a Münchausen by Proxy mother, who took her to various doctors, coaching her to act sicker than she was and exaggerating her symptoms, and demanding increasingly invasive procedures to diagnose the girl's imaginary illnesses.
The 1999 film The Sixth Sense portrays Münchausen syndrome by proxy during a scene in which a mother is caught on video adding floor cleaner to her ill daughter's food.
The plot of the 2003 Japanese J-horror film One Missed Call (着信アリ Chakushin ari) revolves around a mother with a case of Münchausen syndrome by proxy.
In "The Calusari" episode of The X-Files
, Agent Scully initially believes that one of the characters is inducing illness in her grandson and makes reference to Münchausen syndrome by proxy.
American Psychiatric Association
The American Psychiatric Association is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential worldwide. Its some 38,000 members are mainly American but some are international...
. Münchausen by proxy has been described by some as a form of extended child abuse
Child abuse
Child abuse is the physical, sexual, emotional mistreatment, or neglect of a child. In the United States, the Centers for Disease Control and Prevention and the Department of Children And Families define child maltreatment as any act or series of acts of commission or omission by a parent or...
. The motivation is to assume the sick role by proxy. It involves physical abuse
Physical abuse
Physical abuse is abuse involving contact intended to cause feelings of intimidation, injury, or other physical suffering or bodily harm.-Forms of physical abuse:*Striking*Punching*Belting*Pushing, pulling*Slapping*Whipping*Striking with an object...
and medical neglect
Neglect
Neglect is a passive form of abuse in which a perpetrator is responsible to provide care for a victim who is unable to care for himself or herself, but fails to provide adequate care....
.
General information
In the Münchausen by Proxy syndrome, an adult care-giver makes a child sick by either fabricating symptoms or actually causing harm to the child, whereby convincing not only the child but others, including medical providers, that their child is sick.Some conditions or symptoms that may be faked by the care-giver or parents include failure to thrive
Failure to thrive
Failure to thrive is a medical term which is used in both pediatric and adult human medicine, as well as veterinary medicine ....
, allergies, asthma, vomiting, diarrhea, seizures and infections. These symptoms are easy to fake because when a child goes into the doctor’s office the adult can simply say that his or her child is experiencing these symptoms. This usually occurs during the preschool years.
Many experts feel this form of ill treatment is driven not only by the attention that the child and parent/caregiver receive because of the diagnostic tests that must be run, but also by the satisfaction of being able to deceive individuals who the abuser feels are more important or powerful than he or she.
Münchausen by Proxy can have many long-term effects on a child. In some cases, children themselves go on to develop Münchausen Syndrome, which is where they are likely to inflict injury upon themselves or fake illnesses. One of the reasons for this is that they seek the attention they received when they were in poor health. They may also inflict injury or sickness upon themselves so that their caregiver/parent will not leave them.
Initial description
Named after the German nobleman Baron MünchhausenBaron Munchhausen
Karl Friedrich Hieronymus, Freiherr von Münchhausen , usually known as Baron Münchhausen in English, was a German nobleman born in Bodenwerder and a famous recounter of tall tales....
, Münchausen syndrome
Munchausen syndrome
Münchausen syndrome is a psychiatric factitious disorder wherein those affected feign disease, illness, or psychological trauma to draw attention or sympathy to themselves. It is also sometimes known as hospital addiction syndrome or hospital hopper syndrome...
was first described by R. Asher in 1951 as when someone invents or exaggerates medical symptoms, sometimes engaging in self-harm
Self-harm
Self-harm or deliberate self-harm includes self-injury and self-poisoning and is defined as the intentional, direct injuring of body tissue most often done without suicidal intentions. These terms are used in the more recent literature in an attempt to reach a more neutral terminology...
, to gain attention
Attention seeking
Enjoying the attention of others is quite socially acceptable. In some instances, however, the need for attention can lead to difficulties. The term attention seeking is generally reserved for such situations where excessive and "inappropriate attention seeking" is seen.-Styles:The following...
or sympathy
Sympathy
Sympathy is a social affinity in which one person stands with another person, closely understanding his or her feelings. Also known as empathic concern, it is the feeling of compassion or concern for another, the wish to see them better off or happier. Although empathy and sympathy are often used...
.
The term "Münchausen syndrome by proxy" was first coined by John Money
John Money
John William Money was a psychologist, sexologist and author, specializing in research into sexual identity and biology of gender...
and June Faith Werlwas in a 1976 paper titled folie à deux in order to describe the abuse induced and neglect induced symptoms of the syndrome of abuse dwarfism. That same year, Sneed and Bell wrote an article titled The Dauphin of Münchausen: factitious passage of renal stones in a child.
According to other sources, the term Munchausen syndrome by proxy was created by the British pediatrician Roy Meadow
Roy Meadow
Sir Samuel Roy Meadow is a British paediatrician and professor, who rose to initial fame for his 1977 academic paper on the now controversial Munchausen Syndrome by Proxy and his crusade against parents who, he believes, wilfully harm or kill their children. He was knighted for these works...
in 1977. It is also known as Meadow's syndrome after him. In 1977 Roy Meadow — then professor of pediatrics
Pediatrics
Pediatrics or paediatrics is the branch of medicine that deals with the medical care of infants, children, and adolescents. A medical practitioner who specializes in this area is known as a pediatrician or paediatrician...
at the University of Leeds
University of Leeds
The University of Leeds is a British Redbrick university located in the city of Leeds, West Yorkshire, England...
, England
England
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...
— described the extraordinary behavior of two mothers. According to Meadow, one had poisoned her toddler with excessive quantities of salt. The other had introduced her own blood into her baby's urine sample. He referred to this behavior as Münchausen syndrome
Munchausen syndrome
Münchausen syndrome is a psychiatric factitious disorder wherein those affected feign disease, illness, or psychological trauma to draw attention or sympathy to themselves. It is also sometimes known as hospital addiction syndrome or hospital hopper syndrome...
by proxy (MSbP). In 2005 British General Medical Council
General Medical Council
The General Medical Council registers and regulates doctors practising in the United Kingdom. It has the power to revoke or restrict a doctor's registration if it deems them unfit to practise...
(GMC) struck off Meadow from the British Medical Register after he was found to have offered “erroneous” and “misleading” evidence in the Sally Clark
Sally Clark
Sally Clark was a British solicitor who became the victim of an infamous miscarriage of justice when she was wrongly convicted of the murder of two of her sons in 1999...
case. Clark was a lawyer
Solicitor
Solicitors are lawyers who traditionally deal with any legal matter including conducting proceedings in courts. In the United Kingdom, a few Australian states and the Republic of Ireland, the legal profession is split between solicitors and barristers , and a lawyer will usually only hold one title...
wrongly convicted in 1999 of the murder of her two baby sons, largely on the basis of Meadow's evidence. It emerged later that there was clear evidence of a staphylococcus aureus infection that had spread as far as Clark child’s cerebral spinal fluid. Mrs Clark was released in January 2003 after three judges quashed her convictions in the Court of Appeal in London.
In 1977, Burman and Stevens coined the term "Polle syndrome" which was questioned by Meadow and Th. Lennert in 1984.
The medical community was initially skeptical of MSbP's existence, but it gradually gained acceptance as a recognized condition.. Widely used, the term "Munchausen syndrome by proxy" has led to much confusion in the literature: initially referring to harmful medical care, the appellation "Munchausen syndrome by proxy" was then extended to cases in which the only harm arose from medical neglect or noncompliance or even educational interference.
In 1994, the DSM
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...
, Fourth Edition, labeled the condition under a new category called "factitious disorder by proxy." In 2002, the American Professional Society on the Abuse of Children suggested a new terminology: pediatric condition falsification (PCF) .
Indications
Caution is required in the diagnosis of fabricated or induced illness (FII). Many of the items below are also indications of a child with organic, but undiagnosed illness. An ethical diagnosis of MSbP must include an evaluation of the child, an evaluation of the parents and an evaluation of the family dynamics. Diagnoses based only on a review of the child's medical chart can be rejected in court. The adult care provider who is abusing the child often seems comfortable and not upset over the child's hospitalization. While the child is hospitalized, medical professionals need to monitor the caregiver's visits in order to prevent any attempt to worsen the condition of the child. In addition, in most states, medical professionals have a duty to report such abuse to legal authorities. Warning signs of the disorder include:- A child who has one or more medical problems that do not respond to treatment or that follow an unusual course that is persistent, puzzling and unexplained.
- Physical or laboratory findings that are highly unusual, discrepant with history, or physically or clinically impossible.
- A parent who appears to be medically knowledgeable and/or fascinated with medical details and hospital gossip, appears to enjoy the hospital environment, and expresses interest in the details of other patients' problems.
- A highly attentive parent who is reluctant to leave their child's side and who themselves seem to require constant attention.
- A parent who appears to be unusually calm in the face of serious difficulties in their 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.
- The suspected parent may work in the health care field themselves or profess interest in a health-related job.
- The signs and symptoms of a child's illness do not occur in the parent's absence (hospitalization and careful monitoring may be necessary to establish this causal relationship).
- A family history of similar or unexplained illness or death in a sibling.
- A parent with symptoms similar to their child's own medical problems or an illness history that itself is puzzling and unusual.
- A suspected emotionally distant relationship between parents; the spouse often fails to visit the patient and has little contact with physicians even when the child is hospitalized with serious illness.
- A parent who reports dramatic, negative events, such as house fires, burglaries, or car accidents, that affect them and their family while their child is undergoing treatment.
- A parent who seems to have an insatiable need for adulation or who makes self-serving efforts for public acknowledgment of their abilities.
Prevalence by gender
One study showed that in over 90 percent of cases of MSbP, the mother is the abuser. In other cases, the MSbP abuser is often another female caregiver. Fathers have been the perpetrators in a handful of professional reports. The female preponderance may be attributed to socializationSocialization
Socialization is a term used by sociologists, social psychologists, anthropologists, political scientists and educationalists to refer to the process of inheriting and disseminating norms, customs and ideologies...
patterns that encourage females to seek the sympathy and assistance of others. Neuropsychological
Neuropsychology
Neuropsychology studies the structure and function of the brain related to specific psychological processes and behaviors. The term neuropsychology has been applied to lesion studies in humans and animals. It has also been applied to efforts to record electrical activity from individual cells in...
testing of perpetrators has shown either normal results or nonspecific abnormalities.
MSbP may also be attributed to another prevalent socialization pattern, which places females in the primary care-taking role. A psychodynamic model of this kind of maternal abuse exists.
These symptoms may be more prevalent in the parents of those with a learning difficulty or mental incapacity, and as such the apparent patient could in fact be a grown adult.
Controversy
During the 1990s and early 2000s, Meadow was an expert witness in several murder cases involving FII, some of which resulted in parents' being wrongly convicted of murdering their children and imprisoned. In 2003, Lord HoweFrederick Curzon, 7th Earl Howe
Frederick Richard Penn Curzon, 7th Earl Howe is a Conservative front bench member of the House of Lords, and is a Parliamentary Under Secretary of State at the Department of Health-Political and professional career:...
, the Opposition spokesman on health, accused the professor of inventing a "theory without science" and refusing to produce any real evidence
Evidence
Evidence in its broadest sense includes everything that is used to determine or demonstrate the truth of an assertion. Giving or procuring evidence is the process of using those things that are either presumed to be true, or were themselves proven via evidence, to demonstrate an assertion's truth...
to prove that Münchausen syndrome by proxy actually exists. It is important to distinguish between the act of harming a child, which can be easily verified (and there are plenty of cases to prove that it happens), and motive, which is much harder to verify and which MSbP tries to explain. For example, a caregiver may wish to harm a child simply out of malice, rather than in order to draw attention and sympathy.
The distinction is often crucial in criminal proceedings, in which the prosecutor must prove both the act and the mental element constituting a crime to establish guilt. In most legal jurisdictions, a doctor can give expert witness
Expert witness
An expert witness, professional witness or judicial expert is a witness, who by virtue of education, training, skill, or experience, is believed to have expertise and specialised knowledge in a particular subject beyond that of the average person, sufficient that others may officially and legally...
testimony as to whether a child was being harmed but cannot speculate regarding the motive of the caregiver. FII merely refers to the fact that illness is induced or fabricated and does not specifically limit the motives of such acts to a caregiver's need for attention and/or sympathy. There are now more than 2,000 case reports of FII in the professional literature. Reports come from developing countries that include, but are not limited to, Sri Lanka
Sri Lanka
Sri Lanka, officially the Democratic Socialist Republic of Sri Lanka is a country off the southern coast of the Indian subcontinent. Known until 1972 as Ceylon , Sri Lanka is an island surrounded by the Indian Ocean, the Gulf of Mannar and the Palk Strait, and lies in the vicinity of India and the...
, Nigeria
Nigeria
Nigeria , officially the Federal Republic of Nigeria, is a federal constitutional republic comprising 36 states and its Federal Capital Territory, Abuja. The country is located in West Africa and shares land borders with the Republic of Benin in the west, Chad and Cameroon in the east, and Niger in...
, and Oman
Oman
Oman , officially called the Sultanate of Oman , is an Arab state in southwest Asia on the southeast coast of the Arabian Peninsula. It is bordered by the United Arab Emirates to the northwest, Saudi Arabia to the west, and Yemen to the southwest. The coast is formed by the Arabian Sea on the...
. Dr. Meadow was knighted for his work for child protection, though later, his reputation, and consequently the credibility of MSbP, became severely damaged when several convictions of child killing, in which he acted as an expert witness, were overturned.
In 2003, a number of high-profile acquittals brought Meadow's ideas into serious disrepute. Around 250 cases resulting in conviction in which Meadow was an expert witness were reviewed, with few changes. Meadow was investigated by the British
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
General Medical Council
General Medical Council
The General Medical Council registers and regulates doctors practising in the United Kingdom. It has the power to revoke or restrict a doctor's registration if it deems them unfit to practise...
over evidence he gave as an expert witness for the prosecution in the Sally Clark
Sally Clark
Sally Clark was a British solicitor who became the victim of an infamous miscarriage of justice when she was wrongly convicted of the murder of two of her sons in 1999...
trial, where he asserted that the odds of there being two unexplained infant deaths in one family were one in 73 million. That figure was crucial in sending her to jail but was hotly disputed by the Royal Statistical Society
Royal Statistical Society
The Royal Statistical Society is a learned society for statistics and a professional body for statisticians in the UK.-History:It was founded in 1834 as the Statistical Society of London , though a perhaps unrelated London Statistical Society was in existence at least as early as 1824...
, who wrote to the Lord Chancellor to complain. It was subsequently shown that the true odds were much lower, i. e., there was a much higher possibility of two deaths happening as a chance occurrence. In July 2005, the GMC declared Meadow guilty of "serious professional misconduct", and he was struck off the register for giving "misleading" evidence in the Sally Clark case. At appeal, High Court judge Mr. Justice Collins described this as "irrational" and set it aside. Meadow was involved as a prosecution witness in two other high-profile cases resulting in mothers being imprisoned and subsequently cleared of wrongdoing — those of Trupti Patel
Trupti Patel
Trupti Patel is a qualified pharmacist from Berkshire, England, who was acquitted in 2003 of murdering three of her children, Amar , Jamie , and Mia ....
and Angela Cannings
Angela Cannings
Angela Cannings was wrongfully convicted in the UK in 2002 of the murder of her seven-week-old son, Jason, who died in 1991, and of her 18-week-old son Matthew, who died in 1999...
. Collins's judgment raises important points concerning the liability of expert witnesses — his view is that referral to the GMC by the losing side is an unacceptable threat and that only the Court should decide whether its witnesses are seriously deficient and refer them to their professional bodies.
In addition to the controversy surrounding expert witnesses, an article appeared in the forensic literature that detailed legal cases involving controversy surrounding the murder suspect.
The Perri and Lichtenwald article provides a brief review of the research and criminal cases involving Münchausen Syndrome by Proxy in which psychopathic mothers and caregivers were the murderers. This article also briefly describes the importance of gathering behavioral data including observations of the parents who commit the criminal acts and references the 1997 work of Southall, Plunkett, Banks, Falkov, and Samuels.
Legal status in Australia and the UK
In most legal jurisdictions, doctors are only allowed to give evidence in regard to whether the child is being harmed. They are not allowed to give evidence in regard to the motive. Australia and the UK have established the legal precedent that MSbP does not exist as a medico-legal entity.In a June 2004 appeal
Appeal
An appeal is a petition for review of a case that has been decided by a court of law. The petition is made to a higher court for the purpose of overturning the lower court's decision....
hearing, the Supreme Court
Supreme court
A supreme court is the highest court within the hierarchy of many legal jurisdictions. Other descriptions for such courts include court of last resort, instance court, judgment court, high court, or apex court...
of Queensland, Australia, stated:
The Queensland Supreme Court further ruled that the determination of whether or not a defendant had caused intentional harm to a child was a matter for the jury to decide and not for the determination by expert witnesses:
Principles of law and implications for legal processes that may be deduced from these findings are that:
- Any matters brought before a Court of Law should be determined by the facts, not by suppositions attached to a label describing a behavior, i.e., MSBP/FII/FDBP;
- MSBP/FII/FDBP is not a mental disorder (i.e., not defined as such in DSM IV), and the evidence of a psychiatrist should not therefore be admissible;
- MSBP/FII/FDBP has been stated to be a behavior describing a form of child abuseChild abuseChild abuse is the physical, sexual, emotional mistreatment, or neglect of a child. In the United States, the Centers for Disease Control and Prevention and the Department of Children And Families define child maltreatment as any act or series of acts of commission or omission by a parent or...
and not a medical diagnosis of either a parent or a child. A medical practitioner cannot therefore state that a person "suffers" from MSBP/FII/FDBP, and such evidence should also therefore be inadmissible. The evidence of a medical practitioner should be confined to what they observed and heard and what forensic information was found by recognized medical investigative procedures; - A label used to describe a behavior is not helpful in determining guilt and is prejudicial. By applying an ambiguous label of MSBP/FII to a woman is implying guilt without factual supportive and corroborative evidence;
- The assertion that other people may behave in this way, i.e., fabricate and/or induce illness in children to gain attention for themselves (FII/MSBP/FDBY), contained within the label is not factual evidence that this individual has behaved in this way. Again therefore, the application of the label is prejudicial to fairness and a finding based on fact.
The Queensland Judgment was adopted into English law in the High Courts of Justice in Case No. WR03C00142 [A County Council v A Mother and A Father and X,Y,Z children] on 18 January 2005 by Mr. Justice Ryder. In his final conclusions regarding Factitious Disorder, Ryder states that:
In his book Playing Sick (2004), Marc Feldman notes that such findings have been in the minority among U.S. and even Australian courts. Pediatricians and other physicians have banded together to oppose limitations on child-abuse professionals whose work includes FII detection. The April 2007 issue of the journal Pediatrics specifically mentions Meadow as an individual who has been inappropriately maligned.
Münchausen syndrome by proxy involving pets
Medical literature describes a subset of MSbP care-givers, where the proxy is a pet rather than another person. These cases are labeled Münchausen syndrome by proxy: pet (MSbP:P). In these cases, pet owners correspond to care-givers in traditional MSbP presentations involving human proxies. No extensive survey has yet been made of the extant literature, and there has been no speculation as to how closely MSbP:P tracks with human MSbP.In popular culture
The American movie Yes ManYes Man (film)
Yes Man is a 2008 comedy film directed by Peyton Reed, written by Nicholas Stoller, Jarrad Paul and Andrew Mogel and starring Jim Carrey, Zooey Deschanel, Bradley Cooper, John Michael Higgins, Rhys Darby, Maile Flanagan, Danny Masterson, and Terence Stamp...
features a band called Münchausen by Proxy, featuring Zooey Deschanel
Zooey Deschanel
Zooey Claire Deschanel is an American actress, musician, and singer-songwriter. In 1999, Deschanel made her film debut in Mumford, followed by her breakout role as young protagonist William Miller's troubled older sister Anita in Cameron Crowe's 2000 semi-autobiographical film Almost Famous...
's character as lead vocalist.
The novel Sickened: The Memoir of a Munchausen by Proxy Childhood by Julie Gregory
Julie Gregory
Julie Joell Gregory is the author of Sickened: The Memoir of a Munchausen by Proxy Childhood, an autobiographical account of the Munchausen by proxy abuse she suffered as a child.-History :...
details the life of a girl growing up with a Münchausen by Proxy mother, who took her to various doctors, coaching her to act sicker than she was and exaggerating her symptoms, and demanding increasingly invasive procedures to diagnose the girl's imaginary illnesses.
The 1999 film The Sixth Sense portrays Münchausen syndrome by proxy during a scene in which a mother is caught on video adding floor cleaner to her ill daughter's food.
The plot of the 2003 Japanese J-horror film One Missed Call (着信アリ Chakushin ari) revolves around a mother with a case of Münchausen syndrome by proxy.
In "The Calusari" episode of The X-Files
The X-Files (season 2)
The second season of the science fiction television series The X-Files commenced airing on Fox in the United States on September 16, 1994, concluded on the same channel on May 19, 1995, and contained 25 episodes.- Production :...
, Agent Scully initially believes that one of the characters is inducing illness in her grandson and makes reference to Münchausen syndrome by proxy.
See also
- Beverley Allitt
- Sally ClarkSally ClarkSally Clark was a British solicitor who became the victim of an infamous miscarriage of justice when she was wrongly convicted of the murder of two of her sons in 1999...
- Julie GregoryJulie GregoryJulie Joell Gregory is the author of Sickened: The Memoir of a Munchausen by Proxy Childhood, an autobiographical account of the Munchausen by proxy abuse she suffered as a child.-History :...
- Waneta HoytWaneta HoytWaneta Ethel Hoyt was an American serial killer. She was born in Richford, New York and died at the Bedford Hills Correctional Facility for Women....
- Wendi ScottWendi ScottWendi Scott is a Frederick, Maryland mother of two who was charged on November 16, 2007 with sickening her four-year-old daughter in a notable case of Munchausen Syndrome by Proxy....
- David SouthallDavid SouthallProfessor David Southall, OBE, is a UK paediatrician who is a controversial expert in Fabricated or Induced Illness , and who has performed significant research into sudden infant death syndrome....
- Marybeth TinningMarybeth TinningMarybeth Tinning is an American serial killer currently serving a 20 years to life sentence after being convicted of the murder of one of her children. Her case is held to be one of the most extreme cases of Münchausen syndrome by proxy.-Early life:Marybeth Roe was born in Duanesburg, a small town...
- Münchausen by InternetMunchausen by InternetMünchausen by Internet is a pattern of behavior in which Internet users seek attention by feigning illnesses in online venues such as chat rooms, message boards, and Internet Relay Chat . It has been described in medical literature as a manifestation of factitious disorder or factitious disorder by...
- Münchausen syndromeMunchausen syndromeMünchausen syndrome is a psychiatric factitious disorder wherein those affected feign disease, illness, or psychological trauma to draw attention or sympathy to themselves. It is also sometimes known as hospital addiction syndrome or hospital hopper syndrome...
- Mythomania
- Psychosomatic illnessPsychosomatic illnessPsychosomatic medicine is an interdisciplinary medical field studying the relationships of social, psychological, and behavioral factors on bodily processes and well-being in humans and animals...
- Victim playingVictim playingVictim playing is the fabrication of victim-hood for a variety of reasons such as to justify abuse of others, to manipulate others, a coping strategy or attention seeking.-By abusers:...