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FALSE ACCUSATIONS OF
MUNCHAUSEN SYNDROME by
PROXY
presented by Dr Helen Hayward-Brown.

Based in Australia I completed my doctoral research in the social

sciences (interdisciplinary: sociology, anthropology, psychology) on
the subject of false accusations of Munchausen Syndrome by Proxy
(MSBP). Accusations of MSBP have increased in the last ten years
and many mothers are being falsely accused. Many of these
accusations may occur after mothers make complaints about
treatment, when children suffer side-effects from drugs, or when
ex-husbands are accused of sexually abusing their children.
Common patterns in these cases are fabrication of evidence against
mothers, the tampering of files, inaccurate files or mixing of files
with other children, and bad faith allegations following parental
complaints.
If you would like further information or contact, please contact me
on my email address: * email@drhelenhaywardbrown.net.au

DISCLAIMER: All of the material on this site is provided for information

purposes only on false accusations of munchausen syndrome by proxy. You may
download information for your personal use or for non-commercial purposes, but
no modification of the contents is permitted. All original material is copyright by
Dr Helen Hayward-Brown. This internet site may provide links or references to
Munchausen Syndrome by Proxy on other sites originating from other companies,
individuals or organisations, but Dr Helen Hayward-Brown has no responsibility
for the content of such other sites and shall not be liable for any damages or injury
arising from such content. Any links to such other sites are provided merely as a
convenience to the users of this Internet site. Dr Helen Hayward-Brown can take no
responsibility or liability for any errors in or for any omissions from information
you obtain through this website. Any information obtained here is not to be
construed as medical OR legal advice.

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by Proxy

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FALSE AND HIGHLY QUESTIONABLE

ALLEGATIONS OF MUNCHAUSEN
SYNDROME BY PROXY
presented by Dr Helen Hayward-Brown.
This paper was written in 1999 and presented to the 7th Australasian
Child Abuse and Neglect Conference in Perth.
CLICK HERE to download a text copy of this paper.

"Primum non nocere" ("Above All, do no harm")

am a medical anthropologist and my doctoral research, is

concerned with the experiences of parents of children with chronic
illness where there have been difficulties with diagnosis. In the
course of my work, I discovered that many of these parents had
been accused of Munchausen Syndrome by Proxy (MSBP). Briefly,
MSBP purportedly involves a mother deliberately making her child
sick. In other words, these mothers were blamed for their childs
chronic illness. These MSBP allegations were later proven to be
false, appeared to be false, or at the very least were highly
questionable. What then, does a "diagnosis" of MSBP actually
mean? What processes are involved in a "diagnosis"? I shall present
the experiences of these mothers who have been accused of MSBP,
underlining the ramifications of these accusations for the families
involved. Accusations follow a "pathway of suspicion" or may result
from confusion over medical management. In both cases, there is
apparent "certainty" on the part of professionals about the diagnosis.
I shall question this medical certainty and the scientific validity of
MSBP, and in doing so, consider what a "false"diagnosis may
actually mean. Underlining my discussion is a sub-theme - the social
construction of the MSBP diagnosis by medical culture. Is MSBP a
fabrication itself? Perhaps we should consider why the diagnosis of
MSBP has arisen in this context of chronic illness and why women,
rather than men, have been accused. Once accused, how and why
do women resist their diagnosis? What happens to these women?
The strength of these womens resistance is a primary focus of my
paper. I hope to show that a "false diagnosis" of MSBP should be
avoided at all costs.
THE PARENTS IN MY INTERVIEWS
To date, I have engaged in thirty one indepth interviews of parents
(mothers and a few fathers) of children with chronic illness where
there have been difficulties with diagnosis. Of these thirty one
parents, nine were accused or definitively suspected of MSBP.
However, a further five were either referred to psychiatrists or were

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very clearly suspected of MSBP, although this had not been

confirmed by reference to hospital files. This means that
approximately fourteen out of the thirty one parents, nearly half the
parents interviewed, were clearly suspected or accused of MSBP.
Having made this statement, it should be viewed with some caution
and should not be interpreted simplistically, because the collection
of my data was a complex process. I did not initially search for
parents accused, or falsely accused of MSBP. In fact, I was almost
entirely unfamiliar with the concept when I began my research. The
involvement with accusations of MSBP was therefore a process
which evolved during the course of my study, as I discovered
parents who appeared to have been "falsely" accused of the
syndrome. It should be noted at this juncture that my research work
is qualitative, primarily concerned with the experiences of these
parents, rather than quantitative outcomes. Any tables used are for
the express purpose of furthering an understanding of these parental
experiences.
Where did I find the parents to interview? This was mainly a process
of "self-selection". I made contact with parents through local media,
organisations such as AWCH (Association for the Welfare of
Childrens Health), and AHMF (Alison Hunter Memorial
Foundation), "snowballing" and the Internet. As I realised that
MSBP was an issue, I made contact with the M.A.M.A. (Mothers
Against Munchausen by Proxy Allegations) website which originates
in the United States. Over time, the M.A.M.A website gave me
access to mothers accused in Australia. This interest in MSBP
parents did not deter me from making further interviews with other
parents. In this way, further cases came to light, even though I had
not actively sought them out. At this stage it was tempting to
exclude parents who had not been accused of MSBP, however I
concluded that MSBP allegations may be the"extreme" end of a
spectrum of experiences faced by parents and children in these
situations.
These indepth interviews or"narratives" were undertaken in
different States of Australia. However, in order to gain an
international perspective and a deeper understanding of MSBP
issues I utilised telephone, email or personal discussions with
another eighteen parents in Australia, New Zealand, the United
States and the United Kingdom. Of these eighteen parents, fifteen
had been accused or suspected of MSBP. These contacts were not
superficial, but involved intense discussion, often on numerous
occasions. Since the MSBP "diagnosis" had gained momentum
earlier overseas than it had in Australia, due to protagonists in the
U.S. and U.K., these contacts became invaluable.
What concerned the parents about the process of the diagnosis of
MSBP? Most parents showed me evidence of flawed methodology.
Parents spoke about (and usually provided supporting
documentation) of such difficulties as: exclusion of documentation
which supported their innocence, tampering with files,
fabrication of evidence, hearsay evidence in court, intimidation,

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blackmail, inaccurate medical summaries, factual error,

misinterpretation of behaviour, cruelty to the child involved,
withdrawal of treatment, hospital medical errors and
mismanagement, lack of knowledge of overseas expertise or lack
of expertise in the relevant specialty, and attribution of fathers
comments to the mother. It must be emphasised that these
difficulties formed patterns - the same problems appeared repeatedly
in the interviews and discussions I conducted. It became
increasingly clear that these allegations of MSBP were "false" or at
the very least, highly questionable.
Considering the difficulties these parents experienced in the process
of their "diagnosis", it is pertinent at this point to look at the
procedural outcomes for the nine parents who had documented
evidence of the MSBP accusation or suspicion.
Table 1: Nine Families Accused or Suspected (Supported
by Documentation)
Formalisation of Accusations:
Notifications
7
Progression to Court Processes following notification
6
Results of Accusations:
Supervision orders
2
Temp. guardianship lost but rescinded
1
Lost permanent guardianship
3
No action
3

There were complex reasons for the different outcomes for these
mothers. The parents who did not face any further action were
"protected" by committed and extremely supportive paediatricians
in two instances and by an officer of an investigative body in the
third. In other words, it is the "stories" behind these outcomes,
rather than the figures themselves, which are significant.
How are such difficulties created for these parents? What types of
illnesses do their children display? Table 2 below shows the
spectrum of illnesses based on both the indepth interviews and the
additional discussions I held. Some parents had more than one child
who were seen to be "at risk" and the illnesses of some children
overlapped categories. It should be noted that this categorisation is
in many senses "very loose". I found during my research that many
of the childrens difficulties were linked to each other. For example,
severe reflux and "gastro" problems could be found with the
Chronic Fatigue Syndrome children and those with immune
problems. As my interviewing progressed, it was alarming to note
that many of the parents had children who had been extremely
premature. These children therefore started their lives with
difficulties, and parents complained that they were not supported,
but rather criticised and blamed for the childrens problems. The
Yvonne Eldridge case in the U.S. is an example of a mother being
accused of MSBP when the foster babies in her care had clearly

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been shown to suffer from prematurity and/or substance addiction

(Allison and Roberts 1998
Work by Barbara Bryan (NCADRC: National Child Abuse Defense
and Resource Center, Ohio) highlights many illnesses which are
misdiagnosed as MSBP or child abuse. Videos of Expert Witnesses
are provided by this centre to educate professionals and include the
following: Dr. Piero Rinaldo, medical geneticist on IEMs, includes
false "poisoning" and "suffocation" material; Dr. Ian Turnbull,
paediatric neuroradiologist who illustrates disease and genetic
alternatives for apparent presentations of injury, especially to the
head; Dr. Colin Paterson, who looks at genetic and dietary
explanations for "brittle bone" disease and explains how spiral
fracture may not always be indicative of non-accidental injury; Dr
Marvin Miller on "temporary brittle bone" from which a baby may
recover, Dr. Ayub Ommaya and "shaken baby syndrome". In
Australia, Dr. Vera Scheibner, retired research scientist with a
doctorate in Natural Sciences, who acts as an expert witness in
court, indicates that many parents are being falsely accused of
MSBP or "shaken baby syndrome". She states emphatically that the
children may actually be suffering from the ill-effects of
immunisation.
Table 2: Types of Illnesses
1 Congenital disorders
6 Apnoea
ADD (attention deficit
CFS/ "anorexia"
7
disorder
"Immune" problems
2 Tonsils
Pesticide/chemical
4 Nothing
sensitivities
Epilepsy
"Gastro"

2
2
1
2
2

What are the ramifications of false accusations of MSBP? I refer to

these as the "embodied consequences"(Hayward-Brown 1998) as
they involve the day-to-day facts, underlined by the
phenomenological "lived experienced", which involves bodily and
emotional reactions to distress. One immediately clear consequence
is the death or serious illness of the child when it is removed from its
parents. Aligned to this is the maternal and familial deprivation
which occurs as a result, perhaps involving wrongful imprisonment
of the mother. Fear, anxiety, anger and distress were common
long-term inheritances of these painful experiences. One mother I
interviewed attempted suicide on two occasions. When a mother is
suspected of MSBP she is immediately isolated, and support is
withdrawn. As soon as she is suspected she will be treated as guilty
and treatment of her child usually ceases. Even if a child is only
suspected of being "at risk" it may be removed from its parents.
Additionally, a mother may become too terrified to take her child to
the doctor, for fear of being seen as over-protective or over-utilising
hospital services. Doctors use a "snowball" effect to inform each
other of the mothers "problem". Even if the mother is proved

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innocent, it is too late to restore damage to her reputation. I refer to

this as the "closed circuit of doctors". If a doctor speaks out in
favour of a mother, he/she risks conflict with his/her medical
colleagues. Clearly, a final consequence for many families is their
involvement in protracted court cases in an attempt to keep their
children or clear their name, if their child has not already died. This
usually involves great financial and emotional distress. For all
parents, the final embodied consequence is the sense of betrayal
which remains.
I would now like to present a case study, which illustrates the
difficulties parents may face when they are accused or suspected of
MSBP. I shall call this story "Heathers story" although the data has
been confounded to protect the identity of those involved. In
essence, this story is the compilation of a number of stories from
different mothers. The story has been carefully woven together, so
that the credibility of the experiences are not affected in any way.
Let us say that Heathers daughter suffered severe reflux and
"gastro" problems. The story outlines confusion and conflict over
medical management and diagnosis. I could easily have chosen an
example where allegations have been definitively proven to be false,
as in the case of Lorraine, whose son who was later diagnosed with
a chromosomal disorder (Hayward-Brown 1998). However, I have
deliberately chosen an example where the medical issues are more
complex, because it is these situations which often result in "false"
allegations. The parent narratives I heard, with supporting
documentation, told a completely different story to the "official"
medical one. Baldwin (1999) refers to the medical narrative as the
"metanarrative", where a "tactic of narrative privilege" occurs in
relation to parent narrative. Blakemore-Brown (20/20 video n.d.)
also states that because these parents stories are viewed as "lies",
they are never believed. My case study is by necessity a lengthy
one, because I believe that often, although not always, it is the
details of these cases that are significant in gaining a full
understanding of a situation. I would argue that case studies in the
medical literature are often rudimentary.
HEATHERS STORY"IN LUNA PARK: JACK IN THE BOX
FILES AND THE EMOTIONAL ROLLERCOASTER"
Heather is determined to fight what she regards as an issue of
immense injustice in relation to allegations of MSBP. I first
discovered Heathers predicament through the M.A.M.A. website in
the United States. Over time I found three more mothers who had
suffered similar difficulties with the same doctors. Some of these
mothers spoke about other parents who they believed had also been
accused. Heather was initially concerned about whether or not she
could trust me. In fact, I had email contact with Heather over a
number of weeks before she had the courage to give me her name or
any personal details. She has four children and comes from an Israeli
migrant background. We first met in her home in a remote rural
settlement in Victoria. Sitting together on the lounge, we ploughed
our way though her paperwork. Heather has a background in the

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health professions, (unfortunately one of the "symptoms" in the

profile of the MSBP mother), and this knowledge gave her a good
understanding of medical mismanagement issues. Her narrative was
peppered with references to the medical literature to support her
claims. She has been meticulous in her documentation.
Where does Heathers story start? It starts, in fact, with her own
medical history. She suffers from auto-immune disease and had
difficulties with her pregnancy. To avoid early labour she received
treatment with a battery of appropriate drugs . She gave birth
spontaneously, but prematurely. A few hours later her child went
into respiratory distress, would not suck and was severely
hypoglycaemic. The child was put on a drip for ten days and was
tube-fed. Heather herself suffered a slight stroke as a result of the
birth.
How did the child progress? There was some difficulty with weight
gain and at about 4 months of age she developed what Heather
described as a "weird rash" on her face, buttocks and groin, which
was finally attributed to temporary zinc deficiency, after initial
misdiagnosis. Her symptoms included reflux, vomiting and gagging
on feeds. At six months of age the baby was admitted to the local
hospital for tests. These included a barium swallow and a pH probe
which revealed 60% reflux. The difficulties continued, including one
apnoeic episode. Heather complained to me that the specialist who
took over the treatment did not use "conservative" techniques to
control the reflux. Instead, Heather told me that the specialist
"medicalised treatment", instigating naso-gastric feeds and drug
treatment with Cisapride.
Attempts at feeding by mouth were difficult, since by 11 months of
age the child had been continuously tube fed for three months.
Heather alleged that her specialist refused to co-operate with the
speech therapist or dietitian. The episode of apnoea meant that
Heather and Unwin were referred to a surgeon for a fundoplication1.
They indicated that they were not told that this fundoplication could
result in "dumping syndrome". "Dumping syndrome" results from
gastric surgery and is due to rapid transit of food from the stomach
into the small bowel. Additionally, tests such as manometry2 which
would have highlighted her daughters bowel motility disorder were
not performed3.
Heather stated in her complaint to the investigative body that they
specifically told the registrar that they did not wish to have a 360
degree fundoplication. They made this request after seeing the
results of other children in the ward. This request was ignored and a
360 degree fundoplication, rather than a three-quarter, was
performed, Heather once again referred to the medical literature4
and also stated that the vagus nerve was damaged during the
operation, which may increase the likelihood of "dumping
syndrome"5.
What transpired after the operation? Their daughter experienced

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lethargy after eating, blank staring eyes, floppiness, had a tendency

to sleep and would become unconscious, suffered severe diarrhoea,
dry retching, and an aversion to eating food since it produced
abdominal pain. These symptoms are all symptoms of dumping
syndrome, yet dumping syndrome was not diagnosed for 9 months.
Additionally, when diagnosed, Heather said that she was told that
this was a very rare complication, despite medical literature which
states that such a syndrome may develop after Nissen
fundoplication6 and that it is the most common cause of morbidity
after gastric surgery7 with 25-50% of all patients undergoing gastric
surgery suffering some symptom of dumping.
Unfortunately, according to Heather, their specialist decided to insert
a gastrostomy tube8. Heather and Unwin objected to this operation
as they had seen the results of such procedures. She referred me to
medical literature of the time which states that dumping syndrome
can be worsened by the insertion of a gastrostomy tube if the tube is
wrongly inserted9. Heather alleged that the specialist threatened
them and stated that if they did not consent to this operation he
would notify the Department of Social Services. Heather spoke
about her experiences at this time:
Following the insertion of the gastrostomy tube...our lives
became unbearable. Our daughters dumping syndrome
worsened. My life became centred around clearing up her
diarrhoea, listening to her crying with abdominal pain, and
having the continual stress of repeated re-admissions to
hospital.
She stated that instead of removing the tube and commencing an
appropriate diet, the specialist prescribed Octreotide injections twice
a day. These injections were so painful for her to give her child that
she finally refused to give them. Medical literature10 she acquired
pointed to the possibility of exacerbation of diarrhoea with such
medication. The dietitian at the time made notes in the file,
underlining the fact that she was very concerned about the fact that
the child was not obtaining the required calories.
The specialists response to the childs deteriorating condition was to
insert a naso-jejunal tube11. Heather once again pointed to medical
literature12 which shows that such insertion would be
contraindicated, since there is duodenal feedback inhibition of
gastric emptying after bypass of the duodenum with gastrojejunostomy tube. The childs dumping syndrome worsened.
Furious about what they saw as medical mismanagement, Heather
and Unwin consulted with another specialist at the same hospital,
who instigated a diet for their daughter. After removal of the
gastrostomy tube, they were now expected to feed their daughter,
despite the fact that she had not effectively eaten any solid food for
three years. According to Heather, this new specialist insisted that
the child did not have dumping syndrome, later contradicting himself

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and saying that he knew nothing about dumping syndrome. Heather

and Unwin now requested a full review of their daughters care over
the previous years. They also wished to instigate a further review by
a specialist at another hospital. She stated:
I actually threatened the hospital and told them the deep shit
they were in, two days later they held a child protection
meeting, ten days after filling in a child disability form.
Heather had been accused of Munchausen Syndrome by Proxy. In
fact, Heather had advised the hospital that she was going to make a
complaint about her daughters medical management. She
commented:
What they did, they said, if we formalise our complaint with
the investigative body that they would put in a notification to
Community Services about us.
Heather alleged that a notification was made after they put in an
official complaint to the investigative body, who immediately
organised a review of the child at a new hospital. According to
Heather, this new doctor alluded to the fact that he did not agree
with the childs management. He stopped use of Senakot which
Heather said he felt could result in damage to the nerves of the
bowel. A gastric scintigraphy test13 instigated by this new doctor
showed gross abnormality. The conclusion was "mild dumping
syndrome" and the recommendation was dietary measures, (low in
carbohydrates/sugar, high in fat, and low in GI factors) which were
different to those instigated at the original hospital.
Experiences from the original hospital continued to "haunt" her and
confuse issues. For example, Heather spoke about endocrine tests
which were undertaken. She showed me copies of the results of
these tests which showed abnormality. She commented:
They do these endocrine tests and my daughter passed out and
went unconscious, all her insulin and blood sugar levels and
all of these things were grossly abnormal, and all of this was
witnessed by the clinical nurse specialist, the registrar, the
specialist etc but in our child protection file all the results
were normal, she didnt pass out, nobody witnessed anything.
She proceeded to show me her copy of the child protection file from
the original hospital. She showed how entries appeared to have been
made later, squeezed in or on the backs of pages, in different writing
to the original statements. They were not signed. She made further
comment about the child protection file:
It actually says in the notification that the child protection unit
has been involved with my family for years. Now I have never

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met anybody from the child protection unit..

Heather had been seen by a psychiatrist at the original hospital who
had stated that she "had no concerns" about Heather. The
psychiatrists from the child protection units at both hospitals had not
seen her. Much later, Heather was referred to a psychiatrist on the
Child Protection Team for an "independent" assessment. She refused
to comply with this request. On one occasion the doctors attempted
to have her "diagnosed" by an expert from overseas, by mail. This
expert was sent documentation about Heather and her daughter,
which excluded information from a psychiatrist who was fully
supportive of Heather. Heather said that the doctors and community
services were not interested in her daughter, and never asked about
her welfare. In fact, she stated that community services had never
even seen her or her daughter, despite the notification. As she said,
if she really did have MSBP, why had they left the child in her care
for at least eighteen months without seeing her? However Heather
said that Community Services did pursue other avenues for
acquiring information, for example, she showed me a letter
requesting access to her Medicare files, so that they could see how
many times she had visited doctors.
Heather was also accused of removing her daughters tube. She
commented:
My daughters gastrostomy tube fell out when she was over
there, and I was over there [pointing quite a long distance to
other side of room], and I was physically talking to this doctor,
my daughter was like over there, near that door, and this
doctor, I said, please, can you tell them that I was talking to
you and he refused. And I thought, you arse-hole.
Despite the fact that this doctor initially diagnosed her daughter with
polyarthritis, Heather alleged that it later appeared that somebody
had withdrawn this diagnosis, despite a history of red, inflamed and
swollen joints, with abnormal blood tests. Heather had also been
accused of overdosing her daughter with a drug. She showed me the
hospital file which recorded that the hospital had ordered this dosage
and there was no way she could have obtained such large amounts
of the drug anyway. Additionally, Heather was accused of being
"over-familiar" with staff, using their first names, despite the fact
that she had been introduced to the staff in this way.
Over a number of months Heather became increasingly worried
about the care her daughter was receiving at the new hospital. She
became concerned that documents from the original hospital, stating
that she was suspected of MSBP, had been forwarded to the new
hospital. This was confirmed when a doctor would not giver her
daughter treatment, "in case she had Munchausens". She was
amazed by these views, particularly in the light of her daughters
recent weight gain when the new diet was instigated (see chart).
Heather felt that her child had been left without adequate hospital

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treatment, and she could only rely on her local GP, who had always
been fully supportive but felt increasingly under threat. At this time
Heather told me that her GP and an officer of the investigative body
both verified and confirmed that the medical history from the
original hospital was inaccurate, "falsified" and misleading.
However, Heather was feeling a lot safer because she had received
and signed the list of questions which were to form the basis of an
investigation into her diagnosis of MSBP:

1.
2.

3.

4.

5.

6.

7.

8.

On what information did the doctors

base their diagnosis of MSBP?
What was the basis for the shift in the
diagnosis of MSBP from a differential
diagnosis (i.e. query possible MSBP) to
MSBP as the basis for a child protection
notification?
Was the notification made in an attempt
to intimidate you not to complain about
medical treatment?
Did Dr. ( ) threaten you that he would
make a notification to Community
Services?
Did the supporting documents for the
notification exclude documents on the
hospital file which conflicted with a
diagnosis of MSBP?
Was the notification made after your
daughter left the care of the original
hospital?
Was the notification made without any
reference to the current treatment team
at the new hospital?
Did Dr.( ) provide "new evidence" to
Community Services concerning the
notification when he had not seen your
daughter for one year?

Despite the fact that she signed this document, a few weeks later she
told me that she was informed, verbally, that the questions forming
the investigation had been changed. In effect, she said that they had
been completely "watered down". Heather was shattered, concerned
that her child may be removed after the "investigation".
Additionally, a lengthy document which she lodged in relation to
medical mismanagement was assessed by a general paediatrician,
rather than a gastroenterologist, and it was dismissed.
Heather made it clear to me that nobody would take responsibility
for her situation. She spoke about how investigative bodies and
departments "bounced" her backwards and forwards. During this

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time, her file at community services was open, shut and suspended
like a jack in the box. She made the following comment:
The reality is no-one gives a damn about our family. As has
been pointed out several times to me, this was never about my
daughter. It was about power and me attacking the system.
At this time, Heather is still in a state of "flux". She stated that
Community Services wished to do some sort of deal with her - if she
signed certain documents, then they would close the file on her. She
has refused to do so. She frequently stated to me that her
experiences had completely changed the way she viewed the world,
that she had in fact become something of an "anarchist". She
commented:
I feel that I have been emotionally raped and my trust in
people, that I dont know very well, is practically
non-existent.
WHAT IS THIS "DIAGNOSIS" OF MSBP?
As can be seen, Heathers story raises many issues about the
diagnosis of MSBP. Definitions of the "diagnosis" vary widely and
are hotly debated in the medical literature. My research showed that
other labels were often used in conjunction with the MSBP
diagnosis, or as similar alternatives, some directed at the parents,
and some directed at the child. These labels include: somatisation
disorder, abnormal illness behaviour, folie a deux, pervasive refusal
syndrome and hysteria. For example, Donald and Jureidini (1996)
state that somatoform disorder will "raise the index of suspicion for
MSBP". These "illnesses" are seen by the medical profession to be
the result of "over-protective" or "helicopter" (Feldman and Ford
1994:152) parents. This is the driving force behind the "diagnosis". I
argue elsewhere (Hayward-Brown 1998) that this emphasis on the
"over-protective" parent has arisen from psychologys emphasis on
the development of an individual identity, rather than a
phenomenological understanding such as that put forward by
Merleau-Ponty (1962/1964), who suggests that when love is
concerned, identities may merge.
Should the diagnosis of MSBP be used at all? Of concern is the fact
that some practitioners suggest that "exaggerating" a childs
symptoms is all that is needed for a MSBP diagnosis. Whilst it is
clear that some parents do harm their children, it may be more
prudent to follow Morleys (1995:529) suggestion that the MSBP
label be discarded. He suggests that a practitioner should simply
indicate what he feels may be occurring - if it is poisoning or
suffocation, call it that. Nevertheless, there are potential difficulties
with this procedure also. For example, Bryan (pers. comm) suggests
that many IEMS (inborn errors of metabolism) present as
suffocation or poisoning. Additionally, this may change the way a

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mother may be viewed by the law, for example, in relation to murder

vs. manslaughter.
Paediatric versus Psychiatric "Diagnosis" and Links with
"Diagnosis by Immaculate Perception"14
Meadow was the first practitioner, in 1977, to use the term
"Munchausen Syndrome by Proxy". For medical professionals such
as Meadow and Southall in the UK, the "diagnosis" of MSBP is a
"paediatric" one. MSBP is therefore often interpreted as "child
abuse" and a psychiatric diagnosis of the mother is given low
priority. But how can we consider the childs condition, without
reference to the mothers behaviour? Unfortunately the emphasis on
the child leads to "diagnoses" where the mother may not be
interviewed. It also leads to diagnoses which may exclude genetic
and other factors.
In the U.S., the "diagnosis" is seen as a psychiatric one, led by
practitioners such as Schreier and Feldman. The mother is diagnosed
with a mental illness. According to Schreier (1993) the mother
wishes to gain attention from her doctor (1993). According to Rand
and Feldman (1999), the mother wishes to experience the rewards of
"the sick role". For Donald and Jureidini (1996) the mother
continues a "pathologic relationship" with the medical profession.
Despite the focus on the mother, interviews may still not be
conducted with the mother. For example, Schreier testified in the
Storck case that it was not important to interview Mrs. Storck [He
offered that such an interview would have served no useful clinical
purpose since he] cannot discern from parent interviews who is
telling the truth and who is not" (Bergeron 1996).
The medical profession have moved to change the label a number of
times, for example to factitious disorder by proxy, and this further
complicates issues. In Australia the diagnosis "flits" from the
paediatric to the psychiatric. If a parent receives a psychiatric report
refuting MSBP, then this report is deemed "irrelevant" - the
diagnosis "turns" into a paediatric one, despite the fact that the
psychiatrists report was requested by the doctors in the first place.
This occurred with Rebecca and Charles. As an example of
confusion with the "psychiatric" versus "paediatric, I refer to a
paediatric psychiatrists evidence in court which I attended. This
practitioner referred to Meadow and the fact that the diagnosis was
a paediatric one. His evidence centred on the child and the foster
mother who was given glowing reports. However, at the end of his
evidence he made the following statement, directed at the accused
mother: "Other people may see your composure in court as a
strength, but I see it as further evidence of your disassociation".
Clearly, a psychiatric evaluation of the mother, yet he had never
consulted with her and had only seen her on one previous occasion
in court. He had never spoken with her.
The issue of consultation is a critical one. Two of the mothers I
interviewed, Narelle and Fiona, were "diagnosed" by email/mail.

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Fiona was initially diagnosed in this way, despite the fact that the
evidence of her psychiatrist, pointing clearly to her innocence, was
removed from the documents when they were first sent for
"overseas expert opinion". Many of the parents I interviewed
referred to the fact that diagnoses were made without the
practitioner meeting them, and in some cases, their children. This is
such a common practice that it is now referred to by activists as
"diagnosis by immaculate perception"or "Munchausen Syndrome by
Proxy by Proxy". Despite the fact that the American Medical
Association has recently condemned prescribing of medication over
the Internet, without face to face consultation, similar practices with
MSBP continue. It may be related to assertions such as those made
by Donald and Jureidini (1996) that medical practitioners who have
had long-term involvement with families are deceived by these
mothers, and are therefore "colluding" with them. They suggest that
these medical professionals are guilty of generating and maintaining
MSBP. A number of parents also asserted that community services
had opened a file on them, yet they had never met with the family.
Morley (1995:529) shows concern about lack of thorough medical
consultation with the mother in these cases, who are then confronted
with a MSBP allegation. He refers to this behaviour as
"indefensible".
Is the MSBP Diagnosis Scientifically Valid?
The MSBP "diagnosis" is a "research" diagnosis only. It is not a
definitive category in the DSM IV (1994 ref), only appearing in the
appendix. It is a recent and extremely controversial diagnosis
(Allison and Roberts 1998).
The lack of scientific credibility of the diagnosis can be seen by
recent court outcomes in the United States. A number of courts have
ruled that the use of the MSBP diagnosis is not admissible in court.
These include Martinez v. United States of America, State v.
Lumbrera, and Commonwealth v. Robinson. Presently, in the matter
of the State of Florida v Kathleen Bush, the same argument is being
put forward. In fact, it is argued in these submissions that MSBP,
since it is an "emotional topic" is "unfairly prejudicial". For example,
medical professionals may refer to their experiences with previous
childrens deaths and use "melodramatic" evidence of "death rates",
based on statistics which are debated in the literature, but presented
in evidence as "fact". Baldwin (1999) would argue that such
"statistics" are socially constructed into "facts".
It is argued in these cases that expert testimony in relation to MSBP
is unreliable. I am not a lawyer, and would be extremely wary about
making more than brief remarks about such issues. I can only outline
what I have gleaned from documents tendered to courts. These
documents state that according to the US Federal Rule of Evidence
702, the presentation of "expert testimony" should be on the basis of
"scientific, technical or other specialised knowledge". It is further
argued that an expert testimony must "rest on a reliable foundation",
(according to Daubert v Merrell Dow Pharm Inc.) and therefore

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MSBP cannot be covered by this criteria. Daubert provides a five

factor non-exclusive test: 1: whether the experts theory can be or
has been tested, 2: whether the theory has been subject to peer
review and publication 3: the known or potential rate of error of a
technique or theory, 4: the existence and maintenance of standards
and controls and 5: the degree to which the technique or theory has
been generally accepted. In Australia The Rules of Evidence Act is
extremely complex. I can only comment that it appears that the
probative value of expert testimony (and the MSBP label) must be
weighed against the prejudicial effect.
It is the issue of profiling which I argue is extremely prejudicial and
inaccurate. It also lacks scientific validity. The M.A.M.A. website
lists the "characteristics" which supposedly "alert" a medical
practitioner to MSBP and which comprise the "profile" of a MSBP
parent. This "profile" and list of MSBP indicators is being used by
medical practitioners to hastily condemn women. For example,
Jureidini (1996) and Feldman and Ford (1994) suggest that it is best
to act quickly, gathering evidence later. The list provided in 3 table
below is not exhaustive. For further details, refer to Baldwin (1996)
where the paradoxical nature of these lists is highlighted. For
example, over-concern, but also lack of concern, overly
co-operative behaviour with medics, versus non-compliance with
medics, confession versus denial. Of particular concern for Morley
(1995) is the fact that doctors engage in "blackmail". Mothers are
told that they have to confess to MSBP or they are unlikely to have
their children back. Mart (1999) also raises the notion of the "antiprofile". He asserts that the opposite of the behaviours listed would
be far more abnormal than the profile behaviours. Similarly, Allison
and Roberts (1998) raise issues of concern about the use of
"syndrome" in "psychological" diagnoses. They (1998:140) point out
that the medicopsychiatric definition of syndrome is far too broad
and "given to a considerable amount of vagueness", based on a
"cluster of symptoms".
I would argue that the "existence" and "reality" of MSBP has been
"constructed" in the medical literature. Literature is often based on
secondary rather than primary evidence, (as in the case of
Rosenberg 1987) or it relies heavily on previous papers. Allison and
Roberts (1998) refer to the "recursivity" of the literature, indicating
that if enough papers speak about the existence of MSBP, then it is
seen by the medical profession to be a reality. Additionally, the
medical literature may include mistakes. For example, certain
"expert" papers have been shown to include parents (as guilty of
MSBP) who were"cleared" of MSBP before the papers were
published. The epidemiology or statistics based on these papers
would therefore be flawed. Also constructed is the persona of
mothers as "dangerous" - they are dehumanised and referred to as
"perpetrators" of "crimes". The literature is patronising and
misogynist, with commodification of women a key element in the
quest for "sales" of texts. MSBP is "romanticised" and
"sensationalised" with texts displaying visual features of women
"screaming" or out of control, or languishing, neurotic and hysterical

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in"Victorian-style".
Table 3: MSBP Profile/Indicators
(References: MAMA website, Baldwin 1996, Morley 1995)

Symptom

Difficulty

Unexplained medical
problems

Assumes medical
knowledge is finite

Knowledge of medical
terminology

Fits all intelligent,

concerned parents,
informed by their doctors

Highly attentive parent

Any parent of sick child

will be anxious

Neglectful parent

Schreier example: "parents

having coffee"

Angry/hostile parent

Doctors dont listen to

parent, parent becomes
hostile, interpreted as
MSBP

Child gets better away

from mother

Many illnesses
spontaneously resolve. If
child dies or becomes
sicker this proves mothers
innocence.

Mother has suffered

similar illnesses

Ignores genetics

History of allergies

Ignores current research

and chemical sensitivities

Mother has marital

difficulties, father
absent

Fits many parents

Further calamities such

as fire, accidents

Fits many families

Silences women from

Insatiable need for
adulation as parent and going to media
public acknowledgment
Networking with other
mothers

Finding support for false

accusations, means of
silencing women

NOTIONS OF DANGER: WHY WOMEN? WHY MSBP?

At this stage of my paper, I am returning to my anthropological roots
in order to understand what is happening to these women. Why have
they been involved in processes so clearly prejudicial? I see the
concept of ambiguity, as raised by Mary Douglas (1966) is

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significant in relation to MSBP and notions of danger. Shilling

(1993:72-3) states that her work shows how the social body
constrains how the physical body is perceived and experienced.
According to Douglas, individuals of marginal status are attributed
with danger and pollution. In this way, mothers of children with
illness which has been difficult to diagnose, are "ambiguous", and
therefore they are seen as threatening by the medical profession.
Douglas suggests that the concept of "danger" has more recently
been replaced with the more neutral term "risk", however I argue
that in relation to MSBP there has been a resurgence of the concept
of danger. Baldwin (1999) takes up the issue of danger, stating that
there are two aspects of danger in relation to MSBP: the
free-floating notion of danger in relation to the childs safety, and
the pathology of individuals. He states that these pervade the
medical literature.
Foucaults notion of "the dangerous individual" is of significance in
relation to MSBP. He refers to the upsurge of a new mental illness in
the 1830s, at the time psychiatry was seeking to establish itself as a
science. This illness was "monomania", a one-off madness in an
otherwise sane person which results in homicide. It was therefore an
invisible form of insanity, and it occurred in the domestic setting.
Psychiatrists were used as expert witnesses in courts to determine
whether an individual suffered from this mental illness or not. The
medical profession became protectors of "the public hygiene".
However, this diagnosis could not be sustained and its diagnosis
ceased around 1870 (Kritzman 1988:133). It can be seen that there
are many parallels with the recent upsurge in accusations of MSBP.
In particular, it is seen as an "invisible" illness. Schreier (1993)
emphasises that these women are "imposturing", posing as sane,
caring and articulate mothers. Caroline Knowles (1996) extends
Foucauldian notions of the dangerous individual in her notion of the
family as a site of danger from the late 1980s. It is no longer seen as
a place of refuge.
Why then are the mothers accused, rather than the fathers? Aligned
to this notion of ambiguous individuals as polluted, is the notion that
women are regarded as polluted and threatening, rather than men.
Turner (1987:85) states that "throughout history womens bodies
have been treated as especially threatening". The female body is a
metaphor of social relations. It is no surprise then, that women are
seen to be the "perpetrators" of this crime in 95% of cases (Schreier
1993:7). Additionally, women have historically been treated in a
discriminatory way by the psychiatric professions (Pringle 1998,
Pilgrim and Rogers 1993), which had its impetus in the concept of
women and "hysteria". During the course of my research, I realised
that the experiences of these women were similar to witchunts.
Allison and Roberts (1998) also refer to these similarities and state
that many of the signs and symptoms of witches were related to their
power to cause strange behaviour in children. All the women stated
that they were "doomed if they do" and "doomed if they dont" in
relation to the way their behaviour was interpreted. Baldwin (1999)
refers to this as "double-binding". The insistence on the use of a

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"profile" and the fact that the women are simply not believed, means
that it is impossible for them to fight this label of MSBP. How then,
can women show that they are innocent?
THE NOTION OF "FALSE"
When we speak about the notion of "false" allegations of MSBP we
are actually considering two issues. First, the diagnosis itself may not
exist - it may be a social construct without scientific basis. So how
can a parent prove their innocence of an entity which in effect does
not exist? Second, as soon as the notion of "false" allegations is
raised, the onus is to "prove" that the parent is innocent. Perhaps
this needs to be reversed. How can the medical profession prove
that a MSBP diagnosis is indeed positive? In my interaction with
parents it generally became very clear that there was no concrete
evidence for the MSBP allegation. Therefore, the MSBP allegation
itself was never definitively established, it was based on what I
regard as flimsy "probabilities" and the technique of "profiling". I
spent many hours with these women, generally on a repeated
number of occasions, over many months or years. I studied their
documentation, much of which had been excluded from medical
opinion or excluded from the court process. In other words, I have
spent far more time with these mothers than the doctors making the
diagnoses, and I have had access to all documentation. Additionally,
I found that the mothers and fathers rarely erred in their stories.
They did not contradict themselves and whenever I found it
necessary to make "checks", these nearly always fell into place.
If we consider statistics in relation to reports of child abuse, in 1997
in the U.K. (govt statistics), there were 65,000 reports of alleged
child abuse of which less than 25,000 were found to have sufficient
substance for the children to be placed on the Child Protection
Register. Similarly in the U.S. in the same year, there were 3 million
reports of child abuse of which less than 900,000 had any substance
according to U.S.A. Department of Health and Human Services
(Pragnell: pers. comm). This means that approximately two-thirds of
these child abuse reports have been unsubstantiated. In Australia, in
the calendar year 1997/98, there were 110,200 notifications. Of
these, 26,025 were found to be substantiated (Aust. Institute of
Health and Welfare). This means that approximately three-quarters
of child abuse reports in Australia were not substantiated. What is
particularly sobering about these statistics is the fact that parents
accused of MSBP face a triple jeopardy: the accusation itself, the
emotional prejudice which comes with it (making it difficult to prove
ones innocence) and very often the withdrawal of medical
treatment for their child.
Is there any indication of how many MSBP allegations are made and
how many may be "false"? It is difficult to know, since clear records
do not seem to be kept. For example, there is no "coding" for MSBP
by the N.S.W. Department of Community Services. We do not know
how many MSBP notifications are made, and how many are
substantiated or not. However, we may look to the work of Eric

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Mart (1999)for some indications in this regard. He states that

Factitious Disorder by Proxy is particularly prone to overdiagnosis
and that rare disorders are very likely to be overdiagnosed. He states
there is no concrete evidence to show that Factitious Disorder by
Proxy is anything except rare. To suggest otherwise, according to
Mart, is a bit like the familiar riddle "How many undiscovered
islands are there in the Pacific Ocean?"
How do these accusations or suspicions occur? There appears to be
a culture of what I refer to as "certainty of doubt of parents" in the
medical and social worker professions. Parents may be fast-tracked
along a "pathway of suspicion". Baldwin (1999) refers to "triggers"
for such suspicions, such as custody disputes, medical disputes, and
failure to diagnose an illness. Allegations, grounded in suspicion, are
often based in emotion, and may even be quite illogical. The
"certainty of doubt" assures the practitioner excessive confidence in
his/her own abilities as a practitioner, sometimes culminating in
medical and emotional abuse.
Examples of such confidence can easily be found. High-profile
practitioners such as Prof. Southall seem to believe that they do not
make mistakes in diagnosing MSBP (20/20 Lies, Lies and Diagnoses
video clip). In fact, Southall states that he believes he makes
mistakes in the opposite manner - missing further cases. A further
example of this "certainty of doubt" of parents, and certainty about
ones own practitioner skills, is demonstrated by Baldwin (1999). He
refers to a case where the parents were charged with MSBP. A
post-mortem showed the daughter had died from a degenerative
muscle disorder. Baldwin states that the paediatrician "refused to
believe the post-mortem results, stating that if indeed it was that
particular disorder, he would have found it". Such certainty leads to
parents being pursued, even if found innocent in court. One parent,
Deborah, referred to this as the "Rottweiler syndrome", where
doctors pursue mothers, even internationally.
Similarly, there may be an assumption of "guilt". For example, the
belief that the Cleveland Affair in the UK, exposed by social worker
Charles Pragnell, was not scandalous, and that most of the parents
were in fact guilty of sexual abuse. These views are held despite the
fact that Pragnells findings were supported by the Butler-Sloss
Inquiry (pers. com) and there is no definitive evidence to the
contrary. Against such certainty, how does a parent prove their
innocence? Diagnoses such as MSBP are "closed diagnoses" (Reid
1999), once they have been said about a parent, it is almost
impossible to prove ones innocence. Baldwin (1999) refers to this
as a "trajectory" which the parent cannot unwind, even in the face
of contradictory evidence.
How does the suspicion progress? I argue in my doctoral thesis that
the process of suspicion occurs due to the dismissal of emotional
distress of parents when their children are ill, and medical training
for lack of compassion. My research data show the path of suspicion
may involve the following steps: blaming parents and making

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hasty, ill-informed moral judgements, dismissal of clear organic

symptoms, trivialisation of symptoms, withdrawal of care for the
child and medical neglect, communication and listening
difficulties, hasty diagnosis, blaming "the mind", patronising of
parents, interpretation and misinterpretation presented as fact,
judgements about family coping mechanisms, and recruitment
drives of doctors into the MSBP diagnosis.
Despite such attitudes of certainty and suspicion, some practitioners
such as Rand and Feldman (1999) are now acknowledging the
possibility of false accusations. However, I argue that they
erroneously cling to the idea that these mistakes are few and far
between.
Despite the fact that most diagnoses of MSBP are highly subjective
and based on flimsy evidence, practitioners believe strongly in the
cases they diagnose. This means that medical practitioners set
themselves up as the arbiters between the "real" cases and the ones
that may have been "false". I would argue that perhaps most of them
may be false and that medical practitioners may rarely diagnose
"positive" cases accurately. This means that mothers who are "real"
in Rand and Feldmans view, but who may actually be innocent, will
find it even more difficult to prove their innocence if MSBP is given
scientific reification. In other words, in trying to highlight a few
"false" diagnoses, the so-called "real" diagnoses are given
heightened scientific credibility. Subjective diagnoses are made into
"scientific fact".
RESISTANCE: "GOOD FAITH" AND "BAD FAITH"
The process of suspicion may not occur at all. In some cases the
allegation of MSBP does not appear to be based in suspicion or
certainty of doubt, rather it appears to be based on "retaliation" and
"silencing". In essence, what we are speaking about here are "good
faith" allegations versus "bad faith" allegations. However, a
post-structuralist perspective would not dichotomise in this polarised
manner . There may be a merging of "good faith" and "bad faith" at
various times. How do women resist such a subjective "diagnosis"?
Certainly resistance plays a definitive role when mothers believe
that the allegations made against them are vexatious, or at least
contain elements of "retaliation", as the mother progresses down the
"trajectory" of the MSBP allegation. "Heather", in my case study,
regarded herself as having been accused in a vexatious manner. She
resisted her accusation vigorously and began to regard herself as the
Australian version of Patty Ames in the U.K. In Pattys case, it
seemed as if she was projected along a "trajectory" which had its
origins in a bitter custody dispute in the United States and which
later developed "retaliatory" elements.
(at present parents have requested that this paragraph not be placed
on the web)
RESISTANCE AND INVESTIGATIONS

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Against almost overwhelming odds, many mothers have continued in

their resistance against allegations. As well as fighting to regain
custody of their own children, they have actively been involved in
making sure that other women have been protected. The resistance
of mothers against false allegations is a resistance based in emotion,
refuting Foucauldian concepts of passivity and lack of resistance in
the post-modern world. Foucault neglects to consider emotion,
perhaps because his arguments are not based on primary research.
Nearly all the mothers I spoke with who had been accused of MSBP
were extremely assertive women who questioned doctors. A major
proponent of MSBP in the U.S., Dr. Herbert Schreier (1993), states,
"early on we recognised that these women were not wholly passive
in their interactions with the medical profession"! Donald and
Jureidini (1996) also show concern about the mother holding "the
upper hand in the struggle to remain in control".
Recently, investigations into the practices of certain doctors and the
diagnosis of MSBP have been instigated in a number of states and
countries, spearheaded by women falsely accused and other
interested parties. For example, in Australia I know of two
investigative bodies who are proceeding with investigations after
consideration of complaints from parents. However, the efficacy of
these "investigations" is difficult to determine. The Public Interest
Advocacy Centre in Sydney has also instigated an investigation into
the diagnosis of MSBP and the process of notification to community
services.
In the U.K., complaints about Prof. Southall and MSBP are being
investigated by the independent Griffiths inquiry. These inquiries are
considering some of the following issues: Diagnoses of MSBP;
experiments with premature babies, and the use of a specific
ventilator for premature babies. Prof. Southall has allegedly agreed
to withdraw from current child protection work whilst the
investigations are proceeding. The 20/20 video by reporter
Genevieve Westcott highlighted difficulties with false allegations in
the U.K and it now appears that 5 families have proceeded with
legal action (Morgan:pers.comm). In the last few weeks, the Royal
College of Paediatrics and Child Health (RCPCH) in the U.K. has
recommended to its council that guidance should be issued to
members on how to deal with people who are suspected of MSBP.
The RCPCH which has conducted a detailed survey into the extent
of diagnosed MSBP cases, say that because the condition is rare,
doctors need help in identifying it correctly (BBC 1999).
Additionally the British Medical Council has received complaints
about false allegations of MSBP from at least ten parents and
Staffordshire police are investigating parent complaints over
"consent" to medical trials with premature babies.
Patty Ames has placed a complaint against a practitioner with a
State Medical Board in the U.S., with mixed results, as has Ellen
Storck. Patty Ames has also filed a complaint with the relevant State
Attorney General. I have documentary evidence of one practitioner

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failing to appear in court as a witness. Other families in the U.S.

have successfully sued doctors and community services, for example
in the case of Angela Cochrane. A number of families are currently
suing Vanderbilt hospital including the Patricks (owners of the
M.A.M.A.website) and three families (Wise, Evans and Neeson)
have apparently successfully won suits against UCLA hospital.
RESISTANCE AND PUNISHMENT
According to the parents I spoke with, there has been "retaliation"
for bringing these issues to the attention of the public. For example,
in the U.K., Ms. Penny Mellor, advocate of mothers falsely accused
of MSBP and one of the researchers involved in U.K. investigations,
has been arrested on two occasions, her computer and other
documents being seized without warrant. Families involved in giving
evidence in the Griffiths inquiry have also had their homes raided.
Journalist Brian Morgan has been arrested and charged as an
"accomplice in kidnapping" (pers. comm).
Other parents, not "activists", also spoke about the discriminating
manner in which they were treated - the trajectory of doubt,
certainty and suspicion leading to prejudicial and distressing
outcomes for parents. Connections between MSBP allegations and
punishment in the medical profession are raised by Allison and
Roberts (1998:84). They refer to rapid cultural changes within the
medical profession during the 100 year period between publication
of Cheynes (1733) The English Malady and Gavins (1838) On the
Feigned and Factitious Diseases. They suggest that British
medicine became less tolerant of disorders that appeared to be
fabricated. Allison and Roberts refer to Gavins text as the "official
bible, the nascent DSM, of this newly punitive medical era". His text
is seen by Allison and Roberts as allowing medicines primary
concern of healing the sick to become one of detection and
punishment (87). This punishment involved coercion, torture and
terror in order to get a forced confession from the patient (90). The
intense focus on "eliciting a confession" from MSBP mothers is
similar to this process. The more the mother vehemently denies she
is guilty, the more the medical profession insist that this is simply a
symptom of her guilt and deception. How would an innocent person
respond? The work of Foucault is insightful here. He illustrates
increasing invisible surveillance in the post-modern world,
highlighted in his text Discipline and Punish (1977). The
Panopticon, an architectural design of a prison or hospital, illustrates
this disciplinary form of power. Most parents I interviewed who had
been accused or suspected spoke about both surveillance and
deception in the process of their MSBP allegation. However, I would
argue that Foucaults disciplinary form of power is too sanitised a
notion for the parents accused of MSBP. In reality, it is a form of
"sovereign" power, where punishment is overt and public
humiliation occurs. It is a form of "power" which is extremely
difficult to resist.
If parents are harming their children, then a child needs to be

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protected. However, it is not ethical to hastily accuse parents, using

non-transparent and unaccountable methods. It is not acceptable to
simply state that this is "child abuse", which may somehow justify
false allegations and deception. Every attempt must be made to
protect parents from such situations. The MSBP "diagnosis" is
questionable in regards to scientific validity, and is highly prejudicial
to the mother. I argue that many accusations of MSBP are either
false or highly questionable, causing grievous damage to families. I
found that it was the data from the medical professions, rather than
the parents, which did not hold up to intense scrutiny. I found that it
was the behaviour and procedures of the professionals, rather than
the families, which was unacceptable. As one mother, Rebecca,
stated to me, about the doctors involved with her family, "its as if
they arent even human".
*****
1. Fundoplication - mobilisation of lower end of the esophagus and plication of the
fundus of the stomach around it (fundic wrapping) in treatment of reflux esophagitis
2.Manometry - the measurement of pressure by a manometer
3. Whaley and Wong (1991) Nursing Care of Infants and Children pp1499-1501,
Maurer, H. (ed) ?(1983) Paediatrics pp507-8, and Hutson, Beasley and Woodward
(1992) pp 119-20
4. Nixon and ODonnell (1992) The Essentials of Paediatric Surgery (pp119-122)
insist that a wrap should be loose and for this reason a three quarter wrap is
preferred by some surgeons.
5. Lavine, J Hattner, R and Heyman, M (1988) Dumping in Infancy Diagnosed by
Radionuclide Gastric Emptying Technique in Journal of Pediatric
Gastroenterology and Nutrition: 7:614-618.
6. Ibid , p614-618
7. Carvajal, S and Mulvihill, S (1994) Postgastrectomy Syndromes: Dumping and
Diarrhea in Gastroenterology Clinics of North America Vol. 23 no. 2
June:261-271
8. Gastrostomy - surgical creation of an artificial opening into the stomach.
9. Lavine et al 1988 op cit, p615
10. Conelius et al. (1993) Octreotide: A Long Acting Somatostatin Analog in the
Management of Post-operative Dumping Syndrome, Digestive Diseases and
Sciences Vol. 38 No. 2 February p362
11. naso-jejunal tube - a tube is placed down the nose, through the stomach,
duodenum and jejunum.
12. Carvajal, S and Mulvihill, S (1994) op cit p 262
13. scintigraphy - the production of 2 dimensional images of the distribution of
radioactivity in tissues after the internal administration of radionuclide.
14. Phrase coined by Barbara Bryan

Allison, D. and Roberts, M. (1998) Disordered Mother or Disordered Diagnosis?

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Munchausen ?Syndrome by Proxy Hillsdale: The Analytic Press.

Baldwin, C. (1999) Unpublished PhD dissertation
Baldwin, C. (1996) "Munchausen Syndrome by Proxy: Problems of Definition,
Diagnosis and ?Treatment" Health and Social Care in the Community 4 (3),
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Bergeron, M. (1996) Hegemony, Law and Psychiatry: A Perspective on the
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Pediatric ?Adolescent Medicine Vol. 150 July.
Douglas, M (1980/1966) Purity and Danger: An Analysis of Concepts of Pollution
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Foucault, M. (1977) Discipline and Punish London: Tavistock
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Kritzman, L. (1988) Michel Foucault, Politics, Philosophy, Culture, Interviews
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Archives of Disease ?in Childhood 72 (6): 534-39
Morgan, B. (n.d.) Death from Munchausen Syndrome by Proxy is Overestimated
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Viewed with Extreme ?Caution
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Medical Profession ?Cambridge: Cambridge University Press
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