Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Diagnosis of Munchausen Syndrome By Proxy should be viewed with extreme caution
- Charles Pragnell (15 February 1999)
-
Factitious Disorder By Proxy Can Be Emotional As Well As Physical
- Neal Weissman (12 December 1999)
|
|
|||
|
Charles Pragnell, Social Care Management Consultant 74 Redcar Lane, Redcar and Cleveland TS10 2JN.
Send response to journal:
|
In 1994 Professor R. Meadows declared in regard to Munchausen Syndrome By Proxy [MSBP], "There is a danger of the term being overused." Journal of Clinical Forensic Medicine. (1994) 1 121-127. It would seem that his strictures are however being ignored. In several of the cases of MSBP I have studied in detail, there were clear indications that the guidelines for diagnosis as set out by Meadows had not been observed and in some cases the diagnostic criteria defined by Meadows were not present. In at least one case the paediatrician had failed to obtain previous medical records and history before making the diagnosis. If he had done so he would have found that both children involved had experienced serious illnesses from birth and symptoms had been witnessed from birth by several health professionals without either parent being present. In two other cases the MSBP diagnosis was made after the parents had initiated legal action against the paediatrician for medical incompetence and the possibility of retaliatory action has therefore to be considered. In none of the cases was there clear evidence of parents seeking attention for themselves which has been claimed to be the principle diagnostic criteria. Their embellishments and distortions of the children's symptoms appeared to be directed at increasing the paediatrician's interest in their child and to obtaining a diagnosis of their child's condition, and motivated by their own helplesness and frustration. If, as has been claimed, the personality disorder in parents leading to an MSBP diagnosis is untreatable, where is the research evidence that parents who have been so diagnosed and who have retained the care of their children, have continued in their behaviours of harming their children in order to gain attention for themselves. From my studies in such cases, the converse is in fact, true. Such parents have avoided any further contacts with health professionals and because of the social stigma of the MSBP diagnosis, have become social isolates. In consequence the children have failed to receive medical attention when needed even for serious illnesses. In this respect, the MSBP diagnosis is per se being harmful to children. The covert video surveilllance of parents is of dubious validity as it does not appear to conform to the requirements of the Memorandum of Good Practice for such video recordings for use in child protection proceedings and is of poor quality for forming an informed opinion on the actions and behaviours of parents. There also appears to be a need for debate on the ethical considerations of covert video recording and the conduct of paediatricians observing parents harming their children for considerable periods of time, without intervening to prevent serious harm to the child such as the breaking of an arm. Jones and Lynch rightly take issue with Dr. Southall et al regarding the disregard of working in partnership with parents. Working in partnership on an "Equal and Genuine Basis" is not only a legal requirement under the Children Act 1989 but a fundamental human right of parents to be involved in decision making processes concerning their children, no matter what discomfort or difficulty this may present for the professionals. There is also evdience in the cases I have studied that social workers are ignoring the findings of the Cleveland Inquiry and the particular recommendations of Justice Butler-Sloss that social workers should not act solely on the basis of a medical diagnosis but that a full investigation and social assessment should be carried out. This is also a requirement of `Working Together' the DOH Guidelines for child protection investigations. The unquestioning acceptance of MSBP by social workers seems to have parallels with the anal dilatation test used in Cleveland and the Repressed Memory Syndrome which was more widely used and which also led to harmful effects on families. MSBP does not appear to have been verified and validated by any national medical body in the U.K. following trial conditions, nor does there appear to have been any period of independent monitoring and review of its implementation, and yet it has spread into liberal usage by some paediatricians supported by a small group of other professionals. The validity of MSBP as a diagnosis must therefore be seriously questioned and any research into cases of MSBP can only be valid if the pre-history is examined, whether the diagnostic criteria and guidelines have been followed in each case, and the post-diagnosis behaviours of parents reinforce the accuracy of the original diagnosis. A far more rigorous and critical approach to research into MSBP is needed, otherwise it will continue to be seen simply as an endorsement of the position of MSBP devotees. Charles Pragnell Social Care Management Consultant. 16 February 1999. |
|||
|
|
|||
|
Neal Weissman, student
Send response to journal:
|
You who have never suffered are missing the point of Factitious Disorder By Proxy (FDBP, formerly known as Munchausen Syndrome by Proxy) -- the mother is knowingly torturing the child even if that torture takes the form of *emotional abuse*. The carefully planned strategies to do harm need not be confined to the medical setting. My mother, and accomplice father, were "FDBP" parents, and they made my childhood hell. The *emotional crippling* must not to be denied. I certainly don't mean to lessen the importance of the horrendousness and outrageousness of the physical abuse type, but to deny the recognition to children who have suffered emotionally is deliberately denying the medical arena an important avenue to study and understand this criminal mentality and to deny these children the protection that other recognized "oppressed" groups enjoy (regardless of race, creed, color, nationality, gender, ad infinitum ad nauseam). And as a point of fact, the emotional FDBP parents use an occasional irrational physical beating to enforce themselves on a child who has learned to ignore their irrationality. If this were Nazi Germany, gentile European sensibilities would be "outraged." /s/ Neal J. Weissman |
|||