Munchausen's Syndrome by Proxy Reconsidered

by Eric G. Mart

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Author: Eric G. Mart

Publisher: Bally Vaughan Pub

Paperback:
ISBN 10: 097096000X
ISBN 13: 978-0970960009

A thorough critique of the rare diagnosis "Munchausen's Syndrome by Proxy" (MSBP) and the way in which it has been employed by medical, mental health and child protective professionals.

The macabre nature of this syndrome, in which parents or other caretakers fabricate, exaggerate or induce symptoms of illness in their children in order to obtain unnecessary medical treatment, has attracted attention in the scientific literature and popular news media. The number of cases of MSBP reported and prosecuted has steadily increased in recent years, and allegations of MSBP have been appearing in contexts other than child protective actions, such as medical malpractice lawsuits, in which MSBP has been offered as a defense, and child custody disputes. While a number of books and scholarly articles have proposed protocols for the careful evaluation of these complex cases, a review of the collected case materials show that serious methodological errors as well as problems in the conceptualization of the disorder and the steps needed to diagnose it are more the rule than the exception in this area. Further, the doctors and mental health experts who pursue these cases are often haphazard and sloppy in their methods, despite the appalling harm inflicted on families when these professionals are mistaken in their conclusions.

Eric G. Mart, a forensic psychologist and internationally-known expert on Munchausen's Syndrome by Proxy, examines prevalent investigative and diagnostic techniques, as well as the literature and research on the disorder, according to the standards of empirical science. Munchausen's Syndrome by Proxy Reconsidered explores the difference between empiricism and the clinical method and discusses concepts such as confirmatory bias and logical errors, which contribute to the misdiagnosis of MSBP and other conditions. These concepts are illustrated with case narratives and material from alleged MSBP cases in which Dr. Mart has been involved. Dr. Mart concludes with a revealing account of the legal process in child protective cases, and the lack of protections afforded to parents accused of MSBP and in danger of having their children seized by the state. Munchausen's Syndrome by Proxy Reconsidered provides an unsettling look at the harm and injustice that misguided professionals can inflict by means of a "benevolent" process.

About the Author

Eric G. Mart, Ph.D., ABPP, is a licensed psychologist in private practice in Manchester, New Hampshire. He is board certified in forensic psychology, and his work in this area includes assessments of civil and criminal competencies, risk assessments, custody evaluations, special education cases and offender treatment. He also sees children, adolescents, adults and couples for psychotherapy and testing. Dr. Mart is an internationally known expert on Munchausen's Syndrome by Proxy, and has testified on the subject in court cases throughout the United States and Canada.

Excerpt. © Reprinted by permission. All rights reserved.

Preface

I first heard the term Munchausens syndrome by proxy (MSBP) about ten years ago, when I sat in on a panel discussion of the syndrome at an American Psychological Association convention. I gave the matter no more thought until a few years ago, when a defense attorney approached me to review a local child abuse case in which MSBP was suspected.

I had no particular expertise in this form of child abuse, but neither did anyone else involved with the case. In preparing to review the documentation and reports in the case, I spent time at the local university libraries and read as much material as I could find (which was a surprisingly large amount) on the subject of MSBP. I was appalled by what I read. There appeared to be only one or two articles in the professional literature which might have been considered hard research, and in these the research had been done only in the most rudimentary way. The rest of the literature consisted of case studies in which medical and psychological professionals identified what they believed to be MSBP cases and then discussed how closely they corresponded to or deviated from the behavioral profile and clinical features of the hypothetical archetypal case. Much of the science in this literature, which had been published in prestigious journals, would not have passed serious scrutiny in an undergraduate research methods class. Nevertheless, despite the fact that the scientific heavy lifting of empirical research had not been done with this syndrome and its inferred dynamics, it was clear that professionals all over the United States and United Kingdom were willing to diagnose the disorder. Moreover, some of the excesses of the early child sexual abuse prosecutions were being repeated in cases of alleged MSBP.

Because of my familiarity with the issues and research in the area of child sexual abuse, in early 1998 I presented a paper on the subject of MSBP to the Eastern Psychological Association annual meeting. This paper, which discussed how problems with the conceptualization and assessment of MSBP were likely to result in many false positive diagnoses, was published the following year in expanded form in the American Journal of Forensic Psychology (Mart, 1999). As is often the case these days, the article made its way onto the internet, and before long I was deluged with requests for evaluations and testimony in MSBP cases, not just in my home state of New Hampshire but all over the United States.

Unfortunately, MSBP now appears to have become what Thomas Ryan, a well-known Arizona attorney who specializes in medical malpractice, has termed the disease du jour. It is disheartening to see families torn apart by allegations of MSBP, which are almost impossible to fight due to the looseness of the legal process in such cases, the cost of mounting an effective defense, and the fact that almost any behavior on the part of the parent suspected of MSBP is seen as a confirmation of the diagnosis. Although clearly there are cases in which parents have used medicine or the medical system to abuse children (I have seen such cases), it is also clear that many individuals, possibly most, who are given this diagnosis do not meet the diagnostic criteria for MSBP, if indeed the diagnosis itself has any validity.

This book covers a variety of topics related to my concerns about the diagnosis of MSBP and its application. The information and opinions it contains are drawn from my research and my experience in the area of child abuse generally and MSBP specifically. Those cases that I cite have been altered in certain details as necessary to protect the parents, children and professionals involved. It is my sincere hope that this book will serve to help begin a serious examination of the way in which this diagnosis is applied and frequently misapplied.

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Munchausen's Syndrome by Proxy Reconsidered