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Sunday, March 13, 2016

Dr. Roy Meadow and His Munchausen Syndrome by Proxy Doctrine

     In 1977, a pediatrician from England published the results of an investigation he had conducted into the cases of 81 infants whose deaths had been classified either as Sudden Infant Death Syndrome (SIDS) or natural death. The study, by Dr. Roy Meadow of St. James University Hospital in Leeds, covered a period of 18 years. His article, "Munchausen Syndrome by Proxy: The Hinterlands of Child Abuse," which appeared in the journal Lancet, was shocking in its implications. Dr. Meadow claimed that these 81 babies had, in fact, been murdered, and that the forensic pathologists who had performed the autopsies had ignored obvious signs of physical abuse in the form of broken bones, scars, objects lodged in air passages, and toxic substances in their blood and urine. He came close to accusing some of these pathologists of helping patients, mostly mothers, of getting away with murder.

     The Munchausen Syndrome, a psychological disorder identified in 1951 by Richard Asher, described patients who injured themselves, or made themselves sick, to attract sympathy and attention. Asher named the syndrome after Baron von Munchausen, a man known for telling tale tales. Dr. Meadow added "by proxy" because the people gaining sympathy and attention from illnesses and injuries were not hurting themselves. They were getting sympathy and attention by injuring and sickening their infants and children.

     In his landmark article in Lancet, Dr. Meadow profiled some of the pediatric cases that had puzzled him in the early 1970s. For example, he was treating a young boy who had extremely high salt levels in his blood that adversely affected his kidneys. Because there was no way the boy could have eaten this much salt, Dr. Meadow came to suspect that the mother, a nurse, was force-feeding salt into the child through a nasal tube. When Dr. Meadow voiced his hypothesis to his colleagues at the hospital, they ridiculed him. In this case, however, the boy's mother confessed to exactly what Dr. Meadow had suspected. Her intent had not been to kill her child, but to use him as a way to make herself a center of attraction at the hospital, an environment she found exciting and romantic.

     After the publication of Dr. Meadow's shocking article, physicians all over the world sent him accounts of cases similar to the ones he had described in his Lancet piece. Even Dr. Meadow was shocked by some of these stories--cases that involved punctured eardrums, and induced blindness, as well as inflicted respiratory problems, stomach ailments, and allergy attacks. Years later, Dr. Meadow would design a controversial experiment involving hidden cameras in hospital rooms where suspected MSBP victims were being treated. Of the 39 children under surveillance, the cameras caught 33 parents creating breathing problems by putting their hands, bodies, or pillows over the victim's faces. Staff members monitoring nearby television screens quickly entered the hospital rooms, causing the abusers to discontinue their assaults. In England and the United States, some of these videotaped episodes were later shown on commercial television. After that exposure, MSBP was no longer an obscure psychological disorder.

     In the years that followed Dr. Meadow's initial research into these child abuse and infant death cases, he came to believe that the vast majority of MSBP perpetrators were women, and that one-third of them were either nurses, or women who worked in some other capacity within the health care industry. His research also suggested that many of these mothers were married to men who were cold and indifferent, and that at least part of the motive behind making their children ill was an attempt to emotionally energize their spouses. According to Dr. Meadow, many MSBP women also enjoyed the attention and sympathy they received from physicians and nurses.

     Because of his groundbreaking work on behalf of helpless and endangered children, Dr. Meadow received a lot of attention himself. He was in great demand as an MSBP consultant, was asked to give speeches and presentations all over the world, and testified as an expert witness in dozens of high-profile murder trials. In England, he received a knighthood in recognition of his contribution to the fields of medicine and forensic science. As a result of his testimony in homicide trials involving multiple SIDS deaths in the same family, his comment that "one [SIDS death] in a family is a tragedy, two is suspicious, and three is murder," became widely known as Meadow's Law. (In the United States it's referred to as "the rule of three.")

     In Great Britain, in a handful of homicide trials between 1996 and 1999, Dr. Meadow's theory that three SIDS cases in one family equals murder, was challenged by the defendants. As a result, Meadow's Law is no longer a court recognized doctrine in England. (Munchausen Syndrome by Proxy   in Great Britain is now called, "fabricated illness.")

     In the United States, a new version of this personality disorder emerged. Called Munchausen Syndrome by Internet, mothers seek sympathy and attention by faking their own illnesses--mainly cancer--online in support groups and other social networks. At present, this version of the syndrome is not recognized by the American Psychiatric Association. While there is no known cure for the Munchausen Syndrome generally, the virtual form of this disorder does not involve actual self-harm, or the abuse of children.

       

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