The controversy pits doctors against mothers—an irony given that the crux of the theory is the mother's desire for physicians' approval and nurturance. A changing zeitgeist fuels the dispute. Patient empowerment, dissatisfaction with managed health care, and the intensified face of motherhood conspire to escalate standoffs between the medical establishment and parents. Assertive, demanding, and well-informed, mothers increasingly challenge doctors as a matter of course.
When a child stays sick and no one has an answer, relationships can turn sour, even adversarial. "Mothers who argue with doctors or seem challenging have been accused," Pankratz says, "as have those with children who are hard to diagnose or treat. Since mothers with chronically ill children usually have very strong views about treatment, there's a huge pool of candidates at risk."
British Backlash
The Munchausen by proxy story starts across the Atlantic, where British physician Richard Asher described a group of wanderers who trekked from hospital to hospital fabricating complaints. In 1951 Asher named the condition Munchausen syndrome after Baron von Munchausen, whose travel and military adventures spawned a series of fabulist tales.
It wasn't until 1977 that the British pediatrician Roy Meadow, writing in the journal The Lancet, identified mothers he said were causing or fabricating their children's illnesses. The mothers were coldly and intentionally using the children as "proxies," he theorized, taking them to doctors to get the attention they themselves craved.
People found it hard to believe this argument until Meadow's pediatric colleague, David Southall, videotaped suspects, unbeknownst to them. The most shocking Southall tape showed a woman smothering her baby with a piece of plastic wrap, then running out to summon doctors whenever his breathing stopped. Though some of the tapes were later questioned, and suspects including the woman who smothered her baby were actually psychotic, here at last was evidence of mothers doing harm.
Meadow and Southall later spent decades on the Munchausen scene, examining patient records, then using statistics, video surveillance, and the "separation test"—in which a child is removed from a suspect parent and monitored for improvement—to identify MBP perpetrators and testify against them in court. To bolster cases when evidence was slim, they brandished a profile of the classic perpetrator—a seemingly caring mother with great knowledge of medicine, especially the illness at hand, who cultivated doctors, and was intensely involved in her child's care. Thousands of sick British children whose mothers fit the profile were removed from their homes over the course of 25 years.
One mother caught in the frenzy, attorney Sally Clark, lost two children to sudden infant death syndrome in 1996 and 1997. After Roy Meadow testified that the chance of two such deaths was 73 million to one, Clark was convicted of murder and sentenced to life in jail. But Meadow's calculations were wrong—he'd literally made mistakes in math. The correct statistic was 200 to one, a world of difference to the court.
When Clark won her appeal in 2003, it was as if the blinders came off in Great Britain. Excoriated for skewed statistics and the by-then discredited profile (mothers of genuinely sick children are often intensely involved in their children's care), Meadow almost lost his medical license and soon after, retired. Southall too came under fire after accusing Clark's husband, Stephen, of smothering his sons. The accusation was based on no more than Southall's impression of Stephen on TV.
For months, stories of wrongly accused parents rang through the British tabloids. This was junk science, members of Parliament and the British medical establishment ultimately declared.
American Landing
Britain's MBP-backlash notwithstanding, the diagnosis is flourishing in the U.S. One case considered classic by Herbert Schreier is that of Coral Gables, Florida, mother Kathy Bush. Her daughter, Jennifer, spent 640 days in the hospital and underwent 40 operations, including removal of her gall bladder, appendix, and parts of her intestine, from ages 2 through 9. As the tireless advocate for a chronically ill child, Bush appeared with Hillary Clinton in her quest for health-care reform—before being convicted of making Jennifer sick by infecting her feeding tubes and giving her damaging drugs in 1999. She served three years in jail.
Bush has always maintained her innocence, but Schreier isn't impressed. He sees Bush and other such mothers as impostors devoid of feeling for their children. "The purpose is not to kill the child but to keep her sick, so that the mother can be in a relationship with the doctor, who would recognize her devotion, knowledge, and sacrifice," he states. As for the doctors, Schreier says they're routinely fooled by Munchausen mothers, "who may be issuing a dare, a challenge of who can outsmart whom."
No one has done more work to ring the alarm than Louisa J. Lasher, a former child protection worker from Georgia who runs the only forensic service devoted exclusively to MBP. She first learned of it, she says, when a mother she investigated made her daughter appear ill by painting her panties with blood, leading to unnecessary procedures. Soon Lasher was running workshops and training others to look for signs.
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