Munchausen's Syndrome by Proxy Reconsidered

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.