Bad Medicine Parents the State and the Charge of “Medical Child Abuse”

216 University of California, Davis [Vol. 50:205
assume the sick role by proxy; 43 others did not believe that the
parent’s motive should matter. 44 Indeed, there was even debate over
whether to assign the MSBP diagnosis to the parent or the child. 45 To
add to the confusion, it was pediatricians who were most likely to
identify this behavior, but they did not have the expertise necessary to
diagnose the mental health of the parent. 46 Finally, and most
consequentially, the criteria used to diagnose MSBP proved to be
grossly overbroad, falsely identifying many parents of genuinely sick
children. 47
Those problems with MSBP were never resolved. Instead, early this
century, MSBP diagnoses in England were generally discredited after
43 Meadow suggested in his original paper that the mothers described seemed to
“us[e] the children to get themselves into the sheltered environment of a children’s
ward surrounded by friendly staff.” Meadow, Hinterland, supra note 33, at 345; see also
Herbert Schreier, Munchausen by Proxy Defined, 110 PEDIATRICS 985, 985 (2002) (“The
primary motivation seems to be an intense need for attention from, and manipulation
of, powerful professionals, most frequently, but not exclusively a physician.”).
44 See, e.g., Donna Rosenberg, From Lying to Homicide: The Spectrum of
Munchausen Syndrome by Proxy, in MUNCHAUSEN SYNDROME BY PROXY: ISSUES IN
DIAGNOSIS AND TREATMENT 34 (Alex V. Levin & Mary S. Sheridan eds. 1995)
(perpetrator’s intent “diagnostically immaterial”); Donna A. Rosenberg, Web of Deceit:
A Literature Review of Munchausen Syndrome by Proxy, 11 CHILD ABUSE & NEGLECT
547, 547-63 (1987) [hereinafter Web of Deceit] (perpetrator’s motivation excluded
from diagnostic criteria).
45 Compare Meadow, What Is MSBP?, supra note 38, at 535 (assigning diagnosis to
child), and Donna A. Rosenberg, Munchausen Syndrome by Proxy: Medical Diagnostic
Criteria, 27 CHILD ABUSE & NEGLECT 421, 423 (2003) (“MSBP is a pediatric, not a
psychiatric, diagnosis”) [hereinafter Medical Diagnostic Criteria], with Schreier &
Libow, supra note 39 (assigning diagnosis to parent). A special task force of the
American Professional Society on the Abuse of Children sought to split the difference,
dividing the diagnosis into two parts: “factitious disorder by proxy,” properly assigned
to the perpetrator, and “pediatric condition falsification,” to be assigned to the child.
See Catherine C. Ayoub et al., Position Paper: Definitional Issues in Munchausen by
Proxy, 7 CHILD MALTREATMENT 105, 105-06 (2002).
46 See Loren Pankratz, Persistent Problems with the “Munchausen Syndrome by
Proxy” Label, 34 J. AM. ACAD. PSYCHIATRY & LAW. 90, 92 (January 2006) [hereinafter
MSBP Label] (“[S]ome MSBP experts have admitted that they are not qualified to
make a psychiatric diagnosis of the mother.”).
47 By 1995, Roy Meadow himself lamented that the term’s “over use has led to
confusion for the medical, social work, and legal professions,” and that MSBP’s
diagnostic criteria “lack specificity: [too] many different occurrences fulfil them.”
Meadow, What Is MSBP?, supra note 38, at 534. In the United States, two
psychologists — Loren Pankratz and Eric Mart — have provided the most persuasive
critiques of the overbreadth of MSBP diagnostic criteria. See MART, supra note 37;
Pankratz, MSBP Label, supra note 46; Loren Pankratz, Persistent Problems with the
“Separation Test” in Munchausen Syndrome by Proxy, 38 J. PSYCHIATRY & L. 307 (2010)
[hereinafter Separation Test].