The Sunday Times
June 26, 2005
Mumbo-jumbo syndrome
Rod Liddle
Munchausen’s syndrome by proxy is an ailment dreamt up by Professor
Sir Roy Meadow back in 1977. He took an existing condition —
Munchausen’s syndrome, wherein the victims feign illness to draw
attention to themselves — and added “by proxy” to describe victims who,
he said, induced illness or injury in a third party in order to draw
attention to themselves.
I hope that medical science will record that I am the inventor of an
entirely new, if related, mental illness, Munchausen’s syndrome by proxy
by proxy, to describe doctors who make up illnesses for other people to
suffer from in order to draw attention to themselves. We might call it
“hubris” for short.
Meadow is now appearing before the General Medical Council accused of
“naive, grossly misleading, incompetent and careless” use of statistics
that contributed to the conviction of women accused of killing their
young children.
Angela Cannings, one of the women wrongly jailed after his testimony,
wants him to be struck off. You can understand her anger and it has been
shared, pretty much without exception, by the entire media. Yes, strike
him off! Munchausen’s syndrome by proxy may end up being struck off,
too, one of these days. A growing number of other experts believe that
it does not exist except in the unbending minds of paediatricians. It is
no longer recognised as a psychiatric disorder in some Australian states
and its status in America is under threat.
Certainly there can be few fictitious illnesses (it is known
officially as a “factitious” illness, but I prefer my spelling) that
have caused quite so much misery. An estimated 30,000 children have been
taken away from their parents in this country after a diagnosis of
Meadow’s pet condition. In America alleged sufferers have been sentenced
to death for murdering their children solely upon the evidence of clever
and eminent paediatricians.
Clearly Meadow — who, as a former president of the Royal College of
Paediatricians, is about as eminent in his field as it gets — is not
alone in believing that children are being bumped off, willy-nilly, by
their parents or guardians. It is a view that was for a long time an
article of faith in paediatric circles. While it held sway, the police,
the Crown Prosecution Service, the judges, the juries were prepared to
listen to “expert” paediatricians and treat their testimonies as
unvarnished, disinterested, objective fact, not beholden to fashion,
personal subjective belief or professional arrogance. Why? When an
expert “scientist” steps onto the witness stand, for some reason our
natural scepticism dissolves: we listen, agog, uncritically. And then a
few years later when the science changes — as it always does: that is
the point of science — we vilify them for their earlier stupidity.
Meadow’s “crime” was to state what he believed. It looks very much as
if he was utterly, hopelessly wrong; but in that he was far from alone.
Many crimes have been committed against the Angela Canningses of this
world and his professional arrogance is perhaps one of them.
However, the rest of us shoulder more blame for our failure to see
science as it really is: a collection of rather wonderful stories that
we make up in an attempt to explain the world around us, stories that
are flawed, subject to endless revision and usually downright
contradiction. But never certain. Scientists are, in the end, always
proved wrong or at least not quite right — even the most eminent of
them. Talk to Aristotle or Copernicus or, for that matter, Einstein. Yet
they all adhere to their theories with a commitment that, shall we say,
transcends the objective observation of events. So put them on the
witness stands, but listen with caution.
Munchausen’s syndrome by proxy is a quintessential example of that
most suspect of scientific theories — one that brooks no rational
argument, a closed circle we all must accept at face value.
For example, the only cure must begin by the sufferer accepting that
he or she is afflicted with the condition — which, of course, the
alleged sufferer is loath to do. But if someone who is diagnosed as a
sufferer vociferously denies it, this serves to reinforce the diagnosis.
A denial of the condition is, perforce, a symptom of the condition. And
then there’s this: there is no cure but it is accepted that sufferers
can sometimes continue to live among other people without exhibiting the
symptoms — murdering people or making them ill. Furthermore, there is no
agreed biological or psychological cause.
So there we have it: an illness that has no cause or cure and that is
diagnosed at least partly by the alleged victim’s denial that he or she
is so afflicted. The more the victim denies it, the more obviously the
victim is afflicted. And it is an illness that may somehow exist within
a person without cause or cure or indeed any manifestation of its
symptoms.
In the medical establishment, in the law courts and in the press, why
were we prepared to believe this guff for more than a quarter of a
century and send people to prison as a result?