Mick Hartley

I posted earlier about Munchausen’s Syndrome by Proxy as the latest in a long and inglorious line of diagnoses whereby doctors can justify removing children from their parents. This is from “Munchausen’s Syndrome by Proxy Reconsidered” by Dr. Eric Mart, a US psychologist:

I first heard the term Munchausen’s syndrome by proxy (MSBP) about ten years ago, when I sat in on a panel discussion of the syndrome at an American Psychological Association convention. I gave the matter no more thought until a few years ago, when a defense attorney approached me to review a local child abuse case in which MSBP was suspected.

I had no particular expertise in this form of child abuse, but neither did anyone else involved with the case. In preparing to review the documentation and reports in the case, I spent time at the local university libraries and read as much material as I could find (which was a surprisingly large amount) on the subject of MSBP. I was appalled by what I read. There appeared to be only one or two articles in the professional literature which might have been considered “hard research,” and in these the research had been done only in the most rudimentary way. The rest of the literature consisted of case studies in which medical and psychological professionals identified what they believed to be MSBP cases and then discussed how closely they corresponded to or deviated from the behavioral profile and clinical features of the hypothetical archetypal case. Much of the “science” in this literature, which had been published in prestigious journals, would not have passed serious scrutiny in an undergraduate research methods class. Nevertheless, despite the fact that the scientific “heavy lifting” of empirical research had not been done with this syndrome and its inferred dynamics, it was clear that professionals all over the United States and United Kingdom were willing to diagnose the disorder. Moreover, some of the excesses of the early child sexual abuse prosecutions were being repeated in cases of alleged MSBP. […]

Unfortunately, MSBP now appears to have become what Thomas Ryan, a well-known Arizona attorney who specializes in medical malpractice, has termed “the disease du jour.” It is disheartening to see families torn apart by allegations of MSBP, which are almost impossible to fight due to the looseness of the legal process in such cases, the cost of mounting an effective defense, and the fact that almost any behavior on the part of the parent suspected of MSBP is seen as a confirmation of the diagnosis. Although clearly there are cases in which parents have used medicine or the medical system to abuse children (I have seen such cases), it is also clear that many individuals, possibly most, who are given this diagnosis do not meet the diagnostic criteria for MSBP, if indeed the diagnosis itself has any validity.

The article which lead me to this (via AL Daily) looks at a new group of psychologists attempting to inject a little scientific rigour to the mental health field:

They have been called assassins and parasites. They receive hate mail from the proponents of a variety of popular psychotherapies. […]

Dr. Ronald Levant, president-elect of the American Psychological Association, said [they] had gone overboard in their enthusiasm for scientific vetting of therapeutic techniques. “Their fervor about science borders on the irrational,”…

It’s no surprise that many psychotherapists are unhappy about independent scrutiny, but no profession is in greater need of it. To judge by the comments of the president-elect of the APA though, there’s a long way to go.