Short abstract
Is media coverage of Munchausen syndrome by proxy putting children at risk?
Just before Christmas the media moved rapidly to cover the sensational story of the “controversial diagnosis” of Munchausen syndrome by proxy, coverage in which the main villains of the piece seemed to be paediatricians hell bent on destroying families. This followed a statement by the attorney general that there was “cause for concern” and that appeals could be made in 28 out of 297 cases after a review of cases of children taken into care in the wake of the quashing of the Angela Cannings' conviction for murder (BMJ 2004;329: 1256).
On 20 December the Daily Telegraph devoted a full page to a first person account by Angela Cannings, who was released from prison a year ago after the Court of Appeal overturned her convictions for murdering two baby sons. Yet what this article, and the subsequent raft of media coverage, failed to report was that the vociferous campaigners against Munchausen syndrome by proxy, and their supporters in the press, had expected that hundreds of parents who had been jailed for convictions linked to this diagnosis would be released. The attorney general's statement to parliament made it clear that this was far wide of the mark.
Munchausen syndrome by proxy is an enigmatic form of child abuse, often disguised as an illness in the child, which the press seems pathologically unable to report dispassionately. After all, a review of just under 300 cases produced 28 possible worrying cases, and a continuing review of all the care cases in Great Britain—28 607 family law cases—seems to have produced a change to only one care plan. This is not the impression the public would have gained from the media attention devoted to the cases of Sally Clark and Angela Cannings, whose convictions were overturned, and of Trupti Patel, who was acquitted of killing her three babies.
Figure 1.
Sarah Lancashire and Timothy Spall as Angela Cannings and her husband, Terry
Credit: BBC
A dramatised version of the Cannings story, starring Sarah Lancashire and Timothy Spall, is soon to be broadcast on British television. The Telegraph reported that even living Mrs Cannings' life secondhand proved harrowing for former Coronation Street actor Lancashire, who apparently experienced dramatic weight loss just playing the part.
On 23 December the Daily Mail dedicated its key comment piece to another attack on paediatricians. It was by John Sweeney, a BBC reporter who has made television documentaries questioning the existence of Munchausen syndrome by proxy. The article included the statement “There was no laboratory science behind Munchausen's theory.” It also claimed that “according to Professor Meadow's theory [Professor Roy Meadow was an expert witness for the prosecution in many of the cases], denying you were a Munchausen's mother was proof of the syndrome. So being accused of Munchausen's was like being accused of witchcraft in the Middle Ages: if the witch floats, she must be a witch. It was a charge based on circular logic to which there could be no defence.”
At no point did the article give any coherent account of how paediatricians actually arrive at their testimony. Furthermore, it symbolises the confusion at the heart of media coverage: the diagnosis is about what is happening to a child, not what is going on in a parent's mind. Precisely why parents abuse their children by inducing illnesses is a question that ranges across several theories, yet experts can still be confident that a child is being harmed by a parent, without knowing exactly why.
Even when convictions in high profile cases are overturned, this does not mean that in all or even most cases children will be returned to parents, as this is the decision of family courts, where the standard of proof is the “balance of probabilities,” not “beyond reasonable doubt.” This enables family courts to be less adversarial and ensures that the interests of the child come first. In family proceedings the issue is whether the child should be subject to a care order, taken away from the parents, or placed for adoption. This means that some parents might walk free from a criminal court and yet still not get their children back, because family courts decide that the parental home is not a safe environment.
Yet because family courts remain essentially private, unlike criminal proceedings, the media never cover this aspect of paediatricians' work and the relative success with which it protects children. Also, these doctors are advised by their medical defence organisations and their royal college not to speak to the media, so making it impossible to defend themselves from the current spate of attacks.
This is producing a lack of balance in press coverage of the issue, contend many senior paediatricians, who are also fearful of speaking out because of alleged intimidation and vilification by special interest groups and the media. For example, one doctor found that the birth of their own child had been reported widely on the internet by groups campaigning against the syndrome, while the death of another paediatrician was debated on these same websites as an attempt by that expert witness to escape the retribution of the courts.
Some doctors now claim that the fall in the number of young people on the child protection register—from 35 000 in 1995 to 26 600 last year—is evidence that paediatricians are increasingly reluctant to identify child abuse. To do so now opens you to a sustained campaign of complaints and harassment from special interest groups and the media, with little or no protection at all available from medical defence organisations or royal colleges.
Whichever side you take on the issue, there is a group that is even more defenceless than the paediatricians or the parents, a group everyone seems to have forgotten in the increasingly aggressive war of words over the syndrome: the children. Perhaps, sadly, the real story behind the media coverage is how little we as a society really care for children, given what impoverished support we give to the independent procedures and professions that are meant to protect them.