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Fabricated or Induced Illness
Fabricated or Induced Illness (FII), or factitious disorders, originally and more commonly known as Munchausen Syndrome or Munchausen Syndrome by Proxy (MSbP), are insidious disorders in which injury is deliberately and gradually inflicted upon a person usually for gaining attention or some other benefit.
The caregiver is usually a parent, guardian, or spouse, and the victim is usually a vulnerable child or adult. Although cases with feigned or induced physical illness receive the most attention, it is also possible for a perpetrator who emotionally abuses a victim to simulate and fabricate conditions that appear to be psychiatric or genetic problems.[clarify]
Additional recommended knowledge
In 1977, pediatrician Roy Meadow, then professor of Paediatrics at the University of Leeds, England, described the extraordinary behavior of two mothers: One had (Meadow claimed) poisoned her toddler with excessive quantities of salt. The other had introduced her own blood into her baby's urine sample. He referred to this behavior as Munchausen Syndrome by Proxy (MSbP). Although it was initially regarded with skepticism, MSbP soon gained a following amongst medics and social workers. Although it's not listed in the DSM-IV manual,  a formal name since March 2002 is now Fabricated or Induced Illness (FII) according to the Royal College Of Paediatrics and Child Health. In 2003 however, Earl Howe, the Opposition spokesman on health, accused the professor of inventing a "theory without science" and refusing to produce any real evidence to prove that Munchausen Syndrome by Proxy actually exists. It is important to distinguish the act of harming child, which can be easily verified (and there are plenty of cases to prove that it happens), and motive which is much harder to verify and in which MSbP (controversially) tries to explain. For example, carer may wish to harm children for simple reason of malice (similar to domestic abuse by husband or wife) rather than for the aim to draw attention and sympathy, in which case, harming the children is merely incidental to the main purpose. In former case, induced illness is likely to be a mean to avoid detection of domestic abuse (a more elaborate form of the excuse that the victim has "fallen down the stairs").
The distinction is often crucial in criminal proceeding in which the prosecutor need to prove both the act and the motive of crime to establish guilt. In most legal jurisdiction, doctor can give expert witness in regard to whether children was being harmed but can not speculate in regard the motive of carer. FII merely refer to the fact that illness is induced or fabricated and not specifically limit the motives of such acts to a carer's need for attention and/or sympathy. There are now more than 2,000 case reports of FII in the professional literature. Reports come from developing countries that include, but are not limited to, Sri Lanka, Nigeria, and Oman. Dr. Meadow was knighted for his work for child protection though, later, his reputation, and consequently, credibility of MSBP, become severely damaged when several convictions of child killing, in which he acted as an expert witness, were overturned. 
Caution is required in the diagnosis of FII. Many of the items below are also indications of a child with organic, but undiagnosed illness. An ethical diagnosis of MSbP must include an evaluation of the child, an evaluation of the parents and of the family dynamics. Diagnoses based only on a review of the child's medical chart can be rejected in court.
Prevalence by gender
It has been noted that MS applies mostly to men whereas FII perpetrators are disproportionately females. One study showed that in over 90 percent of cases of Munchausen by proxy, the mother is the abuser. In other cases, the MSbP abuser is another female caregiver. Fathers have been the perpetrators in a handful of professional reports. The female preponderance may be attributed to the typical socialization pattern which encourages females to seek the sympathy and assistance of others while males who do so are considered to be "weak". Neuropsychological testing of perpetrators has shown either normal results or nonspecific abnormalities.
MSbP may also be attributed to another prevalent socialization pattern, that which places females in the primary care taking role. For a psychodynamic model of this kind of maternal abuse see Anna Motz's The Psychology of Female Violence: Crimes Against the Body (Routledge, 2001 ISBN 978-0415126755, 2nd ed. forthcoming 2008 ISBN 978-0415403870).
During the 1990s and early 2000s, Meadow was an expert witness in several murder cases involving FII, some of which resulted in parents being convicted of murdering their children and imprisoned. In addition, several children were taken into care. In 2003, a number of high-profile acquittals brought Meadow's ideas into serious disrepute. Around 250 cases resulting in conviction in which Meadow was an expert witness were reviewed, with few changes. Meadow was investigated by the British General Medical Council over evidence he gave as an expert witness for the prosecution in the Sally Clark trial where he asserted that the odds of there being two unexplained infant deaths in one family were one in 73 million, a figure considered crucial in sending her to jail but a claim hotly disputed by the Royal Statistical Society, who wrote to the Lord Chancellor to complain. It was subsequently shown that the true odds were in the region of one in 200. The GMC in July 2005 came to a verdict of guilty of "serious professional misconduct" and he was struck off the register for giving "misleading" evidence in the Sally Clark case. At appeal High Court judge Mr Justice Collins described this as "irrational" and set it aside. Meadow was involved as a prosecution witness in 2 other high profile cases resulting in mothers being imprisoned and subsequently cleared of wrongdoing - those of Trupti Patel and Angela Cannings. Collins' judgment raises important points concerning the liability of expert witnesses - his view is that referral to the GMC by the losing side is an unacceptable threat and that only the Court should decide whether its witnesses are seriously deficient and refer them to their professional bodies.
In 2003, Sickened, an autobiographical account of the Munchausen Syndrome by Proxy abuse Julie Gregory suffered as a child, was published.
In 2003, the documentary film MAMA/M.A.M.A. was released, which questioned the validity of Munchausen Syndrome by Proxy, arguing that in many cases doctors' overmedication of infants may be the real cause of their infirmity rather than the mother's mental illness. The film contains an interview with Sir Roy Meadow.
Legal status in Australia and UK
In majority of legal jurisdiction, doctors are only allowed to give evidence in regard to whether the child is being harmed. They are not allowed to give evidence in regard to the motive as it would be prejudicial to the determination of the guilt. Furthermore, It has been specifically established in legal precedents in Australia and the U.K. that Munchausen Syndrome By Proxy does not exist as a medico-legal entity.
In a June 2004 appeal hearing, the Supreme Court of Queensland, Australia stated:
In some person's opinions, the term factitious disorder (Munchausen Syndrome By Proxy) is merely descriptive of a behavior, not a psychiatricly identifiable illness or condition. American experts mostly disagree, however, and perpetrators' legal actions in the U.S. to quash descriptions and use of Munchausen Syndrome By Proxy have almost always failed. [R v LM  QCA 192.].
The Queensland Supreme Court further ruled that the determination of whether or not a defendant had caused intentional harm to a child was a matter for the jury to decide and not for the determination by expert witnesses:
The diagnosis of Doctors Pincus, Withers, and O’Loughlin that the appellant intentionally caused her children to receive unnecessary treatment through her own acts and the false reporting of symptoms of factitious disorder (Munchausen Syndrome) by proxy is not a diagnosis of a recognised medical condition, disorder, or syndrome. It is simply placing her within the medical term used for the category of people exhibiting such behavior. In that sense, their opinions were not expert evidence because they related to matters able to be decided on the evidence by ordinary jurors. The essential issue as to whether the appellant reported or fabricated false symptoms or did acts to intentionally cause unnecessary medical procedures to injure her children was a matter for the jury’s determination. The evidence of Doctors Pincus, Withers, and O’Loughlin that the appellant was exhibiting the behavior of factitious disorder (Munchausen Syndrome By Proxy) should have been excluded.
Principles of law and implications for legal processes which may be deduced from these findings are that:
The Queensland Judgment was adopted into English law in the High Courts of Justice in Case No. WR03C00142 [A County Council v A Mother and A Father and X,Y,Z children] on 18 January 2005 by Mr. Justice Ryder. In his final conclusions regarding Factitious Disorder, Ryder states that :-
I have considered and respectfully adopt the dicta of the Supreme Court of Queensland in R v. LM  QCA 192 at paragraph 62 and 66. I take full account of the criminal law and foreign jurisdictional contexts of that decision but I am persuaded by the following argument upon its face that it is valid to the English law of evidence as applied to children proceedings.
In his book, Playing Sick (2004) Marc Feldman notes that such findings have been in the minority among U.S. and even Australian courts. Pediatricians and other physicians have banded together to oppose limitations on child abuse professionals whose work includes FII detection. Meadow is among the individuals specifically mentioned as having been inappropriately maligned in the April 2007 issue of the journal Pediatrics.
Munchausen Syndrome by Proxy: Pet
The medical literature includes a number of descriptions of a subset of Munchausen Syndrome by Proxy (MSbP) caretakers, whose cases are labeled Munchausen Syndrome by Proxy: Pet (MSbP:P). This is a factitious disorder with pet proxies, malingering with animal proxies, or even instances of "battered pet syndrome" (in reference to battered woman syndrome). In these cases, pet owners correspond to caretakers in traditional MSbP presentations involving human proxies. No extensive survey has yet been made of the extant literature, and there has been no speculation as to closely MSbP:P tracks with human MSbP.
In popular culture
|This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Fabricated_or_Induced_Illness". A list of authors is available in Wikipedia.|