MUNCHAUSEN SYNDROME BY PROXY
A Study in Secrecy


By
Brian Morgan
UK Journalist


An investigative journalist describes the problems faced by those confronted with 'professional secrecy' when seeking to unearth information about controversial diagnostic techniques.

The experience of attempting to research and report a new 'Cleveland' style scandal in the face of draconian secrecy orders suggests the need for a radically different journalistic approach.

Despite the legal impediments my investigation of this particular scandal is now effectively complete. Only a few loose ends remain. It has been a valuable experience and offers an important case study. Lessons have been learned from mistakes; attempts by the authorities to hinder inquiries and gag reporting have led to new ways of investigating.

One documentary based on the early research was transmitted in the Channel 4 Dispatches strand (The Munchausen File) in February 1994, and included reference to an earlier gagging order against the Cambrian News, the Aberystwyth-based newspaper, which sparked off my investigation.

After the Dispatches research was complete, evidence continued to accumulate that a small number of medical experts, with the willing cooperation of the legal and social work professions, have used the secrecy of the children's legal protection process to promote, internationally, a new child abuse diagnosis.

This has echoes from Cleveland, where child abuse investigators were relying upon evidence of 'anal dilatation' before it had become generally accepted as a valid diagnostic tool. Respectability for this technique was never achieved and its use was abandoned.

Now parents are being falsely accused of a new form of child abuse. In order to maintain their credibility and (dare one say, without risk of legal action) the high fees they can earn as 'experts', the medical profession repeatedly denies there are any false allegations, despite well-researched and clear documentation to the contrary.

Evidence of the seriously-flawed nature of this diagnostic procedure is not being put before the family courts, whose proceedings anyway are conducted in secret.

The medical theory is that parents (particularly mothers) are harming, even killing, their children because the adult suffers from a mental illness which has been given the name 'Munchausen Syndrome by Proxy' (MSBP).

Contentious cases have arisen where there is no forensic evidence to support the allegation that a mother (usually) has been repeatedly attempting to suffocate her baby to in order to induce a form of respiratory illness known as 'apnoea' (sometimes thought of or referred to as a 'Near-Miss Cot Death').

The alleged motive is to gain vicarious medical attention. The primary 'evidence' is that the doctors cannot find any illness in the baby to explain its breathing problems.

There are less than a handful of doctors involved in the UK and probably no more than a dozen throughout the world - paediatricians for the greater part who believe that abusers suffering from this mental illness can be identified by applying a profiling checklist to them.

According to them, those most likely to be 'suffering' from MSBP may:

* have a nursing background;
* have a different social standing from their spouse;
* have committed a crime, however minor, at some time;
* have had a dysfunctional upbringing;
* have experienced a cot death in the family;
* have a tendency towards attention- seeking.

There are a dozen or so 'features' like these that could apply to large numbers of people which implies that a small but significant proportion of the population could be open to accusations that they suffer from MSBP were allegations of abuse ever laid at their door. It is worth noting that, according to the report of the Clothier inquiry into deaths and injuries to babies and children at Grantham & Kesteven Hospital, the serial child killer Beverly Allitt was not suffering from MSBP. And, according to the only scientific study ever conducted into the epidemiology of the syndrome (1992-94), no child deaths have been positively attributed to MSBP. [1]

Indeed there is confusion within the medical profession as to whether MSBP is a form of child abuse, a mental condition among adults, or both, or neither.[2]

Nonetheless the present state of moral outrage concerning child abuse of any sort, and misleading or even false reports of infant deaths as a result of a parent allegedly suffering from the syndrome, feed into social work and litigation.

This ensures heavy anti-parent bias in the investigation of such instances of alleged abuse.

Currently the popular press in the UK and the USA is repeatedly and mistakenly attributing to MSBP the deaths of eight babies and young children from suffocation or poisoning in England and Wales over a two year period, purportedly quoting from the 1992-94 study, without any attempt by the study's authors to correct this false impression.[3] There is a kind of messianic zeal which drives some doctors and social workers along the road to court endorsement of permanent removal of the suspected victim from the alleged abusive family.

The courts, social workers and doctors ignore research which confirms that children, even from proven abusive homes, usually fare better left with their natural parents than in foster placements, provided appropriate resources are applied to supporting the natural home. Local authority coffers, from which support services would have to be financed, have been much depleted by the cost of the court hearings which can run into millions of pounds for each case.

We are expected to accept that those accusing the parents have only the child's interests at heart, and that the Family Court is inquisitorial not adversarial - no-one is on trial, say the Judges.

The truth is that a mother may stand accused of having a mental illness - which is not officially recognized, and of repeatedly attempting to suffocate her baby - without forensic evidence to back up the allegation.

A baby or babies that have been taken into care will be put up for adoption unless the mother admits to having harmed the child by accepting that she suffers from this mental illness - and agreeing to undergo treatment from a child and adolescent psychiatrist. What treatment they might suggest for an adult with a mental illness about which no official information exists is unclear.

It is not difficult to imagine which 'option' most mothers would choose.

No information is currently available as to whether the authorities even remotely consider what safeguards need to be put in place to avoid the scenario of innocent mothers falsely confessing to abuse under officially-sanctioned blackmail to avoid losing their children.

From the limited information about false allegations that has come into my possession alone, what is striking is the number of mothers who have resolutely protested their innocence up to this point and beyond.

Knowing they were innocent they have been prepared to risk the loss of their children in order to clear their names, and have successfully forced a review of the medical evidence.

Fresh examinations have identified the underlying illness in the child which the original doctors had failed to detect. The children have been returned home without any parental admission of guilt or any treatment for mental illness.

Even in these well-documented cases the doctors have refused to admit that the allegations were mistaken.

There is no research that supports their hypothesis, nor any mention of an adult psychiatric illness called 'Munchausen Syndrome by Proxy' as an established medically-accepted entity in either of the two internationally recognized listings, DSM-IV (USA) and ICD-10 (WHO). [4]

The only psychiatrists anywhere in the world who would appear to really believe in this mental illness - and who regularly give evidence against mothers - are the child and adolescent psychiatrists whom some local authorities and the courts are willing to consider as 'appropriate experts'.

The Cleveland scandal was exposed relatively quickly because the families involved were all from the same locality and the scale of the problem obvious.

This new scandal is less obvious - and has been in existence longer - because families are from all parts of the UK. The medical diagnosis is principally made by doctors in just a few regions. The 1992-94 study, which dealt with three different forms of alleged child abuse, appears to indicate four areas - Yorkshire, West Midlands, Trent and the North West - where reporting rates are significant (Yorkshire is highest at 0.8 per 100,000 of the under-16 child population). This may, of course, simply be an indication of high awareness levels of the supposed syndrome among professionals in those areas.

Who are the doctors involved? And the social workers? Which are the local authorities? And the courts? The whole issue is so shrouded in secrecy that it is difficult to discover the names.

Even when decisions are made public the names of the doctors appear only as initials. If you discover or attempt to discover to whom they refer, or to make connections between the agencies involved, you risk a secrecy order forbidding you to tell anyone or make public the details.

Indeed one of the myths promoted by these doctors is that seeking publicity is a characteristic of the MSBP abuser. That is a strong enough deterrent to put someone off seeking the help of the media to prove their innocence; and why lawyers are reluctant to allow the families to expose themselves to possible publicity - if for no other reason than to do so might be taken to imply guilt.

Yet the evidence is almost entirely to the contrary. I have thoroughly researched every case I have come across over the last few years and in nine cases out of ten the allegations were proved to be mistaken. In a small number of these it is possible to see how the allegations might have arisen from genuine misunderstandings about medical treatment needed by children with severe medical problems.

There is now a small but growing number of lawyers and doctors who suspect that this 'mental illness' may be a myth, and who are prepared to defend mothers and counter the propaganda.[5]

There is an also an informal but effective 'grapevine' of previously accused parents who have been proved innocent, to which some freshly accused parents turn for help and advice.

It has even been alleged that I am responsible for creating this 'organization', and maintaining it as a kind of spy network. I only wish there were such a formal network.

In fact the mothers have very little in common other than having been falsely accused of child abuse. They are from different geographical and social backgrounds and each feels that their particular circumstances are unique to them. Most find out about each other by accident rather than design, and they find concerted action very difficult to orchestrate.

Nevertheless the existence of a loose network of contacts has benefited some in their individual quests for recognition and acknowledgment of their traumatic treatment.

During a brief period when they maintained some semblance of an organization - one of the mothers dubbed it MUM (Mothers under Munchausen) but none of the others would agree to the title or her aims - they managed to infiltrate a British Paediatric Association press launch, lobby parliament, and picket a Midlands' hospital and a social work conference in Yorkshire.

The hospital later claimed that adverse publicity had forced it to abandon secret video surveillance of mothers with the babies they were suspected of abusing. It was claimed as a victory by the mothers and a retrograde step by the hospital.

MUM fell apart shortly afterwards and is not now heard of except as part of the medical demonology of investigative reporting.

More recently one of the mothers, acting as an unpaid fund-raiser, infiltrated a charity based at a hospital and run by one of the key doctors involved in making the controversial diagnosis of MSBP child abuse. He also made use of the secret video monitoring technique.

She removed a large number of confidential research papers and other documents and passed them to members of the mothers' grapevine.

Confronted with this serious breach of security, the hospital responded by obtaining exparte injunctions which forced the infiltrator and the other mothers to disclose to whom they in turn had passed the documents.

By this means the hospital was able to trace some of the documents to me. I was obliged to say to whom I had shown some of them - having sought expert opinion on what they revealed.

Bill Goodwin's victory in the European Courts may have given confidence to journalists who seek to protect their sources, but the above sequence of events illustrates how the courts can still force disclosure of a chain of leaks.

Organizations suspecting that a particular person has been leaked documents can, and have, without any evidence that a third party has received them, obtain injunctions as part of a 'fishing expedition' to prevent use of the information contained in them.

This is what happened to me initially. My refusal to acknowledge receipt of any documents, or to hand them over until being made an actual defendant in the proceedings, created a contempt of court risk. Like Bill Goodwin I had to rely upon the National Union of Journalists to step in and defend my position.

I am not the first, nor will I be the last, to find myself at the receiving end of writs and gagging injunctions initiated by an individual or institution under scrutiny. However, after my experience I can suggest some counter strategies.

The Forum will have heard from others that secret hearings in the Family Court, and orders prohibiting interviews with the families involved or the reporting of important details, have the real purpose of protecting the professionals, not the children.

There are sufficient powers within the law to prevent the identification of any child who is or has been the subject of any legal proceedings. And the Official Solicitor will usually take action against any flagrant and deliberate flouting of these safeguards.

Injunctions which prevent the family involved even talking to the press, or the press reporting any information which may have been researched elsewhere, protect the professionals, particularly from medicine and social work, from scrutiny.

What the authorities do not seem to understand is that taking out injunctions to prevent reporting simply increases interest.

Unfortunately the press - the tabloids especially - have a tendency to lose interest in a story if the child and family involved cannot be named.

It is less of a problem for the broadsheets which tend to balance the public interest in exposing an underlying scandal against the lack of an identifiable family.

But sadly it is the tabloid press rather than the broadsheets that has the resources for investigations - and they will not investigate false allegation cases, however strong, where the mother cannot be named. The same goes for the great and admirable 'injustice' strands on television.

Yet women are now in prison - as well as having had their children taken away - as a result of these controversial MSBP diagnoses. All the more reason for the press to be taking a close interest in the risk of injustice being done.

It is essential that journalists should work with the family without disclosing media involvement. The merest hint of press interest in a case leads the local authority or hospital involved to take out an ex parte injunction.

Statutory complaints procedures can be used very effectively to force information out of social services departments' files, hospitals and health authorities. This can be a protracted process and is usually a waiting game - waiting for some particularly revealing information to emerge to be fitted jigsaw-like into data from another, different case, possibly even in a different country.

Journalists may need to help families draft letters of complaint and point them in the direction of the appropriate complaints procedures for different institutions.

In my opinion this is an entirely ethical approach, justifiable in the public interest and necessary in view of the willingness of the Courts to grant unlimited injunctions on an ex parte basis without pausing to consider the alternatives - time limitation, for example, or reporting restrictions.

The authorities are ultimately powerless to prevent a determined family pursuing, say, a Section 26 complaint under the Children Act 1989, or seeking an Independent Professional Review of a medical opinion or diagnosis.

The rights of parents are backed and protected by the different Ombudsmen who will intervene to force reluctant authorities to investigate complaints.

It is a longer road but in the end it will result in the disclosure of information which is far less likely to be gagged, even if it is critical of a hallowed institution. Such alliances between potential victims of injustice and journalists in pursuit of the truth may be one of the few techniques available to expose experimentation and professional secrecy which could be damaging families and children.

Footnotes

1. See Epidemiology of Munchausen Syndrome by Proxy, non-accidental poisoning and non-accidental suffocation, McClure RJ, Davis PM, Meadow SR, Sibert JR, in Archives of Diseases in Children 1996; 75: 57-61.

This is a report of a study of cases of the eponymous forms of child abuse diagnosed between 1 September 1992 and 31 August 1994, organised by the British Paediatric Surveillance Unit, based on returns by members of the British Paediatric Association.

To be considered 'confirmed' a case would have to have been the subject of a first child protection case conference during the study period.

On p.60 the report states 'Eight children are known to have died as a direct result of their abuse, all from either suffocation or poisoning'.

It is not clear from this statement whether the deaths are alleged to be connected with MSBP. For any of the deaths to be MSBP-related it would mean that children died after they had been placed on an 'at-risk' register.

It is my understanding that among these eight child deaths were two from carbon monoxide poisoning caused when a father committed suicide with two of his children in the car.

In November 1995 a mother was convicted of the manslaughter of her child, who died allegedly from salt poisoning some eight years previously. A sibling was the subject of a case conference in the summer of 1993. The mother is currently appealing against the conviction.

2. There would appear to be an 'identity crisis' among professionals about the very use of the term. Some in the USA call it Factitious Disorder by Proxy, others Imposed or Induced Illness Syndrome, and others again Meadow's Syndrome, after Professor Sir Roy Meadow of St James Hospital, Leeds who coined the term Munchausen Syndrome by Proxy in 1977. In his latest edition of the ABC of Child Abuse, BMJ Publishing Group, 1997, London, Professor Meadow lists only two synonyms for MSBP - factitious illness by proxy and Meadow's syndrome. Neither factitious disorder by proxy (FDBP) nor the forms imposed or induced illness syndrome are suggested.

3. See, among others, article by Alyson Gordon, Mail on Sunday (20 Oct 1996); item in New Enjoy, Issue 11 (17 March 1997); MSBP network newsletter, USA (Dec 1996), published in Hawaii.

4. See Diagnostic and Statistical Manual of Mental Disorders Vol IV, (DSM-IV) published by the American Psychiatric Association; and International Classification for Diseases Tenth Revision of chapter V, The Classification of Mental and Behavioural Disorders (ICD-10), World Health Organisation.

5. See Law Society's Gazette, Letters - p16, 26 Feb. 1997

Summary: Information secrecy orders suggest the need for a radically different journalistic approach.

This paper appeared originally in the Report and Recommendations of the Child Exploitation & the Media Forum, pp 91-95, 1997, Smallwood Publishing Group, Dover. This version includes a small number of corrections and minor revisions.

1997 Brian Morgan phone and fax 44(0)1222 222656
E-mail: brianmorgan@btinternet.com
4 Rawden Place Riverside Cardiff CF1 8LF UK

An investigative journalist describes the problems faced by those confronted with 'professional secrecy' when seeking to unearth information about controversial diagnostic techniques.

The experience of attempting to research and report a new 'Cleveland' style scandal in the face of draconian secrecy orders suggests the need for a radically different journalistic approach.

Despite the legal impediments my investigation of this particular scandal is now effectively complete. Only a few loose ends remain. It has been a valuable experience and offers an important case study. Lessons have been learned from mistakes; attempts by the authorities to hinder inquiries and gag reporting have led to new ways of investigating.

One documentary based on the early research was transmitted in the Channel 4 Dispatches strand (The Munchausen File) in February 1994, and included reference to an earlier gagging order against the Cambrian News, the Aberystwyth-based newspaper, which sparked off my investigation.

After the Dispatches research was complete, evidence continued to accumulate that a small number of medical experts, with the willing cooperation of the legal and social work professions, have used the secrecy of the children's legal protection process to promote, internationally, a new child abuse diagnosis.

This has echoes from Cleveland, where child abuse investigators were relying upon evidence of 'anal dilatation' before it had become generally accepted as a valid diagnostic tool. Respectability for this technique was never achieved and its use was abandoned.

Now parents are being falsely accused of a new form of child abuse. In order to maintain their credibility and (dare one say, without risk of legal action) the high fees they can earn as 'experts', the medical profession repeatedly denies there are any false allegations, despite well-researched and clear documentation to the contrary.

Evidence of the seriously-flawed nature of this diagnostic procedure is not being put before the family courts, whose proceedings anyway are conducted in secret.

The medical theory is that parents (particularly mothers) are harming, even killing, their children because the adult suffers from a mental illness which has been given the name 'Munchausen Syndrome by Proxy' (MSBP).

Contentious cases have arisen where there is no forensic evidence to support the allegation that a mother (usually) has been repeatedly attempting to suffocate her baby to in order to induce a form of respiratory illness known as 'apnoea' (sometimes thought of or referred to as a 'Near-Miss Cot Death').

The alleged motive is to gain vicarious medical attention. The primary 'evidence' is that the doctors cannot find any illness in the baby to explain its breathing problems.

There are less than a handful of doctors involved in the UK and probably no more than a dozen throughout the world - paediatricians for the greater part who believe that abusers suffering from this mental illness can be identified by applying a profiling checklist to them.

According to them, those most likely to be 'suffering' from MSBP may:

* have a nursing background;
* have a different social standing from their spouse;
* have committed a crime, however minor, at some time;
* have had a dysfunctional upbringing;
* have experienced a cot death in the family;
* have a tendency towards attention- seeking.

There are a dozen or so 'features' like these that could apply to large numbers of people which implies that a small but significant proportion of the population could be open to accusations that they suffer from MSBP were allegations of abuse ever laid at their door. It is worth noting that, according to the report of the Clothier inquiry into deaths and injuries to babies and children at Grantham & Kesteven Hospital, the serial child killer Beverly Allitt was not suffering from MSBP. And, according to the only scientific study ever conducted into the epidemiology of the syndrome (1992-94), no child deaths have been positively attributed to MSBP. [1]

Indeed there is confusion within the medical profession as to whether MSBP is a form of child abuse, a mental condition among adults, or both, or neither.[2]

Nonetheless the present state of moral outrage concerning child abuse of any sort, and misleading or even false reports of infant deaths as a result of a parent allegedly suffering from the syndrome, feed into social work and litigation.

This ensures heavy anti-parent bias in the investigation of such instances of alleged abuse.

Currently the popular press in the UK and the USA is repeatedly and mistakenly attributing to MSBP the deaths of eight babies and young children from suffocation or poisoning in England and Wales over a two year period, purportedly quoting from the 1992-94 study, without any attempt by the study's authors to correct this false impression.[3] There is a kind of messianic zeal which drives some doctors and social workers along the road to court endorsement of permanent removal of the suspected victim from the alleged abusive family.

The courts, social workers and doctors ignore research which confirms that children, even from proven abusive homes, usually fare better left with their natural parents than in foster placements, provided appropriate resources are applied to supporting the natural home. Local authority coffers, from which support services would have to be financed, have been much depleted by the cost of the court hearings which can run into millions of pounds for each case.

We are expected to accept that those accusing the parents have only the child's interests at heart, and that the Family Court is inquisitorial not adversarial - no-one is on trial, say the Judges.

The truth is that a mother may stand accused of having a mental illness - which is not officially recognized, and of repeatedly attempting to suffocate her baby - without forensic evidence to back up the allegation.

A baby or babies that have been taken into care will be put up for adoption unless the mother admits to having harmed the child by accepting that she suffers from this mental illness - and agreeing to undergo treatment from a child and adolescent psychiatrist. What treatment they might suggest for an adult with a mental illness about which no official information exists is unclear.

It is not difficult to imagine which 'option' most mothers would choose.

No information is currently available as to whether the authorities even remotely consider what safeguards need to be put in place to avoid the scenario of innocent mothers falsely confessing to abuse under officially-sanctioned blackmail to avoid losing their children.

From the limited information about false allegations that has come into my possession alone, what is striking is the number of mothers who have resolutely protested their innocence up to this point and beyond.

Knowing they were innocent they have been prepared to risk the loss of their children in order to clear their names, and have successfully forced a review of the medical evidence.

Fresh examinations have identified the underlying illness in the child which the original doctors had failed to detect. The children have been returned home without any parental admission of guilt or any treatment for mental illness.

Even in these well-documented cases the doctors have refused to admit that the allegations were mistaken.

There is no research that supports their hypothesis, nor any mention of an adult psychiatric illness called 'Munchausen Syndrome by Proxy' as an established medically-accepted entity in either of the two internationally recognized listings, DSM-IV (USA) and ICD-10 (WHO). [4]

The only psychiatrists anywhere in the world who would appear to really believe in this mental illness - and who regularly give evidence against mothers - are the child and adolescent psychiatrists whom some local authorities and the courts are willing to consider as 'appropriate experts'.

The Cleveland scandal was exposed relatively quickly because the families involved were all from the same locality and the scale of the problem obvious.

This new scandal is less obvious - and has been in existence longer - because families are from all parts of the UK. The medical diagnosis is principally made by doctors in just a few regions. The 1992-94 study, which dealt with three different forms of alleged child abuse, appears to indicate four areas - Yorkshire, West Midlands, Trent and the North West - where reporting rates are significant (Yorkshire is highest at 0.8 per 100,000 of the under-16 child population). This may, of course, simply be an indication of high awareness levels of the supposed syndrome among professionals in those areas.

Who are the doctors involved? And the social workers? Which are the local authorities? And the courts? The whole issue is so shrouded in secrecy that it is difficult to discover the names.

Even when decisions are made public the names of the doctors appear only as initials. If you discover or attempt to discover to whom they refer, or to make connections between the agencies involved, you risk a secrecy order forbidding you to tell anyone or make public the details.

Indeed one of the myths promoted by these doctors is that seeking publicity is a characteristic of the MSBP abuser. That is a strong enough deterrent to put someone off seeking the help of the media to prove their innocence; and why lawyers are reluctant to allow the families to expose themselves to possible publicity - if for no other reason than to do so might be taken to imply guilt.

Yet the evidence is almost entirely to the contrary. I have thoroughly researched every case I have come across over the last few years and in nine cases out of ten the allegations were proved to be mistaken. In a small number of these it is possible to see how the allegations might have arisen from genuine misunderstandings about medical treatment needed by children with severe medical problems.

There is now a small but growing number of lawyers and doctors who suspect that this 'mental illness' may be a myth, and who are prepared to defend mothers and counter the propaganda.[5]

There is an also an informal but effective 'grapevine' of previously accused parents who have been proved innocent, to which some freshly accused parents turn for help and advice.

It has even been alleged that I am responsible for creating this 'organization', and maintaining it as a kind of spy network. I only wish there were such a formal network.

In fact the mothers have very little in common other than having been falsely accused of child abuse. They are from different geographical and social backgrounds and each feels that their particular circumstances are unique to them. Most find out about each other by accident rather than design, and they find concerted action very difficult to orchestrate.

Nevertheless the existence of a loose network of contacts has benefited some in their individual quests for recognition and acknowledgment of their traumatic treatment.

During a brief period when they maintained some semblance of an organization - one of the mothers dubbed it MUM (Mothers under Munchausen) but none of the others would agree to the title or her aims - they managed to infiltrate a British Paediatric Association press launch, lobby parliament, and picket a Midlands' hospital and a social work conference in Yorkshire.

The hospital later claimed that adverse publicity had forced it to abandon secret video surveillance of mothers with the babies they were suspected of abusing. It was claimed as a victory by the mothers and a retrograde step by the hospital.

MUM fell apart shortly afterwards and is not now heard of except as part of the medical demonology of investigative reporting.

More recently one of the mothers, acting as an unpaid fund-raiser, infiltrated a charity based at a hospital and run by one of the key doctors involved in making the controversial diagnosis of MSBP child abuse. He also made use of the secret video monitoring technique.

She removed a large number of confidential research papers and other documents and passed them to members of the mothers' grapevine.

Confronted with this serious breach of security, the hospital responded by obtaining exparte injunctions which forced the infiltrator and the other mothers to disclose to whom they in turn had passed the documents.

By this means the hospital was able to trace some of the documents to me. I was obliged to say to whom I had shown some of them - having sought expert opinion on what they revealed.

Bill Goodwin's victory in the European Courts may have given confidence to journalists who seek to protect their sources, but the above sequence of events illustrates how the courts can still force disclosure of a chain of leaks.

Organizations suspecting that a particular person has been leaked documents can, and have, without any evidence that a third party has received them, obtain injunctions as part of a 'fishing expedition' to prevent use of the information contained in them.

This is what happened to me initially. My refusal to acknowledge receipt of any documents, or to hand them over until being made an actual defendant in the proceedings, created a contempt of court risk. Like Bill Goodwin I had to rely upon the National Union of Journalists to step in and defend my position.

I am not the first, nor will I be the last, to find myself at the receiving end of writs and gagging injunctions initiated by an individual or institution under scrutiny. However, after my experience I can suggest some counter strategies.

The Forum will have heard from others that secret hearings in the Family Court, and orders prohibiting interviews with the families involved or the reporting of important details, have the real purpose of protecting the professionals, not the children.

There are sufficient powers within the law to prevent the identification of any child who is or has been the subject of any legal proceedings. And the Official Solicitor will usually take action against any flagrant and deliberate flouting of these safeguards.

Injunctions which prevent the family involved even talking to the press, or the press reporting any information which may have been researched elsewhere, protect the professionals, particularly from medicine and social work, from scrutiny.

What the authorities do not seem to understand is that taking out injunctions to prevent reporting simply increases interest.

Unfortunately the press - the tabloids especially - have a tendency to lose interest in a story if the child and family involved cannot be named.

It is less of a problem for the broadsheets which tend to balance the public interest in exposing an underlying scandal against the lack of an identifiable family.

But sadly it is the tabloid press rather than the broadsheets that has the resources for investigations - and they will not investigate false allegation cases, however strong, where the mother cannot be named. The same goes for the great and admirable 'injustice' strands on television.

Yet women are now in prison - as well as having had their children taken away - as a result of these controversial MSBP diagnoses. All the more reason for the press to be taking a close interest in the risk of injustice being done.

It is essential that journalists should work with the family without disclosing media involvement. The merest hint of press interest in a case leads the local authority or hospital involved to take out an ex parte injunction.

Statutory complaints procedures can be used very effectively to force information out of social services departments' files, hospitals and health authorities. This can be a protracted process and is usually a waiting game - waiting for some particularly revealing information to emerge to be fitted jigsaw-like into data from another, different case, possibly even in a different country.

Journalists may need to help families draft letters of complaint and point them in the direction of the appropriate complaints procedures for different institutions.

In my opinion this is an entirely ethical approach, justifiable in the public interest and necessary in view of the willingness of the Courts to grant unlimited injunctions on an ex parte basis without pausing to consider the alternatives - time limitation, for example, or reporting restrictions.

The authorities are ultimately powerless to prevent a determined family pursuing, say, a Section 26 complaint under the Children Act 1989, or seeking an Independent Professional Review of a medical opinion or diagnosis.

The rights of parents are backed and protected by the different Ombudsmen who will intervene to force reluctant authorities to investigate complaints.

It is a longer road but in the end it will result in the disclosure of information which is far less likely to be gagged, even if it is critical of a hallowed institution. Such alliances between potential victims of injustice and journalists in pursuit of the truth may be one of the few techniques available to expose experimentation and professional secrecy which could be damaging families and children.

Footnotes
1. See Epidemiology of Munchausen Syndrome by Proxy, non-accidental poisoning and non-accidental suffocation, McClure RJ, Davis PM, Meadow SR, Sibert JR, in Archives of Diseases in Children 1996; 75: 57-61.

This is a report of a study of cases of the eponymous forms of child abuse diagnosed between 1 September 1992 and 31 August 1994, organised by the British Paediatric Surveillance Unit, based on returns by members of the British Paediatric Association.

To be considered 'confirmed' a case would have to have been the subject of a first child protection case conference during the study period.

On p.60 the report states 'Eight children are known to have died as a direct result of their abuse, all from either suffocation or poisoning'.

It is not clear from this statement whether the deaths are alleged to be connected with MSBP. For any of the deaths to be MSBP-related it would mean that children died after they had been placed on an 'at-risk' register.

It is my understanding that among these eight child deaths were two from carbon monoxide poisoning caused when a father committed suicide with two of his children in the car.

In November 1995 a mother was convicted of the manslaughter of her child, who died allegedly from salt poisoning some eight years previously. A sibling was the subject of a case conference in the summer of 1993. The mother is currently appealing against the conviction.

2. There would appear to be an 'identity crisis' among professionals about the very use of the term. Some in the USA call it Factitious Disorder by Proxy, others Imposed or Induced Illness Syndrome, and others again Meadow's Syndrome, after Professor Sir Roy Meadow of St James Hospital, Leeds who coined the term Munchausen Syndrome by Proxy in 1977. In his latest edition of the ABC of Child Abuse, BMJ Publishing Group, 1997, London, Professor Meadow lists only two synonyms for MSBP - factitious illness by proxy and Meadow's syndrome. Neither factitious disorder by proxy (FDBP) nor the forms imposed or induced illness syndrome are suggested.

3. See, among others, article by Alyson Gordon, Mail on Sunday (20 Oct 1996); item in New Enjoy, Issue 11 (17 March 1997); MSBP network newsletter, USA (Dec 1996), published in Hawaii.

4. See Diagnostic and Statistical Manual of Mental Disorders Vol IV, (DSM-IV) published by the American Psychiatric Association; and International Classification for Diseases Tenth Revision of chapter V, The Classification of Mental and Behavioural Disorders (ICD-10), World Health Organisation.

5. See Law Society's Gazette, Letters - p16, 26 Feb. 1997

Summary: Information secrecy orders suggest the need for a radically different journalistic approach.

This paper appeared originally in the Report and Recommendations of the Child Exploitation & the Media Forum, pp 91-95, 1997, Smallwood Publishing Group, Dover. This version includes a small number of corrections and minor revisions.

1997 Brian Morgan phone and fax 44(0)1222 222656
E-mail: brianmorgan@btinternet.com
4 Rawden Place Riverside Cardiff CF1 8LF UK

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