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Nowhere is the controversy surrounding Munchausen syndrome by proxy fiercer than in England, the country where the diagnosis was first identified.
The two doctors most closely associated with the syndrome - Roy Meadow, who wrote the article introducing it in 1977, and David Southall, who used covert video surveillance to record parents hurting their children in hospitals - in the last few years found themselves fighting for their medical licenses and reputations. In 2004, the British government ordered the review of more than 250 cases of parents convicted of killing their children on the basis of testimony from Meadow, Southall and other experts dating back a decade.
"I think in England the accusation has been thoroughly trashed by the media and also by professionals who realize now that this really got out of hand, and particularly that it was very easy to blame mothers when that wasn't what was happening," said Eric Mart, a psychologist and Munchausen expert from New Hampshire who has testified on behalf of accused parents in dozens of cases. The acquittals "have really stifled accusations of Munchausen syndrome by proxy."
In the decades following Meadow's 1977 article, which described a mother who injected her own blood into her child's urine and another who poisoned her child with salt, the number of Munchausen accusations in the United Kingdom and beyond began rising. But criticism of Meadow and the diagnosis mounted following two high-profile acquittals in cases that had relied on his expert testimony.
In January 2003, Sally Clark, a lawyer, won an appeal of her conviction for killing two of her children after it was disclosed that at least one boy had a serious bacterial infection. Her conviction four years earlier had been based largely on Meadow's testimony that there is only a one in 73 million chance of two SIDS deaths in a single family, a statistic that has since been discredited.
In December 2003, Angela Cannings, who was convicted of killing two of her children also largely on the basis of Meadow's testimony that she was a Munchausen mother, was freed on appeal when a judge learned there was a history of SIDS in her family. Following these acquittals, Meadow lost his medical license but won it back on appeal.
Southall, a British pediatrician, launched a study using video surveillance to try to identify Munchausen parents in 1986. Over the next eight years, the controversial videotapes, some of which show mothers appearing to suffocate their children or removing their IV tubes, led to Munchausen accusations against 23 parents and 33 total abuse prosecutions. He was investigated by England's General Medical Council, which stripped him of his right to work in child protection but allowed him to keep his medical license, after testifying against the husband of Sally Clark.
The acquittals of Cannings and Clark, coupled with the rising influence of mothers publicly fighting Munchausen accusations, led many in England to begin calling Munchausen the "discredited" diagnosis, and the number of cases there has dropped dramatically. Some say, however, that the pendulum has swung too far - pointing out, for instance, that four of those captured on video by Southall pleaded guilty - and is creating a climate in which practitioners are afraid to make any child abuse accusations at all.
"The strongest piece of scientific data are those 39 cases published by David Southall. You just have to read those cases to know that if this is out there, it's something you want to protect children from," said Herbert Schreier, a child psychiatrist who co-wrote the book "Hurting for Love." "And the reality is that now nobody wants to go near these cases."