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Friday, September 14, 2007
  MSbP - overdiagnosed according doctors in the USA
There is an article in Psychology Today published Yesterday in the USA that has interesting elements:

THE PERFECT STORM
HERE IN THE U.S., AWARENESS OF MBP MAY BE RISING ALONG
with antagonism between doctors and moms. "I have never known a false case not sparked by conflict between a mother and a doctor," New Hampshire psychologist Eric
Mart states.

Schreier says powerless mothers are clamoring for intimacy with doctors. But he could be recalling an era past, when doctors were emotionally present and generous with their time. Indeed, the impersonal nature of modern medicine doesn't seem to support the Munchausen by proxy construct. Marching to the drumbeat of managed care, in fear of litigation, 21st century doctors may have little interest in schmoozing. They are often seen as distant by the very patients they serve.
Mothers, too, have changed. Best described by Judith Warner in her book Perfect Madness: Motherhood in the Age of Anxiety, post-millennium moms are intense, omnipresent, and highly involved. From finding the perfect nursery school to engineering marathon play dates, nothing escapes their attention and no detail is too small. Taught independence by their own feminist mothers, at home with their children by choice, these educated women aren't likely to defer to a doctor when a child stays sick. The more mothers learn, the more they access the Internet, and the more intense and independent they become, the more they will spar with doctors—and the more they'll be at risk of being labeled a Munchausen mom.

"If it were the man demanding help, wanting to know more and wanting to be involved, no one would think anything of it except, 'What a dad! says Mannie Taimuty-Loomis, now executive director of the Jonah & the Whale Foundation. "But when a mother displays the same characteristics she's deemed difficult to work with, overly interested, and very controlling."

"Diseases that can't be fixed can create enormous amounts of anxiety," adds Tracy Davenport, a University of Delaware expert on the social impact of illness. "Doctors want these patients out of their office, while the patients are filled with loneliness and despair—not because they want the doctor to love them, but because they want the disease to go away."

Pennsylvania psychiatrist Virginia Sherr has a special interest in Lyme disease, whose neurocognitive symptoms can seem bizarre and vague. She says she's seen false allegations time and again when a mother tries to get help for a child who's truly sick. "Modern medicine tends to trivialize women's seemingly offbeat concerns, and hurried physicians who seek easy panaceas drastically devalue mothers' opinions," she states. "Worldwide, there have been thousands ofvery sick children forcibly removed from mothers because these women have insisted, quite knowingly, that their children are ill."

"We are seeing a conflict between doctors and patients that didn't exist before," says Davenport. "Mothers are increasingly demanding consumers. They are texting friends by BlackBerry and getting information in minutes that trumps what their doctors advise. Rather than idolize their doctors, they are apt to antagonize them, leading to more misunderstanding and more charges of MBP in years ahead."

The intellectual dilemma here, says Kirk Witherspoon, an Illinois psychologist studying the issue, is that two unrelated elements have been mixed. One of them is motive, which is a cause. The other is abuse, which is a result. There's no proof that the theorized motive—a need for attention-explains the abuse routinely labeled MBP. But that doesn't stop some doctors from "dredging up motive to scapegoat mothers when they don't have answers," says Witherspoon. "Instead of diagnosing the child with a disease, they diagnose the parent with a crime. When mothers challenge their authority, doctors call it a pathology, one that's so broad it fits everyone. For example, if the mother is too friendly, a sign of Munchausen. If the mother is angry, a sign of Munchausen. There's no differential diagnosis. It's preposterous. It doesn't make logical sense."

Feldman attributes the confusion, in part, to invalid profiling. "There is no profile," he says. "There has to be proof."
But there, too, problems abound. Subject to misinterpretation, tools like covert taping (used to entrap Kelly Savage) and family separation (the evidence against the Taimuty-Loomis family) can lead to false allegations. Children who suffer from acid reflux are a prime example. They are often treated with Reglan, a drug that can cause seizures and a full range ofunusual side effects. Mothers are blamed for the symptoms, and then separated from their children. The treatment is stopped, and the children get well, apparently confirming MBP. And since many conditions improve on their own over time, the separation test is an imperfect investigative tool.
In light of all this, even doctors convinced of MBP's reality are pulling back. Feldman insists the syndrome exists, but says "we've gone too far. Those of us on the front lines must take ownership of the problem and admit we've been overzealous. Innocent mothers have been accused." Feldman is especially troubled because when vindictive doctors make false reports, they're protected by the law and consequences are nil.

"We have created a monster in our imagination that we project onto certain mothers," Pankratz says. "Some of these mothers have problems in the medical management of their children and need clinical help, but the exotic label has entangled them in a destructive web, seemingly without escape."

Eric Mart points to psychiatry as a field rife with discredited theories—for instance the idea that "refrigerator mothers" create autistic kids. When studies are done, such concepts are relegated to the dustbin of science, and MBP stands poised to end there, too, he states. "I'm not saying the abuse doesn't happen," Mart emphasizes. "I'm just saying the theory behind the syndrome doesn't hold up."

"Why call it Munchausen," asks Kirk Witherspoon, "when you can just call it abuse or murder."
 
Comments:
1. Not everyone diagnosed with Munchausens By Proxy is innocent.
2. It is impossible to distinguish between the innocent and the guilty
3. There is a high rate of personality disorders within the group accused of child abuse of any sort.
4. Discrediting a diagnosis by stating that it does not exist may well place children at risk.
5. The innocent and the guilty will cite their innocence.

Dr Rita Pal
www.nhsexposed.com
www.nhsexposedblog.blogspot.com
 
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