Medical drama

Part of what makes Carol Dunlavy's case so complicated is the accusation of Munchausen Syndrome by Proxy. The disorder is incredibly rare — rarer still, experts say, if properly diagnosed. And a proper diagnosis is tough. The syndrome is not officially listed in the DSM-IV, though it is mentioned in the appendix as needing more research before it can become a legitimate diagnosis.

Still, the condition gets attention because the image it conjures — a mother slipping poison to her child — is so horrifying.

Derived from Munchausen Syndrome (in which a patient feigns illness for attention, named for the 18th-century German Baron von Münchhausen, who was famous for making up outrageous stories about his life), Munchausen Syndrome by Proxy is a disorder in which an adult fakes an illness in a child, forcing the child to act as a "proxy."

The term was coined by British pediatrician Roy Meadow in 1977 as a way to explain "cot deaths," known in America as sudden infant death syndrome.

Meadow was famously quoted saying, "One cot death is a tragedy, two is suspicious, three is murder."

His testimony put people in jail. But 30 years after he published his first paper on MSBP, Meadow's reputation was destroyed by his allegations against Sally Clark, a British mother accused of killing two of her infant children.

At Clark's trial, Meadow testified that the chances of such tragedy striking the same family twice was one in 73 million. This statistic put Clark in prison for more than three years.

But Meadow was wrong. An appeal revealed gross errors in Meadow's statistical analysis and Clark was exonerated in 2003.

She wasn't the only woman falsely accused by Meadow. In 2003, he accused Trupti Patel of murdering her three children, but according to the London Times, his statistics were so bad, jurors found her innocent in 90 minutes. Meadow was banned from testifying in court, and many women who were put away based on his testimony began to get out of jail.

The U.K.'s General Medical Council took away his license in 2005, calling him, "naive, grossly misleading, incompetent and careless," though he did manage to get his license reinstated on an appeal.

In December 2007, British physician David Southall, who pioneered the use of covert video surveillance in MSBP cases, lost his license for falsely accusing a mother of drugging and killing her son.

A spokesperson for the House of Lords told the BBC that Munchausen Syndrome by Proxy is "one of the most pernicious and ill-founded theories to have gained currency in childcare and social services over the past 10 to 15 years."

At the same time, across the Atlantic, Carol Dunlavy was fighting her own MSBP charge. Eric Mart, a Boston psychologist and nationally recognized expert on MSBP, has seen more than 100 mothers like Dunlavy and says not one of them actually had MSBP.

"I think the mistake people have made with this is that they've taken something that is actually a bunch of different phenomena and treated it as if it's the same thing," he says. "It's a mistake to use that label because it brings so much baggage with it. There's all this clinical lore and no scientific basis. It's a principal of forensic psychology that you never diagnose when you can describe."

Description is important, considering there are over 100 MSBP "red flags." One is a "parent who appears unusually calm in the face of serious difficulties in her child's medical course while being highly supportive and encouraging of the physician, or one who is angry, devalues staff, and demands further intervention."

Another major sign is a parent with the medical knowledge to fake an illness. Dunlavy told doctors she was a child psychologist (she's not), leading them to believe she knew how to make Sarah sick.

Mart says there are too many contradictory warning signs to convict a parent based on any one by itself.

"Do you know anyone who wouldn't be associated with one of them? How many do you have to have? There are so many listed and they are not derived scientifically," he says. "No one bothered to do that in any real way."

He adds there's a huge difference between a parent who exaggerates symptoms, and a parent who poisons a child.

"Not everyone who exaggerates is a murderer," he says.

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Megan Irwin
Contact: Megan Irwin