Tuesday, June 28, 2005

The "science" of child abuse

MetaFilter has an intersting article about Munchausen's by proxy. The syndrome's originator, Roy Meadow, is charged with scientific incompetence and/or misconduct for his work on child abuse. For example, he testified against parents in court claiming that the odds of two unexplained infant deaths in the same family were 73 million to one, which clearly ignores correlated causes such as genetics.

This Times article has some pointed things to say about Munchausen's by proxy:

Munchausen’s syndrome by proxy is a quintessential example of that most suspect of scientific theories — one that brooks no rational argument, a closed circle we all must accept at face value.

For example, the only cure must begin by the sufferer accepting that he or she is afflicted with the condition — which, of course, the alleged sufferer is loath to do. But if someone who is diagnosed as a sufferer vociferously denies it, this serves to reinforce the diagnosis. A denial of the condition is, perforce, a symptom of the condition.


So there we have it: an illness that has no cause or cure and that is diagnosed at least partly by the alleged victim’s denial that he or she is so afflicted. The more the victim denies it, the more obviously the victim is afflicted. And it is an illness that may somehow exist within a person without cause or cure or indeed any manifestation of its symptoms.

Certainly some parents become dangerously obsessed with their child's health, or use the child to gain attention. But I also know from personal experience that certain illnesses can be extremely tricky to diagnose, especially in mild cases or in the early stages. Putting the latter in the factitious pigeonhole is a Bad Thing, not to mention frustrating beyond the patience of saints.

All this reminds me of the diagnostic cult that sprang up around satanic ritual abuse, with lurid tales of babies sacrificed on dark altars, and children forced to do unlikely and preposterous things like eat a jar of scabs*. "Therapists" described the activities as unspeakable, then proceeded to talk about them at length and with enthusiasm. The recovered memory cults were absurd in the same way.

Incidentally, childbirth is more traumatic than most people suspect. Rather than make assumptions, researchers in the UK actually scanned a bunch of non-abused newborns in an MRI machine. Their paper Frequency and natural history of subdural haemorrhages in babies and relation to obstetric factors found that 6% of the normal vaginal births studied (n=3) resulted in subdural hematoma (bleeding between the brain and its surrounding membrane) detectable by MRI. No doubt there are parents rotting in prison because a jury was told that a newborn with a subdural hematoma must have been abused.

*Where the heck do you get a jar of scabs, anyway? The pain and scarring would require considerable devotion to the Dark Lord, that's for sure. And what about a jar of pus? Nevermind where it comes from: does it need refrigeration?

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