Gender bias in the conceptualisation and operationalisation of the diagnosis of Munchausen syndrome by proxy

1. Gender bias in the conceptualisation and operationalisation of the diagnosis of Munchausen syndrome by proxy Clive Baldwin Senior Lecturer Social Sciences and Humanities University of Bradford Gender and Child Welfare Conference 22nd April 2009

2. Munchausen syndrome by proxy (MSbP) is an alleged form of child abuse in which the perpetrator (usually the mother) fabricates or induces illness in another (usually a child).

3. Term used by Meadow 1977 to describe cases of two children being presented for medical investigation and treatment who failed to respond to treatment and in which it was thought that the mothers were harming their children in order to seek medical attention.

4. According to Meadow (1995): 90% of cases involve the mother 5% a female caregiver 5% father

5. Gender bias In conceptualisation Indications of MSbP Deviancy from idealised motherhood Perpetrator characteristics Theories of motivation In operationalisation A-symmetry Profiling In research and the literature Absence of analysis Absence of research

6. Bias in conceptualisation Indicators of MSbP Symptoms start in the presence of the mother One parent (usually the father) absent from hospital A parent constantly at the child’s bedside Norms of motherhood as benchmark against which to identify deviancy Seen in language: e.g ‘the perversion of mothering’ Concern for child’s health Appears as the ‘perfect parent’: nurturing, loving, caring

7. Perpetrator characteristics – more likely to ‘identify’ women • Poor intellectual relationship with the husband • Comes from a higher social background than her husband • Fragmented employment history • History of eating disorders • Previously worked with children • Appears loving, caring and nurturing (female characteristics)

8. Theories of causation Attention of (male) paediatricians (Schreier and Libow 1993) Links to other ‘mental illnesses’ (e.g. depression, generalised anxiety, ‘hysterical illnesses’ etc) in which women predominate Nurturance cast in an evil light (Bergeron 1996) MSbP mothers are over-socialised into caretaking and traditionally female roles and such behaviour is a means of gaining recognition through the exaggeration of these, often undervalued, competencies (Leeder 1990).

9. A-symmetry: treating/interpreting the same behaviour on the part of father/mother differently ‘Diagnostic overshadowing’ In treatment: even if social factors are acknowledged (e.g. Yorker, Leeder) the response is individual therapy Profiling – of mother, no corresponding profile of father In operationalisation

10. Meadow (1995) was sceptical about the masculinity of the first few male perpetrators he came across to the extent of taking steps to find out if they had male chromosomes and glands Randall (1997) in answering a question about why he and his co-author did not address gender issues in their article about social work and MSBP replied: “we didn't want to distract the intended SW [social work] audience from the core issues “ In literature and research

11. Gender-power issues as marginal or irrelevant to the development, diagnosis, treatment and management of MSbP as evidenced by absence of discussion, contextualisation and research