This thesis will demonstrate how Munchausen Syndrome and, by derivation Munchausen
Syndrome by Proxy, grew out of historical themes of assigning disease labels to
anomalous or problematic behaviour, replicating issues of gender, particularly in respect
of illness and madness and power biases, in society. The literature review will
demonstrate how the early case notifications provided 'a Munchausen narrative', which
came both to construct and to pathologise, first patients and later women, as mothers. It
is argued that psychiatric models account for few cases of child abuse. A more coherent
theory allows child abuse and, therefore, Msbp to be understood within a framework,
which takes account ofpast and present ecological influences on the development of
individual experience, characteristics and competency, and importantly, the meaning of a
child within the life-cycle of that individual.
The research, in this thesis, was designed to provide an estimate of the incidence of Msbp
in Scotland. While it confirmed die findings of earlier studies diat illness induction and
fabrication are rare events, it demonstrated a range of manifestations of abnormal
behaviour among parents, in presenting their children to doctors, which were
recognisable as being abusive and which often overlapped other forms of child
maltreatment and neglect.
It became apparent that the connotations of the title Msbp, particularly in relation to its
psychodynamic formulations and evidencing actual or a risk ofsignificant harm, makes
this a professionally fraught and ill-defined area of child protection work for
Paediatricians, irrespective of recent Guidance (RCPCH 2002).
The concluding sections of the thesis will consider inherent difficulties in working in this
difficult area of child abuse and will provide recommendations for facilitating
professional and child protection practices.