Society’s unhealthy obsession with abuse
Sir Roy Meadow is not single-handedly responsible for a culture that sees child abuse everywhere.
This is a response to Dr James Le Fanu’s piece, Expert witnesses, suspect science and dead babies.
Retired paediatrician Roy Meadow is currently facing charges of gross professional misconduct before the General Medical Council in connection with his evidence against a number of parents wrongfully convicted of killing their children.
Over the past two decades he has helped to popularise the view that children are being abused and even killed by their parents much more commonly than was previously believed. But he did not single-handedly create the obsession with abuse that led to these unjust convictions. Nor are these parents the only victims of a climate of opinion that is predisposed to believe the worst about how people behave in intimate relationships.
According to Dr James Le Fanu, ‘the medical advocacy of contentious theories of the mechanisms of child abuse is likely to have been responsible for a systematic miscarriage of justice on a scale without precedent in British legal history - with devastating consequences for the parents wrongly convicted’. Though the scale of these injustices remains unclear - in only a handful of cases has a guilty verdict so far been overturned - the consequences of such wrongful convictions are undoubtedly devastating.
Dr Le Fanu traces the origins of the current situation back to the 1980s, when Professor Meadow (and Dr David Southall, the subject of earlier disciplinary proceedings at the GMC) described ‘two covert forms of child abuse’ - factitious illness (which Meadow labeled Munchausen’s Syndrome by Proxy) and smothering (famously exposed by Southall through covert video surveillance) (1).
Individual doctors, no matter how brilliant and charismatic, do not have the power to transform the culture of society in relation to a matter as important as the ill-treatment of children by their parents. A closer look at the new outlook on children that emerged in British society in the 1980s reveals that when Professor Meadow and his colleagues suggested that there was ‘a hidden epidemic of child abuse’ there was widespread acceptance of this view, among medical - and legal - professionals, the media and the general public.
Children of the risk society
According to one commentator, the distinctive feature of British society in the 1980s was the ‘normalisation of the experience of abuse’ (2). Diverse forces - social fragmentation, political disengagement and ideological exhaustion - combined to create an unprecedented consciousness of risk. In the ‘risk society’, insecure individuals felt themselves to be under threat, not only from environmental dangers, but also from other people. Risks were identified in the public realm - from criminal and anti-social behaviour in the streets and from bullying and harassment in the workplace. Intimate personal relationships, whether romantic, sexual or familial, were also increasingly regarded as being fraught with danger. The concept of risk was most consistently used in relation to the dangers confronting vulnerable children from adults, in both the private and the public realms.
Whereas the family had once been regarded as a refuge for adults from the cares of the world and a safe haven for children, it now came to be regarded a hidden realm in which abusive relationships thrived. The long-standing feminist focus on domestic violence expanded and diversified, taking in ‘recovered memories’ of childhood abuse as well as emotional and psychological ill-treatment. In the past, paediatricians had recognised
occasional cases of ‘battered babies’ and ‘non-accidental injury’. Now they encountered an epidemic of children suffering a wide range of forms of abuse; rare cases of incest were replaced by relatively common allegations of ‘child sexual abuse’. Elder abuse was added to the list of crimes committed furtively behind the net curtains. This obsession with abuse was promoted by therapeutic entrepreneurs in the medical and social work
professions and by voluntary organisations in the spheres of domestic violence and child care.
This misanthropic outlook on intimate relationships was not foisted on a sceptical public. Its promoters appeared to find a responsive audience in an increasingly atomised and individuated society. The media also played their part. Themes of child abuse, sexual violence, paedophilia, stalking and serial sex crime became staples of novels, newspaper reports, television features, dramas and soaps (ChildLine was a spin off from Esther Rantzen’s late 80s BBC TV show, That’s Life). In this climate of opinion, Professor Meadow’s theories were guaranteed a popular reception - and it was not surprising that he rapidly came to enjoy celebrity status in the burgeoning world of child protection.
The event that dramatically revealed the ascendancy of the abuse obsession in Britain (while also imposing some limits on it) was the Cleveland child sexual abuse scandal of 1987. In the course of a few months, more than 120 children were removed from their homes in this industrial town in the northeast and taken into local authority care, following allegations that they had been sexually abused, usually by their fathers.
The initiative for this coercive intrusion into family life came from social workers and doctors influenced by radical feminism - in defiance of the local police. A media campaign scapegoated the leading social workers and doctors, who faced a barrage of personal hostility. Though the subsequent inquiry conducted by Lord Justice Butler Sloss criticised the key professionals for their ‘certainty and over-confidence’, it generally endorsed professional intervention in cases where there were reasonable grounds to suspect abuse.
Miscarriages of justice
Despite the backlash against the leading figures in the Cleveland case, the bleak presumption underlying their activities - that sexual degradation was a virtually universal feature of family life - and their conviction that coercive state intervention was necessary to deal with it became increasingly influential. Over the next decade these views were influential in a number of cases in which parents and care workers were accused of particularly gross forms of child abuse, generally with a sexual dimension. Whereas the police had been reluctant to play a leading role in the Cleveland cases, they now threw major resources into the pursuit and prosecution of alleged child abusers. The result was a series of grotesque injustices.
In 1998 former nursery workers Dawn Read and Christopher Lillie won a libel action against Newcastle council and others who had continued to accuse them of child abuse after they were acquitted in 1994 of charges of serial sexual molestation of children in their care (3). It emerged that these charges were largely the result of suggestive interview techniques used by child protection professionals. Read and Lillie lost their jobs and were obliged to go into hiding to escape the retribution of a mob whipped up by prejudicial media reports. (Paediatrician Camille San Lazaro, whose damning evidence against the nursery workers was described by the judge as ‘unbalanced, obsessive and lacking in judgement’, was recently exonerated by the GMC.) (4)
....Welsh Children’s Homes
In March 1992, 40 police officers in Wrexham arrested 16 men and one woman, all but one of whom had formerly worked at Bryn Estyn, a local care home for adolescent boys, which had been closed down in 1984 (5). This home was said to have been a centre for the homosexual abuse of adolescent boys by a paedophile ring, whose members had terrorised their victims and subjected them to a regime of violence and brutality. The ensuing investigation, after trawling former residents of care homes for retrospective claims of abuse, led to allegations against hundreds of care workers in children’s homes across north Wales, many of which were revealed to have been of dubious reliability.
....Satanic Abuse rings
In a series of cases in the late 1980s and early 1990s, groups of parents were arrested and children taken into care following allegations of ritual sexual abuse by parents involved in paedophile rings (6). Subsequent investigations in Nottingham, Pembroke, Rochdale and the Orkneys failed to confirm any of these allegations, and in 1994 a three-year investigation funded by the UK Department of Health and headed by Professor Jean La Fontaine concluded that there was no evidence that Satanic ritual abuse had taken place anywhere in the UK. Yet children have been traumatised, families disrupted and parents stigmatised in the course of these late twentieth-century witch-hunts.
The scapegoating of Roy Meadow
It is true, as Dr Le Fanu points out, that many of the features held by Professor Meadow to be diagnostic of different forms of child abuse are contentious and lacking in specificity. (The sign of ‘reflex anal dilatation’, which the Cleveland inquisitors regarded as diagnostic of anal penetration, is even more unreliable - though Dr Le Fanu has never objected to this.)
It is also the case that many of the alternative explanations of sudden infant death advanced by campaigners against Professor Meadow are at best speculative (such as the genetic mechanisms suggested by Dr Le Fanu). When campaigners suggest organophosphate poisoning or vaccinations, or hypothetical syndromes such as ‘temporary brittle bone disease’, to explain sudden infant deaths, they enter the realm of junk science. However, Dr Le Fanu is right to insist that parents should not be convicted only on the basis of contentious medical diagnoses, where the causal mechanism between putative assault and subsequent injury remains obscure, in the absence of wider circumstantial evidence.
Emphasising the decisive role of Professor Meadow and his colleagues in the prosecution of parents, Dr Le Fanu argues that ‘their persuasive expert opinion, when expressed in court, was guaranteed a sympathetic hearing, while their confidence in the syndromes they had discovered was virtually unchallengeable’. No doubt Dr Le Fanu is right to note the dogmatic attachment of the child abuse experts to their own theories, a feature forcefully exposed in the case of Dr Southall. Yet this does not explain why they were guaranteed a sympathetic hearing in court, nor why their evidence was considered so convincing.
It is important to recall that these parents were not convicted by Professor Meadow and Dr Southall, but by a judicial process of which their expert evidence was but a small part. Judges are not known for their deference towards expert witnesses and are often ready and willing to dismiss such evidence or to draw attention to its limitations. Juries, too, are capable of coming to their own conclusions on the value of expert testimony. The distinctive feature of recent child abuse prosecutions has been the extent to which the abuse obsession has also influenced the judicial process. As a result, courts are, like professionals in the field of child protection, predisposed to accept the view that abusive relationships between parents and children are much more widespread than was previously believed.
As prominent figures in both the medical and legal worlds, Professor Meadow and his colleagues became beneficiaries of the abuse obsession they helped to promote. Now they have become victims of the backlash against it. Both Professor Meadow and Dr Southall have become the targets of a vituperative campaign, involving supporters of accused parents and a number of journalists - who do not seem to have been similarly outraged by the events in Cleveland and the other scandals listed above.
The distinctive feature of the recent cases overturned in the courts is that, unlike the earlier cases, they often involved middle-class families. According to Dr Le Fanu such parents are quite different from typical child abusers, who are ‘psychopaths, criminals, opioid abusers, alcoholics, and so on’ (the ‘and so on’ clause appears to invite the addition of further categories of people ‘not like us’). In fact, the most recent reference provided by Dr Le Fanu for this abuser profile does not support his interpretation: parents who kill their children are often suffering from mental illness (depression or psychosis) and, though some abuse drugs or alcohol, they often do not have a previous record of child abuse (7). The record suggests that, just as miscarriages of justice can occur in the most respectable families, so also can (genuine) cases of child abuse (even homicide).
While the false conviction of parents on charges of killing their children seems likely to have been a rare occurrence, the prevailing cultural obsession with abuse that proved decisive in securing these convictions has had much wider consequences. It has not only contributed to the series of miscarriages of justice outlined above, but has fostered a widespread belief that all forms of abuse of children are commonplace. Serious child abuse is a terrible thing, but the fact is that it remains a rare occurrence.
The proliferation of codes of conduct and protocols governing all interactions between adults and children reflects prevailing anxieties on this subject and the institutionalisation of distrust between parents and professionals. Parents have become fearful about bringing their children to doctors’ surgeries or hospital accident and emergency departments lest their symptoms be interpreted as manifestations of abuse. Many adults have become reluctant to engage in any form of social activity with children - such as sports coaching, music or drama - because of the inevitable suspicion aroused by their involvement. Whatever the outcome of Professor Meadow’s appearance before the GMC, the narrow focus on his personal role means that the wider abuse obsession remains unchallenged.
Dr Michael Fitzpatrick is author of The Tyranny of Health: Doctors and the Regulation of Lifestyle, Routledge, 2000 (buy this book from Amazon UK or Amazon USA), and MMR and Autism: What Parents Need to Know (buy this book from Amazon (UK) or Amazon (USA)).
(1) The cot death controversy, by Dr Michael Fitzpatrick
(2) Frank Furedi, Therapy Culture: Cultivating Vulnerability in an Anxious Age, Routledge, 2004
(3) Child protection questions, by Jennie Bristow
(4) Though the GMC acknowledged that Dr San Lazaro had behaved in an ‘inappropriate, irresponsible and unprofessional’ manner, it concluded that this did not amount to professional misconduct. BMJ2005; 330: 1168 (11 May)
(5) The making of a modern witch hunt, by Jennie Bristow
(6) Jean La Fontaine, Speak of the Devil: Tales of Satanic Abuse in England, Cambridge University Press, 1998
(7) Michael Craig, ‘Perinatal risk factors for neonaticide and infant homicide: can we identify those at risk?’ Journal of the Royal Society of Medicine 2004; 97:57-61