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‘Munchausen's syndrome by proxy’ or a ‘miscarriage of justice’? An initial application of functional neuroimaging to the question of guilt versus innocence

Published online by Cambridge University Press:  16 April 2020

Sean A. Spence ,
Catherine J. Kaylor-Hughes ,
Martin L. Brook ,
Sudheer T. Lankappa  and
Iain D. Wilkinson
Sean A. Spence*
Affiliation:
Academic Clinical Psychiatry, University of Sheffield, The Longley Centre, Norwood Grange Drive, Sheffield S5 7JT, UK
Catherine J. Kaylor-Hughes
Affiliation:
Academic Clinical Psychiatry, University of Sheffield, The Longley Centre, Norwood Grange Drive, Sheffield S5 7JT, UK
Martin L. Brook
Affiliation:
Academic Clinical Psychiatry, University of Sheffield, The Longley Centre, Norwood Grange Drive, Sheffield S5 7JT, UK
Sudheer T. Lankappa
Affiliation:
Academic Clinical Psychiatry, University of Sheffield, The Longley Centre, Norwood Grange Drive, Sheffield S5 7JT, UK
Iain D. Wilkinson
Affiliation:
Academic Clinical Psychiatry, University of Sheffield, The Longley Centre, Norwood Grange Drive, Sheffield S5 7JT, UK
*
∗Corresponding author. Tel.: +44 (0) 114 22 61519; fax: +44 (0) 114 22 61522. E-mail address: s.a.spence@sheffield.ac.uk (S.A. Spence).
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Abstract

‘Munchausen's syndrome by proxy’ characteristically describes women alleged to have fabricated or induced illnesses in children under their care, purportedly to attract attention. Where conclusive evidence exists the condition's aetiology remains speculative, where such evidence is lacking diagnosis hinges upon denial of wrong-doing (conduct also compatible with innocence). How might investigators obtain objective evidence of guilt or innocence? Here, we examine the case of a woman convicted of poisoning a child. She served a prison sentence but continues to profess her innocence. Using a modified fMRI protocol (previously published in 2001) we scanned the subject while she affirmed her account of events and that of her accusers. We hypothesized that she would exhibit longer response times in association with greater activation of ventrolateral prefrontal and anterior cingulate cortices when endorsing those statements she believed to be false (i.e., when she ‘lied’). The subject was scanned 4 times at 3 Tesla. Results revealed significantly longer response times and relatively greater activation of ventrolateral prefrontal and anterior cingulate cortices when she endorsed her accusers' version of events. Hence, while we have not ‘proven’ that this subject is innocent, we demonstrate that her behavioural and functional anatomical parameters behave as if she were.

Keywords

Munchausen syndrome by proxyFabricated or induced illnessMiscarriage of justicefMRIVentrolateral prefrontal cortexAnterior cingulate cortexResponse timeFactitious or induced illnessLiesTruth
Type
Original article
Information
European Psychiatry , Volume 23 , Issue 4 , June 2008 , pp. 309 - 314
Copyright
Copyright © European Psychiatric Association 2008

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