Shirah Vollmer MD

The Musings of Dr. Vollmer

Munchausen By Proxy-II

Posted by Dr. Vollmer on April 12, 2012

A mom makes her child sick and then acts like a wonderful and caring mother who devotes herself to her ill child. Her friends feel sorry for her because she has a “sick” child. Is this hard to believe? Only if you believe in the myth that all mothers want to see their children healthy and happy. Monique was giving her four-year old Ana a laxative and then taking Ana to multiple gastroenterologists complaining about Ana’s chronic diarrhea. Why would Monique do this? You ask. One reason might be that Monique craves the medical attention. She feels the medical attention given to Ana to be nurturing for herself. She might also appreciate the secondary gain of being seen as this “angelic” mother who cares so deeply for her “sick” child. This theme of parents destroying their children supports Freud’s ideas that rivalries can be vicious and the fight for much needed attention, at times, knows no boundaries. Is there any hope for Ana? You wonder. That depends, is my response. In extreme situations, there is no hope. Monique will  physically and/or emotionally kill off Ana’s potential for a healthy development. In more subtle situations, where Monique, when she is in her own personal struggle causes Ana physical harm, where the issue is more intermittent as opposed to chronic, then Ana has hope to rise above Monique’s desire to poison her. Still, even in that situation, Ana is in a bind of loving and depending on a caretaker who is, at times, trying to harm her. This bind can take years and years to unravel. Ana’s desire to protect Monique is at war with her hatred towards Monique. This internal battle is exquisitely painful and unspeakable. Monique’s friends and family see her as a very loving and wonderful mom, yet Ana knows a different narrative. This discrepancy causes the painful confusion which is seen with so many kinds of child abuse, including Munchausen By Proxy. Some mothers consistently love and care for their children. Some mothers consistently try to harm their children. Most mothers love and hurt their children, to some degree, but fortunately, on a much lighter level. Winnicott’s concept of the “good enough” mother comes to mind. The exception, the outliers, help us understand the more subtle issues of parenting. Seeing Munchausen By Proxy deepens this understanding of what parents can be capable of. The stories amaze.

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4 Responses to “Munchausen By Proxy-II”

  1. Jon said

    This is so incredibly sad that I had troubles reading the name Munchausen by proxy. I mistook it for Munchkins by proxy. I would much rather imagine the silliness of Frank Baum’s make-believe little people than the sadness of what the real world has named after Baron von Munchausen’s telling outlandish stories.

    Baron von Munchausen was an 18th century German nobleman. Let me segue to a 19th century English mathematician, Charles Babbage. He developed plans for (and partially built) the Analytical Engine, the forerunner of the modern computer. On two occasions I have been asked, ‘Pray, Mr. Babbage, if you put into the machine wrong figures, will the right answers come out?’ I am not able rightly to apprehend the kind of confusion of ideas that could provoke such a question.

    None of us are perfect parents, but to have those confusions of ideas that would have a parent act in such a manner as Munchausen by proxy, I cannot rightly apprehend.

    • Thanks, Jon for your comments and thanks for elaborating on the history of Munchausen and Babbage. Outlandish stories are outlandish because we want to think that the world works according to some basic principles of love and care for one’s family, but at the same time, we know that is an ideal, which then has a range of deviations. Thanks Again.

  2. Shelly said

    Can you elaborate on why you say that Monique hates Ana? Ana is just a tool for Monique to get the attention that she craves. I imagine that you will say that Monique hates herself and by extension she hates what she does to Ana (her alter-ego), but why should she hate Ana when Ana is an innocent victim? What is Winnicott”s concept of “The Good Enough” mother?

    • Shirah said

      Yes, you are right. Ana becomes the object of Monique’s projection of her self-hatred. As you knew I would say that, I say that.
      Winnicott’s very useful concept of “the good enough” mother is that as human beings, mothers are flawed and often mis-attuned to their children, but the hope is that there is more attunement, than mis-attunement, thereby allowing the child to gather enough nurturing to grow and develop. Monique’s case is one in which there is not a “good enough” mother in that all of her actions are harmful to Ana. Winicott’s concept is so useful because parents often know that they make mistakes, so it helps to take a longer view in which one acknowledges mistakes, but hopes that there is a net positive. This permission for a broader view of child rearing helps parents have more humility. Thanks, as always, for your comments.

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