As a clinicians attempting to foster change by providing a new attachment relationship, knowledge of the varieties of attachment experience – secure and insecure – can help us identify and eventually make room for the feelings, thoughts, and ways of being with others that were denied a place in the patient’s earliest relationships. Such knowledge can also strengthen our ability to imagine, understand, and empathically resonate with the subjective experience, as well as the childhood histories, of our patients. Moreover, it can cue us with regard to the specific therapeutic stance most likely to be in synch with the particular patient’s developmental needs.
Mary Main’s findings regarding the experience and representation of attachment in infants, six-year-olds, and adults illuminate in evocative detail the development, characteristics, and consequences of each of the four primary states of mind (secure, avoidant, ambivalent, and disorganized) with respect to attachment. In recognition of the pervasive influence of attachment models/rules, it becomes important to highlight the structural continuity of representational patterns that emerge in infancy, evolve over time, and find expression in multiple modalities (including nonverbal behavior, language, imagery, etc.). That continuity across the various dimensions of the self is what makes our patients’ attachment patterns (and our own) so vital to recognize and understood.
The Mental Illness Known As Munchausen By Proxy
Munchausen by proxy, also called medical child abuse, occurs when a caregiver (usually the mother) feigns physical illness of the child or inflicts a medical illness on purpose. The reason for this form of abuse is attention seeking from doctors and nurses and also acts as a reassurance to the self‘s ego. When cases like Munchausen by proxy really happen we are left with an even greater mystery; what causes the manifestation of this mental illness? To untangle the complex psyche that drives any single perpetrator, research is shedding light on what medical child abusers seem to all have in common; insecure attachment. This insecure attachment revolves around issues of loss and separation.
Since researching attachment theory in psychotherapy, the discovery of this mental illness was a serendipitous find that ignited my curiosity. Of the four different types of infant attachment patters (secure, avoidant, ambivalent, and disorganized) it seems that insecure attachment is a common feature in the psyche of the mother’s who abuse there children through the mental illness known as Munchausen by proxy. That means they expressed an attachment style in infancy as either avoidant, ambivalent, or disorganized or some variation thereof.
Take for example the varieties of attachment experience. It is the disorganized infant who experiences their caregiver as both frightening and frightened. It is important to note that not every children who experienced this style of attachment will grow up to abuse their children through medical abuse or even become killers. But the manifestation of this mental illness holds important clues to the representational artifacts they hold in their mental states which were created from their past history with their intimate caregivers.
“Mary Main has hypothesized that disorganized attachment results when the attachment figure is simultaneously experienced not only as the safe haven but also as the source of danger, that is, when the child – pre-programmed to turn to the parent in moments of alarm – is caught between contradictory impulses to approach and avoid. It is an untenable position from which the child’s dependency on the parent affords no escape. Little wonder, then, that the result of such a terrifying “biological paradox” is disorganization and/or disorientation.”
Ongoing research in attachment theory suggests that the human mind is embedded with a stance toward the self. This stance is based on our past history and experience of attachment. This means that the representational self is fundamentally grounded in emotional experiences of attachment and/or its disruption are prone to evoke the most intense of feelings. Thus, our representations of ourselves, of others, and of relationships do not merely have a powerful emotional component; they are in most cases actually dominated by the emotions that underpin them.
Since the Munchausen moms’ are attention seeking to reassure their egos or shore-up their self image, it is not uncommon for Munchausen moms to come from a family background where physical symptoms – real, imagined, or faked – are used to get attention. Children learn physical illness is the best way to get a parent’s attention while more direct ways (crying, expressing emotional distress) are ignored.
Several Munchausen moms have described growing up with a parent who used routinely medical deception to gain the attention of physicians and nurses. When I think of this mental state and its strategies to gain attention, I think of the art work of Orlan and her consecutive plastic surgeries to define herself. Also, it is not uncommon for the perpetrators themselves to have medical records and a history of faking illness.
There remains a continuity between the caregiver’s style of communication and the behavior that originally marked the infants responses. For example, the disorganized infant response can be characterized by the “representational artifacts” of the typical six-year-old, who appeared “inexplicably afraid and unable to do anything about it” (Kaplan, 1987, p. 109).
Children assessed as disorganized in infancy, based on their Strange Situation behavior, revealed an apparent collapse of strategy. Their behavior five years later appeared to reflect a systematic effort to control their parents either through reversing roles and taking care of them (“Are you tired, Mommy? Would you like to sit down and I’ll bring you some [pretend] tea?”) or through being aggressively directive and punitive (“Sit down and shut up, and keep your eyes closed! I said, keep them closed!”) (Hesse & Main, 2000, p. 1107). In either case, it was as through these children were taking on a parental role in order to maintain proximity to their parents while also dealing with the threat they posed. This controlling/role-inverting strategy was very much in evidence during the reunion after separation discourse in which the “dysfluent” conversations (marked by stammering and false starts) were dominated by six-year-olds who either punitively dismissed or solicitously “scaffolded” their parents’ communication (Main et al., 1985; Main, 1995).
Most children who grow up in chaotic or abusive homes do not become medical child abusers. Most children who experience the early loss of a close family member do not become medical child abusers. And, most children whose parents use physical symptoms – even fakes ones – to get attention (again imagining the psychology behind the artwork of Orlan) do not grow up to induce illness in their own children. However, a combination of all three may set the stage for an abnormal relationship between parent, child and the medical profession. Whether or not the parent will act out his childhood drama depends on other factors (to be discussed in future blogs).
Consider these other link which explain the underlying pathology to some other criminal acts:
Violent acts of penetration and enactments of fantasized sexual kleptomania; When infatuation becomes a fetish
Primal Scene Trauma, Sexualized Aggression, and The New Age of Silicon
Camera Catches Mom Poisoning Son At Hospital – Crime Watch Daily
Kaplan, N. (1987, May). Internal representations of attachment in six-year-olds. Paper presented at the biennial meetings of the Society for Research in Child Development, Baltimore.
Hesse, E., & Main, M. (2000). Disorganized infant, child and adult attachment: Collapse in behavioral and attentional strategies. In Journal of the American Psychoanalytic Association, 48(4), 1097-1148.
Main, M. (1995) Attachment: overview, with implications for clinical work. In S. Goldberg, R. Muir, & J. Kerr (Eds.), Attachment theory: Social developmental and clinical perspectives (pp. 407-474). Hillsdale, NJ: Analytic Press.