Search

Treatment with the patient described here, a 28-year-old man in a Regional Secure Unit on a Pre-Discharge ward who had murdered his mother during late adolescence, was aimed at altering the intrapsychic factors through transference-based psychoanalytical psychotherapy in order to facilitate a change of attachment to the internal mother/object and to women, whom he had devalued at part-object level, based on his primitive perception of his mother as 'Satan's dog’and the‘devil's jackal’. There was an apparent change in the way he eventually interacted with the therapist as a whole object. Where the condition of latent murderousness exists, internal (intrapsychic) factors, or external ones, can become the reactivating agents which set into motion a sequence which ends in actual murder. The relationship of such events to a psychotic personality organization is variable and often difficult to delineate because the catastrophic deed itself greatly alters the intrapsychic as well as the external situation. More importantly, the control should be intrapsychic and not externally imposed if we are to deal adequately not only with murder but murderousness.

The key to understanding full-blown Munchausen Syndrome by Proxy (MSBP) is in the recognition that unconscious processes are operating. MSBP mothers are psychotic at the core of their personalities. They have, deep in their internal object world, an aspect of their relationship with their own mothers. This traumatic, psychotic core, perhaps experienced at a pre-verbal phase of development, has become split off and encapsulated. Early childhood trauma, passively experienced by the mother whose own mother displayed perverse and perverting attitudes towards her, mobilizes a perversion of the maternal instinct in adulthood when she herself becomes a mother or is in the role of nurse or carer, occupying a maternal role.