The Birthday Cake
The first time somebody tried to kill me, I had just turned four years old. I know that for a fact because I remember the birthday cake my mother made me. And everything else about that day.
“Are you sure I can have as much as I want?” I said.
“As much as you can eat,” said my mother, carving out almost a quarter of the cake and putting the huge slab on my plate. “After all, it’s your birthday.”
She never let me eat as much as I wanted of anything, let alone of birthday cake. And she’d made the kind of cake I liked instead of the kind she and my father liked, which was a very unusual thing for her to do. She didn’t sing me Happy Birthday, and I have no recollection of my father’s or of my little sister Amy’s being there, though I don’t know why I’d have a birthday party alone. My mother just told me to blow out the four candles, and then she cut the cake. I was giddy as I picked up my fork. My mother left the kitchen while I ate.
It was a wonderful birthday cake. It didn’t have any sprinkles or icing flowers or fancy writing that said Happy Birthday, Sascha like I’d asked for, but it was still a wonderful cake. I stuffed forkful after forkful into my mouth, barely chewing, not remembering another time in my short life when I’d ever enjoyed a piece of food so much, trying to get the whole piece eaten before my mother came back into the kitchen, changed her mind, and snatched the rest of the cake away from me.
She’d made buttercream icing — her specialty and my favorite — and she’d piled it on extra thick. It was the best cake I’d ever eaten, and I believed that I was quite the cake-connoisseur at the time.
No one else was in the kitchen with me the entire time I was eating. No one else was eating any of my birthday cake. Though it was obviously odd enough for me to have noticed at the time, I was too excited about the huge piece of cake on my plate to think very much more about it.
About three-quarters of the way through my piece of cake, my head started to feel funny. It felt like a balloon, detaching itself from my shoulders and floating upward, toward the ceiling, then swinging itself around the room. Or maybe it was the room that was spinning, like a carousel, I couldn’t tell.
There was a strange buzzing in my ears, too, one I’d never heard before. I shook my head to make the buzzing stop, but the balloon-spinning feeling got worse. My eyes started to close though I wasn’t sleepy. As I tried to take another bite of cake, my head dropped over and hit the table with a resounding thump. I heard it even over the buzzing in my ears, which had gotten louder.
When I woke up, I was in the emergency room of a hospital, surrounded by doctors and nurses and blinding light. I couldn’t move my arms and legs because they were tied down or strapped to the table. A big man wearing bluish-green scrubs was holding my face between his hands, looking down on me.
Something was in my stomach, nose, and throat — choking me, making me feel like I couldn’t breathe, and trying to rip my whole stomach out of my body through my mouth and nose. I was crying and trying to tell them how much it hurt, trying to tell them to stop, but because of the tube in my throat and nose, I couldn’t say anything at all.
The man holding my head had silver in his black hair, and he was wiping the tears off my face even as he prevented me from moving my head. He talked to me, the whole time, in a soft and loving voice.
“You sure are a pretty little girl,” he said. “Why’d you have to go and eat all those aspirin for? Don’t you know aspirin can kill you? They’re not candy. Aspirin’s medicine.”
I didn’t understand what he was talking about. I didn’t remember being sick or my mother’s giving me any aspirin. It was my birthday, and I’d been eating birthday cake. Chocolate cake with extra thick, white buttercream icing. Something bad had happened to my head that had made it fall over and hit the table. Was this still my birthday or was it another day? He wiped more tears from my face. He leaned closer. I could see his brown eyes. I could feel his breath when he talked to me.
“It’s almost over now. You’re almost done. And you’re going be okay. You’re not going to die. You’re really lucky your Mama found you and brought you into the emergency room when she did. She saved your life. Don’t eat any more bottles of aspirin when you go home,” he said. “It sure would be a pity to lose a pretty little girl like you. You remember what I’m saying to you, Honey. Don’t die, now, you hear?”
He was a good man. He wiped away my tears and said nice things to me when I was in so much pain. Even then, I’d felt certain that if that tube hadn’t been in my nose and throat, I would have been able to ask him if there were really aspirin in my stomach along with the birthday cake, and he could have told me. But you can’t talk when your stomach is being pumped.
The next time I woke up, I was alone.
I was alone the entire time I was in the hospital.
I was 4 years old, and it was the first time I realized my mother was trying to kill me.
Love in a Cold Climate
Almost everyone has heard of Hypochondria, and most families probably have someone they claim is a Hypochondriac. Munchausen’s by Proxy — usually shortened to MBP — and its precursor, Munchausen’s Syndrome, were once considered “bizarre” forms of Hypochondria. Even though these latter syndromes are personality disorders rather than variations of Hypochondria, it’s necessary to understand Hypochondria before you can understand either Munchausen’s Syndrome or Munchausen’s by Proxy.
People who suffer from Hypochondria have incredibly bad reputations. Everybody thinks they’re liars, fakers, malingerers, or just plain crazy. Only relatively recently has the mental health community recognized that Hypochondriacs are actually suffering from severe emotional pain. Instead of the patients’ being able to even identify, let alone talk about their emotional pain, however, their pain manifests itself by exacerbating pre-existing physical symptoms. When the patients focus their attention on the physical symptoms, which are very real, they don’t have to deal with the emotional pain behind the symptoms.
It appears to be a psychological defense mechanism, with the physical pain “protecting” them from the more devastating repressed emotional pain. But because the emotional pain is simply changed to exacerbated physical pain, the physical symptoms which seem to be causing the only distress can’t be relieved until the emotional trauma underneath is revealed, examined, grieved, and healed.
Unfortunately, most doctors don’t know about Hypochondriacs’ emotional pain. Doctors dismiss or ignore the reported physical symptoms because all diagnostic tests indicate that nothing’s wrong, or, in medical jargon, “everything is within the normal ranges.” So Hypochondriacs spend their whole lives suffering, searching for a cure for their physical pain and illnesses, getting reputations as “liars” because virtually no one knows about the unbearable and hidden emotional pain underneath.
Virtually everyone, however — from family members and friends to members of the medical establishment — does seem to agree, quite erroneously, that Hypochondriacs want attention for being ill.
Hypochondriacs suffer real physical pain, which is aggravated by their underlying emotional pain. Unlike Hypochondriacs, those who practice Munchausen’s — usually referred to as “Munchausers” by medical personnel — do realize that they are not ill. Munchausers consciously invent symptoms or fabricate complicated medical histories to get attention and nurturing. Most Munchausers actually injure themselves or induce serious illness in order to get intense medical attention or to gain admittance to the hospital.
If You Have Tears
The psychiatric disorder now known as Munchausen’s Syndrome was first recognized — but not named — in the 1930’s by Dr. Karl Menninger when he realized that some of his patients were intentionally and consciously inventing unusual symptoms in order to remain hospitalized. In 1951, Dr. Richard Asher coined the term “Munchausen’s Syndrome” for these people, named after a character based on a Prussian cavalry officer, Karl Friedrich Hieronymus Baron von Münchausen, an eighteenth century German mercenary renowned for the outrageous, greatly exaggerated tales of his military exploits. Since people who practice Munchausen’s intentionally lie about their symptoms, injuries, and illnesses in order to get doctors’ attention, they reminded Dr. Asher of the way Baron von Münchausen told elaborate, unreliable adventure tales in order to be at the center of attention. Instead of entertaining you, however, learning about what people with Munchausen’s Syndrome do to themselves could make you shed tears.
Since Munchausers are pathological liars, her “realization” may have been simply another way of keeping the doctors’ attention on her after they realized, without a doubt, that she was feigning illness. By lying to them and saying that she knew she’d done it all to get attention and affection — which may have been unconsciously suggested to her by the doctors themselves — she was able to keep their waning attention, sympathy, and “affection” focused on her.
No one knows why Munchausers focus their behavior on medical injuries or diseases. Are they seeking nurturing that they did not receive as children? Do they view the doctors as surrogate father-figures? As potential mates? As dream lovers? Do they view these educated medical doctors as people to trick or dupe with the Munchausers’ “superior intelligence” and clever ability at manipulation?
Let’s say Munchausers do view doctors as surrogate father-figures or potential mates, and not merely as dupes to confound and manipulate. What about nurses? Do Munchausers view nurses as surrogate mothers? My mother seemed to despise nurses even as she envied them their daily contact with doctors. This was especially true with the nurses who worked for Dr. Kingston. Maida was always insisting that she could do a much better job than they.
What about Munchausers who want to direct their own treatment? Do they have some desperate longing to belong to the medical establishment? If they find themselves connected to the medical establishment, no matter how minor the role, does their Munchauser behavior increase or decrease?
What do Munchausers want from their family members, friends, neighbors, spouses, co-workers, and complete strangers to whom they tell their stories? What do they think the made-up illnesses or self-induced injuries will give them from these other people in their lives? Attention, admiration, respect, love? My own mother terrorized our entire extended family into accepting her version of all medical events, into listening to her illness-injury stories without interrupting, and into giving her “respect” for being sick.
The Hollow Men
Munchausers have a severe personality disorder, as opposed to the emotional disorder of Hypochondriacs. Discovering, acknowledging, and healing a Hypochondriac’s emotional or psychological pain through lengthy and intense psychological therapy usually greatly diminishes or even totally eliminates their physical symptoms. Munchausers, on the other hand, are extremely resistant to such treatment because they are pathological liars, so will not admit they are intentionally hurting themselves. Furthermore, personality disorders are impossible to cure, change, heal, or rehabilitate.
For some Munchausers, the goal seems to be to remain in the hospital or in constant contact with the medical staff. For others, it seems to be to get uninterrupted attention or nurturing from family members, friends, or neighbors. Studies have shown that Munchausers who get constant attention from family members seem to have fewer doctor and hospital visits. Some Munchausers may have both goals: to get attention from medical staff as well as from family members, friends, neighbors, co-workers, and strangers.
Throughout her entire life, my mother was a Munchauser who wanted intense, undivided attention from everyone, all the time, no matter who it was.
Both males and females can be Munchausers, and their numbers are about equal. Only now are doctors beginning to realize that Munchausers may, like Hypochondriacs, be suffering from repressed emotional or psychological pain. Pain so severe and disturbing to their psyches that they begin to view their own bodies as “objects.” The Munchauser then exaggerates minor symptoms into major illnesses or rare diseases, fabricates tales of illness, or intentionally hurts his body — the object — so that he can receive the attention and nurturing he will get from the medical profession, or from friends, family members, co-workers, and even strangers.
Are Munchausers in so much emotional and psychological pain that the physical pain, which they intentionally induce themselves, helps them avoid dealing with the more traumatic and unbearable emotional pain? Do they hurt their own bodies because they feel their bodies are the only things over which they have control? Do they numb their emotional and psychological pain to the point that hurting their bodies and feeling physical pain is the only way for them to feel anything? Do they view their bodies as “objects” because abusive people have done so to them in the past? Do they hurt themselves to get nurturing, love, attention, sympathy, respect, admiration? Do Munchausers hurt themselves to “act out” severe emotional pain, childhood trauma or abuse, or express rage at former abusers or at current people in their lives?
No one knows the answers to these questions, not even the Munchausers themselves. It is imperative, however, to distinguish Munchausers from Hypochondriacs. The former do not intentionally make themselves ill. Hypochondriacs’ emotional pain exacerbates pre-existing physical symptoms, while Munchausers intentionally injure themselves, make themselves ill, or consciously and deliberately lie about being sick.
Better to Halt in Life
Though Munchausers consciously lie and fabricate their symptoms, they will vehemently deny involvement in their own injuries and illnesses if confronted. Beyond the question of why Munchausers do these dreadful, self-destructive things is a more frightening question. Is Munchausen’s genetically inherited?
The experts can only hypothesize about the actions of those who practice Munchausen’s Syndrome since the Munchausers themselves can not, or will not, admit to — nor may they be able to understand — their own dangerous, self-destructive behavior. They’re seriously psychologically ill — incurably so — and there’s no effective prevention or treatment for Munchausen’s Syndrome. Self-induced illnesses, self-inflicted injuries, or fabrications and exaggerations about these things, and the associated caregiving are an integral part of this personality disorder.
Sometimes doctors unwittingly get actively involved in the dance of Munchausen’s Syndrome, doing whatever the Munchauser suggests in their attempt to treat the presenting symptoms. Many times, the doctors “dance” for a little while, then resist the Munchauser’s constant demands for attention and care via tests and unnecessary procedures. When doctors refuse to participate in the Munchausers’ dance, the Munchausers are forced to seek out other doctors, clinics, and hospitals to get the attention they need. Sometimes, the Munchausers visit so many doctors and hospitals with the same illnesses or diseases that the medical establishment and insurance companies begin to take notice. Unfortunately, since they are often unaware of Munchausen’s Syndrome, these doctors, hospitals, and insurance claims adjusters erroneously label the Munchausers as “Hypochondriacs” and send them on their way, not realizing that they are simply en route to another medical provider or facility.
The Most Unkindest Cut of All
After Dr. Asher named Munchausen’s Syndrome, doctors became slightly more aware of it, and in 1977, Dr. Roy Meadow coined the term “Munchausen’s by Proxy” (MBP) after he realized that some Munchausers were not harming themselves but were instead using a proxy — one of their own children, stepchildren, or elderly in their care — to manipulate and create ongoing relationships with medical professionals.
It is estimated that 98% of those who practice Munchausen’s by Proxy are women. Often called “Munchers” by law enforcement and medical personnel who discover the truth about them, MBP women intentionally injure or induce illness in someone else, someone dependent upon their care.
Publicly, these women typically concentrate on only one person at a time. Privately, though, all the children, stepchildren, adopted children, or invalid relatives may be abused simultaneously. Although sometimes the MBP women invent stories of seizures or convulsions when they run the unconscious child into the emergency rooms, most often these women have inflicted the severe damage on the child themselves before calling the Emergency Medical Squad or rushing the child to the nearest emergency room.
Munchers constantly injure and induce illnesses in another, then try to “save” or “care for” the sick or injured person, to get attention, respect, and admiration from doctors, hospital personnel, family members, friends, co-workers, neighbors, and others.
To get love, respect, and admiration for themselves, the Munchers repeatedly and deliberately subject someone in their care — the proxy — to brutal and potentially lethal abuse.
According to many MBP experts, the only other psychological personality disorder that resembles those of MBP women is that of a psychopath. A psychopath is able to compartmentalize the “different” parts of his life. He can torture, rape, and kill someone, then sit down, eat dinner, and watch television with the dead body still in the same room with him. Psychopaths are unable to feel empathy for their victims’ suffering. Instead, male sexual predators, in particular, seem addicted to their victims’ pain and suffering, and the longer these male sexual predators continue killing without getting caught, the more torture they inflict on their victims. The violence escalates because the serial killers need it, much as a drug addict needs increasing amounts of his drug to get the same effect.
Because Munchers repeatedly abuse, torture, and sometimes kill their own children, stepchildren, or others who are in their care in order to receive attention for themselves, or to manipulate the medical establishment and others, they are considered an especially heinous type of psychopath, and are most like male serial killers.
Most female serial killers tend to be less flashy, less flamboyant, more patient, and infinitely more successful and dangerous than their male counterparts since the females tend to kill in ways that are rarely detected as murder. Also, female serial killers tend to murder people known to them, rather than the strangers that male sexual predators seek out.
Black Widows usually murder husbands, lovers, or boyfriends for insurance proceeds or inheritance money. Some women — Medeas — kill their children to punish their ex-husbands or to manipulate the men in their lives. Women who serially kill their victims in conjunction with a partner often insist that they were “forced to participate” in the torture, abuse, rape, and murders, despite evidence to the contrary.
Women who viciously abuse, torture, harm, induce illnesses, injure, and sometimes kill their children, serially, while afterward attempting to “rescue” or “save” them, in order to gain respect, admiration, and praise for their heroic rescue attempts, practice Munchausen’s by Proxy.
Munchers are almost exactly like male serial killers except for the fact that Munchers do not seek out strangers for their victims. The Munchers’ violence escalates because they need the stimulation it provides them. Inflicting pain on their victims excites both Munchers and male serial killers. For all we know, the MBP woman’s “excitement” may be just as sexual as that of a male sexual predator. When male serial killers rape, sodomize, or masturbate over their latest victim, they leave behind physical evidence that the torture and killing are linked to sexual excitement. MBP women may get just as sexually aroused when they torture or kill their victims as male serial killers do. The MBP women, however, do not leave semen as evidence of their excitement.
Like male sexual predators, MBP women have absolutely no empathy for any other person’s pain and suffering. These women repeatedly abuse, torture, and sometimes kill their children, using them as disposable pawns to meet the women’s own emotional needs.
Growing up, I instinctively knew my mother was crazy.
I just didn’t know she was a psychopath.
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