Monthly Archives: June 2009

Münchausen Syndrome and Factitious Disorders

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During a class on crisis intervention nearly 25 years ago the question of how to response to someone threatening suicide when, it turns out, they don’t mean it, came up. The answer rings true to this day. If someone is threatening suicide and they don’t mean it, then the heartbreaking tragedy rests in the person’s belief that unless they come up with a lie that big, no one will care about or pay attention to the pain they are in.

I believe it is the same with Münchausen Syndrome or Factitious Disorders, where a person will feign some kind of illness or malady to draw attention to themselves and, in the sphere of Münchausen Syndrome, a person will exaggerate or create symptoms in their children, Münchausen’s by proxy. What reading I have done shows that those with Münchausen’s (or a Factitious Disorder) are often highly knowledgeable on the medical front, well versed in medical terminology, medications, treatments.

In some cases persons with Münchausen’s will intentionally bring about the symptoms of a disease or inflict medical harm to themselves so they actually need medical treatment, hospitalization.

Antecedents for this syndrome are often found in trauma, being raised in a home where affection was in short supply, if present at all, and more, suffering abuse.

While encountering someone who is faking a disease or medical condition can at first provoke anger, the anger, while understandable, is misplaced. Consider this, on some level this person believes that if they do not convince the world there is something terribly wrong with them, no one will care about them and no one will love them.

The task then is to guide the person to a professional counselor, and help them discover that all they have to do to be cared about and loved, is be themselves. They have several hurdles(he wrote, practicing the art of understatement), one of them is to openly admit they have been misleading people about their condition. This takes time, patience, love and support and, I would think, does not happen all at once.

While they may not have the conditions they claim to have, they have a very real disorder, and deserve love, support, and professional help. All of us deserve to discover that simply being who we are, one day a time, is more than enough reason for others to care about us.

Maceo and the Angel

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Maceo looking in the mirror thinking, When you ever learn? Still thinking that there wasn’t much point in talking to himself because no matter what he says he doesn’t much listen if what he says is suggesting he stop dreaming. Now looking down at his hands, the right one with the toothbrush, still thinking, I did love her – then, correcting himself, I do love her, can’t help it. Love….God almighty, what was I thinking.

That’s when he first saw the angel, looking like shower steam but the shower wasn’t on, then taking shape, morphing into, no shit, an elderly man with snow white hair, gray twinkling eyes. Maceo, toothbrush frozen mid-air, wondering, Can you still have acid flashbacks if you haven’t done acid in 35 years?

The angel now saying, “No, I’m not a flashback.” Maceo thinking, That doesn’t make this better, because then who are you. The angel now answering the unspoken question, “I’m not a flashback, Maceo.”

Maceo saying, “Pardon?”, trying to buy some time, wondering if he has the number for the emergency room and if not can he remember the number for 9-1-1.

“I’m not a flashback, my boy. You know that now.”

Maceo weaving, sure he was either dying or on his way to a rubber room with different color building blocks.

“You think maybe you should sit down?” the angel gesturing to the open bathroom door and the living room on the other side.

Maceo, looking at the toothbrush, dropping it, foolishly thinking, I might need both my hands.

The angel moved past him into the living room, as he passed Maceo smelled lilacs. He followed the angel into the living room. The angel, nodding towards the ugly orange chair, saying, “Why don’t you sit in your chair. We’ll talk…”

Maceo sitting, the angel now sitting on the couch opposite, smiling. Maceo wondering, What now? Then, looking at the angel, “What’s your name?”

The angel smiling, “That’s pretty much up to you.”

“How you figure?”

“I’m your angel…you can pick any name you want.”

“My angel.. You mean you’re my guardian…” he couldn’t finish, the angel helping, nodding, Yes. Maceo adding, “I’m sober, you know.”

“I do, yes. We’re very proud of you.”

Maceo deciding he’s not asking who the we is since he was having a tough enough time wrapping his mind around the fact that he either had a guardian angel or he’d finally lost his fucking mind.

“What name do you like?”

” I don’t know, I’ve never named an angel before.”

“I know.”

“Paul, I think, Paul. I used to be a Paul.”

“Paul it is then.”

“Angel Paul, has a nice ring to it, kind of a blue collar angel.”

“Then it’s the perfect name.”

Maceo, wagging his head, asking, “What do you want?”

Angel Paul answering, “No, it’s what do you want?”

“I love her you know.”

“I do know, yes. You miss her too.”

“Then I do have a question…”

To be continued……

Side Effects – A Word Sketch

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“Okay, I admit it, she’s like medicine to me. I mean like she’s kind a twisted in her own world and shit, like some outta control meteor, but she’s like medicine for me, nothin’ I can do about it. Anyways, wishin’ it wasn’t so doesn’t do a thing since it’s already true.”

“Good medicine or bad?”

“Good…with side effects.”

“Everything has side effects. You wait for something without side effects you be waitin’ a long time.”

“I know it.”

“So what now?”

“You try and tell someone life runs out and not living or wasting what life you have, ’cause you never know how long a run you got, is tragic shit. Most people kind of hear it half way, like you’re talking about some movie screen character, you’re talking about something in the distance that doesn’t connect with them when it’s all kinds of connected to them.”

“What’s she like?”

“Jazz. She’s like jazz. Everything about her moves like jazz. Out of the reach of words, which is why jazz in the first place.”

“Does she know this?”

“I think maybe like that movie screen character in the distance, but not really. I think she’s like too many who buy into the message that down deep they’re nothin’ but a body that people want for sex and anything anyone says is all bullshit and pretense.”

“See? Side effects.”

“I know.”

“Love her?”

“…Yep.”

“Side effects.”

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Micky’s Knuckles – A Sketch in Words

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Micky cracks his knuckles and I think if maybe he cut his hand off instead, problem solved. But that’s just me. Since I was a kid I always figured the quick way to solve things. Not always the best ways, this I know, but if you want speed, I’m your man, or way back, your boy. I can’t figure out why anybody cracks their knuckles in the first place. Like what happens? You’re breezing down the street one day and your knuckles stiffen up and you think, Fuck it, let me crack these bad boys, and you do and somehow something’s all better? Got me.

Now he looks across the table from me, says, “So what were you saying about her?”

The her is Tammy. I met Tammy just a few days back and I’m all caught up in thinking maybe some magic may be happening here except she lives more then 100 miles from me so whatever made me think I can dream. And anyway, Micky and his fuckin’ knuckles have me all out of sync. And I’m not saying shit to him about how I don’t much like the sound of cracking knuckles because it’s always the same response when I do. Someone cracks their knuckles, you say, Why do you do that? Or, Jesus, that’s fucked sounding, and they always go, This bothers you? And crack their knuckles all over again.

I want to think about Tammy. I take a deep breath, trying not to let Micky see I’m taking this breath, because I don’t feel like answering any questions, and start all over.

“Remember I was giving that talk this week? Well, she was there. I mean kind of floating in and out of the room a little in the beginning, way in the back, but man, she came in and that was it. I noticed. You couldn’t not notice. So I’m giving this talk – “

Micky, looking at his knuckles like maybe they needed another go, “What was you talking about?”

“Doesn’t matter, bro. Anyway, when she left the room at first I felt like this empty space inside and I’m thinkin’, What the fuck? I’ve never even seen this person in my life, and she comes into this room, maybe a minute, then leaves, and I’m feeling an empty space inside? What the fuck?”

Micky decids to leave his knuckles be – for now. “She pretty?”

“Yeah, she’s pretty. But it’s more than that. Real. Like you take one look and all this substance just fills you up.”

“So what happens?”

“Nothing. Well, not exactly nothing, yeah, nothing. Not really though. So I’m done with the talk and things and people are coming up and talking to me and I’m listening ‘cause I really do give a shit what they’re saying but most of me wants to say, Excuse me, and go out in the halls and run up and down to see if I can find this woman.”

“And what if you did? Whattaya do then? Hi, there, How you doing> I think you look real?”

“Wasn’t even necessary, and no, I’m not gonna say, Hi, you look real. So these people are talking to me and there’s few left and whattaya think? The door opens and guess who comes in?”

“Miss Real.”

“Exactly.”

“What’d you do?”

“Nothing.”

“Whattaya mean nothing?”

“She asked me some questions about the talk; I answered”

“That’s fucked up man. You shoulda asked her for coffee or something,” and damned if Micky didn’t crack his knuckles again.

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Forrest Gumping It

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Earlier today I spent several hours Forrest Gumping it, walking relentlessly in the woods, I know, I know, Forrest walked all over the country, but cut me a bit of slack, I’m just starting out here.

There really is something healing about hitting the trail and pushing the pace, letting the sweat pour. The endorphins kick in, you shift away from the worldly universe of daily troubles and wounds, and enter in a place of such spiritual beauty is reaches all your muscles, buries deep warm into the marrow of your being, healing… healing.

I’d gone to bed last night with every intention of climbing a 3,500-plus Catskill Mountain this morning, but given that I am just getting back into condition, common sense prevailed. I remember years ago when I ran marathons (very slowly I might add) I would repeatedly read and hear that our minds are ahead of our bodies on the conditioning front.

But I hit it hard today, and I brought Charley who is, I must say, one helluva trail dog. He will celebrate his second birthday the 30th of this month and he and I have been sharing life since the day he turned six weeks old. He has been on the trails from the beginning with me.

As I walk I am reminded of how the woods was always refuge when I was a boy, always it was a place of safety, a place where my imagination could dance and move and create and jump for joy in utter freedom. Realities of life surface for me here, knowing , for example, that while you can love people, you cannot free them of that which blocks them from knowing they are loved. All you can do is love, keep the “door open”, keep going.

I am walking up an incline and instinctively lean forward and push the pace. Charley, of course, cheats. He has four legs. Pushing the pace is an old habit that has no intention of dying. I have the same feeling about on incline on the trails as I did and do climbing hills on a bike; there is a very intense personal relationship between me and the earth, and here we are in a kind of friendly arm-wrestling match. The earth throws me an incline and I see if I can reach the top without stopping. Do I succeed every time? No, of course not, not yet anyway. And when I can’t, I stop and breathe and smile and often my eyes tear up because I am filled with joy because I am alive to have this moment.
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