Towering over mid-century discussions of motherhood is the figure of John Bowlby, a British psychoanalyst of children whose ideas on “attachment theory” and “maternal deprivation” became exceptionally influential. Bowlby waxed lyrical about the importance of a stable mother figure, arguing from research in foster homes that a life of instability, delinquency and psychological problems follow in the wake of inconsistent mothering. Bowlby followed other U.K.-based psychoanalysts such as Anna Freud and Melanie Klein in arguing that small children’s social relations are incredibly important, and disruption of mothering in the early years has wide-reaching psychic and social consequences.
Note the double-edged sword of motherhood here. Attracting the praise of being a “good mother” was always accompanied by the threat that you might fall from the perch at any moment and cause devastating harm to your child. Hence the amplification of mechanisms of control, censure and punishment that go hand in hand with the valorization and surveillance of parenting. Deep within the medical and psychological frameworks promoting motherhood in this period, there lurks male anxiety over female power and influence.
This concern played out over the question of how much time parents should spend at the hospital with their child. Until the middle of the 20th century, visits were strictly limited. Doctors and nurses protected the space and its routines, and limiting visitors helped to prevent the spread of infection: Nurses helped with children’s “settling down” after their mothers had left. However, Bowlby and certain social workers began to interpret this as a damaging form of psychic withdrawal, caused by the trauma of perceived abandonment. They recommended that visiting rules be relaxed in the case of parents of young children, and even that units be designed where mothers could “live in” with their sick children.
Experts began to champion the emotional support that mothers could give, over and above the concerns about spreading disease. Live-in accommodation and relaxed visiting regimes gradually (though unevenly) became accepted, especially in specialist children’s hospitals, such as Sheffield Children’s Hospital, or Great Ormond Street Hospital in London. Mothers and psychological health were inseparable; the accommodation of mothers and mothering as a key part of medical care became more and more commonplace.
However, a new threat arose from these arrangements: MSbP. In 1977, the British pediatrician Roy Meadow published a paper in The Lancet describing two cases where mothers had fabricated or induced illness in their children. In one case, a 6-year-old girl repeatedly presented at the hospital with bloody urine; in another, an infant was diagnosed as “failing to thrive.” In the former case the mother was discovered to have added her own blood to her daughter’s urine samples; in the latter, the boy died due to salt poisoning. Meadow named this phenomenon Munchausen syndrome by proxy—inspired by the original Munchausen syndrome, identified in 1951, which described repeated presentation at hospitals with tall tales and invented or induced symptoms. In MSbP, the deception of medical professionals takes place through a proxy, normally a dependent child.