Saturday, 21 February 2009

BOWLBY ATTACHMENT DISORDER TEACHINGS

5 08 RESEARCHED BY GURU RASA



These dysfunctions are directly due to the a priori nature of the attachment bond - that is to say, to the frustration of the child's absolute need for the maternal presence. The extent of the child's suffering and the damage caused is related to the dura­tion of the separation: brief separations are bad enough; long ones can be devastating. Separated children predictably pass through three stages, which Bowlby described as protest, despair, and detachment, and he showed how the experience of separation can affect the personality for life. In particular, the development of basic trust tends to be impaired, the child becoming a prey to neurotic anxiety and to doubts about its capacity to elicit care and affection - a state which Bowlby termed anxious attachment. The result can be the adoption of a defensive posture of detachment from others, the child becoming self-absorbed and self-reliant to an unusual extent. Such individuals appear odd to their fellows, who may be disconcerted by their remote, somewhat aloof manner, and they commonly experience difficulty in achieving social integration at school and within their local community. A high proportion of them as adults display a schizoid personality.

As Bowlby subsequently pointed out, each of the three phases of response to separation is related to a central issue of psychoanalytic and psychiatric theory: protest raises problems of separation anxiety; despair that of depression, grief, or mourning; detachment that of defence and schizoid personality disorder. These are crucial areas of psychopathology and they can all be understood as the natural consequences of thwarted archetypal intent.


4

ATTACHMENT, RANK, AND PSYCHIATRY

The immediate cause of a large number of psychopathological conditions is a subjective prediction of probable failure in competing for two highly valued social resources: attachment and rank. Anticipated failure in these two crucial areas gives rise to two sets of aetiological contributions to psychiatric disorders.

ATTACHMENT

The credit for bringing attachment into the ambit of evolutionary psychiatry rests firmly with John Bowlby. He not only established that attachment is instinctive and 'prepared for' in both mother and child but also that the behavioural system responsible for making and sustaining the attachment bond is goal-corrected, in the sense that it is designed to maintain both physical proximity and social communication between the bonded partners. Because of its crucial significance for survival, mother-child bonding has evolved in a great variety of species.

Bowlby devoted the greater part of his life to the study of bond formation and to the consequences of its disruption, and he provided a wealth of evidence to show how a person's self-concept is profoundly influenced by these early experiences. Stable attachment bonds in childhood are associated, as already noted in Chapter 2, with emotional security and the devel­opment of an inner model of the self as worthy and capable of giving and receiving affection in a bonded relationship, whereas unstable bonds tend to result in emotional insecurity, development of a flawed self-concept, and indulgence in the kind of 'clinging' behaviour with significant others that Bowlby called anxious attachment. Fear that an attachment bond may be under threat can result in anger and aggression as well as anxiety, while loss of an attachment figure is associated with grief, despair, depression, and, ultimately, detachment. Renewal of an attachment bond, on the other hand, can be experienced as a source of profound iQ^_._____————————.———


EVOLUTIONARY PSYCHIATRY: AN INTRODUCTION

PATHOGENIC PARENTING

The characteristic patterns of deficient parenting which neurotic subjects commonly reveal in their histories may be summarized as follows:

1 Parental absence or separation from the child: one or both parents may go away and leave the child, or put it in hospital or an institution. The earlier the loss and the longer or more frequent the separations the more serious are the consequences for the mental health of the child and future adult.

2 Parental unresponsiveness to the child's attachment needs: one or both parents persistently fail(s) to respond to the child's care-eliciting behaviour, and may, indeed, be actively disparaging and rejecting of such behaviour.

3 Parental threats of abandonment used as sanctions to coerce or discipline the child: one or other parent makes a practice of threatening to withdraw love, to abandon the family, to commit suicide, or even to kill the spouse or child.

4 Parental induction of feelings of inferiority or guilt in the child: the child is subjected to excessive criticism and made to feel bad or unwanted; in extreme cases assertions are made that the child's behaviour is or will be responsible for the illness or death of one or other parent.

5 Parental 'clinging' to the child: the parent (usually the mother) displays 'anxious attachment' to the child, exerting pressure on it to be the primary care-giver in their relationship, thus inverting the normal pattern.

6 Parental inconsistency in the expression of love: one or both parents vacillate between relative neglect of the child's attachment needs and periodic expressions of love, which may be excessive by way of compensation.

Any one of these forms of parental frustration of a child's basic archetypal needs can result in anxious, insecure individuals who report themselves to be lacking in confidence, shy, inadequate, or unable to cope. They often have difficulty in forming and maintaining lasting relationships, and under stress they are prone to develop neurotic symptoms such as phobias, persistent anxiety, and depression.

In addition, the emotional state of the parents, as well as their predominant mode of personality adjustment, have a direct impact on their children. The mother is particularly influential in this regard, for she mediates the world, in all its momentous ambiguity, to the child. In this crucially significant role as mediator, an extremely anxious mother will tend to induce defensive arousal and fear in her children, while a depressed mother will have difficulty in responding to their needs in such a way as to foster their development of 'basic trust'. The world for such children will necessarily remain ambiguous, uncertain, and potentially threatening.

Another critical factor is the kind of mothering that the mother herself received as a child, for these patterns can readily be passed on from generation to generation. Adequate mothering tends to produce adequate mothers.

46


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ATTACHMENT, RANK, AND PSYCHIATRY

The care a mother provides, or fails to provide, is also affected by such factors as the degree to which she feels secure in her bond to her husband, whether the child is of the desired gender, the number of children she already has, and her economic circumstances. A vital aspect of a mother's nurturing behaviour is her capacity to intuit her child's subjective state (whether the child is hungry, soiled, tired, angry, or frightened, and so on) and her ability to respond appropriately to it. This mirroring function, by which she helps the child to understand the nature of what it is experiencing, can go wrong for any of the above reasons, with potentially grave psychopathological consequences. With so much at stake, it says a great deal for the adaptive power of the heterosexual and parental affectional systems that so many children grow up to enjoy the degree of health and happiness that they do.

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At least since Freud we have recognized that the infant-mother relationship is pivotal to the child's emerging personality. Freud (1940) said that for the baby, his mother is "unique, without parallel, laid down unalterably for a whole lifetime, as the first and strongest love object and as the prototype of all later love relations for both sexes." More recently, Greenspan (1997), Schore (1994), and Siegel (1999) have written convincingly about the ways that the early care giving relationship influences the child's developing cognitive ability, shapes her capacity to modulate affect, teaches her to empathize with the feelings of others, and even determines the shape and functioning of her brain. The attachment and care giving systems are at the heart of that crucial first relationship. John Bowlby (1969/1982; 1973; 1980) described the attachment and care giving systems in biological and evolutionary terms stating that, across species, the attachment system was as important to species survival as were feeding and reproduction. At the heart of the attachment and care giving systems is the protection of a younger, weaker member of the species by a stronger one. The infant's repertoire of attachment behaviors are matched by a reciprocal set of care giving behaviors in the mother. As the mother responds to the infant's bids for protection and security, a strong affectional bond develops between the two that forms the template for the baby's subsequent relationships. Attachment behaviors change as the child develops. A young baby who is tired, frightened, hungry, or lonely will show signaling and proximity seeking behaviors designed to bring his caregiver to him and keep her close. The baby may cry, reach out, or cling to his mother. Later when he is more mobile, he may actively approach her, follow her, or climb into her lap. A toddler may use his mother as a secure base, leaving her briefly to explore his world, and then reestablishing a sense of security by making contact with her by catching her eye, calling out to her and hearing her voice, or physically returning to her (Lieberman, 1993). By the time a child is four years old, she is typically less distressed by lack of proximity from her mother, particularly if they have negotiated or agreed upon a shared plan regarding the separation and reunion before the mother leaves (Marvin & Greenberg, 1982). These older children have less need for physical proximity with their mothers, and are better able to maintain a sense of felt security by relying upon their mental image of their mothers and upon the comforting presence of friends and other adults.

Bowlby (1969/1982) referred to attachment bonds as a specific type of a larger class of bonds that he and Ainsworth (1989) described as "affectional" bonds. Ainsworth (1989) established five criteria for affectional bonds between individuals, and a sixth criteria for attachment bonds. First, an affectional bond is persistent, not transitory. Second, it involves a particular person who is not interchangeable with anyone else. Third, it involves a relationship that is emotionally significant. Fourth, an individual wishes to maintain proximity or contact with the person with whom he or she has an affectional tie. Fifth, he feels sadness or distress at involuntary separation from the person. A true attachment bond, however, has an additional criteria: the person seeks security and comfort in the relationship.

It is important to note that an infant does not have only one attachment relationship. Bowlby (1969/1982) posited that babies routinely form multiple attachment relationships, arranged hierarchically, although they most likely have a single preferred attachment figure to whom they will turn in times of distress if she is available. As the baby develops, however, he will form multiple attachment bonds and an even greater number of affectional bonds. And the need for attachment bonds does not end with infancy. Across the lifespan, we all experience times when we feel weak, ill, or vulnerable and turn to a loved person for support and comfort. This turning, we will see, is the echo of our infant attachments, and our expectations of what will happen when we turn to another are also built in infancy.

Patterns of Attachment

The quality of the child's attachment to his mother is determined by the way the mother responds to her child's bids for attention, help, and protection. As Ainsworth (1989) pointed out, the defining characteristic of an attachment bond is that it is marked by one person seeking a sense of security from the other. If the seeker is successful, and a sense of security is attained, the attachment bond will be a secure one. If the seeker does not achieve a sense of security in the relationship, then the bond is insecure.

Ainsworth and her colleagues (1978) established the most widely used research method for assessing quality of attachment: a laboratory procedure known as the Strange Situation which involves two brief separations from mother in which the baby is left with a stranger. The baby's behavior on reunion following these separations forms the basis for classifying her quality of attachment. Ainsworth (1978) described three basic patterns of attachment: securely attached, avoidant, and resistant.

Babies described as securely attached actively seek out contact with their mothers. They may or may not protest when she leaves the laboratory, but when she returns they approach her and maintain contact. If distressed, they are more easily comforted by their mothers than by the stranger, demonstrating a clear preference for their mothers. They show very little tendency to resist contact with their mothers and may, on reunion, resist being released by her.

Babies who are classified as avoidant in the Strange Situation demonstrate a clear avoidance of contact with the mother. They may turn away from her or refuse eye contact with her. They may ignore her when she returns after the separation. Some avoidant babies seem to prefer the stranger and appear to be more readily comforted by the stranger when they are distressed.

The third group, resistant babies, may initially seek contact with their mothers on reunion, but then push her away or turn away from her. They demonstrate no particular preference for the stranger, but on the contrary appear angry toward both their mother and the stranger.

Later, Main and Solomon (1990) described a fourth pattern of attachment behavior: disorganized/disoriented behavior. These babies seem to have no clear strategy for responding to their caregivers. They may at times avoid or resist her approaches to them. They may also seem confused or frightened by her, or freeze or still their movements when she approaches them. Main and Hesse (1990) have hypothesized that disorganized infant attachment behavior arises when the baby regards the attachment figure herself as frightening. Studies have demonstrated a higher incidence of disorganized/disoriented attachment patterns in infants whose mothers report high levels of intimate partner violence (Steiner, Zeanah, Stuber, Ash, & Angell, 1994) and in infants who were maltreated (LyonsRuth, Connell, Zoll, & Stahl, J., 1987). The babies of mothers who abuse alcohol have been shown to have higher incidence of disorganized/disoriented attachment behavior (Lyons-Ruth & Jacobivitz, 1999).

Even though some studies indicate that insecure attachment styles can lead to emotional and behavioral difficulties, it is important to keep in mind that insecure attachment styles are not mental disorders. They are strategies for protection seeking that occur in the normative population. Lieberman and Zeanah (1995) propose three separate categories of attachment disorders: (1) disorders of nonattachment, (2) disordered attachments, and (3) disrupted attachment disorder: bereavement/ grief reaction. This article will discuss only the first two categories.

Disorders of Non-Attachment

The disorders of non-attachment closely parallel the description of reactive attachment disorder that appears in the DSM-IV (APA, 1994). These disorders most frequently appear in children who have not had the opportunity to attach to a single caregiver, and they are of two major types, the first involving emotional withdrawal and the second, emotional promiscuity or indiscriminate behavior.

Example of non-attachment with emotional withdrawal

Ivan was born to a young mother overwhelmed by the demands of poverty. Ivan's active 19monthold brother, and her violent relationship with her children's father, who lived with her sporadically when he was not in jail. Ivan's mother, who reported a lonely childhood in which she sat alone in her apartment many hours each day waiting for her mother to return from work, coped with her negative feelings by drinking heavily. She was ambivalent about her pregnancy with Ivan and abused alcohol throughout. Ivan was born several weeks premature and small for his gestational age.

Example of disorganized/disoriented attachment behavior



Jill was 30 months old when she was removed from her parents' home because of their pervasive neglect of her. Both of her parents were heavy drinkers. They fought with each other, sometimes with knives as weapons, and they had been observed to punish Jill for small infractions by biting her. Jill did not see her parents for the first ten days that she was in foster care, and then was reunited with them for a visit in our clinic playroom. When they came into the room, Jill did not respond to them and seemed not to see them or anyone. She sat frozen in her chair. She did not explore the room or play with any of the toys. When her mother offered her a toy or food, Jill sometimes seemed to be looking at her without seeing her, and sometimes turned away. When either of her parents spoke, Jill startled visibly, pulled at her hair, and shouted, "What?" in an alarmed tone. Other than that she spoke no words during the two hour visit. When the therapist said that it was time to leave, however, she fell screaming to the floor, refused to put on her coat, grabbed for her mother and clung to her as she tried to walk away. She remained inconsolable for nearly 20 minutes after her parents left the visiting room.



Internal Working Models and the Role of Attachment in Normative Development



Bowlby (1969/1982) believed that as the baby or child experienced his caregiver's responses to his bids for help and protection, he developed mental/emotional templates called internal working models of himself and what he could expect in his relationships with other people. A baby whose mother responds quickly and sensitively to his cries comes to see himself as worthy of attention and help. He comes to anticipate that other people in his life will respond to him positively when he needs something. He gains a sense of efficacy and agency: a belief that he can make things happen. On the other hand, a baby whose mother does not respond to his bids constructs an internal working model of himself as unworthy and other people as unresponsive or, perhaps, as dangerous. The avoidant, resistant, and disorganized styles of attachment described above are in response to inconsistent or insensitive caregiver responses to the baby's bids.



The literature suggests that the internal working models of attachment that are formed in infancy and early childhood form the templates for a variety of relationships, not only attachment relationships. Preschool children with secure attachment histories have been shown to be more selfconfident and less dependent with their teachers than insecurely attached children (Sroufe, 1983). The same children, at age ten, were less dependent on summercamp counselors than were children with insecure attachment histories (Urban, Carlson, Egeland, & Sroufe, 1991). Warmer and his colleagues (1994) also found that securely attached six year olds were more competent in play and conflict resolution with peers than were insecurely attached children. Other researchers have found that these increased competencies extended into later childhood (Grossmann & Grossmann, 1991) and adolescence (Weinfield, Sroufe, Egeland, & Carlson, 1999).



Further, insecurely attached babies have grown into children with problems in some areas of functioning. Cohn (1990) and Turner (1991) found that insecurely attached boys were more aggressive than securely attached ones at four and six years of age, respectively; and Turner (1991) found that insecurely attached girls were more dependent and less assertive than securely attached girls. Although other findings of increased aggression, particularly among avoidantly attached children, have been reported, many studies have failed to replicate them. and one must be cautious in suggesting that insecure infant attachment leads to any particular psychopathology. Recent studies have also noted that other factors besides inconsistent or insensitive maternal care giving contribute to attachment insecurity. Some authors now suggestthat an interaction of child characteristics.. (such as a difficult or "slow to warm" temperament), insensitive care giving (including factors such as child maltreatment, maternal depression and maternal substance abuse), and high levels of family adversity and stress interact to result in insecure attachment (Greenberg, 1999).

Disorders of Attachment

He lagged behind in his development and from time to time during his first year of life slipped from his growth curve. He spent the year moving between the homes of his mother, his maternal grandmother, and a maternal aunt. When he was first seen in the clinic he was 17 months old. He could sit and crawl but could not walk and he had no language. He did not respond when his mother spoke or approached him; nor did he respond when the therapist approached him. He would sit quietly for up to an hour on a sofa without toys or anything else to entertain him.

Ivan appeared withdrawn from contact not only with his mother but also from the world. He did not seek stimulation from people or objects in his environment, and he seemed to have given up on asking for anything. It took extraordinary effort, over several weeks, for the therapist to begin to engage him so that he would make consistent eye contact, accept a toy from her or respond by vocalizing and smiling to her emotional expressiveness. Even then, his mother remained ambivalent about Ivan's development. She wanted him to walk so that she would not have to carry him everywhere, but she dreaded the loss of her "easy" baby, who placed so few demands on her. It was difficult for her to understand the importance of talking to Ivan or playing with him, and she seemed unable to follow the therapist's lead in trying to engage her son.

Example of non-attachment with indiscriminate behavior

Susan was 15 months old when she came to live with her paternal aunt and grandmother. Until then, she had been in the care of her crackcocaine addicted mother and had lived with her in a variety of crack houses and, sometimes, on the y street. Her mother also had left Susan sporadically with relatives, sometimes telling them that she would be back in several hours and then not returning to retrieve her daughter for days or weeks. When Susan's mother learned of her own HIV status, she left Susan with her aunt and grandmother, saying that she could no longer care for her. Susan was weak, dirty and malnourished, unable even to sit up. A physical exam disclosed that she had been raped. When she was first seen in the clinic, Susan had been with her grandmother and aunt for three months. She had regained her physical strength and was able to stand and walk. but emotionally she remained devastated. She clung to both her aunt and her grandmother, screaming if they left the room and waking up in terror several times each night to make sure that they were still there. She hugged strangers in line at the bank, and when her uncles came to visit, she crawled into their laps, embraced them, and tried to remove her clothing. She approached the therapist in the very first session, clung to her knees, and sat on her lap. At the end of the hour, she sobbed when the therapist got up to leave, and could not be comforted even by her grandmother. It took many months of sensitive care for Susan to begin to develop a preference for her grandmother and to reliably turn to her for comfort.

Disordered Attachment

Lieberman and Zeanah (1995) make the important point that a child does not have to be nonattached to have disorders of attachment. This is a major step forward that they have made in diagnosing relational problems in infancy that put a baby at developmental risk. As they point out, the principal difference between a disorder of nonattachment and a disordered attachment is that in the latter, the child does express a preference for a particular attachment figure. The preference, however, is unlike normative attachment patterns (even insecure ones) in that it is characterized by intense conflict that pervades the relationship because of intense negative feelings such as anger, fear or anxiety. The child does not express these emotions directly, but masks them with defenses that interfere with the heart of his attachment relationship. Such a child may appear to be extremely inhibited, may engage in selfendangering behavior, or may reverse roles and offer emotional relief to the attachment figure to whom she would more appropriately turn for comfort and safety herself.

Treatment of Attachment Disorders

There are several models for treating attachment disorders. Some of them have sprung up in response to an increase in numbers of children in foster care and children adopted from institutions in the Eastern European block countries. Children from these backgrounds often present as non-attached to any particular caregiver. Keck and Kupecky (1995) use cradling in their work with poorly attached children and adolescents. Cradling is a technique in which the child is physically held on the lap of parent(s). The cradling is intended to provide physical containment, which can be reassuring if frightening feelings are aroused. Hughes (1997) describes a treatment method for working with nonattached children that encourages the caregiver to treat the child in a manner consistent with the child's developmental age, keeping the child under the constant close supervision of the caregiver.

Dyadic Developmental Psychotherapy has been shown to be an effective treatment method for the treatment of children and teenagers with trauma-attachment disorders. Another treatment method that has been tested and empirically demonstrated to facilitate secure attachment is infant-parent psychotherapy, originally described by Selma Fraiberg and her colleagues (1975). In infant-parent psychotherapy, as it was first conceived, the focus of the treatment was on the parent's emotional conflicts as they affect the infant. Fraiberg believed that a parent's emotional difficulties, originating in conflicted relationship histories, mental illness, family disruption, socioeconomic hardship, or a combination of these factors, could interfere with adequate physical and emotional care giving and lead to a disturbed relationship between mother and baby. More recently, infantparent psychotherapy has incorporated the understanding that infant constitutional vulnerabilities, and poorness of fit between the infants' characteristics and needs and the parents' care giving style, may also disrupt the parentchild relationship. Infantparent psychotherapy now focuses on these factors as well as on the parents' emotional liabilities (Lieberman & Pawl, 1988).

In two empirical studies, Lieberman and her colleagues (Fraiberg, Lieberman, Pekarsky & Pawl, 1981; Lieberman, Weston, & Pawl, 1991) have demonstrated that infant-parent psychotherapy can affect changes in the quality of infant-parent attachment, converting insecure attachments to secure ones. This therapy, which combines nondidactic developmental guidance, help with problems in living, and the psychodynamic exploration of the infant-parent relationship and the parents' relationship history, can help repair anxious relationships and improve the baby's chances for the most favorable developmental outcomes. The case of Lily and her parents illustrates how infantparent psychotherapy can facilitate the development of secure attachments in families where there are multiple risk factors in the parents' histories and present lives.

Example of infant parent psychotherapy used with a drug-addicted mother

Karen was separated from her daughter, Lily, at birth because Karen had sought no prenatal care, she and Lily both tested positive for several substances (including heroin and methadone), and she had no stable home. Lily was placed in a group home where she was cared for by nurses and aides, including one nurse who was assigned to be her particular caregiver. Karen engaged in a day treatment program and visited Lily several times a week. Karen and her frequent comings and goings were confusing to Lily. The staff at the home noted that Lily cried frantically whenever Karen left her, but that when Karen was with her Lily was sometimes clingy and sometimes pushed her away or ignored her overtures.

When Lily was ten months old, Karen was admitted to a clean and sober house for mothers and young children, and Lily was transitioned to her care. The referral for infantparent psychotherapy was made to facilitate the transition and to support Karen in undertaking the fulltime care of her daughter. Karen was thrilled to have Lily with her every day, but told the therapist that she could not understand Lily. Lily cried, refused to sleep in her own bed at night, and turned away from Karen when Karen tried to comfort her. Karen was deeply hurt that Lily did not share her joy at their reunion and said, "Lily just doesn't love me. She wants to hurt me to get back at me for leaving her alone. " Over time, the therapist helped Karen to see how difficult the transition from the group home to her care might have been for Lily. Although the group home had been imperfect, it had been Lily's home and filled with familiar figures. The therapist asked Karen about her own responses when she lost people who had been close to her. When Karen began to understand that Lily's behavior might be motivated by grief rather than vengeance, she was able to find ways to comfort Lily.

The therapist observed that in her eagerness to care for Lily, Karen was often intrusive. Rather than responding to Lily's bids for attention, Karen pressed her affection on Lily in ways that made Lily angry. Karen would then feel rejected and pull away. The therapist helped Karen focus on times when Lily turned to . her, and supported her response to Lily at those times. The therapist could then point out the pleasure that Lily took in Karen's attention. The therapist also supported Karen by giving her a place to talk about her hurt and frustration that Lily did not always want her affection when she wanted to give it. With this support, Karen became less intrusive, more aware of Lily's bids, and more consistent in responding to them. As Lily grew more confident that her mother would respond when she expressed her need she turned to her mother more frequently and their interaction became more spontaneous and joyful. Within several months, Lily consistently turned to her mother when she needed help, and no longer pushed Karen away when Karen spontaneously offered her affection. her affection on Lily in ways that made Lily angry. Karen would then feel rejected and pull away. The therapist helped Karen focus on times when Lily turned to . her, and supported her response to Lily at those times. The therapist could then point out the pleasure that Lily took in Karen's attention. The therapist also supported Karen by giving her a place to talk about her hurt and frustration that Lily did not always want her affection when she wanted to give it. With this support, Karen became less intrusive, more aware of Lily's bids, and more consistent in responding to them. As Lily grew more confident that her mother would respond when she expressed her need she turned to her mother more frequently and their interaction became more spontaneous and joyful. Within several months, Lily consistently turned to her mother when she needed help, and no longer pushed Karen away when Karen spontaneously offered her affection.

SUMMARY

Attachment, an affectional relationship between mother and baby and, later, between other caregivers and baby, is central to the personality development of every infant. Secure attachment can be derailed in many ways. Economic and social stresses, mental illness, substance abuse, and the constitutional vulnerabilities of the child can all act to place difficulties in the path of the relationship between a baby and her mother. These relationships can, however, be healed, and the baby returned to a hopeful developmental path.



Avoidant Attachment and Defense Mechanisms
According to attachment theory, children differ in the kinds of strategies they adopt to regulate attachment-related anxiety. Following a separation and reunion, for example, some insecure children approach their parents, but with ambivalence and resistance, whereas others withdraw from their parents, apparently minimizing attachment-related feelings and behavior. One of the big questions in the study of infant attachment is whether children who withdraw from their parents--avoidant children--are truly less distressed or whether their defensive behavior is a cover-up for their true feelings of vulnerability. Research that has measured the attentional capacity of children, heart rate, or stress hormone levels suggests that avoidant children are distressed by the separation despite the fact that they come across in a cool, defensive manner.

Recent research on adult attachment has revealed some interesting complexities concerning the relationships between avoidance and defense. Although some avoidant adults, often called fearfully-avoidant adults, are poorly adjusted despite their defensive nature, others, often called dismissing-avoidant adults, are able to use defensive strategies in an adaptive way. For example, in an experimental task in which adults were instructed to discuss losing their partner, Fraley and Shaver (1997) found that dismissing individuals (i.e., individuals who are high on the dimension of attachment-related avoidance but low on the dimension of attachment-related anxiety) were just as physiologically distressed (as assessed by skin conductance measures) as other individuals. When instructed to suppress their thoughts and feelings, however, dismissing individuals were able to do so effectively. That is, they could deactivate their physiological arousal to some degree and minimize the attention they paid to attachment-related thoughts. Fearfully-avoidant individuals were not as successful in suppressing their emotions.~~~~~~~~~~~~~~~~~~~~~



STAGES OF LOSS

When a child is taken away from a caring mother, the child goes through a predictable sequence of behaviors, which can be divided roughly into three stages:

PROTEST

"This initial phase may begin immediately or may be delayed; it lasts from a few hours to a week or more. During this stage, the young child appears acutely distressed at having lost his mother and seeks to recapture her by the full exercise of his limited resources. He will often cry loudly, shake his cot, throw himself about, and look eagerly towards any sight or sound which might prove to be his missing mother. All of his behavior suggests a strong expectation that she will return. In the meantime, he is apt to reject all alternative figures who offer to do things for him, although some children will cling desperately to a nurse."

DESPAIR

"During this phase, which succeeds protest, the child's preoccupation with his missing mother is still evident, though his behavior suggests increasing hopelessness. The active physical movements diminish or come to an end, and he may cry monotonously or intermittently. He is withdrawn and inactive, makes no demands on people in the environment, and appears to be in a state of deep mourning. This is a quiet stage, and sometimes, clearly erroneously, is presumed to indicate a diminution of distress."

DETACHMENT

"Because the child shows more interest in his surroundings, the phase of which sooner or later succeeds protest and despair is often welcomed as a sign of recovery. The child no longer rejects the nurses; he accepts their care and the food and toys they bring, and may even smile and be sociable. To some this change seems satisfactory. When his mother visits, however, it can be seen that all is not well, for there is a striking absence of the behavior characteristic of the strong attachment normal at this age. So far from greeting his mother, he may seem hardly to know her; so far from clinging to her, he may remain remote and apathetic; instead of tears there is a listless turning away. He seems to have lost all interest in her.

Should his stay in hospital or residential nursery be prolonged and should he, as is usual, have the experience of becoming transiently attached to a series of nurses each of whom leaves and so repeats for him the experience of becoming the original loss of his mother, he will in time act as if neither mothering nor contact with humans had much significance for him. After a series of upsets at losing several mother-figures to whom in turn he has given some trust and affection, he will gradually commit himself less and less to succeeding figures and in time will stop altogether attaching himself to anyone. He will become increasingly self-centered and, instead of directing his desires and feelings towards people, will become preoccupied with material things such as sweets, toys, and food. A child living in an institution or hospital who has reached this state will no longer be upset when nurses change or leave. He will cease to show feelings when his parents come and go on visiting day; and it may cause them pain when they realize that, although he has an avid interest in the presents they bring, he has little interest in them as special people. He will appear cheerful and adapted to his unusual situation and apparently easy and unafraid of anyone. But this sociability is superficial: he appears no longer to care for anyone." ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~



This issue of Reclaiming Children and Youth is dedicated to helping youngsters experiencing difficulties with relationships. In honor of the topic, we turn to the pioneer in relationship research, John Bowlby. His many contributions include a seminal three-volume set on attachment (Bowlby, 1969; 1982). Despite the fact that Bowlby laid out his arguments profoundly intricately, I believe Bowlby is truly accessible to contemporary readers who are willing to expend the effort. His descriptions of attachment behavior in monkeys and great apes struck me as particularly fascinating.

It is nearly second nature these days for helping professionals to speak of attachment and disorders of attachment. Especially since the film Good Will Hunting, concepts related to attachment have entered the popular vocabulary with a vengeance. A breathtaking number of current issues and questions in youth work, psychology, and social work hearken back to the three-volume set penned by John Bowlby, starting with Attachment in 1969:

Detachment, attachment disorder, and problems managing relationships receive frequent attention from both scholars and practitioners. Youth workers often shake their heads over the difficulty of re-educating and encouraging resilience in youth manifesting a history of toxic relationships with the pivotal adults in their lives. It seems likely that early attachment to one or a few close relatives holds great portent for a person’s overall relational abilities. Attachment predicts the ability to relate to many others, to establish trust, to form and retain friendships, and to engage in mutually satisfying emotional and physical relationships.
Why is early experience so important?

Successful learning — even of language — requires that meaningful early connections be forged. As is true of many relational categories, the student/teacher dyad may be more or less effective, depending upon the early health of attachment. After reading Bowlby, it will come as no surprise that the most effective elementary teachers tend to be the best human relaters.

Discussions of parenting style and nurturing very young children often reduce to fundamental questions about attachment and its importance. In order to maintain a middle class lifestyle in the current economy, many families require a two-parent income. We are now engaged in a national debate about the implications of the resulting day-care revolution on child adjustment and development. Of necessity, this debate is often couched in terms related to attachment.

This attachment topic entered the political arena as the so-called welfare reform of recent years cuts off benefits to single parents after a period of time and mandates that they enter the workforce. The results for economically at risk children remain unknown. However, if attachment research is to be believed, the longitudinal results of this policy may be grave and heartbreaking.

I vaguely knew that John Bowlby’s 1969 volume Attachment had exerted great influence in child development circles. Having encountered précis of his work in my educational psychology texts, I had never tackled the original. In 1999, Basic Books reissued Bowlby’s three-volume series in an attractive format, with forewords provided by eminent scholars in development and neuroanatomy. Attachment was followed four years later by Separation: Anxiety and Anger (Bowlby, 1973). The third volume in the set is titled Loss: Sadness and Depression. The Basic Books reissues (2nd Ed., 1982) are attractive and reasonably priced. Modern students, scholars, and practitioners will find the volumes eminently readable — in a way not shared by many other classical works in psychology, education, or sociology. For this review, I concentrated on the initial volume, simply titled Attachment.

Much of our understanding of attachment comes from this seminal volume. Child development experts detected stereotypical problems accruing to some British citizens, who as children had been placed away from London (and, by extension, their parents) during the German bombing. Bowlby asked whether these difficulties could be traced to interference with early bonds between children and parents. In order to ask the correct questions—much less answer them — Bowlby needed to thoroughly examine the biological and psychological basis for what he discovered was the intense, reciprocal relationship between mothers and infants.

Bowlby’s genius was to recognize, and expand upon, the importance of the ethological principle of imprinting as developed by Lorenz in the 1930s. Ethology is the study of animal behavior (innate behavioral norms; Grzimek, 1977). Imprinting (Pragung, in the original German) is defined as follows:

…a relatively rapid learning process that takes place during a short, sensitive period in early youth. It has a prominent-sensitive phase and a stable, often irreversible effect. Young animals learn their own species... with whom they will mate as adults (Grzimek, 1977, p. 692).

Bowlby noted that imprinting manifested itself as a spectacularly more complex phenomenon in primates, including man, that he labeled attachment.

Reclaiming Children and Youth readers will find Bowlby’s exploration of the biological and learning bases for attachment to be particularly worthwhile. In fact, nearly half of the first volume is dedicated to this exposition. I was impressed with the clarity of Bowlby’s explanation of attachment behavior in primates. I found the information fascinating and became convinced that the described behavior did indeed stem from instinct because of its survival value.

Throughout early childhood, they [primates] are either in direct contact with mother or only a few feet or yards from her. Mother reciprocates and keeps the infant close to her. As the young grow older, the proportion of their day when they are in direct contact with mother diminishes, and the distance of their excursions increases; but they continue to sleep with her at night and to rush to her side at the least alarm (p. 184).

Attachment is a reciprocal system of behaviors between an infant and a caregiver—generally the mother. The term reciprocal is apt because not only does attachment affect the child’s behavior (for example, moving closer to the mother when stressed), but also affects the responses of the mother, who emits care-giving responses in the presence of signals from the infant.

The strong relationship between mother and infant appears to be regulated via homeostasis; that is, when the two are within a certain social distance, the system is balanced (i.e., has attained homeostasis). When one or the other moves further away than is appropriate developmentally or when a stranger comes too close, the balance is reduced; when this occurs, the child and/or the mother move to reestablish the "comfort feelings" represented by the attachment dynamic in equilibrium. In the foreword to the 2000 edition, Allan Schorr argues that Bowlby’s hypotheses about such mother-child regulatory synchronicity have been supported by modern neuroanatomical studies. Regulation "of autonomic responses to social stimuli" (p. xii) appears to be situated in the orbito-frontal cortex.

According to Bowlby, early successful attachment becomes organized into an array of complex social behaviors and, by extension, the capacity for successful relationships of all sorts. In short, via successful early attachment to one person, an individual learns to tune her behavior to the subtle social cues of many others. This tuning, in turn, transforms via development and experience into the ability to engage in social relationships, to make friends, and, to eventually attain physical intimacy.

The appropriately attached relationship between the mother and the toddler serves as a safe platform from which the infant explores her environment. Because regulation of the system requires feelings of discomfort when social distance becomes too great, it is reasonable to assume that detached toddlers will find themselves perpetually anxious. Since this state inhibits learning, successful attachment also probably predicts efficient learning during the earliest stages of life. Bowlby, in fact, traces changes in the sophistication of behavior designed to attain proximity to the primary caregiver:

When an older child or adult maintains an attachment to another person, he does so by diversifying his behavior so that it includes not only the basic elements of attachment behaviour present at the first birthday, but, in addition, an increasingly varied array of more sophisticated elements. Compare, for example, the degree of behavioural organisation underlying the actions of a schoolboy when he seeks to find his mother in a neighbor’s house, or pleads with her to include him on a visit she intends to pay on relatives... with that of the same individual when as an infant he first attempted to follow his mother out of a room. (p. 350)

But what is the importance of reciprocal attachment between caregiver and child? Simply, the part of the brain that regulates social behavior, including but not limited to relationship-building and sexuality, does not develop to its full potential in the absence of these bonds. Starting with Harlow’s groundbreaking work with rhesus monkeys in the 1950s and 1960s, it has been shown that in primates, play, other social behaviors, and mating responses do not mature in the absence of critical-period attachment bonds.

The failure of human infants to bond with a primary care-giver is no less damaging — though perhaps manifested more subtly — given human behavioral flexibility. Bowlby even argues that early successful attachment lies at the core of such later manifestations of reciprocity as perspective taking (i.e., empathy). He may have carried the point a bit far in his favorable analysis of later discredited theories about autism by such psychoanalytic-oriented writers as Bettleheim. Early on, writers "blamed" autism on failures of attachment—notably emotionally cold and cognitively unpredictable mothers. We understand now that the autistic spectrum disorders are organically caused.

Yet, the importance of successful attachments in establishing and maintaining healthy relationships is hard to gainsay. The evidence, both that was organized by Bowlby and other information generated since his writing, established very well the genesis of the types of disorders portrayed in Good Will Hunting. Rather than relying on the stability of social relationships, detached and abused children either disdain human contact, or worse, come to loathe and fear these connections. Such problems are explored more deeply in the second (Separation: Anxiety and Anger) and third (Loss: Sadness and Depression) volumes of the Attachment series. However, at the close of Volume 1, Bowlby lays out a clear perspective on the importance of attachment in personality development:

A young child’s experience of an encouraging, supportive, and co-operative mother, and a little later, father, gives him a sense of worth, a belief in the helpfulness of others, and a favorable model on which to build future relationships… by enabling him to explore his environment with confidence and to deal with it effectively, such experiences also promote his sense of competence. (p. 378)

Attachment will not be a particularly difficult read for college students and graduates, though having handy an encyclopedia or dictionary of biological or evolutionary terms may be useful. Bowlby’s American publisher elected to retain the British spellings, though I did not find this particularly distracting. Bowlby presents his arguments meticulously, with infinite patience and care. At times, I would have been satisfied with fewer examples. However, moments of boredom were rare — and would generally be followed by passages of great interest. For example, the pictures of primate mothers caring for their infants were tremendously compelling. These admirably set the stage for later discussions of mother-infant behavior in humans.

The first fifth of the book contains material of significant historical interest. I found it interesting that Bowlby felt the need so strongly to establish the grounds for his respectful disagreements with psychoanalytic child development views. Evidently, Freud still cast a long shadow in 1969. Bowlby’s Attachment is one classic that youth workers and educators will find readable and which the historically minded will wish to add to their collection.~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Sexuality: Wilhelm Reich. 'Der masochistische Charakter'. Internationale Zeitschrift für Psychoanalyse, 1932, Bd. XVIII, S. 303–351.

Abstract by: Adrian Stephen

The author discusses the genesis of masochism and supports his views with detailed excerpts from the analysis of an extreme case of masochistic character formation. He criticizes adversely Freud's later theories with regard to the Death Instinct, the Repetition Compulsion and Primary Masochism, and upholds and elaborates the old theory that masochism is sadism turned inwards. He holds that the conflict which is fundamental to masochism is one between the libido and the patient's environment (the 'patriarchal civilization' of Western Europe). It is not between two essentially opposed internal forces, such as Eros and the Death Instinct. He regards this as of importance both for the theoretical understanding of masochism and for the therapeutic treatment of cases. He criticizes also Alexander's views on the 'need for punishment'.

Reich enumerates the four chief traits which characterize the masochist, namely: (1) the sense of suffering; (2) the tendency to self-abasement and self-injury; (3) the passion for tormenting others as well as the self; (4) the tendency to awkward, ungainly behaviour. He works out the contributions of constitutional predisposition and fixations with regard to each of them.

Skin erotism is a factor of great importance. The painful experiences, such as flogging, which the patient phantasies or actually experiences, have this in common, that they lead to a warming of the skin as well as to pain. One of the foundations of masochism is a feeling of disappointment in love, which was originally a feeling of loss of contact with the warm skin of the love object. The masochist's demands for love are exceptionally great and perhaps unfulfillable, and possibly a physiological basis for this is to be found in some peculiarity of the vasomotor nervous system which controls the dilatation and contraction of the peripheral blood vessels.

The pains to which the masochist subjects himself in reality or phantasy also signify punishment, but are not desired as such: they represent a milder form of punishment than that expected as the result of any sexual pleasure, and so come as a relief. Sexual pleasure is also itself felt as a form of punishment, and is feared as such while it is sought for as pleasure.

The part played by anal and urethral fixations is also of importance. The patient in the case described had received exceptional attention from his mother in connection with the evacuation of his bowels and bladder, but when he proceeded to show a more genital interest in her he received severe rebuffs. His first attempts at genital overtures to his mother took the form of exhibiting his penis. The rebuff in this connection caused an extensive regression to anal and urethral fixations, for exhibitionism in

connection with these zones had been regarded as praiseworthy and encouraged. A severe conflict, however, took place even on the anal and urethral levels owing to an identification with the patient's father, who had severely punished him for dirty behaviour in the presence of strangers.

Reich regards a repression of phallic exhibitionism as specific in the formation of masochism. It led in the patient to more inhibitions in sublimation as well as to various reaction formations.

Oral fixation is also of importance in increasing the insatiability of the masochist's demands for love.

The paper contains some general recommendations as to technique, and an account of certain special measures which the author found it necessary to employ in the case described.

1 comment:

Ranjeet said...

There is no perfect or you can say 100% solution to RAD.To cure RAD,you need something that is important (i.e Patience)RAD kid tends to assume everyone as stranger even their families too.So its difficult to convince them about the bonding.Normal parenting doesn’t work with RAD kids. Neither does traditional therapy, since these therapies are dependent upon the child’s ability to form relationships that require trust.

Reactive attachment disorder