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Tuesday, September 14, 2010

Part VII: A Series on Attachment Theory, a summary of A Secure Base

I'm going to finish up chapter three of a A Secure Base, in this post. We left off with Bowlby's belief that no matter a child's personality, the mother sets the basic tone of mother/child interaction.

This is part of my series studying attachment theory as put forth by one of the premier theorists, in the field of attachment, John Bowlby. If you want to catch up, click here.

In the last post on this topic, I left off with Bowlby essentially saying that a poor attachment will leave people with severe detriments. One example is schizoid personality, also known as false self, borderline personality, or pathological narcissism.

A person with such a diagnosis often represents as independent and emotionally self-sufficient. However, this personality type will often become depressed for no apparent reason and will suffer from psychosomatic symptoms. For depression this type of person will prefer drugs to analysis and if he/she goes for analysis, this person will hold the analyst at arms length and consider the therapy to be an interesting intellectual exercise, but not helpful in fixing their problems.

There are disagreement as to whether this condition is caused by inadequate mothering, or if that is merely one factor.

Bowlby believed that it was important to reach a consensus on the matter. At the time of the writing, the only two sources available to pull information was analytic treatment of psychoanalytic patients and observation of children with their mothers. Bowlby believed that pulling together patients' histories would prove useful and he estimated that it would help prove that inadequate mothering was the direct source of such psychological problems.

Since he was not able to prove his theory, he put forth some examples that he believed were the picture of his theory.

The first example is a 41-year-old woman who presented as emotionally self-sufficient, but had developed some psychosomatic symptoms. After much analysis, she finally revealed the events of her childhood, having been abandoned by her mother and left in the care of various people throughout her childhood.

The next example is of a young woman in her 20s who had been sent to live with an aunt during her mother's pregnancy, when she was only 18 months old. During that time, she began to consider her aunt more like a mother and when she was sent back home, she was severely traumatized. She described herself as "switching off" her anxiety, and therefore, the bulk of her emotional life along with it.

The next example is of a a young man in his 20s, who was contemplating suicide. He described his feelings as more of a life philosophy than an illness. He had been severely rejected by his parents, who fought often, his father worked long hours and his mother ignored her many children, often locking herself in her room for days or leaving the house, taking the girls with her and leaving her sons alone. The young man was often left to cry alone and once he had appendicitis, he moaned all night long and was ignored. By morning he was seriously ill. He often wondered why he had been rejected so. He said that his first day of school was like his final rejection, he cried all day long, but eventually decided to hide his desires for love and support. During therapy he was afraid to break down because he feared his therapist would see him as a nuisance, and he expected her to lock herself in a room if he were to say anything personal.

In treatment all three patients', the analysts used Winnicott's method of permitting free expression of "dependency feelings," this allowed the patients to develop an anxious attachment to the therapist. The results were that the patients were allowed to develop what they had missed out on in childhood and the results were positive for all three patients.

Bowlby admits that these three example don't prove Winnicott's theory of aetiology, however, he believed that they supported it.

Since retrospective anecdotes cannot be used as the only proof, the only other thing to go on is observation of children as a cross-check, says Bowlby.

But is there any evidence that childhood experiences can cause a numbing effect? Yes, says Bowlby. There is.

Observations made by other researchers in the 1950s and later confirmed in the 1960s of children between the ages of 12-36 months when placed in institutionalized care facilities with no apparent mother figure come to act as if mothering (or any human contact) is of no significance to them. As caretakers come and go, the child will become less attached.  When returned home they will remain distant to their parents, for a length of time, the length of time stretches longer when the parents are unsympathetic.

Even more examples of a child's defensive numbing can happen even without separation, but simply maternal rejection, were found by a colleague of Mary Ainsworth, Mary Main. Main found that children ages 12-20 months would not only fail to greet, but actively avoid his mother when she left him with a stranger.

While watching videos of these interactions, Bowlby said he was astonished as to the lengths these children went to in their avoidance. One child met his mother, but averted his head and then retreated from her. Another child, as though facing punishment, knelt in a corner and placed his face on the floor. In each case the videos showed the mothers' expressions when with their children as angry, inexpressive, and disliking physical contact with their child. Some of the mothers scolded in angry tones, others mocked their children, while others made sarcastic comments to or about their child. An obvious possibility of the avoidant behavior is that the child is simply avoiding being treated with hostility.

Bowlby's belief was that these obvious cross checks of the behavior of children and later adult behavior support Winnicott's theory.

Of course, says Bowlby, the way these patients deal with their analysts is often a more intense version of how they act in the world. Additionally, they typically have trust issues, which they act out with their therapists and often treat their therapists in the same manner as they were treated as children.

More intensive research is needed on this topic.

To provide the type of dependency these type of patients need is not easy for analysts. To achieve the balance between the yearning for affection from a patient and being able to provide the support those patients requires of the analyst all the intuition, imagination and empathy they can muster.

It also, however, requires a firm grasp on the patient's needs and what the analyst is trying to do. This is why it is so important to determine to what extent aetiology has on adults' psychological disorders.

The chapter ends (phew!) with a quote from Freud, "What we are in search of is a patient's forgotten years that shall be alike trustworthy and in all essential respects complete."

I feel the need to make more comments than usual on this chapter. First, I wonder how Bowlby would feel about the world of pharmacology today, how general practitioners are passing out anti-depressants like candy for depression instead of people seeking long-term therapy for deeply rooted problems.

I am also pretty fascinated to learn that essentially, the world of attachment parenting stems from psychoanalytic research. It makes sense. Most AP parents I know are parenting the way they do because they are trying to do things differently than previous generations.

I was also intrigued by the examples Bowlby gave. None of them seemed that far-fetched. A child who was raised by more than one person because her mother was inadequate, and finally abandoned her. Another woman who had been severely traumatized as a baby, by one dramatic rejection. And a man, who was neglected, probably in part because he was a male and expected to be strong.

These people all had severe problems that weren't fixable by drugs. They didn't have a chemical imbalance, they had an emotional imbalance, leftover from childhood trauma.

It makes me wonder what problems could be fixed if people could go back and work through their childhood traumas. Road rage, random depression, unexplained anger, perfectionist attitudes, eating disorders, substance abuse. I want to be clear, I did not get any of this from the book. It's all just my own speculation. But I do wonder.

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