Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Tuesday, October 26, 2010

Using and Abusing Metaphors: Attachment, Bonding, and Primal Wound

Several posts ago, I referred to ideas like the “Primal Wound” (a posited psychological injury caused by separation of a baby from its birth mother) as metaphors that could be helpful in therapy or in thinking through personal problems. One reader felt insulted by this statement and equated it with saying that proponents of the Primal Wound approach are “stupid”. I certainly didn’t intend to say that, although I think that if they considered the facts of infant development they would be aware that the Primal Wound is a socially constructed concept rather than a “natural kind”. I did mean just what I said-- that thinking metaphorically can be one of our best ways to figure out puzzling and complicated problems.

If any readers are old enough to remember the comic strip “Pogo”, they may recall the time when another character disparaged Rabbit by saying, “Huh! You ain’t nothin’ but a rabbit!”. Incensed, Rabbit declared, “I am not”. When Pogo Possum gently reminded him that he actually was a rabbit, he explained, “Yeah. But not a Nothin’ But A Rabbit!”. When I say the Primal Wound concept is a metaphor, I don’t mean a Nothin’ But A Metaphor.

To say that something is a metaphor is by no means to belittle it. In psychology, especially, it’s so common to deal with events that can’t easily be observed, events that we infer on the basis of other events, that metaphors are a large part of our stock in trade. The Greek root of the word metaphor means “transfer”, and metaphors transfer the characteristics of things we know well to things we don’t know well, in an attempt to understand the latter. Whether this is useful depends on the extent to which the characteristics of the known thing “map onto” (or match with) the characteristics of the unknown thing. Obviously, if the choice of metaphor is not good, this comparison will not be of much help in understanding the unknown, and this can easily happen because, by definition, we don’t really know the characteristics of the unknown.

We can’t do without metaphors, as the work of people like Hacking, Lakoff, and Johnson suggests. But we need to use them cautiously and watch out for misunderstandings that emerge from the metaphor itself. Two good examples of such misunderstandings are the use of the terms “attachment” and “bond”. Transferring all the characteristics of physical “attachments” or “bonds” to psychological relationships (that is, mapping the psychological onto the physical) is useful in some ways, but makes for misunderstandings in others.

When we consider a physical attachment, like a boat tied to a mooring with a rope, or an electronic one like a document sent with an e-mail, we are looking at a situation where each thing is equally attached to the other thing. The boat is tied to the mooring, and the mooring is tied to the boat. The document accompanies the e-mail, and the e-mail carries the document. These situations map onto emotional attachment in the sense that there is a special relationship between the boat and the mooring, and there is a special relationship between a child and an adult caregiver. However, while the boat and the mooring are equally and identically connected, this is not true of the younger and older human beings. The attitude, motivation, and behavior of the child toward the caregiver are much difference than those of the caregiver toward the child, and the two respond very differently to the breaking of the connection. The same is true for “bonding”; Epoxy bonds two pieces of wood equally to each other, but the attitudes of the “bonded” adult are vastly different from those of the child for whom the bond is experienced.

Using the “attachment” or “bond” metaphors is helpful for understanding, but it also carries the danger of misunderstanding. This is evident in the many inaccurate claims made by people who assume that adult and child experience identical and mutual emotional events, and who also assume that once the knot is tied or the glue set, attachment and bonding do not continue to change with development, but retain their original characteristics.

The language of the Primal Wound metaphor maps emotional experience onto a physical phenomenon. The first, second, and third dictionary definitions of “wound” all refer to injury to a physical body, and only the fourth gives the [metaphorical] meaning of an injury to one’s feelings. Characteristics of physical wounds are that they had an onset caused by some external event, that they hurt, that they are potentially dangerous to physical functioning or even to life, that they provide opportunities for infection or further injury-- but also that they usually have at least some capacity for self-healing. How do these characteristics map onto the Primal Wound, as the term is used by Nancy Verrier in her books, The Primal Wound and Coming Home to Self? Verrier and her followers use "Primal Wound" to refer to adult adoptees’ sense of being abandoned, alone, and grieving, and to the events that they believed caused these feelings, just as “wound” might be used to mean both a lingering injury and the initial damage.

The nature of a physical injury does map reasonably well onto the psychological experience reported by some adult adoptees. There is pain, there is potential danger of further related injury, there are reasons why a sufferer might have his or her pain exacerbated by other experiences. But there are some ways in which physical wounds do not seem to map onto this type of psychological pain. An important one is that while a physical wound has an observable onset and cause, the adoptees’ psychological pain does not have an observable onset in infancy; babies separated from their biological mothers at birth do not show distress, slowing of growth, apathy, or any of the other characteristics that signal grief in older children. It’s the use of the “wound” metaphor that implies that there must have been such an onset, rather than an observable onset that supports the use of the metaphor, and this demonstrates another way that metaphors can hinder our understanding--- by leading us to cherry-pick among evidence for the material our metaphor seems to demand. Someone in thrall to the Primal Wound metaphor may say, “Newborn babies must show distress when separated, because that’s what a wound would cause, and if no one has found any evidence of this it must be just because they haven’t looked the right way.”

Abuse of analogies is not just a trivial logical error. By fostering misunderstanding, it can lead to abuse of infants, children, and adults as well. In my opinion, the Primal Wound metaphor, a much-abused analogy, has done exactly that by encouraging mistaken treatments.

19 comments:

  1. While the objection to the "wound" part of the analogy is valid, I worry about the "primal" part.

    I think it got transferred from the Freudians and their "primal scene": the thing you first see when your parents or significant adults have sex in front of you, or you happen to be there.

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  2. I agree that the primal wound metaphor would, and may have already, encourage mistaken treatments. This is why there is a problem with it.

    I also believe it contributes to romanticizing the birth process, from beginning to end.

    I think that it contributes to an unrealistic expectation put on mother and child to be equally and immediately bonded as well as attached from conception, not only in cases of adoption but also when the relationship remains intact.

    I must say though I've recently been informed by other adopted people that the primal wound does not happen to every person, there's been nothing that's meant to imply that it does. I haven't read either book so am relying on what I read from others impressions and experience.

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  3. Ok, disregard what I've recently been informed of. The following is copied from Verrier's postition page on her website. She clearly states the wound cannot be avoided.

    "..the connection between biological mother and child is primal, mystical, mysterious, and everlasting. Far more than merely biological and historical, this primal connection is also cellular, psychological, emotional, and spiritual. So deep runs the connection between a child and its mother that the severing of that bond results in a profound wound for both, a wound from which neither fully recovers. In the case of adoption, the wound cannot be avoided, but it can and must be acknowledged and understood."

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  4. If it could happen at all, it seems it would have to happen every time. In any case, Campbell, your quotation makes Verrier's position about as clear as it can be.

    I'm beginning to think I don't understand what "primal" is supposed to mean here. I think its denotation is simply "first in time", but there are evidently other connotations.

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  5. As well as Freud's use of the word "primal" there was a fad therapy in the 60s and 70s called "Primal Scream Therapy" that involved some kind of regression to infancy and screaming about all your woes that was supposed to make one feel better. It was popularized by celebrities but went out of fashion pretty quickly.

    Verrier certainly does make it clear that she believes Primal Wound is universal. No ambiguity there.

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  6. "But there are some ways in which physical wounds do not seem to map onto this type of psychological pain. An important one is that while a physical wound has an observable onset and cause, the adoptees’ psychological pain does not have an observable onset in infancy; babies separated from their biological mothers at birth do not show distress, slowing of growth, apathy, or any of the other characteristics that signal grief in older children."

    You are looking for behavior in neonates that you say signals grief in older children. How much older? Six months? Two months? I don't think it's fair to compare a six-month-old with a neonate. What you said is key: there is not "an observable onset in infancy." Depends on your parameters and what you're looking for. I believe in previous conversations, we spoke of there not being a whole lot of research about neonates and separation from their natural families. Have you found articles now to back up your certainty?

    And as for the use of metaphor, I am well versed in it. In my previous career I was an archaeologist, and one of the founders of your field, I believe his name was Sigmund Freud, frequently spoke of psychology as the "archaeology" of the mind.

    I wasn't so much upset that you called it a metaphor, as that it seemed dismissed as a purely semantic metadiscussion of something that never happened. A crutch, if you will, for me to use with my therapist.

    As for "primal," Merriam-Webster's first definition is not the expected "first in time" that you propose, but rather "original, or primitive." "Original wound" would make sense, as that's what those who believe in the primal wound assert happens. Interestingly, Merriam-Webster's second definition of "trauma" (I appreciate your providing the Greek etymology, but I studied Greek for four years in college, thanks) defines it as "a disordered psychic or behavioral state resulting from severe emotional stress or physical injury." So it's not quite as far down the list of accepted definitions as you proclaim above. Sources vary, it would seem.

    I think that I feel frustrated because you approach infant behavior as a positivist: if you can't see it, it doesn't exist/happen. Emotions are not empirical; they are reported, subjective experiences. You seek to deny the possibility of an infant having subjective experiences that cannot be measured by the objective tools in your toolbox. Yet we know that the mind and body of infants grow at tremendous rates in those first weeks and months. You are willing to concede that perhaps a child can recognize her mother's voice or smell at birth, but that is pure instinct, without comfort or value? It doesn't seem far-fetched to me that those things signal safety and comfort to an infant, and when taken away, can lead to stress at least, and trauma at worst. You have said in a comment elsewhere that a neonate might feel "disorganized" by the clumsy early attempts of a substitute caretaker. So what is the difference between "disorganized" and "stressed"? I think elevating positivism over lived experience does a disservice to the people who need help. You have accused me multiple times of claiming that my experience "trumps all," i.e., trumps science. I have never said that, nor do I believe it. An empathetic approach to a person's account of lived experience need not discount the offerings of science. And for the record, I didn't say that you called me "stupid," just "not very intelligent" and to remember that I suffer *only* from a metaphor.

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  7. Part II

    Today I had a conversation with a friend in academia, Dr. Boreth Ly, who is an expert on trauma and has published widely on it. His family was killed in the genocide perpetrated by the Khmer Rouge. We were talking about cases of conversion disorders in which trauma leads to physical conditions for which the stressor is repressed, or for which the patient is unaware of the impact of the stressor. Trauma thus writes itself into the body. He advised me to think about the prerequisite of language for communication of trauma as suspect and sent me to recent feminist writings considering Freud's famous patient Dora, who was silent in her sessions with Freud. Silence *was* her communication of trauma (see Charles Bernheimer and Claire Kahane, eds., In Dora’s Case: Freud/Hysteria/Feminism. New York: Columbia University Press, 1990).

    It bothers me that because infants *cannot* express trauma in a language that is accessible to you, you dismiss it out of hand. I would argue that more studies, careful studies, of neonatal behavior are warranted, as laid out in this peer-reviewed article, published in 2008: "Families by Adoption and Birth: I Socio-emotional Interactions," by Suwalsky, Hendricks, & Borstein.

    "Contrary to our expectation, some differences in the patterns of coherence among maternal socio-emotional behaviors were also noted. Although the correlations did not differ statistically between adopted and birth groups and must await replication with a larger sample, highlighting them may serve a heuristic purpose, given that this is the first time that the structure of behavior in adoptive vs. birth mothers of infants has been reported. There were more than twice as many significant correlations among socio-emotional behaviors for birth mothers, and the nature of the linkages differed for the two groups. Speech to child, imitation, direct attention to mother, and social play were all intercorrelated for birth mothers, whereas there was only one correlation among these variables (between direct attention to mother and social play) in mothers by adoption. Maternal speech to child was positively correlated with 5 of 7 maternal behaviors for birth mothers, but with no other behaviors for mothers by adoption. Measures of physical contact were linked to measures of maternal care (nourish and caregive) for adoptive mothers, but not for mothers by birth.
    These data suggest that, by the middle of an infant’s first year, the socio-emotional repertoire is more coherent for birth than for adoptive mothers."

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2771388/

    It bothers me to see both a desire for real knowledge and compassion missing from these recent exchanges about the primal wound in blogland, especially from people who haven't *lived* adoption. I want to support my fellow adoptees as far as I can (including those who disagree with me, when possible).

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  8. Mary Ann, I think you're probably right, that there's some connection with Janov's ideas, and he's still operating. And I think that for Janov and for Verrier and others, the word "primal" connotes "really really important and mysterious" rather then anything specific about "first in time".

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  9. Dear Ms. Marginalia--

    Forgive me for giving the Greek background, but you aren't the only person who reads this blog, and I thought others might be interested.

    As to the Suwalsky, Hendricks, and Bornstein article--- thanks for bringing up this interesting and useful piece. I need to make a couple of comments,though. The first is that you selected a quotation that suggests support for your view. However, those authors'more general conclusion is this:

    "Taken as a whole,the data paint a picture of infant functioning that is largely similar for babies by birth and by adoption, which is in keeping with the literature reviewed earlier and reflects the resiliency of the human infant... This is the reason that adoption of a young infant is a potentially very successful proposition and why adoption has been practiced in diverse cultures throughout history..."

    Suwalsky et al also give some space to discussion of why adoptive mothers may behave slightly differently in some ways than birth mothers do, and consider the aftereffects of the experience of infertility as well as concern with social disapproval of adoption. [They don't mention the possible ill effects of being told the baby has a Primal Wound, though,and I'd be willing to bet that none of them has heard of PWs.]

    My second point about this article is that it appears to have nothing to do with Primal Wounds. Your argument, I had thought, was that the initial separation from the birth mother causes a psychological trauma that is difficult or perhaps impossible to resolve. But the Suwalsky article is about the possibility that adoptive mothers behave differently with their babies than a matched group of birth mothers with their babies (of course, the comparison is not with the behavior of the birth mothers of the adoptive babies). Rather than addressing the issue of Primal Wounds, you're looking at later experiences with the potential for shaping the relationship between adoptive mother and baby, and influencing the baby's personality development. I'd certainly go along with that idea and have never said otherwise.

    Incidentally, Suwalsky et al made a point of saying that all the mother and child behavior was well within the normal range. They saw a small number of differences, not problems, and nothing that could remotely be considered traumatic. Actually, the very remarkable thing would have been if two groups acted exactly the same-- differences within and between groups are entirely to be expected.

    I'm actually not a positivist, but I am an empiricist, and you are whatever the opposite is-- an essentialist or even a gnostic, I suppose. Never the twain will meet, I think.

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  10. I am not a gnostic! Again, with the labels. I am trying to point out to you that there are other ways of viewing things that you are mowing down with a machete that you call "science." Where is the subtlety.

    Empiricism and positivism are blood cousins, I might add. Positivism says that if something isn't based on empirical evidence, it is nonsense. Which seems pretty close to what you're saying. But if you say you're a empiricist, I will take you at your word.

    I see myself as a person open to different viewpoints. You claim to be, but are not.

    I quoted from the Suwolsky, et al., article, not to prove my point about the primal wound, but to show you that there are people out there who think that there is a call for *more* research about the neonates and natural mothers versus adoptive mothers. That is all. Read my exact words: "I would argue that more studies, careful studies, of neonatal behavior are warranted."

    As for my comment about the Greek, I thought it presumptuous of you to assume that none of your readers are familiar with the language. Humility is a good thing.

    There is much to learn from everyone in adoption, but it is beyond frustrating to this adult adoptee to be trashed and considered a hopeless mystic. I am as well educated as you are.

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  11. Of course more work is needed, and what's more we need to look back at work from the past that's been forgotten. James Robertson did a fascinating study showing that Bowlby was mistaken about some claims he made on the effects of toddler separation experiences, but nobody reads that today. There's a ton of information about normal babies that's missing, because it's so much easier to observe at-risk babies in hospitals. How about breastfeeding, for instance--- where do all those claims about sustained eye contact come from? Interestingly, Piaget described a mpovement he called the "Piagetian reach"; nobody else saw it, but people were too embarrassed for years to point out that they never saw babies do this thing that was in all the textbooks, and we now know that they don't do it. I'm all for plenty more studies of infant development. Nevertheless, with what we've got now, I see no reason to think that separated neonates sustain a PW.

    Now, I have a question for you: some people writing about the PW issues have suggested that if the birth mother dies, and that's the reason for the separation, there's no PW. Is that what you think? If so, can you explain this to me-- why the impact of death should be different from that of social separation?

    I'm sorry, Ms.M., I didn't mean to trash you, and I don't think I did. But I reserve the right to define terms and provide etymologies in my own blog if I want to. You needn't read those bits if you don't like them.

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  12. One person's certainty is another person's dismissal.

    I wonder if you have any experiences in your own life that you could channel to try to understand how painful it is for people to tell you what you do and don't feel about yourself? What it isn't possible for you to know about yourself, and then to tell you that science thinks you're wrong when you speak up?

    I don't feel able to comment intelligently on what happens to an infant who loses a mother to death but is raised by her natural family.You know, I think I would probably trade my position--wonderful as my aparents are--for that. Again, anecdotal, but having a connection with people I look like and act like and who mirror me: that would be priceless.

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  13. Nobody is telling you what you feel-- how could we and why would we? The issue is whether a particular event caused you to feel that way. To say that you probably don't have a PW is not a statement about whether or not you feel abandoned and desolate, and it's certainly not a declaration that nobody cares whether you do or don't feel what you feel. If anything, what I've said here is an expression of concern for people who may be led to choose useless, even harmful, treatments when they're convinced that their distress has a particular cause-- but the cause may actually be different. I would really hate to think that adoption reforms could be based on misunderstanding of development and would potentially create even greater misery.

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  14. But I *say* and my amom *says* (there's my first-hand observer) that I displayed behavior that was not normal for a 10-week-old. Yes, I was in the NICU for six weeks and given phenobarb and then put in a foster family for a month. I didn't want to be held, I slept 12 hours at night, I pushed away from my caretakers, my aparents. There are confounding variables, to be sure, in this story. But my *experience* of my pain predates what *you* say it can. This is *my* life. You *are* dismissing what I am saying.

    I felt pain before toddlerhood. You are saying this is impossible, that I can have felt nothing before having the capacity to organize my thoughts and engage with people using speech. This is *not* my lived experience, and you said it again, above: "you probably don't have a primal wound." Well, which is it? "Probably" not? Or will you go out on a limb and say, "definitely not"? Why use "probably" if you're so sure? Gee, then if I can have felt nothing before I was 3, I made everything up in adulthood? How convenient.

    No. I feel it. I have always felt it.

    As I said before, we don't have all the answers. You have an opinion, based on what I consider to be a paucity of facts.

    And as you said not quite correctly above, "Never the twain SHALL meet" if you remain so resolutely certain that you have all the answers.

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  15. Why do you think it's the separation and not the NICU experience (or other things) that's the cause of your distress?

    I say "probably" because I accept the idea that my entire concept of the universe could be wrong. But one has to commit to a considered worldview or do nothing but spin wheels.

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  16. I did not see Dr. Mercer or anyone else critical of Primal Wound saying that a child could not feel before the age of three. I don't know where you are getting that impression, Ms. M.

    Babies certainly can feel, even before they are born. Animals can feel. Mammals demonstrate feelings of fear, love, grief, joy. If you have any pets you know this is true.

    What infants cannot do is form coherent memories of what they feel that are retained. Their brains are not developed enough, which does not mean they do not have real feelings and cannot be hurt or comforted or in the extreme, traumatized.

    I would also say "probably" about a lot of things that cannot be proven one way or another. You feel that something happened to you as a newborn, and from what you describe and what your mother told you, it certainly did. Whether what hurt you was your time in NICU, the condition that caused you to have to be there, the medication, the lack of human contact, or your birthmother surrendering you nobody can really say with certainty or know, including you.

    You have chosen what you want to believe, that all your pain started with a primal wound that you were aware of shortly after birth. For you, this explains the pain you have felt all your life. Nobody has said you or any adoptee does not feel pain, or that infants are insensitive to pain.

    You are the one who has made that leap when anyone questions primal wound theory. I still do not understand why.

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  17. I'd say"probably" if I felt there was a reasonable chance that something might be so, and "possibly" if I was felt it was less than likely.
    I have *certainly* decided that to say nothing more about this matter. At least for the nonce.

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  18. And you've made that decision *intelligently*. The only reason I keep on is that I'd really like to know more exactly what Ms. M. believes, and why.

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  19. Hi.
    I really enjoy reading this blog and am impressed that there is a forum where people can respectfully espouse a variety of opinions. As most psychology is based on extrapolating theories based on observing external behaviours there can be no definitive answers/explanations. The other issue is that every person is different and experiences the world in their own unique way so there is no single "answer" to what are complex issues. We use our own frames of reference to formulate our judgements. Keep up the good work.
    I do believe that the western world has mythologised (is that a word?) the initial mother/baby bond to an unrealistic level. As stated in another comment many mothers may feel ambivalent to their newborns but love and bonding develops through repeated positive interactions. Also in other cultures the primary caregiver for a child in their early years may not necessarily be the mother but part of the extended family yet they are secure and attached and have strong familial bonds. There are many ways to achieve an outcome

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