Concerned About Unconventional Mental Health Interventions?

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

Tuesday, June 25, 2013

Book Review: "The Nature and Nurture of Love", by Marga Vicedo

I first came across Marga Vicedo’s book The Nature and Nurture of Love: From Imprinting to Attachment in Cold War America (University of Chicago Press, 2013) when it was discussed in a book review in Science by Ben Harris (24 May 2013, p. 926). Harris noted that Vicedo, a historian of science, “accepts no component of attachment theory as empirically revealed, natural truth” (but wouldn’t we be startled and worried if she did so?). Harris also concludes that “put on the witness stand, instinctual attachment theory does not acquit itself well”, an accurate statement, but perhaps puzzling (was this what the book was about?) in light of Vicedo’s focus on the Cold War era and her interest in how  ideas remain lively in spite of contradictory information.  

I often read books on history of science and get a lot of enjoyment from them. When I don’t really know the scientific subject matter that is being treated historically, I sometimes persuade myself that I am learning the science too, with the historical part as the spoonful of sugar that helps the medicine go down. Because I already know a lot about attachment theory and research, I wanted to see what Vicedo had made of it, both scientifically and in its historical context.

The Nature and Nurture of Love provides a good introduction to the development of thinking about attachment, and describes in detail the lurching, ramshackle construction of the theory now presented as smooth and monolithic in child development textbooks and parenting magazines. It’s said that it’s better not to know how either sausages or legislation are made, and the same may be true for psychological theories, which make their way from an idea to a full-scale system in unpredictable fashions shaped by personalities and geopolitics as well as by observation and systematic research. For all the faults of attachment theory (and it has plenty), its developmental trajectory was probably no more awkward or problematic than those of other psychological theories.

Not surprisingly, The Nature and Nurture of Love (hereafter NNL) began as a doctoral dissertation, and it retains some of the flavor of that kind of work, at some points trudging through material that has been described as well or better many times before, and at others revealing connections that have received little attention. The “trudging” part is underlined by the author’s frequent citations to popular publications, while the “revealing” part comes from some primary sources that have rarelybeen accessed or even mentioned--  and I learned a lot from the latter. Readers who were not born until after comparative psychology died will be fascinated by the whole discussion of Daniel Lehrman’s work, although regrettably they will never have a chance to see him act out ringdove courtship (unless someone filmed this tour de force of columbomorphism).

Vicedo presents NNL as an effort to understand the development of attachment theory within the context of the Cold War years, from the 1950s into the 1970s, and this would certainly be an adequate problem for a dissertation. However, many readers with professional or personal interests in attachment theory are more interested in events of the present-day, and in a concluding chapter Vicedo attempts to discuss current views, including those of popular authors like William Sears of “attachment parenting” fame. Here matters become murky, as NNL omits (and indeed has no space for) the thousands of research publications examining attachment behavior, emotions, and thoughts. Neither does she mention more recent statements about the changing nature of attachment theory, like Michael Rutter’s discussion in 1995 and (dare I say it) my own in 2011. How do we understand the popular use of the attachment concept after 2000 without the context of this vast database and the theoretical refinements? Vicedo states herself that that history remains unwritten, so naturally she does not try to explain the position of Sears (e.g.)--  but why mention these popular, even “alternative” views at all, unless under editorial pressure to bring things “up to date”, I wonder? (Or possibly, like the late great Peg Bracken, she is simply cramming in the last few things before slamming the tailgate.) 

I noticed some omissions of material that I think might have clarified some historical events for readers who are newcomers to Bowlby’s attachment theory. For example, Vicedo naturally describes some pre-Bowlby ideas about attachment--  and this is essential, because differences between Freud’s and Bowlby’s views were instrumental in both slowing and refining the development of attachment theory. However, I saw no reference to the previous work of Ian Suttie, the British author whose early death prevented further development of his claims that human affections arose from innate social needs , or of Kenneth Craik, whose concept of the internal working model was adopted by Bowlby as a description of the mental events underlying attachment behavior.

NNL contains a few apparent errors, which while perhaps not significant in themselves do take away from the more general positive impression. John Bowlby, while in line to inherit his father’s baronetcy, was the second son, so was not in the usual sense heir to the title. This title eventually went to John Bowlby’s son (Sir Richard Bowlby, a former medical photographer) as nephew of the second baronet, who died without issue. In a second, more bothersome error, Vicedo states that “ ‘attachment disorder’ has entered the medical vocabulary and, although, not yet recognized by the American Medical Association, has its own criteria for diagnosis and therapy”—a claim that Vicedo cites to the work of a sociobiologist and a philosopher. There are several problems about this claim. One is that this terminology is not the province of the American Medical Association, but of the American Psychiatric Association, publishers of the Diagnostic and Statistical Manual of Mental Disorders, the much revered and much cursed DSM. DSM has included a diagnostic category, Reactive Attachment Disorder, since the 1980s, and you would think that Vicedo would have been aware of this even before 2005, when she finished her dissertation--  but perhaps the problem here is reliance on the secondary sources that can be deceptive.
  
To end with praise: Vicedo’s description of Harry Harlow’s charm and entertainment value does much to help explain the influence of his work and the wish of attachment theorists to include his findings as a foundation for their views. She even refers, although briefly, to some of the issues about Harlow’s choice of a particular type of monkey for his experiments--  an insight rare in the present climate of avoiding animal studies (and a topic I have discussed in more detail at http://childmyths.blogspot.com/2011/09/you-can-pick-your-friends-but-you-cant.html).


2 comments:

  1. Thank you for this interesting review, Dr. Mercer! Thank you for mentioning "Reactive Attachment Disorder". I'm a psychiatrist, and had not heard of this diagnosis. Perhaps because I only treat adult and it's a diagnosis that applies to children. According to DSM-5 it's rarely diagnosed: "The prevalence of reactive attachment disorder is unknown, but the disorder is seen relatively rarely in clinical settings. The disorder has been found in young children exposed to severe neglect before being placed in foster care or raised in institutions. However, even in populations of severely neglected children, the disorder is uncommon, occurring in less than 10% of such children (Gleason et al. 2011)."
    In my professional opinion, I think it's appropriate that the DSM does NOT feature "attachment disorder" in any prominent position and does not give an option to diagnose adults with "attachment disorder". I hope it will stay that way. Maladaptive adult attachment behaviors manifest in the clinical presentation of various personality disorders. Table 2, "Level of Personality Functioning Scale" in the subchapter "Alternative Coding System for Personality Disorders" in Part 3 of the DSM-5 captures the the interpersonal problems associated with maladaptive adult attachment styles succinctly. The understanding of diagnosis and treatment of personality disorders, however, is greatly helped by attachment research, even though psychiatrists cannot diagnose attachment disorders in adults using DSM-5. Advances in the treatment of borderline personality disorder with Mentalization-Based Treatment, Transference-Focused Psychotherapy and Schema-Focused Therapy are the best examples of the clinical progress facilitated by decades of attachment research.

    Karsten Kueppenbender, MD. Boston, MA.

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    1. Dear Dr. Kueppenbender-- thank you for these interesting comments. I too hope that attachment research will remain a foundation of diagnosis and clinical work, but that the belief that "it's all about attachment" will whither away.

      With regard to children, here is an illuminating discussion:

      Woolgar, M., & Scott,S. (2013). The negative consequences of over-diagnosing attachment disorders in adopted children: The importance of comprehensive formulations. Clinical Child Psychology & Psychiatry, pp. 1-12.

      The authors give a number of examples in which assessment of children's problems as solely attachment-related caused important and very treatable difficulties to be missed and left untreated.

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