Monday, September 2, 2013
Attachment Disorders Versus Depraved Hearts: Further Adventures with Unconventional Mental Health Perspectives
On many occasions, I’ve posted on this blog comments about “attachment disorders” in adopted children-- not Reactive Attachment Disorder as described either in DSM-IV-Tr or in DSM-5, but a notional set of problems posited by proponents of Attachment Therapy. The symptoms of these disorders include disobedience, a love of blood and gore, cruelty to animals, “crazy lying”, making eye contact only when lying, the absence of conscience, aloofness, ingratitude, etc. Such disordered moods and behaviors, according to supporters of Attachment Therapy, occur because the children had emotional attachments broken by separation or were never given an opportunity to attach, because they were taken from their birth mothers early, or because they were abused or neglected, or because they experienced many changes of caregiver. With the rationale that a missing early experience can be supplied at any time during development, proponents of this approach claim that they can create the missing and vital attachment at any point in later development. In this stance, they ignore facts of developmental change, as well as a variety of social, genetic, and biological factors that are at work in determining personality and mental health.
There are some reasons to think that Attachment Therapy and its associated views are to come extent connected with evangelical religious beliefs (as I have pointed out at http://thestudyofnonsense.blogspot.com). But I have discovered to my surprise that people of more extreme evangelical beliefs actually consider Attachment Therapy to take an excessively worldly perspective. They reject the idea of attachment disorders as causes of childhood mood and behavior problems and instead seek Biblical explanations.
In a 2006 master’s thesis, for an M.A. in Biblical Counseling, entitled “The Biblical View of Reactive Attachment Disorder” (www.lincolnchristian.edu/library/tren/091-0077.pdf), Linda J. Rice set out a view of disturbing behavior in children that is at odds both with Attachment Therapy and with conventional understanding of child development and mental illness. According to Rice, the problem with the children in question is not that they have suffered a lack of attachment, but that they have depraved hearts.
Although Rice includes the term Reactive Attachment Disorder in her thesis title, and although she begins her second chapter with a description of Reactive Attachment Disorder as given in DSM-IV –Tr, she quickly shifts gears to bring in symptoms of attachment disorders as proposed by Attachment Therapists. Noting that the DSM description is too vague, she writes that “practicing mental health professionals have supplemented specifics to aid in diagnosis”. Rice follows this comment with a list of symptoms drawn from the work of well-known Attachment Therapists such as Magid and McKelvey, among them the problems I alluded to in the first paragraph of this post. In an interesting departure, she refers to a child with Reactive Attachment Disorder as “a RAD”, apparently subsuming the individual identity in the diagnosis--- which may or may not be a step forward from the habit of calling such children “RADishes”. She also refers to the children as “dissociated” but apparently means by this that the child is emotionally disconnected from others, not that he or she has moments of dissociation and lack of awareness of the environment. At the end of the chapter, however, she draws back from the frightening picture she has been painting and acknowledges that not all children with early behavioral problems will be criminals.
Rice’s next chapter explores possible causes of the problems she refers to as Reactive Attachment Disorder. Beginning with the psychological view of attachment, she refers in the same paragraph to John Bowlby, founder of attachment theory (not therapy) and Robert Zaslow, initiator of therapies that use coercive restraint in attempts to change moods and behaviors; although Zaslow apparently believed he was following Bowlby’s view of attachment, most of his approach was not based on attachment theory, but it has been the foundation of various complementary and alternative holding therapies and attachment therapies. In this and the following chapter, Rice goes on to a freewheeling summary of ideas about attachment and childhood mental illness, mixing conventional and unconventional ideas from “attunement” to the “bonding cycle”.
Chapter 5 continues in a similar manner with information about brain development and chemistry. Here, too, there is an idiosyncratic use of the word “dissociation”, apparently to mean social inhibition. There is a certain sense in this chapter of tidying up the picnic and closing the tailgate before getting down to the real business of the thesis, an analysis of children’s mood and behavior difficulties in terms of Biblically-sanctioned ideas.
In her chapter on the Biblical approach to Reactive Attachment Disorder (so-called), Rice begins with a list of objections on Biblical terms to the explanations offered in the previous chapters. Here is her list:
Human beings are not evolved mammals, but are created in God’s image, so it is a mistake to consider human problems without a focus on human moral desires, consequences, and laws.
The mind is not the brain, and moral choices occur in the heart (spirit; the inner thoughts and desires of the immaterial part of man ), not in the neurons.
Genetics and brain damage cannot cause misbehavior or wrong moral choices, because bodily events are not involved in moral choice.
Responsibility is not in factors outside the child, but has to do with the fact that he is a sinner whose own lusts and rebellion create conflict; children are not innately good and are responsible for their own selfish behavior.
Hope is not in man’s ways; attachment therapy cannot transform the heart; a relationship with God can do so.
True change is not temporal, and a child who is a therapy success has simply become a well-behaved sinner rather than a dysregulated sinner.
Having rejected the “psychological” approaches described in her previous chapters, Rice goes on to discuss Reactive Attachment Disorder in Biblical terms as a problem resulting from fear, anger, and a desire for control rather than submission. She makes it clear that according to Biblical definitions of love as self-sacrificing, a baby cannot love its mother, and quotes St. Augustine to the effect that the apparent moral innocence of infants is simply a matter of their weakness and inability to carry out their selfish desires. Acknowledging that young children do not know about good and evil, she nevertheless point out that ignorance does not cancel guilt, and that true compassion will punish wrong behavior rather than letting it pass.
Harsh though Rice’s Biblical view of infants may seem, she also examines the Biblical view of parents and their appropriate behavior. They are not to provoke children to anger or to alienate them by harsh treatment, but instead should behave lovingly and kindly in order to comfort the baby and allow him to be attracted and persuaded to their beliefs. Helping the child to feel comfortable and to behave well, Rice says, prevents him from becoming habituated to angry, rebellious ways.
In a final chapter, Rice pursues her position that only redemption can cure reactive attachment Disorder. She argues against the efforts of therapists to cause children to trust their parents and thus to achieve attachment. Instead, she comments, “This emphasis distracts from the real problem, that the child does not trust God…. Shifting the child’s trust to parents keeps it misplaced on mankind.” Thus, “Teaching and inducing trust in God is where the energy of counselors and parents should be directed.” Rice further notes that “Brain damage cannot destroy the conscience because the brain is not the conscience organ. Conscience is a moral capacity. Therefore, even mentally handicapped people can know right and wrong, and confess sins, and can trust Christ for salvation. Everyone has a conscience. The problem with a seeming lack of conscience is not absence but to what direction it was trained…. Through salvation, instruction, and discipline exercised with compassion, there is hope for a hardened child to choose to heed his conscience and practice obedience and compassion.”
I am fascinated by a number of aspects of Rice’s presentation-- not the least of them being the awareness that Attachment Therapy is under attack both from conventional psychology and from a religious position. Rice’s examination seems to me (a freethinker with Quaker leanings) to make Reactive Attachment Disorder (as she defines it) fit perfectly into a fundamentalist Christian world-view. In making it fit, of course, she rejects the tenet of conventional psychology that human beings can be understood without the assumption that they have any non-material components, and instead posits a motivating principle that operates independent of brain functioning. She also commits what psychologists call the fundamental attribution error by focusing on the nature of the individual rather than taking into account events in the environment. But of course, she knows she is doing these things, and believes that she is right and the psychologists she references wrong. Unfortunately for those of us who are genuinely interested in vernacular beliefs about psychological issues, Rice is vague about exactly how she thinks children with behavioral disorders should be treated. Like some proponents of Attachment Therapy, she believes that children can make moral choices for obedience and compassion; whether she includes in this the voluntary control over vomiting and defecation that Keith Reber’s 1996 paper suggested, is not at all clear to me. Certainly she has presented a framework that is closed to outcome research by any researcher outside Rice’s belief system.