Concerned About Unconventional Mental Health Interventions?

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

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.







  

15 comments:

  1. Wow. That is fascinating. I've never seen a religious critique of "attachment therapy" like this. Though it misses the mark, perhaps it would be a shoehorn into the evangelical communities who have latched onto the Nancy Thomas-style abuse. I'll have to read the source material and ponder.

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    1. I never saw anything like this either... and I neglected to thank Linda Rosa who found it and forwarded it to me.

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    2. Hello, Free Thinker? Clearly you are, , but, Did I hear Quaker? At least Quaker leanings? What do you know! Guess what? Me too.

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    3. You certainly hear Quaker leanings-- I live a block from the Moorestown NJ meetinghouse and my younger son and one of my stepsons went to Friends schools. When confronted with extravagant and frivolous actions, I have been heard to explain why I don't like something: "it isn't quakerly".

      However, I haven't been able to get any meeting, including the Philadelphia Yearly Meeting, to take any interest in attachment therapy. (Same thing goes for the Unitarian-Universalists.) I feel as if some support from the liberal churches and humanist groups would give impetus to the fight against systematic child abuse, but I haven't succeeded in organizing it.

      Individual Quakers are sympathetic and interested, but it's the group that I can't get moving. Any thoughts? Are you a member of a meeting that might be responsive?

      Unfortunately, because of charismatic support for AT, the whole thing contains the makings of a fairly ugly culture war.

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  2. This will take some thinking certainly. Let this sink in a while. I have several ideas about possible actions or activities that I personally would like to initiate, and I don't think we need an official "Meeting" to get going. Friends often create small groups that are not within the official province of the larger Meeting, as Quaker Meetings are notoriously, proddingly slow, for good reason, that sanctioned activities such as perhaps something like an "epistle against torture", (in the political sense) arises from group meditative waiting, and must arise from that collective experience of the Light, and not the "notional" crusades, however worthy, of individuals. (I love your use of the word "notional" and will be sprinkling it in whenever I can!)

    The odd thing is, I was so happy to discover this website as I was weary of discussing minute Quakerly issues on the Quaker website! Good joke on me!

    I will frame up some of my suggestions when I get a chance to organize my thoughts some. And also, I will think of some links to groups that are associated with Friends, where there may all ready be some related work being done. (As I mentioned, there can be a Quaker interest group or action group that is not officially connected nor endorsed by the actual Meeting. That's why there exists the possibility of organizing individuals. )

    I am going to be with my grandchildren for the next week, which is a nice exercise for my theoretical positions as they are at times inclined to test the limits of my compassionate and child-centered yet authoritative grandparenting style!


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    1. That's funny about the Quakerly issues! This one is certainly not minute, anyway.

      Actually, I know someone from the Atlantic County NJ meeting who might be amenable.

      I am going to one set of grandchildren this weekend, the other set next weekend. Naturally they live in opposite directions from where I live, so there's no getting to both in one trip, at least during the school year. My sons seem to have adopted my exhausted parenting principle of just doing what the kids want right away rather than hoping they'll forget about it. Of course, for one set, the present issue is how many times in a row you can sing Old MacDonald.

      E-I-E-I-O until later.

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  3. http://scattergoodethics.org/

    Hi Jean, before I forget I wanted to make sure you knew about the work of Scattergood Ethics. This scholarly group offers publications and seminars and is rooted in Quaker values regarding mental healthcare, although no longer an entirely Quaker enterprise, which is probably for the best. There are two organizations, Scattergood Ethics, and Scattergood Foundation. (my penname is actually Laura Scattergood, but it isn't directly related to the foundation. I found out about the foundation after I chose the penname) So, if you haven't visited this website, this organization may be a resource. Hope it is helpful.

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  4. Cool! Maybe we can have an old McDonald's singing competition, I will get my girls going and we can compare notes. Okay so here is the parent organization of Scattergood Ethics, the Scattergood Foundation:

    http://www.scattergoodfoundation.org/

    I think you will get along famously with the Scattergood Ethics folks!

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    1. I had a look at the Scattergood site-- Art Caplan,hmm? Lots of famous and helpful people there. I will try to figure out a good approach to them-- thanks!

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  5. I don't know if you saw the publications on the Scattergood site, me interesting issues are brought up, concerning adults and children. Such as whether it is ethical to vaccinate against addiction, (don't know if some thing like that is in development, but perhaps so.) A book on children's views of medication. Other issues regarding compulsory treatment.

    What I am wondering though, what are current goals for you regarding these concerns? My activity has been to alert friends in clinical practice. I am on a break from practice at the moment, but in the past I would often be the only therapist in the setting with extensive child development background and extra training in child therapy modalities. I would then perhaps be the lone "fanatic" regarding the rights of the child and related issues. I knew that this type of "therapy" was "out there" but I didn't know it was being promoted openly. I did become aware of cases where I suspected a child was being subjected to practices that I now know are openly recommended by the AT camp, but I didn't often have enough information to make a report. I also have been aware of certain instances where it came to my attention that restraints were used improperly by individuals and even in by staff in poorly regulated settings (e.g. shelters for the homeless) that were using our mental health services. In the latter cases I advocated for training for staff. Most places I have worked for have required a training in one of two emergency restraint methods, emphasis emergency! Only to prevent harm to patient or others, for absolutely no other reason. Not the destruction of property or to change their attitude or anything! Just for immediate safety. There used to be a group, the Coalition Against Institutionalized Child Abuse, but I am no longer finding their website. Also one of the things that I would always advocate for was developing parenting programs for agencies. I notice that the ACT website links to one in particular that I haven't yet looked into in detail. Something about dinosaurs I think.

    I hope your latest book is being used as a text in clinical training programs, and one strategy seems to me to be in communication with educators of clinicians in training. Since you are all ready teaching at a University, that's kind of obvious. . . but to be in communication with a network of frontline educators, perhaps. I have all ready alerted people I graduated with.

    I have some broader ideas that I have kicked around for years. The idea I have is perhaps at the state level and then at the national level, to offer a tax credit for participation in approved parenting classes. This could be highly problematic, first, who approves them? I don't like Big Brother much but I hate child abuse more. I see this as being more of a very basic safety class, designed by pediatricians, NIH or something, perhaps even something online, and that one focus would be to alert the parent to resources for more help. I thought of calling it something like the Informed Parent Tax Credit. I know, I know. . . hugely complicated. Also, just occurred to me, has anyone written a letter to the Surgeon General about these practices? Could the Surgeon General issue a statement of some sort? I am pretty sure the SG issues statements now and again. Anyway that's all I can think of now. But again, I don't know what your goals are at this point. General I know, specific I don't.

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    1. You are helping by forcing me to define my goals!

      I hadn't thought of the Surgeon General, but only of NIH. I think the SG issues reports and recommendations, but very slowly... although slow is better than not at all. The present one seems to be concentrating on vaccination, and I would certainly agree that that gets top priority.

      I think my goals right now involve getting APA and NASW to pay attention to AT and related issues and to advise their practitioners not to do these things-- and ideally to make it possible for state licensing boards to revoke licenses of people who did do them. I am thinking about throwing myself on the mercy of Scattergood, to ask what are the best approaches here.

      A major problem is terminology and the definition of the potentially harmful treatments. Following the death of Candace Newmaker, Holding Therapy morphed into Attachment Therapy (and what could be bad, if you combine two good things?). Now, the organization ATTACh says they do not hold a child unless he or she consents to be held-- although what choice the child has is beyond me. All this means that a regulation using a particular name or definition could be evaded by changing terminology or by minor changes in practice.

      You mention regulations limiting the purposes of restraint. I agree strongly that those have been important, but really I think that it's even more important to document every incident of restraint and to note the events that preceded and followed it. That opens discussion about what may have triggered the restraint, and what its outcome was.

      One difficulty currently is that although NIH has regulations about the use of restraint in mental health facilities, DOE is just trying to catch up about its use in schools. The Miracle Meadow School in West Virginia, now apparently closed, managed to escape consequences of restraining kids by arguing that the regulations did not apply to schools. You might be interested in Googling the various claims and lawsuits about this.

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  6. Also, did you know that there is an official Quaker office in the United Nations? It is called QUNO. Doesn't the United Nations have some kind of "rights of the child agenda"? Is there some kind of international bill of rights for children that has been proposed? The QUNO works on various projects, and I haven't seen them mention anything regarding children and mental health on their website, but just one more link that I am throwing out there. Maybe it wouldn't hurt to write a letter to the QUNO. Quakers sure love their letter-writing! Also there are Quaker groups that focus on opposing torture, specifically QUIT. This means in the political sense ,but perhaps someone among them would be interested in torture in the guise of parenting and therapy. There is an organization called Quakers in Pastoral Care and Counseling. I don't know much about their activities, appear to be mainly nurturing activities for the members, but that could be a resource for meeting people in the field. There is an agency called "Friends Outside". It was Quaker founded and has Quaker values. The agency works with prisoners and families, and places workers in the prison setting. I know they sometimes offer some kind of parenting classes, so talking with someone in that group about recommended programs or offering the programs for free might be good, that is giving this agency a grant to implement one of the appropriate parenting programs, to train their staff in one of the programs. . That's all I got in my head for now!

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    1. Thank you for QUNO! I will pursue that.

      Yes, there is a UN Convention on the Rights of Children, proposed perhaps 30 years ago. Most or all UN members have ratified it, except for the US and Somalia. The objections in the US are from parents' rights groups and the military, who like to be able to enlist 17-year-olds.

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  7. http://www.quakersintheworld.org/quakers-in-action/165

    Useful link. Quaker view of child versus Calvinistic view. Current and historical actions taken by Friends regarding the child.

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    1. This also told me more about QUNO-- I am thinking that's a good direction to try because AT/HT are becoming worldwide problems, between what's happening in the U.S. and Canada, problems created by Jirina Prekopova's followers in the Czech Republic and Germany, and the infiltration of U.S. methods into Russia disguised as "modern treatment".

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