Monday, April 14, 2014
Disorderly Thinking About Developmental Trauma Disorders
Sunday Koffron Taylor [sorry, I gave the wrong name before] kindly posted for a Facebook group the following piece: http://attachmentdisorderhealing.com/developmental-trauma, the work of one Kathy Brous, who is said to be a technical writer and advertises her own book with the statement that she accidentally regressed herself back to infancy. (How’d she get back again? That’s what I want to know.)
I was floored by Brous’s statements about the posited Developmental Trauma Disorder, proposed by Bessel van der Kolk to the editors of DSM-5 and rejected by them on the grounds that there have been no published accounts of cases that are appropriate for this diagnosis and not for other existing diagnoses. Brous appears to quote van der Kolk and Allan Schore correctly, however, so I don’t think the whole problem can be blamed on her.
Let me offer a few quotations from Brous’s article, with rejoinders to each.
First, I note that Brous refers to Allan Schore as the “father of attachment theory in the U.S.” This is an absurd statement and indicates that Brous is in fact ignorant of the actual history of attachment theory as understood by psychologists, rather than by journalists. If one had to choose “fathers” for attachment theory in the U.S., Alan Sroufe and Everett Waters come to mind as the major candidates. Schore’s contribution, if such it can be called, is something he calls “regulation theory” or “modern attachment theory”. As I was preparing an article about attachment theory for the journal Theory and Psychology several years ago, a reviewer asked me to include Schore’s ideas, which I did, looking especially at his attempts to bring material about brain injuries and about behaviors of other species into the discussion. Here is part of what I said: “.. A.N. Schore’s speculation about right-brain functioning is on shaky ground. Passing over the well-known fact of the holistic functioning of an intact brain, we can note that a careful parsing of Schore’s sources (J.R. Schore & A,N, Schore, 2008) suggests a lack of due attention to some important points. In addition to a number of references to Schore’s own publications as evidence for specialized right-hemisphere attachment functioning, Schore and Schore cited about 10 sources as indicating empirical evidence for the postulated connection. Of these, two… involved work on rodents, which was presented as supporting evidence without any textual reference to the use of data from non-humans. One paper… described hemispheric differences in processing upper and lower parts of a facial display, and concluded that lower facial displays are preferentially processed by the left hemisphere and upper facial displays by the right hemisphere; Schore and Schore mentioned only the right-hemisphere data. A fourth paper… discussed facial processing deficits in persons for whom a cataract in early infancy had prevented stimulation of the right visual cortex; Schore and Schore cited this paper as evidence for the right-brain hypothesis without noting that the teratogenic or genetic event that caused the cataract might also have caused atypical brain development…” (Mercer,J. . Attachment theory and its vicissitudes: Toward an updated theory. Theory & Psychology, 21, 25-45). Et cetera, et cetera, all to the point that Schore’s “modern” theory is based on a stroll through the cherry orchard. Read the background material, and you see at once that Schore’s part of this belief system is largely notional.
All right, let’s soldier on to more of Brous’s remarks. How about this one? “Developmental trauma starts in utero when there’s not much more than a brain stem and goes on during the pre-conscious years… until 36 months, when the thinking brain… comes on line. It’s 45 months [apparently beginning at conception, to make the numbers right. JM] ranging from general anxiety to non-stop terror.”
Where to begin? How about psychological trauma in utero? What events are emotionally disturbing to a fetus? Are we talking about emotion-related hormonal changes in the mother, which could certainly shape aspects of brain development but would have to be related to intense and continued distress in order to do so? Is this a theory that actually could apply only to children of mothers held in concentration camps or caught in civil wars, or is there some attempt to think about more typical developmental events? My guess is that Brous, at least, is not talking about any of these things, but instead is committed to the idea of trauma at the time of conception, a la Scientology. My crystal ball suggests that behind Brous’s references lies a belief in “cellular consciousness”-- posited learning that does not require a nervous system-- and that this is also concealed in van der Kolk’s claims about the body keeping score.
All right, and when are these “preconscious years”? Is Brous claiming that children of almost three years are not thinking in the usual meaning of the term? Are these the same children who are known as toddlers to be able to figure out whether to believe a person who has acted “nice” rather than one who has not? Are they the same ones who tell and listen to stories and express intense likes and dislikes, or who reason about their own behavior (I’ll quote one two-year –old of my acquaintance: “I like chickens, but I never kiss them, because they have beaks and no lips.”) If Brous wants to say that cognitive development is very much in progress during the first three years, or even that most people have few or no memories from that period, that’s fine-- but to say young children are “preconscious” is inaccurate and without purpose except to allow for an extravagant emphasis on their experiences of fear, even constant terror.
Let’s jump ahead a bit. Now we see that van der Kolk calls “insecure attachment and attachment disorders” the causes of the posited Developmental Trauma Disorder. But, hold the phone a moment. It’s well known that infant-parent attachment does not develop until at least 6 months after birth. Methods for measuring insecure attachment are directed at children of 12 months or older, so there’s no way anyone could reliably identify this in a child between 6 and 12 months, much less in earlier life. As for “attachment disorders”, these are not the same thing as insecure attachment (see previous post for more about this). How can it be that attachment “problems” cause DTD, but DTD is caused by events as early as conception-- as much as 15 months before attachment even begins? Like a problematic form of attachment behavior, this reasoning is disorganized/disoriented.
Just one more bit here, as I’m sure we’re all getting tired (goodness knows I am; reading this stuff is wearing). Van der Kolk has a treatment for the disorder he proposes. It’s somatosensory healing, which turns out to mean doing theater, yoga, and martial arts in order to “get them inter-personally attuned.” Folks, it’s as easy as that! These children have lived in terror from conception and had their brains skewed as a result, but children’s theater will fix it! Their bodies will change that scoreboard to say “game on”. The National Endowment for the Humanities will take over from NIMH, and the Santa Barbara Graduate Institute will be accredited by acclaim, and Alice Miller will be canonized, and I will become a hermit.