What Is Attachment?

What IS attachment, anyway? This word is used constantly by parents and teachers, attorneys and judges, as well as psychologists and social workers. What do they mean? Is attachment one of those things like obscenity, that we can’t define, but “we know it when we see it”?

Actually, one of the problems with understanding attachment is that many people don’t know it when they see it. As a discussion of attachment and child custody decisions pointed out a couple of years ago, “few custody evaluators recognized the distinction between a highly dependent or demonstratively affectionate relationship between a parent and a child and a secure attachment” (Calloway & Erard [2009]. Introduction to the special issue on attachment and child custody. Journal of Child Custody, 6, 1-7). Some quasi-professionals who emphasize attachment believe that the attachment of a child to a caregiver is indicated by physical demonstrations of affection, eye contact “on the parent’s terms”, obedience, and gratitude.

Many textbooks define attachment as an “emotional bond” or “tie” between two people, especially a parent and a child. The organization ATTACh (Association for the Treatment and Training of Attachment in Children) gives the following lengthier definition of attachment:
“Attachment is a reciprocal process by which an emotional connection develops between an infant and his/her primary caregiver. It influences the child’s physical, neurological, cognitive, and psychological development. It becomes the basis for development of basic trust or mistrust, and shapes how the child will relate to the world, learn, and form relationships throughout life.” (www.attach.org)

But let’s parse these definitions. Is it of any help to say that something is an “emotional bond”, without saying what an emotional bond is? Actual bonds involve close physical proximity, enforced by physical methods like ropes or handcuffs. Attachment, then, is being said to be like a bond in that it maintains proximity, but the way it does this is through emotional factors rather than with ropes. This is an analogy rather than a definition, and it is inadequate for two reasons. One is that although attachment does maintain a young child’s physical proximity to a caregiver, continuing development alters the way in which attachment is expressed. In any case, the seeking of proximity is not the same at all times, but occurs when the child feels threatened or uncomfortable. The other problem is that this description of attachment leaves it unclear whether both members of the pair behave in the same way or have the same emotions or motivations relative to maintaining proximity. In fact, in the course of development, parent and child trade several times the position of being the one that wants more proximity; the child who has a toddler clung to the parent who was leaving for work grows to the teenager whose parent is anxious to know where he is going and when he will be back

Now let’s look at the ATTACh version. It’s longer and more complicated, but is it any better? It begins by saying that “attachment is a … process”. No doubt there are processes leading to attachment, but if attachment is a process, it’s difficult to see how we can determine whether attachment is secure or even present. Surely attachment is some sort of end state, and not simply an ongoing process. Perhaps the “emotional connection” which is said to result from the attachment process is the actual attachment, but it too remains undefined.

ATTACh also says that attachment is not just a process, but a “reciprocal process”. I interpret this as meaning that attachment develops in the course of interactions with other people and could not exist in a social vacuum, and this is certainly correct. ATTACh may also intend to say that attachment (emotional connection?) in a child develops in tandem with some emotional change in the adult caregiver, which may be true, but seems to be irrelevant to the later emphasis placed on the child’s own development.

ATTACh speaks of connections between an infant and the primary caregiver and appears to be limiting attachment to this relationship. Here we encounter some problems, because all the evidence is that young children can have many attachment relationships, some more obvious than others, and that these relationships may or may not share qualities like security. On the other hand, caregivers tend to be monotropic and have one or two preferred infants, even if they work with a group of children of similar ages; perhaps the ATTACh authors were thinking of the adult’s connection with a “primary” baby when they wrote this.

ATTACh goes on to cite the various aspects of development that are influenced by attachment (although whether as a process or as a loosely-defined emotional connection is not clear). It is not stated how attachment affects the child’s physical development, or how psychological development is different from cognitive development, but even if these points are set aside, these remarks do not contribute to the definition of attachment, but simply say more about things that are related to the undefined process or end state. Similarly, in the last sentence, references to basic trust and to shaping relationships do nothing more than to say that something called attachment is involved here. (As to the statement about learning, it is far from clear what the authors meant.)

It would seem that neither the textbook definition nor the ATTACh effort is of much use in clarifying what attachment actually means. I’d like to offer an alternative definition that I believe cuts through some of the difficulties we’ve seen here.

I would suggest that attachment is best thought of as an attitude, or a readiness to behave in particular ways toward the object of the attitude. It is an attitude toward human beings that involves the readiness to behave differently toward familiar and unfamiliar people, but to do so in different ways when there is perceived threat than when there is not. Like other attitudes, attachment changes with development, and although young children show their attachment by seeking proximity to familiar people when uncomfortable, they gradually move toward other related behaviors. Also, like other attitudes, attachment involves characteristic emotional responses that may occur together with or instead of observable behavior, and these too change with development. Attachment attitudes vary with experience as well as with age and culminate in an internal working model of human relationships in general as well as the specific reaction to threat which is their foundation.

This may not be the perfect definition, but at least it actually is a definition. Comments and editing are invited.

Infant and Toddler Overnights: A Focus of Divorce Disagreements

When couples have children of infant and toddler age, the breakdown of marriage is often followed by intense and bitter argument over allowing the child to have an overnight visit and sleep away from the familiar home. In most cases, the mother is the custodial parent and continues to live in the marital home, while the father is more likely to be the one who moves out, lives elsewhere, and does the “visiting”.

Mothers are very likely to resist overnight visits for young children. They are concerned that the father is unaware of the child’s bedtime rituals or needs, that the child may be distressed by the experience, or even that a father who has behaved violently in the past may lose his temper if the child cries or fusses in the unfamiliar night-time setting. Fathers, on the other hand, may be concerned that the child spends less time with them than with the mothers and may therefore be less attached to the fathers. They may also believe that if the child does not form a strong attachment to the father in the first couple of years, no real relationship will ever be possible.

However the estranged couple work things out, this problem will pass (and of course will be replaced by different issues). The child will get older and reasons to resist overnight visits will gradually disappear. At the beginning, though, the overnight issue seems to be of overwhelming importance. In a recent special issue of the journal Family Court Review (2011, Vol. 49), the issue editor noted that when she surveyed readers to ask what they wanted to know about attachment and child custody, 60% of them asked what to do about overnights.

Several well-known psychiatrists and psychologists who contributed to the issue made a point of commenting on the overnight question. And all of them said about the same thing: overnight visits are problematic for about the first two years of the child’s life. Depending on the child, it may be best to wait as late as age 4 before beginning overnights (George, Solomon & McIntosh [2011]. Divorce in the nursery: On infants and overnight care. Family Court Review, 49, 521-528). The reasoning behind this advice is that children have real individual differences in temperament (for instance, the ease with which they accept a new situation) and in language development (which allows them to understand what they are told about the length of a visit). Children who are easily distressed, who have little concept of time, and who are still immature in their understanding of language may interpret an overnight visit as permanent abandonment by the custodial parent and may not be able to communicate their fears to the other parent-- who may have no wish to hear of the child’s longing for the divorced spouse. When children have handicapping conditions that affect communication and cognition, their level of development may be much more important than their chronological age.

But what if there are no overnights? Does this mean that the child’s relationship to the noncustodial parent is negated from the beginning? Charles Zeanah, the well-known attachment researcher, commented about this: “it’s not necessary for both parents to have attachment relationships with the child in the early years. That can happen later, when the child has more sophisticated abilities to sustain attachment relationships over time and place. Where it is possible, it does make sense for the child to keep contact at the level of comfort and familiarity until they are ready for more” (Lieberman, Zeanah, & McIntosh [2011]. Attachment perspectives on domestic violence and the law. Family Court Review,49, 529-538). Alan Sroufe, another leading attachment researcher, said, “I think that if parents, judges, lawyers, and so on took the view that attachment is a gradual building process, and that each relationship is built on its own terms, there would be less paranoia about this… even if they had no overnights for the first 2 years” (Sroufe & McIntosh [2011]. Divorce and attachment relationships: The longitudinal journey. Family Court Review, 49, 464-473).

These commentators are stressing the best interests of the child, a vague standard indeed, but one which we can clearly distinguish from an emphasis on parents’ rights. They seem to agree that it’s in the child’s best interest to have as calm an infancy and toddlerhood as possible and not to be asked to adjust to unnecessary changes and transitions. They also agree that two caring parents-- even if separated-- are better than one, but that there is no natural process that demands that both sets of relationships must develop simultaneously and early on. The fact that no “window of attachment” closes at age 2 means that it’s possible both to preserve family connections and to support a child’s early needs for a peaceful life.

Separated parents with very young children would do well to take these cautions to heart, but at the same time they may want to consider whether they want to try out visits with an eye to overnights. A gradual approach, including nap-time at the noncustodial residence, may give them an idea whether a child is ready to take the step to an overnight stay. If the child copes well with one overnight visit, it is wise to wait a while for the next one rather than rushing to a new schedule of frequent changes and risking overwhelming him or her. But none of this will work well unless the parents are able to concentrate on the child’s needs and reactions rather than hurrying to blame each other for any distress the child shows.

When overnight visits begin, one point that can be difficult for separated parents to deal with is co-sleeping. Plenty of parents let infants and toddlers sleep with them part or all of the time (and I am far from criticizing this practice). In addition, if a father leaves the household, the mother is likely to respond to the child’s distress and her own by letting the child sleep in her bed. What happens, then, if the child stays overnight with the father? Can the co-sleeping mother deal with having the child share a bed with the father, or will this trigger concerns about sexual behavior? How does the father comfort the child who is accustomed to sharing a bed, except by co-sleeping? This highly emotional situation is one in which straightforward discussion with neutral parties is essential in order to avoid distress, fears, and accusations that are in the great majority of cases completely unrealistic.

P.S. The comments of Alan Sroufe about attachment as a gradual building process are also highly relevant to adoption issues.

P.P. S. The issue of Family Court Review I'm referring to is available for free on line. Google the journal name and you'll see how to get to the articles.

RAD on Youtube; or, Caveat Spectator

“Open source” mental health information on Wikipedia is problematic enough, as I’ve written elsewhere, but at least it tends to be watched and corrected (or perhaps just edited) by interested editors and Wiki admins, and citation of sources is supposed to be required. Youtube productions can present a more serious problem, because no one can make corrections by editing within a video; the best they can do is to make their own video and strive to correct any misconceptions that may have been caused by the original presentation. In addition, it’s up to the contributor to decide whether any source of information should be cited-- and often none is given

I’ve been looking at Youtube material that purports to discuss Reactive Attachment Disorder, and a depressing job it’s been. I can’t possibly talk about everything I’ve seen that’s wrong, especially that old TV melodrama “Child of Rage”! However, I do want to comment on two of these gems, http://www.youtube.com/watch?v=dCgb4iu-k8o, whose authorship is not clear, and http://www.youtube.comwatch?v=WV6d1nAgBNI, created by the Association for Treatment and Training of Attachment in Children (ATTACh). Each of these is full of inaccuracies, inconsistencies, and downright errors (it’s a trivial point, but the creator of the anonymous video apparently believes that Mary Salter Ainsworth was a man).

The anonymous video (uploaded by one vsulley) commits the very worrisome error of conflating Reactive Attachment Disorder (RAD) as described in the Diagnostic and Statistical Manual of the American Psychiatric Association with the notional problem sometimes called just “Attachment Disorder” (AD for short). Reactive Attachment Disorder is characterized by age-inappropriate social behavior, especially with respect to familiar caregivers. Children may be unusually aloof, independent, and willing to interact with strangers for their age, or unusually clingy and demanding of adult attention for their age. The RAD diagnosis can be given in either of these cases, but only if the behavior began before age 5 years and if there is a history of poor care. AD has nothing to do with symptoms of RAD, and the manual for the Randolph Attachment Disorder Questionnaire, a test intended to detect AD and cited in this video, actually states that it is not intended to diagnose RAD. Speculative discussion of AD, whose existence is not supported by systematic evidence, claims that symptoms of the disorder include a fascination with blood and gore, cruelty to animals and younger children, refusal to make eye contact on adult terms, “crazy lying”, and so on. These are obviously very different symptoms than those associated with RAD (not to mention the lack of evidence that such a disorder exists or is related to attachment in any way). But the anonymous video treats RAD and AD as equivalent and cites a very weak 2003 Journal of Psychology article by Hall and Geher as a major source. On the positive side, this video does not support the use of holding therapy and notes the lack of evidence that HT is effective, neglecting, however, to state its potential harmfulness.

The ATTACh video, posted by the parent-professional organization that has for many years promulgated the idea that adopted children are likely to suffer from mental health problems associated with attachment, takes a different approach. It rejects the DSM description of Reactive Attachment Disorder as an insufficient diagnosis for the posited problems of adopted children, but rather than referring to AD (once a major tenet of ATTACh’s belief system), the video emphasizes the Developmental Trauma Disorder proposed by Bessell van der Kolk but not included as a diagnostic category in the work on the upcoming DSM-V edition. The ATTACh video fails to state that a lack of systematic evidence for the disorder suggested by van der Kolk is the reason why DTD will not be included in the new revision.

The ATTACh video re-emphasizes a position long taken by the organization-- that Reactive Attachment Disorder in childhood develops into serious personality disorders, antisocial personality, depression, anxiety, and suicidal thinking. The video completely omits any discussion of longitudinal research by Michael Rutter and his colleagues, showing how few children adopted from Romania had later mental health problems. I’ve discussed this research at www.childmyths.blogspot.com/2011/01/urban-legend-about-Russian-orphans.html and included the comment of the developmental scientist Megan Gunnar that so-called attachment problems may not be associated with attachment at all.

There are two other interesting points about the ATTACh video, and both of them require some explanation for those who cannot “read between the lines”. One is a startling acknowledgement of the influence of Foster Cline on the organization and the continuing importance of his views of attachment and related disorders. Foster Cline is an M.D. who was strongly influenced by Robert Zaslow, a psychologist who developed an intense and intrusive form of holding therapy in the 1970s. Cline learned Zaslow’s methods and applied them during the ‘80s and ‘90s, during which time he compared holding therapy to chemotherapy as a painful and frightening but necessary treatment that should not be avoided in spite of its dangers (it was eventually associated with a number of child deaths). Cline stated that “all bonding is trauma bonding”. Both Zaslow and Cline surrendered their professional licenses after disciplinary actions following injuries to patients. It is quite remarkable to me that ATTACh continues to state its Cline connection in contradiction to its efforts to become a kinder, gentler organization following the 2000 death of Candace Newmaker during a therapy session.

A second point, and one surprising to me, is the appearance in this video of the psychologist Michael Trout. Trout, at one time a highly-respected clinician, has in the last 15 years become greatly involved with the Association for Pre- and Perinatal Psychology and Health (APPPAH), a group committed to the idea that babies remember their gestations (perhaps even conceptions) and births and will sometimes spontaneously report on these. APPPAH attributes much emotional disturbance to prenatal and birth trauma and supports massage of neonates by individuals like William Emerson, who claims to release birth trauma by pressure on infants’ heads and necks. In the video, Trout specifically refers to the mantra “baby can remember” on which much APPPAH thinking is based.

Rather than providing reliable facts about childhood mental health issues, the ATTACh video gives some revealing information about the direction ATTACh seems to be going. A connection with APPPAH is a remarkable step away from the “mainstream” status once aspired to by this group. The ATTACh video is thus remarkably informative about ATTACh-- but not so much about Reactive Attachment Disorder.

Do Animals Have Babysitters? An Important Aspect of Human Child Care

A recent book by the anthropologist Sarah Hrdy (“Mothers and Others: The Evolutionary Origins of Mutual Understanding”, Harvard University Press, 2009), describes some important differences between the great apes and human beings in hunter-gatherer groups. Apes and humans are noticeably different in their reproductive and infant-care behaviors, and Hrdy proposes that these differences are important for our understanding of human development. Among the great apes, females give birth only every 6 to 8 years. Hunter-gatherer women usually give birth every 3 or 4 years. Yet apes mature more quickly than humans, so the ape big brother or big sister is almost an adult by the time the next infant is born, while the human child is still very much in need of adult care when the next baby comes. The mother ape invests many years’ work in bringing one offspring near to maturity before taking on the next, but the human may have several children who simultaneously require a great deal of adult nurturance and supervision. Human children particularly need the kind of personal attention that fosters language development, or they will not grow up to be functioning members of their group.

How is this apparently paradoxical situation to be understood? Sarah Hrdy suggests that one very big difference between humans and great apes lies in the number of caregivers each infant has. Ape mothers do not like other apes to so much as touch their young infants. Although other apes play with and help the juvenile apes as they get older, the mother is pretty much on her own in early infant care. Not so with human beings, however. Human mothers allow and even encourage familiar adults to be in contact with their babies. Those adults can and do provide important aspects of care-- not just feeding and cleaning, but the social interactions, gestures, and sounds that contribute to development of communication and speech. In the evolutionary development of our species, Hrdy believes, there were advantages for babies who were good at engaging with adults and getting cared for. Skill at understanding what other people felt and intended would also be advantageous. Those babies would be more likely to survive, grow to maturity, and reproduce, passing on their genetic material and the behavior traits associated with it. Those useful traits would be more important for humans, who might depend on many adults for care, than for apes who initially were cared for by their mothers alone.

It’s interesting to speculate on whether attachment-- the strong preference of humans for staying near familiar people at times of threat-- would also have emerged from having a mother who would tolerate other caregivers for her baby. A toddler who was very engaging might be likely to approach and communicate with strangers, who might then take the baby away-- unless internal attachment processes made it less likely that the child would approach completely unfamiliar people. A baby who was jealously guarded by its mother, as occurs among the great apes, would not need attachment processes to keep it near the family; the mother would do this job. Although attachment is often thought of as the “invisible playpen” that would have kept our ancestors’ babies out of danger from fire and wild animals, we see another important dimension when we realize that the babies’ ability to get attention from adults might have put them in danger of kidnapping or death from enemy humans. If they could crawl or toddle, but did not have the emotional attachment that would warn them away from strangers, they might not live to grow up; when they became mobile, the emergence of attachment and stranger anxiety would keep them safer.

Although social interaction, communication, and forms of attachment occur in species other than our own, it’s not necessarily correct to assume that any of those behaviors is the same in every species. I recently received a journal reviewer’s comment that referred to attachment as “transspecific” (occurring across species). Although that is true, it’s less correct to assume that attachment is “panspecific” (occurring in all species in the same way). Some behaviors of human and animal babies seem so parallel that we tend to think of them as identical when they may not be so. But no human baby exists without adult caregivers, and few animal babies can. That means that in order to understand parallels between humans and animals, we may need to look at adult caregiving behavior as well as at the babies’ own actions. Humans use babysitters, animals don’t--- and many other differences may follow from those facts.

Pseudosymmetry: Adoption, Attachment, Vaccination, and Misinformation

Pseudosymmetry is a useful word, invented by the anthropologist Christopher Toumey some years ago, and used to describe a maddening journalistic phenomenon. It’s a way of reporting news that gives the false impression that opinion is divided on topics that have little or no scientific support on one side and plenty on the other. “Symmetry” suggests that there are arguments of equal weight on both sides; “pseudosymmetry” suggests the practice of making arguments appear equal when they are actually far from equally supported.

We wouldn’t put up with pseudosymmetry in areas where there is immediate danger and where it makes a good deal of difference whether we make one decision or another. What would you think of an article about the Japanese nuclear reactors that described bad possible outcomes, but added that some nuclear scientists thought there was no problem? There well may be some such people-- suffering from dementia, or recently too ill to have seen what is happening-- but it would be deceptive to suggest that their existence means there is any real disagreement about the reactor problems. We would lose all confidence in a news source that gave this false impression.

When the danger is less immediate, though, we are not surprised when a news source gives the “other side” even though few knowledgeable people accept it. In those cases, some may even give credit for high moral standards to people who strive to tolerate someone’s right to unsupported beliefs. Any report about global warming in the popular media will be attacked for unfairness if it omits to say that there are non-believers-- even though the proportion of global warming believers to non-believers among scientists is probably 1000:1 at best.

We are also used to seeing “controversiality” (a word that is a red flag for pseudosymmetry nearby) introduced in any media report on child development. I remember being asked by a reporter at the time of the Candace Newmaker trial, after the child died under the ministrations of Attachment Therapy practitioners: “what do you think about this controversial therapy?” I replied, “it’s not controversial”, and I explained that it couldn’t be controversial if practically no clinical psychologist had ever heard of it, and those who had heard of it rejected it wholeheartedly. “Controversy” is a term that suggests that there are two schools of thought of equal weight, and therefore two opinions that are equally legitimate. When this is not true, “controversy” is a word that gives a false impression-- but it’s so often used by reporters who don’t want to be told they’re unfair, and do want to convey excitement about their topic. Saying something is controversial when it isn’t is a kind of pseudosymmetry.

I suppose one of the reasons for pseudosymmetry in discussions of early development is the idea that it will be a long time before children grow up. Therefore, we needn’t worry about any immediate problem even if we give the wrong impression about an issue-- if we suggest that a well-supported statement is only tentative by including an unsupported opinion shared by a very small number of people. Journalists may decide in these cases that to appear fair by including unsupported beliefs is more important than taking care not to delude readers or judging the likelihood of one of two opinions.

I have pseudosymmetry on my mind because of a recent e-argument with an organization in upstate New York. I won’t name names because, although I believe these people are in the wrong, they politely listened to my concerns and made an effort to discuss a pseudosymmetrical matter. Here was the deal: a communications professor at a small college became involved in the development of a series of public education videos about adoption. Professor knew nothing about the topic and depended on contributors to make the content acceptable. One contributor, an adoption agency staff member, provided an interview on attachment with an “adoption therapist” as a segment on attachment issues in adoption.

The attachment segment is the part of the series that brings up the issue of pseudosymmetry. The “adoption therapist”-- a marriage and family therapist whose information on the Internet suggests that he is also a homeopathic practitioner—concentrated on the role of grief in adoption and attributed this to the emotional attachment he believes to occur prenatally; this view, of course, is quite opposite to the conventional and evidence-based idea that emotional attachment of infant to adult occurs at some time in the second six months of life. The therapist also alluded to the existence of auras as an indication of personality and emotional concerns, a belief that is certainly no part of conventional psychotherapy or personality study. While none of the therapist’s practical suggestions were harmful or out of line with ordinary practice, the belief system he communicated was one with implications that could well lead adoptive parents to wrong assumptions and expectations.

So, why do I connect this matter with pseudosymmetry? Why don’t I just say they were wrong and should not have been spending public money this way? Here’s what the professor told me in an e-mail: “We decided that this issue was one that appears to have some validity in spite of the perspective and that [the therapist] didn’t present the matter as though there was only one, valid perspective. [Our medical adviser] pointed out that a similar situation exists in the medical field in regards to immunizations.”

In other words, professor believes that the presentation is acceptable because it does not present the matter as if there is only one, valid perspective. The fact that indeed there is only one substantiated perspective, and that the other material presented was factually incorrect, is seen as irrelevant. To top off the pseudosymmetrical efforts, he quotes an individual who draws a parallel between this and views of vaccination, an area in which there is one perspective with clear scientific support and another that is factually incorrect and rife with fraudulent and self-aggrandizing counterclaims. Pseudosymmetry apparently demands that we give equal time to opponents of vaccination and to reliable evidence supporting vaccination, and uses that model to declare that unsupported claims about the thoroughly-researched subject of attachment should be included along with evidence-based information.

To be tolerant and kind to other people who have different ways from ours is a good idea-- indeed, we would do well to do more than tolerate, and encourage those cultural differences. But that is a far cry from tolerating the promulgation of claims that are well-known to be wrong. What is it all about, anyway? Why is pseudosymmetry so beloved of journalists and others? Part of it, I’m sure, is the belief that it’s “not nice” to criticize or to suggest that someone else’s work or beliefs could use some fine-tuning. Another part-- and a far less admirable one-- may be plain old mental laziness. Why try to think through a difficult problem when it’s easier to avoid it and you also get moral credit that way? It’s hard work to examine the facts, and it’s also hard to summon the ego strength to deal with others’ objections to your decision that one idea is more supportable than the other.

Pseudosymmetry is an easy way out of the dilemma, if you don’t mind thinking that adoptive families may have troubles, or children may die of contagious disease, because you have created a false impression.

Attachment and "Bonding": The Mainstream and Some Eddies

Psychologists and clinical social workers will be surprised at my bothering to talk about the subject of this post, but if they look back over some recent comments they’ll see why this needs to be done. I’m going to review historical changes in ideas about emotional attachment and show where the mainstream is today.

Sigmund Freud’s discussion of attachment assumed that a child’s preference for a familiar caregiver depended on experiences of feeding-- a sort of “cupboard love”. He also considered that attachment could not begin until the end of the first year, when necessary cognitive abilities developed. While Freud considered early experiences essential in the shaping of personality, he focused on oral experiences rather than attachment per se as the important factor in early life.

A second generation of psychoanalysts in the 1930s included some whom Freud labeled “wild psychoanalysts”. These were people like Georg Groddeck and Sandor Ferenczi who emphasized the role of the body in emotional life. Ferenczi re-enacted parent-child caregiving actions with his patients, a method later advocated by the 1970s “antipsychiatrist” R.D. Laing. Without specifically discussing attachment, these therapists focused on early interactions that can be interpreted as related to attachment, and were concerned with earlier events than Freud usually focused on. One psychoanalyst, Otto Rank, pursued earlier and earlier causes of emotional problems and eventually held that birth itself was a traumatic event.

In the 1940s, therapists using hypnosis claimed that they could use a process of regression to return patients to early periods of development, and that this process could correct the impact of early problems. Within a few years, a popular book, The Search for Bridey Murphy, suggested to the public that hypnotic regression could return a person not just to an earlier stage of his or her development, but to a past life. Scientologists at about the same time contributed to this belief by stating that under their guidance it was possible to remember not only prenatal life but the moment of one’s conception. Popular acceptance of these ideas was not diminished by various studies like those of T.X. Barber, who showed that in fact age-regressed hypnotic subjects were no more accurate in their depiction of what they had been like at age 3 than they were when told they were now 90 (which they had not yet been). However, belief in memory of prenatal or pre-conception life was not part of mainstream psychological thinking about attachment or any other part of development.

With the publication of John Bowlby’s theory of attachment in the 1960s, ‘70s, and ‘80s , mainstream psychology developed an intense interest in attachment, and focused on the timing of this emotional process toward the end of the first year, as Bowlby suggested-- a schedule not very different from the one Freud had originally described. A small number of dissidents offered alternative claims about timing and causes of attachment. W. Ernst Freud (born Halberstadt; the son of Sigmund Freud’s daughter Sophie) published a chapter on “Prenatal Attachment” in a 1980 volume, The Course of Life, edited by Stanley Greenspan and George Pollock.

W.E. Freud’s claims were similar to those made by individuals such as William Emerson, a leader of the Association for Pre- and Perinatal Psychology and Health (APPPAH). Emerson has advocated the use of head and neck massage as a corrective for babies he considers to be influenced by their prenatal and birth circumstances. APPPAH was much influenced by the publications of Stanislav Grof, a psychiatrist, and Frank Lake, a psychiatrist and theologian, both of whom considered experiences induced by LSD to provide useful evidence about the nature of prenatal and birth experiences. These views, while considerably outside the mainstream of psychological thought, were treated with interest by the “psychohistory” school of historians. APPPAH also influenced the suggestion by Nancy Verrier that adopted children experience a “primal wound”.

In the 1970s, the “primal therapy” advocated by Arthur Janov contributed to this picture by its assumption that memory is not confined to the functioning of the nervous system, but is instead a biological function of all cells. Once again, this echoed some thinking of Scientologists and others outside the psychological mainstream.

In the early 1980s, work by M.H. Klaus and J.H.Kennell investigated maternal attitudes and referred to the strong preference of mothers for their babies, and their preoccupation with their babies, as “bonding”. This term was often confused with the term “attachment”, which is properly applied to babies and children, not to adults. Because in Klaus and Kennell’s original work “bonding” appeared to occur shortly after birth, lay readers may have come to believe that attachment occurs shortly after, or even before, birth. As a matter of fact, later work indicated that “bonding” often develops much more gradually than Klaus and Kennel originally reported--- and, to repeat the point, is in any case not an infant process, however much it may influence the infant.

Today, mainstream psychology continues to consider that emotional attachment arises as a result of experiences with a consistent, sensitive, responsive caregiver, and that this becomes evident only in the second half of the first year. For example, the University of Delaware clinician-researcher Mary Dozier, writing in Zero to Three for January 2011, refers to the new attachment concerns of foster children who are more than 10 or 11 months old when they are placed with a caregiver. Dozier and her co-authors also reject the biological factors suggested by Janov , Verrier, and others, stating that “the experience of loss is just as devastating when the infant is moved from a loving, committed foster parent as when he or she is moved from a committed biological parent… From an infant’s point of view, biological relatedness is inconsequential."

Attachment, the New Imperialistic Schema?

Several decades ago, Sandra Bem, a social psychologist interested in gender issues, referred to gender as an “imperialistic schema”. By this term, she meant that gender had become a concept that was strongly linked to other concepts, and that dominated them. For example, a person thinking about gender would automatically also think about how other characteristics of a person-- even of the world-- would line up as either “like males” or “like females”. Stereotypically, people would think of aggressiveness as “male”, peacefulness as “female”; of strength as “male” and weakness as “female”; of angularity as “male” and “curviness” as female; even of the sun as “male” and the moon as “female”. Other concepts that really had nothing to do with gender were somehow (probably because of repetition) hitched on to the gender schema and could hardly be separated from its “empire”.

Stereotyping of ethnic or class differences also gives examples of imperialistic schemas at work. Schema imperialism can cause us to make mistakes, but it also saves us a lot of cognitive effort, and we lazy humans tend to prefer not to have to think too hard.

I’d like to nominate another concept as a rising imperialistic schema. It has come to imply many more related factors than it was ever intended to mean, and as a result, like gender, it conveys much different information than a dictionary definition might suggest.

The new imperialistic schema candidate is, of course, attachment. This term, in its original formulation by John Bowlby and a few of his colleagues, referred to a young child’s strong preference for familiar caregivers and distress when separated from them at times of perceived threat. But when we read how the term attachment is popularly used today, we see it aligned with and almost inextricably connected with other concepts. Here are some common ideas that connect attachment to other concepts and can lead to confused thinking about family relationships:

1. Attachment is a concept that includes all early mother-child interactions, possibly including those occurring before birth; attachment does not really involve fathers.

2. Attachment includes all positive responses to another person, including recognition of voice or face, or interest in prolonging an interaction.

3. Attachment is connected with all positive aspects of personality development from infancy through adulthood, including obedience, respect, and affection for other people.

4. Separation from familiar caregivers is associated with all negative aspects of personality development, including psychopathy, with any displeasing behavior such as disobedience or sexual promiscuity, and with adult depression or prolonged unhappiness. (A few die-hards would still include autism in this list.)

5. Because adoption usually involves separation from the first mother (see #1, above), the concept of adoption can also be brought into the “empire” of attachment, making all these concepts connected to adoption as well as to attachment.

Allowing attachment to become an imperialistic schema (and to associate it with the gender schema!) means that we lose track of the most basic meaning of the term, and that is what’s happened as the list I’ve just given came into being. When Bowlby formulated his attachment theory, he was talking about specific events in development and their probable outcomes, not about everything that happens in the course of development or about every aspect of interpersonal relations. He was concerned that children who had poor early care would become antisocial, but his work on this involved juvenile thieves, not murderers. Reading about attachment as it is discussed in the blogosphere today, it appears that the specifics of Bowlby’s work have melted away, leaving nothing but a general view that bad developmental outcomes of all kinds are the result of the separation of children from their mothers. The imperialistic schema has taken over a wide range of factors that should be considered independently.

Can we ever fight our way back to the original definition of attachment, or make ourselves use other words to describe other aspects of the interaction between infants and adults? Of course we can-- if we want to. But wanting to change will mean being transparent about the agenda that has driven the attachment schema imperialism. That will be the hard part for many.

[Incidentally, next month’s issue of the journal Theory & Psychology will include an article in which I discuss ways in which attachment theory has been supported by the evidence and ways in which it has not.]

Practice Babies, Wet Nurses, Kibbutzim,and Boarder Babies: Are Humans "Omnicarous"?

A lot of concern is being expressed on various blogs about the history of “practice babies”, as described in Lisa Grunwald’s novel The Irresistible Henry House. Those babies, as probably everyone knows by now, were orphans who were cared for by “domestic science” students in colleges and who had many caregivers, in most cases before going to an adoptive family. The “practice babies” usually experienced multiple caregivers during the second half of their first year, a period of time that is associated with the development of attachment behaviors and which might be a time of vulnerability for emotional development.

However, there seems to be no obvious evidence that these children, who had also had multiple caregivers in their orphanages, were emotionally disturbed later in their lives. (Of course, it may well be that there is no such evidence because no one has looked for it, but it seems to me rather likely that adoptive parents would have complained if the babies they received were troubled, and that attention would have been called to the situation. Maybe not, though.)

On the basis of what’s usually said about attachment, we would expect those “practice babies” to be in a lot of trouble because of the absence of a small number of consistent attachment figures from their lives. But… could it be that our present emphasis on attachment is typical of Western culture in this period of history, and not a human universal as John Bowlby suggested it was? Humans are well known to be omnivorous and to thrive on a wide range of different diets, some of them pretty disgusting to those who are not familiar with them. Could they also be “omnicarous”? Forgive this made-up word, but I’m using it to mean capable of thriving on a variety of different infant care “diets”. Of course, human diets do have to contain certain essential components for survival and good health, and infant care “diets” may also have to contain certain essentials. But it may be that those essentials could be embedded in a wide variety of experiences-- not just the ones that we in industrialized Western countries regard as important.

A 1988 book by Valerie Fildes, Wet Nursing, describes a historically-common care method which is disturbing to many modern readers. Fildes traces the history of wet nursing, the practice of having a baby breast-fed by a woman other then the biological mother. Wet nurses received a salary for their services, those services being possible over a long period because human lactation does not have to be “freshened” by repeated pregnancy as is the case for cows, for example. Wet nurses have been used in many ways, sometimes living-in with wealthy families, and in the early 20th century being employed in hospitals to feed babies. Fildes also tells the fascinating and relevant story of the French bureaucracy associated with wet nursing in the 19th century. The demand for wet nurses was high in parts of France where women had skilled jobs in the textile industry and their husbands and families did not want to lose their income for a nursing period of perhaps two years. These families hired a wet nurse who was certified by the government; the wet nurse came to town, picked up the baby, and went back to her own village, where she might have 4 or 5 other infants and toddlers to care for, most of them being at least partially breast-fed. The babies’ families might or might not visit from time to time. Quite a few of these babies died while with the nurse, but the survivors would be brought home at about two years of age. Various sources record that they were frightened of the biological parents, treated them as if they were strangers, and strove to stay near the nurse. One feels terribly sorry for these terrified little people, forced into this abrupt separation-- but again, there seems to be no particular evidence that the thousands of children who went through this experience later showed unusual emotional or personality characteristics.

Much as I hate to quote Bruno Bettelheim, his book about kibbutz children, Children of the Dream, gives a relevant description of the lack of one-to-one child-to-adult social interaction in the original kibbutz culture. Although things are done differently today, one of the goals of the early kibbutzim was to break the emotional connection between children and parents and to make the children feel a primary loyalty to the group. The small number of overworked adult caregivers could not provide individual comfort or play, and children were expected to and did form their major emotional ties to others in their age group. But, again, no unusual number of mental health problems seems to have resulted from a situation which was far from ideal in terms of Bowlby’s theory of attachment.

One group of babies who may give us some insight into the essentials of the infant care “diet” is the “boarder babies”. These infants may be cared for for months in the hospital where they were born because legal tangles make their placement impossible. Informal observations suggest that these babies, at a time in their lives when they might be expected to have strong preferences for familiar people and maintain interactions with them, are instead friendly in a shallow way to everyone. They smile responsively but are not good at carrying on a longer interaction, and this is thought to be because everyone passing the room has stopped to smile and say hello, but then has left very quickly. The long-term effect of this are not yet known, but it’s possible that the boarder baby infant care “diet” does not contain all the essential emotional “nutrients”.

Our impulse to try to protect babies from unhappiness in every way is probably healthy and calculated to assure optimal development. But it’s possible that we have overdone the idea that good emotional development must follow a single pattern and involve the kinds of mother-child experience that we imagine to be “traditional” or even “natural”. To achieve a real understanding of the essential infant care emotional “diet”, we need to consider the whole range of ways in which humans have successfully reared children who grew to be good-enough humans.

The Urban Legend About the Russian Orphans

I thought I would have a peaceful breakfast this snowy morning, January 9, 2011, with the Times Sunday Styles section. What could be in there to bother me, except maybe pictures of people in high-fashion camouflage clothing, an oxymoron to my mind?

But there was something bothersome, and it was on the first page. One Nicole Hardy had written a piece called “Single, Female, Mormon, Alone”, and although what she had to say was interesting, insightful, and well-written, and I wish her all the best, it took only a few paragraphs before my myth alarm went off loudly. Ms. Hardy wanted to find a good metaphor to convey how isolated she felt as a celibate adult, and how she felt she hadn’t been able to really grow up as an “old” virgin, so here’s what she compared herself to: “like the Russian orphans I’d read about whose lack of physical contact altered their neurobiology and prevented them from forming emotional bonds.”

It would seem that everybody now knows these things: Russian orphans can’t form emotional bonds . It’s because they didn’t get much physical contact when they were babies. That changed their neurobiology. They’re not like you and me or other human beings any more.

As is the case with other urban legends, the only trouble with this one is that it isn’t true. None of the parts we can unpack from Ms. Hardy’s statement is a demonstrable fact. I’ve discussed recent research on these issues at www.childmyths.blogspot.com/2010/12/when-romanian-orphans-grow-up-recent.html. Michael Rutter and other researchers of the English and Romanian Adoptees study have been following over 300 children adopted from Romanian orphanages in the early 1990s. These orphanages had appalling conditions, probably for many of these children the worst that could be experienced and still have the child survive; they were certainly worse than present Russian orphanages, so if there are many bad outcomes from poor early care, we would expect those outcomes from the Romanian adoptees.

Here are some points from Rutter’s research that are relevant to the urban legend Ms. Hardy chooses as her metaphor:

1. “Orphans from Eastern Europe can’t form emotional bonds”
In fact, in the Rutter research, most of the children had normal relationships with their adoptive families. Those who seemed unusual in their relationships (and there were more in the adopted group than in a non-adopted comparison group) were overly friendly and more likely than is usual to approach strangers or wander away. The developmental scientist Megan Gunnar, commenting on this in the Society for research in Child Development monograph “Deprivation-Specific Psychological Patterns: Effects of Institutional Deprivation” (Rutter et al, 2010), pointed out: “we should not be focused on garden variety attachment problems but ones that fit within the ‘disinhibited’ framework [excessive friendliness—JM]. There are still plenty of questions about whether [disinhibited attachment] is primarily a disorder of the attachment relationship… Though some [disinhibited attachment] behaviors do deal with failure to check back with the parent in anxiety-provoking situations, most deal with disinhibited behavior or lack of social reserve with strangers… it is not just that these children are really overly friendly with strangers; rather, they seem to have problems with social boundaries” (p. 243). Gunnar’s comments suggest that a failure to form emotional bonds is not the issue.

2. “The reason they have problems is a lack of physical contact.”

Although it is undoubtedly true that few, if any, of the Romanian group were cuddled or kissed the way we expect family babies to be, there is no reason to choose that deprivation as the cause of any problems that may occur. They were also both underfed and malnourished in terms of receiving appropriate nutriments. Some were confined to their cribs almost indefinitely, and were cleaned by being squirted with garden hoses. To choose a lack of physical contact as the major problem out of this menu of deprivations is arbitrary and misleading.

3. “Their experiences changed their neurobiology”.

While this is an important issue, too little evidence presently exists about brain-behavior connections to be able to make this statement. For discussion, see www.santiagodeclaration.org.

Poor Ms. Hardy. She was just looking for a good metaphor to use in communicating some of the peculiarities of her life, and she stumbled into a major controversy. I can’t really blame her for picking up this urban legend--- that’s almost what urban legends are, things people pick up unquestioningly-- but I would have liked it if she hadn’t added this one more brick to the wall that keeps people from seeing through a legend that has caused a lot of trouble to a lot of children and their adoptive parents.

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.

Eye contact? Part 2

"Eye contact", or prolonged mutual gaze, is something adults do when they want to communicate some emotional information. They may stare in order to try to intimidate another person, who looks back in resistance or drops her eyes in submissive response. They may gaze in order to flirt with an attractive companion, who may avoid the gaze, make repeated brief eye contact in a coy way, and perhaps finally permit a long mutual gaze as he or she acknowledges interest. Strangers who want to play with a baby they meet in public may keep on trying to catch the baby's gaze-- but for babies of 8-10 months old or older, this action is alarming, and the more the stranger tries, the more the baby avoids the look or even begins to cry. Lovers walking toward each other in public maintain their mutual gaze, and so do parents and toddlers as they approach each other, but acquaintances only glance at each other periodically, and even when standing together and talking will make and break eye contact frequently.

So, eye contact indicates the nature of a relationship or of the attitude of one person toward another. But, does eye contact actually cause the relationship, as would be suggested by popular beliefs about parents gazing into babies' eyes? Is the attachment of a toddler to a parent based on past experience of eye contact?

When several factors seem to work together, or have mutual effects on each other, it's quite hard to tell which cause determines which outcome. This is especially true when we can only look at natural events rather than doing experimentation. Sometimes, fortunately, natural events provide us with some information that can rule out an explanation.

Considering the connection between eye contact and attachment, it turns out that we do have some natural events that tell us that eye contact is at most one of several causes of attachment. There are some babies for whom a typical experience of eye contact is not possible. There are babies who are born blind or who lose their vision very early in life, and there are sighted babies who have blind parents. In either case, the baby and its parents did not spend time making "eye contact", although up to a few months of age a blind baby may appear to be doing so. Nevertheless, blind babies do develop attachment to their parents, provided they have opportunities for consistent caregiving experiences and social interactions like vocalization or mutual touch.

The fact of attachment without the opportunity for eye contact suggests that the cause and effect connection may be the other way around: that is, toddlers make eye contact with their parents because they are attached to them, not vice-versa.

What about autism? One of the most common ideas about autistic children is that they avoid eye contact and therefore fail to learn the ways of emotional communication which typical humans use with each other. It does seem to be the case that autistic toddlers don't show the "joint attention" behavior of shifting the gaze from someone's eyes to an interesting object and back again, nor do they use eye contact to try to get an adult to do something for them. A typically-developing toddler who wants help to open a container will make eye contact with an adult and hold the container out to the person; an autistic toddler does not gaze at the adult's eyes, but reaches for the person's hand and tries to put it on the container. However, recent research suggests that autistic children can actually pay attention to things they are not apparently "looking at", so questions about their gaze may need a lot more work.