No More Learning

Since no figures appear to be available to indicate the incidence of threats to commit suicide, we can only speculate. Presumably very many children who are exposed to suicidal attempts by a parent are exposed also to threats. Mrs Q is a case in point. In addition, there must be many others who, like Stephen Q, are exposed to threats but not to attempts. All in all the
181
proportion of children who are exposed to threats or attempts, or to both, must be considerable. Both clinical experience and common sense suggest not only that such people will be more than usually prone to anxiety about the availability of attachment figures while they are still children but that they will often continue so long after they are grown up.
____________________
rough. They have been calculated by me, and are given on my sole responsibility, in order to show the order of magnitude of the problem.
-234-
What is so surprising is that, as a source of heightened susceptibility to anxiety, threats of and attempts at suicide by parents should have attracted so little attention, whether from psychoanalysts, psychiatrists, or those engaged in child psychiatry.
Fear of Parental Desertion after a Quarrel
When parents quarrel seriously a risk that one or other will desert is always there. Not infrequently, moreover, it is made explicit. In such conditions children usually hear a great deal more than parents like to believe. Although, therefore, the kind of situation that leads a child to fear abandonment is different from one in which threats to abandon him are directed punitively at him, the effects may still be very unsettling.
Here again it is not unusual for professional workers whom parents may consult about their child's behaviour to be kept in the dark about what is happening at home, and for such workers, ignorant of the true situation, to resort to 'deep' interpretations invoking projection and the inner world to explain a child's symptoms. During the practice of child and family psychiatry and also in work with adolescents and adults it is prudent always to assume that only after some months of work, including joint family interviews, are we likely to have obtained even a reasonably accurate picture of how members of a family behave towards one another and what they say. When after much patience the facts become known, it is usually far less difficult to understand how a child has come to be disturbed and why he fears whatever he does.
Earlier in this chapter it was pointed out that, in studies of the effects on a child of separation, the factors that lead the effects to persist in one child and not to do so in another have in the past been difficult to identify. Review of evidence available today suggests that we may be nearer a solution. We can indeed be confident that when a child is threatened with being abandoned by his parents, either as a disciplinary measure or because of marital discord, the effects on him of any actual separation will not only be magnified but be likely to persist.
When the high incidence of such threats in the lives of children is borne in mind, along with the cumulative effects of actual separations, of threats of separation, of unstable substitute care, and of unstable family life, the fact that many
-235-
children grow up to be anxiously attached becomes explicable. In the light of these findings, moreover, a number of clinical syndromes can be better understood (see Chapters 18 and 19).
182
-236-
Chapter 16
'Overdependency' and the Theory of Spoiling
The child is all the more clinging the more it has an inner conviction that separation will repeat itself.
BURLINGHAM & FREUD ( 1944)
Some contrasting theories
Following presentation of some of the evidence on which the theoretical position adopted here is based, it is useful to consider briefly the whole array of hypotheses that have been proposed to account for why a particular individual is prone to a high degree of overdependency or separation anxiety, the terms by which anxious attachment is usually known. Hypotheses advanced by psychoanalysts and others working in a psychoanalytic tradition not only give varying weight to constitutional and environmental factors but also inculpate different and in some respects contradictory factors in each class. The five main hypotheses, each of which has adherents, are outlined briefly below. Two lay emphasis on constitutional factors, as follows:
1. Some children have inherently a greater amount of libidinal need in their constitution than others, and so are more sensitive than others to an absence of gratification ( Freud 1917b).
2. Some children have inherently a stronger death instinct than others, which manifests itself in unusually strong persecutory and depressive anxiety ( Klein 1932).
Three lay emphasis on environmental factors:
3. Variations in the birth process and severe traumata occurring during the first weeks of
postnatal life may increase the (organic) anxiety response and heighten the anxiety potential, thereby causing a more severe reaction to later (psychological) dangers met with in life ( Greenacre 1941; 1945).
-237-
Some children are 'spoiled' by excess of early libidinal gratification; they therefore demand more of it and, when not gratified, miss it more ( Freud 1905b; 1917b; 1926a).
Some children are made excessively sensitive to the possibility of separation or loss of love through experiencing either actual separation ( Edelston 1943; Bowlby 1951) or threats of abandonment or loss of love ( Suttie 1935; Fairbairn 1941).
It should be noted that whereas hypotheses 1, 4, and 5 are framed to account for a person's liability to a high degree of anxiety about separation in particular, hypotheses 2 and 3 are intended to account for liability to a high degree of anxiety of any kind.
In regard to the first two of these hypotheses there is no evidence either to support or to refute them since, with present research techniques, there is no way of determining differences of these kinds in constitutional endowment. That heritable differences play some part in determining why some people grow up to be more anxious than others is not unlikely; but
183
whether either Freud's or Klein's formulation of the nature of the difference will prove useful seems doubtful.
Clear evidence in support of a hypothesis of the third type comes from the work of Ucko ( 1965) who found that children suffering from neonatal asphyxia are unusually prone to respond to separations and other changes of environment with anxiety. Her findings are described in Chapter 13. While supporting the third hypothesis, they do not conflict with either of the remaining hypotheses.
The fourth and fifth hypotheses, because they raise immediate and practical issues of how to treat children, are perhaps the most controversial of the set, and particularly so since the lessons they hold for how to rear children are of exactly opposite kinds.
The fourth hypothesis, that an excess of parental affection spoils a child by making him exceptionally demanding and intolerant of frustration, is one that was very widely held during the first half of this century and that still dies hard. Freud not only committed himself to it at an early stage of his work but held to it firmly and consistently until the end. Since this view of Freud's has had a deep and lasting influence on psychoanalytic theory and practice, quotations may be useful.
Freud first reference to spoiling is in his Three Essays on theTheory of Sexuality
-238-
Theory of Sexuality, first published in 1905. There, after commending the mother who strokes, rocks, and kisses her child and thereby teaches him to love, he nevertheless warns against excess: '. . . an excess of parental affection does harm by causing precocious sexual maturity and also because, by spoiling the child, it makes him incapable in later life of temporarily doing without love or of being content with a smaller amount of it' ( SE 7: 223). The same theme runs through much of Freud theorizing about 'Little Hans' ( 1909); though, paradoxically, it is in his discussion of this small boy's separation anxiety that he comes nearest the view adopted here. He attributes part of the anxiety to the fact that Little Hans had been separated from his mother at the time of his baby sister's birth ( SE 10: 114 and 132). Nevertheless, both in the Introductory Lectures ( 1917b, SE 16: 408) and in his late work, Inhibitions, Symptoms and Anxiety ( 1926a), Freud makes no reference to such origins and instead explicitly adopts the theory of spoiling:
The undesirable result of 'spoiling' a small child is to magnify the importance of the danger of losing the object (the object being a protection against every situation of helplessness) in comparison with every other danger. It therefore encourages the individual to remain in the state of childhood ( SE 20: 167).
The theoretical context within which Freud advanced these views is referred to in an earlier chapter (Chapter 5) and described rather more fully in Appendix I.
Despite its wide popularity, no evidence of substance has ever been presented to support the theory that anxious attachment is a result of an excess of parental affection. As already indicated, all the evidence points the other way. ? The question arises, therefore, why Freud (and many others also) should have favoured the theory. Possible answers are offered at the
184
end of the chapter. Meanwhile, let us consider further the fifth type of theory, the one favoured here.
However cogent the evidence may be that some cases of anxious attachment are a consequence of separation, or of threats of being abandoned, or of risks of losing a parent inherent when parents quarrel, it is still possible that not all cases are to be explained in this way. Are there perhaps other cases that arise from causes other than those so far considered? To answer this question it is necessary to turn to the results of
-239-
studies conceived on different lines from the studies discussed so far. Studies of 'overdependency' and its antecedents
Despite very frequent references to overdependency in the clinical literature there seem to be few studies in which a clinician has selected a sample of adult patients on the criterion of overdependency and then examined the family experiences these individuals have had during their childhood and compared them with the experiences of an appropriately selected contrast group. Some of the literature on agoraphobia is in fact relevant (see Chapter 19) although the criterion for patient selection, namely fear of leaving home without a companion, is ostensibly quite different.
Studies of the family backgrounds of children selected as being overdependent are also few in number. With regard to these, moreover, a difficulty that has to be borne in mind is the ambiguity of the term overdependent, for it is found to cover two distinct conditions. One comprises children who are exhibiting typically anxious attachment. The other comprises children who are less able than are others of their age to do ordinary little tasks, such as feeding or dressing, for themselves and, instead, ask mother to do them for them.
This distinction emerges clearly in a study undertaken by Stendler ( 1954). A group of twenty six-year-old children, selected by teachers as being markedly overdependent, was found to fall into two subgroups. On the one hand were six children who turned to mother to do everything for them. On the other was a group of fourteen who had no difficulty in doing things for themselves but who were upset by mother's absence and created a scene whenever she went out and left them behind. Not unexpectedly, the family experiences of these two subgroups were radically different.
The six children who constantly turned to mother for help came from stable homes. All six, however, had a mother who was excessively protective and tended to discourage her child from learning to do things for himself.
Of the fourteen children who were anxiously attached eleven had had a very unsettled home life. Changes of caretaker, from mother to grandmother and back again, father constantly coming or going, frequent shifts of residence, and similar instability had been the rule. For the fourteen anxiously attached children taken as a group, the total number of such
-240-
185
discontinuities that had occurred during the period between nine months of age and the third birthday was fifty-two, an average of nearly four apiece. For a control group of twenty children, picked from the same school classes, the equivalent total was twenty-six, giving an average of 1? 3 apiece.
So far as they go, therefore, the results of this small study are consistent with the view that most, if not all, cases of anxious attachment can be understood as being the consequence of a series of separations and similar experiences. A much larger study, by McCord and others ( 1962), gives strong support to this type of hypothesis.
In their study McCord and his colleagues draw on the detailed case records of some 255 boys aged between nine and seventeen years who constituted the 'treatment group' of the Cambridge-Somerville project. All lived in a high-density industrial area and were mainly from the working classes. Half of these boys had been selected, when between the ages of nine and thirteen, by teachers and others in the community as potential delinquents. The other half were selected similarly as developing in a relatively normal way. All these boys and their families were then given such support and help as could be arranged in order to see whether delinquent development could be averted. Since supportive work continued for five years, a great deal of information was amassed both about the boys themselves and about their families. 1 Some years later the information was rated by independent raters who had taken no part in the study. For purposes of this analysis a sub-sample, of forty-three boys, was identified as showing 'overdependent behaviour' and another, of 105 boys, as showing, in this respect, the normal culturally expected pattern of development.
Three-quarters of the overdependent boys showed markedly dependent behaviour towards adults and can almost certainly be regarded as anxiously attached. A minority (eleven) showed dependent behaviour only towards peers and were rather remote from adults; it is an open question whether that behaviour can be regarded as anxious attachment. In the presentation of the results, however, findings for the majority are not distinguished from those for the minority.
When compared with the control group, the overdependent boys were found to be more likely to express feelings of inferiority
____________________
1 Included in the study also were a comparable pair of samples who were not given support.
Because little information on them and their families became available these cases cannot be used for the present analysis.
-241-
(51 per cent against 12 per cent) and to be more prone to 'abnormal fears' (56 per cent against 36 per cent), though unfortunately details of the fears are not specified.
When the family backgrounds and attitudes of parents of boys in the two groups were compared a set of highly consistent findings was obtained. Nearly twice as many of the dependent boys as of the controls were rated as being rejected by father (51 per cent compared with 28 per cent) and/or by mother (39? 5 per cent and 20 per cent). No less than 56 per cent of the dependent boys were found constantly to be compared unfavourably with their siblings; that proportion compares with only 17 per cent of the controls. No data on
186
separations and losses are given. Quarrels between parents and mutual disparagement were reported for almost every home in the overdependent sub-sample; though it must be admitted that in this workingclass neighbourhood a fairly high incidence of such happenings is reported also in the families of the controls. Not unexpectedly, the feelings expressed by some of these overdependent boys towards their mothers were the reverse of warm: one-third of them expressed active dislike, or fear, or contempt of her.
Such other evidence as is available on conditions associated with overdependency, or anxious attachment, is consistent with the findings so far considered. For example, in the previous chapter reference is made to two studies that focus attention on parental behaviour when the children are four or five years old and describe the variety and incidence of different methods of child care used in a particular community; these are the studies by Newson & Newson ( 1968) of families in the English midlands and by Sears, Maccoby & Levin ( 1957) of families in New England. Although in neither study are the effects on the children of different family experiences at the centre of interest, each presents some data relevant to our problem.
The Newsons' findings on overdependency are given in the previous chapter (pp. 213-14). Most of the children who at four years of age were afraid of separation were found to have experienced a separation: either they or their mothers had been hospitalized, or some other separation had taken place.
Sears, Maccoby & Levin ( 1957) report the results of interviewing 379 mothers of five-year- old children attending kindergarten in the suburbs of a large metropolitan area in New England. Among the questions they asked about the children were four designed to give information about 'dependency'.
No evidence was found that separations had played any part in
-242-
the development of those children who, on the basis of mothers' reports, were assessed as most dependent; but the authors point out that the incidence of separation in the sample was very low.
The principle finding of Sears's study in regard to dependency is that the more irritable, scolding, and impatient a mother was when her child was clinging or desirous of attention the more 'dependent' he was likely to be. This significant correlation is appreciably increased in the case of mothers who were initially rejecting but later gave in. The researchers also found a significant correlation between a high degree of dependency and parents who used withdrawal of love as a disciplinary measure, including threats to abandon a child. These findings are consistent with the present hypothesis.
Another of their findings, however, could be taken to support the theory of spoiling. A small group of mothers was assessed as being 'exceptionally demonstrative' of affection, and these were more likely than others to have children rated as 'quite dependent'; the correlation is low but significant.
An explanation of this finding that seems not unlikely is that the children assessed by the researchers as overdependent fell, like Stendler's, into two groups, those who showed anxious attachment and those who looked to mother to do everything for them. If this was so and if
187
Stendler's findings were confirmed, then a number of the mothers assessed by Sears and his colleagues as exceptionally demonstrative would have been found to be not only affectionate but inclined also to discourage their child from doing things for himself.
Further and substantial evidence that strongly supports the hypothesis favoured here, and equally strongly challenges the theory of spoiling, comes from studies of the family backgrounds of individuals who grow up to be notably self-reliant. This is presented in the penultimate chapter.
How came it, then, that Freud should have adopted the theory of spoiling? Apart from the likelihood that he was more influenced than he realized by the accepted opinion of his day, there is some evidence that he was misled by the show of affection and over-protection that is so frequently present either as an over-compensation for a parent's unconscious hostility to a child or as part of the parent's own desire to cling to the child. This explanation is suggested by a passage in Three Essays, immediately following that quoted earlier, in which he refers to 'neuropathic parents, who are inclined as a rule to display excessive affection, [as] precisely those who are
-243-
most likely by their caresses to arouse the child's disposition to neurotic illness' (SE 7: 223). In fact, when such cases are investigated in a psychoanalytically oriented family clinic, it is found, probably invariably, that the child's heightened anxiety over separation and loss of love is a reaction not to any real 'excess of parental affection' but to experiences of an almost opposite kind. On the one hand are threats by a parent either to withdraw love or to abandon the child, threats that, as already discussed, are apt to be kept very secret. On the other are cases in which a parent demands, either overtly or covertly, that the child act as a caretaker to him (or her), thereby inverting the normal parent-child roles. In such cases it is the parent, not the child, who is overdependent or, to use the better term, anxiously attached. These cases are discussed in Chapters 18 and 19.
To some it may seem a trifle absurd to go to such lengths to demonstrate that uncertainty regarding the availability of an attachment figure commonly results in anxious attachment. Yet, so long as terms such as 'overdependent' and 'spoiled' are in use to describe the individuals in question and a theory is current that attributes their condition to an excess of gratification during their early years, children and especially adults who manifest this type of behaviour will meet with scant sympathy or understanding. Once it is recognized that the condition is one of anxiety over the accessibility and responsiveness of attachment figures, and that it develops as a result of bitter experience, there is good prospect not only of helping those who have grown up insecure but of preventing others from doing so.
-244-
188
Chapter 17
Anger, Anxiety, and Attachment Anger: a response to separation
Time and again in preceding chapters reference is made to the anger that is engendered towards a parent figure by a separation or a threat of separation. It is time now to consider this response more systematically and in particular how it is related to attachment and fear.
In the first chapter an account is given of the systematic study by Heinicke & Westheimer ( 1966) of ten children aged from thirteen to thirty-two months during and after a stay of two or more weeks in a residential nursery. When comparisons were made between the separated children and a contrast group of children who remained in their own homes the increased tendency of the separated children to respond aggressively was clear. For example, during their stay in the nursery a doll-play test was administered to the separated children on at least two occasions, at an interval of eight days; and the same tests were administered to the children in the contrast group at the same interval at home. On each occasion episodes of hostile behaviour occurred four times as frequently in the doll play of the separated children as they did in the play of the children living at home. Objects attacked tended to be the parent dolls. Of the separated children eight attacked a doll that had already been identified by the child as a mother or father doll; none of the children living at home did so.
Six weeks after the separated children had returned home, and after an equivalent period for the non-separated children, doll-play tests were again administered; and they were repeated ten weeks later. On neither of these occasions, however, were significant differences in hostility found between the children in the two groups. The reason for this was that, six weeks and more after reunion, the children who had been separated were no longer particularly aggressive in their play, a change for the better that was itself significant.
Nevertheless, it was apparent from mothers' reports that
-245-
during the months after return home a number of the separated children were still behaving hostilely in the home, especially towards mother. During the period from the second to the twentieth week after reunion six of the ten separated children behaved towards mother with an intensity of ambivalence reported for none of the children who had remained in their own homes.
Other observers to have reported notably aggressive and/or destructive behaviour during a period of separation are Burlingham & Freud ( 1944), Robertson ( 1958b), Bowlby ( 1953), Ainsworth & Boston ( 1952), and also Heinicke in an earlier study ( 1956) in which he compared the behaviour of a small sample of children during a short stay in a residential nursery with that of a similar group starting to attend a day nursery.
Others to have noted intensely ambivalent behaviour after a child has returned home include Robertson ( 1958b), Robertson & Robertson ( 1971), and Moore ( 1969b; 1971).
189
Anger: functional and dysfunctional
Although sometimes the aggressive behaviour of a child who has experienced a separation appears to be directed towards all and sundry, often, as in the doll-play sessions mentioned above, it is plainly directed towards a parent or parentsubstitute and is an expression of anger at the way he has been treated. Sometimes it is the anger of hope; sometimes the anger of despair.
On occasion a child's hostility to a parent takes the form of a reproach for his having been absent when wanted. For example, Robertson ( 1952) describes the angry reproaches of Laura, a child of two years and four months whom he had filmed during an eight-day stay in hospital for a minor operation. Some months after her return home Robertson was showing an early version of his film to her parents for their comments, while Laura was in bed believed asleep. As it happened, she awoke, crept into the room and witnessed the last few minutes of the film, in which she is seen on the day of her return from hospital, at first distressed and calling for her mother, later when her shoes are produced delighted at the prospect of going home and finally departing from hospital with her mother. The film over and the lights switched up, Laura turned away from her mother to be picked up by her father. Then, looking reproachfully at her mother, she demanded 'Where was you, Mummy? Where was you? ' Similarly, Wolfenstein ( 1957), in her study of
-246-
responses to disaster, relates how a small girl who had been apart from her father during a tornado, when reunited with him afterwards, hit him angrily and reproached him for having been away from her.
Both these little girls seemed to be acting on the assumption that parents should not be absent when their child is frightened and wants them there, and were hopeful that a forceful reminder would ensure that they would not err again.
In other cases a child's anger is the anger of despair. For example, in Chapter 1 there is a description (quoted from Burlingham & Freud 1944) of Reggie who was being cared for in the Hampstead Nurseries and who, by the age of two and a half years, had already had a number of mother figures. Then, two months later, the nurse to whom he was attached left to get married. Not only was Reggie 'lost and desperate' after her departure, but he refused to look at her when she visited him a fortnight later. During the evening after she had left he was heard to remark: 'My very own Mary-Ann! But I don't like her. '
In the case of Reggie we are dealing with a response, not to a single temporary separation, but to repeated prolonged separations each of which amounts to a loss. Although loss is the topic of our third volume, it is useful at this point to trespass briefly across the boundary.
In several papers (e. g. Bowlby 1960b; 1961b; 1963), the present writer has drawn attention to the frequency with which anger is aroused after a loss, not only in children but in adults also, and has raised the question of what its biological function might be. The answer proposed is that whenever separation is only temporary, which in the large majority of cases it is, it has the following two functions: first, it may assist in overcoming such obstacles as there may be to reunion; second, it may discourage the loved person from going away again.
190
Whenever loss is permanent, as it is after a bereavement, anger and aggressive behaviour are necessarily without function. The reason that they occur so often none the less, even after a death, is that during the early phases of grieving a bereaved person usually does not believe that the loss can really be permanent; he therefore continues to act as though it were still possible not only to find and recover the lost person but to reproach him for his actions. For the lost person is not infrequently held to be at least in part responsible for what has happened, in fact to have deserted. As a result, anger comes to be directed against the lost person, as well as, of course, against
-247-
any others thought to have played a part in the loss or in some way to be obstructing reunion.
Further research on responses to bereavement supports this line of reasoning. In her study of the responses of children and adolescents to the death of a parent, Wolfenstein ( 1969) confirms that anger is extremely common, certainly in disturbed children, and endorses the view that it is linked to strong hopes of recovering the lost parent. Parkes ( 1971a) likewise in his study of the responses of widows to loss of husband finds anger to be common, though not universal. He also sees it as part of the bereaved's attempts to recover the lost person.
Thus, whenever a separation has proved to be temporary, and also whenever it is believed that a separation now in train will prove only temporary, anger with the absent figure is common. In its functional form anger is expressed as reproachful and punishing behaviour that has as its set-goals assisting a reunion and discouraging further separation. Therefore, although expressed towards the partner, such anger acts to promote, and not to disrupt, the bond.
Angry coercive behaviour, acting in the service of an affectional bond, is not uncommon. It is seen when a mother, whose child has run foolishly across the road, berates and punishes him with an anger born of fear. It is seen whenever a sexual partner berates the other for being or seeming to be disloyal. It is seen, again, in some families when a member becomes angry whenever his approaches to another member are met by an unresponsive silence ( Heard 1973). It occurs also in nonhuman primates. For example, when he sights a predator a dominant male baboon may behave aggressively towards any wandering members of his own group who may be at risk. Frightened thereby, their attachment behaviour is aroused and they quickly come closer to him, so obtaining the protection inherent in proximity ( Hall & DeVore 1965).
Dysfunctional Anger
Angry behaviour that has coercion as its function and is compatible with a close tie has tended to be neglected by clinicians. Very probably this is because it can so readily become dysfunctional and it is the dysfunctional forms that are usually met with clinically.
Dysfunctional anger occurs whenever a person, child or adult, becomes so intensely and/or persistently angry with his partner that the bond between them is weakened, instead of strength-
-248-
191
ened, and the partner is alienated. Anger with a partner becomes dysfunctional also whenever aggressive thoughts or acts cross the narrow boundary between being deterrent and being revengeful. It is at this point, too, that feeling ceases to be the 'hot displeasure' of anger and may become, instead, the 'malice' of hatred. 1
Clinical experience suggests that the situations of separation and loss with which this work is concerned are especially liable to result in anger with an attachment figure that crosses the threshold of intensity and becomes dysfunctional. Separations, especially when prolonged or repeated, have a double effect. On the one hand, anger is aroused; on the other, love is attenuated. Thus not only may angry discontented behaviour alienate the attachment figure but, within the attached, a shift can occur in the balance of feeling. Instead of a strongly rooted affection laced occasionally with 'hot displeasure', such as develops in a child brought up by affectionate parents, there grows a deep-running resentment, held in check only partially by an anxious uncertain affection.
The most violently angry and dysfunctional responses of all, it seems probable, are elicited in children and adolescents who not only experience repeated separations but are constantly subjected to the threat of being abandoned.
In Chapter 15 descriptions are given of the intense distress produced in young children by such threats, especially when the threats are given a cloak of verisimilitude. During the treatment of Mrs Q it seemed that nothing had caused her greater pain and distress than her mother's realistic threats either to abandon the family or to commit suicide. From experiencing such intense pain it is only a short step to feeling furiously angry with the person who inflicts it. It was in this light that the intensity of anger that Mrs Q felt at times towards her mother seemed most readily understood.
A similar conclusion was reached some years ago by Stott ( 1950), a British psychologist who lived for four years in an approved school studying the personalities and home backgrounds of 102 youths aged fifteen to eighteen years who had been sent there because of repeated offences. The information he gathered was derived from long interviews with the boys themselves and with their parents, and also from many informal contacts he had with the boys during their stay in the school. The boys, he found, were deeply insecure and their delinquencies
____________________
1 Definitions given in the Oxford English Dictionary.
-249-
in many cases seemed to have been acts of bravado. Adverse parental attitudes and disrupted relationships were found to have been common, as is usual in such studies, and were thought to account for much of the boys' sense of insecurity. Nevertheless, what impressed Stott more than anything else was evidence that in many cases mother, and in a few cases father, had used threats to desert as a means of discipline and how intensely anxious and angry these threats had made the boys. Although Stott gives particulars of some typical cases, he expresses himself reluctant to give numbers, partly because it was only late in the inquiry that he realized how immensely important such threats probably are and partly because there were a number of cases in which he felt fairly confident that threats had played an important role despite the fact that their use in these cases had been strenuously denied by both boy and parents.
192
Stott draws attention to the combination of intense anxiety and intense conflict inevitably aroused by threats of this kind. For, while on the one hand a child is made furiously angry by a parent's threat to desert, on the other he dare not express that anger in case it makes the parent actually do so. This is a main reason, Stott suggests, why in these cases anger at a parent usually becomes repressed and is then directed at other targets. It is a reason also why a child or adolescent who is terrified of being deserted tends instead to complain of being afraid of something else, perhaps of the dark or of thunder or of an accident. In the next two chapters a shift of exactly this kind as regards the situation allegedly feared is held to explain the symptomatology of a large proportion of patients at present diagnosed as phobic.
It seems not unlikely that a number of individuals who become literally murderous towards a parent are to be understood as having become so in reaction to threats of desertion that have been repeated relentlessly over many years. For example, in an early paper that calls attention to the traumatic effects of separation, Kestenberg ( 1943) describes a girl of thirteen who had been deserted by her parents and who had been cared for by a succession of other people. She trusted no one and responded to any disappointment by some vengeful action. During the course of treatment this girl pictured herself as grown up and so able to revenge herself on her mother by killing her. Many analysts who have treated patients with this type of background could give similar examples.
-250-
In another paper that also relates anger to separation, Burnham ( 1965) makes brief reference to two patients who actually engaged in matricide. One, an adolescent who murdered his mother, exclaimed afterwards 'I couldn't stand to have her leave me'. Another, a youth who placed a bomb in his mother's luggage as she boarded an airliner, explained 'I decided that she would never leave me again'. The hypothesis proposed makes these statements less paradoxical than they appear.
These admittedly are no more than clinical anecdotes, and no adequate history of previous family relationships is given for any case. Furthermore, so far as is known, no researcher since Stott has made a systematic study to test a possible causal link between violent anger directed towards an attachment figure and a history of being subjected by that figure to repeated threats of being abandoned. At present, therefore, the suggested link is hardly more than a conjecture; but as a lead for research it seems promising.
A Test for Appraising Responses to Separation
Psychoanalysts and others who adopt an object-relations approach have for many years regarded the balance of a persons's disposition to love, to become angry with, and to hate his attachment figure as a principal criterion in making a clinical assessment. In recent years Hansburg ( 1972), by taking as his starting-point certain measures of how a person responds to separation, has begun to put this onto a more systematic footing.
The clinical test Hansburg is developing comprises a dozen pictures, all but three of which depict a situation in which either a child is leaving his parents or a parent is leaving his child. Some of the situations, such as a child leaving to go to school or mother leaving her child at bedtime, are of a kind that any child of over six would be expected to take in his stride. Others are of a more disturbing character. They include a picture in which the child's mother is being taken by ambulance to hospital, and another in which the child is going off to live
193
permanently with his grandmother. Under each picture is written a title making explicit what the picture represents.
In its present form the test is suitable for children and young adolescents in the age-range ten to fifteen years. Hansburg reports that, despite the upsetting nature of some of the scenes, administering the test has not created difficulties. Should the test prove as useful as it promises to be, versions suitable for
-251-
younger children and also for older adolescents and adults could readily be designed.
In presenting each picture the clinician asks the child being tested, first, 'Did this ever happen to you? ' and then, if the answer is no, 'Can you imagine how it would feel if it did happen? ' The child is then presented with a series of seventeen statements of how a child might be expected to feel in such a situation, and is invited to tick as many of them as he thinks would fit. Although for each picture the seventeen statements are phrased a little differently, the range of feelings described is similar. The following selection of eight statements illustrates part of the range of feeling covered:
'feeling alone and miserable' 'feeling sorry for his parents' 'feeling that he doesn't care what happens' 'feeling he will do his best to get along' 'feeling angry at somebody' 'feeling that, if he had been a good child, it would not have happened' 'feeling that his house will now be a scary place to live in' 'feeling that it is not really happening, it's only a dream'.
Preliminary findings show, among other things, that children growing up in stable families give two or three times as many responses that express distress and concern at what is happening as responses that express anger and blame. By contrast, disturbed children who have experienced long and/or repeated separations, many of whom come from rejecting families, give at least as many angry and fault-finding responses as they do responses expressing distress and concern. This very marked difference in the balance of responses is especially evident in respect of pictures that represent a major disruption of a child's bond with his parents; in respect of pictures that represent only a routine and transient separation the difference in balance is less evident.
Another interesting difference of balance, also seen especially in response to pictures representing a major disruption, is in the proportion of responses that indicate that the child will do his best to get along on his own or that he will be happier as a result of the event. While these form only a small minority of the responses given by children from stable homes, they are much in evidence in the responses of children who have experienced long and repeated separations or who come from
-252-
unhappy homes. There is reason to believe that most such responses are expressions of a forced and premature attempt at autonomy that will prove brittle, a condition described by Winnicott ( 1955a) as a 'false self'. Some characteristics of persons who, by contrast, show a stable autonomy, and the conditions in which such autonomy develops, are the subject of Chapter 21.
194
Anger, ambivalence, and anxiety
In the schema proposed, a period of separation, and also threats of separation and other forms of rejection, are seen as arousing, in a child or adult, both anxious and angry behaviour. Each is directed towards the attachment figure: anxious attachment is to retain maximum accessibility to the attachment figure; anger is both a reproach at what has happened and a deterrent against its happening again. Thus, love, anxiety, and anger, and sometimes hatred, come to be aroused by one and the same person. As a result painful conflicts are inevitable.
That a single type of experience should arouse both anxiety and anger need cause no surprise. At the end of Chapter 8 it is pointed out that students of animal behaviour have observed that in certain situations either form of behaviour may be aroused and that whether an animal responds with attack or withdrawal, or with a combination of both, depends on a variety of factors that have the effect of tipping the balance either one way or the other. Between anxious attachment and angry attachment an analogous type of balance appears to obtain. A child who at one moment is furiously angry with a parent may at the next be seeking reassurance and comfort from that same parent. A similar sequence may be seen in lovers' quarrels. It is not by chance that the words 'anxiety' and 'anger' stem from the same root ( Lewis 1967). 1
____________________
1 It is of interest that in one of the reports of an infant chimpanzee brought up by humans
this same mixture of anger and anxiety is described as occurring when separation threatens ( Kellogg & Kellogg 1933). The authors, who adopted a female chimpanzee, Gua, at the age of seven months, discuss the nature of what are commonly described as 'temper tantrums', and the situations that elicit them. 'By far the most frequent occasion for the appearance of a tantrum', they report, 'was when she was left alone or when . . . it was momentarily impossible for her to get into the protecting arms of one of the experimenters. . . . In the more violent type of tantrum, such as that which resulted when we
-253-
Psychoanalysts have for long been especially interested in the interrelationships of love, fear, and hate, since in clinical work it is common to find patients whose emotional problems seem to spring from a tendency to respond towards their attachment figure with a turbulent combination of all three: intense possessiveness, intense anxiety, and intense anger. Not infrequently vicious circles develop. An incident of separation or rejection arouses a person's hostility and leads to hostile thoughts and acts; while hostile thoughts and acts directed towards his attachment figure greatly increase his fear of being further rejected or even of losing his loved figure altogether.
To account for the intimate connections found between attachment, anxiety, and anger, a number of hypotheses have been advanced. Some are based on an assumption that the aggressive component is reactive to frustration of some kind; others hold that aggressive impulses well up within and find expression almost irrespective of what an individual's experience may be. Among leading analysts who have regarded ambivalence to a loved figure as a key issue in psychopathology and have proposed solutions, Fairbairn ( 1952) advocates a frustration-aggression type of hypothesis; while Melanie Klein ( 1932; 1948b) holds that all aggressive feeling and behaviour is an expression of a death instinct that wells up within and must be directed outwards.
195
Because of the great influence that Melanie Klein has had on many psychoanalysts and child psychotherapists we consider her views first.
The clinical phenomenon to which Klein drew especial attention during the 1920s and 1930s is that some children who are attached to mother with unusual intensity are, paradoxically, possessed of strong unconscious hostility also directed towards her. In their play they may express much violence towards a mother figure and then become concerned and anxious lest they have destroyed or alienated mother herself. Often after an outburst a child runs from the analytic room, not only for fear
____________________
ran away faster than Gua could follow, she seemed to become "blind with fear" and would utter a series of shrill vibrant screams. . . . ' She would then run almost at random and occasionally bump headlong into bushes or other obstacles. Ultimately she would fall to the ground, and grovel in the sand. In their discussion, the Kelloggs are in doubt whether to regard the tantrum as expressing rage or fear. Their account suggests that it contains elements of both.
-254-
of consequences from the analyst, but also, it is suggested, to assure himself that mother is still alive and loving. Observations of this kind are now amply confirmed; and much other evidence demonstrates without doubt that the presence of hostile impulses, whether conscious or unconscious, directed towards a loved figure can greatly increase anxiety. (Witness Mrs Q's acute anxiety for her son's safety arising from her own impulses to throw the child out of the window, recounted in Chapter 15. ) Thus the value of many of Klein's observations remains intact whether or not we accept her ideas in regard to the origin of anger and aggression.
It must, however, be remembered that just as hostility directed towards a loved figure can increase anxiety, so can being anxious, especially that an attachment figure may be inaccessible or unresponsive when wanted, increase hostility. It is of both great theoretical and great practical importance to determine how these vicious circles begin. Does increased anxiety precede increased hostility, is it the other way round, or do they spring from a common source? When looking backwards from data provided by a patient in analysis it is notoriously difficult to unravel the sequence, as Ernest Jones noted many years ago ( Jones 1929); and this difficulty holds no less during the treatment of young children than it does for older patients. Neglect of this methodological difficulty and insufficient attention to family relationships have, it is held, led Klein to one-sided conclusions.
Logically it is clearly possible for intense anxiety to precede intense hostility in some cases, for the sequence to be reversed in others, and for them to spring from a single source and so be coincidental in yet a third group. Such possibilities, however, are not allowed for by Klein's formulation. Instead, her basic tenet is that increased anxiety is always both preceded by and caused by increased hostility; that anxiety may sometimes be independent of, sometimes itself provoke, and often be aroused by the same situation as, increased hostility is not conceded.
Fairbairn addresses himself to the same clinical problem as Klein but proposes a very different solution. In the absence of frustration, he holds, an infant would not direct
196
aggression against his loved object. What leads him to do so is 'deprivation and frustration in his libidinal relationships--and more particularly . . . the trauma of separation from his mother' ( Fairbairn 1952).
-255-
The position consistently adopted by the present writer (e. g. Bowlby 1944; 1951; 1958a), and, as will already be apparent, adopted also in this work, is close to Fairbairn's. 1 Anger and hostility directed towards an attachment figure, whether by a child or an adult, can be understood best, it is held, as being in response to frustration. Frustration, it is true, can affect motivational systems of any kind. But there is reason to believe that the motivational systems with which this work is concerned, namely those mediating attachment behaviour, are those affected in a very large proportion of the most severe and persisting cases of frustration, especially when the agent of frustration is, wittingly or unwittingly, the attachment figure himself/herself.
The reason that anxiety about and hostility towards an attachment figure are so habitually found together, it is therefore concluded, is because both types of response are aroused by the same class of situation; and, to a lesser degree, because, once intensely aroused, each response tends to aggravate the other. As a result, following experiences of repeated separation or threats of separation, it is common for a person to develop intensely anxious and possessive attachment behaviour simultaneously with bitter anger directed against the attachment figure,. and often to combine both with much anxious concern about the safety of that figure. 2
Because of the tendency for anger and hostility directed towards a loved person to be repressed and/or redirected elsewhere (displaced), and also for anger to be attributed to others instead of to the self (projected), and for other reasons too, the pattern and balance of responses directed towards an attachment figure can become greatly distorted and tangled. Furthermore, because models of attachment figures and expectations about their behaviour are built up during the years of childhood and tend thenceforward to remain unchanged, the behaviour of a person today may be explicable in terms, not of his present situation, but of his experiences many years earlier.
____________________
1 A principal point of difference is that in much of his work Fairbairn tends to identify
attachment with feeding and orality and so to attribute proportionally greater significance
to a child's first year or two than is attributed by the present writer.
2 Frustrations of another kind that can engender much anger towards a parent occur when a
parent demands that his (or her) child act as a caretaker to him (or her), thus, as noted above (p. 244 ), inverting the usual parent and child roles.
-256-
It is, indeed, because of these complexities that the nature and origin of our feeling and behaviour are often so obscure, not only to others but to ourselves as well. These are all matters to be considered further in the third volume.
-257-
197
Chapter 18
Anxious Attachment and the 'Phobias' of Childhood
Often and often afterwards, the beloved Aunt would ask me why I had never told any one how I was being treated. Children tell little more than animals, for what comes to them they accept as eternally established.
RUDYARD KIPLING, Something of Myself
Phobia, pseudophobia, and anxiety state
It is argued earlier (Chapter 14) that an individual's susceptibility to respond with fear whenever he meets a potentially alarming situation is determined in very large part by the type of forecast he makes of the probable availability of attachment figures, and that these forecasts derive from the structure of the working models of attachment figures and of self with which he is operating. In the same chapter it is argued, further, that these models are probably built up throughout the years of childhood and adolescence and that they tend thereafter to remain comparatively stable; and, finally, that the particular forms that a person's working models take are a fair reflection of the types of experience he has had in his relationships with attachment figures during those years, and may perhaps be having still. Evidence regarding the nature of the experiences that lead to increased susceptibility to fear is considered in Chapters 15 and 16.
In this chapter and the next the potential usefulness of the theory is illustrated by applying it to certain clinical syndromes in which overt anxiety and fear are prominent. The conditions selected are those commonly grouped under the label 'phobia', a label which, as currently used by psychiatrists and psychologists (e. g. Andrews 1966; Marks 1969), includes a broad range of conditions in which anxiety and fear are the main symptoms. Principal instances to be examined are 'school phobia' and 'agoraphobia'.
Although when the condition is of recent onset some patients
-258-
so labelled respond to fairly simple therapy (e. g. Friedman 1950; Kennedy 1965), others pose a much greater problem. A majority of those whose condition has been present for a long time, it is now agreed, suffer also from a wide variety of other emotional troubles. Most are timid individuals prone not only to fear situations of many kinds but to become depressed, and apt to develop various psychosomatic symptoms as well. In all such cases the feature to which the term phobia is applied, for example fear of school (school phobia) and of crowded places (agoraphobia), is found to be only a small, and sometimes even negligible, part of a deep-seated disturbance of personality that has been present for many years.
There is, however, a small minority of long-standing cases of phobia that appear to be very different. The individuals concerned, to whom Marks ( 1969) has drawn attention, are intensely afraid of some particular animal but, in all other respects, are stable personalities not given to psychological disturbance. Marks presents evidence that, in regard to personality functioning and psychophysiological responses, these individuals not only resemble people
198
who are psychiatrically healthy but differ markedly from those diagnosed agoraphobic. They differ from agoraphobics also in the age when difficulty begins. Whereas agoraphobic symptoms usually appear after the age of ten years, a specific and limited animal phobia has usually been present since before the age of seven years. The specific phobia appears to be due to the persistence into later life of the tendency to fear animals that is found commonly during the early years of childhood but usually diminishes to moderate or negligible proportions before or during adolescence.
Discussion here concentrates on the majority group, namely people who suffer from deep- seated disturbances of personality. The minority group, comprising people who suffer from specific animal phobias, probably present a different type of problem and are touched on only briefly.
In what follows the term phobia is used only because so much of the descriptive material with which we are concerned is to be found in the literature under that head. It is placed in quotation marks in the chapter title in order to indicate a belief that, when applied to patients in the majority group, it is being misapplied.
Others also have held that many of the cases commonly labelled phobic are mislabelled. Brun ( 1946) distinguishes a group that he terms 'pseudophobic', and includes in it all cases of agoraphobia. Snaith ( 1968) similarly argues that agoraphobia
-259-
is best regarded as a pseudophobia (although he uses the term in a way different from Brun). In the present work it is argued that not only is agoraphobia best regarded as a pseudophobia but so also is school phobia. By contrast, intense fear of a specific animal or of some other discrete situation in a person of otherwise healthy personality can sometimes be regarded as a case of true phobia.
The distinction between the two conditions is readily defined in terms of the present theory. In the case of a phobic person, what is most feared is the presence of some situation that other people find much less frightening but that he either takes great pains to avoid or else urgently withdraws from. In the case of a pseudophobic person, what is most feared is the absence or loss of an attachment figure, or some other secure base, towards which he would normally retreat. Whereas in the case of phobia the clinician identifies the feared situation correctly, in the case of pseudophobia the true nature of the feared situation often goes unrecognized and the case is misdiagnosed as one of phobia.
Although the label pseudophobia helps to draw attention both to the problem itself and to the tangled misconceptions about underlying psychopathology that abound in the literature, it is hardly suitable for regular use. A far better way to deal with the pseudophobias is to classify them simply as anxiety states and thereby to combine them with the many cases in which anxiety is said to be 'free-floating'. For cases of pseudophobia and anxiety state not only have in common the same age-range of onset but 'overlap considerably in their clinical features' ( Marks 1969). Indeed, once the role that anxious attachment plays in these conditions is firmly grasped, it becomes clear that patients said to be suffering from free-floating anxiety, no less than those labelled here as pseudophobic, are in an acute or chronic state of anxiety about the availability of their attachment figure(s). ?
199
In support of our thesis we devote most of this chapter to an examination of school phobia, about which there is a large and revealing literature; subsequently we consider afresh two cases of childhood phobia that have long been classics in the literature of psychoanalysis and of learning theory respectively. Special attention is given to the patterns of interaction that appear to have characterized the children's families. In the chapter following we examine agoraphobia in the light of our discussion of school phobia.
-260-
'School phobia' or school refusal
During the past fifteen years there has grown up an extensive literature on a condition known usually as school phobia ( Johnson et al. 1941) or, and better, school refusal ( Warren 1948). These terms apply when children not only refuse to attend school but express much anxiety when pressed to go. Their non-attendance is well known to their parents, and a majority of the children remain at home during school hours. Not infrequently the condition is accompanied by, or masked by, psychosomatic symptoms of one kind or another -- for example, anorexia, nausea, abdominal pain, feeling faint. Fears of many kinds are expressed -- of animals, of the dark, of being bullied, of mother coming to harm, of being deserted. Occasionally a child seems to panic. Tearfulness and general misery are common. As a rule, the children are well behaved, anxious, and inhibited. Most come from intact families, have not experienced long or frequent separations from home, and have parents who express great concern about their child and his refusal to attend school. Relations between child and parents are close, sometimes to the point of suffocation.
In all these respects the condition differs from truancy. Truants from school do not express anxiety about attending, do not go home during school hours, and usually pretend to their parents that they are attending. Often they steal or are otherwise delinquent. Commonly they come from unstable or broken homes, and have experienced long and/or frequent separations or changes of mother figure. Relations between a truant and his parents are likely to be quarrelsome or distant.
The validity of the distinction between school phobia and truancy is well attested, notably by the study of Hersov ( 1960a), who compares a series of fifty cases of school refusal with a matched series of fifty truants and with another contrast group, also drawn from a clinic population. Although several other studies are based on a series of cases seen in clinical practice, in none of them are results treated statistically. Instead, observations are presented descriptively and interwoven with a greater or less measure of theoretical interpretation. Among such studies, each based on a series of between twenty and thirty cases, are those by Talbot ( 1957), Coolidge and his colleagues ( 1957; 1962), Eisenberg ( 1958), and Davidson ( 1961). For her two papers Sperling ( 1961; 1967) draws on experiences with fifty-eight children, some of whom had long analytic treatment.
-261-
Kennedy ( 1965) reports on fifty cases of recent and acute onset dealt with by simple brisk methods. Weiss reports the treatment and follow-up some years later of fourteen children and adolescents treated as inpatients ( Weiss & Cain 1964; Weiss & Burke 1970). A number of empirically based articles on the family background of school refusers are published in the Smith College Studies in Social Work and reviewed by Malmquist ( 1965). A book by Clyne (
200
1966), based on fifty-five cases seen in general practice, gives a vivid description of the many and varied clinical pictures encountered. Among other publications are early papers by Broadwin ( 1932) and E. Klein ( 1945), a book by Kahn & Nursten ( 1968), reviews by Frick ( 1964), Andrews ( 1966), and Berecz ( 1968), and several papers reporting on small numbers of cases that have been treated by one or another method, including some by behaviour therapy (e. g. Lazarus 1960; Montenegro 1968).
At an empirical level there is substantial agreement among these many authors, both in regard to the personalities, behaviour, and symptoms presented by the children and in regard to the personalities, behaviour, and symptoms presented by the parents. Furthermore, there is widespread agreement that what a child fears is not what will happen at school, but leaving home. With the exception of Frick ( 1964), who expresses doubt, almost all students of the problem conclude that disagreeable features of school, for example a strict teacher or teasing or bullying from other children, are little more than rationalizations. In keeping with this view, Hersov ( 1960b) found that only a minority of his fifty school-refusing children made any complaint about teacher or schoolmates. Many of the children he studied stated that once in school they felt quite secure. Thus, unlike what occurs in genuine phobias, exposure to the alleged phobic situation does not exacerbate the sufferer's fear. Several other authors confirm this finding, and also that fear is often at its height either just before leaving home or on the journey to school. The subjects of a follow-up study by Weiss & Burke ( 1970), looking back on their problem, confirm that it arose from difficulties in family relations.
Because the situation feared is that of leaving home, the term school phobia is an obvious misnomer.