No More Learning

The sex and birth position of the child matter: parents are more relaxed and less punitive with second children than with first-borns. Male children are generally more vulnerable to family discord than are females. The death of a
Figure 3. 1 Developmental pathways from maternal deprivation
Maternal deprivation 53
parent is more damaging for a same-sex child than if they are the opposite sex. Temperament plays an important part too: children who are less adaptable and more prone to negative moods are more likely to be targets of parental criticism than their more easy-going siblings, and are more likely to develop a childhood psychiatric disorder. Even in discordant homes, if the child has a good relationship with one parent or with a grandparent, this acts as a protective factor against conduct disorder. Finally, the social environment is important. Inner-city areas have much higher rates of childhood psychiatric disorder than country or small- town areas, and even within inner cities some schools are much more successful in helping their pupils to avoid delinquency than others.
IMPLICATIONS FOR PSYCHOTHERAPY
Key issues for adult psychotherapists are the need to clarify more precisely the links between early childhood difficulty and emotional disorder in later life (Rutter 1986); the question of how some people survive and are even strengthened ('steeled') by adversity, while others go under (Rutter 1985); and the need for a model that will suggest at what points in the process psychotherapeutic intervention is likely to produce change (Holmes 1991).
Social psychiatry tends to emphasise present adversity in the causation of neurosis, while psychoanalytic explanations stress the past. The evidence suggests that both current and past difficulties are important, and that self-esteem is a crucial factor linking the two. Looking at adverse experiences in childhood, those who, despite loss or difficulty, manage to maintain a sense of self-esteem do well. Self-esteem in turn rests on two main foundations: self-efficacy and good relationships. Success at school - in social relationships (especially the capacity to generate humour), athletic prowess, musical ability or scholastic achievement - is correlated with better adjustment in institution- raised children in adult life (Rutter and Quinton 1984). There are likely to be a series of interlocking benign or vicious circles here. Good self-esteem means a child will be likely to cope with deprivation - chronic illness in a parent, for example - and the fact of coping will in itself enhance self-esteem, and give the individual a feeling that they will be able to cope in the future.
54 Origins
This in turn will influence their choice of partner and the kind of relationship they have with them. Conversely, as Beck et al. (1979) and Ryle (1990) argue, depressed people will expect themselves to cope badly, will perceive themselves as doing so, may do so in fact, all of which will be experienced as depression-reinforcing 'failure'.
Apart from coping and competence, the second important childhood component of self-esteem derives from good relationships. Psychotherapists have long suggested that a history of at least one good relationship in the past predicts good outcome in therapy (Malan 1976), and this too is confirmed by empirical studies. An important point about both self-efficacy and good relationships is that they can generalise, so that one positive feature will lead to good self-esteem, despite an otherwise gloomy picture. The opposite is the case in depression (Brown and Harris 1978), where adverse experiences are generalised into a global feeling of hopelessness.
Bion mocked the early psychoanalytic fellow travellers like Suttie for their simplistic overemphasis on past trauma: 'doctor put it in the past' (Pines 1991). Equal in importance to past influences in the adult outcome of maternal deprivation is, as several studies have shown, the quality of a person's current intimate relationships. Vulnerable women who experience loss are protected from depression by the presence of a confiding relationship with a spouse or partner (Brown and Harris 1978). Parker and Hadzi-Pavlovic (1984) found that people whose parents die in childhood are less prone to depression in adult life if they have an affectionate spouse. Rutter and Quinton (1984) report similar findings for institution-raised women, who in general have more psychosocial difficulties than controls, and were much more likely to react badly to stress, unless they had a supportive husband in a harmonious marriage. This suggests another important vicious circle, since maternally deprived girls are more likely to marry unstable and similarly deprived men: childhood difficulty leads to low self-esteem, which makes for poor choice of sexual partner, which in turn leaves women unprotected from stress in adult life. As Bowlby (1952) puts it, there are 'strong unconscious drives which lead husbands and wives to create the very problems of which they complain', and so produce 'the distorted light in which they see the behaviour of their spouse'.
Maternal deprivation 55
There are important implications of these findings for psychotherapy. There is an implicit contradiction in the psychoanalytic emphasis on the overwhelming importance of early experience - and even more so phantasies in early childhood - in determining adult difficulty and the claims for the efficacy of psychoanalytic therapy. If continuity between childhood and adult life is so strong, how is psychoanalysis likely to reverse it? The recent evidence suggests a much more subtle relationship between past and present, in which a person's partner plays a crucial role in determining outcome. Caspi and Elder (1988) found that 'difficult' children were more likely to demonstrate ill-tempered parenting and poor social control in adult life, but this only emerged if they were married to non-assertive men. Difficult behaviour in childhood made it more likely that these women would marry non-assertive men, but when they did not, then poor parenting was avoided. As we shall see in Chapter 8, therapy, through empathy and limit-setting, may play a similar role to marriage in helping to modify maladaptive behaviours. This may be particularly applicable to those whose early experiences have made it hard for them, despite a longing for intimacy, to sustain close relationships at all (Parker et al. 1992).
Apart from very severe cases, there is no simple one-to-one correlation between childhood mental states and adult difficulty. There are a number of environmental, and to some extent accidental, mediating factors which determine whether outcomes are favourable or not: the area a person grows up in, the school they go to, whether or not they happen to meet the right person at the right time. Nor is there a simple relationship between environmental stress and disturbance; the meaning and context of a particular event is critical. A teenager who storms out of the house after a row about what time he should come home, followed by the threat of 'You'll be the death of me', and who returns to find that his father has died suddenly is going to be more vulnerable to difficult relationships (perhaps characterised by avoidance and inhibition of anger and therefore poor conflict resolution), than one whose parent dies peacefully over several months with good opportunities for grieving. Also, it is important to see the 'victim' of deprivation not as a passive recipient of stress, but as an active agent, in a dynamic relationship with his environment, trying to make sense of experience, to master it and to cope as best he can, but also, via the benign and vicious circles of neurosis, as an active participant in his own downfall or deliverance.
56 Origins
CONCLUSIONS
Maternal deprivation emerges from this account not as the cause of neurosis, but as one, albeit vital, vulnerability factor among many in a complex web of developmental influences. Because nothing succeeds like success, and nothing fails like failure, these influences may summate in retrospect to give the impression of a simple choice between primrose or thorny paths, but there are in fact many roads less travelled (Frost 1954) and it is the psychotherapists' task to explore these. The circularity of neurotic patterns both in the present and over time is a central unifying concept, and suggests how and why many different kinds of intervention may be effective. Analytic therapy may be an example of how one good relationship can counteract many adverse influences: the nature of that good relationship will be considered further in Chapter 8. Cognitive-behavioural therapy concentrates on increasing a person's sense of self-efficacy, and reducing generalisation of bad feelings so that self-esteem remains intact despite loss. Family and marital therapy tackle relationships directly, thereby enhancing the buffering against stress. All types of time-limited therapy assume that if a person can be helped to re-engage with the benign cycles of normal life (although feminists argue that the definition of what constitutes a 'normal' family needs to be contested), then outcomes will be good, since, in Bowlby's (1952) words, 'there is in almost all families a strong urge to live together in greater accord, and this provides a powerful motive for favourable change'.
We have moved from simple privation to the complexities of relationships, from loss to the nature of the bond that is broken, from a simple model of environmental trauma to a consideration of its psychological impact. The stage is set for Bowlby's move from maternal deprivation to Attachment Theory, and after a short literary diversion, we shall, in the next and following two chapters, follow him there.
OLIVER TWIST: AN INTERLUDE
Dickens' Oliver Twist, with its mixture of realism, caricature, and fairy-tale, can be seen as a classic account of maternal deprivation. Oliver, orphaned at birth, brought up 'by hand' for the first few months of his life, spends his childhood in the 'parochial' orphanage, 'where twenty or thirty other juvenile offenders against the poor-
Maternal deprivation 57
laws rolled about the floor all day, without the inconvenience of too much food or too much clothing'. Protesting against the 'tortures of slow starvation', he 'asks for more', is sent out to work for his pains, and, after running away from further cruelty, falls among thieves and so begins his career as a delinquent, much as Bowlby would have predicted. But here, despite many reversals and cruel twists, his fortunes change. He is rescued first by the kindly Mr Brownlow, and a second time by the loving Rose Maylie. He is recognised as being in some way different from the run of juvenile thieves. In two crucial passages he is watched over by these parental figures in his sleep:
The boy stirred, and smiled in his sleep, as though these marks of pity and compassion had awakened some pleasant dream of a love and affection he had never known . . . some brief memory of a happier existence, long gone by.
Later, anticipating Winnicott's (1965) concept of 'being alone in the presence of the mother', Oliver once again sleeps after a terrifying escapade of attempted robbery in which he is wounded, watched over by the tender Rose Maylie:
It is an undoubted fact, that although our sense of touch and sight be dead, yet our sleeping thoughts, and visionary scenes that pass before us, will be influenced . . . by the mere silent presence of some external object. [Italics in the original]
The book ends, of course, happily, with Oliver's affluent parentage established, evil (in the shape of Monks, Sykes and the Bumbles) vanquished, and with the beginning of secure attachment:
Mr Brownlow . . . from day to day filling the mind of his adopted child with stores of knowledge, and becoming attached to him, more and more, as his nature developed itself. . . . [My italics]
The universality of Dickens' message means that each generation can bring to the story its own themes and preoccupations. For the Victorians it was a social tract documenting the iniquities of the poor laws, and a contrast between the cruelties of the bad father and the benign love of Mr Brownlow. But this is no sentimental Victorian morality tale. The powers of good and evil
58 Origins
are evenly balanced. Mr Brownlow's benign Bowlbian view of the perfectibility of human nature is contrasted with the cynical realism of his friend Mr Grimwig, who, at least in the short run, wins his wager that Oliver will take Mr Brownlow's money and run.
A Kleinian reading might see in its exaggerations and description of unbearable hunger an account of the 'bad breast' and the projection into it of the child's hatred and rage. As Oliver's bad feelings are balanced by good 'therapeutic' experience, so he becomes strengthened in his resolve to escape from the clutches of Fagin and Sikes, and sees them and the Bumbles no longer as phantasmagoric creatures of enormous power but as the seedy petty criminals which they are.
The Bowlbian perspective on Oliver Twist starts with the mystery of Oliver's parentage. The book opens with the description of a place - the orphanage where Oliver was raised. It ends with a name - Agnes, Oliver's mother, a name on a tomb:
There is no coffin in that tomb. . . . But, if the spirits of the dead ever come back to earth, to visit spots hallowed by the love - the love beyond the grave - of those whom they knew in life, I believe that the shade of Agnes sometimes hovers round that solemn nook.
In finding his story, Oliver has found his lost mother even though he has never met her in reality, and can never do so, not even in her coffin. The movement from the concrete attachment to person and place of childhood to the possession as adults of a story, of a name which has been internalised, is a theme common to literature and to psychotherapy. The book is closed, the parents who nurtured (and failed to nurture) us are no longer there, but their characters remain with us - for good or ill. Therapy recreates past attachments so that they can live inside us again. The progress from attachment to narrative is part of the Bowlbian story too: we shall examine it more closely in the final section of the book.
Part II
Attachment Theory
Chapter 4
Attachment, anxiety, internal working models
All of us, from the cradle to the grave, are happiest when life is organised as a series of excursions, long or short, from the secure base provided by our attachment figures.
(Bowlby 1988)
In this and the following chapter we shall outline the main features of Attachment Theory, starting with the first of the two great themes described poetically by Bowlby as the 'making and breaking of affectional bonds'.
Bowlby was in some ways, like Freud, a late starter. Although he had a substantial body of related work behind him, it was not until around his fiftieth year, in a series of papers published between 1958 and 1963 (Bowlby 1958, 1960, 1961), that he began to formulate the main outlines of Attachment Theory. Perhaps psychological theorising, like novel writing, but unlike poetry or mathematics, requires a certain maturity; perhaps, like Freud too, Bowlby's revolutionary spirit was combined with a cautiousness of personality that meant that he needed to be absolutely certain of his ground before attempting to challenge the heavens. Bowlby had always felt some unease about the scientific status of psychoanalysis: his discovery of ethology in the 1950s provided him with the scientifically secure base from which to make his conceptual advance: 'The time is already ripe for a unification of psychoanalytic concepts with those of ethology, and to pursue the rich vein of research which this unification suggests' (Bowlby 1953c).
62 Attachment Theory
THE THEORETICAL AND EXPERIMENTAL BACKGROUND TO ATTACHMENT THEORY
Bowlby's earlier work had shown that separated or bereaved children experienced, no less than adults, intense feelings of mental pain and anguish: yearning, misery, angry protests, despair, apathy and withdrawal. He had shown too that the longterm effects of these separations could sometimes be disastrous, leading to neurosis or delinquency in children and adolescents, and mental illness in adults. In separating parent from child a delicate mechanism had been disrupted, a fundamental bond broken linking one human being to another. What is the nature of that bond, and how does it develop? These were the questions Bowlby set out to answer.
He had at his disposal two sets of theories. The first was psychoanalysis which, as we have seen, he had embraced and struggled with for the preceding twenty years. The second was ethology, to which his attention had only recently been drawn, when he read the English translation of Konrad Lorenz's King Solomon's Ring (1952) in draft form; soon after, he encountered Tinbergen's (1951) work, and began to collaborate with Robert Hinde (1982b, 1987). Other important influences were the ideas of Kenneth Craik (1943) who, like Bowlby, was a product of the Cambridge Psychology Department, and Ian Suttie (1935), whose book The Origins of Love and Hate was influential in the thirties and had contributed to Bowlby's views on social psychology.
Psychoanalysis offered two different accounts of the infant- mother bond: drive theory and object-relations theory. Both of these were, in Bowlby's eyes, seriously flawed. The first, 'classical', drive-theory account came from Freud's early formulations. Here the bond which links mother to infant is libido, or psychical energy. The newborn infant lives in a solipsistic world of 'primary narcissism' and experiences a build-up of tension - the need to feed, to suck the breast as an expression of his infantile sexuality. The mother provides the vehicle for the discharge of this libido. If she, or her breast, is absent, tension arises due to undischarged libido which is felt by the infant as anxiety. The baby learns to love the mother because she feeds him, and so reduces the inner tension which is felt as anxiety. Bowlby calls this the 'cupboard love' theory of relationships.
In Inhibitions, Symptoms, and Anxiety, Freud (1926) changed his theory of anxiety from one of dammed-up libido to the theory
Attachment, anxiety, internal working models 63
of signal anxiety. Here anxiety is felt whenever there is actual or threatened separation 'from someone who is loved and longed for'. The basis of this love, however, remains satisfaction of physiological need:
The reason why the infant in arms wants to perceive the presence of its mother is only because it already knows by experience that she satisfies all of its needs without delay. The situation, then, which it regards as a 'danger' and against which it wants to be safeguarded is that of non-satisfaction, of a growing tension due to need, against which it is helpless.
(Freud 1926)
Despite this retention of a physiological substratum to relationships, Freud now emphasises that 'it is the absence of the mother that is now the danger'. This shift towards regarding anxiety as based on object-loss is a decisive move towards the Object-Relations viewpoint that has become the predominant psychoanalytic paradigm, especially in Britain (Greenberg and Mitchell 1983). For Melanie Klein, the infant is linked psychologically as well as physiologically to the mother and her breast from birth. She sees an intimate link between the physiological processes of feeding and elimination, and the beginnings of mental and ethical structures in the mind of the infant. The satisfying, nourishing, comforting breast is the prototype of the 'good object'; the absent, withholding, empty breast is the 'bad object', containing not only the actual failures and unresponsiveness of the mother, but also the infant's reactions to those failures, projected into and attributed to the 'bad breast'.
For Bowlby, both Freud and Klein failed to take the all- important step of seeing attachment between infant and mother as a psychological bond in its own right, not an instinct derived from feeding or infant sexuality, but sui generis:
The young child's hunger for his mother's love and presence is as great as his hunger for food. . . . Attachment Theory provides a language in which the phenomenology of attachment experiences is given full legitimacy. Attachment is a 'primary motivational system' with its own workings and interface with other motivational systems.
(Bowlby 1973a)
64 Attachment Theory
He based his new theory of attachment partly on the findings of ethology, partly on his theoretical critique of psychoanalysis.
As a keen naturalist Bowlby had been particularly struck by the phenomenon described by Lorenz (1952) of following responses in some avian species. Newly hatched goslings follow their mother (or a mother-surrogate), and exhibit analogues of 'anxiety' (cheeping, searching) when separated from her, despite the fact that she does not directly provide them with food. Here bonding seems to be dissociated from feeding. The converse example is provided by Harlow's (1958) monkey studies, which became available around the time Bowlby was publishing his first papers on Attachment Theory. Harlow, in an article with the tongue-in-cheek title 'The nature of love', described how he separated infant rhesus monkeys from their mothers at birth and reared them with the help of surrogate 'wire mothers'. In one series of experiments the infant monkeys were presented with a wire 'mother' to which a feeding bottle had been attached, and another 'mother' without a feeding bottle, but covered with soft terry nappy material. The infant monkeys showed a clear preference for the 'furry' mother, spending up to 18 hours per day clinging to her (as they would with their real mothers) even though they were fed exclusively from the 'lactating' wire mother - a finding which Harlow, arguing as forcibly against a behavioural 'derived drive' theory of bonding as did Bowlby against the psychoanalytic 'secondary drive' hypothesis, concluded, 'is completely contrary to any interpretation of derived drive in which the mother form becomes conditioned to hunger- thirst reduction'.
Geese demonstrate bonding without feeding; rhesus monkeys show feeding without bonding. Thus, argues Bowlby, we must postulate an attachment system unrelated to feeding, which, adopting a biological approach from which psychoanalysis had increasingly become divorced, makes sound evolutionary and developmental sense.
By thinking in terms of primary attachment and bringing the ideas of neo-Darwinism to bear on psychoanalysis, Bowlby identified what he saw as some fundamental flaws in psychoanalytic metapsychology. First, it overemphasises internal dangers at the expense of external threat. The biological purpose of the attachment system is protection from predators which would have been a vital necessity in the environmental conditions
Attachment, anxiety, internal working models 65
in which early man evolved. Infants and small children need to stay close to their mothers at all times, and to signal separation if they are to remain safe from predation. Suttie (1935) called this an 'innate need for companionship which is the infant's only way of self-preservation'. Bowlby criticises psychoanalysts for their over-civilised view of man in which they discount environmental threat, and emphasise instead the projection of 'internal' dangers (feelings of rage and hatred, for example) onto a neutral or benign environment. Even in an urban setting external dangers are far from negligible and children who are victims of injuries in the home or from traffic accidents and sexual attacks are likely to be unprotected and unaccompanied.
Second, Bowlby is critical of the psychoanalytical picture of personality development in which each 'phase' - oral, anal, phallic and genital - succeeds each other in a linear fashion. He questions the idea that normal development can be derived from considering pathological states, and is unhappy with the idea of regression to fixation points as an adequate model of psychological illness. He contrasts Freud's 'homuncular' model in which each stage is predetermined according to some pre-existing plan of development, with an 'epigenetic' model (Waddington 1977) in which several lines of development are possible, the outcome of which depends on an interaction between the organism and its environment. Thus, although the developing child has a propensity to form attachments, the nature of those attachments and their dynamics will depend on the parental environment to which he or she is exposed. Also, the development of the attachment dynamic can be considered as a process in its own right independent of other dynamics - for example, sex or feeding - just as the different organs of the body develop relatively independently of one another.
Bowlby also rejects the teleological 'Lamarckian' view in which the 'purpose' of psychological functions can be determined by some a priori goal: for example, the 'purpose' of attachment is not the reduction of physiological need, but, in evolutionary terms, to increase the fitness of those possessed of it, so protecting them from predators. Finally, he is critical of 'hydraulic' models of drive- discharge, seeing human behaviour rather in terms of control theory whose aim is the maintenance of homeostasis. Infant monkeys separated from their mothers respond with a rise in pulse rate and a fall in body temperature. In humans, Brazelton
66 Attachment Theory
and Cramer (1991) have shown that mothers who have to return to work within a year after giving birth show higher levels of physiological disturbance than those who are able to stay with their babies, and that there is a correspondingly higher incidence of infection in the infants. Secure attachment provides an external ring of psychological protection which maintains the child's metabolism in a stable state, similar to the internal physiological homeostatic mechanisms of blood-pressure and temperature control.
The group of analysts to whom Bowlby felt his ideas were closest were the 'Hungarian School', especially Ferenczi (1955) and Michael Balint (1964). Ferenczi, originator of the famous phrase 'it is the physician's love which cures the patient', had fallen out with Freud over his emphasis on Freud's insistence on the 'real' (as opposed to transferential) nature of the relationship between patient and therapist, and his rather dubious propensity to kiss and hug his patients when he felt it necessary. Balint, his pupil, had postulated a 'primary love' and a primitive clinging instinct between mother and child that are independent of feeding. Bowlby also saw an affinity between his ideas and those of Fairbairn (1952) who, like Bowlby, had jettisoned drive theory in favour of primary object-seeking, and who refused to see adult dependency as a relic of orality, but rather conceived of development as a movement from infantile to mature dependence.
As described in the Introduction, the reaction of the analytic world to Bowlby's challenge was, on the whole, unfavourable. The Kleinians saw him as having betrayed analytic principles, contaminating psychoanalysis with behaviourism, trying to expunge the heart of psychoanalysis - its account of the inner world of phantasy. Anna Freud and her supporters could hardly fail to notice that the Oedipus complex and infantile sexuality - for them, the cornerstones of the psychoanalytic edifice - played virtually no part in Bowlby's writings. What started out as an attempt by Bowlby to modernise psychoanalytic metapsychology and to find a sound biological underpinning for Object-Relations Theory became, in the face of the rejection of his ideas by his psychoanalytic colleagues, increasingly to look like a new psychological paradigm. As we shall see in Chapters 6 and 8, recent developments in 'post-Bowlbian' research have opened out the possibility of reconciliation. But first we must focus more clearly on the nature of attachment theory.
Attachment, anxiety, internal working models 67
WHAT IS ATTACHMENT THEORY?
Attachment Theory is in essence a spatial theory: when I am close to my loved one I feel good, when I am far away I am anxious, sad or lonely. The child away from home for the night plays happily until she hurts herself or bedtime approaches and then feels pangs of homesickness. The mother who leaves her child with a new baby minder thinks endlessly about her baby and misses her dreadfully. Attachment is mediated by looking, hearing and holding: the sight of my loved one lifts my soul, the sound of her approach awakes pleasant anticipation. To be held and to feel her skin against mine makes me feel warm, safe and comforted, with perhaps a tingling anticipation of shared pleasure. But the consummation of attachment is not primarily orgasmic - rather, it is, via the achievement of proximity, a relaxed state in which one can begin to 'get on with things', pursue one's projects, to explore.
Definitions
It is useful to distinguish between the interrelated concepts of attachment, attachment behaviour, and the attachment behavioural system (Hinde 1982a), which represent roughly the psychodynamic, the behavioural and the cognitive components of Attachment Theory.
'Attachment' is an overall term which refers to the state and quality of an individual's attachments. These can be divided into secure and insecure attachment. Like many psychodynamic terms, 'attachment' carries both experiential and theoretical over-tones. To feel attached is to feel safe and secure. By contrast, an insecurely attached person may have a mixture of feelings towards their attachment figure: intense love and dependency, fear of rejection, irritability and vigilance. One may theorise that their lack of security has aroused a simultaneous wish to be close and the angry determination to punish their attachment figure for the minutest sign of abandonment. It is though the insecurely attached person is saying to themselves: 'cling as hard as you can to people - they are likely to abandon you, hang on to them and hurt them if they show signs of going away, then they may be less likely to do so'. This particular pattern of insecure attachment is known as 'ambivalent insecurity' (see below and Chapter 6).
68 Attachment Theory
Attachment behaviour is defined simply as being 'Any form of behaviour that results in a person attaining or retaining proximity to some other differentiated and preferred individual'. Attachment behaviour is triggered by separation or threatened separation from the attachment figure. It is terminated or assuaged by proximity, which, depending on the nature of the threat, may vary from being in sight, to physical closeness and soothing words without touching, to being tightly held and cuddled.
Attachment and attachment behaviour are based on an attachment behavioural system, a blueprint or model of the world in which the self and significant others and their interrelationship are represented and which encodes the particular pattern of attachment shown by an individual. The ambivalently attached person we have described might have a working model of others as desirable but unreachable, and of themselves as unworthy of support and love, and/or of an unreliable and rejecting attachment figure with a protesting, attacking self.
An attachment relationship can be defined by the presence of three key features (Weiss 1982).
1 Proximity seeking to a preferred figure
As parents of toddlers well know, small children have a maddening propensity to follow their attachment figures wherever they go. The distance at which the child feels comfortable depends on such factors as age, temperament, developmental history, and whether the child feels fatigued, frightened or ill, all of which will enhance attachment behaviour. Recent separation will lead to greater proximity seeking, or 'mummyishness', as Robertson's (1952) film so beautifully demonstrates. The extent of the proximity required will also depend on circumstances. A three- year-old collected from playgroup after her first day may rush up to the parent and bury her head in his lap and want to be held and cuddled for a long time. A month later she may be content to slip her hand quietly into that of her collecting parent and continue chatting to her friends as she walks down the road.
Of central importance to attachment theory is the notion that attachment is to a discriminated figure (or small group of figures). Bowlby originally explained this by analogy with the phenomenon of imprinting in which young birds will attach themselves to any mobile figure to which they are exposed at the 'sensitive period'
Attachment, anxiety, internal working models 69
in their development. Studies on primates suggest that imprinting does not occur in the same way as in birds, and that attachment, rather than being an all-or-none phenomenon, develops as a result of a gradual process of genetically programmed development and social learning (Rutter 1981; Bretherton 1991b).
The fact that attachment is, in Bowlby's word, 'monotropic' - that is, occurs with a single figure, most usually the mother - has profound implications for psychological development and psycho- pathology throughout the life cycle.
It is because of this marked tendency to monotropy that we are capable of deep feelings, for to have a deep attachment to a person (or a place or a thing) is to have taken them as the terminating object of our instinctual responses.
(Bowlby 1988a)
Monotropy is by no means absolute: a small child's attachments can best be thought of as a hierarchy usually, but not necessarily, with the mother at the top, closely followed by the father (or, rarely, the father followed by the mother), grandparents, siblings, godparents and so on. Inanimate objects such as transitional objects are also important.
Attachment Theory accepts the customary primacy of the mother as the main care-giver, but there is nothing in the theory to suggest that fathers are not equally likely to become principal attachment figures if they happen to provide most of the child care. The theory is a two-person psychology and has little to say directly about the different roles of mother and father, and of sexuality in psychological life. This has the advantage that its findings are perhaps more generally applicable across cultures than mainstream psychoanalysis, but means that it does not address the fact that individuals' identity is intimately bound up with their sexual roles.
Three-person psychology enters into Attachment Theory via separation and loss. The growing child has to learn that the figure to whom he is attached must also be shared with her sexual partner and other siblings, which forms the basis for the Oedipal situation, and makes separation and loss an inherent part of the attachment dynamic. For Melanie Klein (1986), the 'depressive position' represents the realisation that the loved and gratifying breast/ mother and the hated and rejecting breast/mother are one and
70 Attachment Theory
the same. For Bowlby, the human dilemma turns on the central importance of an attachment that cannot be entirely reliable, must perforce be shared, and will be lost, eventually (and often prematurely). The capacity to separate from attachment figure(s) and to form new attachments represents the developmental challenge of adolescence and young adulthood. The cycle repeats itself as parents attach themselves to their children only to let them go as they reach adolescence. Finally, as death of one's loved ones, and one's own death approaches, the 'monotropic' bond to life itself has gradually to be relinquished.
2 The 'secure base' effect
Mary Ainsworth (1982) first used the phrase 'secure base' to describe the ambience created by the attachment figure for the attached person. The essence of the secure base is that it provides a springboard for curiosity and exploration. When danger threatens we cling to our attachment figures. Once danger passes, their presence enables us to work, relax and play - but only if we are sure that the attachment figures will be there if we need them again. We can endure rough seas if we are sure of a safe haven. Anderson (1972) made a naturalistic study of mothers and their toddlers in a London park. The mothers sat on the park benches, reading or chatting while their children toddled and played on the surrounding grass. He found that each child had an invisible radius - a Maginot line - beyond which it would not venture to go. When it neared the limit it would begin to look anxiously towards the mother. Attachment exerted an invisible but powerful pull on the child, just as heavenly bodies are connected by gravitational forces. But unlike gravity, attachment makes its presence known by a negative inverse square law: the further the attached person is from their secure base, the greater the pull of attachment. The 'elastic band' which constitutes the attachment bond is slack and imperceptible in the presence of a secure base. If the secure base becomes unreliable or the limits of exploration are reached, the bond tugs at the heart-strings.
The example of the mother who leaves her child with the child minder and then worries about and misses her dreadfully suggests that attachment behaviour is not confined to infancy and applies to care-givers as well as care-seekers. Heard and Lake (1986) have extended the secure base concept in their model of an adult
Attachment, anxiety, internal working models 71
attachment dynamic in which they postulate a fundamental need for 'companionable interaction' based on 'preferred relationships in the attachment network'. These comprise, as in parent-child attachment, a mixture of support and exploration, with a sense of psychological proximity as the precondition for such companionship. Where no secure base exists, the individual is in a state of 'dissuagement', and resorts to defensive manoeuvres (such as splitting off anger; inhibition of sexuality; or conversely compulsive sexualisation of relationships) in order to minimise the pain of separation anxiety, and, if needs be, to manipulate support at the expense of truly reciprocal companionship.
Violence and a social facade
Jennifer, a successful painter, was forty when she entered psychotherapy. Her complaint was that she could never be her 'real self' in close relationships. In social situations she could be jolly and cheerful and was well liked; by herself she often felt depressed and anxious, but could cope, especially when she was painting. In her marriages (she had had two) she never felt at ease, unable to share feelings openly or to feel relaxed with her husbands. She had rather desperately sought some affirmation of herself through affairs, but in the end these left her feeling empty and valueless. Naturally enough these patterns were repeated transferentially in therapy and she bent her best efforts towards trying to please, seduce and sometimes (via projective identification) to exclude her therapist. She dated the death of her straightforward 'companionable self' and the shattering of her secure base to an incident where her much-feared father (who had been away at the war for the first three years of her life) was playing with her older brother and sister when Jennifer was about four. She tried to gain his attention but was ignored; she pinched his leg harder and harder until suddenly and terrifyingly he threw her across the room. From that day (and similar episodes were repeated in various ways throughout her childhood) she could only get attention, playfulness, support from others by means of pleasing them, controlling them, or vicariously caring for herself through her care for them (this characterised her relationship with her mother, herself chronically depressed). This illustrates in an extreme form a typical family pattern of absent-father/depressed- mother that so often underlies the lack of a secure base, and leads
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to defensive postures by the children who grow up in such an atmosphere. Progress in therapy only began when this woman had tested her therapist again and again for his reliability and had, inevitably, found him wanting, but still felt safe enough to reveal the extent of her disappointment and rage towards him.
3 Separation protest
Try to prise a limpet away from its rock and it will cling all the harder. The best test of the presence of an attachment bond is to observe the response to separation. Bowlby identified protest as the primary response produced in children by separation from their parents. Crying, screaming, shouting, biting, kicking - this 'bad' behaviour is the normal response to the threat to an attachment bond, and presumably has the function of trying to restore it, and, by 'punishing' the care-giver, of preventing further separation. The clinical implications of separation protest are very important and will be dealt with in subsequent chapters. For example, Ainsworth used it in devising her 'strange situation', the basic tool used for classifying the quality of attachment in children (see Chapter 6), and the analysis of patient responses to weekend and holiday 'breaks' are a basic theme in analytic psychotherapy (see Chapter 8).
A remarkable feature of attachment bonds is their durability. The persistence of attachment in the face of maltreatment and severe punishment has enormous implications for child and adult psychopathology. Harlow's monkeys clung ever more tightly to their cloth 'mothers' even when 'punished' by them with sudden blasts of compressed air (Rutter 1980)! It is hard to explain this phenomenon on the basis either of the psychoanalytic 'cupboard love' theory, or of reward-reinforcement learning theory. It is explicable along the ethological lines of Attachment Theory since stress will lead to an enhancement of attachment behaviour even when the source of that stress is the attachment figure itself. The 'frozen watchfulness' of the physically abused child is eloquent proof of the phenomenon of ambivalent attachment and its inhibition of normal exploration and playfulness.
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THE DEVELOPMENT OF THE ATTACHMENT SYSTEM
The human infant is born in a state of great immaturity (a consequence, evolutionary biologists suggest, of the need to get the huge human brain through the pelvic floor before it is too late! ). It is not surprising therefore that, unlike in ducks, monkeys and other animals, the human attachment system takes several months to develop. Only after six months does the baby begin to exhibit the full triad of proximity seeking, secure base effect and separation protest that we have described. The ontogeny of the attachment system can be conveniently divided into four phases.
1 0-6 months: orientation and pattern recognition
Although newborn babies cannot distinguish one person from another, they are highly responsive to human contact. Centrally important in this process is the sight of the human face, which evokes intense interest. The onset of the smiling response around four weeks marks the beginning of the cycles of benign interaction that characterise the relationship between the baby and his caregivers. The baby's smile evokes a mirroring smile in the mother; the more she smiles back the more the baby responds, and so on. As we shall see in Chapter 6, maternal responsiveness is a key determinant of the quality of attachment as development proceeds. Winnicott (1971) famously states: 'What does the baby see when he or she looks at the mother's face? I am suggesting that ordinarily what the baby sees is him or herself. ' He goes on in the same paper to suggest that what happens in psychotherapy is 'a long term giving the patient back what the patient brings. It is a complex derivative of the face that reflects what is there to be seen' (Winnicott 1971).
Daniel Stern (1985), from a perspective of developmental psychology, and Kenneth Wright (1991), from a psychoanalytical viewpoint, both see the mutual looking between mother and baby as a key element in the development of an internal world in which attachment can be represented and regulated. The invariability of the mother's face, the recognition of it as a pattern, give the baby a primitive sense of history, of continuity through time that is integral to the sense of self. To evoke her smile provides a sense of agency and effectiveness. Her mirroring response is the first link between what is perceived out there, and what is felt in here.
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For Wright the mother's face is the first symbol; her face is not part of the self and yet, because it is responsive, feels intimately connected to the self. In the Kleinian account of the origin of symbol formation - based on Freud's idea of hallucinatory wish-fulfilment - images are thought to arise as a consequence of loss or absence: 'no breast; so imagine a breast', thinks the Kleinian infant. Wright proposes a more harmonious theory in which the separation is simply spatial: the face is over there, held off and so is available for thinking about, contemplation, meditation. To watch a 3-month-old baby at the breast is to get visible proof of the rhythm of feeding and mutual gazing that constitutes the mother-child relationship at this stage. Freud, in his discussion of Leonardo (Freud 1910), seems to see looking as a sort of visual incorporation, a drinking in with the eyes, rather than a modality of relating with its own dynamic. The complexity and specificity of the visual world, as opposed to the gustatory world, is what makes looking the basis of attachment: 'Wine comes in at the mouth, love comes in at the eyes. ' The world is mapped through the visual system: the mother's face is imaged on the retina and visual cortex before it is imagined in the inner world. We shall consider later some of the implications of the failure of this mirroring process.
As with looking, so with holding, a term used by Winnicott (1971) in his phrase 'the holding environment' to denote not just the physical holding of the baby by the mother but the entire psychophysiological system of protection, support, caring and containing that envelops the child, without which it would not survive physically or emotionally. The reliability and responsiveness of the holding environment form the nucleus of the emergent attachment patterns as the child begins the process of separation-individuation.
In the second half of the first six months the beginnings of an attachment relationship starts to be evident. The baby becomes much more discriminating in his looking. He listens out for and responds differently to his mother's voice; cries differently when she departs compared with other people; greets her differently; and begins to put his arms up towards her in a request to be picked up. She in turn responds to the physiological and social cues from her baby in a way that leads to the establishment of a
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homeostasis. An interactive matrix is established, felt as a mutual 'knowing' of each other that is the hallmark of a secure mother-infant relationship.
2 6 months-3 years: 'set-goal' attachment
In the second half of the first year several developmental changes occur which mark the onset of attachment proper. Children removed from foster homes into permanent adoptive homes before 6 months show little distress, whereas after that watershed they show increased crying, clinging, apathy, and feeding and sleep disturbance (Bretherton 1985). Around 7 months the baby will begin to show 'stranger anxiety', becoming silent and clingy in the presence of an unknown person (Spitz 1950).
These changes coincide with the onset of locomotion in the child, which entails a much more complex system of communication if the baby is to remain in secure contact with the mother. The immobile baby is bound to remain where he is. The mother of the mobile baby needs to know that the child will move towards her at times of danger, and the child needs to be able to signal protest or distress when necessary to a mother who now feels she can put him down for a few minutes.
Bowlby conceives the attachment system at this stage as being based on 'set-goals', which he compares to the setting on a thermostat, maintained by a system of feedback control. The 'set-goal' for the infant is to keep 'close enough' to the mother: to use her as a secure base for exploration when environmental threat is at a minimum, and to exhibit separation protest or danger signalling when the need arises.
Figure 4. 1 attempts to summarise the features of the attachment system at this stage. Several points should be made about this diagram. First, attachment behaviour, although usually discussed from the point of view of the attached person, is a reciprocal relationship. The parent is simultaneously offering complementary care-giving behaviour that matches, or should match, the attachment behaviour of the child. For example, when put in a new situation the child will, through social referencing, make eye contact with the mother, looking for cues which will sanction exploration or withdrawal. Second, and as a consequence, parent- child attachment systems can be seen in terms of continuously monitored distance-regulation (Byng-Hall 1980), with many opportunities for problematic variants. The over-anxious parent may inhibit the child's exploratory behaviour, making them feel
Figure 4. 1 The attachment behavioural system
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mutual system of feedback and stifled or smothered; conversely, the neglectful parent may inhibit exploration by failing to provide a secure base, leading to feelings of anxiety or abandonment. Third, inherent in the model is the notion of an internal map or 'internal working model' which represents the relative whereabouts of the self and attachment figure. To the analytically minded psychotherapist this may seem like a rather uninteresting predominantly 'cognitive' map, but this would be mistaken. What is stored in the 'internal working model' is not so much an ordnance survey picture but an affective model which, if it could be translated into words, might be along the lines of 'I feel tense when my mummy goes out of the room so I must keep a good eye out for her and scream if necessary', or 'when my mummy comes so close to me while I am playing I feel uncomfortable, so I'll try to move away a bit, without discouraging her so much that she loses interest' (cf. Beebe and Lachmann 1988).
We have moved from a discussion of set-goals which keep toddler and parent in eyesight and earshot of each other to the idea of a relationship, and to a consideration of what internal processes might regulate it. This brings us to the attachment system in its fully fledged form which, Bowlby maintains, is established by the third birthday and persists from then on throughout life.
3 3 years onwards: the formation of a reciprocal relationship
As Bowlby first conceived it, the attachment system in the toddler was something like a 'homing device' in which the child was programmed to focus on the parent with the 'set-goal' of maintaining proximity. With the advent of language and the expanding psychological sophistication of the three- to four-year- old a much more complex pattern arises that cannot be described in simplistic behavioural terms. The child now can begin to think of his parents as separate people with their own goals and plans, and to devise ways of influencing them. If the mother is going to leave the child for the evening he may plead, bribe, charm or sulk in an attempt to maintain attachment, rather than crying or clinging as he would have done a year or two earlier. Attachment Theory at this point merges into a general theory about relationships (or 'affectional bonds', as Bowlby likes to call them) and how they are maintained, monitored and may go wrong.
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INTERNAL WORKING MODELS
A key concept here is that of the 'internal working model'. This is Bowlby's way of describing the internal world of the psychoanalysts, but couched in characteristically practical terms. The idea of an internal 'model' of the world derives from Kenneth Craik's (1943) influential The Nature of Explanation, in which he argues that
Thought models, or parallels reality . . . the organism carries a 'small-scale model' of external reality and its own possible actions within its head which enable it to react in a fuller, safer, and more competent way to the emergencies which face it'.
Wright (1991) has remarked how, until the advent of Winnicott's influence, the work ethic dominated the language of psychoanalysis: working through, getting the patient to work on their problems, forming a working alliance, and Bowlby's internal working models. Wright sees Winnicott as representing the female, maternal influence, a reaction against the paternal force of Freud. Bowlby in turn was in part reacting against the powerful women who had trained him, his analyst Joan Riviere, and supervisor, Melanie Klein. The idea of a 'working model' implies a practical mechanism, a down-to-earth title which he claimed 'allows for greater precision of description and provides a framework that lends itself more readily to the planning and execution of empirical research' (Bowlby 1981c).
Although derived from the psychoanalytic perspective, the idea of internal working models is perhaps closer to that of cognitive therapy (Beck et al. 1979) (itself also a development of and a reaction against the psychoanalytic paradigm). The developing child builds up a set of models of the self and others, based on repeated patterns of interactive experience. These 'basic assumptions' (Beck et al. 1979), 'representations of interactionsthathavebeengeneralised'(Stern1985),'rolerelationshipmodels'and'self- other schemata' (Horowitz 1988), form relatively fixed representational models which the child uses to predict and relate to the world. A securely attached child will store an internal working model of a responsive, loving, reliable care-giver, and of a self that is worthy of love and attention and will bring these assumptions to bear on all other relationships. Conversely,aninsecurelyattachedchildmayviewtheworldasadangerous place in which other people are to be treated with great caution, and see himself as ineffective and unworthy of love. These assumptions are relatively stable and enduring: thosebuiltupintheearlyyearsoflifeareparticularlypersistentandunlikelytobemodified by subsequent experience.
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Bowlby wished to recast psychoanalytic theory in terms of a systems approach in which feedback loops are a key element. They underlie the 'epigenetic' stability of psychological phenomena: the benign circles of healthy development, and the vicious circles of neurosis in which negative assumptions about the self and others become self-fulfilling prophecies.
THEORIES OF NEUROSIS: AVOIDANT AND AMBIVALENT ATTACHMENT
Bowlby uses the notion of faulty internal working models to describe different patterns of neurotic attachment. He sees the basic problem of 'anxious attachment' as that of maintaining attachment with a care-giver who is unpredictable or rejecting. Here the internal working model will be based not on accurate representation of the self and others, but on coping, in which the care-giver must be accommodated to. The two basic strategies here are those of avoidance or adherence, which lead to avoidant or ambivalent attachment (see Figure 4. 2).
In avoidant attachment the child tries to minimise his needs for attachment in order to forestall rebuff, while at the same time remaining in distant contact with the care-giver whose rejection, like the person's own neediness, is removed from consciousness by what, based on Dixon's (1971) concept of perceptual defense, Bowlby calls 'defensive exclusion'. The ambivalent strategy involves clinging to the care-giver, often with excessive submissiveness, or adopting a role-reversal in which the care-giver is cared for rather than vice versa. Here feelings of anger at the rejection are most conspicuously subjected to defensive exclusion. A third pattern of insecure attachment, 'insecure disorganised', less common than the first two but probably associated with much more severe pathology, has also been delineated. All three patterns will be discussed in more depth in Chapter 6.
Although these strategies have the function of maintaining attachment in the face of difficulties, a price has to be paid. The attachment patterns so established are clearly restricted and, if repeated in all relationships, will be maladaptive. Also, defensive exclusion means that models cannot be updated in the light of new experience. Bowlby visualises the coexistence of incompatible models - for example, 'the good mother who lets me come near understood as primarily based on feeding, so adult pair- bonding cannot be adequately explained by sexuality. Sex
Figure 4. 2 Patterns of insecure attachment
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to her (if I look after her)', and the 'bad mother who rejects me and makes me angry (and who I'll try not to think about)' - which lead to sudden changes of mood and poor adaptation. A central problem created by defensive exclusion is the lack of opportunity for emotional processing of painful affect, particularly evident in pathological mourning, which leads to the persistence of primitive feelings of hate and abandonment and restricts emotional growth and development.
ATTACHMENT IN ADULT LIFE
This consideration of internal working models has been a necessary diversion in our discussion of attachment across the life cycle. It is through internal working models that childhood patterns of attachment are carried through into adult life and, as we shall discuss in Chapter 6, are transmitted to the next generation.
As children grow older and begin to reach adolescence they tolerate increasing periods of separation from their parents. Does this mean that the attachment 'phase' has been outgrown, to be superseded by, say, 'adult genitality'? According to Bowlby's 'epigenetic' model, emphatically not! As he sees it, attachment and dependency, although no longer evident in the same way as in young children, remain active throughout the life cycle. For adolescents the parental home still remains an important anchor point, and the attachment system will become re-activated at times of threat, illness or fatigue. The turbulence of adolescence can be seen in Bowlbian terms as springing from the complexity of detachment and re-attachment which the adolescent must accomplish. To disengage from parental attachments, to mourn that loss, to move on via the transitional phase of peer group attachment to the pair-bonding of adult life is no easy task.
Bowlby saw marriage, or its equivalent, as the adult manifestation of attachment whose companionship provides a secure base allowing for work and exploration, and a protective shell in times of need. Like Fairbairn (1952), but unlike Freud (1929) for whom affection was 'aim-inhibited sexuality', Bowlby saw bodily pleasure not as an aim in itself but as a 'signpost to the object', and so tends rather to downplay the role of sexuality in marriage. Just as the mother-infant relationship cannot, in Bowlby's eyes, be
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without attachment and sexless marriages are both all too common, and suggest that the attachment system and sexual behaviour are separable psychological entities, however much society might wish that this were not so. 'In sickness and in health' is a reminder that the psychological purpose of marriage is to provide a secure base and an attachment system which can be awakened in times of need. The unconscious operation of the attachment system via internal working models probably plays an important part in the choice of marital partner and relationship patterns in marriage. Holmes (1993) has described a pattern of 'phobic- counterphobic' marriage in which an ambivalently attached person will be attracted to an avoidant 'counter-phobic' spouse in a system of mutual defence against separation anxiety.
The steeplejack's wife
A young woman developed multiple phobic symptoms soon after the birth of her first baby. At first her fears were of harming the baby; later she became severely agoraphobic, and took to phoning her mother several times a day for reassurance. She insisted on moving house so as to be within easy reach of her mother. Her mother 'helped' by looking after the baby for much of the day, and would herself telephone frequently to check if the baby was 'all right'. When the patient told her mother of a dream in which her son had fallen under a lorry, the mother (who was unlikely to have read Freud) told her that this meant that she wanted to kill her son! As a child the patient had lacked a secure base with this mother whom she felt neglected her in favour of two younger sisters, one of whom had been chronically ill with kidney disease, while the other was epileptic, and to whom she had devoted all her attention.
In an initial phase of individual therapy she was able to link her fears of harming the baby with aggressive feelings towards her younger sisters and her angry dependency on her mother, but her symptoms persisted. Marital therapy was then offered. At the first session she proudly announced that her husband - unlike herself - was afraid of nothing. He accepted the compliment rather diffidently, but confirmed that he had been more or less self-reliant since the age of ten, when his parents
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had divorced and he and his younger brother had been left to fend for themselves on the rough estate where they lived. He worked as a scaffolder on high buildings. When asked if it was true, as his wife believed, that he was frightened of nothing, he confessed that he had slipped on a plank that morning and had been very scared, and that since the birth of the baby he had been much less of a daredevil. His wife seemed surprised at this revelation, but visibly relaxed and perked up. He then admitted that he saw it as his task to conceal his fears and worries from his wife because of her 'illness'. For example, he resented his mother-in-law's intrusions into their family life, but was petrified by the idea of confronting her. Given the task of answering the phone when she rang, and explaining that his wife was too busy to speak, he became quite shaky and said that he would much rather be asked to go up a chimney-stack in a high wind! The patient was asked to rehearse him in this by role-playing her mother, and the session ended in laughter, with a much less anxious patient and subsequent good clinical improvement.
This example shows how attachment patterns are stored as internal working models. The patient saw herself as uncared for, unworthy of care and therefore unable to care for her baby, whom she perceived, in a sense correctly, as in danger of neglect or attack. Lacking a secure base inside herself she was unable to provide one for others, and her anger and frustration about this lack of care interfered with her capacity to look after her baby. The intrusiveness of her mother and the detachment of her husband (due in turn to their own faulty attachment patterns) served to reinforce her sense of an absent secure base. Her demandingness and dependency represented a desperate effort to create an ideally safe attachment, and her protest about the lack of it. Giving her an opportunity to nurture her husband made her feel better about herself, and the affective release of anger and laughter in the sessions enabled her to revise her internal working models towards a more realistic assessment of her capacities.
We shall discuss in Chapter 6 important evidence showing how, as Winnicott (1965) suggested, the advent of parenthood calls into being the new parent's own attachment history. As the life cycle unfolds, each parent is presented with new challenges to their capacity to hold, respond
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to, attune with and release their children. With increasing age the depth and strength of attachment bonds increases. At the same time losses begin to accumulate. Divorce, and separation and death begin to take their toll. We shall see in the next chapter how Attachment Theory provides a schematic map of the painful terrain of depression, disappointment and bereavement.
CONCLUSION: THE MEDIATION AND PSYCHOPATHOLOGY OF ATTACHMENT
Bowlby's original mission was to find links between major life events such as parental loss or neglect and the development of psychiatric symptoms in children and adults. In 'Forty-four juvenile thieves' he linked such disruptions with the two major psychiattic disorders of childhood: conduct disorders and phobias. He anticipated that there would be connections between problems of attachment in childhood and adult conditions such as depression, agoraphobia and psychopathic disorders. He made a fundamental distinction between secure and anxious attachment, seeing the latter as the precursor of developmental difficulty and adult psychiatric disease.
In his early formulations he saw anxious attachment as resulting from gross disruptions of parenting such as parental death or divorce.