Fortunately he had been in the hands of a therapist who understood his problem, gave full credence to the childhood experiences he de- scribed, and sympathetic recognition both of his unrequited
yearning
for love and care and also for the violent feelings towards his mother that her treatment of him had aroused, and which ini- tially were directed towards herself (the therap- ist).
A-Secure-Base-Bowlby-Johnf
?
?
the examples thus far given the form of pressure exerted is crude.
More frequent perhaps and just as damaging are instances in which the pressures are more subtle.
During the past two decades renewed attention has been paid to incest, both to its unrecognized high incidence and to its pathogenic effects on children. Much the commonest forms are between father and daughter or step-father and step-daughter. Among the various problems and symptoms in the children and adolescents con- cerned that are believed to be due to these experi- ences, the commonest include withdrawal from all intimate relationships, sleep disturbances, and suicidal intentions (Meiselman, 1978; Adams- Tucker, 1982). An account of conditions likely to cause cognitive disturbance was given me by a colleague, Brendan MacCarthy, but never pub- lished. He suspected that disturbance is espe- cially likely when the children are prepubertal. In what follows I draw on his conclusions.
When a sexual liaison develops between a fath- er and his adolescent daughter, MacCarthy re- ports, the liaison is usually acknowledged by the father during the course of daily life by such means as secret glances, secret touching, and
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? ? ? innuendoes. In the case of a younger child, however, a father is likely to make no such ac- knowledgements. Instead he behaves during the day as though the nightly episodes never oc- curred; and this total failure to acknowledge them is commonly maintained even long after the daughter has reached adolescence.
MacCarthy describes the case of a married wo- man, Mrs A, whom he treated for depression, re- liance on tranquillizers, and alcohol. She men- tioned the ten years of sexual interference she had suffered from her adoptive father only after she had been in therapy for four months. It had begun when she was 5 or 6, soon after her adopt- ive mother had died, and had continued until she was 16, when she had fled. Among her many problems were frigidity and finding intercourse disgusting, and a sense of inner blackness, of 'a black stain'. Her problems had become exacer- bated when her own daughter was 4 years old. Whenever the daughter became affectionate to her father and sat near him, Mrs A felt agitated, protective, and jealous; on these occasions she could never leave them alone together. During therapy she was obsequious and terrified, and in- tensely vigilant of the analyst's every move.
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? ? ? In regard to the incestuous relationship, Mrs A described how her adoptive father would never at any time during the day allude to his nocturnal visits to her room, which had always remained darkened. On the contrary, he had lectured her incessantly on the dangers of allowing boys to go too far, and on the importance of chastity before marriage. When at the age of 16 she had fled the home, he not only insisted she tell no one, but ad- ded sarcastically: 'And if you do no one will be- lieve you. ' This could well have been so since her adoptive father was a headmaster and the local mayor.
In commenting on this and similar cases MacCarthy emphasizes the cognitive split between the respected and perhaps loved father of daytime and the very different father of the strange events of the night before. Warned on no account to breathe a word to anyone, including her mother, the child looks to her father for some confirmation of those events and is naturally be- wildered when there is no response. Did it really happen or did I dream it? Have I two fathers? Small wonder if, in later years, all men are dis- trusted, and the professional stance of a male therapist is seen as a mere fac? ade that hides a
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? ? ? predatory intent. Small wonder also that the in- junction on no account to tell anyone remains op- erative, and that the expectation that in any case no one would believe you ensures silence. How often, we may wonder, do ill-informed therapists discourage a patient from telling the truth and, should she do so nonetheless, confirm her ex- pectation that no one will believe her story?
In the examples so far described the informa- tion a parent is pressing a child to shut away is information relating to events in the outside world. In other situations the information to be shut away relates to events in the child's private world of feeling. Nowhere does this occur more commonly than in situations of separation and loss.
When a parent dies the surviving parent or other relative may not only provide the children with inadequate or misleading information but he or she may also indicate that it would not be appropriate for the child even to be distressed. This may be explicit: A. Miller (1979) describes how, when a 6-year-old's mother died, his aunt told him: 'You must be brave; don't cry; now go to your room and play nicely. ' At other times the indication is only implicit. Not infrequently
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? ? ? widows or widowers, afraid to express their own distress, in effect encourage their children to shut away all the feeling they are having about their loss. Palgi (1973) describes how a small boy whose mother was chiding him for not shedding tears over his father's death retorted: 'How can I cry when I have never seen your tears? '
There are in fact many situations in which a child is expressly told not to cry. For example, a child of 5 whose nanny is leaving is told not to cry because that would make it more difficult for nanny. A child whose parents leave him in hos- pital or residential nursery insist he should not cry, otherwise they will not visit him. A child whose parents are frequently away and who leave him with one of a succession of au pair girls is not encouraged to recognize how lonely, and perhaps angry, he feels at their constant absence. When parents separate, it is often made plain to a child that he is not expected to miss the departing par- ent or to pine for the parent's return. Not only is sorrow and crying condemned as inappropriate in such situations but older children and adults may jeer at a distressed child for being a crybaby. Is there any wonder that in such circumstances feeling should become shut away?
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? ? ? All these situations are plain enough but have, I believe, been seriously neglected as causes of in- formation and feeling becoming excluded from consciousness. There are, however, other situ- ations also, more subtle and hidden but no less common, that have the same effect. One such is when a mother, who herself had a childhood de- prived of love, seeks from her own child the love she has hitherto lacked. In doing this she is in- verting the normal parent-child relationship, re- quiring the child to act as parent whilst she be- comes a child. To someone unaware of what is going on it may appear that the child is being 'overindulged', but a closer look shows that moth- er is placing a heavy burden on him. What is of special relevance here is that more often than not the child is expected to be grateful for such care as he receives and not to notice the demands be- ing made upon him. One result of this is that, in conformity with his mother's wishes, he builds up a one-sided picture of her as wholly loving and generous, thereby shutting away from conscious processing much information also reaching him that she is often selfish, demanding, and ungrate- ful. Another result is that, also in conformity with his mother's wishes, he admits to consciousness
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? ? ? only feelings of love and gratitude towards her and shuts away every feeling of anger he may have against her for expecting him to care for her and preventing him from making his own friends and living his own life.
A related situation is one in which a parent, having had a traumatic childhood, is apprehens- ive of being reminded of past miseries and so be- coming depressed. As a result her children are re- quired always to appear happy and to avoid any expression of sorrow, loneliness, or anger. As one patient put it to me after a good deal of therapy: 'I see now that I was terribly lonely as a child but I was never allowed to know it. '
Most children are indulgent towards their par- ents, preferring to see them in a favourable light and eager to overlook many deficiencies. Yet they do not willingly conform to seeing a parent only in the light the parent requires or to feeling to- wards him or her only in the way demanded. To ensure that, pressure must be exerted. Pressure can take different forms but all forms depend for their effectiveness on the child's insistent desire to be loved and protected. Alice Miller (1979), who has given these problems much attention, reports the words of an adult patient who was
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? ? ? born the eldest child of an insecure professional woman:
I was the jewel in my mother's crown. She often said: 'Maja can be relied upon, she will cope. ' And I did cope. I brought up the smaller children for her so that she could get on with her professional career. She became more and more famous, but I never saw her happy. How often I longed for her in the evenings. The little ones cried and I comforted them but I my- self never cried. Who would have wanted a crying child? I could only win my mother's love if I was competent, understanding and controlled, if I never questioned her actions nor showed her how much I missed her; that would have limited her freedom which she needed so much. That would have turned her against me.
In other families pressures are less subtle. One form, threatening to abandon a child as a means of controlling him, is an extremely powerful weapon, especially with a young child. Faced with such threats, how could a child do other than conform to his parents' wishes by excluding from further processing all that he knows they wish him to forget? Elsewhere I have given reasons for believing that threats of this sort are responsible for much acute and chronic anxiety (Bowlby 1973) and also for a person responding to be- reavement in later life with chronic depression in which the dominant belief is one of having been deliberately abandoned, as a punishment, by the dead person (Bowlby, 1980).
The hypothesis advanced, that various forms of cognitive disturbance seen in children and also in
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? ? ? later life are to be traced to influences acting ini- tially during the pre-adolescent years, is compat- ible with indications that during these years chil- dren's minds are especially sensitive to outside influence. Evidence of this, already emphasized, is the extent to which young children are vulner- able to threats by parents to reject or even aban- don them. After a child has reached adolescence, clearly his vulnerability to such threats diminishes.
The extent to which the minds of pre-adoles- cent children are prone to the influence of par- ents is well illustrated by an experiment of Gill (1970). The sample comprised 10-year-old chil- dren, drawn from a London primary school, and their parents. Of the 40 non-immigrant families invited to participate, 25 agreed. Each family was visited in its own home and a series of ten pic- tures shown on a screen, each for two minutes.
Of the pictures used, five came from picture book or film and the rest from thematic apper- ception tests. Some were emotionally benign, for example, a mother watching a small girl holding a baby. Some showed scenes of an aggressive and/ or frightening sort. Three depicted a sexual theme: a woman obviously pregnant lying on a
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? ? ? bed; a couple embracing on the grass; and a wo- man clutching the shoulders of a man who seems to be pulling away, with the picture of a semi- nude woman in the background.
The series of ten pictures was presented three times in succession. On the first showing, father, mother, and child were asked to write down inde- pendently what they saw happening in the pic- ture. On the second members of the family were asked to discuss each picture for the two minutes it was shown. During the third showing, each member was asked again to write down inde- pendently what they now saw happening.
When the children's responses to the three pic- tures depicting sexual themes were examined, it was found that, whereas half the children (12) de- scribed the sexual themes in a fairly direct matter-of-fact way, the other half failed to do so. For example, to the picture of the obviously preg- nant woman, one child's candid response ran: 'She's having a rest. I can see that she's expecting a baby. She's asleep, I think. ' Descriptions of the same picture by other children omitted all refer- ence to pregnancy. 'Somebody is asleep in bed,' and 'There's a man on a bed. He is asleep. '
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? ? ? A second step was to analyse how the parents discussed the picture in the child's presence dur- ing the second showing. This was done by a psy- chologist blind to the children's responses. Here again it was evident that, whereas some parents were candid about the scene depicted, others made no reference to it and/or expressed disgust. For example, in the case of the pregnant woman, the mother of one child remarked frankly and on three occasions that the woman was expecting a baby and was having an afternoon rest. By con- trast, the parents of another child completed their two-minute discussion without any such reference. Instead they concentrated on emotion- ally neutral details such as the woman's hairstyle, the material of her dressing gown, and the quality of the furniture. Not surprisingly there was a high correlation between the way the children respon- ded to the pictures and the way the parents had discussed them subsequently.
On the third showing the descriptions given by all the children improved in accuracy; but those of the 12 who had responded candidly on the first showing improved more than did the descrip- tions given by the 13 who had failed to report the pictures' content on the first occasion.
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? ? ? There could be little doubt that during their discussion of the pictures some of the parents were, consciously or unconsciously, avoiding ref- erence to the content of the pictures. It was a reasonable inference also that their children's failure to describe the sexual theme on the first showing was in some way influenced by the 'cli- mate' they had experienced in their homes. What the experiment could not show, of course, was whether these children had truly failed to per- ceive the scene depicted or whether they had per- ceived it but had failed to report what they saw. Since pre-adolescent children tend to be slow and often uncertain in their perceptions, my guess would be that at least some of the children in the experiment had truly failed to register the nature of what was happening. Others may have known intuitively that the scene was one they were not supposed to know about and so avoided seeing it.
At first sight the notion that information of a certain meaning can be shut off, or selectively ex- cluded from perception, appears paradoxical. How, it is asked, can a person selectively exclude from processing a particular stimulus unless he first perceives the stimulus which he wishes to exclude? This stumbling block disappears,
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? ? ? however, once perception is conceived as a multistage process as nowadays it is. Indeed ex- perimental work on human information pro- cessing undertaken during the past decade or so enables us to have a much better idea of the nature of the shutting-off processes we have been discussing than was possible when Freud and others in the psychodynamic tradition were first formulating the theories of defence that have been so very influential ever since. In what fol- lows I give a brief sketch of this new approach.
Studies of human perception (Erdelyi, 1974; Norman, 1976) have shown that, before a person is aware of seeing something or hearing something, the sensory inflow coming through his eyes or ears, has already passed through many stages of selection, interpretation, and ap- praisal, during the course of which a large pro- portion of the original inflow has been excluded. The reason for this extensive exclusion is that the channels responsible for the most advanced pro- cessing are of limited capacity and must therefore be protected from overload. To ensure that what is most relevant gets through and that only the less relevant is excluded, selection of inflow is un- der central, or we might say ego, control.
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? ? ? Although this processing is done at extraordinary speeds and almost all of it outside awareness, much of the inflow has nonetheless been carried to a very advanced stage of processing before be- ing excluded. The results of experiments on dichotic listening provide striking examples.
In this type of experiment two different mes- sages are transmitted simultaneously to a person, one message to each ear. The person is then told to attend to one of these messages only, say the one being received by the right ear. To ensure he gives it continuous attention, he is required to 'shadow' that message by repeating it word for word as he is hearing it. Keeping the two mes- sages distinct is found to be fairly easy, and at the end of the session the subject is usually totally unaware of the content of the unattended mes- sage. Yet there are significant exceptions. For ex- ample, should his own name or some personally significant word occur in the unattended mes- sage, he may well notice and remember it. This shows that, even though consciously unattended, this message is being subjected to continuous and fairly advanced processing during which its meaning is being monitored and its content ap- praised as more or less relevant; and all this
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? ? ? without the person being in any way aware of what was going on.
In the ordinary course of a person's life the cri- teria applied to sensory inflow that determine what information is to be accepted and what is to be excluded are readily intelligible as reflecting what is at any one time in the person's best in- terests. Thus, when he is hungry, sensory inflow concerned with food is given priority, whilst much else that might at other times be of interest to him is excluded. Yet, should danger threaten, priorities would quickly change so that inflow concerned with issues of danger and safety would take precedence and inflow concerned with food be temporarily excluded. This change in the cri- teria governing what inflow is to be accepted and what excluded is effected by evaluating systems central to the personality.
In thus summarizing the findings from a neigh- bouring discipline the main points I wish to em- phasize are first that throughout a person's life he is engaged in excluding, or shutting out, a large proportion of all the information that is reaching him; secondly that he does so only after its relev- ance to himself has been assessed; and thirdly that this process of selective exclusion is usually
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? ? ? carried out without his being in any way aware of its happening.
Admittedly, so far, most of these experiments have been concerned with the processing of cur- rent sensory inflow, namely with perception, and not with the utilization of information already stored in memory, namely with recall. Yet it seems likely that the same general principles ap- ply. In each case criteria are set by one or more central evaluating systems and it is these criteria that govern what information is passed through for further, and conscious, processing and what is excluded. Thus, thanks to the work of cognitive psychologists, there is no longer any difficulty in imagining, and describing in operational terms, a mental apparatus capable of shutting off inform- ation of certain specified types and of doing so without the person being aware of what is happening.
Let us consider next the second category of scenes and experiences that tend to become shut off and forgotten, whilst at the same time con- tinuing to be more or less influential in affecting a person's thoughts, feeling, and behaviour. These are the scenes and experiences in which parents have treated children in ways the
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? ? ? children find too unbearable to think about or re- member. Here again not only is there amnesia, partial or complete, for the sequence of events but also exclusion from consciousness of the thoughts, feelings, and impulses to action that are the natural responses to such events. This results in major disorders of personality which in their commoner and less severe forms tend to be diagnosed as cases of narcissism or false self and in their more severe forms may be labelled as a fugue, a psychosis, or a case of multiple personal- ity. The experiences which give rise to such dis- orders have probably continued or been repeated over several years of childhood, perhaps starting during the first two or three but usually continu- ing during the fourth, fifth, sixth, and seventh years, and no doubt often for longer still. The ex- periences themselves include repeated rejection by parents combined with contempt for a child's desire for love, care, and comforting, and, espe- cially in the more severe forms, physical violence (battering), repeated and sometimes systematic, and sexual exploitation by father or mother's boyfriend. Not infrequently a child in this predic- ament is subjected to a combination of such experiences.
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? ? ? We start at the less severe end of what appears to be a spectrum of related syndromes.
An example of a patient labelled as 'false self' has already been given in an earlier lecture (see p. 59). This concerned a severely depressed and sui- cidal young graduate who recalled during analys- is how his mother had consistently rejected him, ignored his crying, locked herself away in her room for days on end, and had several times left home.
Fortunately he had been in the hands of a therapist who understood his problem, gave full credence to the childhood experiences he de- scribed, and sympathetic recognition both of his unrequited yearning for love and care and also for the violent feelings towards his mother that her treatment of him had aroused, and which ini- tially were directed towards herself (the therap- ist). A patient with rather similar problems but whose experiences included also a period of 18 months in an impersonal institution, starting when she was 4 years old, is reported in Lecture 4. Although both these patients made rewarding progress during treatment, both remained more sensitive than others to further misfortune.
A number of patients, both children and adults, whose disorders appear to have originated in
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? ? ? similar though mainly worse experiences and to have resulted in personality splitting of an even greater degree have been described by therapists during the past decade. An example is Geraldine, aged 11, who had been found wandering in a dazed state and who had lost all memory both of her mother's terminal illness and of events of the three subsequent years. At the end of a long peri- od of therapy, described in great detail by McCann (in Furman, 1974), Geraldine summed up the experiences which had preceded her am- nesia: 'With Mama, I was scared to death to step out of line. I saw with my own eyes how she at- tacked, in words and actions, my Dad and sister and, after all, I was just a little kid, very power- less. . . . How could I ever be mad at Mama--she was really the only security I had . . . I blotted out all feelings--things happened that were more than I could endure--I had to keep going. If I had really let things hit me, I wouldn't be here. I'd be dead or in a mental hospital. '1
The complex psychological state of Geraldine and also the childhood experiences held to have been responsible for it bear close resemblance to the state of patients suffering from multiple
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? ? ? personality and to the childhood experiences held responsible for them.
In an article by Bliss (1980), based on clinical examinations and therapy carried out by means of hypnosis, a description is given of 14 patients, all female, diagnosed as suffering from multiple personality. The hypothesis Bliss advances is that the subordinate personalities that take posses- sion of a patient from time to time are the cognit- ive creations of the principal personality when, as a child of between 4 and 7 years, she was subjec- ted for extended periods to intensely distressing events. According to Bliss, each such personality is created initially to serve a distinct purpose or role. Judged from the examples he gives, the roles are of three main kinds. The simplest and most benign is to act as a companion and protect- or when the creating personality is feeling lonely or isolated, as, for example, when parents are persistently hostile and/or absent and there is no one else to turn to. A second role is to be anaes- thetic to unbearably distressing events, as in the case of a child of 4 or 5 who shared a room with her mother who, dying of cancer, spent hours screaming in pain. The third role is more com- plex, namely to shoulder the responsibility for
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? ? ? thinking, feeling, and acting in ways that the pa- tient cannot bear to accept as her own. Examples given by Bliss include feeling violent hatred of a mother who had attempted to kill the patient when a child, a hatred amounting to an intent ac- tually to murder her; feeling and acting sexually after having been raped as a child; and feeling frightened and tearful after crying had led to pun- ishments and threats from parents.
Since findings derived from hypnotic proced- ures are controversial, it is important to note that a clinical research group at the University of Cali- fornia at Irvine, which uses conventional proced- ures and which has studied a number of cases (Reagor, personal communication), has reached conclusions very similar to those of Bliss. 2 The therapeutic procedures proposed have much in common also and are, moreover, strongly in keeping with the concepts of therapy described in the final lecture.
Lastly, a number of child psychiatrists and child psychotherapists (e. g. Stroh, 1974; Rosen- feld, 1975; Bloch, 1978; Hopkins, 1984), have de- scribed children whose thought and behaviour make them appear either nearly or frankly psychotic, who show pronouncedly paranoid
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? ? ? ideas, and whose condition, the evidence sug- gests, can be attributed to persistently abusive treatment by parents. Such children are often charming and endearing one moment and sav- agely hostile the next, the change occurring sud- denly and for no apparent reason. Their greatest violence, moreover, is most likely to be directed against the very individual to whom they appear, indeed are, most closely attached. Not infre- quently these children are tormented by intense fear that some monster will attack them and they spend their time trying to escape the expected at- tack. In at least some of these cases there is co- gent evidence that what is feared is an attack by one or other parent but, that expectation being unbearably frightening, the expected attack is at- tributed to an imaginary monster.
As an example, let us consider the case of 6-year-old Sylvia, reported by Hopkins (1984), one of whose principal symptoms was a terror that the chairs and other items of furniture, which she called Daleks, would fly across the room to strike her. 'Her terror was intense and when she kept cowering and ducking as though about to receive a blow from a Dalek or some oth- er monster, I thought she was hallucinating. '
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? ? ? From the first Sylvia also expressed the fear that her therapist would hit her like her mother did. Not only did she constantly attack her therapist but she often threatened to kill her.
The father had died in an automobile accident two years earlier. During many months of twice weekly interviews with a social worker, the moth- er was extremely guarded and told little of family relations. At length, however, after nearly two years the veil was lifted. She admitted her own massive rejection of Sylvia from the time of her birth, and the murderous feelings both she and father had had for her. Her treatment of Sylvia, she confessed, had been 'utterly brutal'. The fath- er had had an extremely violent temper and in his not infrequent rages had broken the furniture and thrown it across the room. He had frequently beaten Sylvia and had even thrown her across the room.
Thus the identity of the Daleks was not in doubt. Behind the 'fantasy' of a Dalek attack lay a serious reality-based expectation of an attack by father or mother. As Bloch (1978) has put it, a ba- sic premise of the therapeutic approach she and others like her advocate for these cases is that what is so facilely dubbed as fantasy be
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? ? ? recognized as a reflection of a grim reality, and that an early therapeutic task is to identify the real-life experiences lying close behind the de- ceptive camouflage.
Not only are the childhood experiences of these nearpsychotic children the same as those be- lieved characteristic of adult patients with mul- tiple personality, but the states of mind described by the respective therapists have features strik- ingly similar too. It seems highly likely therefore that the two conditions are closely related. It should be noted furthermore that these findings give support to the hypothesis advanced by Niederland (1959a and b, discussed by Bowlby, 1973) that the paranoid delusions of Judge Schreber, on which Freud based his theory of paranoia, were distorted versions of the ex- traordinary pedagogic regime to which the pa- tient's father had subjected him from the early months of life.
In this contribution, as in almost all my work, I have focused attention on psychopathology and some of the conditions that give rise to it. My reason for doing so is the belief that only with a better understanding of aetiology and psycho- pathology will it be possible to develop
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? ? ? therapeutic techniques and, more especially, pre- ventive measures that will be at once effective and economical in skilled manpower.
My therapeutic approach is far from original. The basic hypothesis can be stated simply. So long as current modes of perceiving and constru- ing situations, and the feelings and actions that ensue therefrom, are determined by emotionally significant events and experiences that have be- come shut away from further conscious pro- cessing, the personality will be prone to cogni- tion, affect, and behaviour maladapted to the cur- rent situation. When yearning for love and care is shut away, it will continue to be inaccessible. When there is anger, it will continue to be direc- ted at inappropriate targets. Similarly anxiety will continue to be aroused by inappropriate situ- ations and hostile behaviour be expected from in- appropriate sources. The therapeutic task is therefore to help the patient discover what these events and experiences may have been so that the thoughts, feelings, and behaviour that the situ- ations arouse, and that continue to be so trouble- some, can be linked again to the situations that aroused them. Then the true targets of his yearn- ing and anger and the true sources of his anxiety
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? ? ? and fear will become plain. Not only will such discoveries show that his modes of cognition, feeling, and behaviour are far more intelligible, given the circumstances in which they originated, than they had seemed before but, once the pa- tient has grasped how and why he is responding as he is, he will be in a position to reappraise his responses and, should he wish, to undertake their radical restructuring. Since such reappraisal and re-structuring can be achieved only by the patient himself, the emphasis in this formulation of the therapist's task is on helping the patient first to discover for himself what the relevant scenes and experiences probably were and secondly to spend time pondering on how they have continued to influence him. Only then will he be in a position to undertake the reorganization of his modes of construing the world, thinking about it, and act- ing in it which are called for.
The concepts of therapeutic process outlined here are similar to those described in much great- er detail by others. Examples are publications by Peterfreund (1983) and by Guidano and Liotti (1983). Although the authors of these two books started their therapeutic work from radically dif- ferent positions, namely traditional versions of
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? ? ? psychoanalysis and of behaviour therapy respect- ively, the principles that now guide their work show a striking convergence. Similarly current forms of bereavement therapy, which focus on distressing events in the comparatively recent past, are found to be based on the very same principles, even when developed within equally different traditions (Raphael, 1977; Melges and DeMaso, 1980). However divergent tactics may still appear, strategic thinking is on a convergent course.
1 A long abstract of McCann's account is given in Loss (Bowlby, 1980, 338-44).
2 See also Bliss (1986). Further evidence that multiple personality disorder develops during childhood as a
defence against overwhelming trauma, usually severe abuse, is reported in Kluft (1985).
7
THE ROLE OF ATTACHMENT IN PERSONALITY DEVELOPMENT
Evidence regarding the role of attachment in personality development has been accumulating apace during the 1980s. Earlier findings have been replicated on samples of diverse origin; methods of observation have been refined and new methods introduced; and the role of easy two-way communication between parent and child in making for healthy emotional develop- ment has been emphasized. Since I believe this new work to have far-reaching clinical implica- tions, my aim in this lecture has been to present a review of these findings in a form suited to those working as psychotherapists in the mental health field.
For the convenience of the reader I begin by restating in summary form some of the features most distinctive of attachment theory.
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? ? ? SOME DISTINCTIVE FEATURES OF ATTACHMENT THEORY
It will be remembered that attachment theory was formulated to explain certain patterns of be- haviour, characteristic not only of infants and young children but also adolescents and adults, that were formerly conceptualized in terms of de- pendency and over-dependency. In its original formulation observations of how young children respond when placed in a strange place with strange people, and the effects such experiences have on a child's subsequent relations with his parents, were especially influential. In all sub- sequent work theory has continued to be tied closely to detailed observations and interview data of how individuals respond in particular situations. Historically the theory was developed out of the object-relations tradition in psychoana- lysis; but it has drawn also on concepts from evolution theory, ethology, control theory, and cognitive psychology. One result is the reformula- tion of psychoanalytic metapsychology in ways compatible with modern biology and psychology and in conformity with the commonly accepted criteria of natural science (see Lecture 4).
Attachment theory emphasizes:
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? ? ? (a) the primary status and biological function of intimate emotional bonds between individuals, the making and maintaining of which are postulated to be controlled by a cybernetic system situated within the central nervous system, utilizing working models of self and attachment figure in relation- ship with each other. 1
(b) the powerful influence on a child's development of the ways he is treated by his parents, especially his mother-figure, and
(c) that present knowledge of infant and child development requires that a theory of developmental pathways should replace theories that invoke specific phases of development in which it is held a person may become fixated and/or to which he may regress.
THE PRIMACY OF INTIMATE EMOTIONAL BONDS
Attachment theory regards the propensity to make intimate emotional bonds to particular in- dividuals as a basic component of human nature, already present in germinal form in the neonate and continuing through adult life into old age. During infancy and childhood bonds are with parents (or parent substitutes) who are looked to for protection, comfort, and support. During healthy adolescence and adult life these bonds persist, but are complemented by new bonds, commonly of a heterosexual nature. Although food and sex sometimes play important roles in attachment relationships, the relationship exists in its own right and has a key survival function of its own, namely protection. Initially the only means of communication between infant and
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? ? ? mother is through emotional expression and its accompanying behaviour. Although supplemen- ted later by speech, emotionally mediated com- munication nonetheless persists as a principal feature of intimate relationships throughout life.
Within the attachment framework therefore in- timate emotional bonds are seen as neither sub- ordinate to nor derivative from food and sex. Nor is the urgent desire for comfort and support in adversity regarded as childish, as dependency theory implies. Instead the capacity to make in- timate emotional bonds with other individuals, sometimes in the careseeking role and sometimes in the caregiving one, is regarded as a principal feature of effective personality functioning and mental health.
As a rule careseeking is shown by a weaker and less experienced individual towards someone re- garded as stronger and/or wiser. A child, or older person in the careseeking role, keeps within range of the caregiver, the degree of closeness or of ready accessibility depending on circum- stances: hence the concept of attachment behaviour.
Caregiving, the major role of parents and com- plementary to attachment behaviour, is regarded
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? ? ? in the same light as careseeking, namely as a ba- sic component of human nature (see Lecture 1).
Exploring the environment, including play and varied activities with peers, is seen as a third ba- sic component and one antithetic to attachment behaviour. When an individual (of any age) is feeling secure he is likely to explore away from his attachment figure. When alarmed, anxious, tired, or unwell he feels an urge towards proxim- ity. Thus we see the typical pattern of interaction between child and parent known as exploration from a secure base, first described by Ainsworth (1967). Provided the parent is known to be ac- cessible and will be responsive when called upon, a healthy child feels secure enough to explore. At first these explorations are limited both in time and space. Around the middle of the third year, however, a secure child begins to become confid- ent enough to increase time and distance away--first to half-days and later to whole days. As he grows into adolescence, his excursions are extended to weeks or months, but a secure home base remains indispensable nonetheless for op- timal functioning and mental health. Note that the concept of secure base is a central feature of the theory of psychotherapy proposed.
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? ? ? During the early months of life an infant shows many of the component responses of what will later become attachment behaviour, but the or- ganized pattern does not develop until the second half of the first year. From birth onwards he shows a germinal capacity to engage in social in- teraction and pleasure in doing so (Stern, 1985): thus there is no autistic or narcissistic phase. Within days, moreover, he is able to distinguish between his mother-figure and others by means of her smell and by hearing her voice, and also by the way she holds him. Visual discrimination is not reliable until the second quarter. Initially cry- ing is the only means available to him for sig- nalling his need for care, and contentment the only means for signalling that he has been satis- fied. During the second month, however, his so- cial smile acts strongly to encourage his mother in her ministrations and his repertoire of emo- tional communications rapidly extends (Izard, 1982; Emde, 1983).
The development of attachment behaviour as an organized system, having as its goal the keep- ing of proximity or of accessibility to a discriminated mother-figure, requires that the child should have developed the cognitive
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? ? ? capacity to keep his mother in mind when she is not present: this capacity develops during the second six months of life. Thus from nine months onwards the great majority of infants respond to being left with a strange person by protest and crying, and also by more or less prolonged fret- ting and rejection of the stranger. These observa- tions demonstrate that during these months an infant is becoming capable of representation and that his working model of his mother is becoming available to him for purposes of comparison dur- ing her absence and for recognition after her re- turn. Complementary to his model of his mother, he develops a working model of himself in inter- action with her, likewise for father.
A major feature of attachment theory is the hy- pothesis that attachment behaviour is organized by means of a control system within the central nervous system, analogous to the physiological control systems that maintain physiological measures such as blood pressure and body tem- perature within set limits. Thus the theory pro- poses that, in a way analogous to physiological homeostasis, the attachment control system maintains a person's relation to his attachment figure between certain limits of distance and
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? ? ? accessibility, using increasingly sophisticated methods of communication for doing so. As such, the effects of its operation can be regarded as an example of what can usefully be termed environ- mental homeostasis (Bowlby, 1969, 1982). By postulating a control system of this sort (with analogous systems controlling other forms of be- haviour) attachment theory contains within itself a theory of motivation that can replace traditional theories which invoke a postulated build-up of energy or drive. Among several advantages of control theory are that it gives as much attention to the conditions terminating a behavioural se- quence as to those initiating it and is proving a fruitful framework for empirical research.
The presence of an attachment control system and its linkage to the working models of self and attachment figure(s) that are built in the mind during childhood are held to be central features of personality functioning throughout life.
PATTERNS OF ATTACHMENT AND CONDITIONS DETERMINING THEIR DEVELOPMENT
The second area to which attachment theory pays special attention is the role of a child's parents in determining how he develops. There is today
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? ? ? impressive and mounting evidence that the pat- tern of attachment that an individual develops during the years of immaturity--infancy, child- hood, and adolescence--is profoundly influenced by the way his parents (or other parent figures) treat him. This evidence derives from a number of systematic research studies, the most impress- ive being prospective studies of socio-emotional development during the first five years under- taken by developmental psychologists who are also clinically sophisticated. Pioneered by Ainsworth (Ainsworth, Blehar, Waters, and Wall, 1978; Ainsworth, 1985) and expanded, notably by Main (Main, Kaplan, and Cassidy, 1985) and Sroufe (1983, 1985) in the United States and by Grossmann (Grossmann, Grossmann, and Sch- wan, 1986) in Germany, these studies are now multiplying fast. Their findings are remarkably consistent and have the clearest of clinical significance.
Three principal patterns of attachment, first described by Ainsworth and her colleagues in 1971, are now reliably identified, together with the family conditions that promote them. These are first the pattern of secure attachment in which the individual is confident that his parent
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? ? ? (or parent figure) will be available, responsive, and helpful should he encounter adverse or frightening situations. With this assurance, he feels bold in his explorations of the world. This pattern is promoted by a parent, in the early years especially by mother, being readily avail- able, sensitive to her child's signals, and lovingly responsive when he seeks protection and/or comfort.
A second pattern is that of anxious resistant at- tachment in which the individual is uncertain whether his parent will be available or responsive or helpful when called upon. Because of this un- certainty he is always prone to separation anxi- ety, tends to be clinging, and is anxious about ex- ploring the world. This pattern, in which conflict is evident, is promoted by a parent being avail- able and helpful on some occasions but not on others, and by separations and, as clinical find- ings show, by threats of abandonment used as a means of control.
A third pattern is that of anxious avoidant at- tachment in which the individual has no confid- ence that, when he seeks care, he will be respon- ded to helpfully but, on the contrary, expects to be rebuffed. When in marked degree such an
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? ? ? individual attempts to live his life without the love and support of others, he tries to become emotionally self-sufficient and may later be dia- gnosed as narcissistic or as having a false self of the type described by Winnicott (1960). This pat- tern, in which conflict is more hidden, is the res- ult of the individual's mother constantly rebuff- ing him when he approaches her for comfort or protection. The most extreme cases result from repeated rejections.
Although in most cases the pattern observed conforms fairly closely to one or another of the three well-recognized types, there have been puzzling exceptions. During the assessment pro- cedure used in these studies (the Ainsworth Strange Situation), in which infant and mother are observed in interaction during a series of brief episodes, certain infants have appeared to be disoriented and/or disorganized. One infant appears dazed; another freezes immobile; a third engages in some stereotypy; a fourth starts a movement, then stops unaccountably. After much study Main and her colleagues have con- cluded that these peculiar forms of behaviour oc- cur in infants who are exhibiting a disorganized version of one of the three typical patterns, more
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? ? ? often than not the anxious resistant one (Main and Weston, 1981; Main and Solomon, 1990).
During the past two decades renewed attention has been paid to incest, both to its unrecognized high incidence and to its pathogenic effects on children. Much the commonest forms are between father and daughter or step-father and step-daughter. Among the various problems and symptoms in the children and adolescents con- cerned that are believed to be due to these experi- ences, the commonest include withdrawal from all intimate relationships, sleep disturbances, and suicidal intentions (Meiselman, 1978; Adams- Tucker, 1982). An account of conditions likely to cause cognitive disturbance was given me by a colleague, Brendan MacCarthy, but never pub- lished. He suspected that disturbance is espe- cially likely when the children are prepubertal. In what follows I draw on his conclusions.
When a sexual liaison develops between a fath- er and his adolescent daughter, MacCarthy re- ports, the liaison is usually acknowledged by the father during the course of daily life by such means as secret glances, secret touching, and
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? ? ? innuendoes. In the case of a younger child, however, a father is likely to make no such ac- knowledgements. Instead he behaves during the day as though the nightly episodes never oc- curred; and this total failure to acknowledge them is commonly maintained even long after the daughter has reached adolescence.
MacCarthy describes the case of a married wo- man, Mrs A, whom he treated for depression, re- liance on tranquillizers, and alcohol. She men- tioned the ten years of sexual interference she had suffered from her adoptive father only after she had been in therapy for four months. It had begun when she was 5 or 6, soon after her adopt- ive mother had died, and had continued until she was 16, when she had fled. Among her many problems were frigidity and finding intercourse disgusting, and a sense of inner blackness, of 'a black stain'. Her problems had become exacer- bated when her own daughter was 4 years old. Whenever the daughter became affectionate to her father and sat near him, Mrs A felt agitated, protective, and jealous; on these occasions she could never leave them alone together. During therapy she was obsequious and terrified, and in- tensely vigilant of the analyst's every move.
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? ? ? In regard to the incestuous relationship, Mrs A described how her adoptive father would never at any time during the day allude to his nocturnal visits to her room, which had always remained darkened. On the contrary, he had lectured her incessantly on the dangers of allowing boys to go too far, and on the importance of chastity before marriage. When at the age of 16 she had fled the home, he not only insisted she tell no one, but ad- ded sarcastically: 'And if you do no one will be- lieve you. ' This could well have been so since her adoptive father was a headmaster and the local mayor.
In commenting on this and similar cases MacCarthy emphasizes the cognitive split between the respected and perhaps loved father of daytime and the very different father of the strange events of the night before. Warned on no account to breathe a word to anyone, including her mother, the child looks to her father for some confirmation of those events and is naturally be- wildered when there is no response. Did it really happen or did I dream it? Have I two fathers? Small wonder if, in later years, all men are dis- trusted, and the professional stance of a male therapist is seen as a mere fac? ade that hides a
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? ? ? predatory intent. Small wonder also that the in- junction on no account to tell anyone remains op- erative, and that the expectation that in any case no one would believe you ensures silence. How often, we may wonder, do ill-informed therapists discourage a patient from telling the truth and, should she do so nonetheless, confirm her ex- pectation that no one will believe her story?
In the examples so far described the informa- tion a parent is pressing a child to shut away is information relating to events in the outside world. In other situations the information to be shut away relates to events in the child's private world of feeling. Nowhere does this occur more commonly than in situations of separation and loss.
When a parent dies the surviving parent or other relative may not only provide the children with inadequate or misleading information but he or she may also indicate that it would not be appropriate for the child even to be distressed. This may be explicit: A. Miller (1979) describes how, when a 6-year-old's mother died, his aunt told him: 'You must be brave; don't cry; now go to your room and play nicely. ' At other times the indication is only implicit. Not infrequently
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? ? ? widows or widowers, afraid to express their own distress, in effect encourage their children to shut away all the feeling they are having about their loss. Palgi (1973) describes how a small boy whose mother was chiding him for not shedding tears over his father's death retorted: 'How can I cry when I have never seen your tears? '
There are in fact many situations in which a child is expressly told not to cry. For example, a child of 5 whose nanny is leaving is told not to cry because that would make it more difficult for nanny. A child whose parents leave him in hos- pital or residential nursery insist he should not cry, otherwise they will not visit him. A child whose parents are frequently away and who leave him with one of a succession of au pair girls is not encouraged to recognize how lonely, and perhaps angry, he feels at their constant absence. When parents separate, it is often made plain to a child that he is not expected to miss the departing par- ent or to pine for the parent's return. Not only is sorrow and crying condemned as inappropriate in such situations but older children and adults may jeer at a distressed child for being a crybaby. Is there any wonder that in such circumstances feeling should become shut away?
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? ? ? All these situations are plain enough but have, I believe, been seriously neglected as causes of in- formation and feeling becoming excluded from consciousness. There are, however, other situ- ations also, more subtle and hidden but no less common, that have the same effect. One such is when a mother, who herself had a childhood de- prived of love, seeks from her own child the love she has hitherto lacked. In doing this she is in- verting the normal parent-child relationship, re- quiring the child to act as parent whilst she be- comes a child. To someone unaware of what is going on it may appear that the child is being 'overindulged', but a closer look shows that moth- er is placing a heavy burden on him. What is of special relevance here is that more often than not the child is expected to be grateful for such care as he receives and not to notice the demands be- ing made upon him. One result of this is that, in conformity with his mother's wishes, he builds up a one-sided picture of her as wholly loving and generous, thereby shutting away from conscious processing much information also reaching him that she is often selfish, demanding, and ungrate- ful. Another result is that, also in conformity with his mother's wishes, he admits to consciousness
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? ? ? only feelings of love and gratitude towards her and shuts away every feeling of anger he may have against her for expecting him to care for her and preventing him from making his own friends and living his own life.
A related situation is one in which a parent, having had a traumatic childhood, is apprehens- ive of being reminded of past miseries and so be- coming depressed. As a result her children are re- quired always to appear happy and to avoid any expression of sorrow, loneliness, or anger. As one patient put it to me after a good deal of therapy: 'I see now that I was terribly lonely as a child but I was never allowed to know it. '
Most children are indulgent towards their par- ents, preferring to see them in a favourable light and eager to overlook many deficiencies. Yet they do not willingly conform to seeing a parent only in the light the parent requires or to feeling to- wards him or her only in the way demanded. To ensure that, pressure must be exerted. Pressure can take different forms but all forms depend for their effectiveness on the child's insistent desire to be loved and protected. Alice Miller (1979), who has given these problems much attention, reports the words of an adult patient who was
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? ? ? born the eldest child of an insecure professional woman:
I was the jewel in my mother's crown. She often said: 'Maja can be relied upon, she will cope. ' And I did cope. I brought up the smaller children for her so that she could get on with her professional career. She became more and more famous, but I never saw her happy. How often I longed for her in the evenings. The little ones cried and I comforted them but I my- self never cried. Who would have wanted a crying child? I could only win my mother's love if I was competent, understanding and controlled, if I never questioned her actions nor showed her how much I missed her; that would have limited her freedom which she needed so much. That would have turned her against me.
In other families pressures are less subtle. One form, threatening to abandon a child as a means of controlling him, is an extremely powerful weapon, especially with a young child. Faced with such threats, how could a child do other than conform to his parents' wishes by excluding from further processing all that he knows they wish him to forget? Elsewhere I have given reasons for believing that threats of this sort are responsible for much acute and chronic anxiety (Bowlby 1973) and also for a person responding to be- reavement in later life with chronic depression in which the dominant belief is one of having been deliberately abandoned, as a punishment, by the dead person (Bowlby, 1980).
The hypothesis advanced, that various forms of cognitive disturbance seen in children and also in
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? ? ? later life are to be traced to influences acting ini- tially during the pre-adolescent years, is compat- ible with indications that during these years chil- dren's minds are especially sensitive to outside influence. Evidence of this, already emphasized, is the extent to which young children are vulner- able to threats by parents to reject or even aban- don them. After a child has reached adolescence, clearly his vulnerability to such threats diminishes.
The extent to which the minds of pre-adoles- cent children are prone to the influence of par- ents is well illustrated by an experiment of Gill (1970). The sample comprised 10-year-old chil- dren, drawn from a London primary school, and their parents. Of the 40 non-immigrant families invited to participate, 25 agreed. Each family was visited in its own home and a series of ten pic- tures shown on a screen, each for two minutes.
Of the pictures used, five came from picture book or film and the rest from thematic apper- ception tests. Some were emotionally benign, for example, a mother watching a small girl holding a baby. Some showed scenes of an aggressive and/ or frightening sort. Three depicted a sexual theme: a woman obviously pregnant lying on a
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? ? ? bed; a couple embracing on the grass; and a wo- man clutching the shoulders of a man who seems to be pulling away, with the picture of a semi- nude woman in the background.
The series of ten pictures was presented three times in succession. On the first showing, father, mother, and child were asked to write down inde- pendently what they saw happening in the pic- ture. On the second members of the family were asked to discuss each picture for the two minutes it was shown. During the third showing, each member was asked again to write down inde- pendently what they now saw happening.
When the children's responses to the three pic- tures depicting sexual themes were examined, it was found that, whereas half the children (12) de- scribed the sexual themes in a fairly direct matter-of-fact way, the other half failed to do so. For example, to the picture of the obviously preg- nant woman, one child's candid response ran: 'She's having a rest. I can see that she's expecting a baby. She's asleep, I think. ' Descriptions of the same picture by other children omitted all refer- ence to pregnancy. 'Somebody is asleep in bed,' and 'There's a man on a bed. He is asleep. '
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? ? ? A second step was to analyse how the parents discussed the picture in the child's presence dur- ing the second showing. This was done by a psy- chologist blind to the children's responses. Here again it was evident that, whereas some parents were candid about the scene depicted, others made no reference to it and/or expressed disgust. For example, in the case of the pregnant woman, the mother of one child remarked frankly and on three occasions that the woman was expecting a baby and was having an afternoon rest. By con- trast, the parents of another child completed their two-minute discussion without any such reference. Instead they concentrated on emotion- ally neutral details such as the woman's hairstyle, the material of her dressing gown, and the quality of the furniture. Not surprisingly there was a high correlation between the way the children respon- ded to the pictures and the way the parents had discussed them subsequently.
On the third showing the descriptions given by all the children improved in accuracy; but those of the 12 who had responded candidly on the first showing improved more than did the descrip- tions given by the 13 who had failed to report the pictures' content on the first occasion.
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? ? ? There could be little doubt that during their discussion of the pictures some of the parents were, consciously or unconsciously, avoiding ref- erence to the content of the pictures. It was a reasonable inference also that their children's failure to describe the sexual theme on the first showing was in some way influenced by the 'cli- mate' they had experienced in their homes. What the experiment could not show, of course, was whether these children had truly failed to per- ceive the scene depicted or whether they had per- ceived it but had failed to report what they saw. Since pre-adolescent children tend to be slow and often uncertain in their perceptions, my guess would be that at least some of the children in the experiment had truly failed to register the nature of what was happening. Others may have known intuitively that the scene was one they were not supposed to know about and so avoided seeing it.
At first sight the notion that information of a certain meaning can be shut off, or selectively ex- cluded from perception, appears paradoxical. How, it is asked, can a person selectively exclude from processing a particular stimulus unless he first perceives the stimulus which he wishes to exclude? This stumbling block disappears,
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? ? ? however, once perception is conceived as a multistage process as nowadays it is. Indeed ex- perimental work on human information pro- cessing undertaken during the past decade or so enables us to have a much better idea of the nature of the shutting-off processes we have been discussing than was possible when Freud and others in the psychodynamic tradition were first formulating the theories of defence that have been so very influential ever since. In what fol- lows I give a brief sketch of this new approach.
Studies of human perception (Erdelyi, 1974; Norman, 1976) have shown that, before a person is aware of seeing something or hearing something, the sensory inflow coming through his eyes or ears, has already passed through many stages of selection, interpretation, and ap- praisal, during the course of which a large pro- portion of the original inflow has been excluded. The reason for this extensive exclusion is that the channels responsible for the most advanced pro- cessing are of limited capacity and must therefore be protected from overload. To ensure that what is most relevant gets through and that only the less relevant is excluded, selection of inflow is un- der central, or we might say ego, control.
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? ? ? Although this processing is done at extraordinary speeds and almost all of it outside awareness, much of the inflow has nonetheless been carried to a very advanced stage of processing before be- ing excluded. The results of experiments on dichotic listening provide striking examples.
In this type of experiment two different mes- sages are transmitted simultaneously to a person, one message to each ear. The person is then told to attend to one of these messages only, say the one being received by the right ear. To ensure he gives it continuous attention, he is required to 'shadow' that message by repeating it word for word as he is hearing it. Keeping the two mes- sages distinct is found to be fairly easy, and at the end of the session the subject is usually totally unaware of the content of the unattended mes- sage. Yet there are significant exceptions. For ex- ample, should his own name or some personally significant word occur in the unattended mes- sage, he may well notice and remember it. This shows that, even though consciously unattended, this message is being subjected to continuous and fairly advanced processing during which its meaning is being monitored and its content ap- praised as more or less relevant; and all this
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? ? ? without the person being in any way aware of what was going on.
In the ordinary course of a person's life the cri- teria applied to sensory inflow that determine what information is to be accepted and what is to be excluded are readily intelligible as reflecting what is at any one time in the person's best in- terests. Thus, when he is hungry, sensory inflow concerned with food is given priority, whilst much else that might at other times be of interest to him is excluded. Yet, should danger threaten, priorities would quickly change so that inflow concerned with issues of danger and safety would take precedence and inflow concerned with food be temporarily excluded. This change in the cri- teria governing what inflow is to be accepted and what excluded is effected by evaluating systems central to the personality.
In thus summarizing the findings from a neigh- bouring discipline the main points I wish to em- phasize are first that throughout a person's life he is engaged in excluding, or shutting out, a large proportion of all the information that is reaching him; secondly that he does so only after its relev- ance to himself has been assessed; and thirdly that this process of selective exclusion is usually
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? ? ? carried out without his being in any way aware of its happening.
Admittedly, so far, most of these experiments have been concerned with the processing of cur- rent sensory inflow, namely with perception, and not with the utilization of information already stored in memory, namely with recall. Yet it seems likely that the same general principles ap- ply. In each case criteria are set by one or more central evaluating systems and it is these criteria that govern what information is passed through for further, and conscious, processing and what is excluded. Thus, thanks to the work of cognitive psychologists, there is no longer any difficulty in imagining, and describing in operational terms, a mental apparatus capable of shutting off inform- ation of certain specified types and of doing so without the person being aware of what is happening.
Let us consider next the second category of scenes and experiences that tend to become shut off and forgotten, whilst at the same time con- tinuing to be more or less influential in affecting a person's thoughts, feeling, and behaviour. These are the scenes and experiences in which parents have treated children in ways the
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? ? ? children find too unbearable to think about or re- member. Here again not only is there amnesia, partial or complete, for the sequence of events but also exclusion from consciousness of the thoughts, feelings, and impulses to action that are the natural responses to such events. This results in major disorders of personality which in their commoner and less severe forms tend to be diagnosed as cases of narcissism or false self and in their more severe forms may be labelled as a fugue, a psychosis, or a case of multiple personal- ity. The experiences which give rise to such dis- orders have probably continued or been repeated over several years of childhood, perhaps starting during the first two or three but usually continu- ing during the fourth, fifth, sixth, and seventh years, and no doubt often for longer still. The ex- periences themselves include repeated rejection by parents combined with contempt for a child's desire for love, care, and comforting, and, espe- cially in the more severe forms, physical violence (battering), repeated and sometimes systematic, and sexual exploitation by father or mother's boyfriend. Not infrequently a child in this predic- ament is subjected to a combination of such experiences.
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? ? ? We start at the less severe end of what appears to be a spectrum of related syndromes.
An example of a patient labelled as 'false self' has already been given in an earlier lecture (see p. 59). This concerned a severely depressed and sui- cidal young graduate who recalled during analys- is how his mother had consistently rejected him, ignored his crying, locked herself away in her room for days on end, and had several times left home.
Fortunately he had been in the hands of a therapist who understood his problem, gave full credence to the childhood experiences he de- scribed, and sympathetic recognition both of his unrequited yearning for love and care and also for the violent feelings towards his mother that her treatment of him had aroused, and which ini- tially were directed towards herself (the therap- ist). A patient with rather similar problems but whose experiences included also a period of 18 months in an impersonal institution, starting when she was 4 years old, is reported in Lecture 4. Although both these patients made rewarding progress during treatment, both remained more sensitive than others to further misfortune.
A number of patients, both children and adults, whose disorders appear to have originated in
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? ? ? similar though mainly worse experiences and to have resulted in personality splitting of an even greater degree have been described by therapists during the past decade. An example is Geraldine, aged 11, who had been found wandering in a dazed state and who had lost all memory both of her mother's terminal illness and of events of the three subsequent years. At the end of a long peri- od of therapy, described in great detail by McCann (in Furman, 1974), Geraldine summed up the experiences which had preceded her am- nesia: 'With Mama, I was scared to death to step out of line. I saw with my own eyes how she at- tacked, in words and actions, my Dad and sister and, after all, I was just a little kid, very power- less. . . . How could I ever be mad at Mama--she was really the only security I had . . . I blotted out all feelings--things happened that were more than I could endure--I had to keep going. If I had really let things hit me, I wouldn't be here. I'd be dead or in a mental hospital. '1
The complex psychological state of Geraldine and also the childhood experiences held to have been responsible for it bear close resemblance to the state of patients suffering from multiple
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? ? ? personality and to the childhood experiences held responsible for them.
In an article by Bliss (1980), based on clinical examinations and therapy carried out by means of hypnosis, a description is given of 14 patients, all female, diagnosed as suffering from multiple personality. The hypothesis Bliss advances is that the subordinate personalities that take posses- sion of a patient from time to time are the cognit- ive creations of the principal personality when, as a child of between 4 and 7 years, she was subjec- ted for extended periods to intensely distressing events. According to Bliss, each such personality is created initially to serve a distinct purpose or role. Judged from the examples he gives, the roles are of three main kinds. The simplest and most benign is to act as a companion and protect- or when the creating personality is feeling lonely or isolated, as, for example, when parents are persistently hostile and/or absent and there is no one else to turn to. A second role is to be anaes- thetic to unbearably distressing events, as in the case of a child of 4 or 5 who shared a room with her mother who, dying of cancer, spent hours screaming in pain. The third role is more com- plex, namely to shoulder the responsibility for
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? ? ? thinking, feeling, and acting in ways that the pa- tient cannot bear to accept as her own. Examples given by Bliss include feeling violent hatred of a mother who had attempted to kill the patient when a child, a hatred amounting to an intent ac- tually to murder her; feeling and acting sexually after having been raped as a child; and feeling frightened and tearful after crying had led to pun- ishments and threats from parents.
Since findings derived from hypnotic proced- ures are controversial, it is important to note that a clinical research group at the University of Cali- fornia at Irvine, which uses conventional proced- ures and which has studied a number of cases (Reagor, personal communication), has reached conclusions very similar to those of Bliss. 2 The therapeutic procedures proposed have much in common also and are, moreover, strongly in keeping with the concepts of therapy described in the final lecture.
Lastly, a number of child psychiatrists and child psychotherapists (e. g. Stroh, 1974; Rosen- feld, 1975; Bloch, 1978; Hopkins, 1984), have de- scribed children whose thought and behaviour make them appear either nearly or frankly psychotic, who show pronouncedly paranoid
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? ? ? ideas, and whose condition, the evidence sug- gests, can be attributed to persistently abusive treatment by parents. Such children are often charming and endearing one moment and sav- agely hostile the next, the change occurring sud- denly and for no apparent reason. Their greatest violence, moreover, is most likely to be directed against the very individual to whom they appear, indeed are, most closely attached. Not infre- quently these children are tormented by intense fear that some monster will attack them and they spend their time trying to escape the expected at- tack. In at least some of these cases there is co- gent evidence that what is feared is an attack by one or other parent but, that expectation being unbearably frightening, the expected attack is at- tributed to an imaginary monster.
As an example, let us consider the case of 6-year-old Sylvia, reported by Hopkins (1984), one of whose principal symptoms was a terror that the chairs and other items of furniture, which she called Daleks, would fly across the room to strike her. 'Her terror was intense and when she kept cowering and ducking as though about to receive a blow from a Dalek or some oth- er monster, I thought she was hallucinating. '
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? ? ? From the first Sylvia also expressed the fear that her therapist would hit her like her mother did. Not only did she constantly attack her therapist but she often threatened to kill her.
The father had died in an automobile accident two years earlier. During many months of twice weekly interviews with a social worker, the moth- er was extremely guarded and told little of family relations. At length, however, after nearly two years the veil was lifted. She admitted her own massive rejection of Sylvia from the time of her birth, and the murderous feelings both she and father had had for her. Her treatment of Sylvia, she confessed, had been 'utterly brutal'. The fath- er had had an extremely violent temper and in his not infrequent rages had broken the furniture and thrown it across the room. He had frequently beaten Sylvia and had even thrown her across the room.
Thus the identity of the Daleks was not in doubt. Behind the 'fantasy' of a Dalek attack lay a serious reality-based expectation of an attack by father or mother. As Bloch (1978) has put it, a ba- sic premise of the therapeutic approach she and others like her advocate for these cases is that what is so facilely dubbed as fantasy be
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? ? ? recognized as a reflection of a grim reality, and that an early therapeutic task is to identify the real-life experiences lying close behind the de- ceptive camouflage.
Not only are the childhood experiences of these nearpsychotic children the same as those be- lieved characteristic of adult patients with mul- tiple personality, but the states of mind described by the respective therapists have features strik- ingly similar too. It seems highly likely therefore that the two conditions are closely related. It should be noted furthermore that these findings give support to the hypothesis advanced by Niederland (1959a and b, discussed by Bowlby, 1973) that the paranoid delusions of Judge Schreber, on which Freud based his theory of paranoia, were distorted versions of the ex- traordinary pedagogic regime to which the pa- tient's father had subjected him from the early months of life.
In this contribution, as in almost all my work, I have focused attention on psychopathology and some of the conditions that give rise to it. My reason for doing so is the belief that only with a better understanding of aetiology and psycho- pathology will it be possible to develop
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? ? ? therapeutic techniques and, more especially, pre- ventive measures that will be at once effective and economical in skilled manpower.
My therapeutic approach is far from original. The basic hypothesis can be stated simply. So long as current modes of perceiving and constru- ing situations, and the feelings and actions that ensue therefrom, are determined by emotionally significant events and experiences that have be- come shut away from further conscious pro- cessing, the personality will be prone to cogni- tion, affect, and behaviour maladapted to the cur- rent situation. When yearning for love and care is shut away, it will continue to be inaccessible. When there is anger, it will continue to be direc- ted at inappropriate targets. Similarly anxiety will continue to be aroused by inappropriate situ- ations and hostile behaviour be expected from in- appropriate sources. The therapeutic task is therefore to help the patient discover what these events and experiences may have been so that the thoughts, feelings, and behaviour that the situ- ations arouse, and that continue to be so trouble- some, can be linked again to the situations that aroused them. Then the true targets of his yearn- ing and anger and the true sources of his anxiety
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? ? ? and fear will become plain. Not only will such discoveries show that his modes of cognition, feeling, and behaviour are far more intelligible, given the circumstances in which they originated, than they had seemed before but, once the pa- tient has grasped how and why he is responding as he is, he will be in a position to reappraise his responses and, should he wish, to undertake their radical restructuring. Since such reappraisal and re-structuring can be achieved only by the patient himself, the emphasis in this formulation of the therapist's task is on helping the patient first to discover for himself what the relevant scenes and experiences probably were and secondly to spend time pondering on how they have continued to influence him. Only then will he be in a position to undertake the reorganization of his modes of construing the world, thinking about it, and act- ing in it which are called for.
The concepts of therapeutic process outlined here are similar to those described in much great- er detail by others. Examples are publications by Peterfreund (1983) and by Guidano and Liotti (1983). Although the authors of these two books started their therapeutic work from radically dif- ferent positions, namely traditional versions of
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? ? ? psychoanalysis and of behaviour therapy respect- ively, the principles that now guide their work show a striking convergence. Similarly current forms of bereavement therapy, which focus on distressing events in the comparatively recent past, are found to be based on the very same principles, even when developed within equally different traditions (Raphael, 1977; Melges and DeMaso, 1980). However divergent tactics may still appear, strategic thinking is on a convergent course.
1 A long abstract of McCann's account is given in Loss (Bowlby, 1980, 338-44).
2 See also Bliss (1986). Further evidence that multiple personality disorder develops during childhood as a
defence against overwhelming trauma, usually severe abuse, is reported in Kluft (1985).
7
THE ROLE OF ATTACHMENT IN PERSONALITY DEVELOPMENT
Evidence regarding the role of attachment in personality development has been accumulating apace during the 1980s. Earlier findings have been replicated on samples of diverse origin; methods of observation have been refined and new methods introduced; and the role of easy two-way communication between parent and child in making for healthy emotional develop- ment has been emphasized. Since I believe this new work to have far-reaching clinical implica- tions, my aim in this lecture has been to present a review of these findings in a form suited to those working as psychotherapists in the mental health field.
For the convenience of the reader I begin by restating in summary form some of the features most distinctive of attachment theory.
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? ? ? SOME DISTINCTIVE FEATURES OF ATTACHMENT THEORY
It will be remembered that attachment theory was formulated to explain certain patterns of be- haviour, characteristic not only of infants and young children but also adolescents and adults, that were formerly conceptualized in terms of de- pendency and over-dependency. In its original formulation observations of how young children respond when placed in a strange place with strange people, and the effects such experiences have on a child's subsequent relations with his parents, were especially influential. In all sub- sequent work theory has continued to be tied closely to detailed observations and interview data of how individuals respond in particular situations. Historically the theory was developed out of the object-relations tradition in psychoana- lysis; but it has drawn also on concepts from evolution theory, ethology, control theory, and cognitive psychology. One result is the reformula- tion of psychoanalytic metapsychology in ways compatible with modern biology and psychology and in conformity with the commonly accepted criteria of natural science (see Lecture 4).
Attachment theory emphasizes:
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? ? ? (a) the primary status and biological function of intimate emotional bonds between individuals, the making and maintaining of which are postulated to be controlled by a cybernetic system situated within the central nervous system, utilizing working models of self and attachment figure in relation- ship with each other. 1
(b) the powerful influence on a child's development of the ways he is treated by his parents, especially his mother-figure, and
(c) that present knowledge of infant and child development requires that a theory of developmental pathways should replace theories that invoke specific phases of development in which it is held a person may become fixated and/or to which he may regress.
THE PRIMACY OF INTIMATE EMOTIONAL BONDS
Attachment theory regards the propensity to make intimate emotional bonds to particular in- dividuals as a basic component of human nature, already present in germinal form in the neonate and continuing through adult life into old age. During infancy and childhood bonds are with parents (or parent substitutes) who are looked to for protection, comfort, and support. During healthy adolescence and adult life these bonds persist, but are complemented by new bonds, commonly of a heterosexual nature. Although food and sex sometimes play important roles in attachment relationships, the relationship exists in its own right and has a key survival function of its own, namely protection. Initially the only means of communication between infant and
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? ? ? mother is through emotional expression and its accompanying behaviour. Although supplemen- ted later by speech, emotionally mediated com- munication nonetheless persists as a principal feature of intimate relationships throughout life.
Within the attachment framework therefore in- timate emotional bonds are seen as neither sub- ordinate to nor derivative from food and sex. Nor is the urgent desire for comfort and support in adversity regarded as childish, as dependency theory implies. Instead the capacity to make in- timate emotional bonds with other individuals, sometimes in the careseeking role and sometimes in the caregiving one, is regarded as a principal feature of effective personality functioning and mental health.
As a rule careseeking is shown by a weaker and less experienced individual towards someone re- garded as stronger and/or wiser. A child, or older person in the careseeking role, keeps within range of the caregiver, the degree of closeness or of ready accessibility depending on circum- stances: hence the concept of attachment behaviour.
Caregiving, the major role of parents and com- plementary to attachment behaviour, is regarded
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? ? ? in the same light as careseeking, namely as a ba- sic component of human nature (see Lecture 1).
Exploring the environment, including play and varied activities with peers, is seen as a third ba- sic component and one antithetic to attachment behaviour. When an individual (of any age) is feeling secure he is likely to explore away from his attachment figure. When alarmed, anxious, tired, or unwell he feels an urge towards proxim- ity. Thus we see the typical pattern of interaction between child and parent known as exploration from a secure base, first described by Ainsworth (1967). Provided the parent is known to be ac- cessible and will be responsive when called upon, a healthy child feels secure enough to explore. At first these explorations are limited both in time and space. Around the middle of the third year, however, a secure child begins to become confid- ent enough to increase time and distance away--first to half-days and later to whole days. As he grows into adolescence, his excursions are extended to weeks or months, but a secure home base remains indispensable nonetheless for op- timal functioning and mental health. Note that the concept of secure base is a central feature of the theory of psychotherapy proposed.
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? ? ? During the early months of life an infant shows many of the component responses of what will later become attachment behaviour, but the or- ganized pattern does not develop until the second half of the first year. From birth onwards he shows a germinal capacity to engage in social in- teraction and pleasure in doing so (Stern, 1985): thus there is no autistic or narcissistic phase. Within days, moreover, he is able to distinguish between his mother-figure and others by means of her smell and by hearing her voice, and also by the way she holds him. Visual discrimination is not reliable until the second quarter. Initially cry- ing is the only means available to him for sig- nalling his need for care, and contentment the only means for signalling that he has been satis- fied. During the second month, however, his so- cial smile acts strongly to encourage his mother in her ministrations and his repertoire of emo- tional communications rapidly extends (Izard, 1982; Emde, 1983).
The development of attachment behaviour as an organized system, having as its goal the keep- ing of proximity or of accessibility to a discriminated mother-figure, requires that the child should have developed the cognitive
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? ? ? capacity to keep his mother in mind when she is not present: this capacity develops during the second six months of life. Thus from nine months onwards the great majority of infants respond to being left with a strange person by protest and crying, and also by more or less prolonged fret- ting and rejection of the stranger. These observa- tions demonstrate that during these months an infant is becoming capable of representation and that his working model of his mother is becoming available to him for purposes of comparison dur- ing her absence and for recognition after her re- turn. Complementary to his model of his mother, he develops a working model of himself in inter- action with her, likewise for father.
A major feature of attachment theory is the hy- pothesis that attachment behaviour is organized by means of a control system within the central nervous system, analogous to the physiological control systems that maintain physiological measures such as blood pressure and body tem- perature within set limits. Thus the theory pro- poses that, in a way analogous to physiological homeostasis, the attachment control system maintains a person's relation to his attachment figure between certain limits of distance and
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? ? ? accessibility, using increasingly sophisticated methods of communication for doing so. As such, the effects of its operation can be regarded as an example of what can usefully be termed environ- mental homeostasis (Bowlby, 1969, 1982). By postulating a control system of this sort (with analogous systems controlling other forms of be- haviour) attachment theory contains within itself a theory of motivation that can replace traditional theories which invoke a postulated build-up of energy or drive. Among several advantages of control theory are that it gives as much attention to the conditions terminating a behavioural se- quence as to those initiating it and is proving a fruitful framework for empirical research.
The presence of an attachment control system and its linkage to the working models of self and attachment figure(s) that are built in the mind during childhood are held to be central features of personality functioning throughout life.
PATTERNS OF ATTACHMENT AND CONDITIONS DETERMINING THEIR DEVELOPMENT
The second area to which attachment theory pays special attention is the role of a child's parents in determining how he develops. There is today
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? ? ? impressive and mounting evidence that the pat- tern of attachment that an individual develops during the years of immaturity--infancy, child- hood, and adolescence--is profoundly influenced by the way his parents (or other parent figures) treat him. This evidence derives from a number of systematic research studies, the most impress- ive being prospective studies of socio-emotional development during the first five years under- taken by developmental psychologists who are also clinically sophisticated. Pioneered by Ainsworth (Ainsworth, Blehar, Waters, and Wall, 1978; Ainsworth, 1985) and expanded, notably by Main (Main, Kaplan, and Cassidy, 1985) and Sroufe (1983, 1985) in the United States and by Grossmann (Grossmann, Grossmann, and Sch- wan, 1986) in Germany, these studies are now multiplying fast. Their findings are remarkably consistent and have the clearest of clinical significance.
Three principal patterns of attachment, first described by Ainsworth and her colleagues in 1971, are now reliably identified, together with the family conditions that promote them. These are first the pattern of secure attachment in which the individual is confident that his parent
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? ? ? (or parent figure) will be available, responsive, and helpful should he encounter adverse or frightening situations. With this assurance, he feels bold in his explorations of the world. This pattern is promoted by a parent, in the early years especially by mother, being readily avail- able, sensitive to her child's signals, and lovingly responsive when he seeks protection and/or comfort.
A second pattern is that of anxious resistant at- tachment in which the individual is uncertain whether his parent will be available or responsive or helpful when called upon. Because of this un- certainty he is always prone to separation anxi- ety, tends to be clinging, and is anxious about ex- ploring the world. This pattern, in which conflict is evident, is promoted by a parent being avail- able and helpful on some occasions but not on others, and by separations and, as clinical find- ings show, by threats of abandonment used as a means of control.
A third pattern is that of anxious avoidant at- tachment in which the individual has no confid- ence that, when he seeks care, he will be respon- ded to helpfully but, on the contrary, expects to be rebuffed. When in marked degree such an
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? ? ? individual attempts to live his life without the love and support of others, he tries to become emotionally self-sufficient and may later be dia- gnosed as narcissistic or as having a false self of the type described by Winnicott (1960). This pat- tern, in which conflict is more hidden, is the res- ult of the individual's mother constantly rebuff- ing him when he approaches her for comfort or protection. The most extreme cases result from repeated rejections.
Although in most cases the pattern observed conforms fairly closely to one or another of the three well-recognized types, there have been puzzling exceptions. During the assessment pro- cedure used in these studies (the Ainsworth Strange Situation), in which infant and mother are observed in interaction during a series of brief episodes, certain infants have appeared to be disoriented and/or disorganized. One infant appears dazed; another freezes immobile; a third engages in some stereotypy; a fourth starts a movement, then stops unaccountably. After much study Main and her colleagues have con- cluded that these peculiar forms of behaviour oc- cur in infants who are exhibiting a disorganized version of one of the three typical patterns, more
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? ? ? often than not the anxious resistant one (Main and Weston, 1981; Main and Solomon, 1990).
