No More Learning

How and why multiple models originate and persist raises difficult questions of defensive processes, to which attention is given in the third volume. The hypothesis of multiple models, one of which is highly influential but relatively or completely unconscious, is no more than a version, in different terms, of Freud's hypothesis of a dynamic unconscious.
In terms of the present theory much of the work of treating an emotionally disturbed person can be regarded as consisting, first, of detecting the existence of influential models of which the patient may be partially or completely unaware, and, second, of inviting the patient to examine the models disclosed and to consider whether they continue to be valid. In pursuing this strategy an analyst finds that how the patient perceives him (the analyst), and what forecasts the patient makes about his likely behaviour, are particularly valuable in revealing the nature of the working models that exert a dominant influence
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in the patient's life. Because certain of these perceptions and forecasts appear to the analyst so clearly to be based on a patient's preconceptions about him and to be derived from working models that stem from experiences with other people during earlier years, rather than from current experience, how the patient perceives and conceives the analyst is often known as 'transference'. When an analyst interprets the transference situation he is, among other things, calling the patient's attention to the nature and influence of those models and, by implication, inviting him to scrutinize their current validity and, perhaps also, to revise them.
Seen in the perspective of Piaget's theorizing, the concept of transference implies, first, that the analyst in his caretaking relationship to the patient is being assimilated to some preexisting (and perhaps unconscious) model that the patient has of how any caretaker might be expected to relate to him, and, second, that the patient's pre-existing model of caretakers has not yet been accommodated -- namely, is not yet modified -- to take account of how the analyst has actually behaved and still is behaving in relation to him.
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Some analysts argue that only those features of the model that are inappropriate to the current situation should be referred to as transference. In practice, however, it is often very difficult to disentangle what parts of a complex model are mistakenly applied to the analyst and what parts are in some degree truly applicable. As a result a tradition has grown up of referring to all aspects of a patient's conception of and attitude towards the analyst as transference. There is perhaps no harm in this, provided that the issue of which parts of the model are inapplicable to the analyst and which parts are in some degree applicable is kept constantly in mind.
Not infrequently, a striking feature of a patient's forecasts is his strong expectation of being abandoned by his analyst, an expectation by no means always fully conscious. During weekends and holidays, and especially during unexpected separations due to illness or other contingency, the way in which a patient behaves and the thoughts and feelings he expresses may be intelligible only on the hypothesis that he forecasts that the analyst will not return, and often also on the assumption that the analyst no longer wishes to see him. Not infrequently these forecasts, either conscious and expressed as fear or not conscious and expressed in some distorted form, persist in spite of assurances that they are mistaken. What is far more impor-
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tant, moreover, they persist often in spite of repeated falsification in real life. 1
At the same time as he is drawing the patient's attention to the nature of the forecasts he (the patient) appears to be making, the analyst is striving, jointly with the patient, to understand how the models on which the forecasts are based may have come into being. During those inquiries it is often found that a model, currently active but at best of doubtful current validity, becomes reasonably or even completely intelligible when the actual experiences that the patient has had in his day-to-day dealings with attachment figures during all his years of immaturity are known. This leads again to the controversial question of the extent to which actual experience is of influence in the development of working models of self and others.
The role of experience in determining working models
There was a time when psychoanalysts were as loath as a Kraepelinian psychiatrist might be to attribute a patient's unfavourable models of attachment figures to his actual experiences. To make such attributions was deemed to be nai? ve, to be underrating the role of projection, and to be failing to give due weight to the contribution that the patient himself had made, and was making, to the misfortunes he experienced. Nowadays, thanks to the influence of Fairbairn, Winnicott, and others, fewer psychoanalysts take that view, which, it is held, is tenable only so long as a clinician limits himself to treating isolated patients, usually adults, and is uninterested in considering systematically what their day-to-day experiences have actually been: to what extent and in what ways has a patient had his attachment behaviour met, not only during early infancy, about which information is usually uncertain and often entirely speculative, but throughout all the later years of childhood also?
Probably no one who has worked for long in a family clinic, in which disturbed children and their parents are treated, still holds the traditional view that actual experience is of little consequence. On the contrary, in the course of that work it is found repeatedly that, when information about a child's experiences of interaction with parents and parent figures is
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1 Although responses of these kinds are referred to in numerous case reports, I am unaware of any systematic empirical record of how one (or more) patient(s) responded to the separations, planned or unplanned, that occurred during the course of his (or their) analysis.
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obtained -- usually partly from first-hand observation of members of the family who are interviewed together and partly from the family's history as it is pieced together, often only slowly and from a diversity of sources -- the forecasts the child makes of how attachment figures are likely to behave towards him are not unreasonable extrapolations from his experiences of the way in which they have behaved towards him in the past, and may perhaps still be behaving towards him in the present. Thus, whatever contributions to variations of personality are made by genetic biases and physical traumata, the contribution of family environment is certainly substantial.
From the viewpoint of the position adopted, adult personality is seen as a product of an individual's interactions with key figures during all his years of immaturity, especially of his interactions with attachment figures. Thus an individual who has been fortunate in having grown up in an ordinary good home with ordinarily affectionate parents has always known people from whom he can seek support, comfort, and protection, and where they are to be found. So deeply established are his expectations and so repeatedly have they been confirmed that, as an adult, he finds it difficult to imagine any other kind of world. This gives him an almost unconscious assurance that, whenever and wherever he might be in difficulty, there are always trustworthy figures available who will come to his aid. He will therefore approach the world with confidence and, when faced with potentially alarming situations, is likely to tackle them effectively or to seek help in doing so.
Others, who have grown up in other circumstances, may have been much less fortunate. For some the very existence of caretaking and supportive figures is unknown; for others the whereabouts of such figures have been constantly uncertain. For many more the likelihood that a caretaking figure would respond in a supportive and protective way has been at best hazardous and at worst nil. When such people become adults it is hardly surprising that they have no confidence that a caretaking figure will ever be truly available and dependable. Through their eyes the world is seen as comfortless and unpredictable; and they respond either by shrinking from it or by doing battle with it.
Between the groups of people with extremes of either good or bad experience lie groups of people with an almost infinite range of intermediate sorts of experience, who grow up to have expectations of the world to match. For example, some may have learnt that an attachment figure responds in a comforting
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way only when coaxed to do so. They grow up supposing that all such figures have to be coaxed. Others may have learnt during childhood that the wished-for response can be expected only if certain rules are kept. Provided the rules have been moderate and sanctions mild and predictable, a person can still come confidently to believe that support will always be available when needed. But when rules have been very strict and difficult to keep, and
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when sanctions on breaking them have been severe and especially when they have included threats to withdraw support, confidence is likely to wilt.
Sanctions of a damaging kind, which are used by many parents, include both refusing to respond to a child's approaches, for example by sulking, and threatening to leave the home or to send the child away. When used repeatedly, or even only occasionally but with intensity, such sanctions or threats of sanctions can have calamitous effects on a developing personality. In particular, because they deliberately cast grave doubt on whether an attachment figure will be available when needed, such threats can greatly increase a person's fear that he will be abandoned, and thereby greatly increase also his susceptibility to respond to other situations fearfully.
Admittedly the influence that these sorts of experience have on the development of personality and especially on susceptibility to fear and anxiety is still controversial. Evidence in support of the position adopted, introduced already in Chapter 16 of the first volume, is presented more fully in the coming chapters. It is hoped that those who adopt a different position, for example that experiences of the kinds described play at most a subordinate role in accounting for variations in personality development, will be stimulated to present the evidence on which they base their views. Only in this way can progress be made.
A note on use of the terms 'mature' and 'immature'
In many clinical circles the practice has developed of referring to personalities as 'mature' or 'immature'. A person who approaches the world with confidence yet who, when in difficulty, is disposed to turn to trusted figures for support is often said to be mature. In contrast, both someone who is chronically anxious and permanently in need of support and someone who never trusts anyone are said to be immature.
The theory underlying this use of immature is that adult personality structures so described are held to be a consequence
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of arrested development and to have remained in a state that, though normal for early childhood, is passed through during the course of healthy growing up and left well behind.
The theory advanced here and discussed further in the final chapter is different. It disputes that mental states either of chronic anxiety or of persistent distrust are characteristic of normal or healthy stages of development. Instead, it holds that the main cause of such deviations is that, during childhood, an individual's attachment behaviour was responded to in an inadequate or inappropriate way, with the result that throughout later life he bases his forecasts about attachment figures on the premise that they are unlikely to be available.
The resemblance of certain of these types of personality to the personalities typical of young children, especially in so far as individuals of both sorts require and often demand the constant presence and support of attachment figures, is held to be superficial only. In the case of a young child he has no means by which to make forecasts except over short spans of time. In the case of an 'immature' personality he not only has the means to make forecasts but the forecasts he makes, and makes with conviction, are that attachment figures will be unavailable unless he maintains constant watchfulness or is constantly humouring them.
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Thus the common usage of the terms mature and immature is held to be inaccurate and misleading. A particularly adverse effect of using immature in this way is that it can, on occasion, lead a clinician to take a humouring patronizing attitude to the persons concerned, instead of recognizing that their behaviour is a legitimate product of bitter experience.
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Chapter 15
Anxious Attachment and Some Conditions that Promote it
If there are quarrels between the parents or if their marriage is unhappy, the ground will be prepared in their children for the severest predisposition to a disturbance of sexual development or to a neurotic illness.
SIGMUND FREUD ( 1905b)
'Overdependency' or anxious attachment
In the opening pages of this volume vignettes are given (quoted from Burlingham & Freud 1944) of children, aged between two and four years and resident in the Hampstead Nurseries, who showed intensely possessive behaviour towards one or another nurse. Jim, for example, who had been in the nursery since the age of seventeen months, is described as having formed 'strong attachments' first to one young nurse and then to another who had successively looked after him. Towards each he was intensely clinging and possessive, and he refused to be left by them for a minute. Numerous other observers, including my colleagues Robertson and Heinicke, have also noted this type of behaviour whenever small children in a nursery setting are given opportunity to make an attachment to a member of staff, and the same behaviour is shown towards mother after they return home.
Clinging behaviour, either literal or figurative, can be seen at every age, during childhood, during adolescence, and during adult years. It goes by many names. Among adjectives used to describe it are 'jealous', 'possessive', 'greedy', 'immature', 'overdependent', and 'strong' or 'intense' attachment. For scientific and clinical purposes, it is argued, each word has drawbacks: because it derives from and implies obsolescent theory, or because it is ambiguous, or, and perhaps most important of all, because it carries with it an adverse value judgement that is held to be inappropriate and unhelpful.
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pejorative. The same is true of 'greedy', which is used mainly by those whose thinking is still influenced by the assumption that attachment derives from food and being fed.
'Strong' attachment and also 'intense' attachment are ambiguous: both of them, and the former especially, might be thought to imply a satisfactory state of affairs.
'Immature' derives from a theory of regression which, as indicated at the end of the previous chapter, is held to be out of keeping with the evidence.
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Some of the ambiguities and false values concealed in the terms 'dependency' and 'overdependency' are emphasized in the first volume (Chapter 12). 1 Let us look further at their deficiencies and also propose an alternative term.
Perhaps no terms are used more frequently in the clinical literature than 'dependent' and 'overdependent'. A child who tends to be clinging, an adolescent reluctant to leave home, a wife or husband who maintains close contact with mother, an invalid who demands company, all these and others are likely sooner or later to be described with one of these words. Always in their use there is an aura of disapproval, of disparagement. Let us consider more closely the behaviour to which these terms are applied and how we are to evaluate the persons who come to be described by them.
Viewed in the perspective of this work, most persons described by clinicians as dependent or overdependent are ones who exhibit attachment behaviour more frequently and more urgently than the clinician thinks proper. Inherent in the terms, therefore, are the norms and values of the observer using them. This leads to many difficulties. One is that norms and values differ greatly not only between individuals but from culture to culture and from subculture to subculture. To take a crude example, behaviour that in some parts of the East might pass unnoticed, or even be encouraged, might in the West be condemned as childishly dependent. Another difficulty is that, even within a single culture, no useful evaluation of the behaviour can be made without knowledge of the conditions, organismic and environmental, in which it is shown. Ignorance of a child's age, of whether he is well or ill, of whether or not a person has recently experienced a shock, can play havoc with an observer's judgements. Individuals who are notoriously apt to be wrongly
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1 For a discussion of how the concepts of dependency and attachment are related to one
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judged as overdependent are children who look older than they are, who are tired or unwell, or who have recently acquired a new sibling, and adults recently bereaved. Another example is a young woman during pregnancy or while caring for small children. In all such instances attachment behaviour is likely to be shown more frequently and/or more urgently than would otherwise be the case. In other words, in the conditions obtaining the behaviour may be well within normal limits and no adverse conclusions on the personality development of the individuals concerned would be appropriate.
There are, however, persons of all ages who are prone to show unusually frequent and urgent attachment behaviour and who do so both persistently and without there being, apparently, any current conditions to account for it. When this propensity is present beyond a certain degree it is usually regarded as neurotic.
When we come to know a person of this sort it soon becomes evident that he has no confidence that his attachment figures will be accessible and responsive to him when he wants them to be and that he has adopted a strategy of remaining in close proximity to them in order so far as possible to ensure that they will be available. To describe this as overdependency obscures the issue. Even the term 'separation anxiety' is not ideal. A better way to describe the condition is to term it 'anxious attachment' or 'insecure attachment'. This makes it clear that
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the heart of the condition is apprehension lest attachment figures be inaccessible and/or unresponsive. For these reasons, therefore, and especially because it can be expected to enlist our sympathy, anxious attachment is the term to be used. It respects the person's natural desire for a close relationship with an attachment figure, and recognizes that he is apprehensive lest the relationship be ended.
The thesis of the present work is that, even though other causal factors may play some part in the development of this condition, those about which by far the most evidence is at present available are experiences that shake a person's confidence that his attachment figures will be available to him when desired. Alternative theories, some long entrenched, are considered in the next chapter.
The following descriptions by two working-class mothers of occasions when their young children went through a phase of 'overdependency' reveal the condition in what is believed to be its true light. The descriptions are taken from the survey of 700
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four-year-old children in Nottingham undertaken by Newson & Newson ( 1968). Asked whether her daughter sometimes wanted to be cuddled, a miner's wife replied:
Ever since I left her that time I had to go into hospital (two periods, 17 days each, child aged 2 years), she doesn't trust me any more. I can't go anywhere -- over to the neighbours or in the shops -- I've always got to take her. She wouldn't leave me. She went down to the school gates at dinner time today. She ran like mad home. She said, 'Oh, Mum, I thought you was gone! ' She can't forget it. She's still round me all the time.
When asked the same question a lorry-driver's wife, whose husband had deserted three months earlier, replied:
Yes, all the time just lately -- only since he left. (What do you do? ) Well, if I'm not busy I sit down and nurse her, because -- you know -- she's continually clinging round me, she keeps saying, 'Do you love me? You won't leave me, Mummy, will you? ' -- and so I sit down and try to talk to her about it, you know; but I mean, at her age [about four], really you can't explain. And she used to dress herself; but since my husband's been gone, she's relied on me for -- well, every mortal thing I've had to do for her. At the moment I'm more or less letting her do what she wants. I mean, she's been upset in one way, and I don't want to upset her again. Because I did put her in a nursery just after he went, because I thought it might take her mind off things, you see, but anyhow the matron asked if I'd mind taking her away, because she said she just sat and cried all day long. I think she'd got it into her head that because her Daddy's gone, and me taking her there and leaving her all day, she p'raps thought I'd left her too, you see. So she was only there a fortnight, and then I took her away. But she's afraid of being left on her own, I mean, if I go to the toilet, I have to take her with me, she won't even stay in the room then on her own. She's frightened of being left.
In summing up their findings on children who exhibited overdependency and fear of separation the Newsons write: 'Most of these children's separation fears are reality-based, in that they or their mothers have been hospitalized or some other separation has already taken place. ' Nevertheless, there were
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some children who had had such an experience without apparently having been left prone to separation anxiety, and other children who were prone to such fears without having had such an experience. Important though experience of actual separation is, therefore, it is clear that variables of other kinds contribute as well.
Among the most influential of these other variables, it seems likely, are, first, threats to abandon a child, made for disciplinary purposes, and, second, a child's recognition that parental quarrels carry with them the risk that a parent may depart. In the light of present evidence, it seems extremely probable that, as Suttie ( 1935) and Fairbairn ( 1941) long ago suggested, threats to abandon a child are the most influential of all. None the less, it must not be forgotten that those threats have the tremendous power they do have only because for a young child separation is itself such a distressing and frightening experience, or prospect.
For that reason, therefore, we return once more to our point of departure, the effects on a young child of being separated from his mother figure.
In the two sections that follow we consider, first, children who are being reared in a residential setting without any permanent mother figure and, second, children who are being reared mainly at home with mother but who, for various reasons and for shorter or longer periods, have been separated from her.
Anxious attachment of children reared without a permanent mother figure
The most systematic data yet available on the attachment and fear behaviour of children reared without a permanent mother figure are provided by Tizard & Tizard ( 1971). They compare the social and cognitive development of two-year-old children cared for in residential nurseries in England with that of children brought up in ordinary families.
In recent years there have been great changes in the organization of residential nurseries in Britain. Not only are links with a child's family encouraged but, within the nursery itself, attempts are made to provide living conditions that are nearer than in the the past to ordinary family living. Apart from babies under twelve months, who are cared for in a separate unit, children live in groups of six, of varying ages up to about five or six years, and are cared for in 'private' accommodation by their own nurse and her assistant. In addition, in some nurseries a system
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obtains whereby each nurse is encouraged to give special attention to one or two children, as a rule from a group other than the one in which she usually works; she takes the child out in her free time, buys him little presents, sometimes puts him to bed, or takes him to her home for weekends.
Although this type of re? gime is a big advance on some of the impersonal re? gimes of the past, examination shows that, so far as mothering care goes, it still falls very far short of what obtains in an ordinary working-class home in present-day London.
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For their study Tizard & Tizard selected fifteen boys and fifteen girls (ten white and five coloured in each case), aged two years, who had been healthy full-term babies, whose health had throughout been good, and who had entered a nursery before the age of four months and had remained there since. All but one were illegitimate Half were visited by mother, who still hoped to be able to care for them; the others had been offered for adoption, but for various reasons adoption had been delayed.
A contrast group, similarly composed by age, sex, and health record, but confined to white English children, was selected from among working-class children living in their own homes and in intact families. For reasons of research convenience, any child whose mother was working full time and who had an older sibling of less than school age was excluded.
The aim of the study was to compare children in the two groups in respect of both their cognitive and their social development. Various cognitive tests were therefore administered, 1 and opportunity was taken to observe the children's responses first to the advent of a stranger and then to the brief departure of the caretaker from the room. In addition, to obtain further information regarding attachment behaviour, a child's caretaker was asked a series of detailed questions about it and also certain particulars regarding the child's experiences with potential attachment figures and with other persons. Both research workers engaged in the project were women.
In reporting results it is useful to begin with particulars of the opportunities that children in each of the groups had to make attachments. Comparison shows there were great differences.
For the thirty two-year-olds living in their families, mother
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1 Results of the cognitive tests showed the mean of the nursery children to be two months
below the norm and three months below the mean of the family children. The inferiority of the nursery children was due mainly to their failures on the verbal subtests ( Tizardet al. 1972).
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was principal attachment figure for twenty, father for four, and both parents equally for five. In one case, where father was away from home, it was a maternal uncle. The total number of figures towards whom attachment was shown was strictly limited, with an average of four per child in the group. Following an attachment figure around the house was reported as a regular activity for all but four of the children.
In contrast to this picture of focused attachment, the attachment behaviour of the nursery children was directed diffusely. By most of them the behaviour was shown in some degree towards a large, indeed an indeterminate, number of people, including usually 'anyone he knows well'. Despite this, however, each of the children had a preference. Provided a child's natural mother visited once a week or more, she was said always to be the preferred figure: 'the child would be very excited to see her and distressed when she left'. Similarly, when a child had a 'special nurse' who took him out (and no mother who visited regularly) the special nurse was always the child's preferred figure, despite the fact that she would probably see him for only a few minutes on most days. Thus, whereas the family children had almost constant contact with their preferred attachment figures, the nursery children saw very little of theirs.
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Furthermore, the nursery children were not permitted to follow anyone out of the room in which they were.
Despite every endeavour by the nursery authorities to stabilize the children's social relationships the results were found to be disappointing. Since entering the nursery twenty months earlier, a majority of the nursery children had had at least twenty different people caring for them for periods of a week or longer, in comparison with an average of two in all for the family children. Even during the course of a single week the average number of nurses looking after the nursery children was found to be six. Furthermore, in the lives of nursery children members of staff were found to come and go at irregular intervals, often disappearing for days or weeks at a time, and sometimes never returning.
When data on attachment and fear behaviour for children in the two groups were compared the nursery children proved to be significantly more anxious 1 in their attachments and significantly more afraid of a stranger.
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1 In their report Tizard & Tizard refer to the 'intensity' of the nursery children's attachment
behaviour as being 'much greater' than that shown by the family children. -217-
Information given by the nurses showed that the attachment behaviour of the nursery children both to the preferred figure and to the rest of the staff was much more anxious than that of the family children (as reported by mothers). For example, twenty-four of the thirty nursery children were apt to cry when their favourite caretaker left the room compared with thirteen of the thirty family children; those who cried regularly numbered ten and two respectively. When the caretaker returned, all but two of the nursery children would run to be picked up (and most of them did so usually), in comparison with only four of the family children (none of them usually). Thus, whereas about two-thirds of the family children took mother's coming and going from the room as a matter of course, all but a handful of the nursery children were upset when an attachment figure left and wanted to be picked up by her when she returned.
For children in each group a standard procedure was used to measure fear of strangers. Every child was assessed in his own living-room with his own caretaker (nurse or mother) present. During the first five minutes the child sat on his caretaker's lap, while the research worker chatted to the caretaker. Then the research worker made a series of standardized overtures to the child: she started with a greeting; as a second step she invited him to come over to look at a picture book; and lastly she invited him to sit on her lap. The child's response to each move was rated on a seven-point scale.
When, during the second phase, the research worker invited the child to come over, only fifteen of the thirty nursery children did so in comparison with twenty-six of the family children. When the nursery children were invited to sit on her lap only eight accepted, while six of them cried and ran away. Of the family children sixteen accepted the invitation and none ran away.
After the researcher had made her initial overtures to a child she engaged the caretaker in a few minutes' further conversation and then asked her to leave the room briefly and to leave the door ajar. The child's response to this was rated on a four-point scale. Towards the end of
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the session the caretaker was again asked to leave the room and the child's response was again rated. When left alone with the research worker on the first occasion, six of the nursery children ran out of the room; and even on the second occasion later in the session five of them were still unwilling to stay with her. On both occasions
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every one of the family children was ready to stay with the researcher.
Finally, at the end of the session, the research worker again invited the child to sit on her lap. The nursery children, although most of them were bolder by now, remained much more cautious than the family children. Two of the nursery children still ran away and cried; and none of them smiled and chatted as did eleven of the family children as they climbed up onto the research worker's lap.
Whereas all the findings cited so far from this study support our hypothesis, there are one or two others that do not. In particular, fearfulness, for example of dogs, was reported by nurses and mothers respectively 'with equal frequency' for children of the two groups. Considering the very different responses of the children to the strange research worker, we are perhaps entitled to question the validity of this information, which comes from informants whose standards may well not be comparable.
In this context a case report by Schnurmann ( 1949) is of interest. This describes how a little girl of two and a half years, who was being cared for in the Hampstead Nurseries, developed fear both of going to bed and of dogs. Although the symptoms are described as phobic and the writer seeks to explain them in terms of castration anxiety resulting from the child's observation of sex differences, it is apparent from the record that the onset of symptoms was closely related in time to the cessation of her mother's daily evening visits, and the remission of symptoms to the resumption of visits. The relation of phobic symptoms to anxious attachment is considered at length in Chapters 18 and 19.
In view of the very different experience with attachment figures that children in a residential nursery have compared with children in a family setting, it is hardly surprising that the attachment behaviour of the nursery children should be so much more anxious or that they should be more prone to fear strangers. Nor would it be surprising were there to be a substantial difference between the working models of attachment figures built by children in the two groups and used by them as the basis of their future predictions about the accessibility and responsiveness of such figures. For, whereas a family child lives in a stable and predictable world with accessible and usually responsive attachment figures, a nursery child, even in a modern nursery, lives in a highly unpredictable world in which his
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preferred attachment figure is usually inaccessible, while subsidiary ones come and go almost at random.
Anxious attachment after a period of separation or of daily substitute care
After a period of separation, especially when it has been spent with strange people, it is usual for small children who are being brought up in families to be more anxious and clinging than
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they were before. This finding, which constitutes part of the basic data on which the present thesis rests and which is well illustrated by the two examples (quoted from Newson & Newson 1968) given in the first section of this chapter, has perhaps ceased to be a matter of controversy. What is debatable concerns the factors that lead one child to recover confidence and another not to. ?
Effects of a Brief Stay in Hospital
A study by Fagin ( 1966) of the behaviour of two groups of children after return home from a short stay in hospital (varying from one to seven days) casts some light on this problem. The thirty children of one group had had mother staying with them in hospital, the thirty of the other group were there without her, though they were visited daily. The children were matched for age, between eighteen and forty-eight months, but not for sex. Interviews held with the mothers prior to the hospitalization suggested that attitudes towards child-rearing did not differ between mothers in the two groups, nor did the mothers differ in regard to their desire to remain with their child in hospital.
For each child, behaviour at one week and again at one month after his return home, as reported by mother at interview, was compared with what it had been before he entered hospital, as reported by her at that time.
Both at one week and at one month following return home the behaviour of the unaccompanied children was reported as markedly disturbed in comparison with what it had been prior to hospital. Significant differences occur in all the usual fields. In particular, these children were reported as being much more upset by a temporary brief separation than they were before hospital and as more 'dependent'. By contrast, children who had been accompanied in hospital by mother showed none of these adverse changes. Indeed, mothers' reports showed them to have developed favourably in all these respects, which suggests that, as MacCarthy and his colleagues ( 1962) have found, mother's
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presence on a potentially upsetting occasion had given a child additional confidence that she would always be available in emergency. 1
These findings are in keeping with those of similar studies. What is of particular interest in Fagin's study is the differential effect on children in the two groups of having a mother who was rated by the interviewer as being very 'irritable'. Of the accompanied children who had an irritable mother none showed any adverse effects of their stay in hospital; whereas, of the unaccompanied children, those who had an irritable mother were even more affected by their experience than were those whose mother was rated as more equable.
A number of other studies point firmly to the view that a separation has a specially adverse effect on children whose parents are inclined to be hostile or to threaten them with separation as a disciplinary measure, or whose family life is unstable. Indeed, evidence is accruing fast that parent-child relations, both before and after the event, play a very large part in accounting for the differential outcome of a separation.
Effects of Periods of Residential Substitute Care
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Moore ( 1964; 1969a and b) has reported a number of findings of much interest to our thesis. In a longitudinal study of London children, starting at birth with 223 cases and reducing to 167 at the age of six years, Moore was able to investigate the shortterm effects on children of separations and other discontinuities of care, and also differences in the behaviour, at the age of six or seven years, of children who, during their early years, had had different types of experience. Information regarding behaviour was obtained: (a) from interviews with mothers (two before the child was born, five during the child's first year, four
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1 Limitations of Fagin's study are that data were derived entirely from mothers' reports and
that, in regard to ailment and length of stay, the two groups were not matched. Twenty-one of the accompanied children were in hospital for hernia operation or tonsillectomy and were out again within two days. Only nine of the unaccompanied children had a similar experience; thirteen had had respiratory or alimentary infections and had been away for between three and five days. It is therefore possible that these differences of experience might account for some of the reported differences in subsequent behaviour, though the findings of MacCarthy, Lindsay & Morris ( 1962) do not support that interpretation.
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during the next two years, and annually thereafter); (b) from psychological tests and observations of the children carried out regularly at the Study Centre; and (c) from interviews with the heads and staffs of any day nurseries or nursery schools that the children attended. Most of the results are expressed in terms of differences between the average frequencies of behaviour in children in a series of samples differing in regard to previous experience.
A number of the children had spent periods of a week or two with relatives, by way of a holiday for the child or for the parents or both. The commonest behaviour of children under three on reunion with mother was clinging around her, sometimes after initial reserve. Although such clinging often passed off after two or three days, in 30 per cent of cases it persisted for a matter of weeks. Moore ( 1969b) concludes: 'It is clear that for most young children separation from the mother is in itself a stressful experience', and that they are especially vulnerable during their second and third years.
Moore reports much evidence that shows that whether disturbances persist or fade turns in great measure on the stability of the home and the attitudes of the parents. Details are given of three of his comparisons.
(a) There were six children who had experienced one or more stays in a residential nursery between the ages of nine and thirty months. All but one, who was backward, were upset on return home, 'showing it in aggressive behaviour, head banging, fear of strangers and/or increased dependence on their mothers'. Four other children had had a similar experience before the age of nine months; of these, two were similarly upset. When all these ten children had reached the age of eight years, two were found to be 'reasonably well-adjusted' and eight were not. It was noted that, whereas the two who were reasonably well adjusted came from homes in which family relationships were good, the eight who presented difficulties, mainly of an aggressive uncontrolled sort, came from homes which were breaking up (two cases) or where relationships were otherwise disturbed.
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(b) Fifteen children who came from stable homes had experienced episodic separations during their first four years. Separations had been in various settings and of varying lengths. In many cases a child had stayed with relatives; in others he had been in a hospital or nursery. When the lengths of time away were summed for each child, summed lengths ranged from
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five to twenty-three weeks. Not only did these children come. from stable families but, apart from the separations, they had been cared for throughout by mother. At the age of six years their behaviour could be compared with that of two similar groups of children:
those who had been cared for by mother throughout without having experienced any separations;
those who had not only experienced a variety of separations but whose home life had been generally unsettled, including frequent changes of daily caretaker during the pre- school years.
Judged by mothers' reports, the children from stable homes who had experienced these episodic separations were rather less given to attention-seeking than were those who had not been separated. This suggests that, for children cared for as a rule by mother in a stable family, episodic separations of the length and kinds described, although in many cases reported to have been very distressing at the time, do not leave obviously adverse effects on the children's later attachment behaviour. Nevertheless in drawing conclusions it is necessary to be cautious since we do not know how such children would react to a new fear-arousing situation. The findings of Hinde & Spencer-Booth, for example, on the effects two years later of a week's separation on young rhesus monkeys when exposed to a fear-arousing situation (see Chapter 4) are a warning against premature confidence. Whereas the children from stable homes who had experienced episodic separations appeared to have developed favourably, those from unstable homes had not. At the age of six they are reported to have shown many typical signs of insecurity: overdependence, anxiety, sleeping problems, and nailbiting.
Effects of Daily Substitute Care
Moore ( 1969a) deals in some detail with the effects on a child's behaviour at the age of six years of different types of daily substitute care experienced before the age of five. About half the mothers of his sample had worked outside their homes for at least three months before the child was five, but patterns both of mother's work and of child care while mother worked varied enormously. At one extreme were mothers who, during their child's fourth and fifth years, did part-time work while the child
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attended nursery school; at the other were women who were doing full-time or near full-time work from early in their child's life while the child attended day nursery or a childminder. Inevitably variables were much confounded. In most cases in which daily substitute care had started early in a child's life, care had been unstable, so that the child had been looked after first by one set of people and then by another. Conversely, when care began after the third birthday, often at nursery school, it had tended to be stable. Another complication, not surprisingly, is that instability in arrangements for care tended to be correlated with instability of parental personality.
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Despite these problems, Moore is able to identify two samples, each of about fifteen children, matched for sex and reasonably well matched in other respects, all of whom had received some daily substitute care before the age of five years. In one sample substitute care had been stable and in the other unstable. For each sample the age at which the children first received daily substitute care varied from a few weeks to about three years.
Sample with unstable daily substitute care: The fifteen children who had experienced unstable and changing daily substitute care, in most cases starting before the second birthday, were conspicuously insecure and anxious in later years. Judged by mothers' reports when the children were six, they showed
far more dependent clinging behaviour -- wanting to sit on mother's knee, hating her to leave, being very upset if she was cross and demanding attention at bedtime. . . . This behaviour was obvious at the Centre, where the group received higher ratings for dependence and nervousness and lower for initial adjustment to the situation. They showed more fears, especially of doctors and hospitals and the dark . . . ( Moore 1969a).
In addition to unstable daily substitute care, these fifteen children had experienced more periods in hospital and elsewhere than had children in the other sample. Moreover, some of their anxious attachment, though not all of it, was probably attributable to the treatment they received from their parents, many of whom were rated as 'unstable personalities'.
Sample with stable daily substitute care: There were only a few cases in which daily substitute care had begun before the second birthday and had also been stable. At the age of six or seven years, these children tended to seek extra attention from mother;
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and some of the mothers had failed to establish a close relationship with their child.
The children whose daily and stable substitute care had not begun before their third birthday, by contrast, showed no evident emotional difficulties at the age of six. This finding is in keeping, of course, with common everyday experience. During their time away from mother these three- and four-year-olds had either been attending nursery school or else been cared for in another family, both of them arrangements that are not only widespread at that age but are usually enjoyed by the children and have never seemed to give rise to any difficulty. 1
Yet a further finding, from a subsequent study by Moore ( 1971), is that some of the children who had remained with mother until the age of five and had never attended nursery school or play group were apt in later years to be over-sensitive to criticism and timid with peers. This finding, if confirmed, supports the commonly held view that, from about their third birthday, children benefit from play with peers within an ordered environment, and this especially when the alternative is confinement within limited living space in an urban environment, and in many cases with a rather controlling and possessive mother, as in Moore's sample.
The findings of Moore's study thus strongly support the theory that anxious attachment develops not because a child has been excessively gratified, as is sometimes held (see next chapter), but because his experiences have led him to build a model of an attachment figure who is likely to be inaccessible and/or unresponsive to him when he desires her. The more
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stable and predictable the re? gime the more secure a child's attachment tends to be; the more discontinuous and unpredictable the re? gime the more anxious his attachment.
To this conclusion one major proviso must be added. Some children subjected to an unpredictable re? gime seem to despair. Instead of developing anxious attachment, they become more or less detached, apparently neither trusting nor caring for others. Often their behaviour becomes aggressive and disobedient and they are quick to retaliate. This type of development occurs much more frequently in boys than in girls; whereas anxious clinging is commoner in girls than in boys.
That separations and instabilities of maternal care should
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1 Compare the case of Lottie who began attendance at nursery school when she was two
years and three months old (see Chapter 3). -225-
lead to responses of two opposed types, anxious attachment and aggressive detachment, and sometimes a mixture of the two, is a little confusing. So also, perhaps, is the finding that in respect of these responses the sexes differ. Nevertheless, that finding is in keeping with the differential incidence between the sexes of certain types of personality disorder in adult life. Anxiety is commoner as a neurotic symptom in women than in men; conversely, delinquency is commoner in men than in women.
Follow-up inquiries when the children were eleven and fifteen years old showed that whatever pattern of attachment behaviour had become established during the first five years tended to persist, whether it was secure attachment, anxious attachment, or some degree of detachment ( Moore 1971). ?
Anxious attachment following threats of abandonment or suicide
Already in previous chapters reference is made to the effects on a child of being threatened by his parents that they will not love him or even will abandon him if he is not good. Clinical experience suggests that threats of these kinds, especially threats to abandon, including threats of suicide, play a far larger part in promoting anxious attachment than has usually been assigned to them.
Threats by parents that, if a child is not good, they will not love him any more have, of course, frequently been referred to as playing a part in the genesis of anxiety. In Inhibitions, Symptoms and Anxiety ( 1926a) Freud discusses them. Yet, although a threat of loss of love is far from being of negligible importance, the threat actually to abandon a child plainly carries immensely greater weight. Reference to such threats rarely appears in case reports, and suggestions in the literature that they play a significant, let alone a key, role are few and scattered. Nowhere do they seem to have been the subject of systematic study and discussion. The reason for their comparative neglect is almost certainly that parents are loth to talk about them.
A threat to abandon a child can be expressed in a variety of ways. One is that if a child is not good he will be sent away, for example, to a reformatory or to a school for bad boys, or that
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he will be taken off by a policeman. A second, made also in a disciplinary context, is that mother or father will go away and leave him. A third, which plays on the same anxiety, is that if a child is not good his mother or father will be made ill, or even die. A fourth, probably of great importance, is an impulsive
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angry threat to desert the family, made usually by a parent in a state of despair and coupled often with a threat to commit suicide. Finally, there is the anxiety engendered in a child when he overhears his parents quarrelling and fears, not unnaturally, that one or other of them is going to leave.
Evidence suggests that threats of these kinds, whether punitive or incidental, are not infrequent and that they almost always have an extremely frightening effect upon a child.
Let us start with threats that are used as part of disciplinary policy. The proportion of parents who use such threats no doubt varies greatly from culture to culture and subculture to subculture. In their study of 700 children and parents in Nottingham, Newson & Newson ( 1968) report that no less than 27 per cent of all the parents interviewed admitted using threats of abandonment as a means of discipline. The incidence was lowest in social classes I and II, the professional and managerial, in which it is reported as 10 per cent. In parents from the remaining social classes it is in the region of 30 per cent. The Newsons are particularly struck that white-collar workers of the shop and clerical groups should show an incidence (34 percent) at least as high as skilled, semi-skilled, and unskilled manual workers, and perhaps higher.
Naturally enough, threats of these kinds can vary in the seriousness with which they are made and believed. Some are plainly no more than teasing. But probably to interviewers like the Newsons, who are inquiring about techniques of discipline, parents would hardly refer to such threats unless they used them seriously and believed in their efficacy. In any case the children concerned in the study were only four years old and to a young child a threat needs very little elaboration to be taken in deadly earnest. Nevertheless, some parents, intent on teaching their children a lesson, clothe their threats in impressive playacting, as the following examples from the Newsons' records show.
In reply to inquiries regarding the techniques of discipline she employed with her four-year- old son, a packet's wife replied:
I used to threaten him with the Hartley Road Boys' Home, which isn't a Home any more; and since then, I haven't been able to do it; but I can always say I shall go down town and see about it, you know. And Ian says, 'Well, if I'm going with Stuart (7) it won't matter'; so I say, 'Well, you'll go to
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different ones -- you'll go to one Home, and you'll go to another'. But it really got him worried, you know, and I really got him ready one day and I thought I'll take him a walk round, as if I was going, you know, and he really was worried. In fact, I had to bring him home, he started to cry. He saw I was in earnest about it -- he thought I was, anyway. And now I've only got to threaten him. I say 'It won't take me long to get you ready'.
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To the same question a miner's wife first denied using such threats to her small girl and then corrected herself:
No -- oh, I tell a lie, I once did -- and upset her that much that I've never said it any more. (What did you say? ) Well, she was having an argument with me, and she says to me 'You don't live here! Hop it! ' So I says, 'Oh, well, I can do that! Where's my coat? I'm moving! ' So I got my coat from the back, and I was gone. I just stood outside the door, and she cried so bitter, she did. As soon as I came in, she got hold of my leg and wouldn't let go, sort of thing, I'll never say it no more.
Another miner's wife also had qualms about using such methods with a four-year-old:
I have said that if he makes me poorly when he's naughty I shall have to go away, and then he'll have no Mummy to look after him, and he'll have to live with someone else, I know that's all wrong, but I do. His Daddy'll say to him 'Pack his bags -- get that bag out, and get his toys, he's going! ' And he has one time put some of his clothes and toys in the bag; and it made him nearly demented -- it upset me, but I didn't like to interfere, you see. And I asked him after, I, said 'Don't do that again, I don't like it, it'll make him feel unsafe, and he belongs here as much as we do. Find another way to punish him, I don't like him to think that. ' I thought it was going too far.
In the last case, although mother drew the line at father's packing the child's bag, she was prepared to threaten that she might become ill and have to go away.
Since the most complete information about the use of threats to abandon a child comes from the Newsons'study conducted in England there may be danger that citizens of other countries will shrug off its findings. Any tendency to complacency is not
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encouraged by some, more limited, findings reported for parents in New England.
When interviewing some hundreds of mothers regarding their child-care practices, Sears, Maccoby & Levin ( 1957) found that such was the reluctance of mothers to acknowledge that they used threats to withdraw love or to abandon a child that information was inadequate in half their cases. In the other half, for which information was believed to be adequate, two out of every ten mothers were assessed as making considerable use of threats to withdraw love and/or to abandon the child, and a further three out of every ten as making moderate use of them. Taken together that makes half of all cases that could be assessed. Examples given in which five-year-old children are described by mothers as becoming 'hysterical' or as weeping 'a rain of tears' when threatened with being sent away from home -- e. g. back to the hospital where he was born -- differ in no way from those reported by the Newsons.
The fact that in a representative sample of lower-middle- and working-class homes in midland Britain today 30 per cent of mothers admit to using threats of abandonment, and another 12 per cent to threatening that they won't love a child any more if he is naughty (and that New England figures appear comparable), may come as a surprise to those brought up in professional-class homes in which such threats are much less common. 1 Yet, once the frequency and effects of such threats are firmly grasped, a great many cases of separation anxiety and anxious attachment that otherwise appear inexplicable become intelligible.
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Furthermore, it becomes easy to understand why so many children who have to go to hospital or residential nursery should suppose that they are being sent there as a punishment.
It is of course true that a majority of parents do not threaten to abandon their children and, as the Newsons found, refrain from doing so as a matter of principle. As a publican's wife remarked: 'It takes the child's security away. You're the whole of their security, and you must not take that away. ' Yet the Newsons also came across mothers who, though sure that such threats were wrong, admitted that none the less they occasionally used them when they were upset.
Such shamefaced admissions by parents may well include
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1 Nevertheless, sanctions of professional ostracism to coerce younger and weaker members
of a profession to accept the theories held by their seniors are not unknown. -229-
the most frightening threats of all. There is certainly a minority of parents who, in fits of exasperation and temper, say the most horrifying things which they later greatly regret. Threats to abandon the home and/or to commit suicide, made perhaps only at rare intervals but with an angry vehemence, are likely to have an effect entirely out of proportion to their frequency. Their effect, moreover, is magnified should the parent, father or mother, subsequently be so ashamed of having made such a threat that he or she cannot acknowledge either what was said or how frightening it must have been to the child. In such families the child has no opportunity to check his inevitable fears against the real risks, whatever they may be.
Furthermore, when families of this sort reach a psychiatric clinic, there is small likelihood that the true facts will be divulged. It is then very easy to attribute the child's fears either to his own guilty phantasies or to his having projected onto others his own guilty wishes. Long familiarity with how easy it is even for experienced clinicians to be misled in such cases suggests that, whenever a child or adult is inexplicably afraid, it is always wise to assume that there is no smoke without fire.
Since the way a parent treats a child is usually modelled on the way his (or her) parents treated him (or her) as a child, it is almost inevitable that the use of such threats should run in families. This was made dramatically clear during the treatment of an acutely anxious and depressed mother and her young son.
An Illustrative Case
Mrs Q and her son, Stephen, were referred originally when Stephen was eighteen months old, because he refused to eat and was seriously underweight. It was soon apparent that Mrs Q was in a chronic state of anxiety and depression which had begun at the time of Stephen's birth. Mrs Q was taken into once-a-week analytically oriented treatment and made good progress. Once Stephen's mother was able to refrain from constantly pressing him to eat, Stephen began to do so, and after a month or two was putting on weight satisfactorily.
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In view of the severity of Mrs Q's condition, she remained in once-a-week treatment for some years. Her father was a skilled artisan, now retired, and her husband a ticket collector on the railway. She herself was an intelligent woman who had had to leave school early in order to earn but who had later become a successful technician. The account she gave of her childhood was
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lucid and consistent, though for many months, indeed years, she had the utmost difficulty in divulging its more distressing and frightening aspects.
Pieced together the following picture emerged. Mrs Q's father had fought in the 1914-18 war and had been invalided on account of 'shell shock'. His neurosis appeared to have developed after his section had been blown up on a bridge, leaving him the sole survivor. Thereafter, he had been subject to long phases of depression and ill temper during which he could treat his family very badly. Mrs Q's mother was an active capable woman of strong opinions, whose own mother had been a chronic alcoholic for many years. Throughout Mrs Q's childhood her parents had had violent quarrels, during which dreadful things were not only said but often done. Crockery was smashed, knives drawn, and furniture set alight. Mrs Q recalled long sleepless nights listening to the battles and dreading the outcome. Yet by breakfast next morning all was quiet. Putting all the horrors of the night behind her, Mrs Q's mother went out to her daily domestic work the picture of peaceful respectability. On no account was any of the trouble at home to be divulged to outsiders; and it was deeply impressed on Mrs Q that she must whisper it to no one -- neighbours, teachers, or schoolfriends. This explained why she hid its full horror from her therapist for so long.
There were a number of occasions when Mrs Q's mother had attempted suicide, and many more when she had threatened it. Twice Mrs Q had returned home to find her mother with her head in the gas oven and once she had found her collapsed after having drunk household disinfectant. Not infrequently her mother, after having threatened to desert the family or to commit suicide, would disappear. On some occasions she would leave the house and not return until after midnight. On others she would hide, perhaps, in a cupboard.