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?
A-Secure-Base-Bowlby-Johnf
?
?
Cognition and Psychotherapy being edited by Mi- chael Mahoney and Arthur Freeman.
This provided an opportunity to expand the original brief paper and led to the version that follows.
The evidence that adverse experiences with par- ents during childhood, such as those described in the previous lecture, play a large part in causing cognitive disturbance is now substantial. For ex- ample, at least some cases in which perceptions and attributions are distorted and some states of amnesia, both minor and major, including cases of multiple personality, can be shown with con- siderable confidence to be the outcome of such experiences. Yet systematic research into these causal sequences is still scarce, and it is clearly a field calling urgently for a major research effort. Why then has it been so woefully neglected?
One adverse influence, referred to in the pre- ceding lecture, is the strong tradition within the psychoanalytic school of thought of focusing at- tention on fantasy and away from the real-life ex- periences a person may have had during child- hood. Another is the undoubted difficulty of do- ing systematic research in the field. For example, those engaged in seeing only adult patients are
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? ? ? usually ill-placed to investigate events alleged to have occurred many years earlier. Those whose childhoods have been spent amongst reasonably stable families and who, like all too many psychi- atrists and psychotherapists, are ignorant of the recent family and child development literature have no norms against which to match their pa- tients' stories. Above all clinicians are often faced with a blanket of silence, from patient and family alike, which neither their training nor their ex- perience has qualified them to penetrate. It is little wonder therefore that the likelihood that many cases of psychiatric disorder, both mild and grave, have had their origins in adverse events of childhood has been discounted or else completely ignored--not only by general psychiatrists but by psychotherapists as well. Even the fact that some children are physically or sexually assaulted by their own parents, often repeatedly and over long periods, has been missing from discussions of casual factors in psychiatry.
At long last the scene is changing. First, know- ledge of parent-child interactions in general, in- cluding a wide range of potentially pathogenic re- lationships and events, is increasing in both qual- ity and quantity as systematic research is applied.
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? ? ? Secondly, the psychological consequences for the children exposed to these relationships and events are becoming much better understood and documented. As a result there are now many oc- casions when a clinician is on reasonably firm ground in drawing aetiological conclusions. This is so especially when (a) his patient presents problems and symptoms which resemble the known consequences of certain types of experi- ence and (b) when in the course of skilled history-taking, or perhaps much later during therapy, he is told of experiences of these same types. In reaching his conclusion the reasoning a psychiatrist uses differs in no way from that of a physician who, having diagnosed a patient as suf- fering from mitral stenosis, proceeds unhesitat- ingly to attribute the condition to an attack of rheumatic fever suffered by the patient many years earlier.
When considering childhood antecedents of cog- nitive disorders a good place to start is with amnesia.
In one of his classical papers on analytic tech- nique Freud (1914) made an important generaliz- ation the truth of which probably every psycho- therapist would endorse:
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? ? ? Forgetting impressions, scenes or experiences nearly always reduces itself to shutting them off. When the patient talks about these 'forgotten' things he seldom fails to add: 'As a matter of fact I've always known it; only I've never thought of it. ' (1914, 148)
Such observations call for explanations of at least three kinds. First, are there special features that characterize the impressions, scenes, and experi- ences that tend to become shut off? Secondly, how do we best conceive of the processes by which memories become shut off and apparently forgotten? Thirdly, what are the causal condi- tions, internal and external to the personality, that activate the shutting-off process?
The scenes and experiences that tend to be- come shut off, though often continuing to be ex- tremely influential in affecting thought, feeling, and behaviour, fall into at least three distinct cat- egories: (a) those that parents wish their children not to know about; (b) those in which parents have treated children in ways the children find too unbearable to think about; (c) those in which children have done, or perhaps thought, things about which they feel unbearably guilty or ashamed.
Since a great deal of attention has for long been given to the third category, here I discuss only the first two. We start with the first.
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? ? ? Children not infrequently observe scenes that parents would prefer they did not observe; they form impressions that parents would prefer they did not form; and they have experiences that par- ents would like to believe they have not had. Evidence shows that many of these children, aware of how their parents feel, proceed then to conform to their parents' wishes by excluding from further processing such information as they already have; and that, having done so, they cease consciously to be aware that they have ever ob- served such scenes, formed such impressions, or had such experiences. Here, I believe, is a source of cognitive disturbance as common as it is neglected.
Yet evidence that parents sometimes press their children to shut off from further, conscious processing information the children already have about events that the parents wish they had never observed comes from several sources. Perhaps the most vivid concerns the efforts made by a surviving parent to obliterate his or her child's knowledge of the (other) parent's suicide.
Cain and Fast (1972) report findings from their study of a series of 14 children, aged between 4 and 14, all of whom had lost a parent by suicide
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? ? ? and all of whom had become psychiatrically dis- turbed, many of them severely so. In reviewing their data the authors were struck by the very large roles played in the children's symptomato- logy by their having been exposed to pathogenic situations of two types, namely situations in which intense guilt is likely to be engendered (not discussed here) and situations in which commu- nications between parent and child are gravely distorted.
About one quarter of the children studied had personally witnessed some aspect of the parent's death and had subsequently been subjected to pressure from the surviving parent to believe that they were mistaken in what they had seen or heard, and that the death had not been due to suicide but to some illness or accident. 'A boy who watched his father kill himself with a shot- gun . . . was told later that night by his mother that his father died of a heart attack; a girl who dis- covered her father's body hanging in a closet was told he had died in a car accident; and two broth- ers who had found their mother with her wrists slit were told she had drowned while swimming' (Cain and Fast, 1972, 102). When a child de- scribed what he had seen, the surviving parent
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? ? ? had sought to discredit it either by ridicule or by insisting that he was confused by what he had seen on television or by some bad dream he had had. Such confusion was sometimes compoun- ded, moreover, by the child hearing several dif- ferent stories about the death from different people or even from his surviving parent.
Many of the children's psychological problems seemed directly traceable to their having been ex- posed to situations of these kinds. Their prob- lems included chronic distrust of other people, inhibition of their curiosity, distrust of their own senses, and a tendency to find everything unreal.
Rosen (1955) describes an adult patient, a man of 27, who developed acute symptoms after his fiance? e had jilted him, because she had found him too moody and unpredictable. The patient began to feel that the world about him and also his own being were fragmenting, and that everything was unreal. He became depressed and suicidal; and he experienced a variety of peculiar bodily sensations, which included a feeling that he was choking. His thoughts, he said, felt like cotton-wool. Sometime during the second year of therapy the analyst, struck by a series of associ- ations the patient gave, and bearing in mind the
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? ? ? life history, ventured a reconstruction, namely that the patient's mother may have made a sui- cidal attempt during the patient's childhood that he (the patient) had witnessed. No sooner had this suggestion been offered than the patient be- came racked with convulsive sobbing. The ses- sion proved a turning point. Subsequently the pa- tient described how it had seemed to him that, when the analyst made his suggestion, it was not so much that he was restoring a memory as giv- ing him (the patient) permission to talk about something he had always in some way known about.
The authenticity of the memory was vouched for by the patient's father who admitted, when pressed, that the patient's mother had made sev- eral suicide attempts during the patient's child- hood. The one the patient had witnessed oc- curred some time during his third year. His nurse had heard sounds in the bathroom and had ar- rived in time to prevent his mother from strangling herself. It was not clear just how much the little boy had seen. But whenever later he had mentioned the event both father and nurse had disconfirmed his memories by alleging that it was something he must have imagined or had simply
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? ? ? been a bad dream. The father now claimed that he had felt it would have been harmful to his son to have remembered such an incident; but he also admitted that his attitude was dictated partly by his wish that the incident be kept secret from friends and neighbours. A year or so later the nurse had been discharged because the mother had found her presence too painful a reminder of the incident.
During one of the sessions before the vital re- construction was offered the patient had recalled the discharge of his beloved nurse as an event which he had always felt had been in some way his fault. Among many associations to it were re- current references to his having been, as a child, witness to something that had changed his life, though he did not know what. He also had the notion that his nurse had been the one witness on his behalf. Thus, although the memory had been shut away from conscious processing, it contin- ued to influence both what he thought and how he felt.
Elsewhere (Bowlby, 1973) I have drawn atten- tion to the far from negligible incidence of suicid- al attempts made by parents, and perhaps the even higher incidence of their threatening
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? ? ? suicide, and have remarked how little attention has been given to either attempts or threats in the psychiatric and psychotherapeutic literature. Per- haps there are many more cases similar to Rosen's than has yet been realized.
Among the many other situations that parents may wish a child had not observed, and that they may press him to suppose he never did, are those concerning their sexual activities. An example of this was told to me by a speech therapist who was trying to help an extremely disturbed little girl who hardly spoke at all. That she was well able to speak was, however, shown on certain dramatic occasions. She would sit a teddybear on a chair in a corner, then go over and, shaking her finger at him, would scold him in tones of extreme sever- ity: 'You're naughty--naughty Teddy--you didn't see that--you didn't see that, I tell you! ' This she repeated again and again with increasing vehe- mence. What the scenes were that Teddy was be- ing instructed he never saw was not difficult to guess: the little girl's mother was a teenage prostitute.
Clearly the purpose of these pressures by par- ents is to ensure that their children develop and maintain a wholly favourable picture of them. In
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? ? ? 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).
The evidence that adverse experiences with par- ents during childhood, such as those described in the previous lecture, play a large part in causing cognitive disturbance is now substantial. For ex- ample, at least some cases in which perceptions and attributions are distorted and some states of amnesia, both minor and major, including cases of multiple personality, can be shown with con- siderable confidence to be the outcome of such experiences. Yet systematic research into these causal sequences is still scarce, and it is clearly a field calling urgently for a major research effort. Why then has it been so woefully neglected?
One adverse influence, referred to in the pre- ceding lecture, is the strong tradition within the psychoanalytic school of thought of focusing at- tention on fantasy and away from the real-life ex- periences a person may have had during child- hood. Another is the undoubted difficulty of do- ing systematic research in the field. For example, those engaged in seeing only adult patients are
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? ? ? usually ill-placed to investigate events alleged to have occurred many years earlier. Those whose childhoods have been spent amongst reasonably stable families and who, like all too many psychi- atrists and psychotherapists, are ignorant of the recent family and child development literature have no norms against which to match their pa- tients' stories. Above all clinicians are often faced with a blanket of silence, from patient and family alike, which neither their training nor their ex- perience has qualified them to penetrate. It is little wonder therefore that the likelihood that many cases of psychiatric disorder, both mild and grave, have had their origins in adverse events of childhood has been discounted or else completely ignored--not only by general psychiatrists but by psychotherapists as well. Even the fact that some children are physically or sexually assaulted by their own parents, often repeatedly and over long periods, has been missing from discussions of casual factors in psychiatry.
At long last the scene is changing. First, know- ledge of parent-child interactions in general, in- cluding a wide range of potentially pathogenic re- lationships and events, is increasing in both qual- ity and quantity as systematic research is applied.
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? ? ? Secondly, the psychological consequences for the children exposed to these relationships and events are becoming much better understood and documented. As a result there are now many oc- casions when a clinician is on reasonably firm ground in drawing aetiological conclusions. This is so especially when (a) his patient presents problems and symptoms which resemble the known consequences of certain types of experi- ence and (b) when in the course of skilled history-taking, or perhaps much later during therapy, he is told of experiences of these same types. In reaching his conclusion the reasoning a psychiatrist uses differs in no way from that of a physician who, having diagnosed a patient as suf- fering from mitral stenosis, proceeds unhesitat- ingly to attribute the condition to an attack of rheumatic fever suffered by the patient many years earlier.
When considering childhood antecedents of cog- nitive disorders a good place to start is with amnesia.
In one of his classical papers on analytic tech- nique Freud (1914) made an important generaliz- ation the truth of which probably every psycho- therapist would endorse:
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? ? ? Forgetting impressions, scenes or experiences nearly always reduces itself to shutting them off. When the patient talks about these 'forgotten' things he seldom fails to add: 'As a matter of fact I've always known it; only I've never thought of it. ' (1914, 148)
Such observations call for explanations of at least three kinds. First, are there special features that characterize the impressions, scenes, and experi- ences that tend to become shut off? Secondly, how do we best conceive of the processes by which memories become shut off and apparently forgotten? Thirdly, what are the causal condi- tions, internal and external to the personality, that activate the shutting-off process?
The scenes and experiences that tend to be- come shut off, though often continuing to be ex- tremely influential in affecting thought, feeling, and behaviour, fall into at least three distinct cat- egories: (a) those that parents wish their children not to know about; (b) those in which parents have treated children in ways the children find too unbearable to think about; (c) those in which children have done, or perhaps thought, things about which they feel unbearably guilty or ashamed.
Since a great deal of attention has for long been given to the third category, here I discuss only the first two. We start with the first.
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? ? ? Children not infrequently observe scenes that parents would prefer they did not observe; they form impressions that parents would prefer they did not form; and they have experiences that par- ents would like to believe they have not had. Evidence shows that many of these children, aware of how their parents feel, proceed then to conform to their parents' wishes by excluding from further processing such information as they already have; and that, having done so, they cease consciously to be aware that they have ever ob- served such scenes, formed such impressions, or had such experiences. Here, I believe, is a source of cognitive disturbance as common as it is neglected.
Yet evidence that parents sometimes press their children to shut off from further, conscious processing information the children already have about events that the parents wish they had never observed comes from several sources. Perhaps the most vivid concerns the efforts made by a surviving parent to obliterate his or her child's knowledge of the (other) parent's suicide.
Cain and Fast (1972) report findings from their study of a series of 14 children, aged between 4 and 14, all of whom had lost a parent by suicide
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? ? ? and all of whom had become psychiatrically dis- turbed, many of them severely so. In reviewing their data the authors were struck by the very large roles played in the children's symptomato- logy by their having been exposed to pathogenic situations of two types, namely situations in which intense guilt is likely to be engendered (not discussed here) and situations in which commu- nications between parent and child are gravely distorted.
About one quarter of the children studied had personally witnessed some aspect of the parent's death and had subsequently been subjected to pressure from the surviving parent to believe that they were mistaken in what they had seen or heard, and that the death had not been due to suicide but to some illness or accident. 'A boy who watched his father kill himself with a shot- gun . . . was told later that night by his mother that his father died of a heart attack; a girl who dis- covered her father's body hanging in a closet was told he had died in a car accident; and two broth- ers who had found their mother with her wrists slit were told she had drowned while swimming' (Cain and Fast, 1972, 102). When a child de- scribed what he had seen, the surviving parent
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? ? ? had sought to discredit it either by ridicule or by insisting that he was confused by what he had seen on television or by some bad dream he had had. Such confusion was sometimes compoun- ded, moreover, by the child hearing several dif- ferent stories about the death from different people or even from his surviving parent.
Many of the children's psychological problems seemed directly traceable to their having been ex- posed to situations of these kinds. Their prob- lems included chronic distrust of other people, inhibition of their curiosity, distrust of their own senses, and a tendency to find everything unreal.
Rosen (1955) describes an adult patient, a man of 27, who developed acute symptoms after his fiance? e had jilted him, because she had found him too moody and unpredictable. The patient began to feel that the world about him and also his own being were fragmenting, and that everything was unreal. He became depressed and suicidal; and he experienced a variety of peculiar bodily sensations, which included a feeling that he was choking. His thoughts, he said, felt like cotton-wool. Sometime during the second year of therapy the analyst, struck by a series of associ- ations the patient gave, and bearing in mind the
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? ? ? life history, ventured a reconstruction, namely that the patient's mother may have made a sui- cidal attempt during the patient's childhood that he (the patient) had witnessed. No sooner had this suggestion been offered than the patient be- came racked with convulsive sobbing. The ses- sion proved a turning point. Subsequently the pa- tient described how it had seemed to him that, when the analyst made his suggestion, it was not so much that he was restoring a memory as giv- ing him (the patient) permission to talk about something he had always in some way known about.
The authenticity of the memory was vouched for by the patient's father who admitted, when pressed, that the patient's mother had made sev- eral suicide attempts during the patient's child- hood. The one the patient had witnessed oc- curred some time during his third year. His nurse had heard sounds in the bathroom and had ar- rived in time to prevent his mother from strangling herself. It was not clear just how much the little boy had seen. But whenever later he had mentioned the event both father and nurse had disconfirmed his memories by alleging that it was something he must have imagined or had simply
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? ? ? been a bad dream. The father now claimed that he had felt it would have been harmful to his son to have remembered such an incident; but he also admitted that his attitude was dictated partly by his wish that the incident be kept secret from friends and neighbours. A year or so later the nurse had been discharged because the mother had found her presence too painful a reminder of the incident.
During one of the sessions before the vital re- construction was offered the patient had recalled the discharge of his beloved nurse as an event which he had always felt had been in some way his fault. Among many associations to it were re- current references to his having been, as a child, witness to something that had changed his life, though he did not know what. He also had the notion that his nurse had been the one witness on his behalf. Thus, although the memory had been shut away from conscious processing, it contin- ued to influence both what he thought and how he felt.
Elsewhere (Bowlby, 1973) I have drawn atten- tion to the far from negligible incidence of suicid- al attempts made by parents, and perhaps the even higher incidence of their threatening
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? ? ? suicide, and have remarked how little attention has been given to either attempts or threats in the psychiatric and psychotherapeutic literature. Per- haps there are many more cases similar to Rosen's than has yet been realized.
Among the many other situations that parents may wish a child had not observed, and that they may press him to suppose he never did, are those concerning their sexual activities. An example of this was told to me by a speech therapist who was trying to help an extremely disturbed little girl who hardly spoke at all. That she was well able to speak was, however, shown on certain dramatic occasions. She would sit a teddybear on a chair in a corner, then go over and, shaking her finger at him, would scold him in tones of extreme sever- ity: 'You're naughty--naughty Teddy--you didn't see that--you didn't see that, I tell you! ' This she repeated again and again with increasing vehe- mence. What the scenes were that Teddy was be- ing instructed he never saw was not difficult to guess: the little girl's mother was a teenage prostitute.
Clearly the purpose of these pressures by par- ents is to ensure that their children develop and maintain a wholly favourable picture of them. In
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? ? ? 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).
