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What — what’s the — what’s the charge if they’re going to come home from school? It doesn’t add up to billions for the individual but it adds up to two, three, four hundred bucks for average families. The price she paid for this adaptation was affective distancing, low self-esteem (‘He would not tolerate me if he knew what I was really like’), and the lack of a sense of movement and growth in her life.
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Can they be related to patterns of maternal–infant interaction in the early months of life? Do they, as psychoanalytic theory might assume, persist into adult life? If maternal handling is relevant to classification pattern, what is the relationship between this and the mother’s own experience of being mothered? If so, what are the psychological mechanisms by which attachment patterns are transmitted from one generation to the next? The remainder of this chapter is devoted to a discussion of these and related questions.
Thus an avoidant person who encounters love and support may discount this as mere manipulation or seductive self-servingness on the part of the other. Bowlby wanted to recast psychoanalytic theory in terms of a systems approach, in which feedback loops are a key element. These are the benign circles of healthy development, and the vicious circles of psychopathology in which negative assumptions about the self and others become self-fulfilling prophecies. All of us, from the cradle to the grave, are happiest when life is organised as a series of excursions, long or short, from the secure base provided by our attachment figures. That the prolonged deprivation of a young child of maternal care may have grave and far reaching effects on his character and so on the whole of his future life. It is a proposition exactly similar in form to those regarding the evil after-effects of German measles before birth or deprivation of vitamin D in infancy.
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Progress in therapy only began when this woman had tested her therapist again and again for his reliability and had, inevitably, found him wanting, but still felt safe enough to reveal the extent of her disappointment and rage towards him. Nevertheless, social psychiatry has firmly established the importance of the environment in influencing the course of schizophrenic illness . Patients living in families in which there is high ‘expressed emotion’ – especially high levels of hostility or overinvolvement – are much more likely to relapse than those who live with calmer, less hostile, less over-involved relations. The effect of EE is not specific to schizophrenia, and also influences, for instance, the course of manic-depression, Alzheimer’s disease and diabetes.
Statements implying that children who experience institutionalisation and similar forms of privation in early life commonly develop psychopathic or affectionless characters are incorrect. None of this would have been possible without Bowlby’s courage, persistence and synoptic vision. He bemoaned the divide between ‘biological’ and psychodynamic psychiatry, insisting that his ethological– developmental model was rooted in evolutionary biology. As we shall see, modern genetics, contemporary neuroscience, together with attachment-informed developmental research, are increasingly converging.
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As a child the patient had lacked a secure base with this mother, whom she felt neglected her in favour of two younger sisters, one of whom had been chronically ill with kidney disease, while the other was epileptic, and to whom she had devoted all her attention. In an initial phase of individual therapy she was able to link her fears of harming the baby with aggressive feelings towards her younger sisters and her angry dependency on her mother, but her symptoms persisted. At the first session she proudly announced that her husband – unlike herself – was afraid of nothing. He accepted the compliment rather diffidently, but confirmed that he had been more or less self-reliant since the age of ten, when his parents had divorced and he and his younger brother had been left to fend for themselves on the rough estate where they lived. When asked if it was true, as his wife believed, that he was frightened of nothing, he confessed that he had slipped on a plank that morning and had been very scared, and that since the birth of the baby he had been much less of a daredevil. His wife seemed surprised at this revelation, but visibly relaxed and perked up.
Bowlby originally explained this by analogy with the phenomenon of imprinting, in which in prosocial species, young birds will follow any mobile figure to which they are exposed at the ‘sensitive period’ in their development. Of those who had been traumatised in this way under the age of six, the figures were 57 per cent for BPD and 13 per cent for other diagnoses. Psychoanalysts working with these patients have emphasised the extensive use of projective identification that arises in the transference–countertransference matrix. For the inexperienced, (and not infrequently the experienced!) all this can be unexpected and difficult to tolerate.
Morbid jealousy and agoraphobia David was a fifty-year-old former taxi-driver who developed panic attacks whenever he was separated from his wife, even for half an hour, and could not go out of the house unaccompanied. Her life was made increasingly miserable by his possessiveness, and his ceaseless questioning of her when she returned from brief excursions. During David’s attacks he was convinced that he would die and was frequently rushed to hospital casualty departments with suspected heart attacks.
A few weeks later he wrote saying that he had returned to Glasgow, had stopped drinking and was now happily looking after the children. A further letter a year later confirmed that things continued to go well. Perhaps Jock felt sufficiently ‘held’ by his weekly contact with the therapist at the hospital to rebuild his inner world.
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If the secure child’s overt and accepted display of angry emption is a ‘primary’ attachment response to threatened or actual separation, both avoidant and ambivalent children employ what has been described as ‘secondary’ attachment strategies . The ambivalently attached child shows overt aggression towards the inconsistent mother who, in the Strange Situation, has just left him for two successive periods (albeit only for 3 minutes – but how was the oneyear-old to know that?). ’, but clinging on at the same time since he knows from experience that the chances are that she will. The avoidant child shows little overt aggression in the Strange Situation, although such children do show outbursts of unprovoked aggression at home. Avoidance is a way of dampening aggression and so appeasing the mother to whom the child needs desperately to feel close, but whom he fears will rebuff him if he reveals his needs too openly, or shows her how angry he feels about being abandoned . It is hoped that this madness of western society will never be copied by socalled less developed societies.
