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THE BIOPSYCHO SOCIAL ROLE OF MOTHER-INFANT ATTACHMENT

IN EMOTION REGULATION AND A MODEL OF PROJECTED

PSYCHOPATHOLOGY RESULTING FROM ATTACHMENT DEFICITS AND

DISTORTIONS

A DISSERTATION SUBMITTED TO THE FACULTY

OF

THE SCHOOL OF PROFESSIONAL PSYCHOLOGY

SPALDING UNIVERSITY

BY

VICKI LYNN HAYES

IN PARTIAL FULFILLMENT OF THE

REQUIREMENTS FOR THE DEGREE

OF

DOCTOR OF CLINICAL PSYCHOLOGY

MARCH 26, 2001



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UMI Num ber. 999 998 9

Copyright 2001 by

Hayes, Vicki Lynn

All rights reserved.

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Copyright © 2001 by Vicki L. Hayes

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THE BIOPSYCHOSOCIAL ROLE OF MOTHER-INFANT ATTACHMENT

IN EMOTION REGULATION AND A MODEL OF PROJECTED

PSYCHOPATHOLOGY RESULTING FROM ATTACHMENT DEFICITS AND

DISTORTIONS

A DISSERTATION SUBMITTED TO THE FACULTY

THE SCHOOL OF PROFESSIONAL PSYCHOLOGY

SPALDING UNIVERSITY

VICKI LYNN HAYES

IN PARTIAL FULFILLMENT OF THE

REQUIREMENTS FOR THE DEGREE

DOCTOR OF CLINICAL PSYCHOLOGY

LOUISVILLE, KENTUCKY

OF

OF

APPROVED: DATE:

John A. James, Ph.D.

David L. Morgan, J ’h.D

DATE: ^ ^ (

David W. Richart, Ph.D.

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ACKNOWLEDGEMENTS

I take this opportunity to thank the members of my dissertation committee, Dr.

John A. James (chair), Dr. David L. Morgan, and Dr. David W. Richart, for granting me

the freedom to pursue this unusual dissertation, for their encouragement and support, for

their patience in grappling with such a lengthy document, and for their words of wisdom.

Each offered valued contributions and together they provided a terrific blend of

biopsychosocial perspectives, that not only enhanced the quality o f this work, but

enriched the thinking that shaped and produced it.

I especially want to thank Dr. John James, not just because he was my chair, but

because he has been an inspiration and mentor throughout my graduate career at

Spalding. John is the quintessential teacher. His classes were my absolute favorites,

introducing me to astounding subjects and new concepts regarding how human beings are

made that reshaped my thinking. He always left me wanting to learn even more (and still

does). Perhaps what I appreciate above all else is his genuine passion for psychology.

The respect, warmth, kindness, and support he has continued to show me mean a lot.

I want to thank Dr. James P. Bloch for his inspiration, understanding, unfailing

support, warmth, kindness, and incredible wisdom. Jim, too, has a passion for

psychology. He never stops thinking about it; he never stops learning. Always ten steps

ahead, no one knows more about attachment and attachment related psychopathology

than Jim Bloch.

Thanks also go to supervisors (and good friends) Drs. Nancy Schrepf, Terry

Pearson, Pat McGinty, Paul Stratton, and internship training director, Larry Gaupp who

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provided the freedom, respect, encouragement, mentoring, and mirroring I needed to

come into my own as an emerging, competent clinician.

I dedicate this dissertation to those individuals who have permitted me access to

their innermost selves—who entrusted me with their pain, vulnerabilities, and greatest

fears. It is hoped that through this work I have come to better understand the nature of

their wounds and what needs to be done to help heal them.

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ABSTRACT

This study (1) delineated the biopsychosocial roles of mother-infant attachment in

emotion regulation, (2) devised a developmental model for projecting psychopathology

resulting from attachment deficits and distortions, and (3) provided a demonstration of

the model’s effectiveness, using existing data. Contributions of mother-infant attachment

phenomena to emotion regulation in the developing child were delineated per each o f six

incremental age periods spanning 0-3 years o f age. Literature reviews synthesized six

strands o f data (available brain, developing brain, observable infant capabilities, relevant

developmental theories o f psychology, mother-infant attachment mechanisms,

psychopathology) from which a list o f projected enduring traits o f attachment deficits and

distortions were formulated per each o f the age periods. Data—selected for consistency

across neurobiological, neurophysiological, developmental, behavioral, and clinical

vantage points—were mapped together for the purpose of bringing a “bigger

(biopsychosocial) picture” into view. Predictive descriptions of psychopathology arising

from attachment deficits and distortions were formulated by working forward—in a

sequential, additive fashion—from the emerging end of the developmental trajectory, in

keeping with the model’s developmental premise and General Systems Theory principles.

Demonstrating the model’s effectiveness produced a theory of aberrant aggression

resulting from early infant trauma based on evidence of opioid mediated adaptations,

depletions, and deficiencies.

IV

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TABLE OF CONTENTS

Page

ACKNOWLEDGEMENTS............................................................................................... ii

ABSTRACT.........................................................................................................................

iv

LIST OF FIGURES............................................................................................................ viii

CHAPTER

L INTRODUCTION................................................................................................. 1

Background............................................................................................................. ........J

Purposes o f Dissertation........................................................................................ 8

Questions Addressed by Dissertation..................................................................

10

Research Methodology.......................................................................................... 11

Implications ............................................................................................................. 12

H. REVIEW OF ATTACHMENT THEORY MILESTO NES .............................. 13

EH. METHODOLOGY................................................................................................">oJJ

A Biopsychosocial M odel for Projecting Psychopathology Resulting from

Attachment Deficits and Distortions....................................................... 33

Adherence to General Systems Theory (and Evolution) Princip les................. 33

Interaction of Stress and Ability to Achieve Homeostas is................................. 42

Systematic Biopsychosocial Steps for Projecting Psychopathology

Resulting from Attachment Deficits and Distortions............................. 43

Definitions............................................................................................................... 46



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IV. RESULTS PART I: DETAILED DEMONSTRATION OF MODEL’S

EFFECTIVENESS FROM BIR TH -TW O MONTHS: (ANYTHING BUT)

AUTISM.......................................................................................................................50

The Nature o f Brain Development Following Birth................................................

50

Differentiation .................................................................................................51

Myelination ..................................................................................................... 57

Critical Periods................................................................................................59

Available Brain ............................................................................................................71

Structures........................................................................................................ 73

Neurophysio logy ............................................................................................ 77

Emotion Circuitry.......................................................................................... 82

Developing Brain: Coming (On-Line) Attractions ................................................. 92

Structures........................................................................................................ 92

Emotion Circuitry.......................................................................................... 98

Newborn Capabilities: Observable Phenomena .....................................................108

Developmental Theories of Psychology Rooted in Corresponding

Observable Phenomena................................................................................ 117

Developmental Tasks and Mechanisms o f Mother-Infant Attachment:

Birth to Two Months: Achieving Homeostasis......................................... 126

Mother as the Facilitating Environment.....................................................127

Mother-Infant Developmental Task: Achieving Homeostasis:

Arousal Regulation is a Two-Person Job .......................................137

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Psychopathology Resulting from Attachment Deficits and Distortions:

Birth to Two Months: Dysregulation of Arousal................................... 176

Infants of Depressed M others.......................................................................178

Traumatized Newborns................................................................................. 188

Summary: Nature o f Psychopathology Arising from

Developmental Period: Birth to Two Months.......................... — 243

IV. RESULTS PART II: SUMMARY OF PROJECTED PSYCHOPATHOLOGY

RESULTING FROM ATTACHMENT DEFICITS AND DISTORTIONS

DUR ING SEQUENTIAL AGE PERIODS FROM AGE 2-36

MONTHS...............................................................................................................

-.-248

2- 5 Months: Symbiosis............................................................................................248

5-8 Months: Selective Attachment.......................................................................... 279

8-18 Months: Practicing............................................................................................296

18-24 Months: Rapprochement.......................................................................... — 318

24-36 Months Object Constancy .............................................................................327

V. DISCUSSION....................................................................................................... -...339

REFERENCES................................................................................................................... - .374

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LIST OF FIGURES

FIGURE 1 Emotional Brain Development: Ages 0-36 Months..................................338

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CHAPTER I

INTRODUCTION

There have been many approaches to understanding long-term psychopathology

with good agreement that such psychopathology is rooted in events o f early childhood.

However, most have elected to elucidate possible causal factors by extrapolating

backward from the point in the developmental trajectory at which symptoms are showing

themselves—adulthood. Such symptoms are quite salient compared to otherwise normal

adult features such as intellectual or physical capabilities, interests, competencies, or

behaviors. In this manner, they take on a mysterious, intriguing quality. However, if such

symptoms are viewed as clues to the developmental “age” at which psychopathology first

emerged, they can provide pathways back to what might have been going on in the

individual’s life that disrupted normal, healthy psychological development. Theorizing can

certainly be done working backwards, but speculation may remain vague with limited, if

any, legitimate opportunity to collect data that can retroactively confirm (or disaffirm)

hypotheses.

Another approach is to begin at the beginning of the developmental trajectory, to

catch psychopathology as it first emerges in direct relation to its precipitant. If

psychopathology represents abnormal or disrupted development, what has thrown normal

development o ff course? In order to explore the roots o f psychopathology in this manner,

several steps must be taken. First, normal developmental processes and their required

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conditions must be pinned down. Psychopathology might, therefore, be projected by

anticipating what would occur if critical aspects of those conditions were missing or

abe rrant-given developmentally determined capacities for adaptation—at various points

along the brain’s developmental trajectory.

As with all mammals, human development unfolds within the context of mother-

infant interaction. Therefore, deficits or distortions in this reciprocal relationship might be

causal factors giving rise to psychopathology. Should such causal factors go uncorrected,

perhaps fo r the duration of periods in which affected portions of the brain are becoming

formed and set in their ways, this would provide explanation for the long life and

intractability of such symptoms—symptoms that have been around so long they are often

considered to be characteristics of an individual’s personality.

It is the aim of this dissertation to generate a model for elucidating long-term

psychopathology using such a developmental, epigenetic approach. To develop the

model, contributions o f mother-infant attachment phenomena to emotion regulation in the

developing child will be delineated per each o f six incremental age periods spanning 0-3

years o f age. Literature reviews will synthesize six strands of data (available brain,

developing brain, observable infant capabilities, relevant developmental theories of

psychology, mother-infant attachment mechanisms, and psychopathology) from which a

list o f projected enduring traits of attachment deficits and distortions will be formulated

per each o f the age periods. Data will be selected for consistency across neurobiological,

neurophysiological, developmental, behavioral, and clinical vantage points and mapped

together for the purpose o f bringing a “bigger (biopsychosocial) picture” into view.

Predictive descriptions of psychopathology arising from attachment deficits and distortions

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will be formulated by working forward—in a sequential, additive fashion—from the

emerging end o f the developmental trajectory, in keeping with the model’s developmental

premise and General Systems Theory principles.

A detailed demonstration to determine effectiveness of proposed model steps will

be produced fo r the initial 0-2 Months age period. It is predicted, that by following model

steps, new insights into long-term psychopathology, continuing even into adulthood, will

be gained from conducting the demonstration.

Background

In his landmark 1945 article, “Hospitalism”, Rene Spitz brought to the fore that

young infants confined to foundling homes and other institutions during the first year of

life suffered dire consequences, primarily due to maternal deprivation. Not only did

institutionalized, mother-deprived children become “asocial, delinquent, feeble-minded,

psychotic, or problem children”, (p. 54), bu t they could die. In 1944, John Bowlby, the

English child psychiatrist from the Tavistok Clinic, began his studies o f the effects of

mother-infant separations on the development o f children’s personalities leading him to

develop his theory o f mother-infant attachment, first published in his 1958 article, “The

Nature o f a Child’s Tie to His Mother” , and culminating in his seminal trilogy: Attachment

(1969), Separation (1973), and Loss (1980). Bowlby’s writings remain the quintessential

work on attachment, generating a vast body o f research by developmentalists, biologists,

clinicians, behaviorists, and neurobiologists that continues to grow by leaps and bounds

into the 21st Century. The reason this work retains its edge, even at this time when new

technologies permit human as well as animal neurobiological discoveries at a breath-taking

pace, is that Bowlby’s conceptualization is rooted in evolutionary principles, biology,

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neurobiology, and natural behavioral observation. Bowlby was so taken with the theory

o f evolution that he penned a biography of Charles Darwin (1990). In part, through his

participation in the World Health Organization, he was exposed to and greatly influenced

by cutting edge scientists o f the 1950’s that included ethologist Konrad Lorenz; primate

biologist Harry Harlow; neurobiologists Miller, Galanter, Pribram, and Young (whose

control theories provided models for neurobiological substrates o f homeostatic behavior),

anthropologist Margaret Mead; developmentalists Sigmund Freud, Rene Spitz, Jean

Piaget, and Erick Erickson; and last, but certainly not least to this dissertation, general

systems theorist von Bertalanfly (Ainsworth & Bowlby, 1991; Bowlby, 1969).

John Bowlby’s theory captures the essence o f a biopsychosocial approach to

understanding and articulating phenomena of psychology and psychopathology. That his

work continues to hold up against vast new biological discoveries, and that the drive to

understand attachment phenomena has intensified, to include its role as the “facilitating

environment” (Winnicott, 1965) for the developing brain, nearly 50 years later, attes ts to

the advantage o f the biopsychosocial model. Part and parcel of this approach is the

understanding that living organisms are grounded in their evolutionary roots.

The scientists who have just completed the awesome achievement o f detailing the

entire human gene code (National Institutes of Health & Celera Genomics Corporation,

2001) shared that among their most amazing discoveries is that the evidence o f evolution

is so readily apparent. Fo r example—consistent with nature’s fondness for tinkering with

old systems to refine or produce new, even more adaptive functions in the service of

meeting existing environmental demands—human genes appear to be constructed by

mixing, matching, or “globbing” new parts onto old parts. Another discovery is that

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phenotypic presentations are not so hard wired as commonly believed, affording a great

deal of flexibility which, of course, can be an adaptive advantage should conditions

change. These scientists warned against the simplistic notion that one specific gene gives

rise to one particular trait or disease, stressing instead that environmental influence (at

multiple levels) provides the interactive context that guides genetic expression.

Intracellular protein dynamics, which also have a primary role in maintaining homeostasis

sensitive to environmental demands, appear to hold the key to the complexity of genetic

expression not just to the end o f maturation, but throughout the lifespan.

The obvious “big picture” (vs. piece meal) advantage of coming to understand

psychology phenomena from a biopsychosocial (three or more tiered systems) approach is,

needless to say, offset by the added complexity. This is where general systems theory

comes to the rescue by providing a few hard and fast rules o f nature that absolutely cannot

be violated. Therefore, systems theory provides the frame for placing one overlay o f data

atop the next as well as the means o f weeding out extraneous, systems-inconsistent

material. Examples of systems rules that are critical to the formulation of the model

proposed in this dissertation are that systems evolve from simple to complex, systems are

hierarchical with higher order systems subsuming all components of the subsystems that

comprise them, and that the integrity of higher order systems is, therefore, dependent upon

the integrity of their lower order systems. Systems exchange energy with and are

dependent upon their environmental systems for their ongoing development and survival.

Should such energy not be forthcoming, systems can begin to unravel, losing their

complexity, perhaps becoming disorganized altogether in the process called entropy

(James, 1999).

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To tease out characteristics of psychopathology arising from attachment deficits

and distortions, the logical first step (albeit a. daunting one) is to understand how

“normal” mother-infant attachment operates as the context for facilitating the development

of the human brain. The subject o f this dissertation, therefore, demands beginning at the

beginning, and following the brain’s epigenetic course o f increasing sophistication and

reorganization as it gains momentum along its developmental trajectory. To begin at

birth, when phenomena are more “simple” and easier to grasp also demonstrates how

nature’s tools (often simply retooled) are used time and again, lending order to the

increasing complexity. The concept o f how/ developing brains reinvent or reorganize

themselves as more sophisticated inform ation processing systems come on-line—adding a

new twist, yet based on information already^ collected by lower systems—is perhaps best

articulated by Greenough, Black, and Wallace (1987) who refer to this process as “stage-

setting” (p. 553).

Two other percepts developed by these theorists are “experience-expectant” and

“experience-dependent” information mecha_nisms utilizing the brain’s plasticity in

interaction with its environment to obtain amd incorporate information required for

ongoing development and optimal survival. Experience-expectant systems refer to

emergent brain components—coming on board during infancy—that require (are genetically

hard wired for) specific types of stimuli from the environment to spur their normal

development. If the expected stimuli are no t forthcoming or are somehow distorted

during the span of that brain part’s developmental window, abnormal development will

ensue. No t only did Harry Harlow’s (H arlow & Zimmerman, 1958) work with primates

provide some of the most compelling evidemce that the physical contact w ith a soft mother

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provides a more potent, desirable stimulus to an infant than even food, he was able to

demonstrate that infants who are deprived of their mothers during “critical periods” of

their development suffer dire, permanent psychopathological consequences (Deets &

Harlow, 1971).

For efficiency; to gain a simplified, more understandable view; and to aim for as

much precision as possible, the au thor o f this dissertation made the decision to pin down

the neurobio logical subsystem bones first, then overlay only those social, developmental,

behavioral, and clinical observations that fit the bones. Fortunately, Jaak Panksepp

provided a place to start. This neurobiologist (Panksepp et al., 1978) identified a critical

biological substrate by discovering the role o f endogenous opioids in mediating mother-

infant attachment (that will be discussed in depth throughout this dissertation). In

addition, Panksepp has reconceptualized human emotions based on the neurobiological

circuits giving rise to them. He has utilized evolutionary principles and sorted through

vast numbers o f animal studies—many o f which he and colleagues conducted themselves—

to develop constructs that are so tangible they provide a fairly tight, concrete (vs. elusive,

abstract) frame for understanding emotions, particularly as they arise from within the

social-emotional context of the mother-infant attachment relationship. Once getting used

to some new descriptive names and ways of looking at emotions, Panksepp’s

reformulations provide practical insights into otherwise baffling observations of emotional

behavior.

Jaak Panksepp (1998) conceptualizes each emotion system as a genetically

predetermined, organized neural circuit that responds “unconditionally to stimuli arising

from major life-challenging circumstances” (p. 48), provides feedback (feelings), solves a

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particular set o f problems, and organizes adaptive behaviors or other responses in relation

to the environment for the ultimate goals o f survival and reproduction. Emotion circuits

“organize diverse behaviors by activating o r inhibiting motor subroutines and concurrent

autonomic-hormonal changes that have proved adaptive in the face o f such life-challenging

circumstances during the evolutionary history of the species” (p. 49).

Ability to delineate biological substrates is a logical litmus test for any theory of

psychology, because without biology, psychology would cease to exist. And, in this day

and age, neurobio logical discoveries (i.e. Harry Chugani’s PET scans showing the

ascendancy of each new brain subsystem as it comes on board and subsequent

reorganization—from brainstem to cortex—over the course o f the developing human brain)

are beginning to fill in the gaps where previously theoretical “intervening variables” had to

serve as stand-ins to explain as o f yet to be understood psychological observations (James,

1999, p. 19). John James (1999) proposes that

Systems theory would suggest that as the gap represented by brain complexity is

reduced, intervening variables will be replaced by concrete systems models that can

specify the physical path o f the (Energy/Information) through the brain. Those

scientific psychologists who wish to construct models of behavioral functioning

that will interface and articulate with those models developed by sciences using

concrete systems will have to formulate their research using terminology and

concepts tha t map onto concrete systems, (p. 23)

The author of this dissertation plans to follow this approach.

Purposes of This Dissertation

The purposes of this dissertation are to (1) delineate the biopsychosocial roles of

mother-infant attachment in emotion regulation, (2) devise a developmental model for

projecting psychopathology resulting from attachment deficits and distortions, and (3)

provide a demonstration of the model’s effectiveness, using existing data. Inherent goals

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Questions Addressed by this Dissertation

1. What components of attachment theory inform this work?

2. Can biological substrates be identified that can account for observations o f infant

behavior and tenets of existing developmental theories of psychology?

3. What are the nature and functions o f mother-infant attachment, particularly as they

relate to emotion regulation in the developing child?

4. What are the biological substrates (brain structures, psychopharmacology, and

emotion circuitry) involved in mother infant attachment?

5. Do environmental factors affect human brain development? If yes, how?

6. What are the nature and sources o f attachment deficits and distortions (infant trauma)

and their relationship to emotion dysregulation?

7. What are the biological substrates (brain structures, psychopharmacology, and

emotion circuitry) involved in separation, prolonged separation, attachment deficits,

and attachment distortions (infant trauma)?

8. What risk factors to resiliency (i. e. from loss, illness, physical pain, subsequent

traumatic event) are likely to emerge from attachment deficits and distortions?

9. What are some predicted enduring traits resulting from attachment deficits and

distortions? How might they look at various points along the developmental

continuum?

10. Can attachment related psychopathology for children and adults be identified by

working forward from the emergent end of the developmental trajectory (vs.

extrapolating attachment deficits and distortions by working backward from

adulthood)? If yes, what are the advantages and disadvantages to this approach?

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Research Methodology

A biopsychosocial model for projecting psychopathology resulting from

attachment deficits and distortions, adherent to general systems theory principles, will be

delineated (CHAPTER IH). Model steps will be followed in developing a demonstration

of its effectiveness for age 0-2 months (CHAPTER IV-RESULTS: PART I). Using an

abbreviated process, projected vulnerabilities resulting from the types o f attachment

deficits and distortions tha t might emerge pe r each of six age periods (0-2, 2-5, 5-8, 8-18,

18-24, and 24-36 months) will be summarized (CHAPTER IV-RESU LTS: PART II).

Advantages and disadvantages o f this model as well as its implications for assessment,

treatment, and prevention will be addressed (CHAPTER V-DISCUSSION).

Multiple literature reviews will be conducted to (1) delineate the biopsychosocial

roles o f mother-infant attachment in emotion regulation and (2) demonstrate the

effectiveness of the proposed Biopsychosocial Model for Projecting Psychopathology

Resulting from Attachment Deficits and Distortions. All research questions (above) will

be addressed in the process. To accomplish these tasks, data—selected for consistency

across developmental, neuropsychological, psychopharmacological, behavioral and clinical

vantage points—will be pulled together for the purpose o f bringing a “bigger

(biopsychosocial) picture” into view.

Literature reviews will synthesize six strands of data (available brain, developing

brain, observable infant phenomena, relevant developmental theories of psychology,

mother-infant attachment mechanisms, psychopathology) from which a list of projected

enduring traits of attachment deficits and distortions can be formulated, per each of six

incremental age periods from 0-36 months. Predictive descriptions o f what individuals

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with attachment deficits and distortions would look like at various points along the

developmental continuum will be formulated by working forward—in a sequential, additive

fashion—from the emerging end o f the developmental trajectory, in keeping with the

model’s developmental premise.

Due to the synthesized nature and exceptional length o f this document, this

dissertation’s committee has granted special permission to utilize a large number of

extended quotations and to utilize single-spacing for extended quotations vs. the

customary double-spacing generally required for dissertations. Special headings for the

six sequential age periods: "Autism", "Symbiosis", "Selective Attachment", "Practicing",

"Rapprochement", and "Object Constancy", are terms formulated by Margaret Mahler,

Fred Pine, and Anni Bergman (1975) for these developmental periods as delineated in

their landmark theoretical work, The Psychological Birth o f the Human Infant.

Implications

The significance of the proposed model is that it will provide a more systematic

and consistent developmental, biopsychosocial framework for acquiring data, formulating

hypotheses, researching, conceptualizing, assessing, and treating attachment related

psychopathology. It can be used to elucidate environmental contributions to the

development of psychopathology, providing hope of prevention. It can also be used to

identify, protect, and enhance essential factors for establishing a healthy psychological

foundation.

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CHAPTER II

Review of Attachment Theory Milestones

There is universal agreement tha t the first individual to propose a theory for human

mother infant attachment was the English child psychiatrist from the Tavistok Clinic in

London—John Bowlby. Following his undergraduate studies in medicine at Cambridge

University, Bowlby worked as a volunteer in a residential school for maladjusted children.

Two children at this school made a notable impression on him, an impression that served

to steer him into the course o f his life’s work:

One was an isolated, affectionless adolescent who had never experienced a stable

relationship with a mother figure, and the other was an anxious child who followed

(me) around like a shadow. Largely because o f these two children, (I) resolved to

continue (my) medical studies toward a specialty in child psychiatry and

psychotherapy, and was accepted as a s tudent for psychoanalytic training.

(Ainsworth & Bowlby, 1991, p. 333)

While working at the London Child Guidance Clinic in 1944, Bowlby completed his first

research study on the role played by parents in the development of a child’s personality,

noting that experiences o f mother-child separation or deprivation of maternal care were

much more common among 44 juvenile thieves than among control group subjects. Those

who had such experiences were also m ore likely to be “affectionless” (Ainsworth &

Bowlby, 1991).

His work was soon interrupted by World War II. Following the war, Bowlby and

associates reorganized the Tavistok Clinic which became part of the National Health

Service; and he became its consulting psychiatrist and Director for the Department for

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Children and Parents. He started his own research unit there in 1948. Convinced that the

effects o f real events in a child’s life were far more important than a child’s fantasy life

(the popu lar notion of the day for fellow psychoanalysts like Melanie Klein), he focused

the work o f this unit on the “effects o f early separation from the mother because

separation was an event on record, unlike disturbed family interaction, of which, in those

days, there were no adequate records” (Ainsworth & Bowlby, 1991, p. 333-334) One

member of the team, a social worker named James Robertson who had worked for a time

in Anna Freud’s nursery during the war, undertook a study in which he observed the

behavior o f young children upon separation from their mothers in three different

institutional settings. He also, whenever possible, observed the children in interaction with

their parents in their homes before and after their separations (stays in the institutions).

During this same period of time, Bowlby was asked to prepare a report fo r the

World Health Organization on “what was known of the fate of children without families”

(Ainsworth & Bowlby, 1991, p. 334) leading him to travel widely and to read all available

literature on separation and maternal deprivation (Ainsworth & Bowlby, 1991). Much of

the literature described abandoned or orphaned infants who ended up in institutions such

as foundling homes, as was especially the case during World Wars I and n .

Perhaps the most historically significant example of such work was provided by

Rene A.. Spitz in his 1945 article entitled Hospitalism. Through interviews with physicians

and administrators and review of records and other accounts, Spitz reported that mortality

rates o f infants under the age o f two years who were placed in institutions in the United

States and Europe from the turn of the century ranged from 31.7% to 90% compared to

10% of children in the general population. As hospital conditions improved and more

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children survived, a new problem emerged: “institutionalized children practically without

exception developed subsequent psychiatric disturbances and became asocial, delinquent,

feeble-minded, psychotic, or problem children” (p. 54). The general agreement was that

two factors were responsible for the “psychological injury” suffered by these children:

Lack of stimulation and absence o f the child’s mother.

In his own study (1945), Spitz used developmental quotients obtained at two

four-month intervals to compare four groups of children with differing living conditions,

(1) children from professional homes in a large city, (2) children from an isolated fishing

village o f499 inhabitants, where living conditions and medial care were considered very

poor, (3) children placed in a nursery within a penal facility for delinquent girls. (Mothers

of these infants were “mostly delinquent minors as a result of social maladjustment or

feeble-mindedness, or because they are physically defective, psychopathic, or criminal (p.

60).”), and (4) children from an urban area who had been placed in a foundling home (“A

certain number o f the children housed have a background not much better than that of the

Nursery children; but a sufficiently relevant number come from socially well-adjusted,

normal mothers whose only handicap is inability to support themselves and their children”

(p. 60).) Findings were astounding; developmental quotients for the Foundling Home

Group had plummeted compared to the others: Group 1 (Professional) = 133 to 131;

Group 2 (Fishing Village) = 107 to 108; Group 3 (Nursery) = 101.5 to 105; Group 4

(Foundling Home) = 124 at 4 months, dropping to 72 at 8 months, and to 45 at 24

months. And, even more horrific,

In spite o f the fact that hygiene and precautions against contagion were

impeccable, the children showed, from the third month on, extreme susceptibility

to infection and illness of any kind .. .O f a total of 88 children up to the age of 2 14,

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23 died... In the ward o f children ranging from 18 months to 2 1/2 years only two

of the twenty-six surviving children speak a couple o f words. The same two are

able to walk. A third child is beginning to walk. Hardly any of them can eat

alone. Cleanliness habits have not been acquired and all are incontinent, (p. 59)

Why had such drastic deterioration not occurred in the other groups—particularly

the Nursery group? An important difference between the Nursery and Foundling Home

conditions was that the infants in the Nursery were able to spend a great deal of time with

their mothers, who were encouraged by staff to play and interact with their children.

These infants were also in sight and sound of other babies and their mothers, particularly

when—at age six months—they were moved to larger rooms holding up to five babies each.

They lived in well-lit, reasonably stimulating surroundings and always had toys.

By contrast—although they received adequate clothing, food, and medical

attention—Foundling Home infants were kept in bleak, dimly lit cubicles with sheet-draped

cots for up to 18 months where they received no stimulation, could see no other babies,

and had no access to their own mothers (other than for the few cases where they were

breast fed by their mothers who did not, in other ways, interact with them. Interestingly,

all Foundling Home infants were breast fed—usually by wet nurses—up to age three

months. This may account for why children in this younger group had a better illness

survival rate than did older infants.) Foundling Home infants didn’t even have a toy to

look at or play when Spitz and colleagues first arrived on the scene. For months on end

(up to age 10-12 months), these little ones were left to lie in their cribs—without human

contact for most of the day—to the point their tiny bodies left hollows in the bedding

which further restricted their movement.

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Spitz noted that while the Nursery babies had a steady rise in development, the

Foundling Home babies began to show a rapid drop in development of body mastery after

the end o f the third month. He attributed this decline to the fact that “as soon as the

babies in Foundling Home are weaned the modest human contacts which they have had

during nursing at the breast stop, and their development falls below normal” (p. 66). He

developed an extremely perceptive hypothesis to account for this phenomenon-one that

foreshadowed theories and findings o f Margaret Mahler who delineated psychological

developmental stages for children up to four years o f age based on the type and quality of

interaction with their mothers (Mahler, Pine, & Bergman, 1975) and contemporary

attachment theorists such as Edward Tronick and Daniel Stem. He noted that “libidinal

cathexis” (p. 68), i.e. investment o f interest in toys, was made possible by emotional

development afforded through the interaction with the mother or mother substitute, and

that this interaction appeared to be a critical factor in a baby’s developmental progress:

A progressive development o f emotional interchange with the mother provides the

child with perceptive experiences of its environment. The child learns to grasp by

nursing at the mother’s breast and by combining the emotional satisfaction of that

experience with tactile perceptions. He learns to distinguish animate objects frominanimated ones by the spectacle provided by his mother’s face in situations

fraught with emotional satisfaction. The interchange between mother and child is

loaded with emotional factors and it is in this interchange that the child learns to

play. He becomes acquainted with his surroundings through the mother’s carrying

him around; through her help he learns security in locomotion as well as in every

other respect. This security is reinforced by her being at his beck and call. In

these emotional relations with the mother the child is introduced to learning, and

later to imitation. We have previously mentioned that the motherless children in

Foundling Home are unable to speak, to feed themselves, or to acquire habits of

cleanliness: it is the security provided by the mother in the field o f locomotion, the

emotional bait offered by the mother calling her child that “teaches” him to walk.

When this is lacking, even children two to three years old cannot walk. (p. 68)

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In developing his theory o f attachment Bowlby was also notably influenced by the

work o f Charles Darwin (Bowlby wrote a biography of Darwin in 1990.); Sigmund Freud

for his emphasis on defense mechanisms and the significance of traumatic events during

early childhood; ethologists Konrad Lorenz and Robert Hinde for their wo rk on imprinting

patterns of baby geese and other animals; Harry Harlow for his studies o f affiliative

behaviors in primates; and Miller, Galanter, Pribram, and Young whose control theories

provided models for neurobiological substrates of homeostatic behavior (Ainsworth &

Bowlby, 1991; Bowlby, 1969). Bowlby’s attraction to ethological and biological

explanations grew as he found Freud’s theory valuable—but insufficient to adequately

describe or explain the phenomena he was observing. He was drawn to the use of

observation in field studies, descriptions of imprinting in birds, and discussion of active,

goal directed behavior patterns that would begin and cease given particular types o f cues,

responses, or circumstances in the environment. A particularly stimulating source of fresh

vantage points and exciting new ideas was Bowlby’s membership in an “international and

interdisciplinary study group on the psychobiology of the child convened by the World

Health Organization” which met yearly during the 1950’s. “Among the members were

Piaget, Lorenz, and Margaret Mead, and among guest speakers were Julian Huxley, von

Bertalanffy, and Erik Erikson.” (Ainsworth & Bowlby, 1991, p. 335).

An American contemporary o f Bowlby, Harry F. Harlow, was making important

discoveries about the significance of “affection” in mother-infant attachment in the

research he was conducting at his University o f Wisconsin primate lab (Harlow, 1958;

Harlow & Zimmerman, 1958). He provided a vivid description in perhaps his most

famous study, The Nature o f Love, in 1958. In three years of previous work with

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monkeys, many of the animals had been separated from their mothers with the justification

that they would live longer if provided supplemented nourishment from the human

investigators. Harlow (1958) provides an account o f the observations that led him to

begin his affection studies:

During the course o f these studies we noticed that the laboratory-raised babies

showed strong attachment to the cloth pads (folded gauze diapers) which were

used to cover the hardware-cloth floors o f their cages. The infants clung to these

pads and engaged in violent temper tantrums when the pads were removed and

replaced for sanitary reasons We also discovered during some allied

observational studies that a baby monkey raised on a bare wire-mesh cage floor

survives with difficulty, if at all, during the first five days of life We were

impressed by the possibility that, above and beyond the bubbling fountain o f breast

or bottle, contact comfort might be a very important variable in the development of

the infant’s affection for the mother, (p. 675)

For his Nature of Love study, Harlow constructed two types o f surrogate monkey

mothers. The first “was made from a block of wood, covered with sponge rubber, and

sheathed in tan cotton terry cloth. A light bulb behind her radiated heat” (p. 676). The

second was “made of wire-mesh, a substance entirely adequate to provide postural

support and nursing capability, and she is warmed by radiant heat” (p. 676). Some of the

monkeys received their milk from the cloth mothers, some from the wire mothers,

although they had access to both. The amount o f time was recorded for how long the

baby monkeys spent clinging to the two types of mothers from the time they were 1 day

old up to 25 days of age. The results were startling. Even those babies fed by the wire

monkeys preferred the cloth mothers. Babies fed by the cloth monkeys spent 15 to 18

hours a day on the cloth mothers and none on the wire mothers. Babies fed by the wire

mothers started out spending about 6-12 hours a day clinging to the cloth mothers, with

this time increasing steadily to the point that by age 16 days, they were spending up to 15-

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18 hours a day on the cloth mothers. They, too, spent as little time as possible (only time

necessary to feed) with the cold, unappealing wire mothers throughout the 25 day period.

In addition, these infants had softer stools, leading Harlow to conclude there was

“psychosomatic involvement” (p. 677). In his discussion of the findings, Harlow offered

these remarks:

We were not surprised to discover that contact comfort was an important basic

affectional or love variable, but we did not expect it to overshadow so completely

the variable of nursing; indeed, the disparity is so great as to suggest that the

primary function o f nursing as an affectional variable is that o f insuring frequent

and intimate body contact o f the infant with the mother, (p. 677)

Harlow’s studies, complete with gut-wrenching photographs of distressed infant monkeys,

were a tremendous influence in Bowlby’s work. Deets and Harlow (1971) conducted

another landmark study in which they provided evidence of critical periods for healthy

emotional development. A half century later, primate research by Gary Kraemer, Stephen

Suomi, and others continues to provide some o f the most compelling findings regarding

the long-term social, emotional, and biological developmental consequences of maternal

deprivation.

Bowlby first published an articulation of his new theory in 1958 in the article, The

Nature o f a Child’s Tie to his Mother. However, this modest initial effort to put forth an

ethological model for parent-child interaction amidst the prevailing psychoanalytic/object

relations school of thought was eclipsed by what remains the definitive work on

attachment: his trilogy of books entitled Attachm ent (1969), Separation (1973), and Loss

(1980). Bowlby drew from Robertson’s work; readings regarding human, primate, and

othe r animal infants; and 20 years o f his own observations stemming from work with

parents and children to demonstrate remarkably consistent separation and reunion

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behavior patterns in infants and young children—the backbone o f his theory o f attachment.

In Attachment , Bowlby provided his oft-cited description of the predictable sequence of

separation and reunion behaviors in young children: protest, despair, and detachment:

The initial phase, tha t o f protest, may begin immediately or may be delayed;it lasts from a few hours to a week or more. During it the young child appears

acutely distressed at having lost his mother and seeks to recapture her by the full

exercise o f his limited resources. He will often cry loudly, shake his cot, throw

himself about, and look eagerly towards any sight or sound which might prove to

be his missing mother. All his behavior suggests strong expectation that she will

return. Meantime he is apt to reject all alternative figures who offer to do things

for him, though some children will cling desperately to a nurse ...

During the phase o f despair, which succeeds protest, the child’s

preoccupation with his missing mother is still evident, though his behaviour

suggests increasing hopelessness. The active physical movements diminish or

come to an end, and he may cry monotonously or intermittently. He is withdrawn

and inactive, makes no demands on people in the environment, and appears to be

in a state of deep mourning. This is a quiet stage, and sometimes, clearly

erroneously, is presumed to indicate a diminution of distress...

Because the child shows more interest in his surroundings, the phase of

detachment which sooner or later succeeds protest and despair is often welcomed

as a sign of recovery. The child no longer rejects the nurses; he accepts their care

and the food and toys they bring, and may even smile and be sociable. To some

this change seems satisfactory. When his mother visits, however, it can be seen

that all is not well, for there is a striking absence o f the behaviour characteristic of

the strong attachment normal at this age. So far from greeting his mother he may

seem hardly to know her; so far from clinging to her he may remain remote and

apathetic; instead o f tears there is a listless turning away. He seems to have lost allinterest in her. (p. 27-28)

Another key component o f Bowlby’s theory is the concept o f “internalized

working models” for self in relation to others, rooted in initial and continuing experiences

with attachment figures:

each individual builds working models o f the world and o f himself in it, with the

aid o f which he perceives events, forecasts the future, and constructs his plans. In

the working model of the world that anyone builds, a key feature is his notion o fwho his attachment figures are, where they may be found, and how they may be

expected to respond. Similarly, in the working model o f the self that anyone builds

a key feature is his notion o f how acceptable or unacceptable he himself is in the

eyes of his attachment figures. On the structure o f these complementary models

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are based that person’s forecasts o f how accessible and responsive his attachment

figures are likely to be should he turn to them for support. And.. .also, whether he

feels confident that his attachment figures are in general readily available or

whether he is more or less afraid that they will not be available—occasionally,

frequently, or most o f the time. (Bowlby, 1973, p. 203)

In his book Separation (1973), Bowlby focused attention on fear and anxiety

experienced by the young child upon separation from mother. Colleague Mary Ainsworth

utilized the concepts put for th in this work in developing her now famous “Strange-

Situation” studies which served as the basis for delineating patterns of secure vs. anxious

attachment (Ainsworth & Bowlby, 1991; Ainsworth, Blehar, Waters, & Wall, 1978). In

Loss, Bowlby described the grie f and mourning process of adults and children when

confronted with the loss of a close loved one. An extremely precise definition of

attachment is provided by Bowlby in his 1988 book, A Secure Base:

In re-examining the nature of the child’s tie to his mother, traditionally referred to

as dependency, it has been found useful to regard it as the resultant o f a distinctive

and in part pre-programmed set o f behaviour patterns which in the ordinary

expectable environment develop during the early months of life and have the effect

o f keeping the child in more or less close proximity to his mother-figure. By the

end o f the first year the behaviour is becoming organized cybemetically, which

means, among other things, that the behaviour becomes active whenever certain

conditions obtain and ceases when certain other conditions obtain. For example, achild’s attachment behaviour is activated especially by pain, fatigue, and anything

frightening, and also by the mother being or appearing to be inaccessible. The

conditions that terminate the behaviour vary according to the intensity o f its

arousal. At low intensity they may be simply sight or sound of the mother,

especially effective being a signal from her acknowledging his presence. At higher

intensity termination may require his touching or clinging to her. At highest

intensity, when he is distressed and anxious, nothing but a prolonged cuddle will

do. The biological function o f this behaviour is postulated to be protection,

especially protection from predators, (p. 3)

Mary D. Salter Ainsworth’s work would come to provide much o f the evidence

that supported Bowlby’s theory. She entered a course of study in psychology as an

undergraduate at the University of Toronto in Canada “hoping to understand how she had

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come to be the person she was, and what her parents had to d o with it.” (Ainsworth &

Bowlby, 1991, p. 334). During this time she was drawn to thie work o f one of her

professors, William E. Blatz, who had recently “formulated thieory o f security as an

approach to understanding personality development” (Ainsworth & Bowlby, 1991, p.

334). Among the various types o f security he described was *he “immature dependent

security” o f young children tha t accounted for their need o f a secure base of parental

availability from which to explore and leam and to which they could retreat when that

exploration and learning became too frightening. He had alscn acknowledged that agents

akin to defense mechanisms could provide a temporary kind o f security, although they did

not deal with the source o f insecurity—“like treating a tooth a^che with an analgesic” (p.

334). For her 1940 dissertation, Ainsworth “constructed two» self-report paper-pencil

scales intended to assess the degree to which a person was secure rather than insecure” in

order to obtain additional data for this theory, (p. 334).

In 1950, Ainsworth left the University o f Toronto w h« n her husband Leonard

pursued his Ph.D. at the University of London. Jobless, she an sw ered an advertisement in

the Times Educational Supplement for a position as a developmental researcher at the

Tavistock Clinic “investigating the effect on personality development o f separation from

the mother in early childhood.” (p. 335). Needless to say she: got the job, beginning a life

long collaboration with John Bowlby. She was particularly intr igued by his hypotheses for

separation anxiety and provides this account o f his theory (Ainsw orth Sc Bowlby, 1991):

Separation anxiety occurs when attachment behavior 5s activated by the absence of

the attachment figure, but cannot be terminated. It di ffe rs from fright, which is

aroused by some alarming or noxious feature of the environment and activates

escape responses. However, fright also activates attachment behavior, so that the

baby not only tries to escape from the frightening stimulus but also tries to reach a

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haven o f safety—the attachment figure. Later in infancy the baby is capable of

expectant anxiety in situations that seem likely to be noxious or in which the

attachment figure is likely to become unavailable...only a specific figure, usually

the mother figure, could terminate attachment behavior completely once it had

been intensely activated...hostility toward the mother is likely to occur when

attachment behavior is frustrated, as it is when the child is separated from her,

rejected by her, or when she gives major attention to someone else. When suchcircumstances are frequent or prolonged, primitive defensive processes may be

activated, with the result that the child may appear to be indifferent to its mother

.. .o r may be erroneously viewed as healthily independent, (p. 336)

Ainsworth and followers amassed a body o f research that included field studies

(i.e. her description o f mothers and infants in Uganda in the early 1950’s), data from a

1963-1964 longitudinal study in Baltimore described in Patterns o f Attachment

(Ainsworth, Blehar, Waters, & Wall, 1978), and countless replications by other

investigators using her Strange-Situation technique to assess secure vs. anxiously attached

infants all over the world.

Ainsworth’s Strange Situation experiments, detailed in Patterns o f Attachm ent

(Ainsworth, Blehar, Waters, & Wall, 1978), involved observing infants in each of the

following 8 sequential conditions o r “episodes”:

1. Mother, baby, & observer. (30 sec.) Observer introduces mother and baby to

experimental (playroom), then leaves

2. Mother & baby. (3 min.) Mother is nonparticipant while baby explores; if

necessary, play is stimulated after 2 minutes

3. Stranger, mother, & baby. (3 min.) Stranger enters. First minute: Stranger

silent. Second minute: Stranger converses with mother. Third minute:

Stranger approaches baby. After 3 minutes mother leaves unobtrusively.

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4. Stranger & baby. (3 min.) First separation episode. Stranger’s behavior is

geared to that o f baby.

5. Mother & baby. (3 min.) First reunion episode. Mother greets and/or

comforts baby, then tries to settle him again in play. Mother then leaves,

saying “bye-bye”.

6. Baby alone. (3 min.) Second separation episode.

7. Stranger & baby. (3 min.) Continuation o f second separation. Stranger enters

and gears her behavior to that of baby

8. Mother & baby. (3 min.) Second reunion episode. Mother enters, greets

baby, then picks him up. Meanwhile stranger leaves unobtrusively, (p. 37)

Pre-separation interactions o f infants and their mothers were noted. Infants were

then observed in the separation and reunion conditions at which time they were sorted into

one o f three groupings based on anxiety level and relationship style. Whenever possible,

infants and mothers were observed before and after the test in the natural setting of their

homes. Ainsworth and colleagues thus identified three patterns of attachment. Ainsworth

(1979) summarizes the three patterns:

Group B (Secure) babies use their mothers as a secure base from which to explore

in the preseparation episodes; their attachment behavior is greatly intensified by the

separation episodes so that exploration diminishes and distress is likely; and in the

reunion episodes they seek contact with, proximity to , or at least interaction with

their m others ... .Group B babies were more cooperative and less angry than either

A or C Babies.Group C (Insecure-Ambivalent-Resistant) babies tend to show some signs

of anxiety even in the preseparation episodes; they are intensely distressed by

separation; and in the reunion episodes they are ambivalent with the mother,seeking close contact with her and yet resisting contact or interaction.

Group A (Insecure-Avoidant) babies, in sharp contrast, rarely cry in the

separation episodes and, in the reunion episodes, avoid the mother, either mingling

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proximity-seeking and avoidant behaviors or ignoring her altogether...Group A

babies were even more angry than those in Group C. (p. 932)

Ainsworth also observed patterns o f behavior in mothers that corresponded to

each o f the three styles of attachment seen in their infants. Mothers of Secure infants were

responsive and sensitive to their infants’ signals across all contexts. This was not the case

for mothers of insecure infants, whose responsiveness to infant signals was inconsistent at

best, ill-timed, inappropriate, or even nonexistent (Ainsworth, 1979). The most troubling

findings were for mothers o f Avoidant infants:

In regard to interaction in close bodily contact, the most striking finding is that the

mothers of avoidant (Group A) babies all evinced a deep-seated aversion to it,

whereas none of the other mothers did. In addition they were more rejecting,more often angry, and yet more restricted in the expression o f affect than were

Group B or C mothers. (Ainsworth, 1979, p. 933)

That similar patterns of infant attachment have been found in Strange-Situation

studies conducted in diverse cultures throughout the world (Grossman & Grossman, 1990;

Main, 1990; Sagi, 1990) lends support to the biological aspect o f Bowlby’s theory. And,

reliable findings that these attachment patterns persist over time (Cassidy & Main, 1984;

Cicchetti, Toth, & Lynch, 1995; Matas, Arend, & Sroufe, 1978) are consistent with

Bowlby’s notion o f an internalized working model. There is even some evidence to

suggest that an individual’s attachment pattern extends into adulthood. A body of work

on adult patterns of relating has emerged from Phillip Shaver’s findings that adult love

relationships can be characterized as Secure, Avoidant, or Anxious/Ambivalent (Hazan

and Shaver, 1987). One particularly fascinating finding in his studies is that the three

patterns of attachment exist in adulthood in roughly the same percentages as in early

infancy (Secure: 56% in adulthood vs. 60% in infancy; Avoidant: 23-25% in adulthood vs.

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20% in infancy; and Anxious/Ambivalent: 19-20% in adulthood vs. 20% in infancy).

Shaver suggests that the same internalized working model o f self in relation to others that

first emerges within the context o f that all-important initial experience with the parent

continues to organize on e’s social beliefs and behaviors throughout the lifespan.

An individual who was instrumental to Ainsworth in conducting, interpreting,

compiling, and expanding her work was colleague Mary Main. Main and others

(Crittenden, 1985a, 1985b; Egeland and Sroufe, 1981a, 1981b; Spieker and Booth, 1985)

who conducted Strange Situation studies had observed that there were a group of infants

in middle class samples—and especially in high-risk samples from abusive and/or neglecting

families—whose unclassifiable behaviors showed marked departures from Secure,

Ambivalent, or Avoidant criteria. In 1986, Main and Solomon introduced a fourth

“Insecure-Disorganized/Disoriented Attachment Pattern” (Pattern D) (p. 95). Unlike the

overly independent Avoidant and highly dependent Ambivalent patterns, this pattern was

remarkable for its lack o f organized behavior when the infant was confronted with a

difficult, stressful situation. Main was astonished to discover that all previously

unclassifiable infants fit one or more criteria of this 4th pattern, rendering it unnecessary to

elucidate additional patterns as had been expected. Parents o f these infants are

characterized as abusing, neglecting, and/or having mental illness (i.e. Bipolar Disorder,

Major Depression), thereby creating the “most extreme o f family conditions” (p. 107). The

Disorganized/Disoriented pattern o f attachment has also been found to persist over time

(Cassidy & Main, 1984; Lyons-Ruth, 1996; Lyons-Ruth & Easterbrooks, 1997).

Mary Main’s work was also instrumental in demonstrating that patterns of

attachment extend across generations. In her 1984 landmark study, she and Goldwyn

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utilized the Berkeley Adult Attachment Interview (AAI) to determine the quality of

children’s attachments with their mothers based on the mothers’ verbal recollections of

childhood interactions with their own mothers. Subjects were 30 mothers (largely white,

middle class) whose infants had been tested six years prio r to determine their pattern of

attachment (Secure, Ambivalent, or Avoidant). Mothers’ interviews were rated by

investigators who had no knowledge o f children’s pre-determined attachment patterns.

Mother interview results were then compared to the predetermined child attachment

patterns. Findings showed

a significant positive relationship between apparent rejection by mother in

childhood and inability to recall childhood, and there was a strong relationship

between rejection by m other in childhood and idealization o f mother now. Finally,the more rejected the mother was by her own mother in childhood , the less

coherent she appeared to be in discussing attachment relationships and experience

now. All three findings were significantly predictive of a woman’s rejection of her

own infant, (p. 213)

However, those parents w ho’d had a negative experience growing up—but were able to

give a cohesive, detailed recollection (indicating they had been able to work through and

integrate their experience)—had developed healthy, secure attachments with their own

infants.

Based on his interpretation o f Ainsworth’s research, Daniel Stem (1983; 1985)

honed in on “affect attunement” of the mother with her infant as the critical process

involved in the initial regulation o f the child’s emotional states. In his book, The

Interpersonal World o f the Infant (1985), he defines affect attunement as “the

performance of behaviors that express the quality o f feeling o f a shared affect state

without (simply) imitating the exact behavioral expression o f the inner state” (p. 142).

Similar to the concept o f sensitivity to infant signals, this process involves parental

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resonance with the child’s feeling state conveyed by some type o f matching o f the child’s

expressive behavior. The channel of modality o f expression used by the mother to match

the infant’s behavior is frequently, i f not mostly, different from the channel or modality

used by the child; and what is being matched is not so much the child’s behavior, but some

aspect o f the behavior that reflects the child’s feeling state.

His cross-modal emphasis is consistent with initial organization of the central

nervous system in the newborn, involving brain-stem mechanisms that coordinate multi

modal sensory-motor processing systems. The infant’s orienting response, turning to

locate mother’s voice in space and linking it to her face, is an example. Stem, (1985)

believes that infant biological mechanisms and abilities for engaging the environment are

far more sophisticated a t a very early age than previously thought. Although Bowlby

would certainly agree with this observation, he and Ainsworth focussed their attention on

older infants who had already formed a selective attachment with their mothers, an event

that begins about six months o f age. Stem stresses that the socialization afforded by

mother-child interaction is critical to healthy emotional development from the beginning of

an infant’s life.

Attachment theorists Edward Tronick and Tiffany Field demonstrated that a

mother’s emotional unavailability (i.e. from depression) can be as devastating to her infant

as physical unavailability (Field 1985, 1998; Tronick, 1986; Tronick et al., 1978). A

powerful illustration o f what happens to infants when emotional feedback is not

forthcoming from their mothers emerged in Tronick’s famous “still face” experiments

(Tronick, 1986; Tronick et al, 1978). In these studies mothers were asked to engage in

normal interaction with their infants. In the middle o f the interaction, the parent was

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instructed to go “still-faced” (remain impassive and emotionafly expressionless). Typically

these healthy infants, looking puzzled, would initially make several attempts to engage

their mothers; but~after repeated failures to engage her~woulld eventually look down and

withdraw. This sequence of events happened within a matter o f minutes.

Like Daniel Stem, Edward Tronick (1986) believes th a t the mother’s response to

her child is a key factor in helping the infant establish regulation o f emotional states from

the beginning o f life. Tronick links relationship to biological functioning as he describes a

dyadic process whereby the primary care-giver assists her infa_nt to achieve homeostasis by

regulating arousal in her infant. The infant can utilize self-d irected regulatory behaviors to

obtain self-comfort (i.e. sucking, rocking) or to decrease sensory stimulation (i.e. turning

head away). However, due to the infant’s immature neurological organization and lack of

coordination, these behaviors—which serve to decrease con tact with the external

environment~are not sufficient. Another way the child seeks to regulate emotions is

through other directed behavior which serves to engage the emvironment (mother) for

assistance. Tronick, like Stem, notes that:

When the mother responds appropriately to her infantas other-directed regulatory

displays, the infant is able to maintain both self-regulaltion and regulation o f the

interaction, and positive emotions are generated. W hen the mother fails to

respond, the infant’s regulatory efforts are unsuccessful, and negative emotions are

generated, (p.7)

Jaak Panksepp was the first to explore and identify neairobiological substrates for

mother-infant attachment phenomena. Spurred by the discovery in 1972 of the

endogenous opioids, Panksepp was able to demonstrate that a form o f endogenous opioid

analgesia, or pain relief, appears to obtain in baby chicks, puprpies, and other animals upon

acquiring contact comfort and reassurance from the mother. IPanksepp suggests that

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attachment behavior and opiate addiction are very closely related in that they appear to be

mediated by the same systems in the central nervous system. He notes that separation

from the object of attachment and opiate withdrawal produce similar painful symptoms

(Panksepp, 1986, 1998; Panksepp et al., 1978; Panksepp, Siviy, & Normansell, 1985).

Most recently, Allan Schore has proposed that the “visuoaffective” component of

mother-infant attachment facilitates infant frontal lobe development. In his book, A ffect

Regulation and the Origin o f the S e lf (1994), he theorizes that a primary function of

mother-infant attachment is to stimulate development of the frontal lobes, particularly the

right orbitofrontal lobe—key to healthy social-emotional functioning. He pinpoints age

11-18 months (corresponding to Margaret Mahler’s Practicing Stage) as an important

time frame for this dopamine-driven developmental process that occurs when mother

connects with her baby through the eyes. Eye contact, during a time the child is also

becoming upright and mobile, enables the youngster to obtain some distance (and

eventually separation) from mom—permitting the freedom to explore that spurs further

development o f the cortex.

The attachment milestones thus selected and described are essential to the

biopsychosocial premise o f the model proposed in this dissertation. Because attachment

theory—from its inception—has linked social-emotional development to its biological and

ethological roots, its percepts remain fresh and relevant, even against the litmus test of

burgeoning findings from state-of-the-art neurobiological research. Because attachment

theory is aligned with the principles of Systems Theory, attachment phenomena (i.e.

homeostatic processes) identified at the molecular, neurobiological, individual, dyadic, and

social system levels will probably retain a consistency that would not be true for other

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theories which depart from these standards. Attachment provides a classic example of

how biology and environment-infant and mother—become engaged in the dance of

reciprocity.

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CHAPTER m

METHODOLOGY

A Biopsychosocial Model for Projecting Psychopathology Resulting from

Attachment Deficits and Distortions

This section will propose a biopsychosocial model fo r elucidating development

dependent patterns of psychopathology—with focus on emotion dysregulation—resulting

from attachment deficits and distortions. Using the model, predictions for typical

symptomatic presentations that would emerge during six incremental age periods from

age 0 to 36 months o f age will be formulated, based on the developmental status of brain

structures, psychopharmacology, and emotion circuits available to the infant at those

points in time. Key to this model is that proposed descriptions of attachment related

psychopathology for children and adults will be constructed by working forward—

sequentially and additively (consistent with brain structures and circuitry coming on

line)—from the emergent end of the developmental trajectory toward adulthood vs.

extrapolating backward from adulthood.

Adherence to General Systems Theory Principles

Key to this biopsychosocial model is its adherence to the guiding principles of

General Systems Theory that apply to all systems in nature (James, 1999). Meeting these

standards provides an initial litmus test for any such model or theory that attempts to

elucidate the nature of phenomena that exist in nature. Therefore, incorporating general

systems principles from this model’s inception increases the likelihood that its

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components have internal consistency and that predictive descriptions deriving from the

model are consistent with findings from an array o f disciplines attempting to study the

same phenomena from differing vantage points or system levels (i.e. neurobiological,

individual, social). Becau se higher order systems cannot violate systemic principles o f

the subsystems tha t comprise them, another litmus test for a model’s viability is that

biological substrates can accoun t for the individual and social psychological phenomena

it addresses. Therefore, although this model is focused on individual psychopathology

and addresses the attachm ent o r social-related context from which it derives, it is

biologically based. Systems principles that represent recurring themes emerging in the

phenomena addressed by th is model will now be discussed.

(1) Systems Evolve from Simple to Complex

Systems change in two possible directions: toward decreased organization

(entropy) or toward increased organization (evolution). Systems evolve (develop) from

simple to complex. The biological, individual, and social phenom ena addressed by this

model will be presented in a m anner that reflects their increasing complexity through the

sequential, additive, organizational, and reorganizational processes involved in human

development. The simple-to-complex theme emerges time and again at each system

level.

Examples include:

• neuron, migration o f neurons to target sites, grouping of neurons with harmonious

firing patterns into components o f brain structures, organization o f brain

structures and neurotransmitters into emotion circuits

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• infant’s ability to tolerate arousal o f increasing duration, intensity over time as the

autonomic nervous system matures in interaction with the modulating effects of

increasingly sophisticated emotion systems (emerging sequentially) and

experience

• the development of motoric abilities from sitting up by self, to crawling, walking,

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