by June Manala
Founding father of psychoanalysis Sigmund Freud (1856-1939) was a medical doctor and a neurologist before he became a psychiatrist and psychoanalyst. John Bowlby (1907-1990), who founded attachment theory, was a medical doctor, child psychiatrist and psychoanalyst, but worked as an ethnologist with animals in nature before pursuing his other professional interests. He drew on all of these areas of expertise to formulate his ideas on attachment. His follower, developmental psychologist Mary Ainsworth (1913-1999), researched attachment with mothers and infants in Uganda and developed the Maternal Behaviour Sensitivity Rating Scales from identified attachment patterns. These patterns measure maternal responsiveness and sensitivity, as well as feeding and other patterns.
The attachment theory of human infants which developed from this work is based on the knowledge that humans are born ready to share a relationship in which they have very strong emotions towards their mothers. An early loss or separation from their mother or primary caregiver can have a lifelong impact and strongly influence child development. All human infants turn instinctively to their primary figures when they need comfort or soothing in distress.
Human infants are born with the capacity to participate proactively in the caregiving relationship. They communicate their physical and emotional needs through a range of behavioural cues such as eye contact, crying or smiling. Adult responses to their communications shape their patterns of expressing or suppressing cues. The relationship between a child and primary caregiver forms the basic, internal model for relationships in a child and has long term consequences for personality, emotional development and how a child will parent one day. The child’s earliest relationship can assist him/her in learning how to manage strong emotions and boost brain development. When the earliest relationship fails, the child’s brain development can be adversely affected.
Experts in the neurosciences have identified the last trimester in utero together with the first three years of life as the period during which the brain is most receptive and sensitive to certain emotional and social experiences, such as loving and soothing, which help to grow the brain. Violence and emotional neglect, on the other hand, affect the growth of the brain and lead to hormonal high stress and even toxic stress.
A caregiver’s ability to receive primitive, non-verbal, strong emotions, cues and signals from an infant is a crucially-needed quality in making babies feel safe and comforted. Three quarters of the infant brain is formed during the first year and this growth happens according to how the infant’s earliest relationship flourishes or falters.
Ainsworth found that differences in caregiving or parenting result in different attachment patterns and that these patterns occur in all people and cultures, regardless of class, education, race, income level and intelligence. Infants attach securely or insecurely to a caregiver and these ways of attaching that develop in infancy are unconsciously passed on from one generation to the next. All living children attach to a primary caregiver and all children can attach to more than one caregiver. With increased awareness, insecure attachment patterns – and Ainsworth identified three – can be prevented or corrected.
In secure attachment, according to Ainsworth’s Maternal Behaviour Sensitivity Rating Scales, a baby protests while with mother and a stranger and the mother leaves, showing she is not feeling safe. She may also cry and protest her mother’s absence while she is away. She will allow her mother to comfort her on her return and soon resume play. A securely attached infant explores freely while the primary caregiver is present, engages with strangers, is visibly upset when the mother leaves the room and happy when she returns. So, secure children are curious and can explore in the safety and proximity of the primary caregiver. This kind of curiosity and exploration forms the basis for learning.
Once an adult, a securely attached person will soothe himself when distressed or turn to a trusted person for comfort and become soothed within an appropriate period of time, able to continue with what needs to be done. For this adult the world is predictable. He can develop mature hope and have internal relations (an internal model for relationships).
Secure attachment is most important because this kind of relationship allows the infant to use the caregiver as a secure and comforting base to which he can turn when he is in distress and from which he can be loved and learn loving. In the mother or caregiver’s presence the child uses his senses – smell, sight, hearing and touch – to explore the environment, beginning with the mother’s face and breast. Exploration is essential for social, cognitive, language and motor development and starts off with face-to-face contact with the mother. Secure attachment can be seen as prophylaxis for later mental health, physical health and resilience because it regulates strong affect.
Ainsworth identifies three forms of insecure attachment: insecure anxious attachment, insecure avoidant attachment and insecure disorganised attachment.
In insecure anxious attachment the child is anxious or worried about exploration and about strangers even in the presence of her primary caregiver. Such a child becomes distressed when her mother leaves the room and will be difficult to soothe when the mother returns, pulling away from the mother while being clingy at the same time. A primary caregiver who was herself insecurely attached might experience the infant as rejecting and might retaliate. A child who is insecure and anxiously attached will calm down over a long period of time before engaging in play once again and will form anxious, insecure and ambivalent attachments with others. In adulthood they cannot be soothed easily, even when they turn to others, as they find it hard to recover fully from upsets. Such adults are fearful that others may leave them. Their world is unpredictable and unsafe and this limits exploration. When young, they find it difficult to connect socially.
In insecure avoidant attachment a child explores the room independently and does not protest when the mother leaves the room, but continues to play, which is a way in which he protects himself – he has learnt to be independent much earlier. When the mother returns to the room, the child either ignores her or moves away and it is up to the mother to make contact with the child. When mothers feel rejected in these circumstances they may become distant themselves. Interestingly, it used to be thought that these children are securely attached, but research shows they are the ones we should watch out for since they have elevated heart and cortisol rates – their bodies register their distress at how they experience their primary caregivers. They are deeply stressed and distressed, but hide their anxiety much too successfully.
Avoidant adults do not own up to their distress. They often deny the impact of distress on themselves. They may say, “It is nothing”. Avoidant adults use activities such as work, physical exertion, substance abuse, aggression, sex addiction, gambling and television to deal with their hidden stress. The film The Wolf of Wall Street, which stars Leonardo di Caprio, portrays such a kind of person well.
The most worrisome insecure attachment pattern is that of the insecure disorganised whose mothers tend to have experienced domestic violence, abuse and substance abuse in their childhood and may neglect their infants as they are out of tune with their needs and communications. Such mothers may also be intrusive. As a result infants disregulate. Their brains are in defensive mode, also called fight and flight, as if they are always in danger, as if there is no adult-assisted soothing available for them. They are reactive rather than self-soothing.
How to Foster Secure Attachment?
The following is important in fostering secure attachment:
- Being good enough, not perfect, parents trying their best;
- Building early relationships built on love, empathy and support;
- Watching and listening to an infant’s communication, thinking about what it could mean and responding appropriately since infants often let us know whether we heard them or not;
- Reading and observing the cues and signals given by children especially also when they are in distress;
- Increased self-awareness so we can know ourselves better;
- Bearing the infant’s strong emotions which are often communicated non-verbally;
- Thinking for the baby and thinking about the infant;
- Placing ourselves in the infants proverbial shoes so we can respond empathically; and
- Naming and accepting strong feelings so children can learn to soothe themselves, instead of abandoning children to their strong feelings.
Children who can understand that their and others’ feelings differ begin the process of separation and individuation and understanding that, “I am not my feelings or behaviour, I am accepted as I am”. Such children can also link behaviour to meaning.
Attachment theory linked up to convergences in neuroscience, neurobiology, psychiatry, psychology and the medical sciences aim to have an integrated understanding of mind and body, nature and nurture. The validation of attachment theory that has come from these approaches spurred on further research and applications such as the kangaroo baby-mother care programme in in some hospitals and the home visits to mothers with young babies by Ububele in Gauteng and the Red Cross Children’s Hospital in the Western Cape. In addition, current policy initiatives hope to change the caregiving of infants on a broader scale.
* This edited text is by past-chairperson of the Gauteng Association for Infant Mental Health (GAIMH), June Manala. She is a psychodynamically-trained educational psychologist and psychotherapist who does parent-infant psychotherapy and gives talks to and trains parents in attachment patterns and the neurology of the brain to enhance the quality of parenting care.