Figure 2 - The first year of life cycle -
The cycle of bonding and attachment
There is an almost magical cycle that gives birth to our soul. (Zaslow, 1975) I use the word "soul" because it expresses those unique, special human qualities of thoughtful caring for others and the internal belief of something beyond us and far greater than we are. Many great thinkers have written of the results of this cycle in their own terms. Erikson wrote of the development of "basic trust." Martin Buber talked of the "I/Thou" relationship. Psychoanalysts have spoken about "the internalization of the good parent. " This special cycle rolls around every four hours, as the infant is fed. By the age of six months, the cycle has been completed hundreds of times. The cycle "locks in" our first associational patterns.
These patterns stick with us all of our lives. Although unconscious, these associations dictate many of our actions.
This cycle deserves step-by-step examination. At any step, if things go wrong, lasting and severe psychopathology may result. The importance of this cycle cannot be overemphasized.
Stage One: Need
Infants are basically a bundle of needs during their first year. During the second year of life, they become a bag of wants. If early needs aren't met, the infant will die.
Stage Two: Rage Reaction
Infants express their needs in a rage reaction. It might be hypothesized that their feelings build to a crescendo of rage as hunger pains grow intolerable. They may go through a series of feelings that range from helplessness, anger, and hopelessness, all of which together form rage. The rage is expressed by loud, agitated crying. Because their needs are survival issues, the rage is oceanic and total. So a young mother does not look at her raging infant and say, "My, you seem uncomfortable." She says, "Boy, are you mad!" She then lifts the baby out of its crib and tries to satisfy its needs.
Stage Three: Gratification or Satisfaction
Adequate satisfaction of needs happens best in a normally responsive environment and with a healthy organism. There, moving from Stage Two (rage) to Stage Three (gratification), is the time when things often go wrong. The cycle becomes broken and severe psychopathology may set in.
I'M HIGH ON MY SUGAR
Let us digress for a moment and see how childhood antecedents and associations that occur in the first year are unconsciously carried on in adult life. In infancy, satisfaction of needs generally involves food. As noted in the diagram, while infants are being satisfied with food, they are also given other sensory inputs which will be closely associated for a lifetime. These are:
1. Food (warm fluid)
2.Labyrinthine stimulation and touch (The labyrinth is that part of the inner ear associated with motion and position.)
3.Eye contact
4.The human face and a smile
These early associations are subtle, but powerful elements that shape our relationships and language for the remainder of our lives. When we want to become friends with someone it is not enough just to invite the new acquaintance over. We want to demonstrate our expression of friendship or love with food. Just as it was done in forgotten days of infancy, so it continues: "Jane, won't you come over for coffee?" "Joe, let's get together, I'll buy you a drink."
The infant is first nurtured with lactose milk sugar. That sweet, nutritious fluid is also associated with skin-to-skin touch, close eye contact, a soft, sweet voice, and all that good things we associate with love. Even as adults, we call our loved ones a names that are associated with food: "You're my cupcake," or "Hi ya, honey," or "You're so sweet, sugar." It's not just sweetness that we associate with love, it's a good, nutritious carbohydrate.
The importance of labyrinthine stimulation cannot be overemphasized. Labyrinthine stimulation occurs when the fluid in the inner ear flows against tiny hair cells, giving a sense of movement and direction change. Millions of dollars are spent in amusement parks simply to provide these minute hair cells with stimulation!
Although such stimulation is enjoyable for adults and children, it is essential for normal neurological development in infancy. We can now begin to appreciate the beauty of a young mother absent-mindedly bouncing her baby on her knee: she is doing what comes naturally, but also helping to assure normal development.
Stage Four: Trust
If the environment is normally giving, and if infants are able to assimilate the environmental satisfactions, then they move on to Stage Four in which a sense of trust develops. Sometimes the early environment does not meet children's needs and they cannot develop basic trust. At other times, the environment is normally giving, but unfortunately the children have a painful problem that the environment (a loving mother or a father) cannot relieve. Parents can relieve hunger pangs, and that relief leads to satisfaction and a sense of trust. But they cannot relieve the pain of chronically increased cerebral fluid pressure. They cannot relieve the pain of a chronic, unrecognized middle ear infection. They cannot take away the pain of many congenital problems.
There are many nonphysical reasons for a break in the cycle. Postpartum depression, parental break-ups, famines and natural catastrophes, if they occur during the early infancy, tend to prevent the mother from being normally responsive, spontaneous, receptive and gratifying to her helpless charge.
So, in view of all the things that can stop the Soul Cycle from spinning, it is not surprising that the people of the world can be divided into two large camps: those who lack and those who have a sense of basic trust. The difference between the two is clear. Distrustful people assume the other person will botch things and has to be stopped before they do it. Thus, those who distrust tend to lean toward heavy prophylactic regulation, and are very watchful. Trusting people show less concern and assume the other person is doing things right, unless the opposite proves to be true. The former assume the worst and are surprised when things work out well. The latter assume things will go well, and accept things going poorly. Generally, those with a sense of basic trust live their lives in a much more relaxed manner because they believe things usually work out. From this it is possible to see that basic trust has three distinct components:
1. Trust of self
2. Trust of others
3. Trust of humanity
All great teachers have emphasized the importance of a sense of basic trust.
Normal attachment, usually attachment between mother and child, fails to take lace when the cycle of the first year of life is severely broken. When there is a lack of trust, proper attachment is impossible. Both lack of attachment and lack of trust have far-reaching, destructive influences on personality development and interpersonal relationships. This will be closely examined in a later chapter.
Physical and psychological milestones in development happen at fairly predictable times provided that the organism is healthy and responsive to the environment. Retardation in milestones is often a very significant indicator of psychological or physical problems. Surprisingly, when certain milestones develop ahead of their predicted occurrence, this too may set the stage for escalating parent/child difficulties.
Knowledge of milestone development is imperative for diagnosis, and is usually relevant for prognosis.
Milestones help one to understand diagnosis (what's going on) and prognosis to understand (what will probably result).
Spitz (1971) notes that at about 5 days of-life, the nursing child's eyes are locked into the eyes of the mother. The mother looks down at her child and the child stares back. At 10-days-of-age the child is beginning to track its mother's eyes; that is, if she moves her head, the child follows that movement with its eyes. Some infants do this almost at the time of birth.
Throughout our culture, sayings in prose and poetry reflect the importance of eye contact: "He looks right through me!" "Tell me that and look me in the eye." "The eye is the window to the soul."
When people lose contact with outer reality, they withdraw into themselves, often back to the very beginnings of their contact with others. Such patients regress and often overemphasize eye contact in their art. They begin to make drawings of eyes. On the hospital ward, they draw large eyes, bleeding eyes, weird eyes. At the same time, the individuals may avoid eye contact when speaking. Anyone who has visited an occupational therapy room of a psychiatric ward has seen these portraits of faces with startling emphasis on eyes. Such eyes may also emphasize the nuclear basic trust issue: "Are those watchful eyes for me or against me?"
Children who have difficulties with attachment demonstrate obvious problems with eye contact. There can be different reasons for attachment problems, but almost all will always have problems with eye contact. They may be hyperactive and lose contact because they are too busy "climbing the walls." Other schizophrenic and autistic children stare at rotary machines and phonograph turntables, (they may be interested in elbows and navels) but they will certainly avoid eye contact.
Loss of eye contact, however, does not mean a child must have an attachment problem. There are other reasons for loss of eye contact. Eye contact is often momentarily lost when children are not telling the truth. Sometimes children will lose eye contact, as do adults, when they are telling the truth, but are ambivalent about what they are saying. Because of the natural tendency to look away when telling a lie, a good sociopath studiously develops the ability to maintain eye contact and give the appearance of utmost sincerity.
Good eye contact is generally directly proportional to:
High Self-Concept
Lack of ambivalence
Truthfulness
John enters the office and flops into the chair. He stares at the wall four inches off my right shoulder. I know he is going to answer most of my questions with an "I dunno." Perhaps he will give me vague and "unstraight" replies. All of this time he is staring just a little bit off my right shoulder or at the floor.
Figure 3 - The reciprocal smile - The foundation of positive relationships
When adolescents are resistant, some are basically floor-starers. Others prefer staring at the ceiling. Some children prefer twisting a piece of cloth or tearing at their tennis shoes.
It must be emphasized that when dealing with a child (or an adult) who is a professional liar( who lies without ambivalence(eye contact appears both genuine and intense.
Generally, our findings show that the more severe the child's lack of attachment, the more severe is the loss of eye contact - when the adult is initiating the relationship. (Almost any child has good eye contact when he or she wants a cookie!) Lack of eye contact in most children who have reactive attachment disorder problems is matched only by autistic children.
Lance was 6 weeks old when he was adopted by his parents, Chuck and Barbara. At 7 months he was hospitalized out of town for over a month. The parents were unable to visit him. His father talks about Lance's eye contact:
I call him "motor eyes" because his eyes dance all over the place when I'm asking him a question. Sometimes I've gotten angry and grabbed his chin and said, "Lance, look at me!" But even when I put my face right in front of his, his eyes are going bip, bip, bip. . . all over the place. They're scanning, like a radar or something. Just occasionally he'll stop for a moment on mine and then bip, bip, bip. . . they're off again! It's worse whenever I'm asking him a direct question or requesting him to do something. If he initiates the contact because he wants something, then his eye contact is better."
Normal infants and small children like to snuggle. In fact, skin contact is so important that Spitz (1971) hypothesized that lack of skin contact is one of the reasons for infantile eczema. Prior to birth, the child was surrounded by the warm, pliable softness of fluid and membranes. After birth, as best we can, we wrap the child in soft folds of cloth. When we first remove these layers the child is naked and is in the natural state, usually lying close to or against his mother's skin. Their bodies mold to each other.
Very early, some children do not cuddle. Parents will say, "Every time I tried to pick her up or hold her, she pushed away. Sometimes she pushed me away so hard I was afraid she would fall over backwards."
Another parent will say, "When I try to hold him, he is stiff as a board. I mean, he is absolutely rigid."
This is a common problem. It happens when the first-year-of-life cycle is broken. Like adults, toddlers hate being confined (held) by someone they don't trust. But not all children who do not like cuddling have trust problems. On the other hand, all children with trust and attachment problems hate being held. Often, parents feel embarrassed to mention this problem. One parent said, "Now, I know this is really going to sound weird, but I felt as if my love were a virus. Teresa avoided me as though I had some type of contagious illness. She just wouldn't accept my holding her. She was different from the very first."
In her anguish, this mother shows a common self-referencing of her child's problem. The mother felt as if she were contaminated. She felt as if something was wrong with her and not her child.
When a mother feels this way, she tries to examine herself and make herself more lovable. Thus, a common vicious circle is initiated. (See Figure 3)
The reciprocal smile is the bonding mechanism between human beings. It is the very essence of our humanness. The 3-month-old infant smiles reflexively. When we see him smile, we feel happy too. Throughout life a smile continues to evoke a smile. Maintaining a reciprocal smile is of primary importance in working with children successfully.
If a behavior modifier were to count one thing of real importance in the average classroom or home, it would be the reciprocal smile exchange between the educator and the students; between parent and child.
If all adult or childhood psychopathology could be characterized by only one major symptom, it would be lack of reciprocity.
At the age of six to eight months, infants begin to start crying when congenial strangers come up and tickle them under the chin. They are no longer happy with any old friendly face. The development of "stranger anxiety" is a healthy sign. It means the infant is attaching tightly to particular individuals. Perceptual equipment has developed to a point of establishing discrimination. A modification of what the mother's face is now seems to be grotesque. (In fact, a modification of what we expect in other situations appears grotesque to us. In 1956, the new Studebaker looked odd and therefore sold poorly. Now that we're used to it, that model is considered a classic.) Gargoyles, hunchbacks, and artificial limbs, when first seen by children, in their own words, "gross me out."
When normal children reach the age of three they no longer exhibit extreme infantile anxiety around strangers. Nevertheless, there is a "let-me-eyeball-you-first-and-then-we'll-be-friends" attitude. A normal child is somewhat reluctant to run up to a stranger, even when invited to do so. He's not going to be palsy-walsy immediately without knowing the person. This is not true of unattached children.
.
Tommy had been through four foster homes when he was adopted by Pat and Chuck. They were immediately struck by his charm and his friendliness. At their first meeting he crawled up in Chuck's lap, played with pens in his pocket and smiled his bright, intriguing smile. In the span of a weekend, he thoroughly won the hearts of his prospective parents. Pat talked of their ensuing experience with Tommy:
We were happy that Tommy was so friendly. Right after the adoption, when Tommy came to live with us, we found him friendly to everyone. But somehow we knew that this friendliness was really an "overfriendliness." We felt this would end when he came to love Chuck and me. But it never did end. Months after we adopted Tommy he would wander off with anyone. Once this man came up to the house with a rather embarrassed look, Tommy in tow, and said, "Is this yours?" Tommy had just grabbed his hand as he was walking past the house and started walking away with him.
Tommy had absolutely no fear (actually no discrimination) of others. Children with severe attachment problems do not cry when their mothers leave them. They have no deep attachment to family members. This lack of attachment to anyone leads to superficial attachments with everyone.
A child who attaches deeply to no one is superficially very friendly to anyone. This is extremely disconcerting to the parents:
I mean, I'd be really upset because we would have friends over to the house and they would say to Joe, "What a cute little boy. I'd like to take you home with me!" Then, of course, they'd leave. And there was Joe, crying. . . screaming, really. . .because they didn't take him home with them. He was the only kid I'd ever seen do this, and I wondered, "What in the world is wrong with my mothering that this kid would want to go home with almost anyone else?" It was such a helpless feeling.
This brief transcript gives an overview of how children with an attachment problem relate to strangers on a casual basis. It is important to note that these children also relate to their family in a similar, but escalated manner. In this instance, a mother, Jeanette, and her two children, 9-year-old Lisa and Connie, 13, were waiting in our office for about 10 minutes while Pamela (an attachment-disordered patient) was there playing with toys. For the first time in their lives, they were exposed briefly to a child with this diagnosis. Because they had never seen Pamela before, and because their reactions would be spontaneous and without clinical interpretation, we asked them to give their first impressions of Pamela. They consented, and the following transcript was taped.
The problem that the adult, Jeanette, has a "hard time putting my finger on" is a lack of reciprocity! Watch for it:
I: Interviewer
L: Lisa
J: Jeanette
C: Connie
I:I'm talking with you now on this tape about the little girl who was in the waiting room with you. I thought this interview might be helpful because I'm doing some writing on little girls like the one you were just with. Now, what are your names?
J:Well, I'm Jeanette, and this is Lisa. She's 9.
C:My name is Connie, and I'm 13.
I:Well, what did you think of the little girl you were just with in the waiting room? Did you like her? What did you think about the way she talked and reacted to you all?
C:Well, whenever we would say something, she 'd walk over and say, "What, what, what!" She didn't play with any particular toys, but right when someone else started to play with something, then she'd run over and say, "That's mine." She asked what our names were and wanted to see all of the stuff that was around.
I:Was she fun?
C:Well, she'd always do, "That's mine," or when someone said something, she'd say, "No sir, it's supposed to be like this," or something like that.
I:Well, was she fun? How did she make you feel?
L:Well, I thought she was nice. I thought she was fun -- but sometimes she was -- what do you say, obnoxious.
I:(to the mother) Did you have any thoughts on this little girl?
J:Well, my first thought was, "What's wrong with this child?" At first, I thought she might be a little retarded because of her speech. That was kind of funny. But then she seemed very bright and very attractive.
I:So, you didn't think she was retarded?
J:No, I didn't think she was retarded at all. She seemed very friendly. She asked everybody's name. It seemed very important for her to know whose name was whose. She asked about some characters in a magazine she was reading and she asked my name and the names of the children. But then when I asked her what her name was, she didn't answer.
I:What do you mean, she wouldn't answer?
J:Well, she just ignored me when I asked her name. She was too busy to answer.
I:Anything else?
J:Well, she acted like she had known us for years and, as I said, she was very friendly. She asked me to tie a bow in her hair with a ribbon. I tied it, but it was short and so I just tied it in a little knot. Then she asked me if I had tied it into a bow.
I:What did you say?
J:Well, I said, "No it wasn't long enough." Then she said that the bow didn't match her socks and didn't match her shoes but went with her "pink."
I:Her pink?
J:Well, she was wearing a pink dress. I simply thought this was a very bright and friendly, but somewhat demanding, child. There was something wrong with the way she interacted with us. It's hard to put my finger on it. She seemed to want to know all about us, but she seemed somewhat detached on her own part.
L:She bugged Mother a lot saying, "What, what, what," questioning all the time.
I:Well, thank you all very much.
In the first-year-of-life cycle, during Stage Three in which satisfaction normally takes place, we notice the association of warm fluid; labyrinthine stimulation and touch; eye contact, and the smile and human face. As time passes, these individual components generalize and become much wider in scope:
1. Warm fluid generalizes to food, which generalizes to all things put in the mouth.
2. Labyrinthine stimulation generalizes to the enjoyment of being bounced and cuddled, which generalizes to excitement about all labyrinthine stimulation (roller coaster, boat ride, etc.).
3. Feelings generated by a mother's touch become generalized to good feelings about skin contact, which finally generalize to all feelings about touch by clothing and others.
4. The smile that first comes from the mother, and is reflexively returned to her, generalizes toward the human race.
These four components together come to mean acceptance and love. The normally receptive child receives from the normally giving environment 25 fictitious points of each of the four components.
Hypothetically, most children grow up expecting 100 points from the world in general. They expect the 100 points to be broken down into 25 points in each of the categories:
Eye contact 25 points
Touch and labyrinthine stimulation 25 points
Food 25 points
Smile 25 points
100 points
Fewer than 100 points would constitute deprivation, and more than 100 would indicate overgratification. Although this is only a hypothetical point system, the concept itself is very real and valid. The average effective mother provides optimal gratification and optimal frustration for her infant. (She cannot do either without doing both.)
Although this is a work that focuses on reactive attachment disorder and intrusive techniques of therapy, overgratification of infants as the symptoms arising from overgratification may be confused with reactive attachment disorder. Overgratification does cause a disordered bonding and attachment but it is qualitatively different from reactive attachment disorder. A therapist summed up both the propensity for confusion, and the qualitative differences:
I remember the mother who administrated a large New England department of social services. She brought her son to Evergreen because he was suffering from reactive attachment disorder. It was true that the child was a severe control problem, and had difficulties at home and school. He didn't have a lot of friends, and was often nasty. But he loved her. And he had an honest-to-God poor self image. The kid really hated himself, and was basically a spoiled brat. He needed firm limits, that's all. Clarifying the diagnosis made the mother angry. I think she would rather have had a kid with an attachment disorder than a simple spoiled brat!
The mother who overgratifies is unknowingly raising a child who will develop an oral personality. The overgratified child ends up expecting 150 points from the world, when the world only gives 100 points! Thus, an oral personality looks around and sees the world as a constantly depriving one. Compared with all the goodies his mother gave him during the first years of life, it is! He is always 50 points in the hole, because when he was small, this is what his mother gave him:
Eye contact 35 points
Touch and labyrinthine stimulation 35 points
Food 45 points
Smiles 35 points
150 points
Figure 4 - The Oral Personality
An oral person typically feels this way about the world: "I work my fingers to the bone but I never get back what I really deserve." "I never really get all the love I need." "I go around with an empty feeling in my gut." Of course, the world really does deprive the oral person more than it deprives most people.
This problem perpetuates itself, since the individual with an oral personality perceives a deficit and, as a result, goes through life being demanding and bossy. So others take their affections elsewhere. As an adult, the oral personality whines or demands, "Damn it, please come here and give me a kiss!" Of course, oral people get far fewer kisses than the average person! Yet, this is a way of trying to suck in what is most lacking! Because these dynamics are largely unconscious, the person goes through the world without understanding the effects of his behavior and how it increases the perception of deprivation.
In an effort to get enough points, the oral person usually goes on binges. Usually these can be food binges, but they also can be sex, cuddling, or money-spending binges: "I bought myself a new outfit. I deserve it!" Many adolescents go on a binge to obtain more affection from another adolescent.
Because of their age, many unhappy girls who simply wanted "touch" get "pregnant."
This sets into motion a generational vicious circle, which undoubtedly will be repeated by their own touch-deprived infant. Oral adolescents are so needy themselves that they have little left over to give their infants.
Problems with overeating, or gorging and then vomiting, often extend into adulthood, as oral people futilely try to self-gratify and fill their empty feelings. This occurs frequently and is often unrecognized by the therapist. Because this gorging-on-food symptom has archaic, primordial underpinnings, the reasons for it are a complete mystery to those who suffer from it and to parents who witness it in their children:
All kids like food, but Barbara is really something special. She's the only kid I know who can easily eat two boxes of dry Jello. I just can't imagine what that does to her stomach! Frankly, the first time she did it, I was hoping she would get sick, short of death, from it.
The overgratified child sees the world as undernourishing, because early in life he was used to so much. On the other hand, the deprived child sees the world as malnourishing because of a chronic, unfulfilled emptiness.
The overgratified child has too much given to him during the first two years, as parents interpret wants as needs. This continues the first-year-of-life cycle into the second year, when the usual 1-year-old rage reaction simply becomes a prolonged 2-, 3- and 4-year-old temper tantrum.
The overgratified child and the child lacking attachment have superficial similarities:
However, because the overgratified child had all his needs met during the first two years, there is generally no thought disorder and no speech pathology. Therapeutically, the overgratified child needs limits and psychological weaning.
In contrast, the deprived child exhibits thought disorders, speech pathology, and other signs that will be discussed at length in the chapter concerning lack of attachment.
OVERGRATIFIED, DEMANDING AND DRAINING: SIMILARITIES AND DIFFERENCES
Both overgratified (spoiled) children and children with reactive attachment disorder may appear demanding and draining.
5
The overgratified child and the deprived child are different but have similarities, too. The overgratified child latches onto a person and becomes both demanding and angry if needs (usually really only wants) are not met. Overgratified children form lasting, tight, draining relationship to any giving adult. Usually the "enabling person" is a parent, and later a spouse, but the person may drain anyone who is constantly in the environment; schoolteachers and therapists, for example. Once the others realize that regardless of the amount given, overgratified people continue to drain, others often become more withholding, and even angry themselves. A good therapist, however, will at first give an abundance of attention and warm milk. Then this is given in decreasing amounts so that the child will respond by, hopefully, being weaned and becoming less draining in all future intimate relationships.
Children who are not "weaned" before age 11, grow into draining adults who have difficulty achieving autonomy and developing healthy, interdependent relationships. By the time adulthood is reached, effective treatment is difficult for a first spouse (assuming more than one partner follows the first marriage). Things improve with the third and fourth spouse.
The deprived child may also be seen as draining and demanding. But when not allowed to have his or her way in relationships, a fragmentation and perhaps life-threatening rage is the result.
These children form no tight primary relationship. Instead, they try to drain from any source in the environment. Such children cannot relate tightly to parents. In adulthood, these same individuals will engage in numerous short-lived draining affairs that are at best, emotionally destructive to others. At worst, serial homicidal situations could be the result. Others in the environment feel rageful and frightened themselves. Relationships are shallow, and as children, they easily drop one set of parenting figures and work on draining another set. (Often, the adults, who do not understand the situation at all, agonize about "What one more loss will do to this child!?" The answer is simple, nothing!) Borderline and psychopath are among the many terms that can be used to describe these individuals, both as children and as adults.
The diagram that follows shows major differences in the oral or narcissistic personality types. Certainly it is not an either/or situation in every instance and there may be some overlap. Freud talked about individuals who had a "swiss cheese" superego, or holes in their conscience. Likewise, oral personalities can be classified by the amount of cheese (conscience) that is present.
SPOILED EARLY ABUSE / NEGLECT
Personality: Narcissistic Narcissistic
demanding demanding
clinging threatening
Relationships: With depth Shallow relationships
(may be love/hate)
Emotion Anger and focused Rage, often with fragmentation
when crossed:
Others feel: Drained, suffocated, Drained, suffocated, frightened
put out
Thought disorder: Generally none present May be present and subtle
Character traits: Usual Extremely manipulative,
convincing, lying