Attachment Disability, Volume 1

The Hidden Cause of Adolescent Dysfunction and Lifelong Underperformance

John Curran

• Publisher: Bidwell Learning Center
• Year: 2018
• ISBN:
  9780999602836
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

Trauma’s lasting aftershock: misunderstood emotional disability

No one is immune from the pain of loss and abandonment. A beloved figure’s death, a betrayal of trust, or abuse can inflict a degree of pain that is seriously traumatic. Those suffering such trauma may react with mistrust and depression, becoming unwilling or unable to reach out to others or accept attention and love. Their learning potential and life performance are impaired and their ability to develop stable relationships is disrupted: this is Attachment Disability.

Unfortunately, contemporary psychiatry minimizes the significance of trauma, leaving many attachment-disabled people misdiagnosed, mismanaged, and enduring unnecessary suffering.

In Attachment Disability, Dr. John Curran, a psychiatrist with decades of private and institutional practice, demonstrates that emotional disability is always trauma related. He draws on professional literature and dozens of case studies to define three types of Attachment Disability: Avoidant, Entangled, and Acting-out. He persuasively advocates a psychiatric management style that avoids making things worse and helps people in pain clarify and accept their trauma and then focus on what they can change.

Dr. Curran concludes with suggestions on how American psychiatry can be invigorated by clearly distinguishing between mental illness and the emotional disability it generates.

Attachment Disability offers an invaluable contribution to the psychiatric profession and the people it seeks to serve.

"I wish I had this book thirty years ago; I would have made it required reading for every therapist on my staff."

—Richard Obershaw, AMW, MSW, LICSW; author of the best-selling Cry Until You Laugh: Comforting Guidance for Coping with Grief

Part 1

Understanding Attachment Disability

… to be human is to cultivate attachments

1

Origins of the Idea of Attachment

In the middle decades of the twentieth century certain psychoanalysts revised and extended Freudian concepts of psychological development. These individuals, the “neo-Freudians,” had trained with Freud and his disciples but later modified classical psychoanalytic concepts. Rather than focusing solely on intrapsychic structures—ego, superego, id—as the source of conflict, their interest was more extrapsychic. In their view, conflict was related to the strength and consistency of parental or surrogate nurturing (or lack of thereof) during infancy and childhood. That is, quality of childhood nurturing foreshadowed quality of life relationships. Psychological development was less the consequence of an unfolding father-mother-child triad; much more relevant was whether there were parental relationships to begin with.

Of the many revisionists, here I will briefly review two figures whose elucidation of the vicissitudes of child development is absolutely crucial to the understanding of Attachment Disability and, by extension, the management of adolescent dysfunction and underperformance.

John Bowlby (1907–90): Attachment Defined

Attachment is a term originated by the British psychoanalyst and pediatrician John Bowlby, derived from his pioneering studies of childhood development.

During World War II he investigated what happened to children who had been separated from their familiar caregivers during the war. He studied orphans, youngsters who had been evacuated to the countryside to live with relatives, children raised in communal nurseries, and even those separated from their families during brief hospitalizations. He concluded that any early life separation could have a profound and lasting effect on all subsequent relationships. The child’s ability to develop trusting and stable relationships—attachments was the term he used—was impaired. Anxieties and concerns about loss and abandonment prevailed, sometimes openly, sometimes hidden.¹ Once in school, as security concerns sapped their energies, they tended to fall behind. The security of relationships consumed their attention. How teachers and peers looked and what they did, not what they said, were paramount.

On this side of the Atlantic, attachment-disordered kids came to be understood as the product of extreme deprivation—orphans adopted from abroad, for example—or extreme turmoil: youngsters raised in crack houses or subject to frequent placements. Attachment problems were therefore seen as an issue of early childhood. In youngsters of that age, Attachment Disorders are relatively easy to recognize, especially if the youngsters come from backgrounds of flamboyant neglect, deprivation, turmoil, or abuse.

Eventually Bowlby’s notions were incorporated into our psychiatric diagnostic terminology as Reactive Attachment Disorders. Two polar types are identified: inhibited and uninhibited. The child either connects with no one or everyone. The latter condition is especially dangerous because it renders the child very vulnerable to persuasion: for example, likely to wander off with a passing stranger.ⁱ

However, in recent years it has become apparent that not all attachment problems appear in early childhood, nor are they all accompanied by a history of dramatic neglect or abuse. Some develop in later childhood or early adolescence when a figure who has earned trust is lost because of such causes as illness, death, separation, or divorce.

Moreover, such later attachment disruption does not inevitably result in Attachment Disability. This is because children, although vulnerable, are tough and adaptable. Their needs drive them to seek and restore the lost relationship. If things work out, they find a replacement who earns their trust—an aunt or uncle or older sibling or step-parent or sobered-up parent or special friend. They learn that the world is not totally chaotic. If that figure remains present and stable, they may learn to extend their trust to others whom that figure seems to trust. Thus they begin to find security in other relationships. They become able to manage transitions and the anxieties that transitions inevitably engender. In short they learn to manage separation anxiety. The loss and sense of abandonment are more or less repaired. It is not that they “get over” what has been lost—one never really “gets over” a lost love; rather, they learn to accept the pain without blame. Acceptance releases energy and motivation previously consumed by blame. Wounds heal, although a scar remains, and youngsters move forward to explore new attachments. The impossible now seems possible.²

But sometimes the turmoil of separation and abandonment sustained during later childhood and adolescence is not repaired. Disturbance and turmoil evolve into disability.

There are three possible outcomes, or corners of the disability triangle: Attachment Avoidance, Attachment Entanglement, and Attachment Acting-out. The first two may be understood as delayed manifestations of the inhibited and uninhibited early childhood behaviors Bowlby first described. The third apex of the triangle, however, was first recognized by his contemporary, Donald Winnicott, whom I will discuss in the next section.

Attachment Avoidance

In this situation wounded youngsters fail to heal, and their life grinds to a halt. Their school performance suffers and their grades decline. They close up and withdraw from or spurn friendship. Their attitude becomes sour and negative; they radiate a sense of hopelessness and despair. In short, their ability to replace the lost relationship has atrophied. They now avoid reaching out and withdraw from the opportunity to do so: they now fear attachment. J. D. Salinger’s portrayal of the aimless Holden Caulfield, who has yet come to grips with the death of his beloved younger brother three years before, is a textbook description of Attachment Avoidance.³ In most cases the disability, while enduring, is not deadly but occasionally can evolve into severe Depression and suicide risk.

Attachment Entanglement

This corresponds to the uninhibited type of Attachment Disorder seen in early childhood. Here adolescents deal with their miseries by becoming emotionally overattached, so to speak, to others—especially peers and family—feeling increasingly responsible for their welfare.ⁱⁱ Their appreciation of their own needs and feelings becomes engulfed and smothered—entangled—by their perceived sensitivity to the needs and feelings of the other. They report worrying about “everything.” Cutting is always a sign of entanglement, ping-pong suicidal behavior between peers an extreme sign. In my experience adolescent girls are more likely than boys to develop this attachment style. If they manage to navigate their adolescent and early adult life without a life disaster, they typically are attracted to careers in nurturing professions—medicine, veterinary medicine, teaching, counseling, and so forth—and occasionally in criminal justice—police, probation officer, for example.

Donald Winnicott (1896–1971)

Bowlby did not consider acting-out behavior—externalizing behavior is the more contemporary term—to be an attachment issue. This notion comes from the work of his contemporary, Donald Winnicott.

Like Bowlby, Winnicott was a psychiatrist and psychoanalyst. He, too, studied and commented on the vicissitudes of children evacuated to the countryside during the Blitz. ⁴ He originated the notion of the “good-enough” mother. As he saw it, the developing child did not require heroic attentiveness or perceptiveness from its mother to develop normally. Constant tangible skin-to-skin contact and fondling of the child were not necessary prerequisites for social development. Some constancy was “good enough.” In fact the behavioral principle of intermittent reinforcement soundly supports his position.ⁱⁱⁱ An infant frustrated by the lack of an immediate response to its unmet needs does not give up but proclaims its problem with increasing vigor. Hopefully a caretaker, not necessarily its mother, will respond, creating the potential for trust building and perseverance: socialization, in other words.^iv

Of particular interest to this book, however, is that Winnicott viewed the emergence of “antisocial” behaviors characteristic of the later stages of child and adolescent development as the youngster’s “claim” on its environment.⁵ As he saw it, such behavior represented an attempt to correct for deficient mothering; that is, mothering that had not been “good enough.” The disruptiveness was a disguised plea for help, a demand for need fulfillment from the larger world, an attempt to repair mothering failure.

In my view his perceptive insights have stood the test of time and are constrained only by his limited notion of “mothering.” His observations were derived within a society where most children were born and raised by two adults united in wedlock. In our postmodern society, an increasing percentage of children are born out of wedlock and raised by an array of figures. “Mothering” now incorporates nurturing from unwed and often single parents, their partners, teachers, grandparents, older siblings, relatives, stepparents, neighbors, sitters, day care staff, and more. Relationships with nurturers are therefore more equivocal, shifting, and evanescent. On the one hand this bestows resilience and protection because of the increased security to be found in a potentially wider support network. On the other hand it bestows vulnerability if a vital support is lost and the network, such as it is, is too fragile and disjointed to respond to the unmet needs of a youngster who perceives the lost relationship as abandonment.

But too frequently the subsequent search for need relief is unfocused, misfires, and takes the form of angry, even defiant demands. What we professionals might define as “oppositional,” Winnicott would recognize as a cry for help from the environment. In short, the failed healing takes the form of the acting-out kid.^v In this respect it is very unfortunate that the traditional concept of acting-out behavior has been replaced by “externalizing behavior” because this deflects attention from considering what unmet needs drive this kind of behavior.

As professionals we must be careful, therefore, when dealing with students, not to misinterpret such a disguised plea for relief. It is important to recognize the underlying attachment issue and direct our awareness toward the youngster’s unmet need for (and fear of) “mothering” in the larger sense of the word: that is, as a need for a perceptive attentiveness. Above all, the idea is not to make things worse by our own loss of control in response to the defiant provocativeness that is the signature camouflage of these troubled youngsters.

Attachment Acting-Out

Here a fear of recurrent loss becomes cloaked with anger. The behavior of such youngsters is (not necessarily consciously) designed to keep parents and teachers at a distance, to alienate them, to avoid closeness—in other words, to establish an interpersonal boundary. The idea is to establish a wall of behavior behind which the adolescent feels safe. If you are not close to anyone, you are at less risk of experiencing the pain of abandonment, which, as these youngsters now believe, is inevitable. These days such youngsters are more likely the product of a broken home or a serial placement experience than an orphanage or crack house.

Thus they relate at a distance, so to speak, by using behavior to keep others irritated and frustrated. “They enjoy provoking me, bugging me!” sponsors say. (Younger miscreants not infrequently display a guilty smile, and sometimes will fess up when I inquire.) Such disrespectful and defiant behavior serves a second function as well. It is an indirect way of asking for love, which frustrated sponsors express when, flooded with guilt about their own angry response to the provocations, they afterward apologize and try to make up. This kind of failed healing, while more...