7. GETTING ON THE SAME WAVELENGTH: ATTACHMENT AND ATTUNEMENT
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CHAPTER 7
GETTING ON THE SAME
WAVELENGTH: ATTACHMENT AND
ATTUNEMENT
The roots of resilience … are to be found in the sense of being
understood by and existing in the mind and heart of a loving,
attuned, and self-possessed other.
—Diana Fosha
he Children’s Clinic at the Massachusetts Mental Health Center was
filled with disturbed and disturbing kids. They were wild creatures who
could not sit still and who hit and bit other children, and sometimes even
the staff. They would run up to you and cling to you one moment and run
away, terrified, the next. Some masturbated compulsively; others lashed out
at objects, pets, and themselves. They were at once starving for affection
and angry and defiant. The girls in particular could be painfully compliant.
Whether oppositional or clingy, none of them seemed able to explore or
play in ways typical for children their age. Some of them had hardly
developed a sense of self—they couldn’t even recognize themselves in a
mirror.
At the time, I knew very little about children, apart from what my two
preschoolers were teaching me. But I was fortunate in my colleague Nina
Fish-Murray, who had studied with Jean Piaget in Geneva, in addition to
raising five children of her own. Piaget based his theories of child
development on meticulous, direct observation of children themselves,
starting with his own infants, and Nina brought this spirit to the incipient
Trauma Center at MMHC.
Nina was married to the former chairman of the Harvard psychology
department, Henry Murray, one of the pioneers of personality theory, and
she actively encouraged any junior faculty members who shared her
interests. She was fascinated by my stories about combat veterans because
they reminded her of the troubled kids she worked with in the Boston public
schools. Nina’s privileged position and personal charm gave us access to
the Children’s Clinic, which was run by child psychiatrists who had little
interest in trauma.
Henry Murray had, among other things, become famous for designing
the widely used Thematic Apperception Test. The TAT is a so-called
projective test, which uses a set of cards to discover how people’s inner
reality shapes their view of the world. Unlike the Rorschach cards we used
with the veterans, the TAT cards depict realistic but ambiguous and
somewhat troubling scenes: a man and a woman gloomily staring away
from each other, a boy looking at a broken violin. Subjects are asked to tell
stories about what is going on in the photo, what has happened previously,
and what happens next. In most cases their interpretations quickly reveal
the themes that preoccupy them.
Nina and I decided to create a set of test cards specifically for children,
based on pictures we cut out of magazines in the clinic waiting room. Our
first study compared twelve six- to eleven-year-olds at the children’s clinic
with a group of children from a nearby school who matched them as closely
as possible in age, race, intelligence, and family constellation.1 What
differentiated our patients was the abuse they had suffered within their
families. They included a boy who was severely bruised from repeated
beatings by his mother; a girl whose father had molested her at the age of
four; two boys who had been repeatedly tied to a chair and whipped; and a
girl who, at the age of five, had seen her mother (a prostitute) raped,
dismembered, burned, and put into the trunk of a car. The mother’s pimp
was suspected of sexually abusing the girl.
The children in our control group also lived in poverty in a depressed
area of Boston where they regularly witnessed shocking violence. While the
study was being conducted, one boy at their school threw gasoline at a
classmate and set him on fire. Another boy was caught in crossfire while
walking to school with his father and a friend. He was wounded in the
groin, and his friend was killed. Given their exposure to such a high
baseline level of violence, would their responses to the cards differ from
those of the hospitalized children?
One of our cards depicted a family scene: two smiling kids watching
dad repair a car. Every child who looked at it commented on the danger to
the man lying underneath the vehicle. While the control children told stories
with benign endings—the car would get fixed, and maybe dad and the kids
would drive to McDonald’s—the traumatized kids came up with gruesome
tales. One girl said that the little girl in the picture was about to smash in
her father’s skull with a hammer. A nine-year-old boy who had been
severely physically abused told an elaborate story about how the boy in the
picture kicked away the jack, so that the car mangled his father’s body and
his blood spurted all over the garage.
As they told us these stories, our patients got very excited and
disorganized. We had to take considerable time out at the water cooler and
going for walks before we could show them the next card. It was little
wonder that almost all of them had been diagnosed with ADHD, and most
were on Ritalin—though the drug certainly didn’t seem to dampen their
arousal in this situation.
The abused kids gave similar responses to a seemingly innocuous
picture of a pregnant woman silhouetted against a window. When we
showed it to the seven-year-old girl who’d been sexually abused at age four,
she talked about penises and vaginas and repeatedly asked Nina questions
like “How many people have you humped?” Like several of the other
sexually abused girls in the study, she became so agitated that we had to
stop. A seven-year-old girl from the control group picked up the wistful
mood of the picture: Her story was about a widowed lady sadly looking out
the window, missing her husband. But in the end, the lady found a loving
man to be a good father to her baby.
In card after card we saw that, despite their alertness to trouble, the
children who had not been abused still trusted in an essentially benign
universe; they could imagine ways out of bad situations. They seemed to
feel protected and safe within their own families. They also felt loved by at
least one of their parents, which seemed to make a substantial difference in
their eagerness to engage in schoolwork and to learn.
The responses of the clinic children were alarming. The most innocent
images stirred up intense feelings of danger, aggression, sexual arousal, and
terror. We had not selected these photos because they had some hidden
meaning that sensitive people could uncover; they were ordinary images of
everyday life. We could only conclude that for abused children, the whole
world is filled with triggers. As long as they can imagine only disastrous
outcomes to relatively benign situations, anybody walking into a room, any
stranger, any image, on a screen or on a billboard might be perceived as a
harbinger of catastrophe. In this light the bizarre behavior of the kids at the
children’s clinic made perfect sense.2
To my amazement, staff discussions on the unit rarely mentioned the
horrific real-life experiences of the children and the impact of those traumas
on their feelings, thinking, and self-regulation. Instead, their medical
records were filled with diagnostic labels: “conduct disorder” or
“oppositional defiant disorder” for the angry and rebellious kids; or “bipolar
disorder.” ADHD was a “comorbid” diagnosis for almost all. Was the
underlying trauma being obscured by this blizzard of diagnoses?
Now we faced two big challenges. One was to learn whether the
different worldview of normal children could account for their resilience
and, on a deeper level, how each child actually creates her map of the
world. The other, equally crucial, question was: Is it possible to help the
minds and brains of brutalized children to redraw their inner maps and
incorporate a sense of trust and confidence in the future?
MEN WITHOUT MOTHERS
The scientific study of the vital relationship between infants and their
mothers was started by upper-class Englishmen who were torn from their
families as young boys to be sent off to boarding schools, where they were
raised in regimented same-sex settings. The first time I visited the famed
Tavistock Clinic in London I noticed a collection of black-and-white
photographs of these great twentieth-century psychiatrists hanging on the
wall going up the main staircase: John Bowlby, Wilfred Bion, Harry
Guntrip, Ronald Fairbairn, and Donald Winnicott. Each of them, in his own
way, had explored how our early experiences become prototypes for all our
later connections with others, and how our most intimate sense of self is
created in our minute-to-minute exchanges with our caregivers.
Scientists study what puzzles them most, so that they often become
experts in subjects that others take for granted. (Or, as the attachment
researcher Beatrice Beebe once told me, “most research is me-search.”)
These men who studied the role of mothers in children’s lives had
themselves been sent off to school at a vulnerable age, sometime between
six and ten, long before they should have faced the world alone. Bowlby
himself told me that just such boarding-school experiences probably
inspired George Orwell’s novel 1984, which brilliantly expresses how
human beings may be induced to sacrifice everything they hold dear and
true—including their sense of self—for the sake of being loved and
approved of by someone in a position of authority.
Since Bowlby was close friends with the Murrays, I had a chance to
talk with him about his work whenever he visited Harvard. He was born
into an aristocratic family (his father was surgeon to the King’s household),
and he trained in psychology, medicine, and psychoanalysis at the temples
of the British establishment. After attending Cambridge University, he
worked with delinquent boys in London’s East End, a notoriously rough
and crime-ridden neighborhood that was largely destroyed during the Blitz.
During and after his service in World War II, he observed the effects of
wartime evacuations and group nurseries that separated young children
from their families. He also studied the effect of hospitalization, showing
that even brief separations (parents back then were not allowed to visit
overnight) compounded the children’s suffering. By the late 1940s Bowlby
had become persona non grata in the British psychoanalytic community, as
a result of his radical claim that children’s disturbed behavior was a
response to actual life experiences—to neglect, brutality, and separation—
rather than the product of infantile sexual fantasies. Undaunted, he devoted
the rest of his life to developing what came to be called attachment theory.3
A SECURE BASE
As we enter this world we scream to announce our presence. Someone
immediately engages with us, bathes us, swaddles us, and fills our
stomachs, and, best of all, our mother may put us on her belly or breast for
delicious skin-to-skin contact. We are profoundly social creatures; our lives
consist of finding our place within the community of human beings. I love
the expression of the great French psychiatrist Pierre Janet: “Every life is a
piece of art, put together with all means available.”
As we grow up, we gradually learn to take care of ourselves, both
physically and emotionally, but we get our first lessons in self-care from the
way that we are cared for. Mastering the skill of self-regulation depends to
a large degree on how harmonious our early interactions with our caregivers
are. Children whose parents are reliable sources of comfort and strength
have a lifetime advantage—a kind of buffer against the worst that fate can
hand them.
John Bowlby realized that children are captivated by faces and voices
and are exquisitely sensitive to facial expression, posture, tone of voice,
physiological changes, tempo of movement and incipient action. He saw
this inborn capacity as a product of evolution, essential to the survival of
these helpless creatures. Children are also programmed to choose one
particular adult (or at most a few) with whom their natural communication
system develops. This creates a primary attachment bond. The more
responsive the adult is to the child, the deeper the attachment and the more
likely the child will develop healthy ways of responding to the people
around him.
Bowlby would often visit Regent’s Park in London, where he would
make systematic observations of the interactions between children and their
mothers. While the mothers sat quietly on park benches, knitting or reading
the paper, the kids would wander off to explore, occasionally looking over
their shoulders to ascertain that Mum was still watching. But when a
neighbor stopped by and absorbed his mother’s interest with the latest
gossip, the kids would run back and stay close, making sure he still had her
attention. When infants and young children notice that their mothers are not
fully engaged with them, they become nervous. When their mothers
disappear from sight, they may cry and become inconsolable, but as soon as
their mothers return, they quiet down and resume their play.
Bowlby saw attachment as the secure base from which a child moves
out into the world. Over the subsequent five decades research has firmly
established that having a safe haven promotes self-reliance and instills a
sense of sympathy and helpfulness to others in distress. From the intimate
give-and-take of the attachment bond children learn that other people have
feelings and thoughts that are both similar to and different from theirs. In
other words, they get “in sync” with their environment and with the people
around them and develop the self-awareness, empathy, impulse control, and
self-motivation that make it possible to become contributing members of
the larger social culture. These qualities were painfully missing in the kids
at our Children’s Clinic.
THE DANCE OF ATTUNEMENT
Children become attached to whoever functions as their primary caregiver.
But the nature of that attachment—whether it is secure or insecure—makes
a huge difference over the course of a child’s life. Secure attachment
develops when caregiving includes emotional attunement. Attunement
starts at the most subtle physical levels of interaction between babies and
their caretakers, and it gives babies the feeling of being met and understood.
As Edinburgh-based attachment researcher Colwyn Trevarthen says: “The
brain coordinates rhythmic body movements and guides them to act in
sympathy with other people’s brains. Infants hear and learn musicality from
their mother’s talk, even before birth.”4
In chapter 4 I described the discovery of mirror neurons, the brain-to-
brain links that give us our capacity for empathy. Mirror neurons start
functioning as soon as babies are born. When researcher Andrew Meltzoff
at the University of Oregon pursed his lips or stuck out his tongue at six-
hour-old babies, they promptly mirrored his actions.5 (Newborns can focus
their eyes only on objects within eight to twelve inches—just enough see
the person who is holding them). Imitation is our most fundamental social
skill. It assures that we automatically pick up and reflect the behavior of our
parents, teachers, and peers.
Most parents relate to their babies so spontaneously that they are barely
aware of how attunement unfolds. But an invitation from a friend, the
attachment researcher Ed Tronick, gave me the chance to observe that
process more closely. Through a one-way mirror at Harvard’s Laboratory of
Human Development, I watched a mother playing with her two-month-old
son, who was propped in an infant seat facing her.
They were cooing to each other and having a wonderful time—until the
mother leaned in to nuzzle him and the baby, in his excitement, yanked on
her hair. The mother was caught unawares and yelped with pain, pushing
away his hand while her face contorted with anger. The baby let go
immediately, and they pulled back physically from each other. For both of
them the source of delight had become a source of distress. Obviously
frightened, the baby brought his hands up to his face to block out the sight
of his angry mother. The mother, in turn, realizing that her baby was upset,
refocused on him, making soothing sounds in an attempt to smooth things
over. The infant still had his eyes covered, but his craving for connection
soon reemerged. He started peeking out to see if the coast was clear, while
his mother reached toward him with a concerned expression. As she started
to tickle his belly, he dropped his arms and broke into a happy giggle, and
harmony was reestablished. Infant and mother were attuned again. This
entire sequence of delight, rupture, repair, and new delight took slightly less
than twelve seconds.
Tronick and other researchers have now shown that when infants and
caregivers are in sync on an emotional level, they’re also in sync
physically.6 Babies can’t regulate their own emotional states, much less the
changes in heart rate, hormone levels, and nervous-system activity that
accompany emotions. When a child is in sync with his caregiver, his sense
of joy and connection is reflected in his steady heartbeat and breathing and
a low level of stress hormones. His body is calm; so are his emotions. The
moment this music is disrupted—as it often is in the course of a normal day
—all these physiological factors change as well. You can tell equilibrium
has been restored when the physiology calms down.
We soothe newborns, but parents soon start teaching their children to
tolerate higher levels of arousal, a job that is often assigned to fathers. (I
once heard the psychologist John Gottman say, “Mothers stroke, and fathers
poke.”) Learning how to manage arousal is a key life skill, and parents must
do it for babies before babies can do it for themselves. If that gnawing
sensation in his belly makes a baby cry, the breast or bottle arrives. If he’s
scared, someone holds and rocks him until he calms down. If his bowels
erupt, someone comes to make him clean and dry. Associating intense
sensations with safety, comfort, and mastery is the foundation of self-
regulation, self-soothing, and self-nurture, a theme to which I return
throughout this book.
A secure attachment combined with the cultivation of competency
builds an internal locus of control, the key factor in healthy coping
throughout life.7 Securely attached children learn what makes them feel
good; they discover what makes them (and others) feel bad, and they
acquire a sense of agency: that their actions can change how they feel and
how others respond. Securely attached kids learn the difference between
situations they can control and situations where they need help. They learn
that they can play an active role when faced with difficult situations. In
contrast, children with histories of abuse and neglect learn that their terror,
pleading, and crying do not register with their caregiver. Nothing they can
do or say stops the beating or brings attention and help. In effect they’re
being conditioned to give up when they face challenges later in life.
BECOMING REAL
Bowlby’s contemporary, the pediatrician and psychoanalyst Donald
Winnicott, is the father of modern studies of attunement. His minute
observations of mothers and children started with the way mothers hold
their babies. He proposed that these physical interactions lay the
groundwork for a baby’s sense of self—and, with that, a lifelong sense of
identity. The way a mother holds her child underlies “the ability to feel the
body as the place where the psyche lives.”8 This visceral and kinesthetic
sensation of how our bodies are met lays the foundation for what we
experience as “real.”9
Winnicott thought that the vast majority of mothers did just fine in their
attunement to their infants—it does not require extraordinary talent to be
what he called a “good enough mother.”10 But things can go seriously
wrong when mothers are unable to tune in to their baby’s physical reality. If
a mother cannot meet her baby’s impulses and needs, “the baby learns to
become the mother’s idea of what the baby is.” Having to discount its inner
sensations, and trying to adjust to its caregiver’s needs, means the child
perceives that “something is wrong” with the way it is. Children who lack
physical attunement are vulnerable to shutting down the direct feedback
from their bodies, the seat of pleasure, purpose, and direction.
In the years since Bowlby’s and Winnicott’s ideas were introduced,
attachment research around the world has shown that the vast majority of
children are securely attached. When they grow up, their history of reliable,
responsive caregiving will help to keep fear and anxiety at bay. Barring
exposure to some overwhelming life event—trauma—that breaks down the
self-regulatory system, they will maintain a fundamental state of emotional
security throughout their lives. Secure attachment also forms a template for
children’s relationships. They pick up what others are feeling and early on
learn to tell a game from reality, and they develop a good nose for phony
situations or dangerous people. Securely attached children usually become
pleasant playmates and have lots of self-affirming experiences with their
peers. Having learned to be in tune with other people, they tend to notice
subtle changes in voices and faces and to adjust their behavior accordingly.
They learn to live within a shared understanding of the world and are likely
to become valued members of the community.
This upward spiral can, however, be reversed by abuse or neglect.
Abused kids are often very sensitive to changes in voices and faces, but
they tend to respond to them as threats rather than as cues for staying in
sync. Dr. Seth Pollak of the University of Wisconsin showed a series of
faces to a group of normal eight-year-olds and compared their responses
with those of a group of abused children the same age. Looking at this
spectrum of angry to sad expressions, the abused kids were hyperalert to the
slightest features of anger.11
COPYRIGHT © 2000, AMERICAN PSYCHOLOGICAL ASSOCIATION
This is one reason abused children so easily become defensive or
scared. Imagine what it’s like to make your way through a sea of faces in
the school corridor, trying to figure out who might assault you. Children
who overreact to their peers’ aggression, who don’t pick up on other kids’
needs, who easily shut down or lose control of their impulses, are likely to
be shunned and left out of sleepovers or play dates. Eventually they may
learn to cover up their fear by putting up a tough front. Or they may spend
more and more time alone, watching TV or playing computer games, falling
even further behind on interpersonal skills and emotional self-regulation.
The need for attachment never lessens. Most human beings simply
cannot tolerate being disengaged from others for any length of time. People
who cannot connect through work, friendships, or family usually find other
ways of bonding, as through illnesses, lawsuits, or family feuds. Anything
is preferable to that godforsaken sense of irrelevance and alienation.
A few years ago, on Christmas Eve, I was called to examine a fourteen-
year-old boy at the Suffolk County Jail. Jack had been arrested for breaking
into the house of neighbors who were away on vacation. The burglar alarm
was howling when the police found him in the living room.
The first question I asked Jack was who he expected would visit him in
jail on Christmas. “Nobody,” he told me. “Nobody ever pays attention to
me.” It turned out that he had been caught during break-ins numerous times
before. He knew the police, and they knew him. With delight in his voice,
he told me that when the cops saw him standing in the middle of the living
room, they yelled, “Oh my God, it’s Jack again, that little motherfucker.”
Somebody recognized him; somebody knew his name. A little while later
Jack confessed, “You know, that is what makes it worthwhile.” Kids will go
to almost any length to feel seen and connected.
LIVING WITH THE PARENTS YOU HAVE
Children have a biological instinct to attach—they have no choice. Whether
their parents or caregivers are loving and caring or distant, insensitive,
rejecting, or abusive, children will develop a coping style based on their
attempt to get at least some of their needs met.
We now have reliable ways to assess and identify these coping styles,
thanks largely to the work of two American scientists, Mary Ainsworth and
Mary Main, and their colleagues, who conducted thousands of hours of
observation of mother-infant pairs over many years. Based on these studies,
Ainsworth created a research tool called the Strange Situation, which looks
at how an infant reacts to temporary separation from the mother. Just as
Bowlby had observed, securely attached infants are distressed when their
mother leaves them, but they show delight when she returns, and after a
brief check-in for reassurance, they settle down and resume their play.
But with infants who are insecurely attached, the picture is more
complex. Children whose primary caregiver is unresponsive or rejecting
learn to deal with their anxiety in two distinct ways. The researchers noticed
that some seemed chronically upset and demanding with their mothers,
while others were more passive and withdrawn. In both groups contact with
the mothers failed to settle them down—they did not return to play
contentedly, as happens in secure attachment.
In one pattern, called “avoidant attachment,” the infants look like
nothing really bothers them—they don’t cry when their mother goes away
and they ignore her when she comes back. However, this does not mean that
they are unaffected. In fact, their chronically increased heart rates show that
they are in a constant state of hyperarousal. My colleagues and I call this
pattern “dealing but not feeling.”12 Most mothers of avoidant infants seem
to dislike touching their children. They have trouble snuggling and holding
them, and they don’t use their facial expressions and voices to create
pleasurable back-and-forth rhythms with their babies.
In another pattern, called “anxious” or “ambivalent” attachment, the
infants constantly draw attention to themselves by crying, yelling, clinging,
or screaming: They are “feeling but not dealing.”13 They seem to have
concluded that unless they make a spectacle, nobody is going to pay
attention to them. They become enormously upset when they do not know
where their mother is but derive little comfort from her return. And even
though they don’t seem to enjoy her company, they stay passively or angrily
focused on her, even in situations when other children would rather play.14
Attachment researchers think that the three “organized” attachment
strategies (secure, avoidant, and anxious) work because they elicit the best
care a particular caregiver is capable of providing. Infants who encounter a
consistent pattern of care—even if it’s marked by emotional distance or
insensitivity—can adapt to maintain the relationship. That does not mean
that there are no problems: Attachment patterns often persist into adulthood.
Anxious toddlers tend to grow into anxious adults, while avoidant toddlers
are likely to become adults who are out of touch with their own feelings and
those of others. (As in, “There’s nothing wrong with a good spanking. I got
hit and it made me the success I am today.”) In school avoidant children are
likely to bully other kids, while the anxious children are often their
victims.15 However, development is not linear, and many life experiences
can intervene to change these outcomes.
But there is another group that is less stably adapted, a group that
makes up the bulk of the children we treat and a substantial proportion of
the adults who are seen in psychiatric clinics. Some twenty years ago, Mary
Main and her colleagues at Berkeley began to identify a group of children
(about 15 percent of those they studied) who seemed to be unable to figure
out how to engage with their caregivers. The critical issue turned out to be
that the caregivers themselves were a source of distress or terror to the
children.16
Children in this situation have no one to turn to, and they are faced with
an unsolvable dilemma; their mothers are simultaneously necessary for
survival and a source of fear.17 They “can neither approach (the secure and
ambivalent ‘strategies’), shift [their] attention (the avoidant ‘strategy’), nor
flee.”18 If you observe such children in a nursery school or attachment
laboratory, you see them look toward their parents when they enter the
room and then quickly turn away. Unable to choose between seeking
closeness and avoiding the parent, they may rock on their hands and knees,
appear to go into a trance, freeze with their arms raised, or get up to greet
their parent and then fall to the ground. Not knowing who is safe or whom
they belong to, they may be intensely affectionate with strangers or may
trust nobody. Main called this pattern “disorganized attachment.”
Disorganized attachment is “fright without solution.”19
BECOMING DISORGANIZED WITHIN
Conscientious parents often become alarmed when they discover
attachment research, worrying that their occasional impatience or their
ordinary lapses in attunement may permanently damage their kids. In real
life there are bound to be misunderstandings, inept responses, and failures
of communication. Because mothers and fathers miss cues or are simply
preoccupied with other matters, infants are frequently left to their own
devices to discover how they can calm themselves down. Within limits this
is not a problem. Kids need to learn to handle frustrations and
disappointments. With “good enough” caregivers, children learn that broken
connections can be repaired. The critical issue is whether they can
incorporate a feeling of being viscerally safe with their parents or other
caregivers.20
In a study of attachment patterns in over two thousand infants in
“normal” middle-class environments, 62 percent were found to be secure,
15 percent avoidant, 9 percent anxious (also known as ambivalent), and 15
percent disorganized.21 Interestingly, this large study showed that the
child’s gender and basic temperament have little effect on attachment style;
for example, children with “difficult” temperaments are not more likely to
develop a disorganized style. Kids from lower socioeconomic groups are
more likely to be disorganized,22 with parents often severely stressed by
economic and family instability.
Children who don’t feel safe in infancy have trouble regulating their
moods and emotional responses as they grow older. By kindergarten, many
disorganized infants are either aggressive or spaced out and disengaged, and
they go on to develop a range of psychiatric problems.23 They also show
more physiological stress, as expressed in heart rate, heart rate variability,24
stress hormone responses, and lowered immune factors.25 Does this kind of
biological dysregulation automatically reset to normal as a child matures or
is moved to a safe environment? So far as we know, it does not.
Parental abuse is not the only cause of disorganized attachment: Parents
who are preoccupied with their own trauma, such as domestic abuse or rape
or the recent death of a parent or sibling, may also be too emotionally
unstable and inconsistent to offer much comfort and protection.26,27 While
all parents need all the help they can get to help raise secure children,
traumatized parents, in particular, need help to be attuned to their children’s
needs.
Caregivers often don’t realize that they are out of tune. I vividly
remember a videotape Beatrice Beebe showed me.28 It featured a young
mother playing with her three-month-old infant. Everything was going well
until the baby pulled back and turned his head away, signaling that he
needed a break. But the mother did not pick up on his cue, and she
intensified her efforts to engage him by bringing her face closer to his and
increasing the volume of her voice. When he recoiled even more, she kept
bouncing and poking him. Finally he started to scream, at which point the
mother put him down and walked away, looking crestfallen. She obviously
felt terrible, but she had simply missed the relevant cues. It’s easy to
imagine how this kind of misattunement, repeated over and over again, can
gradually lead to a chronic disconnection. (Anyone who’s raised a colicky
or hyperactive baby knows how quickly stress rises when nothing seems to
make a difference.) Chronically failing to calm her baby down and establish
an enjoyable face-to-face interaction, the mother is likely to come to
perceive him as a difficult child who makes her feel like a failure, and give
up on trying to comfort her child.
In practice it often is difficult to distinguish the problems that result
from disorganized attachment from those that result from trauma: They are
often intertwined. My colleague Rachel Yehuda studied rates of PTSD in
adult New Yorkers who had been assaulted or raped.29 Those whose
mothers were Holocaust survivors with PTSD had a significantly higher
rate of developing serious psychological problems after these traumatic
experiences. The most reasonable explanation is that their upbringing had
left them with a vulnerable physiology, making it difficult for them to
regain their equilibrium after being violated. Yehuda found a similar
vulnerability in the children of pregnant women who were in the World
Trade Center that fatal day in 2001.30
Similarly, the reactions of children to painful events are largely
determined by how calm or stressed their parents are. My former student
Glenn Saxe, now chairman of the Department of Child and Adolescent
Psychiatry at NYU, showed that when children were hospitalized for
treatment of severe burns, the development of PTSD could be predicted by
how safe they felt with their mothers.31 The security of their attachment to
their mothers predicted the amount of morphine that was required to control
their pain—the more secure the attachment, the less painkiller was needed.
Another colleague, Claude Chemtob, who directs the Family Trauma
Research Program at NYU Langone Medical Center, studied 112 New York
City children who had directly witnessed the terrorist attacks on 9/11.32
Children whose mothers were diagnosed with PTSD or depression during
follow-up were six times more likely to have significant emotional
problems and eleven times more likely to be hyperaggressive in response to
their experience. Children whose fathers had PTSD showed behavioral
problems as well, but Chemtob discovered that this effect was indirect and
was transmitted via the mother. (Living with an irascible, withdrawn, or
terrified spouse is likely to impose a major psychological burden on the
partner, including depression.)
If you have no internal sense of security, it is difficult to distinguish
between safety and danger. If you feel chronically numbed out, potentially
dangerous situations may make you feel alive. If you conclude that you
must be a terrible person (because why else would your parents have you
treated that way?), you start expecting other people to treat you horribly.
You probably deserve it, and anyway, there is nothing you can do about it.
When disorganized people carry self-perceptions like these, they are set up
to be traumatized by subsequent experiences.33
THE LONG-TERM EFFECTS OF DISORGANIZED
ATTACHMENT
In the early 1980s my colleague Karlen Lyons-Ruth, a Harvard attachment
researcher, began to videotape face-to-face interactions between mothers
and their infants at six months, twelve months and eighteen months. She
taped them again when the children were five years old and once more
when they were seven or eight.34 All were from high-risk families: 100
percent met federal poverty guidelines, and almost half the mothers were
single parents.
Disorganized attachment showed up in two different ways: One group
of mothers seemed to be too preoccupied with their own issues to attend to
their infants. They were often intrusive and hostile; they alternated between
rejecting their infants and acting as if they expected them to respond to their
needs. Another group of mothers seemed helpless and fearful. They often
came across as sweet or fragile, but they didn’t know how to be the adult in
the relationship and seemed to want their children to comfort them. They
failed to greet their children after having been away and did not pick them
up when the children were distressed. The mothers didn’t seem to be doing
these things deliberately—they simply didn’t know how to be attuned to
their kids and respond to their cues and thus failed to comfort and reassure
them. The hostile/intrusive mothers were more likely to have childhood
histories of physical abuse and/or of witnessing domestic violence, while
the withdrawn/dependent mothers were more likely to have histories of
sexual abuse or parental loss (but not physical abuse).35
I have always wondered how parents come to abuse their kids. After
all, raising healthy offspring is at the very core of our human sense of
purpose and meaning. What could drive parents to deliberately hurt or
neglect their children? Karlen’s research provided me with one answer:
Watching her videos, I could see the children becoming more and more
inconsolable, sullen, or resistant to their misattuned mothers. At the same
time, the mothers became increasingly frustrated, defeated, and helpless in
their interactions. Once the mother comes to see the child not as her partner
in an attuned relationship but as a frustrating, enraging, disconnected
stranger, the stage is set for subsequent abuse.
About eighteen years later, when these kids were around twenty years
old, Lyons-Ruth did a follow-up study to see how they were coping. Infants
with seriously disrupted emotional communication patterns with their
mothers at eighteen months grew up to become young adults with an
unstable sense of self, self-damaging impulsivity (including excessive
spending, promiscuous sex, substance abuse, reckless driving, and binge
eating), inappropriate and intense anger, and recurrent suicidal behavior.
Karlen and her colleagues had expected that hostile/intrusive behavior
on the part of the mothers would be the most powerful predictor of mental
instability in their adult children, but they discovered otherwise. Emotional
withdrawal had the most profound and long-lasting impact. Emotional
distance and role reversal (in which mothers expected the kids to look after
them) were specifically linked to aggressive behavior against self and
others in the young adults.
DISSOCIATION: KNOWING AND NOT KNOWING
Lyons-Ruth was particularly interested in the phenomenon of dissociation,
which is manifested in feeling lost, overwhelmed, abandoned, and
disconnected from the world and in seeing oneself as unloved, empty,
helpless, trapped, and weighed down. She found a “striking and
unexpected” relationship between maternal disengagement and
misattunement during the first two years of life and dissociative symptoms
in early adulthood. Lyons-Ruth concludes that infants who are not truly
seen and known by their mothers are at high risk to grow into adolescents
who are unable to know and to see.”36
Infants who live in secure relationships learn to communicate not only
their frustrations and distress but also their emerging selves—their interests,
preferences, and goals. Receiving a sympathetic response cushions infants
(and adults) against extreme levels of frightened arousal. But if your
caregivers ignore your needs, or resent your very existence, you learn to
anticipate rejection and withdrawal. You cope as well as you can by
blocking out your mother’s hostility or neglect and act as if it doesn’t
matter, but your body is likely to remain in a state of high alert, prepared to
ward off blows, deprivation, or abandonment. Dissociation means
simultaneously knowing and not knowing.37
Bowlby wrote: “What cannot be communicated to the [m]other cannot
be communicated to the self.”38 If you cannot tolerate what you know or
feel what you feel, the only option is denial and dissociation.39 Maybe the
most devastating long-term effect of this shutdown is not feeling real inside,
a condition we saw in the kids in the Children’s Clinic and that we see in
the children and adults who come to the Trauma Center. When you don’t
feel real nothing matters, which makes it impossible to protect yourself
from danger. Or you may resort to extremes in an effort to feel something—
even cutting yourself with a razor blade or getting into fistfights with
strangers.
Karlen’s research showed that dissociation is learned early: Later abuse
or other traumas did not account for dissociative symptoms in young
adults.40 Abuse and trauma accounted for many other problems, but not for
chronic dissociation or aggression against self. The critical underlying issue
was that these patients didn’t know how to feel safe. Lack of safety within
the early caregiving relationship led to an impaired sense of inner reality,
excessive clinging, and self-damaging behavior: Poverty, single parenthood,
or maternal psychiatric symptoms did not predict these symptoms.
This does not imply that child abuse is irrelevant41, but that the quality
of early caregiving is critically important in preventing mental health
problems, independent of other traumas.42 For that reason treatment needs
to address not only the imprints of specific traumatic events but also the
consequences of not having been mirrored, attuned to, and given consistent
care and affection: dissociation and loss of self-regulation.
RESTORING SYNCHRONY
Early attachment patterns create the inner maps that chart our relationships
throughout life, not only in terms of what we expect from others, but also in
terms of how much comfort and pleasure we can experience in their
presence. I doubt that the poet e. e. cummings could have written his joyous
lines “i like my body when it is with your body.… muscles better and
nerves more” if his earliest experiences had been frozen faces and hostile
glances.43 Our relationship maps are implicit, etched into the emotional
brain and not reversible simply by understanding how they were created.
You may realize that your fear of intimacy has something to do with your
mother’s postpartum depression or with the fact that she herself was
molested as a child, but that alone is unlikely to open you to happy, trusting
engagement with others.
However, that realization may help you to start exploring other ways to
connect in relationships—both for your own sake and in order to not pass
on an insecure attachment to your own children. In part 5 I’ll discuss a
number of approaches to healing damaged attunement systems through
training in rhythmicity and reciprocity.44 Being in synch with oneself and
with others requires the integration of our body-based senses—vision,
hearing, touch, and balance. If this did not happen in infancy and early
childhood, there is an increased chance of later sensory integration
problems (to which trauma and neglect are by no means the only pathways).
Being in synch means resonating through sounds and movements that
connect, which are embedded in the daily sensory rhythms of cooking and
cleaning, going to bed and waking up. Being in synch may mean sharing
funny faces and hugs, expressing delight or disapproval at the right
moments, tossing balls back and forth, or singing together. At the Trauma
Center, we have developed programs to coach parents in connection and
attunement, and my patients have told me about many other ways to get
themselves in synch, ranging from choral singing and ballroom dancing to
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