7. GETTING ON THE SAME WAVELENGTH: ATTACHMENT AND ATTUNEMENT

You are being pro­vid­ed with a book chap­ter by chap­ter. I will request you to read the book for me after each chap­ter. After read­ing the chap­ter, 1. short­en the chap­ter to no less than 300 words and no more than 400 words. 2. Do not change the name, address, or any impor­tant nouns in the chap­ter. 3. Do not trans­late the orig­i­nal lan­guage. 4. Keep the same style as the orig­i­nal chap­ter, keep it con­sis­tent through­out the chap­ter. Your reply must com­ply with all four require­ments, or it’s invalid.
I will pro­vide the chap­ter now.

T
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