Tag Archives: Mary Main

The Adult Attachment Interview (AAI) (Pt.2 of 2): Mary Main’s Scary Parent Study

Scary Parents

Mary Main BerkeleyPart 1 of this blog Jan. 23 concluded that by 1978, Dr. Mary Ainsworth’s estimate for U.S. babies was that (A) 23% were Avoidant insecure (avoid parents); (B) only 69% were Securely Attached; and (C) 8% were Ambivalent insecure (unhappy and indecisive).  [FN1, 11]

By 1988, her Strange Situation study had been done with 2,000 infant-parent pairs in 32 studies in 8 countries. By 1999 it  had been done globally with 6,282 infant-parent pairs. Some countries varied, but worldwide results averaged out the same as Ainsworth’s 1978 original. [FN1, 9, 11]

In 1973 Mary Main [above] became Ainsworth’s grad student at Johns Hopkins in Baltimore, working on the Strange Situation experiments from the start. After her doctorate, Main moved to Berkeley, to see if Ainsworth’s Kampala and Baltimore findings would replicate.[FN8]  In 1978 she ran a Strange Situation study of 189 Bay Area infant-parent pairs and made the same findings. [FN10]

But by 1979 Dr. Main was making her own discoveries—out of concern about the parents. “In none of Ainsworth’s original observations was the possibility considered that some mothers… could also be frightening,” Main notes. “For my dissertation at Johns Hopkins, I watched 50 children in the Strange Situation… Using Ainsworth’s three-part classification (secure, avoidant and ambivalent), I found at least five infants could not be classified.”  Ainsworth was concerned, too; in fact, she’d left some babies in her Secure set only since they didn’t fit her other two sets. [FN8]

By 1982, Main decided to “extend attachment theory to include the import of infant exposure to anomalous fear-arousing parental behaviors… The mother is the haven of safety that must be approached in times of danger. However, when the infant’s biological haven of safety has simultaneously become a source of fright, the infant is placed in an irresolvable and disorganizing approach-flight paradox,” she said.  [FN8]

Soon after 1982, Main and Ainsworth agreed that 14-15% of babies actually belong in a new, fourth category: (D) Insecure Disorganized. Their mothers were so frightening that the babies couldn’t develop any consistent response at all. These infants “exhibited a diverse array of inexplicable or overtly conflicted behaviors in the parent’s presence” including “disorganization, disorientation, and confusion.” This includes crying loudly then suddenly freezing; ignoring the parent to rock on hands and knees; moving away; raising hand to mouth in fear; or even swiping at the parent’s face. They seemed vulnerable to dissociation.   [FN11, 8]

This finding that a whopping 15% of average U.S. babies are so insecure they’re almost incoherent was so shocking, it was checked for years and not used as a formal 4th category until after 1990 (the delay confused many scholars during 1982-1990). [FN12] But the number held. Worse, among children of American adolescent mothers the rate is over 31%, and is over 25% in many Third World nations. [FN13]

And: to remove the 14-15% of disorganized babies from Ainsworth’s original 69% Secure, reduced the Secure set to only 54-55%.  What was up with parents that 45-46% of their kids couldn’t manage secure attachment?  If so, Main would have  four categories: Avoidant 23%, Ambivalent 8%, Disorganized, 14-15%, Secure 54-55%.  [FN1, 11]

Mary Main '09 Bowlby-Ainsworth award(Inge Bretherton,Everett Waters)By 1982 Main had seen enough to begin developing the Adult Attachment Interview (AAI).  She’d seen plenty of disorganized babies – that meant a lot of scary parents. She needed a way to document the behavior of parents. [FN14] (Right: Dr. Main receives the Bowlby-Ainsworth Attachment Award, 2009.)

The AAI was designed to document the level of secure, loving attachment the parents had, during their own childhoods with the babies’ grandparents. Parents were asked “both to described their attachment-related childhood experiences – especially their early relations with parents – and to evaluate the influence of these experiences on their development and current functioning.”

Parents were studied not just on facts they gave, but on how coherent a narrative they could produce quickly. That’s easy for folks who had a secure childhood, but difficult for folks who did not. The AAI questions are designed to “surprise the unconscious” to yield information about the “state of mind with regard to attachment” that might not otherwise show up. Each AAI was taped and transcribed verbatim. Then transcripts were classified by specific patterns by independent trained specialists. [FN15, 10]

In 1983 Main also created the “Berkeley Longitudinal Study” to take the Bay Area infant-parent pairs in her 1978 Strange Situation, and study them for a generation. In 1978, the babies were 12-18 months old; Main and her team re-studied these pairs when the kids reached age 6 in 1983, and studied the kids again when they reached 19 in 1996.  [FN8].   In 1983 Main and her team gave three completely different tests to the Bay Area pairs:

— 1. The six year olds were again studied with their parents in the Strange Situation (as in 1978 when they were infants).

— 2. The “sixes” were also individually (without parents) given a new Separation Anxiety Test (SAT): they were shown pictures of children being separated from their parents, then asked how they felt. This was taped, transcribed and sorted by Main’s student Nancy Kaplan into Ainsworth’s three sets: secure, avoidant and ambivalent. [FN16, 8]

— 3. The parents were given the AAI (without their kids). Responses were sorted into three set of adult attachment matching Ainsworth’s three 1978 categories of infant attachment: Secure-autonomous (matching infant Secure), Dismissing (infant Avoidant)  and Preoccupied (infant Ambivalent). (Main’s new 4th category wasn’t in use until after 1990.) [FN 17, 8, 10]

Astonishing Results You’ve Never Heard

Mary Main, Erik Hesse '09 Bolwby-Ainsworth AwardDr Main’s first 1983 results were so astonishing that attachment researchers have been buzzing ever since.  (Dr. Main and Dr. Erik Hesse, right.) Her results were also so important that it’s outrageous that your doctor never learned this in medical school; your therapist (and mine) never heard of this; you’ve never heard of it; and so you have to read about it here, since the media doesn’t report it. It’s hard to even find this story on the internet; I had to sleuth it out.  Her results were:

First: the six year olds’ 1983 responses with parents in the Strange Situation correlated strongly to their 1978 responses in the Strange Situation as infants five years earlier. In 1978 the infants were Securely attached 69%;  Avoidant 23%, and Ambivalent 8%. In 1983 the same kids at six were the same as they had been as infants, in the same percents. [FN7]

Second: the six year olds’ 1983 solo responses to the SAT photos also produced the same results and percentages.

Third: The parents’ 1983 solo responses to the Adult Attachment Interview correlated strongly with just how their own kids had behaved as infants, five full years earlier.  The parents also turned out to be Secure-autonomous (matching infant “Secure”) 69%;  Dismissing (matching infant “Avoidant”) 23%;  and Preoccupied (matching infant “Ambivalent”) 8%.

Fourth:  The match of the parents’1983 AAI security with how securely their babies behaved five years back in 1978, was at an unheard-of level. It correlated more than 70% of the time, in a field where a 20% correlation is highly significant. “A marked relation between a parent’s discussion of his/her own attachment history (AAI), and the offspring’s Strange Situation behavior 5 years previously, had been uncovered.”  [FN8, 10]

Fifth: When the 1978 infants reached age 19 in 1996, they too were given the Adult Attachment Interview. Again results correlated strongly: the 19 year olds’ responses in the AAI in 1996, correlated precisely to their infant behavior in the Strange Situation in 1978, their behavior at six in 1983, and to their parents’ 1983 AAI responses.

That means the Strange Situation predicts an infant’s behavior for life, and the AAI proves it.  [FN8, 10]

Sixth: When after 1990 Mary Main’s four categories were used, the results of all the tests were just as strongly correlated across Main’s four categories, as when data were sorted into only three sets. Main’s four categories did become Avoidant 23%, Ambivalent 8%, Disorganized, 14-15%, and Secure 54-55%.  Whenever responses to the Strange Situation, SAT, and AAI were sorted into these four sets,  the same percents were found. [FN1, 11]

By 2009, over 10,500 subjects globally had been given the AAI and the results continued to average out the same.  [FN18]

“Researchers worldwide have replicated the relation originally uncovered in the Bay Area study between a parent’s status in the Adult Attachment Interview and an infant’s Strange Situation response to that same parent… The same average parent-to-child, secure/insecure match of 75% holds even when the interview is conducted before birth of the first child…

“Describing the strength of this relation across studies conducted several years ago, van I Jzendoorn (1995) calculated that it would take 1,087 further attempted replications, every one yielding insignificant results, to reduce the present relation between adult and infant attachment status to insignificance,” Main concluded. [FN7, p.1091]

———————————
Kathy’s news blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

Footnotes

FN1  NIH: Benoit, Diane, MD, FRCPC, “Infant-parent attachment: Definition, types, antecedents, measurement and outcome,” Paediatr Child Health, Oct 2004; 9(8) p. 541–545 at: www.ncbi.nlm.nih.gov/pmc/articles/PMC2724160/  4th subhead “Measurement” reports:
“The three ‘organized’ strategies (secure, avoidant and resistant) are assessed in the Strange Situation (SS), a 20-minute laboratory procedure where patterns of infant behaviour toward the caregiver following two brief separations are categorized… “Infants with secure attachment greet and/or approach the caregiver and may maintain contact but are able to return to play, which occurs in 55% of the general population… Infants with insecure-avoidant attachment fail to greet and/or approach, appear oblivious to their caregiver’s return… avoiding the caregiver, which occurs in 23% of the general population. Infants with insecure-resistant [ambivalent] attachment are extremely distressed by separations and cannot be soothed at reunions,  displaying much distress and angry resistance to interactions with the caregiver, which occurs in 8% of the general population.” [This NIH article earlier reports that the remaining “approximately 15% suffer insecure ‘disorganized’ attachment,” citing their own footnote which states “In normal, middle class families, about 15% of  infants develop disorganized attachment.” [23%+8%+15%  = 46% not securely attached.]

FN2  Felitti VJ, MD; Anda RF, MD, et. al, 1998, “Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study,” American Journal of Preventive Medicine 1998;14:245–258.  Detailed article on the ACE Study: http://acestoohigh.com/2012/10/03/the-adverse-childhood-experiences-study-the-largest-most-important-public-health-study-you-never-heard-of-began-in-an-obesity-clinic/

FN3  Karr-Morse, Robin, Wiley, Meredith,  “Scared Sick,”  Penguin Basic Books, 2012

FN4  Porges, Stephen, PhD, “Body, Brain, Behavior: How Polyvagal Theory Expands Our Healing Paradigm,” 2013, http://stephenporges.com/images/NICABM%202013.pdf
“Beyond the Brain: Vagal System Holds the Secret to Treating Trauma,” 2013, http://stephenporges.com/images/nicabm2.pdf
–“The Polyvagal Theory for Treating Trauma,” 2011, http://stephenporges.com/images/stephen%20porges%20interview%20nicabm.pdf
–“Polyvagal theory: phylogenetic substrates of a social nervous system,” International Journal of Psycho-physiology 42, 2001,  Dept. of Psychiatry, Univ. Illinois Chicago, www.wisebrain.org/Polyvagal_Theory.pdf

FN5   Earned secure attachment occurs when we experience harmful parenting, so we start with insecure attachment, but find ways to “rise above” childhood trauma and “are now securely attached… What’s more important than what happened to us, is how we’ve made sense of our own childhood,” Dr. Dan Siegel says. “When we make sense of our past… we become free to construct a new future for ourselves and for how we parent our children. Research is clear: If we make sense of our lives, we free ourselves from the prison of the past.”  (Source: video by Dr. Mary Main, Dr. Erik Hesse, Dr. Daniel J. Siegel, Dr. Marion Solomon: https://www.youtube.com/watch?v=YJTGbVc7EJY )
The question is: what ways?  How do we “rise above” and “make sense” of our childhood trauma?
“Mindfulness has been shown to be effective in healing insecure attachment,” say Siegel’s recent writings. “The purpose of both psychotherapy and mindfulness practice is to provide this internalized secure base. Attunement, whether it is internal in mindfulness, or interpersonal in attachment, is what leads to a sense of secure base.” (The Mindful Therapist: A Clinician’s Guide to Mindsight and Neural Integration, W.W. Norton, 2010;   Mindsight: The New Science of Personal Transformation,  Random House, 2010).
“The regular exercise of mindful awareness seems to promote the same benefits–bodily and affective self-regulation, attuned communication with others, insight, empathy, and the like–that research has found to be associated with childhood histories of secure attachment,” Siegel wrote earlier. “ Mindfulness and secure attachment alike are capable of generating… the same invaluable psychological resource: an internalized secure base.” (Siegel, 2007, Wallin, 2007, p. 5-6).
In his 1999 book “The Developing Mind: How Relationships and the Brain interact to shape who we are,” (Guilford Press),  Siegel defined “earned secure/autonomous attachment” as a pattern noticed by therapists doing the Adult Attachment Interview:  “individuals whose experiences of childhood… [were] likely to produce insecure attachment (avoidant, ambivalent, or disorganized),” but their AAI interview responses instead show “a fluidity in their narratives and a flexibility in their reflective capacity, such that their present state of mind with respect to attachment is rated as secure/autonomous. These individuals often appear… to have had a significant emotional relationship with a close friend, romantic partner, or therapist, which allowed them to develop out of  insecure…into a secure/autonomous AAI status.”

FN6  Bowlby, John, “The Nature of a Child’s Tie to His Mother,” British Psychoanalytical Society, London, 1958; “Attachment and Loss,” New York, Basic Books, 1969

FN7  Main, Mary,  2000, “The Adult Attachment Interview: Fear, attention, safety and discourse processes;” also titled “The Organized Categories of Infant, Child, and Adult Attachment: Flexible vs. Inflexible Attention Under Attachment-Related Stress,” Jour of Amer Psychoanalytic Assoc, 48:1055-1095; 2000.  *p.1091: “The same average parent-to-child, secure/insecure match of 75% holds even when the interview is conducted before birth of the first child…” Lifespanlearn.org/documents/Main.pdf

FN8  Main, Mary, 2005, with Hesse, Erik & Kaplan, Nancy, “Predictability of Attachment Behavior and Representational Processes at 1, 6, and 19 Years of Age – The Berkeley Longitudinal Study,” Chapter 10 of “Attachment from Infancy to Adulthood: The Major Longitudinal Studies,” edited by Klaus E. Grossmann, Karin Grossmann, and Everett Waters, pp. 245–304, New York: Guilford Press. Main refers to it as “Regensburg.”
https://lifespanlearn.org/documents/5.Main Regensburg 2005 .pdf
–Main’s summary of the Strange Situation in this document:
“Ainsworth structured the Strange Situation procedure to include three of Bowlby’s ‘natural clues to danger’ in eight episodes:  1. Introduction to the room.  2. Mother and infant are left alone in a toy-filled environment whose unfamiliarity supplies the first natural clue to danger.  However, the mother’s presence is expected to provide the infant with security sufficient for exploration and/or play.  3. Providing a second clue to danger, a stranger joins the mother and infant.  4. The mother leaves the infant with the stranger, providing two combined clues to increased danger. 5. The mother returns, and the stranger departs…. Many infants initially seek proximity but then, reassured of their mothers’ nearness, resume play. 6.  The mother leaves, and the infant remains entirely alone in the unfamiliar setting. Infant distress can be strong at this point, and this episode is often terminated rapidly. 7. The stranger, rather than the mother, enters the room. 8. The mother returns… By now, most infants are expected to be crying, and actively not only seeking proximity to mothers, but also… indicating a strong desire to be held… Nonetheless, they are expected to settle and renew interest in exploration and play by the end of this 3-minute period…
“Somewhat surprisingly, Ainsworth found that infant responses to separation and reunion in this procedure fell into three distinct, coherently organized patterns of attachment (“secure,” “insecure-avoidant,” and “insecure-ambivalent” (Ainsworth, Blehar, Waters, & Wall, 1978). … Given the length and complexity of this chapter, we suggest individuals divide reading to its three central parts (secure attachment, pp. 261–273; avoidant attachment, pp. 273–279; and disorganized attachment pp. 279–288).”

FN9  (1988 van Ijzendoorn: on global proof of Ainsworth’s 3 categories; written before Main’s 4 category put in use)
van IJzendoorn, Marinus H.; Kroonenberg, Pieter M.  “Cross-Cultural Patterns of Attachment: A Meta-Analysis of the Strange Situation,” Child Development,Vol 59 No 1, Feb 1988, p.147–56.   Abstract: http://www.jstor.org/discover/10.2307/1130396?uid=3739560&uid=2&uid=4&uid=3739256&sid=21103831443011

FN10   Hesse, E., (2008) “The Adult Attachment Interview: Protocol, Method of Analysis, and Empirical Studies,” Chap. 25 of Cassidy, Jude &  Shaver, Phillip R. (Eds), “Handbook of Attachment: Theory, research, and clinical applications,” 2nd edition, 2008, p. 552-598, New York, Guilford Press. It was online (I downloaded it Aug. 2014) but was taken down or has web issues; try here: http://icpla.edu/wp-content/uploads/2012/10/Hesse-E.-Adult-Attachment-Int-Protocol-Method-ch.-25.pdf   [His 1999 version in Cassidy & Shaver’s 1st edition, Chap. 19,  “The Adult Attachment Interview: Historical and current perspectives,” p. 395-433 wasn’t online.]

FN11   (1999 van Ijzendoorn on Main’s nw Disorganized group; confirms Main’s 4 categories)
van IJzendoorn MH, Schuengel C, Bakermans-Kranenburg MJ, Disorganized attachment in early childhood: Meta-analysis of precursors, concomitants and sequelae. Dev Psychopathol. 1999; 11:225–49. [PubMed] at https://openaccess.leidenuniv.nl/bitstream/handle/1887/1530/168_212.pdf?sequence=1

FN12  Main, Mary, & Solomon, Judith, (1986), “Discovery of an insecure disoriented attachment pattern: procedures, findings and implications for the classification of behavior,” in Brazelton T, Youngman M. Affective Development in Infancy, Ablex, Norwood, NJ
Main, M., & Solomon, J. (1990). “Procedures for identifying infants as disorganized/disoriented during the Ainsworth strange situation,” in Greenberg, M. T., Cicchetti, D., & Cummings, M. (Eds.),. Attachment in the preschool years: Theory, research, and intervention (pp. 121-160), University of Chicago Press

FN13  “Among children of American adolescent mothers, the rate is over 31% (Broussard 1995). Disorganized attachment is also common among the Dogon of Mali (~25%, True et al 2001), infants living on the outskirts of Cape Town, South Africa (~26%, Tomlinson et al 2005) and undernourished children in Chile (Waters and Valenzuela 1999),” reports NIH [op cit FN1; NIH cites v. Ijzendoorn 1999 and the other authors just mentioned]

FN14  George, Carol, Kaplan, Nancy, & Main, Mary, “Adult Attachment Interview,” Unpublished MS, Department of Psychology, University of California at Berkeley, third ed. 1996.  Original 74-page MS dated 1984, 1985, 1996.  Described in FN10 op cit Hesse 2008. ( I have it, but it was removed from the web during 2014.)

FN15  Main, Mary B., “Adult Attachment Interview Protocol,” 11 pgs, 20 questions, no date or publisher. Dr. Main requires intensive training for use of the AAI. The questions per se, marked “Do not reproduce this material without permission of the author,”  are here:  http://www.psychology.sunysb.edu/attachment/measures/content/aai_interview.pdf   UCLA’s Lifespan Learning Institute in Los Angeles holds AAI workshops and has an extensive CD  lectures on the AAI at www.lifespanlearn.org

FN16  Kaplan, Nancy, (1987), Separation Anxiety Test (SAT): “Individual differences in six-year-olds’ thoughts about separation: Predicted to actual experiences of separation,”  Unpublished doctoral dissertation, University of California, Berkeley.
Kaplan, N. (2003, April), “The development of attachment in the Bay Area study: One year, six years, nineteen years of age.” Paper at the biennial meeting of the Society for Research in Child Development, Tampa, FL.

FN17  Main 1985; Main & Goldwyn 1984

FN18  Bakermans-Kranenburg MJ, van IJzendoorn MH, “The first 10,000 Adult Attachment Interviews,” Attach Hum Dev. 2009 May; 11(3): 223-63. doi: 10.1080/14616730902814762 at http://www.ncbi.nlm.nih.gov/pubmed/19455453

More by Mary Main on the AAI:
Main, Mary, PhD, “Introduction to the special section on attachment and psychopathology: 2. Overview of the field of attachment,” Journal of Consulting and Clinical Psychology, 64, 237-243, 1996
Steele, Howard and Miriam, Editors, “Clinical Applications of the Adult Attachment Interview,” The Guilford Press,  New York, 2008

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The Adult Attachment Interview (AAI) (Pt.1 of 2): Mary Ainsworth’s Strange Situation

Mary Main & Dan Siegel December-2010-UCLAOnly 55% of us have “secure attachment”– a number which would worry us all if we knew of it–according to research on over 6,280  infant-parent pairs during 1970-1999. [FN1, 11]  And, the attachment we get as infants continues all our lives in our relationships, say related studies of over 10,500 adults done 1982-2009. [FN18]

The math says the other 45% of us suffer “insecure attachment.”  That means 45% can’t handle a committed, stable relationship with anyone, from childhood to the rest of our lives, as of 1999.  We also pass this emotional pain to our children, who turn out similarly.  A National Institute of Health article summarizes the secure rate:  “Infants with secure attachment greet and/or approach the caregiver and maintain contact but are able to return to play, which occurs in 55% of the general population.” [FN1, 11]

This is the blockbuster result of Dr. Mary Ainsworth’s 1970-1978 “Strange Situation” study of babies, as completed by her student Mary Main.  Main’s research led to shocking conclusions. (Dr. Main & Dr. Daniel Siegel, above)

Main discovered so many upset babies, that she got concerned about the parents. So in 1982 she created the Adult Attachment Interview (AAI) to study the adults, releasing results 1984-96.  Her journey was so “Strange” and involved it was published in language hard to decipher (or even google) for most folks. The tale took me weeks to unravel (footnotes below).

This huge “insecure” figure is a predictor of broken homes and broken hearts for half the nation. It starts to explain why we’ve got a 50% divorce rate. If  (like me) you’ve tried over-40 dating after divorce, it won’t surprise you that science shows 50% of adults out there can’t carry on a secure, committed, loving relationship. Ouch, you’ve experienced it.

And if 45% of us were “insecurely attached” in 1999, what’s the percent in 2016?  In 1999 most of us hadn’t heard of the Internet. In almost 20 years since, email, texting, and so on have further trashed our ability to relate in person. Several psychotherapists interviewed for this blog said that a round number of “about 50%” is a  conservative estimate for how many Americans lack secure attachment today. Many believe it’s much higher.

It gets worse; check out another “about 50%” shocker.  The 1998 Adverse Childhood Experiences (ACE) Study showed that two-thirds (64-67%) of  17,421 middle class subjects had one or more types of childhood trauma, and 38-42% had two or more types.  In less privileged populations, these numbers are far higher. A national average of all economic groups would likely show 50% or more suffer severe trauma from ACEs.

The ACE Study lists physical and sexual abuse and 8 other types, including traumas that happen even to newborns like physical and emotional neglect. [FN2]  Such trauma by definition puts children into technical “fight-flight,” a chronic state biologically proven to shut down the organism’s capacity for feelings of attachment and love. Think soldier in a  battle ramped up in “fight-flight”– he can’t really feel much love for the other side. [FN3]

And it doesn’t go away. Continued fight-flight puts the nervous system into freeze: our vagus nerve starts shutting down bodily functions, Dr. Stephen Porges shows. [FN4] So ACEs create the conditions underlying the top 10 medical causes of death in the U.S.

Half of us are in serious emotional health and medical trouble – and don’t even know it.  Let’s get informed –then we can heal. If we didn’t get securely attached as kids, we can develop “earned secure attachment.”  “It’s possible to change attachment patterns,” as Main said in 2010. [FN5]

 Strange Situation  Experiment

bowlby-johnAttachment Theory isn’t new, it just gets too little air time. British psychiatrist John Bowlby (left) developed it in the 1950s while dealing with the post-WWII crisis of dislocated orphans. [FN6]  Bowlby believed that all infants would seek to stay close to parents, since “proximity-seeking behavior” is best for survival. In 1952 he published a study of toddlers’ responses to separation from parents. It showed that “when toddlers were placed in unfamiliar surroundings that provided no stable caregivers, they underwent three… stages of response to separation: protest, despair, and finally detachment.” [FN7]

Mary Ainsworth ca 1990Dr. Mary Ainsworth studied with Bowlby in London 1950-54, then studied this same “proximity-seeking behavior” (attachment) in infant-mother pairs in homes in Kampala, Uganda, published as “Infancy in Uganda” (1967).  Next, she “found astonishing similarities in homes in Baltimore, Maryland.” [FN7]

So Ainsworth created the Strange Situation in the early 1970s, as a science experiment at Johns Hopkins in Baltimore to document this infant behavior. “Ainsworth deliberately structured the Strange Situation to include three of Bowlby’s ‘natural clues to danger’… to arouse babies to seek proximity” to the parent, Main says. Researchers watch and video-tape through one-way glass, as infant-mother pairs react to apparent danger.  First the babies respond to the strange lab room; then to two entrances of a stranger; then separation from mother at two different times. [FN8]

All or most babies were expected to stay close to parents as Bowlby thought.  Such babies “that Ainsworth termed ‘secure,’ play and explore happily prior to separation; show signs of missing the parent during separation, such as crying and calling; seek proximity immediately upon the parent’s return; and then return to play and exploration, ‘secure’ once again in the parent’s presence,” said Main. [FN8]

But 30% of babies did not act secure — they avoided mom.  Given a choice, they show no preference between mom and the stranger.  “While a majority of infants behaved as expected and were termed secure, to Ainsworth’s amazement six showed little or no distress at being left alone in the unfamiliar environment, and then avoided and ignored the mother upon her return.”  [FN7]

Ainsworth decided to categorize these babies separately, as “avoidant” of mother, so now she had two types: (A) Insecure Avoidant, and (B) Secure. She concluded that their mom didn’t respond to them, or respond with enough sensitivity to understand their actual need, so the infants felt “insecure.”  [FN8]

Still later Ainsworth saw that of the insecure babies, some had yet a third reaction: actually, they were “ambivalent” about mom. They were very distressed when mom left, but on her return, they alternated between avoiding and frantic clinging–plus, they never calmed down. Research showed that ambivalent attachment results from moms who are sometimes available, sometimes not, so babies learn they can’t depend on mom to be there when they need her.

Thus it was that “surprisingly, Ainsworth found that infant responses to separation and reunion fell into three distinct, coherently organized patterns of attachment,” and added a third category: (C) Insecure Ambivalent, Main reports. [FN8-9]

By 1978, Ainsworth’s estimate for U.S. babies was (B) Securely attached 69%; (A) Avoidant 23%, (C) Ambivalent 8%.

By 1988, her Strange Situation study had been done with 2,000 infant-parent pairs in 32 studies in 8 countries. By 1999 it  had been done globally with 6,282 infant-parent pairs. Some countries varied, but the worldwide results averaged out the same as Ainsworth’s 1970s studies. Amazing, but it makes sense considering the U.S. is a global melting pot. [FN1, 9, 11]

But stay tuned for my next blog Feb. 6, when Ainsworth’s grad student Mary Main gets into the act big time.  Main found that Ainsworth’s concept of Securely Attached had flaws that made necessary a whole new fourth category of attachment failure.  And a whole lot fewer than 69% turned out to be “secure.”

If you can’t wait for Part 2 on Feb. 6, the whole article is here: http://attachmentdisorderhealing.com/adult-attachment-interview-aai-mary-main/

———————————
Kathy’s news blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

Footnotes

FN1  NIH: Benoit, Diane , MD, FRCPC, “Infant-parent attachment: Definition, types, antecedents, measurement and outcome,” Paediatr Child Health, Oct 2004; 9(8) p. 541–545 at: www.ncbi.nlm.nih.gov/pmc/articles/PMC2724160/  4th subhead “Measurement” reports:
“The three ‘organized’ strategies (secure, avoidant and resistant) are assessed in the Strange Situation (SS), a 20-minute laboratory procedure where patterns of infant behaviour toward the caregiver following two brief separations are categorized… “Infants with secure attachment greet and/or approach the caregiver and may maintain contact but are able to return to play, which occurs in 55% of the general population… Infants with insecure-avoidant attachment fail to greet and/or approach, appear oblivious to their caregiver’s return… avoiding the caregiver, which occurs in 23% of the general population. Infants with insecure-resistant [ambivalent] attachment are extremely distressed by separations and cannot be soothed at reunions,  displaying much distress and angry resistance to interactions with the caregiver, which occurs in 8% of the general population.” [This NIH article earlier reports that the remaining “approximately 15% suffer insecure ‘disorganized’ attachment,” citing their own footnote which states “In normal, middle class families, about 15% of  infants develop disorganized attachment.” [23%+8%+15%  = 46% not securely attached.]

FN2  Felitti VJ, Anda RF, et. al, 1998, “Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study,” American Journal of Preventive Medicine 1998;14:245–258.  Detailed article on the ACE Study: http://acestoohigh.com/2012/10/03/the-adverse-childhood-experiences-study-the-largest-most-important-public-health-study-you-never-heard-of-began-in-an-obesity-clinic/

FN3  Karr-Morse, Robin, Wiley, Meredith,  “Scared Sick,”  Penguin Basic Books, 2012

FN4  Porges, Stephen, PhD, “Body, Brain, Behavior: How Polyvagal Theory Expands Our Healing Paradigm,” 2013, http://stephenporges.com/images/NICABM%202013.pdf
“Beyond the Brain: Vagal System Holds the Secret to Treating Trauma,” 2013, http://stephenporges.com/images/nicabm2.pdf
–“The Polyvagal Theory for Treating Trauma,” 2011, http://stephenporges.com/images/stephen%20porges%20interview%20nicabm.pdf
–“Polyvagal theory: phylogenetic substrates of a social nervous system,” International Journal of Psycho-physiology 42, 2001,  Dept. of Psychiatry, Univ. Illinois Chicago, www.wisebrain.org/Polyvagal_Theory.pdf

FN5   Earned secure attachment occurs when we experience harmful parenting, so we start with insecure attachment, but find ways to “rise above” childhood trauma and “are now securely attached… What’s more important than what happened to us, is how we’ve made sense of our own childhood,” Dr. Dan Siegel says. “When we make sense of our past… we become free to construct a new future for ourselves and for how we parent our children. Research is clear: If we make sense of our lives, we free ourselves from the prison of the past.”  (Source: video by Dr. Mary Main, Dr. Erik Hesse, Dr. Daniel J. Siegel, Dr. Marion Solomon: https://www.youtube.com/watch?v=YJTGbVc7EJY )
The question is: what ways?  How do we “rise above” and “make sense” of our childhood trauma?
“Mindfulness has been shown to be effective in healing insecure attachment,” say Siegel’s recent writings. “The purpose of both psychotherapy and mindfulness practice is to provide this internalized secure base. Attunement, whether it is internal in mindfulness, or interpersonal in attachment, is what leads to a sense of secure base.” (The Mindful Therapist: A Clinician’s Guide to Mindsight and Neural Integration, W.W. Norton, 2010;   Mindsight: The New Science of Personal Transformation,  Random House, 2010).
“The regular exercise of mindful awareness seems to promote the same benefits–bodily and affective self-regulation, attuned communication with others, insight, empathy, and the like–that research has found to be associated with childhood histories of secure attachment,” Siegel wrote earlier. “ Mindfulness and secure attachment alike are capable of generating… the same invaluable psychological resource: an internalized secure base.” (Siegel, 2007, Wallin, 2007, p. 5-6).
In his 1999 book “The Developing Mind: How Relationships and the Brain interact to shape who we are,” (Guilford Press),  Siegel defined “earned secure/autonomous attachment” as a pattern noticed by therapists doing the Adult Attachment Interview:  “individuals whose experiences of childhood… [were] likely to produce insecure attachment (avoidant, ambivalent, or disorganized),” but their AAI interview responses instead show “a fluidity in their narratives and a flexibility in their reflective capacity, such that their present state of mind with respect to attachment is rated as secure/autonomous. These individuals often appear… to have had a significant emotional relationship with a close friend, romantic partner, or therapist, which allowed them to develop out of  insecure…into a secure/autonomous AAI status.”

FN6  Bowlby, John, “The Nature of a Child’s Tie to His Mother,” British Psychoanalytical Society, London, 1958; “Attachment and Loss,” New York, Basic Books, 1969

FN7  Main, Mary,  2000, “The Adult Attachment Interview: Fear, attention, safety and discourse processes;” also titled “The Organized Categories of Infant, Child, and Adult Attachment: Flexible vs. Inflexible Attention Under Attachment-Related Stress,” Jour of Amer Psychoanalytic Assoc, 48:1055-1095; 2000.  *p.1091: “The same average parent-to-child, secure/insecure match of 75% holds even when the interview is conducted before birth of the first child…” Lifespanlearn.org/documents/Main.pdf

FN8  Main, Mary, 2005, with Hesse, Erik & Kaplan, Nancy, “Predictability of Attachment Behavior and Representational Processes at 1, 6, and 19 Years of Age – The Berkeley Longitudinal Study,” Chapter 10 of “Attachment from Infancy to Adulthood: The Major Longitudinal Studies,” edited by Klaus E. Grossmann, Karin Grossmann, and Everett Waters, pp. 245–304, New York: Guilford Press. Main refers to it as “Regensburg.”
https://lifespanlearn.org/documents/5.Main Regensburg 2005 .pdf
–Main’s summary of the Strange Situation in this document:
“Ainsworth structured the Strange Situation procedure to include three of Bowlby’s ‘natural clues to danger’ in eight episodes:  1. Introduction to the room.  2. Mother and infant are left alone in a toy-filled environment whose unfamiliarity supplies the first natural clue to danger.  However, the mother’s presence is expected to provide the infant with security sufficient for exploration and/or play.  3. Providing a second clue to danger, a stranger joins the mother and infant.  4. The mother leaves the infant with the stranger, providing two combined clues to increased danger. 5. The mother returns, and the stranger departs…. Many infants initially seek proximity but then, reassured of their mothers’ nearness, resume play. 6.  The mother leaves, and the infant remains entirely alone in the unfamiliar setting. Infant distress can be strong at this point, and this episode is often terminated rapidly. 7. The stranger, rather than the mother, enters the room. 8. The mother returns… By now, most infants are expected to be crying, and actively not only seeking proximity to mothers, but also… indicating a strong desire to be held… Nonetheless, they are expected to settle and renew interest in exploration and play by the end of this 3-minute period…
“Somewhat surprisingly, Ainsworth found that infant responses to separation and reunion in this procedure fell into three distinct, coherently organized patterns of attachment (“secure,” “insecure-avoidant,” and “insecure-ambivalent” (Ainsworth, Blehar, Waters, & Wall, 1978). … Given the length and complexity of this chapter, we suggest individuals divide reading to its three central parts (secure attachment, pp. 261–273; avoidant attachment, pp. 273–279; and disorganized attachment pp. 279–288).”

FN9  (1988 van Ijzendoorn: on global proof of Ainsworth’s 3 categories; written before Main’s 4 category put in use)
van IJzendoorn, Marinus H.; Kroonenberg, Pieter M.  “Cross-Cultural Patterns of Attachment: A Meta-Analysis of the Strange Situation,” Child Development,Vol 59 No 1, Feb 1988, p.147–56.   Abstract: http://www.jstor.org/discover/10.2307/1130396?uid=3739560&uid=2&uid=4&uid=3739256&sid=21103831443011

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The Adult Attachment Interview (AAI): Mary Main in a Strange Situation

Mary Main & Dan Siegel December-2010-UCLA[Updated 7-7-16]  Only 55% of us have “secure attachment”– a number which would worry us all if we knew about it–according to research on over 6,280  infant-parent pairs during 1970-1999. [FN1, 11]  And, the attachment we get as infants continues all our lives in our relationships, say related studies of over 10,500 adults done 1982-2009. [FN18]

The math says the other 45% of us suffer “insecure attachment.”  That means 45% can’t handle a committed, stable relationship with anyone, from childhood to the rest of our lives, as of 1999.  We also pass this emotional pain to our children, who turn out similarly.  A National Institute of Health article summarizes the secure rate:  “Infants with secure attachment greet and/or approach the caregiver and maintain contact but are able to return to play, which occurs in 55% of the general population.” [FN1, 11]

This is the blockbuster result of Dr. Mary Ainsworth’s 1970-1978 “Strange Situation” study of babies, as completed by her student Mary Main.  Main’s research led to shocking conclusions. (Dr. Main & Dr. Daniel Siegel, above)

Main discovered so many upset babies, that she got concerned about the parents. So in 1982 she created the Adult Attachment Interview (AAI) to study the adults, releasing results 1984-96.  Her journey was so “Strange” and involved it was published in language hard to decipher (or even google) for most folks. The tale took me weeks to unravel (footnotes below).

This huge “insecure” figure is a predictor of broken homes and broken hearts for half the nation. It starts to explain why we’ve got a 50% divorce rate. If  (like me) you’ve tried over-40 dating after divorce, it won’t surprise you that science shows 50% of adults out there can’t carry on a secure, committed, loving relationship. Ouch, you’ve experienced it.

And if 45% of us were “insecurely attached” in 1999, what’s the percent in 2016?  In 1999 most of us hadn’t heard of the Internet. In almost 20 years since, email, texting, and so on have further trashed our ability to relate in person. Several psychotherapists interviewed for this blog said that a round number of “about 50%” is a  conservative estimate for how many Americans lack secure attachment today. Many believe it’s much higher.

It gets worse; check out another “about 50%” shocker.  The 1998 Adverse Childhood Experiences (ACE) Study showed that two-thirds (64-67%) of  17,421 middle class subjects had one or more types of childhood trauma, and 38-42% had two or more types.  In less privileged populations, these numbers are far higher. A national average of all economic groups would likely show 50% or more suffer severe trauma from ACEs.

The ACE Study lists physical and sexual abuse and 8 other types, including traumas that happen even to newborns like physical and emotional neglect. [FN2]  Such trauma by definition puts children into technical “fight-flight,” a chronic state biologically proven to shut down the organism’s capacity for feelings of attachment and love. Think soldier in a  battle ramped up in “fight-flight”– he can’t really feel much love for the other side. [FN3]

And it doesn’t go away. Continued fight-flight puts the nervous system into freeze: our vagus nerve starts shutting down bodily functions, Dr. Stephen Porges shows. [FN4] So ACEs create the conditions underlying the top 10 medical causes of death in the U.S.

Half of us are in serious emotional health and medical trouble – and don’t even know it.  Let’s get informed –then we can heal. If we didn’t get securely attached as kids, we can develop “earned secure attachment.”  “It’s possible to change attachment patterns,” as Main said in 2010. [FN5]

 Strange Situation  Experiment

bowlby-johnAttachment Theory isn’t new, it just gets too little air time. British psychiatrist John Bowlby (left) developed it in the 1950s while working on the post-war orphan crisis. [FN6]  Bowlby believed that all infants would seek to stay close to parents, since such “attachment” promotes survival. In 1952 he published a study of toddlers’ responses to separation from parents. It showed that “when toddlers were placed in unfamiliar surroundings that provided no stable caregivers, they underwent three… stages of response to separation: protest, despair, and finally detachment.” [FN7]

Mary Ainsworth ca 1990Dr. Mary Ainsworth studied with Bowlby in London 1950-54, then researched his concept of “proximity-seeking behavior” in infant-mother pairs in Kampala, Uganda, published as “Infancy in Uganda” (1967).  Then she found “astonishing similarities” in Baltimore, MD pairs. [FN7]

Ainsworth created the Strange Situation in the early 1970s, as a science experiment at Johns Hopkins in Baltimore to document this infant behavior. “Ainsworth structured the Strange Situation to include three of Bowlby’s ‘natural clues to danger’… to arouse babies to seek proximity” to the parent, Main says. Researchers watch and video-tape through one-way glass, as infant-mother pairs react to apparent danger.  First a baby responds to a strange lab room; then to two entrances of a strange person; then to  two different separations from its mother. [FN8]

Babies were expected to stay close to parents as Bowlby thought.  Babies “that Ainsworth termed ‘secure,’ play and explore happily prior to separation; show signs of missing the parent during separation, such as crying and calling; seek proximity immediately upon the parent’s return; then return to play and exploration, ‘secure’ once again in the parent’s presence,” said Main. [FN8]

But 30% of babies did not act secure — they avoided mom.  They showed no preference between mom and the stranger!  “While a majority of infants behaved as expected and were termed secure, to Ainsworth’s amazement six showed little or no distress at being left alone in the unfamiliar environment, then avoided and ignored the mother on her return.”  [FN7]

Ainsworth decided to categorize these babies separately, as “avoidant” of mother. Now she had two types: (A) Insecure Avoidant, and (B) Secure. She concluded that their mom didn’t respond to them, or have the sensitivity to understand their actual need, so the infants felt “insecure.”  [FN8]

Still later Ainsworth saw that of the insecure babies, some had yet a third reaction: actually, they were “ambivalent” about mom. They were very distressed when mom left, but on her return, they alternated between avoiding and frantic clinging–plus, they never calmed down. Research showed that ambivalent attachment results from moms who are sometimes available, sometimes not, so babies learn they can’t depend on mom.

Thus it was that “surprisingly, Ainsworth found that infant responses to separation and reunion fell into three distinct, coherently organized patterns of attachment,” and added a third category: (C) Insecure Ambivalent, Main reports. [FN8-9]

By 1977 Ainsworth had categorized U.S. babies as (B) Securely attached 69%; (A) Avoidant 23%, (C) Ambivalent 8%.

By 1988 Strange Situation research had been done with 2,000 infant-parent pairs in 32 studies in 8 countries. By 1999 it  had been done globally with 6,282 infant-parent pairs. Some countries varied, but global results averaged the same as Ainsworth’s 1977 categories.  [FN1, 9, 11]

Scary Parents:  The Adult Attachment Interview

Mary Main BerkeleyIn 1973 Mary Main became Ainsworth’s grad student at Johns Hopkins in Baltimore, working on the Strange Situation experiments from their start. After her doctorate Main moved to Berkeley, to see if Ainsworth’s Kampala and Baltimore findings would replicate. [FN8]  In 1977 Main did a Strange Situation study of 189 Bay Area infant-parent pairs which did replicate Ainsworth. [FN8,10]

But by 1979 Dr. Main was making her own discoveries—out of concern about the parents. “In none of Ainsworth’s original observations was the possibility considered that some mothers… could also be frightening,” Main notes. “For my dissertation at Johns Hopkins, I watched 50 children in the Strange Situation… Using Ainsworth’s three-part classification (secure, avoidant and ambivalent), I found at least five infants could not be classified…

“I had visited most of the mothers in their homes,” Main said, “and I knew that at least three of the five mothers of the un-classifiable infants had behaved most peculiarly with their offspring. One—frighteningly, to me—had treated her toddler as an animal.” [FN8]

Ainsworth was concerned, too; in fact, she’d left some babies in her Secure set only because they didn’t fit her other two sets. [FN8]

By 1982, Main decided to “extend attachment theory to include the import of infant exposure to anomalous fear-arousing parental behaviors… The mother is the haven of safety that must be approached in times of danger. However, when the infant’s biological haven of safety has simultaneously become a source of fright, the infant is placed in an irresolvable and disorganizing approach-flight paradox,” she said.  [FN8]

Soon after, Main and Ainsworth agreed that 14-15% of babies actually belong in a new, fourth category: (D) Insecure Disorganized. Their mothers were so frightening that the babies couldn’t develop any consistent response at all. These infants “exhibited a diverse array of inexplicable or overtly conflicted behaviors in the parent’s presence” including “disorganization, disorientation, and confusion,” Main wrote. This included crying loudly then suddenly freezing; ignoring the parent to rock on hands and knees; moving away; raising hand to mouth in fear; or even swiping at the parent’s face. They seemed vulnerable to dissociation.   [FN11, 8]

This finding that a whopping 15% of average U.S. babies are so insecure they’re almost incoherent was so shocking, it was checked for years and not used as a formal 4th category until after 1990 (this delay confuses many scholars who look at 1982-1990). [FN12]  But the number held. Worse, among children of American adolescent mothers the rate is over 31%, and is over 25% in many Third World nations. [FN13]

Further: to remove the 14-15% of disorganized babies from Ainsworth’s original 69% Secure, reduced the Secure set to only 54-55%.  What was up with parents that 45-46% of their kids couldn’t manage secure attachment?  Main was developing  four categories: Avoidant 23%, Ambivalent 8%, Disorganized, 14-15%, Secure 54-55%.  [FN1, 11]

Mary Main '09 Bowlby-Ainsworth award(Inge Bretherton,Everett Waters)By 1982 Main had seen enough to create the Adult Attachment Interview (AAI).  She’d seen plenty of disorganized babies, and that meant a lot of scary parents. She needed a way to document the behavior of the parents. [FN14] (Right: Dr. Main (center) receives the 2009 Bowlby-Ainsworth Attachment Award.)

The AAI was designed to document the level of secure, loving attachment the parents had, during their own childhoods with their babies’ grandparents. Parents were asked “both to described their attachment-related childhood experiences – especially their early relations with parents – and to evaluate the influence of these experiences on their development and current functioning.”

Parents were studied not just on facts they gave, but on how coherent a narrative they could produce quickly. That’s easy for folks who had a secure childhood, but difficult for folks who did not. The AAI questions are designed to “surprise the unconscious” to yield information about the “state of mind with regard to attachment” that might not otherwise show up. Each AAI was taped and transcribed verbatim. Then transcripts were classified by specific patterns by independent trained specialists. [FN15, 10]

In 1982 Main also created the “Berkeley Longitudinal Study” to take 67 Bay Area infant-parent pairs from her 1977 Strange Situation and study them for a generation. In 1977 the babies were 12-18 months old.  Main and her team re-studied these pairs when the kids reached age 6 in 1982, and studied the kids again when they reached 19 in 1995.  [FN8,10]  In 1982 Main and her team gave three different tests to the Bay Area pairs:

— 1. The six year olds were again studied with their parents in the Strange Situation (as in 1977 when these kids were infants).

— 2. The “sixes” were also individually (without parents) given a new Separation Anxiety Test (SAT): they were shown pictures of children being separated from their parents, then asked how they felt. This was taped, transcribed and sorted by Main’s student Nancy Kaplan into Ainsworth’s three sets: secure, avoidant and ambivalent. [FN16, 8]

— 3. The parents were given the AAI (alone). Responses were sorted into three types of adult attachment matching Ainsworth’s three categories of infant attachment: Secure-autonomous (matching infant Secure), Dismissing (infant Avoidant)  and Preoccupied (infant Ambivalent). (Again, Main’s 4th category wasn’t used until after 1990.) [FN17, 8, 10]

Astonishing Results You’ve Never Heard

Mary Main, Erik Hesse '09 Bolwby-Ainsworth AwardDr Main’s first 1982 AAI results were so astonishing that attachment researchers have been buzzing ever since.  (Dr. Main and Dr. Erik Hesse, right.) Her results were also so important, it’s a tragedy that your doctor never learned this in medical school; your therapist (and mine) never heard of it; you’ve never heard of it; and so you have to read about it here, since the media doesn’t report it. It’s hard to even find this story on the internet; I had to sleuth it out.  Dr. Main’s initial AAI results were:

First: the six year olds’ 1982 responses to parents in the Strange Situation correlated strongly to their 1977 responses in the Strange Situation as infants — five years earlier. In 1977 the infants were Securely attached 69%;  Avoidant 23%, and Ambivalent 8%. In 1982 these kids at six responded to parents just as they had as infants, in the same percents. [FN7]

Second: the six year olds’ 1982 solo responses to the SAT photos also produced the same results and percentages.

Third: The parents’ 1982 solo responses to the Adult Attachment Interview correlated strongly with how their kids behaved as infants in the Strange Situation — five  years earlier.  The parents also turned out to be Secure (matching infant “Secure”) 69%;  Dismissing (matching infant “Avoidant”) 23%;  and Preoccupied (matching infant “Ambivalent”) 8%.

Fourth:  The match of the parents’ own 1982 AAI security, with how secure their babies were five years back in 1977, was at an unheard-of level. It correlated more than 70% of the time, in a field where a 20% correlation is highly significant. “A marked relation between a parent’s discussion of his/her own attachment history (AAI), and the offspring’s Strange Situation behavior 5 years previously, had been uncovered.”  [FN8, 10]

Fifth: When the 1977 infants reached age 19 in 1995, they too were given the Adult Attachment Interview. Again results correlated strongly: the 19 year olds’ responses in the 1995 AAI correlated precisely to their infant behavior in the 1977 Strange Situation, their 1982 behavior at six, and to their parents’ 1982 AAI responses.  This was astonishing.

It means that the Strange Situation predicts an infant’s emotional behavior for life, and the AAI proves it.  [FN8, 10]

Sixth: When after 1990 Mary Main’s four categories were used, the results of all these tests correlated just as strongly across the four new categories, as when data were sorted into only three sets. Main’s four categories did become Avoidant 23%, Ambivalent 8%, Disorganized, 14-15%, and Secure 54-55%.  Whenever responses to the Strange Situation, SAT, and AAI were sorted into these four sets, the same percents were found. [FN1, 11]

By 2009, over 10,500 subjects globally had been given the AAI and the results continue to average out the same.  [FN18]

“Researchers worldwide have replicated the relation originally uncovered in the Bay Area study between a parent’s status in the Adult Attachment Interview and an infant’s Strange Situation response to that same parent… The same average parent-to-child, secure/insecure match of 75% holds even when the interview is conducted before birth of the first child…

“Describing the strength of this relation across studies conducted several years ago, van I Jzendoorn (1995) calculated that it would take 1,087 further attempted replications, every one yielding insignificant results, to reduce the present relation between adult and infant attachment status to insignificance,” Main concluded. [FN7, p.1091]

———————————
Kathy’s news blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

Footnotes

FN1  NIH: Benoit, Diane, MD, FRCPC, “Infant-parent attachment: Definition, types, antecedents, measurement and outcome,” Paediatr Child Health, Oct 2004; 9(8) p. 541–545 at: www.ncbi.nlm.nih.gov/pmc/articles/PMC2724160/  4th subhead “Measurement” reports:
“The three ‘organized’ strategies (secure, avoidant and resistant) are assessed in the Strange Situation (SS), a 20-minute laboratory procedure where patterns of infant behaviour toward the caregiver following two brief separations are categorized… “Infants with secure attachment greet and/or approach the caregiver and may maintain contact but are able to return to play, which occurs in 55% of the general population… Infants with insecure-avoidant attachment fail to greet and/or approach, appear oblivious to their caregiver’s return… avoiding the caregiver, which occurs in 23% of the general population. Infants with insecure-resistant [ambivalent] attachment are extremely distressed by separations and cannot be soothed at reunions,  displaying much distress and angry resistance to interactions with the caregiver, which occurs in 8% of the general population.” [This NIH article earlier reports that the remaining “approximately 15% suffer insecure ‘disorganized’ attachment,” citing their own footnote which states “In normal, middle class families, about 15% of  infants develop disorganized attachment.” [23%+8%+15%  = 46% not securely attached.]

FN2  Felitti VJ, MD; Anda RF, MD, et. al, 1998, “Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study,” American Journal of Preventive Medicine 1998;14:245–258.  Detailed article on the ACE Study: http://acestoohigh.com/2012/10/03/the-adverse-childhood-experiences-study-the-largest-most-important-public-health-study-you-never-heard-of-began-in-an-obesity-clinic/

FN3  Karr-Morse, Robin, Wiley, Meredith,  “Scared Sick,”  Penguin Basic Books, 2012

FN4  Porges, Stephen, PhD, “Body, Brain, Behavior: How Polyvagal Theory Expands Our Healing Paradigm,” 2013, http://stephenporges.com/images/NICABM%202013.pdf
“Beyond the Brain: Vagal System Holds the Secret to Treating Trauma,” 2013, http://stephenporges.com/images/nicabm2.pdf
–“The Polyvagal Theory for Treating Trauma,” 2011, http://stephenporges.com/images/stephen%20porges%20interview%20nicabm.pdf
–“Polyvagal theory: phylogenetic substrates of a social nervous system,” International Journal of Psycho-physiology 42, 2001,  Dept. of Psychiatry, Univ. Illinois Chicago, www.wisebrain.org/Polyvagal_Theory.pdf

FN5   Earned secure attachment occurs when we experience harmful parenting, so we start with insecure attachment, but find ways to “rise above” childhood trauma and “are now securely attached… What’s more important than what happened to us, is how we’ve made sense of our own childhood,” Dr. Dan Siegel says. “When we make sense of our past… we become free to construct a new future for ourselves and for how we parent our children. Research is clear: If we make sense of our lives, we free ourselves from the prison of the past.”  (Source: video by Dr. Mary Main, Dr. Erik Hesse, Dr. Daniel J. Siegel, Dr. Marion Solomon: https://www.youtube.com/watch?v=YJTGbVc7EJY )
The question is: what ways?  How do we “rise above” and “make sense” of our childhood trauma?
“Mindfulness has been shown to be effective in healing insecure attachment,” say Siegel’s recent writings. “The purpose of both psychotherapy and mindfulness practice is to provide this internalized secure base. Attunement, whether it is internal in mindfulness, or interpersonal in attachment, is what leads to a sense of secure base.” (The Mindful Therapist: A Clinician’s Guide to Mindsight and Neural Integration, W.W. Norton, 2010;   Mindsight: The New Science of Personal Transformation,  Random House, 2010).
“The regular exercise of mindful awareness seems to promote the same benefits–bodily and affective self-regulation, attuned communication with others, insight, empathy, and the like–that research has found to be associated with childhood histories of secure attachment,” Siegel wrote earlier. “ Mindfulness and secure attachment alike are capable of generating… the same invaluable psychological resource: an internalized secure base.” (Siegel, 2007, Wallin, 2007, p. 5-6).
In his 1999 book “The Developing Mind: How Relationships and the Brain interact to shape who we are,” (Guilford Press),  Siegel defined “earned secure/autonomous attachment” as a pattern noticed by therapists doing the Adult Attachment Interview:  “individuals whose experiences of childhood… [were] likely to produce insecure attachment (avoidant, ambivalent, or disorganized),” but their AAI interview responses instead show “a fluidity in their narratives and a flexibility in their reflective capacity, such that their present state of mind with respect to attachment is rated as secure/autonomous. These individuals often appear… to have had a significant emotional relationship with a close friend, romantic partner, or therapist, which allowed them to develop out of  insecure…into a secure/autonomous AAI status.”

FN6  Bowlby, John, “The Nature of a Child’s Tie to His Mother,” British Psychoanalytical Society, London, 1958; “Attachment and Loss,” New York, Basic Books, 1969

FN7  Main, Mary,  2000, “The Adult Attachment Interview: Fear, attention, safety and discourse processes;” also titled “The Organized Categories of Infant, Child, and Adult Attachment: Flexible vs. Inflexible Attention Under Attachment-Related Stress,” Jour of Amer Psychoanalytic Assoc, 48:1055-1095; 2000.  *p.1091: “The same average parent-to-child, secure/insecure match of 75% holds even when the interview is conducted before birth of the first child…” Lifespanlearn.org/documents/Main.pdf

FN8  Main, Mary, 2005, with Hesse, Erik & Kaplan, Nancy, “Predictability of Attachment Behavior and Representational Processes at 1, 6, and 19 Years of Age – The Berkeley Longitudinal Study,” Chapter 10 of “Attachment from Infancy to Adulthood: The Major Longitudinal Studies,” edited by Klaus E. Grossmann, Karin Grossmann, and Everett Waters, pp. 245–304, New York: Guilford Press. Main refers to it as “Regensburg.”
https://lifespanlearn.org/documents/5.Main Regensburg 2005 .pdf
–Main’s summary of the Strange Situation in this document:
“Ainsworth structured the Strange Situation procedure to include three of Bowlby’s ‘natural clues to danger’ in eight episodes:  1. Introduction to the room.  2. Mother and infant are left alone in a toy-filled environment whose unfamiliarity supplies the first natural clue to danger.  However, the mother’s presence is expected to provide the infant with security sufficient for exploration and/or play.  3. Providing a second clue to danger, a stranger joins the mother and infant.  4. The mother leaves the infant with the stranger, providing two combined clues to increased danger. 5. The mother returns, and the stranger departs…. Many infants initially seek proximity but then, reassured of their mothers’ nearness, resume play. 6.  The mother leaves, and the infant remains entirely alone in the unfamiliar setting. Infant distress can be strong at this point, and this episode is often terminated rapidly. 7. The stranger, rather than the mother, enters the room. 8. The mother returns… By now, most infants are expected to be crying, and actively not only seeking proximity to mothers, but also… indicating a strong desire to be held… Nonetheless, they are expected to settle and renew interest in exploration and play by the end of this 3-minute period…
“Somewhat surprisingly, Ainsworth found that infant responses to separation and reunion in this procedure fell into three distinct, coherently organized patterns of attachment (“secure,” “insecure-avoidant,” and “insecure-ambivalent” (Ainsworth, Blehar, Waters, & Wall, 1978). … Given the length and complexity of this chapter, we suggest individuals divide reading to its three central parts (secure attachment, pp. 261–273; avoidant attachment, pp. 273–279; and disorganized attachment pp. 279–288).”

FN9  (“van Ijzendoorn 1988,” global replication of Ainsworth’s 3 categories; written before Main’s 4th category came into use) – van IJzendoorn, Marinus H.; Kroonenberg, Pieter M.  “Cross-Cultural Patterns of Attachment: A Meta-Analysis of the Strange Situation,” Child Development,Vol 59 No 1, Feb 1988, p.147–56.   Abstract: http://www.jstor.org/discover/10.2307/1130396?uid=3739560&uid=2&uid=4&uid=3739256&sid=21103831443011

FN10  Hesse, E., (2008) “The Adult Attachment Interview: Protocol, Method of Analysis, and Empirical Studies,” Chap. 25 of Cassidy, Jude &  Shaver, Phillip R. (Eds), “Handbook of Attachment: Theory, research, and clinical applications,” 2nd edition, 2008, p. 552-598, New York, Guilford Press. It was online (I downloaded it Aug. 2014) but was taken down or has web issues; try here: http://icpla.edu/wp-content/uploads/2012/10/Hesse-E.-Adult-Attachment-Int-Protocol-Method-ch.-25.pdf   [His 1999 version in Cassidy & Shaver’s 1st edition, Chap. 19,  “The Adult Attachment Interview: Historical and current perspectives,” p. 395-433 wasn’t online.]

FN11   (“van Ijzendoorn 1999” on Main’s new Disorganized category; confirms need for 4 categories)  van IJzendoorn MH, Schuengel C, Bakermans-Kranenburg MJ, Disorganized attachment in early childhood: Meta-analysis of precursors, concomitants and sequelae. Dev Psychopathol. 1999; 11:225–49. https://openaccess.leidenuniv.nl/bitstream/handle/1887/1530/168_212.pdf?sequence=1

FN12  Main, Mary, & Solomon, Judith, (1986), “Discovery of an insecure disoriented attachment pattern: procedures, findings and implications for the classification of behavior,” in Brazelton T, Youngman M. Affective Development in Infancy, Ablex, Norwood, NJ
Main, M., & Solomon, J. (1990). “Procedures for identifying infants as disorganized/disoriented during the Ainsworth strange situation,” in Greenberg, M. T., Cicchetti, D., & Cummings, M. (Eds.),. Attachment in the preschool years: Theory, research, and intervention (pp. 121-160), University of Chicago Press

FN13  “Among children of American adolescent mothers, the rate is over 31% (Broussard 1995). Disorganized attachment is also common among the Dogon of Mali (~25%, True et al 2001), infants living on the outskirts of Cape Town, South Africa (~26%, Tomlinson et al 2005) and undernourished children in Chile (Waters and Valenzuela 1999),” reports NIH [op cit FN1; NIH cites v. Ijzendoorn 1999 and the other authors just mentioned]

FN14  George, Carol, Kaplan, Nancy, & Main, Mary, “Adult Attachment Interview,” Unpublished MS, Department of Psychology, University of California at Berkeley, third ed. 1996.  Original 74-page MS dated 1984, 1985, 1996.  Described in FN10 op cit Hesse 2008. ( I have it, but it was removed from the web during 2014.)

FN15  Main, Mary B., “Adult Attachment Interview Protocol,” 11 pgs, 20 questions, no date or publisher. Dr. Main requires intensive training for use of the AAI. The questions per se, marked “Do not reproduce this material without permission of the author,”  are here:  http://www.psychology.sunysb.edu/attachment/measures/content/aai_interview.pdf   UCLA’s Lifespan Learning Institute in Los Angeles holds AAI workshops and has an extensive CD  lectures on the AAI at www.lifespanlearn.org

FN16  Kaplan, Nancy, (1987), Separation Anxiety Test (SAT): “Individual differences in six-year-olds’ thoughts about separation: Predicted to actual experiences of separation,”  Unpublished doctoral dissertation, University of California, Berkeley.
Kaplan, N. (2003, April), “The development of attachment in the Bay Area study: One year, six years, nineteen years of age.” Paper at the biennial meeting of the Society for Research in Child Development, Tampa, FL.

FN17  Main 1985; Main & Goldwyn 1984

FN18  Bakermans-Kranenburg MJ, van IJzendoorn MH, “The first 10,000 Adult Attachment Interviews,” Attach Hum Dev. 2009 May; 11(3): 223-63. doi: 10.1080/14616730902814762 at http://www.ncbi.nlm.nih.gov/pubmed/19455453

More by Mary Main on the AAI:
Main, Mary, PhD, “Introduction to the special section on attachment and psychopathology: 2. Overview of the field of attachment,” Journal of Consulting and Clinical Psychology, 64, 237-243, 1996
Steele, Howard and Miriam, Editors, “Clinical Applications of the Adult Attachment Interview,” The Guilford Press,  New York, 2008

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Substance Abuse or Survival?

Substance Abuse or Survival Mechanism?
What the ACE Study Tells Us About – Ourselves …  November 8

BrousBlog7a ACE pyramidLast Friday Nov. 1, down the road from county Mental Health Services in San Diego, CA, eleven local activists from the mental health, health care, social outreach, and justice systems met for lunch.  We discussed the Adverse Childhood Experiences (ACE) Study, research on 17,421 average clients at an average San Diego HMO, who were simply asked if they’d had bad childhood experiences, physical or emotional. The study compared their childhoods, to whether they later developed life-threatening physical medical conditions and/or addictions.

The data revealed staggering proof of the health, social, and economic risks that result from childhood trauma.  It showed that such trauma and its consequent serious medical issues affect over 50% of the population of the U.S.  The ACE Pyramid shows that Adverse Childhood Experiences often lead to impaired thinking, unhealthy behavior, life-threatening disease, and are topped off by early death.

The ACE Study participants are mostly middle-class, college-educated HMO clients. Two-thirds (64-67%) had one or more types of childhood trauma, and 38-42% had two or more types.   One in six had an ACE score of 4 or more, and one in nine had an ACE score of 5 or more.  Child trauma and its lethal results affect an unknown higher percent of Americans raised in poverty.  A national average of all economic groups would likely show 50% or more suffer severe trauma from ACEs.

This is not an issue to which one might donate at Christmas, then forget. This could well be about you and your family, and almost any American.  So why are you and your family in the dark?

How can almost 20 years of official study on 17,421 people be so far under our radar? The ACE Study began in 1995 at Kaiser Permanente, the largest HMO in California, as joint research with the U.S. government Centers for Disease Control (CDC). First results were reported in the 1998 American Journal of Preventive Medicine by chief investigators Dr. Vincent Felitti MD of Kaiser, Dr. Robert Anda, MD of CDC and their colleagues, and have appeared in over 60 medical journals. [FN1]

The public info gap is not for lack of alarm-ringing. Drs. Felitti and Anda, who started as curious scientists and became passionate advocates, have burned the global lecture circuits.  ACEsConnection, its news site ACEsTooHigh and their creator, science journalist Jane Ellen Stevens, have spent the last eight years knocking on national media doors and spurring grassroots education. [FN2]

Felitti SoCal ACEs Nov1 2013 cropOur Nov. 1 lunch was the first meeting of  “SoCal ACEs,” the Southern California chapter of ACEsConnection, started by another career writer, me, with Jane’s help. We’re all passionate about ringing the alarm.  While we were passionately passing the curry, in walked Dr. Vincent Felitti himself, much to our surprise.

“Public Health Problems – or Personal Solutions?”

Dr. Felitti made some eye- opening comments to our SoCal ACES lunch, remarks he’s made before in speeches, DVDs, and videos released by the CDC and other agencies. [FN3] Yet since so few have gotten his message, it’s necessary to repeat his comments, and flatly state the implications. Sometimes a badly needed wake-up call can feel as if it were in-your-face.  Sorry to play Paul Revere, but we can do plenty about this – if we have the courage to get to the bottom of it and think it through.

Based on the ACE Study statistics, Dr. Felitti said, “The risk factors which can be  attributed to Adverse Childhood Experiences include… about 2/3 of all alcoholism, about half of all drug abuse, and about 3/4s of intravenous drug use (in the U.S.).  These are the risk factors that underlie the 10 most common causes of death in the United States.  With an ACE score of zero,” he notes, “You have a very medically un-interesting population:  non-obese, non-smoking, non-alcoholic, non-diabetic, non-hypertensive. No internist has a chance of making a living with that group. But with an ACE score of 4 or more, this is big medicine!

“And,” Dr. Felitti continued, “the things that we call ‘risk factors’ are in fact, effecting coping devises.  This is an important idea.

“Many of these things termed ‘public health problems’ are in fact, personal solutions.  Personal solutions to problems (ACE) that are well-hidden, by time, by shame, by secrecy, by social taboo (many child traumas are sexual, physical, and emotional hidden for a lifetime).

“Public health problem = personal solution?  That’s a pretty heavy-handed statement, but I feel very comfortable making it…

“This is what psychoanalysts have been saying for a hundred years; but they’ve been saying it based on two cases or four – and we’re saying it based on 18,000 cases.  One way of describing it would be: you have this large base of individuals with Adverse Childhood Experiences, and most of them are going to be impaired as a result in some way, maybe socially, maybe emotionally, maybe cognitively…

Felitti ACE DVD 3-min Preview screenshot“By the time they become adolescents and have some freedom, they ordinarily will try to do something to feel better, and hence initiate what we call health-risk behaviors, but which might be called more properly ‘self-help behaviors.’  Those, over time, will produced disease and disability in many of them, and a significant portion of them will die early,” as the ACE pyramid shows. (‘Early Death’ being the top of the pyramid.) [ FN4]

“Swiss psychoanalyst Alice Miller says: ‘The truth about our childhood is stored up in our bodies, and lives in the depths of our souls’,” Dr. Felitti ended.  ” ‘Our intellect can be deceived, our feelings can be numbed and manipulated, our perceptions can be shamed and confused, our bodies tricked with medication. But our soul never forgets. And because we are one whole soul in one body, some day our body will present its bill.’

“In this study, we are looking at it literally. The cost of this is truly enormous. Whoever would have thought that pediatrics, is the breeding ground for internal medicine.”

The ACE Study “provides more understanding about the lives of hundreds of millions of people around the world who use biochemical coping methods – such as alcohol, marijuana, food, sex, tobacco, violence, workaholism, methamphetamines, thrill sports – to escape intense fear, anxiety, depression, anger,”  as Jane Stevens told the Huffington Post.  Such  compulsive forms of self-abuse, also including internet porn and more, are endemic to every income bracket.

“Public health experts, social service workers, educators, therapists and policy makers commonly regard addiction as a problem,” she writes. “Some, however, are beginning to grasp that turning to these drugs is a normal response to serious childhood trauma, and that telling people who smoke or overeat or overwork that these are bad for them and that they should stop, doesn’t register when those approaches provide a temporary, but gratifying solution.” [FN5]

Trauma and Survival

Are all these people broken crop3Do all these individuals “just happen” to be broken? Are they the problem?  Or at least, are they mere individual problems?

Or is our society as a whole, which is producing human
children with a 50% or higher failure rate, the thing which needs major policy changes and a great deal of healing?

To be clear: this is not to condone, aid, or abet the abuse of
alcohol, marijuana, food, sex, tobacco, violence, workaholism,
methamphetamines, internet porn, thrill sports, and many
more. No need for right or left wing to get on a soap box.

Nevertheless the real question now is: what if all this substance abuse, and the disease, broken families, crime, and other tragedies which flow from it, is in scientific fact, a survival mechanism?

What if the human organism, when subjected to the childhood traumas reported in the ACE Study, reacts with these addictions as a form of sheer biological and physiological necessity?  What if these behaviors turn out to be necessary for the raw survival of each separate traumatized individual being turned loose to fend for his or her self under current conditions in this country?

Consider their alternative. Let’s not condone “Early Death” for millions.

One consulting engineer told me, “We’ve tried everything based on the assumption that ‘they’ are the broken widgets. But what we’re doing isn’t working, because we’re just producing more and more broken widgets. Einstein’s definition of insanity is repeating the same procedure and expecting to get a different outcome. Engineering science says at this point in any process, that it’s our assumptions and axioms which are wrong and we need a paradigm shift.”

Let’s define “Adverse Childhood Experience.” Just as everyone should know their cholesterol score, everyone should know their ACE score.  Take the ACE Questionnaire from the Centers for Disease Control, the same questions used on the ACE Study and in follow-on ACE Surveys done by 21 states and several nations globally.

aceslistIt asks about 10 types of childhood trauma. The first five questions are personal: Did you suffer childhood sexual abuse, physical abuse, physical neglect, verbal abuse, or emotional neglect? The last five relate to family: Did you have a family member in jail, a family member with mental illness, a mother suffering domestic violence, an alcoholic parent, or a parent who disappeared?

Medical doctors – and most Americans – long assumed “these things” are products of poverty and violence.  Yes, these things are scary: childhood sexual abuse, physical abuse, physical neglect, family members in jail, with mental illness, or domestic violence — and often assumed to be the effects of poverty.  So government, social agencies and others have focused on the basic physical needs of poor families for food, clothing, shelter, health, education, etc. It was and is still necessary. But not sufficient.

Doctors also assumed “these things” rarely if ever happen to middle-class, college-educated folk such as the 17,421 ACE Study participants – all of whom had jobs and great health care or they wouldn’t be in Kaiser Permanente!  As Dr. Felitti puts it, “nice people don’t ask about these things, and most doctors are nice people.”

But “these things,” the ACE Study reveals, do happen in middle/ upper-class families – 40-60% of the time. Childhood sexual abuse, and physical abuse may be scary – but they happen in higher income brackets. Verbal abuse and emotional neglect?  Many higher income families dismiss these as unimportant – they happen all the time. Kids are told to “suck it up,” behave and achieve since others are worse off.

A mother suffering domestic violence, an alcoholic parent?  Not unheard of in well-off suburbia. A family member with mental illness?  Most middle income folk growing up in the 1960s or 70s – like the ACE Study participants — never heard of Bi-Polar, Borderline Personality Disorder, or such, and never asked if a parent had it. Yet many parents did, we now know. Parents who disappear? Death, divorce, and walk-outs do happen here.  But more widespread “disappearance” takes many forms usually dismissed as unimportant: parents who are physically around but mentally out to lunch, unable to handle emotional connection (tech term “attunement”), always stressed out, or plain hostile to kids.

Thus we arrive at today, with “these things” of childhood ACE trauma occurring in half of higher income brackets and surely a far higher percent of lower income brackets – still most doctors don’t ask. “These things” are not discussed – and considered irrelevant to medicine.

Don’t worry, we’ll get to “What to Do” (Harvard’s working on it).

But first, let’s nail down the fact that the ACE issue is every family’s problem, not some issue about “them.” Let’s take this up close and personal.  Let me tell you a bit of my story.

The Heartbreak ACE of Attachment Disorder

This is not an academic issue to me. I had a 30-year career in the fast lanes of New York City and Washington DC, as an economist for 18 years in New York, then in Washington as a technical writer.  There I produced complex documents for Pentagon subcontractors for 12 years, while pursuing my hobby as an opera singer. I was too busy flying around the world to have children and build a family.

Suddenly in 2007, I faced divorce from a 27-year marriage to my college sweetheart, leaving me bankrupt.  A move to California was followed by the death of both my parents in 2008 and then two bad rebound affairs – five life disasters in two years.  My persona cracked wide open and there was nothing inside, so I took myself to therapy.

I learned that I was an unwanted pregnancy, born with a terrible infection which nearly killed both my mother and me, and incubated at birth for numerous weeks. But my first two therapists in 2008-2009 were about as good at healing as Torquemada. They had no insight into the topics in this article and never mentioned the ACE Study, what my post-natal experience might mean, or even the word “trauma.”  In fact, I was a patient in Kaiser Permanente in Anaheim, CA for two years after that, working nearby. I even made an appointment with a (third) Kaiser therapist, but left when she had nothing to say. No one ever mentioned the ACE Study.

Brousblog1a Perry brains X-secIn 2011 I heard about “Adult Attachment Disorder” at a church meeting (sic), and decided that was me.  I began researching attachment and brain science, and writing a book about my experience. “Science has only recently demonstrated that unless kids are given deep emotional connection (‘attachment’) from birth by parents or other humans, infant neurological systems don’t develop well. They can now do brain scans showing that chunks of neurons in some brain regions don’t fire; it’s dark in there,” I wrote.  It’s called “in-secure attachment” or attachment disorder.

I figured out myself that my persistent feeling that “parts of my brain were dark” had been a result of my incubation. Later in 2011 a fourth and competent therapist finally confirmed it. Much later in March 2013, I was at a conference where Dr. Bruce Perry, MD of the Child Trauma Academy in Houston, showed these brain scans. The scan at above right is of a normal 3-year old; the scan at left, of a 3-year old with attachment disorder. Parts of it are dark. That hurt.

I went to attachment and brain science conferences, and bought every book I could get by Judith Herman, Ruth Lanius, Daniel Siegel, Allan Schore, Bruce Perry, Bessel van der Kolk, Peter Levine, and so on. Check the footnotes in my book blogs.

Deluged with the bad news about my brain, at some point I dimly recalled that Dr. Perry had also mentioned something called the ACE Study, so I Googled it and logged into ACEsConnection.  The first thing I saw was a video of a baby in a Polish orphanage that turned my heart and digestive tract inside out.

Baby Casey fr video crop2Brace yourself before you watch – this is what the physical pain of attachment failure looks like.  (Click the link above and scroll down to this photo).  Left alone for weeks or months in the under-staffed Warsaw facility, Baby Casey did not get the “face time,” physical holding, emotional attunement, or any of the millions of interactions required for an infant’s brain to grow. [FN6]

Humans, from the instant of birth, require a constant stream of “emotional, spiritual, psychological, and physical inputs” from another loving human, says Dr. Mary Jo Barrett of the University of Chicago —  just as we require air, food, and liquid. “Complex or developmental trauma is about traumatic interruptions [of that stream],” she notes. “I from birth…have a series of relationships where I am emotionally, spiritually, physically vulnerable… If my spirit, my emotional stability is endangered, my physical being, is endangered, if I am repeatedly interrupted in the context of these relationships, these repetitions create a person who spends their life in fight, flight or shut down.” [FN7]

A child left without this input stream learns that its own hard-wired biological needs are terrifying.  “I learn that what I experienced internally and expressed externally with a cry, was met by a response that didn’t make any sense to what I needed,” says Dr. Daniel Siegel, MD of UCLA. “The organization of that child’s brain will be quite different, as neurons which fire together, wire together.

“I will have learned: it doesn’t matter what I’m feeling, because people don’t get me what I need. So I’ll learn to live without calling out to other people, and studies show, as I have those experiences over and over again, I will actually have a different way of being in the world.  Ultimately, I’ll become quite disconnected, not only from other people, but even from my own internal bodily self and my emotional experience. ” [FN8]

The emotional pain and terror are so intense, the child will do anything to distract itself from those screaming needs. “In this distress I can only comfort myself in ways that are often maladaptive – I may bite myself, I may rock myself perpetually, trying to distract myself from my needs,” Dr. Siegel states. Such children “have all sorts of self-regulatory processes that are not interpersonal. They are very isolated.”

The fight-or-flight stress chemicals flood the bloodstream at a level which feels so terrifying, the baby would rather pass out — or  die — than feel it. “The baby thinks it’s going to die,” Dr. Nancy Verrier says. [FN9]

I saw Baby Casey and said, “She’s trying to knock herself out.” How many times have I felt that in the last few years: “The baby thinks it’s going to die” becomes “I feel like I want to die.”

“From the very beginning to the very end of our lives together, Casey suffered from violent and debilitating rages and temper tantrums,” her father John Brooks writes in his new book “The Girl Behind The Door.”  “The ‘experts’ told us she’d grow out of it; we just had to be tougher with her. How clueless they – and we – were.” Despite loving parents and a beautiful home, Casey and her family were unaware of the enormity of her buried emotional pain.  Casey took her own life at 14.

Why Do We Drink?

We’ve just  detoured to the “attachment” ball park to gather a wider set of data on Dr. Felitti’s original Big Question:

Do so many Americans use alcohol, tobacco, marijuana, meth, IV drugs, food, sex, violence, workaholism,  sports, internet porn, etc. for sheer survival?  Are they compelled to medicate with these to escape an intense fear, anxiety, depression, or anger which if they had to feel it, might literally kill them — by body part failure or suicide?  Suicide rates are abnormally high in the ACE population; compared to ACE Study participants with zero ACE traumas, those with four ACEs are 12 times more likely to attempt suicide.

Are the high-ACE folks who want to avoid suicide, doing things sure to cause “early death” in a few years or decades, as the ACE Pyramid shows, in order not to die now?  That’s one way to do “survival.”

I’ve learned the hard way that if we want to help sick people (and Lord knows I’ve been one), we’ve got to get at the science of what drives them. We’ve got to deal in reality, not prejudice.

So here’s what Attachment Theory and brain science say about attachment and substance abuse like alcohol.

Harvard Science of Neglect Video screenshot“At birth we are biologically waiting for input from adults around us to ‘serve and return,’ a back and forth interaction that literally shapes the architecture of the infant brain,” report Dr. Jack Shonkoff, M.D., Director of Harvard’s Center on the Developing Child and his colleagues in a 2012 video “The Science of Neglect.”  “It begins when a child looks at something, observers something, that’s the serve. The return is when the parent responds to the child. When serve and return is broken, you literally are pulling away the essential ingredients for the development of human brain architecture… When a baby is not attended to, that is a sign of danger to the baby’s biological systems, so its stress systems are activated. In a brain that is constantly bathed in stress hormones, key synapses, the connections between nerves, fail to form in critical regions of the brain.” [FN10]

And the flood of stress chemicals doesn’t just stop. It can go on for years and decades, biology gone haywire.  Bruce Perry explains it in terms of how the three regions of the brain react. His slide below shows the highest thinking “cortex” level of the brain in blue, the next higher emotional-attachment-relational “limbic’ brain in green, and the lowest survival brain, aka reptilian brain, made up of the cerebellum and the brain stem, the foundation of the entire brain, in yellow and red.

The survival brain doesn’t think and it has no feelings for others. It’s only job is to keep our breathing, heart beat, and basic functions going so we survive. “We run into three things that cause developing brain neurons to get screwed up, causing across the board developmental trauma,” Perry said in March at UCLA.

“1. Intra-uterine insult – stress, threat to the mother, or BrousBlog9c Perry Slide1 Brain 4 Partssubstance abuse by the mother adversely effect brain neurons. In particular, the brain stem (survival brain) must be organized before you are born. So there is a lot of activity there and it’s the most vulnerable part of the brain in the womb.  With stress in utero, we have a cascade of mental and physical problems in every part of the body and brain. Brain stem neural networks organize before birth and influence every part of the brain, so every part of the brain will be dysreglated.

“2.  Disrupted Attachment: If you disrupt post-natal bonding, if the caregiver is not capable of attuned, regulated care giving, all these brain networks will be dysregulated.

“3. Post-natal Trauma such as violence in the home. With all three, we have a 100% prospect that this child’s going to be dysregulated,” Perry stated. “But because of the way we’ve ‘invented’ our health service delivery models, the pediatrician treating his asthma won’t make the connection to his intra-uterine insult.  The psychiatrist will just give him ritalin and whatever the drug rep tossed on his desk.”

So why do people drink?

“We can’t persuade people with developmental trauma with a cognitive argument (cortex brain), or compel them with an emotional affect (limbic brain), if their brain stem (survival brain) is dysregulated,” Perry warns.  “We can’t talk people in this kind of alarm state into doing the right thing, because their thinking brain’s been turned off by the alarm state.  And we  can’t reach their emotional-attachment-relational (limbic) brain if they feel so threatened they get into an alarm state, because they can’t feel reward from relations with people.

“If their brain stem, the foundation of their entire brain as a whole, is completely dysregulated, the only way they can feel reward is from sweet/salty/fatty foods, alcohol, drugs, sex, and so on. They know in their head that it’s wrong to steal from Grandma, and they may love Grandma in their heart – but at that moment, cognitive beliefs, or even human relational consequences, can’t relieve their anxiety.  They are in such distress in the lowest parts of their survival brain that it (survival brain) needs the reward of the drugs too badly.

“In fact, they can get to the point where they can’t feel any reward at all –  reward can’t even reach the lower part of the brain, if they’re so ramped up and anxious. At that point, the ONLY thing they want is to relieve the distress, and the only thing that can do it is to drink.  Alcohol will reduce the anxiety. It also makes us more vulnerable to other unhealthy forms of rewards.”  [FN 11]

When Vincent Met Mary: Survey Says

Mary Main & Dan Siegel December-2010-UCLALike ACE trauma, Attachment Disorder has also been demonstrated to affect 50% of Americans – but completely independently.  That’s why I have a “bucket list” item to see that Dr. Vincent Felitti’s been introduced Dr. Mary Main of the University of California, Berkeley, shown here with Dr. Dan Siegel at UCLA.

British psychiatrist John Bowlby developed Attachment Theory in the 1950s. [FN12]  In 1978 Bowlby’s American co-worker Mary Ainsworth showed that the way an infant behaves with strangers when its mother leaves, shows the quality of mothering it’s getting — and predicts its emotional traits for life.  Ainsworth wrote that 69% of children are “securely attached” to mom. [FN13]

In 1982, Ainsworth’s student Mary Main and her own students created the Adult Attachment Interview (AAI). This interview shows (with 79%+ accuracy!) how securely attached they got as kids. It also remarkably predicts what kinds of relations they have as adults with co-workers, dates, and mates. [FN14] Dr. Main concluded by 1996 that only 55% of Americans are in fact securely attached, and Dr. Ainsworth agreed. That’s a shocking low number; it says 45% have some attachment disorder.

Now take the radical changes since 1996 in how humans relate, since the rise of cell phones, texting, the internet and its electronic “social” networking.  There’s nothing social about it.

“Well-developed human beings can self-regulate their emotional state by being with other humans,”  top neuro-scientist Dr. Stephen Porges says. “But what about people who regulate their emotional state with objects?…We’re in a world now being literally pushed on us, by people who are challenged in their social regulation, and we’re calling this ‘social networking.’  We’re using computers, we’re texting — we’re stripping the human interaction from all interactions… We’re allowing the world to be organized upon the principles of individuals who have difficulty regulating emotionally in the presence of other human beings.” [FN15]

Three specialists who have seen a large volume of patients over almost 20 years’ clinical experience since 1996 have confided their concern to me in person this year, that with people spending so much more time online, texting, on the phone, etc, rather than face to face, we’re lucky if we’ve got 40% securely attached these days.  That would mean 60% by now have some attachment disorder.

So do 45% or 60% of Americans have some attachment disorder?  Unclear, but 50% is a reasonably conservative estimate.

Now:  what if the 17,400 ACE Study participants were to be given Dr. Mary Main’s Adult Attachment Interview? Might there be a correlation between the 38-42% of ACE participants with two or more ACE incidents, and the general population’s 45% score for insecure attachment?

You can already hear 1980s TV show “Family Feud” host Richard Dawson shouting: “Survey Says!”

“Addiction as an Attachment Disorder”

Attachment disorder is surely a major component of many Adverse Childhood Experiences.

Flores, Addiction as Attachment DisorderAs to ACEs and substance abuse, note Dr. Philip J. Flores’ 2004 book entitled “Addiction as an Attachment Disorder.”

Dr. Flores reports that the human need for social interaction is a physiological one, linked to the well-being of the nervous system, as we’ve already seen. When someone becomes addicted, he says, mechanisms for healthy attachment are “hijacked,” resulting in dependence on addictive substances or behaviors. Flores believes that addicts, even before their addiction kicks in, struggle with knowing how to form emotional bonds to connect to other people.

Co-occurring disorders, such as depression and anxiety, make it even harder to build those essential emotional attachments. “We, as social mammals, cannot regulate our central nervous systems by ourselves,” Flores said. “We need other people to do that.”  That’s Attachment Theory 101.

While it’s commonly understood that early childhood attachments to parents and family are necessary for healthy development, Flores says, emotional attachments remain necessary throughout adulthood. It’s not enough, he says, to “just stop drinking. ” To achieve long-term well-being, addicts need opportunities to forge healthy emotional attachments.

Flores reports that this is the reason for the phenomenal success rate of Alcoholics Anonymous over more than 50 years.  When people walk into an A.A. meeting, the whole point is to admit openly that they are an alcoholic and yet to feel fully accepted for exactly who they are, with no condemnation.  What a relief! This experience of, in essence, pure attachment, may be the best attachment experience in their lives – and most people who walk in and experience this, miraculously, stay sober for decades or a lifetime.

“What A.A. does… is what good psychotherapy does,” says Flores. It provides “a community for people to break their isolation and start to connect on an emotional level with other people.” [FN16 ]

Dr. Flores’ study is one of many cited in “Does Science Show What 12 Steps Know?” — a lengthy feature in the August 2013  National Geographic about the use of solid human emotional attachment to heal addiction behavior.  [FN17]

If most addictions are caused by the way in which attachment disorder underlies many ACEs, now we know what to do.

Heal the Adults, Heal the Children

To the extent the ACE Study, attachment disorder, and the biology of brain stem dysregulation have become understood in the last ten years, many alarmed at this have focused on creating “preventative programs” to alert parents to be more attentive to their infants and to these issues.  By itself this is necessary.

But again, it’s not sufficient.  Here’s the major problem: if half of today’s parents themselves, like so many adult ACE Study participants, have moderate to severe brain stem trauma, will pamphlets, on-line seminars and Facebook campaigns do it? What do we do about all the attachment disorder in adults?

In just one example of many, several experts report that the infant brain, from conception and early cell division, must divide cells and grow based on some kind of rhythm, and for nine months it is driven to tune on a cellular level to its mother’s heart and breathing rates, among her other vitals.  “We have a pregnant employee who’s an athlete who’s resting heart rate is 40 beats/minute; she’s likely to have a very relaxed baby who likes relaxed rhythms. And a hyper-thyroid mother whose heart rate is 95 may have a baby who finds a higher regulating rhythm,” Bruce Perry reports.

But a mother with ACE trauma herself, hysteria, or any high stress often has  “a totally irregular heart rate, breathing and other vital signs,” he notes.  “These moms end up with kids who are difficult to sooth because the mother had no rhythm consistently present for them to entrain to in utero. After birth, they can’t find any rhythm that is soothing.” [FN18]

No amount of public information is going to solve this problem for this mother or her baby.  Such mothers themselves, even the most determined to love their baby, require deep psychological and biological healing for their own trauma. That is often true for fathers who marry such women as well.

Dr. Joanne  Loewy, Director of the Louis Armstrong Center for Music & Medicine at Beth Israel Medical Center in New York, and her colleagues nationally, have published extensively on the superiority of lullabies which are personally recorded by the parent (versus pre-recorded music) to sooth preemies and term babies born with other need for ICU or incubation stays. [FN19]

But if a mother isn’t “attuned” inside herself, how can she truly attune to her baby?  I had so little ability to attune to a baby in my 20s and 30s that I literally “didn’t even have it in me” to have children.  “I would have thought the very idea would have been absolutely terrifying to you,” my last therapist said (I finally found a good one).  Without far-reaching programs to heal the parents, many will remain biologically incapable of attuning to children.

It’s Adult Attachment Disorder which is the underlying cause of childhood trauma – not babies.

Harvard Build Adult Capabilities, Improve Child OutcomesIn his video “Building Adult Capabilities to Improve Child Outcomes: A Theory of Change,” Dr. Jack Shonkoff at the Harvard University Center on the Developing Child explains this to a degree.  He notes that programs to distribute information and advice to parents and caregivers have limited effect.  Dr. Shonkoff calls for active training of the adults on focusing attention, working in teams, and  regulating their own emotions.  This is a good start. [FN20]

But it took deep emotional attachment to heal the adult me over the last years. It required a broad safety net: an empathic, painstaking therapist skilled in Adult Attachment Theory; support groups modeled on the A.A. principle of total acceptance and emotional attachment for the wounded; and close friends who were serious about staying attached to me because they wanted to heal, too.

As Dr. Felitti told me November 1 in San Diego, “After we talked to the very first round of ACE Study participants about their childhood experiences in the results of their ACE questionnaires, we saw a staggering 20% or higher reduction in the number of medical complaints, office visits, and other indicators of physical ailments in the next year alone.  Over and over, people thanked us for simply listening to them and their stories.”

“I want to thank you for caring enough about people to read all those charts and find out what happens to all of us who are molested, raped and abused in childhood,” one ACE participant wrote to Dr. Felitti.  “I suffered for years. The pain became so great I was thinking of jumping off the San Diego Bay Bridge… How many people may have taken their life because they had no program to turn to? How many lives can be saved by this program?”

That’s human emotional attachment: being seen, being known, just as we are, warts and all, by another human being – and then being fully accepted, and finally feeling that we belong.

Any wonder that “Avatar” was such a hit, when at the end theAvatar I see you2 giant Na’vi heroine Neytiri picks up her fiancee Jake with his tiny, crippled, broken body in one hand, looks into his eyes, and says “I see you?”  In Na’vi that means: “I see your soul, and I love you for who you truly are.  You really belong now.”

People have an enormous craving to be accepted for who they really are and to feel they truly belong, without having to fear all the stress of performance to earn a little affection or condemnation of their warts.  That longing seems to be going unsatisfied in the lives of, gosh, would that be about 50% of Americans?

Just what the Harvard study said an infant needs for brain development: attunement.  Just what some 50% of us apparently did not experience enough as infants and children – for babies do all sorts of things which are far from perfect! Yet we needed to feel accepted and to belong, to grow out of it.

This is what Dr. Felitti, Dr. Anda and company gave their ACE Study participants by simply listening to their terrible stories for the first time in their lives.  From all these experiences, we can begin to craft a program broad enough to heal.

Footnotes

FN1   Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS, “Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study,” American Journal of Preventive Medicine 1998;14:245–258.   http://www.ncbi.nlm.nih.gov/pubmed/9635069?dopt=Abstract

FN2  They’ve gotten articles into the New York Times in Sept. 2012 and just this past October 30, as well as in Salon, This American Life Radio, and more.  See David Brooks, “The Psych Approach,”  Sept 27, 2012; www.nytimes.com/2012/09/28/opinion/brooks-the-psych-approach.html?_r=0
Thomas Rogers, “How stress is really hurting our kids:  New science shows that childhood trauma can cause cancer, heart disease and other problems,” Jan 2, 2012 www.salon.com /2012/01/02/how_stress_is_really_hurting_our_kids/
David Bornstein, “Protecting Children From Toxic Stress,” Oct. 30, 2013, http://opinionator.blogs.nytimes.com/2013/10/30/protecting-children-from-toxic-stress/?_r=0

FN3  Dr. Felitti made the same remarks as those quoted here from his 13-minute video  “Adverse Childhood Experiences” at www.youtube.com/watch?v=GQwJCWPG478

FN4  Centers for Disease Control (CDC), “ACE Study DVD Pre-View movie,”  http://www.youtube.com/watch?v=v3A_HexLxDY

FN5  Jane Ellen Stevens, “The Adverse Childhood Experiences Study: The Largest, Most Important Public Health Study You Never Heard of, Began in an Obesity Clinic,” original in Huffington Post, Oct. 8, 2012,  Part 1 of 3: http://www.huffingtonpost.com/jane-ellen-stevens/the-adverse-childhood-exp_1_b_1943647.html

FN6  John Brooks, “Video of Baby Casey in the Orphanage,” Warsaw, Poland, 1991, from “The Girl Behind the Door: An Adoptive Father’s Lessons Learned About Attachment Disorder,” at http://parentingandattachment.com/the-girl-behind-the-door/.  Original video: http://parentingandattachment.com/meet-my-casey/.

FN 7  Barrett, Mary Jo, MSW, “How to Treat the Patient Without Further Trauma,” June 29, 2011 webinar, NICABM.com.  She is professor at the University of Chicago, founder and director of the Center for Contextual Change, co-author of “Systemic Treatment of Incest,” and co-editor of “Treating Incest: A Multiple Systems Perspective.”

FN8  Siegel, Daniel J., MD,  “Early childhood and the developing brain,” on “All in the Mind,” ABC Radio National, Radio Australia,  June 24, 2006: www.abc.net.au/rn/allinthemind/stories/2006/1664985.htm

FN9  Verrier, Nancy PhD., “Coming Home to Self: The Adopted Child Grows Up,” self-published, Lafayette, CA, 1993

FN 10  Harvard University Center on the Developing Child, “The Science of Neglect: The Persistent Absence of Responsive Care Disrupts the Developing Brain: Working Paper 12,”  2012, www.developingchild.harvard.edu.  Accompanying video “InBrief: The Science of Neglect”  and PDF summary at http://developingchild.harvard.edu/resources/multimedia/videos/inbrief_series/inbrief_neglect/
by Jack P. Shonkoff, M.D., Director Harvard University Center on the Developing Child & Harvard Medical School Professor of Pediatrics;  Linda C. Mayes, MD, Yale University School of Medicine;  et. al.

FN11  Perry, Bruce MD,  “Born for Love: The Effects of Empathy on the Developing Brain,” speech at conference “How People Change: Relationship & Neuroplasticity in Psychotherapy,” UCLA Extension, Los Angeles, March 8, 2013. See also “Overview of Neuro-sequential Model of Therapeutics (NMT)” at www.childtrauma.org, 2010

FN12   Bowlby, John, “The Nature of a Child’s Tie to His Mother,” British Psychoanalytical Society, London, 1958; “Attachment and Loss,” New York, Basic Books, 1969

FN13  Ainsworth, Mary D.S., Blehar, M.C., et al, “Patterns of attachment: A psychological study of the  Strange Situation,” Erlbaum, Hillsdale, NJ, 1978

FN14  For articles and documentation by Mary Main and background on the AAI, see “The Adult Attachment Interview (AAI): Mary Main in a Strange Situation,” at http://attachmentdisorderhealing.com/adult-attachment-interview-aai-mary-main/

FN15  Porges, Stephen, PhD: – On Social Neworking: page 15 of his April-June 2012 webinar: “Polyvagal Theory,”  http://www.stephenporges.com/images/NICABM%20April%202012.pdf
– Overview of his work, 2013: “Body, Brain, Behavior: How Polyvagal Theory Expands Our Healing Paradigm,”  NICABM Webinar, http://stephenporges.com/images/NICABM%202013.pdf
– On Trauma, 2013: “Beyond the Brain: How the Vagal System Holds the Secret to Treating Trauma,” http://stephenporges.com/images/nicabm2.pdf
–  Academic background, 2001: “The polyvagal theory: phylogenetic substrates of a social nervous system,” International Journal of Psychophysiology 42 Ž, 2001, 123 146, Department of Psychiatry, Uni ersity of Illinois at Chicago, http://www.wisebrain.org/Polyvagal_Theory.pdf

FN16  Flores, Phlip J, PhD, “Addiction as an Attachment Disorder,” Jason Aronson, Inc.  Publishing,  2004

FN17  National Geographic, “Does Science Show What 12 Steps Know?,” August 2013, http://news.nationalgeographic.com/news/2013/08/130809-addiction-twelve-steps-alcoholics-anonymous-science-neurotheology-psychotherapy-dopamine/

FN18  In addition to Dr. Perry’s speech in FN11 op.cit., see for example Mindlin, Galina, MD, PhD, “Your Playlist Can Change Your Life,” Sourcebooks, Inc., Naperville, IL, 2012.

FN19   Loewy, Joanne V. et. al,  Journal of Pediatrics, April, 2013  http://pediatrics.aappublications.org/content/early/2013/04/10/peds.2012-1367.abstract

FN20  Shonkoff, Jack MD et. al,  Harvard University Center on the Developing Child,  “Building Adult Capabilities to Improve Child Outcomes: A Theory of Change http://developingchild.harvard.edu/index.php/activities/frontiers_of_innovation/

Tagged with: Adult Attachment Disorder, Adult Attachment Theory, Attachment Disorder in Adults, Adult Attachment Interview, Brain science, Brain stem, Developmental Trauma, Emotional pain, Limbic Brain, Vincent Felitti, Bruce Perry, Daniel Siegel, Mary Main, Jack Shonkoff

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Hole in My Heart

#4 in my ongoing book series; original post August 9, 2013

brousblog4a Siegel Hawn CooperIf there’s been an Adult Attachment Interview (AAI) since 1996 which can diagnose the 50% of Americans with attachment disorder, why doesn’t our medical system use it? [FN12a]

Why aren’t family doctors asking why a patient “just feels lousy” for years, to send us at least for one AAI check by a therapist? Why haven’t more than a small minority of therapists even heard of the AAI? Using it would’ve saved me three years in failed treatment hell.

Instead it’s been left to activists like comedienne Goldie Hawn, alarmed by the jump in stress and violence among children, to put attachment specialists like UCLA’s Dr. Dan Siegel, MD on TV with plastic models of the brain, to wake us all up.  Check out the priceless video above.  “You sent us a brain in the mail !” Anderson Cooper exclaims. [FN12b]

Models of the brain and brain science show a lot: where Attachment Disorder gets created, why we don’t even know that it’s there, and how to heal it.

Most of what occurred with family or caregivers in the almost 4 years from conception to 36 months, which makes us securely or in-securely attached, happened ‘way before we had much of a thinking brain – and before we had any conscious memory banks. So we still fly blind about it today.

Our brain parts which allow us to calm ourselves, feel good alone, or even make sense of sights, sounds, touch, and other sensory data pouring in from outside, weren’t working at the time attachment misfired. Babies can’t self-calm or feel good alone. The “thinking brain” hippocampus which makes sense of that barrage of incoming data, doesn’t even work until 24 to 36 months. That’s why we can’t remember much before age 3.

But the problem is down there, in the pre-thinking, un-conscious parts of the brain which were online, and down in our body with a vengeance. We can have cancer for a long time and be unaware of it until late in the game. Attachment Disorder too is usually an 800lb gorilla which is utterly outside of consciousness. Yet wounded un-conscious parts of our brain have been in a state of panic since attachment misfired before age 3.

Hole in My Heart

brousblog4b Cyndi Lauper“There’s a hole in my heart,” or  “a hole under my feet,” people report. We’re anxious, panicky, depressed about being dropped off at school, or to do work, marriage, child rearing. We feel unequipped to do Life.

I’d felt emotional pain as a “hole in my heart” ever since I could remember; I alternated between denial and praying my parents wouldn’t notice my fear. My first memory of TV was a documentary about an early open-heart surgery on a “blue baby” born with cardiac perforation.

As the camera showed a scalpel probing a gap in bloody tissue, the announcer intoned, “Here is the hole in Julie’s heart.”  I couldn’t forget the sight and my terror at the announcer’s voice for years.  Fairy tales with witches, children’s stories like Peter and the Wolf, TV and movies were as likely to terrify me as a kid as to entertain. “Normal?” Anything resonate?

One day in 2010, I went to my local library on a job request for a sale coaching book, a branch so small that self-help and psychology were shelved together.  I stumbled on books of case studies of people whose parents died early, like “The Loss That Is Forever: The Lifelong Impact of the Early Death of a Mother or Father,” by Dr. Maxine Harris. [FN13a]  “Irrelevant, my parents died in 2008,” I said, but tossed the book in my car trunk with the rest.  There it sat for six weeks until the night before due date.

I opened it and was blown away.  The case studies report exactly the disoriented feelings I’d had all my life.  A week later my branch closed for two years renovation; what an accident.

I wrote this long before I ever saw Cyndi Lauper’s video “Hole in My Heart,” but it’s a shock how empty she feels inside. [FN13b]  “I’ve got a hole in my heart that goes all the way to China!” she wails, “You gotta fill it up with love before I fall inside… You can’t see the bottom, you can’t see the bottom, but believe me – it’s a long way down…”

Poor Cyndi, she thinks the hunky guys who bail her out at the end are gonna solve her problem.  She doesn’t know her pain is from her childhood emotions about parents.  Those hunks are just gonna hurt her again.

OK, so that’s Psychiatry 101: “80% of the pain in adult romantic relationships is projecting the pain we received in childhood.” [FN14]  Trouble is, 99% of Americans are unaware of that fact, and we 50% with Attachment Disorder fight it tooth and nail. We want someone to hold us so bad we could die – someone, anyone, who cares!  So don’t confuse us with the facts.  But it never works, ‘cos it’s a flight from reality.

Emotional Object Constancy

There’s a way out, recently dubbed neuroplasticity.  As the Anderson Live video shows, we can re-train our brains using compassionate therapy, meditation and other “brain gym work” to change the neural structures that hold painful old memories. It was thought that nerve tissue, if damaged, could never heal, but recent science shows the reverse.  “We’re hard-wired to heal,” say doctors Henry Cloud and John Townsend. [FN15a]

But to do it, humans require “face time,” face to face work with other “Safe People,” human beings who actually care enough to be present with us. [FN15b] Because it was face time, or lack of it, which damaged our developing brains in the first place.

brousblog4c Claire+MosesFace time is what develops a baby’s brain into an adult brain. An emotionally attuned mother, who feels her baby’s internal states, shows it how to sooth and feel better.  She does it wordlessly, with a lot of eye contact (tech term “limbic resonance”).  The emotional lobes of the mother’s brain and the baby’s brain actually resonate to each other, as attachment specialist Dr. Allan Schore has shown. [FN16a,16b]

This is my neighbor and her son, whom she’s carried pretty much constantly for a year in a face-to-face carrier, not because anyone told her to, but because, she says, “it feels natural.”  I see them several times a week and I have never seen this baby without a glorious smile.

Like any newborn, he would have cried non-stop at first if she weren’t always there; again, babies don’t have the neural hardware to sooth themselves. But gradually over weeks and months, this baby could be put down for a longer and longer time without getting upset.

“Why should that be?” asks Dr. Henry Cloud. What’s he got now, that he didn’t have before?  The mother’s love comes from the outside, then literally goes inside her baby, via limbic resonance.  She gives the gift of feeling loved inside to her baby, called “emotional object constancy.”

This is a deep knowing, that we have so warmly attached to mother, the love object, that even when she is absent, we do not feel alone or lonely. We instead feel constancy: we feel that we carry around mom’s love inside us 24×7. This is the source of the strength which allows a healthy child to be dropped off at school and feel so secure inside, that he’s eager to try something new and play with strangers.

The way out of attachment disorder is to create more emotional object constancy, that feeling of deep attachment and safety the baby in the photo has. The reason we feel bad, anxious, depressed or have chronic emotional pain, is usually that this did not develop well when we were kids.

Communicating object constancy to kids is a major reason humans have families. Pre-agricultural man required at least six adults to raise one child safely – four to feed and take care of mom while dad hunted, so mom could safely take care of the child 24 x 7 and get this job done. Who has time for that in this ratty economy? [FN17]

If you have Attachment Disorder, my tale will start to resonate if you let it. If you let yourself feel the hurt with me, you’ll start to unfreeze your frozen bad feelings and if you get the right help, you’ll feel the healing, too.

Secure attachment can be “earned,” as Dr. Mary Main, creator of the AAI, also said.  But we need  face time with safe people to do it, to widen what Dan Siegel calls our “window of tolerance” to feel frozen feelings.

Days before Christmas 2011 at a local nursery, a friend dared me to sit on Santa’s lap.  As I alighted gingerly, he asked, “And what do you want for Christmas, young lady?” Lost and alone for the holidays, I looked the poor guy straight in the eye and blurted without thinking, “Please Sir, I want peace of mind.”

“Don’t we all,” he said, tearing up.

I think I’ll go find the nice man this Christmas 2013 and thank him for making my wish come true.

———————————-

This is from Kathy’s forthcoming book DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment DisorderHow I accidentally regressed myself back to infancy and healed it all. Watch for the continuing series of excerpts from the rest of her book each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

Kathy Brous from FEMHC 1READ MORE from “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder”
by Kathy Brous

 

 

Footnotes
12a. Op Cit blog #3: George, C.; Kaplan, N.; Main, Mary, “An Adult Attachment Interview,”  Unpublished MS, University of California at Berkeley, 1994
12b. Siegel, Daniel J.,MD & Hawn, Goldie, TV Special on the Brain, CNN Anderson Live, Sept. 24, 2012.  See www.drdansiegel.com/press/ for more; or direct to video at http://cdnapi.kaltura.com/index.php/extwidget/openGraph/wid/0_c40uup5m
13a. Harris, Maxine, PhD, “The Loss That Is Forever: The Lifelong Impact of the Early Death of a Mother or Father,” Penguin Books, New York, 1996
13b. Cyndi Lauper video: www.youtube.com/watch?v=hP9b4zlO2cU
14.   Verrier, Nancy, PhD, “Coming Home to Self: The Adopted Child Grows Up,” self-published, Lafayette, CA, 1993
15a.  Cloud, Henry, PhD, “Changes that Heal,” Zondervan, Grand Rapids, 1990. See also:  “Getting Love on the Inside,” Lecture CD, April 2002, Cloud-TownsendResources.com
15b.  Townsend, John, PhD & Cloud, Henry,Phd, “Safe People,” Zondervan Press, Grand Rapids, 1995. Also by both: “Boundaries,” Zondervan Press, Grand Rapids, 2004
16a.  Schore, Allan N., PhD, “Affect Regulation and Mind-Brain-Body Healing of Trauma,” National Institute for the Clinical Application of Behavioral Medicine (NICABM), June 15, 2011, www.nicabm.com  See also his book  “Affect Regulation and the Origin of the  Self”, Norton textbook May 2003; first edition 1994.
16b.  Op Cit blog #2: Lewis, Thomas MD, Amini, Fari MD, Lannon, Richard MD; “A General Theory of Love”,Random House, 2000. Great link: www.paulagordon.com/shows/lannon/
17.  Perry, Bruce, MD, PhD, “Born for Love: The Effects of Empathy on the Developing Brain,” speech at conference “ How People Change: Relationship & Neuroplasticity in Psychotherapy,” UCLA Extension, Los Angeles, March 8, 2013. See also his article  “Overview of Neuro-sequential Model of Therapeutics (NMT),” www.childtrauma.org, 2010

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The Day That Einstein Feared Has Arrived

#3 in my book series; original post August 2, 2013    

brousblog3a Cat Bad DayAs I’ll show based on the Adult Attachment Interview (AAI), some 50% of us have a degree of Attachment Disorder.  How can there be so little information on it available?  What about us blindsided adults who suffer this?

The federal NIMH estimates about 6% of Americans are technically “mentally ill,” and the rest of us attachment-challenged are just the “worried well.” [FN1]

I’m sure attachment work can cure not only us 50% “worried well,” but lots of the NIMH’s 6%. That’s probably in some brain science book but not for me to show. Attachment Disorder is not mental illness per se. A professor told me this week, “What you’re writing about is just sociology.”

So Widespread It’s Sociology

You said it!  It’s us “worried well” that worries me – exactly since it’s so widespread that it’s a “sociological phenomenon” like, say, surfing.  Plus, there’s the enormity of the emotional pain that so many of us “worried well” each feel, in secret, with no clue where to go for help.  So the pain gets worse and worse as we trudge on, trying to perform, without knowing there is some nasty crud accumulating over the decades around our hearts.

Even if it never makes for visible mental cracks, that continuous cortisol stream over decades eats at internal body parts, causing stress-induced digestive, vascular, and other diseases well-documented by trauma experts.

Attachment Theory is not new; British psychiatrist John Bowlby developed it in the 1950s. [FN2]  Bowlby’s co-worker Mary Ainsworth showed that the way an infant behaves with strangers when its mother leaves, the “Strange Situation” experiments, predicts a child’s emotional traits for life.  [FN3]

In 1982, Ainsworth’s former student Mary Main created the Adult Attachment Interview (AAI) to show the reverse: how securely attached adults became as kids. Main concluded that only 55% of us are actually securely attached, and Dr. Ainsworth agreed.  Already a shocker as a low number. [FN4]

Now:  take the radical changes since 1996 in how we relate, after the rise of cell phones, texting, the internet and social networking.  There’s nothing social about it.

“Well-developed human beings can self-regulate their emotional state by being with other humans,” said top neuroscientist Dr. Stephen Porges recently.  “But what about people who regulate their emotional state with objects?…We’re in a world now being literally pushed on us, by people who are challenged in their own social and emotional regulation, and we’re calling this ‘social networking.’ We’re using computers, we’re texting — we’re stripping the human interaction from all interactions… We’re allowing the world to be organized upon the principles of individuals who have difficulty regulating emotionally in the presence of other human beings.” [FN5]

I’ve interviewed a number of specialists who have seen a large volume of patients in almost 20 years’ clinical experience since 1996, who believe that with people spending so much more time on electronic devices, rather than face to face, we’re lucky if we’ve got 40% who are well-attached these days.

“I fear the day that technology will surpass our human interaction,” warned Albert Einstein.  That day is now.

brousblog3c Day Einstein Feared

Whether it’s 55%, 50%, or 40% of Americans who are securely attached – it leaves  roughly the other half of us in some degree of attachment disorder.  With a 50% divorce rate, and all that’s happened to destroy attachment since 1996 — there was no internet in 1996, outside the Pentagon — 50% seems a good talking point.  Believe me, I don’t want it to be so high. I’d like to remarry – and the idea of having to ditch 50% of the frogs is annoying.

Which 50% are you in?

Don’t think, focus only on your physical sensations as you read this list:

• Unusual birth stress for mother and/or infant
• Exposure to extreme heat or cold, especially in children and babies
• Childhood surgery or other major illness terrifying to a child
• Childhood neglect, left alone for prolonged periods, abandonment
• Childhood emotional, physical, or sexual threats or abuse
• Sudden loud noises now or at any time

If you’re in my 50%, you may feel discomfort or constriction in the chest, gut or elsewhere, however minor.  This can be the re-activation of stress experienced in some childhood event which never made it to our conscious memory banks.  Not everyone grows agitated reading this list.

“It’s very important to understand that nervousness, anxiousness, or almost any response you might have, has to do with the activation of the energy you experienced during the original overwhelming event,” writes trauma expert Dr. Peter Levine. “When you are threatened, your body instinctively generates a lot of energy to help you defend yourself… the unused energy aroused when you are threatened can get frozen into your body and cause problems and symptoms years later.” [FN6]

Wondering why your therapist, or your several failed therapists (I had three duds) haven’t helped? You may not be the problem. Attachment Theory, which shows how Attachment Disorder works, was hardly taught during college training until after 2000. A new Norton Textbook Series is just being published. [FN7]  Many therapists today don’t diagnosis attachment disorder well or are at sea how to treat it.

Why don’t all professionals use the AAI? What are they thinking?  No wonder three psychiatrists-turned-neuroscientists felt compelled to publish “A General Theory of Love” in 2000, a book about attachment which also warns that their profession is failing America. [FN8]

———————————

This is from the Forward of Kathy’s forthcoming book DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder How I accidentally regressed myself back to infancy and healed it all.  Watch for the continuing series of excerpts from the rest of her book each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

Footnotes

FN1  “Even though mental disorders are widespread in the population, the main illness is concentrated in a much smaller proportion — about 6 percent, or 1 in 17 — who suffer from a serious mental illness (Kessler RC, Chiu WT, Demler O, Walters EE, “Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R),” Archives of Gen. Psychiatry, 2005 Jun; 62(6):617-27)” From “The Numbers Count: Mental Disorders in America,” www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml

FN2  Bowlby, John, “The Nature of a Child’s Tie to His Mother,” British Psychoanalytical Society, London, 1958; “Attachment and Loss,” New York, Basic Books, 1969

FN3   Ainsworth, Mary D.S., Blehar, M.C., et al, “Patterns of attachment: A psychological study of the  Strange Situation,” Erlbaum, Hillsdale, NJ, 1978

FN4  PDFs by Mary Main are below. The NIH at www.ncbi.nlm.nih.gov/pmc/articles/PMC2724160/ says under 4th subhead “Measurement” :
“The three ‘organized’ strategies (secure, avoidant and resistant) are assessed in the Strange Situation (SS) (Ainsworth , Mary DS, Blehar MD, Waters E, Wall S, “Patterns of Attachment,” Hillsdale Erlbaum, 1978), a 20-minute laboratory procedure where patterns of infant behaviour toward the caregiver following two brief separations are categorized as secure or insecure (insecure avoidant or insecure resistant). The SS can be used when infants are 12 to 20 months old. “Infants with secure attachment greet and/or approach the caregiver and may maintain contact but are able to return to play, which occurs in 55% of the general population (van IJzendoorn MH, Schuengel C, Bakermans-Kranenburg MJ, “Disorganized attachment in early childhood: Meta-analysis of precursors, concomitants and sequelae,” Dev Psychopathol. 1999;11:225–49.
“Infants with insecure-avoidant attachment fail to greet and/or approach, appear oblivious to their caregiver’s return and remain focused on toys, avoiding the caregiver, which occurs in 23% of the general population. Infants with insecure-resistant attachment [aka insecure-ambivalent-kb] are extremely distressed by separations and cannot be soothed at reunions,  displaying much distress and angry resistance to interactions with the caregiver, which occurs in 8% of the general population.”
[This NIH article earlier reports that the remaining “approximately 15% suffer insecure ‘disorganized’ attachment,” i.e.  virtually failed attachment, citing their own footnote which states “In normal, middle class families, about 15% of  infants develop disorganized attachment.”
[Note: 23%+8%+15%  = 46% not securely attached.

Articles by Mary Main on the AAI:
–Main, Mary,  2000, “The Adult Attachment Interview: Fear, attention, safety and discourse processes;” also titled “The Organized Categories of Infant, Child, and Adult Attachment: Flexible vs. Inflexible Attention Under Attachment-Related Stress,” Journal of the American Psychoanalytic Association, 48:1055-1095, at http://70-40-200-36.bluehost.com/documents/Main.pdf –Main, Mary, 2005, with Hesse, Erik & Kaplan, Nancy, “Predictability of Attachment Behavior and Representational Processes at 1, 6, and 19 Years of Age – The Berkeley Longitudinal Study,” Chapter 10 of “Attachment from Infancy to Adulthood: The Major Longitudinal Studies,” edited by Klaus E. Grossmann, Karin Grossmann, and Everett Waters, pp. 245–304, New York: Guilford Press, at http://70-40-200-36.bluehost.com/documents/5.Main%20Regensburg%202005%20.pdf

FN5  Porges, Stephen, PhD: — On Social Neworking: page 15 of his April-June 2012 webinar: “Polyvagal Theory,”  http://www.stephenporges.com/images/NICABM%20April%202012.pdf
— Overview of his work, 2013: “Body, Brain, Behavior: How Polyvagal Theory Expands Our Healing Paradigm,”  NICABM Webinar, http://stephenporges.com/images/NICABM%202013.pdf
— On Trauma, 2013: “Beyond the Brain: How the Vagal System Holds the Secret to Treating Trauma,” http://stephenporges.com/images/nicabm2.pdf
—  Academic background, 2001: “The polyvagal theory: phylogenetic substrates of a social nervous system,” International Journal of Psychophysiology 42 Ž, 2001, 123 146, Department of Psychiatry, Uni ersity of Illinois at Chicago, http://www.wisebrain.org/Polyvagal_Theory.pdf

FN6  Levine, Peter A., PhD, op.cit “Healing Trauma: A Pioneering Program for Restoring the Wisdom of Your Body,” ‘Sounds True, Inc.,’ Boulder CO, 2005; ISBN 1-159179-247-9

FN7  Norton Textbook Series on Interpersonal Neurobiology, featuring:
Siegel, Daniel J., MD et. al, “The Healing Power of Emotion: Affective Neuroscience, Development & Clinical Practice,” November 2009; 368 pages
Schore, Allan N., “Affect Regulation and the Origin of the Self,” Norton textbook May 2003;  first edition 1994; 432 pages

FN8   Lewis, Thomas MD; Amini, Fari MD; Lannon, Richard MD;A General Theory of Love”, Random House, 2000. See: www.paulagordon.com/shows/lannon/

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