Invisible disability: Building Great Britons

A report was published on Wednesday by the All Party Parliamentary Group (APPG) for Conception to Age 2 – the First 1001 days. It’s called Building Great Britons.
The thrust of the report is similar to Early Intervention: Good Parents, Great Kids, Better Citizens (2008) and Early Intervention: The Next Steps (2011) from MPs Graham Allen and Iain Duncan Smith. Building Great Britons sets out a policy framework aimed at preventing the social problems believed to originate in adverse experiences between conception and a child’s second birthday.

Breaking the cycle

The conceptual model underpinning the report is a familiar one. Neglect, maltreatment and insecure relationships in early childhood are assumed to be a primary cause of mental health problems and antisocial and criminal behaviour. Parents who had such experiences during childhood tend to adopt the same child-rearing strategies as their parents, setting up a damaging (and costly) self-perpetuating intergenerational cycle.

Like the Early Intervention reports, Building Great Britons argues that preventing child neglect, maltreatment and insecure attachment will save money and result in a flourishing society due to the emergence of well-rounded citizens who are “physically and mentally healthy, well educated, empathic, prosocial, hardworking and contributing to the costs of society” (p.3). As Tim Loughton, Co-Chair of the APPG says “the economic value of breaking these cycles will be enormous” (p.4).

“This” it’s claimed, “is not ‘rocket science.’ Technically it is ‘neuro-science’” (p.3).
The basis for that claim seems to reside in repeated references to brain development, although there’s no detail about how brain development is involved. The association between early adverse experiences and long-term unwanted outcomes is well established, but there are some problems with the model.

what causes what?
The first is that just because two things are correlated, it’s not safe to assume that one causes the other. They might both be caused by something else, or be totally unrelated. So parents might neglect, maltreat or form poor attachments with their children because their parents did, or because the family has a genetic predisposition towards severe post-natal depression, or because they are grappling with challenging life circumstances.

multiple causes
The second problem is that even if we could predict with certainty that all neglected, maltreated, chaotically attached children will develop mental health problems or anti-social behaviour in later life, the causal chain doesn’t always hold in the opposite direction because mental health problems and anti-social behaviour have other causes such as poor physical health, adverse life events or peer pressure.

looking back vs looking forward
A third problem is that retrospective surveys linking adverse childhood experience with later health and social problems, such as the ACE study referred to in Building Great Britons (p.14), tend to rely on self-reports – not always the most reliable sources of information, especially about early life. Prospective assessments that track children through their life course such as the Dunedin and Cambridge studies tend to be more reliable. They have also found correlations between adverse childhood experiences and problems in later life but that the emerging patterns are quite complex.

When reading through the research findings, I was struck by how often researchers expressed surprise at the frequency of adverse childhood experiences. The ACE study was prompted by the unexpectedly high incidence of sexual abuse in childhood reported by people dropping out of a weight loss programme. The Dunedin study began as a small-scale follow-up assessment of perinatal risk. Its scope was broadened after researchers found a higher incidence than they expected of accidental injury and impairments to sensory function, development and behaviour in 4/5 year olds. The implication wasn’t that the children had been neglected or maltreated (although some might have been), but that developmental impairments in the general population were more frequent than had been previously thought.

children with disabilities: noticeable by their absence

This brings me to a glaring omission in Building Great Britons. One group of children is especially susceptible to social, emotional and behavioural problems and is at increased risk of poor physical and mental health in later life. They are children with disabilities. But the only mention of disability that I could find in Building Great Britons was of children with Foetal Alcohol Syndrome, caused by a mother’s excessive alcohol intake during pregnancy.

Childhood disabilities can be caused by neglect or maltreatment but they can also be caused by factors such as;

• inherited genetic conditions
• spontaneous genetic variations at or before conception
• mother’s illness during pregnancy
• environmental damage during gestation (e.g. exposure to toxins)
• childhood infections
• accidental injury.

Whether you think disability is caused by a ‘functional impairment’ or by the way society responds to that functional impairment, for administrative and legal purposes a clear-cut distinction is usually made between someone who’s deemed disabled and someone who isn’t. But from a biological perspective the boundary is rather blurred. As the Dunedin study found, a significant proportion of children has some sort of developmental impairment; currently in the USA it’s 15%. In the UK, only 6% of children are classified as disabled, but that figure rises with age. Around 16% of the working-age population has a disability.

Not all disabilities are obvious, and some are difficult to detect. The average age at which autism is diagnosed, for example, is 5.5 years, and diagnosis is often much later than that. Autistic children have unusual attachment patterns and autism is so frequently confused with attachment disorder that Heather Moran, a consultant clinical psychologist, devised the Coventry Grid to help professionals distinguish between them.

There’s little doubt that neglect, maltreatment or poor attachment in childhood can, and does, lead to social, emotional and behavioural problems and to impaired physical and mental health. But what Building Great Britons does is to frame the causes of those problems solely in terms of neglect, maltreatment or poor attachment, and more specifically in terms of the ‘troubled families’ who are deemed to be the source of these societal ills (pp.3-4).

When I was delving into the thinking behind the Early Intervention reports, I asked a few researchers who’d been actively involved how some obviously erroneous claims about brain function had crept in. None had had a say in the final content of the reports, but one told me that it was sometimes necessary to present data in a way that was most likely to persuade government to come up with funding. I take his point; but I couldn’t see how that justified presenting the data in a way that was misleading.

What the data on social, emotional, behavioural, physical and mental health problems tell us is that children by definition are vulnerable, and parenting by definition is challenging. They also tell us that we are all, at all times, at risk from unforseen life events that could trigger social, emotional, behavioural, physical or mental health problems that result in us needing help from the community. That’s why in the developed world we have education, health and social care services.

It’s true that a minority of families cause a disproportionate number of problems, for themselves and others. There are good reasons why early intervention is appropriate for them. But because all children are vulnerable and all parenting is challenging, there are good reasons why early intervention should be available to all families. We shouldn’t have to justify it in terms of ‘good citizenship’ or the financial costs for ‘society’ – which at one time we were told didn’t exist.

Nor should reports produced by Members of Parliament about vulnerable children and challenged parents look right past one of the most vulnerable groups of children and one of the most challenged groups of parents. In the total of 351 pages that make up the two Early Intervention reports and Building Great Britons, childhood disability is mentioned, in passing, only five times – and three of those references are to Foetal Alcohol Syndrome.

When I contacted @first1001days, the Twitter account for http://www.1001criticaldays.co.uk/ to point out the omission, I got a prompt response inviting me to write some supplementary material. Within an hour, another parent and I had responded with a paragraph summarising the main issues, and notified @first1001days. I wasn’t surprised not to get an immediate reply, as the report was being launched that morning. But we’re still waiting…

Disabled people are still invisible, it seems.

Martin Narey on social worker education

The tragic death of Victoria Climbie in 2000 focussed attention on the effectiveness of social services departments. The Laming reports published in 2003 and 2009 made recommendations for reform, and the 2011 Munro review of child protection referred to gaps in social workers’ expertise. A couple of weeks ago, Sir Martin Narey, fomer CEO of Barnardo’s and previously Director General of the prison service, published his review of the education of social workers. Although Narey recognises the high quality of some social work education, he is generally critical of the admissions criteria, content, quality and regulation of courses and makes a number of recommendations for improvement. What was striking about the report, I felt, was not so much what it said, but what it didn’t say.

Narey opens by directly addressing the fact that his inquiry was a one-man one, that evidence was gathered through private interviews, and says elsewhere that he didn’t have detailed terms of reference. Conducting an inquiry in this way has several advantages; it’s quicker and cheaper, reports are shorter, more focused, and more likely to be read and acted on – and as Narey points out, it encourages contributors to be more candid (p.3). There are also disadvantages; the opinion of a single reviewer is more likely to colour the inquiry’s conclusions and no one else can evaluate the evidence they’re derived from – with the best will in the world, people might misremember or misunderstand the evidence they present.

In addition, in complex systems like education health and social care, all elements of the system are connected, directly or indirectly. This means it’s often cost-effective in the long-term to remove the causes of problems, rather than to keep putting sticking plasters on the problems themselves. (Ten of Narey’s 18 recommendations involve increased regulation, rather than addressing the causes of what’s going wrong.) In an inquiry with narrow terms of reference the primary causes of problems the inquiry has been set up to investigate might actually fall outside its remit and not even get a mention. This is exactly what appears to have happened in the Narey review.

Narey makes it clear that some social workers are very able, are educated to a high standard and have no trouble getting a job when they graduate. But the rest of the picture he paints is a bit bleak. It suggests that school-leavers with low qualifications are being admitted to over-subscribed courses that offer insufficient teaching, inappropriate work placements and that lecturers and supervisors are sometimes under pressure not to fail inadequate students. In 2011 some local authorities had 20% of social worker posts vacant despite nationally almost 30% of Newly Qualified Social Workers (NQSWs) being unemployed; local authorities were clearly reluctant to employ NQSWs perceived as inadequately prepared for the job.

Why on earth would this situation arise? Narey locates the causes primarily in the calibre of applicants for social work courses, the content and quality of courses and the availability and quality of supervised work placements. And he makes a number of recommendations related to these factors. It’s apparent from his report, however, that the long-standing crisis in social worker recruitment might be driven by factors that Narey doesn’t explore in detail, such as the level of social worker qualifications, the reasons for the core content of courses, the regulation of social worker education, and university funding.

Level of qualifications

Throughout the 20th century, the level of qualification required to become a social worker rose steadily. In the 1970s Birmingham University offered a postgraduate diploma, a master’s level qualification and a four-year social work degree. In 1994, the national route to qualification became a postgraduate diploma involving partnership with employer, but during the 1990s there was a significant fall in applications. In response, in 2003 the government introduced a three-year social work BA – a sandwich course that included two work placements – or alternatively a two-year MA for graduates. This means that in the last decade the level of social worker qualification has fallen, something that is likely to have had an impact on the expertise of NQSWs and on the willingness of local authorities to employ them.

Core content of courses

Narey comments in some detail on the content of social worker courses. The original course offered by Birmingham University in 1908/9 consisted of 117 lectures covering topics as diverse as industrial history, law, statistics and sanitation & hygiene, as well as visits to a variety of institutions, and traditionally universities have continued to focus on the principles underpinning social work. But recent complaints from students and employers include challenges about the relevance of the courses including “weeks and weeks…looking at Plato, Socrates and Aristotle etc” rather than “skills relevant to social work” (p.9). Another student complained “ I have so far learned nothing concerning signs of abuse… There is not enough practical experience or theory related to its actual use in practice”(p.9). Narey adds “employers need to be more confident that students at every university will graduate with an adequate grasp of the basics necessary for them to develop into competent and confident children’s social workers.” (p.9)

Narey complains about the current focus of social work on ‘non-oppressive practice’ (or ‘anti-oppressive practice’ – he uses the terms interchangeably). He points out that there is a serious downside to a view that encourages working in partnership with, and the empowerment of, parents whose children are at risk. What he doesn’t seem to fully appreciate is that ‘non-oppressive practice’ is, and always has been, fundamental to the ethos of social work. Of course if anti-oppressive practice is the only theoretical framework presented to aspiring social workers, that does pose a problem that should be addressed. Narey entitles his critique of anti-oppressive practice the politics of social work teaching (p.10). Politics is about the distribution of power, so an anti-oppressive model of social work is in a sense ‘political’, but it’s not clear if Narey is using the term in that way, or if it’s because he suspects that this dominant conceptual model originates with the progressive Left (p.13).

Having debunked one core concept in social work teaching, Narey introduces another. In his own list of what he thinks social workers should understand he includes child development and attachment theory as two separate items (p.10). At first glance this looks like one of the conclusions of the Munro review that refers to social workers needing to know about ‘child development and attachment’ (Munro p.96). The difference is that Munro and the sources she cites could be construed as seeing attachment as one facet of child development, whereas Narey unambiguously presents them as distinct issues. My conclusion in previous posts about attachment theory is that there’s a serious risk of social workers seeing child development not as involving attachment, but solely in terms of attachment, rather than as a highly complex set of interacting biological, social and environmental factors of which attachment is only one. Narey’s suggestion is likely to perpetuate that over-simplification.

Intriguingly, given his focus on conceptual models in social work, Narey says he has never discussed the international definition of social work with the current Secretary of State for education or with any of his predecessors (p.13). It would be interesting to know why.

Narey isn’t the only one to take issue with the content of social worker education. There’s also disagreement between universities and employers, but much of it appears to centre on the difference between education and training. It seems fair to argue that social workers’ education should include statutory frameworks, but it’s debatable whether signs of abuse, a highly specialised skill, should be included in education or be approached via on-the-job training. My guess is that the problem actually boils down to who pays for what. The budgets of universities and local authorities have been under pressure for many years, and it’s understandable why local authorities might want social workers to emerge fully formed from their university courses, but that universities don’t want to broaden what they offer unless they have to. The ultimate losers are, tragically, the most vulnerable members of society that social workers are supposed to support.

Regulation of social worker education

Narey draws attention to the facts that social worker education is regulated by three different bodies and that universities need to consult at least five different source documents to shape the academic content of courses. He observes in respect of the Health and Care Professions Council (HCPC) that social work sits ‘very oddly’ with the list of other professions it regulates (p.21). Social work isn’t the only profession in this situation. In 2009, the HCPC replaced the Council for Professions Supplementary to Medicine (CPSM) set up in 1960, which regulated several professions that fall broadly under the umbrella of medicine. When the HCPC replaced it, the regulatory remit was broadened and practicing psychologists and social workers were added to the mix. This caused some consternation amongst psychologists, previously regulated by their own professional body, many of whom didn’t see themselves as working in professions related to either health or care. Only two of psychology’s protected titles – clinical and health psychology – could be clearly classified as involved in health or care whereas others covered fields as diverse as international educational systems and business management. Doubts were expressed as to whether the HCPC could have the range of expertise required in order to regulate effectively. From what Narey reports, it’s still a relevant question.

University funding

I mentioned earlier the three-year BA in social work introduced in 2003, following a fall in applications for social work courses. Narey doesn’t address the causes of the drop in applications, but it’s worth considering what it they might be.

Prior to 1945, some students from less well-off families could access a university education via much sought-after Board of Education grants, often on condition that they became teachers after graduation. In 1962 student funding by local education authorities became mandatory. A steady increase in student numbers coupled with a policy decision to increase the numbers of graduates and universities, led to the Dearing review of university funding in 1996, which recommended the introduction of an annual contribution of £1000 toward tuition fees, and in 1999 student loans were introduced. That meant that a four-year social work qualification was a relatively expensive way of getting a degree, so it’s hardly surprising that applications fell. In an attempt to boost social worker numbers, the three-year BA was introduced in 2003, accompanied by the offer of a bursary. The bursary, counterintuitively, appears to have had little impact on social worker recruitment, but does appear to have encouraged applicants wanting a low-cost route to a degree (p.28). Subsequent reductions in government funding have resulted in universities becoming increasingly reliant on student fees as a source of income; universities can now charge UK students up to £9000 p.a. and students from overseas usually pay much more. It appears that some universities have adopted a ‘pile ’em high’ approach to social work degrees, attracting large numbers of students but failing to provide them with the qualifications that employers are looking for.

Thinking outside the box

Times change, and social workers are no longer preoccupied by the impact of industrial injuries or poor sanitation as they were in 1908 (although hygiene is still an issue). But as far as I can see the social worker role is fundamentally unchanged; it still has to address the problems people encounter often as a result of societal factors over which they have little control. That doesn’t appear to be how social work is viewed by central or local government, however. In the last three decades, there’s been a noticeable shift from viewing social workers’ clients as people who are primarily victims of circumstance, to viewing their problems as the outcomes of individual choices. Both ways of framing people’s problems are over-simplifications and neither is helpful, because in reality everybody’s problems are due to a complex interaction of systems pressures and individual choices.

Another apparent shift is in respect of the focus of social work. Narey advocates not only restoring the option to specialise in adult or child social care following basic generic tuition, but also suggests the development of children’s social work degrees. Although specialisation seems justified, from the outside it looks as if social work is becoming increasingly polarised, toward care for the elderly at one end of the spectrum and toward children at risk at the other (p.37). In other words, adult social work will be about care of the elderly and children’s social work will be about child protection, as if adults and children had no other issues to deal with.

The location of the source of problems in the individual – or in individual organisations (universities and regulatory bodies in the case of the Narey report) – is an inevitable consequence of successive governments adopting a ‘market’ model for services. This is because the free market model rests on assumptions about the behaviour of individuals; that people make rational decisions, that they have free choices about the goods and services they purchase and that their free, rational choices ensure that competition between suppliers drives up quality. In reality none of these assumptions holds true.

The narrow terms of reference of the inquiry have resulted in the impact of some key systems issues being overlooked. These include; the underlying economic model chosen by government for the delivery of public sector services, the way context and individual behaviour are framed by government, the remit of regulatory bodies, the way the underlying purpose of social work is perceived, and how higher education is funded.

And a shift of the focus of social work from problems at all levels from the individual to the societal, is an inevitable consequence of shrinking the public sector; as a result there will be a tendency to focus on people most at risk, rather than in addressing the underlying systemic causes of a wide range of obstacles that people encounter when they are trying to get on with their lives.

what about attachment parenting?

During my excursion into the world of child development theory, I’ve been acutely aware of one important group I’ve so far overlooked; the advocates of attachment parenting (AP). Attachment parenting is an approach derived from Bowlby’s theory, but includes practices like extended breastfeeding, ‘babywearing’ – carrying the baby close to the parent’s body, co-sleeping, and a high level of responsiveness to the baby’s needs. I must admit to being sympathetic to AP as an approach; I must also admit (like many other parents) to being something of an attachment parenting backslider. Both my children were in a buggy by the age of six weeks because I couldn’t find a sling that didn’t hurt my back, due to a series of complications I stopped breastfeeding my son at four months, and one child slept happily in bed with me whereas the other simply wouldn’t.

A significant influence in the AP movement is William (‘Dr Bill’) Sears, a paediatrician and author of a number of best-selling parenting books. Dr Sears’ wife Martha is a director of Attachment Parenting International (API), an organization founded in 1994 by Barbara Nicholson, a learning disabilities specialist and Lysa Parker, who also has a background in special education. Parker also worked with La Leche League International, as did four other of the API’s eight directors. (La Leche League was founded in Illinois in 1956 by a group of mothers who wanted to promote breastfeeding, a practice then rapidly dwindling in the USA.)

Dr Bill’s shoes have to an extent been filled by Gordon Neufeld, founder of the Neufeld Institute in Vancouver, Canada. Unsurprisingly, Neufeld’s approach is firmly grounded in attachment theory, with separation, for example, being seen as playing a key role in the ‘epidemic of anxiety’ that apparently afflicts our children. Neufeld’s ideas are very popular, but it’s instructive to read what a group of parents who have used the AP approach with their special needs children have to say here.

Why attachment parenting?

The predominant reasons given for the attachment parenting approach are that it involves ‘instinctive’ and ‘natural’ child-rearing practices that parents have used for thousands of years. In essence this is the same argument used by Bowlby and Perry in support of their models of child development. I think it’s flawed in two respects. One is that ‘instinctive’ behaviours have also led to the adoption of practices that attachment parenting advocates are unlikely to approve of, such as infanticide, cranial deformation and genital mutilation. You could argue, of course, that such practices might be instinctive but they’re not ‘natural’. Unfortunately, ‘nature’ isn’t always benign either.Throughout human history, infants in hunter-gatherer societies have been at high risk of death from predation, starvation, injury and infection. And if hunter-gatherer societies appear to be healthier than those in the developed world, it’s often because of the price paid by their ancestors and the weaker members of their community. Although AP proponents often advocate as natural a lifestyle as possible, few in the developed world would expect mothers and children to be self-sufficient, live in huts, cook over open fires or fail to take advantage of modern medical interventions if required.

Evidence or belief?

In other words, neither the ‘instinctive’ nor ‘natural’ justifications for attachment parenting provide sufficient evidence to support it. I suspect that rather than AP consisting of practices based on a careful evaluation of the evidence, AP is actually based on a set of beliefs. They’re not unreasonable beliefs; breastfeeding, carrying babies in a sling and being responsive to a child’s needs are highly likely to be of benefit because they optimize nutritional intake and reduce the risk of gastro-intestinal infection, keep the infant warm, comfortable and within the parent’s sight and increase the likelihood of the child’s needs being responded to promptly. In other words, they are beneficial to the child for good, demonstrable reasons, not because they are ‘instinctive’ or ‘natural’. Other practices are less obviously beneficial; Attachment Parenting International has issued safety guidelines in respect of children sleeping in the parent’s bed, for example, and numerous parents have described attachment parenting resulting in outcomes such as a bad back and sleep deprivation.

Personally, I have no problem with parents basing their parenting approach on a set of beliefs; as long as children aren’t harmed, parents are free to bring up their children as they see fit. They are also entitled to share their beliefs with others and to try to persuade them that those beliefs are right. I don’t even have a problem with practitioners such as Sears or Neufeld advocating a particular approach to child-rearing, because parents and practitioners committed to an approach don’t generally claim to have carried out an exhaustive evaluation of the relevant evidence. It’s usually fairly obvious that they are propagating beliefs and are using evidence selectively to back up their views. What I do find worrying is researchers adopting the same approach. Even though their credentials suggest they are able to evaluate all the relevant evidence in a reasonably objective manner, some follow the same strategy as attachment parenting advocates and base their theoretical models on beliefs backed up with supporting evidence only. What’s also worrying is that an uncritical evaluation of the evidence appears to be acceptable to some peer-reviewed journals.

In a previous post I compared Leo Kanner’s and Bruno Bettelheim’s approaches to the early evidence relating to autism. Kanner’s initial model of autism was based on his evaluation of evidence in the light of contemporary child development theory. As time went by, he repeatedly revised his model as new evidence became available. Bettelheim, by contrast, not only based his model on a belief about the cause of autism (parental behaviour), but also used evidence selectively to support it, and his background in philosophy appears to have persuaded him that this was valid way of handling evidence. I don’t know if Bettelheim’s approach is embedded somehow in the world of child development research, but it keeps cropping up amongst child development researchers. Bowlby’s essential dismissal of genetics and unquestioning acceptance of the idea that the origins of psychiatric disorders are to be found in childhood experiences contrasts starkly with his painstaking analysis of concepts such as instinctive behaviour and emotion. Schore goes into considerable technical detail about the development of the orbitofrontal cortex, but doesn’t question Bowlby’s model of attachment or the findings of researchers he uses to support his orbitofrontal model, despite Bowlby’s theory and the function of frontal areas of the brain being the subject of considerable debate. Perry’s discussion of the evolution of human socio-emotional behaviour is pretty speculative, and although on the face of it his brain scan findings are persuasive, digging a little deeper suggests that he hasn’t paid sufficient attention to defining concepts such as neglect, nor to the range of other possible causes of abnormal brain development.

Carrot or stick?

Another issue that’s concerned me is what the attachment model is used for. AP proponents tend to take a resoundingly positive approach to parenting – AP practices are recommended because they are seen as being good for babies and their families and ultimately, society at large. Parents are encouraged to use strategies flexibly and adapt them to their own lifestyles, even though some AP supporters might get a bit over-zealous and risk making parents feel needlessly guilty. When attachment theory filters through into public policy, however, a rather different picture emerges; one in which there’s a real risk of attachment theory being used as a stick with which to beat parents. Poor attachment is blamed for poor health, antisocial behaviour and psychiatric disorders, locating the source of those problems firmly within the family, particularly with parents and notably mothers.

Despite references being made in policy documents and textbooks to Bronfenbrenner’s ecological systems theory, his framework is rarely applied except in the sense of recommending interventions at the community, state or international level to prevent or compensate for the damage caused by poor parenting. So far, I’ve found little consideration given to the possibility that problems manifested by individuals could have causes at all levels, from genes through physiology, to economic, social and cultural pressures at the community, national or international level.

In my next post, I look at a book by a critic of current child development theories, John Bruer’s The Myth of the First Three Years.

Acknowledgement: with grateful thanks to Jennifer Skillen for information about the history of La Leche League.

another post about nature and nurture: Allan Schore’s model

Allan Schore’s work is widely cited in the child development and child protection literatures – notably in documents relevant to public policy. In this post I look at Schore’s paper ‘Attachment and the regulation of the right brain’ because it deals directly with Bowlby’s theory of attachment. Schore seeks to map Bowlby’s model of attachment onto recently acquired knowledge about how the brain develops, and a shortened version of this paper forms the foreword to a reprint of Bowlby’s classic book Attachment.

Schore is described on his website as “the American Bowlby”, so I expected to see similarities between his model of attachment and Bowlby’s. There is indeed a resemblance, but Schore differs from Bowlby in the use of three terms; ‘emotion’, ‘imprinting’ and ‘environment of adaptedness’. These differences sound trivial, but in fact are quite important.

Schore summarises Bowlby’s model of attachment as follows (page references are for Attachment unless otherwise indicated);

“…that attachment is instinctive behavior with a biological function, that emotional processes lie at the foundation of a model of instinctive behavior, and that a biological control system in the brain regulates affectively driven instinctive behavior.” (Schore p.24)

Emotion

A key departure from Bowlby is encapsulated in the phrase ‘emotional processes lie at the foundation of a model of instinctive behavior’. Schore’s reasoning goes as follows;

Bowlby emphasizes the salience of ‘facial expression, posture, tone of voice, physiological changes, tempo of movement, and incipient action’ (p.120). The appraisal of this input is experienced ‘in terms of value, as pleasant or unpleasant’ (pp.111–112) and the movements ‘may be actively at work even when we are not aware of them’ (p.110); in this manner feeling provides a monitoring of both the behavioral and physiological state (p.121). Emotional processes thus, he says, lie at the foundation of a model of instinctive behavior.” (Schore pp.28-29)

Firstly, I think Schore differs from Bowlby over emotional processes lying at the foundation of anything. Bowlby’s reasons for avoiding using the term ‘emotion’ are pretty clear; he sees emotion as part of a range of ‘feelings’ and those feelings as being part of an organism’s appraisal of its environment; feelings would include hunger, thirst and discomfort – not usually classified as emotions. To clarify his point Bowlby quotes philosopher Susanne Langer’s analogy of the heating and cooling of iron:

When iron is heated to a critical degree it becomes red; yet its redness is not a new entity which must have gone somewhere else when it is no longer in the iron. It was a phase of the iron itself, at high temperature.

As soon as feeling is regarded as a phase of a physiological process instead of a product of it – namely a new entity metaphysically different from it – the paradox of the pyschical and the physical disappears.” (p.108)

Certainly emotional processes (or more accurately ‘feelings’) are an important part of Bowlby’s model of attachment because the expression of feeling is the means of communication between infant and carer. But the phrase ‘emotional processes lie at the foundation of a model of instinctive behavior’ to me implies that in order to be foundational, emotional processes must have an existence independent of the process of appraisal – exactly the opposite of what Bowlby and Langer are saying.

The second point is that Schore doesn’t say that emotional processes lie at the foundation of a model of attachment, but at the foundation of a model of instinctive behaviour. I suspect many of the zoologists cited by Bowlby in his analysis of instinctive behaviour would disagree. Even according to Bowlby’s definition (which excludes reflexes) many behaviours he would consider instinctive don’t actively involve emotion as far as we can tell. He cites for example, imprinting (e.g. ducks and geese following the first object they see after they hatch) and nest-building as instinctive behaviours, but although these behaviours might be associated with emotion (difficult to assess in birds) there is as far as I’m aware no evidence that emotional processes are foundational to them. Of course it could be argued that Schore is referring exclusively to humans, in which case he would be departing from Bowlby’s model again, because Bowlby clearly sees human instinctive behaviour as on a continuum with instinctive behaviour across the animal kingdom.

Despite Bowlby explicitly choosing not to use the term ‘emotion’ Schore’s paper contains 69 mentions of it in 26 pages. Here are a couple of them;

“… Bowlby’s scientifically-informed curiosity…envisioned the center stage of human infancy, on which is played the first chapter of the human drama, to be a context in which a mother and her infant experience connections and disconnections of their vital emotional communications.” (Schore pp.23-24)

I’m not sure this Bowlby actually did this, since he saw emotional communications as only part of the complex interactions involved in attachment, he wasn’t happy with the use of the term ‘emotion’, and goes into some detail about why he doesn’t use it.

“… in his second volume Bowlby (1973) attempted to define more precisely the
set-goal of the attachment system as seeking not just proximity but access to
an attachment figure who is emotionally available and responsive
.” (Schore p.26)

I haven’t read Bowlby’s two later volumes (Separation and Loss), but searching their text on-line shows Bowlby using the word ‘emotionally’ descriptively in case studies, but only one instance of him referring to the mother being “physically present but ‘emotionally’ absent” (Loss, p.43; the quotes around ‘emotionally’ are Bowlby’s). Again, he’s guarded about the use of this word and doesn’t seem to see emotion per se as central to the mother-child interaction.

Imprinting

‘Imprinting’ is a term that has several different meanings. In studies of development, it refers to an animal learning to recognise the features of a particular stimulus – regardless of what happens as a result. Konrad Lorenz’s famous experiments showed that goslings imprint on the first object they see, whether that object is their mother or Lorenz’s boots. But Schore doesn’t use ‘imprinting’ in quite the same way.

Attachment theory, as first propounded in Bowlby’s (1969) definitional
volume, is fundamentally a regulatory theory. Attachment can thus be conceptualized
as the interactive regulation of synchrony between psychobiologically attuned organisms. This attachment dynamic, which operates at levels beneath awareness, underlies the dyadic regulation of emotion. Emotions are the highest order direct expression of bioregulation in complex organisms (Damasio, 1998). Imprinting, the learning process it accesses, is described by Petrovich and Gewirtz (1985) as synchrony between sequential infant maternal stimuli and behavior…
” (Schore, p.34)

I think this paragraph simply lumps together attachment, emotion and imprinting and assumes they form a coherent whole. The first part of the paragraph – about attachment – makes sense in the light of Bowlby’s explanations. But no supporting evidence is offered for the claim that attachment underlies the dyadic regulation of emotion, and Damasio’s claim about emotions doesn’t necessarily have anything to do with dyadic interactions. And the final sentence is unclear about what ‘it’ refers to or why imprinting necessarily involves maternal stimuli or synchrony – young birds have been reported imprinting onto inanimate objects.

Emotion and imprinting are lumped together again here;

Emotionally focused limbic learning underlies the unique and fast-acting processes of imprinting, the learning mechanism associated with attachment, as this dynamic evolves over the first and second years. Hinde (1990, p.162) points out that ‘the development of social behavior can be understood only in terms of a continuing dialectic between an active and changing organism and an active and changing environment.” (Schore pp.30-31)

Again, an unsupported claim is made about emotion and imprinting and Hinde’s comment about social behaviour being an interaction between an organism and its environment involves a dialectic much broader than that between an infant and primary caregiver.

Another anomaly in the use of the term ‘imprinting’ occurs here;

“… I offer evidence to show that attachment experiences, face-to-face transactions of affect synchrony between caregiver and infant, directly influence the imprinting, the circuit wiring of the orbital prefrontal cortex, a corticolimbic area that is known to begin a major maturational change at 10 to 12 months and to complete a critical period of growth from the middle to the end of the second year.” (Schore p.30)

‘Imprinting’ has a number of different meanings, including psychological imprinting (the way it’s usually used in studies of development), but it can also mean to impress or make a mark, so can be used in reference to neural circuits. It’s quite likely that imprinting in the behavioural sense is associated with imprinting in the neural sense, but to use the same term with different meanings without clarification is confusing.

Environment of adaptiveness

Bowlby frequently refers to what he calls the ‘environment of adaptedness’, the environment that shaped human instinctive behaviour. In other words, it’s an environment to which the behaviour is adapted (past tense). But Schore uses the term ‘environment of adaptiveness’ instead. I assumed he must explain elsewhere why he does this, until I noticed that he misquotes Bowlby;

More specifically, it [the control system for instinctive behaviour] evolves in the infant’s interaction with an ‘environment of adaptiveness, and especially of his interaction with the principal figure in that environment, namely his mother’ (p.180).” (Schore p.28; Bowlby has ‘adaptedness’ in the original from which Schore quotes)

Schore also appears to use the term ‘environment of adaptiveness’ to mean something different to the ‘environment of adaptedness’;

“… Bowlby concludes that the mother–infant attachment relation is ‘accompanied by the strongest of feelings and emotions, happy or the reverse’ (p.242), that the infant’s ‘capacity to cope with stress’ is correlated with certain maternal behaviors (p.344), and that the instinctive behavior that emerges from the co-constructed environment of evolutionary adaptiveness has consequences that are ‘vital to the survival of the species’(p.137).” (Schore pp.28-29)

For Bowlby, the ‘environment of adaptedness’ was the evolutionary environment that interacted with genetic endowment to produce the instinctive behaviours typical of human beings. For healthy development to take place, a child needs to be raised within the limits of that environment. For Schore the ‘environment of adaptiveness’ is an environment co-constructed with the mother. In relation to attachment, the two would be very similar, but Bowlby’s environment is much broader than Schore’s. It includes, but isn’t limited to, the interaction with the mother. Schore not only narrows Bowlby’s concept considerably, he actually changes Bowlby’s terminology without – in this paper at least – explaining why.

Placing mother-child interactions centre-stage

I have three main problems with models like Freud’s, Bowlby’s and Schore’s, that make parental behaviour central to the development of child behaviour. The first is that making any factor central by definition marginalizes other factors. There’s a difference between saying “My theoretical model recognizes that there are n factors involved in the development of child behaviour and I’m going to focus on factor a” and saying “There are n factors involved in the development of child behaviour but only factor a is important, so it’s the only one I’ll include in my model”. Some factors are undoubtedly more important than others, and parental behaviour might be one of them, but that doesn’t mean we can assume it’s central to child development. Bowlby bases his assumption that it is, on the correlation found by psychoanalysts between pathologies of personality and childhood trauma. The problem with that correlation is that although childhood trauma might be the cause of a personality pathology it doesn’t mean it’s necessarily the cause or that it’s the only cause. There might be people with pathologies who didn’t have a traumatic childhood, or some who have had a traumatic childhood but haven’t developed pathologies. Psychoanalysts would be unlikely to see many patients in the latter group.

My second misgiving is that a link between childhood trauma and pathology is intuitively appealing. Most of us can recall childhood events involving our parents that we still find painful many years later and examples of other parents dealing with their children inappropriately readily spring to mind. But we don’t often hear people say “I reckon it’s due to a 7R variant of DRD4” or “I suspect serotonin levels, myself” or even, surprisingly since it affects up to 20% of some populations, “Have you considered lactose intolerance?” partly because all these possible causes of abnormal behaviour require more specialized rather than general knowledge and also because they are not obvious – they need to be tested for.

The third reason is related to the second – and it’s that the link between childhood trauma and pathology is superficially simple. Most people will know of examples that appear to confirm it. Fewer people are likely to be familiar with the complex physiological pathways triggered by genes that can affect brain chemistry, or the even more complex interactions between a constantly changing brain chemistry and a constantly changing environment, so fewer people are likely to opt for those explanations. However, when you look at Freud’s, Bowlby’s or Schore’s attempts to map out a possible biological mechanism for child-parent interactions, you realize that the apparent simplicity of the idea is deceptive.

Brains and behaviour

I haven’t yet discussed the second part of Schore’s paper, about the development of the orbitofrontal cortex and its links to the limbic system of the brain. That’s partly because I don’t have sufficient knowledge about brain development to question the accuracy of Schore’s account. It’s also because, although an overview of the development of the orbitofrontal cortex might be informative, I can’t see how it adds support to Bowlby’s theory. Schore asks;

So the next question is, 30 years after the appearance of this volume [Attachment], at the end of the ‘decade of the brain’, how do Bowlby’s original chartings of the attachment domain hold up?” (Schore, p.29).

Schore’s answer is “In a word, they were indeed prescient.” My response would be a bit wordier; that since Bowlby’s theory (despite the fact that I think it’s flawed in some respects) was based on careful observations and thoroughly grounded in behavioural theories that Bowlby had worked through from first principles, it doesn’t actually need any evidence from brain research for it to ‘hold up’. The reason for this is that if a behaviour is occurring, we know that the part of the brain involved in that behaviour must be working, otherwise the behaviour wouldn’t happen. So if a child recognizes faces, it’s a pretty safe bet that the parts of the brain that deal with face-recognition are up and running. If a child can speak and understand language, we can be pretty sure that the language areas are functioning. If a baby cries when hungry and laughs when playing peek-a-boo, the control mechanism involved in the regulation of feelings is probably on track. It’s when there are deficits in face-recognition or language or sad/happy responses that we’d start to wonder about the pathways from the eyes to the fusiform facial area, from the ears to the fronto-temporal areas of the brain or in the limbic-orbitofrontal pathway.

The problem for Freud’s, Bowlby’s and Schore’s theories is that there are many factors in addition to maternal behaviour that can interfere with the typical development of the orbitofrontal cortex. A variation in a tiny section of genetic material can result in, say, the absence of an enzyme that regulates the way neurons connect to each other, or that changes levels of neurotransmitters. A genetic variation might result in a food intolerance in mother and/or baby, affecting the balance of nutrients available to the infant. These factors could affect the baby’s behaviour, impacting on the mother’s response, in turn influencing the baby’s behaviour, in a complex chain of interactions culminating in a unique pattern of attachment behaviours and in a unique brain structure in the infant.

In other words, if a child is behaving unusually, it’s highly likely that a brain scan would show ‘differences’ in brain structure and/or function. But that doesn’t tell you anything about the origins of the differences; they could be genetic, or environmental, or both. In order to draw useful conclusions about those origins, you’d need a DNA profile for mother and infant, a detailed history, some careful observations of the way they interact, and probably a long wait before the relevant gene-behaviour pathways were mapped out by researchers. Unfortunately, DNA profiling, brain scans, detailed histories and careful observation are expensive and require specialist expertise; it’s simpler and cheaper to attribute all behavioural anomalies to poor parenting.

The implications of Schore’s model

So if, as I claim, Bowlby’s model of child development is questionable and Schore’ model lacks Bowlby’s rigour, why take the time and trouble to critique what Schore has to say? The reason is that Schore’s work has had a significant impact. It’s frequently cited in policy documents and his emphasis on emotion is echoed in the child protection literature – Davies and Ward’s Safeguarding children across services: Messages from research mentions ‘emotional’ 261 times in 226 pages. Damasio was right to point out that research into emotion has been a neglected field of research, but as Bowlby explains, one of the reasons for that is because ’emotion’ is a construct that’s challenging to define. It would certainly be useful to find the mechanisms underlying specific emotions such as anger or sorrow, but the usefulness of ‘emotion’ as a general concept – despite its current popularity – is debatable.

I mentioned brain scans and behaviour; in my next post I’ll look at some of Bruce Perry’s work.

back to Bowlby, briefly

John Bowlby

Two names that keep cropping up in the child protection literature (apart from Bowlby) are those of Bruce Perry and Allan Schore. Perry is a recognised expert in child mental health and is especially interested in the effects of trauma. Schore has been described as ‘the American Bowlby’ and as ‘the world’s leading expert in neuropsychoanalysis’. I want to focus on one paper by each of them. I’ve chosen the Perry paper because it tackles the nature/nurture debate head-on and is the source of the brain photograph on the cover of Graham Allen’s report Early Intervention: the Next Steps. The Schore paper “Attachment and the regulation of the right brain” seeks to map Bowlby’s attachment theory onto recently acquired knowledge about how the brain develops, and a shortened version of it forms the foreword to a recent edition of Bowlby’s classic book Attachment. Attachment is the first of three volumes dealing with attachment; the others are entitled Separation and Loss.

The frequent mention of the same few names isn’t unusual in a specialist field, and what I expected to find when I read Perry’s and Schore’s work was the painstaking, step-by-step hypothesis testing typical of researchers working in a little-explored area. That wasn’t quite what I found. Before tackling either of the papers, I need to re-visit Bowlby’s attachment theory because Schore’s paper starts where Bowlby leaves off, and Perry’s paper opens with a discussion about the evolution of human behavioural characteristics – a topic central to Bowlby’s thesis.

The title of this post refers to a brief return to Bowlby’s theory, not to the length of the post. I’ve evaluated Bowlby’s ideas in some detail because later interpretations of his ideas are many and varied and sometimes haven’t taken into account Bowlby’s often meticulous reasoning.

Schore and Bowlby

Schore begins by summarising Bowlby’s view of the biological systems underpinning attachment, and then shows how recent findings about the development of regulator systems in the brain’s right hemisphere support Bowlby’s predictions. In the abstract to his paper Schore summarises Bowlby’s model of attachment like this:

“… attachment is instinctive behavior with a biological function, that emotional processes lie at the foundation of a model of instinctive behavior, and that a biological control system in the brain regulates affectively driven instinctive behavior”.

The first thing that struck me about Schore’s paper is that he doesn’t define terms such as attachment, instinct and emotion. Biologically speaking, none of these constructs is straightforward and Bowlby discusses their definitions at length. It’s a pity Schore doesn’t explore these terms, because re-reading Bowlby’s explanations half a century after publication (revisions in the second edition of the book in 1983 notwithstanding) suggests that there are some implicit assumptions in his thinking that are open to question. And anyone unfamiliar with either Bowlby or the animal behaviour literature might be unaware of the complexity of the issues involved.

Let’s start with some of the key concepts that underpin Bowlby’s theory of attachment – first, psychoanalysis.

Psychoanalysis

Bowlby opens Attachment with a chapter called “Point of View” in which he explains the basis for his model. He begins with a quote from Freud, and takes as his starting point an underlying principle of psychoanalysis; that personality, both healthy and pathological, is shaped by events that occur in childhood. But Bowlby differs from Freud on several key points;

Despite these differences, Bowlby assumes that personality (one construct that he doesn’t attempt to define) is shaped by childhood events and that pathologies of personality originate in traumatic experiences in childhood, observations suggesting that a significant trauma is separation from, or loss of, the mother. In the two later volumes of his Attachment trilogy Bowlby suggests that separation is an underlying cause of anxiety and that loss is a cause of sadness and depression. Bowlby points out that his model’s underlying mechanism involves biological processes rather than psychical energy. A central biological process is evolution.

Evolution

Bowlby’s theory is rooted firmly in the Darwinian model of evolution. Darwin’s theory is based on two main concepts, inherited characteristics and natural selection. Neither of these concepts was new when Darwin proposed his theory. People had known for millennia that offspring inherit physical and behavioural characteristics from their parents and that plants and animals thrive in a particular environment only if their characteristics are well adapted to it. Farmers had been using artificial selection for centuries to breed characteristics into or out of plants and animals to suit a specific purpose or environment. What was new about Darwin’s theory was the idea that environmental factors acting on inherited characteristics could result in changes to a species, or in new species arising. What was missing from his theory was the mechanism by which characteristics were passed on to subsequent generations. Although DNA had been discovered in the mid-19th century, its structure and function were unknown and it wasn’t until the turn of the 20th century and the re-discovery of Gregor Mendel’s work showing that characteristics were inherited via discrete units of heritability, that the concept of genes was developed.

Genes

Bowlby sees ‘instinctive’ behaviours like attachment as emerging from the interaction between genetic endowment and environment, but essentially limits his comments on genes to the following paragraph:

The basic concept of the genetical theory of natural selection is that the unit central to the whole process is the individual gene and that all evolutionary change is due to the fact that certain genes increase in number over time whereas alternative genes decrease or die out. What this means in practice is that, through the process of differential breeding success, individuals that are carrying certain genes increase in numbers whilst individuals that are carrying others diminish. A corollary is that the adaptedness of any particular organism comes to be defined in terms of its ability to contribute more than the average number of genes to future generations. Not only, therefore, does it have to be designed so that it is capable of individual survival but so that it is capable also of promoting the survival of the genes it is carrying. This is commonly done through reproducing and promoting the survival of offspring.” (pp.55-56)

Although what Bowlby says is true at one level, his comments don’t give any indication of the complexity of genetic variation in a population. This is despite de novo (spontaneous) mutations having been discovered in fruit flies by the 1920s, and by the time Bowlby published Attachment in 1969 population genetics was a well-established field. The second edition of Attachment came out in 1983, only five years before the commencement of the Human Genome Project.

Bowlby is clear that a debate about whether development is primarily a matter of nature or nurture is meaningless because individual development is a product of an interaction between genes and the environment (pp.38, 296). Nonetheless Bowlby plays down the likelihood of genetic causes of behavioural anomalies in favour of environmental causes;

There are many reasons why, in the course of development, one or another feature of an animal’s diverse biological equipment may fail to develop satisfactorily… Though occasionally one or more genes are responsible for the failure, more often some anomaly of the embryo’s environment is the cause – a virus, a chemical, a mechanical trauma and so on. It is probably the same with failures in development of behavioural systems. Whilst genes may well account for some forms and cases of failure, anomalies of a juvenile’s environment beyond those to which behavioural equipment is adapted are likely to be the cause of most of them.” (pp. 129, my emphasis).

Bowlby couldn’t have known about the frequency of de novo mutations in humans and he was studying a behavioural interaction that’s highly susceptible to environmental factors, but his speculative ruling out of genetic causes is rather surprising. His emphasis leads to a detailed discussion of environments.

Environment

A central concept in Bowlby’s model is what he calls the environment of adaptedness. Although human beings occupy a wide range of environments, all those environments fall within limits outside which human beings can’t function efficiently. Bowlby argues that each biological system of each species has its own environment of adaptedness; the one to which it is evolutionarily adapted and the one in which it functions best. He points out that cardio-vascular systems work only within certain limits of oxygen and carbon dioxide, and that those limits vary for different species. So, he concludes, the behavioural systems responsible for maternal behaviour will work within certain limits of the physical and social environment, but not outside them. In short, the environment of adaptedness produced instinctive behaviour so instinctive behaviour will work effectively only within the environment of adaptedness.

Instinctive behaviour

Bowlby presents the traditional definition of instinctive behaviour as;

• species-typical
• a sequence of behaviours running a predictable course
• having obvious survival value for the individual and/or the species
• arising in the absence of opportunities for learning the behaviour.

During the heyday of research into instinctive behaviours there was considerable debate about whether they were innate (inborn) or acquired (learned). Bowlby thinks this is a pointless distinction, because all the characteristics of biological organisms are products of an interaction between genetic endowment and environment (p.38). He follows zoologist Robert Hinde in suggesting that instinctive behaviour forms a continuum ranging from characteristics that remain stable regardless of environment such as nest-building behaviour, to those that are labile and environmentally dependent, such as show jumping or piano playing. Although he wouldn’t include reflexes as instinctive behaviour, Bowlby’s continuum could be seen as extending from reflexes and simple stimulus-response reactions at the stable end, to complex chains or hierarchies of behaviour that include both innate and acquired behaviours, at the labile end. Although ‘instinctive’ might be a more useful concept than ‘innate’ or ‘acquired’ for researchers studying behaviour, for those investigating the biological mechanisms underpinning behaviour, a distinction between innate and acquired behaviours might be more useful than the umbrella term ‘instinctive’.

Emotion

Schore’s summary of the concept of attachment says ‘that emotional processes lie at the foundation of a model of instinctive behavior’. Bowlby devotes an entire chapter to emotion, which is well worth reading if you’re interested in behavioural theory. In it, he opts to use the term ‘feeling’ rather than ‘emotion’ because ‘feeling’ can be applied to a wide range of… well, feelings, but ‘emotion’ tends to have a more restricted use. (And one that’s proved notoriously difficult to define.) Essentially Bowlby sees feeling, not as a stand-alone biological phenomenon, but as having an important role in an organism’s appraisal of its internal and external state. The appraisal process involves;

• assigning a value (e.g. nice/nasty) to current sensory input
• comparing the current situation with previous ones
• selecting an appropriate behavioural response
• evaluating the behavioural response in terms of the organism’s goals

Bowlby shares the view of philosopher Susanne Langer that ‘being felt is a phase of the process itself’ (p.108). In other words, feelings are a phase of the process of appraisal.

He explores the role of feelings in communication – via facial expressions, for example, and whether feelings cause behaviours. Bowlby’s analysis is very thorough. So although feelings clearly play an important role in the interaction between mother and infant, I find it difficult to understand how Schore can conclude that Bowlby sees emotional processes as at the root of attachment, especially as Bowlby warns repeatedly about the danger of reifying feelings and emotions as if they can exist apart from the process of appraisal of the internal and external environment.

Strengths and weaknesses of Bowlby’s model

This is my understanding of Bowlby’s model of attachment;

Over time, human beings have evolved instinctive, biologically regulated behaviours that increase the likelihood of the survival of the individual and the species. Mating, parenting and attachment behaviours are critically important (p.179). Attachment involves infants seeking proximity to a primary caregiver, usually the mother. Separation from the attachment figure causes anxiety, and loss of the attachment figure causes depression.

Elsewhere I’ve been quite critical of attachment theory so it might be worth highlighting in more detail where I think Bowlby is wrong – and where he’s right.

There are some aspects of Bowlby’s model I wouldn’t question. It’s clear that childhood experiences affect development and adult behaviour. Some behaviour fits Bowlby’s definition of instinctive, and it’s valid to describe the proximity-seeking behaviour of young children toward a caregiver as ‘attachment’. Attachment behaviours would generally improve an infant’s chances of survival. And there’s no question that there’s usually an emotional bond between infants and their mothers and that separation from the mother can have lasting effects.

What I am questioning is some of Bowlby’s underlying assumptions about nature and nurture. I think there are four questionable assumptions – about genetic endowment, the environment of adaptedness, typical development and what causes developmental differences. Bowlby sees the nature/nurture debate as pointless because development – of the species and the individual – is the outcome of interactions between genetic endowment and environment. Yet he sees individual development as being influenced predominantly by environmental factors. How does he come to what appears to be a contradictory conclusion?

genetic endowment

As far as I can tell, the contradiction originates in his first implicit assumption about genetic endowment; that the human genome has already evolved and is unlikely to evolve further. In Bowlby’s model, instinctive behaviour has evolved once and for all in its environment of adaptedness. It’s as if human beings, like all other species, have ended up in a kind of evolutionary cul-de-sac. That’s true in the sense that past genetic changes limit future ones, but it doesn’t preclude the minute de novo changes in genetic material between generations that are now believed to be involved in many developmental disorders.

The interaction between genes and environment can occur at a molecular level. A small genetic variation can result in changes to levels of a specific protein that can in turn trigger a cascade of developmental abnormalities, including abnormal social interaction, with variations between individuals resulting from interacting developmental and environmental factors interacting in different ways; this is what occurs in Williams syndrome, for example.

environment of adaptedness

The second assumption involves the environment of adaptedness – the environment that shaped the genetic endowment and the instinctive behaviour of a species. Bowlby says;

So long as the environment is kept within certain limits, it seems likely that much of the variation in the behaviour of different children is attributable to genetic differences. Once environmental variation is increased, however, the effects to which such variation gives rise are plain to see”. (p.296)

The problem with this view is that although the limits of the environment of adaptedness are clear for something like the cardiovascular system – if they are exceeded the system stops functioning and the organism dies – we don’t actually know for sure what those limits are for various behavioural systems. We can only speculate by observing the points at which behaviour begins to depart from typical patterns. And typical behaviour varies not only between individuals, but also within individuals – over time and in different environments. Although some behaviour patterns can be described as typical of a species, the typicality itself isn’t clear-cut; all we can say is that a species has a tendency to behave in particular ways in particular circumstances.

typical development

Although he doesn’t say so explicitly, Bowlby appears to be moving towards a normative view of child development. So a third assumption is that not only are some patterns of behaviour typical of human beings, those are also patterns that healthy human beings should be showing.

causes of developmental differences

The fourth assumption is that psychoanalysis is correct in locating the root of many pathologies in attachment patterns;

If the satisfactory development of attachment is as important for mental health as is claimed [by Freud], there is an urgent need to be able to distinguish favourable development from unfavourable and also to know what conditions promote one or the other.” (p.331)

Bowlby explains Freud’s view of separation anxiety as follows;

“… we try at times to withdraw or escape from a situation or object that we find alarming, and … we try to go towards or remain with some person or in some place that makes us feel secure. … So long as the required proximity to the attachment-figure can be maintained, no unpleasant feeling is experienced. When, however, proximity cannot be maintained … The consequent searching and striving are accompanied by a sense of disquiet … and the same is true when loss is threatened. In this disquiet at separation and at threat of separation Freud in his later work came to see ‘the key to an understanding of anxiety’.” (p.330)

Bowlby supports this thesis by referring to studies that show typical attachment patterns in infants. I think this is where his theory runs into problems because the studies also show a great deal of variation in behaviour in both babies and mothers. Despite this, Bowlby focuses on the correlation between infant and maternal behaviour and concludes;

Whatever the causes of a mother’s behaving in one way or another towards her infant, there is much evidence suggesting that whatever that way is plays a leading part in determining the pattern of attachment he ultimately develops.” (p.345)

At one level Bowlby understands the importance of the interaction between genetic endowment and environment in behaviour and that genetic endowment and environment can vary. But because of his underlying assumptions about the human genome, the environment in which it evolved, the nature of instinctive behaviours and a psychoanalytic model that locates the source of mental health in childhood experiences, it’s almost inevitable that Bowlby ends up placing a disproportionate emphasis on environmental factors – especially on the mother’s behaviour.

Does the nature/nurture debate really matter?

Despite child development theorists from Darwin onwards espousing the idea that behaviour develops from an interaction between genetic make up and environment, child development theory has throughout its history swung between an overemphasis on genes and an overemphasis on environment. An overemphasis one way or another isn’t just an obscure theoretical issue. Overemphasising the role of genes resulted in the eugenics movement that had catastrophic outcomes for minority groups worldwide. Overemphasising environmental factors (coupled with a misunderstanding of probability) led to the relatively recent imprisonment in the UK of several mothers wrongfully convicted of murdering their children – with tragic consequences.

Attachment theory has experienced something of a resurgence in recent years, but professionals using it don’t necessarily have sufficient biological knowledge to critique it. In the publications on child development referred to by the Munro review of child protection Bowlby’s ideas were generally presented as givens, with little discussion. In other words, there appears to be an assumption implicit in the child protection literature – and amongst politicians – that the most likely cause of abnormal behaviour in children is parental behaviour. The problem with an overemphasis on parental behaviour is that there’s a serious risk of genetic and medical disorders and alternative environmental factors being overlooked. I’ve lost count of the number of accounts I’ve read from parents who have been puzzled as to why their child refusing to go to school is attributed by teachers and social workers to a child having a problem with attachment (rather than a problem with school), or where problems with attachment have transformed into a diagnosis of autism or ADHD once practitioners who are specialists in those fields get involved.

My fundamental problem with attachment theory is not that I think attachment behaviours don’t exist – they clearly do. It’s that Bowlby’s theory consists of a number of phenomena over which there’s little disagreement, held together by a series of assumptions. Those assumptions implicitly rule out a host of other possible causes for mothers and children behaving in the ways they do. In the next post, I’ll look at what Allan Schore makes of Bowlby’s model.

Edited for clarity 11/7/15.

Image of Bowlby from http://tinyfootprints.wikispaces.com/John+Bowlby

what’s wrong with attachment theory?

I’ve encountered enough examples of inadequate, chaotic, manipulative and abusive parenting to understand why people working with troubled children might view parents as prime suspects. However, there are many possible causes for children’s unusual behaviour and a focus only on parental behaviour means that other causal factors are likely to be overlooked.

In the next few posts, I want to explore three concepts – Attachment Theory, Fabricated or Induced Illness (FII) and the ‘cycle’ theories of deprivation and abuse – that attribute the cause of children’s abnormal behaviour primarily to parental behaviour. Although these concepts aren’t directly related to autism, parents of children with developmental issues and learning difficulties have reported these ideas being proposed as causes for their children’s behaviour despite evidence to the contrary.

Attachment theory

Attachment theory was an idea developed by John Bowlby, born in 1907, one of the six children of Sir Anthony Bowlby, surgeon to the King’s household, and his wife Maria. Like many children in well-to-do families of the period, Bowlby was brought up by a nanny and sent to boarding school at the age of seven. He later became a psychologist, psychiatrist and psychoanalyst who worked with maladjusted and delinquent children, studied the effects of maternal deprivation and after WWII became a mental health consultant to the World Health Organization. Bowlby’s work led him to the conclusion that ‘to thrive emotionally, children need a close and continuous caregiving relationship’ (Bretherton, 1992). He drew on new research in cybernetics, brain function and on Lorenz’s work on imprinting to develop his theory, and realized that a complete revision of Freudian ideas about child development was required. This he attempted to do in three books published under the title Attachment and Loss: Attachment (1969), Separation (1973) and Loss, Sadness and Depression (1980).

In 1950, a University of Toronto graduate called Mary Ainsworth had joined Bowlby’s research team. Three years later, having moved with her husband to Uganda, she carried out the first of several studies on infant-mother attachment. She then developed an assessment procedure for determining the nature of an infant’s attachment – the Strange Situation – and concluded that infants showed one of four distinct patterns of attachment to their mothers; secure, anxious-resistant insecure, anxious-avoidant insecure and disorganized/disoriented. The patterns of attachment developed with primary caregivers were seen as foundational for social interactions and mental health throughout later life – an insecure or disorganized attachment could lead to later problems.

It’s easy to see how attachment theory could be used to lay the blame for a child’s behavioural issues at the feet of parents, particularly mothers. Bowlby, however, doesn’t appear to have had any intention of blaming parents; his theory is firmly grounded in the idea of behaviour involving an interaction between genes and environment. But that doesn’t seem to be the way attachment theory is presented in texts that inform public policy. Before moving on to these texts I want to examine the ideas behind attachment theory in more detail because, like the concept of autism, it’s a theory constrained by the state of knowledge at the time of its inception.

Background to attachment theory

In the opening chapters of his first volume of the Attachment and Loss series – Attachment – Bowlby explains, systematically and in detail, the theoretical framework for his model. Bowlby brought together concepts from a number of different fields. Here’s a summary of his reasoning:

• Observations have shown that separation from the mother-figure can be extremely traumatic for children. There is evidence that this separation can result in problems with behaviour, personality and mental health in later life – e.g. stealing, depression and schizophrenia.

• Attachment theory is grounded in psychoanalytic theory because ‘despite limitations, psychoanalysis remains the most serviceable and most used of any present-day theory of psychopathology’ (p.xv).

• Data can be obtained by observing behaviour, as well as from introspective reports from participants.

• Freud drew attention to the importance of feedback in homeostatic biological systems; in behaviour, motivation is regulated by homeostasis in the same way.

• Instinctive behaviours can be complex and are the outcome of an interaction between ‘genetic endowment’ and environment – partly innate and partly acquired.

• Behavioural systems are goal-directed (ie they evolve in order to fulfil a specific purpose) – analogous to engineering control systems.

As I understand it, at inception, the Freudian psychodynamic model of behaviour was a novel idea; it was developed from first principles derived from contemporary understanding of biological mechanisms. Bowlby’s model wasn’t novel; it was an extension of the psychodynamic model based on new knowledge about those mechanisms. This means that Freud and Bowlby based their theories on the same assumptions:

1. Species-specific patterns of behaviour are biologically ‘provided’ – although they can be affected by the environment.

2. Biologically provided behaviour patterns are normative. That means that in the ‘right’ environment they will unfold naturally, but could be disturbed if something goes ‘wrong’ with either the genetic endowment or the environment.

3. Biologically provided behaviour patterns are goal-directed – they have evolved to fulfil a specific purpose.

4. Behaviour is driven by the need to maintain emotional (feelings) homeostasis.

5. Relationships between parents and children are central to child development.

Attachment theory is clearly a theory of its time, since research in all these areas has since moved on. That doesn’t necessarily invalidate attachment theory, but does suggest there are some problems with it.

What’s wrong with attachment theory?

1. Freud saw social and sexual development as central to human behaviour because of their importance in sexual reproduction – the means by which inherited characteristics (including behavioural drives) are passed on to offspring. This is why a child’s relationship with his or her parents was seen as so important; it could disturb the natural unfolding of social and sexual drives. Subsequent research, by contrast, shows that social and sexual behaviour is influenced by complex array of factors that change over time. Despite revising Freud’s framework, Bowlby still viewed social and emotional factors as central to the development of human personality rather than being two factors amongst many.

2. Much of Bowlby’s research was carried out prior to the structure of DNA being discovered and the consequent development of molecular biology. Subsequent research suggests that rather than behaviour patterns being biologically provided, they emerge from interactions between genetic expression and environment. Similarities between individuals in both genetic material and environment result in species-specific behaviours but differences mean that species-specific behaviour patterns vary between individuals. Oppenheim et al. (2009) noted, for example, secure attachment patterns in autistic children that were different to the one that Ainsworth described.

3. Biological behaviour patterns can only be goal-directed if the genome and the environment remain stable – but they don’t. Genetic make-up is unique to an individual and the environment changes constantly; behaviour patterns emerge from a dynamic interaction between the two. Although there’s no doubt that children do exhibit patterns of behaviour towards their primary caregivers, and it’s likely that those patterns can be seen across different individuals, the patterns are descriptive, rather than normative. Even if the patterns provide a useful way of identifying problems in infant-parent relationships, they show how children interact, not how they should interact.

4. Some biological systems – those that regulate body temperature or the levels of oxygen and water in the body, for example – are maintained via homeostasis because the biochemical reactions necessary for survival can occur only within certain narrow limits. Emotions and behaviour aren’t so constrained and tend to be cyclical rather than stable.

5. There’s no doubt that a child’s relationship with his or her primary caregiver is important. But in focussing on a single relationship, attachment theory by definition marginalises the role of genetic, biological and other environmental factors – including other relationships – in a child’s social and emotional development.

This brings us back to the concept of reification that cropped up in a previous post about Kanner’s model of autism – although I didn’t call it that at the time. Reification literally means ‘making a thing’ – the implication being that a ‘thing’ is made that doesn’t necessarily exist in the real world. There’s no question that ‘attachment’ can be used as a descriptive label for certain kinds of behaviour, just as ‘autism’ can. It doesn’t follow that attachment must be a clear-cut psychological function, nor that autism must be a distinct medical disorder.

When I studied psychology as an undergraduate in the 1970s, attachment theory was already being viewed with some skepticism for the above reasons. I haven’t kept in touch with child development research so I was surprised to find that attachment theory is still alive, well and influencing social policy in the 21st century. That’s the subject of the next post.

References

Bowlby, J (1969). Attachment and Loss vol 1: Attachment. Revised 2nd edition, 1997, Pimlico.
Bretherton, I (1992). The origins of attachment theory:John Bowlby and Mary Ainsworth, Developmental Psychology, 28, 759-775.
Oppenheim, D., Koren-Karie, N., Dolev, S. and Yirmiya, N. (2009) Maternal insightfulness and resolution of the diagnosis are associated with secure attachment in preschoolers with autism spectrum disorders. Child Development, 80: 519–527

Acknowledgements

I want to thank everyone who sent me links relevant to this and related posts. You know who you are!