The One Thing That's Missing from Attachment Theory

One of the strongest articles of faith among psychotherapists is the intuitively attractive proposition that the security of early attachments to parents has a profound influence on adult mental health. Thousands of articles, books, and conferences have probed this topic, and many therapists have made attachment theory a cornerstone of their clinical approach. Even clinicians who aren't particularly loyal to attachment theory accept the general proposition that the quality of infants' emotional experiences with their caretakers affects their vulnerability to psychological disorders as adults. However, when I examine the evidence for this belief as a research psychologist, rather than as a clinical practitioner, a different, less clear-cut picture emerges.

Attachment Theory in Perspective

Some influential ideas in the social sciences have their roots in the life experiences of the creator and his or her culture. This appears to be true of attachment theory. Let us consider the life experiences of the British psychiatrist John Bowlby, the father of attachment theory. As the fourth of six children growing up in an upper-middle-class London family, Bowlby, born in 1907, and his siblings were cared for by nurses on the top floor of the family's spacious home. He recalled seeing his mother for perhaps an hour each day after teatime, and his father, a prominent surgeon, once a week. His favorite nanny, with whom he had a close relationship, left the household when he was 4. By 7, he'd been sent to a boarding school. He later said of that experience, "I wouldn't send a dog away to boarding school at age 7."

At age 21, he worked for a short time at a progressive school for emotionally disturbed children. Some of these children had experienced early separation from their parents or obvious neglect, and Bowlby interpreted their disturbed behavior patterns as support for his belief that a mother's love for a child was vital for healthy psychological development—as vital as good nutrition is for physical growth.

In 1946, Bowlby joined the staff of the famous Tavistock Clinic in London, where he met a social worker named James Robertson, who was angry at the hospital's policy of not allowing mothers to visit young children who'd been admitted for surgery—a hospital policy intended to prevent infections from spreading through the ward. Robertson noticed that children in the second year, but not those who were younger or older, became unusually distressed when they were alone on the ward lying in a crib, and he told Bowlby about his observations. Bowlby interpreted these children's distress as further confirmation of his ideas on attachment. However, Robertson disagreed, arguing that the children's distress could be avoided by simply having any adult present on the ward. This fact meant that the crying didn't reflect the fact that the children missed their mothers, but rather that they were frightened because they were alone in an unfamiliar place.

Bowlby’s work first gained currency at a time when important changes in American society made their ideas particularly attractive. These changes include the public's brooding on the horrors of World War II and the new economic structures that were transforming the traditional family that had dominated Western culture during the prior 200 years. Young mothers were now entering the workforce in unprecedented numbers and needed to find surrogate care for their babies, often in day care centers. This disruption in the time-honored form of infant care by mothers provoked a contagion of worry among professionals and parents. Could infants be cared for adequately if they didn't have the full-time attention of their mothers? This worry had a long tradition in Europe as well as America. In the middle of the 18th century, Jean-Jacques Rousseau wrote that when women are good mothers, their sons will be good husbands and fathers. Sigmund Freud thought that mothers' nursing and toilet-training practices affected adult personality.

The evidence indicates clearly that serious neglect or abuse of infants during the first year or two can harm the child's future psychological development. No one quarrels with that statement. But there are no studies to date that have investigated the mother-infant interaction in the first year with a large group of infants from all social classes, followed these children to age 20, and demonstrated that insensitive mothers usually produced less happy adults than sensitive mothers, when social class and culture are controlled. Thus, this aspect of attachment theory remains a hunch.

The Course of Human Development

A serious limitation of attachment theory is its failure to recognize the profound influences of social class, gender, ethnicity, and culture on personality development. These factors, independent of a mother's sensitivity, can be as significant as the quality of the early attachment.

Research has demonstrated that social and economic factors have a powerful influence on development. The strongest predictor of adult depression or anxiety in many cultures is growing up in a disadvantaged social class. For example, Mississippi has a larger proportion of minority residents living in poverty than North Dakota, and the incidence of depression in Mississippi is three times that of North Dakota, according to the Centers for Disease Control.

Why does a disadvantaged social class position predict mood disorders, criminal careers, or addictions? One reason is that children identify with their class, which in the United States and Europe is defined by type of work, education, and income. Children belonging to less-advantaged class categories feel less potent, less virtuous, and possess a weaker sense of agency because of their identification. These traits are reflected during childhood—long before a depression or anxiety disorder develops—in lower school motivation, poorer grades, hostility to more advantaged peers, and less willingness to persist with difficult challenges.

The Researcher's Role

By remaining skeptical of oversimplified explanations of the human psyche and reductive answers to complex questions, psychological research forces clinicians to ask difficult questions and not pretend that they know more than they do. In that way, research serves as a corrective against the pervasive human temptation to construct a narrative that matches our preconceptions and unexamined biases, walled off from the messy reality in which all of us—clients, therapists, and researchers alike—have to live.

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This blog is excerpted from "Bringing Up Baby" by Jerome Kagan. The full version is available in the March/April 2011 issue, The Great Attachment Debate: How Important is Early Experience?

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Topic: Anxiety/Depression | Attachment Theory | Children/Adolescents

Tags: addiction | addictions | anxiety disorder | attachment disorder | depression | mood disorders | psychotherapy | therapy | attached | John Bowlby | babies | mothers | infants | baby | mother | infant | social class