Prior to a 10 year sabbatical from psychiatry, I trained and sub-specialized in treating children with attachment related issues - many from international orphanages or foster care. When I returned to psychiatry, the focus of my work (and my own healing) was more physiologic - addressing areas such as nutrient imbalances, toxicity, inflammation, etc. That I was seeing good responses to such treatments, even for children with attachment issues, confirmed for me that these were the topics to write about and share. Inevitably, my work (and approaches to my own health and my daughter's health) has come full circle. I'm realizing that we can't fully understand topics like inflammation or mast cell activation, the autonomic nervous system, right and left brain hemisphere differences, or even methylation without putting them into the context of our first three years of life.
- What We Don't Remember
- Environmental Impacts on the Foundation (our first 3 years)
- Yes, Nurture, But What About Nature (stress hormone pathways, epigenetics, right and left brain hemispheres)
- Where Are We on the Attachment Spectrum? (secure, avoidant, anxious, disorganized?)
- Going Forward - Strengthening the Foundation (ours, our childrens' and even our adult childrens')
WHAT WE DON'T "REMEMBER"
Like you, I carry within my body and my unconscious the infant and toddler I once was. And, like many of you, I am a parent. I understand the desire to go back and make different parenting choices. “We can only know what we know when we know it,” I remind myself.
As much as we might think about our lives, most of us aren’t considering our first three years when the foundation upon which our physical, cognitive, emotional and social wellbeing was being built. Though our conscious or thinking brain doesn’t recall this time, our bodies, autonomic nervous system and stress hormone pathways do.
In our first year of life, our brain doubled in size. By three, our brain was 80% of what it is now. By our 5th birthday - 90%. Our newborn, infant and toddler experiences are impacting us all the time. I’ll spare you the research method, but know that if you blindfold kittens for three months after their birth, they will be blind. Without visual sensory input, their visual pathways won’t form properly. If you blindfold an adult cat, they don’t lose their vision.
Our environment as infants (namely our caregivers), could have been loving, warm and responsive or absent, detached, anxious or hostile. Our environment as toddlers could have been a secure base (again, our caregiver) that allowed us to explore and return for refueling or our caregiver could have been absent, restrictive, or emotionally reactive. Whatever our experiences, our neuronal connections were forming and becoming reinforced in such a way as to increase our survival in our world. We weren’t all born into the same world.
Becoming conscious, or at least curious, about this early time in our lives can bring clarity to why we think and feel the way we do. It can explain why we repress our feelings. Why do we sometimes use addictive behaviors, food or substances to check out? Why do we become angry out of the blue? Do we feel ignored, jealous or believe we aren’t getting our due? Why is it so uncomfortable to receive praise, affection, gifts or even attention from others? Why do we gravitate to those who ignore or hurt us? Why do we create drama in our relationships? The answers may be in our very beginnings. Beliefs, feelings and behaviors that may have made perfect sense then, don’t now.
In addition to carrying that infant/toddler inside of us, we also carry a responsive caregiver who notices and accepts our feelings as part of our human condition and wants to comfort us. However we refer to this part of ourself - our soul, our higher self, our inner parent or God - the main thing is that we know this part of us is there, no matter how hidden it may seem. We can turn to it when we need to.
WE’RE ALL WOUNDED
I write this chapter with the assumption that we’re all wounded to some degree by our early experiences. Most of us haven’t been directly impacted by war or famine. Many of us haven’t been abused or severely neglected. Some of us have. However, we all have been shaped by cultural influences, whether it was the medicalization of childbirth which separated newborns from their mothers, the shunning of breastfeeding, the “cry it out” approach to bedtime, or screen media intended to calm and sedate infants in place of a caregiver.
Obviously, our choices can be impacted greatly by our circumstances. We may be a single working parent struggling to keep our infant fed in a country without policies that support this time of development. We may have financial resources, but believe we have no choice, other than to obey the parenting advice of experts, marketers, family or friends. And unless we’re conscious, which can be hard when parenting very young children, we’re all making choices influenced by our own early and “forgotten” experiences.
WHAT’S LOVE GOT TO DO WITH IT?
While “attachment” is about love and our first connection to another human being, it is also decidedly...not ...about...love. As parents we can love our children and have perfect intentions, and still make choices that lead to unintended trauma. By trauma I mean a severe or persistent physiologic stress response that leaves its mark on the body.
As parents, we can experience tragedy and adversity during our child’s earliest years. Our stress inevitably will affect our child and more so if we don’t have support. Still, loving our children and having good intentions doesn’t build a foundation; just as loving flowers and intending to plant them doesn’t make for a flourishing garden. It takes learning about what flowers need. It takes time (from one, two or more gardeners)...and still there can be unexpected weather conditions.
Attachment is not about perfection. Just as I wouldn’t suggest we can live a life free of toxins, inflammation, damage to our microbiome, I won’t suggest we should have had the perfect attachment experience - whatever that even is.
PURPOSE OF ATTACHMENT
We are biologically wired to desire proximity to our caregiver(s) so that as infants we will be protected from harm and as a species we will survive. British Psychiatrist John Bowlby’s pioneering Attachment Theory says that we will organize our behavior and thinking in order to maintain these relationships. Because our survival is at stake, we will maintain these relationships even at great cost to our functioning. Bowlby’s theory says that if our parents/caregivers are unable to meet our needs and the attachment is essentially disturbed, we will develop distortions of thinking and feeling which is at the root of mental disorders.
When under stress as babies or toddlers (just as when we’re adults), our bodies produced adrenaline which caused our heart rate and blood pressure to increase. Stress also causes the stress hormone cortisol to be released. This is the “fight or flight response,” even though as babies we couldn’t do either. Ideally if we were in pain, uncomfortable, or hungry, this stress response was activated and supportive caregivers responded. We became calm and our bodies returned to homeostasis. This repeated resolution has allowed us to develop an autonomic (automatic) nervous system conducive for a healthy stress response. This type of neurological wiring is what allows us to tolerate normal amounts of stress and to bounce back when we experience stress as we grow older.
If, however, as infants and toddlers, our stress response was extreme or persistent, and not buffered by a responsive caregiver, we can have higher cortisol levels that persist for hours or even days. This would result in our brains being wired for danger, vigilance and self reliance - some of us more than others depending on our genetic vulnerabilities.
IMPACT ON BELIEFS ABOUT SELF, OTHERS & THE WORLD
Attachment requires someone for us to attach to - a caregiver(s) - one who is present and recognizes and meets our needs as infants and toddlers. Ideally, we were fed when we were hungry, comforted when we were distressed, and regularly engaged with. These repeated experiences create the belief that our needs will be met. We learn the world is safe. People can be trusted. We are worthy to receive.
On the other hand, if cries or reaching out aren’t adequately or appropriately responded to, we learn that our needs are never met, or they’re sometimes met but don’t count on it. The world is a dangerous place. Others can’t be trusted. We’re afraid. We believe we’re not worthy to receive.
In toddlerhood, our needs change. Hopefully we can trust that when we start to explore our environment, our attachment figure(s) will be there for us as a secure base. We repeatedly return for refueling before exploring some more. But what if our caregiver can’t tolerate our need for autonomy and connection? What if our exploration and autonomy is constantly interrupted or punished or met with rejection when we return? We won’t explore. We forgo our needs in order to meet the needs of our caregiver. What if our secure base up and leaves or threatens to leave? Then, that’s what we’ll come to expect of others.
ENVIRONMENTAL IMPACTS ON THE FOUNDATION
Child-rearing values reflect cultures. While some features of attachment seem to be shared across the world, other features vary widely. Some of us are born into a “child-centered” world, which emphasizes the bond between an infant and a primary caregiver. While this may seem optimal, it’s not if it leaves parents feeling stressed out, and not seeking help from others when they and their child need it.
An exclusive parent-infant bond would likely not bode well for a child born in the Cameroonian Nso community where maternal exclusivity is discouraged. This goal of having children used to everyone and loving everyone equally may in part be driven by high maternal death rates. In Kenya, Kissi mothers carry their babies everywhere but avoid eye contact which is felt to convey power to the child and lead to attention seeking. In Norway when infants turn one, they typically go to state subsidized day care from 8 am to 5 pm. Right next door in Sweden, policies allow for generous parental leave entitlements. Together parents have 16 months of parental leave which can be used up over 8 years during which they receive 80% of their salary.
While our culture is impacting child rearing, our child rearing is shaping our culture; or at least the culture that we’ll be living in when the youngest among us are the adults in charge. When we hear about groups engaging in genocide or terrorism, the first question should be, “How were they treated as infants and toddlers?” Nazi educator and physician, Johanna Haarer, wrote “The German Mother and Her First Child,” of which 600,000 copies were made. This manual on caring for an infant, existed for the seeming purpose of preparing children for submission to the Nazi regime. The intent, which was aligned with the philosophy of the Hitler Youth movement, was to rear children who would be brave, obedient, disciplined and have no self-pity, self-indulgence or self-concern.
The manual said babies should be separated from their mothers for 24 hours after their birth and placed in a separate room. There’s a lot going on in these first 24 hours (which I’ll get to). This separation, the book advised, should continue for three months. The mother and infant would only be together for breastfeeding for 20 minutes during which she was not to play with the infant. Mother’s were discouraged from caring, rocking or attempting to comfort their crying babies. With that type of attachment experience, one could only expect a population that is full of fear, obedient to authority and lacking in empathy. It’s not a coincidence that Haarer and others described babies as “pre-human’ and the Nazi’s described the Jews and many other’s as “subhuman.” This dehumanization of “the other'' made it even more possible to commit atrocities.
As parents, we can have our own trauma, addictions and illness - mental and/or physical. As parents, we can be preoccupied with another child who is sick. We can be struggling financially and be glad just to be able to feed our children. A natural disaster can be impacting our world.
We may have been abused, neglected, or experienced threats of abandonment ourselves as children. We may have been abandoned. For anyone who thinks, “I would never” (cause a child harm), you can be grateful because it’s unlikely you had these experiences as an infant or toddler. The cycle of abuse can occur if children are victims of abuse and/or neglect, but also if they witness violence between their parents or caregivers.
There doesn’t have to be overt abuse or severe neglect. We may project our unresolved conflicts onto our children by idealizing one and disliking the other. We may be jealous of our infants and toddlers. We may be preoccupied with our careers. Maybe this information about the importance of the first three years of life never crossed our path or seemed important if it had. Maybe we don’t even realize our family system is upside down - where the children’s emotional needs are secondary to the parents or where the children are in the service of keeping the parents happy. We thought all families were that way
In this system, referred to as the “Narcissistic Family,” there isn’t obvious abuse or addiction. Everything can look just right - maybe too right - leaving the child feeling that what is wrong is them. As teens and then as adults, their struggles mirror those of “adult children of alcoholics.” But because they can’t put their finger on the problem and because they idealize their parents, many will never move forward. Many will find themselves compulsively care giving in their work and relationships. If you think this may be you, you might consider reading the “Drama of the Gifted Child" and/or “The Narcissistic Family - Diagnosis and Treatment.”
Even less obvious still is when there’s just high stress around the child. There could be significant family stress due to poverty, divorce, or multiple moves. The child’s emotional needs may be set as a priority, however, the stress around the child is so high inevitably their brain development is impacted. Research shows that parents’ or caregivers’ stress affects the child’s developing brain structure and chemistry in ways that make them more susceptible to stress related disorders later in life. It makes sense. As infants and toddlers, our survival is dependent on our attention to our parents’ stress response. By way of our autonomic nervous system (and thus without conscious thought), we are taking in the stress response of those around us through their facial expressions and the tone of their voice.
POOR QUALITY DAYCARE
There have been a number of studies that have looked at stress hormone levels in children in day care settings compared to home care. Researchers find that children who spent significant amounts of time in poor-quality daycare (meaning high ratios of children to adults, less supportive relationships and harsh adult-child interactions) had higher elevations of cortisol. Those with more sensitive temperaments were even more vulnerable.
The earlier attachment is disrupted, the more challenges we can face. For example, having a healthy attachment relationship throughout our first 3 years and then being placed in an institution (such as an international orphanage) would predict greater wellbeing into adulthood than going straight into such a setting at birth.
Because disrupted attachment leaves its impression on the autonomic nervous system, the limbic system and stress hormone pathways, it is considered trauma. For this type of trauma, there are no words - literally no words. For later traumatic events, we have a way of verbalizing the experience. That doesn’t mean that we can’t also be changed by severely traumatic events later in life - it means we have tools we can use. We’re more able to make sense of the traumatic event. We can even make meaning of it, if we choose.
YES, NURTURE, BUT WHAT ABOUT NATURE?
Research shows that having a sensitive and responsive caregiver can prevent elevations in cortisol among toddlers who have a fearful or anxious temperament. Research also suggests that shy children are especially vulnerable to high cortisol levels in poor quality day care settings.
Some of us will have a greater physiological stress response to the same early life experience. An exaggerated stress response can have many downstream effects, including mast cell activation, elevated pyrroles, dysfunction of the autonomic nervous system and autoimmunity. The more stress we experience in our early life, the more likely these conditions are to be expressed. For example, some of us may have a significant genetic loading for pyrrole disorder. A secure attachment may have lowered the likelihood of us ever having this expressed. Or, we may have had very little genetic loading, but because of attachment disruption we go on to have symptoms of pyrrole disorder.
ATTACHMENT AND GENES
Researchers are looking more specifically into how responsive caregiving impacts our genetic expression. Remember, we have a pair of genes - one set from each parent. Some of them have mutations. Methyl molecules - called markers - turn genes on and off causing those genes to be “expressed” or not expressed. A gene being expressed means that it makes a protein. Proteins being made or not makes all the difference in our health. Our environment, for example, in the form of trauma or toxicity, can cause an epigenetic change.
The original research into attachment and epigenetics was a study in which mother rats were separated into two groups. One group had mother rats who licked and groomed their pups a lot. The other group had mother rats who did not. Because the pups were expected to genetically share their mothers temperament and attachment style, they took some pups from each group and put them with mothers from the opposite group. They found that the pups born of licking and grooming mice, but reared by those that didn’t lick and groom, went on to resemble pups who were born and reared by those with low licking and grooming behaviors. Essentially they were anxious into adulthood.
So which genes might this licking and grooming be impacting? The researchers identified one, which turns out to be important in the stress response. The glucocorticoid receptor, which is involved in the HPA (hypothalamic-pituitary-adrenal) axis, was altered through DNA methylation. The licking and grooming altered the gene in such a way that the pups were less stressed as adults and went on to to lick and groom their own pups. Later studies in humans postmortem (associated with child abuse) have supported this finding that there is an epigenetic modification of this gluocorticoid receptor.
Aside from genetic modification, there is a gene that will decrease our vulnerability to negative environmental experiences. One of my child psychiatry mentors had once referred to the “Invulnerables.” He was talking about those children who despite significant early life adversity, seemed to be fine. Since then, research has shown that children homozygous for the “l” alleles of the 5hffllpr gene (one “l” from each parent) will show secure attachment regardless of their care. Not surprisingly, this gene relates to the transport of serotonin - the key neurotransmitter associated with feelings of well-being and happiness.
ATTACHMENT & THE RIGHT BRAIN
Imagine cradling a newborn infant in your arms. Likely, if you’re a woman you’re positioning the baby’s head to the left (and thus carry their weight in your left arm). Studies show this to be the case with 60-90% of women, independent of whether they have their own children. This female gender-specific motor behavior has been observed across cultures, in other times in history (as seen in photographs), in children holding their dolls and even different animal species. This bias does lessen after the infant is 3 months of age. Until then, however, the research suggests the left-cradle bias indicates a higher quality of attachment and attunement. There is debate about how being left handed (10% of people) impacts this preference.
One study found that mothers separated from their children for 24 hours did not show a significant cradling-side preference. Other studies observed a right-cradling preference in mothers who were separated from their children from 1-7 days. Right-cradling parents were found to have had mental health conditions prior to their child being conceived and were more likely to have been worried about childbirth. Other research has shown depressed mothers and those reporting domestic violence had reduced left-cradling bias. Collectively, the research suggests that right-cradle bias may reflect less ability to become emotionally involved with the infant.
So what is happening in that left-cradling position? It seems, without thinking, we put infants in our left visual field and left auditory field. Sensory information coming in from the left is transmitted to the right hemisphere of our brain. The right side of the brain is associated with empathy. Also mostly residing in our right hemisphere is our ability to recognize emotional facial expressions, such as crying - important if we need to monitor the wellbeing of our child.
As infants, this position would allow us to see more of our mother’s face. Also, it turns out that the left side of the face is more emotionally expressive (because facial muscles on the left are also connected to the right hemisphere). So the right hemisphere is good for detecting and reacting to threatening stimuli (fight or flight) and thus for our survival, but also for detecting and reacting to smiles. Just as it’s good for us to be able to read the infant, it’s good for us as infants to be able to read our caregiver.
If we’re a mother who is highly anxious, depressed, traumatized or sick after birth, we may not have the capacity to take in anymore emotions from our infant. We could even experience our infant as another threat and instinctively cradling them on the right. The right-cradle bias could be a red flag that a mother and her infant are in need. This need could potentially be identified when that mother was a child. There is research showing children who cradle dolls on the left show higher social cognitive abilities than those who don’t. These girls likely have greater right hemisphere capacities (from their own attachment experience and genetics) and their doll carrying would be predictive of how they will likely carry their own infants some day.
WHERE ARE WE ON THE ATTACHMENT SPECTRUM?
We all land somewhere on the attachment spectrum.
In the middle lies the greatest abilities to connect with others, while still having autonomy and the ability to recognize and express our feelings and not be overwhelmed by them. 60-65% of us are seemingly securely attached.
A toddler’s attachment style, which can be measured, can predict their attachment style as an adult and even how they will respond to their own children’s attachment needs. Reversely, an adult’s attachment style reflects their attachment style as a toddler and is a window into how able their parents were (given their own attachment and life circumstances) to meet their needs.
I do believe that our attachment tendencies can be exacerbated (or unmasked) by how inflamed or how toxic we are at the time. It is arguable that if particular parts of our brains are well wired through a secure attachment, we would be less vulnerable to attachment related issues (e.g. difficulties in relating to others, emotional regulation) when we have toxicity or inflammation. It is also arguable that a secure attachment would lower our vulnerability to these conditions. Still, I believe that those with secure attachment and enough genetic loading, can have what looks like an attachment related problem. Someone with toxicity, for example, could go from thriving in their relationships to not wanting to be with people and losing their emotional expressiveness. Either way, the needs for healing are the same - address inflammation, address toxicity and address the neuronal pathways that may need to be brought back online.
ATTACHMENT & THE ARTS
Aside from our own attachment style, and those around us, you’ll likely notice the below attachment styles in the arts. Stories are typically about personal growth - people struggling to find themselves and find connection with someone they can trust. One doesn’t have to study attachment to write a book or screenplay to intuitively know how to make characters believable or to connect the dots between a character’s childhood and their traits as an adult. Usually, however, the writer doesn’t go back far enough - to the first three years. They’re writing (and their audience is thinking) as far back as they can “remember” as if that’s when life began.
Researcher and psychologist Dr. Mary Ainsworth came up with the “Strange Situation” as a way to measure attachment in toddlers. The situation is set in a room and looks like this:
- Infant plays in mother’s presence
- Stranger enters the room, plays with the baby
- Mother leaves
- Mother and child reunite and stranger leaves
- Mother leaves child alone
- Stranger returns
- Mother and child reunite (stranger leaves)
What is listened for is not in the events described, but in the way the events are remembered and organized. For example, someone with a secure attachment wouldn’t describe their childhood and their parents as basically perfect or ideal. Someone with an insecure (avoidant type) might. A securely attached person would be able to give a more nuanced, flexible and real description that would include positives and negatives.
4 PATTERNS OF ATTACHMENT
To give you a sense of the trajectory of attachment styles, I’ve combined how these look in toddlers and adults. I’ve also included the basic “survival belief,” and, finally, my impression of what someone with this style needs are as they move toward healing or wellbeing. I’ve also included my hypothesis about how these attachment styles may relate to methylation imbalances, left brain vs right brain and functioning of the autonomic nervous system (discussed in previous chapters). Inevitably, my hypothesis (listed within each subtype) is an oversimplification. I share it, however, with the hope it can help readers more easily identify other tools that may be helpful.
60-65% of people (some studies show this be as low as 40% in children in the US)
Toddlers - “Secure”
- Strange Situation - toddler is able to separate from parent, seek comfort from parent when frightened; return of parent is met with positive emotions, prefers parents to strangers
- Toddler can explore and is happy
- Caregiver is quick to respond, sensitive and consistent or at least “consistent enough”
- Survival belief - “My needs will always be met.”
- Prediction - As an adult this toddler will have trusting lasting relationships, tend to have good self-esteem, be comfortable sharing feelings with friends and partners and can seek out social support.
- Comfortable with intimacy and autonomy in close relationships
- Resolves conflict constructively
- Adult Attachment Interview - can access a range of positive and negative feelings about attachment experiences. Thoughts and memories about parents are coherent and flexible. They don’t tend to idealize their parents.
- Less likely to have or be impacted by a methylation imbalance (unless an incident, such as a toxic exposure or trauma causes an epigenetic event)
- There is healthy functioning of right and left hemispheres
- Autonomic nervous system is functioning well - “good vagal tone”
15-20% of people
Toddler - “Avoidant”
- Strange Situation - toddler avoids parents, doesn’t seek comfort or contact from them, shows little or no preference between parent and stranger
- Toddler doesn’t explore and is emotionally distant
- Caregiver is distant and disengaged (likely because of their own attachment experience)
- Survival belief - “My needs are unlikely to be met.”
- Prediction - As an adult will have problems with intimacy, will not be motivated toward social and romantic relationships, and will be unable or unwilling to share thoughts and feelings with others.
- Compulsively self-reliant
- Distant in relationships
- Less awareness of emotions and bodily sensations
- Downplays the importance of intimate relationships and emotions
- Adult Attachment Interview - painful events are described in detached and contradictory ways. Early attachment experiences are idealized.
- Higher incidence of obsessive-compulsive personality, schizoid personality, narcissistic personality, antisocial personality, eating disorders, substance abuse and dependence, depression and anxiety
- More likely to be undermethylated (or be impacted by undermethylation) and with this, have:
- Lower neurotransmitter activity (Those who are undermethylated tend to be lower in serotonin and dopamine activity.)
- May explain lack of emotional expressiveness
- if depressed - tends more towards apathy (lack of emotion) and/or anhedonia (lack of enjoyment) as opposed to sadness
- If anxious - tends more toward OCD, perfectionism, phobias
- May explain sensory-seeking for some - if substance dependence or addictive behaviors, these are more related to sensory-seeking (to try to increase neurotransmitter activity)
- If substance abuse/dependence or addiction - substance or behaviors may be related to sensory seeking
- May explain problems with concentration endurance (except for activities of high interest)
- May explain lack of emotional expressiveness
- Lower neurotransmitter activity (Those who are undermethylated tend to be lower in serotonin and dopamine activity.)
- Diminished functioning of the right hemisphere
- May explain lack of emotional expressiveness
- May explain lack of social relatedness (and facial recognition)
- Over-functioning left hemisphere
- May explain hyperfocus and high self-motivation in some
- Autonomic Nervous System - marked by underarousal. When under threat, instead of fight or flight, the physiologic defense is a dorsal vagal shut down
- To use an extreme example fitting with this hypothesis - those with antisocial personality disorder have as mentioned, deficits in empathy, emotional expressiveness, social relatedness and often sensory-seeking in the form of harming others. 95% have been found to be undermethylated. Those with this condition have also been shown to have underarousal on resting skin conductance and heart rate measures - fitting with autonomic dysfunction. To be clear, most people with undermethylation and avoidant/dismissive attachment do not have APD.
- Consider working with a psychotherapist who can help facilitate healing and allow you to grow in the context of a therapeutic relationship as you:
- Make sense of childhood
- Recognize addictive behaviors and consider if sensory seeking, avoiding feelings, and/or avoiding connection are contributing factors
- Become aware of sensations in your body as they relate to your emotions
- Increase emotional awareness
- Express thoughts and feelings
- Learn that being human involves being vulnerable. Such vulnerability, including mistakes and failure, connect us to each other. Perfectionism and endless success does not.
- Learn ways to increase social engagement with those you trust (and like or love)
- Make eye contact
- Be present with people (literally and figuratively)
- Listen well - avoid advising, fixing, correcting or rescuing
- Share your vulnerability, mistakes and failures with those you trust
- Pay attention to, learn from and be inspired by emotionally expressive and socially engaging people
- Learn to ask for help
- Ideally, choose partners who have a secure attachment or who are intentional about their own personal growth and/or seek couples therapy - but not in place of individual therapies.
- Shift attention from details to big picture, from linear to expansive
- Journaling - replace “to do” and similar lists (or even journaling about symptoms and triggers) with gratitude lists. Replace planning with imaginative stories or expound on something you’re grateful for
- Reading - minimize or replace functional medicine blogs/social media (or other technical nonfiction) with reading fiction or watching comedy or media that evokes positive emotion, alone or if possible with others
- Shift your attention off of yourself to a creative project
- Shift your attention off of yourself to serving others (in ways fitting with your aspirations), but not at the expense of self care
- Practice mindfulness - learn ways to be in the present moment as opposed to being focused on a future goal or “getting things done.”
- If you are ill (with brain related or physical symptoms), consider shifting your mindset from one of controlling and fixing your body to one of acceptance and honoring your body. This doesn’t mean stopping your treatment. I have seen this to be very powerful for some people.
- And based on my hypothesis - I would argue one should address methylation [if inflamed or toxic, address these before addressing methylation], access autonomic nervous system (access the vagus nerve), and strengthen the right hemisphere.
(3) AMBIVALENT/ PREOCCUPIED
Toddler - Ambivalent
- Strange Situation - toddler may be wary of strangers, become severely distressed when parent leaves and not comforted by parents returning
- Toddler is anxious, insecure, angry
- Caregiver is inconsistent, sometimes sensitive, other times neglectful (likely because of their own attachment experience)
- Survival belief - “I can’t rely on my needs being met.”
- Prediction - becomes an adult who is reluctant to become close to others; worries that their partner doesn’t love them, becomes distraught when a relationship ends
- Prediction - as adults they will have a relative absence of structure for regulating emotions
- Overly invested and involved in close relationships
- Dependent on others for self-worth
- Demanding, needy approach to others
- Adult Attachment Interview - Overwhelmed with emotions associated with early attachment experiences
- Adults will have a higher incidence of histrionic and borderline personality disorders
- Depression, if present, is marked by sadness (as opposed to apathy)
- Anxiety, if present, is obvious (relative to avoidant/dismissive type above) - e.g. panic
- If substance abuse or addiction - may be an attempt to dampen emotional states
- Higher neurotransmitter activity. (Two reasons someone could have higher neurotransmitter activity could be mast cell activation and or over-methylation.) I would expect, mast cell activation, however, to be likely to occur in any of the insecure attachment orientations.
- May explain problems regulating emotions
- May amplify anxiety in social relationships
- Diminished left hemisphere functioning (which is involved in organization and planning)
- May explain problems containing emotional states
- May explain why relationships can be highly intense and anxiety provoking
- Right hemisphere over-functioning
- Fear of loss of connection
- Lack of autonomy
- Autonomic Nervous System - high sympathetic activity (fight or flight). This has been shown in measures of those with borderline personality disorder
(These considerations may also be helpful for someone who's previously secure attachment traits, seem to be impacted by physiological factors - inflammation, toxicity, etc.)
- Consider working with a psychotherapist who can help facilitate healing and allow you to grow in the context of a therapeutic relationship as you:
- Make sense of childhood
- Build structure in your life to contain and organize emotions
- Develop a routine so that emotions don’t derail your day, week or life
- Increase body awareness and how your thoughts may be fueling bodily sensations so that you can respond appropriately
- Practice lowering reactivity - accessing the vagus nerve can be helpful
- Thoughts/attention - when experiencing fears of rejection or abandonment consider alternative narratives - ie. “Maybe they have something going on that has nothing to do with me.” “Maybe their own attachment style is the reason they want to be alone right now.”
- Learn about appropriate boundaries (which I address in a later chapter). Like anything, setting boundaries takes practice and doesn’t come all at once. Be gentle and forgiving of yourself as you move forward. Some people may become angry as you become more autonomous. Some will make their own adjustments to have a relationship with you. Others will seek drama somewhere else.
- Ideally, choose partners who have a secure attachment style or who are intentional about their own personal growth and/or seek couples therapy - but not at the expense of individual therapies.
- Shift attention from the big picture to more details, from expansive to linear, from chaos to structure (at least initially - to exercise that left hemisphere). Initially, this can feel a bit like trying to be more like someone with avoidant/dismissive attachment style
- Journal - replace discourse about overwhelming emotional states, drama, loss; instead, set short term goals (even for if just for the day), gratitude lists, etc.
- Reading - avoid fiction that you think has the potential to be triggering, maybe avoid it all together for the time being. Consider nonfiction that helps you move toward your goals or where you learn about something that you’re interested in.
- Practice mindfulness - learn to be in the moment as opposed to worrying about the future or about what others are thinking or feeling
- Use guided meditation
- And again, based on my hypothesis, I would argue - address inflammation and toxicity, access the healthy ventral aspect of the vagus nerve (which counters the fight or flight response) and strengthen the left hemisphere.
10-15% - An insecure attachment style that does not fit into avoidant or anxious types (and likely could fall on either end of the spectrum), but is marked by confusion and dissociation secondary to trauma.
Toddler - Disorganized
- Strange Situation - the toddlers exhibited diverse, unclassified behaviors
- Toddlers were depressed, angry, completely passive, non-responsive
- Caregiver is extreme, erratic, fighting or frightened, passive or intrusive
- Survival Belief - “I’m confused. I have no strategy to have my needs met.”
- As a child, they may take on a parental role and may even start to act like the caregiver toward the parent - all to increase likelihood of proximity
- Dependent on others, but avoids intimacy due to fear of rejection
- Low self-esteem
- High attachment anxiety
- Cognitive and emotional disorientation, confusion or dissociation
- Faulty neuronal communication between left and right brain hemispheres from inconsistent, confusing and traumatizing experiences
- Autonomic Nervous System - Polyvagal theory suggests that the dorsal aspect of the vagus nerve is accessed (as opposed to the fight or flight/sympathetic nervous system) when fighting or fleeing aren’t possible. This defense would allow one to become immobilized and disconnect from the current reality as a means of self-protection. The problems come from the neurological wiring for this type of defense. When under stress that is not life threatening or severe, one could still dissociate and loose touch with their current reality.
- Trauma based therapies including EMDR and others allow one to be grounded in the moment and in body. These types of therapies make it possible for one to stay present (in their body and in the moment) while addressing topics that otherwise could cause dissociation or immobilization.
SYMPTOMS OF DISRUPTED ATTACHMENT IN CHILDREN
There are a number of symptoms, not mentioned above, which have been associated with attachment disruption. They too can have other contributing factors (methylation imbalance, elevated pyrroles, copper overload, inflammation, toxicity). For example, I have seen a number of children with failure to thrive that improved when they were treated for mold toxicity.
Physical - symptoms range from being disconnected from the body to being overwhelmed by stimulation
- Resists or dislikes being held; does not hold on when held
- Tactile sensitivities
- High pain tolerance
- Feeding and eating problems
- Sleep disturbance
- Enuresis (wetting) and encopresis (soiling) (seeming lack of body awareness)
- Failure to thrive
- Poorer behavioral self-control during preschool years and beyond
- Attention problems
- Poor cause and effect thinking (our earliest cause and effect thinking is learned when we cry and someone responds)
- Learning delays
- Speech and language delays
- Lack of impulse control
- Lack of emotional responsiveness
- Low self-esteem, feeling of inadequacy
- Symptoms of anger
- Unable to self-regulate
- Rage episodes
- Destructive to self, other’s and property - out of stimulation seeking or acting out feelings
- Cruelty to animals
- Preoccupation with fire
- Lack of eye contact
- Less social or poorer peer relationships
- Lack of ability to give and receive affection on parent’s terms
- Superficially engaging - not genuine
- Inappropriately clingy and demanding
- Indiscriminately affectionate with strangers
- Extreme control problems
- Persistent nonsense questions and incessant chatter
- Crazy lying
Though I’m won't be providing a comprehensive list of treatment for children or adults with severe attachment disorders, what I will emphasize is the importance of having a therapist who is knowledgeable about attachment, especially for children. Therapists with experience in attachment related issues have sessions with parents alone and parents with their child. They typically do not meet alone with the child. The primary goal is to increase the connection between parent and child and address the needs that I’ve previously mentioned.
GOING FORWARD - STRENGTHENING FOUNDATIONS
If we are prospective parents, we may want to ask ourselves some questions. First, do we want to have a child? Do we want to be thoughtful about our child’s first three years in relation to career choices or the ages of our other children? What kind of birth process would we like? What do you want the first 24 hours after birth to be like? (The medicalization of birth can encroach on the early parent child bond). What can we do to promote connection and minimize our level of stress in the first three years of our child’s life?
As prospective or current parents, we can think about our own attachment experience. If we want to optimize our child’s attachment, we can optimize our own. We can aspire to connect - to be present, to really listen (which may not be natural if we weren’t listened to). We can be aware that our children have thoughts and feelings separate from ours and guard against projecting our fears and wants onto them. We can also guard against an upside down family system where our emotions matter more than theirs.
I like the image of a loving, warm, playful Mama Bear who is powerful enough to keep her cubs safe from outside dangers and safe from themselves. (I’d include Papa Bear, but apparently they’ve been known to kill their cubs...not what we’re after here.) Mama bear may be friendly, but she’s not a peer to her cubs. I’m not suggesting as parents we can’t thoroughly enjoy our children’s company. It just means we’re providing a sense of security by being the adults in the family.
Effective parenting strategies are the ones in which we as parents are responsive, but not reactive. Our power is in our wisdom and ability to pull back and see the bigger picture. We use praise, but not excessively. Over the top praise is more about our emotional need, not our child’s. It keeps the attention on us and distracts from our child’s intrinsic motivation - the fuel that will carry them towards their goals and purpose.
As wise parents, when our child has a problem, we seek ways to connect (remember proximity), and try to see it from their perspective. We don’t oppose them, we get on their side and look with them. We don’t create distance by dominating, punishing, guilting, withholding our love or yelling. We’re able to see the bigger picture of our child’s life. It’s not hard to find a parent whose heart breaks with regret for their adult child who can’t leave a domineering or abusive spouse, who stays in a toxic workplace or who chooses to follow a religious or political movement with an authoritarian leader.
But what about when our child keeps doing the same thing over and over again? How does Mama Bear handle that? First, we can shift from the angry “They are a problem” or fearful “How are they going to make it in the world” to “They have a problem and it’s our job to help find answers and solutions.” The mind shift makes all the difference in whether we react with anger or start problem solving. In the past, I would have said, “ Instead of punishing, or even using reward or token systems, use “natural consequences.” But, I’ve found that even natural consequences, if we’re not careful, become punitive.
Our child calls from school. They forgot their homework project and are about to get a zero. “That’s what happens when you don’t bring your homework,” we say in an irritated voice that isn’t helpful (even if it’s human). It creates distance and shame and does nothing to decrease the likelihood of anything changing. It shifts the attention to our feelings. Where we should want their attention is how forgetting affects them so they invest time into preventing it happening.
In a matter of fact or compassionate tone of voice - “Honey....I’m sure you’re upset with yourself. I’m in an important meeting and won’t be able to bring it,” or “Okay, I can bring it, but that’s going to cut into my time, so I’ll need help with extra chores later. If this were to happen again on another day, I may not be able to bring it.”
We can have compassion, honor ourselves in our relationships and keep the attention where it should be. And, obviously, if we’re realizing our child has a serious problem with memory, attention, or organization, we’ll want to help find answers and solutions.
If and when we recognize that we’re shaming, punishing, dominating or guilting our children, we can stop. Children are never too young to hear us apologize. A parent who hurts their child and doesn't think their child is worthy of an apology, undoubtedly has an inner child who feels unworthy. If we want to stop causing harm, but don’t, we can seek help from a professional.
PARENTING TEENS & ADULTS
It’s also never too late to tell our teen or adult children what we remember, what choices we regret, and what we wish we had done differently….even if our parents never did, or were never able to do this. This can be powerful for our child and powerful for us. Not only can an acknowledgement help our adult child make sense of their lives - it also provides them with a role model - someone who has the courage to grow and change and be vulnerable and honest. Putting our ego and pride aside is hard and uncomfortable. If it were easy, there wouldn’t be so many estranged families.
If we have a teen or adult child with an addiction (or other brain related symptoms), that addiction may be their way of trying to regulate emotions and/or avoid connection. When we reject them, thinking that will motivate them to change, we’re only confirming a belief that they’re unworthy of connection. We’re saying, “You can’t safely communicate your feelings to me.” or “You are a problem and not worthy.” We live in a culture where those in greatest need of connection and purpose (purpose is how we connect to the world - how we serve each other) are banished or locked away. I’m not suggesting we enable or rescue. Nor am I saying we should support someone’s addiction or allow them to abuse or take advantage of us. I’m suggesting we wisely pull back far enough to see what it is that we have to offer - usually it’s the shared knowledge that there’s someone in the world that is always there for them with an open heart.
APPROACHING OUR INNER INFANT-TODDLER
Even if our parents could help us rewrite the stories we’ve been telling ourselves about ourselves; even if they were the ideal parents for our needs; the reality is that there isn’t a parent, spouse, partner, or friend who can provide what we as adults ultimately need - a realization that we already have a part of our self ready to care for us. You might call it an inner parent. I think of it as the soul.
How can this nurturing part care for the vulnerable infant-toddler part we carry within us? The same way we would interact (or aspire to intact) with any other infant or toddler - with tenderness, patience and presence. If we have an insecure attachment style, we can use tools to address our “needs'' (listed earlier) and take advantage of neuroplasticity - the brain’s ability to rewire itself. Even if we’re securely attached, our well-being and our ability to fulfill our purpose depend on our tending to this inner infant-toddler.
One way to bring this vulnerable part of us into consciousness is to find a photo from when we were very young. For some of us, doing so may be too soon and trigger strong emotions. We’ll know if this is something for us to do at this time or not. Otherwise, we can place the photo somewhere we’ll see it each day - maybe our nightstand or desk. We can notice and be curious about that infant or toddler. We can begin to have affection for them and want to take care of them.
All the while, our day-to-day lives move forward. Things will happen. We become angry and may act out our feelings. Maybe we feel ignored or ashamed. Maybe we learn something that makes us scared for ourselves or someone we love. Maybe we find ourselves turning to an addiction in an attempt to numb our feelings. Or, maybe we don’t know what we’re feeling. Each of these reactions are opportunities to consider what that vulnerable child needs in that moment. And, each of these are opportunities to consider what the caregiver within of us can provide.
We can express our feelings through journaling or talking to a trusting friend. We can comfort ourselves with a warm blanket and a good book, a hot bath, a breathing exercise or a meditation. We can unabashedly announce (to ourselves or anyone in earshot ), “I’m going out - taking my inner toddler for a walk. My toddler is learning to shift their attention from the details of life to the bigger picture.” We can remind ourself in a reassuring voice - “You are safe.”.... “Your feelings matter.”..... “You are worthy to receive.” And, whenever we notice tension in our body, we can play, hum, or better yet, sing a song we know makes us feel calm............"When you're weary......Feeling small.......When tears are in your eyes.......'ll dry them all'......
(from "Bridge Over Troubled Water" - Thank you, Paul Simon).