Born to Connect

What role does secure attachment play in building resilience to depression, anxiety and trauma?

August 16, 2007—On the timeline of human history, the structure of the modern nuclear family is a relatively new invention. When we refer to past norms, we often stop at “Leave It to Beaver,”   as though parents always left home to spend their days in an office and Grandma’s house was never closer than over the river and through the woods.

But once upon a time in the very real world, it was not so unusual for extended families to live together in the same community—each family member contributing significantly to the wellbeing of the group. When children were old enough to help, they worked alongside their parents, and if a mother became overwhelmed with the care of an infant, there were likely to be grandparents, cousins or siblings who could step in to help.
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This hands-on experience taught older children how to care for infants in the family, so that by the time they had children of their own they were not ignorant about child care.

Now, of course, especially in the West, family life is very different. We often live hundreds, even thousands of miles from the support of relatives—and if we drive into our garages when we come home from work, as is the habit of some, we may not see our neighbors often enough to remember their children's names. Families also tend to be shrinking in size, so it is no longer unusual for a child to have no siblings at all. As a result, an increasing number of adults have had very little practical experience in caring for young children. It should not surprise us then that by the time these adults are parents they are relatively ignorant about the needs of young children, and the results can be heartrending.

Jane hadn’t intended to return to work so soon after the birth of their new baby, but her husband's business was booming and Mark needed her help. Concerned about the general quality of daycare, they decided to hire a cousin to sit with the baby during the day. What Jane and Mark didn’t know was that the cousin had also taken an outside job. For more than a year—the first year of the baby’s life—the cousin left the baby alone daily, feeding and changing him in the morning after Jane and Mark left, again at her midday lunch break, and once more just before the parents returned.

Jane did notice that the baby’s development seemed unusually slow, but the pediatrician felt it was not excessively so, and Jane was inexperienced enough to be reassured by the fact that her baby never cried.

Then the inevitable happened. Jane came home unexpectedly one day to find the house dark. When she found her son sitting alone in his crib with a soiled diaper and no one caring for him, she was understandably upset enough to fire the cousin. But she heaved a sigh of relief that all had ended well—the house had not burned down; he hadn’t choked on anything—she was sure her son had come through unscathed. Of course, he hadn’t. As the boy grew, no one connected the odd rocking behavior he exhibited under stress or his stunted social development and depression with the neglect he’d endured in his first 18 months of life.

When their son was 14, Mark and Jane took him to see Dr. Bruce Perry for the first time. Perry is an experienced child psychiatrist with an impressive background. During his career he has served as chief of psychiatry at Texas Children’s Hospital, vice-chairman for Psychiatric Research at Baylor College of Medicine, and a consultant to the FBI. He has treated a number of children who had experienced incredible trauma and extensive neglect.

Perry’s approach to treatment is “neurosequential,” based on the contributions of neuroscience and the explosion of understanding that emerged in the 1990s during the “decade of the brain”

“A foundational principle of brain development is that neural systems organize and become functional in a sequential manner,” he explains. “The organization of a less mature region depends, in part, upon incoming signals from lower, more mature regions. If one system doesn’t get what it needs when it needs it, those that rely upon it may not function well either, even if the stimuli that the later developing system needs are being provided appropriately. The key to healthy development is getting the right experiences in the right amounts at the right time.” This makes it extremely important for parents to be literate about what their children need, especially during the earliest years.

Pepperdine University psychologist Louis Cozolino agrees. “Because the first few years of life are a period of exhuberant brain development,” he says, “early experience has a disproportionate impact on the development of neural systems. In this way, early negative interpersonal experiences become a primary source of the symptoms for which people seek relief in psychotherapy.”

What experiences are necessary for the developing infant brain? It may seem obvious, but the first needs of human beings include cuddling, healthy touch and gentle, affectionate stimulation. To develop what psychologists call “secure attachment” infants need caretakers who are attuned to their emotions, who demonstrate that they love them, who meet their needs, calm their fears, keep them safe and encouragingly help them achieve physical milestones. When these basic needs are withheld, the brain’s corresponding neurosystems are shaped accordingly. Since they are “use-dependent,” the systems that do not become stimulated at this crucial time will not develop, and these are the very areas of the brain that moderate our ability to maintain healthy relationships, to respond appropriately to stress, and to mediate pleasure and empathy.

“We are social mammals,” Perry points out. “For years mental health professionals taught people that they could be psychologically healthy without social support, that ‘unless you love yourself, no one else will love you.’ . . . The truth is, you cannot love yourself unless you have been loved and are loved. The capacity to love cannot be built in isolation.”

Cozolino makes a similar point. "The individual neuron or a single human brain does not exist in nature. Without mutually stimulating interactions, people and neurons wither and die."

Unfortunately, too many children do suffer the consequences of complete neglect or high doses of the wrong kind of stimulation. But the brain is an amazingly plastic and resilient organ as Jane and Mark discovered when Perry began teaching them techniques that would replace the stimulation their son had missed. Did it help that he received this attention before adulthood? Probably so. Certainly the earlier the intervention, the easier and more complete the cure. But there is plasticity in the adult brain as well, which says something about the significance of our social connections as we continue through life.

“In the transition from dating to marriage,” says Cozolino, “there is a broad tendency for partners with insecure and disorganized attachment to develop increasingly secure patterns . . . . For many of us, adult relationships give us a second, third, and fourth chance at shaping our attachment circuitry and living a happy and satisfying life.”

Ideally, of course—children should not need to wait for a second, third or fourth chance. Perry believes that closer families and stronger communities would increase the chances that children would receive what they need the first time around, and that any problems would be noticed earlier. “We need to educate people about the needs of infants and create better ways of addressing them,” he says. “We need to have an infant- and child-literate society, where everyone who has or works with children knows what to expect. For example, if an infant doesn’t cry at all, it’s just as much of a cause for concern as if he cries too much. Becoming more aware of age-appropriate behavior will ensure that, when necessary, children can get help as soon as possible.”

GINA STEPP
August 16, 2007

SELECTED REFERENCES:
1. The Boy Who Was Raised As a Dog: And Other Stories From a Child Psychiatrist’s Notebook, by Bruce D. Perry, MD, PhD and Maia Szalavitz. 2. The Neuroscience of Human Relationships: Attachment and the Developing Social Brain, by Louis Cozolino. 3. “How Do Relationships Support Parenting? Effects of Attachment Style and Social Support on Parenting Behavior in an At-Risk Population,” Beth L. Green, Carrie Furrer, Carol McAllister. American Journal of Community Psychology. New York: Sep 2007