A response to Andrew Leed's Article

A response to Andrew Leed's Article

Written By Orit Badouk Epstein

From ESTD Newsletter Volume 3 Number 1, December 2012 > read the original article in our newsletter

 

’Confusion is a word we have invented for an order is not understood.’     Henry Miller

            Andrew Leeds’ article engages with issues of attachment trauma and its stimulating, provocative style has made me want to clarify and answer some of the issues raised.

As an Attachment-based psychoanalytic psychotherapist, and with my experience of infant observation, clinical work and also as a mother, I feel that working in the field of trauma often has us entangled in parallel processes in understanding the nature of disorganized attachment.

            The following assumptions underlie Leeds’ article:

  1. Some non-disorganized infants in research studies develop dissociative symptoms.
  2. Early childhood maltreatment does not predict adolescent dissociative symptoms.
  3. ‘It is the quality of maternal communication during infancy and disrupted parent-infant dialogue not maltreatment that predicts adult dissociation.’

            The article states: ‘But what if research from not just one, but from two, longitudinal studies indicated that threat of abandonment and other trauma experiences (such as frightened/frightening parental behaviours, Liotti, 1992, 2009) are not the central factor in predicting the later development of adult dissociation?’

            John Bowlby emphasised how all insecure attachment - avoidant, preoccupied and disorganised - will be the bedrock of most maladaptive behaviour in adulthood.  Daniel Stern in his infant-caregiver micro-laboratory observations has demonstrated evidence of misattunement from the caregiver as the core foundation of insecure attachments.  In order to treat our clients effectively, based on trust, a reparative model tries to build a new intersubjective space between therapist and client, empathically attuning into early loss, lack of parental attunement and other traumatic experiences. Both external experiences and the internal working models of the client should be at the heart of such treatment.  From that point alone, the studies by Ogawa et al. and Dutra et al. haven’t told us something we didn’t already know.

            By saying: ‘lack of positive maternal affective involvement, maternal flatness of affect and overall disrupted maternal communication were the stronger predictors of dissociation in young adulthood’ seems to open the gate of dissociation to all types of insecure attachments and is also misrepresentative of the nature of DA (Disorganized Attachment). For that reason, it is important that we distinguish the difference between dissociative symptoms per se and dissociative disorders, including DID.

            According to Lyons-Ruth, Attachment-based dissociation can be an outgrowth of disorganized attachment (Howell, 2005, 161). Hess and Main’s (1999) studies shows how disorganized attachment in its essence is a relational place where intersubjective space has collapsed, where BOTH misattunement and fear without a solution often take place (cited in Howell, 2011, 97). It is the culmination and repetition of both emotional neglect AND abusive, frightening and unpredictable events in the child’s life which leave the child powerless and can result in severe dissociation and DID later on (Liotti, 2004). To think that the two factors can be pulled apart, in my opinion is where the article has been misleading, and also seems to understate the importance of trauma in the development of pathological dissociation (see Dalenberg et al., 2012). 

            With regard to disorganized attachment, Solomon and George (1999) argue that ‘At the level of content the frightening and explosively angry themes depicted by many of the disorganized/controlling children are consistent with Bowlby’s (1973) emphasis on the ‘dysfunctional’ rage and immobilizing fear that would result when the attachment system was strongly activated but not assuaged’ (Solomon and George, 1999, p. 18).  They are also consistent with Main and Hess’s (1990) hypothesis that fear lies at the root of disorganization.  Disorganized attachment may result from several parental behaviours (not just the mother): abuse, frightening behaviour, neglect (emotional included), disrupted affective communications, disconnectedness and unavailable care-giving  all of which lead to the creation of segregated and contradictory self state/ internal working models. (Blizard, 2003).

            Misattunement is integral to abusive relationships and experiences. Misattunement can also activate fear. Is there such thing as disorganized attachment without misattunement?  Furthermore, how can ‘Disrupted parent-infant dialogue NOT maltreatment’ be pulled apart, when they often are based on overlapping experiences?  More than once I have heard clients remembering lying in their cot where no one attended to them. How does one measure such experience, is it abusive or misattuned?  

             Diluting ‘Mother’s flatness of affect and lack of mother’s positive affective involvement ‘as the root cause for dissociation’, is in my opinion reductionist and misrepresentative of our DID clients’ needs. By doing this, we are at risk of neglecting and undermining this client group’s real traumatic experience and the atrocities against the child. As one of my DID clients told me: ‘My mother knew all along what he (father) used to do to us, yet she never cared nor did anything to stop it’. ‘The minute he (father) enters the room, I disappear’. To think that just the mother’s emotional unavailability is at the root cause to this client’s DID would mean misattuning to her horrific ordeal and the parts she had to create in order to survive her abuse.

            Elizabeth Howell eloquently wrote; ‘We can’t quantify trauma but we can define it conceptually in terms of its effects on individuals.’(p.75, 2011). Whether it is small t traumas (quality of early care) or big T traumas (traumatic events), it is important that we don’t trivialise, misrepresent or oversimplify the aetiological pathways to complex dissociative disorders, so we give the right weight to our DID sufferers’ double T trauma.

 

References

Dalenberg, C. J., Brand, B. L., Gleaves, D. H., Dorahy, M. J., Loewenstein, R. J., Cardeña, E., Frewen, P. A., Carlson, E. B., & Spiegel, D. (2012). Evaluation of the Evidence          for the Trauma and Fantasy Models of Dissociation. Psychological Bulletin, 138, 550- 588

Blizard, R.A. (2003). Disorganized attachment, development of dissociated self states, and a relational approach to treatment. Journal of Trauma and Dissociation, 4(3) 27-50.

Howell, E. F. (2005). The Dissociative Mind. NY, Routledge.

Howell, E. F. (2011).  Understanding and Treating Dissociative Identity Disorder. NY,            Routledge.

Loitti G, (2004), Trauma, dissociation and disorganized attachment: Three strands of a       single braid. Psychotherapy: Theory, Research, Practice, Training, 41, 472-486.

Solomon, J. & George, C. (1999). Attachment Disorganization, NY, Guilford