Attachment-Loss_V2_Bowlby.md

Attachment and Loss Volume Two, John Bowlby

Dr. Bowlby's second pioneering volume examines the effect of separation on the development of the child and the psychopathology that often follows separation. The experience of separation and the ensuing susceptibility to anxiety, anger, and fear constitute the flip side of the attachment phenomenon. In an authoritative new foreword to Bowlby's classic study, Stephen Mitchell (who gives resonant voice to the relational perspective in psychoanalysis) bridges the distance between attachment theory and the psychoanalytic tradition. - Attachment and loss, vol.II: Separation

Volume II

Attachment-caregiving: one type of social bond

I. Attachment-Caregiving: A Special Type of Social Bond

• Focus on attachment relationship between a caregiver and an individual
• Specify usage of term "attachment" to refer to child-parent relationship and behavioral system
• Caregiving refers to complementary behavior towards a less capable individual
• Both parties are bonded in an attachment-caregiving relationship

II. Social Relationships: Shared Dyadic Programmes

• Exist when each partner constructs shared interactive programs with the other
• Vary in type of principal shared program, role similarity/complementarity, number and meshing of programs, idiosyncracy, and duration
• Social bonds are few relationships to which both parties are committed
• Parent-child relationship is a committed, complementary bond

III. Attachment-Caregiving: Parent-Child Relationship

• Normally non-changing roles, but can change in marriages or elderly care
• Reversal of roles between child and parent indicates pathology unless temporary
• Study of caregiving as behavioral system recommended
• Mothers' and fathers' caregiving differ
• Caregiving development proposed within interaction between genetic bias and environmental sequence

IV. Personality Development

• Encouraging motherly/fatherly relationship fosters a sense of worth, belief in others' helpfulness, and favorable model for future relationships
• Promotes confidence, competence, and resilient personality structure
• Adverse childhood experiences lead to lowered resilience and defective control structures
• Personality response to subsequent adverse events depends on earlier structure.

Preface

Background:

• John Bowlby's interest in maternal deprivation and its impact on children's mental health began with clinical experience and research in the late 1940s and early 1950s.
• He concluded that a warm, intimate relationship between infant/child and mother (or permanent substitute) is essential for mental health.
• The report he wrote for the World Health Organization was controversial at the time but many of its conclusions are now accepted.
• Missing from the literature was an explanation of how maternal deprivation or discontinuities in the mother-child bond lead to various psychological problems.

Research Strategy:

• Bowlby and his colleagues adopted a research strategy that involves identifying potential pathogens and studying their effects prospectively to understand the processes leading to specific disturbances.
• They were impressed by James Robertson's observations of young children's responses to separation from their mother figure.
• Children in unfamiliar settings are likely to be distressed initially, followed by detachment or intense clinginess upon return home, and fear of further separations.
• Loss of mother figure is believed to generate responses and processes similar to those observed in older individuals with neurotic tendencies and difficulties forming deep relationships.

Controversial Issues:

• The impact of variables other than separation itself on children's responses, such as illness, strange surroundings, type of substitute care, and pre-existing relationships.
• Presence or absence of mother figure is a significant condition in determining emotional state.

Empirical Studies:

• James and Joyce Robertson conducted a foster-care project to investigate the effects of separation from the mother under controlled conditions.
• Bowlby's own theoretical and clinical work focused on developing a schema to understand the data from various sources, including young children away from their mothers, older subjects, and clinically disturbed individuals.

Theoretical Framework:

• First steps towards formulating a theoretical schema were taken in a series of papers published between 1958 and 1963.
• Volume 1, Attachment, focuses on the development of the child's tie to their mother.
• Volume 2, Separation Anxiety, covers separation anxiety and related phenomena.
• Volume 3, Loss, deals with grief and mourning and defensive processes.
• Frame of reference is psychoanalytic, but significant differences exist from classical psychoanalytic theories.

Key Concepts:

• Maternal deprivation or discontinuities in the mother-child bond
• Warm, intimate relationship between infant/child and mother (or permanent substitute)
• Prospective research strategy
• Loss of mother figure and its impact on emotional development
• Separation anxiety and related phenomena
• Theoretical schema to understand data from various sources
• Psychoanalytic frame of reference with differences from classical theories.

Part I: Security, Anxiety, and Distress

Chapter 1 Prototypes of Human Sorrow

• Children's unhappiness during early childhood can be compared to a dark tunnel with no end (Graham Greene)
• Burlingham and Freud's observations on children in residential nurseries during the Second World War
• Emphasis on the difficulty of providing substitute figures that can mother a child as well as their own mother
• Children became possessive of their nurse and distressed when she was absent
• Reasons for children's behavior discussed: spoiling or lack of mother figures?
• Children also showed hostility, rejection, or emotional detachment towards their nurses
• These observations shed light on the nature of anxiety, depression, and psychopathic conditions in adulthood
• Early childhood experiences can be linked to later psychiatric disturbances
• Recovery from early childhood experiences is common but not universal; reasons for differential response important

Variables Affecting Children's Response to Separation (Category A)

• Conditions intrinsic to or closely associated with the separation itself

Children in Residential Nurseries vs. Foster Homes

• Residential nursery: child in strange place with limited mothering from strangers
• Foster home: child receives full-time, skilled care from a foster mother they have become familiar with beforehand

Children's Behavior in Different Settings

• In residential nurseries: children became possessive, jealous, anxious, and distressed when their nurse left or gave attention to other children
• In foster homes: children formed strong bonds with their foster mothers and showed fewer signs of separation anxiety or distress

Implications

• The importance of consistent mothering and familiar caregivers for young children's emotional well-being
• Understanding the impact of early childhood experiences on later life, including psychiatric disturbances
• Addressing questions about differential response to childhood separations and losses
• Considering both intrinsic factors (the conditions surrounding separation) and long-term factors (children's relationships with parents) for understanding children's responses.

Conditions leading to intense responses

Early Studies on Children's Responses to Separation:

• Observations of children in institutional settings led to identification of protest, despair, and detachment responses (Robertson & Bowlby, 1952)
• Two subsequent studies by Heinicke (1956) and Heinicke & Westheimer (1966) with smaller sample sizes but rigorous design and observation
• Contrast groups of children observed in day nurseries or their own homes for comparison
• Studies describe individual children's behavior in detail and statistically, using categorized observations

Study Design:

• Three residential nurseries with similar arrangements and facilities
• Contact made with families before admission and full information collected
• Observations during free play sessions (6 per week) and standardized doll-play sessions
• Use of reliable categorization method for behavioral units

Selection Criteria:

• Children had limited previous separations or none at all
• Age range: 13-32 months instead of 15-30 months
• Four children entered with a sibling (older or younger)
• All children lived with both parents and not being rejected by placement in nursery

Reason for Residential Care:

• Family emergencies: seven mothers in hospital having new babies, two mothers in hospital for medical reasons, one family became homeless

Principal Findings:

• Behaviors typical of children during their time in the nursery were similar to those reported earlier by Robertson (protest, despair, and detachment)
• Behaviors typical of children after they returned home also reported: reunion behavior, clinging, sadness, and relief.

Behaviour during Separation

Behaviour during Separation:

• Children arrived at nursery with one or both parents
• Some children were subdued and anxious (brought by father), others more confident (brought by mother or both)
• Crying or screaming was common when parents departed
• Bedtime also caused crying and resistance to being put in cot
• Children searched for parents, particularly mother
• Resistance to nurses and observers during early days
• Preferences for specific nurses emerged after a few days
• Children clung to favorite objects from home but later showed inconsistent behavior towards them
• Hostile behavior, such as biting or ill-treating objects, occurred infrequently but increased over two weeks
• Sphincter control was generally lost during the observation period
• Different children exhibited various behaviors: some were constantly active, others preferred to stay in one spot, a few rocked or rubbed eyes
• Children with siblings present showed less frequent and intense responses to nursery environment
• Siblings sought each other's company and presented united front during early days.

Behaviour at and after Reunion

Study on Children's Behavior at Reunion after Long Absence

• Ten children's behaviors were observed upon their return home after varying lengths of absence (12-21 weeks) from a nursery.

Observation Methods:

• Ilse Westheimer maintained contact with families and made firsthand observations during reunions.
• Two observers, Christoph Heinicke and Elizabeth Wolpert, observed children in the nursery and visited them sixteen weeks after their return home.

Behavior upon Reunion:

• All children showed some detachment from mother on first meeting.
• Detachment was more pronounced with mothers than fathers.
• Detachment duration correlated highly with length of absence.
• Nine children showed persistent detachment for first three days.
• Five children exhibited ambivalence towards parents, demanding and rejecting them in turns.
• Length of ambivalence depended on mother's response.
• Children were fearful of strangers who visited their homes.

Pre-existing Factors:

• Detachment was not necessarily indicative of an unfavorable relationship between child and mother before separation
• Young children from satisfactory homes showed protest, despair, and detachment in the absence of their mothers
• Children with no attachment figures or repeated prolonged separations were less disturbed

Variables Influencing Disturbance:

• Strange surroundings and people increased fright and disturbance.
• Painful medical procedures also increased fright and distress.
• Mother's presence or absence played a crucial role in determining the sequence of protest, despair, and detachment.

Conditions mitigating the intensity of responses

Conditions Mitigating Intensity of Responses in Young Children Separated from Mother:

• Familiar Companion and/or Possessions:
  • Effective in reducing distress, especially in residential nurseries with a sibling
  • Provides comfort even with negligible degree of substitute mothering
  • Inanimate objects like favorite toys and personal clothes also provide comfort
• Mothering Care from a Substitute Mother:
  • Reduces disturbance but has limitations
  • Stranger initially feared and rejected by the child
  • Child shows intense conflict behavior towards the substitute mother
  • Only after days or weeks may the child become accustomed to the new relationship
  • Duration of disturbance depends on foster mother's skill and age of the child

Additional Information:

• Distress is less severe in younger children when cared for by a grandmother due to combination of familiar companion and substitute mothering
• In one study, every child aged between 7 and 12 months was disturbed after being moved from a temporary foster home to a permanent adoptive home
• Severity and pervasiveness of disturbance increases with increasing age (ages 7-12 months)
• Foster mother's skill in adapting behavior to a distressed child and the child's age are factors that influence the duration of disturbance.

An Experimental Project

Study by James and Joyce Robertson (1971): Experiment on how young children respond in a separation situation with ameliorating conditions.

• Took in four children needing care while mothers were in hospital as observers and foster parents.
• Introduced children to foster home through interchange visits and learned about their development, likes, dislikes, and mother's methods of care.
• Provided familiar items from home and kept image of missing mother alive.
• Minimized change and openly accepted child's concern over loss.

Children:

• Kate: 2 years 5 months, away for 27 days, first child, good eater and sleeper, yearned for parents, expressed anger.
• Thomas: 2 years 4 months, away for 10 days, first child, active and friendly, sad and angry about parent's absence.
• Lucy: 1 year 9 months, away for 19 days, first child, had minimal disturbance.
• Jane: 1 year 5 months, away for 10 days, first child, had minimal disturbance.

Thomas:

• Settled with foster parents but missed mother.
• Talked of her and cuddled photograph.
• Understood temporary nature of separation but showed increasing strain.
• Rejected foster mother's attention and clung to father.
• More aggressive and defiant after return home.
• Cautious with foster mother during visits.

Kate:

• Cheerful, active, cooperative, and ate/slept well.
• Expressed yearning and anger towards parents.
• Deepened relationship with foster mother but continued yearning for own mother.
• Anger directed at foster mother after hospital visits.

Behavior Changes in Kate during Separation:

• Fearful of getting lost and clingy
• Cried more easily
• Preoccupied and dreamy
• Repression of yearning for mother

Kate's Reaction upon Returning Home:

• Greeted mother immediately
• Ignored foster mother
• Demanding of parents' attention
• Intensely afraid of another separation

Behavior Changes in Jane and Lucy during Separation:

• Restless and demanding of attention
• Under strain and bewildered
• Transfer of attachment to substitute easily
• Functioned well but all was not well

Effects of Separation on Jane:

• Spoke first word 'Mama'
• Refused to enter foster home
• Deteriorating relations with father
• Clung and cried when father made to leave

Effects of Separation on Lucy:

• Distressed after father's departure
• Refused comfort from foster mother
• Oscillated between affection and apprehension towards foster mother
• Marked conflict in relation to foster mother
• More hostile to mother after separation

Additional Information:

• Mother eager to enroll Kate in school early, resulting in separation anxiety
• Both younger children recognized mother immediately upon return
• Neither child showed acute yearning for or anger with mother during separation, only in response to specific reminders
• Older children kept absent mother clearly in mind and did not transfer attachment easily.

Interpretation of Findings

• The Robertsons' study shows that children foster cared in a benign environment show less distress than institutionized children, but still exhibit signs of strain and awareness of missing mother.
• Opinion differs on the interpretation of these responses:
  • Robertsons believe that the sequence of protest, despair, and detachment can be prevented.
  • Alternative view holds that the sequence is present but reduced in intensity.
• Key variable is the presence or absence of a mother figure.

Mother Figure:

• Mother figure refers to the person to whom a child directs attachment behavior by preference.
• Substitute mother refers to any other person to whom a child is willing to direct attachment behavior temporarily.
• Attachment figure and support figure are terms used in a generic way to cover anyone towards whom attachment behavior is directed.
• Presence and absence are relative terms: presence means ready accessibility, absence means inaccessibility.
• Separation and loss imply that the attachment figure is inaccessible, either temporarily or permanently.
• Problems with defining separation, distinguishing between temporary and permanent, and recognizing emotional vs. physical absence.

Accessibility and Responsiveness:

• Whether a child or adult is in a state of security, anxiety, or distress is determined largely by the accessibility and responsiveness of their principal attachment figure.
• Disbelief in the significance of attachment figure accessibility may stem from:
  • Supposition that distress or anxiety must be irrational if there's nothing objectively painful or dangerous.
  • Faulty theory of instinctive behavior and failure to distinguish causation from function.
  • Confusions and false value judgments related to dependency.
• Inconvenience in practical life of the facts of attachment and separation compared to an idealized world where every child is content with any caretaker.

Historical Context:

• Examining the place of separation in psychoanalytic literature:
  • Role in theories of anxiety.
  • Influence and explanations proposed.
• Comparing the standpoint adopted in this work with traditional psychoanalytic works.

Chapter 2. The Place of Separation and Loss in Psychopathology

• Sigmund Freud wrote a pamphlet, "Inhibitions, Symptoms and Anxiety," challenging established views on anxiety and defense
• Neurotic anxiety and defense have been central issues for Freud since his earliest studies on neuroses
• Freud's ideas on anxiety, mourning, and defense evolved throughout his life
• Various schools of psychoanalysis have emerged based on differing views on anxiety and defense
• Data in psychoanalytic psychopathology derived from studying developed personalities in the analytic setting
• Frustrating literature due to competing and inconsistent theories with no clear methods for sorting facts from speculation
• In this chapter, an approach is taken prospectively by observing young children's behavior in defined situations

Early Formulations of Anxiety, Mourning, and Defense in Freud

• In Freud's early work, no connection between anxiety, loss, or defense was made
• Only late in his life did Freud propose that anxiety arises from loss or threat of loss, and defensive processes are activated during intense anxiety
• Ideas on anxiety, mourning, and defense influenced each other but remained distinct strands until later in Freud's work

Data Obtained and Methodology

• Data derived from observing young children's behavior during separation and loss
• An attempt is made to describe early phases of personality functioning based on these observations
• Focus on patterns of response that occur regularly in early childhood and their continuity in later personality functioning

Behavior of Young Children During Separation and Loss

• Distress when separated from a mother figure
• Protests and attempts to recover the mother
• Despair, preoccupation with the mother, and vigilance for her return
• Emotional detachment from the mother
• Re-attachment and insistence on staying close after reuniting
• Suspected loss leads to acute anxiety.

Understanding the Bond Between Child and Mother:

• The first step in examining theoretical problems related to child-mother bond is gaining a clearer understanding of the attachment bond.
• Bowlby (1960a) proposed that separation anxiety, grief and mourning, and defense are phases of a single process.

Historical Context:

• Freud's understanding of separation anxiety, grief, and mourning evolved over time.
• Defense mechanisms, such as repression, were recognized early in his psychoanalytic work.
• Grief and separation anxiety were given less attention until later in his career.

Development of Psychoanalytic Thought:

• The focus on defense mechanisms and castration anxiety dominated psychoanalytic thought during the 1920s and 1930s.
• Melanie Klein's hypothesis relating anxiety to aggression became a key concept in a significant new system.

Early Research on Separation Anxiety:

• Some of the earliest clinical papers drawing attention to the pathogenic significance of separation experiences were published in the 1930s and 1940s.
• Fairbairn, Suttie, Odier, Therese Benedek, Dorothy Burlingham, and Anna Freud all contributed to the understanding of separation anxiety.
• Studies on infants raised without mother figures were also conducted.

Neglect of Separation Anxiety:

• Despite early research, separation anxiety has been slow to gain a central place in psychoanalytic theorizing.
• Some influential analysts, such as Kris and Zetzel, did not acknowledge its importance.
• Rycroft also gave it scant attention in a recent book.

Freud's Late Perspective:

• In his later work, Freud recognized separation anxiety as a principal source of the processes he had devoted half a lifetime to studying.
• He sketched out a new perspective, viewing anxiety as the reaction to the danger of losing the object, mourning as the reaction to the actual loss, and defense as a mode of dealing with anxiety and pain.

Differences in Perspectives:

• The perspective adopted in this work is based on a Darwinian-type theory of evolution, while Freud's perspective was not.

Separation anxiety and other forms of anxiety

Separation Anxiety and Anxiety in General

• Freud's later belief that separation anxiety is the root cause of neurotic anxiety is not definitively correct.
• The term "anxiety" is used broadly to cover various states, and "neurotic anxiety" is also ill-defined.
• The role of separation anxiety in neurosis is unclear, and a general theory of anxiety is beyond the scope of this work.

Children and Anxiety

• Young children are distressed by brief separations.
• Older children and adults are distressed by longer or permanent separations.

Clinical Reports on Separation Anxiety

• Numerous clinical reports indicate that experiences of separation and loss play a significant role in the origin of various clinical conditions, both recent and distant.
• These findings justify focusing on separation anxiety as a key to understanding anxiety.

Misconceptions about Separation Anxiety

• Freud's claim that missing someone who is loved and longed for is the sole key to understanding anxiety may be incorrect.
• Multiple factors can cause fear and anxiety.

Impact of Separation Anxiety

• Despite its complexity, missing someone who is loved and longed for is an important contributor to anxiety.
• The specific anxiety caused by separation and loss is common and results in significant suffering.

A challenge for theory

• Separation anxiety in children: distress and anxiety when mother figure is absent
• Six theories to explain separation anxiety:
  • Rank's birth-trauma theory (1924)
  • Freud's signal theory (1926a)
  • Freud's earlier theory of transformed libido (1905b)
  • Klein's persecutory anxiety theory (1934)
  • Klein's depressive anxiety theory (1935)
• All theories complex; none consider absence as the primary cause
• Suttie, Hermann, Fairbairn, and Winnicott: primary responses due to attachment to mother
• William James (1890): solitude is a great source of terror in infancy
• Freud was aware of data but never adopted sixth type theory
• Practical importance: different models of personality functioning and psychopathology

Additional Observations on Separation Behavior

• Mother leaves child or child is removed unwillingly from mother
• Child initiates movement, knows where mother is: content and adventurous
• Reverse situation (mother remains while child explores): discussed in previous volume

Theories of Separation Anxiety

1. Rank's Birth-Trauma Theory (1924)

   • Child distressed due to traumatic experiences during birth
   • Mother's absence triggers memories of trauma

2. Freud's Signal Theory (1926a)

   • Anxiety results from conditioned response to mother's absence
   • Child learns to associate separation with danger or loss

3. Freud's Earlier Theory of Transformed Libido (1905b)

   • Separation anxiety linked to childhood sexuality
   • Mother represents a source of pleasure, and her absence means loss of pleasure

4. Klein's Persecutory Anxiety Theory (1934)

   • Child has innate fear of being destroyed or annihilated
   • Separation anxiety arises from the child's fear of losing mother, who represents protection

5. Klein's Depressive Anxiety Theory (1935)

   • Child experiences guilt and sadness due to separation
   • Fear of losing love and object permanence contributes to anxiety

6. Primary Responses Theory

   • Distress and anxiety are primary responses to attachment loss
   • Emotional bond between child and mother is the cause
   • Suttie, Hermann, Fairbairn, and Winnicott proposed this theory

Historical Significance

• Continuing influence on personality functioning and psychopathology theories
• Important for understanding different approaches to psychoanalysis and preventive psychiatry.

Chapter 3

Chapter 3: Behaviour with and without Mother

• Anxiety in children is an expression of loss of a loved person - Sigmund Freud (1905b)
• Naturalistic observations of young children's behaviour in strange places without mothering for short durations.

Separation Situations and Children's Behaviour:

• Short-term separations: last from a day to a few hours, in a strange place with strange people.
• Evidence of distress when starting nursery school before age three.
• Misguided enthusiasm for quick independence leads to unnecessary anxiety.
• Records provide valuable data, no exaggeration of upset.
• First major study: Shirley at Harvard School of Public Health (1941, 1942).

Study Details:

• Observed 199 children (101 boys and 98 girls) aged 2-8 years in a research centre.
• All-day visit with various examinations, play, meals, rest.
• Children visited every six months, attended for about three years.
• Age at starting varied: 2-5.5 years old.
• Results given as percentage of children upset during:
  • Leaving mother
  • Play period
  • Meeting mother at end of day

Study Findings:

• About half of children aged 2-4 were upset on leaving and meeting mother.
• Older children's proportion upset decreases but never falls below 30% for boys.
• During free play period:
  • Substantial percentage (40%, 20%, 15%) of children upset based on age.
  • Ways children showed uneasiness: standing, shifting, peering, ignoring toys, fidgeting, sitting distracted, crying, calling for mother, reverted to babyishness upon reuniting with her.
• Children older than 4 years express desire for mother less frequently but still ask occasionally.
• Some children who didn't show upset earlier in the day wept on reunion with mother.

Study Findings on Children's Reactions to Separation from Home:

Shirley (1942):

• Proportionally fewer girls than boys were overtly upset.
• Girls had less intensity and duration of upset than boys.
• Three-year-olds were more aware of the day's demands and more reluctant to leave home.
• Children became more apprehensive with familiarity and previous experiences.
• Older children (five years and upwards) were more likely to settle down or even enjoy the day.

Heathers (1954):

• Study focused on youngest children's response to being removed from home for nursery school.
• Thirty-one children observed during first five days of starting nursery school.
• Children exhibited various responses such as crying, hiding, clinging to mother, and resisting going to school.
• Daily scores ranged from zero to 13 on eighteen items, showing great individual variation.
• Older children (aged thirty to thirty-seven months) were more upset on the first day than younger ones (twenty-three to twenty-nine months).

Murphy (1962):

• Study involved fifteen children aged between two and a half and four years visiting a research center for a planned play session.
• Children encouraged to go off in the car with an escort but not entirely strange.
• Mother allowed to accompany child if he protested or preferred.
• Findings consistent with earlier studies, as some children determined to have mother present.

Janis (1964):

• Detailed descriptive study of one girl named Lottie attending nursery school at age two years and three months.
• Anxious behavior hidden initially but became more pronounced as time passed.
• Lottie's crying, clinging, regression, disobedience, and urinary accidents increased.
• Both parents and teacher expected too much of Lottie, putting pressure on her not to cry.
• Normal, healthy reaction for young children in a strange place with unfamiliar people is to want mother present.

Experimental studies

Experimental Studies on Child Behavior:

• Ethically permissible to study child behavior during brief separations from mother
• Controlled environment allows for detailed observation and comparison of behavior with mother present and absent
• Arsenian (1943) was the first to conduct such studies, followed by Ainsworth (1969, 1970), Rheingold (1969), Cox and Campbell (1968), Maccoby and Feldman (1972), Lee, Wright, and Herbert (in preparation), and Marvin (1972)

Ainsworth's Study:

• 56 infants aged one year from white American middle-class families observed
• Detailed observations of 23 infants' social behavior throughout first year, focusing on attachment behavior
• Observations of other 33 infants began during ninth month and continued at first birthday
• Infants brought into a novel room with chairs for mother, stranger, and toys
• Stranger introduced gradually to minimize fear
• Eight experimental episodes:
  • Episode 1: Mother and observer enter room, observer leaves
  • Episode 2: Mother sits quietly while infant plays (3 minutes)
  • Episode 3: Stranger enters, sits quietly, then converses with mother, then shows toy to infant (3 minutes)
  • Episode 4: Mother leaves, stranger comforts or distracts infant if distressed (3 minutes)
  • Episode 5: Mother returns and stranger departs
  • Episode 6: Infant left alone (3 minutes)
  • Episode 7: Stranger returns
  • Episode 8: Mother returns

Procedure:

• Mother and stranger given instructions on roles to play
• Episodes arranged in increasing order of disturbance
• Each episode lasted 3 minutes, unless curtailed due to infant distress
• Infant's spontaneous response to mother's return observed during episode 5.

Behavioral Observations of Infants:

• Fifty-six one-year-old infants' behavior was recorded during six episodes with different conditions: mother present (episode 2), stranger joining mother and infant (episode 3), mother absent (episodes 4 and 6), and mother's return after absence (episodes 5 and 8).

Measurements:

• Two measures were taken for each infant: (a) frequency of behavior during each episode, measured by scoring 1 for every fifteen seconds of specific behavior; (b) intensity of certain behaviors.

Behavior During Mother's Presence (Episode 2):

• Infants were actively interested in the scene, moving around freely and playing with toys. Only a few infants were inactive. Crying was rare.

Behavior During Stranger's Presence (Episode 3):

• Most infants showed interest and cautious friendliness towards the stranger but exploration and play decreased significantly. Some infants showed signs of distress or cried, but not intensely.

Behavior When Mother was Absent (Episodes 4 and 6):

• Infants exhibited anxious or distressed behavior, seeking mother or showing signs of distress. Crying was much more frequent and intense than during episode 3. Thirty-nine infants either cried or searched for their mother, while seventeen did neither.

Behavior During Mother's Return (Episodes 5 and 8):

• Half of the infants actively approached mother upon her return and showed a clear desire for physical contact. Many infants clung to their mothers and resisted being put down. All crying stopped, but some distressed infants were not comforted quickly. Thirty-five infants actively approached mother and showed an evident desire for physical contact.

Summary of Infant Behaviors:

• During mother's absence (episodes 4 and 6), an infant was extremely likely to search or cry or do both together. In episode 6, when mother was absent, forty-four infants searched for her, thirty-one followed her to the door, fourteen of whom banged on the door or tried to open it. Forty infants cried more or less strongly, and thirty did both search and cry. Only two infants neither searched nor cried. In episode 8, thirty-five infants actively approached mother and showed an evident desire for physical contact. A minority of infants ignored mother or refused to respond when invited to come.

Episode Behaviour 4 6

Episode Behaviour 4: This section discusses the behavior of children during a series of episodes where mother leaves and returns. The text focuses on common features of infants' responses:

• Infants' behavior changed when mother left, with play and exploratory behavior decreasing or ceasing altogether.
• Most infants showed distress and anxiety during mother's absence, even if the room and toys remained the same.

Observed Behaviors: The text then provides a description of one case (Brian) to illustrate the significance of these episodes for an individual child and his mother:

1. Mother, Baby: Brian held on to his mother, looked around, and explored toys while occasionally glancing at her. No interaction occurred between them.
2. Stranger, Mother, Baby: Brian played with a stranger but sought out his mother during their conversation. He eventually reached for a toy from the stranger and showed no interaction with his mother.
3. Stranger, Baby: Brian did not notice when his mother left, focusing on the stranger and toys instead. When he noticed his mother's absence, he became less active and eventually cried.
4. Mother, Baby: Brian was immediately comforted by his mother upon her return, hugging her hard and resisting being put down. He continued to cry and cling to her.
5. Baby Alone: Brian cried when mother left, sitting and crying until the episode was curtailed.
6. Stranger, Baby: Brian cried while in the stranger's arms, eventually stopping when she picked him up.
7. Mother, Baby: Upon his mother's return, Brian initially did not notice her but soon recognized her and hugged her upon being taken from the stranger's arms.

Findings from Other Studies: The text mentions several other studies that have investigated attachment behavior in infants:

• Maccoby and Feldman (1972), Marvin (1972): Similar to Ainsworth's study, but children were older (2.5 to 4 years old). Findings showed that children maintained greater proximity to their mothers and were more hesitant in approaching strangers at 2 years of age compared to 1 year old.
• Cox and Campbell (1968), Lee et al. (in preparation): Different experimental settings, but both provided opportunities to study children with mother present and absent. Findings from one of these studies showed that attachment behavior continued to be active at the second birthday but had changed in many ways, including increased proximity seeking and hesitancy towards strangers.

Attachment Behavior in Young Children: Comparison of One-Year-Olds and Two-Year-Olds:

• Two-year-olds have more sophisticated cognitive strategies for maintaining contact with mother
• Make greater use of looking, verbal communication, and mental imagery
• Proximity-keeping is more proficient
• Protest less during mother's brief absence

Changes in Behavior During the Third Year:

• Three-year-olds have greater ability to communicate over a distance
• Increased understanding that mother will return
• Decrease in crying and going to closed door when mother leaves
• Faster recovery of equanimity upon rejoining with stranger

Maccoby and Feldman's Study:

• Children between their second and third birthdays showed greater ability for three-year-olds to communicate
• Decrease in crying and going to the closed door when mother leaves
• Three-year-olds recover equanimity faster when rejoined, even by a stranger

Behavioral Differences When Mother is Absent:

• Manipulative play decreases significantly for both age groups
• Proportion of children who cried increases dramatically for both age groups
• Majority of children at each age level showed desire to follow mother and expressed anger at her absence

Behavior of Kibbutzim Children:

• Similarities in behavior between American and Kibbutzim children
• Increased activity observed when left alone, especially evident at ages two and two-and-a-half
• Anxious searching or agitated movement, or frozen immobility

Miniature Separation Experiments: Summary and Findings

Background:

• Ainsworth's study on mother-child separation in infants aged 12 to 36 months.
• Mother departed for short periods, usually no more than three minutes.
• Findings consistent with cross-sectional studies by Marvin (1972) and others.

Common Observations:

• Young children show noticeable anxiety or distress upon mother's absence.
• Play activity decreases.
• Efforts to reach mother are common.

Age Differences: One-Year-Olds:

• Show intense anxiety and distress in mother's absence.
• Keep trying to reach mother and may be inconsolable.

Two-Year-Olds:

• Similar level of anxiety as one-year-olds.
• Slow recovery upon reunion.

Three-Year-Olds:

• Less upset than two-year-olds.
• Better understand that mother will return.
• Quick recovery upon reunion.

Four-Year-Olds:

• May be little affected or highly distressed.
• Disturbed by mother's arbitrary behavior in test situations.
• Able to use vision and verbal communication to keep in contact with mother.

Additional Findings:

• Up to 30% of children become angry when left alone.
• Boys explore more in mother's presence and make more determined attempts to reach her.
• Girls tend to stay closer to mother and make friends more readily with strangers.

Test–Retest Study:

• When retested, one-year-old children are more upset and anxious than during the first test.
• Keep closer to mother when she is present and cry more in her absence.
• Findings suggest that short separations at this age can make a child more sensitive to future separations.

Ontogeny of responses to separation. The First Year

• Infant responses to separation develop during the first year of life.
• Studies on this development are limited and focus on hospitalized infants.

Development of Attachment Behavior

• Before sixteen weeks, infant's attachment behavior is not yet focused on a discriminated figure.
• Between sixteen and twenty-six weeks, differentially directed responses become more numerous and apparent.
• After six months, responses to separation are plainly visible.

Schaffer's Study

• Schaffer studied seventy-six infants under twelve months admitted to hospital.
• Infant responses differed greatly according to age:
  • Twenty-eight weeks and under: infants accepted the situation with little or no protest or fretting, responding normally to both mother and strangers.
  • Twenty-nine weeks and over: infants fretted piteously, showing negative responses to strangers and clinging desperately to mother during separation.
• At about thirty weeks, infants showed a sudden shift in behavior towards their attachment figure and strangers.
• Older infants cried loudly and for a long time when left alone or when mother departed, while younger infants showed no sign of protest.
• Infant behavior on return home from hospital differed significantly between age groups:
  • Seven months and over: intense attachment behavior with clinginess, fear of strangers, and distress during separation.
  • Under seven months: indifferent or avoidant behavior towards adults, scanning the environment, and little or no attachment behavior.

Understanding Younger Infants' Responses

• Younger infants show different responses to separation from older infants.
• Piaget's work on object permanence suggests that the capacity to understand a person as an independent object develops during the second half of the first year.
• Bell's study confirms this finding and adds that the capacity for person perception lags behind that of inanimate objects.
• The types of response to separation are not expected before seven months due to cognitive development.

Change after the First Birthday

Early Childhood and Response to Separation:

• Typical patterns of response to being placed in strange surroundings with strange people do not change much before the third birthday.
• Intensity of separation anxiety begins to diminish, but slowly.
• A child accepts another familiar person when in an unfamiliar place if they know where their mother is and expect her return soon.
• Factors reducing the effects of separation from mother: familiar possessions, companionship of another familiar child, skilled and familiar foster mother.
• Strange people, places, and proceedings are always alarming, especially when encountered alone.
• Distress at being separated unwillingly from an attachment figure is an inherent part of attachment, and responses to separation change alongside changes in the form of attachment behavior. (Refer to Chapters 11 and 17 in the first volume for more details)
• Human children's responses to separation are an integral part of their lives, with a potential for feeling distress and anxiety at the prospect of separation.

Comparison of Human Responses to Separation with Other Species:

• Attachment behavior occurs in similar forms across mammalian and avian species, making humans no isolated case.
• Responses to separation are also comparable across different species.

Chapter 4. Behaviour with and without Mother: Non-human Primates

Darwin's Observations on Human Origin and Animal Attachments

• Humans possess noble qualities, but still bear the physical mark of their lowly origin.
• Animals, including humans, exhibit intense attachment to their mother figures.

Attachment and Separation in Non-human Primates

Birds:

• Young birds show distress when separated from their mother figure.

Mammals (Non-human Primates):

• Isolation and separation cause distress, expressed through calling and searching.
• Intense protest and clinging occur upon reunions.

Examples of Attachment in Infant Monkeys:

• Bolwig's account of a little patas monkey: intense attachment to caretaker.
• Viki, the chimpanzee, exhibited anxiety and clinginess towards her foster mother.
• Gua, another chimpanzee, displayed an intensive impulse to remain within sight and call of a friend or protector.

Comparisons with Human Behaviour:

• Similar behaviour observed in humans, including anxiety and fear of separation.

Attachment and Separation in Wild Chimpanzees:

• Infants rarely out of contact with mother during the first year.
• Proximity maintained through auditory signals (mother's "hoo" whimper, infant's scream).
• Separations rare and quickly rectified.

Effects of Separation on Young Chimpanzees:

• Infants use vocal signals to signal distress and to re-establish contact with their mother.
• Mother responds by retrieving the infant.
• Juveniles up to five or six years old also use screams to signal for help.
• Separations rare in wild chimpanzees, and proximity maintained until pre-adolescence.

Early experimental studies

Attachment Behavior in Young Non-Human Primates:

• Similarities between young children and monkeys in attachment behavior and responses to separation
• Experimental studies on monkey infants due to ethical considerations in human studies
• Species used: rhesus, pigtail, bonnet, and patas monkeys (all semi-terrestrial, group-living old-world monkeys)
• Differences in responses to separation:
  • Rhesus, pigtail, and Java macaques: great distress during and after separation; cling to mother
  • Bonnet macaques and patas monkeys: intense distress wanes quickly; more activity after reunion due to substitute care
• Studies on rhesus and pigtail infants due to closer resemblance to human infants and larger number of studies

Experimental Studies:

• Early study by Jensen and Tolman (1962) using pigtail monkeys
  • Five-minute separations caused intense distress for both mother and infant
  • Infant's screams and mother's aggression towards attendants
  • Reunion resulted in immediate mutual clinging lasting fifteen minutes to forty hours
• Harlow's studies (Seay, Hansen, and Harlow, 1962) on rhesus infants kept apart from mothers for three weeks
  • Infants protested violently during separation with high-pitched screeching and attempts to reach mother
  • Little interest in companions during separation; increased clinging to mother afterwards
• Other studies reported extreme distress during first twenty-four hours followed by quiet period of depression lasting up to a week.

Studies on Rhesus and Pigtail Macaques: Separation from Mother

Seay and Harlow's Experiment (1965)

• Infants separated for two weeks without mother, companion infant available for half an hour daily
• Disoriented behavior on first day, little interest in companion
• Passed into a stage of low activity, crying occasionally, and minimal play
• Believed to be similar to "despair" stage observed in earlier studies
• Strong mutual clinging during reunion

Findings by Hinde's and Kaufman's Laboratories (1966-1967)

• Infants lived with mother as part of a larger social group
• Mother removal was the only change in infant's environment
• Detailed observations of infants' behavior before, during, and after separation

Kaufman and Rosenblum's Study (1967)

• Four pigtail monkey infants, aged 21-26 weeks
• Mother removed for four weeks
• Behavior divided into three phases: agitation, depression, and recovery
• Three infants exhibited signs of depression: hunched posture, decreased movement, disinterest in environment, occasional cooing
• Fourth infant showed less depression, spent time with other females
• After 5-6 days, depression began to lift, followed by a resurgence of interest in the environment and social interactions
• Post-reunion observations: significant increase in dyadic closeness (clinging, protective enclosure, nipple contact), decreased departures from mother, shorter departure duration

Behavior During Separation (Infants 1-3)

1. Agitation phase: pacing, searching head movements, frequent trips to door/windows, brief play bursts, cooing, increased self-directed behavior, occasional aggression
2. Depression phase: decreased movement, disinterest in environment, minimal social interaction, decreased play, occasional cooing
3. Recovery phase: resumption of interest in environment, increased exploration, gradual return to normal behavior

Behavior After Reunion (All Infants)

• Increase in measures of dyadic closeness: clinging, protective enclosure, nipple contact
• Decreased departures from mother and shorter departure duration
• Significant change in behaviors continued for months after reunion.

Studies on Rhesus Monkeys' Reactions to Separation from Mother:

• Initial studies: Four rhesus monkeys (30-32 weeks old) showed similar reactions to four pigtail monkeys in Kaufman's experiment despite differences in species and age.
• Subsequent research: Hinde and Spencer-Booth conducted further studies with a larger sample size (21 infants), some of whom experienced multiple or longer separations, and studied their development for up to two and a half years.

Reactions during Separation:

• Emotional response: All infants screamed and geckered persistently on the first day but less so on subsequent days. Some infants showed signs of depression and inactivity.
• Play behavior: Manipulative play decreased initially, then recovered, while social play remained low.
• Interaction with adults: Infants interacted more with adults during separation but it was a fraction of what they had with their mothers. Some infants clung to or were cradled by adults; others showed brief episodes of attachment.

Eating behavior: Infants ate less on the first day and tended to eat more afterward, but overall behavior remained disturbed during separation.

Reactions after Reunion:

• Clinginess and tantrums: Infants were more clingy than before separation and showed intense tantrums when rejected. Two infants exhibited long-lasting effects.
• Unpredictable mood swings: Infants could switch from calm to upset without apparent cause.

Long-term Effects:

• Behavioral differences: Separated infants were less willing to approach strangers, stayed closer to their mothers, made shorter visits to strange cages, and were less active after being frightened compared to control infants.
• Implications: These results demonstrate that separation from mother can be traumatic for young monkeys, causing long-lasting effects on behavior.

Additional Findings: Hinde and Spencer-Booth's further research provided more evidence of the impact of separation on rhesus monkeys. (For a detailed description, see their publications in 1968 and 1971.)

Note: Robertson (1953, 1958b) and Bowlby (1951, 1960a) have also observed similar reactions in human infants.

Further studies by Hinde and Spencer-Booth

Short-term Effects:

• Two six-day separations: no apparent differences during separation or subsequent month, but follow-up shows long-term effects (Spencer-Booth & Hinde, 1971a)

Long-term Effects:

One Six-day Separation:

• At twelve and thirty months, previously separated infants showed some persistence of symptoms of depression and disturbed mother-infant relations (Spencer-Booth & Hinde, 1971c)
• Differences more evident in strange environments than home runs
• Fewer differences at thirty months than twelve months
• Significant differences were between controls and twice-separated infants, once-separated infants occupied intermediate position

Two Six-day Separations:

• At twelve months, previously separated animals spent less time at a distance from mother, played a greater role in maintaining proximity, and showed less locomotor activity and social play than controls (no longer observable at eighteen or thirty months)
• In strange environments, previously separated infants waited longer, paid shorter visits, and spent less total time in filter cage
• Twice-separated infants showed greater divergence from control scores
• At twelve months, previously separated animals were less willing to approach experimenter for vitamins

Thirteen-day Separation: (Long-term findings not yet available)

Comparison of Findings:

• Significant differences between controls and twice-separated infants
• Once-separated infants occupied intermediate position
• Differences more evident in strange environments than home runs
• Fewer differences at thirty months than twelve months.

Short-term Effects of a Thirteen-day Separation

Short-Term Effects of Thirteen-day Separation on Rhesus Infants

• Six infants were separated for a single period of thirteen days between thirty to thirty-two weeks of age. (Spencer-Booth and Hinde, 1971 b)
• During the second week, they remained as depressed and inactive as at the end of the first week.
• One month after separation:
  • More distress calls.
  • More depressed.
  • Spent more time sitting inactivity.
  • Less active than other separated infants.
• By end of the first month of reunion, infants separated once for six days showed similar activity levels as before the separation.
• Infants separated for thirteen days still had significantly reduced activity levels.
• Twice-separated infants' activity level was intermediate between single and thirteen-day separations.

Effects of Separation Proportionate to Length

• Single six-day separation has perceptible effects two years later.
• Thirteen-day separation is worse than a six-day separation.
• Two six-day separations are worse than one six-day separation.
• Effects of separation can be compared to smoking or radiation, with small doses having cumulative and significant effects.

Individual Variations in Response

• Age had little effect on responses to separation.
• Sex played some part: males were more affected than females.
• Ability to cling to another animal during separation had no effect on behavior after reunion, but reduced distress calling at the time.
• Significant correlations between degree of distress shown by an infant and certain features of mother–infant relationship:
  • Infants that are most distressed tend to be those that are most frequently rejected by mothers.
  • Consistency in rejection frequency for each mother–infant pair over time.
• Correlations do not justify the conclusion that differences in mother–infant relation cause differences in infants' responses, but likely.

Effects of Separation: Mothers' Behavior After Reunion

• Hinde and Davies (1972) altered separation conditions: infants removed, mothers remained in home cage.
• Infants more disturbed during separation in strange cage, but less disturbed after reunion than infants whose mothers were removed.
• Mothers that remained behind were less distressed during infant's absence and more maternal/less rejecting upon reunion.
• Harmonious interaction between mother and infant was restored more quickly when mothers remained behind.
• Detachment observed in rhesus infants (Abrams, 1970) but not reported in monkey young:
  • One-quarter of infants ran away from mother on reunion after two-day separation.
  • Proportion doubled after second two-day separation.
• It is unclear if response observed by Abrams is homologous with human detachment responses.

Part II: An Ethological Approach to Human Fear.

Chapter 5: Basic Postulates in Theories of Anxiety and Fear

• Thomas S. Kuhn's observation on paradigms in science (1962)
  • Provide a map and directions for researchers
  • Differing paradigms lead to conflicting perspectives
• Anxiety and Fear: closely related emotional states
• Traditional views on anxiety and fear
  • Anxiety's nature and origin are obscure
  • Fear's nature and origin are simple and intelligible
• This work challenges the tradition in regards to fear's conditions
• Closely related emotional states, but differing perspectives on their causes
• Misconceived assumptions about fear and its arousing conditions
  • Assumption 1: Fear is only aroused by presence of harm or danger
    • Mistaken belief: fear arising in other situations is abnormal
  • Assumptions linked to Freud's early motivation model

Misconceptions about Fear and its Arousing Conditions

• Presence vs. Indirect Danger:
  • Not all stimuli or objects that frighten us are directly harmful
  • Indirect relationships between fear-inducing stimuli and danger
• Absence vs. Expected Absence:
  • We are frightened by the absence or expected absence of situations or people
  • Fear of loss or separation

Origins and Effects of these Misconceptions

• Rooted in early assumptions made by Freud
• Influences understanding of anxieties and fears in psychoanalytic and psychiatric circles
• Adversely affects our ability to help patients with their distressing emotions
• A different model of motivation leads to a changed perspective on fear and its causes

Models of motivation and their effects on theory

Models of Motivation and Their Effects on Theory

Freud's Model of Motivation:

• Assumes that stimuli, whether external or internal, are responded to by the organism as things to be eliminated or reduced.
• Incessant instinctual stimuli present a greater problem since they cannot be withdrawn from.
• Nervous system responds by undertaking complex activities to change the external world and obtain satisfaction.
• No biological function attributed to these activities as distinction between causation and function not appreciated at the time.
• Stimuli are sought only insofar as they aid in eliminating instinctual stimulation, leading to beliefs about fear being linked to helplessness.

Effects on Psychoanalytic Theories:

• Deep influence on psychoanalytic theories of anxiety, including separation anxiety.
• Still commonly held belief that a key source of fear is helplessness.
• Adverse effects on clinical thinking and treatment of patients.

Freud's Quotes:

• "The nervous system is an apparatus which has the function of getting rid of the stimuli that reach it, or of reducing them to the lowest possible level; or which, if it were feasible, would maintain itself in an altogether unstimulated condition." (SE 14: 120)
• "Instinctual stimuli…present a far greater problem since they cannot be removed by means of withdrawal." (SE 14: 122)

Advantages and Disadvantages:

• Nothing self-evident about Freud's basic postulate.
• Advancement of postulates in science to test their explanatory value.
• Great difficulties of communication when workers adopt different paradigms.

New Model of Motivation:

• Based on current evolution theory and same as that of modern biology.
• Behaviour results from activation and termination of behavioural systems.
• Instinctive behaviour follows a recognizably similar pattern in almost all members of a species.
• Causal factors include hormonal levels, central nervous system organization, environmental stimuli, and proprioceptive feedback.
• Biological function is consequence that promotes species survival.

Effects on Anxiety and Fear:

• New solutions become possible when a model of motivation that distinguishes causation from function is applied to problems related to anxiety and fear.

Puzzling phobia or natural fear

Freud's View on Anxiety (1926)

• Freud adhered to his original model of motivation with an assumption that only external dangers should elicit fear
• Consequences of this assumption:
  • Perplexity in understanding common and strong fear in non-dangerous situations
  • Complex theories to explain neurotic anxiety
  • Misguided yardstick for distinguishing health and pathology Freud's Definition of Anxiety:
• Real danger: external object threatening harm
• Neurotic anxiety: fear of unknown dangers (SE 20: 165–7)
• Common childhood fears classified as neuroses (SE 20: 168) Problems with Freud's View:
• Difficulty explaining commonplace phobias, such as fear of being alone or in the dark
• Equates fear of these situations with fear of losing object and psychical helplessness
• Believes that developmentally healthy individuals outgrow these fears Klein's Theory (1946):
• Acceptance of Freud's view that children's fears cannot be realistic
• Advances theory: anxiety arises from the death instinct within an organism, felt as fear of annihilation (death), and takes the form of fear of persecution
• Core of Kleinian system Alternative Perspective:
• Contrasts Freud's view with modern understanding: natural disposition of man to fear common situations
• Fear is not pathological; absence or unusual intensity may indicate pathology
• Survival value explained by a different theory of motivation and evolutionary perspective

An Evolutionary Perspective

Evolutionary Perspective on Fear and Retreat:

• Comparative studies of animal behavior reveal different conditions leading to fear than Freud's assumptions
• Conditions that elicit fear have indirect relation to actual harm or damage
• Conditions associated with increased risk of danger: strangeness, noise, sudden approach, isolation, and darkness for many species
• Noise may signal natural disasters; predators are strange, noisy, fast-approaching, and often strike at night or in isolation
• Animals that respond to such clues have survival and breeding advantages
• Genetically biased response to danger clues can affect animal evolution
• Fear responses to these naturally occurring clues are part of man's basic behavioral equipment

Freud's View:

• Toyed with idea that some phobias may have biological function but dismissed it
• Believed only the fear of loss relevant to humans and interpreted in non-evolutionary way

Naturally Occurring Clues to Danger:

• Presence of strangers or animals
• Rapid approach
• Darkness
• Loud noises
• Isolation

Genetically Determined Biases:

• Result in preparedness to meet real dangers
• Developed not only in animals but also in man throughout the life-cycle

Instinctive Response:

• Fear of being separated unwillingly from an attachment figure at any phase of the life-cycle
• Classifiable as instinctive response to one of the naturally occurring clues to increased risk of danger.

Chapter 6. Forms of Behaviour Indicative of Fear

• Alexander F. Shand discusses the importance of an empirical approach to understanding human fear and anxiety
• Animals respond differently to fear based on their abilities to move or hide
• Humans have more complex responses to fear, which can include fight or flight, hiding, or other means of safety
• The focus of this chapter and the next is on understanding the natural conditions that cause fear in humans
• Terminology problems exist regarding anxiety and fear; usage and further discussion are postponed until Chapter 12
• Everyday term "fear" used broadly to refer to both emotion and expected behavior
• Disproportionate attention has been given to fear behavior, so it is a good starting point for investigation

Understanding Fear and Anxiety

• Necessary to study actual situations that cause fear and anxiety in humans
• Eschew preconceived notions of what is realistic, reasonable, or appropriate to fear
• Empirical study of natural conditions that arouse fear in children, women, and men
• Understanding these fears will help consider neurotic fears and anxieties

Distinguishing Fear from Anxiety

• Terminological problems exist regarding anxiety and fear
• Everyday term "fear" used to refer to both emotion and behavior
• Detailed discussion postponed until Chapter 12
• Fear has referent in how a person feels and how they are predicted to behave
• Fear behavior has received insufficient attention

Responses to Fear

• Humans have more complex responses to fear than animals due to their cognitive abilities
• May choose to take flight, hide, or adopt other means of safety when not deprived of power to make choices by overwhelming fear.

Fear Behavior:

• Indicative forms: wary watching, inhibition of action, frightened facial expression with trembling or crying, cowering, hiding, running away, seeking contact with someone and clinging to them
• Reasons for grouping: occur simultaneously or sequentially, elicited by similar events, serve the function of protection, self-reported feeling of fear or anxiety
• Risks: different conditions eliciting various forms, distinct autonomic responses
• Distinct forms: immobility, increased distance from threatening objects, increased proximity to protective objects
• Confusion and alternative theories: single all-embracing "instinct of fear" vs. heterogeneous collection of interrelated forms

Fear Behavior Indicative Outcomes:

• Immobility: freezing, withdrawal
• Increased Distance: running away, withdrawing from threatening objects or persons
• Increased Proximity: seeking contact with protective objects or persons, clinging to them

Relation between Attachment and Fear Behavior:

• First step in sorting out different forms: examining their relation to attachment behavior

Withdrawal behaviour and attachment behaviour

• Attachment Behavior:
  • Reduces distance from persons or objects perceived as providing protection
  • Serves the function of protection
  • Elicited by conditions that arouse fear, as well as fatigue or illness
  • May be compatible with withdrawal behavior but can also conflict
• Withdrawal Behavior:
  • Increases distance from persons or objects perceived as threatening
  • Serves the function of protection (by removing oneself from danger)
  • Terms include escape, avoidance, and freezing
  • Shares many eliciting conditions with attachment behavior but not all
  • Conflict can occur between attachment and withdrawal behavior

Compatibility and Conflict:

• When both behaviors are active together, they are usually compatible
• Examples of compatibility: staying stationary or getting to attachment figure by making a detour
• Conflict occurs when stimulus situation elicits both behaviors in an individual, situated between the individual and attachment figure (e.g., barking dog)
• Four ways the frightened individual may behave:
  • Escape behavior takes precedence
  • Attachment behavior takes precedence
  • Both behaviors evenly balanced

Everyday Examples:

• Attachment behavior frequently takes precedence over withdrawal in young animals and humans (e.g., lambs on a road, children)
• After a disaster, people remain in close contact with attachment figures for comfort

Special Situations:

• When the attachment figure is also the source of fear (threats or violence), young creatures may cling to the threatening figure instead of running away
• This propensity may be relevant to phobic patients who have difficulty leaving home due to alarming parental threats.

Conclusion:

• Attachment behavior and withdrawal behavior are distinct behavioral systems that share the same function of protection but can easily conflict.
• In cases of conflict, it is a matter for inquiry to discover which behavior takes precedence.

Fear and Attack

Fear and Attack:

• Stimuli that evoke fear can also elicit attack behavior (Chapter 8 for animals, Chapter 17 for humans)
• Feelings of fear, alarm, and anxiety are common responses to threatening situations
• Attachment behavior and escape behavior often serve the same function: protection

Feelings of Fear:

• Distinction between feeling afraid, alarmed, and anxious
• Promiscuous use of language makes it difficult to differentiate between these feelings
• Freud's emphasis on separation anxiety has faced resistance due to misunderstandings and language usage

Separation Anxiety:

• Separation anxiety is a response to the absence of a protective figure
• Rycroft's objections to this idea are illogical, as both conditions (presence of threat and absence of protection) contribute to safety
• Military analogy: an army's safety depends on both defense against attack and maintaining open communications with its base

Terminology:

• Same vocabulary is used to describe feelings in different situations, suggesting similarity but potentially obscuring differences
• Proposed usage: 'alarmed' for feeling when trying to withdraw or escape, 'anxious' for feeling when seeking attachment figure but unable to find/reach them
• Supporting arguments presented in Appendix III.

Chapter 7. Situations that Arouse Fear in Humans

• Ghostly terror: A combination of simpler horrors including loneliness, darkness, inexplicable sounds, moving figures, and vertigo (baffling of expectation) produces maximum fear. (William James, 1890)

Fear Behavior and Its Variables

• Distress and anxiety arise from removal of attachment figure and placement with strangers. (Chapters 3 and 4)
• Focus on effects of presence or absence of mother; now exploring other variables that elicit fear behavior.
• Fear behavior is heterogeneous, and so are situations and events that elicit it.
• Situations include being lost or alone, sudden noises and movements, strange objects and persons, animals, height, rapid approach, darkness, pain, imaginary fears, etc. (motley list)

Complexity of Fear-Eliciting Situations

• Immediate situations eliciting fear are uncertain.
• Potential situations that a person may foresee as disagreeable or dangerous add to the confusion.

Theories on Fear-Eliciting Situations

• J.B. Watson's theory: Two basic stimulus situations - loud sound and loss of support.
• Freudian theory: Fears in external world reflect danger situations encountered in internal one.
• Empirical evidence is essential to understand fear-eliciting situations.

Key Findings on Fear-Eliciting Situations

• Two fear-inducing stimulus situations together can arouse intense fear.
• Presence or absence of attachment figure influences fear intensity greatly.

Studying Fear-Eliciting Situations in Humans

• Recent focus on studying situations that arouse fear during infancy.
• Difficulty in studying fear in older children due to limited mobility and cognitive development.
• Reliance on reports from mothers during interviews has limitations.

Overall, understanding the situations that commonly elicit fear in humans is essential given its importance in human life and psychiatric illness. Despite this significance, there have been few systematic attempts to study these situations empirically, particularly beyond infancy.

Inadequacy of Mothers’ Reports

Mothers' Reports as a Source of Information on Children's Fear:

• Mothers are not expert observers nor disinterested
• Technical difficulties in defining and identifying fear behavior
• Environmental conditions and child's state influence expression of fear
• Mothers may be biased, exaggerate or minimize, or overlook situations
• Discrepancies between mothers' and children's reports

Disagreements Between Mothers and Children:

• Study by Lapouse and Monk (1959) found marked discrepancies in reports
• Differences ranged from 7% to 59%, depending on the situation
• Mother under-reported fear of getting lost, strangers, calamities, family members' health issues
• Child reported fear when mother did not, especially for these situations

Limitations of Mothers' Reports:

• Necessary to be cautious in accepting mothers' reports on children's fear
• Direct observation or interviews with children are more reliable sources of information

Understanding Fear Behavior:

• Developmental perspective is crucial for studying fear behavior in humans
• Fear in infancy as a starting point

Fear-arousing situations: the first year

Early Infant Responses:

• Initial responses during infancy consist of startle, crying, and diffuse movements
• Bronson suggests they are better termed 'distress' during the first three months
• Between fourth and sixth months, infant is 'wary'
• Fear is appropriate from the second half of the first year
• Infant can predict unpleasant happenings by end of first year

Early Situations and Responses:

• Discomfort, pain, sudden sharp sounds upset a baby leading to crying, muscle tension, and diffuse movement
• Babies are quieted by being rocked or patted and non-nutritive sucking
• Vision plays little part in arousing fear during earliest months
• Infant becomes wary of unfamiliar things from about four months
• Sight of stranger may arouse fear response in some infants from seven to ten months

Fear of Strangers:

• Bronson studied reactions to strange persons using videotape-recording and sensitive measures
• Infant responds with cry, whimper or frown from about four months
• Visual discrimination of strangers remains uncertain at this age
• Response becomes more differentiated and predictable after six months
• Term 'fear' becomes more applicable once response is clearly aversive
• Perceptual identification of stranger poses fewer difficulties as infant grows older
• Infant shows unease towards particular person or sex by end of first year
• Fear of strangers varies greatly according to conditions, including distance from infant and mother, approach, and touch.

Fear of Strange Objects

Fear of Strange Objects and Novel Situations in Infants

• Around the same age children become afraid of strangers, they also develop fear of novel situations and strange objects.
• Jack-in-the-box: Meili (1959) found that many infants become afraid at about ten months old. Scarr and Salapatek (1970) confirmed this finding in a cross-sectional study where more than one-third of children between nine and fourteen months were frightened by the jack-in-box test.
• Response to Unfamiliar Objects: Schaffer investigated discrimination in infants' responses to unfamiliar objects. At six months, infants cannot distinguish between familiar and unfamiliar objects. From eight months onwards, infants show sharp discrimination and treat unfamiliar objects with caution (freezing, staring, or withdrawing).
• Mother as a Source of Comfort: A one-year-old infant turns to their mother when uncertain, but a six-month-old infant does not.
• Fear of Heights (Visual Cliff): Infants show fear on perception of clues indicative of height, even without experiencing falling. Discrimination and avoiding movements develop very early in other species as well. Human infants are less reliable in discriminating and more clumsy but show a strong bias to avoid the chasm.
• Fear of Approaching Objects (Looming): An approaching or looming object elicits fear reactions in human infants as young as two weeks old, indicated by head withdrawal and crying. This response is also observed in young rhesus monkeys. The fear-eliciting properties of an approaching object have been underestimated in the past.
• Fear of Darkness: Fear of darkness is not very evident during the first year of life but ten-month-old infants are more likely to leave mother to enter a brightly illuminated room than a dimly lit one.

Fear of an Anticipated Situation

First Year:

• Before eleven months, only occasional infants react with fear to anticipated situations.
• At ages eleven and twelve months, one-quarter of the sample do react with fear.
• Learning from experience occurs, leading to organized withdrawal from potentially dangerous situations.
• Infants discriminate between familiar and strange, agreeable and disagreeable stimuli.

Sources of Data: Second and Later Years:

• Few studies have systematically explored fear-arousing situations in humans.
• Most data come from longitudinal studies of children's development.
• Information was not obtained directly or from the children themselves.
• Paucity of recently gathered data, so older studies are crucial.

Early Studies:

• A.T. Jersild conducted a series of studies describing fear situations and their changes with age.
• Different methods were used: parental recording, simple experiments, child interviews, adult questionnaires.
• Various subjects and age ranges.
• Findings confirm ordinary experience and are supported by earlier and recent work.

Methods:

• Day-to-day recording by parents: detailed descriptions of children's fear responses over an extended period.
• Simple experiments: controlled situations designed to evoke fear.
• Child interviews: asking children about their fears.
• Adult questionnaires: recalling childhood fears.

Limitations:

• Shortcomings include subjective reporting, lack of direct observation, and age range limitations.
• Despite these limitations, early studies remain the most extensive attempts to understand fear-arousing situations in humans.

Findings from Parents’ Records and Naturalistic Observations

Study by Jersild: findings from parents' records and naturalistic observations

Objective: To obtain detailed records of occasions and situations in which ordinary children exhibit fear during their everyday lives.

Methods:

• Over 100 young children's parents kept records of every fear occasion for 21 days.
• Parents recorded: behavior exhibited, situation including cause and setting, and child's condition.

Findings:

• Occurrences of fear: Average 6 per child (younger age groups) and 3.5 per child (older age groups). Some children showed no fear.
• Children's ages: Biased towards higher socio-economic scale, large city dwellers, with distribution in second to fifth years.
• Types of situations causing fear: Noise, heights, strange people/familiar people in strange guise, strange objects and surroundings, animals, pain or persons associated with pain.
• Forms of behavior when afraid: Crying, turning towards adult, avoiding action or running away, trembling, hiding, staying still.

Additional findings:

• Few occurrences of fear in Valentine (1930) and Anderson (1972a) studies.
• Children's behavior varies depending on presence/absence of a trusted adult.
• Limitations: Uncertainty if a child is never afraid in a certain situation or not confronted during recording period.

Jersild & Holmes experiments: help clarify uncertainty from records and naturalistic observations.

Ethical Considerations:

• Limited kinds of experiments on fear in young children due to ethical considerations
• Precautions taken: adult present, non-frightening situations, gradual introduction, and child's refusal respected

Experimental Design:

• Children aged 2-6 tested
• Eight potentially fear-provoking situations presented over several days
• Situations presented in the same order for all children
• Response to earlier situations may have influenced later responses

Situations:

1. Being left alone: child left alone for two minutes while playing with a toy (25% showed fear responses)
2. Sudden displacement or loss of support: board gives way under child's weight (37-69% showed fear responses)
3. Dark passage: child asked to retrieve ball from dark passage (19-68% showed fear responses)
4. Strange person: child encounters stranger (26-53% showed fear responses)
5. High board: child asked to walk across a raised board (17-33% showed fear responses)
6. Loud sound: child experiences unexpected loud noise (10-46% showed fear responses)
7. Snake: child encounters snake in a box (50-80% showed fear responses when including all categories)
8. Large dog: child asked to pat a large dog (23-66% showed fear responses when including all categories)

Subjects and Methodology:

• 105 children tested, half from private and half from public nursery schools
• Children were fit, willing, and in good humor
• Testing not combined with other examinations
• Each experiment presented in four stages with reassurance and encouragement offered if needed
• Performance scored on a five-point scale (0-4)

Findings:

• Proportions of children showing fear responses (categories 3 and 4) differ little between two-year-olds and three-year-olds, but reduce significantly after the fourth birthday
• The three most frightening situations up to the fifth birthday are nos. 3, 7, and 8: dark passage, snake, and large dog (never less than one-third of children refused to perform alone in these situations)
• Including all fear response categories (categories 1-4), an overwhelming majority of children exhibited some trace of fear in these three situations.

The Findings in Relation to Age

Age and Fear:

• Four main categories of fear-inducing situations for children in their first five years:
  • Noise and associated situations: sudden change of illumination, unexpected movement, height (most common in first three years)
  • Strangeness: strange people, familiar people in strange guises, objects, places (most common in last quarter of first year to third year)
  • Animals: commonly elicits fear in children of all age groups (35% in second year and above)
  • Darkness and being alone: about 20% of children at each age level are afraid, incidence may rise with age
• Simple situations like those in categories (a) and (b) tend to elicit fear in younger children and less so as they get older
• Complex situations like those in categories (c) and (d) may include potential events and their fear-inducing properties do not diminish during early childhood, some may even increase

Fear of Strangers:

• Fear of strangers is complex and depends on various conditions
• Presence of a passing stranger can go unnoticed by young children, but approach by known strangers (relatives or friends) can elicit fear due to combination of strangeness and approach
• Children in residential nurseries often show fear of the observer because they are without mother, stranger, and the observer actively approaches them

Fear of Animals and Dark:

• Fear of animals and dark reported in children from age three and up (Macfarlane, Allen and Honzik 1954, Lapouse and Monk 1959, Jersild)
• Dogs and the dark were most frequently reported as feared, especially in younger age-groups
• Fear of animals highest at younger age-levels: 27% for five-six year-olds, 22% for seven-eight year-olds, 11% for older children
• Among adults, about one in six reported fear of animals as earliest, most intense, or most persistent
• Fear of the dark a mixture of being afraid when alone and being attacked, reported by about 20% of five-to twelve-year-olds and young adults

Fear of Damage, Illness, Death:

• Fear of getting damaged in an accident or fight reported by some 10% of subjects in both children and young adults
• Fear of pain as such rarely mentioned
• Fear of becoming ill or dying infrequent: none under nine years old, six of nine-to twelve year-olds, 3% of young adults
• Absence of fear of death among children under ten (Anthony's study)
• Fear of parent's illness or death rarely mentioned: about 3% in both children and young adults
• Under-reporting of fear-arousing situations in older children and recall by young adults, but information given can be considered valid

Additional:

• Interviews and questionnaires used to gather data on fear-arousing situations
• Clinicians may be skeptical about accuracy of data from interviews or questionnaires
• Description of common fear-arousing situations in humans with rough indication of changes as child grows towards adulthood. (Explanations postponed until later chapters.)

Compound Situations

• Situations that elicit fear are often characterized by two or more potentially alarming features (Jersild and Holmes, 1935a)
• These situations are referred to as "compound" situations due to their dramatic effect on fear response
• Commonly involve situations with animals and darkness
• Presence of multiple alarming features can result in more severe or different fear responses compared to a single feature

Being Alone:

• Being alone is a significant situational factor that increases the likelihood of fear being aroused
• In a potentially frightening situation, the presence of an adult can significantly reduce fear
• The significance of being alone in fear and anxiety is often underestimated by psychologists, psychiatrists, and most psychoanalysts (Freud being an exception)

Experimental Findings:

• Jersild and Holmes' experiments involved a child completing tasks in potentially frightening situations with the experimenter present
• Children who did not show fear were often given much reassurance and encouragement from the experimenter to complete the task
• Children who showed fear refused to carry out the task on their own but were ready to do so with the experimenter present

Fear-Arousing Properties:

• Animal situations and dark environments are likely to elicit fear due to their common presence of multiple alarming features
• These fear responses develop during early childhood and will be discussed further in Chapter 10

Significance of Being Alone:

• Being alone significantly increases the likelihood of fear being aroused
• The presence of an adult can significantly reduce fear in a potentially frightening situation
• The significance of this factor is often underestimated by psychologists and mental health professionals.

Fear behaviour and the development of attachment

• Fear responses in infants can be influenced by their environment and relationship with attachment figures. (Watson & Rayner, 1920; English, 1929)
• The concept of "soteria" introduced by Laughlin (1956) to denote the comforting presence of a loved object or person.
• Morgan and Ricciuti's (1969) study on fear response in infants towards strangers:
  • During first eight months, response to stranger is similar whether seated on mother's lap or not.
  • From twelve months, proximity to mother becomes crucial: older infants are more likely to show fear and sensitive to mother's presence.
• Bronson (1972) studied the effect of mother's presence on response to strangers at different ages:
  • At four months, being held by mother or seeing her makes little difference in wariness towards a stranger.
  • By six and a half months, being held by mother reduces wariness and presence within sight makes a difference.
  • At nine months, visual contact with mother significantly reduces wariness and babies may crawl to her when a stranger approaches.
• Albert's case study (Watson & Rayner, 1920) shows that infants under the influence of love stimuli are less responsive to fear-arousing situations.
• Schaffer's findings support the development of attachment and fear response:
  • Infants before 28 weeks do not protest when removed from mother; after seven months, they do.
  • Infant of twelve months refers to mother when confronted with strange objects if she is present, while a six-month-old appears oblivious.
• By twelve months, children have cognitive ability to respond in dual ways: moving away from fear-arousing situations and toward attachment figures or comforting objects.

Fear of Future Contingencies:

• Humans often experience fear for situations that may occur in the future, known as fear of future contingencies.
• Chapters 10 and 11 will discuss these fears in detail after immediate fear-arousing situations have been considered in relation to their biological function.
• Animals also exhibit fear responses towards future contingencies.

Chapter 8. Situations that Arouse Fear in Animals.

Natural clues to potential danger

• Ethologists believe that many stimuli that cause fear in animals can be considered as naturally occurring clues to potential danger for specific species.
• Distance receptors (sight, sound, smell) are primarily used to detect potential threats before proximal receptors (touch and pain) are activated.
• Broad-spectrum clues:
  • Strangeness and sudden approach: regularly evoke fear responses in birds and mammals.
  • Visual cliffs: young mammals respond by taking avoiding action.
  • Alarm calls: broadly responded to by various species, often resemble each other due to natural selection.
• Narrow-spectrum clues:
  • Specific stimuli that only elicit fear responses in certain species (e.g., sight of mammalian fur, staring eyes, or falling objects).
  • Olfactory stimuli: effective in eliciting fear behavior; can come from enemies (predators) or friends (alarm scents).
• Fear behavior varies among species and individuals based on various factors like sex, age, and physiological condition.
• Distinctive situations can lead to distinct types of fear responses in birds (warning calls elicit specific behaviors).
• Movement towards companions is a common fear response in many species, especially young mammals.
• Not all stimuli that cause fear are responded to on the first encounter; some require learning through association with other danger signals or pain.
• Pain: proximal receptor and late warning sign of potential danger; animals learn to recognize potentially painful situations from associated distal clues.
• Learning from watching how companions respond to new threats is a significant way for mammals, especially primates, to categorize new situations as potentially dangerous.

Fear behaviour of non-human primates

• Yerkes and Yerkes (1936): Suddenness, intensity, abruptness, movement, and rapidity are primary triggers for avoidance responses in primates.

Field Observations:

• Sudden movements or sounds lead to alarm and rapid disappearance of primates.
• Safety lies in different places depending on the species:
  • Tree-dwelling species like langur monkeys find safety in tree-tops.
  • Ground-living species, such as olive baboons and Hamadryas baboons, require access to tall trees or cliffs for safety.
• Systematic attention is not always given to fear behavior and its triggers in field studies of non-human primates.

Chimpanzee Fear Behavior:

• Initial response to fear: ducking head, shielding face, throwing hands in the air, or hitting away with back of hand.
• Flight accompanied by loud screaming when frightened by a more dominant chimpanzee, otherwise silent.
• Alternative to flight: cautious withdrawal out of sight and occasional peering-out.
• Triggers for fear responses: sudden noise or movement (low-flying birds, large insects, snakes) and threatening gestures from other chimpanzees or humans.
• Chimpanzees do not give alarm calls when frightened but alerted by the alarm calls of other species and move silently away.
• Fear behavior includes moving towards safety or companions:
  • Adult chimpanzees hug one another when frightened, an extension of infant behaviors.

Animal Comfort and Reassurance:

• Van Lawick-Goodall discusses calming effects of animal contact on subordinate animals.
• Touch, pat, or embrace from a dominant animal can quickly calm a subordinate.
• Frightened animals cling to companions (e.g., Hamadryas baboons).
• Young animals seek out highest-ranking individual when frightened.

Behavioral Patterns in Animals:

• Kummer's study of Hamadryas baboons: mated male-female relationship mirrors mother-infant relationship.
• Persistence of infant behaviors into adulthood is common among primate species.
• Observed behaviors should not be assumed as examples of regression in humans.

Learning Fear in Animals:

• Wild animals learn to fear situations through experience and tradition.
• Example: olive baboons' fear of man or cars, passed down by elders.

Cultural Traditions in Animals:

• Cultural traditions exist in various forms of behavior among animal species.
• Examples: how to sing (Thorpe 1956), what to eat (Kawamura 1963), where to go (Wynne-Edwards 1962).

Learning Fear by Observation:

• Recent studies on monkeys show animals can learn to fear a situation through observing companions.
• Example: monkeys cease playing with certain objects after witnessing another monkey's fear response (Bandura 1968, Crooks study).

Experimental Studies

Experimental Studies on Fear Behaviour in Non-Human Primates:

• Looming Stimulus:
  • Two studies conducted on rhesus monkeys (Schiff, Caviness & Gibson, 1962; Fantz, 1965)
  • Immediate fear response in most animals: withdrawal, ducking, alarm calls, or springing to the rear of the cage
  • No age differences or habituation observed
  • Response consistent regardless of speed and form of stimulus
• Visual Cliff:
  • Few studies conducted on rhesus monkeys (Walk & Gibson, 1961)
  • Avoidance improves with age: initially ineffective but shows rapid improvement after locomotion begins
• Strangeness as a Fear-Arousing Stimulus:
  • Infant rhesus monkeys show no fear of new visual stimuli before 20 days of age (Harlow et al., unspecified)
  • After 20 days, infants exhibit fear and quickly rush away from new toys, but may later return to explore them
  • Infants reared on a cloth dummy mother show more pronounced fear responses and cling tightly when presented with alarming toys
  • Older infants (12 weeks or more) may initially flee, then relax and approach the toy or remain curled up and screaming when the familiar dummy mother is absent
• Effects of Being Alone:
  • Mason's experiments with chimpanzees using strangeness as a fear-arousing stimulus
  • Behaviour varies depending on whether an animal is alone or in a group: more fearful responses observed in solitary situations.

Compound Situations and Isolation in Monkeys and Apes:

• Monkeys and apes show greater fear intensity when faced with compound situations, i.e., situations that include multiple alarming features.
• Being alone in the presence of a fear-inducing stimulus intensifies fear behavior.

Experimental Study by Rowell and Hinde (1963) on Rhesus Monkeys:

• seventeen rhesus monkeys, thirteen adults and four sub-adults, were tested in simple situations.
• Animals were first observed for half an hour before testing, then subjected to three tests with five minutes intervals.

Tests Conducted with the Monkeys in Their Groups:

• Monkeys showed increased threat noises, activities, and stress responses, such as urination, hair standing on end, and a frightened expression.
• Response increase was more significant when observer wore mask and cloak and moved.
• Results suggest that monkeys were 'made uneasy' when observer quietly watched but became 'alarmed and angry' with the mask.

Tests Conducted with Each Animal Alone:

• Animals were isolated from their groups for six hours before testing began, so they could hear and see their companions.
• Fear responses to simple tests were far more frequent when animals were alone than when they were in their groups, with increases ranging from threefold to fiftyfold.
• The greatest increase was observed in looking into the window where they could see their absent companions.

Summary of Findings by Rowell and Hinde:

• Isolation is not an additional stress-producing factor acting equally under all circumstances but rather multiplies the effects of other stressors.

Harlow's Experiments on Young Rhesus Monkeys (1965):

• Infants showed different behaviors depending on whether their dummy mother was present or absent.
• When the dummy mother was present, infants explored and seemed relaxed and confident.
• In the absence of the dummy mother, infants either curled up crying or ran around clutching themselves, with brief and erratic exploration.

Mason's Experiments on Young Chimpanzees (1965):

• Animals showed less anxiety when held by an observer compared to when alone during electric shocks or novel situations.
• Results suggest that presence of a human companion reduces anxiety in monkeys and apes.

Gantt's Experiments on Anxiety Reduction in Dogs (in Pavlovian tradition):

• Anxiety was reduced in dogs when they were exposed to electric shocks with a human companion present, especially someone well known to the animal.
• Petting and patting were particularly effective in reducing anxiety.

Fear, Attack, and Exploration:

• Stimuli that induce fear can also elicit alternative behaviors: attack or exploration
• Factors influencing the choice between attack and withdrawal: Organismic:
  • Species, age, sex
    • Older animals (especially males) more likely to attack
    • Immaturity and females more likely to withdraw
  • Ill health and fatigue may lead to withdrawal
  • Hunger often triggers attack Situational:
  • Familiarity with territory: boldness on familiar ground, withdrawal elsewhere
  • Presence of escape routes: attack when blocked, withdrawal otherwise
  • Combination of both behaviors possible during an attack
• Behaviors of attack, threat, flight, and submission are collectively referred to as "agonistic behavior" due to shared causal conditions.
• Strangeness or novelty can elicit withdrawal, exploration, or both together.
• Small changes in situations can have significant impacts on behavior.
• Balance between discretion (withdrawal) and valour (attack) necessary for survival.

Chapter 9 Natural Clues to Danger and Safety

• Natural clues not intrinsically dangerous: Strangeness, sudden change, height, being alone are indicators of potential danger but not inherently hazardous.
• Signal value conferred by statistical association and transmitted genetically: Human response to natural clues is a survival mechanism developed over millions of years.
• Biases to respond differentially to natural clues for safety and danger: These biases are an intrinsic part of human nature, apparent during childhood and old age.
• Natural clues as indicators of increased risk: They signal potential danger but do not provide information on absolute degree of risk.
• Advantage of responding to natural clues: Natural clues indicate a high proportion of dangerous situations, making it better to be safe than sorry.

Genetically Biased Groundwork

• Physical pain as a natural clue: Strongest and most universal natural clue, triggers immediate withdrawal response.
• Human fear rooted in primitive mechanisms: Behavior, cognitive structures, and feeling states influenced by genetically biased responses to natural clues.
• Elaboration of human fear: Chapters to follow explore how increasingly refined processes of appraisal lead to a broad spectrum of human feeling states.

The Limitations of Pain as a Natural Clue

• Pain is not the only type of stimulus that elicits a fear response, as some theories suggest.
• Pain serves as a last-ditch warning system, unlike distal clues (sight, sound, smell) that allow for precautions to be taken before danger is imminent.
• Pain has the advantage of prompting immediate and urgent action due to its late onset.
• Pain also plays a role in promoting learning by allowing animals to avoid situations associated with pain.
• However, pain is not infallible as a warning system and cannot detect all dangers.

Dangers that Have No Natural Clues

• Some naturally occurring hazards, such as infectious illnesses, do not emit clues that humans can sense or are genetically biased to avoid.
• Man-made dangers, like carbon monoxide gas and X-rays, also lack natural clues for detection.
• Humans must rely on man-made indicators for detecting these hazards.

The Natural Clue of Being Alone

Background:

• Being alone is statistically less safe than being with a companion.
• This is especially relevant in certain situations, even though the absolute risk may be low.

Reason for Being Alone Increasing Danger

• In man's evolutionary history, attachment behavior (proximity to companions) was crucial for protection from predators.
• Being alone made ground-living primates more vulnerable to predation.

Modern Perception of the Importance of Being Alone

• Some people consider this theory an academic curiosity or irrelevant in modern times.
• However, there are still dangers associated with being alone.

Current Risks and Conclusions

• Children and the elderly are particularly vulnerable to accidents when alone.
• Statistically, a significant portion of child pedestrian injuries occur when they are alone or with peers.
• In conclusion, humans should remain aware of the potential dangers associated with being alone and take appropriate precautions.

Risk to Adults

Safety and Risks for Adults:

• Being alone poses risks for healthy adults as well as children and the elderly.
• Comparative figures suggest that the risk of injury or death is greater when a person is alone than in company.
• Walking in city streets at night, participating in active sports, and engaging in hazardous activities are examples where being alone increases risk.
• Fatigue can be a hazard for individuals who are alone as they cannot protect themselves while asleep.
• Safety lies in numbers and companionship of familiars.

Potential Safety of Familiar Companions and Environment:

• Humans tend to be drawn towards familiar people and places due to the absence of strangeness and being alone, which are natural clues to potential danger.
• Animals also exhibit similar behavior and remain within their ecological niche by regulating their movements based on physical and biological measures.
• Individuals usually spend their entire lives within an extremely restricted segment of an ecologically suitable environment, known as the home range.
• Familiarity with the environment provides advantages such as knowledge of food and water sources, shelter, and common dangers.
• Remaining in the company of familiar companions allows individuals to benefit from established customs and social action when threatened by a predator.
• Behavioral systems mediating fear behavior tend to remove individuals from potentially dangerous situations while those mediating attachment behavior lead them towards or retain them within safe situations.
• Attachment behavior, such as attachment to a parent figure, is the first form of this type of behavior that develops in most species.
• Recognizing the unique role of an individual's personal and familiar environment in determining emotional state is crucial for understanding how people feel.

Maintaining a stable relationship with the familiar environment: a form of homeostasis

Homeostasis and Attachment:

• Behavioral systems maintaining a stable relationship between an individual and their environment can be viewed as a form of homeostasis.
• Physiological homeostasis maintains internal measures within organisms, while behavioral homeostasis maintains the relationship of the organism to the environment.

Advantages of Homeostatic Perspective:

• Links theory to theories of stress and stress diseases.
• Links to defensive processes theory, which contributes to maintaining a steady 'representational' state.

Genetic Bias and Complementary Systems:

• Individuals are genetically biased to develop systems that maintain a stable relationship between organism and familiar environment.
• Systems maintaining each form of homeostasis are complementary, easing the load on each other.

Importance of Maintaining Steady Relationship:

• Important for finding food, drink, protection, and reducing stressors.
• Healthier individuals can more effectively maintain themselves within their environment.

Homeostasis as an 'Outer Ring' of Life-Maintaining Systems:

• Regulatory systems maintaining a steady relationship between an individual and their familiar environment are considered an "outer ring" of life-maintaining systems, complementary to the "inner ring" of physiological homeostasis.

Limitations of Homeostasis:

• States are never maintained absolutely stable, and set-points and limits change throughout the lifecycle.
• Growth processes are the antithesis of homeostatic processes.

Exploratory Behavior and Developmental Changes:

• Special attention is given to the tendency for individuals to maintain a steady relationship with their environment, but exploratory behavior and developmental changes are not overlooked.

Chapter 10 Natural Clues, Cultural Clues, and the Assessment of Danger

Freud's Perspective on Anxiety in Infancy

• Children have little realistic anxiety during infancy (Freud, 1917b)
• They respond to natural clues for fear (e.g., water, heights, sharp objects)
• Realistic anxiety is a result of education and experience

Natural Clues: Early Fear Response in Infancy

• Initial stimuli situations causing fear are natural clues
• Includes: water, heights, and sharp objects
• Natural clues derived from: darkness, presence of animals
• Response is often without insight into danger

Cultural Clues: Learned Fear Responses

• From second year, children learn fear responses from adults and environment
• Conveniently referred to as 'cultural clues'
• Examples: fear of ghosts, loud noises
• Response is often without insight into the danger being avoided
• Not realistic in Freud's sense

Assessing Real Danger and Calculating Risk

• As children grow, they begin to distinguish natural or cultural clues from real danger
• Fear behavior becomes more 'rational' and 'realistic'
• Capacity to assess real danger improves throughout childhood and adolescence
• However, bias to respond to natural and cultural clues persists

Adult Fear Behavior: Response to Multiple Sources of Clues

• Adults respond to clues from natural, cultural, and sophisticated methods for calculating danger
• Natural clues elicit quick and simple responses, minimizing danger
• Behavior based on clues of the first and second types is consistent with normal development and mental health
• Fear behavior can occur simultaneously or sequentially, and be compatible or in conflict.

Misconceptions about Adult Fear

• Misconception: adults are only afraid of real danger
• Misconception: fear of anything else is childish or neurotic
• Principal thesis: adults respond to natural and cultural clues in addition to assessing real danger
• Fear behavior elicited by natural and cultural clues is not necessarily irrational or unhealthy.

Real danger: difficulties of assessment

I. Real Danger: Assessment Challenges for Psychiatrists

• Difficulties in assessing real danger exist both in everyday life and clinical practice.
• Two main types of problems: self-assessment and assessment of others' safety.
• Defining "real danger" is complex.

II. Problems with Defining Real Danger

• Boundary of personal interests: what is considered dangerous varies among individuals.
• Understanding the cause of injury or damage: not all threats are obvious.
• Protection capabilities: some people can protect themselves better than others.

III. Extent of Personal Environment

• Threats to personal possessions, house, and favorite haunts can be significant.
• Neglecting the whole personal environment may result in overlooked dangers.

IV. Difficulties in Assessing Real Danger

• Accurate calculation requires comprehensive knowledge of the world and predictive ability.
• Reality is subjective, and our comprehension is imperfect.
• The capacity to assess danger improves only slightly with age.

V. Factors Affecting Assessment of Danger

• Dog attack risk: breed, situation, behavior, familiarity, and personal strength.
• Food poisoning risk: origin, handling, cooking, and organisms' survival capabilities.
• Children's ability to assess danger is limited due to their lack of knowledge and inability to consider multiple factors at once.

VI. Conclusion

• Assessing real danger accurately requires complex appraisal and extensive knowledge.
• Many adults struggle with this assessment, leading to misconceptions or fear.
• Children are even less capable of making accurate assessments due to their limited knowledge and cognitive development.

‘Imaginary’ dangers

Theory of Fear and Imaginary Dangers:

• Fear arises from forecasts of future dangers, which can be imminent or remote.
• "Imaginary" fears refer to those situations that are highly improbable or even impossible, yet elicit strong fear responses.
• The difficulty in making accurate forecasts of danger is grasped when survival is considered.
• Children have a difficult time accurately assessing danger due to their limited understanding of the world.
• "Imaginary" fears can stem from misunderstandings, generalizations based on small samples, or secret information.
• Fear can arise from forecasts of one's own desires or actions (projection and rationalization).

Sources of Imaginary Fears:

• Misunderstandings: A child mistaking the meaning of words or situations, leading to fear.
• Generalizing from too small a sample: If one event occurs, it may be feared that another similar event will happen.
• Secret information: Threats or fears expressed in private by significant others that are unknown or denied to the person experiencing fear.
• Personal desires and unconscious thoughts: Hostile wishes towards loved ones can lead to fear.
• Projection and rationalization: Fears based on one's own desires or thoughts, which can be projected onto others or rationalized as valid reasons for fear.

Understanding Others' Fears:

• Forecasts of future dangers are personal and private, with relationships being a significant concern.
• Each person has their unique forecasts of what good and harm may come their way.
• This private world of future expectations plays a crucial role in one's anxiety or confidence.
• Understanding the sources of others' fears requires recognizing that individual experiences and past events shape their perceptions.

Cultural clues learnt from others

Learning Fears from Others:

• Children's fears may be influenced by their parents' fears, a phenomenon known as observational learning or vicarious learning.
• Observational learning is a significant means of behavioral development in many species, including humans.
• Bandura (1968) claims that virtually anything can be learnt through observing others and the consequences of their behavior.
• Observational learning allows for cultural transmission of fear behavior.

Benefits of Learning Fears from Others:

• Extends the range of stimulus situations avoided.
• Induces young individuals into traditional wisdom of social group, avoiding hazards.
• Can reduce or extinguish fear-arousing properties of a situation.

Studies on Correlation between Children's and Parents' Fears:

• Hagman (1932) found significant correlations between children and mothers who feared dogs and insects.
• Bandura and Menlove (1968) also found a significant correlation between pre-school children and parents who were afraid of dogs.
• Shoben and Borland (1954) reported that attitudes and experiences of family members significantly influence fear of dental treatment.
• John (1941) found a correlation between intensity of fear in children and their mothers during bombing raids.

Ease of Vicarious Acquisition of Fear:

• Well documented through experiments where a sound comes to arouse fear after observation of another person's reaction.
• People commonly observe others when in strange or potentially dangerous situations for safety cues.

Complexity and Further Research:

• Not all children's fears are correlated with their parents'.
• Individuals learn to fear certain types of situations more easily than others, taking us back to natural clues.

Continuing role of the natural clues

Natural Clues and Fear Response:

• Throughout our lives, humans respond with fear to natural clues such as strangeness, sudden change, rapid approach, height, being alone, and compound situations where two or more clues are present together.
• Fear of animals is a common example of fear responses triggered by multiple natural clues.

Fear of Animals:

• During the first eighteen months of life, few children show fear of animals.
• Between the ages of 18 months and five years, a majority of children develop fear of animals due to their simultaneous presentation of several natural clues: rapid approach, sudden movement, and sudden noise.
• Even after childhood, fear of animals remains common in older children and adults.
• Children may also develop fear of animals based on additional stimulus properties, such as being furry or wriggling.

Observational Learning:

• Valentine (1930) observed that young children develop a fear of animals more easily than other objects.
• In an experiment, he found that a caterpillar, when paired with a whistle, caused more fear in a child (Y) than opera glasses and a whistle or just the caterpillar alone.

Factors Contributing to Fear of Animals:

• Common natural clues: Strangeness, sudden movement, and rapid approach are common reasons for fear of animals.
• Specific natural clues: Crawling or wriggling movements may also contribute to the development of fear in children.
• Behavior of others: Observing the behavior of companions can either decrease fear and encourage approach or increase fear and withdrawal.

Statistics on Fear of Animals:

• In Jersild and Holmes (1935a) experiments, between one-third and half of children aged between two and six years showed marked fear of snakes.
• A survey of children in England revealed that 27% of them disliked snakes, making it the most commonly disliked animal among children aged from four to upwards.

Additional Factors:

• The ease with which monkeys and apes develop a fear of snakes is also noted.
• Further research suggests that other factors like past experiences, cultural influences, or individual temperament may also play a role in the development of fear of animals.

Fear of Darkness

• Common fear at all ages, comparable to fear of animals
• Development explained similarly, with different natural clues

Natural Clues in Darkness

• Strangeness and being alone
• Visual stimuli ambiguous and difficult to interpret
• Examples: bedroom curtains, trees in wood, dimly lit cellar
• Sounds more difficult to interpret without visual cues

Effects of Darkness

• Much seems uncertain or strange, leading to alarm
• Strangeness would cause little fear without being alone

Freud's Theory vs. Current Theory

• Freud: dark not feared, but absence of loved ones (Separation Anxiety)
• Current Theory: both strangeness and being alone as natural clues to increased risk

Freud's Three Essays and Introductory Lectures

• Story of a three-year-old boy afraid in the dark
• Afraid of absence of loved one, not the dark itself
• Led Freud to view anxiety as separation from mother

Comparison between Theories

• Current Theory: fear in darkness adaptive
• Freud: fear when alone irrational and neurotic

Fear of Being Alone and Disasters:

• Being alone is a natural clue to increased risk of danger and frequently occurs in combination with other clues, cultural situations, and realistically assessed dangerous situations.
• Being alone stimulates or intensifies fear, while the presence of companions reduces it.
• During and after a disaster, family members huddle together for support and comfort.

Behavior in Disasters:

• Family members cling to each other during the impact of a disaster.
• Separated family members seek each other out as soon as possible.
• Physical embraces are common following a disaster.
• Being alone during a disaster is extremely frightening.
• The presence of companions, even if inadequate, can transform the scene and reduce fear.
• The tendency to attachment behavior persists for days or weeks after the disaster is over.

Children's Reactions to Disasters:

• Children show signs of increased anxiety, such as clinging to parents and avoiding situations associated with the disaster.
• Older children are more disturbed than younger ones due to greater exposure to the impact zone and separation from parents.
• Parents also experience increased anxiety and may seek support from their children in some cases.
• Reports of regression in children's behavior after a disaster may not fully explain the situation, as there are often underlying causes for clinging behavior.

Conclusion:

• Being alone is a natural clue to increased risk and can stimulate or intensify fear.
• The presence of companions reduces fear, especially during and after a disaster.
• Family members seek each other out for support and comfort during and after a disaster.
• Children's reactions to disasters include increased anxiety and clinging behavior, which is adaptive and explains the underlying causes of so-called regressive behavior.

Chapter 11: Rationalization, Misattribution, and Projection**

• Difficulties in identifying situations that arouse fear:
  • Doubt about stimulus situation when fear is expressed
  • Psychoanalytic tradition claims fears are often based on primal danger situations
  • Misattribution common due to natural clues and cultural expectations

Misattribution:

• Projection:
  • Invoked when a fear appears not to be appropriate to the situation
  • Encouraged by cultural expectations that fear should be based on real dangers

Rationalization of fears:

• Common in children and emotionally disturbed adults
• Simple rationalizations: e.g., a child's fear of monsters in the dark may be a rationalization of fear of the dark
• Encouraged by others who tease or taunt the fearful person

Mistaken or biased attributions in compound situations:

• Two or more stimulus conditions present, causing intense fear
• Tendency to focus on one component and ignore the others
• Rationalize fear based on the focused component

Freud's position on fear:

• Infantile anxiety not based on realistic danger
• Closely related to neurotic anxiety of adults
• Derived from unemployed libido (internal danger)
• Fear of external object/situation is a replacement for the missing love-object

Compound situations and fear of separation:

• Many intense fears can be understood as arising in compound situations
• Main component: expectation of being separated from a principal attachment figure
• Case study: 'Little Hans' who was afraid of horses, evidence suggests fear of separation played a larger role than realized.

Misattribution and the role of projection

Definition and Uses of Projection:

• Projection: process of perceiving an object or person with preconceived notions, "projecting" qualities onto them (normal)
• Projection: attributing one's own unliked or feared characteristics to another (false and unfavorable attributions)
  • Also called "assimilation" in some contexts
  • Most frequent usage in psychoanalytic traditions

Projection as a Cause of Fear:

• Projection used extensively in psychoanalysis to explain unjustified fears
• Melanie Klein's perspective: major scale during early development with far-reaching effects on personality
  • Infant regularly attributes own impulses to parent figures
  • Creating working models of distorted parent figures (bad introjected objects)
  • Reason for fear of persecution: operation of the death instinct within the organism

Cautions and Criticisms:

• Blanket application of projection concept alien to present approach
• Klein's system rooted in non-evolutionary paradigm, ignoring modern biology
• Dangers of bringing a useful concept into disrepute

Alternative Explanations for Fear:

• Subject has rightly detected harmful intent in other (most likely explanation)
• Subject's childhood experience: significant people often hostile when friendly (assimilation)
• Subject expects ill intent to be reciprocated (aware of own hostility)
• Unaware of own ill intent, maintains other is hostile to them (projection in restricted sense)

Conclusion:

• Projection can be a source of misattributions but it's not the only explanation for fear or misunderstanding. It's essential to consider alternative explanations before deciding which one applies.

The case of Schreber: a re-examination

• Urgent need for fresh thinking in the field of psychopathology
• Freud's analysis of Schreber case (1911) based solely on his memoirs
• Schreber was a judge who developed psychiatric illness twice, spending nine years in an asylum (1893-1902)
• Principal theme: painful and humiliating bodily experiences construed as 'miracles' from God

Freud's Analysis of Schreber's Delusions:

• Ambivalent feelings towards God: love and reverence mixed with criticism and rebellion
• Homosexual attitude towards God, believing he had a duty to play the part of a woman for God's enjoyment
• Delusions of persecution as attempts to contradict 'I (a man) love him (a man)', replacing it with 'I do not love him – I hate him'
• Projection: suppression of internal perception, replaced by external perception distorted by affect transformation

Niederland's Re-examination:

• Schreber's father held extreme views on physical and moral education
• Applied regimes from infancy, including posture control harnesses and exercises for toughness
• Viewed bad elements in the mind as 'weeds' to be 'exterminated' with strict moral discipline
• Compared Schreber's descriptions of divine miracles with father's methods
• Hypothesis: Schreber's delusory beliefs derived from memories of his father's treatments

Possible Explanations for Delusional Beliefs:

• Injunctions from parents, explicit or implicit, to construe experiences as beneficial or not to remember certain acts
• Children wish to see parents in a favorable light and distort perceptions accordingly

Implications:

• Known childhood experiences can provide new insights into adult paranoid symptoms
• Distorted responses to historical events instead of autogenous, imaginary symptoms.

Chapter 12. Fear of Separation.

Development of Fear of Separation

• Presence and absence are relative terms, with presence meaning ready accessibility and absence meaning inaccessibility.
• In this chapter, we discuss the developmental processes leading to fear when a child believes his attachment figure is inaccessible (separation) or permanently unavailable (loss).

Questions Raised

1. Is fear elicited by mother's inaccessibility without any learning taking place? (hypothesis A)
2. Or does such fear develop only after the child has associated her inaccessibility with a distressing or frightening experience?
3. If the latter, what type of learning is involved and how is it linked to separation?

Basic Adaptive Response

• Fear response to mother's inaccessibility can be considered an adaptive response due to increased risk of danger for young individuals.
• This fear response may not necessarily require learning or a distressing/frightening experience associated with separation.

Hypotheses

A. Instinctive development without learning (hypothesis A)
B1. Freud's hypothesis: Fear of mother's absence results from infant learning that needs go unmet and accumulation of dangerous stimuli when she is absent, leading to a fear of helplessness.
B2. Associative learning: Infant learns presence of mother is associated with comfort while absence with distress through simple associative learning.
B3. Associative learning: Mother's absence elicits fear due to past experiences and associative learning.

Discussion on Hypotheses

• Freud's hypothesis has several objections, including its embedding in a different paradigm and postulating insight into cause and effect.
• Hypothesis B2 is simpler and implies no insight learning but is similar to the theory of attachment behavior proposed in the first volume.
• Hypothesis B3 suggests that an infant becomes more afraid of fear-arousing situations when mother is absent, leading to fear of her absence through associative learning.
• It's not possible to decide between hypotheses A, B2, and B3 but evidence supports associative learning occurring during infancy and early childhood.

Individual Differences in Susceptibility to Fear

• Children who have been well mothered are less susceptible to fear, while children with distressing experiences when away from their mothers show increased susceptibility to fear, especially to separation.
• These differences might result in various responses to separation and loss. Further research is needed to determine if such differences occur.

Need for two terminologies

Distinction between Fear and Danger:

• Two distinct terminologies necessary: one for feelings and one for objective reality
• Situations that arouse fear are not infallible indicators of actual danger
• Feelings bear an indirect relationship to degree of risk present in a situation

Terminology:

• Anxious, alarmed, and afraid belong to the world as reflected in feeling
• Dangerous belongs to the world as it is

Distinguishing Terms:

• Feeling secure: free from care, apprehension, anxiety or alarm (world as reflected in feeling)
• Situation of safety: free from hurt or damage (world as it is)

Historical Usage:

• 'Secure' originally means feeling free from fear, apprehension, etc.
• 'Safe' originally means free from harm or damage

Quotation Illustrating the Distinction:

• "The way to be safe is never to be secure"

Current Usage in Literature and Clinical Practice:

• 'Haven of safety': secure base
• 'Feeling of safety': feeling of security

Secure Base vs. Safety:

• A secure base can make someone feel secure but not guarantee safety
• Feelings of security are not infallible indicators of safety or lack of danger

Summary:

• Two distinct terminologies are necessary to accurately describe feelings and objective reality
• Feelings of security do not always indicate actual safety, just as fear does not always indicate danger.

Part III: Individual Differences in Susceptibility to Fear: Anxious Attachment.

Chapter 13. Some Variables responsible for Individual Differences Cons

• Individuals differ significantly in their susceptibility to respond to situations with fear.
• Genetic differences and sex are two variables that contribute to individual differences in fear response.

Genetic Differences:

• Little is known about the role of genetics in human fear response, but it is well documented in other mammals.

Sex Differences:

• It is commonly believed that there are differences in susceptibility to fear between men and women.
• Four sources support this idea:
  1. Experiments with nursery-school children by Jersild and Holmes (1935a) revealed higher percentages of girls were afraid than boys.
  2. In interviews of mothers, a higher proportion of girls reported being afraid of strangers and animals compared to boys.
  3. Girls reported more situations as feared than boys in two other studies.
  4. Epidemiological studies report women suffer from anxiety states twice as frequently as men.
• Evolutionary perspective: females protect young and are more likely to retreat from dangerous situations, while males bear the brunt of defense and attack predators.

Minimal Brain Damage:

• Children who suffer from minimal brain damage at birth are more sensitive to environmental change than matched controls.

• Differences apparent during first three years of life: when family goes on holiday or changes house, or a family member is absent for a time.
• At age five, children start infant school and differences become significant.

Other Variables:

• Relationship to attachment figures plays a pervasive role in susceptibility to fear and is the main focus of following chapters.
• Culture can either magnify or reduce potential sex differences in fear response.

Childhood Autism:

• Absence of attachment and chronic fear
• Tinbergen and Tinbergen suggest underlying condition may be persistent fear that cannot be alleviated by contact with an attachment figure
• Possible causes: genetic factors, brain damage, inappropriate mothering

Blind Children:

• More prone to fear due to frequent separations from attachment figures
• Difficulties tracking mother visually and keeping close during separation
• Reactions vary based on mother's mental health and caregivers

Developmental Trends in Fear:

• Infants broaden range of situations feared during first two years, then become more discriminating and confident
• Processes reducing susceptibility to fear: habituation, observational learning, active tackling of situations

Factors Reducing Susceptibility to Fear:

• Getting used to alarming situations
• Discovering others are not afraid
• Actively dealing with situations
• Reciprocal inhibition/counter-conditioning
• Growing stronger and more skilled

Clinical Significance:

• Findings from learning theorists may have limited value in psychiatric practice, but likely relevant to understanding normal fear reduction during development.

Habituation:

• Process of learning not to respond to a situation when it is followed by nothing of consequence.
• Restricts an infant's initial tendency to respond with fear to all strong or sudden stimulation.
• Limits the range of situations responded to with fear because they are strange.
• Does not affect the basic and persistent tendency to respond with fear or curiosity to anything perceived as strange.

Observational Learning leading to Vicarious Extinction:

• Observational learning can result in not fearing situations previously feared.
• Key component is seeing that the feared situation can be approached and dealt with without bad consequences.
• Identity of model and degree of identification with them are less significant.
• Watching a film sequence can have reassuring effect if consequences are clearly depicted.

Observational Learning combined with Guided Participation:

• Model demonstrates that the feared situation is safe, then encourages the person to tackle it themselves.
• Crucial part is the learner discovering for themselves that approaching and tackling the situation can be done without untoward consequences.
• Subjects who observe therapist interact with feared object and participate in gradual exposure show least fear.
• Method must be carefully graduated so fear is not beyond low intensity.
• Trusted and encouraging companion essential for success.

Key Findings:

• Parents intuitively know that no good comes from allowing a child to become acutely frightened.
• Child growing up in a family has endless opportunities to learn that many feared situations are harmless.
• Mothers tend to favor explanation and cuddling as remedies for children's fears.
• Observational learning combined with guided participation is effective in reducing fear.

Experiences and processes that increase susceptibility to fear

Experiences and Processes Increasing Susceptibility to Fear

• Two types of experiences leading to increased susceptibility to fear:
  • Specific experiences that make a person prone to avoid or withdraw from a situation (e.g., a child's fear of mud following a traumatic experience)
  • Uncertainty about the availability of attachment figures, resulting in free-floating anxiety

Frightening Experiences

• Can lead to an increased susceptibility to respond with fear in that specific situation
• Evidence from research on children:
  • Reasonable fears based on past experiences (Newson and Newson, 1968)
  • Cases of children's fear generalization from small samples (Jersild and Holmes, 1935b)
  • Fear following a specific alarming experience (Jersild and Holmes, 1935a)

Stories Heard

• A major cause of persistent and/or intense fear for some individuals
• Evidence includes reports of children being afraid of wolves during the popularization of 'Who's Afraid of the Big Bad Wolf?' (Jersild and Holmes, 1935b)
• Children have difficulty distinguishing fact from fiction and assessing potential danger

Culturally Determined Fears

• Socio-economic class influences fear of certain situations (Jersild and Holmes, 1935a; Lapouse and Monk, 1959; Croake, 1969)
• Other differences in fear incidence between groups likely due to cultural influences

Threats

Threats and Fear Development

• Jersild and Holmes (1935a) found that many young adults had intense and persistent fears, which they couldn't explain, but identified deliberate threats as a significant factor.
• Threats came from older children, parents, or teachers.
• Threats included physical punishment and exploiting natural fears (darkness, isolation, abandonment).
• Examples of threats: being locked in a dark room or cellar, alleged presence of vicious animals, threats of separation from parents.

Threats of Separation

• Jersild and Holmes (1935a) and Newsons (1968) reported that threats of separation were used for disciplinary purposes.
• Threats could take various forms: being sent away, alarming figure coming to take child away, mother leaving.
• Many children are exposed to such threats, and they play a larger role in increasing susceptibility to separation anxiety than realized.

Role of Experience in Fear Development

• Clinicians often overlook or misattribute fear-arousing experiences.
• Experiences may be unknown to patient or relatives, deliberately unreported, or go unreported because they seem irrelevant or clinician uninterested/unsympathetic.
• Fears related to attachment figure's inaccessibility or unresponsiveness are often missed or camouflaged.
• No fear-arousing situation is overlooked as frequently as fear of attachment figure being inaccessible or unresponsive.

Chapter 14: Susceptibility to Fear and Availability of Attachment Figures

Background:

• G.K. Chesterton's quote emphasizes the importance of having an attachment figure during times of fear.
• Attachment figures are trusted companions whose presence diminishes fear.
• The absence or unavailability of attachment figures increases fear.

Proposition 1:

• Confidence in the availability of attachment figures reduces fear.
• Lack of such confidence increases fear.

Proposition 2:

• Expectations of attachment figure availability develop during infancy, childhood, and adolescence.
• These expectations persist throughout life with decreasing sensitivity as childhood progresses.

Proposition 3:

• The role of experience in shaping expectations of attachment figure availability is controversial.

Accessibility and Availability:

• Presence: ready accessibility, not actual presence.
• Absence: inaccessibility.
• Availability: accessible and responsive.

Three Propositions:

1. Confidence in attachment figure availability reduces fear (familiar to object-relations theorists).
2. Expectations of attachment figure availability develop during immaturity and persist throughout life (somewhat controversial).
3. The role of experience in shaping expectations is controversial (extremely controversial in psychoanalytic circles).

Testing Propositions: Each proposition can be tested, claims the author, and they provide the foundation for understanding fear and attachment in human behavior.

Working models of attachment figures and of self

Working Models of Attachment Figures and Self

• Working models refer to representational or mental frameworks individuals use to perceive events, forecast future scenarios, and construct plans.
• Key features of these models include notions of attachment figures and self-perception.

Attachment Figures and Working Models

• Attachment figures are significant people in an individual's life who offer support and protection.
• Individuals build working models to understand the availability and responsiveness of their attachment figures.
• Forecasts of availability and unavailability depend on both actual presence or absence and confidence that they will be accessible and responsive when not present.

Factors Affecting Working Models

• Working models can vary in terms of simplicity versus sophistication, validity, and differentiation of attachment figures' and self-roles.
• Confidence in an attachment figure's availability and responsiveness turns on two variables:
  • whether they respond to calls for support and protection
  • the self's perceived worthiness of receiving support.
• Common sense suggests a single model per attachment figure or self, but individuals may hold multiple models that differ in origin, dominance, and awareness.

Transference and Influential Models

• Transference refers to how patients perceive their analyst based on pre-existing mental models formed from past experiences with significant figures.
• Interpreting the transference situation involves acknowledging its influence on current relationships and inviting reconsideration of its validity.

Forecasts and Abandonment Expectations

• Some individuals hold strong expectations of abandonment by their attachment figures, which can persist despite reassurances or evidence to the contrary.
• Understanding the origins of these models requires examining past experiences with significant attachment figures.

Role of Experience in Determining Working Models

• Psychoanalysts used to downplay the significance of actual experiences in shaping attachment models due to the focus on projection and the patient's contribution to misfortunes.
• With the influence of Fairbairn, Winnicott, and others, this view is less common today.
• Experience throughout childhood plays a significant role in determining adult personality.
• Attachment Figures: individuals who provide support, comfort, and protection.

Impact of Family Environment on Personality Development

• Adult personality as a product of interactions with key figures during all years of immaturity, especially attachment figures.
• People with good experiences: confident approach to the world, trust that caretaking figures will be available.
• People with bad experiences: lack of confidence, fearful or defensive responses to the world.
• Intermediate experiences: varying expectations based on learned patterns.
• Sanctions and threats of abandonment can have calamitous effects on a developing personality.

Use of Terms 'Mature' and 'Immature'

• Traditional usage in clinical circles: mature = confident, trusting adults; immature = anxious, distrustful adults.
• Theory advanced here: deviations from healthy development result from inadequate or inappropriate responses to attachment behavior during childhood, not arrested development.
• Using 'immature' inaccurately and misleading: people with these personality traits are not in a childlike state; they base their forecasts on the premise that attachment figures will be unavailable.
• Humoring or patronizing attitude towards individuals with these traits can result from using imprecise terminology.

Chapter 15. Anxious Attachment and Some Conditions that Promote it

Anxious Attachment or Insecure Attachment:

• A condition characterized by apprehension and fear of attachment figures being inaccessible or unresponsive.
• Alternative term to 'overdependency' or 'separation anxiety.'

Observations of Anxious Attachment:

• Intensely possessive behavior towards caregivers.
• Children form strong attachments to multiple caregivers, refusing to be left for a minute.
• Behavior seen in childhood, adolescence, and adulldhood.
• Numerous observers have noted similar behavior in nursery settings and after children return home.

Terminology and Evaluation:

• Terms like 'jealous,' 'possessive,' 'greedy,' 'immature,' 'overdependent,' 'strong attachment,' and 'intense attachment' have drawbacks:
  • Pejorative connotations.
  • Ambiguous meaning.
  • Based on outdated theories.
• The term 'anxious attachment' is preferred as it respects the person's natural desire for a close relationship while acknowledging their fear of loss.

Problems with the Terms 'Dependent' and 'Overdependent':

• Carry an aura of disapproval and disparagement.
• Norms and values differ between individuals, cultures, and subcultures.
• Misjudgments can result from ignorance of conditions, organismic or environmental factors.

Anxious Attachment:

• People prone to show frequent and urgent attachment behavior without apparent reason are often described as 'overdependent.'
• Characterized by a lack of confidence that attachment figures will be accessible and responsive.
• People with this condition adopt strategies to ensure attachment figures' availability.

Description of Anxious Attachment:

• Two working-class mothers describe their children's phase of overdependency after experiencing loss or separation.
• Children fear being left alone, cling to caregivers, and seek constant reassurance.

Causes of Anxious Attachment:

• Experiences that shake a person's confidence in the availability of attachment figures.
• Threats of abandonment, real or perceived, are influential.
• Separation is inherently distressing and frightening for young children.

Children Without Permanent Mother Figure:

• Children reared without a consistent mother figure may exhibit anxious attachment due to instability and lack of security.

Children Separated from Mother for Shorter or Longer Periods:

• Separation can have distressing effects on young children, even if temporary.
• Threats of abandonment and recognition of parental quarrels contribute to anxious attachment.

Summary: This chapter discusses the concept of anxious attachment or insecure attachment, which is characterized by apprehension regarding attachment figures being inaccessible or unresponsive. Factors contributing to anxious attachment include experiences that shake a person's confidence, threats of abandonment, and the inherent distress of separation for young children. Observations of anxious attachment are discussed through vignettes of mothers and their children in various situations.

Attachment and Fear Behavior of Children Raised Without a Permanent Mother Figure:

• Tizard and Tizard (1971) studied the social and cognitive development of two-year-old children in residential nurseries and those raised in ordinary families.
• In recent years, residential nurseries have improved with efforts to create family-like environments, but still fall short of an ordinary home in terms of mothering care.
• Tizard and Tizard selected 30 children from each group: 15 boys and 15 girls, healthy full-term babies, entered the nursery before age 4 months, and remained there since.
• The aim was to compare children's cognitive and social development in both groups.

Opportunities for Attachment:

• Family Children: Mother is the primary attachment figure for most; father for a few; both parents equally for a few; average of 4 attachment figures per child.
• Nursery Children: Behavior directed towards various people, including caretakers and peers; preference exists but less focused than family children.
• Family Children have almost constant contact with preferred attachment figures.
• Nursery Children see little of their preferred attachment figures and not allowed to follow them out of the room.

Stability of Social Relationships:

• In nurseries, children had numerous caretakers over time, averaging 20 different people in 20 months vs. an average of 2 for family children.
• Children in nurseries also experienced irregular staff appearances and disappearances.

Attachment and Fear Behavior:

• Nursery Children were more anxious in their attachments and more afraid of strangers than family children.
• Information from caretakers showed more anxious attachment behavior towards preferred figures and other staff in the nurseries compared to family children.

Fear of Strangers:

• In a standard procedure, every child was assessed for fear of strangers.
• Fewer nursery children approached a research worker or accepted invitations to sit on their laps than family children.
• Nursery children were more reluctant to stay alone with the researcher and less willing to smile and chat as family children did.

Limitations:

• Some findings do not fully support the hypothesis, such as fear of dogs being reported with equal frequency in both groups, which may be questionable due to different informants' standards.

Additional Case Study:

• Schnurmann (1949) described a case of a two-and-a-half-year-old girl who developed fear of going to bed and dogs after her mother stopped visiting daily, which remitted when visits resumed.

Implications:

• The unpredictable nature of nursery life and the inaccessibility of preferred attachment figures may contribute to more anxious attachment and fearfulness in nursery children.
• Differences in working models of attachment figures between children from residential nurseries and those from families may also exist.

Anxious attachment after a period of separation or of daily substitute care

Attachment Theory: Small children who have experienced a period of separation become more anxious and clingy upon return. This is a well-established finding, but the factors influencing recovery are debated.

Study by Fagin (1966): Two groups of children (accompanied vs. unaccompanied) were observed after hospital stays to understand the impact of separation on behavior.

Group Differences:

• Age: 18-48 months, not sex-matched
• Mothers' attitudes towards child-rearing and desire to stay in hospital were similar in both groups

Behavioral Changes:

• Unaccompanied children showed significant disturbances at one week and one month after returning home:
  • More upset by temporary separation
  • More "dependent"
• Accompanied children developed favorably, suggesting mother's presence provided additional confidence

Impact of Mother's Irritability:

• Children with irritable mothers in the unaccompanied group were even more affected by their hospital experience than those with equable mothers
• No adverse effects reported for accompanied children with irritable mothers

Additional Findings:

• Hostile or threatening parents, as well as unstable family life, can have a particularly adverse effect on children during separations.
• Parent-child relations before and after the separation play a significant role in explaining differential outcomes.

Effects of Periods of Residential Substitute Care

Study by Moore (1964; 1969a and b)

• Longitudinal study of London children (223 cases reduced to 167 at age 6)
• Investigated short-term effects of separations, behavior differences based on previous experience
• Obtained information: interviews with mothers, psychological tests, observations, interviews with nursery staff

Findings

• Separation from mother is stressful for most young children, especially during their second and third years
• Stability of home and parental attitudes influence whether disturbances persist or fade

Comparisons

(a) Children with residential nursery experiences:

• Ten children had spent time in residential nurseries before age 3
• Nine of these children were upset on return home, showing aggressive behavior, fear of strangers, increased dependence on mothers
• At age 8: two reasonably well-adjusted (good family relationships), eight not (homes breaking up or otherwise disturbed)

(b) Children with episodic separations:

• Fifteen children from stable homes had experienced separations during first four years
• Separations in various settings, lengths ranged from 5 to 23 weeks
• At age 6: compared to children cared for by mother without separations and those with unsettled home life

Children from Stable Homes with Episodic Separations

• Less given to attention-seeking than those not separated
• May not show obvious adverse effects on attachment behavior, but caution needed

Children from Unstable Homes

• Reported signs of insecurity at age 6: overdependence, anxiety, sleeping problems, nail-biting

Effects of Daily Substitute Care

Effects of Daily Substitute Care (Moore, 1969a)

• Moore studied the effects on a child's behavior at age six of different types of daily substitute care experienced before age five.
• Variables were confounded due to patterns of mother's work and care arrangements.
• Two samples identified: one with unstable daily substitute care, another with stable daily substitute care.

Unstable Daily Substitute Care

• Fifteen children experienced unstable care starting before age two.
• These children were insecure and anxious, showing dependent clinging behavior.
• Higher ratings for dependence and nervousness, lower for adjustment.
• More fears, especially of doctors, hospitals, and dark.
• Experienced more periods in hospital and elsewhere.
• Some mothers were rated as "unstable personalities."

Stable Daily Substitute Care

• Few cases where daily substitute care began before age two and was stable.
• Children tended to seek extra attention from mother but showed no evident emotional difficulties at age six.
• Nursery school attendance or care in another family, arrangements not problematic for children aged three-four.

Effects of Unpredictable Care Regime

• Some children subjected to unpredictable regime become more or less detached, showing aggressive and disobedient behavior.
• Differential incidence between sexes: anxiety commoner in women, delinquency commoner in men.

Follow-up Findings (Moore, 1971)

• Patterns of attachment behavior during first five years tended to persist.
• Data do not permit conclusions regarding effects on a child of starting full-time day care during third year.
• Clinical experience suggests caution about full-time attendance for young children.

Recent Study by Blehar (1974)

• Used Ainsworth's strange situation procedure to study the behavior of middle-class children in day care and at home.
• Older day-care children cried more during mother's absence, avoided her upon return.
• Day-care children avoided stranger more than home-care children, increasingly so throughout test procedure.

Conclusion

• Stable daily substitute care leads to more secure attachment.
• Unpredictable care regime may lead to anxious attachment or aggressive detachment, sometimes both.
• Findings support the view that from age three, children benefit from play with peers within an ordered environment.

Anxious attachment following threats of abandonment or suicide

Anxious Attachment and Threats of Abandonment or Suicide

• Anxious attachment is significantly influenced by threats of abandonment or suicide, especially those that are not love-based but involve actual abandonment.
• Freud discussed the impact of threats of loss of love in Inhibitions, Symptoms and Anxiety (1926a).
• Threats to abandon a child can take various forms: sending away to reformatories or schools for bad boys, going away and leaving, making ill or dying, impulsive angry desertion, and overhearing parents quarreling.
• Systematic study and discussion of these threats are rare due to the reluctance of parents to talk about them.

Incidence and Seriousness of Threats

• In Nottingham study (1968), 27% of all parents interviewed used abandonment threats as a means of discipline, with highest incidence among working-class parents.
• Threats can vary in seriousness; some are teasing while others are believed and taken seriously by children.
• Parents may use impressive play-acting to teach a lesson.

Examples of Threats

• Packer's wife: threatened son with Hartley Road Boys’ Home and walked him around the neighborhood as if leaving.
• Miner's wife: threatened to go away when her daughter argued, making her child "nearly demented."
• Miner's wife: prepared to threaten illness and departure to punish her child.

Threats in Other Countries

• Limited findings on threats to abandon a child in New England; mothers were reluctant to acknowledge their use of such threats.
• Half of assessed cases showed significant use or moderate use of threats to withdraw love or abandon the child.

Implications and Consequences

• Threats of abandonment contribute to separation anxiety and anxious attachment in children.
• Children may believe they are being sent away as a punishment when they go to hospital or residential nursery.
• Some parents, though aware that such threats are wrong, occasionally use them out of frustration or exasperation.
• Horrifying threats to abandon the home and/or commit suicide have a significant impact on children's development.
• Families with these dynamics often keep their true circumstances hidden from mental health professionals, complicating diagnoses and treatments.

An Illustrative Case

Background:

• Mrs. Q and her son, Stephen, were referred for help due to Stephen's refusal to eat and severe underweight issue.
• Mrs. Q was diagnosed with chronic anxiety and depression which started at the time of Stephen's birth.

Mrs. Q's Upbringing:

• Her father, a skilled artisan, suffered from "shell shock" after surviving a bridge explosion during the war.
• He experienced long phases of depression and ill temper, leading to violent behavior towards his family.
• Mrs. Q's mother was an active capable woman with strong opinions whose own mother was a chronic alcoholic.
• Their home was marked by frequent violent quarrels, resulting in smashed crockery, drawn knives, and set furniture.
• Mrs. Q and her siblings were instructed to hide the family troubles from outsiders.

Impact on Mrs. Q:

• She grew up an anxious girl, constantly afraid to go far from home, with spasms of violent anger.
• As a child, she would sometimes vent her anger on her dolls.
• During treatment, she had difficulty acknowledging her mother's impact on her feelings towards Stephen.

Mrs. Q's Relationship with Stephen:

• After Stephen's birth, Mrs. Q experienced strong impulses to harm him and became extremely anxious about his safety.
• Her hostility towards her own mother was redirected (displaced) onto Stephen, causing outbursts of violence and damaging items in his presence.
• Stephen developed fear that his mother might die due to Mrs. Q's threats of suicide during rare outbursts.

Consequences and Implications:

• Many parents are reluctant to admit threatening their child due to shame or disapproval from professionals.
• Children are also reluctant to divulge such information due to fear of their parents' reactions and protecting their reputation.

Interventions:

• Joint sessions with Mrs. Q and Stephen helped acknowledge and address the fears and threats, easing the situation.

Incidence of ‘Attempted’ Suicide by Parents

Parental Suicidal Attempts:

• The incidence of attempted suicide among parents of children under 18 is high compared to completed suicide due to coercive or attention-seeking intentions.
• In Edinburgh, approximately 0.3% of women aged 15-34 attempt suicide annually; about 4% of mothers will have attempted during their childbearing years, with one-third attempting more than once.
• Incidence for men is lower, estimated to be between 2 and 2.5%.
• Approximately one in twenty children in Edinburgh experienced a suicidal attempt by a parent before age ten.
• Not evenly distributed throughout population; higher incidence in socio-economic class V and certain subcultural groups.
• Threats to commit suicide are also prevalent but no figures are available.

Fear of Parental Desertion:

• Parental quarrels can lead to fear of abandonment in children, whether explicit or implicit.
• Children often hear more than parents realize.
• Professionals may not be informed about home situations and may misinterpret child's symptoms.
• Understanding family dynamics requires time and joint family interviews.
• Threats of abandonment magnify effects of actual separation and can lead to persistent anxiety in children.
• High incidence of threats of abandonment, along with other factors like unstable care and family life, contributes to anxiously attached children.
• Better understanding of clinical syndromes related to parental desertion (see Chapters 18 and 19).

Chapter 16 ‘Overdependency’ and the Theory of Spoiling

Background: The child's fear of separation and clinginess (anxious attachment) explained by various theories.

Theories on Anxious Attachment:

Constitutional Factors:

1. Freud (1917b): Some children have a greater libidinal need in their constitution, making them more sensitive to an absence of gratification.
2. Klein (1932): Some children have a stronger death instinct, causing unusually strong persecutory and depressive anxiety.

Environmental Factors: 3. Greenacre (1941, 1945): Severe traumas during birth or first weeks of postnatal life may increase anxiety response and heighten anxiety potential. 4. Freud (1905b, 1917b, 1926a): Excessive parental affection 'spoils' a child by making them demanding and intolerant of frustration. 5. Edelston (1943), Bowlby (1951), Suttie (1935), Fairbairn (1941): Experiencing actual separation or threats of abandonment/loss of love increases the likelihood of anxiety about separation.

Evidence: Ucko's research (1965) on children suffering from neonatal asphyxia supports hypothesis 3 but does not conflict with hypotheses 4 and 5. No substantial evidence supports hypothesis 4, which Freud widely propagated.

Possible reasons for Freud's belief in spoiling theory: Discussed at the end of the chapter.

Further studies on anxious attachment: To determine if all cases can be explained by separation/threats of abandonment, it is necessary to examine results from studies with different approaches.

Overdependency and Its Antecedents

• Few studies examining overdependency in adults with a clear criterion for patient selection and comparison to a contrast group (Section 1).
• Agoraphobia literature relevant but focuses on fear of leaving home without a companion, not overdependency (Chapter 19).
• Studies on family backgrounds of children identified as overdependent are limited in number (Section 2).

Ambiguity of Overdependency

• Two distinct conditions: anxious attachment and lack of self-sufficiency.
• Stendler's study identified two subgroups of overdependent children: those who constantly seek help from mother and those anxiously attached but capable of doing tasks themselves (Section 2).

Family Experiences of Overdependent Children

• Differences in family backgrounds between the two subgroups (Section 2):
  • Six children with stable homes, excessively protective mothers who discouraged independence.
  • Fourteen children with unsettled home lives, frequent separations and instability.

Supporting Evidence of Antecedents: McCord et al.'s Study (1962)

• Large study with detailed case records of 255 boys aged 9-17 from a high-density industrial area.
• Supportive work continued for five years, providing extensive information on boys and families.
• Subgroups identified: overdependent (43 boys) and normal development (105 boys).
• Overdependent boys showed:
  • More feelings of inferiority (51% vs 12%).
  • More prone to 'abnormal fears' (56% vs 36%).
• Family backgrounds and attitudes of parents compared:
  • Higher rejection rates by father (51% vs 28%) and mother (39.5% vs 20%).
  • More frequent comparisons to siblings (56% vs 17%).
  • High incidence of parental quarrels in overdependent subsample, but also reported in control group.
• Some overdependent boys expressed negative feelings towards mothers (one-third).

Additional Evidence on Overdependency and Antecedents

• Newson and Newson's studies on child care practices at age 4 or 5 (Section 3):
  • Children afraid of separation experienced a separation.
• Sears, Maccoby, and Levin's study of families in New England: findings on overdependency mentioned previously.

Sears, Maccoby and Levin's Study on Dependency (1957):

• Interviewed 379 mothers of five-year-olds attending kindergarten in a large metropolitan area in New England
• Four questions asked about dependency, no evidence of separation playing a role in development of most dependent children due to low incidence
• Principal finding: Irritable, scolding, and impatient mothers correlated with more dependent children, especially those who initially rejected but later gave in
• High degree of dependency linked to parents using withdrawal of love as disciplinary measure
• Exceptionally demonstrative mothers had children rated as quite dependent, possibly due to discouraging child from independence (anxious attachment and looking to mother for everything)
• Substantial evidence against theory of spoiling from family backgrounds of self-reliant individuals
• Freud's adoption of spoiling theory likely influenced by accepted opinion and misled by show of affection/over-protection disguising underlying issues (abandonment threats or parental demands for child to act as caretaker)

Findings:

1. No evidence that separations contributed to dependency in children, but low incidence.
2. Irritable and scolding mothers led to more dependent children.
3. High degree of dependency linked to parents using withdrawal of love as disciplinary measure.
4. Exceptionally demonstrative mothers had children rated as quite dependent.
5. Substantial evidence against spoiling theory from family backgrounds of self-reliant individuals.
6. Freud's adoption of spoiling theory possibly influenced by misperception of affection and over-protection.

Theory Explanations:

1. Anxious attachment: Children assessed as overdependent may fall into two groups – those showing anxious attachment and those looking to mother for everything.
2. Parental demands/role reversals: Parents demanding child act as caretaker or threatening abandonment invert normal roles, making the parent anxiously attached or overdependent.
3. Misperception of affection/over-protection: Freud may have been misled by show of affection and over-protection masking underlying issues, such as abandonment threats or parental demands for child caretaking.
4. Bitter experiences: Uncertainty regarding the availability and responsiveness of attachment figures commonly results in anxious attachment.
5. Sympathy and understanding: Recognizing anxiety over accessibility and responsiveness of attachment figures can help those who have grown up insecure and prevent others from doing so.

Chapter 17. Anger, Anxiety, and Attachment.

Anger: a response to separation

• Systematically studied by Heinicke and Westheimer (1966) in children aged 13-32 months during and after a stay in a residential nursery
• Increased tendency of separated children to respond aggressively towards parent dolls during their stay
• Hostility towards parent or parent-substitute, expression of anger at the way they have been treated
• Anger can be functional or dysfunctional

Functional Anger:

• Sometimes directed towards all and sundry, but often towards a parent or parent-substitute
• Anger of hope: reproach for absence when wanted (Robertson, 1952; Wolfenstein, 1957)
• Assists in overcoming obstacles to reunion
• Discourages loved person from going away again

Dysfunctional Anger:

• Anger of despair: response to repeated prolonged separations (Burlingham and Freud, 1944; Bowlby, 1960b, 1961b, 1963)
• Occurs in adults after loss, especially during early phases of grieving
• Belief that loss can be permanent, despite evidence to the contrary
• Anger directed against lost person and others obstructing reunion

Attachment:

• Important relationship between anger and attachment
• Anger can promote bond by encouraging reunion and discouraging further separation
• Anger with an affectional bond is not uncommon (Heard, 1973; Hall and DeVore, 1965)

Studies:

• Heinicke and Westheimer (1966): ten children aged 13-32 months in residential nursery showed increased aggression towards parent dolls
• Robertson (1952): child's angry reproaches to mother for being absent during hospital stay
• Wolfenstein (1957): child's anger and reproachful behavior towards father after tornado separation
• Burlingham and Freud (1944): Reggie's intense anger and despair after multiple losses of caregivers
• Bowlby, Ainsworth, and Boston: reported intensely ambivalent behavior in children after separation
• Robertson (1958b), Robertson and Robertson (1971), Moore (1969b; 1971): noted hostile behavior during and after reunions.

Dysfunctional Anger

Dysfunctional Anger:

• Intensely and persistently angry behavior towards a partner that weakens instead of strengthens the bond
• Occurs when anger becomes revengeful and crossed the boundary between deterrent and vengeful
• Results in deep-running resentment held in check by anxious uncertain affection
• Especially likely to occur during situations of separation and loss

Effects of Separation:

• Anger is aroused, love is attenuated
• Intense pain and distress can lead to intense anger towards the person inflicting the pain
• Threats of abandonment can elicit intense anxiety and anger

Threats of Desertion:

• Used as a means of discipline by some parents
• Can make children intensely anxious and angry
• Repressed anger at parent often directed towards other targets or manifested as phobias

Clinical Examples:

• Mrs Q: intense anger towards her mother due to repeated threats of abandonment or suicide
• Stott's study: many delinquent boys were deeply insecure and intensely anxious and angry due to parental threats of desertion
• Kestenberg's case: girl who had been deserted by parents became vengeful and pictured herself killing her mother
• Burnham's cases: two patients who engaged in matricide expressed a fear of abandonment

Conclusion:

• Dysfunctional anger towards an attachment figure can be caused by repeated threats of being abandoned
• This link is currently a conjecture, but a promising lead for further research.

A Test for Appraising Responses to Separation

Object-Relations Approach

• Principal criterion for clinical assessment: balance of disposition to love, anger, hate attachment figure
• Hansburg (1972) developed a systematic test for appraising responses to separation

Hansburg's Clinical Test

• Consists of 12 pictures with situations of child or parent separation
• Suitable for children and young adolescents aged 10-15 years
• Asks child if picture has happened or how they would feel
• Presents 17 statements describing feelings a child might have in such situations

Range of Feelings Covered

• Feeling alone and miserable
• Feeling sorry for parents
• Feeling that they don't care
• Feeling angry at someone
• Feeling that separation is their fault
• Feeling that home will be scary
• Feeling that it's a dream

Preliminary Findings

• Children from stable families give more responses expressing distress and concern than anger
• Disturbed children, especially those with long or repeated separations, give equal or more angry and fault-finding responses
• Difference in balance is more pronounced for major disruptions of child's bond with parents
• Some disturbed children may show false self, expressing forced autonomy
• Chapter 21 discusses characteristics of stable autonomy and conditions for its development.

Anger, ambivalence, and anxiety

Attachment Theory:

• Proposed theory suggests separation or threats of separation lead to both anxious and angry behavior towards attachment figure
• Anxious attachment: seeking maximum accessibility to attachment figure
• Anger: reproach and deterrent against separation happening again
• Love, anxiety, anger, and sometimes hatred towards one person can result in painful conflicts
• Observed in animals as well (animal behavior)
• Clinical phenomenon of intense love, fear, and hate towards attachment figure
• Vicious circles can develop between attachment, anxiety, and anger
• Hypotheses proposed to explain connections:
  • Frustration–aggression hypothesis by Fairbairn
  • Death instinct hypothesis by Melanie Klein

Melanie Klein:

• Observed intense hostility towards mother in children attached to her with unusual intensity
• Hostility and anxiety increase each other
• All aggressive feeling/behavior an expression of death instinct

Fairbairn:

• Frustration leads infant to direct aggression against loved object
• Consistently holds frustration–aggression response in attachment relationships

Common Ground:

• Anxiety and hostility towards attachment figure linked
• Both aroused by separation or threats of separation
• Complexities in understanding feeling and behavior due to repression, displacement, projection, unchanged expectations from childhood experiences.

Chapter 18. Anxious Attachment and the ‘Phobias’ of Childhood

• The susceptibility to respond with fear in potentially alarming situations is determined by an individual's forecast of the availability of attachment figures, shaped by their working models of attachment figures and self. (Theory of attachment)
• Working models are built up during childhood and adolescence and tend to remain stable throughout life. (Childhood experiences influence anxiety and fear responses)
• In this chapter and next, theory is applied to clinical syndromes with overt anxiety and fear: 'phobia'
• Phobias include a broad range of conditions where anxiety and fear are main symptoms (Marks 1969; Andrews 1966)
• Two types of phobias: deep-seated disturbances of personality (majority group), specific animal or situation fears in otherwise healthy personalities (minority group)

Deep-seated Disturbances of Personality:

• Prone to fear situations, depression, and psychosomatic symptoms (Marks 1969; Friedman 1950; Kennedy 1965)
• Agoraphobia: fear of crowded places or absence of secure base
• School phobia: fear of school, often misdiagnosed as phobia but best classified as an anxiety state (Brun 1946; Snaith 1968)
• Overlap between pseudophobias and free-floating anxiety

Specific Animal Phobias:

• Intense fear of a specific animal or situation
• Differ from deep-seated disturbances: stable personalities, no other psychological issues, age of onset before seven years old (Marks 1969)

Pseudophobias:

• Best regarded as anxiety states rather than phobias (Brun 1946; Snaith 1968)
• Fear is about the absence or loss of attachment figure(s)
• Clinician fails to recognize true nature, leading to misdiagnosis

School Phobia:

• Large and revealing literature
• Misconceptions about underlying psychopathology in literature (Marks 1969)
• Patterns of interaction with families to be examined in this chapter

Agoraphobia:

• To be considered in next chapter, in light of school phobia discussion

School Phobia or School Refusal:

• Condition where children refuse to attend school and express anxiety when pressed to go (Johnson et al., 1941; Warren, 1948)
• Differentiated from truancy
  • Children with school phobia express anxiety and do not pretend attendance
  • Often accompanied by psychosomatic symptoms (anorexia, nausea, abdominal pain, feeling faint)
  • Fear is expressed of various situations: animals, dark, bullying, harm to mother, desertion, or panic
  • Children are well-behaved, anxious, and inhibited
  • Comes from intact families with close relationships (sometimes suffocating)
• Truants do not express anxiety about attending, pretend attendance, and often delinquent
• Comes from unstable or broken homes, experiences long separations or changes of mother figure
• Relationships between truant and parents are quarrelsome or distant

Research:

• Hersov (1960a) compared 50 school refusers with 50 truants and another contrast group
• Several descriptive studies based on clinical practice (Talbot, 1957; Coolidge et al., 1957, 1962; Eisenberg, 1958; Davidson, 1961; Sperling, 1961, 1967; Kennedy, 1965; Weiss and Cain, 1964; Weiss and Burke, 1970)
• Agreements on personalities, behaviors, and symptoms of children and parents
• Fear is not about school but leaving home
• Disagreeable features of school are usually rationalizations

Terminology:

• Johnson abandoned the term "school phobia" in favor of "separation anxiety" (Estes, Haylett, & Johnson, 1956)
• 'School refusal' is best name for a clinical syndrome as it's descriptive and least laden with theory.

Theories:

• Freudian tradition: child's individual psychopathology, process of projection (Freud, 1909), dependency and overdependency, over-gratification and spoiling, fixation at or regression to one or another level of psychological development (Sperling, 1967; Clyne, 1966)
• Family interactions: instigating and maintaining the condition by one or other parent (Johnson et al., 1941)
• Learning theory (Andrews, 1966): conceived in terms of individual psychopathology but practitioners of behavior therapy are often more aware of interpersonal relations and family dynamics.

Four Patterns of Family Interaction

Four Patterns of Family Interaction in School Refusal Cases:

• Based on clinical literature, workers identify similar features in cases of school refusal, despite varying theoretical standpoints.
• These findings can be understood through the lens of anxious attachment theory.

Pattern A:

• Mother (or rarely father) suffers from chronic anxiety regarding attachment figures.
• Retains child at home to be a companion.
• May be combined with other patterns.

Pattern B:

• Child fears something dreadful may happen to mother or father while they are at school.
• Remains at home to prevent it from happening.

Pattern C:

• Child fears something dreadful may happen to themselves if they are away from home.
• Remains at home to prevent that from occurring.

Pattern D:

• Mother (or rarely father) fears something dreadful will happen to the child while they are at school.
• Keeps child at home to protect them.

Additional Information:

• Multiple patterns can be present in a single case, and they are not mutually exclusive.
• Pattern A is the most common pattern.
• Anxious attachment plays a significant role in understanding these patterns and school refusal cases.

Family Interaction of Pattern A

• A family pattern where a parent, usually the mother, suffers from anxiety over attachment figures and retains the child at home as a companion.
• Mother may act deliberately or unconsciously.
• Reasons for keeping child at home: fear of losing love, feeling unloved in childhood, need to be cared for by the child.
• Child often kept from school under false pretenses like illness or bullying.
• Parents' own difficulties and disturbed relationships with their own parents contribute to this pattern.

Mother's Experience

• Mother may feel unwanted or less wanted in her family, resulting in a need to fight for affection.
• Mother has often been put under pressure to provide care for demanding parents.
• Resentment against the parent figure builds up over time.
• Mother's intense ambivalent relationship with her own mother can also be an example of an inverted parent–child relationship.

Child's Experience

• Child is prevented from engaging in play or school activities with peers.
• Child may feel trapped, frustrated, and not free to express themselves.
• May exhibit behaviors like winding a window cord around themselves or drawing images of being on a tight leash.

Other Possible Agents

• Father can also be the principal agent in this condition.
• Grandparents' dynamics may contribute to the pattern, with demands for parental-type care and affection.

Origins and Implications

• Parents' pathological behavior is a reaction against or reflection of deeply disturbed relationships with their own parents.
• Understanding the dynamics and historical origins requires systematic data on parents and grandparents.
• Parents are seen as unhappy products of an unhappy home rather than villains.

Marital Relations and School-Refusing Children:

• Parents' relationships are often disturbed, with variations ranging widely (not detailed in text)
• One common form: wife is locked in ambivalent relationships with her own mother and passive husband, who may be entangled with his mother instead
• Mother treats school-refusing child as replica of her own mother, seeking care and comfort from him and behaving dominantly
• Three processes contributing to hostile treatment of school-refusing child by emotionally disturbed parent:

1. Redirecting (displacing) anger: Resentment towards own mother expressed against child
2. Misattribution of characteristics: Child is seen as making unreasonable demands or being rejecting/ungrateful
3. Modelling angry behavior: Parent behaves angrily towards child, mimicking how own mother treated them

Pattern A:

• Mother's need for dependence remains constant
• Child's response alternates: clinging or striving for independence
• Mothers respond with varying actions: increased clinginess, guilt-inducing, anger, or rejection (sometimes violent)

Processes leading to Hostile Treatment:

(a) Redirecting Anger:

• Mother resents own mother's meager affection and intense demands
• Unable to express anger openly, finds a figure (child) to vent it on

(b) Misattribution of Characteristics:

• Mother attributes unreasonable demands or rejection/ingratitude to child
• Assimilates child to attachment figure model and expects similar behavior

(c) Modelling Angry Behavior:

• Parent's behavior towards child mirrors how own mother treated them
• Threats are common in families of school-refusing children, key to understanding clinical problems in patterns B and C

Family Interaction of Pattern B

A child fears that something dreadful may happen to mother or father while they are at work or away from home, causing the child to stay home to prevent it.

Prevalence:

• Second most frequent pattern among the four
• Occurs frequently in conjunction with Pattern A

Empirical Studies:

• Fear of harm to mother or close relative is common reason given by school-refusing children for not attending school
• Reported by Talbot (1957), Hersov (1960b), Klein (1945), Lazarus (1960), Kennedy (1965), Clyne (1966), and Sperling (1961; 1967)

Explanations: 1. Unconscious Hostile Wishes:

• Psychoanalytic explanation for why a child may fear harm befalling their mother or father
• Child harbors unconscious hostile wishes against the parent and fears these wishes coming true
• Advocated by Broadwin (1932), Klein (1945), Waldfogel, Coolidge and Hahn (1957), Davidson (1961), Clyne (1966), Sperling (1967), and those holding Melanie Klein's views

2. Real Experiences:

• Child's fear based on real experiences or threats of harm
• Child may fear mother's illness, death, or abandonment after witnessing similar events in their own lives or hearing threatening statements from the parent

Factors that Contribute to a Child's Fear: 1. Actual Events:

• Mother's illness or death
• Death of close relatives or friends

2. Threats:

• Threats of abandonment, desertion, or suicide from the parent
• Statements implying that the child is responsible for the parent's wellbeing

Evidence:

• Many workers have reported that school refusal begins following a significant event in the family, such as an illness or death
• Mother's actual illness or a friend's death can heighten a child's fear of their unconscious hostile wishes coming true
• Factors external to the child (threats, concealment) can also contribute to intense and prolonged fears

Additional Factors: 1. Misplaced Attempts to Conceal Information:

• Parents' dissembling and evasion may increase a child's anxiety
• Child may feel they cannot trust the information they receive from their parents

2. Threats of Harm:

• Threats of abandonment, desertion, or suicide can make a child believe that their parent's predictions are coming true and that harm is imminent
• Children may fear that they are responsible for their parent's wellbeing and that their actions could cause harm to the parent.

Family Background:

• Multi-problem family known to medical and social agencies for several years
• Mother, aged 47, incapacitated with ulcerated legs, had worked as a charwoman
• Father, chronically disabled, dying of cancer at home
• Two older sons evicted from house before father's death

Intervention:

• Systematic therapeutic work began when Susan, aged 13, refused to attend school for 18 months
• Crisis intervention approach taken following father's death
• Child care officer arranged assessment interview with all family members present

Assessment Interview:

• Mother made bitter recriminations against Susan and threatening remarks towards her
• Hostile remarks passed between family members
• Description of loneliness, anxiety, and concern for each other only possible with skilled assistance
• Arrangement for regular weekly visits from caseworker for three months, with all family members present

Family Interaction Pattern:

• Prominent threat pattern identified during first half-dozen sessions
• Mother's threats of desertion or death led to children staying home to protect her
• Both children expressed strong hostility towards each other and the caseworker

Outcome:

• Susan attended school for the first time in 18 months at session seven
• Children took turns standing guard over mother to prevent her desertion
• Family much improved six months later: mother's ulcers healed, renewed contact with older son, and both children attended school regularly

Implications:

• Regular family interviewing sheds light on childhood problems and hidden interaction patterns
• Inappropriate clinical techniques and lack of recognition of family pathology hinder progress in child psychiatry and psychoanalysis
• Parents' threats play a crucial role in many cases of school refusal
• Wish-fulfilment theory may have some application but must be considered alongside family events and children's frustration

Additional Patterns:

• Less frequent patterns of family interaction can be dealt with briefly.

Family Interaction of Pattern C

• A child is afraid of leaving home due to fear of abandonment.
• Threats from parents, both overt and covert, are a common explanation.

Case Study: Tommy (Wolfenstein, 1955):

• Mother lost both her parents and husband around the time of his birth.
• Lived an isolated life with mother due to her conflicting thoughts about abandoning him or keeping him.
• Overheard and directly threatened with being placed in a foster home when misbehaving.
• Anxiety response included intense anxiety, provocative behavior, hectic laughter, and violence towards teachers.
• Behavior mirrored mother's towards herself.
• Central fear was abandonment by his mother.

Pattern C Observations:

• Mothers who struggle to bring up children alone often entertain ideas of getting rid of them.
• Many children may be subjected to threats that are kept secret.

Case Study: Eric (Tyerman, 1968):

• Conscientious pupil with no apparent signs of distress.
• Refused to go to school due to fear of dying.
• No apparent source of tension or hostility towards him.
• Accused of stealing money and threatened with abandonment when confessed, even though he didn't steal it.
• Parents did not mention the incident during earlier interviews due to shame and fear.
• Clinicians may be misled into believing that children's fears have no basis in reality.

Key Concepts:

• Family interaction patterns C: Fear of abandonment and threats from parents.
• Central anxiety: Abandonment by mother.
• Observed and hidden threats impacting child behavior and development.
• Unacknowledged parental actions contributing to children's fears.

Family Interaction of Pattern D

• Mother or rarely father keeps child at home due to fear of something dreadful happening
• Fear may be exacerbated by past or recent illness of the child, real or imagined

Theories for Parental Anxiety:

• Wish-fulfillment theory: Unconscious hostile wishes towards the child coming true
• Past tragedy theory: Parent's heightened apprehension due to past family tragedies

Explanations of Parental Anxiety:

• Unconscious Hostile Wishes:

  • Parental fears may stem from unconscious desires
  • Theory adopted by psychoanalysts
  • Not mutually exclusive with past tragedy theory

• Past Family Tragedies:

  • Parent's fear linked to a past family tragedy
  • Can be a significant factor in the development of anxiety
  • Examples:
    • Father's brother died at age 17, father felt responsible (Eisenberg, 1958)
    • Mother's sister died at age 11, girl believed grandmother was over-protective (Davidson, 1961)
    • Parents still preoccupied with deaths that occurred years ago (Talbot, 1957)

Case Example: Mrs. Q and Stephen

• Intense apprehension felt by Mrs. Q about Stephen's safety
• Direct reaction to her own impulse to throw her baby out of the window
• Hostility towards Stephen likely redirected from anger towards her own mother's behavior
• Unconscious feelings of hostility and past experiences may contribute to parental anxiety.

Parents of School-refusing Children: Results of Psychiatric Examination

• High incidence of psychiatric disturbance among parents
• Marital disharmony is universal in more severe cases

Mothers:

• Hersov (1960b): 8/50 had previous treatment (depressive, hysterical)
• Hersov (1960b): 17/50 suffered from anxiety and depression
• Davidson (1961): 12/30 showed symptoms of depression (2 hospitalized)
• Britton (1969): 10/18 mothers under treatment, another 6 exhibited psychiatric symptoms

Fathers:

• Hersov (1960b): 8/50 showed psychiatric symptoms (depression, anxiety)
• Davidson (1961): 11/30 fathers suffered from neurotic symptoms
• Malmquist (1965): Evidence of father involvement and role in problem

Family Interaction:

• Behavior of school-refusing children understood within family context
• Previous judgments about children's motivations often mistaken and unjust.

Two classical cases of childhood phobia: a reappraisal

• Two famous cases of childhood phobia reported during the first quarter of the 20th century:
  • Freud's case of a five-year-old boy named Little Hans (1909) - psychoanalytic tradition
  • Mary Cover Jones' case of a two-year-old and ten-month-old boy named Peter (1924b) - learning theory tradition
• Anxious attachment as a key factor in childhood phobia:
  • Reevaluating these cases to determine if anxious attachment played a role.

Freud's Case of Little Hans:

• Five-year-old boy with horse phobia (1909).
• Family interaction likely to have been pattern B:
  • Overprotective mother
  • Father absent or indifferent
• Anxious attachment possible:
  • Mother's overprotection may have increased child's fear of separation.
  • Father's absence could lead to insecure attachment.

Mary Cover Jones' Case of Peter:

• Two-year-old and ten-month-old boy with dog phobia (1924b).
• Family interaction likely to have been pattern C:
  • Parents present but distant and unresponsive
• Anxious attachment possible:
  • Lack of parental responsiveness could lead to insecure attachment.
  • Peter's fear might have developed as a result of feelings of abandonment or lack of security.

Overall:

• Both Little Hans and Peter presented with animal phobias.
• In both cases, there is evidence of anxious attachment playing a role:
  • Freud overlooked this factor due to his focus on psychoanalytic theories.
  • Jones relegated it to a subordinate position due to her focus on learning theory.
• Understanding the family patterns and potential impact on anxious attachment can provide valuable insight into childhood phobias.

The Case of Little Hans

Case of Little Hans: A landmark paper in psychoanalytic theory, written by Sigmund Freud about a horse phobia in a five-year-old boy named Hans.

Key Points:

• Hans's fear of horses was due to the repression and projection of his aggressive impulses, which included hostility towards his father and sadism towards his mother.
• Later, Freud concluded that fear of castration was the primary motivator for the repression.
• Recent analysis suggests that anxious attachment may have played a larger role in Hans's condition than Freud realized.
• Hans's anxiety stemmed from threats by his mother to desert the family.
• The evidence includes the sequence of symptoms and statements made by Hans himself, as well as evidence in the father's account of mother's use of alarming threats.
• The analysis was conducted primarily through conversations between the father and Freud, with limited interaction between Freud and Hans.
• Hans had a younger sister, Hanna, whom he was jealous of.
• Hans developed the phobia after expressing fear that his mother might disappear or abandon him.
• Hans's fear of horses being linked to someone's departure.
• Freud saw Hans's intense affection for his mother as sexual in nature, rather than an expression of anxious attachment.
• Mother used threats and warnings to discipline Hans, including the threat of leaving him.
• Hans expressed fears that both his parents might leave him.
• Subsequent to these events, Hans's parents separated and later divorced.

The Case of Peter

Behavior Therapy Case Study: Peter

• Peter, a 2-year-old-boy, was the first recorded example of fear being deconditioned in behavior therapy.
• He had an intense fear of animals, including white rats and rabbits.
• Researchers believed he was conditioned to fear animals, but his mother's threatening behavior may have played a larger role.
• Peter was afraid of these creatures while other children his age were not.

Procedures to Decondition Peter

• First procedure: Playing with fearless children during rabbit introduction.
• Second procedure: Receiving candy before the rabbit appeared.
• Total sessions: 45, spread over a six-month period with a two-month interruption for scarlet fever.

Background of Peter's Family

• Came from a disturbed family living in impoverished conditions.
• Spent time in residential nurseries or hospitals.
• Mother: highly emotional, displayed tears during interviews, had lavished 'unwise affection' on Peter since older sister died.
• Discipline was erratic, resorted to threats (e.g., "Come in Peter, someone wants to steal you").
• Family interaction pattern: C.

Impact of Student Assistant on Deconditioning Process

• Peter became less afraid when the assistant he liked was present.
• Assistant made no overt suggestions during sessions.
• Jones suggested that the assistant's presence contributed to Peter's general feeling of well-being, indirectly affecting his reactions.

Animal phobias in childhood

Animal Phobias in Childhood

• Some animal phobias in childhood may be a result of direct experiences with animals, misinterpreted experiences, or exposure to fearful adults.
• True and limited animal phobias may exist, but many children's fears stem from the home environment.
• School refusers often exhibit animal fears as one of their symptoms, which disappears once family issues are addressed.
• Examine family interactions carefully when dealing with a patient complaining of animal phobia.

Causes of Animal Phobias in Childhood

• Direct experiences: child was attacked by an animal or witnessed an attack.
• Misinterpreted experiences: seeing or hearing about animal attacks, often at a young age and in dramatic circumstances.
• Exposure to fearful adults: prolonged exposure to parents or other adults who are afraid of specific animals.

Case Study: Moss (1960)

• A woman developed an intense fear of dogs due to her mother's reaction to a tragic event in which the patient was involved when she was four years old.
• The patient recalled that her mother blamed her for her younger sister's death, making her deeply afraid of dogs.
• The accuracy of the recalled event is questionable, but research suggests that parents often blame older children after a young child's death.

Implications

• Animal phobias may be rooted in family dynamics and should be considered in conjunction with other potential emotional disturbances.
• Understanding the family context can help explain why a child feels misunderstood, guilty, and experiences deep ambivalence towards important relationships.

Chapter 19 Anxious Attachment and ‘Agoraphobia’

• Freud's emphasis on the importance of human and social circumstances in understanding mental disorders
• Agoraphobia resembles school phobia with regard to fear of public places, anxiety attacks, depression, psychosomatic symptoms, traumatic precipitating events, family neurosis, and overprotective mothers (Roth, Harper & Roth, Marks, Snaith)
• Principal features of agoraphobia: fear of leaving familiar surroundings and being alone (Roth, Marks, Snaith)
• Agoraphobia not a true phobia but "non-specific insecurity fear" (Snaith)

Evidence for Fear of Leaving Home and Being Alone

• High incidence of traumatic precipitating events: illness, bereavement, family illness (Roth, Marks, Gelder)
• High incidence of depersonalization and anxiety/depression (Roth)
• Principal fear is leaving home (Snaith)
• Intensity of fear magnified when patient becomes more anxious (Snaith)
• Patients unable to leave house without a companion (Roberts)
• Anxiety increases the further from home (Weiss)
• Findings consistent despite varying approaches and outlooks

Childhood Fears and Phobias

• 50-70% of agoraphobic patients report childhood fears and phobias (Roth, Roberts, Snaith)
• Recent survey of 786 cases found 22% described themselves as having been "school phobic" (Berg et al.)

Psychoanalytic Perspective

• Psychoanalysts report same findings: fixation on those on whom libido is fixated (Abraham, Deutsch, Weiss)
• Anxiety reaction to abandoning a fixed point of support (Weiss)

Three Types of Theorizing for Agoraphobia

1. Psychoanalytic Theory:
   • Two main variants based on fear of being in the street or fear of leaving home
   • Freud's focus on fear of being in the street as a displacement of fear of libido
   • Later theories focus on patient's fear of leaving home due to unconscious hostile wishes or unresolved dependency needs (Deutsch, Weiss, Fairbairn)
   • No suggestion of family behavior impact in psychoanalytic formulations
2. Learning Theory:
   • Focus on understanding discrete animal phobias
   • Unable to explain why certain symptoms develop or occur together in agoraphobia
   • Marks suggests panic attacks and depression act as super-reinforcers for phobic conditioning
   • Anxiety attack comes first, situations feared are learned later through secondary conditioning or rationalization
3. Roth's Psychosomatic Theory:
   • Invokes psychological and neurophysiological processes
   • Major aetiological agent in agoraphobia is missing (conspicuous by its absence)

Psychoanalytic Theories of Agoraphobia:

• Freud's focus: fear of being in the street as displacement of fear of libido
• Two variants for fear of leaving home:
  • Unconscious hostile wishes (Deutsch)
  • Regression to unresolved dependency needs (Weiss, Fairbairn)
• No suggestion of family behavior impact on patient's refusal to leave home

Learning Theory:

• Understanding discrete animal phobias but limited applicability to agoraphobia
• Marks: agoraphobia is complex with symptoms like panic attacks, depression, obsessions, and frigidity
• Learning theory doesn't explain the origin or association of these symptoms
• Marks suggests anxiety attacks may have unknown physiological origin
• Anxiety attack comes first and situations feared are learned later through secondary conditioning or rationalization
• Fear of going out of the house and fear of becoming separated from a companion develop through secondary conditioning

Roth's Psychosomatic Theory:

• Invokes psychological and neurophysiological processes
• Major aetiological agent in agoraphobia is missing, and this theory should be considered alongside other theories

Marks' Scepticism Towards Precipitating Factors

• Marks expresses skepticism towards the causal role of precipitating factors in agoraphobia
• Believes they may act as non-specific stressors or elicitors for patients already prone to the disorder
• Claims that some phobias start suddenly without any obvious change in a patient's life situation

Case Example: A Woman with Depression and Separation Anxiety

• Developed anxiety, sweating, and shaking of legs while travelling by train at age 23
• Discovered relief in the presence of her husband and took a job where he worked
• Became afraid of separation from him, developed intense fear of not being able to contact him, leading to panic attacks
• Had childhood experiences of fear when parents were away and infrequent desires to scream
• Marks suggests that agoraphobia came before separation anxiety

Flaws in Marks' Position

• Uncertain validity of retrospective data from the patient's account
• Lack of consideration for suppression of information by patients
• Two distinct psychopathologies proposed for a pair of symptoms that often co-occur (agoraphobia and separation anxiety)
• No explanation for how or why patients first experience anxiety and panic attacks
• Alternative hypothesis: Childhood experiences of abandonment might contribute to agoraphobic symptoms

The Role of Parents in the Genesis of Agoraphobia

• Learning theorists and traditional psychoanalysts agree that parental behavior is not a significant factor in the development of agoraphobia
• Both groups invoke the theory of spoiling, suggesting patients have learned to withdraw and remain at home due to overprotective parents

Roth's Psychosomatic Theory

• Regards agoraphobia as truly psychosomatic
• Emphasizes vulnerable personalities, precipitating role of stressful events, and depersonalization as core symptoms
• Suggests specific cerebral mechanism causing chronic derangement of mechanisms regulating awareness
• Offers little detail on how difficult childhood experiences and later life stressors interact to produce an agoraphobic syndrome

Central Symptom of Agoraphobia: Fear of Leaving Home

• All workers agree that the central symptom of agoraphobia is fear of leaving home

Family Interaction and Anxious Attachment in Agoraphobia:

• The applicability of anxious attachment theory to agoraphobia is uncertain due to limited data on family interaction patterns.
• General evidence suggests a high incidence of disturbance in the families of origin of agoraphobic patients.

General Evidence:

• Most agoraphobic patients come from intact families, but relationships are often far from harmonious.
• Neurotic or disturbed first-degree relatives are common (21% based on clear-cut neurotic breakdown).
• A minority of patients come from homes broken by death, divorce, or other causes.

Family Categories:

• Category I: Intact and Reasonably Stable Families (37 patients):
  • Happiness or no adverse information about home life.
  • One-third reported neurotic trouble in family members (two parents were agoraphobic, two were over-protected, ten were notably fearful as children).
• Category II: Intact Families with Unhappy Childhoods (26 patients):
  • Perpetual quarrels, violence, and alcoholism.
  • Lack of affection or rejection.
  • Two patients were school refusers.
  • Three patients had agoraphobic mothers.
• Category III: Disrupted Families (24 patients):
  • Death, divorce, desertion, or prolonged separations.
  • Ten lost one or both parents before the age of ten.
  • Five mothers deserted.
  • Two patients were evacuated during wartime.
  • Three patients had chronically sick mothers.
  • Three patients described themselves as having suffered from anxiety as children (two were school refusers, one was agoraphobic).
• Over half of the patients (categories II and III) likely came from families with extensive disturbance during childhood.
• One-third of the minority from seemingly stable homes reported covert disturbance.

Some Specific Patterns

Agoraphobia in Adults vs. School Refusal in Children:

• Strong similarities between families of agoraphobic patients and school-refusing children
• Expectation of common patterns of interaction based on limited evidence

Common Patterns of Interaction in Families: Pattern A:

• Mother (or rarely father) suffers from chronic anxiety regarding attachment figures
• Keeps patient at home as companion

Pattern B:

• Patient fears something dreadful happening to mother or father while away
• Patient either stays home or insists mother accompanies him

Pattern C:

• Patient fears something dreadful happening to himself when away from home
• Patient remains at home to prevent it

Pattern D:

• Parent fears for child's safety and keeps him at home (not directly recorded in agoraphobic families but indirect evidence suggests occurrence)

Compatibility of Patterns:

• Mixed cases are common
• Not mutually exclusive

Evidence Support:

• Limited quality of evidence available
• Expectation based on resemblance between agoraphobia and school refusal
• Indirect evidence suggesting presence of pattern D in agoraphobic families.

Family Interaction of Pattern A

Family Interaction and Agoraphobia: Pattern A

• Pattern A: Parent retaining a child at home as companion, leading to dominating and possessive behavior by parents, especially mothers
• Consistent findings in various studies (Roth, Snaith, Webster, Terhune)
• Mothers have played controlling role in children's lives, excluding outside contacts
• Young women described as emotionally immature and dependent
• Emotional Immaturity: A person trying to realize ambitions to become an independent member of society
• Over-protection: Reported in at least 7 out of 27 cases (Snaith) and all but one of 25 cases (Webster)
• No explanation for why mothers behave dominantly or possessively towards their children
• Case study by Deutsch (1929)
  • Mother made insistent demands on daughter to act as companion and caretaker
  • Highly neurotic mother, unsatisfied libido focused on the child
  • Father treated as a nonentity
  • Mother's account of relationship may be inverse of reality
• Evidence from Lipsedge's unpublished study
  • 8/87 patients reported one or both parents were agoraphobic
  • Need for systematic research into parent-child and grandparent relationships
• Further areas of research
  • Neurotic difficulties of parents in context of their own experiences as children
  • Relationship between an agoraphobic patient and spouse
• Fry's study (1962)
  • 7 patients with agoraphobic husbands, though covertly so
  • Husband's pressure for company may be more their own than the wife's.

Family Interaction of Pattern B

Family Interaction and Agoraphobia

• Rare reports of a patient's fear of something dreadful happening to one of their parents in agoraphobia literature.
• Possible reasons for underreporting include patients' inability to discuss or psychiatrists' ignorance.
• Lipsedge described disturbed family interactions in many agoraphobic patients' backgrounds.
• Eleven out of eighty-seven patients reported violent behavior or perpetual quarrels between parents.
• Childhood fear of parents' violent and quarrelsome behavior can be terrifying, with threats of desertion or suicide.
• Threats used to control children can continue into adulthood, resulting in permanent intimidation.

Case Study: Agoraphobic Patient’s Fear of Something Dreadful Happening to Mother

• Principal symptom: fear that something dreadful might happen to her mother.
• Afraid mother would be run over or something dreadful would happen while she was away from home.

Possible Origins of the Patient's Anxiety

• Deutsch hypothesized that the patient's anxiety was an over-compensation for unconscious hostile wishes toward her mother due to oedipus complex.
• Other possibilities:
  • Mother prone to threatening suicide.
  • Mother evoked patient's hostile impulses through insistent yet unacknowledged demands.
  • Patient took cue for wish to push mother under a tram from mother's threats.
• Clinicians must explore cases anew with knowledge of family influences to make progress in understanding and helping patients.

Family Interaction of Pattern C

Agoraphobia and Fear of Being Abandoned:

• Agoraphobic patients often experience fear of something dreadful happening to themselves while outside the house, with fears of dying and becoming helpless being common.
• These fears may be linked to physical symptoms like palpitations, dizziness, and weakness, which are interpreted as signs of imminent disability or death.
• Some patients describe an overwhelming feeling of insecurity.
• Fear of similar happenings can be seen in children who refuse to go to school.
• Agoraphobic patients may have been exposed to threats of abandonment or ejection from the family.

Research on Threats and Agoraphobia:

• Most studies on agoraphobia do not consider the possibility that symptoms may be a response to childhood threats.
• One study by Webster (1953) focused on twenty-five married women with agoraphobia, all of whom had been in psychotherapy for at least three months.
• Webster found that twenty-four out of twenty-five mothers were dominant and over-protective.
• He suggested that the patients' feelings of insecurity may have resulted from their upbringing by such parents.

Case Study:

• A patient described as having severe agoraphobia recalled being frightened when her parents left the house and sent her younger brother to find them.
• She later described her mother as a "tartar" who used threats, including rejection, to get her way.
• The patient's father was frightened of his wife and spent much time outside the home.
• The patient felt fond of her father and sympathized with him.

Supporting Evidence:

• Unpublished study by Lipsedge supports the view that a substantial proportion of agoraphobic patients have been subjected to harsh treatment in their homes.
• Snaith (1968) reports that while some agoraphobic patients' mothers are over-protective, others are rejecting.
• Parental behavior is likely to be intensely ambivalent and may be a legacy of similar behavior experienced by the parents themselves.

Family Interaction of Pattern D

Family Interaction and Agoraphobia:

• Pattern D: A parent's fear for a child's safety leading to keeping them at home
  • In the context of agoraphobia, a parent may be afraid of harm coming to their child due to past traumatic experiences
  • No direct evidence of this pattern in families of agoraphobic patients but over-protectiveness is common

Family Interaction and School Refusal:

• Parents keep children at home out of fear of harm or safety concerns
• Tragic events in a parent's past may be the reason for their fear

Pattern D and Agoraphobia:

• Application to agoraphobia is tentative with limited data available
• Suggested that Pattern D may occur in families of agoraphobic patients but not conclusively proven

Importance of Family Interaction Studies:

• Examining family interaction can help understand clinical features of agoraphobia
• Limited data on agoraphobic patients and their families makes definitive conclusions difficult
• Call for special data collection to explore hypotheses further and test them systematically.

‘Agoraphobia’, bereavement, and depression

• Agoraphobia and school refusal share a commonality: acute symptoms are often precipitated by a bereavement, serious illness, or major family change.
• In Roth's (1959, 1960) study of 135 agoraphobic cases, precipitating events were identified in 83%:
  • Bereavement or sudden illness of a close relative: 37%
  • Severance of family ties or domestic crisis: 15%
  • Illness or acute danger to the patient: 31%
• Bereavement may play a specific role in agoraphobia, not just an incidental one.
• Evans and Liggett (1971) found that agoraphobic patients identified bereavement more often using a projection test.
• Studies of bereaved people show high prevalence of anxiety symptoms, suggesting a connection.
• Agoraphobia and depression are linked:
  • Symptoms change in the same direction: get worse or get better (Roth 1959; Snaith 1968).
  • Agoraphobic patients have a higher risk of developing depressive illnesses (Schapira, Kerr and Roth 1970).
• Further exploration of the relationships between agoraphobia, bereavement, and depression will be addressed in volume three.

A note on response to treatment

I. Background:

• Andrews (1966) noted similarities in treating agoraphobic patients between behavior therapists and some psychoanalytic traditions.
• Both believe in two phases: 1) patient seeks support from therapist, 2) therapist urges confrontation of fears.
• Behavior therapy's technique of confrontation has been studied extensively.
• Maudsley Hospital conducted trials on behavior therapy with agoraphobic patients.

II. Behavior Therapy Trials:

• Two forms: 1) graded retraining & systematic desensitization, 2) flooding.
• Flooding involves continuous visualization of phobic images for 50 minutes while therapist maintains anxiety.
• Afterward, patient confronts feared situations with therapist.

III. Results:

• Combination of both treatments reduced symptom level in nine agoraphobic patients.
• Flooding was more effective than graded retraining & systematic desensitization.
• Patients were 33 years old on average, had symptoms for 12 years, and were highly motivated towards treatment.

IV. Explanation of Results:

• Patients often fear complementary situations but not the core ones that initially caused phobia.
• Family situation may have changed since the onset of phobia, making confronting fears easier.
• Phobic symptoms might persist even if causing situation no longer exists.

V. Implications:

• Results do not definitively support or disprove theory but are compatible with it.
• Caution against drawing theories from treatment results.

Chapter 20. Omission, Suppression, and Falsification of Family Context.

Suppressio veri suggestio falsi

Anxious attachment and disturbed family interaction:

• Some forms of phobias (school refusal, agoraphobia, animal phobia) can be understood as anxious attachments arising from disturbed family interactions.
• Two questions arise: why are patients afraid of situations outside the family when their attachment problems lie within it, and why is this often overlooked?

Processes obscuring the true situations:

1. Increased fear response in insecure individuals: insecure individuals are more likely to respond with intense fear to any potentially fear-arousing situation due to uncertainty about their attachment figures' availability and responsiveness.
2. Singling out one component of compound situations: when fear is aroused by a compound situation, there's a tendency to focus on one component while ignoring others due to personal biases and cultural norms.
3. Omission, suppression, and falsification of the family context: parents often keep silent about their own roles in patients' symptoms or deliberately misrepresent them.

Reasons for omission/suppression/falsification:

• Parents may genuinely fail to recognize relevance or believe clinicians are uninterested.
• Motivated omission: fear of criticism, deeper roots in familial dynamics.
• Presenting the patient's behavior as unreasonable and themselves as reasonable people.
• Focus on extra-familial situations as causes.

Patient and clinician roles:

• Patients may accept or rebut their parents' definitions of their situation.
• Clinicians may not grasp the import of what the patient is saying.
• Some patients genuinely believe extra-familial situations are the root cause of their problems, often due to:
  • Natural bias of children to see parents in a favorable light.
  • Parental efforts to ensure the child does not reveal adverse information.

Misleading pictures of the family:

• Developing when a person is provided with systematically false information about family figures, motives, and relationships.

Chapter 14: Child's Construction of Working Models of Attachment Figures and Self

• A child constructs working models of attachment figures and self based on experiences, statements from parents, and information from others.
• Data from diverse sources are usually compatible, leading to internally consistent and complementary models.
• Incompatible data may lead to grave dilemmas for the child: accept own viewpoint or parent's, or attempt integration (with possible cognitive breakdown).
• Possible outcomes:
  • Child adheres to own viewpoint, risking rupture with parents.
  • Complete compliance with parent's version, disowning own.
  • Uneasy compromise, oscillating between views.
  • Integration attempt leading to cognitive breakdown (e.g., Schreber).
• Parental suppression or falsification of family roles is pathological.
• Clinicians may be biased towards parents or children due to identification, respect for parents, or reification of emotions.
• Cultural image of mental illness in psychiatry and psychoanalysis favors giving credence to a parent's constructions over a child's.
• Anti-psychiatry perspective deems patient right and parent wrong.
• Parental behavior is seen as determined by their own experiences, not for moral condemnation.

Working Models:

• Constructed from diverse sources during childhood development.
• Internally consistent and complementary when data from different sources are compatible.
• Incompatible data can lead to dilemmas, affecting child's predictions and plans of action.

Parental Suppression or Falsification:

• Gravely pathological behavior that influences the child's development.
• Can be convincing to outsiders if they are not aware of the possibility of distortion.

Clinician Bias:

• Clinicians may identify with parents due to shared experiences or respect.
• Reification of emotions can lead clinicians to overlook family context and attribute behavior to psychological or physiological anomalies in children.

Cultural Image of Mental Illness:

• Psychoanalysis and psychiatry dominant bias favors giving credence to a parent's constructions over a child's.
• Discrepancies are attributed to a child's feelings and phantasies, not to parents' distortions or experiences.
• Anti-psychiatry perspective deems patients right and parents wrong, discrediting family perspective and valid points.

Understanding Parental Behavior:

• Parental behavior seen as determined by their own experiences, not for moral condemnation.
• Adhering to this perspective offers hope of breaking the generational succession.

Chapter 21. Secure Attachment and the Growth of Self-reliance

Personality Development and Family Experience

• Discussion of conditions leading to anxious and fearful personality development versus stable and self-reliant personality growth
• Uncertainty about parental support is a primary condition for anxiety and instability
• Confidence in unfailing parental support builds self-reliance
• Family experiences shape patterns of interaction transmitted from one generation to another, affecting mental health inheritance

Conditions for Stable and Self-Reliant Personality Development

• Unfailing parental support
• Encouragement towards increasing autonomy
• Open communication and questioning of working models

Impact of Family Experience on Personality Development

• Anxious and fearful personality development: uncertainty about parental support and covert pressures
• Stable and self-reliant personality development: unthinking confidence in parental support and steady encouragement towards autonomy

Evidence for the Impact of Family Experience on Personality Development

• Studies since 1960 provide consistent findings, despite limitations (challenged evidence, methodology, sample restrictions, etc.)
• Over a dozen studies draw upon, primarily from the United States, with some UK professionals reporting similar findings

Sector Studies of the Life-cycle

• Human development can't be studied from birth to old age; instead, sectors are considered piecemeal
• Focus on personality patterns and their typical pathways within specific family environments

Studies of Personality Development and Family Experience During Pre-adolescence to Early Adulthood

• Three studies cover early childhood: Baumrind (1967), Heinicke et al. (1973), and Ainsworth and colleagues
• Study of effective and self-reliant men in their early and middle thirties (Korchin and Ruff 1964)
• Additional study of adults in their early thirties who have been subjects of longitudinal surveys (Siegelman et al. 1970)

Common Aims of Studies on Personality Development and Family Experience

• Relate healthy personality organization and effective performance to various family experiences
• Focus on favorable development, with biased samples to counterbalance clinical studies' typical bias towards disturbed or delinquent subjects

Sources of Information

Sources of Information for Personality Development and Family Experience

Personality Development:

• Information can be obtained from the subject himself through interviews, questionnaires, and self-rating scales.
• Information can be gathered from informants like parents, teachers, and peers.
• Inferences can be derived from the subject's responses during interviews or projective testing.
• Observations of behavior in natural settings or laboratories can provide insight.

Family Experience:

• Information can be obtained from the subject's parents or siblings through interviews, questionnaires, or self-rating scales.
• The subject himself is another source of information.
• Inferences can be derived from the parents' responses during interviews or projective testing.
• Observations of families in interaction can provide valuable insights.

Criteria for Evaluating Personality Structure

• Deciding criteria for evaluating personality structure and mental health is challenging.
• Criteria vary, including competent performance in social settings and self-esteem.
• Some studies use complex criteria derived from psychiatric experience.
• Several studies apply multiple criteria to ensure accuracy and minimize bias.

Confidence in Criteria

• The multiplicity of criteria used by different researchers helps reduce unwitting prejudice.
• Evidence shows that the criteria for healthy development correlate negatively with mental ill health.
• Grading of personalities based on these criteria is weakly correlated with social class, meaning middle-class values are not the only indicators of mental health.

Adaptability as a Criterion

• Adaptability refers to the capacity to adapt successfully to various physical and social environments.
• It's related to the criteria used in these studies and measures 'survival' in different contexts.
• Although it could be subjected to empirical test, it would be challenging to do so effectively.

Other Applicable Criteria

• Degree of originality, creative spirit, and capacity for innovation are other applicable criteria but not the focus of this discussion.
• The reader is referred to further discussions by Grinker, Heath, Douvan and Adelson, and Offer and Sabshin for more information on various criteria.

Studies of adolescents and young adults

Studies of Adolescents and Young Adults: The Peck and Havighurst Study

• Detailed study of 34 children (17 boys and 17 girls) from Prairie City, a small mid-west town
• Conducted as part of an extensive social and psychological study started in the 1940s
• Selected based on "moral character" and social class, with a focus on well-organized personalities
• Sampling:
  • Representative of all moral character ranges
  • Representative of lower half of socio-economic scale in Prairie City
• Data collection:
  • Child interviews
  • Standardized tests and questionnaires
  • Projection tests
  • Sociometric measures from the whole cohort
  • Teachers' ratings
• Data analysis:
  1. Analyzed separately by source
  2. Clinical conference for a comprehensive picture
  3. Research workers rated each child based on character structure scales
  4. Children grouped into eight adaptability categories

Character Types (from least mature to most mature)

I. The Amoral:

• Five children with inaccurate perception of situations, people, and self
• Poor goal-setting abilities
• Maladaptive behavior
• Lack of impulse control

II. The Immature:

• Ten children with inconsistent behaviors
• Difficulty in adjusting to new situations
• Limited ability to form lasting relationships
• Prone to mood swings and emotional instability

III. The Impulsive:

• Five children acting on impulse without considering consequences
• Lack of foresight and planning skills
• Easily distracted, restless, and bored with routine tasks

IV. The Self-centered:

• Six children focused primarily on their own needs and desires
• Difficulty understanding the perspectives of others
• Limited empathy for others' emotions
• Lack of consideration for others in decision making

V. The Conforming:

• Four children who follow rules and societal expectations
• Fear of deviating from social norms
• Lack of initiative or original thought
• Overly concerned with peers' opinions

VI. The Cooperative:

• Three children who prioritize relationships over individual goals
• Empathetic towards others
• Strong sense of duty and responsibility
• Collaborative in group settings

VII. The Achieving:

• Three children driven to achieve personal goals
• High levels of ambition and motivation
• Adaptable to various situations
• Good problem-solving skills

VIII. The Integrated:

• Two children who have integrated their personal and social development
• Balance between individual needs and societal expectations
• Emotionally stable and adaptable
• Self-confident, independent decision-making skills

Amoral-Impulsive

• Hostile and immature emotionality
• Pattern of childishly inappropriate emotional lability
• Negativism and hostility towards self-restraints and positive precepts
• Suffer from punitive but ineffectual guilt feelings
• Inner conflict and lack of positive self-regard or self-respect
• Not at peace with themselves or the world, despite denial

Expedient

• Take the easy way out
• Seek personal gratification by fitting in with their world
• Absence of active immorality
• Requires suppression of selfish impulses, leading to tension and discomfort
• Unable to recognize human warmth and approval
• Hedonistic efforts result in empty satisfactions

Impulsive-Yet-Guilt-Ridden

• Primitive, harsh conscience disowned
• React to impulse or internalized moral principles without belief
• Dislike other people and have low self-regard
• Protect themselves against recognizing guilt by distorted self-image
• Inner conflict too severe to ignore
• Unable to find real pleasure in life

Conforming

• Controlled hostility with a punitive conscience
• Unable to express wishes spontaneously and derive little satisfaction from life
• Chronic guilt about 'bad impulses' even though seldom expressed
• Superegos composed mostly of negative "Don'ts"
• Feel themselves to be a bad kind of person, see little to like in others
• Unable to check punitive conscience against reality in a rational way
• Depressed, dull, unhappy, and unable to stand up to the world.

Some conforming children also described as friendly with an ease with themselves but lacking inner direction and passively conforming to demands around them.

Irrational-Conscientious

• Three children described as having a strong Puritan conscience
• Hostility towards others, but not intense guilt or personal intent
• Automatically behave responsibly and demand conventional morality from others
• Lack strong positive concern for individuals and rigid in their righteousness
• Take cold satisfaction from following the letter of the law

Type with Good Integration but Less so than in Type VIII

• Five children with rationality, friendliness, altruistic impulse, high autonomy, and good integration of major drives
• Liked by peers but not always considered very moral
• Enjoy life thoroughly and have respect for themselves and others
• Freely use emotional energy since they are free from conflict and need to follow convention blindly

Rational-Altruistic

• Four children with firm, internalized moral principles that they apply insightfully
• Thoroughly enjoy life and show healthy self-respect
• Free from serious conflict and irrational need to conform for security
• Highly regarded by peers in terms of friendship, cheerfulness, and leadership ability

Comparison of Researchers' and Peers' Assessments

• Significant correlations between researchers' assessments of children's maturity and their peers' evaluations of friendliness, cheerfulness, and leadership ability
• Disagreements on a few children's categorization are open issues

Families and Moral Development

• Detailed information on the children's families from an independent research group
• Four dimensions of family interaction identified through factor analysis

Family Interaction Factors

• Mutual trust and approval between the child and parents:
  • Parents accept and give affection to their child
  • Child feels free to discuss issues with parents
  • Parents encourage socialization and make friends welcome
  • Congenial relations between parents
• Consistency of family life:
  • Regularity of daily routine
  • Predictability in parents' methods of control
  • Frequent participation in shared activities

Families of Children with High and Low Maturity

• Families of children rated highest in maturity were high on both trust and approval and consistency
• Families of children rated lowest in maturity were low on both dimensions

Family Patterns and Child Development Families of Amoral Children:

• Marked inconsistency and mistrust
• Lack of love, emotional security, and consistent discipline
• Children express active hate for their families

Families of Expedient Children:

• Laissez-faire parenting with indiscriminate freedom and leniency
• Inconsistency in parental support and discipline
• Children have little feeling for parents and are ready to reject them

Families of Conforming Children:

• Severely autocratic punitive homes with mistrust
• Consistency and less distrust results in 'irrational-conscientious' type

Families of Irrational-Conscientious Children:

• Severe or very severe discipline with low mutual trust
• Variable consistency
• Children have strong positive feelings towards parents but not necessarily extended to others

Families of Rational-Altruistic Children:

• Strong approval and engagement from parents
• Harmonious relationships between parents
• Regular routine without rigidity
• Parents are consistent in discipline with leniency prevailing
• Children have strong positive feelings towards parents, which extend to others
• Open discussion of standards of behavior

Anomalous Case:

• Boy rated highly for maturity and peer regard
• Poorly rated family on various scales
• Appeared acceptant and supportive later in life
• Researchers' initial impression may have been influenced by material untidiness

Consistency of Development:

• Children's personalities and families show high degree of consistency over seven years
• Whatever pattern is shown at age ten, it is likely to persist into late adolescence
• Parents also consistently develop in their relationship with a given child.

Studies of Large Representative Samples:

• Emphasis on findings similar to or compatible with Peck and Havighurst, despite differences in samples, criteria for character development, and indices of family life.
• Advantage of studying large representative samples as they can examine various aspects of family life.
• Caution needed as most information about families comes from subjects themselves.

Rosenberg's Study (1965):

• Sample: 5,024 boys and girls aged 16-18 from ten public high schools in New York State.
• Criterion of personality: Self-esteem, measured by a checklist of ten questions.
• Correlations:
  • Low self-esteem correlates with potential psychiatric disability (loneliness, sensitivity to criticism, anxiety, depression, psychosomatic symptoms).
  • High self-esteem correlates with trust in other people, active social participation, and being chosen as a leader.
• Family factors:
  • Children of divorced parents have lower levels of self-esteem, especially those from mothers who married young, had children soon after marriage, and were divorced before their 24th birthday.
  • Explanation: Early divorce or widowhood leaves mother in a difficult position, affecting her mood and child's development.
  • Additional contingency: Young children of young singlehanded mothers are often subjected to unstable substitute care.

Megargee, Parker, and Levine's Study (1971):

• Sample: 488 university students (280 men and 208 women) aged 19.
• Measure of socialization: California Personality Inventory Socialization Scale.
• Family factors:
  • Students from families with both natural parents, rated excellent marriage, and happy childhood have higher socialization scores.
  • Families where parents are divorced have lower socialization scores.
• Results:
  • Percentages of students in high- and low-scoring groups reporting specific family characteristics.
• No differences of consequence between sexes.

Study on Socialization and Parental Death:

• No correlation found between parental death and socialization score in a study with a small sample of bereaved adolescents.
• Lack of correlation may be due to fewer bereaved adolescents having reached college.

Bronfenbrenner's Study:

• Aimed to investigate family background of sixteen-year-old boys and girls in relation to leadership and responsibility.
• Sample consisted of 192 equal numbers of boys and girls from each socio-economic class based on father's education level.
• Boys rated higher on leadership, girls on responsibility.
• Children with more educated fathers were rated higher on both criteria.
• Leadership linked to high parental support and control; responsibility linked to parental authority.
• Differences in family experience between boys and girls at higher and lower ends of rating scales: overdose of support/control for girls vs. indifference/rejection for both.

Coopersmith's Study:

• Focused on family background of boys from intact white families aged 10-12 in relation to self-esteem.
• Sample comprised 85 boys, drawn from a larger initial sample and stratified by self-assessment and teacher assessment.
• Low self-esteem correlated with anxiety and emotional problems.
• Mothers of children with high self-esteem found to have closer relationships and more loving attitudes compared to mothers of children with low self-esteem.
• Boys with high self-esteem expected to meet high standards and received care, respect, and firm guidance, while boys with low self-esteem were given little care or guidance and subjected to harsh punishment.

Personality Development, Modes of Discipline, and Social Class

I. Personality Development and Modes of Discipline

• Consistency found between unfavorable personality development and severe or arbitrary punishment, ignoring or rejecting children
• Differences in modes of discipline associated with social class

A. Modes of Discipline and Personality Development

• Low ratings for leadership and responsibility linked to parents showing little interest, arbitrary/punitive methods or lack of guidance
• Arbitrary methods more common among less-educated parents
• Children of less-educated parents rated lower on leadership and responsibility

B. Rosenberg's Findings

• Low self-esteem linked to lack of attention/concern from fathers, social class

C. Threats of Abandonment or Suicide by Parents

• Used more frequently by working and lower-middle class parents

II. Intensive Studies of Small Samples

A. Findings from Three Studies

1. Astronauts in Training
   • Balance of initiative/self-reliance and help-seeking/use of help
   • Closely knit families with supportive parents
   • Stable family base for growth and autonomy
2. College Students
3. High School Students Bound for College
   • Smoothly working balance of initiative and dependence
   • Supportive, encouraging families
   • Gradual growth in competence and confidence

B. Astronauts' Life-Histories

• Grow up in organized communities with strong father identification
• Happy memories of outdoor activities with fathers
• Environment did not challenge them beyond their capacities
• Relatively smooth growth pattern in meeting challenges and gaining confidence
• Stable self-concepts with clear professional values

Study on Astronauts:

• Korchin's study on astronauts' family backgrounds
• Men showed family solidarity, identification with father, and smooth growth patterns
• Danger of circular reasoning due to selection process based on these factors
• Demonstrates compatibility of family background and stable personality development with high self-reliance and trustful reliance on others

Study on College Students:

• Grinker's study on college students' mental health and stability
• Sample comprised over a hundred students from various sub-samples
• Selected due to apparent good mental health and potential as youth leaders
• Findings based on questionnaire study and psychiatric interviews
• Majority of students reported secure childhoods with loving parents, close identification with father
• Most students described consistent discipline and fair parenting
• Students reported seeking responsibility while also seeking advice in appropriate situations
• Close match between their values, goals, and those of their parents and college staff
• Low incidence of neurotic character structures among students

Commonalities:

• Both studies indicate significance of family background in mental health and personality development
• Importance of secure childhoods, close relationships with both parents, and strong identification with father figures
• Presence of supportive environments (astronaut training program, college community)

Comparisons:

• Astronauts: outstanding test pilots before selection
• College students: free of neurotic difficulties, sought responsibility while seeking advice
• Both studies: danger of circular reasoning but reduced in the second study due to comparison between sub-samples

Challenges and Defenses:

• Criticism of conformity and lack of creativity: not relevant to mental health and self-reliance concerns
• Validity of historical information: derived from subjects' reports but supported by other studies using firsthand information
• Students' contribution to family stability: acknowledgement of limitations but offset by consistent findings across studies.

Study Overview:

• Hamburg et al. conducted a study on students transitioning from high school to college in Washington D.C.
• Nineteen college-bound students selected based on academic effectiveness, close peer relationships, and social group participation.
• Students interviewed multiple times before and during their freshman year, parents interviewed three times.
• Students assessed on autonomy and family relatedness at the end of the study.

Criteria for Assessment:

• (i) Autonomy: ability to make choices and assume responsibility.
• (ii) Family Relatedness: mutual rewarding relationships with parents.

Subgroups:

• (a) High in both autonomy and family relatedness: nine students.
• (b) High in autonomy but low in family relatedness: six students.
• (c) Low in autonomy but high in family relatedness: one student.
• (d) Low in both autonomy and family relatedness: three students.

Findings:

• Only half of the students lived up to initial expectations.
• Students in subgroup (a) had self-reliant college experience with increasing intimacy with parents.
• Subgroup (b) students were making good use of opportunities at college but relationships with parents were distant or hostile.
• Subgroups (c) and (d) showed little ability to stand on their own feet.

Parental Involvement:

• Parents in subgroup (a) had clear values, encouraged autonomy, treated students as adults, communicated effectively, and provided support when asked.
• Parents in subgroup (b) provided conditions similar to those in subgroup (a), but assigned roles based on their interests rather than the student's.
• Students in subgroup (d) had parents who were unclear, communication was poor, and conflicts remained latent.

Conclusion:

• Students who receive the most support from clear, supportive, and encouraging relationships at home are best able to make the most of college opportunities.
• This pattern of self-reliance resting on a secure attachment to a trusted figure is found during various stages of life.

Studies of young children

• This section discusses studies on young children and their association with family experiences that contribute to well-integrated and adaptable development.
• Baumrind's (1967) cross-sectional study of nursery school children and Ainsworth et al.'s (1971, 1973) short-longitudinal study of children during their first year are mentioned as key studies.

Nursery School Children:

• Baumrind screened 110 children attending a university nursery school, aged three or four years from middle-class homes.
• Three groups were identified: Group I (well-integrated and adaptable), Group II (poor explorers, difficulty tackling new tasks, and cooperating with others), and Group III (poor in participation in activities, sustaining effort, and standing up for themselves).
• Information on family experience was gathered from home visits, laboratory observations, and parent interviews.

Family Experience:

• Home Visits:
  • Two visits, each lasting three hours, recorded parent-child interactions to assess the reliability of observation. Parents were rated using four rating scales: nurturance, maturity demands, control, and mode of communication.
• Laboratory Observations:
  • Mother-child interaction was observed in two phases: teaching elementary concepts and free play. Ratings on the same four rating scales as home visits were used.

Baumrind's Study:

• Children were screened based on teacher and psychologist rankings, and further studied in an experimental situation.
• Three groups (I, II, III) were formed based on children's behavior in the nursery school setting.
• Group I children had high rankings for participation in activities, exploring new tasks, obedience to rules, capacity to stand up for themselves, and seeking help when necessary.
• Groups II and III showed suboptimal development in these areas.

Ainsworth et al.'s Study:

• Focused on children's development from infancy to 21 months.
• Information was collected through home visits, structured laboratory observation, and interviews with parents.
• Parenting practices were assessed using the same four rating scales as Baumrind's study.
• The studies suggest that family experiences associated with well-integrated and adaptable adolescents may also contribute to young children's development along similar pathways.

Study Findings:

• The consistency of observations of mother's behavior in home and laboratory settings suggest validity.
• Differences in parental behavior based on three groups:
  • Group I: Active, Controlled, Self-reliant children
    • Parents rated highly on nurturance, control, maturity demands, and verbal give-and-take.
    • In interviews, parents were consistent, loving, and conscientious.
  • Group II: Anxious and Aggressive children
    • Parents rated low on nurturance, control, and maturity demands.
    • In interviews, mothers reported using disciplinary measures that entailed frightening the child.
  • Group III: Unassertive and Inactive children
    • Parents rated low on control and maturity demands, and self-effacing.
    • In interviews, mothers were inclined to use withdrawal of love and ridicule as methods of discipline.
• Another study by Heinicke in Los Angeles examines the relationship between family experience and nursery school behavior, finding similar associations.

One-year-olds

Chapter 3: Observing Mother-Infant Interaction

• Ainsworth's study of mother-infant interaction among 56 one-year-olds from white middle-class homes
• Sub-sample of 23 infants observed at home every three weeks for four hours
• Findings focused on three sets of data: infant behavior with mother in experimental situation, infant behavior at home, and mother's behavior towards the infant

Infant Behavior at Twelve Months in Experimental Situation:

• Classification based on two criteria: exploration and attachment to mother

Group P:

• Infants explore more with mother present
• Use mother as a base and seek contact
• Warmly greet mother upon her return
• N = 8

Group Q:

• Infants similar to Group P but more exploratory in strange situation
• Ambivalent towards mother
• N = 4

Group R:

• Infants explore actively, regardless of presence or absence of mother
• Indifferent to mother's return
• N = 3

Group S:

• Inconsistent behavior
• Anxious about mother's whereabouts
• Ambivalent about contact with mother
• Ignore mother in strange situation
• N = 5

Group T:

• Passive infants
• Show little exploratory behavior
• Anxiously cling to mother
• Cry frequently in her absence
• N = 3

Future Personality Development:

• Infants in groups S and T least likely to develop a well-integrated personality due to anxiety and ambivalence towards mother
• Children in group R appear independent but may struggle with trusting others
• Children in group Q lie between groups R and P and are more difficult to assess
• Children in group P most likely to develop a well-integrated personality, combining self-reliance and trustful relationships with others.

Mothering Behavior and Infant Development:

• Ainsworth used four rating scales to assess mother's behavior towards their infants: acceptance-rejection, cooperation-interference, accessibility-ignoring, and sensitivity.
• Sensitivity scale measures a mother's ability to interpret and respond correctly to infant signals.
• Infants of group P received uniformly high sensitivity ratings (5.5-9.0), groups R, S, and T received low ratings (1.0-3.5), and group Q received middle ratings (4.5-5.5).
• Differences were statistically significant across all scales.

Impact of Mothering on Infant Development:

• A more responsive mother during early life leads to less frequent crying, cheerful greeting upon return, and gradual growth of independence.
• Infants who had more physical contact in their earliest months develop a high degree of trust in their mother and enjoy active affectional interaction when in contact.

Long-Term Impact:

• Secure infants at 12 months were observed to have more intense concentration, smile and laugh more frequently, and be more cooperative at 21 months compared to insecure infants.
• Secure children also showed more interest from their mothers during observation sessions.
• Findings support the conclusion that sensitive mother-infant interaction predicts a child's willingness to explore and play, as well as cooperative behavior and better developmental test scores.

Importance of Further Research:

• Many factors could influence child development beyond mothering, such as education, number of siblings, previous experience or inexperience with toys.
• More research is required for drawing conclusions with confidence.

Overall Findings:

• Mothering behavior during early life plays a significant role in child development.
• Infants who receive sensitive and responsive mothering develop trust, self-reliance, and enjoyment of their mother's company.
• The patterns of interaction established at 12 months remain stable during the following nine months.

Self-reliance and reliance on others

Self-Reliance and Attachment:

• Three propositions regarding personality functioning and development introduced in Chapter 14:
  1. Confidence in availability of attachment figures reduces fear.
  2. Expectations regarding accessibility of attachment figures developed gradually during immaturity and persist throughout life.
  3. Expectations are accurate reflections of past experiences.
• Application to individuals of all ages.
• Self-reliant people rely on others when needed.
• Trusted person provides a secure base for operation.

Attachment Theory:

• Human beings are happiest and most effective when they have trusted people to rely on.
• A self-reliant person can switch roles between providing a secure base and relying on one.
• Wenner's study: Women capable of coping with shifts in life phases express desire for support effectively and give spontaneously, while those experiencing difficulties have ambivalent relationships with their own mothers.

Theoretical Background:

• Fairbairn (UK): Abandonment of infantile dependence in favor of mature dependence.
• Winnicott (UK): Capacity to be alone is based on good-enough mothering and introjection of ego-supportive environment.
• Benedek (US): Confidence in existence of helping figures comes from gratifying experiences with mother during infancy and childhood.
• Mahler (US): Self-confidence develops out of trust and confidence in others, built up through maternal support and freedom to pass through developmental phases.

Common Principles:

• A well-founded self-reliance is compatible with and grows out of the ability to rely on others.
• Strong family support and respect for personal aspirations, sense of responsibility, and ability to deal with the world encourage self-reliance rather than undermining it.

Chapter 22. Pathways for the Growth of Personality

• Organism and environment are interconnected, not separate
• Models of personality development:
  • Traditional model: single track development with stages and arrests
  • Anna Freud's model: multiple areas of functioning with developmental lines
• Alternative models:
  • Personality as a structure developing on various pathways
  • Interaction between organism and environment at each stage

Traditional Model (Single Track Development)

• Progression through stages towards maturity
• Arrests or fixations cause personality disorders
• Mature and immature personalities defined
• Stages of development: libido development in Abraham's model, multiple areas in Anna Freud's

Alternative Model (Multiple Pathways)

• Personality develops on one of several possible pathways
• Access to many pathways initially, choices determined by interaction between organism and environment at each stage
• Genetic makeup determines potential developmental paths
• Structures differentiate as development progresses, reducing the number of open pathways
• Model compared to railway systems: traditional model is a single main line with stations, alternative model is a system that forks into distinct routes with convergent possibilities

Implications for Research and Practice

Traditional Model:

• Disordered states of adult personality are patterns of normal, healthy development
• Developmental psychology based on observations of disordered personalities in various life stages

Alternative Model:

• Rejects the notion that disordered states reflect early healthy development
• Requires mapping of multiple developmental pathways and their interacting variables
• Understanding gained by studying personalities as they develop in specific environments

Developmental pathways and homeorhesis

Developmental Pathways and Homeorhesis

• Alternative model for personality structure based on Waddington's epigenesis theory (1957)
• Development processes governed by genome, with features being environmentally stable or labile
• Environmentally stable traits: insensitive to environmental change, ensure adaptive development in various environments but lack adaptability
• Environmentally labile traits: sensitive to environmental change, provide flexibility and adaptability but risk producing maladapted forms
• Every species adopts a balance of sensitivity and insensitivity during development
• Epigenetic sensitivity greatest during early life and diminishes over time
• Physiological and behavioral processes evolve to limit epigenetic sensitivity (homeorhesis)
  • Maintain individuals on chosen developmental pathway, irrespective of environmental fluctuations

Application to Human Personality Development

• Psychological processes result in personality structure with a degree of sensitivity to environment during early years
• Sensitivity diminishes throughout childhood and is limited by end of adolescence
• Adaptive outcome likely, but sensitivity provides no guarantee
• Maladapted outcomes:
  • Pathway taken in severely atypical family environments (psychopathic personality)
  • Pathway reasonably well-adapted to developmental environment but maladapted to adult life (conforming obsessive personality)

Homeorhetic Pressures on Personality Development

Homeostatic Pressures on Personality Development:

• Two types of pressures: environmental and organismic
• Environmental pressures come mainly from family environment
• Family pressures persist and maintain development on current pathway
• Changing a child's personality structure without changing the family environment is unavailing
• Organismic pressures come from within the individual's personality
• Structural features of personality self-regulate and maintain current direction of development
• Therapeutic measures must address both environmental and organismic pressures to effect change

Determinants of One Person's Pathway:

• Fundamental characteristics of personality are time-extended properties
• Which pathway is taken depends on a multitude of variables
• Family experiences have far-reaching effects on personality development
• Experiences of separation, loss, and threats of abandonment can divert development from optimum pathway
• Many other limitations and shortcomings of parenting can also divert development
• Diversions can follow any major life event or crisis, especially for immature individuals or those on suboptimal paths
• Experiences of separation, loss, and threats provide a valuable point of entry for studying personality development and its deviations
• Understanding these events is helpful for clinicians dealing with psychiatric disability and prevention
• Human personality is complex, describing components, understanding how it works, and mapping pathways are tasks for the future.

Appendix 1. Separation Anxiety: Review of Literature

Approaches to Separation Anxiety:

• Six main approaches to understanding separation anxiety in children
• Three approaches related to theories regarding child's attachment to mother

1. Theory of Transformed Libido (Freud, 1905b):

• Morbid anxiety due to transformation of sexual excitation of somatic origin that cannot be discharged
• Separation anxiety is an example of this, as a child's libido remains unsatisfied leading to anxiety

2. Birth-Trauma Theory:

• Anxiety shown by young children on separation from mother is a reproduction of birth trauma
• Counterpart of theory of return-to-womb craving to account for child's tie

3. Signal Theory (Freud, 1926):

• Absence of mother leads to risk of traumatic psychic experience
• Child develops anxiety behavior to prevent prolonged separation
• Principal variants:
  • Economic disturbance due to unsatisfied bodily needs (Freud, 1926a)
  • Total and permanent extinction of capacity for sexual enjoyment (Jones, 1927)
  • Narcissistic injury (Spitz, 1950; Joffe & Sandler, 1965)

4. Depressive Anxiety Theory (Melanie Klein, 1935):

• Child believes he has eaten up or destroyed mother when she disappears
• Ambivalent feelings for mother leads to belief in permanent loss

5. Persecutory Anxiety Theory (Melanie Klein, 1934):

• Child perceives mother as persecutory leading to belief of abandonment or punishment
• Mother's departure is perceived as hostile

6. Frustrated Attachment Theory:

• Separation anxiety is primary response not reducible to other terms
• Distressing and arouses intense fear in child when attachment figure is absent

Additional Notes:

• Most psychoanalytic theories of anxiety and fear are based on outdated biological paradigms
• Multiple, complex, and contradictory theories exist due to this limitation.

Freud's Views on Separation Anxiety:

• Freud gave systematic attention to separation anxiety in Inhibitions, Symptoms and Anxiety (1926)
• Previously paid little attention due to neglect of child's attachment to mother
• Drawing attention since Three Essays (1905):
  • Anxiety is expression of loss of loved person
  • Anxiety in children equals neurotic anxiety in adults due to unemployed libido
• Introductory Lectures (1917):
  • Infantile anxiety not realistic but related to neurotic anxiety
  • Identified neurotic anxiety of adults with separation anxiety of infants
• Anxiety arising at birth added later as speculative addition to theory
• Separation anxiety holds center stage in Freud's writings on infantile anxiety (1905-1926)
• Beyond the Pleasure Principle (1920):
  • Cotton-reel incident reveals child's attachment to mother and instinctual renunciation
  • Game of throwing objects away and pulling them back symbolizes separation and return
• Anxiety arising at birth acquires equal status but never usurps the place of anxiety arising on separation from mother.

Theories on Anxiety:

• Freud's perception of anxiety clarified through observation of separation anxiety in children.
• Publication of Rank's Trauma of Birth (1924) led Freud to reexamine theory of anxiety.
• Freud struggled with the idea of birth as a trauma, focusing instead on separation anxiety.
• Abandoned hypothesis that anxiety is a direct transformation of libido due to recognition that repression follows anxiety, not vice versa.

Separation Anxiety:

• Occurs when a child feels it has lost or is losing someone loved and longed for.
• Anxiety appears as a reaction to the felt loss of an object.
• Infants fear non-satisfaction (economic disturbance) and displace fear onto absence of mother.
• Economic viewpoint: nervous system functions to get rid of stimuli, damming up of psychical energy threatens infant (source of anxiety).

Two Sources of Anxiety:

1. Automatic phenomenon with physiological features, arising from traumatic situations in the id (helplessness).
2. Rescue signal felt by the ego to indicate danger and allow for self-preservation (requires cognitive development).

Developmental Phases:

• Trauma situations: birth, loss of object, fear of father, fear of superego.
• Anxiety signals the potential traumatic situation to prevent it from happening.

Freud's Late Reflections:

• Towards end of his life, Freud considered the possibility that separation anxiety might be a built-in response (archaic heritage).
• Clarified relationship between separation anxiety, mourning, and defense: anxiety is reaction to danger of loss, mourning to actual loss, defenses protect against instinctual demands.

Ernest Jones

Ernest Jones' Theory of Aphanisis:

• Advanced in 1927 without reference to Freud's latest thoughts on anxiety or attachment to mother
• Theory is based on the fear of permanent extinction of sexual enjoyment
• Later attempted to integrate it with Freud's theory of signal anxiety in 1929, resulting in a more complex theory
• Difficulty lies in understanding the tie to mother irrespective of child's sex

Melanie Klein's Theory of Anxiety:

• Developed independently of Freud's and emphasizes the role of aggression
• Believes fear of annihilation is a primary anxiety arising from the death instinct
• Infant experiences persecutory anxiety from birth, making external world appear hostile
• Sees both objective (known external danger) and neurotic (unknown internal danger) anxieties as contributing to infant's fear of loss
• Both sources of anxiety are present from the beginning and interact constantly
• Depressive anxiety is seen as a response to threat of destruction within
• May also postulate birth as an additional source of primary anxiety, which reinforces persecutory anxiety

Comparisons:

• Jones developed theory before Freud's latest thoughts on anxiety and attachment
• Klein developed her theory independently and underlined differences from Freud's
• Jones accepted Freud's view on signal anxiety but added notion of aphanisis
• Melanie Klein saw anxiety as result of death instinct, with persecutory anxiety as the primary component
• Both theorists had different theoretical backgrounds when they wrote about separation anxiety.

Anna Freud

Anna Freud's Approach to Separation Anxiety:

• Anna Freud observed children's behaviors during separation but focused little on theoretical implications until her experiences at Hampstead Nurseries during the war.
• In her early works, she acknowledged the intensity of children's reactions to parting but did not relate it systematically to anxiety or separation anxiety.
• Belief in secondary drive theory and signal-anxiety theory influenced her views on separation anxiety.
• She saw attachment as developing from stomach love to constant love based on needs being met.
• Inadequate mothering could lead to slow transformation and insecurity.
• Anna Freud identified several forms of anxiety during the early years: archaic fears, separation anxiety, castration anxiety, fear of loss of love, and guilt.
• Separation anxiety is characteristic of the symbiotic stage, marked by biological unity between mother-infant couple and maternal narcissism extending to the child.
• Intense separation anxiety in later years may result from fixation at the symbiotic stage or parental errors during object constancy stage.

Background:

• Anna Freud wrote little about separation anxiety before her observations at Hampstead Nurseries.
• Her theoretical orientation was set before Freud's appraisal of the nature and genesis of anxiety.
• Separation anxiety received no mention in her books from 1926, 1927, and 1945 or in "The Ego and Mechanisms of Defence" (1936).

Observations at Hampstead Nurseries:

• Children aged one to three years reacted violently to parting.
• Desperation and intolerable longing for mother caused great distress.
• Belief that separation was a punishment may contribute to distress.

Theoretical Interpretations:

• Attachment grows from stomach love to constant love based on needs being met.
• Mother's role as provider affects transformation.
• Inadequate mothering can lead to insecurity and worry about needs being met.

Forms of Anxiety during Early Years:

• Anna Freud identified several forms of anxiety during the early years: archaic fears, separation anxiety, castration anxiety, fear of loss of love, and guilt.
• Separation anxiety is characteristic of the symbiotic stage, marked by biological unity between mother-infant couple and maternal narcissism extending to the child.
• Intense separation anxiety in later years may result from fixation at the symbiotic stage or parental errors during object constancy stage.

Implications:

• Anna Freud's approach emphasizes the importance of adequate mothering for healthy emotional development.
• Separation anxiety is a significant issue during early childhood, with potential long-term effects if not addressed properly.
• Understanding different stages in object relations development can provide insight into various forms of anxiety and their underlying causes.

Contributions by Other Exponents of Ego Psychology

Ego Psychology: Contributions by Other Exponents

• Anna Freud's theories on anxiety and developmental phases were also supported by Nunberg (1932), Fenichel (1945), and Schur (1953, 1958)

Schur's Contributions:

• Strictly limits biologically given components of human behavior
• Postulates two phases of development: undifferentiated phase with inner danger from unmet needs leading to anxiety; later phase with fight or flight reactions
• Separation anxiety develops as a learned derivative from the fear of inner danger
• Discusses various dangers but doesn't consider loss of mother as one of them

Kris' Contributions:

• Incorporates separation anxiety into his theorizing, but based on previous theory rather than data
• Distinction between losing the love object and the object's love
• Development of a permanent personalized love object occurs synchronously with awareness of danger of losing love
• Anxiety reactions to loss of a particular love object occur before twelve months
• Theoretical distinction between anxiety and mourning is mistaken

Melanie Klein and Therese Benedek:

• Recognize the close relationship between anxiety, grief, and mourning
• Helene Deutsch divorces anxiety from grief and mourning, seeing them as different responses to separation
• Separation anxiety in older individuals is a regression to infancy and occurs when ego is too weak for mourning
• Anxiety is universal response to separation; experience of being separated increases longing
• Benedek struggles with explaining infant crying and proposes two theories: signal-anxiety theory and danger of ego disorganization

Benedek's Theories:

• Crying response can be explained in terms of attachment, separation anxiety, grief, and mourning theories
• Committed to a secondary-drive theory of child's tie to mother
• Increase in longing at separation is due to regression to oral dependency
• Confused interpretations of infant crying as anxiety or ego disorganization
• Young children turn to mother for ego integration when faced with fear of ego disintegration
• Older children can maintain their own ego integration.

Margaret Mahler's Theorizing:

• Follows Therese Benedek and Anna Freud in theorizing about object relations and stages of development
• Differences in attribution of anxiety to specific stages:
  • Mahler: Separation anxiety during third and fourth years after object constancy is achieved
  • Anna Freud: Separation anxiety during first stage due to infringements on biological mother-infant tie
• Different concept of anxiety at symbiotic stage: fear of self-annihilation, loss of symbiotic object amounts to loss of integral part of the ego itself

Heinz Spitz's Theorizing:

• Adherent of secondary-drive theory and signal-anxiety theory of separation anxiety
• Advances theory of "narcissistic trauma" in third quarter of life, when true objects appear and loss is a severe narcissistic trauma
• Concerned with explaining eight-months' anxiety, not necessarily separation anxiety
• Focuses on later responses to separation, such as grief and depression

Sandler and Joffe's Theorizing:

• Adopt traditional theory of secondary drive and dependency
• Emphasize feeling states produced by mother's presence or absence
• Place little emphasis on instinctive behavior or survival value of mother's presence
• View loss of object as loss of aspect of self-presentation, leading to mental pain and injury to narcissism

Comparisons:

• Differences between Mahler and others lie in their paradigms and the specific stages and types of anxiety attributed to developmental periods.

Other Contributors

Sullivan's Perspective on Anxiety:

• Sullivan sees anxiety as a function of interpersonal relationships, specifically the child's relationship with their mother and other significant people.
• Anxiety is exclusively attributed to the mother's attitude, with approval leading to contentment and disapproval inducing anxiety.
• He denies that separation from a loved object can cause anxiety in itself.
• Anxiety is seen as a product of training and learning, confined to domesticated species.
• The experience of intense anxiety resulting in repression is attributed to ill-conceived educational methods.
• Induction of anxiety remains a mystery but is connected to processes of child-training and restriction or denial of tenderness.
• Sullivan seems unaware that lack of tenderness and separation per se can cause distress and anxiety, especially for infants and young children.
• Loneliness is seen as an experience primarily encountered in adolescence and adultherhood.
• He had limited understanding of infant attachment and security.

Other Contributors' Perspectives:

Phyllis Greenacre:

• Separation anxiety, grief, and mourning are omitted from her psychopathology.
• Experiences during birth process and first weeks of postnatal life are advanced as major variables accounting for a later differential liability to neurosis.

Fairbairn:

• Follows Rank in viewing separation anxiety as the mainspring of all psychopathology.
• Postulates that birth anxiety is the prototype of all subsequent separation anxiety and return-to-womb craving accounts for the child's tie.

Suttie, Hermann, Odier:

• Anxiety is seen as an expression of apprehension or threat to the child's need for company or security.
• It arises from separation or absence of mother or caregiver during the time when the infant needs them most.

Winnicott:

• Earliest anxiety is related to being insecurely held and feeling a failure in infant care technique.
• It is normal for the infant to feel anxiety if there is a failure of infant care technique, as emphasized by William James many years ago: 'The great source of terror in infancy is solitude'.

Appendix II. Psychoanalysis and Evolution Theory

Pre-Darwinian Assumptions in Freud's Psychoanalysis and Evolution Theory

• Freud's Pre-Darwinian Commitment: Although Freud was an evolutionist, he was not a Darwinian. His commitment to pre-Darwinian concepts in theoretical biology left no room for Darwin's theory of natural selection.
• Historical Context: During the late 19th century, there were two separate debates: one about the historical reality of evolution and the other about the process of evolution. The term "Darwinian" is often mistakenly used to refer to a belief in the historical reality of evolution.
• Scientific Climate: Belief in the historical reality of evolution was becoming well established during this time, but ideas on how it occurs remained in heated dispute. Lord Kelvin's criticism of Darwin's theory gave encouragement to Lamarckian ideas.
• Freud's Early Influences: Freud was deeply influenced by the work of Helmholtz and Brücke, who held pre-Darwinian assumptions about forces and energy in nature.
• Later Commitment to Lamarckian Ideas: Freud became increasingly committed to Lamarckian ideas later in his career, especially the heritability of acquired characters and the role of inner feelings or needs in evolution.
• Consequences of Freud's Position: As biology firmly established its Darwinian perspective, the gulf between it and psychoanalysis grew wider. The only conceivable outcomes are: (1) for biology to renounce its Darwinian perspective; (2) for psychoanalysis to be recast in terms of modern evolution theory; or (3) for the present divorce to continue indefinitely with psychoanalysis remaining beyond the fringe of the scientific world.

Appendix III. Problems of Terminology

Problems of Terminology in Fear and Anxiety

• Discussing additional terminology issues regarding fear, alarm, anxiety, and phobia.
• Countless attempts have been made to clarify terminology, but no single solution will satisfy everyone due to the connection between theories and adopted terms.

Problems of Reification

• It is essential to avoid reifying feelings such as fear and anxiety, treating them as things in their own right.
• Jersild's research on children's fears is an example of reification, as he tabulated the number of specific fears and expressed results as percentages of total fears (Jersild, 1943).
• In psychoanalysis, anxiety was previously considered a transformation of libido, making it a reified concept. Freud referred to anxiety as being related to libido as vinegar is to wine (SE 7: 224n).

Understanding Anxiety and Its Usages

• In this work, the term "anxiety" refers to:
  • How we feel when attachment behavior is activated, but we cannot find an attachment figure.
  • How we feel when uncertain about the availability of attachment figures.
• Freud's use of German term Angst and its translation into English and the difficulties it poses are discussed (Strachey, 1959; 1962).
• The usage of anxiety by English-speaking psychoanalysts is examined (Rycroft, 1968b).
• The uses of "anxiety" in psychiatry and psychopathology are discussed, highlighting its ambiguous meanings and the challenges it poses (Lewis, 1967).
• Anxiety is often used to indicate fear that is considered inappropriately intense for the situation, or fear of a future situation. These usages are not satisfactory as they lack clear definitions.

Usage of Alarm and Fear

• The term "alarm" is used complementary to anxiety and applies to what is felt when we try to withdraw or escape from a frightening situation.
• The origins of the word "alarm" mean 'to arms!', implying surprise attack.
• The usage of "fear" as a general-purpose term is common in modern English, despite its etymological roots being closer to alarm.

Phobia: Disadvantages and Alternatives

• Phobias are defined as a special form of fear which is out of proportion to the demands of the situation, cannot be explained or reasoned away, beyond voluntary control, and leads to avoidance of the feared situation (Marks, 1969).
• Phobia tends to reify fear and focuses on escape components of fear behavior.
• Instead of using the term "phobia," it is recommended to consider how the person concerned has developed and why they have become more frightened and anxious in certain situations.