John Bowlby’s Attachment Theory

John Bowlby (1907 – 1990) was a psychoanalyst (like Freud) and believed that mental health and behavioral problems could be attributed to early childhood.

Evolutionary Theory of Attachment

Bowlby (1969, 1988) was greatly influenced by ethological theory, but especially by Lorenz’s (1935) study of imprinting.  Lorenz showed that attachment was innate (in young ducklings) and therefore had a survival value.

During the evolution of the human species, it would have been the babies who stayed close to their mothers that would have survived to have children of their own.  Bowlby hypothesized that both infants and mothers had evolved a biological need to stay in contact with each other.

Bowlby (1969) believed that attachment behaviors (such as proximity seeking) are instinctive and will be activated by any conditions that seem to threaten the achievement of proximity, such as separation, insecurity, and fear.

Bowlby also postulated that the fear of strangers represents an important survival mechanism, built-in by nature.

Babies are born with the tendency to display certain innate behaviors (called social releases), which help ensure proximity and contact with the mother or attachment figure (e.g., crying, smiling, crawling, etc.) – these are species-specific behaviors.

These attachment behaviors initially function like fixed action patterns and share the same function. The infant produces innate ‘social releaser’ behaviors such as crying and smiling that stimulate caregiving from adults.

The determinant of attachment is not food but care and responsiveness.

Bowlby’s monotropic theory

A child has an innate (i.e., inborn) need to attach to one main attachment figure (i.e., monotropy).

Bowlby’s monotropic theory of attachment suggests attachment is important for a child’s survival.

Attachment behaviors in both babies and their caregivers have evolved through natural selection. This means infants are biologically programmed with innate behaviors that ensure that attachment occurs.

Although Bowlby did not rule out the possibility of other attachment figures for a child, he did believe that there should be a primary bond which was much more important than any other (usually the mother).

Other attachments may develop in a hierarchy below this. An infant may therefore have a primary monotropy attachment to its mother, and below her, the hierarchy of attachments may include its father, siblings, grandparents, etc.

Bowlby believes that this attachment is qualitatively different from any subsequent attachments.  Bowlby argues that the relationship with the mother is somehow different altogether from other relationships.

The child behaves in ways that elicit contact or proximity to the caregiver.  When a child experiences heightened arousal, he/she signals to their caregiver.

Crying, smiling, and locomotion are examples of these signaling behaviors.  Instinctively, caregivers respond to their children’s behavior, creating a reciprocal pattern of interaction.

Critical Period

A child should receive the continuous care of this single most important attachment figure for approximately the first two years of life.

Bowlby (1951) claimed that mothering is almost useless if delayed until after two and a half to three years and, for most children, if delayed till after 12 months, i.e., there is a critical period.

If the attachment figure is broken or disrupted during the critical two-year period, the child will suffer irreversible long-term consequences of this maternal deprivation.  This risk continues until the age of five.

Bowlby used the term maternal deprivation to refer to the separation or loss of the mother as well as the failure to develop an attachment.

The underlying assumption of Bowlby’s Maternal Deprivation Hypothesis is that continual disruption of the attachment between infant and primary caregiver (i.e., mother) could result in long-term cognitive, social, and emotional difficulties for that infant.

The implications of this are vast – if this is true, should the primary caregiver leave their child in daycare, while they continue to work?

Maternal Deprivation

Bowlby’s maternal deprivation hypothesis suggests that continual attachment disruption between the infant and primary caregiver (i.e., mother) could result in long-term cognitive, social, and emotional difficulties for that infant.

Bowlby (1988) suggested that the nature of monotropy (attachment conceptualized as being a vital and close bond with just one attachment figure) meant that a failure to initiate or a breakdown of the maternal attachment would lead to serious negative consequences, possibly including affectionless psychopathy.

Bowlby’s theory of monotropy led to the formulation of his maternal deprivation hypothesis.

John Bowlby (1944) believed that the infant’s and mother’s relationship during the first five years of life was crucial to socialization.

According to Bowlby, if separation from the primary caregiver occurs during the critical period and there is no adequate substitute emotional care, the child will suffer from deprivation.

This will lead to irreversible long-term consequences in the child’s intellectual, social, and emotional development.

Bowlby initially believed the effects to be permanent and irreversible:

• delinquency,
• reduced intelligence,
• increased aggression,
• depression,
• affectionless psychopathy

Bowlby also argued that the lack of emotional care could lead to affectionless psychopathy,

Affectionless psychopathy is characterized by a lack of concern for others, a lack of guilt, and the inability to form meaningful relationships.

Such individuals act on impulse with little regard for the consequences of their actions.  For example, showing no guilt for antisocial behavior.

The prolonged deprivation of the young child of maternal care may have grave and far-reaching effects on his character and so on the whole of his future life (Bowlby, 1952, p. 46).

Bowlby believed that disrupting this primary relationship could lead to a higher incidence of juvenile delinquency, emotional difficulties, and antisocial behavior. To test his hypothesis, he studied 44 adolescent juvenile delinquents in a child guidance clinic.

Bowlby 44 Thieves

Aim

To investigate the long-term effects of maternal deprivation on people to see whether delinquents have suffered deprivation.

According to the Maternal Deprivation Hypothesis, breaking the maternal bond with the child during their early life stages is likely to affect intellectual, social, and emotional development seriously.

Procedure

Between 1936 and 1939, an opportunity sample of 88 children was selected from the clinic where Bowlby worked. Of these, 44 were juvenile thieves (31 boys and 13 girls) who had been referred to him because of their stealing.

Bowlby selected another group of 44 children (34 boys and 10 girls) to act as ‘controls (individuals referred to the clinic because of emotional problems but not yet committed any crimes).

On arrival at the clinic, each child had their IQ tested by a psychologist who assessed their emotional attitudes toward the tests. The two groups were matched for age and IQ.

The children and their parents were interviewed to record details of the child’s early life (e.g., periods of separation, diagnosing affectionless psychopathy) by a psychiatrist (Bowlby), a psychologist, and a social worker.  The psychiatrist, psychologist, and social worker made separate reports.

Findings

Bowlby found that 14 children from the thief group were identified as affectionless psychopaths (they were unable to care about or feel affection for others); 12 had experienced prolonged separation of more than six months from their mothers in their first two years of life.

In contrast, only 5 of the 30 children not classified as affectionless psychopaths had experienced separations.

Out of the 44 children in the control group, only two experienced prolonged separations, and none were affectionless psychopaths.

The results support the maternal deprivation hypothesis as they show that most of the children diagnosed as affectionless psychopaths (12 out of 14) had experienced prolonged separation from their primary caregivers during the critical period, as the hypothesis predicts

Conclusion

Bowlby concluded that maternal deprivation in the child’s early life caused permanent emotional damage.

He diagnosed this as a condition and called it Affectionless Psychopathy. According to Bowlby, this condition involves a lack of emotional development, characterized by a lack of concern for others, a lack of guilt, and an inability to form meaningful and lasting relationships.

Evaluation

Strength

Bowlby directly observed parental separation’s harm in evacuating children from bombing during WWII, strengthening his hospital research indicating it profoundly impacts children’s emotional and behavioral development.

Limitations

The supporting evidence that Bowlby (1944) provided was in the form of clinical interviews of, and retrospective data on, those who had and had not been separated from their primary caregiver.

This meant that Bowlby asked the participants to look back and recall separations.  These memories may not be accurate.

A criticism of the 44 thieves study was that it concluded affectionless psychopathy was caused by maternal deprivation.  This is correlational data and only shows a relationship between these two variables. It cannot show a cause-and-effect relationship between separation from the mother and the development of affectionless psychopathy.

Other factors could have been involved, such as the reason for the separation, the role of the father, and the child’s temperament. Thus, as Rutter (1972) pointed out, Bowlby’s conclusions were flawed, mixing up cause and effect with correlation.

Many of the 44 thieves in Bowlby’s study had been moved around a lot during childhood, and had probably never formed an attachment.  This suggested that they were suffering from privation, rather than deprivation, which Rutter (1972) suggested was far more deleterious to the children. This led to a very important study on the long-term effects of privation, carried out by Hodges and Tizard (1989).

The study was vulnerable to researcher bias. Bowlby conducted the psychiatric assessments himself and made the diagnosis of Affectionless Psychopathy. He knew whether the children were in the ‘theft group’ or the control group. Consequently, his findings may have been unconsciously influenced by his own expectations. This potentially undermines their validity.

Bowlby struggled to apply his new maladaptation model to retrospective research on adolescents with conduct problems, as such studies prejudice outcomes by selecting for problems and then looking backward.

Cautious of this, in 1950, Bowlby, Robertson, and new researcher Mary Ainsworth (1956) began a forward-looking “follow-up study” on whether preschoolers who were hospitalized long-term subsequently developed conduct issues.

Assessing 60 such children aged 6-13 and controls, contrary to maternal deprivation hypotheses, they found more emotional apathy, withdrawal, and poor control than criminality.

So, while early prolonged separation impacted some children’s later adjustment, outcomes proved far more varied than Bowlby’s theory initially predicted. The improved prospective methodology highlighted limitations in Bowlby’s previous retrospective approaches.

In the conclusions of the paper Bowlby admitted that his theory regarding the development of conduct problems may be wrong:

It is clear that some of the workers, including the present senior author, in their desire to call attention to dangers which can often be avoided have on occasion overstated their case. In particular, statements implying that children who are brought up in institutions or who suffer other forms of serious privation and deprivation in early life commonly develop psychopathic or affectionless characters (e.g., Bowlby, 1944) are seen to be mistaken. (Bowlby et al., 1956, p. 240)

Short-Term Separation

When WWII ended in 1945, Bowlby had to choose between completing child psychoanalysis training or researching parental separation’s impact on children. He chose the latter, joining colleagues at London’s Tavistock Clinic.

Robertson and Bowlby (1952) believe that short-term separation from an attachment figure leads to distress.

John Bowlby spent two years working alongside a social worker, James Robertson (1952), who observed that children experienced intense distress when separated from their mothers. Even when other caregivers fed such children, this did not diminish the child’s anxiety.

They found three progressive stages of distress:

1. Protest: The child cries, screams, and protests angrily when the parent leaves. They will try to cling to their parents to stop them from leaving. Protest could last from a few hours to several days.
2. Despair: The child’s protesting gradually stops, and they appear calmer, although still upset. The child refuses others’ attempts for comfort and often seems withdrawn and uninterested in anything. In the despair stage, children become increasingly withdrawn and hopeless.
3. Detachment: If separation continues, the child will engage with other people again. All emotions are suppressed, and children live moment-to-moment by repressing feelings for their mother. On the surface, children were seen to be happy and content, but when the mother visited, they frequently ignored her and hardly cried when she left. If this state continues, children become so withdrawn as to seek no mothering at all – a sign of major psychological trauma.

Controversy arose between Bowlby and Robertson regarding the stages of separation, particularly the third stage, which Robertson termed denial, but Bowlby called detachment.

However, both powerfully influenced attitudes and practices around keeping mothers and children together. This led to advocacy for allowing parental presence and major reforms in hospital policies.

A Two-Year-Old Goes to Hospital

Though doctors saw the despair phase as adjustment, Bowlby felt it showed distress’s harm.

To demonstrate this, Robertson filmed two-year-old Laura’s distress when hospitalized for eight days for minor surgery in “A Two-Year-Old Goes to Hospital” (1952).

Time series photography showed the stages through which a small child, Laura, passed during her 8-day admission for umbilical hernia repair. The film graphically depicted Laura’s behavior while separated from her mother for a period of time in strange circumstances” (Alsop-Shields & Mohay, 2001).

Laura cries out for her mother from admission onward, pleading in anguish to go home when visited the second day. As the week progresses, her initial constant distress gives way to listlessness and detachment during the parents’ increasingly ambivalent visits.

However, when approached by hospital staff, Laura startles out of her trance to suddenly burst into tears and fruitlessly call for her mother once more.

The raw behaviors captured on film revealed the three-phase separation response of protest, despair, and detachment observed in Bowlby and Robertson’s prior research.

Laura’s suffering starkly contradicts expectations of childrens’ ready hospital adjustment, instead demonstrating their deep distress from both physical separation and the hospital environment itself.

These findings contradicted the dominant behavioral theory of attachment (Dollard and Miller, 1950), which was shown to underestimate the child’s bond with their mother.  The behavioral theory of attachment states that the child becomes attached to the mother because she feeds the infant.

Implications for nursing include the development of family-centered care models keeping parents integral to a child’s hospital care in order to minimize trauma, principles now widely implemented as a result of this pioneering work on attachment.

Internal Working Model

The child’s attachment relationship with their primary caregiver leads to the development of an internal working model (Bowlby, 1969).

This internal working model is a cognitive framework comprising mental representations for understanding the world, self, and others.

The social and emotional responses of the primary caregiver provide the infant with information about the world and other people, and also how they view themselves as individuals.

For example, the extent to which an individual perceives himself/herself as worthy of love and care, and information regarding the availability and reliability of others (Bowlby, 1969).

Bowlby referred to this knowledge as an internal working model (IWM), which begins as a mental and emotional representation of the infant’s first attachment relationship and forms the basis of an individual’s attachment style.

A person’s interaction with others is guided by memories and expectations from their internal model which influence and help evaluate their contact with others (Bretherton & Munholland, 1999).

Working models also comprise cognitions of how to behave and regulate affect when a person’s attachment behavioral system is activated, and notions regarding the availability of attachment figures when called upon.

Bowlby (1969) suggested that the first five years of life were crucial to developing the IWM, although he viewed this as more of a sensitive period rather than a critical one.

Around the age of three, these seem to become part of a child’s personality and thus affect their understanding of the world and future interactions with others (Schore, 2000).

According to Bowlby (1969), the primary caregiver acts as a prototype for future relationships via the internal working model.

There are three main features of the internal working model: (1) a model of others as being trustworthy, (2) a model of the self as valuable, and (3) a model of the self as effective when interacting with others.

It is this mental representation that guides future social and emotional behavior as the child’s internal working model guides their responsiveness to others in general.

The concept of an internal model can be used to show how prior experience is retained over time and to guide perceptions of the social world and future interactions with others.

Early models are typically reinforced via interactions with others over time, and become strengthened and resistant to change, operating mostly at an unconscious level of awareness.

Although working models are generally stable over time they are not impervious to change and as such remain open to modification and revision.  This change could occur due to new experiences with attachment figures or through a reconceptualization of past experiences.

Although Bowlby (1969, 1988) believed attachment to be monotropic, he did acknowledge that rather than being a bond with one person, multiple attachments can occur arranged in the form of a hierarchy.

A person can have many internal models, each tied to different relationships and different memory systems, such as semantic and episodic (Bowlby, 1980).

Collins and Read (1994) suggest a hierarchical model of attachment representations whereby general attachment styles and working models appear on the highest level, while relationship-specific models appear on the lowest level.

General models of attachment are thought to originate from early relationships during childhood, and are carried forward to adulthood where they shape perception and behavior in close relationships.

Attachment & Loss Trilogy

The attachment books trilogy developed key concepts regarding attachment, separation distress, loss responses, and clinical implications over the course of the three volumes.

Attachment (1969/1982)

• Provided evidence for the importance of early parent-child relationships.
• Analyzed the systemic and “goal-corrected” nature of behavior.
• Introduced the concept of an “environment of adaptedness” that organisms inherit a potential to develop systems suited for.
• Discussed how attachment behaviors in infants are components of an attachment system designed to achieve security.
• Explained how attachment behaviors change via feedback from caregivers, becoming oriented toward discriminated figures.
• Posited attachment as a foundational system for survival that interacts with other systems like exploration.

Separation (1973)

• Focused on the negative impacts of separation from attachment figures.
• Outlined phases of separation responses in infants and children.
• Analyzed short- and long-term pathological effects of loss or deprivation.
• Studied how mourning progresses in relation to attachment bonds.
• Linked separation distress and avoidance to later issues of delinquency.

Loss (1980)

• Explored the concept of “loss” in relation to attachment theory.
• Proposed stages of the mourning process.
• Studied outcomes following the loss of an attachment figure.
• Examined detachment and defense processes resulting from loss.
• Applied attachment theory understanding to treatment approaches.

Critical Evaluation

Implications for children’s nursing

• During Robertson and Bowlby’s research, the British government established a parliamentary committee investigating children’s hospital conditions. This resulted in the 1959 Platt Report, containing 55 recommendations, including allowing parental presence and provisions for their accommodation and children’s education/recreation (Alsop-Shields & Mohay, 2001).
• Robertson also specifically critiqued task-oriented nursing and childcare institutions (Robertson, 1955, 1968, 1970) as emotionally neglectful. He and Bowlby suggested dysfunctional families be kept together but supported (Robertson & Bowlby, 1952) – principles now accepted but decades ahead of their time.
• Robertson and Bowlby’s work has greatly influenced the development of family-centered pediatric nursing models like partnership-in-care and family-centered care in the 1990s. By planning care around the whole family unit rather than just the hospitalized child, and involving parents closely in care, these models aim to reduce emotional trauma for children.

Strengths

Bifulco et al. (1992) support the maternal deprivation hypothesis. They studied 250 women who had lost mothers, through separation or death, before they were 17.

They found that the loss of their mother through separation or death doubles the risk of depressive and anxiety disorders in adult women. The rate of depression was the highest in women whose mothers had died before the child reached 6 years.

Mary Ainsworth’s (1971, 1978) Strange Situation study provides evidence for the existence of the internal working model. A secure child will develop a positive internal working model because it has received sensitive, emotional care from its primary attachment figure.

An insecure-avoidant child will develop an internal working model in which it sees itself as unworthy because its primary attachment figure has reacted negatively to it during the sensitive period for attachment formation.

Bowlby’s Maternal Deprivation is supported by Harlow’s (1958) research with monkeys.  Harlow showed that monkeys reared in isolation from their mother suffered emotional and social problems in older age.  The monkey’s never formed an attachment (privation) and, as such grew up to be aggressive and had problems interacting with other monkeys.

Konrad Lorenz (1935) supports Bowlby’s maternal deprivation hypothesis as the attachment process of imprinting is an innate process.

Bowlby’s (1944, 1956) ideas had a significant influence on the way researchers thought about attachment, and much of the discussion of his theory has focused on his belief in monotropy.

Limitations

Although Bowlby may not dispute that young children form multiple attachments, he still contends that the attachment to the mother is unique in that it is the first to appear and remains the strongest.  However, the evidence seems to suggest otherwise on both of these counts.

• Schaffer & Emerson (1964) noted that specific attachments started at about eight months, and very shortly thereafter, the infants became attached to other people. By 18 months, very few (13%) were attached to only one person; some had five or more attachments.
• Rutter (1972) points out that several indicators of attachment (such as protest or distress when an attached person leaves) have been shown for various attachment figures – fathers, siblings, peers, and even inanimate objects.

Critics such as Rutter have also accused Bowlby of not distinguishing between deprivation and privation – the complete lack of an attachment bond, rather than its loss.  Rutter stresses that the quality of the attachment bond is the most important factor, rather than just deprivation in the critical period.

Bowlby used the term maternal deprivation to refer to the separation or loss of the mother as well as the failure to develop an attachment.  Are the effects of maternal deprivation as dire as Bowlby suggested?

Michael Rutter (1972) wrote a book called Maternal Deprivation Re-assessed.  In the book, he suggested that Bowlby may have oversimplified the concept of maternal deprivation.

Bowlby used the term “maternal deprivation” to refer to separation from an attached figure, loss of an attached figure and failure to develop an attachment to any figure.  These each have different effects, argued Rutter.  In particular, Rutter distinguished between privation and deprivation.

Michael Rutter (1981) argued that if a child fails to develop an emotional bond, this is privation, whereas deprivation refers to the loss of or damage to an attachment.

Deprivation might be defined as losing something that a person once had, whereas privation might be defined as never having something in the first place.

From his survey of research on privation, Rutter proposed that it is likely to lead initially to clinging, dependent behavior, attention-seeking, and indiscriminate friendliness, then as the child matures, an inability to keep rules, form lasting relationships, or feel guilt.

He also found evidence of anti-social behavior, affectionless psychopathy, and disorders of language, intellectual development and physical growth.

Rutter argues that these problems are not due solely to the lack of attachment to a mother figure, as Bowlby claimed, but to factors such as the lack of intellectual stimulation and social experiences that attachments normally provide.  In addition, such problems can be overcome later in the child’s development, with the right kind of care.

Bowlby assumed that physical separation on its own could lead to deprivation, but Rutter (1972) argues that it is the disruption of the attachment rather than the physical separation.

This is supported by Radke-Yarrow (1985), who found that 52% of children whose mothers suffered from depression were insecurely attached. This figure raised to 80% when this occurred in a context of poverty (Lyons-Ruth,1988). This shows the influence of social factors. Bowlby did not take into account the quality of the substitute care. Deprivation can be avoided if there is good emotional care after separation.

Is attachment theory sexist?

There are implications arising from Bowlby’s work.  He reinforced the idea that a mother should be the most central caregiver and that this care should be given continuously. An obvious implication is that mothers should not go out to work.  There have been many attacks on this claim:

• Mothers are the exclusive carers in only a very small percentage of human societies; often there are a number of people involved in the care of children, such as relations and friends (Weisner, & Gallimore, 1977).
• Van Ijzendoorn, & Tavecchio (1987) argue that a stable network of adults can provide adequate care and that this care may even have advantages over a system where a mother has to meet all a child’s needs.
• There is evidence that children develop better with a mother who is happy in her work, than a mother who is frustrated by staying at home (Schaffer, 1990).

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