Understanding of Attachment Theory

“The relationship between mothers and babies is critical for child development. For whatever reason, in some instances, that relationship doesn’t develop normally. Neglect and abuse can result, with devastating effects on a child’s development” (Strathearn, 2008).

A psychological perspective of attachment is a term used to describe a mutual emotional tie that develops over time. There are many developmental theories related to attachment and desire, and many arguments regarding the nature-nurture debate.

However, the name that comes to mind for most people when discussing this subject is John Bowlby, the pioneer in relationship research. Bowlby’s work revolutionized the way people thought about a child’s tie to their mother and made people examine how separation, desire, and mourning affected them.

Bowlby’s work produced an abundance of research and had a great deal of impact on the emotional care of young children. This essay will explore the evolutionary theory of attachment exemplified by Bowlby, along with his maternal desire hypothesis, and examine studies that support and challenge his theories.

The essay will follow a pattern of questions: What is attachment, and when does it start? How and why is it established? And what happens if no attachment is formed? The conclusion will discuss how these theories help in the understanding of obstetrics practice.

When you become attached to someone, you have formed a special bond or relationship with that person, and he or she with you. It is a strong emotional bond or several ties that develop over time between an infant and their primary caregiver (Maurer and Maurer, 1989). “Attachments are welded in the heat of interactions” (Maurer and Maurer, 1989, 227).

Maccoby (1980) identified four features of this bond: seeking propinquity, hurt upon separation, pleasure when reunited, and a general orientation of behavior towards the primary caregiver. Maccoby was inspired by Schaffer and Emerson’s (cited in Cardwell et al., 2008) study of 60 Glaswegian babies. As part of this study, they hoped to find the age at which attachments start and how intense they were by observations of separation and stranger anxiety.

Their findings were that unique attachments appear to develop at 7 months with multiple attachments developing shortly after; they also found that attachments were formed with those who would interact and were responsive to the baby rather than those that were present most frequently.

Schaffer and Emerson believed that this showed attachment as developmental stages (Cardwell et al., 2008). Bowlby (1969) also proposed that there were different phases of development, starting with ‘pre-attachment’ at 0-2 months where babies produce similar responses to all things, objects, or people. His second phase between 2-6 months, ‘attachment in the making’, is when the baby starts to recognize familiar people. Bowlby (1969) believed ‘real’ attachment begins at around 6 months when the baby starts to show signs of separation and stranger anxiety. In contrast, more recent research shows that attachment could start much earlier.

Bushnell et al. (1989) found that at less than 24 hours old, babies would look for longer at their mother than another woman. Another study using an operant suction procedure shows that newborns, ranging from 12 to 36 hours of age, produced significantly more responses to their mothers’ faces as opposed to a stranger’s (Walton et al., 1992).

Although impossible to measure from the infants’ perspective and classified as bonding, it is believed that attachment could even start in gestation (Friedman and Gradstein, 1982).

“Soon after conception, the psychological and physiological processes of gestation are set in motion.” (Friedman and Gradstein, 1982, 7)

There is support for the views of the likes of Bowlby that an attachment is made between 6-7 months, but more modern research is less supportive of this and shows that a different sort of attachment, bonding, is linked to gestation. Parents in a study using ultrasound scans explained their natural desire to see and know their baby before birth.

In addition to receiving reassurance of the baby’s health, the majority of the mothers felt that seeing their baby on the screen or looking at images created a closer relationship between them and their unborn child (Pretorius, 2005). It is also clear from the emotional and psychological effects of abortion, miscarriage, and stillbirth that attachments are formed with the fetus (Friedman and Gradstein, 1982).

What is fond regard, and when does it commence? This has been encapsulated. The following logical measure is to look at how and why fond regards are made. Bowlby (1969) believed that fond regard is unconditioned. Babies who form fond regards are more likely to last and reproduce, and so, through development, the attachment cistron is naturally selected, and babies are born with an innate schedule.

Bowlby argued that something similar to the forming Konrad Lorenz (1952) discovered in hand-reared goslings might happen in humans. Babies cannot follow their female parents everywhere, but they do follow with their eyes, smiling, cleaving, suction, and call. He believed that using this adaptive behavior is how attachment is promoted.

These social releasers elicit a attention-giving reaction from others around them, and the infant becomes uniquely attached to the person who responds most sensitively. This is usually the mother. This one person is known as the infant’s primary caregiver.

Bowlby called this monotropy and recognized this unique relationship as highly important, as the baby internalizes a blueprint of all future relationships based on their relationship with the primary caregiver (Bowlby, 1969).

However, Ainsworth & Bell are cited by Cardwell (2008) to show that the quality of the attachment is dependent upon the quality of the interaction. Bowlby agreed and added that this particular attachment must happen in what he called the critical period: the infant’s first 2.5 years. After this, the child would not be capable of doing so, and it would lead to long-term irreversible effects (Cardwell, 2008).

In contrast, learning theorists believe humans are a clean slate at birth, and attachment behaviors are learned through conditioning. Pavlov’s (cited in Cardwell, 2008) area of expertise was classical conditioning, learning through association.

Whoever feeds the baby becomes associated with food and the feeling of pleasure. Dollard & Miller (cited in Cardwell, 2008) considered operant conditioning, learning through reinforcement. Babies feel discomfort when hungry and find that if they cry, their mother will feed them, and the discomfort is removed.

Therefore, the mother is associated with food, and the baby will want to be near to her. These theories correspond with Freud’s approach that food is the motivating force in the attachment development and they are identified as closet love theories (Cardwell, 2008).

The famous study by Harlow and Harlow (cited in Bellur et al., 2003) using baby Rhesus monkeys contradicted the theory of food being the source of attachment. The results of experiments showed that the monkeys spent most time with the cloth-covered surrogate, who gave them comfort and a base for exploration, rather than the wire surrogate, which produced food.

Harlow concluded that the monkeys have an innate need for comfort, which is as basic as their need for food (Bellur et al., 2003). The Glasgow babies study from Schaffer and Emerson (cited in Cardwell et al., 2008) showed that 39% of the babies formed their first attachment with someone other than the person who fed them, again suggesting that food is not the main need for forming attachments.

Regarding Monotropy, Bowlby (1953, 240) believed that fathers were not of any direct emotional importance and stated: “Mother love in babyhood is as important for mental health as vitamins and proteins for physical health.”

Schaffer & Emerson’s study (cited in Cardwell et al., 2008) showed that over 80% of the Glasgow babies formed multiple attachments, and over 30% had no attachment to the mother or a stronger attachment to someone else, mainly the father.

These findings concur with Bowlby’s rejection of cupboard love theories but challenge his notion that multiple attachments are the exception, and they show that fathers are attachment figures in their own right (Cardwell, 2008). Another challenge to Monotropy came from Freud & Dann (cited in Bellur et al., 2003) in a case study of six orphaned, 3-year-old children brought up in a concentration camp from the age of 6-12 months.

They had little opportunity to form attachments with any adults and as a result, they showed intense attachments to each other (Bellur et al., 2003). Hazan & Shaver’s (1987) Love Quiz presented results that supported the theory that early attachment acts as a template for future relationships.

Babies who were securely attached were now in enduring and trusting relationships. Those who were resistant-insecure in childhood showed jealousy, obsessive behaviors, and felt they were not loved. Those who were avoidant as babies presented fears of intimacy and believed they did not need to be loved to be happy.

There are many situations whereby an attachment can be broken or not formed at all; hospitalization, imprisonment, or death. This break of attachment is known as deprivation. The innovator of this theory is again Bowlby (1953) with his maternal deprivation hypothesis, which came about some 20 years after his publication of his attachment theory. The hypothesis focuses on the significance of a continuous relationship. Relationships that are discontinuous become less predictable and unstable.

The hypothesis stated:

“If an infant is unable to develop a warm, confidant, and uninterrupted relationship with his mother, then the child would have difficulty forming relationships with other people and be at risk of behavioral disorders” (Bowlby, 1953, p. 120-3).

There is support for the maternal deprivation hypothesis. Harlow & Harlow (cited in Bellur et al., 2003) found that the monkeys in their study went on to be highly aggressive adults and failed to develop normal relationships or parent well.

Spitz & Wolf (cited in Cardwell, 2008) found that children raised in institutions with poor quality care and rare interaction were developmentally inferior, depressed, withdrawn, and helpless compared to those raised in a prison where their mother cared for them.

Bowlby’s own study of 44 thieves found that a high percentage were diagnosed as being affectionless sociopaths, and most of these had experienced separation before the age of 5 (Cardwell, 2008). Later studies show, however, that many of the effects of deprivation can be overcome. Robertson & Robertson (cited in Cardwell, 2008) showed that if adequate emotional care is provided in separation, then the effects (deprivation) can be avoided.

In midwifery terms, attachment is known as bonding, and there are numerous ways in which a midwife can help the mother and family bond with their baby, and these can be related to attachment theories. For instance, the social releasers that Bowlby talks about may be inhibited when the baby has an abnormality, for example, blindness or a cleft palate.

This may, at first, shock the mother, who may not respond in the sensitive manner that is important for the quality of attachment. For a midwife, careful consideration needs to go into the communication with the parents in the postnatal period (Prince and Adams, 1987).

“Physical appearance is an important element of interpersonal relations, and in the last two decades, there have been several studies demonstrating the psychological importance of physical appearance” (Clifford and Bull, cited in Prince and Adams, 1987, p. 163).

A disfigured baby may shock the mother deeply, and while she may not want to look at him, Kennell & Klaus (cited in Prince and Adams, 1987) believe that the haptic experience and bodily contact are just as important for the development of attachment.

The way in which a mother handles her baby is obviously affected by her feelings in the peripartum, and a midwife will need to be there to help the mother through this time with encouragement, answers to the many questions, and picking up on any nonverbal cues, which are extremely important.

There is mixed evidence for claims of a critical period in attachment. The age of a child may be important, but there is no conclusive evidence to show it must be 2 years old. However, it is shown that mothers who have immediate contact are more likely to be more responsive and giving up, and spend a longer period of time looking at their babies.

(The Biological Impetus to Attachment, 2008) Klaus & Kennel (cited in Prince and Adams, 1987) believed that skin-to-skin contact between mother and baby is essential for bonding. They found that mothers who cuddled their baby in a critical period after birth enjoyed better relationships with their child than those mothers who did not have the opportunity. This can be related to caesarean sections where mother and baby are sometimes separated immediately after birth.

A midwife who is present can be of utmost importance. They can ensure that injury and separation are avoided and encourage the same skin-to-skin contact that is encouraged in a normal birth. It is also an opportunity for the father or partner to be heavily involved as the mother will have limited mobility and be uncomfortable.

It has been noticed that hands-on fathers or partners find attachment much easier, and sometimes it takes a caesarean section for this to happen. In a normal vaginal birth, the mother tends to have the immediate contact and engagement. Midwives can encourage the fathers and partners to get more hands-on in the vaginal birth. An example of this would be to allow them to cut the cord after delivery. (Mutryn, 1993)

Another aspect of Bowlby’s theory that is criticized is the Monotropy theory. Midwives see this in twins, particularly those that are pre-term. Complications and problems related to multiple birth and prematurity challenge maternal attachment. Twins stimulate each other and have an indescribable bond to each other, which is seldom seen in other siblings. (Barnes, 2003)

There is certainly evidence that midwifery practice can relate to the theories discussed; however, it is evident that more research needs to be done, especially on biological theories and the release of hormones in a natural birth versus a caesarean section.

Do attachments in these births differ? Furthermore, no consideration is taken in any of the theories as to the disposition of the baby or the fact that this may make it easier or harder for them to make attachments.

Mentions:

1. Bellur, R. et al. (2003). AS Level Psychology. Newcastle Upon Tyne: CGP Books.
2. Bowlby, J. (1953). Child Care and the Growth of Love. Harmondsworth: Penguin.
3. Bowlby, J. (1969). Attachment and Loss. Vol. 1. Attachment. London: Hogarth Press.
4. Bushnell, I. et al. (1989). Neonatal Recognition of the Mother’s Face. British Journal of Developmental Psychology, 7(1), 3-15.
5. Cardwell, M. et al. (2008). Psychology AS for AQA. 4th ed. London: Collins.
6. Friedman, R. and Gradstein, B. (1982). Surviving Pregnancy Loss. New York: Little, Brown and Company.
7. Hazan, C. and Shaver, P. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52(3), 511-524.
8. Integrated Psychology (2008). The Biological Impetus to Attachment. [online] Available at: http://www.integratedsociopsychology.net/biological_impetus-attachment.html [Accessed: 13th January 2011].
9. Lorenz, K. (1952). King Solomon’s Ring: New Light on Animal Ways. London: Methuen.
10. Maccoby, E. (1980). Social development: psychological growth and the parent-child relationship. California: Harcourt Brace Jovanovich.
11. Maurer, C. and Maurer, D. (1989). The World of the Newborn. New York: Basic Books, p. 227.
12. Mutryn, C. (1993). Psychosocial impact of cesarean section on the family: A literature review. Social Science & Medicine, 37(10), 1271-1287.
13. Noble, E. (2003). Having Twins and More: A Parents’ Guide to Multiple Pregnancy, Birth and Early Childhood. 3rd ed. New York: Houghton Miffin Company.
14. Pretorious, D. et al. (2005). Effects of ultrasound on maternal-fetal bonding: a comparison of two- and 3-dimensional imaging. Ultrasound in Obstetrics & Gynecology, 25(5), 473-477.
15. Prince, J. and Adams, M. (1987). The Psychology of Childbirth: An Introduction for Mothers and Midwives. 2nd ed. New York: Longman Group Limited.
16. Strathearn, L. (2008). What’s in a Smile? Maternal Brain Responses to Infant Facial Cues. 122(1), 40.
17. Walton, G. et al. (1992). Recognition of familiar faces by neonates. Texas: University of Texas, p. 265-269.