Early Caretaking Function and Long-Term Behavioral Adaptation

November 4th, 2010

“From a trauma perspective, a variety of models are pertinent in explaining the risk of PTSD. These include developmental theory, attachment theory, and the resource model.
 
The resource model is particularly relevant in natural disasters and war violence involving death or disappearance of parents.
 
Knowledge of early attachment of infants to their caretakers helps us to understand why failed parenting (caretaking) can have a damaging effect on a child’s mood, sense of autonomy, self-agency, sense of self, use of defenses, and outlook towards the world.
 
The innate experience of the human infant is, by general consensus, unorganized and chaotic. His early environment envelops him, and he is only minimally capable of understanding or transforming it.
 
Freud’s approach to developmental maturation was predicated around the sequential unfolding of the libidinal stages. According to Freud, the human psychological apparatus is organized around the purpose of lowering drives and tensions, with the predominant role of experiencing pleasure. 
 
However, as the field of developmental psychology evolved, an account of   how the infant differentiates from formlessness into a healthy, autonomous, self-regulating entity became crucial to many developmental theorists (Greenacre, P. “Early Determinants in the Development of the Sense of Identity.” Journal of the American Psychoanalytic Association, 1958).
 
For an individual to achieve inner well-being, he or she needs a healthy supply of sharing and validation by caregivers. In this regard, the first bonding between parent and child begins in the womb. 
 
A child who grows up in a warm, safe, and nurturing environment is going to carry into adulthood a feeling of security, worth, well-being, and optimism (Kohut, Heinz and Miriam Elson, ed. ”The Kohut Seminars on Self-Psychology.” New York: W.W. Norton, 1987).
 
A child who receives this will feel more confident and empowered as an adult and will be more effective in personal relationships, interactions at work, and in society in general.
 
According to Kohut (known by some as the “Father of Self-Psychology”), the infant “self” begins from an amorphous state, has no durable sense of structure, cannot stand alone, and requires the participation of others to maintain a sense of well-being, cohesion and constancy. 
 
Kohut refers to “others” (from the infant’s early perspective) as not yet feeling separate from the infant’s personal sense of “self.” 
 
In other words, for the infant, there is no sharp distinction between the internal world and external world. 
 
How the infant internalizes his experience of the caretaker is what determines the final outcome of how the infant will experience himself.
 
This is what Kohut calls the “self-object.”
 
For Kohut, the ideal situation is when a child is born into an empathic, responsive human milieu. 
 
He regards these early caretaker relationships with others to be as essential for psychological survival as oxygen is for one’s physical survival. 
 
Donald Winnicott, a developmental psychologist who popularized the concept of the “Good Enough Mother,” is in agreement with Kohut regarding this observation:
 
“Disorders of the Self are understood as environmental deficiency diseases” (“The Maturational Process and the Facilitating Environment.” New York: International University Press, 1956).
 
According to Winnicott, the caretaker (ideally the mother) provides the “holding environment” within which the infant can begin to develop a sense of self-awareness.
 
Moreover, solidification of the self requires the mother’s continued devotion and empathic anticipation of the child’s needs. 
 
When the mother is able to resonate with the child’s needs, the latter becomes attuned to his own physical and emotional functions.
 
In addition to this “holding function” of the mother, where she “brings the world to the child,” Winnicott also considers what conditions are necessary for the child to develop the capacity to tolerate being alone.
 
This led Winnicott to the observation of the role played by “transitional objects.”
 
Soft and cuddly toy animals may serve this development need by helping the child negotiate the gradual shift from total dependence on the good caretaker to a process of self-soothing via a substitute good “self-object” (Greenberg, Jay and Stephen Mitchell, eds. “Object Relations in Psychoanalytic Theory.” Boston: Harvard University Press (1983): 195).
 
The relevance of this will be revisited in the article addressing the role of the trauma therapist as a transitional figure in the reconstruction of the “damaged self” following trauma.
 
For Margaret Mahler (another influential developmental theorist), the organizing principal of developmental success is also based on the successful internalization of the nurturing “good parent.” 
 
In order to facilitate this process, the parent has to walk through the developmental stages with the child in a sharing and empathic way, paying attention to the child’s bonding cues.
 
Mature object-relationships require the right balance between nurture and graded separation.
 
In order to accomplish this, the “good parent” remains only as far as the child can tolerate, and is predictably available for emotional “refueling” upon recall by the child.
 
In Mahler’s framework, the mother has to demonstrate a capacity to “move with the child in order to enhance the successful sense of confident autonomy.”
 
The benchmark of successful development depends on the movement from a symbiotic dependence on the mother to the achievement of a stable individual identity within the world. 
 
Mahler refers to this process as the successful “psychological birth” of the child, or “separation-individuation” (Mahler, Margaret, Fred Pine, and Anni Bergman. “The Psychological Birth of the Human Infant.” New York: Basic Books, 1975).
 
Her requirements for optimal mothering bear a striking similarity to Winnicott’s “Good Enough Mother.”
The successful process of “hatching” is what Phyllis Greenacre calls the child’s “love affair with the world,” as discussed in her article “Early Physical Determinants in the Development of the Sense of Identity” (Journal of the American Psychoanalytic Association, 1958). 
 
Resolution of the rapprochement crisis is considered by Mahler as an essential developmental requirement for the prevention of subsequent psychopathology.
 
In trauma research, “foraging patterns” are used to study stress responses by replicating different attachment models.
 
A research team led by Leonard Rosenblum and Jeremy Coplan from the Primate Behavior Laboratory at the SUNY Health Sciences Center, Brooklyn, studied infant primates nursed by mothers randomly assigned to a variety of foraging conditions. 
 
Using this research model, stress hormones were elevated in infants whose foraging pattern was totally unpredictable (“Nonhuman Primates Exposed to Unpredictable Early Rearing: Relevance to PTSD.” Annals of the New York Academy of Science, 1997).
 
By manipulating foraging conditions, these researchers created a laboratory model that corresponds to a parent who is unavailable during the critical “rapprochement phase.” 
 
Their findings support the notion that adverse early rearing experiences have longstanding effects on neurochemicals relevant to emotional regulation.
 
It would appear that this process (described by Winnicott in “The Maturational Process and the Facilitating Environment”) also ensures the healthy development of limbic structures such as the hippocampus.
 
The capacity to maintain a sense of autonomy and empowerment will later be needed to ward off the predatory behaviors of others. 
 
Extended caretaker failure to provide empathy may lead to deficits ranging from shyness and introversion to serious disorders of the self. 
 
These disorders, which are beyond the scope of this book, are listed as “Cluster B Personality Disorders” on Axis II in the DSM-IV, and are covered at length in the classic book edited by James Masterson and Ralph Klein, Disorders of the Self: New Therapeutic Horizons (Brunner/Mazel Inc., 1995).
 
According to Judith Herman, traumatization is not static (“Captivity.” Trauma and Recovery. Basic Books (1992), 86-92). 
 
If critical psychological and material resources are not replaced, the trauma survivor remains vulnerable to ordinary life stressors, hindering further psychological and social growth. 
 
This concept also applies to other settings where caretaking is temporarily delegated to others, such as babysitters, schools, day care centers, or summer camps. 
 
It has been well established that inadequately trained or negligent caretakers can psychologically damage children.
 
A child that grows up in a warm, safe, and nurturing environment is going to carry into adulthood a feeling of security, worth, well-being, and optimism. 
 
The more nurturance the child received during upbringing, the more confident and empowered he or she will feel as an adult, which will translate into interactions at work and in society at large. 
 
This link between childhood socialization and adult functioning evolves from the organizing principal of Margaret Mahler’s “map of developmental success.” 
 
She refers to the success of this “separation-individuation” process as “the setting for developmental readiness” for pleasure in independent functioning.
 
The process begins with symbiotic fusion with the mother, followed by the infant’s absorption with its own autonomy, and the availability of the mother to refuel during moments of insecurity when the infant can retreat until a secure sense of self takes hold.
 
Mastery of this phase terminates with the successful achievement of the child to organize itself around the parent as an external love object.
 
Given the close dynamics of such relationships, good caretakers become internalized as good “self-objects.”
 
These become available for recall during times of psychological trauma. 
 
Successful conclusion of this stage is what enables victims, following a trauma, to attach themselves to surrogate caretakers (such as friends and family) in order to reawaken latent soothing “self-objects” from childhood.
 
Kohut, in “Restoration of the Self,” notes that victims assimilate the emotions of their caretakers (New York: International Universities Press, 1977).
 
This includes the caretaker’s gentleness, tone of voice, mood, and empathic responses. 
 
If a victim successfully internalized the parent as a good “self-object” during childhood, the individual will be far more receptive to being comforted during stress by surrogate caretakers. 
 
The capacity to be soothed when faced with a trauma is also crucial for maintaining one’s inner sense of cohesion and well-being. 
 
The good “self-object” is easily rekindled via bonding with significant others (such as spouses, siblings, friends, chaplains, or therapists) who can then function as soothing “transitional objects” during times of crisis.
 
The power of healing through emotional attachments has been illustrated in combat environments.
 
In 1947, Abram Kardiner (author of The Traumatic Neuroses of War) and Herbert Spiegel (a military psychiatrist during the Second World War) reported that the strongest protection against “overwhelming terror” was the degree of relatedness between the soldier, his fighting unit, and the unit commander (Rev. ed. New York: Hoeber, 1947).
 
Carey-Trefzer noted in a study of children during the Battle of Britain that the mental shock of bombing was far more serious when children were under the care of an emotionally unstable parent (Eth and Pynoos, ed. “PTSD in Children.” American Psychiatric Press, 1985).
 
Healing does not take place in a vacuum. Trauma victims need to receive an emotional sense of comfort from anyone with whom they are in a healing relationship. 
 
This allows the victims to share their stories within the supportive matrix of empathic others. Gradually, traumatized patients internalize the sense of safety that they feel within the relationship as becoming part of themselves.
 
The renowned psychoanalyst Otto Kernberg made the following observation regarding treatment of patients with “disorders of the self” (such as borderline personality disorder):
 
“The therapist’s empathic attitude has elements similar to the empathy of the ‘good enough mother’ with her infant (Psychotherapeutic Strategies. New Haven: Yale University Press, 1984).” 
 
In trauma recovery, another self-function that is fundamental to healing is that of “sense of agency.” 
 
The annihilation of any sense of self may be the ultimate goal of the predator for his victim.
 
I have described this in some detail in the article on Stockholm syndrome.
 
In her chapter titled “A Forgotten History,” Judith Herman notes that “the more powerful the perpetrator, the greater is his prerogative to name and define reality” (Trauma and Recovery. Basic Books, 1992).
 
In the instance of rape and incest, perpetrators make every attempt to escape accountability, and a very effective tool is to attack the credibility of his victim.
 
Anything possible is done to silence the victim and rationalize the atrocity, such as “the victim exaggerated” or “brought it upon herself.”
 
The therapeutic challenge of re-empowering the survivor spans from the individual relationship with the victim to the social and political spectrum.
 
In the larger social arena, keeping trauma in consciousness is necessary to affirm and protect the victim.
 
The challenge of re-empowering a victim is quite daunting in cases of repeated abuse leading to a state of learned helplessness experienced as a dreaded and unavoidable fate.
 
Survivors of childhood abuse may develop a deep self-loathing, directing their negative emotions into self-abuse in the form of self-mutilation or even suicide.
 
As Herman notes in her chapter titled “A Healing Relationship,” the first principal of recovery is the empowerment of the victim. “No intervention that takes power away from the survivor can possibly foster recovery (Trauma and Recovery. Basic Books, 1992).”

6 Responses to “Early Caretaking Function and Long-Term Behavioral Adaptation”

  1. Elinor Weal says:

    I really enjoy this topic but it looks askew on my Blackberry

  2. Hello! Thank you for this post but are you really sure about what you’re saying? Do you have more sources for us? thank you

    • btrappler says:

      The simple answer to your question is “Yes. I know what I`m saying”.
      If you want specifics I can provide reference material.
      My articles have often been co-authored by other experts such as Stephen Friedman, Director of the Anxiety Clinic at S.U.N.Y.,N.Y.,
      Carl Cohen, Chairman of Geriatric Psychiatry at S.U.N.Y., N.Y., and Jean Endicott, Director of Biological Research, Columbia University.
      My book on Trauma was, among others, endorsed by Carolyn Wells, Director of Community Mental Health Services, N.Y. Office of Mental Health.I have been published in the American J. of Psychiatry
      and American J. of Geriatric Psychiatry. My papers have been presented at annual Conventions of the American Association of Psychiatry and American Association of Geriatric Psychiatry.
      I have also refereed for several journals including “The International Journal of Traumatic Stress”, regarded by many as the premier Journal on Psychological Trauma.

  3. Sue Lemasurier says:

    As a trained psychoanalytic psychotherapist and also as a patient who experienced degrees of trauma throughout my childhood from birth I just want to say that I enjoyed reading this article and the understanding it put forward. I myself wrote a dissertation many years ago covering the same issues.

  4. tin says:

    Thank you for your work. Article assisted me quite a bit

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