Bowlby: Expressions of Loss, Grief, and Anxiety in a Child and Psychoanalysis – IX

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makes the common observation that the psychoanalytic theory of normal development is almost entirely based upon work with adult patients. Obviously, in clinical practice, the psychoanalyst is constantly preoccupied with the understanding of defences that, although once useful for survival, are now obsolete. When these findings are projected back onto the theory of infant and child development, we find an imbalance towards a study of the mechanisms of defense, and an ignorance of the normal child’s expressions of loss, grief, and anxiety, opines Prof Ashoka, in the ninth part of his erudite research, in the weekly column. A exclusive.

John Bowlby has made various suggestions as to why psychoanalysts have found it so very difficult to conceptualise in theory that which they so clearly observe. First, Bowlby makes the common observation that the psychoanalytic theory of normal development is almost entirely based upon work with adult patients. Obviously, in clinical practice, the psychoanalyst is constantly preoccupied with the understanding of defences that, although once useful for survival, are now obsolete. When these findings are projected back onto the theory of infant and child development, we find an imbalance towards a study of the mechanisms of defense, and an ignorance of the normal child’s expressions of loss, grief, and anxiety.

Second, traditional psychoanalysis assumes that a child does not seek out other for their own sake but only as containers or modulators of tension, anxiety, aggression and so forth, or as sources of gratification. This tenet discourages the idea that a child might react directly to the absence of a loved one.

Third, Bowlby believes that the lack of distinction between cause and function has not only harmed psychoanalytic theory in general but also that this confusion particularly impedes its understanding of the anger that so often follows a loss. This anger is caused not just by the separation. Bowlby believes that its function is to recover the lost person. Not only do anger and reproach ensure the person’s return, they also threaten him so that he or she dare not desert again. In a responsive mother-child , the child’s anger is often very effective. The aggressive wishes not only express the simple desire to hurt the person who has inflicted pain and suffering, but they are also intended to punish the person for desertion and to reinstate proximity.

Fourth, Bowlby makes another distinction between guilt and grief in response to loss. Freudian and Kleinian theory lose track of the difference between these two responses. Grief and mourning are expressions of depressive guilt. Guilt is a “natural” reaction to loss. For Bowlby, grief covers an amalgam of emotions—anger, anxiety, and despair. Guilt, on the other hand, may often signify displacement and may result from an angry reproach against the self instead of the lost person. When the expression of natural feelings, such as yearning, anger, and reproach, are discouraged (which is very often the case, particularly when the bereaved are young children), these feelings can be redirected either to third parties or on to the self. When reinforced socially, these displacements can generate various pathological behaviors, such as denial of permanent loss with sustained secret beliefs in reunion or vicarious caregiving and sympathy for other bereaved persons. Repressed yearning can lead to compulsive wandering, depression, and suicide. Depressed people often tend to idealize their attachment figures. In traditional theory, idealizations are often thought to mask aggressive and destructive phantasies. According to Bowlby, however, such depressed people, particularly children, may be entertaining two completely incompatible models of relationship—their own and that of their caretakers. When circumstances are favourable, however, anger, reproach, and yearning fade following their expression to the appropriate person. The mourner finally accepts that his loss is permanent and that his or her feelings are non-functional. These responses are then succeeded by a period of disorganization and almost unbearable grief. However, if this grief is expressed to and understood by others, it can lead to reconnection with the world and “a relieving sweet sadness may break through”

Fifth, Bowlby makes a crucial distinction, ignored in traditional theory, between “natural” and “reasonable” fear. This distinction affects our understanding of separation anxiety and of the responses to actual or threatened loss. Following Freud, psychoanalysts have concluded that when anxiety is not related to real danger, it signifies a neurosis. Absence per se does not seem to threaten life or limb. However, as we noted earlier, the zero message exerts just as much influence as its positive counterpart. Even among mature adults, mourning often is mixed with acute and “irrational” terror. Nearly all bereaved persons report symptoms such as insomnia and fear of being alone or of going to strange places. All these feelings are natural to separated children. The loss of a secure base threatens both children and adults as much as physical assault. This phenomenon, Bowlby (1973) notes, prompts the psychoanalyst to engage in “a prolonged hunt for some primal danger situation”. The analyst concludes that the expressed fear is not the real fear. So many of the fear stimuli that affect us seem inappropriate in the modem context. We don’t see too many saber-toothed tigers these days! Nevertheless, it is perfectly natural for a young and vulnerable child to fear the existence of dangerous creatures. All children exhibit some fear of the dark, of being alone, of loud or sudden noises, of bright lights and of looming objects, particularly when these appear in combination. Bowlby points out that these same phenomena frighten the same child much less if they occur when the child is with an older, trusted person. All these fears are viewed by Bowlby and other ethologists as natural. They contribute to survival in the environment of evolutionary adaptedness. As Bowlby notes, these fears still hold their survival value. Although in the city we need not worry too much about wild animals, we still need to remain alert to danger. City children are vulnerable to traffic accidents, for example, and many city parents worry about the risk of criminal assault. Besides, the fear of wild and dangerous animals is still reasonable in many parts of the world. Even in Los Angeles, a young child growing up in certain hillside areas must treat his environment with some caution. Chances are they are sharing the hill with a of coyotes and the odd rattlesnake. Fears are often ordered hierarchically. For instance, children will follow their mothers in the face of dangerous traffic rather than risk separating from her. When we investigate a fear that has become unmanageable, we would consider its evolutionary context before making our interpretation. Otherwise, we risk taking up arms against a mechanism of survival.

Sixth, Bowlby’s concept of defence—renamed selective exclusion— also reflects the systemic approach. In the normal course of events, we exclude a vast proportion of information from consciousness. This protects our attention from distraction and overload. The selective exclusion of information is as necessary and adaptive as the reduction of flexibility that follows from specialization. Both contain the potential for maladaptation, however. Persistent exclusion is usually maladaptive; nor does automatic attachment and attachment behaviour necessarily contribute to survival. Change can be economical, but it is difficult; and correction requires skilled attention. Bowlby (1980) also stresses the diversionary role of defensive activity, “for the more completely a person’s attention, time and energy are concentrated on one activity and on the information concerning it, the more completely can information concerning another activity be excluded.” Any activity—work or play—can be undertaken as a diversion. The only psychological requirement is absorption. Much defensive exclusion is related to suffering. A response is disconnected from its context in an interpersonal situation and relocated upon the self. This gives rise to symptoms such as hypochondria, guilt and morbid introspection. For Bowlby, no system is more vulnerable to defensive exclusion than attachment. For instance, pathology may develop if defensive exclusion continues beyond the initial stages of bereavement.

The evolutionary context makes Bowlby’s theory of attachment and mourning seem simple, even blindingly obvious. Human beings come into the world genetically biased to develop certain behaviours that, in an appropriate environment, result in their keeping close to whoever cares for them. This desire for proximity to loved ones persists throughout life. Only when children feel secure in their primary attachments can they go out with confidence to explore and make the most of their world.

(To be continued) 
©Prof. Ashoka Jahnavi Prasad

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Ashoka Jahnavi Prasad is a physician /psychiatrist holding doctorates in pharmacology, history and philosophy plus a higher doctorate. He is also a qualified barrister and geneticist. He is a regular columnist in several newspapers, has published over 100 books and has been described by the Cambridge News as the ‘most educationally qualified in the world’.