Attachment: The impact of early relationships.

Attachment (Bowlby, 1969) is an instinctive tendency to seek safety in the company of a specific other when feeling anxious or vulnerable.  This is most evident in babies, who are especially in need of the care and protection of a parent or caregiver in order to survive, but is a major component of human experience, and continues to play a part in how we relate to others throughout our lives.

With limited communication skills at birth, babies express their needs through their behaviour and facial expressions.  The infant's needs are both practical (safety, warmth, nourishment, etc) and emotional, and the absence of one or other type of care can have a long-term detrimental impact on their development.  

Over time, the child learns what to expect of their caregiver and their environment, and begins to form an "internal working model"; a sort of blueprint for how things might go, e.g whether they should anticipate frequent threat and/or danger, and how the caregiver might respond should such circumstances arise.  The general pattern of responses from the caregiver also helps the child to develop a sense of themselves and their value, e.g. are they worth the caregiver's time, and are their needs important?

For succinctness, I will refer to the primary caregiver as "mum" from now on; however for many children this might be their father, another relative, or perhaps a foster-parent.  Who the person is is less important than what they do.  Simply meeting the child's physical needs will not necessarily invite an attachment, something effectively demonstrated by Harlow's monkeys.  In Harlow's (rather distressing) study, newborn rhesus monkeys were separated from their mothers and placed in a cage with two 'surrogate mothers', one of which was made of wire, and held food, and one of which offered no food, but was covered in terry cloth, and thus offered tactile comfort.  Harlow found that all of the monkeys preferred the cloth 'mother', and would stray from her only to access food.  If a frightening object was placed in the cage, the babies would flee to the safety of the cloth mother, and cling.  He thus concluded that attachment was about more about comfort than the provision of food.

Attachment in human infants

As an infant's sense of self-worth and safety is contingent on the attachment relationship, the quality of this attachment (Ainsworth, 1971, 1978) is paramount.  

Secure attachment

Here we have Luke and his mum Clare.  Luke is securely attached to Clare, because she is attuned to his needs, and interprets his cues accurately enough.  Since Clare is not psychic she will not know Luke's mind all of the time, and might misunderstand what he wants and needs occasionally!  This is okay, because for the most part she is at least close with her interpretations, and her responses are therefore appropriate.  Luke communicates a need and he feels confident that Clare will meet it.

Because Luke believes help will be available as and when he might need it, he feels able to explore his environment and learn about the world.  From time to time he looks back to check Clare is there, and might bring things to her or draw her attention to something he is looking at to see what she thinks of it.  This kind of social referencing helps Luke learn what he should make of things and what is safe or unsafe.  If at any time he becomes uncertain or scared, he can run back to Clare who will comfort and protect him.  In Luke's internal working model, the world is relatively safe, and people are helpful, responsive, and available.

Avoidant attachment

Kelsey's mum, Sarah, is not sensitive to her needs in the way Clare is to Luke's.  Sometimes Kelsey cries for a very long time before Sarah responds, or she finds that Sarah is overwhelmed by her needs and gets upset or angry herself.

Kelsey doesn't feel very confident that Sarah will be there when she is feeling distressed, or that she will help her feel better if she is.  She tries to be independent of her mum when exploring her environment, and doesn't seek her when she is scared or upset.  Kelsey's internal working model tells her help is often unavailable when she needs it, and her mum may even walk away at times.  She has therefore developed an avoidant attachment style. 


Resistant attachment

Mieko can be quite inconsistent in meeting Hiroto's needs. Though she tries her best she can struggle with depression and is sometimes emotionally or even physically absent when Hiroto needs her.  At other times she tries desperately to make things up to him and can be intrusive in a way which is frightening or confusing for him.

Because Mieko's behaviour is inconsistent, Hiroto is not sure what to expect from her.  At times he can cling and appear very dependent, but he might also reject her efforts when they interact.  Hiroto has been unable to form a sense of security in his relationship with his mother, so it is difficult for her to soothe him when he is distressed.  His attachment type can be described as resistant.

Disorganised attachment

Hope has a problem.  Her mother, Tracey, is terrifying. Sometimes, without any real warning, Tracey completely loses her temper and shouts and screams at Hope.

Hope's instinct (like that of any child) is to seek safety.  But the person who is supposed to protect her is the source of her fear.  There is no real solution available to her.  Sometimes Hope instinctively starts towards her mother for help, but then freezes as she remembers this isn't safe.  At other times she dissociates to remove herself psychologically from a situation she cannot physically escape.  Because Hope has no single effective way of relating to Tracey, her attachment style is disorganised.


Through our relationships with our parents we learn what to expect from our environments and from other people.  A child who learns the world is largely safe and that help is readily available when it is not is far more likely to feel confident in exploring it, and thus to access more opportunities to learn and develop than a child who has found the world to be a dangerous, frightening place in which they are very much alone.  In this way, early attachments begin to establish patterns in the way individuals think, feel, and behave, which may persist across their lifespan in the absence of corrective or reparative experiences.

The Bear xXx

Why does maternal mental health matter?

It is widely accepted that mental health is a product of both biology and environment, and the ways in which the two interact. However, some may be surprised by how early in life this begins to be the case.   Recently,  studies have suggested that our experiences in-utero can begin to shape us neurologically in a way that can have lasting consequences (Talge, Neal, & Glover, 2007).

For the sake of simplicity, let's imagine a mother and baby.

This is Sandra.  Sandra would describe herself as usually being "a bit of a worrier", and is having a stressful time at the moment.  As a result, she is feeling quite anxious and depressed.  She is not alone.  Up to 13% of women experience depressive episodes during pregnancy or within their baby's first year (Swinson, 2005).

Sandra's current mental health is associated with a biochemical imbalance.  Her norepinephrine and cortisol (stress) levels are high, and her dopamine (reward and pleasure) levels are low.  She is feeling sick with anxiety and eating less than usual.

Inside Sandra is her unborn child, Billy.  Billy is exposed to his mother's hormonal imbalance, and his behaviour becomes dysregulated.  His levels of activity, sleep pattern, and movements are not typical of a foetus at this stage of development.  His heart rate is also different, and he responds less to vibratory stimuli.  As a baby of a depressed mother, Billy is at risk of being born prematurely with a low birth weight, with consequences for his later development (Gold & Marcus, 2008).

At birth, Billy's sleep pattern is not predictable or settled.  He is less responsive to the facial expressions of others, and his own facial expressions tend to be sad or angry.

Sandra is still feeling depressed, and varies between being withdrawn (emotionally, and physically), and being overly intrusive (fussing, or interfering with Billy in a way that makes them both feel irritable).  Billy is not sleeping well and Sandra is frustrated and exhausted.  Whenever she looks at Billy he looks miserable, and he seems more comfortable with her when she is sad than when she is happy  (Field, 1998).  

If things continue like this for Sandra and Billy, Sandra may feel more and more defeated and less able to parent Billy, who in turn will feel and show more distress. Intervention is needed.

One recent study found that something as simple as music and massage therapy for both mum and baby can reduce levels of cortisol and norepinephrine in both, leaving mum more receptive to being coached to engage with her baby in a more positive way, with a resultant improvement in their relationship.

New mothers suffering with mental health problems may also need the support of their partner, friends, family, or a healthcare professional, and may even consider taking medication to reduce their symptoms.  Existing mental health problems can be exacerbated by pregnancy and the transition to parenthood, and first episodes can also occur.  The evidence suggests the impact of maternal mental illness on an infant is buffered by the input of a stable caregiver, for example, the child's father.

Sandra and Billy try music and massage, and Sandra confides in a friend and her healthcare visitor about how she feels.  She is supported to try relating to Billy in a different way, and to enjoy her time with him more.  Her partner ensures she has time for herself, during which she naps or pursues a hobby.  Both Billy and Sandra feel less stressed, his sleep settles into a more organised pattern, and he steadily gains weight. Both parties are happier and more connected.  The intervention came at the right time for Sandra and Billy.

But what happens when the relationship between infant and caregiver continues to be difficult?  This is where attachment styles comes into play.

The Bear xXx

We all have mental health.

Mental health is something we all have, just like physical health.  It is something we need to work to maintain, and something which fluctuates in response to what is going on inside our bodies and in our environments.  Much as we can become physically ill, we can become mentally ill, and whilst the episode may resolve with rest and appropriate nurture, we might also need treatment to get well.  

As with physical health, there are some conditions we cannot "cure" and which we simply learn to manage to ensure the best possible quality of life.  Likewise, other episodes of mental illness can be successfully treated and may never recur.

Our education system teaches us little if anything about mental health unless we choose to study specific subjects later in our academic lives.  As such, the general public is historically poorly informed about this subject, and misunderstanding and stigma abound.

When faced with mental illness, we should bear in mind that mental health is part of the human experience, and mental illness is therefore very common, affecting 1 in 4 people each year.

This blog seeks to share some basic information about mental health and psychology in a bite-sized doodle format.  I hope you find it either interesting or helpful.

The Bear xXx