Attachment and Loss LOSS SADNESS AND DEPRESSION

355 Pages·2006·1.66 MB·English

Attachment and Loss

VOLUME III
LOSS SADNESS AND DEPRESSION

John Bowlby

A Member of the Perseus Books Group
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Copyright © 1980 by The Travistock Institute of Human Relations
Published by Basic Books, A Member of the Perseus Books Group
All rights reserved. Printed in the United States of America. No part of this book may be
reproduced in any manner whatsoever without written permission except in the case of brief
quotations embodied in critical articles and reviews. For information, address Basic Books, 10
East 53rd Street, New York, NY 10022-5299.
Library of Congress Catalog Number: 79-2759
ISBN o-465-04237-6 (cloth)
ISBN o-465-04238-4 (paper)
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TO MY PATIENTS who have worked hard to educate me
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Contents

Foreword xiii

Acknowledgements xvi

Preface 1

Part I: Observations, Concepts and Controversiesi

1 The Trauma of Loss 71
Prelude 71

Grief in infancy and early childhood 9

Do young children mourn? a controversy 14

Detachment 19

2 The Place of Loss and Mourning in Psychopathology 231
A clinical tradition 23

Ideas regarding the nature of mourning processes, healthy and pathological 24

Ideas to account for individual differences in response to loss 34

3 Conceptual Framework 38
Attachment theory: an outline 38

Stressors and states of stress and distress 41

4 An Information Processing Approach to Defence 44
A new approach 44

Exclusion of information from further processing 44

Subliminal perception and perceptual defence 46

Stages at which processes of defensive exclusion may operate 52

Self or selves 59
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Some consequences of defensive exclusion 64

Conditions that promote defensive exclusion 69

Defensive exclusion: adaptive or maladaptive 72

5 Plan of Work 75

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Part II: The Mourning of Adults

6 Loss of Spouse 81
Sources 81

Four phases of mourning 85

Differences between widows and widowers 103

Note: details of sources 106

7 Loss of Child 112
Introduction 112

Parents of fatally ill children 113

Parents of infants who are stillborn or die early 122

Affectional bonds of different types: a note 124

8 Mourning in Other Cultures 126
Beliefs and customs common to many cultures 126

Mourning a grown son in Tikopia 132

Mourning a husband in Japan 134

9 Disordered Variants 137
Two main variants 137

Chronic mourning 141

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Prolonged absence of conscious grieving 152

Mislocations of the lost person's presence 161

Euphoria 169

10 Conditions Affecting the Course of Mourning 172
Five categories of variable 172

Identity and role of person lost 173

Age and sex of person bereaved 178

Causes and circumstances of loss 180

Social and psychological circumstances affecting the bereaved 187

Evidence from therapeutic intervention 195

11 Personalities Prone to Disordered Mourning 202
Limitations of evidence 202

Disposition to make anxious and ambivalent relationships 203

Disposition towards compulsive caregiving 206

Disposition to assert independence of affectional ties 211

Tentative conclusions 222

12 Childhood Experiences of Persons Prone to Disordered Mourning 214
Traditional theories 214

The position adopted 216

Experiences disposing towards anxious and ambivalent attachment 218

Experiences disposing towards compulsive caregiving 222

Experiences disposing towards assertion of independence of affectional ties 224

13 Cognitive Processes Contributing to Variations in Response to Loss 229
A framework for conceptualizing cognitive processes 229

Cognitive biases affecting responses to loss 232

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Biases contributing to chronic mourning 234

Biases contributing to prolonged absence of grieving 239

Biased perceptions of potential comforters 240

Biases contributing to a healthy outcome 242

Interaction of cognitive biases with other conditions affecting responses to loss 243

14 Sadness, Depression and Depressive Disorder 245
Sadness and depression 245

Depressive disorder and childhood experience 246

Depressive disorders and their relation to loss: George Brown's study 250

The role of neurophysiological processes 261

Part III: The Mourning of Children

15 Death of Parent during Childhood and Adolescence 265
Sources and plan of work 265

When and what a child is told 271

Children's ideas about death 273

16 Children's Responses when Conditions are Favourable 276
Mourning in two four-year-olds 276

Some tentative conclusions 285

Differences between children's mourning and adults' 290

Behaviour of surviving parents to their bereaved children 292

17 Childhood Bereavement and Psychiatric Disorder 295
Increased risk of psychiatric disorder 295

Some disorders to which childhood bereavement contributes 300

18 Conditions Responsible for Differences in Outcome 311
Sources of evidence 311

Evidence from surveys 312
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Evidence from therapeutic studies 317

19 Children's Responses when Conditions are Unfavourable 320
Four children whose mourning failed 320

Peter, eleven when father died 321

Henry, eight when mother died 327

Visha, ten when father died 333

Geraldine, eight when mother died 338

20 Deactivation and the Concept of Segregated Systems 345

21 Disordered Variants and Some Conditions Contributing 350
Persisting anxiety 351

Hopes of reunion: desire to die 354

Persisting blame and guilt 358

Overactivity: aggressive and destructive outbursts 361

Compulsive caregiving and self-reliance 365

Euphoria and depersonalization 370

Identificatory symptoms: accidents 376

22 Effects of a Parent's Suicide 381
Proportion of parents' deaths due to suicide 381

Findings from surveys 382

Findings from therapeutic studies 383

23 Responses to Loss during the Third and Fourth Years 390
Questions remaining 390

Responses when conditions are favourable 390

Responses when conditions are unfavourable 397

24 Responses to Loss during the Second Year 412
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A transitional period 412

Responses when conditions are favourable 412

Responses when conditions are unfavourable 416

25 Young Children's Responses in the Light of Early Cognitive Development 425
Developing the concept of person permanence 425

The role of person permanence in determining responses to separation and loss 433

Epilogue 441

Bibliography 443

Author Index 463

Subject Index 467

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Foreword

John Bowlby's work has profoundly marked the second half of the twentieth century. It has
brought about what is probably the most important and far-reaching shift in our perspective
and direction of inquiry in the field of early human development.
Bowlby's own perspective on attachment and loss derived from several sources--classical
psychoanalysis, object relations theory as practiced by the British school, ethology, and
evolutionary biology-none of which alone could have prefigured the central place of
attachment in early social-emotional development. Accordingly, the path by which attachment
theory has come to be accepted was not direct; its initial impact on the psychoanalytic
community and clinical psychology in general was modest--disappointing, in fact, since these
disciplines were dearly pivotal in Bowlby's mind.
Attachment theory instead entered the psychological mainstream through the door of
developmental psychology, thanks in large part to the observational and experimental work of
Mary Ainsworth and two generations of her students. Only later, after it had accumulated a
body of convincing empirical data did attachment theory become a central concept in all
clinical psychologies.
Today it seems incredible that until Bowlby no one placed attachment at the center of human
development, thereby facilitating a satisfying approach to the issue of separation and loss.
Inded, before Bowlby, there had been a gaping omission in evolutionary and psychoanalytic
theory: two basic motivational systems were postulated, one for assuring the self-survival of
individuals so that they could reproduce, and one that led them to do so; the perpetuation of
the gene pool therefore was not in doubt--but how did a baby stay alive long enough for these
systems to kick in and do him or her much good? The magnitude of Bowlby's contribution is
that attachment theory identified a new basic motivational system to account for the missing
link in the intergenerational chain.
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The impact of Bowlby Attachment and Loss on psychoanalytic theory and practice is gaining.
The road has been harder because attachment theory challenges many basic tenets of
psychoanalytic developmental theory. To cite just a few:
attachment theory, emphasizing the first years of life, gives relatively more importance to
the pre-oedipal period in determining later development and pathology;
attachment theory insists that its fundamental motivational system is not derivative from
other basic instincts but is basic in its own right;
attachment theory has begun to diminish the role of the psychosexual stages of
development as it replaces their explanatory power;
attachment theory has given a new and different impetus to the exploration of the
representational world of the infant.
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In short, attachment theory has had an uphill fight against existing psychoanalytic theories,
and a downhill ride filling in gaps in most other clinical psychologies. Regardless, attachment
theory has become the paradigm in considering not only early pathology but also our
understanding of the human responses to separation and loss.
This volume, already a classic, is a cornerstone in the construction of attachment theory and
its implications.
Daniel N. Stern, M.D. Geneva, October 1999
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Acknowledgements

Once again in preparing this volume I have been helped and encouraged by many friends and
colleagues who have given most generously of their time and thought. To all of them I am
deeply grateful.
One to whom I am especially indebted is Colin Murray Parkes. At a time in the early
nineteen-sixties when I was struggling to clarify the nature of mourning he drew my attention
to Darwin's ideas and to the part played by the mourner's urge to recover the lost person.
Subsequently we joined forces and he began his studies of widows, first in London and later
in Boston, which have made such a big contribution to our understanding. He has read
through the chapters in Part II of this volume, on the mourning of adults, and has made a large
number of valuable criticisms and suggestions. Others to have read through these chapters and
to have made valuable suggestions are Robert S. Weiss and Emmy Gut. Whilst I believe that,
as a result, the chapters have been much improved, I alone am responsible for the deficiencies
that remain.
Beverley Raphael kindly checked the accuracy of my exposition of her work in Chapter 10,
and George Brown did the same for my exposition of his in Chapters 14 and 17. The final
section of Chapter 4 owes much to a discussion with Mary Main. Among those who have
contributed in other ways are Mary Salter Ainsworth and Dorothy Heard, both of whom read
through drafts of almost every chapter and made many valuable suggestions.
Once again the script has been prepared by my secretary, Dorothy Southern, who from start to
finish has typed every word of these volumes, often many times over, with unflagging zeal
and devotion. Library services have been provided with traditional efficiency by Margaret
Walker and the staff of the Tavistock Library. For preparation of the list of references and
other editorial help I am indebted to Molly Townsend, who has also prepared the index. To
each of them my warmest thanks are due.
The many bodies that from 1948 onwards supported the research
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on which the work is based are listed in the first volume. To all of them I remain deeply
indebted. During the time that this volume has been in preparation I have received hospitality
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