Good day! I'm going to discuss attachment as a theory of human development and functioning in positive psychiatry. First up, I'll give some background and then talk about how our attachment can be usefully applied in human health and well-being for recovery, for mental illness and distress. This will also connect up with other mood talks on stress, trauma, psychotherapies, and resilience. Modern medicine and psychiatry now promote the idea of treating the whole person in an integrated way. Attachment theory is one model that provides an explanation for health and well-being and what happens when they break down. It affirms the interconnections between biological, psychological, and social factors and can guide recovery. John Bowlby got us on track in the middle of last century by recognizing that human beings develop in relationships. He wrote that children need care from caregivers with whom they have an attachment bond over a long period of development. Without this care, children's mental and physical health suffers. At the extreme end of the spectrum, children without any care simply die. At the positive end, nurtured children thrive and become resilient. Bowlby suggested that this need for nurturing attachments had evolved over time. The attachment system supports the infant's motivation to connect to others and form a bond with their caregiver. This gave a survival advantage for the species as a little ones stayed close to parents and were protected and nurtured, and more likely to survive to become parents themselves. When they needed help, the system would turn on until help had arrived and being helpful. A dovetailing caregiving system in adults motivates them to care for infants. We all know the pool of those big anime eyes of children, and the "Oh!" the greets our first encounter with a new baby. The babushka doll would be one strong image of the way one generation protects and nurtures the next. Current research supports attachment theory and the idea that human beings develop physically, mentally, socially, in relationships. A real experiences of care shape and organize our responses to ourselves, to others and to stress, working at every level of our being. In this picture, we can see the early beginnings and growth of a secure attachment of a child to parent. We can see here the close connection between mother and baby through gaze, voice, touch, position, and feeling. The baby's hand is touching mom and they are sharing a kind of largely wordless conversation with a warm positive feeling called the protoconversation. As a caregiver responds to the baby's need for care and comfort in all the simple daily routines, feeding, bathing, soothing, going to sleep, and playing, the baby learns about good connection with another person, they learn that they can ask for and get help when needed, both practical and emotional. Babies learn how to feel settled and relaxed and share moments of real joy, pleasure, play. Over many repetitions, a pattern is established and baby comes to expect that the parent will be a source of help and love. When they begin to explore, they find that they can return to safety when they encounter problems and be helped and reassured. We now know that this expectation of help and comfort is fundamental and shapes how we see others beyond our family. As the child grows, the experiences become internalized as a schema or template, a set of feelings and beliefs about themselves and others. They feel lovable and feel others can be helpful. They acquire a capacity for self soothing and calm, and learn to tolerate strong feelings and some stress. They become resilient. So someone is raised to be confident and use their own coping wherever possible, but know that they can directly ask for help if they need it. They achieve a balance of strategies for managing life under the stresses and strains. This is attachment security. And such an individual is called secure in their attachment style. This style promotes our active meaningful way of being connected to ourselves and others, and buffers us against the effects of stress and trauma. It is associated with health and flourishing in many contexts. In normal populations however, many people do have an insecure attachment strategy. And most of the time, that's not problematic. However in really tough times, this can mean that they might not be as flexibly and comfortably supported in their recovery from stress, distress, trauma, and illness. The person's past experience has shaped their expectations about help. Attachments can be insecure in one of two fundamental ways: A person can turn away from help and feel that they have to manage alone, termed an avoidant or dismissing strategy; or in the second way, they can feel unconfident in their own coping and can tend to anxiously or even angrily rely on others, termed an anxious ambivalent or preoccupied strategy. So attachment describes our organization of attention, feeling, thinking, and behavior towards ourselves and others to manage stress. The three main attachment strategies are also known as states of mind. These states can also affect body functions such as sleep, eating, and sexuality. The figure here titled Attachment States of Mind shows the three different attachment states of mind that we've discussed so far, spread along the top line. We can all move around the map a bit, but at times of stress, tend to find ourselves mostly in one of the states described, or occasionally flip between them. The last important fourth pattern of attachment happens when people have gone through a loss or traumatic experience that breaks down the normal organized way of coping and being. So they move from one of the states along the top row to this bottom state. Our thoughts, feelings, and behaviors become disorganized. This occurs naturally when people are grieving or have experienced a trauma. They can feel shocked, numb, or feel very intensely and might experience disturbances of sleeping and eating and energy, and an unusual sense of confusion, disorientation, disconnection that don't feel like their normal selves. More will be said about this in the talk on trauma. Some people have had very traumatic early experiences and don't feel that others are safe. They have had disorganizing fearful experiences within their early relationships and so come to not expect safe help. Instead they fear others, that they can make it all worse or cause harm. We'll say more about this in the trauma and the psychotherapist talks. Importantly, our attachment templates are not set in stone. New experiences like personal and therapeutic relationships can shift attachment templates. We can move towards security. And move to reorganize after loss and trauma towards feeling safe almost settled, resilient, and more flexible in our sense of self and our relationships with others. Given that the attachment system organizes our coping, it can shed light on many symptoms in mental and physical health and identify coping strengths and paths to resilience in recovery. When people are too stressed, they become distressed and disorganized, and their normal coping can breakdown and they experience symptoms. So, these days health workers check in with people presenting for care to discuss how they manage their stress. And so can collaborate to work out their normal attachment state of mind and what's happening with coping at the moment, together. We then work out what might be helpful. This could be in supporting normal coping, helping them return to normal, or at times, we might encourage new coping strategies. Sometimes, we encourage people to balance up. For example, those with an avoidance strategy could perhaps try accepting more social support and practice expressing difficult emotions. For those with a preoccupied strategy, they could learn more skills in managing their anxiety, maybe by practicing relaxation, diaphragmatic breathing, meditation, mindfulness, or exercise. In this process, we sometimes realize when trauma or loss is really disrupting someone and find the need to re-establish a sense of safety, support, stability, to build their recovery. Bowlby said, "Attachment goes from the cradle to the grave." - meaning that across a whole life, we need to be in relationships to give and receive help and love. And that this is a part of the story of being human, being well, resilient, and of recovering and growing after illness.
