Attachment, Disease and the Biology of Loss

mother and baby securely attachedWe are seeing an unprecedented rise in mental health issues like depression and anxiety. They are considered by mainstream medicine to be biological entities; i.e. disordered brain physiology which demands a biological resolution.

A different approach is the behavioural model which seeks to explain it as ‘bad behaviour’ e.g. with a label like Addiction, ADHD, BPD, etc which needs control either by punishment (progressing from the ‘naughty step’ in childhood, through to social isolation and ultimately, for some, prison) or ‘just say no’ admonishments. Neither of these approaches show much long term benefit, and it ignores the fact we are socially regulated creatures. If you look at how other social creatures operate, e.g. ants for instance, in an ant colony it is epigenetic (environmental) mechanisms that create the queen – she has no different genes to any other ant – it is purely the result of how she is treated that determines her development. Things like the foods she is fed, the touch she receives and the hormones and other chemicals that infuse her changes the expression of her genes. Could it not be true of humans also?

These conditions and most diseases are Biopsychosocial phenomena (BPS) -they are biological, psychological and socially mediated; it is the combination of these things that determines the individual experience of health or disease. In other words, “the one contains the many” and “all the lives that surround us are within us”.

We are noticing the limitations of the biomedical model (which assumes disease is a chemical/ material deviation from the norm). For instance, looking at the common childhood disease of asthma – which is caused by bronchial spasm causing inflammation. It is commonly treated with drugs that are mimics of cortisol and adrenaline (the hormones of stress) but we hardly ever ask whether stress is involved. This is a peculiar omission. It is the same with all inflammatory disease which often, (some would say always), has stress at its heart.

It can’t be purely biological for reasons that are becoming clear. Not all smokers get lung cancer, and some people seem to get disease despite having none of the obvious risk factors. Cancer, for instance, is not a disease of the individual but of the physiological effects of your relation to others. if your emotional pattern is one of never looking at your own needs but complying with the demands of others, and burying your feelings, especially anger, disease is often the result.

Another example is MS; the incidence has been rising inexorably particularly in women where there is now a preponderance 4:1 of women to men. Social isolation and stress plays a big role – women have traditionally been the absorbers of stress in our culture – now they are expected to take an economic role too. And this is not supported by a society that fails to support the needs of women and children.

Stress is more than a bad day at the office; it is an unconscious internal dynamic usually related to unconscious childhood beliefs, that can become chronic. Cortisol, the major hormone of the stress response, may be the mechanism; it is certainly damaging long term. We do know that stress can be assuaged by connection with others.

The BPS model informs both mental and physical illness

The work of Hoffman in ‘The Biology of Loss’ and that of trauma researcher Bessel van der Kolk shows us that chronic trauma in childhood as a developmental landscaper of the brain is highly significant. Trauma is a much misunderstood word. It may be may be that something terrible happened like mental or physical abuse but more commonly, it may be that something positive was withheld i.e. unconditional love and emotional connection. This trauma then represents the loss of attachment relationship and its results can be lifelong if unaddressed.

Humans are creatures of attachment. It overrides even the desire for life. This is biologically important so that we can be taken care of. A human child especially is vulnerable to loss of attachment because they are born almost entirely helpless and need attachment to survive; our brains are very immature. The quality of that attachment is significant for further brain development outside the womb and is something that actually changes the brain of the child when it is withheld; a developmental stage is often not completed properly, with the emotional brain (limbic system in the centre of the brain) failing to develop with a sense of safety at its core.

Now, all children have stress of some sort – even with the best parents in the world. Most children adapt to a rupture of relationship if it is repaired in good time by an empathetic and caring parent or significant caretaker. Indeed it is important for the child’s development to have some stress to create good boundaries and a sense of itself as separate. When the child learns that emotions (including conflict) can be born and even constructive they develop resilience . However, if it is prolonged and unrelieved then short-term stress translates into chronic stress which is the harbinger of long term disease and pathology.

An adaptation to early stress in the short term becomes a long-term adaptation if the stress is not mitigated. Stress as a ‘state’ then becomes a ‘trait’ i.e. hardwired into biologically driven survival behaviours. And it may not even be limited to one generation; certain patterns of multi-generational stress may be transferred down the generations as those childhood adaptations survive into the adult who then becomes a parent and is driven by anxiety and their own loss to unwittingly inculcate in their child more of the sense of lack, fear and loss. This has been shown in three generations of Holocaust survivors for instance and in animal models. It allows us to provide an explanation for why trauma seems to run in families.

A child is quite helpless to change the situation and has recourse to only a few options which are ruled by our biology; either the social engagement system (help-seeking) or the sympathetic response of fight and flight in that order. If they don’t work or are impossible then the only response is a freeze or dissociation response. Dissociation takes many forms, not all of them obvious; for instance, we ‘tune out’ or scatter attention (ADHD) to defuse the stress. It is a common feature of stressed children along with bed wetting, chronic ear infections, gut problems and so on. They are all elements of a reptilian freeze response arising from the parasympathetic system which innervates the head, face, and neck as well as the major organs above and below the diaphragm*.

And it can start from before birth. Children can feel the stress of their mother; they are bathed in stress hormones as they share a common blood supply through the placenta. Remember, brain development is a response to the environment and determines health and learning behaviour. One of the most important mind and body connections is a branch of the autonomic nervous system (ANS), the vagus nerve; and it is highly influenced by emotions. So, for example, a colicky baby which cries a lot, stresses the parents, will upset them. They then fail to respond to the baby, becoming nervous or fearful of the upset of their child. A dysfunctional dynamic is set up already which can be hard to rectify. Imagine if the mother is addicted, depressed or just unavailable permanently. The quality of adult responsiveness to the child then determines the development of that child’s brain and the ability to self-regulate their nervous system with lifelong effects on concentration, attachment behaviour and impulse control etc.

Many diseases have trauma at their core and the primary need is to re-establish a sense of bodily safety. No amount of talking can do this. It needs a bodily learning to re-train the ANS to operate under conditions not of threat but of safety; this then allows resolution of normal functioning and play, intimacy and creativity can resume. As medicine does not know of this link, (although it is written about in paediatric journals) the symptomatic treatment of specific ‘organ’ problems continues without any sense of the nervous and endocrine system that sustains it. We don’t yet have a systems-based of functional medicine approach[ii].

*This is the understanding of polyvagal theory developed by Stephen Porges. It is a major advance in our understanding of our neurobiology.

[i] Based on the workshop given by Gabor Mate at the Breath of Life Conference May 2017

[ii] Although there are doctors now training in this Functional medicine approach, they are still not state-funded in the UK. See the Institute of Functional Medicine for details of training and practitioners. See also the BBC TV programme Doctor in the House which shows examples of this approach.