Wednesday, 22 February 2012

Gabor Maté and Attachment Theory

We humans spend 18 years grooming our children for adulthood, a job that cats and dogs dispatch in a few months, and mice in a couple of weeks. Ironically, this slowness to mature, an apparent design flaw in the human animal, is a direct consequence of our greatest asset. If we stayed in the womb any longer, our over-sized brains would never fit through the birth canal. The premature nature of our birth, however, means that much brain development that occurs safely in utero for other mammals takes place for humans in the dangerously uncertain outside world. This makes us singularly vulnerable to developmental problems, especially in the first 3 years of life, during which time the fledgling brain grows to 80% of its adult size.

According to iconic Vancouver MD Gabor Maté, brain development can only proceed correctly in the right environment, which requires the presence of an emotionally available, constantly available, non-stressed adult caregiver. This is Attachment Theory which, like most of life's greatest truths, is at once incredibly simple and extraordinarily far-reaching in its ramifications. Seen through the lens of Maté's wisdom and experience, it is (for want of a better expression) a no-brainer.

Kids internalize everything. They steep in the emotional environment of their parents. It doesn't matter if those emotions are explicitly expressed or not, because over 90% of communication is non-verbal, and infants are hard-wired to read subtle cues. Parental moods are the air children breathe, parental energy the water in which they swim.

On a very practical level, stressed parents are not as present, and cannot respond reliably to cues. The infant internalizes such absence, inconsistency or unpredictably, becomes chronically anxious, and unconsciously draws a number of conclusions: people cannot be trusted, the world is not safe, hyper-vigilance is required. Or: I'm not worthy of attention, I'm not loveable, I'll never be good enough. Biologically encoded, these messages become the blueprint upon which all future relationships and life endeavours are based. The stressed child grows into a stressed adult, who creates self-perpetuating stressful life circumstances, then raises stressed-out kids. And on it goes...

In his four books, Gabor Maté has carefully exposed the many consequences of poor attachment relationships, beginning in Scattered Minds with Attention Deficit and Hyperactivity Disorder, a diagnosis that he received himself. The hallmark symptom of ADHD, he tells us, is 'tuning out'. As a long-term trait, tuning-out behaviour is disastrous. But in the short-term it is a healthy and logical adaptation for dealing with stress. When stress is chronic for a child, tuning out becomes a default setting, biologically encoded as deficits in emotional regulation and self-soothing, and low levels of dopamine, which Maté describes as 'the motivation molecule'. ADHD is treated with Ritalin, a medication which raises levels of dopamine. It shares this quality with cocaine, crystal meth, coffee, and cigarettes.
Our society has a tendency to judge addicts. We blame them for choosing to live the way they do. In his book about addiction, In the Realm of Hungry Ghosts, Gabor Maté describes the lives of numerous addicts he treated in Vancouver's Downtown East Side neighbourhood. It becomes clear that many of these people lead lives that are truly horrible, a living Hell, begging the obvious question: why would anyone choose such a life? What is the addiction doing for the person to justify so high a price? The answer is that, in a sense, all addiction is self-medication. The brain craves, discovers and consumes what it is lacking: dopamine, cortisol, endorphins, and so on.

Maté suggests that most issues, from mental disorders to addictions to physical ailments, could be explained by a single underlying diagnosis: Developmental Trauma Disorder. As evidence, he asks us to consider Adverse Childhood Experience scores, which measure trauma, neglect, abuse and so on. Research has demonstrated that, with higher ACE scores, the risks not only of addiction and mental health issues, but also of obesity, asthma, cancer, premature death, suicide, and numerous physical ailments, all rise exponentially. The link between chronic stress and diseases including cancer, by the way, is brilliantly exposed in his book When the Body Says No.

Hold on to Your Kids, a book that Maté wrote with Clinical Psychologist Gordon Neufeld, explores a more insidious danger. In the absence of healthy adult attachment figures, kids attach to other kids. Attachment naturally entails emulation. When kids become peer-oriented, they mimic each others vocabulary, opinions, feelings and culture - which are inevitably narrow and immature - instead of aspiring to those of adults. Attachment also engenders a sense of belonging and loyalty. The eight teenagers involved in the 1997 murder of Reena Virk here in Victoria displayed great loyalty to each other, a tragic example of how noble qualities can be hideously corrupted when a gang mentality is untempered by mature reasoning, when teens look desperately to each other for values and acceptance.

There is no safety in the peer group, because belonging is always contingent on obedience to implicit rules. Rule number one is that the exhibition of vulnerability is shameful, and punishable by mockery and exclusion. Like crabs, who have to shed the protective armour of their hard shells in order to grow, human emotional growth requires vulnerability. When growth is blocked and emotional shut-down becomes the norm, only the most extreme stimuli - such as violent TV, graphic video games, premature and risky sexuality, alcohol and drugs - can get through the hard shell to evoke any reaction at all.

The good news is that we adults can offer our kids something that their peers can never equal: unconditional love and acceptance. If you feel that you've already lost your kids to the peer group, resist imposing pressure: that will only make them push back harder. The solution is to re-engage them in a relationship based on unconditional love.

For those with infants, Gabor Maté's message is equally clear and positive. Airlines instruct us to secure our own oxygen mask before helping our kids with theirs. It makes sense: a dead parent is no use to anyone. Since kids internalize their parents' emotional state, it makes equal sense that we must fix ourselves - dealing with our own stress, frustration, anger, regret and dissatisfaction - before we can give our kids what they need: the presence of an emotionally available, constantly available, non-stressed adult caregiver.

Paraphrasing Vietnamese Buddhist monk Thich Nhat Hanh, Maté assures us that the greatest gift a parent can give to their child is their own happiness. Happy wife, happy life, I used to believe (and still do). Now I've added: happy parent, happy child. As a counsellor, I believe that people sometimes need help to find that happiness, and there are many resources for those that seek them. But for all parents, the greatest source of happiness is also its final recipient: their children. All we have to do is love them and en-joy them, "not" as Gabor Maté says, "because of what they do, but because of who they are."

When a client starts describing their life in terms of recurring patterns, I immediately suspect that their childhood attachment relationship is involved. It makes sense: the brain development that occurs in infancy provides the blueprint for our future life, as well as the foundation upon which that life will be built. Particularly because they date back to a time which our conscious memory can remember only hazily, if at all, these issues are very hard to address. But there are two clear routes through which healing can proceed:

Relationship: It is through relationship that many problems begin, and through relationship that they can be healed. If the attachment relationship has provided a dysfunctional blueprint that keeps replaying in a person's life, then the powerful counsellor-client relationship can over-write that blueprint with a new, more healthy alternative. Why? Because a good counsellor is able to offer their client the things that we all need and crave: unconditional positive regard, a complete lack of judgement, acceptance of the person as they are, understanding, empathy, authenticity, and the encouragement of the person's deepest, truest, most positive self.

Through the pivotal role of choice, as explained in my blog of October 13, 2011: We do not have to keep reliving our dysfunctional patterns. We can recognize them, explore them, challenge them, and choose, moment by moment, to inhabit and engender the alternative, more positive self that we want to carry into the future. Who will win, the black wolf or the white wolf? The one we feed!

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