“Addictions from an Attachment Perspective”—A Review (part I)

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Each year starting in 1993 The Bowlby Centre in London has put on The John Bowlby Memorial Conference. For the twentieth anniversary in 2013, the theme of the conference was addiction looked at from an attachment perspective. In 2014 the proceedings of the 2013 conference were published under the title Addictions from an Attachment Perspective—Do Broken Bonds and Early Trauma Lead to Addictive Behaviours? In this blog series I’d like to pull a number of insights from each chapter. I found this book to be wildly informative mainly because it looks at addiction and attachment from many different points of view: clinical, research, individual, family, political, theoretical, and policy. The authors (speakers)—either individually or as a group—take stands that are similar to the various stands I have taken in my Bowlby Less Traveled blog posts. As an example, Jason Wright [1] writes the following in Chapter Two (Addiction: Treatment and its Context):

The emptying out of symbol into hollow commodity, and the resulting attachment to commodity rather than relationships between individuals or communities is the emptying out of life….

[An] example might be the turning of life’s difficult experiences into medical and insurable commodities of the DSM 5 (Diagnostic and Statistical Manual 5).

I have railed against the DSM in my blog posts by pointing to such books as Gary Greenberg’s 2013 book entitled The Book of Woe: The DSM and the Unmaking of Psychiatry. And now we have Zero to Three—a professional trade organization representing infant mental health practitioners—creating a book of woe for infants and young children: Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Revised (DC:0-3R). As Greenberg points out, the DSM is a big multi-million dollar money-maker for the APA (American Psychological Association). My guess is that the DC:0-3R is also a profit center for Zero to Three. Recall that Zero to Three got their hand caught in the Disney cash jar when they entered into an agreement with Disney to produce and sell instructional DVDs aimed at infants and young children. Zero to Three backed off after the public (and many infant mental health experts such as T. Berry Brazelton) called foul. For more on this topic, see the Washington Post article entitled Experts Rip ‘Sesame’ TV Aimed at Tiniest Tots.

Did I find kindred spirits in the pages of Addictions from an Attachment Perspective? You bet. Will everyone enjoy this book? Probably not. Why? Well, the authors take stands that are not necessarily popular. As an example, Bob Johnson in Chapter Six (Using “Intent” to Remedy Mal-Attachment) emphatically states: “All mental health problems, especially and including addiction, are ‘software problems,’ not ‘hardware problems’ and require copious software support and insight to correct.” Translation: there’s no such thing as an “addiction gene.”

So, if you care for the DSM (and many do) and such things as gene explanations (i.e., there’s an alcoholism gene or a drug abuse gene) then Addictions from an Attachment Perspective will most certainly get your hackles up. Did I agree with everything said? No. Many of the authors used psychodynamic frames. Like Bowlby, I’ve become adept at translating psychodynamic concepts over to more scientifically informed concepts. As an example, in my review of Bowlby’s book The Making and Breaking of Affectional Bonds, I pointed out that Bowlby would regularly translate the psychodynamic concept of “internalizing an object” over to the world of cognitive science with its focus on Inner Working Models. Outside of a bit of translation along the lines of what I have just described above I got along with the authors swimmingly. I’m not sure behaviorists or determinists will fare as well. Let’s dig in.

In his introductory chapter Richard Gill asks a question that will come to guide the information presented in subsequent chapters: “Is addiction a search for a secure base?” If you answer no, then the information to come will probably be of little help. Gill fleshes out his question thus: “Does addiction provide the soothing and safety which are features of an internalised secure base and from which the person can then emerge and engage in exploration?” Rather than “internalised secure base” I would use the term Bowlby used (drawn from cognitive science): Inner Working Model. For an in depth look at the topic of Inner Working Models or Maps, I would point the reader to neurobiologist Antonio Damasio’s 2010 book entitled Self Comes to Mind (which I have blogged about recently). Again, with a bit of translation, the neurobiologists and cognitive scientists among us should feel comfortable with the psychodynamic concepts used in Addictions from an Attachment Perspective. Gill suggests that we frame addiction in adults as both a “signpost to earlier suffering” and as evidence of a “human being’s struggle to survive.” Gill cautions us to not fall into the trap of framing addiction as “the end result of selfish indulgence,” which, sadly, is a common frame often associated with descriptions of the addictive process.

To close out his introduction Gill moves up to community and even global levels. Gill invites “society to become more aware that the pain and shame that those with an addiction carry belongs not only to them, but is the result of how society treats the breakdown in early attunement and later emotional communication difficulties on an individual, worldwide and everyday level.” As cognitive scientist turned political commentator George Lakoff tell us in his 1995 book Moral Politics, conservatives tend to place social problems within individuals (YOYO – you’re own your own). In contrast, liberals tend to place social problems on a continuum that contains the individual as well as society (WIIT – we’re in it together). Suffice it to say that Addictions from an Attachment Perspective takes a liberal, “we’re in it together,” view.

In the next installment I’ll start with Jason Wright’s Chapter Two—Addiction: Treatment and Its Context (mentioned above). I’ll skip over Kate White’s Chapter One (Attachment Theory and The John Bowlby Memorial Lecture 2013: A Short History) as it’s a short history of The John Bowlby Memorial Conference. If that history is of interest to you, then, by all means, grab a copy of Addictions from an Attachment Perspective. White does mention one important point worth keeping in mind: “The [long history of] hostility of the psychoanalytic establishment to Bowlby’s ideas.” White does suggest that this animosity has cooled a bit in recent decades owing in large part to the fact that the “clinical relevance of attachment theory has been unquestionably established.” As I pointed out in my review of the book entitled The Origins of Attachment—Infant Research and Adult Treatment co-written by Beatrice Beebe and Frank Lachmann, hostility hotspots remain (especially when discussions turn to one of Bowlby’s favorite topics: evolution). White does make the following “take home” statement: “[Bowlby’s] preparedness to leave the closed world of psychoanalysis of his time in order to make links with other disciplines such as animal studies [ethology] and academic psychology was vital to the building up of attachment theory.” Clearly Bowlby felt secure enough to leave the safety of psychoanalysis, venture out and explore other worlds—organic systems theory, cognitive science, ethology, developmental psychology, control theory, evolution and others. I’ll see you again in part II.


[1] If you’d like to know the backgrounds of the various authors (speakers), grab a copy of Addictions from an Attachment Perspective. Their profiles appear at the beginning of the book. Keep in mind that most of the speakers hail from the UK. So, when they talk about “commodification of lived experience” or “manualisation of treatment protocols,” these are problems occurring in both the US and the UK. Recall that I blogged about an article by Dr. Jay Watts entitled Cognitive Behavioural Therapy Does Not Exist. Dr. Watts is from the UK. Commodification of lived experience, manualisation of treatment protocols, and the DSM are largely US exports that other countries are having to grapple with as well. He who creates a standard of practice, wins. Facebook and Amazon are evidence of this fact.