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THE BIOPSYCHOSOCIAL ROLE OF MOTHER-INFANT ATTACHMENT

IN EM OTION REGULATION AND A MODEL OF PROJECTED
PSYCHOPATHOLOGY RESULTING FROM ATTACHMENT DEFICITS AND
DISTORTIONS
A DISSERTATION SUBMITTED TO THE FACULTY

OF
THE SCHOOL OF PROFESSIONAL PSYCHOLOGY
SPALDING UNIVERSITY
BY
VICKI LYNN HAYES
IN PARTIAL FULFILLMENT OF THE

REQUIREMENTS FOR THE DEGREE
OF
DOCTOR OF CLINICAL PSYCHOLOGY
MARCH 26, 2001
UMI Number. 9999989
Copyright 2001 by
Hayes, Vicki Lynn
All rights reserved.
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unauthorized copying under Title 17, United States Code.
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Copyright 2001 by Vicki L. Hayes
THE BIOPSYCHOSOCIAL ROLE OF MOTHER-INFANT ATTACHMENT

IN EMOTION REGULATION AND A MODEL OF PROJECTED
PSYCHOPATHOLOGY RESULTING FROM ATTACHMENT DEFICITS AND
DISTORTIONS
A DISSERTATION SUBMITTED TO THE FACULTY

OF
THE SCHOOL OF PROFESSIONAL PSYCHOLOGY
SPALDING UNIVERSITY
VICKI LYNN HAYES
IN PARTIAL FULFILLMENT OF THE

REQUIREMENTS FOR THE DEGREE
OF
DOCTOR OF CLINICAL PSYCHOLOGY
LOUISVILLE, KENTUCKY
APPROVED:
DATE:
John A. James, Ph.D.
DATE:
^ ^
David L. Morgan, J h.D
David W. Richart, Ph.D.
Reproduced with permission o f the copyright owner. Further reproduction prohibited without permission.
ACKNOWLEDGEMENTS
I take this opportunity to thank the members o f my dissertation committee, Dr.
John A. James (chair), Dr. David L. Morgan, and Dr. David W. Richart, for granting me
the freedom to pursue this unusual dissertation, for their encouragement and support, for
their patience in grappling with such a lengthy document, and for their words of wisdom.
Each offered valued contributions and together they provided a terrific blend of
biopsychosocial perspectives, that not only enhanced the quality o f this work, but
enriched the thinking that shaped and produced it.
I especially want to thank Dr. John James, not just because he was my chair, but
because he has been an inspiration and mentor throughout my graduate career at
Spalding. John is the quintessential teacher. His classes were my absolute favorites,
introducing me to astounding subjects and new concepts regarding how human beings are
made that reshaped my thinking. He always left me wanting to learn even more (and still
does). Perhaps what I appreciate above all else is his genuine passion for psychology.
The respect, warmth, kindness, and support he has continued to show me mean a lot.
I want to thank Dr. James P. Bloch for his inspiration, understanding, unfailing
support, warmth, kindness, and incredible wisdom. Jim, too, has a passion for
psychology. He never stops thinking about it; he never stops learning. Always ten steps
ahead, no one knows more about attachment and attachment related psychopathology
than Jim Bloch.
Thanks also go to supervisors (and good friends) Drs. Nancy Schrepf, Terry
Pearson, Pat McGinty, Paul Stratton, and internship training director, Larry Gaupp who
ii
provided the freedom, respect, encouragement, mentoring, and mirroring I needed to

come into my own as an emerging, competent clinician.
I dedicate this dissertation to those individuals who have permitted me access to
their innermost selveswho entrusted me with their pain, vulnerabilities, and greatest
fears. It is hoped that through this work I have come to better understand the nature of
their wounds and what needs to be done to help heal them.
iii
ABSTRACT
This study (1) delineated the biopsychosocial roles o f mother-infant attachment in
emotion regulation, (2) devised a developmental model for projecting psychopathology
resulting from attachment deficits and distortions, and (3) provided a demonstration o f
the models effectiveness, using existing data. Contributions o f mother-infant attachment
phenomena to emotion regulation in the developing child were delineated per each of six
incremental age periods spanning 0-3 years of age. Literature reviews synthesized six
strands o f data (available brain, developing brain, observable infant capabilities, relevant
developmental theories o f psychology, mother-infant attachment mechanisms,
psychopathology) from which a list o f projected enduring traits o f attachment deficits and
distortions were formulated per each o f the age periods. Dataselected for consistency
across neurobiological, neurophysiological, developmental, behavioral, and clinical
vantage pointswere mapped together for the purpose o f bringing a bigger
(biopsychosocial) picture into view. Predictive descriptions of psychopathology arising
from attachment deficits and distortions were formulated by working forwardin a
sequential, additive fashionfrom the emerging end o f the developmental trajectory, in
keeping with the models developmental premise and General Systems Theory principles.
Demonstrating the models effectiveness produced a theory o f aberrant aggression
resulting from early infant trauma based on evidence o f opioid mediated adaptations,
depletions, and deficiencies.
IV
TABLE OF CONTENTS
Page
ACKNOWLEDGEMENTS...............................................................................................
ii
ABSTRACT.........................................................................................................................
iv
LIST OF FIGURES............................................................................................................
viii
CHAPTER
L
INTRODUCTION.................................................................................................
Background............................................................................................................. ........ J
Purposes o f Dissertation........................................................................................
Questions Addressed by Dissertation..................................................................
10
Research Methodology..........................................................................................
11
Implications.............................................................................................................
12
H.
REVIEW OF ATTACHMENT THEORY MILESTONES..............................
13
EH.
METHODOLOGY................................................................................................
"JJ
>o
A Biopsychosocial Model for Projecting Psychopathology Resulting from

Attachment Deficits and Distortions.......................................................
33
Adherence to General Systems Theory (and Evolution) Principles.................
33
Interaction of Stress and Ability to Achieve Homeostasis.................................
42
Systematic Biopsychosocial Steps for Projecting Psychopathology

Resulting from Attachment Deficits and Distortions.............................
43
Definitions...............................................................................................................
46
IV.
RESULTS PART I: DETAILED DEMONSTRATION OF MODELS

EFFECTIVENESS FROM B IR T H -T W O MONTHS: (ANYTHING BUT)
AUTISM.......................................................................................................................50
The Nature o f Brain Development Following Birth................................................ 50
Differentiation.................................................................................................51
Myelination..................................................................................................... 57
Critical Periods................................................................................................59
Available Brain............................................................................................................71
Structures........................................................................................................ 73
Neurophysio logy............................................................................................ 77
Emotion Circuitry.......................................................................................... 82
Developing Brain: Coming (On-Line) Attractions................................................. 92
Structures........................................................................................................ 92
Emotion Circuitry.......................................................................................... 98
Newborn Capabilities: Observable Phenomena..................................................... 108
Developmental Theories o f Psychology Rooted in Corresponding
Observable Phenomena................................................................................ 117
Developmental Tasks and Mechanisms of Mother-Infant Attachment:
Birth to Two Months: Achieving Homeostasis......................................... 126
Mother as the Facilitating Environment.....................................................127
Mother-Infant Developmental Task: Achieving Homeostasis:
Arousal Regulation is a Two-Person Job....................................... 137
vi
Psychopathology Resulting from Attachment Deficits and Distortions:

Birth to Two Months: Dysregulation of Arousal................................... 176
Infants of Depressed M others.......................................................................178
Traumatized Newborns................................................................................. 188
Summary: Nature of Psychopathology Arising from
Developmental Period: Birth to Two Months.......................... 243
IV.
RESULTS PART II: SUMMARY OF PROJECTED PSYCHOPATHOLOGY

RESULTING FROM ATTACHMENT DEFICITS AND DISTORTIONS
DURING SEQUENTIAL AGE PERIODS FROM AGE 2-36
MONTHS...............................................................................................................-.-248
2- 5 Months: Symbiosis............................................................................................248
5-8 Months: Selective Attachment.......................................................................... 279
8-18 Months: Practicing............................................................................................296
18-24 Months: Rapprochement.......................................................................... 318
24-36 Months Object Constancy.............................................................................327
V.
DISCUSSION....................................................................................................... -...339
REFERENCES...................................................................................................................- . 3 7 4
vii
LIST OF FIGURES
FIGURE 1
Emotional Brain Development: Ages 0-36 Months..................................338
viii
CHAPTER I
INTRODUCTION
There have been many approaches to understanding long-term psychopathology
with good agreement that such psychopathology is rooted in events o f early childhood.
However, most have elected to elucidate possible causal factors by extrapolating
backward from the point in the developmental trajectory at which symptoms are showing
themselvesadulthood. Such symptoms are quite salient compared to otherwise normal
adult features such as intellectual or physical capabilities, interests, competencies, or
behaviors. In this manner, they take on a mysterious, intriguing quality. However, if such
symptoms are viewed as clues to the developmental age at which psychopathology first
emerged, they can provide pathways back to what might have been going on in the
individuals life that disrupted normal, healthy psychological development. Theorizing can
certainly be done working backwards, but speculation may remain vague with limited, if
any, legitimate opportunity to collect data that can retroactively confirm (or disaffirm)
hypotheses.
Another approach is to begin at the beginning of the developmental trajectory, to
catch psychopathology as it first emerges in direct relation to its precipitant. If
psychopathology represents abnormal or disrupted development, what has thrown normal
development off course? In order to explore the roots of psychopathology in this manner,
several steps must be taken. First, normal developmental processes and their required
conditions must be pinned down. Psychopathology might, therefore, be projected by

anticipating what would occur if critical aspects of those conditions were missing or
aberrant-given developmentally determined capacities for adaptationat various points
along the brains developmental trajectory.
As with all mammals, human development unfolds within the context o f motherinfant interaction. Therefore, deficits or distortions in this reciprocal relationship might be
causal factors giving rise to psychopathology. Should such causal factors go uncorrected,
perhaps for the duration of periods in which affected portions of the brain are becoming
formed and set in their ways, this would provide explanation for the long life and
intractability o f such symptomssymptoms that have been around so long they are often
considered to be characteristics of an individuals personality.
It is the aim of this dissertation to generate a model for elucidating long-term
psychopathology using such a developmental, epigenetic approach. To develop the
model, contributions of mother-infant attachment phenomena to emotion regulation in the
developing child will be delineated per each of six incremental age periods spanning 0-3
years of age. Literature reviews will synthesize six strands of data (available brain,
developing brain, observable infant capabilities, relevant developmental theories of
psychology, mother-infant attachment mechanisms, and psychopathology) from which a
list o f projected enduring traits of attachment deficits and distortions will be formulated
per each o f the age periods. Data will be selected for consistency across neurobiological,
neurophysiological, developmental, behavioral, and clinical vantage points and mapped
together for the purpose of bringing a bigger (biopsychosocial) picture into view.
Predictive descriptions of psychopathology arising from attachment deficits and distortions
will be formulated by working forwardin a sequential, additive fashionfrom the

emerging end o f the developmental trajectory, in keeping with the models developmental
premise and General Systems Theory principles.
A detailed demonstration to determine effectiveness of proposed model steps will
be produced for the initial 0-2 Months age period. It is predicted, that by following model
steps, new insights into long-term psychopathology, continuing even into adulthood, will
be gained from conducting the demonstration.
Background
In his landmark 1945 article, Hospitalism, Rene Spitz brought to the fore that
young infants confined to foundling homes and other institutions during the first year of
life suffered dire consequences, primarily due to maternal deprivation. Not only did
institutionalized, mother-deprived children become asocial, delinquent, feeble-minded,
psychotic, or problem children, (p. 54), but they could die. In 1944, John Bowlby, the
English child psychiatrist from the Tavistok Clinic, began his studies o f the effects o f
mother-infant separations on the development o f childrens personalities leading him to
develop his theory of mother-infant attachment, first published in his 1958 article, The
Nature o f a Childs Tie to His Mother, and culminating in his seminal trilogy: Attachment
(1969), Separation (1973), and Loss (1980). Bowlbys writings remain the quintessential
work on attachment, generating a vast body o f research by developmentalists, biologists,
clinicians, behaviorists, and neurobiologists that continues to grow by leaps and bounds
into the 21st Century. The reason this work retains its edge, even at this time when new
technologies permit human as well as animal neurobiological discoveries at a breath-taking
pace, is that Bowlbys conceptualization is rooted in evolutionary principles, biology,
neurobiology, and natural behavioral observation. Bowlby was so taken with the theory
o f evolution that he penned a biography o f Charles Darwin (1990). In part, through his
participation in the World Health Organization, he was exposed to and greatly influenced
by cutting edge scientists o f the 1950s that included ethologist Konrad Lorenz; primate
biologist Harry Harlow; neurobiologists Miller, Galanter, Pribram, and Young (whose
control theories provided models for neurobiological substrates o f homeostatic behavior),
anthropologist Margaret Mead; developmentalists Sigmund Freud, Rene Spitz, Jean
Piaget, and Erick Erickson; and last, but certainly not least to this dissertation, general
systems theorist von Bertalanfly (Ainsworth & Bowlby, 1991; Bowlby, 1969).
John Bowlbys theory captures the essence o f a biopsychosocial approach to
understanding and articulating phenomena of psychology and psychopathology. That his
work continues to hold up against vast new biological discoveries, and that the drive to
understand attachment phenomena has intensified, to include its role as the facilitating
environment (Winnicott, 1965) for the developing brain, nearly 50 years later, attests to
the advantage o f the biopsychosocial model. Part and parcel o f this approach is the
understanding that living organisms are grounded in their evolutionary roots.
The scientists who have just completed the awesome achievement o f detailing the
entire human gene code (National Institutes of Health & Celera Genomics Corporation,
2001) shared that among their most amazing discoveries is that the evidence o f evolution
is so readily apparent. For exampleconsistent with natures fondness for tinkering with
old systems to refine or produce new, even more adaptive functions in the service o f
meeting existing environmental demandshuman genes appear to be constructed by
mixing, matching, or globbing new parts onto old parts. Another discovery is that
phenotypic presentations are not so hard wired as commonly believed, affording a great
deal o f flexibility which, o f course, can be an adaptive advantage should conditions
change. These scientists warned against the simplistic notion that one specific gene gives
rise to one particular trait or disease, stressing instead that environmental influence (at
multiple levels) provides the interactive context that guides genetic expression.
Intracellular protein dynamics, which also have a primary role in maintaining homeostasis
sensitive to environmental demands, appear to hold the key to the complexity of genetic
expression not just to the end o f maturation, but throughout the lifespan.
The obvious big picture (vs. piece meal) advantage o f coming to understand
psychology phenomena from a biopsychosocial (three or more tiered systems) approach is,
needless to say, offset by the added complexity. This is where general systems theory
comes to the rescue by providing a few hard and fast rules o f nature that absolutely cannot
be violated. Therefore, systems theory provides the frame for placing one overlay o f data
atop the next as well as the means o f weeding out extraneous, systems-inconsistent
material. Examples o f systems rules that are critical to the formulation o f the model
proposed in this dissertation are that systems evolve from simple to complex, systems are
hierarchical with higher order systems subsuming all components o f the subsystems that
comprise them, and that the integrity o f higher order systems is, therefore, dependent upon
the integrity o f their lower order systems. Systems exchange energy with and are
dependent upon their environmental systems for their ongoing development and survival.
Should such energy not be forthcoming, systems can begin to unravel, losing their
complexity, perhaps becoming disorganized altogether in the process called entropy
(James, 1999).
To tease out characteristics o f psychopathology arising from attachment deficits

and distortions, the logical first step (albeit a. daunting one) is to understand how
normal mother-infant attachment operates as the context for facilitating the development
o f the human brain. The subject o f this dissertation, therefore, demands beginning at the
beginning, and following the brains epigenetic course o f increasing sophistication and
reorganization as it gains momentum along its developmental trajectory. To begin at
birth, when phenomena are more simple a n d easier to grasp also demonstrates how
natures tools (often simply retooled) are used time and again, lending order to the
increasing complexity. The concept o f how/ developing brains reinvent o r reorganize
themselves as more sophisticated information processing systems come on-lineadding a
new twist, yet based on information already^ collected by lower systemsis perhaps best
articulated by Greenough, Black, and W allace (1987) who refer to this process as stagesetting (p. 553).
Two other percepts developed by these theorists are experience-expectant and
experience-dependent information mecha_nisms utilizing the brains plasticity in
interaction with its environment to obtain amd incorporate information required for
ongoing development and optimal survival. Experience-expectant systems refer to
emergent brain componentscoming on board during infancythat require (are genetically
hard wired for) specific types o f stimuli from the environment to spur their normal
development. If the expected stimuli are n o t forthcoming or are somehow distorted
during the span of that brain parts developmental window, abnormal development will
ensue. Not only did Harry Harlows (H arlow & Zimmerman, 1958) w ork with primates
provide some o f the most compelling evidemce that the physical contact with a soft mother
provides a more potent, desirable stimulus to an infant than even food, he was able to
demonstrate that infants who are deprived of their mothers during critical periods of
their development suffer dire, permanent psychopathological consequences (Deets &
Harlow, 1971).
For efficiency; to gain a simplified, more understandable view; and to aim for as
much precision as possible, the author o f this dissertation made the decision to pin down
the neurobio logical subsystem bones first, then overlay only those social, developmental,
behavioral, and clinical observations that fit the bones. Fortunately, Jaak Panksepp
provided a place to start. This neurobiologist (Panksepp et al., 1978) identified a critical
biological substrate by discovering the role o f endogenous opioids in mediating motherinfant attachment (that will be discussed in depth throughout this dissertation). In
addition, Panksepp has reconceptualized human emotions based on the neurobiological
circuits giving rise to them. He has utilized evolutionary principles and sorted through
vast numbers o f animal studiesmany o f which he and colleagues conducted themselves
to develop constructs that are so tangible they provide a fairly tight, concrete (vs. elusive,
abstract) frame for understanding emotions, particularly as they arise from within the
social-emotional context o f the mother-infant attachment relationship. Once getting used
to some new descriptive names and ways o f looking at emotions, Panksepps
reformulations provide practical insights into otherwise baffling observations of emotional
behavior.
Jaak Panksepp (1998) conceptualizes each emotion system as a genetically
predetermined, organized neural circuit that responds unconditionally to stimuli arising
from major life-challenging circumstances (p. 48), provides feedback (feelings), solves a
particular set of problems, and organizes adaptive behaviors or other responses in relation
to the environment for the ultimate goals o f survival and reproduction. Emotion circuits
organize diverse behaviors by activating or inhibiting motor subroutines and concurrent
autonomic-hormonal changes that have proved adaptive in the face o f such life-challenging
circumstances during the evolutionary history o f the species (p. 49).
Ability to delineate biological substrates is a logical litmus test for any theory o f
psychology, because without biology, psychology would cease to exist. And, in this day
and age, neurobio logical discoveries (i.e. Harry Chuganis PET scans showing the
ascendancy o f each new brain subsystem as it comes on board and subsequent
reorganizationfrom brainstem to cortexover the course o f the developing human brain)
are beginning to fill in the gaps where previously theoretical intervening variables had to
serve as stand-ins to explain as o f yet to be understood psychological observations (James,
1999, p. 19). John James (1999) proposes that
Systems theory would suggest that as the gap represented by brain complexity is
reduced, intervening variables will be replaced by concrete systems models that can
specify the physical path o f the (Energy/Information) through the brain. Those
scientific psychologists who wish to construct models o f behavioral functioning
that will interface and articulate with those models developed by sciences using
concrete systems will have to formulate their research using terminology and
concepts that map onto concrete systems, (p. 23)
The author of this dissertation plans to follow this approach.
Purposes of This Dissertation
The purposes o f this dissertation are to (1) delineate the biopsychosocial roles of
mother-infant attachment in emotion regulation, (2) devise a developmental model for
projecting psychopathology resulting from attachment deficits and distortions, and (3)
provide a demonstration o f the models effectiveness, using existing data. Inherent goals
are to identify necessary factors for establishing a healthy psychological foundation and to
provide plausible explanations for resistant, long-standing psychopathology.
This dissertation will explore phenomena o f mother-infant attachment, particularly
their contributions to emotion regulation in the developing child over six incremental age
periods spanning 0-3 years. Once the nature and functions o f healthy attachment
phenomena are delineated, focus will shift to the nature o f attachment deficits and
distortions (baby trauma) and their contributions to emotion dysregulation during the same
time periods. Predictions will be formulated for what individuals with attachment deficits
and distortions would look like at various points along the developmental continuum.
Projected descriptions of attachment related psychopathology will be formulated by
working forward from the emergent end o f the developmental trajectory vs. extrapolating
backward from adulthood. The hope is that this processwhich overlays consistent data
from a variety o f disciplines and vantage pointswill shed additional light on entrenched,
long-standing patterns of psychopathology.
Questions Addressed by this Dissertation

1. What components o f attachment theory inform this work?
2. Can biological substrates be identified that can account for observations o f infant
behavior and tenets o f existing developmental theories o f psychology?
3. What are the nature and functions o f mother-infant attachment, particularly as they
relate to emotion regulation in the developing child?
4. What are the biological substrates (brain structures, psychopharmacology, and
emotion circuitry) involved in mother infant attachment?
5. Do environmental factors affect human brain development? If yes, how?
6. What are the nature and sources o f attachment deficits and distortions (infant trauma)
and their relationship to emotion dysregulation?
7. What are the biological substrates (brain structures, psychopharmacology, and
emotion circuitry) involved in separation, prolonged separation, attachment deficits,
and attachment distortions (infant trauma)?
8. What risk factors to resiliency (i. e. from loss, illness, physical pain, subsequent
traumatic event) are likely to emerge from attachment deficits and distortions?
9. What are some predicted enduring traits resulting from attachment deficits and
distortions? How might they look at various points along the developmental
continuum?
10. Can attachment related psychopathology for children and adults be identified by
working forward from the emergent end of the developmental trajectory (vs.
extrapolating attachment deficits and distortions by working backward from
adulthood)? If yes, what are the advantages and disadvantages to this approach?
10
Research Methodology
A biopsychosocial model for projecting psychopathology resulting from
attachment deficits and distortions, adherent to general systems theory principles, will be
delineated (CHAPTER IH). Model steps will be followed in developing a demonstration
o f its effectiveness for age 0-2 months (CHAPTER IV-RESULTS: PART I). Using an
abbreviated process, projected vulnerabilities resulting from the types o f attachment
deficits and distortions that might emerge per each o f six age periods (0-2, 2-5, 5-8, 8-18,
18-24, and 24-36 months) will be summarized (CHAPTER IV-RESULTS: PART II).
Advantages and disadvantages o f this model as well as its implications for assessment,
treatment, and prevention will be addressed (CHAPTER V-DISCUSSION).
Multiple literature reviews will be conducted to (1) delineate the biopsychosocial
roles o f mother-infant attachment in emotion regulation and (2) demonstrate the
effectiveness o f the proposed Biopsychosocial Model for Projecting Psychopathology
Resulting from Attachment Deficits and Distortions. All research questions (above) will
be addressed in the process. To accomplish these tasks, dataselected for consistency
across developmental, neuropsychological, psychopharmacological, behavioral and clinical
vantage pointswill be pulled together for the purpose o f bringing a bigger
(biopsychosocial) picture into view.
Literature reviews will synthesize six strands of data (available brain, developing
brain, observable infant phenomena, relevant developmental theories o f psychology,
mother-infant attachment mechanisms, psychopathology) from which a list of projected
enduring traits of attachment deficits and distortions can be formulated, per each of six
incremental age periods from 0-36 months. Predictive descriptions o f what individuals
11
with attachment deficits and distortions would look like at various points along the
developmental continuum will be formulated by working forwardin a sequential, additive
fashionfrom the emerging end o f the developmental trajectory, in keeping with the
models developmental premise.
Due to the synthesized nature and exceptional length o f this document, this
dissertations committee has granted special permission to utilize a large number of
extended quotations and to utilize single-spacing for extended quotations vs. the
customary double-spacing generally required for dissertations. Special headings for the
six sequential age periods: "Autism", "Symbiosis", "Selective Attachment", "Practicing",
"Rapprochement", and "Object Constancy", are terms formulated by Margaret Mahler,
Fred Pine, and Anni Bergman (1975) for these developmental periods as delineated in
their landmark theoretical work, The Psychological Birth o f the Human Infant.
Implications
The significance o f the proposed model is that it will provide a more systematic
and consistent developmental, biopsychosocial framework for acquiring data, formulating
hypotheses, researching, conceptualizing, assessing, and treating attachment related
psychopathology. It can be used to elucidate environmental contributions to the
development of psychopathology, providing hope o f prevention. It can also be used to
identify, protect, and enhance essential factors for establishing a healthy psychological
foundation.
12
CHAPTER II
Review of Attachment Theory Milestones

There is universal agreement that the first individual to propose a theory for human
mother infant attachment was the English child psychiatrist from the Tavistok Clinic in
LondonJohn Bowlby. Following his undergraduate studies in medicine at Cambridge
University, Bowlby worked as a volunteer in a residential school for maladjusted children.
Two children at this school made a notable impression on him, an impression that served
to steer him into the course o f his lifes work:
One was an isolated, affectionless adolescent who had never experienced a stable
relationship with a mother figure, and the other was an anxious child who followed
(me) around like a shadow. Largely because o f these two children, (I) resolved to
continue (my) medical studies toward a specialty in child psychiatry and
psychotherapy, and was accepted as a student for psychoanalytic training.
(Ainsworth & Bowlby, 1991, p. 333)
While working at the London Child Guidance Clinic in 1944, Bowlby completed his first
research study on the role played by parents in the development o f a childs personality,
noting that experiences o f mother-child separation or deprivation o f maternal care were
much more common among 44 juvenile thieves than among control group subjects. Those
who had such experiences were also more likely to be affectionless (Ainsworth &
Bowlby, 1991).
His work was soon interrupted by World War II. Following the war, Bowlby and
associates reorganized the Tavistok Clinic which became part o f the National Health
Service; and he became its consulting psychiatrist and Director for the Department for
13
Children and Parents. He started his own research unit there in 1948. Convinced that the
effects o f real events in a childs life were far more important than a childs fantasy life
(the popular notion of the day for fellow psychoanalysts like Melanie Klein), he focused
the work o f this unit on the effects o f early separation from the mother because
separation was an event on record, unlike disturbed family interaction, of which, in those
days, there were no adequate records (Ainsworth & Bowlby, 1991, p. 333-334) One
member o f the team, a social worker named James Robertson who had worked for a time
in Anna Freuds nursery during the war, undertook a study in which he observed the
behavior o f young children upon separation from their mothers in three different
institutional settings. He also, whenever possible, observed the children in interaction with
their parents in their homes before and after their separations (stays in the institutions).
During this same period o f time, Bowlby was asked to prepare a report for the
World Health Organization on what was known o f the fate o f children without families
(Ainsworth & Bowlby, 1991, p. 334) leading him to travel widely and to read all available
literature on separation and maternal deprivation (Ainsworth & Bowlby, 1991). Much of
the literature described abandoned or orphaned infants who ended up in institutions such
as foundling homes, as was especially the case during World Wars I and n .
Perhaps the most historically significant example o f such work was provided by
Rene A.. Spitz in his 1945 article entitled Hospitalism. Through interviews with physicians
and administrators and review o f records and other accounts, Spitz reported that mortality
rates o f infants under the age o f two years who were placed in institutions in the United
States and Europe from the turn o f the century ranged from 31.7% to 90% compared to
10% o f children in the general population. As hospital conditions improved and more
14
children survived, a new problem emerged: institutionalized children practically without

exception developed subsequent psychiatric disturbances and became asocial, delinquent,
feeble-minded, psychotic, or problem children (p. 54). The general agreement was that
two factors were responsible for the psychological injury suffered by these children:
Lack o f stimulation and absence o f the childs mother.
In his own study (1945), Spitz used developmental quotients obtained at two
four-month intervals to compare four groups o f children with differing living conditions,
(1) children from professional homes in a large city, (2) children from an isolated fishing
village o f 499 inhabitants, where living conditions and medial care were considered very
poor, (3) children placed in a nursery within a penal facility for delinquent girls. (Mothers
o f these infants were mostly delinquent minors as a result o f social maladjustment or
feeble-mindedness, or because they are physically defective, psychopathic, or criminal (p.
60).), and (4) children from an urban area who had been placed in a foundling home (A
certain number o f the children housed have a background not much better than that of the
Nursery children; but a sufficiently relevant number come from socially well-adjusted,
normal mothers whose only handicap is inability to support themselves and their children
(p. 60).) Findings were astounding; developmental quotients for the Foundling Home
Group had plummeted compared to the others: Group 1 (Professional) = 133 to 131;
Group 2 (Fishing Village) = 107 to 108; Group 3 (Nursery) = 101.5 to 105; Group 4
(Foundling Home) = 124 at 4 months, dropping to 72 at 8 months, and to 45 at 24
months. And, even more horrific,
In spite o f the fact that hygiene and precautions against contagion were
impeccable, the children showed, from the third month on, extreme susceptibility
to infection and illness of any kind.. .O f a total of 88 children up to the age of 2 14,
15
23 died... In the ward o f children ranging from 18 months to 2 1/2 years only two
o f the twenty-six surviving children speak a couple o f words. The same two are
able to walk. A third child is beginning to walk. Hardly any o f them can eat
alone. Cleanliness habits have not been acquired and all are incontinent, (p. 59)
Why had such drastic deterioration not occurred in the other groupsparticularly
the Nursery group? An important difference between the Nursery and Foundling Home
conditions was that the infants in the Nursery were able to spend a great deal o f time with
their mothers, who were encouraged by staff to play and interact with their children.
These infants were also in sight and sound o f other babies and their mothers, particularly
whenat age six monthsthey were moved to larger rooms holding up to five babies each.
They lived in well-lit, reasonably stimulating surroundings and always had toys.
By contrastalthough they received adequate clothing, food, and medical
attentionFoundling Home infants were kept in bleak, dimly lit cubicles with sheet-draped
cots for up to 18 months where they received no stimulation, could see no other babies,
and had no access to their own mothers (other than for the few cases where they were
breast fed by their mothers who did not, in other ways, interact with them. Interestingly,
all Foundling Home infants were breast fedusually by wet nursesup to age three
months. This may account for why children in this younger group had a better illness
survival rate than did older infants.) Foundling Home infants didnt even have a toy to
look at or play when Spitz and colleagues first arrived on the scene. For months on end
(up to age 10-12 months), these little ones were left to lie in their cribswithout human
contact for most of the dayto the point their tiny bodies left hollows in the bedding
which further restricted their movement.
16
Spitz noted that while the Nursery babies had a steady rise in development, the
Foundling Home babies began to show a rapid drop in development o f body mastery after
the end o f the third month. He attributed this decline to the fact that as soon as the
babies in Foundling Home are weaned the modest human contacts which they have had
during nursing at the breast stop, and their development falls below normal (p. 66). He
developed an extremely perceptive hypothesis to account for this phenomenon-one that
foreshadowed theories and findings o f Margaret Mahler who delineated psychological
developmental stages for children up to four years o f age based on the type and quality of
interaction with their mothers (Mahler, Pine, & Bergman, 1975) and contemporary
attachment theorists such as Edward Tronick and Daniel Stem. He noted that libidinal
cathexis (p. 68), i.e. investment o f interest in toys, was made possible by emotional
development afforded through the interaction with the mother or mother substitute, and
that this interaction appeared to be a critical factor in a babys developmental progress:
A progressive development o f emotional interchange with the mother provides the
child with perceptive experiences of its environment. The child learns to grasp by
nursing at the mothers breast and by combining the emotional satisfaction of that
experience with tactile perceptions. He learns to distinguish animate objects from
inanimated ones by the spectacle provided by his mothers face in situations
fraught with emotional satisfaction. The interchange between mother and child is
loaded with emotional factors and it is in this interchange that the child learns to
play. He becomes acquainted with his surroundings through the mothers carrying
him around; through her help he learns security in locomotion as well as in every
other respect. This security is reinforced by her being at his beck and call. In
these emotional relations with the mother the child is introduced to learning, and
later to imitation. We have previously mentioned that the motherless children in
Foundling Home are unable to speak, to feed themselves, or to acquire habits of
cleanliness: it is the security provided by the mother in the field o f locomotion, the
emotional bait offered by the mother calling her child that teaches him to walk.
When this is lacking, even children two to three years old cannot walk. (p. 68)
In developing his theory o f attachment Bowlby was also notably influenced by the
work o f Charles Darwin (Bowlby wrote a biography of Darwin in 1990.); Sigmund Freud
for his emphasis on defense mechanisms and the significance o f traumatic events during
early childhood; ethologists Konrad Lorenz and Robert Hinde for their w ork on imprinting
patterns of baby geese and other animals; Harry Harlow for his studies o f affiliative
behaviors in primates; and Miller, Galanter, Pribram, and Young whose control theories
provided models for neurobiological substrates o f homeostatic behavior (Ainsworth &
Bowlby, 1991; Bowlby, 1969). Bowlbys attraction to ethological and biological
explanations grew as he found Freuds theory valuablebut insufficient to adequately
describe or explain the phenomena he was observing. He was drawn to the use o f
observation in field studies, descriptions o f imprinting in birds, and discussion o f active,
goal directed behavior patterns that would begin and cease given particular types o f cues,
responses, or circumstances in the environment. A particularly stimulating source o f fresh
vantage points and exciting new ideas was Bowlbys membership in an international and
interdisciplinary study group on the psychobiology o f the child convened by the World
Health Organization which met yearly during the 1950s. Among the members were
Piaget, Lorenz, and Margaret Mead, and among guest speakers were Julian Huxley, von
Bertalanffy, and Erik Erikson. (Ainsworth & Bowlby, 1991, p. 335).
An American contemporary o f Bowlby, Harry F. Harlow, was making important
discoveries about the significance o f affection in mother-infant attachment in the
research he was conducting at his University o f Wisconsin primate lab (Harlow, 1958;
Harlow & Zimmerman, 1958). He provided a vivid description in perhaps his most
famous study, The Nature o f Love, in 1958. In three years o f previous w ork with
18
monkeys, many o f the animals had been separated from their mothers with the justification
that they would live longer if provided supplemented nourishment from the human
investigators. Harlow (1958) provides an account of the observations that led him to
begin his affection studies:
During the course o f these studies we noticed that the laboratory-raised babies
showed strong attachment to the cloth pads (folded gauze diapers) which were
used to cover the hardware-cloth floors o f their cages. The infants clung to these
pads and engaged in violent temper tantrums when the pads were removed and
replaced for sanitary reasons
We also discovered during some allied
observational studies that a baby monkey raised on a bare wire-mesh cage floor
survives with difficulty, if at all, during the first five days of life
We were
impressed by the possibility that, above and beyond the bubbling fountain o f breast
or bottle, contact comfort might be a very important variable in the development of
the infants affection for the mother, (p. 675)
For his Nature o f Love study, Harlow constructed two types o f surrogate monkey
mothers. The first was made from a block o f wood, covered with sponge rubber, and
sheathed in tan cotton terry cloth. A light bulb behind her radiated heat (p. 676). The
second was made of wire-mesh, a substance entirely adequate to provide postural
support and nursing capability, and she is warmed by radiant heat (p. 676). Some of the
monkeys received their milk from the cloth mothers, some from the wire mothers,
although they had access to both. The amount o f time was recorded for how long the
baby monkeys spent clinging to the two types of mothers from the time they were 1 day
old up to 25 days o f age. The results were startling. Even those babies fed by the wire
monkeys preferred the cloth mothers. Babies fed by the cloth monkeys spent 15 to 18
hours a day on the cloth mothers and none on the wire mothers. Babies fed by the wire
mothers started out spending about 6-12 hours a day clinging to the cloth mothers, with
this time increasing steadily to the point that by age 16 days, they were spending up to 15-
19
18 hours a day on the cloth mothers. They, too, spent as little time as possible (only time
necessary to feed) with the cold, unappealing wire mothers throughout the 25 day period.
In addition, these infants had softer stools, leading Harlow to conclude there was
psychosomatic involvement (p. 677). In his discussion o f the findings, Harlow offered
these remarks:
W e were not surprised to discover that contact comfort was an important basic
affectional or love variable, but we did not expect it to overshadow so completely
the variable of nursing; indeed, the disparity is so great as to suggest that the
primary function o f nursing as an affectional variable is that o f insuring frequent
and intimate body contact o f the infant with the mother, (p. 677)
Harlows studies, complete with gut-wrenching photographs o f distressed infant monkeys,
were a tremendous influence in Bowlbys work. Deets and Harlow (1971) conducted
another landmark study in which they provided evidence o f critical periods for healthy
emotional development. A half century later, primate research by Gary Kraemer, Stephen
Suomi, and others continues to provide some o f the most compelling findings regarding
the long-term social, emotional, and biological developmental consequences o f maternal
deprivation.
Bowlby first published an articulation o f his new theory in 1958 in the article, The
Nature o f a Childs Tie to his Mother. However, this modest initial effort to put forth an
ethological model for parent-child interaction amidst the prevailing psychoanalytic/object
relations school of thought was eclipsed by what remains the definitive work on
attachment: his trilogy o f books entitled Attachment (1969), Separation (1973), and Loss
(1980). Bowlby drew from Robertsons work; readings regarding human, primate, and
other animal infants; and 20 years o f his own observations stemming from work with
parents and children to demonstrate remarkably consistent separation and reunion
20
behavior patterns in infants and young childrenthe backbone o f his theory o f attachment.
In Attachm ent, Bowlby provided his oft-cited description o f the predictable sequence of
separation and reunion behaviors in young children: protest, despair, and detachment:
The initial phase, that o f protest, may begin immediately or may be delayed;
it lasts from a few hours to a week or more. During it the young child appears
acutely distressed at having lost his mother and seeks to recapture her by the full
exercise o f his limited resources. He will often cry loudly, shake his cot, throw
himself about, and look eagerly towards any sight or sound which might prove to
be his missing mother. All his behavior suggests strong expectation that she will
return. Meantime he is apt to reject all alternative figures who offer to do things
for him, though some children will cling desperately to a nurse...
During the phase o f despair, which succeeds protest, the childs
preoccupation with his missing mother is still evident, though his behaviour
suggests increasing hopelessness. The active physical movements diminish or
come to an end, and he may cry monotonously or intermittently. He is withdrawn
and inactive, makes no demands on people in the environment, and appears to be
in a state of deep mourning. This is a quiet stage, and sometimes, clearly
erroneously, is presumed to indicate a diminution o f distress...
Because the child shows more interest in his surroundings, the phase of
detachment which sooner or later succeeds protest and despair is often welcomed
as a sign of recovery. The child no longer rejects the nurses; he accepts their care
and the food and toys they bring, and may even smile and be sociable. To some
this change seems satisfactory. When his mother visits, however, it can be seen
that all is not well, for there is a striking absence o f the behaviour characteristic of
the strong attachment normal at this age. So far from greeting his mother he may
seem hardly to know her; so far from clinging to her he may remain remote and
apathetic; instead o f tears there is a listless turning away. He seems to have lost all
interest in her. (p. 27-28)
Another key component o f Bowlbys theory is the concept o f internalized
working models for self in relation to others, rooted in initial and continuing experiences
with attachment figures:
each individual builds working models of the world and o f himself in it, with the
aid o f which he perceives events, forecasts the future, and constructs his plans. In
the working model o f the world that anyone builds, a key feature is his notion o f
who his attachment figures are, where they may be found, and how they may be
expected to respond. Similarly, in the working model o f the self that anyone builds
a key feature is his notion o f how acceptable or unacceptable he himself is in the
eyes o f his attachment figures. On the structure o f these complementary models
21
are based that persons forecasts o f how accessible and responsive his attachment
figures are likely to be should he turn to them for support. A nd...also, whether he
feels confident that his attachment figures are in general readily available or
whether he is more or less afraid that they will not be availableoccasionally,
frequently, or most o f the time. (Bowlby, 1973, p. 203)
In his book Separation (1973), Bowlby focused attention on fear and anxiety
experienced by the young child upon separation from mother. Colleague Mary Ainsworth
utilized the concepts put forth in this work in developing her now famous StrangeSituation studies which served as the basis for delineating patterns o f secure vs. anxious
attachment (Ainsworth & Bowlby, 1991; Ainsworth, Blehar, Waters, & Wall, 1978). In
Loss, Bowlby described the grief and mourning process o f adults and children when
confronted with the loss of a close loved one. An extremely precise definition of
attachment is provided by Bowlby in his 1988 book, A Secure Base:
In re-examining the nature o f the childs tie to his mother, traditionally referred to
as dependency, it has been found useful to regard it as the resultant o f a distinctive
and in part pre-programmed set o f behaviour patterns which in the ordinary
expectable environment develop during the early months o f life and have the effect
o f keeping the child in more or less close proximity to his mother-figure. By the
end of the first year the behaviour is becoming organized cybemetically, which
means, among other things, that the behaviour becomes active whenever certain
conditions obtain and ceases when certain other conditions obtain. For example, a
childs attachment behaviour is activated especially by pain, fatigue, and anything
frightening, and also by the mother being or appearing to be inaccessible. The
conditions that terminate the behaviour vary according to the intensity of its
arousal. At low intensity they may be simply sight or sound o f the mother,
especially effective being a signal from her acknowledging his presence. At higher
intensity termination may require his touching or clinging to her. At highest
intensity, when he is distressed and anxious, nothing but a prolonged cuddle will
do. The biological function o f this behaviour is postulated to be protection,
especially protection from predators, (p. 3)
Mary D. Salter Ainsworths work would come to provide much o f the evidence
that supported Bowlbys theory. She entered a course o f study in psychology as an
undergraduate at the University o f Toronto in Canada hoping to understand how she had
22
come to be the person she was, and what her parents had to d o with it. (Ainsworth &
Bowlby, 1991, p. 334). During this time she was drawn to thie work o f one of her
professors, William E. Blatz, who had recently formulated thieory o f security as an
approach to understanding personality development (Ainsworth & Bowlby, 1991, p.
334). Among the various types o f security he described was *he immature dependent
security o f young children that accounted for their need o f a secure base of parental
availability from which to explore and leam and to which th ey could retreat when that
exploration and learning became too frightening. He had alscn acknowledged that agents
akin to defense mechanisms could provide a temporary kind o f security, although they did
not deal with the source of insecuritylike treating a tooth a^che with an analgesic (p.
334). For her 1940 dissertation, Ainsworth constructed two self-report paper-pencil
scales intended to assess the degree to which a person was secure rather than insecure in
order to obtain additional data for this theory, (p. 334).
In 1950, Ainsworth left the University o f Toronto w hn her husband Leonard
pursued his Ph.D. at the University o f London. Jobless, she answered an advertisement in
the Times Educational Supplem ent for a position as a developmental researcher at the
Tavistock Clinic investigating the effect on personality development o f separation from
the mother in early childhood. (p. 335). Needless to say she: got the job, beginning a life
long collaboration with John Bowlby. She was particularly intrigued by his hypotheses for
separation anxiety and provides this account o f his theory (Ainsworth Sc Bowlby, 1991):
Separation anxiety occurs when attachment behavior 5s activated by the absence o f
the attachment figure, but cannot be terminated. It differs from fright, which is
aroused by some alarming or noxious feature o f the environment and activates
escape responses. However, fright also activates attachm ent behavior, so that the
baby not only tries to escape from the frightening stimulus but also tries to reach a
23
haven o f safetythe attachment figure. Later in infancy the baby is capable o f

expectant anxiety in situations that seem likely to be noxious or in which the
attachment figure is likely to become unavailable...only a specific figure, usually
the mother figure, could terminate attachment behavior completely once it had
been intensely activated...hostility toward the mother is likely to occur when
attachment behavior is frustrated, as it is when the child is separated from her,
rejected by her, or when she gives major attention to someone else. When such
circumstances are frequent or prolonged, primitive defensive processes may be
activated, with the result that the child may appear to be indifferent to its mother
...o r may be erroneously viewed as healthily independent, (p. 336)
Ainsworth and followers amassed a body o f research that included field studies
(i.e. her description o f mothers and infants in Uganda in the early 1950s), data from a
1963-1964 longitudinal study in Baltimore described in Patterns o f Attachment
(Ainsworth, Blehar, Waters, & Wall, 1978), and countless replications by other
investigators using her Strange-Situation technique to assess secure vs. anxiously attached
infants all over the world.
Ainsworths Strange Situation experiments, detailed in Patterns o f Attachment
(Ainsworth, Blehar, Waters, & Wall, 1978), involved observing infants in each of the
following 8 sequential conditions or episodes :
1. Mother, baby, & observer. (30 sec.) Observer introduces mother and baby to
experimental (playroom), then leaves
2. Mother & baby. (3 min.) Mother is nonparticipant while baby explores; if
necessary, play is stimulated after 2 minutes
3. Stranger, mother, & baby. (3 min.) Stranger enters. First minute: Stranger
silent. Second minute: Stranger converses with mother. Third minute:
Stranger approaches baby. After 3 minutes mother leaves unobtrusively.
24
4. Stranger & baby. (3 min.) First separation episode. Strangers behavior is

geared to that of baby.
5. Mother & baby. (3 min.) First reunion episode. Mother greets and/or
comforts baby, then tries to settle him again in play. Mother then leaves,
saying bye-bye.
6. Baby alone. (3 min.) Second separation episode.
7. Stranger & baby. (3 min.) Continuation o f second separation. Stranger enters
and gears her behavior to that o f baby
8. M other & baby. (3 min.) Second reunion episode. Mother enters, greets
baby, then picks him up. Meanwhile stranger leaves unobtrusively, (p. 37)
Pre-separation interactions o f infants and their mothers were noted. Infants were
then observed in the separation and reunion conditions at which time they were sorted into
one o f three groupings based on anxiety level and relationship style. Whenever possible,
infants and mothers were observed before and after the test in the natural setting of their
homes. Ainsworth and colleagues thus identified three patterns o f attachment. Ainsworth
(1979) summarizes the three patterns:
Group B (Secure) babies use their mothers as a secure base from which to explore
in the preseparation episodes; their attachment behavior is greatly intensified by the
separation episodes so that exploration diminishes and distress is likely; and in the
reunion episodes they seek contact with, proximity to , or at least interaction with
their m others... .Group B babies were more cooperative and less angry than either
A or C Babies.
Group C (Insecure-Ambivalent-Resistant) babies tend to show some signs
o f anxiety even in the preseparation episodes; they are intensely distressed by
separation; and in the reunion episodes they are ambivalent with the mother,
seeking close contact with her and yet resisting contact or interaction.
Group A (Insecure-Avoidant) babies, in sharp contrast, rarely cry in the
separation episodes and, in the reunion episodes, avoid the mother, either mingling
25
proximity-seeking and avoidant behaviors or ignoring her altogether...Group A

babies were even more angry than those in Group C. (p. 932)
Ainsworth also observed patterns o f behavior in mothers that corresponded to
each of the three styles o f attachment seen in their infants. Mothers o f Secure infants were
responsive and sensitive to their infants signals across all contexts. This was not the case
for mothers of insecure infants, whose responsiveness to infant signals was inconsistent at
best, ill-timed, inappropriate, or even nonexistent (Ainsworth, 1979). The most troubling
findings were for mothers o f Avoidant infants:
In regard to interaction in close bodily contact, the most striking finding is that the
mothers of avoidant (Group A) babies all evinced a deep-seated aversion to it,
whereas none o f the other mothers did. In addition they were more rejecting,
more often angry, and yet more restricted in the expression o f affect than were
Group B or C mothers. (Ainsworth, 1979, p. 933)
That similar patterns o f infant attachment have been found in Strange-Situation
studies conducted in diverse cultures throughout the world (Grossman & Grossman, 1990;
Main, 1990; Sagi, 1990) lends support to the biological aspect o f Bowlbys theory. And,
reliable findings that these attachment patterns persist over time (Cassidy & Main, 1984;
Cicchetti, Toth, & Lynch, 1995; Matas, Arend, & Sroufe, 1978) are consistent with
Bowlbys notion o f an internalized working model. There is even some evidence to
suggest that an individuals attachment pattern extends into adulthood. A body of work
on adult patterns o f relating has emerged from Phillip Shavers findings that adult love
relationships can be characterized as Secure, Avoidant, or Anxious/Ambivalent (Hazan
and Shaver, 1987). One particularly fascinating finding in his studies is that the three
patterns o f attachment exist in adulthood in roughly the same percentages as in early
infancy (Secure: 56% in adulthood vs. 60% in infancy; Avoidant: 23-25% in adulthood vs.
26
20% in infancy; and Anxious/Ambivalent: 19-20% in adulthood vs. 20% in infancy).

Shaver suggests that the same internalized working model o f self in relation to others that
first emerges within the context o f that all-important initial experience with the parent
continues to organize ones social beliefs and behaviors throughout the lifespan.
An individual who was instrumental to Ainsworth in conducting, interpreting,
compiling, and expanding her work was colleague Mary Main. Main and others
(Crittenden, 1985a, 1985b; Egeland and Sroufe, 1981a, 1981b; Spieker and Booth, 1985)
who conducted Strange Situation studies had observed that there were a group of infants
in middle class samplesand especially in high-risk samples from abusive and/or neglecting
familieswhose unclassifiable behaviors showed marked departures from Secure,
Ambivalent, or Avoidant criteria. In 1986, Main and Solomon introduced a fourth
Insecure-Disorganized/Disoriented Attachment Pattern (Pattern D) (p. 95). Unlike the
overly independent Avoidant and highly dependent Ambivalent patterns, this pattern was
remarkable for its lack o f organized behavior when the infant was confronted with a
difficult, stressful situation. Main was astonished to discover that all previously
unclassifiable infants fit one or more criteria o f this 4th pattern, rendering it unnecessary to
elucidate additional patterns as had been expected. Parents o f these infants are
characterized as abusing, neglecting, and/or having mental illness (i.e. Bipolar Disorder,
Major Depression), thereby creating the most extreme o f family conditions (p. 107). The
Disorganized/Disoriented pattern o f attachment has also been found to persist over time
(Cassidy & Main, 1984; Lyons-Ruth, 1996; Lyons-Ruth & Easterbrooks, 1997).
Mary Mains w ork was also instrumental in demonstrating that patterns of
attachment extend across generations. In her 1984 landmark study, she and Goldwyn
27
utilized the Berkeley Adult Attachment Interview (AAI) to determine the quality of
childrens attachments with their mothers based on the m others verbal recollections of
childhood interactions with their own mothers. Subjects were 30 mothers (largely white,
middle class) whose infants had been tested six years prior to determine their pattern of
attachment (Secure, Ambivalent, or Avoidant). Mothers interviews were rated by
investigators who had no knowledge o f childrens pre-determined attachment patterns.
Mother interview results were then compared to the predetermined child attachment
patterns. Findings showed
a significant positive relationship between apparent rejection by mother in
childhood and inability to recall childhood, and there was a strong relationship
between rejection by mother in childhood and idealization o f mother now. Finally,
the more rejected the mother was by her own m other in childhood , the less
coherent she appeared to be in discussing attachment relationships and experience
now. All three findings were significantly predictive o f a womans rejection o f her
own infant, (p. 213)
However, those parents w hod had a negative experience growing upbut were able to
give a cohesive, detailed recollection (indicating they had been able to work through and
integrate their experience)had developed healthy, secure attachments with their own
infants.
Based on his interpretation o f Ainsworths research, Daniel Stem (1983; 1985)
honed in on affect attunement o f the mother with her infant as the critical process
involved in the initial regulation o f the childs emotional states. In his book, The
Interpersonal World o f the Infant (1985), he defines affect attunement as the
performance o f behaviors that express the quality o f feeling o f a shared affect state
without (simply) imitating the exact behavioral expression o f the inner state (p. 142).
Similar to the concept o f sensitivity to infant signals, this process involves parental
28
resonance with the childs feeling state conveyed by some type o f matching o f the childs
expressive behavior. The channel of modality o f expression used by the mother to match
the infants behavior is frequently, if not mostly, different from the channel or modality
used by the child; and what is being matched is not so much the childs behavior, but some
aspect o f the behavior that reflects the childs feeling state.
His cross-modal emphasis is consistent with initial organization o f the central
nervous system in the newborn, involving brain-stem mechanisms that coordinate multi
modal sensory-motor processing systems. The infants orienting response, turning to
locate mothers voice in space and linking it to her face, is an example. Stem, (1985)
believes that infant biological mechanisms and abilities for engaging the environment are
far more sophisticated at a very early age than previously thought. Although Bowlby
would certainly agree with this observation, he and Ainsworth focussed their attention on
older infants who had already formed a selective attachment with their mothers, an event
that begins about six months o f age. Stem stresses that the socialization afforded by
mother-child interaction is critical to healthy emotional development from the beginning of
an infants life.
Attachment theorists Edward Tronick and Tiffany Field demonstrated that a
mothers emotional unavailability (i.e. from depression) can be as devastating to her infant
as physical unavailability (Field 1985, 1998; Tronick, 1986; Tronick et al., 1978). A
powerful illustration o f what happens to infants when emotional feedback is not
forthcoming from their mothers emerged in Tronicks famous still face experiments
(Tronick, 1986; Tronick et al, 1978). In these studies mothers were asked to engage in
normal interaction with their infants. In the middle o f the interaction, the parent was
29
instructed to go still-faced (remain impassive and emotionafly expressionless). Typically

these healthy infants, looking puzzled, would initially make several attempts to engage
their mothers; but~after repeated failures to engage her~woulld eventually look down and
withdraw. This sequence o f events happened within a matter o f minutes.
Like Daniel Stem, Edward Tronick (1986) believes th a t the mothers response to
her child is a key factor in helping the infant establish regulation o f emotional states from
the beginning o f life. Tronick links relationship to biological functioning as he describes a
dyadic process whereby the primary care-giver assists her infa_nt to achieve homeostasis by
regulating arousal in her infant. The infant can utilize self-directed regulatory behaviors to
obtain self-comfort (i.e. sucking, rocking) or to decrease sensory stimulation (i.e. turning
head away). However, due to the infants immature neurological organization and lack of
coordination, these behaviorswhich serve to decrease contact with the external
environment~are not sufficient. Another way the child seeks to regulate emotions is
through other directed behavior which serves to engage the emvironment (mother) for
assistance. Tronick, like Stem, notes that:
When the mother responds appropriately to her infantas other-directed regulatory
displays, the infant is able to maintain both self-regulaltion and regulation o f the
interaction, and positive emotions are generated. W hen the mother fails to
respond, the infants regulatory efforts are unsuccessful, and negative emotions are
generated, (p.7)
Jaak Panksepp was the first to explore and identify neairobiological substrates for
mother-infant attachment phenomena. Spurred by the discovery in 1972 of the
endogenous opioids, Panksepp was able to demonstrate that a form o f endogenous opioid
analgesia, or pain relief, appears to obtain in baby chicks, puprpies, and other animals upon
acquiring contact comfort and reassurance from the mother. IPanksepp suggests that
30
attachment behavior and opiate addiction are very closely related in that they appear to be
mediated by the same systems in the central nervous system. H e notes that separation
from the object o f attachment and opiate withdrawal produce similar painful symptoms
(Panksepp, 1986, 1998; Panksepp et al., 1978; Panksepp, Siviy, & Normansell, 1985).
Most recently, Allan Schore has proposed that the visuoaffective component o f
mother-infant attachment facilitates infant frontal lobe development. In his book, A ffect
R egulation and the Origin o f the S e lf (1994), he theorizes that a primary function o f
mother-infant attachment is to stimulate development o f the frontal lobes, particularly the
right orbitofrontal lobekey to healthy social-emotional functioning. He pinpoints age
11-18 months (corresponding to Margaret Mahlers Practicing Stage) as an important
time frame for this dopamine-driven developmental process that occurs when mother
connects with her baby through the eyes. Eye contact, during a time the child is also
becoming upright and mobile, enables the youngster to obtain some distance (and
eventually separation) from mompermitting the freedom to explore that spurs further
development o f the cortex.
The attachment milestones thus selected and described are essential to the
biopsychosocial premise o f the model proposed in this dissertation. Because attachment
theoryfrom its inceptionhas linked social-emotional development to its biological and
ethological roots, its percepts remain fresh and relevant, even against the litmus test of
burgeoning findings from state-of-the-art neurobiological research. Because attachment
theory is aligned with the principles o f Systems Theory, attachment phenomena (i.e.
homeostatic processes) identified at the molecular, neurobiological, individual, dyadic, and
social system levels will probably retain a consistency that would not be true for other
31
theories which depart from these standards. Attachment provides a classic example of
how biology and environment-infant and motherbecome engaged in the dance of
reciprocity.
32
CHAPTER m
METHODOLOGY
A Biopsychosocial Model for Projecting Psychopathology Resulting from
Attachment Deficits and Distortions
This section will propose a biopsychosocial model for elucidating development
dependent patterns o f psychopathologywith focus on emotion dysregulationresulting
from attachment deficits and distortions. Using the model, predictions for typical
symptomatic presentations that would emerge during six incremental age periods from
age 0 to 36 months o f age will be formulated, based on the developmental status o f brain
structures, psychopharmacology, and emotion circuits available to the infant at those
points in time. Key to this model is that proposed descriptions o f attachment related
psychopathology for children and adults will be constructed by working forward
sequentially and additively (consistent with brain structures and circuitry coming on
line)from the emergent end o f the developmental trajectory toward adulthood vs.
extrapolating backward from adulthood.
Adherence to General Systems Theory Principles
Key to this biopsychosocial model is its adherence to the guiding principles of
General Systems Theory that apply to all systems in nature (James, 1999). Meeting these
standards provides an initial litmus test for any such model or theory that attempts to
elucidate the nature o f phenomena that exist in nature. Therefore, incorporating general
systems principles from this models inception increases the likelihood that its
33
components have internal consistency and that predictive descriptions deriving from the
model are consistent with findings from an array o f disciplines attempting to study the
same phenomena from differing vantage points or system levels (i.e. neurobiological,
individual, social). Because higher order systems cannot violate systemic principles o f
the subsystems that comprise them, another litmus test for a models viability is that
biological substrates can account for the individual and social psychological phenomena
it addresses. Therefore, although this model is focused on individual psychopathology
and addresses the attachment or social-related context from which it derives, it is
biologically based. Systems principles that represent recurring themes emerging in the
phenomena addressed by this model will now be discussed.
(1) Systems Evolve from Simple to Complex
Systems change in two possible directions: toward decreased organization
(entropy) or toward increased organization (evolution). Systems evolve (develop) from
simple to complex. The biological, individual, and social phenomena addressed by this
model will be presented in a manner that reflects their increasing complexity through the
sequential, additive, organizational, and reorganizational processes involved in human
development. The simple-to-complex theme emerges time and again at each system
level.
Examples include:
neuron, migration o f neurons to target sites, grouping o f neurons with harmonious

firing patterns into components o f brain structures, organization o f brain
structures and neurotransmitters into emotion circuits
34
infants ability to tolerate arousal o f increasing duration, intensity over time as the
autonomic nervous system matures in interaction with the modulating effects o f
increasingly sophisticated emotion systems (emerging sequentially) and
experience
the development o f motoric abilities from sitting up by self, to crawling, walking,

running, skipping, dancing, to driving a car
systems for memory and learning that evolve from interoceptive and other forms
o f primed classical/associative conditioning, to approach/avoidance preferences
based on consequential experiences, to social modeling
social development from nearly total dependency upon a more powerful other to
get psychological (and other basic survival) needs met, to the gradual process of
internalization that results in psychological independence, to chosen
interdependence with others to get common or complementary needs met
Living, biological organisms adhere to principles of evolution.
Because biological systems have evolved over time toward optimized capacity for
their ultimate purposes o f survival and reproduction, developmental phenomena

addressed by this model will be consistent with and utilize evolution concepts such as
adaptation. Nature has a tendency to be economical and efficient in its use o f adaptive
mechanisms. Similar mechanisms can be seen across species. (These similarities render
much animal research applicable to humans.) Or, a same mechanism may undergo
adjustments (generally over long periods o f time) to accommodate a variety o f
environmental demands encountered by differing species. Panksepp (1998) utilizes the
35
term exaptations for processes by which evolution has modified homologous parts for
very different ends in different species (p. 17).
A. new and growing conceptual view, commonly known as evolutionary
psycho logy... readily accepts that many complex adaptive strategies have been built into
the human brain and that many o f them may serve functions that are not readily apparent
to our conscious mind (Jaak Panksepp, 1998, p. 11). John James (1999) elaborates:
Despite the fact that means o f adaptation have changed profoundly even in this
century via the explosion o f technological culture, adaptations (that) evolved
during the Pleistocene era (1.7 million-10,000 years before the present) of our
prehistory, and even more remotely during our pre-human primate evolutionary
history, will be manifested in human behavior, in a sense, whether these
adaptations are currently adaptive or not. (p. 10)
The scientists who have just completed the awesome achievement of detailing the
entire human genetic code (National Institutes o f Health & Celera Genomics Corporation,
2001) shared that among their most amazing discoveries is that the evidence of evolution
is so readily apparent. For example-consistent with natures fondness for tinkering with
old systems to refine or produce new, even more adaptive functions in the service of
meeting existing environmental demandshuman genes appear to be constructed by
mixing, matching, or globbing new parts onto old parts. Another discovery is that
phenotypic presentations are not so hard wired as commonly believed, affording a great
deal of flexibility which, o f course, can be an adaptive advantage should conditions
change. These scientists warned against the simplistic notion that one specific gene gives
rise to one particular trait or disease, stressing instead that environmental influence (at
multiple levels) provides the interactive context that guides genetic expression.
Intracellular protein dynamics, which also have a primary role in maintaining
homeostasis sensitive to environmental demands, appear to hold the key to the
36
complexity o f genetic expression not just to the end o f maturation, but throughout the
lifespan.
MacCleans (1973) conceptualization o f the Triune Brain, delineates three major
evolutionary divisions of human brains, one laid down atop the other in a kind o f
sedimentary rock fashion, to include (1) the Reptilian brain (brainstem) with its basic life
sustaining functions topped by the (2) M ammalian brain, containing the motivational
social-emotion (limbic) systems topped by (3) the Neomammalian brain (cortex) with its
advantageous fine-tuning executive systems. Human infant brains follow this very same
sequence in the course of their unfolding development (Risser & Edgell, 1988).
Developmental trajectory.
The movement along the simple to complex continuum will hereafter be referred
to as development. The point that represents the brains status along the developmental
trajectory could be said to indicate the individuals level o f ego functioningthe
individuals ability to assimilate and accommodate information to restabilize, adapt, and
achieve optimum survivalat that given point in time.
(2) Systems Utilize Energy and Information from Within Toward Optimal Survival
Systems utilize energy and information from within to stabilize, restore order,
adapt, develop, and reorganize themselves for optimal survival. Information is
defined as energy which is formed in such a way as to allow transfer from
element to element (or system to system ).. ..Inherent in this definition o f the
communication of information is the idea that some sort of co-evolutionary
process has rendered the energy transferred from one system to another
translatable from one system to the other (James, 1999, p. 4)
Relevant examples include genetic code; utilization o f glucose by active neurons;
chemical information, embodied in neurotransmitters, passing from one neuron to the
next through the synapse; brain stem nociceptors and hypothalamic set points that alert
37
the brain to the presence o f an irritant or biological need; associative areas o f the cortex
acting in concert during memory recall, thought, or creative process.
(3) Systems Incorporate Energy and Information (Resources') from Their Environments
Toward Optimal Survival
Systems incorporate energy and information (resources) from their environments
to stabilize, restore order, adapt, drive their development, and reorganize themselves
toward optimal survival. Systems also expend or transfer energy into the environment to
achieve this end. This particular principle is embodied in mother-infant attachment,
particularly in that the childs neurobiological, psychological, and social development
unfolds within the context o f this initial and reciprocal environmental interaction.
Related examples are D. W. Winnicotts (1965) description of mother as the Facilitating
Environment; Daniel Stems (1985) concept o f Affect Attunement whereby mother
provides a multi-modal, empathic response to her infants signals; Jaak Panksepps
(1978) discovery that contact with mother permits a young child to regain homeostasis by
triggering the release o f arousal-quelling endogenous opioids; and Allan Schores (1994)
proposition that mother-infant Visuo-Affective connection stimulates dopamine driven
frontal lobe development.
Other pertinent examples include emergence o f a neurons phenotypic expression
under the influence o f its intercellular environment (Purves et al, 1997); motivational
dopamine-driven seeking (appetitive) system that promotes moving toward and acting
upon the environment to obtain significant resources; newborns primed preference for
looking at stripes and other high contrast patterns (Gopnik, Meltzoff, & Kuhl, 1999) to
spur occipital lobe development; synaptic pruning due to lack o f incoming stimulation
38
from the environment to reduce inefficient redundancy; the cascade o f neurobiological

processes set into motion with the stress response to an environmental threat; childs
utilization o f visual referencing with mother to elicit her feedback in uncertain situations;
reflective cognitive response to social cues that permits selection o f a best strategy for
meeting a particular need; and the use o f language.
(4) Energy Transfers Between and Among Systems are Directly Measurable
Advances in neurobiological measurement technologies are permitting scientists
to fill in the gaps where previously theoretical intervening variables had to serve as
stand-ins to explain psychological phenomena that appeared to represent unseen energy
exchanges in the brain (James, 1999, p. 19). John James (1999) proposes that
as the gap represented by brain complexity is reduced, intervening variables will
be replaced by concrete systems models that can specify the physical path o f the
(Energy/Information) through the brain. Those scientific psychologists who wish
to construct models o f behavioral functioning that will interface and articulate
with those models developed by sciences using concrete systems will have to
formulate their research using terminology and concepts that map onto concrete
systems, (p. 23)
Harry Chugani (1998) has used PET scans to measure glucose metabolism in the
brains o f infants, children, and youth to track the normal course o f human brain
development. Edward Tronicks Still Face experiments (1978) have measured energy
transfer between mother and child through behavioral observation o f infant affect during
periods o f active interaction and during periods o f maternal non-responsiveness.
(5) Adaptive Self-Organization is Manifested in a Systems Ability to Achieve
Homeostasis
Systems tend universally to respond to perturbations from outside the system by
expending energy internally to return those parameters affected by outside forces
to their original values. In living systems this process is termed
homeostasis...Natural, open systems can be shown to respond to perturbations by
39
return o f parametric values to a range o f function values, rather than a precise,

invariant set-point. This range o f values is called a steady state to denote the
action o f the system to conserve coherence and order among its elements in the
face o f external perturbations. In response to sufficiently intense and/or repeated
perturbations, the ability o f a system to self-stabilize may be insufficient to
preserve the integrity o f the system as it existed prior to the perturbation. The
system may then either disintegrate into constituent subsystems at some lower
level or organization... or may engage in a process o f adaptive self-organization.
This process preserves some aspects of the pre-stress system but in effect
produces a new system, one with some properties not characteristic o f the pre
stressed (pre-perturbed) system. A system may then have to continue to
establish new steady states in the face o f changing perturbation, rendering the
system a qualitatively different system from a previous one.
(James, 1999, p. 4-5)
Perturbations can come from outside or from within the system. Examples o f
homeostatic mechanisms within the human central nervous system include autoreceptors
on presynaptic neurons that reabsorb, then turn off the supply o f neurotransmitter when
optimal levels have been released into the synaptic cleft; increased or decreased numbers
o f postsynaptic cell receptor sites adjusting to decreased or increased amounts of
neurotransmitter (respectively); sensitization and desensitization o f postsynaptic cell
receptors; counterbalancing effects of catecholamines and 5-HT; and arousal and
restorative states produced by the sympathetic and parasympathetic branches of the
autonomic nervous system.
Mother-infant attachment relationship.
Mother-Infant Attachment provides the context that facilitates the young infants
CNS development. Initially mother serves as the infants auxiliary ego (Jacobson,
1964) and central nervous system (i.e. autonomic nervous system). Due to CNS
components that have yet to mature, the infants regaining homeostasis is a two-person
job. Achieving homeostasis is the primary function o f attachment. With sensitive
maternal responses to infant signals, the infant will eventually develop tolerance for
40
increasing perturbation. Adaptation to appropriate degrees of perturbation induces

development.
W hen the infant is subjected to conditions o f deprivation, distortion, and/or abuse,
homeostasis cannot be achieved without (1) reducing the systems complexity (i.e.
uncoupling arousal from experience with dissociation) or (2) adapting. Adaptations
represent utilization o f available internal resources to adjust to abnormal and o r extreme
environmental demands, therefore adaptations may appear distorted or extreme and
aberrant. Such aberrant adaptations used for long periods, especially throughout critical
developmental windows, may become permanent.
(6)
Systems are Organized Hierarchically with Higher Order Systems Subsuming the
Properties o f Those that Comprise Them

Epigenetic developmental process is consistent with this principle. Achieving
subsequently more complex developmental levels is determined by how successfully one
negotiates earlier, less complex developmental levels. In addition, various brain
structures and circuits are coming on-line at varied times during development. Various
brain systems maturing at differing rates develop parallel to and in concert with one
another. When brain systems become connected, permitting them to act in concert,
conditions are ripe for second order shifts. The Stage-Setting concept proposed by
Greenough, Black, and Wallace (1987), Piagets theory o f psychological development
(Piaget & Inhelder, 1969), and Eriksons Social Psychoanalytic-Stage theory (Feist,
1990) address this process.
41
(7) A System Becomes Disorganized Through the Process o f Entropy

With entropy, the system comes undone. It loses its energy, becoming disorganized
and less complex. Entropy occurs when a system is unable to restabilize following
perturbation, achieve homeostasis, or obtain needed resources. Human examples include
emotion dysregulation, regression, dissociation, and decompensation in unmanageable,
survival-threatening, stressful conditions.
(8) The Integrity o f a System is Dependent Upon the Integrity o f All Subsystems that
Comprise It
The integrity o f a given system within a hierarchy depends upon the integrity of all
subsystems that comprise it. If lower systems in the hierarchy have been compromised,
then so have all subsequent systems that subsume them. Therefore, the earlier in
development that damage occurs, the more profound the pathology.
Interaction o f stress and ability to achieve homeostasis lego functioning*).
Stress has been defined as a state o f disharmony, or threatened homeostasis
(Chrousos & Gold, 1992, p. 1245). Stress occurs when an internal or external
perturbation threatens to destabilize ones system. It is experienced as escalating arousal,
activating the sympathetic nervous system and other defensive components o f the brains
threat response. An individuals ability to restabilize in response to stress is mediated by
his or her developmentally determined repertoire of coping mechanisms in interaction
with the intensity, frequency, quantity, timing, and duration of the stressor and the
stressors meaning to the individual. If a stressor occurs at a level o f intensity or duration
that outstrips an individuals adaptive repertoire, as is most likely to occur in earliest
42
infancy, stress quickly becomes distress. Disorganizing distress that threatens ones very
existence becomes traumatic stress.
An individuals ability to achieve homeostasis can be referred to as ego
functioning. Young infants, whose nervous systems have yet to mature, must rely on
their mothers to lend them ego (Edith Jacobson, 1964). The primary role o f the
mother-infant attachment relationship is to assist the infant to achieve homeostasis and,
therefore, develop further. When infants are subjected to attachment deprivation,
distortion, or abuse they must make extraordinary adaptations to regain their equilibrium
or face reduction or disorganization o f their systems. These extraordinary adjustments
may be short-term and state-like or long-term and trait-like. If aberrant adjustments are
prolonged, particularly throughout the course of a critical developmental window, they
can become permanent.
Systematic Biopsvchosocial Steps for Projecting Psychopathology Resulting from
Attachment Deficits and Distortions
Utilization o f Existing Data
Multiple literature reviews will be conducted to (1) delineate the biopsychosocial
roles o f mother-infant attachment in emotion regulation and (2) demonstrate the
effectiveness o f the proposed Model for Projecting Psychopathology Resulting from
Attachment Deficits and Distortions. All research questions (CHAPTER I) will be
addressed in the process. Dataselected for consistency across neurobiological,
psychopharmacological, developmental, behavioral, and clinical vantage pointswill be
pulled together for the purpose o f bringing a bigger (biopsychosocial) picture into
view.
43
Literature reviews will synthesize six strands of data, from which a list of
projected enduring traits o f attachment deficits and distortions can be formulated,
per each o f six developmental age periods from 0-36 months. Predictive descriptions of
what individuals with attachment deficits and distortions would look like at various
points along the developmental continuum will be formulated by working forward from
the emergent end o f the developmental trajectory, in keeping with the models
developmental premise and with adherence to general systems theory principles.
Strands per age period include:
1. Brain Available (emotion structures, psychopharmacology, and circuitry up
and running~to include additive components contributing to emotion quality,
modulation, and capacity for regulation)
2. Developing Brain (what is in the process of coming on-line that will
contribute to emotionto include emergent emotion structure(s),
psychopharmacology, circuitry, quality, modulation, and capacity for
regulation)
3. Infant Capabilities: Observable Phenomena (to include age-connected
emotion provoking stimuli, emotion displays, and capacity for self regulation)
4. Developmental Theories o f Psychology Grounded in Observable Phenomena
5. Developmental Tasks and Mechanisms o f Mother-Infant Attachment (critical
to healthy development, emotion regulation)
6. Psychopathology Resulting from Attachment Deficits and Distortions
(resulting in aberrant development, emotion dysregulation)
Variables Taken into Account to Project Psychopathology

Variables that must be taken into account to project psychopathology include the
stressful nature o f the maternal environment (deficits, distortions, abuse; intensity,
frequency, quantity, timing, and duration o f events) in interaction with the infants degree
o f ego functioning based on neurobiological developmental status and capabilities.
Consequences must be considered per each emotion system on board and for experienceexpectant systems coming on line. Probable adaptations for regaining homeostasis or
tendencies for disorganization are hypothesized based on neurobiological and behavioral
mechanisms available to the infant at this time. These aberrant adaptations or tendencies
toward disorganization can be short-term (state-like) or long-term (trait-like); if they are
prolonged, especially over the course o f an experience-expectant (critical) developmental
window, they may become permanent. Long-term consequences or vulnerabilities can be
described by projecting how they might lookco-mingled with other increasingly
sophisticated aspects of developmentup the developmental trajectory
Age Periods:
In Utero
0-2 Months: (Anything But) Autism
2-5 Months: Symbiosis

5-8 Months: Selective Attachment
8-18 Months: Practicing
18-24 Months: Rapprochement
24-36 Months: Object Constancy
45
Using the proposed model, a demonstration o f its effectiveness, to include a

developmental formulation of projected psychopathology resulting from attachment
deficits and distortions, will be provided for Age 0-2 Months (CHAPTER IV-RESULTS:
PART I). This section lays out neurobiological, behavioral, and environmental variables
at the simplest ground floor level, providing an anchor for moving sequentially up the
developmental trajectory through increasingly complex age periods. Based on a much
more abbreviated data collection process (but following the same steps), projected
psychopathology (enduring traits, vulnerabilities) resulting from the types o f attachment
deficits and distortions most likely to emerge from each age period will be summarized.
(CHAPTER IV-RESULTS: PART II).
Definitions
Attachment: Because of its precision and evolutionary implications, John Bowlbys
definition will be utilized:
the nature o f the childs tie to his mother, traditionally referred to as dependency,
.. .has been found useful to regard it as the resultant of a distinctive and in part
pre-programmed set of behaviour patterns which in the ordinary expectable
environment develop during the early months o f life and have the effect o f
keeping the child in more or less close proximity to his mother-figure. By the end
o f the first year the behaviour is becoming organized cybemetically, which
conditions that terminate the behaviour vary according to the intensity o f its
especially effective being a signal from her sound of the mother, especially
effective being a signal from her acknowledging his presence. At higher intensity
termination may require his touching or clinging to her. At highest intensity,
when he is distressed and anxious, nothing but a prolonged cuddle will do. The
biological function of this behaviour is postulated to be protection, especially
protection from predators. (Bowlby, 1988, p. 3)
Separation: Period when mother is physically and/or emotionally unavailable to her

infant.
Mother: Biological mother or other primary care-taker filling the primary dyadic
attachment relationship role with the infant and serving as the facilitating (Winnicott,
1965) interactive environment required for the infants continued development.
Emotion: Genetically predetermined, organized neural circuit that responds
unconditionally to stimuli arising from major life-challenging circumstances
(Panksepp, 1998, p. 48), provides feedback (feelings), solves a particular set o f problems,
and organizes adaptive behaviors or other responses in relation to the environment for the
ultimate goals o f survival and reproduction. Emotion circuits organize diverse
behaviors by activating or inhibiting motor subroutines and concurrent autonomichormonal changes that have proved adaptive in the face of such life-challenging
circumstances during the evolutionary history o f the species (Panksepp, 1998, p. 49).
Affect: Observable emotion display (i.e. facial expression, body language, tone o f voice,
pace o f speech).
Afreet Attunement: The performance o f behaviors that express the quality o f feeling o f a
shared affect state without (simply) imitating the exact behavioral expression o f the inner
state (Stem, 1985, p. 142). This process involves parental resonance with the childs
feeling state indicated by some type o f matching of the childs expressive behavior.
However, the channel or modality o f expression used by the mother to match the infants
behavior is frequently, if not mostly, different from the channel or modality used by the
child; and what is being matched is not so much the childs behavior, but some aspect o f
the behavior that reflects the childs feeling state.
47
Stress: A state o f disharmony, or threatened homeostasis (Chrousos & Gold, 1992, p.

1245).
Coping: An individuals ability to achieve homeostasis in response to stress as mediated
by his or her developmentally determined repertoire o f coping mechanisms in interaction
with the intensity, frequency, quantity, timing, and duration o f the stressor and the
stressors meaning to the individual (ego-functioning).
Emotion Regulation: Emotion regulation involves the ability, when experiencing a
strong emotion, to self-soothe (by reducing autonomic arousal), focus attention, and
organize behavior in the service o f an externally imposed goal. It involves the ability to
use self-regulatory coping behaviors in the face o f distress, such as passive avoidance,
distraction or attention to pleasurable events, increased concentration to goals, and selfsoothing. I f emotion regulation represents the internal regulation of emotional arousal,
physiologic measures o f sympathetic activity would be expected to reflect this
regulation. (Scarpa & Raine, 1997, p. 386-387)
Emotion Dvsregulation: Converse o f emotion regulation.
Trauma: An individuals ability to restabilize in response to stress is mediated by his or
her developmentally determined repertoire o f coping mechanisms in interaction with the
intensity, frequency, quantity, timing, and duration o f the stressor and the stressors
meaning to the individual. If a stressor occurs at a level of intensity or duration that
outstrips an individuals adaptive repertoire, as is most likely to occur in earliest infancy,
stress quickly becomes distress. Disorganizing distress that threatens ones very
existence becomes traumatic stress. The most devastating components o f traumatic stress
48
at any age are to be all alone, faced with the threat o f impending annihilation, while
powerless to do anything about it.
Attachment Psychopathology: Biological, psychological, and social adaptations to
accommodate abnormal experience in order to achieve homeostasis and optimize survival
within the context o f the given environment. When infants are subjected to attachment
deprivation, distortion, or abuse they must make extraordinary adaptations to regain their
equilibrium or face reduction or disorganization o f their systems. These extraordinary
adjustments may be short-term and state-like or long-term and trait-like. If aberrant
adjustments are prolonged, particularly throughout the course of a critical developmental
window, they can become permanent.
49
CHAPTER IV
RESULTS
PART I: DETAILED DEMONSTRATION OF MODELS EFFECTIVENESS
FROM BIRTH - TWO MONTHS: (ANYTHING BUT) AUTISM 1
The Nature of Human Brain Development Following Birth
Emotion and the social bond in which it emerges, mother-infant attachment, would
not exist without the biological systems that make them possible. The purpose o f this
section is to share some o f what is known or postulated (for much is yet unknown) of the
biological substratesbrain structures, emotion circuits, and the neurotransmitters that
infuse themthat underlie these extraordinarily rich, complex phenomena. Much o f this
information has emerged from animal research, due to obvious ethical constraints.
However, with the recent surge in human data that has been made possible by new
scientific techniques, it is becoming apparent that we mammals have a great deal in
common, especially when it comes to these evolutionarily old emotion systems. For
instance, scientists who have now completed detailing the entire human genetic code have
found it to be remarkably similar to that of mice (National Institutes o f Health & Celera
Genomics Corporation, 2001). An overview o f human brain development, focussing on
the systems o f emotion, provides the foundation for understanding the mechanisms o f
1 Special headings for the six sequential age periods: Autism, Symbiosis, Selective Attachment,
Practicing, Rapprochement, and Object Constancy, are terms formulated for these developmental periods
by Mahler, Pine, & Bergman (1975) in The Psychological Birth o f the Human Infant.
50
mother-infant attachment, their essential contributions at various points along the

developmental trajectory, and what can go so terribly wrong if they do not occur as
expected.
By birth, proliferated neurons have migrated to their ultimate destinations. Many,
differentiating in response to repeated firing patterns, have begun to serve particular
purposes. However, specialized brain functions may remain immature or poorly integrated
for some time, particularly if neurons in those systems have axons which have not yet
myelinated. Due to their developmental criticality, the processes of differentiation and
myelination will be discussed in some detail.
The notion o f critical periods in human brain development has been a
controversial one, particularly in application to psychological development. However,
there is now general agreement, especially among neurobiologists, that critical periods do
exist. Critical periodsreframed as experience-expectant (Greenough, Black, &
Wallace, 1987) periods for emergent brain structures, neurophysiological systems, and
emotion circuitryare critical to the developmental model for psychopathology proposed
in this dissertation and will also be discussed in detail.
Differentiation
As Risser and Edgell (1988) explain:
Birth occurs while the majority o f neuronal populations are still differentiating. As
the sine qua non for future brain-behavior development, birth provides the evolving
brain with the environmental context to guide subsequent maturation. (Risser &
Edgell, 1988, p. 47).... Aspects o f differentiation, such as the growth and pruning
o f synaptic spines on dendrites (receptive postsynaptic regions), appear to have a
strong environmental component, occurring in response to the experience o f the
organism in its postnatal environment (e.g., Lund, 1978 in Risser & Edgell, 1988,
p. 45-46)...During differentiation, (neuronal) redundancy dissipates. A
competition among neurons for limited aspects o f their synaptic target zones
51
results in a weeding out o f those neurons that lose the competition either by not
establishing synapses at the proper time or by somehow synapsing in improper
fashion (Cowan, Fawcett, OLeary, & Stanfield, 1984; Purves & Lichtman, 1980
in Risser & Edgell, 1988, p. 46)
Purves et al. (1997) estimate that a newborn baby starts out with two to three
times the 100 billion neurons found in the mature, human brain. Joseph (1996) estimates
there are anywhere form 15% to 85% more neurons in the infant as compared to the 6070-year-old adult brain (p. 655). The neocortex itself will be trimmed to approximately
10,000 billion with up to 1000 to 10,000 synapses per neuron (Panksepp, 1998, p. 74).
The good news is that, due to this overabundance, functional organization (or
compensatory organization in the event of postnatal injury or disease) is most possible
during infancy and early childhood. However, as Rhawn Joseph (1996) explains
the rate o f neocortical and dendritic drop-out is largely affected by environmental
conditions and associated with neural activity (i.e. the use it or lose it principle).
For example, when animals are reared under conditions o f social isolation and/or
reduced sensory stimulation, neurons drop out and/or become smaller, and
dendritic density is reduced (Casagrande and Joseph, 1978, 1980; Diamond, 1985,
1991; Greenough and Chang, 1988; Rosenzweig, 1971; Rosenzweig et al., 1972)
... Thus these excessive neurons, dendrites, etc., do not always simply die, such
as occurs with programmed cell death. Rather, the nature of ones environment
and the stresses involved in large part determine which neurons and neural
pathways are developed, which die out, and which dendrites come to be pruned
away. (p. 655)
The human brain will come to express more than 50% o f an individuals genetic
potential (Panksepp, 1998). Based on findings from detailing the entire human genetic
code, the number o f human genes is now estimated to be 26,000 to 35,000~-much lower
than expected (National Institutes o f Health & Celera Genomics Corporation, 2001).
Other observations are that there is a great deal o f evolutionary redundancy; genes appear
to be constructed by mixing, matching, or globbing new parts onto old parts; and that
52
phenotypic presentations are not so hard-wired as commonly believed (i.e. one specific
gene giving rise to one particular trait or disease). Intracellular protein dynamics appear
to hold the key to the complexity o f genetic expression. These scientists stress that nature
and nurture can not be separated out and that environmental influence provides the
context that guides genetic expression. Purves and colleagues (1997) note that neuronal
differentiation is not a simple, rigid unfolding o f genetically predetermined functions, but a
process that is highly dependent upon intercellular communication:
When very young precursor cells are transplanted, they usually acquire the host
phenotype; transplants at increasingly older ages, however, usually retain the
original phenotype. The progressive restriction o f possible phenotypes that a given
cell can assume almost certainly results form local cellular and molecular cues that
progressively limit the complement o f genes expressed in that cell... In short, the
emergence o f diverse cell types in the mammalian nervous system does not result
from the unfolding of a rigid program based on lineage, but from elaborately
orchestrated spatial and temporal interactions between neuronal precursors and
molecular signals derived from other cells, (p. 390)
As stated previously, there is abundant redundancy~not just of neuronsbut o f the
synapses among them. Now that all neurons have migrated to their functional sites,
differentiation following birth focuses on honing the interactions between axons and
dendrites as the functional circuits they create continue to form and mature.
As explained by Purves et al. (1997)
the formation o f synaptic contacts between growing axons and their synaptic
partners signals the beginning o f a new stage o f development. Once synaptic
contacts are made, neurons become dependent in some degree on the presence o f
their targets for continued survival and differentiation; in the absence of synaptic
targets, the axons and dendrites o f developing neurons atrophy and the nerve cells
may eventually die. (p. 407)
The overabundance o f synapses is referred to as polyneural innervation (Purves et al.,
1997, p. 419). Joseph delineates the two types o f transient connections that are made at
53
this early stage o f development and how the process o f pruning these redundancies will
occur:
Divergent transient interconnections are charactesrized by neurons (or populations
of neurons) that exuberantly innervate more cells than is seen in the adult brain.
However, via the retraction of these axonal collaterals or via the shrinking o f the
axons terminal arbors, these extra connections a_re eventually lost. (p. 635)
Convergent transient interconnections a re characterized by a single target
neuron (or population o f neurons) that is simultaneously innervated by many
different neurons. However, over the course o f development, only one o f these
neurons maintains these connections, whereas axions from the others drop out and
are eliminated. This drop out involves the elimination of extra and transient
interconnections, the pruning of axons and axonal collaterals, a decrease in
synaptic numbers and densities, and cell death. i(p. 635)
Neurons develop delicate, immature axons even [prior to the completion o f
migration. Axons find their ways to synaptic targets through several apparent, albeit not
well-understood, mechanisms. Two of these mechanisms involve molecular substances
categorized as tropins (which guide them) and trophins ((which promote their survival,
growth, and differentiation). Tropin factors are located either on other cell surfaces or in
the intracellular matrix surrounding cells. When an a x o n s growth cone comes in contact
with tropin factor, it will either change shape and move tow ard its target or its growth
may become inhibited, depending on whether the tropin molecule has attractant or
repellant properties (Purves, 1997).
Trophin factor is produced by the target cell itself and serves as the prize for those
neurons competing to maintain contact with it. Those th a t dont get it will atrophy and
eventually die. Cell death due to trophic deprivation (apoptosis), differs from death due
to injury or disease, in that it appears to be genetically diriven to ultimately match the
appropriate number o f inputs to available targets. Dendirites have self-serving purposes
for producing trophin factor, because those that dont find an axon to innervate them will
54
degenerate. Those that do become innervated, will thrive and branch further (Joseph,
1996). Purves et al. (1997) note that neuronal branching o f axons or dendrites occurs
with mere exposure to nerve growth factor (NGF), whether the parent cell itself has been
exposed to (and affected by) the factor or not.
These authors speculate that, because trophin factor is released in limited amounts,
this is one way to winnow out weaker connections, assuring that each target cell is
innervated by the right number o f axons, and that each axon innervates the right number of
target cells (Purves et al., 1997, p. 410). They clarify that the reduction is in the
number o f inputs to target cells from different neurons, not necessarily in the number of
inputs on the target cell (several o f which can come from multiple axonal branches o f a
single cell), with the ultimate range o f synaptic inputs in the mature mammalian brain of
1 to 100,000 (Purves et al., 1997, p. 410) per postsynaptic cell. The greater the
number o f dendrites, the greater the number o f inputs from different axons that can
become supported, permitting a broader scope o f responding. Therefore, dendritic form
greatly influences function (Purves et al., 1997, p. 421). Thus, the size o f nerve cell
populations in the adult is not fully determined in advance, but is governed in part by
idiosyncratic neuron-target interactions in each developing individual (Purves et al., 1997,
p. 407). This initial response o f presynaptic neurons to thrive (or not) based on trophic
feedback from target cells foreshadows the flexible, dynamic processes that will emerge
between axons, neurotransmitters, receptor sites, and dendrites based on firing patterns
and chemical feedback systems when mature synapses are obtained.
Indeed, emergence o f neurotransmitter produced electrical communication
between cells is the other, and most familiar, mechanism by which cellular and synaptic
55
redundancy will become reduced. Innervated target cells become increasingly robust with
a corresponding increased production and branching o f dendritic spines. Larger
postsynaptic targets, in turn, permit increased inputs from larger numbers o f presynaptic
cells.
Firing patterns will become a potent determinant as to which cells will take their
place as functioning members o f activated neuronal circuits and which will atrophy, then
die in this use it or lose it affair. For example, synaptic strength is produced when the
terminal site receives synchronized (vs. asychronized) inputs from presynaptic neurons.
This results in stronger postsynaptic terminals which, in turn, sprout new branches. Those
cells whose synapses are weakened by disorganized or blocked inputs will lose their hold
and eventually fall by the wayside (Purves, 1997). Apparently neuronal cooperation
afforded by inputs with similar firing patterns gives rise to groupings or ganglia with
specific functions. Dissimilar patterns foster competition for available target sites (Purves,
1997). Purves et al. (1997) speculate that correlated neural activity affects synaptic
strength by mechanisms similar to those proposed for long-term potentiation (LTP) and
long-term depression (LTD) (p. 434).
Rhawn Joseph (1996) underscores the vital role of the neurotransmitter systems
(i.e. NE, DA, 5-HT, and ACh), which are in place by birth, in the processes o f
differentiation. Active as early as the second trimester, they have exerted their own
trophic influences on developing fetal neurons in addition to their more familiar role of
transmitting information from one cell to the next. Which neurotransmitters cells
encounter depends upon their migratory locations. Norepinephrine, however, may be
particularly vitalespecially for cells that will come to form the neocortex:
56
NE axons arrive prior to migrating neocortical neurons and quickly infiltrate layers
I and VII, and then proceed to innervate the cortex in a rostral-caudal direction.
By birth, both cerebral hemispheres have been densely infiltrated by NE Axons
(Levitt and Moore, 1979), and NE levels are about 30-40% o f adult levels
(Johnston, 1988)... .NE innervation o f the entire neocortex derives from the A6
catecholamine group in the locus ceruleus...Apparently, NE stimulates cyclic AMP
formation in the developing cortex, which in turn regulates protein kinase
phosphorylation of intracellular proteins, as well as energy metabolism via
glycogenolysis stimulation (reviewed in Johnston, 1988). Hence, NE is important
in neural growth and neural metabolic activity, (p. 638)
NE also plays important roles in neuronal plasticity and in guiding and inhibiting neural
development, even in non-NE systems (p. 638); in promotion o f cell migration,
neuronal and axonal maintenance, synaptic development, and neuronal differentiation
(Pamavelas et al., 1988) (p. 638); and in counterbalancing the inhibitory effects of 5HT. For example, NE apparently is instrumental in maintenance as well as development
o f initial synapses in fetal cells in the deepest cortical layer while they are in a waiting
pattern to begin their ascent to more superficial layers.
NE has been shown electrophysiologically to inhibit or suppress irrelevant
background activity while simultaneously enhancing evoked responses in both
inhibitory and excitatory afferent neural circuits associated with the processing o f
relevant environmental input (Foote et al., 1983)...Hence, in the developing
nervous system, NE may also act to suppress the establishment o f irrelevant neural
circuits, while simultaneously stabilizing and/or promoting the growth and
formation of relevant synaptic neural networks (see Bear and Singer, 1986;
Pettigrew and Kasamatsu, 1978). (p. 637-638)
Mvelination
Joseph (1996) explains how myelin growth follows on the heels o f a neurons
achieving synaptic maturity: In fact, the functional development o f each individual
neuron appears to initiate or trigger myelination (Grafstein, 1963), which in turn increases
functional and transmission capacity by a magnitude o f400% (e.g., Rain & Path, 1991)
(p. 656). Myelination, generally proceeding in a rostral-caudal direction, largely accounts
57
for the dramatic increase in brain structure and size that occurs from birth to early
childhood (Risser & Edgell, 1988).
Subcortical systems (i.e. for hunger, thirst, reward/pleasure, rage, and other id
like activities) are much more fully developed and operational in the infant and young child
than are the emergent, complex executive ego and super-ego like systems provided
by the neocortex. Infant and young child activity (i.e. motor control, cognition, language)
is poorly integrated until which time the process of myelination speeds firing and furthers
development o f neuronal pathways from subcortical to cortical areas, across the
hemispheres via the corpus callosum, and to the association cortexa process that can
take up to 10-18 years to complete (Chugani, 1998; Joseph, 1996). Myelination can be
severely disrupted by stress, which can delay or even reverse the myelination process
(Joseph, 1996, p. 640).
Risser and Edgell (1988) explain that areas of the brain that receive input from the
senses or control m otor activity appear to become fully functional by the first year of life
and form the basis for successful subsequent development o f areas responsible for
integrating modality-specific information into perceptive information. In turn, healthy
development o f these areaswhich become fully functional within the first five years of
lifeprovides the basis for associative, supramodal areas responsible for integrating
information across modalities and controlling executive, purposive, and conative aspects
o f functioning. These areas mature between the ages of five and eighteen (Chugani, 1998;
Joseph, 1996). Both hierarchical and lateralized systems with specialized functioning
emerge.
58
Critical Periods
Neurobiologists are extremely consistent in their conclusions that critical periods
do indeed exist for developing infant brains (Chugani, 1998; Greenough, Black, &
Wallace, 1987; Joseph, 1996; Purves et al., 1997; Wynder, 1998). Even though brains at
this age are known for their plasticity, mild to profound permanent aberrations in
development can occur if the brain is disrupted or deprived o f what it needs during the
specific windows for the various emergent structures or circuits forming during these
periods. Once its formative stage window has closed, the opportunity for optimal or
normal development o f that structure or circuit has passed. Development continues to
unfold, whether or not all systems have come on-line as expected. Critical to this concept
is the understanding that the integrity o f higher order systems which have yet to emerge
and therefore the potential quality o f their functionswill be dependent upon the integrity
o f those earlier emerging systems that comprise them.
Perhaps the most biologically precise and up-to-date approach to the critical
period concept is the one developed by Greenough, Black, and Wallace (1987). At the
heart o f this parsimonious model is how the mammalian brain incorporates
environmentally originating information (p. 540) to drive its own development and to
make ongoing adaptations toward optimal survival throughout its lifetime. These authors
describe two distinct types o f information processing and storage mechanisms for
incorporating environmental experience, both of which make use o f the brains plasticity:
the (1) experience-expectant and (2) experience-dependent processes (p. 540). The
experience-expectant processwhich accounts for critical-period phenomenais
designed to utilize the sort o f environmental information that is ubiquitous and has
been so throughout much o f the evolutionary history o f the species. Since the
normal environment reliably provides all species members with certain
experiences, such as seeing contrasting borders, many mammalian species have
evolved neural mechanisms that take advantage o f such experiences to shape
developing sensory and motor systems. An important component.. .appears to be
the intrinsically governed generation o f an excess o f synaptic connections among
neurons, with experiential input subsequently determining which o f them survive.
(p. 540)
The experience-dependent process is
involved in the storage o f information that is unique to the individual. Mammals in
particular have evolved nervous systems that can take advantage o f such
information, as o f sources o f food and haven, and individual survival depends upon
it to a very great extent. Since such experience will differ in both timing and
character among individuals, the nervous system must be ready to incorporate the
information when it becomes available. An important aspect o f the mechanism
underlying experience-dependent information storage appears to be the generation
of new synaptic connections in response to the occurrence o f a to-be-remembered
event, (p. 540)
Experience-dependent processes, which make use of novel (vs. familiar)
information have been found to operate throughout the course o f an individuals lifetime.
(A similar mechanism posited by Panksepp (1998), the seeking emotion circuit, will be
described at length below.) It is the incorporation of novel information stimulating new
synaptic growth (vs. repetitions o f known information) that provides the best training to
keep brains in shape even into old age (Black, 1998). The experience-dependent system
provides hope for change, i.e. through a corrective experience in therapy (Black, 1998,
p. 168). However, the trade-off is that it requires effort and energy expenditure.
This process is dramatically illustrated in brain imaging studies conducted by
investigator Leslie Ungerleider (1996). When subjects encountered novel stimuli or
attempted to learn a new skill, metabolic activity indicated many neurons in several regions
o f the cortex were firing. However, as repeated exposure to stimuli occurred, rendering
60
them familiar, or tasks were learned, neocortical metabolic activity was drastically
reduced even though response times for recall or task completions were faster (reflecting
commitment to memory). The advantages of memory or habit formation appear to be
energy conservation and freeing up previously activated neocortical neurons to attend to
other new stimuli or tasks should they arise.
Although able to utilize both forms of plasticity, the newborn is primed for
experience-expectant opportunities. Incorporation o f novel information out o f sync with
inborn expectations can be somewhat more taxingat least for a few monthsfor a fragile
new autonomic nervous system, so youngest infants tend to prefer stimuli that are in or
restore harmony with their expectations (Brazelton, 1992; Geva, Gardner, & Karmel,
1999). When well fed (or otherwise satisfied), and therefore less aroused, newborns not
only can tolerate, but prefer novel stimuli (Geva, Gamer, & Karmel, 1998).
To answer the question o f why critical periods exist in evolutionparticularly the
prospect o f permanent, survival diminishing impairment should an individual not be able to
access the required experiences at the right times for normal brain development
Greenough, Black, and Wallace (1987) propose
the offsetting advantage appears to be that sensory systems can develop much
greater performance capabilities by taking advantage o f experiences that can be
expected to be available in the environment o f all young animals. Thus many
species seem to have evolved such that the genes need only roughly outline the
pattern o f neural connectivity in a sensory system, leaving the more specific details
to be determined through the organisms interactions with its environment, (p.
543)... if proper connections are selectively retained (or if improper ones are
selectively eliminated), a highly ordered pattern can emerge from a much less
organized one by the loss o f synaptic connections (Changeux & Danchin, 1977).
(p. 543)
61
This explanation makes sense, particularly as it mirrors the flexible and, thereby, more
efficient process by which fetal neurons apparently come to express their functional
phenotypes under the influence o f neighboring cells in their target site environments
following migration vs. adhering to a rigid, genetically pre-programmed function per each
individual cell prior to making the migrational journey (Purves et al., 1997).
During experience-expectant periods, particular neural assemblies require their
own specific types o f experiences with the environment to assure their activation and
stabilization as functional circuits. Greenough and colleagues (1987) posit that repeated
exposuresand therefore repeated firingsto expected stimuli, as well as synchronized
firings (as previously discussed), are the mechanisms that come to stabilize the particular
synapses that comprise a circuit. Experienced neurons have the obvious advantage.
These authors also suggest that infants, themselves, play a role in obtaining the
specific stimuli needed during the various experience-expected time frames by providing
positive feedback to their care-givers when they are in the zone (i.e. excited smiles;
focussed, alert attention) or negative, distressed feedback when their arousal range has
been exceeded as parents miss the mark. Since required stimuli change over the course of
development, depending upon which brain structures or regions are coming on-line, those
parents who are sensitive, tuned in, and appropriately responding to their babys signals
will generally provide the expected experiences at the right timesquite naturally and
normallythat foster healthy brain development.
Developmental irreversibility arises because
a set of synapses has become committed to a particular pattern o f organization,
while synapses that could have subserved alternative patterns have been lost...The
rate and extent of commitment o f synapses may be regulated by both the quality o f
62
experience and intrinsic factors such as broadly acting neurochemical

systems... .both the quality o f information and the way in which it is used can affect
the rate o f pattern formation as well as the character o f the pattern. (Greenough,
Black, & Wallace, 1987, p. 546)
A normal example o f irreversibility that occurs in language acquisition is described by
Gopnik, Meltzoff, and Kuhl (1999). Up to approximately age ten months, infants have the
capability o f hearing and possess the potential o f eventually speaking any sound from any
culture in the world. However, by age ten months, those sounds that they have not
experienced (heard spoken) drop out o f their repertoire. For instance, Pat Kuhl found
through her research that
Japanese and American seven-month-olds discriminated r from 1 equally well. But
just three months later, the two groups of infants were as different as night and
day. At ten months, Japanese infants could no longer hear the change from r to 1.
American infants not only could do so but had actually gotten much better at
making this distinction, (p. 107)
The synaptic fine tuning or streamlining process has now been visually documented
through a series of PET scan studies by Harry Chugani (1998) o f developing human brains
overtime. For instance,
the measurement o f absolute rates o f glucose utilization during development
indicates that the cerebral cortex undergoes a dynamic course o f metabolic
maturation that persists until ages 16-18 years. Initially, there is a rise in the rates
o f glucose utilization from birth until about age 4 years, at which time the childs
cerebral cortex uses over twice as much glucose as that of adults. From age 4 to
10 years, these very high rates o f glucose consumption are maintained, and only
after then is there a gradual decline o f glucose metabolic rates to reach adult values
by age 16-18 years. (Chugani, 1998, p. 184)
Exaggerated glucose consumption represents the overabundance of yet to be pruned
synaptic activities. These dramatic glucose accelerations and expenditures are not seen in
those structures that have matured (and, therefore, have streamlined their synapses), such
as the brain stem in two-month old infants or the neocortex in adults.
63
Chuganis work also provides clear evidence that various brain structures or
cortical regions come on line at differing times. Exaggerated activity represents neurons
hard at work, taking in environmental information and competing for coveted lifesustaining target space on postsynaptic neurons. It may be presumed that accelerated
activity o f specific brain structures or regions heralds the appearance o f their unique
experience-expectant time frames as described by Greenough, Black, and Wallace (1987).
For example, the consistent metabolic pattern for newborns shows
the highest degree o f activity in primary sensory and motor cortex, thalamus, brain
stem, and cerebellar vermis. The cingulate cortex, hippocampal region, and
occasionally the basal ganglia may also show a relatively high glucose metabolism
compared with most o f the cerebral cortex in the newborn period. The relatively
low functional activity over most o f the cerebral cortex during the neonatal period
is in keeping with the limited behavioral repertoire of newborns, characterized by
the presence o f intrinsic brain stem reflexes and limited visuomotor integration.
(Chugani, 1998, p. 184)
Greenough, Black, and Wallace (1987) have proposed:
that by staggering the developmental schedule for maturation o f different brain
regions, the human species (and other mammals, for which such patterns are also
evident) may have gained substantial advantages, most importantly by allowing one
developmental system to provide a suitable framework for a subsequent,
experience-sensitive system (Black & Greenough, 1986; Turkewitz & Kenny,
1982). (p. 553)
These authors refer to this process as stage-setting (p. 553).
The concept o f how developing brains reinvent or reorganize themselves as more
sophisticated information processing systems come on lineadding a new twist, yet based
on information already collected by lower systemsis in keeping with those of other wellknown developmentalists. For instance, drawing from his meticulous observations, Piaget
proposed that it was a reorganization o f brain capabilities that accounted for the shift from
preoperational to concrete operational thought (Piaget & Inhelder, 1969). Infant
64
behaviorists Gopnik, Meltzoff, and Kuhl (1999), although reluctant to acknowledge the
possibility o f a biological clock for aspects of infant development, provide a similar
reorganizing view o f developing infant brains, using the metaphor o f a computer (p.
153) that can efficiently retool itself as it acquires new data sets. They concede
it may be that experience itself has changed our brains so that we perceive and
interpret the w orld in a certain way. Once the neural wiring occurs, it is difficult to
interpret the w orld in any different way. Once we have a representation that
works, and instances mount up that confirm that representation, it becomes
increasingly difficult to change it. (p. 191)...Experience changes the brain, but
then those very changes alter the way new experience affects the brain. The
sequence o f development seems very important: choosing one path early on may
heavily influence which paths will be available later, (p. 195)
Ramifications fo r the way in which a brain organizes itself as it develops within the
context of its environment are summarized by James Black (1998) :
as different regions o f the brain become relatively mature, they can serve to
organize and stabilize information for other brain regions to incorporate... In
general terms, some species have apparently evolved self-organizing programs for
brain development, components o f which sometimes incorporate expected forms
o f experience, with other more canalized brain regions developing independently of
experience, som e brain regions serving as scaffolding to stabilize or organize
information fo r other components, and still others using experience to fine-tune
their anatomy fo r optimal function. Note that if a species relies heavily on the
quality and tuning o f experience for organizing its brain, it also becomes quite
vulnerable to disruption of it. (p. 169)
If the necessary am ount o f expected experience required to establish a circuit is not
forthcoming at the appropriate time, there are some limited safeguards:
The character o r quality o f expected experiences may also play a role in
determining th e length o f time that the developing nervous system remains
sensitive to their effects. For example, since success in competition and
consequent elimination o f alternative neural patterns is promoted by experiencebased neural activity, a relative reduction in that activity may prolong the
competition process (p. 544)....Relatively small amounts of normal (i.e. visual)
experience appear to set in motion processes that can protect the organism against
later deprivation. (Greenough, Black, and Wallace, 1987, p. 545)
65
Another protective factor that can serve to buy time is norepinephrines ability to promote
synaptic sensitivity when the expected experiences are forthcoming. (Joseph, 1996;
Greenough, Black, & Wallace, 1987). If, for instance, NE is reduced in a grouping of
neurons during a period devoid of its expected experience, an organizational pattern for
this grouping may be delayed (Greenough, Black, & Wallace, 1987).
But, the brain cant wait forever in an unaltered state. Indeed, as previously
discussed, many areas o f the brain are progressing at various developmental stages
simultaneously. Structures that are delayed may lose out on their rightful, appropriately
influential place within a circuit; the circuit may become abnormal by components that are
out o f sync developmentally. Let us now turn attention to qualitative effects o f
experiential input.
As simply stated by Rhawn Joseph (1996), if environmental input is abnormal or
not forthcoming, abnormal interconnections may be formed in their place (p. 663).
Black (1998) demonstrates how stage-setting can be applied to explain pathological
development:
Aberrant experience or deprivation will probably affect a young childs brain
anatomy as well, and here the issue o f sensitive periods arises again from the
animal literature. While adults certainly retain some neural plasticity and can be
traumatized by experience, children are likely to be far more vulnerable to
pathological experience (either abuse or deprivation), particularly during periods o f
rapid creation or modification o f synaptic connections, (p. 170)
Aberrant interconnections result from presynaptic neuronal competition for target
space on postsynaptic cells. If an experience-expectant stimulus is unavailable to activate
awaiting neurons positioned to receive it, other neighboring neurons that are receiving
stimulation may invade and take over what would otherwise have become their target
66
space. This was the case in the classic, Nobel Prize winning research by Wiesel and
Hubei (1965) in which they sutured shut a single eye o f kittens at about six days following
birthnot removing the stitches until six months later after the formative time period for
visual wiring o f the thalamus, then visual cortex had passed, producing permanent severe
visual defects for those eyes. Neurons responding to visual stimuli in the non-sutured eye
had invaded the target space o f the non-activated neurons corresponding to the deprived
eyes, making the damage irreversible. When they conducted the same experiment on a
different set o f kittens, but this time waiting until one year o f age to suture the eyes, there
was little or no adverse effectindicating that the appropriate connections were in place
prior to the suturing. Wiesel and Hubei used the term critical period to describe the
formative time frame that had been affected. They also found, that if they conducted this
experiment close to the peak of the critical period (at about four weeks o f age), it would
take as little as 3-4 days o f deprivation to obtain the same damaging, irreversible effect.
One o f the most famous and oft-cited human examples o f evidence for critical
periods is the case o f Genie, one of only a handful o f extremely rare recorded cases o f a
human being who grew up without any human contact from infancy (Gopnik, Meltzoff, &
Kuhl, 1999; LeFrancois; 1984; Pines, 1981 in Junn & Boyatzis, 1996). In 1970, the sight
o f thirteen-year-old Genie, in the company of her mother who was seeking California
public assistance after running away from her husband (Genies father), raised immediate
concern in agency social workers who, in turn, called police. From the age o f 20 months
until she was 13, Genie was forced by her abusive father to live isolated in a small room
where he decreed she was not to be spoken to by anyone. Drawing on a previous book,
67
Genie: A psycholinguistic Study o f a M odern-Day W ild C hild by Curtiss, Maya Pines

(1981) provides a chilling account o f what this child endured:
Naked and restrained by a harness that her father had fashioned, she was left to sit
on the potty seat day after day. She could only move her hands and feet. She had
nothing to do. At night, when she was not forgotten, she was put into a sort o f
straight jacket and caged in a crib that had wire-mesh sides and on overhead cover.
She was often hungry.
If she made any noise, her father beat her. He never spoke to her, wrote
Curtiss. He made barking sounds (and) he growled at her.. .Her mother was
terrified o f himand besides, she was too blind to take much care o f Genie. The
task fell largely on Genies brother, who, following his fathers instructions, did
not speak to Genie either. He fed her hurriedly and in silence, mostly milk and
baby foods. There was little for Genie to listen to. Her mother and brother spoke
in low voices for fear o f her father.
When Genie arrived in Childrens Hospital in November 1970, she was a
pitiful, malformed, incontinent, unsocialized, and severely malnourished creature.
Although she was beginning to show signs o f pubescence, she weighed only 59
pounds. She could not straighten her arms or legs. She did not know how to
chew. She salivated a great deal and spent much o f her time spitting. And she was
eerily silent. (P. 65)
Although Genie received extensive, intensive treatment over the next eight years,
did leam some language (There is evidence that she had learned and was able to speak
some words prior to her exile at age 20 months.), and increased her IQ score from 38 to
74; she continued to display serious, intractable deficits and was last reported living in a
home for adults unable to care for themselves. Primarily studied for her language
development, it was discovered, for instance, that she failed to incorporate grammatical
principles (i.e. grasping the difference between various pronouns, or between active and
passive verbs, p. 66). Staff at the UCLA Brain Research Institute discovered that Genie
was reliant on her right hemisphere for language with deficits indicating damage to the
left. Atrophy o f left hemisphere neurons was suspected (Pines, 1981).
Lest anyone continue to cling to the incredibly obsolete notion o f nature vs.
nurture as mutually exclusive sources from which development derives (i.e. that what
happens to us is preprogrammed in our genes), consider what brain expert Rhawn Joseph
(1996) has to say regarding the numerous waysfor better or worsein which experience
can affect the physiological formation o f the brain:
The nature o f ones early learning and social-emotional and physical and visual
environment can exert dramatic influences on brain structure, determining the size
and thickness o f the neocortex and nerve cells; the number and size o f synaptic
structures; the location , density, and number o f vesicles in the presynaptic
terminals; the shape o f postsynaptic spines; and the perforations in postsynaptic
density, as well as which neural pathways are strengthened and which neurons,
axons, and dendrites will die and drop out (Casagrande & Joseph, 1978, 1980;
Diamond, 1985; Denenberg, 1981; Greenough & Chang, 1988; Joseph, 1982;
Rosenzweig, 1971: Rosenzweig et al., 1972). In the occipital cortex, for example,
the dendritic fields are increased by about 20% among those reared in an enriched
visual environment. In fact, environmental conditions can affect synapse numbers
on the order o f thousands o f synapses per neuron, or billions, perhaps trillions of
synapses per brain (Greenough and Chang, 1988:405)...In this regard,
experience acts to organize neuronal interconnections and the establishment of not
just synapses but vast neural networks subserving a variety o f complex behaviors
and perceptual activity, (p. 662-663)
We now know that babies come equipped with sophisticated systems for engaging
the environment and eliciting attachment (These systems and capabilities will be discussed
in great detail below). Babies have a propensity to look at human faces, cry, root, suck,
grasp, and smileall o f which are hard-wired into the system (Bowlby, 1969; Brazelton,
1992; Gopnik, Meltzoff, & Kuhl, 1999; Risser and Edgell, 1988; Stem, 1985). Far from
passive, infants require interaction to survive outside the womb and to perpetuate
development o f their central nervous systems. Human infants, due to their large heads, are
bom quite prematurely, compared to other species. The upside is that that large brain will
surpass all others in its capabilities to adapt, survive, and reproduce within its
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environment. The downside is that human infants have an extended period o f time in
which they must rely upon others to meet all their survival needs until, gradually over
time, they can come to do this for themselves.
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Available Brain
Overview
The unfolding development o f a childs brain mirrors that o f MacLeans (1973)
description o f the evolution of the Triune Brain. Systems for neuronal transmission are
largely in place and functioning prior to birth; subcortical systems are much more fully
developed and operational in the infant and young child than are the emergent complex
executive systems provided by the neocortex; infant and young child activity (i.e. motor
control, cognition, language) is poorly integrated until which time the process o f
myelination furthers development of neuronal pathways from subcortical to cortical areas,
across the hemispheres via the corpus callosum, and to the association cortex; and
developing brain systems are shaped to some degree by the youngsters experience with
the external environment. The process o f myelination can be observed, for instance, as a
child gains control over motor systems in a cephalocaudal (head to foot) direction.
Subcortical structures which have come on line by birth include those
encompassed by the brain stem and the hypothalamus. Neurophysiological systems to
include dopamine (DA), norepinephrine (NE), serotonin (5HT), and the endogenous
opioids were in place during gestation and are fully functioning at birth (although, o f
course, in baby vs. adult quantities). Immature limbic structuresthe amygdala (on line
prior to six months), then septal area (on line at six months), followed by the cingulate
gyrus (on line at twelve months), then hippocampus (40% at birth; on line at 15 months)
will undergo rapid development over the next six months, important to keep in mind when
considering the role of experience expectant developmental windows that require
specific stimuli to drive their development during this time.
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Although all neurons have proliferated and migrated to their appropriate sites in
the neocortex, cortical systems are vastly immature with only about 19% functioning
capacity at birth (Joseph, 1996). The occipital cortex accounts for the greatest, operating
at about 33% of its adult capacity by birth (Joseph, 1996); the frontal lobes, which will
come to exert their executive influence over emotions, are the least developed at only 11%
(Joseph, 1996). It is critical to keep in mind, however, that the human cortex will grow
rapidly over the next twelve months, obtaining approximately 57% o f its adult capacity.
The success o f its development and the quality o f its functioningparticularly its capacity
to regulate emotionwill be contingent upon the integrity o f those subcortical systems that
subserve it.
The emotional structures o f the brain develop sequentially from least to most
sophisticated. As each comes on line, it superimposes its unique emotion specialization
thereby exerting influence over the systems below it. With each emergent structure the
young child gains more emotional sophistication and control. However it is not until
maturation of the cingulate gyrus that conscious, willed responses begin to emerge.
Emotion mediating circuits that are in place and operating at birth include the
autonomic nervous system, pleasure (satiety), seeking (appetitive), and rage circuits.
Stress and pain response systems are partially in place. The ability to experience pleasure
and take in the environment at birth resonate with Freuds Pleasure Principle.
Newborns are capable o f feeling good and bad. If they feel bad long enough, they get
mad. The raw emotional and hedonistic qualities of the hypothalamus have often been
likened to the id.
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All sensory-motor systems are primed and ready to go by birth. Systems for orality
(i.e. feeding, sucking, mouthing) are first to arrive on the scene thanks to facial nerves and
the brain stem. Hearing and vision systems are surprisingly sophisticated, as well. The
sensori-motor system o f the newborn has exquisitely evolved to interact with its new
environment on the outsideparticularly to that initial human environment known as mom.
An in-depth look at the brain structures, neurophysiology, circuits, and resulting
functions available at birthparticularly those producing the various components of
emotionwill provide insight into observed infant capabilities and will serve as a litmus
test for which aspects o f the prominent theories of psychological development ring true.
(The results may be surprising.) Things that could go wrong during this stage of brain
development will serve as sign posts for predicting attachment related psychopathology.
Structures
Brainstem
The brainstem (alias basal ganglia, striatal complex, corpus striatum) is in place
and functioning by birth. It will achieve full maturity within the next six months (Joseph,
1996). Comprised o f the medulla, pons, and midbrain; its collective structures include the
reticular formation (mediates arousal), cranial nerves, caudate nucleus, globus pallidus,
inferior colliculi (process auditory information), superior colliculi (process visual
information, store maps for auditory and somatosensory spatial representations and
programs for certain motor control functions, especially the spontaneous eye movements
needed for rapid orientation during pursuit), periaqueductal gray (PAG), ventral
tegmentum area (VTA) (produces DA), nucleus accumbens, entopeduncular nucleus,
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substantia nigra (produces DA), locus coeruleus (produces NE), raphe nucleus (produces
5-HT), and other neurotransmitter producing nuclei (Joseph, 1996; Panksepp, 1998).
Brainstem functions are hard-wired, requiring no conscious awareness, thinking, or
planning. They include monitoring and control of heart rate and breathing; sleep
(including REM); arousal, vigilance, and sensory filtering; stereotyped or rhythmic
reflexive motor responses to visual, somesthetic, auditory, vestibular, painful, sexual, and
edible stimuli (i.e. sucking); eye coordination; multi-modal sensorimotor processing;
coordination o f head movements; the orienting response to environmental stimuli;
primitive visual-spatial mapping; and reflexive emotional components that serve to engage
the environment such as universal facial expressions for happiness (smiling), sadness, fear,
anger, surprise, and disgust (Buck, 1988; Ekman, Sorenson, & Friesen, 1969 in Buck,
1988), and vocalizations (crying, laughing) (Joseph, 1996; Panksepp, 1998).
The periaqueductal gray (alias central gray or PAG) in the midbrain provides the
lowest level o f integration for the emotion systemsa virtual mecca for the convergence of
emotion relevant inputs from pathways throughout the brain. It receives inputs from six
areas (Panksepp, 1998): from the frontal cortex (i.e. computes reward contingencies; via
frontal eye fields, directs eye movements to significant stimuli in environment),
orbitoinsular cortex (mediates perception of irritants, pain, sound), medial hypothalamus,
vestibular complex (bodily orientation), locus coeruleus, and the solitary tract (which
collects information from the vagus nerve).
The PAG coordinates activity o f laryngeal, oral-facial, and other muscles for
respiration and inspiration (Joseph, 1996). Emotional vocalization programs (i.e. laughter,
crying) are stored here and can be produced even without consciousness (Joseph, 1996).
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The PAG receives spinal chord input from painful and noxious stimuli (Joseph, 1996, p.
358). It sends input down through the spinal chord, resulting in visceral (interoceptive)
responses. The PAG is a critical part o f circuits for physical pain, emotional pain,
separation distress, panic, rage, fear, defensiveness, pleasure, sexual urges, and
exploration.
Panksepp (1998) suggests that brainstem systems provide the
first evolutionary appearance o f a sophisticated representation o f self. This might
be expected simply from the fact that this part o f the brain contains multimodal
sensory systems designed to elaborate simple orientation responses. In other
words, these systems may provide a sense o f presence for the animal within its
world, (p. 77)
Hypothalamus
The hypothalamus is at 100% and fully functioning by birth (Joseph, 1996).
Perhaps the most id-like o f all brain structures, it is the central core from which all
emotions derive their (motivational) force (Joseph, 1996, p. 169). The hypothalamus is
responsible for obtaining biological requirements to maintain the organisms well-being
(homeostasis). In this capacity it regulates autonomic nervous system functions and
mediates circadian rhythms, temperature, eating, drinking, sex, pleasure, and rage.
Emotion sensations elicited in the hypothalamus are very primitive, diffuse, undirected,
and unrefined. The organism feels pleasure in general, or aversion/displeasure in general
(Joseph, 1996, p. 172-173).
Pleasurable states derive from sex, maternal behavior, attachment, play, and other
forms o f positive social contact as well as satisfaction of bodily needs. Aversive states
arise with unmet needs or threats to the organism. Aggression may take one o f two forms:
hot rageful, reactive (defensive) aggression in response to unmet needs or threat or
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cool, even enjoyable predatory (instrumental) aggression (i.e. cat-like stalking) in

seeking to get needs met (Panksepp, 1998).
Emotion at this level is quite biological, raw, and reflexivealthough somewhat
more flexible than the more fixed, reflexive motor patterns programmed into the brain
stem. A wider range o f stimuli will elicit or satisfy its various bodily, survival, or
reproductive requirements; and it permits a wider range of responding to meet those
needs through its interconnections with other brain systems. When a stimulus is removed
from the hypothalamus itself, the emotion ceases immediately. With its internal focus,
there is little or no conscious, subjective awareness of feelings at this subcortical leveleven when the neocortex is fully developed (Joseph, 1996; Panksepp, 1998).
Neurons and dendrites in specific sections of the hypothalamus are organized into
a predominantly male or female pattern as a consequence o f the presence or absence of
testosterone in the human brain during its critical period o f fetal formation (Joseph, 1996).
This sexualization will produce differences in thinking, sexual orientation, aggression, and
cognitive functioning (Barnett & Meek, 1990; Beatty, 1992; Dawson et al., 1975; Harris,
1978; Joseph, et al., 1978; Steward et al., 1975) (Joseph, 1996, p. 170). For example,
gender specific sexual behaviors are mediated by the preoptic portion o f the
hypothalamus.
Lateral hypothalamic nuclei mediate sympathetic nervous system activities (i.e.
increased heart and associated metabolic rates for heightened emotional or motivational
arousal) which counterbalance those in the medial hypothalamus that produce
parasympathetic activities (i.e. reduced emotional or motivational arousal with
corresponding decreased heart rate) (Joseph, 1996). Counterbalancing lateral and medial
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nuclei are responsible for maintaining homeostasis, utilizing bodily set points (i.e. ceasing
behaviors when upper limits are obtained) (Joseph, 1996; Panksepp, 1998). Consistent
with arousing sympathetic activities, lateral nucleidensely packed with reward sitesare
part o f the pleasure circuit; the medial forebrain bundle (MFB) is located here, famous for
its propensity to elicit crazed self-stimulation in laboratory rats (Olds & Milner, 1954).
The lateral portion also mediates predatory aggressive behaviors (Siegel, 1999).
The medial hypothalamic nuclei mediate parasympathetic functions. Therefore,
this area generally promotes quiescence, in which the individual tends to simply cease
behaving. However, the medial portion also has sites that, when stimulated, are so
aversive, relief or avoidance is actively sought (Joseph, 1996; Panksepp, 1998). The
medial portion, loaded with substance P receptors, mediates defensive rage (Siegel et al.,
1997; Siegel et al., 1999).
Neurophvsiology
Primary neurotransmitters for mediating emotion are Norepinephrine (NE),
Dopamine (DA), Serotonin (5-HT), and the endogenous opioids. NE circuits are formed,
in place, and fully functioning at birth with newborn quantities of this neurotransmitter at
about 30-40% o f adult levels (Joseph, 1996). It is a member o f the catecholamine family
o f neurotransmitters, along with epinephrine and dopamine. The primary function of the
catecholamines is to promote CNS arousal. They generally have an antagonistic or
counterbalancing relationship with the indoleamines (i.e., serotonin), which reduce or
inhibit activity (Joseph, 1996; Panksepp, 1998). As Panksepp (1998) points out, the
catecholamineswhich mediate the alerting, arousal, and efficiency o f information
processing (p. 110)probably influence performance in a classic inverted U-shaped
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fashion. Behavior increases from the initial point o f arousal up to a certain level an d then
diminishes as excessive arousal begins to preclude behavioral flexibility (p. 110).
Norepinephrine
Norepinephrine is manufactured in the locus coeruleus (pons) in the brain stem.
From here its circuits extend to the cortex, hypothalamus, cerebellum, lower brain SJtem,
and spinal cord (Joseph, 1996; Panksepp, 1998). It promotes sensory arousal, in
particular (Joseph, 1996; Panksepp, 1998) (i.e., cortical NE terminals are concentrarted in
the sensory projection areas) (Panksepp, 1998). N E cells are exquisitely sensitive to
environmental stimuli, especially powerful emotional events (Abercrombie & Jacobs,
1987) (Panksepp, 1998, p. 110). It is implicated in pleasure and reward. Especially
important in developing infant brains, NE suppresses irrelevant neural circuits, w hile
stabilizing or promoting growth and formation o f relevant synaptic neural
networks.. .innervation o f the entire neocortex derives from the catecholamine g ro u p in
the Locus Coeruleus. (Joseph, 1996, p. 636). NE also plays a key role in activating and
maintaining the stress circuit, as discussed at length below.
Too little NE results in attention deficits. Without adequate NE arousal o f th e
neocortex, individuals act impulsively instead o f deliberately-permitting unrestrained
subcortical emotionally driven urges to govern behavior (Panksepp, 1998, p. 1 lO).
Another manifestation is difficulty shifting cognitive sets in accordance with shifting
stimulus demands (i.e. perseveration) (Panksepp, 1998).
Dopamine
Dopamine (DA) exerts its arousing effects on motor systems (i.e. its cortical
terminals are concentrated in motor areas) (Panksepp, 1998). DA neurons in the
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substantia nigra (in the midbrain) send projections to the caudate nuclei via the
nigrostriatal tract. DA neurons from the ventral tegmental area (VTA~also in the
midbrain) innervate the nucleus accumbens and frontal cortex via the mesolimbic and
mesocortical tracts (Panksepp, 1998). VTA DA appears to be the driving force in the
seeking (appetitive) circuits (Panksepp, 1998), infusing these systems with the energy
required for sustaining effort toward getting needs met. It serves attractant and
maintenance functions for newly developing neurons (i.e. in the neocortex) (Joseph, 1996;
Schore, 1994). It is implicated in sustaining attention to novel stimuli and the mediation
o f pleasure, reward, and motivation (Joseph, 1996). There appear to be counterbalancing
DA systems for approach and withdrawal (Panksepp, 1998).
Serotonin
Serotonin (5-HT), an indoleamine, is manufactured by neurons in the raphe nuclei
(in the pons and medulla). Serotonin projections are fairly global in the brain, and also
tend to run parallel to those of the catecholamines within the same circuits, reflecting their
counterbalancing effects. Therefore, you can find 5-HT projections in the striatum,
hypothalamus, amygdala, hippocampus, and the cortex. 5-HT tends to have a tonic,
inhibitory influence in the brain (i.e. modulation o f appetite, pain, fear and other emotional
states) (Joseph, 1996). All motivated and active emotional behaviors including feeding,
drinking, sex, aggression, play, and practically every other activity (except sleep) appear to
be reduced as serotonergic activity increases (Panksepp, 1998, p. 111). It is implicated in
generating sleep and dreaming (Joseph, 1996). Serotonin inhibits incoming sensory inputs
and modulates m otor expression. It appears to aid perceptual and attentional functioning
by tuning out irrelevant and non-rewarding stimuli (Joseph, 1996). Unlike NE neurons,
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their activity is more modestly affected by environmental events, requiring quite stressful
stimuli to jog them into a faster firing rate (Panksepp, 1998, p. 111). With too little NE,
neurons may become over-inhibited by proportionally too much 5-HT (Joseph, 1996, p.
639).
Endogenous Opioids
Endogenous opioids, chains o f proteins known as neuropeptides, were discovered
in the mid 1970s (Panksepp, 1998). Hot topics of research ever sincethey appear to
serve a variety of modulatory functions throughout the central nervous system, many of
which are as yet poorly understood or remain undiscovered. However, research is
beginning to uncover critical roles o f endogenous opioids (primarily endorphins,
enkephalins, and dynorphins) in the brain, where they act as neurotransmitters with thenown postsynaptic receptor sites and are especially abundant in emotion circuits.
Endogenous opioids have been implicated as a major factor in maintaining
homeostasis to include stress reduction (Chrousos and Gold, 1992; Panksepp, 1986).
They are instrumental components o f classical conditioning (as the unconditioned reward
signifying the satisfaction o f organismic needs necessary to survive, reproduce, or maintain
homeostasis) (Grilly, 1994; Kehoe & Blass, 1989; Panksepp, 1998; Shide & Blass, 1991)
and habituation (Grilly, 1994; Smotherman & Robinson, 1993). Opioids mediate good
tastes and appetite promotion (Panksepp, 1998); sexual satisfaction, maternal behavior,
infant attachment, social enjoyment, and social play (Grilly, 1994; Panksepp, 1998;
Panksepp et al., 1978); dampening o f aversive feelings statesdepression, fear, and rage
(Grilly, 1994; Panksepp, 1986); analgesia to quell both physical and emotional pain
(Grilly, 1994; Panksepp, 1998; Panksepp et al., 1978); dissociation (van der Kolk, 1996);
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self-injurious behaviors (Coccaro, 1996; Russ, 1992); and suppression o f immune system
functioning (Grilly, 1994). Opioids can trigger inhibition of the sympathetic nervous
system, mediating bradycardia and respiratory depression (Grilly, 1994; Hayar & Guyenet,
1998; Kiritsy-Roy, Marson, & Van Loon, 1989; Kwok & Dun, 1998; Musha et al., 1989;
White & Irvine, 1999), even anaphylactic shock (i.e. in opiate overdose death) (Grilly,
1994). Naturally occurring stimuli that release the rewarding, calming effects o f
endogenous opioids in newborns include contact with mother, holding, touch, taste of
sugar, and milk ingestion (Blass, 1996; Grilly, 1994; Panksepp, 1998; Shade & Blass,
1991; Smith et al., 1992).
Endogenous opioids (particularly endorphins and enkephalins)just like exogenous
ones (i.e. morphine, heroin)are subject to tachyphylaxis, rapidly losing their pleasurable,
euphoric effects if produced in large quantities over an extended period o f time. They
apparently work best in small amounts provided in bursts, characterized as phasic (vs.
tonic) (Grilly, 1994; Panksepp, 1986). Analgesic effects of opioids, mediated by mu
receptors in the PAG, locus coeruleus, and medulla, may be more resistant to
tachyphylaxis (slower to develop tolerance)even with chronic release (Grilly, 1994;
Panksepp, 1986; Panksepp, 1998). Emotion modulating endogenous opioids activate
abundant delta receptors in limbic system structures (i.e. locus coeruleus, medial
hypothalamus, amygdala, hippocampus, cingulate) (Grilly, 1994; Panksepp, 1998).
Dynorphins activating kappa receptors in the cortex are also thought to have an emotion
modulating role (Grilly, 1994; Panksepp, 1998).
Opioid mechanisms and their effects are varied, widespread, interactive, and
extremely complex. For example, stimulation of one type of opioid may cause activation
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o f another (Grilly, 1994); two or more types o f opioids may have coordinated,
potentiated, or even opposite effects depending upon receptor sites activated (Panksepp,
1998); CNS opioids interact with other neurotransmitters to potentiate effects (i.e.
dopamine in the VTA, oxytocin in social mediating systems) (Panksepp, 1998), but
suppress others (i.e. NE, CRF, cortisol in response to stress) (Chrousos & Gold, 1992;
Panksepp, 1986); and opioids have been found to coexist with other neurotransmitters
inside, or activating receptor sites on, the same neuron (i. e. inside 5-HT neurons in the
raphe nucleus, CRF neurons in the hypothalamus) (Grilly, 1994; Panksepp, 1998; Wang &
Wessendorf, 1999). They utilize both neurotransmission pathways and paracrine
(diffusion) routes to activate their receptor sites (Panksepp, 1998) as well as modulatory
intracellular mechanisms when they co-inhabit other neurotransmitter producing neurons
(Panksepp, 1998; Wang & W essendorf 1999).
Emotion Circuitry
Autonomic Nervous System
The autonomic nervous system is comprised of two counterbalancing networks
that produce an active, aroused state (sympathetic nervous system) and a relaxed,
restorative state (parasympathetic nervous system). Its function is to achieve homeostasis,
required to ensure the survival, integrity, and well-being of the organism. Circuit
structures include the hypothalamus, brain stem, spinal cord neurons, and neuronal
synapses that directly stimulate or inhibit activity o f bodily organs (i.e. pupils, salivary
gland, lungs, heart, stomach, adrenal gland, intestines, bladder, and genitals). Sympathetic
and parasympathetic functions are interconnected in that activating one state cancels the
effects o f the other.
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For normal, healthy, optimal functioning an individual would appropriately

alternate between the two systems (vs. remain predominately in only one o f them) to take
full advantage o f their benefits. An infant must engage in the dance between the two
systems (1) to meet the new challenges that drive growth, development, and competence
and (2) to be able to calm down, absorb, digest, integrate, and incorporate new
experiences, as well as restore the energy that will be needed for the next go-around.
Brain stem components perched atop the spine monitor and regulate homeostatic
functions: i.e. nociceptors detect pain, irritants, and other aversive feeling states,
providing feedback that can trigger appropriate reflexive or neurochemical responses; the
medulla interacting with the vagal nerve mediate homeostatic processes for breathing and
heart rate regulation. Vagal tone is a measure o f the ability to shift efficiently from
sympathetic stimulation to parasympathetic slow down as measured by heart rate.
Therefore, variability in vagal tone (heart rate) across different states is desirable as an
indicator this counter-balancing system is functioning as it should.
The hypothalamus also monitors and regulates homeostasis through chemical
feedback loops or set points (i.e. for temperature regulation, thirst, hunger) that act much
like a thermostat to turn off or engage the appropriate system depending on the needs of
the organism. The hypothalamus and amygdala also contain reward and punishment
systems that enhance the organisms chances o f obtaining appropriate supplies to meet its
demands.
Sympathetic nervous system.
The sympathetic nervous system, which emerges first during fetal development
(Lester, Boukydis, & LaGasse, 1996), includes lateral hypothalamic neurons, brain stem,
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spinal cord neurons, sympathetic ganglia (just to left and right o f spinal cord) which
innervate increased activity in those bodily organs required to take action (i.e. heart and
breathing rates speed up) and decreases activity in those bodily organs with restorative
functions (i.e. digestive activity slows down). The actions o f the sympathetic ganglia are
closely linked and act in sympathy (Kalat, 1988, p. 86) with one anotherpromoting a
fast, organized response especially effective during emergencies. Most o f the final
synapses o f the sympathetic nervous system are norepinephrine driven. This system
produces a visceral state of arousal and excitement.
Parasympathetic nervous system.
The parasympathetic nervous system, in place at birth in healthy full-term infants
(Lester, Boukydis, & LaGasse, 1996), includes various hypothalamic nuclei (i.e. medial,
preoptic), brain stem, cranial nerves, spinal cord, and parasympathetic ganglia that lie right
next to each o f the organs (instead of next to the spinal cord). The parasympathetic
neurons, therefore, at times can act more independently from one another.
Parasympathetic activity includes decreased heart and breathing rates and increased
digestive activity toward the purpose o f energy restoration. Final synapses onto organs
use acetylcholine (Kalat, 1988). However, in the brain itself, endogenous opioids provide
rewarding effects as restorative needs are fulfilled (Panksepp, 1998). This system
produces a visceral state o f calm and well-being.
Pleasure fSatietv: Consummatory) Circuit
After years o f sifting through a myriad of empirical studies, as well as conducting
quite a few of his own, Jaak Panksepp (1998) has postulated very specific neural
substrates giving rise to pleasure, which he collectively calls the Consummatory circuit.
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These include set point detectors (each with its ow n limited range o f w hats acceptable for
the organism) in the hypothalamus for regulating .homeostasis, probable neuroceptors in
the brain stem that provide other chemical feed-back loops regarding the biological status
o f the organism, and the autonomic nervous systemespecially its parasympathetic
components. Panksepp suggests that the evolutionary purpose o f pleasure is to relish the
accomplishment o f achieving homeostasissome manifestation o f which is essential to
survival. It signals the fact that an organismic need has been fulfilled. Therefore, a
satisfying meal (renewed energy), quenched thirst, comfortable temperature, sexual
orgasm, and social contact feel good.
Panksepp proposes, based on available evidence, that the reward is most likely
provided by a burst of endogenous opioidwhichi, by shutting off (no longer needed)
arousal, generates a soothing sense o f well-being. He suggests that classical conditioning
o f stimuli associated with fulfilling need states, wlhen paired with opioids as the
unconditional reward, may occur in hypothalamic neurons, providing the infanteven at
this early agesome experience with forming expectations.
Pleasure, therefore, is hard-wired into the system, first experienced at the visceral
level, and fully operational by birth. Fortunately fo r most infants, the calming experiences
for which they are primed (i.e. soothing voice, gerntle holding, mothers milk), will be
readily available to them in their new environment on the outside. It is noteworthy that
these life-sustaining, biologically significant stimuili for which newborns are primed have
been found to have opioid releasing components <Blass, 1996; Panksepp, 1998), providing
built-in, unconditioned reward upon their obtainnnent.
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Seeking fAppetitive) Circuit

Panksepp (1998) supports a convergence o f thought among neurobiologists that
there is a separate motivational (or appetitive) system whose purpose is to engage and
sustain the activity required to obtain need fulfillment (homeostasis). This system would
produce the doing (effort) it takes to obtain the pleasure prize. It promotes approach,
engagement with, and excitement about life. The seeking circuit, infused with energizing
dopamine, follows the course o f its ascending mesolimbic pathway from the ventral
tegmental area (VTA), through the nucleus accumbens (a particularly exciting spot), to
the lateral hypothalamushome o f the legendary medial forebrain bundle (MFB). There is
evidence that opioid and dopamine co-mingle in these areas producing potentiated,
reinforcing effects (Berridge et al., 1997).
The MFB is the area that Olds and Milner (1954) discovered rats would frantically
self-stimulate, presumably because it felt so good. However, Panksepp (1998) explains
that humans stimulated in this area report that something very interesting or exciting is
going on (Heath, 1963). This contrasts with electrical stimulation of the septal area,
where., .feelings o f sexual pleasure have been evoked (p. 149). Apparently this is the
case for rats also, who demonstrate more slow and methodical behavior (vs. frantic) when
stimulated in this site. Therefore, Panksepp suggests that rats may have been exhibiting
more o f a frantically crazed do-loop (p. 151) in the famous 1954 study.
Eventually DA will infuse the mesocortical tract as first the amygdala, basal
ganglia, and eventually, the frontal lobes come on-line (Schore, 1994). Other
neurotransmitters, such as N E and endogenous opioids, apparently facilitate DA effects
along this tract (Joseph, 1996; Panksepp, 1998).
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Good descriptions o f the human subjective experience generated by the seeking

system might include eager anticipation, intense interest, and engaged curiosity
experienced when expecting rewards (Panksepp, 1998, p. 149), all o f which might be
observed in the young infant. Interestingly, unlike other more transient emotion systems,
the experience generated by the seeking system tends to be around most o f the time (i.e.
continued sense o f curiosity) and therefore, is more tonic or trait like. However, upon
obtaining the pleasure prize, the seeking sensation (with its inherent arousal) dissipates as
the individual quickly shifts into the pleasure state.
The seeking system promotes approach-motivated movement over time toward
the eagerly anticipated positive outcome; the expectation o f reward would appear to be
the essence of hope . To expecf a reward requires some type o f learning that would
result in a primitive form of memory. Panksepp suggests that learning in the seeking
system results from classical conditioning (as previously discussed in the pleasure section)-a primitive, but rapidly acquired, hypothalamic precursor to the more sophisticated
production of expectancies by the emergent amygdala. The seeking system responds
unconditionally to homeostatic imbalances (i.e. bodily need states) and environmental
incentives. It spontaneously learns about environmental events that predict resources via
poorly understood reinforcement processes. (p. 145). He postulates how this might
work:
The pleasures and reinforcements o f consummatory processes appear to be more
closely linked to a reduction o f arousal in this brain system. It makes sense that
the many reward objects that naturally satiate appetitive behaviorssuch as food,
water, and sexshould be closely linked to internal processes that signal
encounters with objects o f clear biological relevance. Indeed, consummatory
behavior causes a transient inhibition o f appetitive arousal. As the animal
encounters a need-relevant reward object and shifts into the consummatory mode,
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the appetitive urge to move forward ceases temporarily. It is hypothesized that

this rapid shift in the patterns o f neural activity may establish the neural conditions
that engage reinforcement processes in the brain...The transient external cues
associated with life-sustaining events may be the ones that gradually develop
conditioned neural routes back to the appetitive system, (p. 147)
He points out that an increasing number o f studies measuring DA cellular activity,
as well as dopamine release in the pathways emanating from the VTA, now indicate that
this system is especially highly tuned to stimuli that predict rewards, rather than to rewards
themselves (Damsma et al., 1992; Schultz & Romo, 1990; Schultz, 1992; Wilson et al.,
1995) (p. 152). Such predictive stimuli would likely include sensory components such
as sights, sounds, tastes, or smells that would become classically conditioned through
association with the reward and, therefore, become remembered at some level as
beneficial.
The seeking system utilizes a rather non-specific problem solving strategy to obtain
positive (and perhaps avoid aversive) ends (Panksepp, 1998). This would afford beneficial
flexibility in a resource-rich environment that offers such a wide array o f stimuli (i.e.
foods) from which to choose.
Thus, resource depletions within the body can lead to a generalized arousal of
seeking behaviors regardless o f the specific regulatory imbalances that exist, and
specific need states that sensitize distinct consummatory reflex tendencies (e.g.,
licking, biting, chewing, and swallowing) and key support mechanisms such as
sensory, perceptual, and memory fields relevant for the specific needs. By the
interplay o f these processes, a generalized search system can efficiently guide
animals to relevant environmental goal objects. In other words, the nonspecific
SEEKING system, under the guidance of various regulatory imbalances, external
incentive cues, and past learning, helps take thirsty animals to water, cold animals
to warmth, hungry animals to food, and sexually aroused animals toward
opportunities for organismic gratification, (p. 166-167)
Rage Circuit
Rage and aggression are not one in the same. Aggression may take one o f two
forms: (1) hot rageful, reactive (defensive) aggression in response to unmet needs or
threat or (2) cool, even enjoyable, predatory (instrumental) aggression (i.e. cat-like
stalking) utilized to acquire desired resources or outcomes (Panksepp, 1998). Rage
comes from a mounting, aversive build-up o f energizing arousal resulting from inability to
meet one or more bodily needs required to maintain the organisms equilibrium
(homeostasis). The Frustration Hypothesis, formulated by Dollard et al., 1939 (in
Panksepp, 1998), proposes that aggression will increase proportionately to the level of
frustration resulting from the thwarted goal. Panksepp (1998) agrees, observing that
a rapid suppression o f activity within the SEEKING system, in the absence o f
homeostatic pleasures, which would normally index that a reward has been
obtained, should unconditionally promote the arousal o f anger circuitry. Indeed,
such effects have been observed in animals elevated tendency to bite when
rewarding brain stimulation is terminated (Hutchinson & Renfrew, 1978). (p.
191)
The described dynamics are striking in their resemblance to opiate withdrawal effects that
are, o f course, the direct opposite o f those produced by the opioids themselves. With
opioid depletion (i.e. due to on-going, insufficiently met need or removal o f rewarding
stimulus prior to getting ones fill o f it), aversive, agitated feeling states and behaviors, to
include craving and aggression, can rebound with renewed intensity (Grilly, 1994).
Evolution based advantages o f rage would include decreasing arousal by venting it
onto a substitute target (goal object), resisting restraint, beckoning others for assistance to
get the need met through dramatic display o f affect, increase the probability o f success in
the pursuit of ones ongoing desires and competition for resources (Panksepp, 1998),
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and fighting off threatening predators. Panksepp reminds us that anger can be experienced
as a positive emotion: if the energized behavior o f rage produces the desired changes in
the environment, then it is rapidly mixed or associated with positive emotional feelings
(p. 196).
Restriction o f movement, powerlessness in getting needs met (as described above),
miss-match between expectation and reward as appraised by the amygdala (Panksepp,
1998), irritation, pain, social isolation (Panksepp, 1998), and threat can provoke rage. The
intensity o f rage can fall along an arousal continuum with mild irritation near the least
aroused end, varying degrees o f anger in between, and full-blown rage at the most aroused
end of the continuum.
Based on their research with cats and rats, Siegel and colleagues (1999) have
identified two distinct neural circuits involving the hypothalamus and PAG (that)
subserve two different kinds o f aggression: defensive rage and predatory (quiet biting)
attack (p. 359). Rage pathways include the medial amygdala (fully developed by six
months of age) (Joseph, 1996; Panksepp, 1998); stria terminalis, a cord of fibers
connecting the medial amygdala to the medial hypothalamusconsiderably thicker in males
(Joseph, 1996); medial hypothalamus (Joseph, 1996; Panksepp, 1998; Siegel, Schubert, &
Shaikh, 1997); NMD A glutamate receptors in the periaqueductal gray (PAG) in the
midbrain portion o f the brainstem (Siegel, Schubert, & Shaikh, 1997); and the sympathetic
nervous system. In addition, defensive rage is mediated by abundant substance P
receptors (more commonly known for roles in pain and depression) within the medial
hypothalamus (Siegel, Schubert, & Shaikh, 1997). Rage provoked at higher (i.e. cortical)
brain systems is critically dependent on lower systems; however lower systems (even at
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the hypothalamic level) are not dependent upon higher ones for this response (Panksepp,
1998).
Siegel and colleagues (Siegel, Schubert, & Shaikh, 1997) have also identified a
powerful rage suppression circuit comprised o f enkephalin opioids, arising from the
central nucleus o f the amygdala, that achieve their effect by activating mu receptors in the
PAG. Serotonin also has a role in modulating hypothalamically evoked attack (Siegel
et al., 1999, p. 359).
As previously discussed, rage is but one pathway to aggression (reactive or
defensive emotional aggression); others include predatory (seeking system activated and
pleasure producing) goal-directed behavior to acquire desired resource or outcome
(proactive, instrumental aggression); intimidating male-to-male behaviors to compete for
females, establish dominance in pecking-order, or claim territory; and maternal protective
behavior when her young are threatened.
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Developing Brain
Coming (On-Line) Attractions
Structures
Amygdala
The amygdala, immature at birth, will become fully functioning prior to six months
o f age (Joseph, 1996). Until that time, it can be considered to be at its critical
experience-expectant developmental peak. This structure comes to assign meaning to
emotion; its neurons monitor, appraise, interpret, and abstract from the sensory array
thoseespecially tactile, visual, auditory, and socialstimuli that are motivationally
significant. In this capacity, through its connections with the hypothalamus, it helps
regulate the autonomic and hormonal responses to that information (Joseph, 1996; Van
der Kolk, 2000) so biological needs get met. The amygdala intensifies rage and also
creates new capacities to include fear and emotional memory. The amygdalas implicit,
emotional memory system (outside of conscious awareness) is made possible by a long
term potentiation (LTP) mechanism which permits the development of
expectancies/anticipations connected to stimuli evoking punishment and reward (LeDoux,
1996; Purves et al, 1997). Unlike the hypothalamus, feeling states processed by the
amygdala, can become sustained past removal o f the stimulus producing them, giving rise
to mood.
The experience-expectant amygdala is primed for social contact. Joseph (1996)
suggests that evolution has maximized infants chances o f getting this by the indiscriminate
contact-seeking they display with emergence o f the amygdala. Its neurons are prepared
for learning species specific cues, i.e. from faces (LeDoux, 1996), eyes, others gaze, and
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smiles (Joseph, 1996); are polymodal, responding to a variety of stimuli from different
modalities simultaneously (Joseph, 1996, p. 178); and are especially sensitive to
somesthetic input and physical contact, so that even a slight touch anywhere on the body
can produce their excitation. Contact with others is an extremely potent and necessary
stimulus at this point in development (Joseph, 1996).
Cortex
As previously described, PET scans o f newborn brains by Harry Chugani (1998)
show a lot o f metabolic activity in the hippocampus and portions of the cortex, although
these structures will mature at later pointsfollowing the amygdalaalong the
developmental trajectory. This activity represents the overabundance o f synapses at this
early agea hot bed o f competition for coveted target space activated by experience
responsive neurons, characteristic of a developmental window.
All cortical neurons are in place on the day o f birth; however, their differentiation
through synaptic pruning, followed by myelination, is just beginning. All local circuit
inter-neurons assume final cortical position on the day o f birth. Those in the deeper layers
o f the cortex will mature more rapidly, while those cells in the most superficial layers will
continue to develop and establish their connections during the first five years. (Joseph,
1996, p. 636) Due to the use it or lose it principle, an infant requires an appropriate
level o f stimulationparticularly sensory-motor stimulation at this young ageto spur
healthy cortical development.
The visual cortex in the occipital lobe is fast forming; getting a head start in the
womb, it is already operating at 33.7% of its adult capacity by birth (Joseph, 1996; Purves
et al., 1997). This growth likely accounts for the newborns preference for stripes and
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other high contrasts (Gopnilc, Meltzoff, & Kuhl, 1999). The temporal lobe, which
contains the auditory cortex, is at 22% of its adult capacity by birth (Joseph, 1996). The
parietal lobe is only at about 14% (Joseph, 1996). Frontal lobe capacity is least developed
at birth, at about 11% (Joseph, 1996). In the future, frontal areas o f the neocortex (and
their executive functions) will become especially influenced by the integrity of subcortical
emotional systems, as they eventually establish rich synaptic connections with them.
Recent MRI studies show frontal areas of the cortex continue to establish synaptic
connections and undergo pruning up to age 15-16 or longer (Chugani, 1998).
Intracortical communication is poorly integrated until which time synapses have
matured (followed by the process of myelination) to form the rich connections that
converge in association areas~a process that can take up to ten or more years to complete
(Joseph, 1996). It is these interconnections in the association areas that will make
multimodal processing possible, facilitating complex skills such as reading, math, and
abstract thought. At birth, howeveralthough some areas o f the cortex are already firing
awaythese groupings o f neurons represent islands o f functioning. Synaptic bridges will
emerge, stimulated first by interconnections with subcortical structures and, later, with
intracortical, regions, innervated by ever increasing encounters with the external world.
Lateralization.
Corresponding areas o f the right and left hemispheres develop at differing rates
(Joseph, 1996; van der Kolk, 2000). For instance, the motor cortex in the left hemisphere
generally emerges faster than motor cortex in the right with these neurons gaining
competitive synaptic advantage over those in the right (Joseph, 1996). This accounts for a
predominance o f right-handed individuals. The left hemisphere will eventually give rise to
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language perception, production, interpretation, and conceptualization; a sequential sense

o f time; rational thinking, deductive reasoning; ability to categorize and label experience
(i. e. internal states); ability to develop meaningful, sequential narrative for experience;
emotion modulation; and conscious awareness as we recognize it (Joseph, 1996)~but not
for some time to come. While motor cortex is developing in the left, emotion and related
sensory functions are emerging faster in the right (Joseph, 1996; van der Kolk, 2000).
Joseph provides explanation for these processes:
Limbic system nuclei develop earlier and mature at a faster rate than neocortical
tissues. In consequence, because of hierarchical representation, portions o f the
right hemisphere are larger than the left, the right hemisphere is heavier than the
left, white matter (nonmotor axonal) interconnections with subcortical structures
are more extensive (reviewed in Joseph, 1982, 1988a), and the formation o f
nonmotor gyri begins sooner and more rapidly (Chi et al., 1977). (p. 657)
Therefore, the right hemisphere, which develops faster and then maintains rich
interconnections with limbic and related sensory structures, gains dominance for non
verbal, visual-spatial, social, and emotional functioning. At maturity, its specializations
will include perception, interpretation, comprehension , and expression o f non-verbal
emotional communication as well as
perception and identification o f environmental sounds (e.g. wind, rain, thunder,
birds singing)... the maintenance of the body image... comprehension and
expression o f prosodic, melodic, and emotional features of speech, as well as in the
perception o f most aspects of musical stimuli (i.e., chords, timbre, tone, pitch,
loudness, melody, intensity)... analysis of geometric and visual space, including
depth perception, orientation, position, distance, figure-ground, perspective, visual
closure, and stereopsis...dreams during REM sleep...expression and perception of
visual, facial, and verbal affect, and the ability to determine a persons mood,
attitude, and intentions via the analysis of gesture, facial expression, and vocalmelodic and intonational qualities... (and virtually) all aspects of social-emotional
intellectual activity. (Joseph, 1996, p. 116)
It is important to note, that even up to age five, the slow maturation (of synaptic
neuronal differentiation and myelination) and, therefore, plastic nature o f the cortex in
general permits each hemisphere to subsume functions o f the other should some type o f
problem arise. I f an insult occurs, for instance in the left, axons originally headed in the
direction o f those left hemisphere targets will compete for postsynaptic spaces in the right.
Serious debate continues, however, whether resulting functioning is really normal or
whether some functions may suffer or lose out altogether due to crowding from the
competition for more limited target space (Caplan et al., 1999; Dobbing & Smart, 1974,
Winick & Rosso, 1969, and Isaacson, 1975 in Risser and Edgell, 1988; Joseph, 1996;
Menard et al., 2000; Pines, 1981; Shields et al., 1999; Vining et al., 1997).
The period o f maturation for the right hemisphere, which remains somewhat larger
throughout life (Barkley, 1997; Joseph, 1996), is more extended than for the left (Joseph,
1996). Due to its prolonged maturation and development (as well as sulci variability),
Joseph (1996) believes the right hemisphere is:
not only subject to crowding effects and synaptic competition because o f early left
hemisphere lesion, but is more vulnerable to injury secondary to emotional trauma
and social-emotional neglect (Joseph, 1982, 1992b), a function also o f its role in
emotional processing and expression and hierarchical limbic representation, (p.
658)
There is some evidence that the right hemisphere is smallermore equal in size to the left
in individuals with Attention Deficit Hyperactivity Disorder, (Barkley, 1997), although the
origins o f this disorder are not known at this time. Bessel van der Kolk (2000) notes that
psychological trauma is processed in the right in both children and adults.
Joseph (1996) summarizes the contribution o f the right hemispheres role in human
emotion:
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Although there is evidence o f considerable overlap as well as inter-hemispheric

cooperation on a number o f tasks, it certainly appears that the mental system
maintained by the right cerebral hemisphere is highly developed, social-emotional,
bilateral, and in many ways dominant over the temporal-sequential, languagedependent half o f the cerebrum. Indeed, the right cerebrum can independently
recall and act on certain memories with purposeful intent; is the dominant source
o f our dreams, psychic conflicts, and desires; and is fully capable o f motivating,
initiating, as well as controlling behavioral expressionoften without the aid or
even active (reflective) participation o f the left half o f the brain, (p. 117)
Corpus callosum.
Axons giving rise to the corpus callosum permit information transmission across
the hemispheres. It arises from immature neurons in the superficial layers of the neocortex
(the last layers to come on line) and parallels neocortical development patterns.
Myelination of the Corpus Callosum can take well over 10-12 years to complete (Joseph,
1996). For an infant and young child, the dissociation o f experience (involving right vs.
left hemispheric processing) appears, in many respects, to be the normal and natural state
o f affairs. The mechanisms that integrate emotional and cognitive aspects of experience
will remain immature for so long that Rhawn Joseph (1996) predicts children as old as age
seven will normally continue to display transfer deficits in their information processing.
This is especially problematic for young children (let alone infants) who have
experienced trauma, preventing them from integrating their experience (i.e. by bringing to
bear narrative, rational thought, time-limiting skills from the left) or even putting their
experience into words to convey it to others. Thus, the non-verbal sensory components,
pain, and terror o f trauma can remain fresh, powerful, and isolating as it dwells in the
timeless regions o f the right hemisphere and subcortical structures below.
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Emotion Circuitry
Fear Circuit
With the emergence o f the amygdala, a new emotion system comes on board: fear
(Joseph, 1996; LeDoux, 1996; Panksepp, 1998). Panksepp (1998) defines fear as
an aversive state o f the nervous system, characterized by apprehensive worry,
general nervousness, and tension, which tells creatures that their safety is
threatened. It is accompanied by specific forms o f autonomic and behavioral
arousal. The most common clinical symptom o f fear is generalized anxiety, (p.
207)
Fear circuitry runs from the lateral, central amygdala through the ventral-anterior and
medial hypothalamus to the PAG in the midbrain portion o f the brainstem. From here the
pathway continues through the lower brainstem into the spinal cord, activating the
sympathetic nervous system (LeDoux, 1996; Panksepp, 1998). Ultimately, with CNS
maturity, this circuit will involve practically every structure in the brain (Panksepp, 1998).
This pathway runs adjacent to the rage circuit. At low levels o f arousal intensity,
fear and anger can inhibit one another; at high levels, however, they can co-occur
(Panksepp, 1998). Defensive rage represents a mixture o f these two emotions. Fear and
rage at the amygdala level signify an amplification of arousal that the 4-6 month old infant
is better equipped to handle than the newborn. Consistent with this is the finding by Leger
et al. (1996) that the cries o f six-month-old babies were rated as significantly more intense
than those o f one-month-old babies across three scales (anger, fear, distress) by male and
female raters inexperienced in infant care as well as parents.
Subjective feeling states associated with fear are a sense o f dread and sense of
disconcerting uncertainty. As with anger, fear sensation varies per its intensity and can be
viewed on an arousal continuum with mild apprehension on the low end ranging up to
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terror near the top. Anxiety is considered to be on this same fear continuum per
conclusions o f knowledgeable neurobiologists, particularly those who have conducted
animal research; they draw striking parallels between behavioral markers associated with
fear in animals and anxiety in humans: tachycardia (both), dry mouth (both), stomach
upset (ulcers in animals), fast and shallow breathing (both), scanning and vigilance (both),
increased startle (both), frequent elimination in both (urination, defecation or diarrhea),
agitation (grooming in animals; restlessness in humans), and apprehension (freezing
behavior in animals) (Panksepp, 1998; Purves, et al., 1997). However, specific anxiety
circuitry remains elusive as do brain mechanisms giving rise to the subjective feelings o f
fear.
Neurophysiology mediating fear/anxiety has been especially difficult to tease out
since so many different neurotransmitter receptor sites run along this pathway. These
include an abundance o f NMD A receptors for glutamate, NE receptors (both likely
involved in consolidation o f fearful memories), CRF, ACTH (both of which have been
associated with aversive sensation), and others (LeDoux, 1996; Panksepp, 1998).
Abundant receptor sites for GABA (brains most pervasive inhibitor (Panksepp, 1998,
p. 217), serotonin, oxytocin, and opioids mediate fear suppression (Panksepp, 1998).
With fear and the amygdala comes a new type o f learningthe ability to remember
and, therefore, avoid painful, punishing, dangerous, and other survival-threatening
conditions in the environment. Unconditioned and/or primed stimuli that elicit fear in
infants include pain, sudden or loud noises, sudden movements, unexpected changes,
strange objects, loss o f physical support, and scary (angry) faces (LeFrancois, 1984;
Panksepp, 1998). Previously neutral stimuli can become classically conditioned as
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aversive (dangerous) if they occur at the same time as unconditioned punishing or fear
eliciting stimuli; cells that fire together wire together (LeDoux, 1996, p. 214). The
stronger the neuronal firing response (intensity, quantity o f neurons involved), the stronger
the memory. This is a different classical conditioning process from opioid mediated,
arousal reducing (reward) conditioning at mu receptors.
The amygdalas specialty is storing and remembering (at a subconscious level)
discrete bits o f sensory information o f emotional significance to the individualparticularly
social information such as faces, voices, or touch. This includes remembering rewarding
as well as aversive or dangerous stimuli. Fear expert, pscyhobiologist Joseph LeDoux
(1996) believes that the amygdalas implicit (encoded at the subcortical level and therefore
subconscious) memory is extremely accurate, lasts life long, and is most resistant to
modulation or reconfiguration by higher brain systems (i.e. the cortex). Based on his
extensive body o f research, he has concluded that fear conditioning is particularly
resilient, and in fact may represent an indelible form of learning (p. 204). Trauma
expert Bessel van der Kolk (2000) would agree that emotional memory may be forever
(p. 16).
This would be especially true for emotional memories encoded in the amygdala
prior to maturation o f the hippocampus, cingulate, or language centers in the cortex, as
would be the case for very young infants. That most o f us cannot recall any memories
back past age three (LeDoux, 1996) bears this out. Therefore, you do not have to recall
an experience within conscious awareness to have become conditioned by it. LeDoux has
concluded, based on a large body o f neurobiological research, that
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absence o f (conscious) awareness is the rule o f mental life, rather than the
exception, throughout the animal kingdom...Emotional responses are, for the most
part, generated unconsciously. Freud was right on the mark when he described
consciousness as the tip o f the mental iceberg, (p. 17)
Direct sensory inputs from the thalamus to the amygdala permit rapid-fire implicit
processingeven after the cortex comes on board (Panksepp, 1998). This makes good
evolutionary sense in that the sympathetic nervous system can be rapidly triggered by
sensory stimulipreviously associated with threatto ready the body for action to take
flight post haste from eminent danger (i.e. predators). Time is o f the essence in a survival
emergency; mulling it over (in the cortex) slows things down.
Five Responses to Threat: Fight. Take Flight. Enlist Others. Freeze, and Submit
Aversive (frightening, dangerous) stimuli are processed as threats, activating the
sympathetic nervous system, thus mobilizing the individual to actively fight or confront the
threat, take flight to get out o f harms way, elicit others (infants distress cry), or to freeze
(keep a very low profile) to remain undetected by predators. The author of this
dissertation argues that these five response strategies are in descending order of
powerfulness based on an individuals sociological, psychological, physiological, and
developmental capacity to manage the threat. The ability to sense threat triggers the
neurobiological cascade o f events known as the stress response, also coming on-line at
this time. Otherwise, the only available and least powerful response to threat is to submit:
a passive, parasympathetic responsealong the lines o f damage controlthat enlists
endogenous opioids to quell the pain, calm the organism, and conserve energy (similar to
going into shock with serious physical injury) when one is overtaken.
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Stress Response
George Chrousos and Philip Gold (1992) define stress as a state o f disharmony,
or threatened homeostasis (p. 1245). Activation of the stress system leads to behavioral
and peripheral changes that improve the ability o f the organism to adjust homeostasis and
increase its chances for survival (p. 1244). The purpose o f a mature stress response is
to prepare the individual to take quick action (fight, flee, elicit others, freeze, submit)
when faced with threat. The author o f this dissertation suggests that the potency o f the
threat that gives rise to stress depends upon its intensity, duration, frequency, quantity,
timing, and meaning to the individual in interaction with his or her sociological,
psychological, physiological, and developmental capacity to cope (facilitate homeostasis;
regain equilibrium). The ability to appraise danger and, thus, experience fearthe emotion
that drives this circuitcomes with maturation of the amygdala. Fear requires an upgrade
in arousal tolerance for both intensity and duration that a six month old nervous system is
more equipped to handle.
The stress circuit is comprised o f several complex components, some of which are
in place by birth and others (i.e. the HP A described below) that have yet to mature.
Components include the emergent amygdala; hypothalamus, pituitary gland, and adrenal
cortex (known as the hypothalamic-pituitary-adrenal axis or HP A); the locus coeruleus in
the brain stem; and the sympathetic nervous system.
Chrousos and Gold describe a component that is in place and functioning at birth:
a reciprocal circuit involving the locus coeruleus in the brain stem and the paraventricular
nucleus (PVN) o f the hypothalamus that is activated when the individual encounters stress
(perturbation). When this system is activated, Norepinephrine (NE)released by NE
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neurons in the locus coeruleusstimulates the release o f corticotropin-releasing factor

(CRF) from the paraventricular nucleus o f the hypothalamus. CRF, in turn, has an
excitatory effect on locus coeruleus NE neurons, and the process continues until the
circuit is disrupted. Excitation o f this circuit is instrumental in activating the sympathetic
nervous system (Chrousos & Gold, 1992; Panksepp, 1986; Preston, 2000).
CRF also activates the HP A. This component, functioning at a subdued, immature
level in newborns, is
instigated by stress releasing corticotrophin releasing factor (CRF) from the
paraventricular nucleus o f the hypothalamus (PVN), which triggers release of
ACTH from the anterior pituitary, which releases cortisol (or corticosterone in
rats) form the adrenal cortex. Cortisol then activates bodily metabolism and feeds
back into the brain to directly control its own activities in the PVN as well as to
higher brain areas that provide adaptive psychological responses to stress, such as
the hippocampus (HC). (Panksepp, 1998, p. 119)
In addition, this stress circuit activates dopamine (DA) tracts in mesolimbic and
mesocortical areas o f the brain responsible for anticipation and reward and the amygdala,
responsible for the retrieval o f information and emotional analysisespecially fearregarding the stressor. The release o f NE appears to be largely responsible for excitation
o f these systems (Chrousos & Gold, 1992).
Examples o f behaviors or bodily changes set into motion with moderate release of
CRF include increased heart rate and blood pressure, heightened arousal, increased
vigilance, cautious restraint, and reduced appetite. CRF is also involved in activating
crying in young infants (Panksepp, 1998). These changes are well suited for dealing with
short term stress. However, examples of bodily changes set into motion with excessive
release o f CRF (which might occur in conditions o f extreme or chronic stress) include
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anxiety, hyper-responsiveness to sensory stimuli, decreased exploration in unfamiliar

environments, and assumption o f a freeze posture. (Chrousos & Gold, 1992).
B-endorphin and dynorphin endogenous opioids in the hypothalamus appear to
play a homeostatic role by inhibiting CRF released from the PVN, thus dampening the
stress circuit, and returning the individual to baseline (Chrousos & Gold, 1992). Opioid
receptor sites exist in both the locus coeruleus and paraventricular nucleus. Dynorphin
apparently has a reciprocal relationship with CRH, whereby CRH stimulates dynorphin
release and dynorphin release inhibits the action of CRH in both parts o f the circuit
(Chrousos & Gold, 1992; Panksepp, 1986). Opioid suppressing effects are also in place at
birth.
Hypoactivity o f an immature HP A and cortisol suppressing effects, mediated
through CRF inhibition by endogenous opioids, are especially adaptive at this young age in
that cortisol levels must be kept within a narrow range o f concentrations required for
normal development (Rosenfieid, Suchecki, & Levine, 1992, p. 553). Animal evidence
shows that chronic exposure to cortisol has been implicated in dendritic atrophy and even
cell death in the hippocampus (Gunnar, 1998; Lombroso & Sapolsky, 1998; McEwen,
1999), which could have dire consequences for the developmental outcome of this
structure that will become so vital to memory and learning, during its current experienceexpectant window (Chugani, 1998).
Megan Gunnar (1998) has tracked the trajectory o f cortisol levels of human infants
over the first two years o f life. She found that from birth to about age three months
the human adrenocortical system is highly labile and responsive to stimulation.
Events as seemingly minor as undressing, weighing, and measuring the newborn
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will elicit significant elevations in cortisol The system also responds discriminantly
to stressors o f different magnitudes, (p. 209).
Cortisol levels then show a marked decrease beginning about three months o f age
that lasts up to about age two years. She believes it is the close relationship with mother
through the attachment process that buffers HPA responding (p. 209) during this
period.
Panksepps (1978) discovery that a form o f opioid mediated analgesia, or pain
relief, appears to be obtained upon an infants acquiring contact comfort and reassurance
from its mother bears this out. Indeed, Panksepp suggests that attachment behavior and
opiate addiction are very closely related in that they appear to be mediated by the same
systems in the central nervous system. He notes that separation from the object o f
attachment and opiate withdrawal produce similar painful symptoms (Panksepp et al.,
1978; Panksepp et al., 1985) and in general, when animals cannot experience opioid
activity in their brains, they seek (non-threatening) social contact (Panksepp, 1998). By
contrast, animals with moderate doses of opiates tend to socially isolate themselves
(Panksepp, 1998, p. 271). B-endorphin opioid bursts obtained from contact with mother
activate mu receptors (which mediate Morphine addiction) and appear to provide euphoric
as well as quelling sensations (Nelson & Panksepp, 1998; Panksepp, 1998). The most
powerful endogenous opioid-like molecule that interacts with the mu receptor is Bendorphin, which also has the most powerful ability to alleviate separation distress
(Panksepp, 1998 p. 264). B-endorphin inhibits stress-triggered CRF released from the
PVN in the hypothalamus (Chrousos & Gold, 1992).
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For the infant, contact with mother appears to be the primary stimulus for
activating stress quelling opioids. Should such contact be deficient, harsh, even
threateningor should opioid from other brain sources become depletedthe stress circuit
would become hyperactivated.
Panksepp (1986) proposes that the global function o f opioid systemsespecially
those involving mu receptors (which mediate pain) and perhaps delta receptors (found in
the limbic system) is to counteract the influence of stress (p. 95). He describes a
homeostatic process o f perturbation and calming that mirrors the functions o f the
sympathetic and parasympathetic nervous systems. This process also mirrors observations
by van der Kolk and Stem regarding the role o f alternating periods o f arousal and calm in
modulating infant affect states and consolidation of infant experience. According to
Panksepp, it would appear that endogenous opioid systems are set up to deal with
intermittent stress or stress bursts as opposed to sustained or chronic stress, during which
they lose their effectiveness or fail to engage. Loss of effectiveness over time is likely due
to some form o f tolerance (i.e. depletion o f the endogenous opioid neurotransmitter, down
regulated receptor sites, decreased receptor sensitivity), although this may not provide a
complete explanation. Chrousos and Gold (1992) remind us that Selye
believed that mild, brief, and controllable states of challenged homeostasis could
actually be perceived as pleasant or exciting and could be positive stimuli to
emotional and intellectual growth and development. It was the more severe,
protracted, and uncontrollable situations of psychological and physical distress that
Selye believed led to frank disease states, (p. 1245)
Newborn Biological Capability for Emotion Regulation
Newborn babies are exciting, excitable, emotional creatures. Primed for sensorym otor interaction (especially with other humans) in their new world on the outside, brains
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begin to grow rapidly as they take in preferred experience-expectant stimuli. Up and

running emotion circuits include autonomic nervous system, pleasure, seeking, and rage.
The amygdala, fear, and stress circuits, although functioning at subdued levels, are in the
formative stagesactively processing the specific types o f information that fuel their
development. At this stage, higher-order, ego-producing brain structures that assist an
infant to begin to gain control have not yet matured. Emotions are basically feltat the
visceral levelas good or badpleasurable, exciting, or aversive. They are honest, raw,
pure, and unmodulated. The gaining control task at this age is to maintain homeostasis.
A young infant is easily overstimulated with limited capability for bringing arousal back
down to a manageable level. Too much arousal can be disorganizing and hard on tiny,
fragile new organs (Brazelton, 1992). Fortunately, babies have excellent means at their
disposal for engaging helpful, competent otherslike momto assist them to bring things
back under control. Being a baby is a two-person job.
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Newborn Capabilities: Observable Phenomena

Risser and Edgell (1988) note that neonatal reflexes and modal sensory abilities,
once viewed as primitive, are now considered to be quite specific adaptations geared
toward ensuring a lower risk birth and obtaining other developmental requirements. Their
observations are consistent with those of John Bowlby (1969); Daniel Stem (1985);
Alison Gopnik, Andrew Meltzoff, and Patricia Kuhl (1999) who suggest that babies come
equipped with sophisticated systems for engaging the environment and eliciting
attachment. By contrast, Margaret Mahler (1975) may have underestimated infants during
this early period she called Autism. Reflexes, as defined by Ross Buck (1988), are
automatic unconditioned actions released by highly specific internal and external stimuli
(p. 11) and represent the most fixed and unlearned o f motivational systems (p. 11). A
normal newborns reflexive repertoire is astonishingexquisitely geared to engage, get,
absorb, savor, and incorporate all sorts of stuff from that new world on the outside.
New little babies engage in nuzzling or body molding when held, taking full
advantage o f the bigger bodys warmth (Brazelton, 1992). Most parents will find this
irresistible. Contact comfort is produced, in large part, by the soothing effects of
endogenous opioid release (Panksepp, 1998). Young infants prefer slow and gentle
stroking (vs. overstimulating) touch (Brazelton, 1992). A particular form o f infant
massage that tracks from head to toe, following the direction o f the circulatory system,
has been found to effectively reduce arousal, and appears to be especially pleasing for the
infant (Scafidi & Field, 1996 ).
Newborns will turn their faces toward familiar smells, particularly items that have
their mothers smell (Gopnik, Meltzoff, & Kuhl, 1999), but turn faces away in response to
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strong, unpleasant smells such as ammonia (LeFrancois, 1984). Reflexes related to

feeding include rooting or head turning reflex (when side o f mouth is touched, turns
toward that side (LeFrancois, 1984; Brazelton, 1992); palmar or grasping reflex (often
sufficiently strong to be pulled up by fingers of adults) (LeFrancois, 1984; Brazelton,
1992); sucking on object such as a nipple placed in the mouth (LeFrancois, 1984); Babkiim
reflex (hand comes to mouth when finger is put in palm, precursor of finger sucking)
(Brazelton, 1992); and vegetative reflexes elicited by appropriate nourishment-related
stimulation (p. 123) such as swallowing, hiccoughing, digesting, elimination, and
vomiting (LeFrancois, 1984). Newborns have distinct negative reactions to sour, salty,
and bitter tastes (Panksepp, 1998); but have a definite preference for sweetness
(Panksepp, 1998; LeFrancois, 1984). The enjoyable taste o f sucrose, mediated by
endogenous opioid release, has a calming effect at this early age (Smith et al., 1992;
Panksepp, 1998). Milk digestion also produces opioids (Blass, 1996; Panksepp, 1998), soo
it, too, has a pleasurable, calming effect~an even nicer experience if being held.
Newborns are sensitive to a wide range o f sounds (LeFrancois, 1984).
They can localize and orient toward sound (LeFrancois, 1984; Gopnik, Meltzoff, & Kuhl,.
1999). They show preference for (by maintaining a state o f attention to) human voices-especially gentle, soothing female ones (Brazelton, 1992). Brazelton (1992), Gopnik,
Meltzoff and Kuhl (1999) have observed that babies recognize and prefer familiar voices
(i.e. dads), and prefer their mothers most o f all, probably based on their ability to hear
them in muted form from the womb. Newborn faces also become quite animated in an
attempt to match the sound and rhythm o f the human voice (Brazelton, 1992). Babies
calm in response to low-frequency and rhythmic sounds (Brackbill, 1970 in LeFrancois,
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1984); high frequency sounds may be over-stimulating judging by violent, agitated infant
reactions (Passman, 1976 in LeFrancois, 1984, p. 131). An astounding finding by
Anthony De Casper, at the University o f North Carolina (in Brazelton, 1992), is that
babieseven in the w omb~can learn and remember what they hear; he has demonstrated
that newborns will pay special attention to songs and stories they heard during their
mothers last three months o f pregnancy.
Although visual acuity starts out somewhat fuzzy and blurred (LeFrancois,
1984), incredibly sophisticated aspects o f the visual system are in place at birth. Pupillary
reflexes permit adjustment to changes in light brightness. Within a few days of birth,
babies are capable o f visually tracking a moving object, especially if that happens to be a
human face (LeFrancois, 1984), especially a familiar face like moms (Gopnik, Meltzoff,
& K u h l, 1999). They have difficulty adjusting their focus to see both near and far objects,
but can see just fine at about a distance o f twelve inches--which just so happens to be the
distance from babys eyes to moms while breast-feeding or to anyone elses eyes who
happens to be holding them (Gopnik, Meltzoff, & K uhl, 1999). Little faces can become
quite animated in response to the faces o f others. In fact, newborns have even been
observed imitating the facial expressions o f others (Brazelton, 1992; LeFrancois, 1984).
Gopnik, Meltzoff, & Kuhl (1999) suggest that by one month, if not at birth, babies are
able to imitate facial expressions and synchronize these movements with the person theyre
imitating. They speculate, that in order to do this
newborn babies not only distinguish and prefer faces, they also seem to recognize
that those faces are like their own face. They recognize that other people are like
me. There is nothing more personal, more part o f you, than this internal sense
you have o f your own body, your expressions and movements, your aches and
tickles. And yet from the time were bom, we seem to link this deeply personal
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self to the bodily movements o f other people, movements we can only see and not
feel. (P. 30)
These authors believe, as does attachment theorist Allan Schore (1994), that visual
connection provides a more direct communication link between human beings than does
the process o f language.
Babies are attracted to stripes and other areas o f high contrast (precursors for
developing an understanding where objects end and begin, and building blocks in the
occipital cortex) (Gopnik, Meltzoff & Kuhl, 1999). Movement (either of objects in
babies view or o f the babies themselves while they look around) is especially important
for organizing complex visual-spatial systems. Babies will pay longer attention to parts
that move together in common fate fashion, an observation which will assist infants to
begin to impose order on an otherwise chaotic world o f moving parts, which must seem
like the norm at first. They will come to learn that when things move together on the
same path, they must be part o f the same object (Gopnik, Meltzoff, & Kuhl, 1999, p. 66).
Another astounding finding is the apparent innate ability to predict the trajectory o f
a moving object in space and to experience some discomfort when that expectation is
thwarted. Baby researchers Gopnik, Meltzoff, & Kuhl (1999) describe evidence of this
astonishing feat:
Young babies not only can follow the movements of an object in front o f them,
they seem to be able to predict how an object will move in the future. Suppose
you show the babies an object following a particular trajectorythat is, moving in
a particular path at a particular speed say, a ball rolling on the table. Now the
ball rolls behind a screen. They will look ahead to the far edge o f the screen, to
the place where the object ought to appear if it keeps moving at the same rate and
on the same path. If the object does appear there, the babies are unperturbed and
keep following the object. But if the object doesn't appear there, or if it appears at
the wrong spot or too quickly or too slowly, they look intently at the edge of the
screen for much longer. Sometimes, in fact, they look back to the other edge o f
ill
the screen, or look farther ahead along the path the object should have taken.
They seem able to predict where the object should be and when it should get there,
(p. 66-67)
Reflexes especially reflective of ethological heritage and heralding development o f
motoric systems include the Babinski Reflex (spreading toes when sole of foot is stroked)
(Brazelton, 1992); walking or stepping reflex (when held upright with feet slightly
touching surface will attempt to step first with one, then the other foot) (LeFrancois,
1984; Brazelton, 1992); tonic neck reflex (when head turned to one side will arch away
from face, precursor to lateralized movements and dominant side) (Brazelton, 1992);
swimming or Gallant Reflex (elicited when held up horizontally on stomach or flexing o f
whole body to side thats stroked) (Brazelton, 1992); and crawling (with attempts to pick
head up if placed on stomach) (Brazelton, 1992). In one month, babies will be able to
hold up their chins; by two months of age they can raise up their chests (LeFrancois,
1984) (These locomotor milestones serve as reminders that the myelination process is
proceeding underneath.).
Multimodal sensory-motor systems serve to elaborate simple orientation responses
(afforded by interconnected sensory and motor systems, i. e. vestibular, in brain stem)
(Panksepp, 1998) that enable newborns to pay attention to a stimulus. Gopnik, Meltzoff,
and Kuhl (1999) provide an example from Meltzoffs research: when one-month-old
babies were given either a bumpy or smooth pacifier to suck on, the babies looked longer
at the object that was the same shape as the one they had just been sucking on. Somehow
they could relate the feel o f the pacifier in their mouths with its visual image (p. 69).
Another example is when newborns turn their heads and look toward an interesting noise,
suggesting that they already expect to see something in the direction of the noise.
1L2
Meltzoff was able to confirm this, as his findings are described: you can show babies two
objects bouncing at different times and play an audiotape o f a boing, boing, boing sound
that is synchronous with only one of them. Babies can tell which visual display matches
what they hear; they look longer at the one that bounces in sync with the audiotape (p.
69). Meltzoff and Kuhl found that babies could even match correct vowel sounds after
watching them mouthed by a silent face.
With the emergence o f the autonomic nervous system in utero (Lester, Boukydis,
& LaGasse, 1996; Groome et al., 1999), newborns, o f course, feel arousal when the
sympathetic component is activated in response to stimulation. However, their fragile new
nervous systems can tolerate arousal that falls within a range that mirrors their bodies:
short. When arousal exceeds their comfort zone, this feels bad, and they generally let it be
known. Other sensations that newborns can feel are pleasure, excitement, and rage
(Panksepp, 1998). Newborns are more sensitive to pain than previously thought, and girls
more so than boys (Olkkola, Hamunen, & Maunuksela, 1995; LeFrancois, 1984).
Babies, even in the womb, cycle through altered states of consciousness (Wolff in
LeFrancois, 1984; Brazelton, 1992). For the young infant, these include deep sleep, light
(REM) sleep, semi-alert or indeterminate state, wide-awake alert state, fussiness, and
crying. Brazelton (1992) refers to the infants pattern o f moving in and out o f the states
of consciousnesswhich generally sets in by about age three monthsas the infants
temperamental style. He acknowledges that temperamental style can result from
environmental influence. For instance, a baby can become fussy or irritable from
experiencing stress in the womb (Smith et al., 1992). Brazelton (1992) considers all
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premature babies to be stressed, due to their immature nervous systems poor capability
for handling external stimuli.
The newborn infant is capable o f an array o f facial expressions that include smiling,
sadness, fear, anger, surprise, and disgust (LeFrancois, 1984; Ekman, Sorenson, &
Friesen, 1969 in Buck, 1988; Buck, 1988) and vocalizations (i.e. cooing, crying)
(LeFrancois, 1984; Joseph, 1996; Panksepp, 1998; Gopnik, Meltzoff, & Kuhl, 1999).
Smiling, a particularly seductive way to captivate parents~or anyone else who happens to
be around, has been described by LeFrancois (1984) as
a fleeting response in the warm, well-fed infant and appears to occur as early as
two to twelve hours after delivery (Wolff, 1963). In the weeks and months
following birth, infants smile in response to an ever-widening range o f sights and
sounds. The social smile occurs first in response to a human voice (by the third
week), (p. 148).
Crying is another highly effective device for eliciting parental attention. W olffs
research (1969, in LeFrancois, 1984) using tape recordings, identified three types o f cries:
the hungry, rhythmic cry that gets mom to provide food; the angry cry which is
characterized by its protracted loudness and results from more air being forced through
the vocal cords (p. 147), and the long wailing cry followed by breath holdingindicative
o f pain. Brazelton (1992) has identified six different cries for: pain, hunger, discomfort,
fatigue, boredom, and tension discharge (p. 42).
Babies come equipped with an array, albeit a limited one at this early age, o f
defensive mechanisms geared to cope with unpleasant to overwhelming circumstances.
Coping reflexes include sneezing when nasal passages become irritated; protective reflexes
(i.e. to clear airway o f obstruction by head arching and bringing hands up to clear cloth
away from face) (Brazelton, 1992); and the Moro Reflex (startle) i.e. to loud noise or to
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sensation o f falling in which babies will throw out arms and legs to catch a branch to
save themselves (LeFrancois, 1984, p. 131; Brazelton, 1992). Initially infants display a
reflexive fearful reaction, i.e. startle, to loud noises and sudden loss o f support
(LeFrancois, 1984). Newborns will even display the startle response to their own agitated
movements when upset (Brazelton, 1992).
Newborns have several self-directed mechanisms available to them for reducing
arousal. These include the thumb-sucking reflex to self-sooth following upset (Brazelton,
1992), head-turning to avert the stimulus (Tronick, 1986), habituation (Brazelton, 1992;
Smotherman & Robinson, 1993), and altering their state o f consciousness (i.e. sleeping,
dissociating) (Brazelton, 1992; van der Kolk & Fisler, 1994). And, last, but not least,
infants make use o f other-directed behaviorsparticularly cryingto elicit assistance
required to restabilize.
Babies are already demonstrating innate capabilities to form expectations for how
things should be; develop preferences for pleasurable, familiar stimuli; and avoid (to the
best o f their ability) unpleasant or aversive stimuli. Classical conditioning reigns supreme.
Although vocalizations are undeniable, newborns do not produce deliberate speech as we
recognize it. Remarkably, at this early point in life, the newborn has the potential to hear
or articulate any speech sound from any culture in the world (Gopnik, Meltzoff, & Kuhl,
1999). This will only last for about 6-7 months, however, as the brain begins to hone its
abilities to understand and produce language within the context of the language it gets
used to hearing (Gopnik, Meltzoff, & Kuhl, 1999).
Nothing succeeds like success. It appears that nature, by way o f evolution, has
bestowed an empowering complement o f ready-to-go abilities that give newborns a terrific
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head start at feeling self-efficacious. These abilities permit infants to experience an array
of automatic, fail-safe, positive outcomes arising from their own actions that begin to
impose order on an exciting, albeit chaotic new world. Who wouldnt feel invincibleand
goodwhen most everything you did worked. This is omnipotence as so eloquently
described by Winnicott (1965). Babies simply cant resist taking in the feelings, sights,
sounds, smells, and tastes that provide the very experiences they need at this point in time
to continue their development. Indeed they expect them.
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Developmental Theories o f Psychology

Rooted in Corresponding Observable Phenomena
The theorists who have been selected for this section developed concepts that
remain remarkably fresh, especially in light o f an ever-growing body o f findings on the
human brain that are now coming to light at a rapid pace. With the exception of
Winnicott, Jacobson, and Kemberg, these scientists arrived at a sequential stage approach
to development that facilitates alignment o f their percepts with emergent emotion circuit
components at various points along the developmental trajectory. Grounded in evolution,
biology, and meticulous observations and articulated with precise descriptions, their works
continue to provide a wealth o f insight into the psychological world o f developing human
beings. Reviewing this work anew from the perspective o f the theorists own words
(whenever possible), superimposed on even the most recent neurobiological findings, has
been especially excitingeven surprising.
Piaget
Piagets cognitive developmental theory, based on careful observation o f his own
as well as other children, is comprised o f four stages: Sensorimotor (age 0-2),
Preoperations (age 2-7), Concrete Operations (age 7-11), and Formal Operations (age 12adulthood). There are two processes by which children interact with the world:
assimilation (to incorporate aspects of the environment into existing schemes) and
accommodation (forced to adjust or change a schema). It is through a continual process
o f exercising previously learned behaviors (assimilating to previously learned schemes) and
changing these behaviors (accommodating) that the infant gradually develops the skills and
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knowledge that characterize the course o f human development. (LeFrancois, 1984, p.

133). Piaget described the mechanism o f assimilation as
comparable to biological assimilation in the broad sense: meaning that reality data
are treated or modified in such a way as to become incorporated into the structure
o f the subject. In other words, every newly established connection is integrated
into an existing schematism. According to this view, the organizing activity o f the
subject must be considered just as important as the connections inherent in the
external stimuli, for the subject becomes aware o f these connections only to the
degree that he can assimilate them by means o f his existing structures... the input,
the stimulus, is filtered through a structure that consists of the action-schemes ( o r ,
at a higher level, the operations of thought), which in turn are modified and
enriched when the subjects behavioral repertoire is accommodated to the demands
o f reality. The filtering or modification of the input is called assimilation; the
modification o f internal schemes to fit reality is called accommodation. (Piaget &
Inhelder, 1969, p. 5-6.)
The Sensorimotor Stage is the world o f here and now, with no language or
thought during this earliest period, and no notion o f objective reality. (LeFrancois, 1984).
The Reflex Schemata, initial substage of the Sensorimotor Stage, is characterized by
simple unlearned behaviors or reflex responses. (Piaget & Inhelder, 1969). During this
time babies respond reflexively (via primed schemes such as sucking and looking) to
internal and external stimuli. Eventually these responses become more deliberate.
(LeFrancois, 1984).
Beginning about age one month and lasting up to four months is the Primary
Circular substage. During this period activities that center on ones own body and that
give rise to pleasure are repeated (i.e. thumb-sucking). (LeFrancois, 1984, p. 136). This
period is characterized by habit formation. In Piagets words
the end in question is attained only by a necessary succession of movements which
lead to it, without ones being able to distinguish either an end pursued from the
start or means chosen from among various possible schemes. (Piaget & Inhelder,
1969, p. 9)
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Freud
Sigmund Freud was the first to put forth the concept o f developmental stages for
psychology. Medically trained, this mans painstaking observations, although
extrapolated from his work with adult subjects, were also rooted in biology and
Darwinism. According to his five-stage theory, the first to emerge is the Oral Stage (from
birth to about 18 months). This is a period for taking-in type activities like sucking the
breast and eventually mouthing parts of ones own body. Pleasure or erotic systems are
rooted in sensations experienced with the mouth, tongue, and lips. If baby has rewarding
experiences with stimulation in these areas, he or she will take them in; if experiences are
painful, the child will expel or withdraw from them. The infant will cathect psychological
(deriving from biological) energy onto the stimulus o f those pleasurable experiences (i.e.
into the part o f the object providing pleasure, such as mothers breast or own thumb).
These objects or part objects are then actively sought to satisfy drives or biologically
based needs.
The more insistent the drive, the more preoccupied the baby will become with
phantasies o f seeking activities that will satisfy these needs. It is suggested that the
preoccupations may be precursors to memory traces and thought (i.e. one o f the earliest
mental images may be o f mothers breast in its absence). Psychic energy is also, then,
cathected into the phantasies. This type o f hallucinatory wish fulfillment is called primaryprocess thought, which is characteristic of the id (Miller, 1989). As the infants
development progresses, he or she becomes more capable o f deriving pleasure
independently through bodily auto-arousal and phantasies.
At birth, the id reigns supreme. Freud proposed that
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the id is the dark, inaccessible part o f our personality.a chaos, a cauldron full of
seething excitations (Freud, 1933 in J. Strachey, ed. andtrans., 1964, p.73)...
Furthermore, the id contains everything that is inherited, that is present at birth,
that is laid down in the constitution-above all, therefore, the instincts, which
originate from the somatic organization and which find a first psychical expression
here (in the id) in forms unknown to us (Freud, 1940 in J. Strachey, ed. and trans.,
1964, p. 145.per Miller, 1989, p 129).
All of its material and activity fall within the realm o f the unconscious.
Early interactions between the childs drives and social environment set the stage
for later learning, social adjustment, and capacity for coping with anxiety. The ego
mediator between the id, reality o f the world outside ones skin, and/or the Superegosoon begins to emerge, rooted in the childs history o f repeated experiences with objects.
Indeed, the nature (and quality) o f the childs ego, personality, and psychological future
are shaped by these events.
Key to successful negotiation o f early developmental stages are processes of
homeostasis that are titrated within the context o f the mother-infant relationship. Anxiety,
present at birth, comes from over-stimulation from internal or external forces. Too little
need gratification by the parent results in increased anxiety, continued seeking o f
gratification, and a pessimistic world view. If there is too much gratification, it will be
difficult for the child to give it up, shift gears, and move on (fixation); and, even if the
child does, there may be rapid regression back to this comfortable state in the face o f even
relatively minor demands. A baby subjected to too little (or too much) need gratification,
may not be able to take care o f business during a particular stage before biological
maturation pushes her/him on into the next. Regression to an earlier level o f development
will likely occur if present anxiety is too much to handle (Miller, 1989). Unresolved
conflicts, particularly in the earliest four stages o f development, will haunt a person
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throughout his or her lifetime. Remnants o f earlier stages (for better or worse) will remain
in later stages.
Erickson
Ericksons 8-stage psychosocial developmental theory utilizes the epigenetic
principle, modeled on fetal development:
Somewhat generalized, this principle states that anything that grows has a ground
plan, and that out o f this ground plan the parts arise, each part having its time of
special ascendency, until all parts have arisen to form a functioning whole. At
birth the baby leaves the chemical exchange o f the womb for the social exchange
system o f his society, where his gradually increasing capacities meet the
opportunities and limitations o f his culture. (Erickson, 1968, p. 92 in Miller, 1989,
p. 179)...Each stage adds something specific to all later ones, and makes a new
ensemble out o f all the earlier ones. (Erickson in Evans, 1967, p. 41 in Miller,
1989, p. 180)
During each stage, there is a conflict that must be resolved between a syntonic
(harmonious) element and a dystonic (disruptive) element. With successful resolution of
this crisis, the person achieves a basic (ego) strength (Ericksons terms in Feist, 1990, p.
84) that furthers development. Unsuccessful resolution produces a core pathology.
Each subsequent stage subsumes elements of all previous stages. Seeds of healthy
development, therefore, are sewn in infancy.
The initial stage, during infancy, is the Basic Trust vs. Basic Mistrust (oralrespiratory, sensory-kinesthetic, incorporative) stage. The radius o f relationship is
the Maternal Person. With adequate negotiation o f this period o f development the
strength o f Hope emergeslike a plant grows toward the warmth o f the sun. The core
pathology that would emerge from inability to negotiate this stage is Withdrawal
(Erickson, 1982, p. 32-33 in Feist, 1990, p. 102-103). Basic Trust is an essential
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trustfulness o f others as well as a fundamental sense o f ones own trustworthiness

(Erickson, 1968, p. 96 in Miller, 1989, p. 182).
Winnicott
Winnicott said that, at the beginning, mother must give undivided, empathic
attention to her infant, anticipating and fulfilling the babys needs in such a way that baby
somehow learns that his or her needs will be met. Mother must serve as the holding
environment to reduce to a minimum impingements that the infant cannot manage or
which cause the child to shut down or feel annihilated (St. Clair, 1996, p. 79). It is this
process o f empathic anticipation and response that is at the root of the emergence o f a
safe, benign world view. After all, this is babys first view o f the world on the outside
(and we all know how lasting first impressions can be). The childs early months need to
be spent basking in the good, safe, secure feelings that come with omnipotencewhen
all seems to be under the infants control. Life feels good; therefore, life is good. If all
goes well, this good feeling will soon apply as well to emerging self and object
representations (baby in combination with environment/mom when needs get met
sufficiently): I feel good; therefore, I am good; the world is good. (The converse would
occur should needs not be met sufficiently.)
An empathically attuned mother will gradually be able to relinquish more and more
of her care and attention in proportion to what the child is able to do for self. Winnicotts
concept o f good enough mothering means that motherswho cannot be perfectly
attuned all the timehave provided enough repetitions o f sensitive responding that the
babys psychological development hits somewhere in the positive range along the healthy
psychological development continuum.
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Winnicott3s (1965) describes the emergence o f self3within the facilitating

environment provided by mother:
First comes I3 which includes everything else not me3. Then comes I am, I
exist, I gather experiences and enrich myself and have an introjective and
projective interactions with the NOT-ME, the actual world o f shared reality3. Add
to this: I am seen or understood to exist by someone3; and, further, add to this:
I get back (as a face seen in a mirror) the evidence I need that I have been
recognized as a being.3 (p. 61)
Jacobson and Kemberg
Jacobson posited that mom3s task at this time is to serve as the infants ego33
(Edith Jacobson in St. Clair, 1996), by doing those things for her infant (i.e. kissing,
feeding, holding, calming, changing) that her infant cannot yet do for self. In serving as
her childs ego, she provides psychological structure, organization, and regulation o f
feeling states from the outside~in. This fosters the development of the babys ego as baby
eventually internalizes33these functions when he or she becomes more capable.
Edith Jacobson and Otto Kemberg noted that external stimulation from mother
leads to biologically determined reactions, basically libidinal experienced as pleasure (good
or rewarding feelings) or aggressive experienced as displeasure (dysphoric feelings), even
though baby has not yet developed an awareness o f the source of these reactions. With
many repetitions o f this process, early memory traces o f sensory experiences with mother
begin to build up. From the memory traces, images o f the self as gratified or deprived
will eventually emerge. As babys senses are repeatedly engaged (i.e. explores by putting
things in mouth), image traces o f the object world begin to build up, as well (Jacobson,
1964 in St. Clair, 1996, p. 94).
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Mahler
Margaret Mahler delineated three developmental stages in the Psychological Birth
o f the Human Infant: Autism (age 0-1 month), Symbiosis (age 1-peaking at 4-5 months),
and Individuation/Separation (6-36 months) (Mahler, Pine, & Bergman, 1975). In the
initial Autism stage, the primary task is the achievement o f homeostatic equilibrium of
the organism within the new extramural environment, by predominantly somatopsychic
(Spitz), physiological mechanisms (Mahler, Pine, & Bergman, 1975, p. 43). The infant
requires protection against the extremes o f stimulation (Mahler, Pine, & Bergman,
1975, p. 42). At this time internal self and object representations are nonexistent or
undifferentiated, as the infant cannot distinguish between its own attempts to reduce
tension (by urinating, regurgitating, squirming) and the actions of the mother to reduce
hunger and other tensions and needs (Mahler & Furer, 1968, p. 7 in St. Clair, 1996, p
112-113).
From the second month on, dim awareness of the need-satisfying object marks the
beginning o f the phase o f normal symbiosis, in which the infant behaves and functions as
though he and his mother were an omnipotent systema dual unity within one common
boundary (Mahler, Pine, & Bergman, 1975, p. 44). During this period, the stimulus
barrier...this autistic shell which kept external stimuli outbegins to crack (Mahler, Pine,
& Bergman, 1975, p. 44). Symbiosis represents a state o f undifferentiation, o f fusion
with mother, in which the I is not yet differentiated from the cnot-I and in which inside
and outside are only gradually coming to be sensed as different (Mahler, Pine, &
Bergman, 1975, p. 44).
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Kohlbere
In Kohlbergs Moral Development theory, the newborn is in the Pre-Moral
stage (LeFrancois, 1984). The purpose o f babys behavior during this stage is to obtain
immediate pleasure and avoid pain. As a childs cognitive capacity emerges, children will
initially comprehend right and wrong based on experiences with obedience and punishment
(i.e. if I get caught and am punished, I did something wrong). The Pre-Moral stage may
last up to age five.
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Developmental Tasks and Mechanisms of Mother-Infant Attachment

Birth to Two Months: Achieving Homeostasis
Attachment is a young childs tie to his or her primary caretaker (hereafter referred
to as mother, because mother is by far the most usual object o f attachment)a process
perhaps best articulated by John Bowlby (1988):
In re-examining the nature o f the childs tie to his mother, traditionally referred to
as dependency, it has been found useful to regard it as the resultant o f a distinctive
and in part pre-programmed set o f behaviour patterns which in the ordinary
expectable environment develop during the early months o f life and have the effect
o f keeping the child in more or less close proximity to his mother-figure. By the
end o f the first year the behaviour is becoming organized cybemetically, which
conditions that terminate the behaviour vary according to the intensity of its
especially effective being a signal from her acknowledging his presence. At higher
intensity termination may require his touching or clinging to her. At highest
intensity, when he is distressed and anxious, nothing but a prolonged cuddle will
do. The biological function of this behaviour is postulated to be protection,
especially protection from predators, (p. 3)
In keeping with the biopsychosocial approach, this section will elucidate the nature
and functions of healthy attachment and normal separation processes through synthesis of
descriptions o f observable parent-child interactions with the biological events that
underlie them. Through decades o f research, this process has been well established, not
only in humans from cultures all over the planet, but in many species o f mammals. This
suggests that the mechanisms for attachment are hard-wired into the biological substrates-central nervous system~of the organism. Not only are the mechanisms hard-wired into
her infant; reciprocal behaviors elicited by the infant are hard-wired into mother, as well
(Buck, 1988; Joseph, 1996).
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M other as the Facilitating Environment

The good-enough mother meets the omnipotence o f the infant and to some extent
makes sense o f it. She does this repeatedly. A True Self begins to have life,
through the strength given to the infants weak ego by the mothers
implementation o f the infants omnipotent expressions. (D. W. Winnicott, 1965,
p. 145)
M others Biological Advantage
Fortunately for babies, their mothers also have systems hard-wired into their brains
that predispose them to connect with and care for their infants, although many o f the
specifics o f these neural circuits continue to elude identification. Evolution o f the capacity
to conceive, carry the developing fetus during pregnancy, give birth, and develop milkproducing breasts has predisposed females to become the primary caretakers and
attachment figures for their infants. Panksepp (1998) offers these insights:
Because of our ability to conceptualize social rules, human mothers and fathers can
care for a child equally well, but only a mother can provide sustenance from her
breasts. She is also more likely to offer affective engagement from emotional
depths unfamiliar to most men. We now know that among all mammals that have
been closely studied, the female brain is more prepared than the typical male brain
to care for infants. Indeed, it may have been the evolution o f the maternal circuits
that initially led creatures down the mammalian path that now makes us humans
the sophisticated social creatures that we are. (p. 249)
Rhawn Joseph (1996) suggests that human language evolved from socialemotional adaptations to keep infants in close proximity to their mothers, noting that the
inner ear and cingulate emerged with the appearance o f nursing breasts (around 225
million years ago), making awareness o f sounds possible and thus usable to safeguard
offspring survival. For instance, infant primates will protest loudly when they become
separated from their mothers (as long as mothers are believed to be in earshot) so they can
be found. I f she calls back, infants can also localize and make their way to her. However,
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if she does not respond, infants will become very quiet, presumably to keep a low profile
in the event o f predators (Bayart et al., 1990).
Female communication differences are consistently observed in human as well as
primate studies. Adults as well as infants will vocalize more in the presence o f adult
females, who, in turn, are likely to offer a soothing response. Verbalized female
communications tend to be more social, melodic, and expressive in naturewhich infants
prefer. Male vocalizations tend to be louder and less expressive. Vocalizations of male
primates are most likely to increase when they are challenged by or in the act o f seeking
dominance over other males. Evidence suggests that females are also more adept at
discerning, perceiving, and comprehending emotional nuances in verbalizations and faces;
and they demonstrate superior capability for feeling and expressing empathy (Joseph,
1996).
Maternal neurobiolosv.
Brain circuits mediating maternal feelings and behaviors include the PAG, ventral
tegmental area (which produces DA), preoptic and medial portions o f the hypothalamus,
stria terminalis, amygdala, septal area, and cingulate gyrusthe same social-emotional
circuits developing in their infants and that will promote and sustain social relationships in
general (Joseph, 1996; Panksepp, 1998). Panksepp (1998) cautions that the precise area
o f the brain in which maternal-infant bonding transpires is unknown at this time, but
suggests that the best candidates are the amygdala, septal area, and cingulate gyrus due to
the fact that damage to any o f these areas can result in disturbed maternal competence.
All social-emotional structures and circuits are sexually differentiated, to include variations
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in neuronal development, structure portions allotted to differing functions, and numbers

and types o f receptor sites.
Panksepp and colleagues (Nelson & Panksepp, 1998; Panksepp, 1998) have
identified maternal neurophysiological agents that appear to elicit nurturance and maintain
the long-term relationship that is required to safeguard the unfolding CNS development o f
her offspring:
At present, brain oxytocin, opioids, and prolactin systems appear to be the key
participants in these subtle feelings that we humans call acceptance, nurturance,
and love~the feelings o f social solidarity and warmth. Although many human
interactions and cognitive experiences also contribute to maternal states, without
the underlying mood-and behavior-altering neuropeptides, those experiences
would probably remain shallow and without emotional intensity. (Panksepp, 1998,
p. 249).
In the last few days before giving birth, mothers levels o f estrogen, prolactin, and
oxytocin rise sharply, as progesterone begins to drop. Although prolactin is critical to
development o f milk in mothers breasts and shares roles in enlisting and sustaining
maternal behavior, the neuropeptide oxytocin is emerging as a particularly potent factor.
Oxytocin, which promotes uterine contractions during childbirth as well as milk letdown
from the breasts, has been strongly implicated in triggering nurturance. From studies of
rat mothers, Panksepp (1998) has determined that
During the last few days of pregnancy and the first few days of lactation, there are
remarkable increases in oxytocin receptors in several brain areas, as well as
increases in the number of hypothalamic neurons that begin to manufacture this
neuropeptide. Both o f these effects are controlled by the elevations o f estrogen at
the end of pregnancy, and the induction occurs in circuits that promote nurturance.
(P- 251)
The greatest proliferation o f oxytocin receptors occurs in the stria terminalis, the
connecting fibers between the hypothalamus and amygdala, taking advantage o f the
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oxytocin secretions triggered by the infants suckling. N ot only do secretions, in turn,

cause more milk to be released from the breasts, but they may contribute to sustenance o f
a maternal mood mediated by these receptors (Panksepp, 1998).
In a study by Y oung et al. (1996 in Nelson & Panksepp, 1998) of maternal
behavior o f rats with a knock-out gene for oxytocin, the one significant effect was that
infants were unable to procure milk from their mothers and, if left with them, starved to
death. If knock-out m others were injected with oxytocin, their babies survived. Otherwise
there were no other discemable effects, even on the labor process~a surprising finding.
This study, which seems to contradict others that have implicated this neuropeptide in a
wide variety o f affiliative behaviors, underscores just how elusive a process it has been to
tease out precisely what it is that oxytocin does. While oxytocin may be especially
important in the initial triggering o f maternal behavior, prolactin, opioids, and social
learning are important fo r sustaining it once the behavior pattern has developed
(Panksepp, 1998, p. 252). In animal studies, oxytocin antagonists produced no effects o f
deterring maternal behavior once it had been put into motion and mothers had gained
experience with their offspring.
Panksepp and N elson (Nelson & Panksepp, 1998; Panksepp, 1998) suggest
oxytocin may have a role in sustaining maternal behavior by inhibiting the development o f
tolerance to endogenous opioids that underpin social pleasure. The experience o f ongoing
pleasure in a long-term relationship would make evolutionary sense toward providing
continued parental safeguarding o f offspring who require sustained care over a long period
o f time. Sustained pair-bonding o f mother and father would further strengthen such an
advantage. Indeed, Nelson and Panksepp (1998) have concluded that sufficient evidence
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exists to suggest that endogenous opioids, which have been implicated in the sensation o f
sexual orgasm (Panksepp, 1998)along with oxytocin, and norepinephrineare key
components o f a neural circuit which regulates affiliative and attachment behaviors
across mammalian species and across development (p. 437) for males as well as
females. Analgesic and pleasure evoking properties o f endogenous opioids may mediate
classical conditioning toward these ends (Panksepp, 1998).
Other neurotransmitters have been implicated in social memory formation, another
key aspect o f social bonding. Norepinephrine has been found to mediate social memory
formation, probably through amplification o f signals from sensory inputs that induce long
term changes resembling long-term potentiation (LTP). This process likely occurs in the
neocortex in humans vs. the olfactory system in animals. Social memory formation serves
to sustain the attachment parents feel toward their infants (Nelson & Panksepp, 1998).
Vasopressin (AVP) is currently under study regarding its implications in the onset o f
maternal behavior, in paternal behavior, and in emergent affiliative behavior in young
mammals. Although poorly understood at this time, it is thought to have some type o f
role in sexually induced pair-bonding in males (not in the sex act itself) and in forming
social memories for both sexes (especially in the septal area) that serve to foster
attachment enhancing social preferences. AVP may work in conjunction with oxytocin to
produce these effects (Nelson & Panksepp, 1998).
Biological windows for the period in which a mother can effectively bond with her
infant appear to be more extended in those species, such as humans, producing relatively
immature newborns. However, data remains inconclusive regarding optimal windows for
human mothers. It is conceivable that missing such a window (i.e. due to medical
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complications or postpartum depression) could reduce the intensity or other qualitative

aspects o f the bond with her infant. In those species in which newborns are quite
developed and raring to go (i.e. sheep), the bonding window is extremely short:
I f ewe and lamb are separated for several hours after birth, the window of bonding
opportunity passes, and mothers will then reject the care-soliciting overtures o f
their own lambs, butting them and refusing them opportunities to nurse.
(Panksepp, 1998, p. 258)
It is striking to observe that mammalian maternal behavior, an apparent
amplification o f affiliative functioning due to well-endowed neuronal properties in
subcortical limbic circuits, mirrors in an exaggerated fashion the emergent affiliative
circuits in infantswith both systems engaged in a reciprocal feedback loop. Social
stimuli provided by the infant release a physiological response in the mother; mothers
response, in turn, becomes a releasing stimulus that furthers development in her child.
Fathers. Adoptive Parents, and Other Caretakers in the Primary Attachment Relationship
Role
Can fathers, adoptive parents, or other primary caretakers (i.e. grandparent, foster
parent, institutional staff) be as emotionally motivated, involved, and effective as
biological mothers in the primary attachment relationship? Although the opportunity to
bond immediately following birth is certainly enhanced by the release o f oxytocin and
prolactinwhich trigger nurturant feelings and behaviormere exposure can engage
attachment feelings. Studies in which male and virgin female adult rats were repeatedly
exposed to newborn baby rats showed that maternal behaviors could be induced in females
in about 4-7 days and in males in about 6-8 days (Panksepp, 1998). Panksepp (1998)
speculates that subcortical endogenous opioid systems may play a role in the established
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phenomenon known as mere exposure effect: if one simply exposes animals to various
stimuli, they begin to develop a preference for those stimuli, especially if they have been
paired with positive affective experiences (Saegert, Swap, & Zajonc, 1973) (p. 259).
This familiarity mechanism apparently operates at the subcortical level, probably in the
systems that evaluate the significance o f social stimuli. Such a biological pathway to
attachment would bode well for fathers or adoptive parents (who would not have the
other obvious birth mother advantages) in allowing them to experience intense pleasure
and other powerful emotions emerging with and further promoting a developing intimate
bond with their infant.
It goes without saying that female primary caretakers would come equipped with
all the same advantageous biological hardware except for the components activated by
pregnancy and childbirth. We also know that newborns are primed to prefer female
characteristics such as soft, gentle, soothing or expressive voices. However, as will be
addressed in the Psychopathology section, being a biological mother or being female does
not guarantee maternal feelings of nurturance or attachment. If baby geese can attach to
an adult male animal not even o f their own species (i.e. to Konrad Lorenz through the
imprinting process as described by Panksepp, 1998, p. 255); and if babies begin to
associate (via classical conditioning) their fathers with getting good biologically significant
stuff (producing excitement and pleasure feelings mediated by dopamine and endogenous
opioids); and if fathers are sensitive responders to their infants signals there is no reason
to believe that a strong, nurturing attachment relationship cant be formed. Indeed, we
know this occurs. Unfortunately, there are next to no studies that address father-infant
attachment.
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Characteristics o f Mothers o f Secure Infants

Mary Ainsworth and colleagues identified three patterns o f infant attachment using
her Strange Situation experimentSecure, Insecure-Ambivalent, and Insecure-Avoidanta
finding which has been replicated in varied cultures throughout the world. (See
CHAPTER E E : Review o f Attachment Theory Milestones for a detailed description of
these historic studies.). Ainsworth (1979) summarizes the three patterns:
Group B (Secure) babies use their mothers as a secure base from which to explore
in the preseparation episodes; their attachment behavior is greatly intensified by the
separation episodes so that exploration diminishes and distress is likely; and in the
reunion episodes they seek contact with, proximity to, or at least interaction with
their m others....Group B babies were more cooperative and less angry than either
A or C Babies.
Group C (Insecure-Ambivalent-Resistant) babies tend to show some signs
o f anxiety even in the preseparation episodes; they are intensely distressed by
separation; and in the reunion episodes they are ambivalent with the mother,
seeking close contact with her and yet resisting contact or interaction.
Group A (Insecure-Avoidant) babies, in sharp contrast, rarely cry in the
separation episodes and, in the reunion episodes, avoid the mother, either mingling
proximity-seeking and avoidant behaviors or ignoring her altogether...Group A
babies were even more angry than those in Group C. (p. 932)
In her book Patterns o f Attachm ent (Ainsworth et al., 1978) Ainsworth and colleagues
provide these additional observations of Secure infants:
The typical Group-B infant uses his mother as a secure base from which to explore
an unfamiliar environment, just as at home he spends a large amount o f his time in
exploratory play. (p. 312)... .Group-B babies tend to be more readily socialized
that is more cooperative and willing to comply with mothers commands and
requeststhan non-B babies...predisposed to comply with her efforts to control
(their) behavior across a distance through signals and verbal commands...are
found to be more positively outgoing to and cooperative with relatively unfamiliar
adult figures than is true for those deemed to be anxiously attached (p.
313).. .tend to be more competent than babies whose relationship has been
characterized as anxious... explore more effectively and more positively, and thus
have a head-start in learning about the salient features o f the environment.. .are
more enthusiastic, affectively positive, and persistent, as well as less easily
frustrated, in problem-solving tasks...(and) tend to receive significantly higher
scores on developmental tests both in the first year and later, (p. 314).
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Mothers o f Secure infants

were, throughout the first year, more sensitively responsive to infant signals than
were the mothers of the two anxiously attached groups, in terms o f a variety of
measures spanning all o f the most common contexts for mother-infant interaction
(Ainsworth et al, 1978). (in Ainsworth, 1979, p. 933)
Contexts included feedings, face-to-face interactions, close bodily contact, and responses
to infant cries (Ainsworth, et al., 1978). This was not the case for mothers o f Insecure
infants, whose responsiveness to infant signals was inconsistent at best, ill-timed,
inappropriate, or even nonexistent (Ainsworth, 1979). Ainsworth (1979) postulated that
sensitive responsiveness to infant signals
enables an infant to form expectations, primitive at first, that moderate his or her
responses to events, both internal and environmental. Gradually, such an infant
constructs an inner representationor working model (Bowlby, 1969)o f his or
her mother as generally accessible and responsive to him or her. Therein lies his or
her security. In contrast, babies whose mothers have disregarded their signals, or
have responded to them belatedly or in a grossly inappropriate fashion, have no
basis for believing the mother to be accessible and responsive; consequently they
are anxious, not knowing what to expect o f her. (p. 933)
In their 1997 meta-analysis o f 21 Strange Situation attachment studies, De Wolff and van
Uzendoom found that, in addition to sensitivitywhich they defined as the ability to
respond appropriately and promptly to the signals o f the infant (p. 584)mutuality,
synchrony, positive attitude, and emotional support also characterized the interactions of
mothers with Secure infants.
Mary Mains work was instrumental in demonstrating that patterns o f attachment
extend across generations. In their 1984 landmark study, she and Ruth Goldwyn utilized
the Berkeley Adult Attachment Interview (AAI) to determine the quality o f childrens
attachments with their mothers based on the mothers verbal narratives o f childhood
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interactions with their own mothers. Findings showed that mothers o f Secure infants
were able to give a clear, cohesive, detailed recollection o f their relationship with their
own mother growing up. This was true even for those mothers of Secure infants whose
own childhood experiences had been hurtful, indicating they had been able to work
through, integrate, and get beyond their past. This was not the case for mothers of
Insecure infants, whose accounts lacked specificity and detail; were vague, inconsistent,
even incoherent; or were grossly idealized. These women often had trouble even
remembering their childhood.
Implications are that mothers of Secure infants, freed up from unmet needs of their
own, can view their babies with much less distortion, enabling them to tune into and
respond more accurately and effectively to their infants signals. Mothers o f Secure
infants were characterized as autonomous, self-reflective, nurturant, sensitive, and
noncontroling. These women valued their relationships with their infants, maintained a
balanced view o f their own roles in relationships, demonstrated tolerance for imperfection
in themselves and others, did not idealize their own parents, and could re-examine their
past with objectivity and perspective (Main, 1995; Main & Goldwyn, 1984).
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Mother-Infant Developmental Task: Achieving Homeostasis

Arousal Regulation is a Two-Person Job
The first and foremost task for the newborn is to achieve control o f homeostasis.
Gaining control and making use o f arousal emerging from internal pressures (elicited by
bodily need) or from exciting new stimuli from the environment outside the womb is
essential to a young infants stabilization, adaptation, brain growth, and optimal survival.
However, fragile new nervous systems can tolerate arousal that falls within a short range
that mirrors babies tiny bodies. According to a 1981 model proposed by attachment
expert Tiffany Field (in Lester, Boukydis, & LaGasse, 1996)
attention and positive affect occur within a range or band of activation with an
attention threshold at the lower limit in which stimulation is accepted and an
aversion threshold at the upper limit in which stimulation is rejected. Biological
insults such as prematurity may result in a narrower band, that is, a higher attention
threshold and a lower aversion threshold, (p. 781)
Newborns have a limited tolerance range for arousal intensity, duration, frequency, or
simultaneous quantities o f arousal-triggering stimuli. In the wisdom of Goldilocks:
stimulation can be too big (destabilizing), too little (depriving), or just right (restabilizing ,
growth promoting in ways that do not outstrip the upper and lower limits o f the infants
coping zone).
Up and running emotion structures available to the newborn include brain stem
components and the hypothalamus (as previously discussed in detail). Emotion circuitry
includes the autonomic nervous system with counterbalancing activation and restorative
systems extending to the visceral organs in the body; an immature, partially functioning
stress response; calming, pleasure-producing satiety system that rewards the fulfillment o f
a biologically significant need; motivating, excitement-producing seeking system for
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obtaining biologically significant resources from the environment required for stabilization,
adaptation, and subsequent development; and primitive rage resulting from escalating
arousal of unmet need.
Babies can feel good when calming endogenous opioids are released as needs and
primed expectancies get met or when exciting dopamine and NE are released (within the
parameters of their comfort zone) as fascinating new stimuli from the environment are
encountered. And, babies can feel bad when arousal escalates beyond their comfort zone
(due to overstimulation, deprivation, pain, irritation, or unmet need) and even mad when
arousal intensifies as need remains unmet. O f course, babies, being the here-and-now, idlike creatures that they are, demand that their needs be met ASAP.
Overstimulation, due to immature biological systems, can quickly escalate arousal
to the point it outstrips the limited coping capacity o f the newborn, resulting in
dysregulation. Brazelton provides this vivid description o f a very young infant in a
disorganized state:
When a baby is extremely overstimulated, her eyes may seem to float, her arms and
hands may go limp, her face may frown, or she may avert her gaze. Spitups and
bowel movements can be a sign o f stress. They can come at unexpected times,
along with whimpering, high-pitched cries. These responses are signs that the
baby needs time out to recover and reorganize, (p. 47)
Infants Self-Directed Coping Mechanisms for Arousal Regulation
Edward Tronick (1986) provides insight into the internal world of the infant:
Disruptions to the infants emotional state come from both inside and outside.
They are produced by physiological states such as hunger, conflicting infant goals,
too much or too little stimulation, a mismatch o f the infants expectations and the
external outcome, too large a discrepancy between the infants internal schema and
the external event, and the like. In the face o f these difficulties, the infant can
utilize his or her self-directed regulatory behaviors in order to modify internal and
external sources o f disruption. One set o f such behaviors regulates the infants
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emotional state by decreasing the infants engagement with the external

environment and by substituting self-stimulating behaviors. These include all forms
o f self-comfort, such as sucking and rocking, as well as behaviors that decrease the
infants perceptual receptivity, such as withdrawal and turning away. (p. 6)
As previously discussed newborns have several self-directed coping mechanisms
available to them (or rapidly coming on-line) for reducing arousal. These include headturning to avert the stimulus, thumb-sucking reflex, habituation, and altering their state of
consciousness (i.e. sleeping, dissociating). Thumb-sucking and the use o f a pacifier can be
considered forms o f non-nutritive suckling. The neurobiological mechanism for non
nutritive suckling, which has a powerful quieting effect on baby animals as well as humans,
remains unknown (Blass, 1996).
Habituation is a biological process that results in decreased responding over the
course o f repeated exposures to a sensory stimulus. Although this complex mechanism is
still not well understood, it is thought to be mediated by CNS processes involved in
attention and stimulus selectionand not by sensory adaptation or fatigue (Smotherman &
Robinson, 1993). Smotherman & Robinson (1993) believe that endogenous opioids,
particularly at kappa receptor sites, mediate habituation. These authors suggest an
evolutionary purpose for habituation which is hard-wired into a wide range of animal
species, to include those with the simplest of nervous systems:
Habituation is an important process because virtually all organisms must
distinguish frequently encountered and generally irrelevant stimuli from novel and
important stimulus features within their environment. Habituation thus promotes
selection of salient stimuli from a much broader array o f stimuli available, (p. 611)
Because ability for habituation emerges early in development (even in the fetus), capacity
for habituation is often utilized to assess CNS developmental status in newborns
(Brazelton, 1992; Smotherman & Robinson, 1993). For example, an infants ability to
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tune out a noise after a couple o f responses and fall back to sleep woulld be a good sign
that development is progressing nicely (Brazelton, 1992).
In the 1950s and 60s, P. H. Wolff delineated six states o f consciousness in infants
based on degree and type o f arousal: deep sleep, light sleep, semi-alertt, wide-awake alert,
fussing, and crying (Brazelton, 1992; LeFrancois, 1984). Harvard-bas*ed pediatrician, T.
Berry Brazelton (1992) describes them:
Deep sleep is a protected state
in which the infant can shut out disturbing stimuli from the environment around
him. He breathes deeply, regularly, and heavily. Eyes tight shut, he is motionless,
(p. 59)
In light or REM sleep
breathing is shallower and irregular. From time to time the infant sucks with or
without a finger in his mouth. He periodically moves in a w rithing way. He may
startle once or twice. In this state, he is more vulnerable to outside influences.
When roused, he will either awaken sleepily and fussily or struggle to sink into
deep sleep, (p. 59)
The short-lived semi-alert or indeterminate state
is one that occurs frequently as the infant rouses or returns to sleep. In this state
he squirms and moves jerkily. His eyes open dully and close again sleepily. He
may whimper or cry out, but without focus. He will often try t o curl up into a
comfortable position, but starting, jerky movements interfere. Tie looks
disorganized, and his frowning face shows the uncomfortable attem pts he makes to
reach a more organized stateeither o f deep sleep or of an alert state, (p. 59-60).
During the wide-awake alert state
the babys bright face and shining eyes demonstrate his open resceptivity. His
movements are contained. If he moves he moves smoothly a n d can even achieve a
goal, such as bringing his hand to his mouth or holding one hand with the other.
His breathing fits itself to the stimulus. With an exciting stimulus, his breathing is
deep. For a negative one, it is shallow and rapid. One can see his responsiveness
on his face and in his entire body as he attends to an interesting noise or a familiar
face. His face, his breathing, his bodys postureall convey interest and attention,
or else a desire to withdraw and turn away from an overwhelming stimulus.
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Parents look for, and learn to help him to prolong this wonderful alert state, for
this is the time they can communicate with him. An attentive parent soon learns
his signals for I ve had enough when hes tired or for I want attention when
hes feeling overlooked, (p. 60)
Fussing
often follows the alert state. The babys movements become jerky and his
respirations irregular. He turns away from stimuli, fussing or whimpering from
time to time. He makes ineffective attempts to control himself. As he thrashes
around in his bed, his face reflects his feelings o f ineffectuality. In this state he
cannot control his movements, his autonomic system, or his ability to take in
stimuli from around him. (p. 60)
When a baby cries
his movements are thrashing, yet somewhat organized, in spite o f his constant
activity. He may quiet briefly as if to listen. He is likely to quiet when picked up,
rocked, or fed. This state demands parents attention, and they learn which
comforts relive it. It serves many purposes, (p. 60-61).
Brazeltons Neonatal Behavioral Assessment Scale (NBAS), used in hospitals and
research studies worldwide, can be used to assess the babys behavioral repertoire as he
responds to human and nonhuman stimuli. The way he uses states o f consciousness to
control his responses reveals his capacity to adjust to his new environment (Brazelton,
1992, p. 24). I f he is active and intense, he will move in and out quickly. If he is laid
back, he will move slowly in and out o f the six states. (Brazelton, 1992, p. 61).
By the age o f three weeks, babies nervous systems generally have matured to the
point that a predictable pattern is beginning to emerge. Manifestations include better
sleeping, predictable heart rate responses to visual and auditory stimuli (faster to
negative ones, slower to positive ones), ability to wait longer between feedings (p. 61),
paying more attention to (their) parents (p. 61), more cooing, and more smiling.
Brazelton (1992) refers to this pattern as an infants temperamental style. However, he
141
acknowledges that non-genetic factors can influence the emergence o f a particular pattern
(1992). It should become quite apparent throughout this section and the next that
environmental factors related to attachment or attachment deficits and distortions can
contribute to the development o f particular temperamental patterns, as well.
Another self-directed arousal management strategy available to young infants is
dissociation. However, Van der Kolk and Fisler (1994) have observed that children seem
to resort to dissociation only when caregivers are not available to provide them with
stroking, rocking, feeding, verbalizing, and singing to help them change their internal
states from agitated and dysphoric to calm and contented (p. 149). An infants use of
dissociation~as an emergency mechanism for staving off systemic disorganizationwill be
explored at length in the Psychopathology section.
Due to the newborns immature neurological organization and lack of
coordination, self-directed behaviorswhich serve to regulate (decrease or increase)
stimulationare not sufficient. Another way babies seek to regulate arousal is through
other-directed behaviors which serve to engage the environment (mother) for assistance.
Examples of primed other-engaging mechanisms (as previously described) include
orienting, smiling, body-molding, sucking, and crying.
Mothers Role as Auxiliary Central Nervous System for Her Infant
Consistent with Edith Jacobsons concept that an infant borrows ego from its
mother (Jacobson, 1964 in St. Clair, 1996, p. 94), Edward Tronick (1986) believes that
the mothers sensitive response is an essential factor in helping her infant establish
regulation of emotional states:
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When the mother responds appropriately to her infants other-directed regulatory

displays, the infant is able to maintain both self-regulation and regulation o f the
interaction, and positive emotions are generated. When the mother fails to
respond, the infants regulatory efforts are unsuccessful, and negative emotions are
generated...When the feedback provided by the mother is appropriate to the
infants self- or other-directed regulatory behaviors, she provides the infant with
the regulatory capacity that the child lacks, enabling him or her to regulate his or
her state successfully. Thus, the infants regulatory system is fundamentally a
dyadic system, dependent on both infant and mother, (p. 7)
Based on his extensive attachment research with rats, beginning in the 1960s,
Myron Hofer (1995) also concluded that mothers serve as regulators o f biological
activities in their infants through their availability to and normal contact with their pups.
Mechanisms affected include heart rate, body warmth, psychopharmacology, feeding,
sleeping, and activity level. W. D. Winnicott (1965) introduced the concept o f the
Holding Environment to indicate a similar process of meeting psychological needs that
occurs within the context o f mother-child interaction. Even though holding is used as a
metaphor, he chose it becausein the beginning of lifethe young infant literally needs
holding as much as anything else.
Brazelton (1992) suggests that parents can (and generally do) become more
effective responders by getting to know their babies. Specific ways they can do this is to
learn their infants preferred arousal/stimulus range, the ways in which they utilize and
cycle through the six states o f consciousness, and the meaning o f their infants different
types of cries. He also recommends that parents attempt to put aside their preconceived
notions of who their child is or how theyd like for the child to be, so they can see this tiny
person for who they are. Armed with this information and unclouded by distortion,
parents can make more precise judgments about what exactly it is that their baby needs
from them and select a best response to meet a particular need at that specific point in
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time. For instance, Instead o f a frantic effort to stop all crying, (parents) can learn the
more realistic goal o f helping the baby calm herself and regain control (Brazelton, 1992,
p. 43).
Research has shown that parents generally learn to distinguish their own infants
cry within three days and among their infants variety o f cries by the 10th to 14th day
(Brazelton, 1992). Developmentalist Guy LeFrancois (1984) notes that
Mothers appear to be remarkably sensitive to the nature of infant cries, although
here, too, there are individual differences (Ainsworth & Bell, 1969). Wolff (1969)
reports that most mothers respond quickly to hunger cries and even more quickly
to cries o f anger or pain. Whereas hunger cries often lead to the presentation o f
food, cries o f pain typically elicit comforting behavior or alarm. (p. 148).
With pediatric wisdom, Brazelton (1992) provides this excellent example o f how
sensitive parents might augment the raw nervous systems o f their stressed newborns by
selecting among an array o f possible responses:
Parents o f a hypersensitive baby can help him develop an effective threshold for
screening out unimportant information. They can cut down on stimuli; they can
arrange a quiet room at home, with subdued light, and use low-pitched, soft voices
or visual or tactile stimuli, especially at feeding times or when they want to play
with him. We have even found that some babies can tolerate being looked at or
touched, or picked upbut only one of these at a time. By waiting until the baby
subsides, another modality can be added. Gradually, all of them can be put
together at once, but in a low-keyed way and with respect for the babys easily
overloaded nervous system, (p. 26)
Brazelton has observed that when a parent is on the right track, an infants face will be
placid and content, her body will be relaxed, and her responses will be organized and
predictable (p. 47). However, when a parent is missing the babys cues, the infant will
be disorganized and unreachable. She will avert her face from (the parents). Shell
thrash around and be unable to get calm. Her color will change to either very red or
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slightly blue. Her limbs will stiffen out, and her cry may be piercing and breathless (p.
48).
A sensitive mother who can assist her infant to regulate arousal, serving as an
externalized augmentation of her childs central nervous system will be rewarded for all
her loving effort on the front end o f her infants life. If all goes well, she will gradually be
able to relax her amount o f time and attention commensurate with her youngsters ability
to gain control. For instance, a study by Stifter, Spinrad, & Braungart-Ricker (1999) at
Pennsylvania State University found that an infants ability to regulate arousal was
correlated in a positive direction with infant compliance at age five, ten, and eighteen
months.
Reciprocal Emotion Systems for Pleasure and Pleasure Seeking
Citing work by Field (1985) and Stem (1983), Van der Kolk and Fisler (1994)
note that the modulation o f arousal by the parent requires providing a balance o f
experience that alternates between soothing and an optimal range o f stimulation. Stem
(1985) suggests that during the process o f affect attunement, infants need periods o f
quiescence in between stimulating interactions with their mothers for consolidation of
integrated experience and learning. These observations regarding the existence of
homeostatic information processing systems are consistent with Margaret Mahlers notion
o f Rapprochement, Piagets mechanisms o f assimilation (for incorporating familiar
information) and accommodation (for incorporating novel information), and the
biologically sophisticated experience-expectant and experience-dependent information
incorporation mechanisms which make use o f the brains plasticity to promote its
development, formulated by Greenough, Black, & Wallace (1987).
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Two reciprocating emotion circuits available to the newborn infant which provide
the neurobiological substrates that can account for such observations are the pleasure
circuit (that promotes energy restoration and conservation upon obtainment o f required
resources) and the seeking circuit (that expends energy in the process o f obtaining
resources). The pleasure circuit, which utilizes the parasympathetic nervous system, is
critical to resource integration; the seeking system, which utilizes the sympathetic nervous
system, mobilizes the system to obtain resources and make necessary adaptations for
optimal survival, spurring systemic growth and development.
Pleasure
The pleasure principle, then, is a tendency operating in the service o f a function
whose business it is to free the mental apparatus entirely from excitation or to keep
the amount o f excitation in it constant or to keep it as low as possible. (Sigmund
Freud, 1920, translation in Gay, 1989, p. 625)
The unconditional pleasure prize: endogenous opioids.
Panksepp (1998) proposes that the sensation o f comfort or pleasure is most likely
provided by a burst o f endogenous opioidwhich, by shutting off the arousal caused by
unmet needgenerates a sense o f well-being. He suggests that classical conditioning o f
stimuli that become associated with fulfilling need states, when paired with opioids as the
unconditional reward, may occur in hypothalamic neurons, providing the infanteven at
this early agesome experience with forming expectations. Pleasure, therefore, is hard
wired into the system, first experienced at the subcortical-visceral level, and fully
operational by birth. Indeed, endogenous opioids are abundant in the newborn
(Smotherman & Robinson, 1993)particularly in emotion circuits (i.e. brainstems
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medulla, PAG, locus coeruleus, raphe nucleus, ventral tegmentum, nucleus accumbens;
hypothalamus; amygdala).
Fortunately for most infants, the biologically significant stimuli for which they are
primed (i.e. mothers milk, holding, gentle touch, sugar taste) will be readily available to
them in their new environment on the outside o f the womb. Therefore, it may come as no
surprise that such energy replenishing, energy conserving, and thus, life-sustaining factors
have been found to have opioid releasing ccomponents (Blass, 1996; Panksepp, 1998;
Robinson & Smotherman, 1997), providing built-in, unconditioned reward upon their
obtainment.
The allure of the familiar.
Youngest infants tend to prefer stimuli that are in or restore harmony with their
expectations (Brazelton, 1992; Geva, Gardiner, & Karmel, 1999). As previously
discussed, newborns are attracted to specific types o f experience-expectant stimulireadily
available in their new environmentthat pro-mote development in brain systems coming on
board (i.e. to visual stimuli with sharply conttrasting patterns required by the occipital
cortex) (Greenough, Black, & Wallace, 198;7). And, these young infants appear to prefer
stimulus outcomes that are in sync with innate expectations, such as moving objects
adherence to their anticipated visual trajectories. An initial preference for harmonious
outcomes matching built-in expectancies likely reflects the brains desire for synchronized
(vs. asynchronized) neuronal firing patterns required to strengthen synaptic pathways,
build brain structures, and link up functional circuits (Joseph, 1996).
This initial reliance on primarily harmonious experiences makes good
developmental senseespecially in the beginningserving to focus newborns on
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biologically significant, stabilizing stimuli from the vast, bewildering (and potentially
disorganizing) array suddenly available to them outside the womb. Harmonious
incorporation o f new stimuli would require less energy, and, therefore, would be less
taxing on a brand new nervous system. Fulfillment o f these easily met needs would also
provide lots o f practice shifting from the sympathetic to parasympathetic systemfrom an
aroused state to a calm state~to regain control. This author proposes that arousal
reduction produced by obtainment o f innate expectations (harmonious outcomes similar to
gestalts) might also be mediated (and rewarded) by a soothingprobably analgesicendogenous opioid release. Along these lines, there is now general agreement that
placebo expectancy effects are mediated by endogenous opioids, although exact
mechanisms remain unknown (Amanzio & Benedetti, 1999).
The pleasure of your company.
Endogenous opioids have been implicated in rewarding social interactions in
general to include play, sex, and maternal feelings (Panksepp, 1998). With so many built
in sensory preferences for maternal features (voice, smell, milk) and reflexive behaviors
geared to engage her (eyes that work best at a distance that equals the distance from
babys face to hers when held, body molding, rooting, sucking) it seems reasonable to
assume that unconditioned reward would be obtained through contact with mother.
Although the functions o f the neuropeptide oxytocin remain elusive, Nelson and Panksepp
(Nelson & Panksepp, 1998; Panksepp, 1998) have speculated that it may sustain opioid
effects in social-emotional circuits, staving off its normal tachyphylaxis, in order to sustain
social bonds over time.
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Comfort obtained upon contact with mother.

Jaak Panksepp has proposed that emotional pain has evolved from the same system
that mediates physical pain (Panksepp et. al., 1978). This makes evolutionary sense if the
signaling effects o f affective pain motivate proximation seeking or attachment behavior
which, if successful, serve to insure survival o f the developing infant. Panksepp became
interested in this area o f research when studies revealed that the analgesic effects o f
opiates appeared to stem from an alteration o f the affective component of pain as opposed
to alteration o f the direct sensory stimulation o f the pain producing event (Panksepp et.
al., 1985). Another influential factor was the discovery o f the existence o f endogenous
endorphin (opioid) systems in the human brain in the mid 1970s. He began to test
hypotheses that the opiate family o f analgesics might also quell emotional pain, especially
the distress engendered in infants who were removed from their mothers and placed in
socially isolated conditions.
In an oft-cited and replicated landmark study, Panksepp et al. (1978) discovered
that weak doses o f the exogenous opiate morphine were significantly effective in reducing
the distress cries and agitated behavior in socially isolated puppies without interfering with
other behavior (i.e. motor coordination). He had previously attempted this same type of
experiment with chicks and baby guinea pigs with similar results; in addition, an
administration o f an opiate antagonist had increased distress vocalizations in these animals.
The implication o f this work is that a form o f analgesia, or pain relief, appears to be
obtained upon acquiring contact comfort and reassurance from the mother.
Indeed, Panksepp found that the endogenous opioid, B-endorphin was released in
infants brains in contact with their mothers. This opioid, abundant in social-emotion
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circuits (i.e. hypothalamus), may not only produce calming effects, but also give rise to
euphoric feelings (Panksepp, 1998). B-endorphin inhibits corticotropin releasing factor
(CRF), a major instigator o f the stress response, in the paraventricular nucleus (PVN) of
the hypothalamus (Chrousos & Gold, 1992; Panksepp, 1998). Panksepp suggests that
attachment behavior and opiate addiction are very closely related in that they appear to be
mediated by the same systems in the central nervous system. He notes that separation
from the object o f attachment and opiate withdrawal produce similar painful symptoms
(Panksepp, 1998; Panksepp et al., 1978; Panksepp et al., 1985).
Separation: developing the capacity to be alone (Independent!
The capacity to become separate from mother begins, paradoxically, within the
safety net o f being in her presence while being alone. However, with Panksepps
discovery, we now know that mothers presence has the protective capacity of generating
endogenous opioid mediated calming effects in her infant. Winnicott (1965) believed that
the capacity o f the individual to be alone
is one o f the most important signs of maturity in emotional development (p.
29)
Although many types of experience go to the establishment of the capacity
to be alone, there is one that is basic, and without a sufficiency of it the capacity to
be alone does not come about; this experience is that o f being alone, as an infant
and small child, in the presence of mother. Thus the basis o f the capacity to be
alone is a paradox; it is the experience o f being alone while someone else is
present, (p. 30)
He calls this ego-relatedness (p. 30).
The relationship o f the individual to his or her internal objects, along with
confidence in regard to internal relationships, provides of itself a sufficiency o f
living, so that temporarily he or she is able to rest contented even in the absence of
external objects and stimuli. Maturity and the capacity to be alone implies that the
individual has had the chance through good-enough mothering to build up a belief
in a benign environment. This belief is built up through a repetition of satisfactory
instinctual gratifications, (p. 32)
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Relaxation for an infant means not feeling a need to integrate, the mothers egosupportive function being taken for granted (p. 61). The safety inherent in a trustworthy
environment makes relaxing into a state o f unintegration possible. This is a very
different state from disintegration (p. 61) which occurs when the infant is alone, but all
alone. Winnicott uses the term disintegration in a way that is similar to (and even more
drastic than) dissociation (which implies an uncoupling) in that both serve to reduce the
complexity o f the infants systemic organization to a simpler, more manageable state:
The term disintegration is used to describe a sophisticated defence, a defence that
is an active production of chaos in defence against unintegration in the absence o f
maternal ego-support, that is, against the unthinkable or archaic anxiety that results
from failure o f holding in the stage o f absolute dependence. The chaos of
disintegration may be as bad as the unreliability of the environment, but it has the
advantage o f being produced by the baby and therefore o f being nonenvironmental. It is within the area o f the babys omnipotence. (Winnicott,
1965, p. 61)
It is quite conceivable (from a built-in evolutionary or systems perspective), thatjust as
Winnicott proposedthis extremely vulnerable, agitating unintegrated state in the absence
o f maternal support (of being alone, but all alone), would be experienced (processed by
the earliest, least modulated, and most genetically hard-wired emotion systems) as
annihilation (p. 61). Annihilation, meaning entropy rather than death, may be
experienced as more horrific than death.
Seeking
Panksepp (1998) supports a convergence o f thought among neurobiologists that
there is a separate motivational (or appetitive) system whose purpose is to engage and
sustain the activity required to obtain need fulfillment (homeostasis) which he calls the
SEEKING circuit. This system, which engages the sympathetic nervous system, produces
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the doing (effort) it takes to obtain the pleasure prize. It promotes approach,
engagement with, and excitement about life. The seeking circuit, infused with energizing
dopamine, follows the course of its ascending mesolimbic pathway from the ventral
tegmental area (VTA), through the nucleus accumbens (a particularly exciting spot), to
the lateral hypothalamushome o f the legendary medial forebrain bundle (MFB). There is
evidence that opioid and dopamine co-mingle in these areas producing a potentiated,
reinforcing effect (Berridge et al., 1997; Pocock & Wise, 1991).
Good descriptions o f the human subjective experience generated by the Seeking
system might include eager anticipation, intense interest, and engaged curiosity
experienced when expecting rewards (Panksepp, 1998, p. 149), all of which can be
observed in the young infant. Interestingly, unlike other more transient emotion systems,
the experience generated by the seeking system tends to be around most o f the time (i.e.
continued sense o f curiosity) and therefore, is more tonic or trait like. However, upon
obtaining the pleasure prize, the seeking state (and its inherent arousal) shuts off rapidly.
The rapid dissipation of sexual arousal upon obtaining orgasm is an example.
Great expectations motivate approach back to the future.
O f great developmental importance, the seeking system promotes approachmotivated movement over time toward the eagerly anticipated positive outcome. The
expectation o f reward would appear to be the essence of hope. To expect a reward
requires some type of learning that would result in a primitive form of memory. The
pleasure system is most id-like in its focus on reveling in the here and now. The seeking
system, however, will (with some effort and courage on the infants part) facilitate the
ability to stretch out time to incorporate the past and the future. Being able to learn
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from past, familiar experiences and to approach unknown new ones are awesome
adaptations, permitting cohesion and movement (i.e. shifts in vantage points, through time
and space), leading to all sorts o f new possibilities. For these tiny time travelers, the
experience o f going into the new dimension o f the future must be like boarding the
Starship Enterprise to depart on a journey where no one has gone before. The
advantage, o f course, is that they get to take their mothers along.
Classical conditioning: pleasure and comfort by association.
Developmental psychobiologists Robinson and Smotherman (1997) conducted a
series o f fascinating experiments on rat fetuses still attached to the womb to tease out
factors that permit classical conditioning to occur. Each experiment involved placement
o f a tiny artificial nipple near the pups mouth (conditioned stimulusno previous effect on
opioid response) and/or milk infusion onto to the pups tongue (unconditioned stimulus
always eliciting opioid-mediated calming effects) in varied configurations. Milk elicits an
unconditioned opioid-mediated response at kappa receptors which promotes changes in
motor behavior and reduces fetal responsiveness to other forms o f sensory stimulation for
several minutes after milk exposure (p. 1086).
Findings were that
1. The opioid reward response is plastic, changing from a simple kappa receptor
site mediated response elicited on the first exposure to milk (alone) to a milkelicited response mediated by both kappa and mu receptor sites once milk has
been paired with the conditioned stimulus.
2. It takes two paired trials to get this combination kappa-mu receptor site effect
for milk.
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3. After pairing with milk, the nipple (conditioned stimulus) produced its own
opioid-mediated effect at mu receptor sites.
4. Two conditioning trials (nipple paired with milk infusion) were significantly
more effective than one to elicit a mu-mediated opioid effect, although 60% o f
the pups showed the effect after just one pairing.
5. Two preexposures to the unconditioned stimulus (nipple) before pairing with
the milk enhanced the effectiveness o f a single conditioning trial, with 90% of
the pups showing the opioid-mediated effects after just one pairing.
6. And, preexposures to the nipple resulted in a more vigorous response to the
milk when it was introduced for the first time.
Results led investigators to conclude that exposure to familiar stimuli facilitates
classical conditioning of physiological responses, including opioid activity, during the first
suckling episode (p. 1086) This implies that fetal subjects can attend to and retain
information about the sensory characteristics o f the artificial nipple during preexposure
treatments (p. 1091).
Robinson and Smotherman also determined, that in this case, the repeated
preexposures to a sensory stimulus did not result in habituation. Why not? Currently, the
answer is unknown, but authors speculate that perhaps the pups were primed to respond
to the artificial nipple because it had characteristics o f a natural analogue (p. 1096) that
would normally be associated with obtaining milk.
Similarly, a previously neutral stimulus (associated with an unconditioned stimulus
that elicits a calming opioid-mediated effect within a safe context) can become
conditioned to elicit an opioid response o f its own under stressful (i.e. novel, painful)
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conditions. Because the conditioned stimulus was associated with a safe condition, it
becomes a signal that elicits the expectation o f safety in the new, stressful condition-even
though the circumstances are quite different (Wiertelak et al., 1994).
Transitional objects.
Use o f the familiar as a protective safety device is illustrated in a study by
Shoemaker and Kehoe (1995), in which investigators placed groups of rat pups in two
isolation conditions: one in a cage which contained familiar bedding (of the same odor
and texture to which they had been exposed prior to separation from their mothers and
siblings) and the other in a cage with different, odor-free bedding. Although analgesic
enkephalin was released in both groups o f subjects (due to the stressful, agitating nature o f
the isolation conditions), the group with familiar bedding had the extra protective factor of
an additional, endorphin opioid release. B-endorphin is released in the infants brain upon
contact with mother, indicating the smell in the bedding had become conditioned by her
and could now evoke some calming effects o f its own.
The implication is that familiar objectsparticularly those that have become
associated with mom and/or previous safe places (i.e. nest, crib, home) or other
conditionsprovide opioid-mediated comfort (a safety signal), much in the same way that
a teddy bear serves as a transitional object to assist the child to cope with unsettling
physical and psychological separations from parents, as conceptualized by Winnicott
(1965). Children can cling to their bearsusing them as an arousal reducing anchor to
distance themselves from their mothers or to cope with novel and/or threatening
circumstances. In this way, transitional objects can provide a stepping stone to becoming
independent. Eventually children will even be able to transport parents comforting words
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into a scary situation, by comforting their teddy bears with the same wordsa stepping
stone to using comforting self-talk inside their own heads. Newborns preference for their
mothers voices may indicate they are using it as a transitional object o f sorts, having
come to associate it (back in the good old prenatal days) with the safe environment o f the
womb.
Regular, reliable reinforcement generates tolerance and optimism.
When seeking system behavior in animals is stimulated on a fixed interval schedule,
whereby rewards are consistently forthcoming, Panksepp (1998) has observed that
animals tend to withhold their responses during the first half o f each postreward
interval, and operant behavior increases gradually during the second half o f the
interval, before there is any realistic opportunity to obtain rewards. Thus, animals
appear to be natural optimists, invariably underestimating the amount o f time
they need to w ait.. .it seems as if animals working on FI schedules exhibit a gradual
intensification o f behavioral excitement, or anticipation, as each interval draws to a
close, (p. 157, 159)
Withholding behavior for the first half o f the interval suggests these animals are
able to sustainor even stave offarousal discomfort across some period o f time precisely
because they have come to trust (based on a build-up o f consistent past experiences) that
the desired reward will be forthcoming at a regular point in the future. They are hopeful,
and that hope is consistently re-reinforced with subsequent experiences.
Perhaps newborns, whose needs were met on an ongoing, uninterrupted basis
while still in the womb, enter the world as innocent optimists with high expectations.
Birth launches them into a new existence, however, where getting needs met is not nearly
so fool proof. A lot now depends on the newbornwho starts out with some rather
effective basic tools for engaging the environmentto let needs be known. Therefore, it
would seem that meeting newborns needs quickly, so reward is consistently placed in
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close proximity to an infants signal of unmet need, would be essential to maintaining that
optimistic outlook.
Soon, a mother whos paid her dues by doing this sufficiently in the beginning, can
capitalize on her infants trust, gradually shaping or stretching out her babys tolerance
intervals in order to bring the infants eating and sleeping schedule more into alignment
with her own (and likely readjusting or broadening infant hypothalamic set points). Only
if mother continues to establish her reputation as a reliable responder, while gradually
stretching out the waiting periods in between, can her infant afford the luxury o f hope,
trusting that critical resourcesupon which ones very existence dependswill be
forthcoming.
Endogenous opioids, dopamine, and a role for addiction in attachment.
Panksepp (1998) points out that
an increasing number o f studies measuring DA cellular activity, as well as
dopamine release in the pathways emanating from the VTA, now indicate that this
system is especially highly tuned to stimuli that predict rewards, rather than to
rewards themselves (Damsma et al., 1992; Schultz & Romo, 1990; Schultz, 1992;
Wilson et al., 1995). (p. 152).
Such predictive stimuli would likely include sensory components such as sights, sounds,
tastes, or smells that would become classically conditioned through association with the
reward and, therefore, become remembered at some level as beneficial. Since so many of
these sensory components would be associated with mother herself, she would not only
provoke calming pleasurable feelings, she would also provoke exciting pleasurable
feelings. As the primary source of her infants supplies, she is an incredibly potent
stimulus that elicits both unconditioned (i.e. hypothalamic B-endorphin) and conditioned
reward mediated by endogenous opioid and co-mingled, interactive opioid and dopamine
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producing exciting, reinforcing effects (i.e. in the ventral tegmental area, nucleus
accumbens) (Berridge, et al., 1997; Panksepp, 1998).
One might even speculate that the scenario o f the good enough mother who
provides supplies on a dependable, as-needed basis has all the ingredients for establishing a
powerful addiction in her infant, certainly a dependency. This might be one time in nature
when the phenomenon of addiction has a positive, indeed critical, rolelocking in the
desire for attachment from the very beginning o f life. Addiction makes evolutionary sense
by building in assurances that an infantbom quite early into its developmental processwili get the essential protection and resources for optimal survival within a facilitating
environment over the long period o f time required for maturation. It would also make
sense that mother and father would become addicted by falling in love with their baby
and to each other by falling in love to strengthen the pair-bond that further optimizes
survival for themselves and their offspring. As previously discussed, the role o f oxytocin
may be to prolong the effects o f endogenous opioids in rewarding social relationships
staving off the tachyphylaxis that would normally occur (Nelson and Panksepp, 1998).
This casts the infants cathexis (investment o f energy) in mother in a whole new
lightor actually back into the old one intended by Sigmund Freud. Per his own account
(Freud, 1895 in Gay, 1989, p. 89) he selected the term cathect to mean one neurons
passing energy to the next. A neuron could either be empty or cathected (filled with
energy). (He believed that neurological functions provided good metaphors for the system
at large.) Drug addicted individuals invest or cathect considerable amounts of energy in
obtaining their supplies, and in the supplies themselves, often to the exclusion o f other
aspects o f their lives to include human relationships. This is particularly true for opiate
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addicts. This would represent an aberrant use o f the seeking (appetitive) system that
would appear to w ork against optimal survival and reproductive outcomes.
Separation spawns wish-fulfilling dreams and hallucinations.
The Seeking system utilizes a rather non-specific problem solving strategy to
obtain positive (and perhaps avoid aversive) ends (Panksepp, 1998). This would afford
beneficial flexibility in a resource-rich environment that offers such a wide array o f stimuli
(i.e. foods) from which to choose. However, if an expected reward (and anticipated
reduction in arousal) is not readily forthcoming, energized seeking behavior can be
displaced onto another target (Panksepp, 1998). Perhaps the need to get rid ofby
displacingbuilt up arousal energy is a function o f nonnutritive suckling and self
stimulation. One might even speculate that displacement of energy onto an alternative
target (when the appropriate target is unavailable, i.e. to conscious awareness) could
represent the earliest form o f projection.
The surge o f dopamine that drives the seeking systems pursuit o f supplies for
unmet biological needs is a possible mechanism for producing a delusion or hallucination
(Panksepp, 1998). Examples o f naturally occurring hallucination phenomena include the
mirage, candle flame meditation (after staring at flame, can continue to see it even after
closing eyes), dopamine driven hallucinations in schizophrenia, and those produced by
intense drug cravings. One o f the most reliable reports by opiate addicts going through
withdrawal is having vivid dreams about their drug. It is quite conceivable, particularly if
an infant is neurobiologically addicted to mother, that cravings for her supplies during
normal separations like sleep or those that extend beyond the infants comfort zone
(consistent with Panksepps observation of opiate withdrawal symptoms during
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separations) could result in similar wish-fulfillment dreams or even hallucinations fueled

by escalating internal stimulation produced by the dopamine driven seeking system.
We now know that the development o f REM sleep (ability to dream) occurs
during human fetal development (Brazelton, 1992), and there is startling new evidence
that other animals (mice) are capable of importing sensory experiences from waking states
into their dreams during REM sleep (Louie & Wilson, 2001). Therefore, the ability to
have a subsequent mental representation o f an original perceptual experience elicited by
environmental sensory stimuli during a waking state appears to be hard-wired and
automatic, although neurobiological mechanisms that produce this phenomenon remain
poorly understood.
Freud believed that hallucinations and wish-fulfillment dreams were mechanisms
for binding intensifying arousal or drive that occurs when need fulfilling objects are not
readily available. The bindings purpose is to stabilize the organism. A failure to effect
this binding would provoke a disturbance analogous to a traumatic neurosis (Freud,
1920, in Gray, 1989, p. 611). The more insistent the drive, the more preoccupied the baby
will become with phantasies of seeking activities that will satisfy these needs. One might
speculate that a repetition compulsion occurs as seeking system arousal is displaced
onto the mental representation (i.e. during dreaming, laterrumination) in a continued
attempt to obtain the desired resource or to master the process of obtaining the desired
outcomenot unlike the compulsive drinking or shredding activity of Panksepps (1998)
unfulfilled mice. Freuds thoughts along these lines were quite similar:
The manifestations o f a compulsion to repeat (which we have described as
occurring in the early activities of infantile mental life as well as among the events
o f psycho-analytic treatment) exhibit to a high degree an instinctual character and,
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when they act in opposition to the pleasure principle, give the appearance o f some
daemonic force at work. In the case o f childrens play we seemed to see that
children repeat unpleasurable experiences for the additional reason that they can
master a powerful impression far more thoroughly by being active than they could
by merely experiencing it passively. Each fresh repetition seems to strengthen the
mastery they are in search of. (Freud, 1920, in Gray, 1989, p. 611)
It has been suggested that such preoccupations, dreams, or hallucinations may be
precursors to memory traces and thought (i.e. one o f the earliest mental images may be of
mothers breast in its absence). However, Freud was very clear that hallucinations are
sensory perceptual experiences, not memories or thoughts (Freud, 1923, in Gay, 1989, p.
633). Psychic energy would also, then, be cathected into the phantasies (mental
representations o f desired resources/outcomes). This type o f hallucinatory wish fulfillment
is called primary process, which is characteristic o f the id (Miller, 1989) and very young
infants. As the infants development progresses, he or she becomes more capable o f
deriving pleasure independently through bodily auto-arousal and phantasies.
A key point arises: if babies are overprotected, or otherwise never permitted to
experience arousal just beyond the limits o f their comfort zone, they would not be forced
to invent an adaptation o f their own making to get that arousal under control. They
would have no incentive for moving on and becoming independent. Freuds concept o f
fixation as a developmental stuck point describes this predicament. By contrast, the wishfulfilling dream or hallucination (likely candidates for the initial mental representation) is
an example o f how a remarkable developmental milestone might emerge from the
adaptations and reorganizations required to cope with disquieting conditions. This is most
likely to occur, o f course, during a period o f normal separation and illustrates how growth
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occurs when the young infant is of necessity left to his or her own devices to cope with
increasing need-driven arousal. Necessity thus becomes the mother o f invention .
Sustained attention.
Attending to novel, unfamiliar stimulior even familiar stimuli that exceed the
comfort zoneescalates arousal in newborns. Infants predictably respond to preferred
stimuli with a slowing heart rate (bradycardia) accompanied by slower, deeper breathing.
By contrast, they respond to aversive stimuli with shallow, rapid breathing and an
accelerating heart rate (Brazelton, 1992), indicative o f defensiveness in young infants
(Lester, Boukydis, & LaGasse, 1996). In the short term, processing novel stimuli (which
carry the potential for threat as well as reward) requires adaptation, accommodation, and,
therefore, energy expenditure that can be extremely taxing to a brand new infant.
However, in the long term such adaptations will lead to more complex brain development
which affords greater flexibility, efficiency, and ultimately energy acquisition and
conservation.
The process o f sustained attention to a stimulus is threefold: (1) when a stimulus
captures the infants interest, heart rate begins to decelerate; (2) heart rate continues to
decelerate gradually as the infant continues to attend to the stimulus; (3) finally, the heart
rate begins to accelerate to its prestimulus level, signaling the infants disengagement from
the stimulus (Richards & Gibson, 1997). During the period of sustained attention, often
referred to as cardiac orienting (Lester, Boukydis, & LaGasse, 1996, p. 772), infants are
least distractible by other stimuli; they also show better recognition memory later on for
stimuli presented during this time (Richards & Gibson, 1997). The optimal (even
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necessary) condition for sustained attention is that the infant is in the alert state
(Brazelton, 1992; Lester, Boukydis, & LaGasse, 1996).
Sustained attention requires a coupling of heart and breathing functions mediated
by the vagus nerve. This coupling signifies that the parasympathetic nervous system has
come on-line and is now able to counterbalance the sympathetic system, affording control
or regulation o f arousal. A shift to parasympathetic dominance begins anywhere from up
to a month before (Groome et al., 1999) to soon after birth (Lester, Boukydis, &
LaGasse, 1996). Based on their research with healthy term and preterm infants, Lester,
Boukydis, & LaGasse (1996) believe
that the healthy term infant is capable of handling the combination o f internal,
somatic plus external, especially attentional demands. When challenged by
attentional demands, be it passive attention, as when swaddled and left alone, or
active attention during the orientation condition, activation o f the attention system
preempts the cardiac somatic relationship and results in increased parasympathetic
control or coupling o f cardiorespiratory activity. This in turn facilitates stimulus
intake and enhances information processing, (p. 780)
Although both branches of the autonomic nervous system are generally in place by
birth, the sympathetic nervous system, which emerges first during fetal development, has
been dominant up to this point. Assuring metabolic functions are in place and functioning-even more basic to survival--is a developmental priority that supercedes attentional
functioning (Lester, Boukydis, & LaGasse, 1996). Because this coupling process is a
relatively new addition to the newborns repertoire, youngest infants can still have some
difficulty bringing their hearts under control, thus becoming easily overstimulated. Lester
and colleagues observed that less developed preterm infants could
activate the attention system...and they are responsive. However, the attentional
system cannot compete with the metabolic system and cannot override the somatic
demands to control cardiac processes to facilitate information processing. Rather,
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we see increased somatic demands, a loss o f parasympathetic control and less

coordinated cardiorespiratory effort. Attentional responsivity can be achieved in
these infants but at the expense o f physiological stability, (p. 780)
This is especially true for active (vs. passive) attention conditions in which infants engage
in the orienting response. Authors suspect that these more fragile infants are putting all
their energies into producing the orienting behavior itself and, therefore, are not
processing stimuli at the CNS level. They look like they are taking in information, when
they are not.
Sinus arrhythmia which represents heart rate variability due to breathing rate
(Lester, Boukydis, & LaGasse, l996)--a measure o f vagal tone~is considered a positive
developmental indicator that this coupling has occurred. High vagal tone is associated
with the ability to sustain attention (Lester, Boukydis, & LaGasse, 1996) and with more
efficient regulation o f homeostasis in infants and late term fetuses in general (Groome et
al., 1999, p. 25).
Panksepp (1986) has suggested that the primary function of endogenous opioids
(looking at the outcomes o f all of their various activities taken together) is to maintain
homeostasis. Bradycardia and slowed breathing are mediated by endogenous opioid
activated receptor sites in the medulla of the brainstem leading to the vagal nerve (Hayar
& Guyenet, 1998; Hernandez et al., 1997; Kiritsy-Roy, Marson, & Van Loon, 1989;
Kwok & Dun, 1998; Musha et al., 1989; White & Irvine, 1999). (This is a different type
o f opioid activity from the analgesic opioid classical conditioning previously discussed.)
Based on developmental data compiled from their numerous studies o f rat fetuses and
pups, Smotherman & Robinson (1993) speculate
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that regulation o f selective attention is an important function o f opioid activity

immediately after birth, when the neonate is exposed to a broad range o f stimuli,
only some o f which are important for development or survival. Through activation
o f the opioid system o f the pup, milk letdown by the lactating mother is likely to
suppress newborn responses to extraneous cues at the nipple and in the nest
environment and focus attention on the suckling situation. Thus opioid-mediated
changes in behavioral state and selective attention would be regulated within the
context o f maternal-infant interactions (Smotherman & Robinson, L992d),
providing one mechanism for the neonate to discriminate between biologically
relevant and irrelevant sensory information during early development, (p. 616)
The mother-infant feeding interaction provides a perfect example o f how a
newborn is able to alternate pleasure and seeking system activities in a way that makes
stimulus processing possible, utilizing multiple opioid mechanisms. Having obtained milk,
resulting in calming effects lasting for several minutes (Blass, 1996), very young infants
often shift into the alert statethe state in which they are most able to sustain attention
(Brazelton, 1992; Geva, Gardner, & Karmel, 1999; Lester, Boukydis, & LaGasse, 1996).
Brazelton (1992) provides an example of this early refueling alternated with
exploring, in which he describes a predictable breast feeding behavior pattern observed in
young infants: A baby will start out with a short burst o f constant sucking. Very
quickly, she resorts to a burst-pause pattern. A burst o f sucks will be followed by a pause:
suck-suck-suck-pause (p. 44). He and colleague Kenneth Kaye studied these pauses and
discovered that at least fifty percent were accompanied by a maternal response (expressive
talking, gentle touching, playing, coaxing). They also observed that when mother didnt
respond, the infants pauses were considerably shorter, leading them to conclude that the
baby seemed to prolong her pauses to capture social stimuli (p. 44). Geva and
colleagues (1999) add their observation that even very young infants are able to (and often
do) shift their preference from familiar stimuli before feeding to novel stimuli afterward.
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Various opioid mechanisms at work in this example include (1) release o f opioids
into the system from the gut with milk digestion, producing calming effects that can serve
to bring arousal down (freeing up space in the arousal tolerance range), (2) opioidmediated vagal response producing bradycardia and slowed breathing permitting sustained
attention, (3) classical conditioning o f mom as a stimulus that produces good, reinforcing
(and safe) feelings mediated by opioid activated mu receptor sites in the brainstem, and (4)
the infants sustained effort to maintain attention across a longer pause time to obtain the
expected endogenous opioid mediated pleasure feelings elicited by moms response. This
last mechanism may be a rather complex one that also involves dopamine if effort is
required in the seeking systems quest to obtain a significant biological outcome.
Capturing and processing social stimuli required to drive further brain development (i.e. of
amygdala, sensori-motor areas o f cortex) would certainly qualify.
During the feeding interaction, the infant is associating mother as the source o f
much pleasure, while at the same time dopamine release (potentiated by opioids) in the
Ventral Tegmentum Area (VTA) (Panksepp, 1998)is producing excited, anticipatory
feelings associated with her. This appears to be a win-win condition for the infants
establishing a potent attachment to her/his mother.
A description o f the VTA component o f the seeking system process as proposed
by Panksepp (1998) seems to mirror the feeding pattern described by Brazelton:
DA neurons typically fire in a fairly rhythmic pattern, with two or three spikes at a
time, diminishing spike amplitudes, and longer than normal durations o f the action
potentials. It is worth noting again that DA neurons have endogenous pacemaker
activities. They continue firing at a fairly stable rate throughout the day, including
during REM sleep, when other biogenic amine neurons are sleeping. This may
suggest that the system is ready to mediate behavioral arousal at a moments
notice. Also, it may be a way for the brain to keep abreast of the passing o f time.
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It is almost like the second hand o f a watch. When the system is aroused and
begins to actively mediate behavior, the neurons assume a bursting pattern
whereby a series o f action potentials are generated in a rowthat more effectively
promotes dopamine release in the synaptic fields. Also, this type o f bursting may
help speed up the internally sensed passage o f time, thereby leading to the
elevation o f anticipatory behaviors, as is seen in the scalloped response patterns
animals exhibit when working for rewards on fixed-interval schedules...There is
also now a great deal o f evidence that VTA-DA neurons are exquisitely responsive
to incentive stimulinamely, stimuli that predict the occurrence o f rewards in the
environment, (p. 156)
We now know that opioids and dopamine have interactive effects, although much
remains unknown regarding specific interactive mechanisms and activities, which vary
depending upon brain site, receptor type, pathway, paracrine (diffusion) route, or even
intracellular mechanisms within dopamine neurons coinhabited by opioids. Opioids in the
nucleus accumbens and ventral tegmentum area are thought to potentiate stimulating
and/or reinforcing dopamine effects (Berridge, et al., 1997; Panksepp, 1998). There is
evidence that opioids inhibit activity of neurotransmitter-producing neurons via
intracellular mechanisms, i.e. serotonin neurons in the rostral ventromedial medulla (Wang
& Wessendorf, 1999), dopamine neurons in the striatum (Panksepp, 1998). Therefore
several types o f mechanisms may be operativein close proximity or even simultaneously.
Consider a scenario whereby opioid brings both reinforcing and dampening effects
as it co-mingles with dopamine, i.e. in the nucleus accumbens. Reinforcing, exciting
feelings may result by bringing the dopamine down a notch, within a tolerably stimulating
range that feels good. If dopamine had no such mechanism to reduce its intensity, an
individual might feel wired, stimulated over the topo f their comfort zone. It is also
possible that opioid co-mingled with dopamine gradually intensifies its reinforcement
effects until the needed resource, close at hand, is obtained as detected by its
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hypothalamic set point range, at which time it reaches the level that shuts off the
sympathetic seeking system, to include its rush o f dopamine. The process would begin
anew as the need realises, signaled by increasing catecholamine (DA and NE) mediated
arousal inherent in the seeking system.
Another scenario may be that DA mediated stimulation itself becomes classically
conditioned as it becomes associated with the endogenous opioid reward that signifies
seeking system efforts have successfully resulted in the obtainment o f the biologically
significant outcome. Seeking system stimulation may then come to be experienced as
good feeling anticipatory excitement (motivation) as desired resources or outcomes are
close at hand. I f an infants efforts are rewarded (through moms sensitive responding)
upon obtainment o f the desired resource or outcome, infant efforts themselves may
become classically conditioned to feel good, giving rise to self-efficacy.
It is probably no coincidence that the shift to parasympathetic dominance coincides
with newborns initial preferences for unconditioned, biologically significant stimuli;
comfortable, familiar (vs. novel) stimuli; and stimulus outcomes consistent with primed
expectancies. All would provide quick, easy avenues to arousal reduction that can be
handled within the limited range o f a brand new nervous system encountering what could
be an overwhelmingly chaotic stimulus array in the new world outside the womb. These
kinds o f experiences would give the parasympathetic system lots o f practice as it comes
on-line. And, all would capture the types o f stimuli required to lay down the foundational,
prerequisite building blocks that facilitate survival and continued brain development. It
makes good evolutionary sense that the infants early life would be dominated by pleasure
and pleasure seekingjust as Freud concluded.
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Visual referencing: anchor for the small boat in an ocean o f uncertainty.

Elliott Blass (1996) raises the possibility that, as more sophisticated brain
structures come on board, the opioid systems (particularly abundant in emotion circuits)
serve to reward (signal and reinforce) utilization o f the precise types o f experienceexpectant stimuli required to activate their development. H e provides this astounding
finding regarding a marked shift in stimulus requirements for calming the four vs. two
week old infant
In the case o f 2-week-old infants, 0.5 ml sucrose must be delivered each time in
order for calming to occur with its attendant changes in cardiac rate. By 4 weeks
o f age the volume delivered must be 1.0 ml. There is a remarkable qualitative
change that marks the transition o f human infant social motivational systems from
their chemosensory and tactile bases to the primate visual base. 4-week-old infants
are only partially calmed by sucrose that is delivered without visual contact, and
the calm does not endure. However, when sucrose is delivered when infant and
experimenter gazes meet, the 4-week-old behaves like the newborn, even though
the adult holding the infants gaze is a stranger. Crying stops within 1 min o f the
first delivery and calm persists for well after the cessation o f sucrose, (p. I l l )
This suggests several possibilities: (1) that mutual gaze itself provokes an
unconditioned opioid-mediated response; (2) that perhaps the social nature o f mutual gaze
elicits oxytocin that interacts with opioid to prolong its effects; (3) that unconditional
opioid-mediated reward kicks in for experience-expectant visual or other stimuli required
at specific times to spur developing brain structures coming on-line; or (4) looking into
mothers eyes during feedings has classically conditioned mutual gaze to elicit the same
opioid-mediated calming (safety) effects as her milk, touch, or proximity. However, for
now, the calming effects o f gaze remain a mystery. We do know that the retina itself is
one o f the sites o f dopamine producing neurons (Panksepp, 1998), making it much easier
to explain the exhilarating effects o f mutual gaze.
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That eye to eye contact is the one way that the brain o f one individual becomes
directly exposed to the brain o f another would appear to make this an evolutionarily
significant social-neurobiological mechanism. It may be no accident that infants are
primed to initially see only at a distance that permits a baby-to-moms-face-view while
being held in a feeding position~as a component o f the initial brainstem based sensori
motor orienting response. It is quite conceivable that locking in on contact (connection)
with moms eyes (and her voice) while getting a nice calming dose of endogenous opioid
through digesting her milk, facilitates eye contacts central role in providing the initial
anchoring focal point (moms face) in a chaotic, overstimulating new environment. And,
mother-infant eye contact may continue to provide that same anchor through each of the
brains subsequent reorganizations as new, more sophisticated structures come on line-not just during the Practicing stage in the service of frontal lobe development, as proposed
by Allen Schore (1994).
Currently it is the amygdala, arguably the most critical emotion structure in the
brain, that is coming on-line. It requires (seeks) social-sensory (i.e. visual, auditory,
kinesthetic) stimuli to drive its development. The amygdala, among its other functions,
will come to specialize in recognizing faces and assigning meaning to social cues (i.e.
facial expressions, tone of voice). Since the amygdala also brings the newest emotion, fear
(anxiety)which could swamp a young nervous systemit would be most efficient for
eyes to have become conditioned as safety anchors, too.
The author o f this dissertation suggests that visuoaffective connection (Shore,
1994) gives the child an arousal-reducing, reorienting (in space) anchoring device in the
midst o f uncertainty as she or he encounters and incorporates new, potentially threatening,
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but development-provoking informationand that this begins with birth. Therefore, it

would appear critical that mother not only provide ample face-to-face opportunities for
visual connection with her infant, but that what her infant sees in her eyes assiures her
infant (1) that contact has been made by the expression on her face, (2) the irufant is no
longer alone should dangerous conditions arise, and (3) that her eyes convey good news
regarding the infants survival status.
Daniel Stem (1985) has described two types o f parental responses he believes to
be necessary for effective attachment and, subsequently, healthy psychological
development o f children, both of which facilitate an emergent sense of self:
These responses are mirroring (a concept developed by Winnicott),
a process by which the mother is helping to create something within tlie infant that
was only dimly or partially there until her reflection acted somehow t o solidify its
existence, (p. 144)
and affect attunement (a concept developed by Stem) in which
the performance of behaviors that express the quality of feeling o f a sliared affect
state without (simply) imitating the exact behavioral expression o f the: inner state,
(p. 142)
This process involves parental resonance with the childs feeling state indicated by some
type o f matching o f the childs expressive behavior. However, the channel oir modality of
expression used by the mother to match the infants behavior is frequently, if not mostly,
different from the channel or modality used by the child; and what is being msatched is not
so much the childs behavior, but some aspect o f the behavior that reflects tine childs
feeling state. This process lies largely outside conscious awareness o f the moither and may
involve up to 48% of mothers behavior with their infants (Stem, 1983; 1985 ). Stem
(1985) stresses that
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interpersonal communion, as created by attunement, will play an important role in

the infants coming to recognize that internal feeling states are forms o f human
experience that are shareable with other humans, (p. 151)
Magical conclusions, feelings o f omnipotence, and other grand delusions.
Panksepp (1998) has observed another intriguing phenomenon associated with
the seeking system:
arousal o f the SEEKING system spontaneously constructs causal insights from
the perception o f correlated events. Some o f the relationships may be true, but
others are delusional. Indeed, all forms o f inductive thought, including that which
energizes scientific pursuits, proceed by this type o f logically flawed thinking.
(Panksepp, 1998, p. 161)
Things that occur together get wired together by neurons that fire together,
especially by the very young brain. For instance, objects that move together in space
become connected by the process o f sharing a common fate. If an infants signals are
met with sensitive, appropriate, timely responses~and met consistentlythose signals
become connected to their rewarding outcomes. In this way, self-efficacy is bom. The
signals themselves become how needs get met and are, therefore, experienced as powerful
and trustworthy. With mothers repeated implementation o f her infants gestures, feelings
o f omnipotence emergegiving the sense that all seems to be under the infants control
(Winnicott, 1965). Early months spent basking in the delights o f omnipotence perpetuate
an optimistic world view. Magical conclusions may unfold something like this (although
experienced, o f course, in feeling statesnot thoughts): I feel good; therefore, I am good;
I feel good with mom, therefore mom is good, therefore the world is good. (Sadly, the
converse is also likely to occur when needs are not sufficiently met.)
Such magical conclusions are not to be underestimated. We all know how lasting
first impressions can be. The world view that takes root in these initial impressions
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provides the filter through which subsequent incoming information gets processed. If
goodness is whats familiar, good stuff becomes expected; therefore, good stuff gets
noticed and selected from the vast stimulus array in the environment; and good stuff is
readily assimilated into the systems existing schema; and that feels good.
An ample cushion o f early omnipotence will soften blows to the youngster down
the pike: when its time to adjust to fear feelings mediated by the emergent amygdala
(beginning at about 4-6 months); separation anxiety produced with emergence o f the
septal area, hippocampus, and cingulate (beginning at 6-8 months); and to feeling separate
and powerless in the face o f environmentally imposed demands in the process Margaret
Mahler (1975) calls Rapprochement (beginning about age 18 months).
Rage.
If resources for meeting biological needs through seeking activities are not readily
forthcoming, the infants arousal level will escalate. If arousal is permitted to edge toward
the ceiling o f the infants tolerance zone, one gets an angry, upset baby. Newborns lack
experience with beginnings and endings. They live in a here and now world, where the
discomfort o f unmet need feels like forever. True to id form, babies lack ability to delay
gratification, demanding that needs be met ASAP. If mother responds to her infants
angry cries, providing the desired resource or outcome, protest becomes an effective
other-seeking strategy for re-establishing homeostasis.
Protest may become especially salient for power, because it produces a more
drastic, rapid intensity shift (release) from high to low arousal. Feeling powerful,
omnipotent in this way can give rise to a form o f social self-efficacy called assertiveness.
If assertiveness works, resulting in good feelings (initially without punishment), it is likely
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to be repeated and refined with experience. In this way anger energized protest can
become incorporated into the infants system as an effective, familiar strategy that is
expected to produce good results in the service o f hope.
Emergence o f Self
Perhaps the most intriguing psychological entity that will evolve out o f ones
genetic predispositions in interaction with the multitude o f unique adaptations and
reorganizations that accrue through countless encounters with the environment, is the
emergence o f the self. The human self might be viewed as an individuals phenotypesimilar to the way a young neurons phenotype becomes expressed under the influence of
interaction with neighboring cells in its environment. The nature and quality o f obtained
resources and information garnered from the environment, an individuals unique
strategies (based on what has workednot worked) for extracting resources from the
environment or coping with impingements, and the unique ways the individual
incorporates (processes) the information into his or her system can give rise to enduring
long-term patterns or traits that, collectively, might be called personality.
Mother-Infant Attachment Does Two Good Things At Once
Mother-infant attachment not only minimizes vulnerability by assuring the infants
ability to establish and maintain homeostasis; it maximizes biopsychosocial developmentdriven by the facilitating environment for which the infant is primed. Optimizing survival,
in turn, reduces vulnerability. From this secure base (Bowlby, 1988), an infant can
begin to gain control in a gradual process o f individuation that mirrors the brains
maturation. The next section will focus on psychopathology that results from attachment
deficits and distortions: parental distortion, deprivation, and abuse. Due to the dire
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synergistic consequences o f maximized vulnerability and minimized opportunities for

development, attachment deficits and distortions can be considered traumatizing to infants.
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Psychopathology Resulting from Attachment Deficits and Distortions

Birth to Two Months
Dysregulation o f Arousal
The two conditions that give rise to attachment deficits and distortions are
maternal (or parental) unavailability and intrusiveness. In the first condition infants are
deprived o f their mothers due to physical separations (i.e. death; hospitalization o f (infant
or) mother for physical illness, injury, mental illness, or substance addiction; incarceration;
extended trip; work; avoidance; physical neglect; abandonment) or due to emotional
separations (i.e. lack o f empathy, insensitivity, role-reversal, projection, misattribution,
preoccupation, self-absorption, intoxication, psychosis, rejection). In Tiffany Fields
(1994) studies to determine which types of separations (hospitalizations, conference trips,
emotional unavailability) would most affect infants, she found that emotional unavailability
resulting from the mothers depression had the most negative effects:
The disorganization or emotion dysregulation in this case is more prolonged.
Changes in physiology (heart rate, vagal tone, and cortisol levels), in play behavior,
affect, activity level, and sleep organization as well as other regulating functions
such as eating and toileting, and even in the immune system persist for the duration
o f the mothers depression, (p. 226)
With intrusiveness, infants not only experience some form(s) o f maternal
deprivation, their mothers actively inflict some type o f psychological and/or physical harm
on them (i.e. well-intended, but large proportion o f inappropriate or ill-timed responses;
responses that exceed limits of infants stimulation tolerance range; responding with harsh
tone, loud volume, rough handling, angry face; projective identification; anger
displacement onto infant as safe target; restraint; leaving infant in wet diapers or hungry
for extended periods; exposure to dangerous conditions; permitting others to inflict harm
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on infant; physical abuse; sexual abuse; intentional, sadistic acts; use o f infant in occult
rituals; attempts to kill infant). At best, endangered infants may become swamped with
aversive feelings during reactive, hyperaroused states; at worst, they may become
permanently altered by aberrant adaptations necessitated to survive under extreme
conditions.
The critical factor missing in both conditions is warm, sensitive, affectionate, non
distorted, here-and-now child-focused attunement o f mother with her infant. Stephen
Bavoleks (1980; 1989) research revealed that the most prominent trait distinguishing
abusing from nonabusing parents was the lack o f empathy for their children. Indeed, as
will be demonstrated below, the most devastating factor for even endangered infants
appears to be maternal deprivation. No matter the cause, separation in and of itself is
extremely stressful to infants who are helpless to survive all alone. Babies are primed at
birth to obtain expected stimuli from their environment within the context o f interaction
with their mothers, not only to assure their immediate survival, but to drive their continued
development. Significant disruption of that interaction can compromise developmental
outcomes, particularly in the absence of other potential care-takers (i.e. fathers,
grandmothers; adoptive parents) who can step into the nurturing role.
The primary task o f attachment for the newborn is to establish homeostasis over
the first few months o f life. Newborns require mothers help to promote and quell arousal
states within a healthy, tolerable range. Not only is the unavailable and/or intrusive
mother creating distress, she is unable to assist her infant to recover from it. This horrific
double bind can readily outstrip limited coping mechanisms, while preventing manageable
opportunities for developing healthy new ones (i. e. extending arousal tolerance range);
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can overwhelm a fragile nervous system; and can escalate the infants arousal into a
disorganized state. In order to survive, infant adaptations to aberrant conditions may lead
to necessarily abnormal developmental adjustments. These abnormal adjustments may be
short-lived (state-like), or long-lastingeven permanent (trait-like), depending upon the
nature of stressful conditions in interaction with the developmental status o f various brain
components.
Based on brain developmental status and maternal-infant attachment tasks, it is
predicted that predominant psychopathology arising during the newborns first two
months would reflect normal (responses to abnormal conditions), altered, or compromised
abilities to establish homeostasis and arousal regulation. Affected CNS components
would include the brainstem, hypothalamus, amygdala (forming), autonomic nervous
system; pleasure, seeking, rage, fear, and stress response circuits; and the
psychopharmacological agents that infuse them (i.e. norepinephrine, dopamine, serotonin,
corticotropin releasing factor, cortisol, and endogenous opioids). Emergent, experienceexpectant structuresparticularly the amygdala, hippocampus, and sensori-motor cortex
may be especially vulnerable to adverse environmental conditions. Known and proposed
effects of attachment deficits and distortions on infants ages 0-2 months will be explored
in depth, utilizing existing data from brain, behavioral, developmental, and clinical
research.
Infants o f Depressed Mothers
Parental Environment: Emotional Unavailability: Low Interaction: Negative Affect
It is clear that interpersonal communion, as created by attunement, will play an
important role in the infants coming to recognize that internal feeling states are
forms o f human experience that are shareable with other humans. The converse is
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also true: feeling states that are never attuned to will be experienced only alone,
isolated from the interpersonal context o f shareable experience. (Daniel Stem,
1985, p. 151-152)
Depressed mothers show particular aberrant interaction patterns with their infants
(Field, 1998). During withdrawn periods these women are, for all practical purposes,
emotionallyand at times physicallyunavailable to their infants. Without sufficient
compensatory interaction with other available caregivers, maternal deprivation can be
dangerous and extremely stressfuleven traumatizingfor an infant. Frequently
preoccupied and energy deprived, these parents have difficulty redirecting their attention
outward to notice and effectively respond to their infants signals. When they do attempt
interactions, depressed mothers frequently display an intrusive style that is out o f sync
with and stressful to their infants (Field, 1998; Lyons-Ruth, Easterbrooks, & Davidson,
1997). Depressed mothers also tend to be more critical and irritable with their babies than
nondepressed mothers (Lyons-Ruth, Easterbrooks, & Cibelli, 1997; Tarullo et al., 1995).
In a 1992 study o f ability to recognize facial and verbal expression, investigators
Rubinow and Post found that depressed adults (15 women, 2 men) showed right
hemisphere deficits in their ability to interpret facial expressions when compared to
nondepressed controls. Specifically, depressed subjects were impaired in their ability to
recognize sadness, happiness, and interest, but not anger, surprise, disgust, or fear (p.
951). This selectivity appears to represent a processing bias mediated by expectations in a
depressed state. Expressions of others that appear congruent with the feelings o f the
depressed subjects themselves are, therefore, easily recognizable and assimilated into
currently activated schema. It is noteworthy that the recognizable expressions are those
that would most likely signify threat, enabling these vulnerable feeling individuals to retain
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the capacity for vigilance, essential for triggering a survival protecting response in an
emergency.
Such findings have serious implications for the likelihood of missing or
misinterpreting infant signals from a self-absorbed or biased (vs. infant-focused) vantage
point. Depressed mothersbefitting their moodmay only perceive and, therefore,
respond to expected negative attributes in their infants while happy, interested infant
overtures go begging. Should the infants, themselves, become viewed or labeled as
negative (even if they arent), this may create a vicious cycle that perpetuates distortion in
their treatment.
This dynamic was demonstrated in a study by Martinez et al. (1996) of 44 three- to
six-month-old infants o f depressed and nondepressed mothers. Participating mothers were
videotaped interacting with their own infant and afterwards asked to rate their baby based
on the tape. H alf o f the mothers were then asked to rate an unfamiliar infant in a similar
tape who had been labeled depressed ; the other half were asked to rate the same
unfamiliar infant without a label. Both the depressed and non-depressed mothers rated
the depressed labeled infant more negatively than the non-labeled infant on the attributes
o f physical potency, cognitive competence, sociability and difficult behavior (p. 15).
Although all mothers rated their own infants more positively than unfamiliar infants on
most criteria, depressed mothers saw their own babies as less physically attractive than did
nondepressed mothers.
Infant Adaptations
Unwittingly, infants may adjust themselves to align with distorted, parental
expectations. Sadly, this appears to be the case even at this young age. Lundy and
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colleagues (1999) found that, at age seven days, infants o f depressed mothers had higher
cortisol, NE, but lower DA levels that mirrored their mothers. Field, too, found these
infants, just like their mothers, had significantly elevated NE and cortisol levelscardinal
markers o f the stress response, which continued across the first several months (Field et
al., 1996) (Field, 1998, p. 201).
These findings are troublesome in that young infants generally have a subdued,
immature hypothalamic-pituitary-adrenal (HP A) stress circuit, with initially labile cortisol
levels decreasing by about age three months and remaining low up until about age two
years (Gunnar, 1998). Consistent with Panksepps endogenous opioid findings
(Panksepp, et al., 1978), Gunnar believes that the close mother-child relationship during
this period buffers the infant against stress (p. 209). Suppressed cortisol levels during
these critical months makes good developmental sense, because elevated and sustained
cortisol levels have been implicated in cell death, i.e. in the emergent hippocampus
(Gunnar, 1998; Lombroso & Sapolsky, 1998; McEwen, 1999), which comes on line by
about 15-18 months o f age.
In summarizing her extensive research, Tiffany Field (1998) also reports that
newborn infants o f depressed mothers display
inferior performance on the Brazelton orienting items (particularly on the
inanimate items), they received inferior scores on the depression and robustness
factors, and they demonstrated more stressed behavior (Abrams, Field, & Scafidi,
1995; Lundy, Field, & Pickens, 1997). They also showed excessive indeterminate
sleep (sleep that is difficult to code), which is disconcerting given the findings,
suggesting an inverse relationship between the amount of indeterminate sleep
during the neonatal period and IQ scores at 12 years. Finally, they were less
attentive and less expressive during a neonatal procedure o f modeling exaggerated
faces for them and coding their looking behavior and their mimicry (Lundy et al.,
1997). (p. 201).
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These young infants appear to lack sustained energy necessary to take part in and
become acquainted with their new world. Lundy and colleagues (1999) found seven-dayold infants o f depressed mothers had lower dopamine levels than did infants of
nondepressed mothers. These little ones also showed inferior performance on the
orientation, reflex, excitability, and withdrawal clusters o f the Brazelton Neonatal
Behavioral Assessment Scale (Lundy et al., p. 119). Hemandez-Reif and colleagues
(2000) conducted a study in which
24 newborns (mean age 12 days) o f depressed and nondepressed mothers were
assessed for oral exploration and perception o f a nubby and smooth texture.. .Both
groups o f newborns discriminated between these textures and showed a sucking
preference for the smooth texture. However, the newborns of depressed mothers
spent 50% less time orally exploring the stimuli, one-third less time exploring the
more novel nubby texture, and 59% less time mouthing the smooth texture.
(Hemandez-Reif et al., 2000, p. 204).
Authors Rubinow and Post (1992)although speaking o f adultsoffer the
proposition that disruption of the face-processing system contributes in a major fashion
to the inappropriate social behavior and social ostracism that follows damage to the
amygdala (Perrett et al., 1982; Kling and Steklis, 1976) (p. 952). This is especially
foreboding in light o f the amygdalas emergence during these early months o f infant life.
Deprived o f adequate expressive, positive affective feedback from their mothersor if the
majority o f facial expressions infants have the opportunity to see and imitate are flat,
angry, distressed, or sadthis has dire implications. Indeed, Tiffany Field and colleagues
(1998) have found:
(a) depressed mothers exhibit fewer positive faces and fewer animated faces and
voices (Raag et al., 1997). (b) Infants o f depressed mothers produced more sad
and angry faces and showed fewer expressions o f interest (Field et al., in press).
They also showed a preference for sad faces/voices (greater looking time at
videotaped models looking and sounding sad) (Field et al., in press), which might
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relate to sad expressions being more familiar to them. They also displayed less
accurate matching o f happy facial expressions with happy vocal expressions (Field
et al., in press), (c) The absence o f a relationship between infant facial
expressions and vagal tone in infants o f depressed mothers suggests biobehavioral
uncoupling that might derive from the infants excessive vigilance in emotional
situations (Field et al., in press), (d) Later, at 1 year, during a mother holding
doll situation, infants o f depressed mothers showed less protest behavior (Hart et
al., submitted for publication), (p. 201)
A surprising discovery to Field and her colleagues was that
assessments o f E EG asymmetry revealed a pattern that is noted in chronically
depressed adults, namely right frontal EEG activation in both the mothers and their
infants when the infants were 3 months o f age (Field et al., 1996), when they were
1 month o f age (Jones et al., 1997), and even as early as 1 week o f age (Jones et
al.). Right frontal EEG at 1 month was also related to indeterminate sleep patterns
and negative affect at the neonatal period (Jones, et al., 1997). (p. 201)
Field (1998) finds this disturbing,
given the supposed plasticity of brain development during the first several months
of life. In addition, this pattern appeared to be stable in infants o f depressed
mothers, at least from 3 months to 3 years of age (Jones, et al., 1997). (p. 201)
Intergenerational Factors
Synchronization ('primitive role-reversaD.
It would appear that babies are set up to become depressed themselves by adapting
to these problematic interactions with their mothers. Such adaptations would permit
synchronization with mother in order to sustain and benefit from the relationship with her,
so crucial to the infants continued survival and neurobiological development.
Synchronization, which might be considered a primitive form o f role reversal whereby
the infant is mirroring mothers signals to bring resonance and connectedness to the
interaction, provides an astounding alternative path for passing along psychopathology
from one generation to the next. Harmonious interaction patterns would also assist the
infant to get as much benefit as possible from an interaction in which mother is

emotionally available in order to make up for lost time when mother has been unavailable.
If the necessary amount o f expected experience required to establish a brain circuit
is not forthcoming at the appropriate time, one of the brains safeguards is that relatively
small amounts o f normal (i.e. visual) experience appear to set in motion processes that can
protect the organism against later deprivation (Greenough, Black, and Wallace, 1987, p.
545). Another protective factor that can serve to buy time is norepinephrines ability to
promote synaptic sensitivity when the expected experiences are forthcoming. (Greenough,
Black, & Wallace, 1987; Joseph, 1996).
A stronger neuronal firing pattern is produced when a large number o f neurons fire
in a synchronized pattemparticularly with repeated such experiences over timegiving
rise to sturdy familiar, neural circuits. If infants are getting a predominance of
experience with angry, disgusted, or distressed faces, this may become whats familiar.
Since these emotions are generally processed in the right hemisphere, the right frontal
EEG patterns seen in infants of depressed mothers would make sense. Happy emotions
are generally processed in the left hemisphere (Joseph, 1996). If the negative emotion
circuits are getting sturdier due to lots o f practice, with deficient stimulation leading to
proportionately underdeveloped positive emotion circuits, it is quite conceivable that an
enduring negative emotion processing bias could come to dominate an individuals life.
A striking illustration o f what happens to infants when emotional feedback is not
forthcoming from their mothers emerged in Edward Tronicks famous still face
experiments (Tronick, 1986; Tronick et al, 1978). In these studies mothers were asked to
engage in normal interaction with their infants who were approximately 3-6 months old.
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In th e middle o f the interaction, the parent was asked to go still-faced (impassive and
emotionally expressionless). Typically the infants would make various attempts to engage
th eir mothers, look puzzled, andafter repeated failings in their attem ptseventually look
dow n and withdraw. Those infants who
experienced more repairs during the normal interaction directed more signals
toward the mother when she was acting unresponsive and persisted longer in
trying to reinstate a normal interaction. We saw this as indicating that they had the
clearest representation o f the interaction as reparable and o f themselves as
effective. Infants who had experienced fewer repairs in the normal interaction
were more likely to turn away from their mothers and to get distressed and sad.
Their reaction suggests that they represented the normal interaction as not being
easily reparable and themselves as not being very effective in repairing it.
(Tronick, 1986, p. 8)
Based on these experiments, Tronick (Tronick, Cohn, & Shea, 1986) developed a
M utual Regulation Model (MRM) o f mother-infant interaction characterized as a dyadic
system in which emotional messages are exchanged between the partners functioning such
that one partner achieves his or her own goals in coordination with those of the other
partner (Tronick, 1880; Tronick, Als, & Brazelton, 1980) (p. 11).
Tronick elaborates further
The infant, through active deployment of his emotional signals, attempts to control
the social environment. When the infant succeeds, positive emotions are generated
and the infant gains a sense o f effectance. When the infant fails, negative emotions
are generated and a sense o f ineffectance or helplessness results. The infants
success to some extent depends on the sensitivitycooperationo f the mother in
responding reciprocally to him. Emotions are not magically transferred from
mother to infant but rather the infant generates his own emotions as he processes
the emotional input provided by the mother in relation to his own interactive goal.
(p. 12)
Although some emotion theorists have postulated that it is possible to reflexively and
physiologically experience an emotion simply by making its corresponding facial
expression, research has not bom this out (Buck, 1988).
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Instilling shame
A particularly disturbing possibility arises as the infant becomes increasingly reliant
upon mothers facial expression to mirror back information about the infants survival
status. For instance, moms happy, smiling, excited facewith eyes connecting to her
infants to show that she really means itwould produce good, happy, excited feelings in
her infant that convey (through visceral sensation) a good self thats highly desirable to
others and, therefore, exceedingly worthy of belonging on the planet. Should an infant see
instead a frowny, critical, disgusted, or repulsed look in mothers face because she finds
her own infant unattractive (or perhaps worse, with flat affect and looking-away eyes, she
doesnt even acknowledge her infants presence)a devastating sense o f shame may
descend and come to pervade the infants physiological and psychological being to its
core. Shame comes from sensing that there is something terribly defective about the self
that renders it unworthy o f survival, and therefore unspeakably vulnerable. Shame is an
extremely hyperaroused state that may not yet be available to the newborn. However, the
sickening, visceral sense o f dread that comes with shames implication o f expected
rejection can trigger the All Alone state (that will be discussed at length in the upcoming
section on traumatized infants). Shame in and o f itself can be traumatizing.
A depressed mother with poor self-esteem (perhaps with shame-based traits of her
own) would be more likely to project or see similar negative, unattractive, defective
traits in her infant, even if they were not originally there at all. The tragedy is that the
mothers unhappiness may lead to negative infant affectin a normal, primed attempt to
imitate or otherwise engage herthat, in turn, becomes unattractive.
186
Fortunately, at this very early age, the amygdala--which specializes in attributing

meaning to socially significant sensory stimuliis still in its flexible, albeit critical,
developmental window. If mother gets therapeutic help to lift her depression so she can
become emotionally available to and actively enjoy her infant, negative effects on her
infant may remit as well. Ideally, another loving care-taker (i.e. dad) could take over the
nurturing, primary attachment role. Additionally, there is some evidence to show that
fathers, who tend to be overstimulating when they play with their young infants, may be
able to provide some compensation for the lack of or negative stimulation provided by
their depressed partners (Hossain et al., 1994; Martinez et al., 1996). And, up until
approximately five months o f age, at which time the developmental task is to hone in on a
selective attachment to one particular person, the young baby (even with strong built-in
preferences for mother) can benefit from the loving, sensitive interactions o f multiple, but
consistently available (familiar), care-takers.
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Traumatized Newborns
Unthinkable anxiety has only a few varieties.. .(1) Going to pieces, (2) Falling for
ever, (3) Having no relationship to the body, (4) Having no orientation. (D. W.
Winnicott, 1965, p. 58)
Initially all infants display a reflexive fearful reactionstartleto loud noises and
sudden loss o f support (LeFrancois, 1988). Newborns will even display the startle
response to their own agitated movements when upset (Brazelton, 1992):
These startles, orM oro reflexes, consist o f his throwing out his arms, arching his
back, grimacing, and then crying out. When there is nothing to grab and hold, or
no one to hold the baby, each startle sets off more startles. Soon, the baby will be
very upset, with constant flailing activity and a persistent demanding cry. (p. 32)
Brazelton (1992) provides these descriptions o f the dilemmas confronting
underdeveloped preterm infants with raw nervous systems:
These infants cannot shut out stimuli and must respond over and over, mercilessly,
(p. 25). Unable to habituate, their heart and respiration rates increase with
continued exposure to a noxious stimulus or too many stimuli. They may make
attempts to quiet themselves by arching away or by bringing a hand up to their
mouths. I f they cant manage the repetitious stimulation by going into sleep, they
may have to build up to a crying, thrashing state. Crying also can serve to shut out
stimulation, but it, too, can be costly for a fragile baby... .Hyperactivity can
become one way a baby discharges the overwhelming overload o f too many
incoming stimuli ... .Stressed infants will also be less likely to sustain beneficial
states o f consciousness such as deep sleep or the alert state, instead shifting rapidly
from one state to another (p. 26)... A baby who cant get himself under control or
cant use help in controlling himself will be difficult for his parents... If not
consoled, an infants escalating startles in response to his or her own thrashing
movements may throw the baby into an anguished state (p. 33).
Traumatic Stress
Stress has been defined as a state of disharmony, or threatened homeostasis
(Chrousos and Gold, 1992, p. 1245). Stress occurs when an internal or external
perturbation threatens to destabilize ones system. It is experienced as escalating arousal,
activating the sympathetic nervous system and other defensive components o f the brains
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threat response. An individuals ability to restabilize in response to stress is mediated by

his or her developmentally determined repertoire o f coping mechanisms in interaction with
the intensity, frequency, quantity, timing, and duration of the stressor and the stressors
meaning to the individual. If a stressor occurs at a level of intensity or duration that
outstrips an individuals adaptive repertoire, as is most likely to occur in earliest infancy,
stress quickly becomes distress. Disorganizing distress that threatens ones very existence
becomes traumatic stress.
This author proposes that the most devastating components o f traumatic stress at
any age are to be all alone, faced with the threat o f impending annihilation, while
powerless to do anything about it. Mammals have evolved to function within a social
context for the very reason that social interaction affords a potent advantage toward
likelihood o f individual and species survival. To be all alone may, in and o f itself, equate
withand, therefore be experienced asimpending annihilation, particularly by
evolutionarily older subcortical emotion systems. To be completely alone may set into
motion a cascade o f neurobiologic activities that prepares the organism to become
devoured by predators or otherwise face the dismantling of its systema fate more horrific
than death.
Maternal Deprivation
Maternal deprivation is extremely traumatizing to infantsso traumatic, in fact,
that infants in extreme separation conditions have been known to die from it. In a 1966
study by Griffin and Harlow to determine effects o f three months o f social isolation
beginning 12 hours after birth on four infant rhesus monkeys, one unfortunate animal died
on the sixth day following removal from the isolation cage (apparently o f starvation), and
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a second had to be force-fed to keep it alive. All four went into a period o f severe
depression (p. 539) upon their removal. Deprived o f orientation and classically
conditioned safety devices (familiar cage and pad), these infants were likely overwhelmed
and hyperstimulated by the chaotic novel environment to which they were removed.
The fate of these young monkeys bears a striking resemblance to that o f rats used
in another set o f landmark studies by Paul Richter (1957). Richters work provided
insights into the biological mechanisms, specifically those involving the autonomic nervous
system, leading to spontaneous, previously unexplainable voodoo deaths in dire
conditions. As recounted by Kalat (1988), Richter discovered a heart-stopping
parasympathetic rebound reaction to extreme sympathetic hyperactivation in scared to
death rats:
Ordinarily, rats can swim in turbulent warm water nonstop for 48 hours or more.
However, Richter found that a rat would die quickly if he cut off its whiskers just
before throwing it into the tank. (A rats whiskers are critical to its ability to find
its way around.) The rat would swim frantically for a minute or so and then
suddenly sink to the bottom, dead. Richter found that many, but not all, laboratory
rats died quickly under these conditions. Wild rats, which are known to be more
nervous and emotional than domesticated laboratory rats, all died quickly under
the same conditions. According to the results of autopsies, the rats had not
drowned; their hearts had simply stopped beating.
A rat is capable o f swimming without its whiskers. I f its whiskers are
trimmed hours or days in advance, a rat can swim for hours. Evidently, the sudden
death resulted from combining the dewhiskering operation with immersion into the
water. That combination greatly stimulated the rats sympathetic nervous system
and greatly elevated its heart rate. After the rat swam frantically for a minute or so
and found no escape, its parasympathetic system became highly activated, both as
a rebound from the strong sympathetic activation and as the natural response to a
terrifying, apparently inescapable situation. The parasympathetic response was so
great that it stopped the rats heart altogether, (p. 327)
To confirm the role o f apparent escapability or inescapability, Richter
performed an additional experiment. As before, he cut a rats whiskers before
putting it into the water. Before the rat sank, however, he rescued it and allowed
it to revive on a safe, dry platform. Later, when he put it back into the water, it
swam successfully for many hours. The rescue had apparently immunized the rat
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against extreme terror in this situation and therefore also immunized it against an
extreme parasympathetic rebound, (p. 328)
It appears that the previous successful swimming-rescue experience rendered the second,
even more precarious swimming experience tolerable. Again, the familiarity component,
perhaps an endogenous opioid classically conditioned memory bridge, provided a
protective factor in the more extreme condition causing the rat to hope~ look forward
across time to the expected rescue reward. Previous experience under similar conditions
altered the meaning of the second swimming session: it was likely to result in life, not
death. The world view o f the mouse was apparently one o f optimism vs. fatalism, as it
increased its effort and extended its discomfort tolerance to a considerable degree with the
expectation that the desired outcome would thus occur.
That human infants have died from lack of maternal warmth and affection, even
when clothed, fed, and otherwise well-cared for, has been well-documented in yet another
classic body o f work by Rene Spitz. Perhaps Spitz, more than anyone else, brought the
ramifications o f maternal deprivation to the fore. (Please see CHAPTER II for detailed
description o f his work.) Reviewing records o f children placed in institutionalized,
residential care at the turn o f the 20th century, Spitz determined that the mortality rates for
these children were extremely high, ranging from 31.7% to 90% compared to 10% in the
general population. In his own study he discovered that 23 o f 88 children up to age 30
months, placed in a foundling home (with little or no access to their mothers), died. He
also noted that these foundling home children were susceptible to a variety o f illnesses,
especially between the ages of 18 to 30 months (Spitz, 1945).
191
Could there be a common neurobiological link that could account for the deaths of
Harlows monkeys, Richters rats, and Spitz infants? This author will propose thatyes
there are trauma response mechanisms in place at birth (ordinarily effective under short
term conditions) that could account for various types o f death to include appetite
suppression, parasympathetic rebound, and susceptibility to infection.
Opioid mediated svmpathoinhibitorv trauma response.
In a state o f extreme agitation produced by inescapable traumatic conditions,
endogenous opioid is released in the brain stem, protecting the individual from the full
force o f the traum anot unlike going into shock after sustaining life-threatening bodily
injuries. In fact, opioids have been implicated in various forms o f shock, with naloxone
reversing shock effects (Grilly, 1994; Ohnishi et al., 1997; Panksepp, 1986). Under
emergency conditions, opioid activated mu and delta receptors in the rostral ventrolateral
medulla (RVL) mediate a vagal (nerve) sympathoinhibitory response that slows down
heart and breathing rates (Hayar & Guyenet, 1998; Kiritsy-Roy, Marson, & Van Loon,
1989; Kwok & Dun, 1998; Musha et al., 1989; White & Irvine, 1999), effectively
shutting off an overactive sympathetic nervous system that is threatening to hurl the
organism out o f control (i.e. heart arrhythmia produced by its sustained exposure to
norepinephrine daring sympathetic activation). It would appear that a parasympathetic
rebounda response o f commensurate intensity to that o f the hyperactivated sympathetic
responsewould be required to effectively stabilize the organism . However, if the shift
from sympathetic hyperactivation to parasympathetic slow down is too drastic, the heart
may stop altogether, bringing death.
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Opioid mediated sympathetic shut down also stops breathing. Indeed, anaphylactic
shock is reported as a common cause o f overdose death for opiate addicts (Grilly, 1994;
White & Irvine, 1999). It is noteworthy that addicts are more likely to die from an
upgraded dose level if they self-administer that dose in a novel vs. their usual drug-using
environment (Grilly, 1994). Apparently the novel conditions, which increase sympathetic
activationin combination with the lack o f classically conditioned, analgesic opioid
producing familiar conditionsreduce the amount o f opioid in the system, eroding
tolerance heretofore protecting them from the drastic effects o f dangerously high doses.
All Alone state.
It is quite conceivable (from a built-in evolutionary or systems perspective), that
just as Winnicott proposedthe extremely vulnerable unintegrated state in the absence of
maternal support (o f being alone, but all alone)~would be experienced by the earliest,
least modulated, and most genetically hard-wired emotion processing systems as
annihilation . Subjective descriptions o f the All Alone state (i.e. abandonment
depression, annihilation regression) are striking in their similarity to the cascade o f
biological sensations that would likely occur within the context o f an early, maternal
deprivation trauma: all alone, floating adrift in outer space with no one touching me,
feeling unconnected to anyone, an empty black hole in the gut that goes unfilled,
screaming but no one can hear me, cant get calm, spiraling out o f control, coming apart
bodily, feelings o f suffocation, and sense o f impending doom. These sensations have a
desperate, timeless quality. Often individuals triggered back into this visceral trauma find
themselves without words, as would be the case at such an early age, making it very
difficult to convey their experience. The newborns physical immaturity (eyes that have yet
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to focus, unmyelinated arms and legs that have yet to be brought under control, complete
dependence upon other human beings to meet bodily needs) is the embodiment of
helplessness in a chaotic new world outside the womb, rendering escape impossible.
An unresponsive or rejecting parent provides no touching or holding to help the
infants skin boundary feel its realness, affirming its ability to contain the inside and
prevent it from becoming swallowed up by or absorbed into the outside. This is an
extremely aversive, hyperagitated stateto be avoided at all costs. This author suggests
that those who continue to have these experiences beyond infancy are perhapsquite
accuratelyreexperiencing intrusive aspects o f very real trauma that occurred quite early
in their lives. The reexperiencing o f traumatic material is a hallmark o f Posttraumatic
Stress Disorder; numbing is another.
Opioid mediated analgesic trauma response.
Another emergency defense mechanism available to newborns during conditions o f
inescapable or otherwise intensely stressful conditions is endogenous analgesia produced
by enkephalin opioid activation o f mu receptors in the rostral ventromedial medulla o f the
brainstem (Barr & Zadina, 1999; Chamey et al., 1993; Foo & Helmstetter, 2000; Grilly,
1994; Panksepp, 1998; van der Kolk, 1996). Opioid analgesia effectively quells highly
aversive feeling states produced by nociceptive stimuli such as pain or agitation. These
same analgesic receptor sites are activated by the exogenous opiate Morphine and are
susceptible to tachyphylaxis (Grilly, 1994). However, evidence strongly suggests that
analgesic opioid effects resist tolerance for longer periods than euphoric opioid effects
(Grilly, 1994). Endogenous opioid is released in bursts per repeated traumatic events
(Panksepp, 1986). Sustained analgesic effects minus the euphoric effects (i.e. of initial
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analgesic bursts or o f other rewarding opioid bursts produced in emotion circuits from
social contact) would probably be experienced as numbing or depersonalizing.
Self-iniurious behavior effectively shifts states: from unbearable to calm.
The analgesic opioid defense mechanism may explain why many individuals
experiencing a highly aversive, agitated state find cutting and other self-injurious behaviors
to be an effective, albeit primitive, means of relieving the agitation. Self-injurious
behaviorswhich have been observed across species (especially during periods of
separation distress) and which often have an addictive or self-sustaining qualityhave been
linked with increased levels o f endogenous opioids (Coccaro, 1996; Russ, 1992).
If an infant monkey is deprived of its only familiar object (i.e. gauze pad) that has
become classically conditioned to produce its own opioid calming response, while at the
same time is thrust into a hyperstimulating, novel environment, the most immediate
symptoms likely to occur would be those resulting from opiate depletion and
intensification o f the stress response. Opiate withdrawal symptoms include despondency,
anorexia, insomnia, crying, aggression, and heightened sympathetic arousal (Panksepp,
1998;). As previously discussed in the Attachment section, these are the same symptoms
experienced with attachment separation distress (Grilly, 1994; Panksepp, 1998).
Harlows infant monkeys, already suffering from separation distress, may simply
have been pushed over the edge with removal of the last vestige o f something familiar to
which they had desperately clung. If their systems did not shut down altogether (i.e. from
anaphylactic shock), a new burst o f analgesic opioid rushing in to numb extreme
separation agitation may have also contributed to sustaining anorexia. For instance,
opioid activated mu receptors in the brain stem have been implicated in appetite
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suppression by kicking in withand thus rewardingstarvation (Carr & Papadouka,

1994), similar to addictive effects o f self-injurious behaviors. This analgesic opioid
mechanism, activated under adverse conditions, is different from another type o f opioid
mechanism that normally enhances appetite by rewarding good (biologically significant)
tastes like sugar and mothers milk (Blass, 1996; Panksepp, 1998).
Analgesic endogenous opioid activity at mu receptor sites has also been found to
suppress the immune system (Grilly, 1994; Perez & Lysle, 1997). Not only does immune
suppression occur following a single event o f subjection to an inescapable punishing
stimulus, butthrough classical conditioningit occurs upon re-exposure to formerly
neutral aspects o f the contextual environment that have become associated with the event,
even in the absence o f the original punishing stimulus (Perez & Lysle, 1997). Such effects
could account for the deaths o f infants who succumbed to various types of illness (i.e.
infections) following extended periods of maternal deprivation as described by Spitz
(1945).
Vagal sympathoinhibition and analgesic opioid effects are two fairly welldeveloped emergency survival options available to the newborn for coping with intense,
escalating arousal that threatens to engulf the organism. Brain stem analgesic opioid
receptor sites, although not at mature quantities by birth, will obtain adult levels soon after
the neonatal period (Barr & Zadina, 1999; Olkkola, Hamunen, & Maunuksela, 1995).
Endogenous opioid released in extreme and/or repeated, inescapable traumatic conditions
will be explored further as an instrumental component in other types o f psychobiologic
adaptations with long-term developmental ramifications. Opioids, particularly those
activating mu receptors in the brain stem, may play a particularly critical role if trauma
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occurs before all structures involved in the mature stress response have come on board.
Therefore, long-term effects (i.e. in neurochemistry, brain structure function) may vary
depending upon what point in an individuals developmental trajectory traumatic
experienced was first incurred.
Developmental consequences o f maternal deprivation: primate studies.
A large body o f primate research spanning nearly 50 years, much of it inspiring or
inspired by Bowlbys attachment theory, demonstrates just how toxic maternal
deprivation~in and o f itselfcan be for developing infants, particularly during experienceexpectant (critical) periods. Deets and Harlow (as reported in Buck, 1988) concluded
from their classic 1971 study that neuronal structures underlying affection, fear, and
aggression develop in a fixed maturational sequence. However, the way that the animal
learns to deal with and use these emotions depends on social experience (p. 301).
Monkeys isolated for the first six months o f life developed low affiliative behavior, high
fear, andby age threehigh aggression directed at inappropriate targets. Monkeys
isolated for the first twelve months of life showed almost no social behavior, very high
fear, and beginning low levels of aggression that developed into high levels over time.
Effects were irreversible. Those monkeys who were placed in isolation conditions
following 18-26 months o f lifean adequate period in which all emotion circuits were well
establishedappeared normal, with few or no developmental consequences.
Gary Kraemer and Susan Clarke (1996), based on reviews as well as their own
extensive studies o f Rhesus monkeys both in the laboratory and in the wild, have observed
that normal aggression
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usually occurs in definable social contexts and has a level o f duration and severity
appropriate to the context (EDgley, Linnoila, & Suomi, 1994; Kraemer & Clarke,
1990; Harlow, Harlow, & Suomi, 1971; Bernstein & Ehardt, 1986). It is exhibited
in competition for dominance, resources, territory, and in protection of offspring,
to cite a few examples, (p. 124).
Usual aggression arises out o f a normal developmental context in which
a rhesus monkey is bom, cared for by its biological mother, plays with peers, learns
the social rules, and becomes an adequate member o f its society. Interactions with
the mother are critical in the offsprings learning of the when and how, and
how vigorously to defend and aggress, (p. 124)
By contrast,
maternally deprived monkeys exhibit aggression that is not predictable, out of
proportion in severity and duration, and directed towards improbable objects
(Harlow, Harlow, & Suomi, 1971; Anderson & Mason, 1978; Harlow, 1969;
Mason, 1985). One could anthropomorphically refer to the latter form o f unusual
aggression as violence. (Kraemer & Clarke, 1996, p. 125)
Kraemer and Clarke (1996) have been able to tease out neurobiological correlates
specific to maternal deprivation vs. social deprivation through a series of studies that have
compared peer- vs. mother-raised monkeys:
peer-reared monkeys had lower levels of CSF NE and HVA than their motherreared counterparts. This suggests that maternal privation reduces the baseline
activity o f the NE and DA systems in juvenile rhesus monkeys. It also appears that
maintenance o f below normal baseline activity in these systems eventually results in
postsynaptic receptor supersensitivity. So when the catecholamine (CA) systems
are activated by either drugs that promote release o f CA neurotransmitters or
social stressors, the behavioral response to the stressor or drug is exaggerated and
inordinate (Kraemer & Clarke, 1990). A similar explanation has been forwarded
for NE/D A activation o f irritable aggression in rodents (Hegstrand & Eichelman,
1983). It is also noteworthy that levels of ACTH and cortisol were lower in peerby comparison to mother-reared monkeys. Other studies indicate that peer-reared
monkeys have a blunted HPA axis response (increase in ACTH and/or cortisol) to
psychosocial stressors (Clarke, 1993). Thus, the exaggerated behavioral response
to stressors in peer-reared monkeys, perhaps mediated in part by brain CA
receptor systems, is not paralleled by comparably enhanced or even normal
neuroendocrine responses. This suggests that the usual organization o f responses
to stressors among brain neurochemical and neuroendocrine mechanisms fails to
materialize in peer-reared monkeys. (Kraemer & Clarke, 1996, p. 131)
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Stephen Suomi (2000), in his review o f primate research over the past 30 years,
additionally concludes that peer-reared monkeys who were not, therefore, socially
deprived experienced long-term effects o f maternal separation that included reluctance to
approach novel stimuli or new situations, avoidance o f initiating contact with strangers,
lower social positions in dominance hierarchies, severe reactions to social separations,
higher levels o f withdrawal behaviors, less ability to cope with stress, prolonged cortisol
elevations, higher levels o f aggression toward strangers, lower 5-HT metabolism, greater
likelihood o f becoming ostracized by peers, andeven when capablegenerally
demonstrating inadequate care for their own infants.
Developmental consequences o f maternal deprivation: human studies.
Perhaps the most historically significant example o f human studies was provided by
Rene A. Spitz in his 1945 article entitled Hospitalism. Through interviews with physicians
and administrators and review o f records and other accounts, Spitz reported that mortality
rates o f infants under the age o f two years who were placed in institutions in the United
States and Europe from the turn of the century ranged from 31.7% to 90% compared to
10% o f children in the general population. As hospital conditions improved and more
children survived, a new problem emerged: institutionalized children practically without
exception developed subsequent psychiatric disturbances and became asocial, delinquent,
feeble-minded, psychotic, or problem children (p. 54). The general agreement was that
two factors were responsible for the psychological injury suffered by these children:
lack o f stimulation and absence o f the childs mother.
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Van der Kolk (Van der Kolk et al., 1994b) suggests that humans who suffer early
abuse and neglect, like nonhuman primates with early separation experiences, would
develop serious problems with emotion regulation. Van der Kolk and Fisler (1994a) have
concluded from their own research that
distinct, isolated incidents o f trauma are likely to produce rather discrete
conditioned biological and behavioral responses to reminders o f the trauma,
without necessarily affecting the totality o f a persons identity. Chronic abuse and
neglect, on the other hand, are likely to have a more pervasive effect on
psychological and biological regulatory processes, without necessarily producing
discrete conditioned responses. In the long ru n , lack o f secure attachments may
produce the most devastating effects because consistent external support appears
to be a necessary condition in learning how to regulate internal affective states and
how to modulate behavioral responses to external stressors. (P. 147)
In support o f this theory, these authors have found that the patients with the most severe
neglect histories were the ones who appeared to benefit least from psychotherapy.
Parental Environment: Emotionally Unavailable-Reiecting and Harsh-Dangerous
Infants who are abused are in a particularly bad double bind: trauma creates
extreme arousal in the child, while at the same time, the crying the newborn reflexively
employs (that would normally elicit parental holding or rocking to comfort the infant) can
trigger an abusive parent to harm or avoid the baby further. Therefore, instead o f
augmenting their infants fragile nervous systems, these parents escalate the overload.
Providing additional insight into this destructive reciprocal dynamic, Frodi and Lamb
(1980) found that abusing parents responded to crying infants with greater increases in
their own heart rates, greater aversion, and less sympathy than non-abusing parents. In
addition, abusing parents responded in a similar pattern even to smiling babies; whereas
nonabusing parents responded to smiling babies with no change or even declines in
physiological arousal. Deprivation o f tender, warm, sensitive, and affectionate mother
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love may very well be the most devastating component o f the double bind in which abused
infants find themselves.
In her 1996 review, Karlen Lyons-Ruth concluded that maternal rejection and
hostile behaviors directed at young infantseven before these youngsters were
developmentally capable o f engaging in coercive behaviors o f their ownwere predictive
o f future aggressive behavior in these children. Elaborating further (Lyons-Ruth,
Easterbrooks, & Cibelli, 1997), she described the interaction style o f these mothers as
intrusive and not readily modified by infant communications so that infant initiatives are
often ignored or overridden. Covert or overt hostility may also accompany intrusive
behavior (p. 682). In their 1997 review, Schwartz and colleagues likewise found that
punitive parenting, parental hostility, and lack of warmth (p. 666) are the
socialization factors most closely linked to the emergence o f aggressive behavior.
Parenting by mothers of aggressive children is typified by misperception and
misattribution o f infant behaviors; rejecting, nonaffectionate, nonresponsive, and/or rolereversing, coercive, aggressive, abusive, and frightening interactions with their infants;
lack o f tender touching and holding (p. 67); and absence o f warmly approving,
autonomy respecting, and contingent parental responsiveness (p. 65) (Lyons-Ruth,
1996). These mothers are frequently poor reporters o f infant characteristics (i.e.
temperament, behavior), tending to perceive their children as more difficult than do neutral
observers (Lyons-Ruth, 1996). These women lack social competence (i.e. verbal
communication skills) and tend to repeat the poor parenting practices of their own
mothers (Lyons-Ruth, 1996).
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Among the most reliable of findings associated with early onset childhood
aggression is diagnosable maternal psychopathology, particularly antisocial personality
disorder (i.e. frequent arrests, frequent physical fighting, driving under the influence,
incarcerations), major depression, and substance abuse (Lahey et al., 1988; Lahey et al.,
1998; Lyons-Ruth, 1996); as well as dysthymia, somatization disorders (Lahey et al.,
1988), inpatient hospitalizations, and childhood histories o f violence and abuse (LyonsRuth, 1996). Based on vague or missing accounts o f their own childhood interactions on
the Adult Attachment Interview, Lyons-Ruth (1996) suspects that many o f these parents
may experience some forms o f dissociation, although no known studies have been done to
confirm this.
In a cohort study o f 4269 males bom in Copenhagen, Denmark from 1959-1961,
Raine, Brennan, and Mednick (1994) found that those who were most likely to become
violent criminals in adulthood were those who had suffered from a combination o f birth
complications and maternal rejection. In a 1986 study o f 15 condemned male and female
death-row inmates from five states, Feldman, Mallouh, and Lewisutilizing extensive
corroborating evidencefound that 13 had been subjected to extraordinary (p. 348)
conditions o f childhood trauma that included witnessing violence inflicted on other family
members; emotional, sexual, and physical abuse, much o f it brutally or sadistically
inflicted; and abandonment. Eight o f these individuals had been subjected to parental
attempts to kill them, and four others were brutally assaulted to a point considered by
raters to be short of actual attempted murder (p. 348). Families o f all 15 were
perpetually chaotic and extremely disorganized; all 15 subjects had been confused growing
up as to who their biological parents actually were.
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Intergenerational factors.
Three unconscious dynamicsprojective identification, transference, and aberrant
internal representational models (all sequelae o f hurtful o r traumatic experiences in
mothers own lives)~may contribute to maternal distortions shaping maladaptive
interactions with their infants. Otto Kemberg (1986) defines projective identification as an
especially primitive, developmentally early defense mechanism
characterized by (1) the tendency to continue to experience the impulse that is
simultaneously being projected onto the other person, (2) fear o f the other person
under the influence o f that projected impulse, and (3) the need to control the other
person under the influence o f this mechanism, (p. 16)
Transferences, as defined by Sigmund Freud (1905) are
new editions or facsimiles o f the impulses and phantasies which are aroused... .that
replace some earlier person... .(in which) a whole series o f psychological
experiences are revived, not as belonging to the past, but as applying to the person
...a t the present moment. (Freud, 1905, translation in Gay, 1989, p. 234).
Bowlbys (1988) representational model connotes a similar process described as
the pathway along which (the childs) attachment behavior comes to be organized
and...is determined in high degree by the way his parent figures treat him, not only
during his infancy but throughout his childhood and adolescence as well. A
principal means by which such experiences influence personality development is
held to be through their effects on how a person construes the world about him
and on how he expects persons to whom he might become attached to behave,
both o f which are derivatives o f the representational models o f his parents that he
has built up during his childhood. Evidence suggests that these models tend to
persist relatively unmodified at an unconscious level and to be far more accurate
reflections o f how his parents have really treated him than traditional opinion has
supposed. Within this framework aberrations o f behaviour and neurotic symptoms
are conceived as due to the interactions that have occurred and that may still be
occurring between an individuals personality as it has so far developed and the
situation in which that individual now finds himself, (p. 65)
Each o f these processes could easily account for a mechanism by which psychopathology
is passed to the next generation. Other pathways include non-genetic maternal brain
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developmental factors, genetic transmission, development altering pre- and postnatal

environmental assaults to the infant, and infant brain structural or chemistry changes in
adaptation to environmental influences.
Noneenetic maternal brain developmental factors.
That early abnormal brain developmental factors~due to mothers own attachment
deficits and distortionsresult in faulty parenting, in turn creating attachment deficits and
distortions in their own offspring, has been well established through decades o f primate
research. These deficits will be discussed throughout this dissertation within the context
o f the developing infant, who may grow up to also be a parent. One of the earliest
influences on this dissertation was the statement by staff at a Lexington, Kentucky
preschool for youngsters with emotional and behavior problems that they were now
working with the children of parents who had themselves participated in this very same
program when they were preschoolers.
Genetic factors.
Genetic evidence, a stalwart in explanations for the development o f aggressive
patterns o f behavior since the turn o f the previous century, has been difficult to prove, is
confusing, and is at times conflicting. For example, Cadoret, Leve, and Devor (1997)
conclude from their review of this subject that genetic estimates o f aggression and
violence are somewhat larger for adults than for children and adolescents, regardless of
the type o f measure used (p. 307); while longitudinal studies, including those informing
the DSM-IV (American Psychiatric Association, 1994; Lahey et al., 1992; Lahey et al.,
1998), show general consensus that early childhood-onset vs. adolescent- or adult-onset
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aggression is predictive o f a more severe course, worse prognosis, and full-blown

Antisocial Personality Disorder in adulthood.
Although Cadoret, Leve, and Devor (1997) cite several types of studies attempting
to get at genetic factorsi.e. twin, sibling, adoption, and biological marker studiesdata
remains inconclusive. Adoption (and twin adoption) studies may be problematic in teasing
out genetic vs. early environmental influences depending upon any nongenetic factors
affecting the developing fetus (i.e. maternal substance abuse), reasons for adoption, age of
infant at time o f adoption, and infant reaction to separation from biological mother and/or
twin. None o f this information is typically provided. Studies pointing to low or excessive
levels o f neurotransmitters (i.e. low 5-HT) as evidence o f a genetic determinant are also
problematic, because adaptations to numerous types of environmental stressors can cause
similar changes (i.e. low 5-HT resulting from maternal deprivation as previously
discussed).
These authors described several sibling studies in which mothers endorsements of
aggression items on the Child Behavior Checklist (CBCL) had high correlations for
monozygotic twins compared to dizygotic twins. However, in similar twin studies where
a different method was usedneutral observer-rated aggressive behaviors in a laboratory
settingsuch correlations for monozygotic vs. dizygotic twins were virtually nonexistent.
This discrepancy is noteworthy in light o f the study by Lyons-Ruth, Easterbrooks, and
Cibelli (1997) that found endorsement o f high externalizing behavior (i.e. aggressive
behaviors) on the CBCL was predicted by maternal depression. Mothers of aggressive
children more often report their infants as difficult, make negative misattributions about
their children, and display hostile, rejecting attitudes toward their offspring (Lyons-Ruth,
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1996). Such parental factors could, therefore, bias questionnaire measures utilized in
genetic studies.
Cadoret, Leve, and Devor (1997) found in their own research o f adopted children
with a biological parent diagnosed with Antisocial Personality Disorder (APD) that the
interaction o f adverse environmental factors within the adoptive families combined with
the APD biological parent factor to produce the strongest correlation with childhood
aggression than either factor alone. However, they cited other similar studies producing
the same types o f results for biological parents with alcoholism and other types o f
psychiatric disorders. Cadoret, Leve, and Devor also found that the low, medium, or high
conflict ratings o f the adoptive families appeared to have nothing to do with whether the
adopted child did or did not have a biological parent with ADP. These authors thus
concluded that the environment played an important role in the emergence o f aggression in
these children. Michael Rutter (1997) drew similar conclusions regarding the role of
adverse family relationships in his review of genetic research of Oppositional Defiant and
Conduct Disorders.
In his book, The Psychopathic M ind (1992), J. Reid Meloy discusses an earlier
Denmark population study by Mednick et al. (1984) o f genetic factors for antisocial
behavior that did provide some details regarding the age o f infants at adoption:
In the largest systematic adoption study to date, Mednick and colleagues (1984)
drew a sample o f 14, 427 male and female adoptees from all adoptions in Denmark
between 1924 and 1947. A cross-fostering analysis of the 4065 adopted males in
the final sample found that the highest proportion o f adoptees with one criminal
conviction came from the group with both biological and adoptive criminal
parents; the next highest proportion o f males with one conviction came from the
group with only biological parents who were criminal, (p. 23)
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Meloy concluded this provides strong genetic evidence, particularly in that it did not
matter at what age an infant was adoptedwhether at birth, by the end of one year, or by
age two.
There has been long-standing general consensus that bipolar disorder is
underpinned by a complement o f genetic factors. Demitri and Janice Papolos in their
book, The Bipolar C hild (1999), list several extremely reliable features of children with
early-onset bipolar disorder that involve dysregulation in the same early emergent systems
described in this section (i.e. brain stem, hypothalamus, autonomic nervous system).
These include marked problems modulating sensory stimuli (p. 165), emotional
sensitivity, sleep-wake and activity-rhythm and mood disturbances, sensitivity to daily and
seasonal changes, oppositional and socially avoidant behavior, and anger dyscontrol (p.
166). Common symptoms include
separation anxiety, rages and explosive temper tantrums lasting up to several
hours, marked irritability, oppositional behavior, rapid cycling...or mood lability,
distractibility, hyperactivity, impulsivity, restlessness/fidgetiness, silliness,
giddiness, goofiness, racing thoughts, aggressive behavior, grandiosity,
carbohydrate cravings, risk-taking behaviors, depressed mood, lethargy, low self
esteem, difficulty getting up in the morning, social anxiety, (and) oversensitivity to
emotional or environmental triggers (p. 51).
Utilizing findings from the newest generation o f genetic research techniques
(mapping gene allele (location) variations on the chromosome that, when inherited in
particular combinations, may give rise to a particular physical difference), these authors
have been studying the genetic code variations for catechol-O-methyltransferase (COMT)
as a possible factor in the development o f some forms o f aggression. This particular
enzyme, which breaks down NE, DA, and epinephrine, comes in three inherited varieties:
high activity, moderate activity, and very low activity. Very low activity has been
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connected to some forms o f rapid cycling, aggression, and violent behaviorquite similar
to the dramatic patterns seen so often in children with early-onset bipolar disorder. This
very low activity version o f COMT has also been associated with co-morbidity of
alcoholism and bipolar disorder in adults.
Another striking finding by these authors is that up to 80% o f their young bipolar
subjects have had a unique bilineal transmission showing family histories with mood
disorders and/or alcoholism coming down both the maternal and paternal sides (p. 157)
not unlike parental characteristics correlated with childhood aggression as previously
described. However, Papolos and Papolos have taken the stance that as molecular
genetic studies progress, bipolar disorder is looking more and more like a multiple-gene
disorder, or at least like one with a single important genetic mutation (perhaps several
different single important mutations), modified by other variations in the genetic makeup,
(and) greatly influenced by interactions with the environment (p. 161).
In a well-documented multigenerational Pennsylvania Amish population with a
recurrent strain o f bipolar disorder, early child-onset symptoms tend to take a less severe
form than in non-Amish early-onset cases. Separation anxiety, ADHD, and oppositionaldefiant behaviors are seldom seen in Amish children; and the intensity of their angry
outbursts is much less extreme. Although one key factor may be the rarity o f alcoholism
in this population, Papolos and Papolos suggest that Amish children have been protected
by their unique environmental factors:
The regularity and simplicity of the Amish lifestyle, characterized by consistent
social values; a philosophy o f nonviolence, strong family and community kinship
structures, and a prescribed daily, weekly, and monthly schedule centering around
the church provide focus and structure to the social world. The absence of
electricity weds the Amish to the natural daily and seasonal light/dark cycles, and
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in comparison to the ordinary American childintroduces a complete buffer to

overstimulation, (p. 155)
It seems safe to say that virtually all contemporary investigators looking into the
role o f genetic factors in the development of psychopathology have concluded that the
environment plays a critical interactive role in any individuals unique phenotypic
presentation o f a particular disorderor in whether the disorder will even emerge in a
maladaptive form at all.
Other environmental factors.
Mothers o f aggressive children (as previously described) would be at high risk for
exposing their offspring to development altering pre- and postnatal environmental hazards.
Examples include alcohol or cocaine use during pregnancysubstances known to alter
fetal cellular development producing troublesome behavioral outcomes that include poor
impulse control, anger dysregulation, and aggressive behaviors; exposing their infants to
pre- or postnatal doses o f nicotine from cigarette smokerecently discovered to increase
arousal thresholds (Franco et al., 1999); incurring damage to the fetus from partner abuse
during pregnancy; inflicting injuries or subjecting children to dangerous conditions
resulting in permanent CNS damage (i.e. head trauma from Shaken Baby Syndrome).
Indeed, many aggressive children have a history o f early physical abuse, i.e. by fathers,
step-fathers, maternal boy friends, female babysitters, or their mothers (American
Psychiatric Association, 1994; Schwartz et al., 1997; Starling, S. P., Holden, J. R., &
Jenny, C., 1995).
Whether living in the home or not, biological fathers o f aggressive children are
more likely to have Antisocial Personality Disorder (i.e. frequent arrests, frequent physical
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fighting, incarcerations) and histories o f substance abuse (Frick et al, 1992; Lahey et al.,
1988). Exposure to aggressive adults, hostility among family members, punitive
parenting, poor communication, marital conflict, domestic violence, and lack o f positive
affect within the family environment are associated with development of aggression in
children (Schwartz, et al, 1997). Although the focus o f this dissertation is on attachment
related psychopathology, it goes without saying that the addition o f one or more of these
extremely challenging variables can increase the impactperhaps synergisticallyupon the
developing child.
Infant Adaptations
Sadly, there are few studies that describe the immediate psychobiological effects
o f maternal deprivation, rejection, hostility, or abuse on newborn human infants.
Howeverconsistent with primate research findings on the effects o f maternal deprivation-numerous studies o f aggressive individuals, especially those who meet DSM-IV criteria
for Conduct Disorder (CD) and Antisocial Personality Disorder, have retrospectively
identified a childhood history o f maternal rejection, hostility, or parental abuse as a
predominant correlational, if not causal, factor (American Psychiatric Association, 1994;
Feldman, Mallouh, and Lewis, 1986; Lyons-Ruth, 1996; Raine, Brennan, and Mednick,
1994; Schwartz et al., 1997).
Childhood-onset Conduct Disorder (also referred to as CD Solitary Aggressive
Type) is generally more severe and unremitting than adolescent-onset CD with more
frequent displays o f physical aggression, disturbed relationships even with peers, and
greater likelihood o f developing into full-blown Antisocial Personality Disorder in
adulthood (American Psychiatric Association, 1994; Lahey et al., 1998). Lahey and
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colleagues (1998) found that children reporting their first aggressive act prior to age 10
were 7-8 times more likely to commit subsequent aggressive acts than were individuals
who reported their first act of aggression at age 11 or older. Deutsch and Erickson (1989)
found that male adolescents with the more severe undersocialized (vs. socialized) form o f
Conduct Disorder had experienced a greater number o f stressful events resulting in
physical or emotional separations prior to age four. In this study undersocialized subjects
were characterized by failure to establish a normal degree o f affection, empathy, or
bonding with others (p. 543).
Low DBH: a biological marker for early attachment psychopathology?
A well-documented biological marker reliably correlated with early-onset conduct
disorder symptoms in male (but not female) children is markedly low levels o f dopamineBeta-hydroxylase (DBH) compared to controls (Galvin et al., 1991; Galvin et al., 1995;
Rogeness et al., 1986; Rogeness et al., 1988). DBH is an enzyme involved in conversion
o f dopamine to norepinephrine. Therefore, low DBH would predict decreased NE levels.
(Evidence that low DBH would also reflect increased vs. decreased DA levels is mixed.)
In a 1986 study by Rogeness and colleagues o f 548 children hospitalized for psychiatric
problems, very low DBH levels were significantly correlated with conduct, attention, and
relationship problems; psychotic episodes under stress; fire-setting; and fewer depressive
or anxious symptoms in boysbut only anxiety symptoms in girls. Galvin et al. (1991) also
found significantly lower levels o f DBH in children with histories o f abuse and/or neglect
prior to age 36 months.
Galvin and colleagues (1995) link low DBH to reduced NE levels seen in
protracted stress conditions in attachment studies o f mother-deprived primates, proposing
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that initial overstimulation o f catecholamines under such conditions may ultimately be

followed by a shift to lowered DBH activity over time. They also suggest that young
children may be developmentally more susceptible to modification o f DBH levels under
chronic duress, noting that human serum DBH activity increases in activity particularly in
the first 2-3 years o f life with little further increases after age 6 years (p. 822), suggestive
o f an experience-expectant developmental window for expression o f this enzyme.
There is contradictory evidence that abnormally high levels of DBH (and,
therefore, NE) are apparently produced by altered gene transcription in animals and
humans subjected to traumatic conditions (Serova et al., 1999; Hamner & Gold, 1998).
These findings would appear to rule out the hypothesis that there is an initial increase
followed by decrease in DBH levels over time in chronic stress conditions. Other possible
explanations for these DBH discrepancies are the immature developmental status o f brain
structures and neurochemistry systems involved in producing the stress response or a
genetically predetermined DBH deficiency. Interestingly, in medical studies o f those bom
with a DBH deficiency (studies which tend to focus on autonomic nervous system
dysfunction), aggression is never mentioned as a characteristic o f these individuals.
Rather, these individualsboth human and animal subjectstend to show remarkably
normal behavior (Thomas & Palmiter, 1997).
The DBH gene (and its varied presentations) has been mapped and is considered to
be an extremely robust genetic marker (Cubells et al., 1998; Gilbert, et al., 2000).
According to Cubells and colleagues (1998), DBH genes are expressed in (1) the
sympathetic component o f the autonomic nervous system with heritability estimated at
.98 and (2) NE neurons o f the central nervous system with heritability estimated at .83
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(p. 534). However, linking specific types o f psychopathology directly to this gene has
proved elusive. There appear to be no studies linking DBH gene variations to aggression.
Interestingly, low DBH plasma levels have been associated with psychotic major
depression (Cubells et al., 1998; Hamner & Gold, 1998; Sapru, Rao, & Channabasavanna,
1989), but not bipolar disorder or even schizophrenia (Cubells et al., 1998; Hamner &
Gold, 1998; Sapru, Rao, & Channabasavanna, 1989). Indeed, the DBH gene itself has
been ruled out as a possible contributor to the development o f bipolar disorder (Cubells et
al., 1998; Ewald et al., 1994). Because DBH genetic variability is just as strong in healthy
populations and because variability due to environmentally imposed factors such as
psychotropic medication is so insignificant, Cubells and colleagues have concluded that
any DBH genotype-phenotype associations to psychiatric disorder or environmental
factors are quite unlikely (p. 539).
Given these findings, low DBH levels may prove useful in teasing out a differential
diagnosis o f childhood-onset conduct disorder vs. childhood-onset bipolar disorder in
aggressive male children. Andin light o f Kraemer and Clarke primate findings (1996) o f
low NE and D A levels in mother-deprived monkeys and Galvin et al. findings (1991) o f
low DBH levels in children abused and/or neglected prior to three years o f agelow DBH
activity may come to serve as evidence o f abnormal CNS development during a critical,
experience-expectant developmental window for phenotypic expression o f DBH due to
early and profound attachment failure, neglect, and/or abuse.
Other biological markers for aberrant aggression.
In an ambitious review of psychobiological markers for aggressive and violent
behavior in children, adolescents, and adults, Scarpa and Raine (1997) reanalyzed a large
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body of research, to include famous studies by R. D. Hare and others, in an attempt to

tease out reliable factors in the puzzling presentations o f these individuals. Measures
utilized in this body o f work have included skin conductance to detect variations in
autonomic response and classical conditioning; EEGs to measure intensity o f event
evoked potentials (electrical activity indicative o f arousal) in the brain stem and cortex;
vagal tone; resting heart rate; heart rate while anticipating, in the midst of, or following a
threatening experience; cortisol levels and startle patterns to determine stress reactivity;
and metabolite quantities in blood and urine samples to assess cortisol levels.
Viewed developmentally, these measures have uncovered abnormalities in the
same brain systems and emotion circuits available or emergent in newborn infants.
Collectively, these studies have identified abnormalities in arousal, autonomic nervous
system functioning, orienting response, classical conditioning, as well as in pleasure,
seeking, rage, fear, and stress response systems. Primary structures involved include the
brain stem, hypothalamus, amygdala, autonomic nervous system components, and the
cortex.
Arousal patterns.
Arousal anomalies are among the most reliable o f findings. In a reformulation of
event-related potential (ERP) studies o f brain electrical activity in response to particular
stimuli, Raine (1997) found
(1) long early latency brain stem averaged evoked responses, reflecting excessive
environmental filtering and reduced arousal; (2) increased middle latency ERP
amplitudes to stimuli o f increasing intensity, which has been linked to sensation
seeking; and (3) enhanced late latency ERP P300 amplitudes to stimuli o f interest,
suggesting enhanced attention to stimulating events, (p. 382-383)
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Scarpa and Raine also found that a large number o f studies implicate EEG
abnormalities in violent recidivistic offenders, which is thought to reflect general
underarousal or cortical immaturity (p. 382). However, data regarding cortical arousal
in psychopathic individuals, whose aggression is considered to be more predatory than
reactive, is mixed: One study even showed the opposite pattern, that primary
psychopathic subjects were more aroused than secondary psychopathic subjects (p. 383).
Autonomic responses.
Resting heart rates and skin conductance reactivity are significantly lower in
aggressive and antisocial populations of all ages--but especially in children and
adolescentswhen compared to nonaggressive controls (Scarpa & Raine, 1997; Raine,
Venables, & Mednick, 1997). Stress response studies have often shown abnormal heart
rate patterns to threatening stimuli that include escalating heart rate in anticipation o f the
threat, low or suppressed heart rate in the midst o f the threat, and prolonged arousal
recovery to baseline following removal o f the threatening stimulus. Scarpa and Raine
(1997) are cautious to point out that heart rate and reactivity appear to vary, however,
depending upon the nature and meaning o f the stimulus to the individual.
Cortisol.
Characteristic low cortisol presentations in this predominantly male adolescent and
adult population (Scarpa & Raine, 1997) and in a group o f persistently aggressive boys
studied longitudinally, beginning at ages 7-12 years (McBumett, et al., 2000), are
surprising considering that male newborns, in general, show significantly increased cortisol
levels following stressful events compared to females (Davis & Emory, 1995) and children
of both sexes show increased cortisol reactions to chronic stress and trauma (De Beilis et
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al., 1999a). Noteworthy are findings showing th a t cortisol response is highly reactive in
normal newborn infants up until about age three mionths, at which time it becomes
suppressed with cortisol levels remaining quite lo w until about age two years (Gunnar,
1998). Under normal conditions this would be quite adaptive, because excessive o r
prolonged exposure to cortisol could have deleteri ous effects on developing brain
structures (i.e. causing cell atrophy or death in the hippocampus) (Lombroso & Sapolsky,
1998; McEwen, 1999). Studies o f cortisol levels Ln adults who have experienced trauma,
however, are mixed with many showing decreased. levels (van der Kolk, 1996). V an der
Kolk (1996) found that blunted cortisol patterns w ere indicative o f a history o f multiple
trauma experiences, suggesting lowered resiliency across repeated traumatic events.
Blunted HPA and cortisol patterns have also been a consistent finding in mother-deprived
primates (Kraemer & Clarke, 1996).
Instrumental/proactive aggression vs. reacttive/defensive aggression.
Stress reactivity may vary depending upon whether an individual is more prone to
cold-blooded proactive (instrumental) aggressiom or hot-blooded reactive aggression.
Instrumental aggression tends to focus on resource acquisition and most resembles
predatory or pray stalking behavior mediated by thie hypothalamus. This seeking system
type behavior may be experienced as exciting, evem enjoyable, involving little or no
subjective experience o f aversive feelings such as cage or fear. Reactive aggression,
however, is driven by an excessive, aversive build up o f arousal (rage) due to thwarted
goal, ongoing unmet need, or threat. Defensive raige most likely represents the comingling of hyperaroused rage and fear feelings, w hose circuits run close together in the
brain. As Scarpa and Raine point out, very few human studies have attempted to separate
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out these disparate forms o f aggression, although Siegel and colleagues have identified
two separate circuits for predatory aggression and defensive rage in rats and cats. Rage is
mediated by the amygdala, hypothalamus, PAG, and autonomic nervous system (Siegel et
al., 1999; Siegel, Schubert, & Shaikh, 1997).
Scarpa and Raine (1997) suggest risk factors leading to reactive aggression,
particularly to violence, include
(1) a predisposition to experience negative affect and arousal,
(2) the inability to regulate or soothe negative affect and arousal, and
(3) thought processes that will increase the likelihood of experiencing anger or
making a decision to aggress, (p. 385).
Reactive aggression would be expected to result in a preponderance o f impulsive acts
triggered by anger or fear, whereas proactive or predatory aggression may involve
planfulness, methodical implementation, even patience. Instrumental aggression appears
to lack influence or modification by socially-dependent emotion regulation systems
mediated by the amygdala, septal area, and cingulate. The associative processing and
executive functions o f the neocortex may, therefore, come to service in a very direct way
the more primitive id-like emotion motivation systems mediated by the hypothalamus.
The label psychopathic has most generally been applied to those individuals who display
this more predatory pattern.
Startle response.
The few available studies that do distinguish aggression types, as reviewed by
Scarpa and Raine (1997) and Reid Meloy (1992), would appear to support differing
presentations for predominantly proactive, instrumental vs. reactive aggression patterns;
although data is often unclear, mixed, or inconsistent. For example, startle responses were
217
found to vary. Startle potentiation is utilized to determine reactivity, with more rapid and
intense startle responses indicative o f greater reactivity and negative emotion. Scarpa and
Raine (1997) found that
criminals with high emotional detachment (including psychopathic individuals)
exhibited reduced startle potentiation, whereas criminals with low emotional
detachment exhibited robust startle potentiation. Furthermore, negative affect was
related to high antisocial behavior and low emotional detachment in these
individuals, (p. 386).
They therefore concluded that psychopathic individuals display a core emotional deficit in
fear potentiation and defensive response modulation (p. 386).
Norepinephrine fNE) and dopamine (DAT
Meloy (1992) has found that individuals most likely to display instrumental
patterns have abnormally low levels o f 5-HT, NE, and DA; while individuals most likely to
display reactive aggression have low 5-HT levels, but higher than expected levels o f NE
and DA. Lower NE levels are consistent with low DBH found in aggressive children,
especially those fitting criteria for Conduct Disorder, Solitary Aggressive Type (Galvin et
al., 1995) with a more deleterious course, as previously described. Lower DA and
especially NE levels have been consistent findings in mother-deprived primates who also
generally develop abnormal aggression patterns (Kraemer & Clarke, 1996).
Hyperactivity, impulsivity, emotional reactivity, and attention deficits, associated with low
NE activity (Panksepp, 1998), are common problems among aggressive populations
especially for children and adolescents (American Psychiatric Association, 1994). Higher
NE and DA levels, however, are consistent with PTSD patterns for children and adults of
both sexes (Chamey et al., 1993; De Beilis, et al., 1999a; van der Kolk, 1996) and,
218
developmentally, may reflect a more fully functioning amygdala and HPA circuit (threat
response system).
Serotonin f5-HT).
Low serotonin (5-HT) levels generally seen in this populationregardless of
aggression typehave, thus, become linked to aggression. Low 5-HT has also been
linked to impulsive acting-out behaviors (Cadoret, Leve, & Devor, 1997; Panksepp,
1998). However, Kraemer and Clark (1996) warn that a causal relationship between
brain 5-HT function and aggression in humans has not been demonstrated (p. 121).
Craig Ferris (1996) has found some evidence that one way 5HT may act to inhibit
aggression is by suppressing vasopressin activity, which may also have its own role in
aggression.
Although genetic factors can account for reduced 5-HT levels, Panksepp (1998)
notes that lower 5-HT levels can also result from environmental factors or interaction of
genetic and environmental factors:
Across different strains o f rodents, aggressiveness produced by prolonged social
isolation is highly correlated to isolation-induced decreases in brain serotonin
activity (Valzelli & Bemasconi, 1979), and serotonin supplementation can
decrease aggression in animals that have become irritable because of long-term
social isolation (Bevan, Cools, & Archer, 1989). (p. 202).
In their 1996 study Kraemer and Clarke found that peer-reared vs. motherreared
monkeys had lower levels o f NE, ACTH, and cortisol; but normal 5-HT levels, even
though this group was more likely to display higher activity levels and unusual aggression
patterns.
Lower than normal serotonin levels are also characteristic o f adults and children
with depression, anxiety disorders, trauma and suicide histories, as well as social isolation
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and maternal deprivation in primates and other animals (Meloy, 1992; Panksepp, 1998;
van der Kolk, 1996). Because low 5-HT occurs in such a wide range o f psychopathology,
it is not particularly useful as a biological marker for aggression or attachment failure.
5 SRIs and other medications targeted at increasing serotonin have not been found
effective in curbing aggression or rage (vs. irritability). According to Panksepp, to this
day there is no highly specific way to treat pathological anger pharmacologically (Conner
6 Steingard, 1996) (p. 202).
Sex differences.
Although males are undeniably more prone to aggression than females, and
testosterone in the sexualized brain is highly suspected as the reason, a clear link
implicating this hormone has yet to be established (Panksepp, 1998). The generally larger
size and muscular strength o f males put them at an obvious advantage for successfully
utilizing aggression to obtain desired goals. Although other factors that might account for
such a marked sex difference have been investigated, data remains inconclusive. The
sexualization o f brain emotion structures and their neurochemistry systems is extensive
and complex, so pinning aggression to any one of them in particular will likely prove
difficult or even misleading. For example, an increased level o f oxytocin in the male
system (i.e. induced by pro-social activities such as child-care) may serve to reduce
aggressive behavior (Joseph, 1996; Panksepp, 1998).
Socialization vs. biological vulnerability contributions.
Possible explanations that can account for discrepant autonomic, catecholamine,
cortisol, and stress reactivity patterns include genetically transmitted predispositions,
environmental assaults (i.e. fetal exposure to alcohol, nicotine; postnatal illness or injury),
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and/or developmental status o f brain structures and neurochemistry systems in interaction

with an extremely adverse, overstimulating, and/or nonresponsive environment. Scarpa
and Raine found in their review that
the greatest degree o f violence, however, occurred in those individuals who had
both minor physical anomalies and had been raised in unstable, nonintact families.
The rate o f violence in those with both biologic and social predispositional factors
was seven times that o f those who had only minor physical anomalies, (p. 388)
Meloy (1992) proposed in his developmental^ based theory, that psychopathic character,
more often associated with cold-blooded instrumental aggression, represents an especially
aberrant and severe form o f infant adaptation.
Emergence o f Aberrant Aggression from Early Infant Trauma: A Theory Based on
Evidence o f Opioid Mediated Adaptations and Deficiencies
This dissertation also proposes early adaptation explanations for arousal,
autonomic, and neurotransmitter anomalies seen in these populationsadaptations that in
all likelihood were necessitated soon after birth given the persistence and severity o f the
types o f maternal mental health problems associated with the development o f aggressive
behavior. Such adaptations would, o f course, be consistent with the developmental status
o f the brains various structures, circuits, and neurophysiological systems at this early
point in life.
Newborn brains are capable o f producing three types o f opioid mediated responses
for quelling excessive, aversive arousal (i.e. traumatic stress). These include (1) vagal
nerve parasympathetic slowing o f coupled heart and breathing rates (sympathoinhibitory
response mediated by mu and delta receptors in the rostral ventrolateral medulla (RVL) of
the brainstem; (2) antinoceptive analgesia mediated at mu receptors in the rostral
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ventromedial medulla (RVM) and PAG o f the brainstem in response to pain, irritants, or
intense agitation during uncontrollable and inescapable stressful conditions; and (3)
dampening o f the stress circuit by inhibiting corticotropin releasing factor (CRF) from the
paraventricular nucleus (P VN) o f the hypothalamus, which, in turn, inhibits both
norepinephrine activity in the locus coeruleus of the brainstem and cortisol release.
Opioid mediated sympathoinhibition and analgesia are advantageous in that they
restore homeostasis quickly, critical to the survival of fragile biological organ systems such
as the heart, and occur quite independently of help from another human being. For abused
and neglected infants, such help may not be forthcoming~or, if a parental response is
elicited by the infants cries, it may be an angry, even dangerous one. Indeed, the parent
to whom the child looks for comfort may be the very cause o f the infants precarious,
overstimulated state. However, if these opioid defenseswhich work best in short term,
emergency situationsare employed repeatedly, adaptations may have long-term, adverse
developmental consequences.
At birth, brain stem opioid receptor sites are still in the process o f obtaining adult
levels, although this normally occurs soon after the neonatal period (Olkkola, Hamunen, &
Maunuksela, 1995). Analgesic opioid is also eliminated at slower rates in newborns, not
approaching adult elimination rates until about one year of age (Olkkola, Hamunen, &
Maunuksela, 1995). Implications are that the opioid systems, although up and running,
are still in the process o f coming on linea process thats guided by experience during
developmental windows.
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Dissociation: vasal svmpathoinhibitorv trauma response.

In a state of extreme agitation produced by inescapable traumatic conditions,
endogenous opioid is released in the brainstem, protecting the organism from the full force
o f the traumanot unlike going into shock after sustaining life-threatening bodily injuries.
As previously discussed, opioids have been implicated in various forms o f shock, with
naloxone reversing shock effects (Grilly, 1994; Ohnishi et al., 1997; Panksepp, 1986).
Under emergency conditions, opioid activated mu and delta receptors in the rostral
ventrolateral medulla (RVL) o f the brainstem mediate a vagal nerve sympathoinhibitory
response that slows down heart and breathing rates (Hayar & Guyenet, 1998; Kiritsy-Roy,
Marson, & Van Loon, 1989; Kwok & Dun, 1998; Musha et al., 1989; W hite & Irvine,
1999), effectively shutting off an overactive sympathetic nervous system that is
threatening to hurl the organism out o f control (i.e. heart arrhythmia produced by its
sustained exposure to norepinephrine during sympathetic activation). However, if a
parasympathetic rebound (commensurate to the sympathetic arousal its countering) is too
drastic, breathing or heart activity could be shut off altogether, as previously discussed.
The sympathoinhibitory response appears to be the same vagal-mediated
mechanism thatunder normal conditionsfacilitates sustained attention, as described in
the Attachment section (Hernandez et al., 1997; Lester, Boukydis, & LaGasse, 1996). It
makes evolutionary sense that these two actionssustained attention and system shut
downwould represent two different points o f intensity along the same continuum.
Sustained attention would not only be essential for locating biologically significant
resources (i.e. food) amidst a vast environmental stimulus array (Smotherman &
Robinson, 1993), butat a more intensified arousal levelit would be critical for zooming
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in for an even narrower focus on a potentially deadly threat (i.e. predator) to increase
chances o f surviving an encounter. The frequently reported sensation o f everything going
into slow motion during an emergency would be consistent with an intensification of this
heart slowing (and probable dopamine suppressing) process. However, as chances of
surviving grow dim because the threat overtakes the individual (perhaps accounting for
the sensation o f everything going black), shutting down the system would not only be a
drastic way to conserve energy while reducing energy depletion from hyperactivated
metabolic systems, but it would ultimately prevent the organism from incurring the full
force o f the trauma.
Parasympathetic control over heart rate is an indicator o f good developmental
progress (Lester, Boukydis, & LaGasse, 1996) and more efficient regulation of
homeostasis in infants and late term fetuses in general (Groome et al., 1999, p. 25).
High heart rate variability is ideal, indicating an effective coupling o f heart and breathing
rates and the ability to shift back and forth between the sympathetic and parasympathetic
systems to meet life demands. An infant with an immature coupling (and higher resting
heart rate) might become easily overstimulated in response to stressful stimuli showing an
accelerating heart rate indicative of sympathetic dominance. However, a more mature
infant who has already achieved parasympathetic dominance, with too much opioid
exposure, may show the opposite extreme: a heart that that is more invariably slowed.
Ordinarily, a decelerating heart rate would facilitate attention to stimuli. However,
if the system is too slowed down already (i.e. due to more extreme opioid release
triggered by more extreme arousal), attention may also suffer. This would represent the
inverted U-curve principle, whereby a neurotransmitter functions best at the top o f the
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curve, at a level thats just rightmidway between too little at one extreme or too much at
the other (Panksepp, 1998). This would appear to be supported in studies by Hernandez
et al. (1997). These investigators found a large heart deceleration occurs when a
previously neutral stimulus is paired with an unconditioned stimulus producing an
unconditioned reward (opioid surge). The deceleration persists over several more beats.
I f there is already too much opioid in the systempreventing what would feel like a large
enough initial surge and preventing a sufficient dip in an already suppressed heart rate, one
could easily assume that conditioned learning might not occur. These investigators also
found that a large heart rate deceleration normally occurs when attending to novel stimuli,
but this response habituates with repeated, unreinforced stimulus presentations (p. 50).
Habituation to insignificant stimuli, o f course, is a healthy self-management strategy for
arousal control in young infants (Brazelton, 1992). However, if there is already too much
opioid in the system to experience large decelerations to even initial presentations of new
stimuli, this could serve to effectively filter out stimuli at the brainstem levelproviding
a protective stimulus barrier.
DBH neurons are found in brain stem areas (i.e. nucleus accumbens, locus
coeruleus, ventral medulla) that mediate stress, arousal, and sympathetic (but not
parasympathetic) nervous system activities (Batten, 1995; Berridge et al., 1997; Zhu,
Blessing, & Gibbins, 1997); are concentrated in the same areas as and maintain numerous
contacts with enkephalin in the ventral medulla (Batten, 1995; Cesselin et al., 1984); and
have been implicated in homeostatic cardiovascular and neuroendocrine regulation
(Ciriello, Caverson, & Park, 1986). Since Cesselin and colleagues (1984) found such high
correlations between DBH activities and enkephalin concentrations, they have suggested
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that DBH may be regulated in some way by these opioids. It is quite conceivable that
excessive exposures to and suppression by opioid activity triggered to counter frequent
episodes o f hyperactivated sympathetic response to extremely stressful conditions (i.e.
harsh handling, maternal deprivation), over the span of its critical developmental window,
could prevent DBH and, therefore, NE from becoming fully expressed at normal
maturational levels.
Dissociation: analgesic trauma response.
Another emergency defense mechanism available to newborns during conditions o f
inescapable or otherwise intensely stressful conditions is endogenous analgesia produced
by enkephalin opioid activation o f mu receptors in the rostral ventromedial medulla
(RVM) o f the brainstem (Barr & Zadina, 1999; Chamey et al., 1993; Grilly, 1994; Foo &
Helmstetter, 2000; Panksepp, 1998; van der Kolk, 1996; Wang & Wessendorf 1999).
Wang & Wessendorf (1999) have discovered that approximately half o f the serotonin
neurons projecting through the RVM to the spinal cord contain mu receptors, and that
opioid activity at these sites inhibits 5-HT. These authors warn, however, that other
studies contradict these findings, showing opioid potentiation o f 5-HT analgesic effects.
Opioid analgesia effectively quells highly aversive feeling states produced by
nociceptive stimuli such as pain or agitation and increases the latency for (suppresses)
onset o f startle and other reflexive behaviors triggered by noxious stimuli (Tershner,
Mitchell, & Fields, 2000). Newborns are more sensitive to pain than previously thought,
and girls more so than boys (LeFrancois, 1984; Olkkola, Hamunen, & Maunuksela, 1995).
Animal research showing that males produce greater magnitudes and potencies o f mu
activated analgesia in both the RVM and PAG is consistent with this finding (Krzanowska
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& Bodnar, 1999; Tershner, Mitchell, & Fields, 2000). Analgesic opioid is also believed to
have a role, particularly at medulla sites, in producing the sympathoinhibitory response
(Hernandez, et al., 1997).
Analgesic receptors are also found in the PAG o f the brainstem and in the
amygdala, currently in its experience-expectant developmental window (Foo &
Helmstetter, 2000; Siegel, Schubert, & Shaikh, 1997). Two emergent emotion systems,
rage and fear, run their circuits from the medial and lateral-central areas o f the amygdala
(respectively), through the stria terminalis into the medial hypothalamus, then to the PAG
in the midbrain portion o f the brainstem. From here, pathways descend into the spinal
cord, activating their respective components o f the sympathetic nervous system (Joseph,
1996; Panksepp, 1998; Siegel, Schubert, & Shaikh, 1997). Paradoxically, the medial
hypothalamic nuclei mediate parasympathetic functions and generally promote quiescence
in which the individual simply stops behaving. However, the medial portion has sites that-when stimulatedare so aversive, relief or avoidance is actively sought (Joseph, 1996;
Panksepp, 1998).
Substance P receptors (more commonly associated with pain) within the medial
hypothalamus and NMD A glutamate receptors in the PAG have been identified as
mediators of defensive rage (Siegel, Schubert, & Shaikh, 1997). Siegel and colleagues
have also identified a powerful rage suppression circuit comprised of enkephalin opioids,
arising from the central nucleus o f the amygdala, that achieve their effect by activating mu
receptors in the PAG.
Receptors giving rise to subjective fear and anxiety feelings have been difficult to
pin down because so many neurotransmitters run along this pathway, but are thought to
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include NMD A glutamate, NE, CRF, and ACTH receptors (LeDoux, 1996; Panksepp,
1998). Abundant receptor sites for GABA serotonin, oxytocin, and opioids mediate fear
suppression (Panksepp, 1998). In experiments subjecting animals to punishment,
predators, or electrical stimulation o f hypothalamic nuclei, subjects initially freeze; then as
stimulation intensifies, they take active flight. Fear can inhibit pain feelings under these
emergency conditions (LeDoux, 1996; Panksepp, 1998).
Severe, untreated, long-standing maternal psychopathology such as Antisocial
Personality Disorder, major depression, and substance abuse (or other psychiatric
disorders such as bipolar disorder, Borderline Personality Disorder, Dissociative Identity
Disorder, or schizophrenia) in all likelihood, will persist for the duration o f an infants
formative years. Add to this the stressful, nonsupportive, or chaotic conditions of a
mothers own environment, and ingredients are in place for a potentially treacherous infant
developmental environment. Unconditioned and/or primed stimuli that elicit fear in infants
include pain, sudden or loud noises, sudden movements, unexpected changes, strange
objects, loss o f physical support, and scary, angry faces (LeFrancois, 1984; Panksepp,
1998). Newborn babies with fragile, tiny nervous systems subjected to combinations of
maternal deprivation, rejection, hostility, and interactions characterized as withholding,
nonresponsive, cold, inconsistent, noncontingent, role-reversing, angry, coercive, grossly
distorted, punitive, painful, or frightening, will in all likelihood become traumatized.
With infant initiatives often ignored, overridden, or even punished the
overstimulation that would be produced by the rage pain o f unmet needs and expectancies;
frightening and/or painful harsh handling; and sensations o f powerlessness could rapidly
push arousal well beyond the tolerance range into the danger zone. Due to the amygdalas
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immaturity and the close proximity o f their circuits (i.e. in the medial hypothalamus and
PAG), excessive experience with intense rage may overtake portions of hypofunctioning
neuronal groupings comprising the emergent fear system. Such overstimulation would
also probably result in the infants becoming disorganized.
It is conceivable, that for some traumatized newborn infants, heightened arousal o f
any type becomes associated with, and therefore comes to signal at a nondiscriminating
visceral level, impending annihilation. Newborns are primed to respond to familiar or
expected stimuli. As previously discussed, visual objects that move together in space
become linked by common fate, a mechanism that ordinarily assists infants to begin to
impose order on an otherwise chaotic world (Gopnik, Meltzoff, & Kuhl, 1999, p. 66) and,
due to simultaneous neuronal firings, multiple stimuli within the same context can become
associated (Joseph, 1996). Posttraumatic Stress Disorder expert Dennis Chamey and
colleagues (1993) have found that substantial analgesia is seen following presentation of
neutral stimuli previously paired with aversive stimuli (Fanselow, 1986) (p. 299),
providing evidence of classical conditioning. In this way, aversive feelings in and o f
themselves, even if provoked by nonendangering stimuli, may come to trigger an opioid
analgesic response that effectively dissociates (splits off) the arousal from the experience
that is causing it, rendering the experience more survivable.
Sympathoinhibitory and analgesic mu receptor sites are activated by the exogenous
opioid Morphine and, like Morphine, are susceptible to tachyphylaxis (Grilly, 1994).
However, evidence strongly suggests that sympathoinhibitory and analgesic opioid effects
resist tolerance for longer periods than euphoric opioid effects produced in other emotion
circuit sites (Grilly, 1994; White & Irvine, 1999). Analgesic opioid is also eliminated at
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slower rates in newborns for up to approximately twelve months of age (Olkkola,

Hamunen, & Maunuksela, 1995). Sustained analgesic effects minus the euphoric effects
would probably be experienced as numbing or depersonalizing.
In their review o f Psychobiologic Mechanisms o f Posttraumatic Stress Disorder,
Chamey and colleagues (1993) also found evidence that trauma can produce analgesic
opioid receptor sensitization, or just the opposite o f tolerance: reexposure to less intense
shock in rats previously exposed to uncontrollable shock also results in analgesia (Maier,
1986) (p. 299). In this case, an infant who has an initial traumatic experience soon after
birth would be getting an extremely early head start on reducing resiliency for subsequent
traumaseven for less stressful events that, heretofore, would have provoked arousal
within a tolerable range. The stimulus tolerance range has thus been reduced instead o f
extended.
Because the very young infant, through experience, has learned that the opioid
mediated analgesic system provides a reliable, trustworthy, independent means of quelling
aversive feelings, this may become the preferred defense. However, if dissociating
arousal from the stimulus giving rise to it becomes routine, an infant will miss out on felt
experience required for further emotional development (i.e. attending to and processing
significant and/or novel information; habituating insignificant stimuli; soothed, pleasured,
or excited conditioning within the context o f a loving social relationship; getting a sense
that feelings can lose their intensity or come to an end as they run their course;
conditioned associations to specific outcomes in and across time; predictability; selfefficacy in obtaining desired resources and outcomes from a responsive social
environment; modulation o f felt experience with optimistic, hopeful expectations shaped
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by good feeling memories o f previous experiences; increased tolerance for delayed

gratification). Emotion arousal with minimal coupling to experience and, therefore,
minimal exposure to the influence o f increasingly sophisticated regulatory systems would
retain its pure, primitive, potent, and engulfing somatic form. Such individuals at a later
point in life might appear oddly devoid o f emotions or deny having them.
Particularly tragic, these infants are probably coming to associate their mothers
with punishing, bad feelingsa far cry from the abundance o f good feelings associated
with moms within the context o f a warm, loving, affectionate relationship. Initial self and
world view schemes (expectation filters) for traumatized newborns might translate into: I
dont feel, therefore Im not; (or later:) I dont feel; therefore others dont feel; (When I
do feel) I feel bad, therefore I am bad; I feel scary, therefore I am scary; Mom feels bad,
therefore Im bad, therefore the world is bad.
Immature stress response: functioning below the amygdala-HPA level.
Sympathoinhibitory and analgesic defenses provide parasympathetic activation and
stimulus barrier that could effectively suppress or prevent the stress response (Han et al.,
1999). McCubbin and colleagues at the University o f Kentucky (McCubbin, et al., 1993)
found that monkeys with low heart rate responses to stress have an effective opioidergic
inhibition of circulatory and pituitary-adrenocortical reactivity. Monkeys showing
excessive heart rate reactivity during psychological stress have a less active opioidergic
inhibitory mechanism (p. 23). There is also some evidence that analgesic opioids may
inhibit NE neurons in the locus coeruleus (Van Bockstaele, 1998). Therefore, under the
influence of these opioids, NE and cortisol would probably not become elevated by stress.
However, under less extreme conditions, arousal levels may be low enough to activate
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young components o f the stress response without triggering the more drastic
sympathoinhibitory or analgesic defenses. Female infants, with lower quantities o f
brainstem analgesic mu receptors than males, might be more susceptible to feeling stress
effects, as would infants with less developed nervous systems who still find it difficult to
engage the parasympathetic system.
The stress circuit available to the newborn is comprised of the emergent but
immature amygdala, HP A, hypothalamus, locus coeruleus in the brainstem, and the
sympathetic nervous system. Sensing threat triggers a cascade o f neurobiological
activities that includes activation o f a reciprocal circuit involving the locus coeruleus in the
brainstem and the paraventricular nucleus (P VN) o f the hypothalamus. When this system
is activated, Norepinephrine (NE), released by NE neurons in the locus coeruleus,
stimulates the release o f corticotropin-releasing factor (CRF) from the paraventricular
nucleus o f the hypothalamus. CRF, in turn, has an excitatory effect on locus coeruleus NE
neurons, and the process continues until the circuit is disrupted. CRF and NE activate the
sympathetic nervous system, increasing heart rate, intensifying arousal, and creating
hypersensitivity to sensory stimuli (Chrousos & Gold, 1992). CRF also activates the HP A
resulting in cortisol release (Chrousos & Gold, 1992). Starting at about age three months
(but not yet), cortisol levels will become subdued (Gunnar, 1998).
B-endorphin endogenous opioids in the hypothalamus, stimulated by comforting
contact with mother (Panksepp, et al., 1978) play a homeostatic role by inhibiting CRF
released from the paraventricular nucleus o f the hypothalamus, thus dampening the stress
circuit, and returning the organism to base line (Chrousos & Gold, 1992). This opioid
mediated component is also in place and fully functioning at birth (Adamson, et al., 1991).
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Panksepp (1998) suggests that attachment behavior and opiate addiction are very
closely related in that they appear to be mediated by the same systems in the central
nervous system. He notes that separation from the object o f attachment and opiate
withdrawal produce similar painful symptoms (Panksepp et al., 1978; Panksepp et al.,
1985) and in general, when animals cannot experience opioid activity in their brains, they
seek (non-threatening) social contact (Panksepp, 1998). Babies, of course, would cry
(instigated by CRF). By contrast, animals with moderate doses o f opiates tend to socially
isolate themselves (Panksepp, 1998, p. 271). B-endorphin opioid bursts obtained from
contact with mother activate mu receptors (which mediate Morphine addiction) and
appear to provide euphoric as well as quelling sensations (Nelson & Panksepp, 1998;
Panksepp, 1998). The most powerful endogenous opioid-like molecule that interacts
with the mu receptor is B-endorphin, which also has the most powerful ability to alleviate
separation distress, i.e. crying (Panksepp, 1998 p. 264). For the infant, contact with
mother appears to be the primary stimulus for activating stress circuit opioids. Should
such contact be deficient, harsh, even threatening~or should opioid from other brain
sources become depletedthe stress circuit would become hyperactivated.
Opioid depletions and deficiencies.
In his 1986 article, The Neurochemistry o f Behavior, Panksepp proposes that
the global function o f opioid systemsespecially those involving mu receptors (which
quell pain) and perhaps delta receptors (found in the limbic system) is to counteract the
influence o f stress (p. 95). According to Panksepp, it would appear that endogenous
opioid systems are set up to deal with intermittent stress or stress bursts as opposed to
sustained or chronic stress, during which they lose their effectiveness. Loss of
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effectiveness over time is likely due to some form o f tolerance (i.e. depletion o f the
endogenous opioid neurotransmitter, downregulated receptor sites, decreased receptor
sensitivity), although this may not provide a complete explanation.
Chamey and colleagues (1993) found that uncontrollable, but not controllable,
shock: decreases the density o f mu opiate receptors (Stuckey, et al., 1989) (p. 299).
This m ost likely represents a form o f tolerance, a homeostatic process whereby receptor
sites are downregulated to counterbalance heightened neurotransmitter quantity or
activity. Downregulation requires increasingly higher or more potent doses o f the
neurotransmitter to achieve the same effect, which, in turn, may further reduce receptor
site quantities (Grilly, 1994). In this case, a repeatedly stressed infant may become opioid
depleted with a diminished number o f receptor sites for mediating opioid effects. This
baby would experience withdrawal effects from decreased opioid in the system.
Withdrawal produces another type o f homeostatic reboundexact opposite effects
o f the (now depleted) drugs effects. Opiate withdrawal symptoms include intense
agitation, despondency, anorexia, insomnia, crying, aggression, heightened sensitivity to
psychological and physiological pain, and rage (Grilly, 1994; Panksepp, 1998). As
previously discussed, these are the same symptoms experienced with attachment
separation distress (Panksepp, 1998). Animal evidence has shown that opioid withdrawal
can precipitate a significant reduction in dorsal raphe nucleus 5-HT and that the PAG (a
component o f fear and defensive rage circuits) has been implicated in producing
withdrawal symptoms (Tau, Zhiyuan, & Auerbach, 1998). Low 5-HT levels are
consistently seen in mother-deprived primates and other animals, particularly those who
have also been deprived of other types o f nonthreatening social contacts (Kraemer &
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Clarke, 1996; Panksepp, 1998). Symptoms similar to withdrawal are also characteristic of
individuals with PTSD (American Psychiatric Association, 1994; van der Kolk, 1996).
I f opioid mediated sympathoinhibitory and analgesic effects have produced a
prolonged parasympathetic dominated state (overprotecting the infant from experience
and arousal), the intensity o f a rebound to the sympathetic state resulting from opioid
depletion would be proportionately extreme (overexposing the infant to experience,
enhancing sensory-sensitivity, and hyperactivating aversive arousal). With chronic opioid
use effectively suppressing NE and DA activity that would normally occur in an activated
sympathetic system, NE and DA receptor sites would likely upgrade (increase in number)
to catch every last drop o f neurotransmitter. (This is natures way o f doing a lot with a
little, if a little is all youve got.). If opioid becomes depleted, permitting NE and DA
activity to resume, increased quantities o f these neurotransmitters activating large numbers
o f receptor sites would result in a power surge of sympathetic driven neurobiological
and peripheral activities. This process would account for the potent, unbearable
withdrawal rebound effects typically seen in opiate addicts (Grilly, 1994).
Although these authors did not make the opioid link, Kraemer and Clarke (1996)
have speculated that reduced NE and DA activity levels in mother-deprived monkeys may
result in supersensitized postsynaptic NE and DA receptors (Kraemer & Clarke, 1996)
that would produce an exaggerated and inordinate (p. 131) response to social stressors
resulting in aggression. This represents another homeostatic mechanism for doing a lot
with a little, but is different from upgraded numbers of sites; in this case there is a change
in the chemical processing components o f the receptors themselves.
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Smith, Torgerson, Kim, and Stevens (1992) found that human infants bom well
past their due dates, and who thus had experienced chronic prenatal stress (due to
inadequate nutrition and fluid due to the rapid decrease of amniotic fluid after 40 weeks of
gestation) had developed a tolerance to endogenous opioids (B-endorphins) released in
their central nervous systems in response to the distress while still in the womb. Not only
did post-term infants require significantly more concentrated sucrose solutions (Sucrose
produces unconditioned opioid calming effects in infants.), they found these babies could
not remain calm after the sucrose was no longer being delivered to them in stark contrast
to normal controls who could remain calm for an extended period of time after stopping
sucrose delivery. Smith et al. suggest that chronic stress precipitating altered, less
effective endogenous opioid functioning may be responsible for the difficult temperaments
and social interaction problems often observed four to five years after birth in postmature
babies.
Bessel van der Kolk (1996) has found that for persons with PTSD, traumatic
reexposure can cause a sufficient increase in endogenous opioid levels to obtain an
analgesic effect. This dynamic could account for Freuds observed repetition
compulsion as well as the addiction to trauma observed in Vietnam Veterans with
PTSD (van der Kolk, 1996). Therefore, children and adults with PTSD might engage in
risk-taking behaviors or provoke others into repeated dramatic, tumultuous conflicts in
order to achieve the intense degree of stimulation required to obtain an analgesic
endogenous opioid effect.
Release o f rage, resulting in an extremely salient reduction in arousal, may also
produce an opioid-mediated pleasure response. A 1984 study by R. M. Post et al.,
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reported in Emil Coccaros (1996) review o f Neurotransmitter Correlates o f Impulsive

Aggression in Humans lends some support to this hypothesis, showing a positive
correlation between CSF opioid binding protein and the Buss-Durkee subscale
assaultiveness (r = 0.77, n = 18, p < 0.0002) in healthy male volunteers (p. 85).
(Remarkably this was the only study linking endogenous opioids to aggression Coccaro
and the author o f this dissertation were able to find.)
A hidden advantage even in high-conflict parent-child relationships is that young
children are at least in emotional contact with their mothers, perhaps affording some type
o f primed, unconditioned opioid mediated sense o f social connectedness. To be alone, but
all alone is unbearable. In a desperate, albeit primitive, attempt to escape this extremely
agitating state, relief can be obtained by head-banging, biting, cutting, or other selfstimulating and/or self-injurious behaviors. Self-injurious behaviorswhich have been
observed across species (especially during periods of separation distress) and which often
have an addictive or self-sustaining qualityhave been linked with increased levels o f
endogenous opioids (Coccaro, 1996; Russ, 1992). Such desperate adaptations are
especially poignant when contrasted with the (also opioid mediated) comfort provided by
a warm, loving, affectionate mom within the context of a safe, healthy attachment
relationship as described by John Bowlby.
Maternal deprivation rage.
This dissertation proposes that expected emotional connectedness with mother is
as hard-wired into an infants brain as the need for food or drink. When such contact is
not forthcoming, intensifying rage pain, perhaps mediated by its substance P receptors
deep within the medial hypothalamus (Panksepp, 1998; Siegel, Schubert, & Shaikh, 1997)
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is equivalent to the intense pain experienced in other deprivation conditions: starvation or

extreme thirst. When the expected contact is not forthcoming infant reactions appear
equally, if not more, extreme.
Harry Harlows Nature o f Love experiments, perhaps the most compelling
attachment studies of all, found that reinforcement obtained through contact with a soft
mother analog is even more potent than reinforcement obtained from food, contrary to his
own prediction (Harlow, 1958; Harlow, 1959 in LeFrancois, 1984). For these
experiments, Harlow constructed tw o types o f surrogate monkey mothers. The first was
made from a block of wood, covered with sponge rubber, and sheathed in tan cotton terry
cloth. A light bulb behind her radiated heat (Harlow, 1958, p. 676). The second was
made o f wire-mesh, a substance entirely adequate to provide postural support and
nursing capability, and she is warmed by radiant heat (Harlow, 1958, p. 676). Some of
the monkeys received their milk from the cloth mothers, some from the wire mothers,
although they had access to both. An account o f experiment results is provided in
LeFrancois (1984):
Harlow measured attachment in two ways: the total time per day that the infant
spent embracing one model or the other, and the infants response to a fearproducing stimulus such as the plaster cast of a monkey head or a mechanical
teddy bear that moved and played a drum. The results? After the age o f twentyfive days (presumably some time is required for the attachment to develop), all
monkeys spent little time with the naked wire model, but spent over twelve hours a
day with the terry-cloth mother. If the models were placed in close proximity, the
infant would attempt to feed from the wire model while clinging to the terry-cloth
model. Similarly, the infants ran into the arms o f the soft mother when shown the
frightening stimulus. If she was not present, the infant monkey reacted with much
greater fear, frequently cowering in a comer of the cage or the room and adopting
a quasi-fetal attitude, occasionally covering its eyes. (p. 158-157)
In his discussion o f the findings, Harlow offered these remarks:
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We were not surprised to discover that contact comfort was an important basic
affectional or love variable, but we did not expect it to overshadow so completely
the variable o f nursing; indeed, the disparity is so great as to suggest that the
primary function o f nursing as an affectional variable is that o f insuring frequent
and intimate body contact of the infant with the mother. (Harlow, 1958, p. 677)
It would make evolutionary sense to seal this bond, so critical to infant brain development,
that must be sustained over such as extended period o f time, with perhaps the brains most
potent chemical, endogenous opioid. If babies are deprived o f this inborn expected
relationship, it would come as no surprise that arousal would escalate into extreme rage.
Maternal (opioid) deprivation would be expected to send an infant (one who is old
enough to move about) into a contact seeking frenzy. If the expected goalcontact with
mother (and anticipated arousal reduction)is unobtainable, energized seeking behavior
might be displaced onto another, even inappropriate, target. Panksepp (1998) provides
this example of rats who have been induced to crave water through a series o f
deprivations (first by depriving them of enough food to quench hunger, forcing them to
displace food craving onto water-drinking, then depriving them o f water):
If water is not available, the animal will exhibit other behaviors such as compulsive
shredding o f available objects or schedule-induced wheel running. One can even
obtain aggression if another animal is nearby. Animals appear to vent the
frustration o f neuroemotional energy emerging from unfulfilled expectations on
any available target... In other words, hungry animals may experience sustained
foraging arousal, and if they cannot satisfy this urge by homeostatically appropriate
consummatory behavior, they will start to exhibit alternative consummatory
behaviors that can partially alleviate feelings o f excessive appetitive arousal.
(Panksepp, 1998, p. 161)
This is consistent with the Frustration Hypothesis, formulated by Dollard et al.
(1939, in Panksepp, 1998) which proposes that aggression will increase proportionately to
the level of frustration resulting from the thwarted goal. The extreme rage seen in
preschool aged children who have been deprived of attachment (i.e. adopted infants from
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Russian orphanages diagnosed with Reactive Attachment Disorder) would appear

proportionate to the intensity o f the desperate cliraging observed in Harlows motherdeprived infant monkeys (not unlike the food-hoairding behaviors observed in severely
neglected children) and would appear consistent w ith the emergence o f aberrant
aggression during the toddler age consistently s-een in mother-deprived primates (Deets
& Harlow, 1971; Kraemer & Clarke, 1996).
Expectancy (placebo) effects are evidently mediated by opioids (Amanzio &
Benedetti, 1999), as is unconditioned reinforcement upon obtaining biologically significant
resources such as foods containing sugars and fats (Blass, 1996). Panksepp (1978) has
demonstrated that infants obtain endogenous opioid mediated relief in contact with their
mothers as evidenced in attenuation o f their distress cries. The particular type of opioid
they are receiving, B-endorphin, is the most potent opioid activating mu receptors
(Panksepp, 1998), is abundant in social-emotion brain structures to include the
hypothalamus, and may produce euphoric as well as quelling effects. It would only make
sense that the converse would also be true, that deprivation o f this opioid in socialemotion circuits would result in withdrawal rag;e pains. Endogenous and exogenous
opioids can quell rage and associated aggressive behaviors; withdrawal from opioids can
produce them (Panksepp, 1998; Siegel, Schubert, & Shaikh, 1997).
With emergence of the septal nucleus (at about five months o f age), babies can
discriminate and form selective attachments with ttheir mothers. It is about this age that
Bowlby (1969) observed the onset o f normal prottest reactions in infants upon separation
from their mothers. It may be that the protest (crying at this age) is underpinned by a
corresponding dip in B-endorphin with a commermsurate increase in CRF. CRF activates
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distress cries in young infants (Panksepp, 1998). CRF would also stimulate NE in the
locus coeruleus which, in turn, would activate the sympathetic nervous system producing
intensified arousal. This description o f predictable, normal seeking behavior-contact
seeking upon separation from motheris provided by Bowlby (1969):
The initial phase, that of protest, may begin immediately or may be delayed; it lasts
from a few hours to a week or more. During it the young child appears acutely
distressed at having lost his mother and seeks to recapture her by the full exercise
o f his limited resources. H e will often cry loudly, shake his cot, throw himself
about, and look eagerly towards any sight or sound which might prove to be his
missing mother. All his behavior suggests strong expectation that she will return.
Meantime he is apt to reject all alternative figures who offer to do things for him,
though some children will cling desperately to a nurse, (p. 27)
Human children and primates deprived of social stimuli, particularly maternal
social stimuli, may have hypersensitized or upgraded numbers o f B-endorphin receptors in
social-emotion circuits. Therefore, exposures to social contact may be experienced as
potent (salient) opioid surges that leave the system faster than analgesic opioid. Such
rapid depletionthat might be worsened by subsequent separations from social contact
might also produce proportionately extreme withdrawal rebound effects with intense
arousal. Additionally, as illustrated in the previous example o f cravings induced in mice,
only partially fulfilled deprivation demands appear to further intensify the cravings. These
factors would greatly exacerbate already escalating arousal due to unfulfilled need.
Intensified agitation coupled with insufficient experiences with positive outcomes would
further erode the arousal tolerance range. Enraged children, desperate to get rid o f these
aversive agitating feelings might displace them onto the closest available target: their toys,
animals, other children, or even themselvesnot unlike consistently observed
unpredictable aggression of mother-deprived primates which is out o f proportion in
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severity and duration, and directed toward improbable objects which Kraemer and Clarke
call violence (Kraemer & Clarke, 1996, p. 125
Predominantly opioid dominant vs. opioid deficient: state becomes trait.
Lowered cortisol and NE levels seen in mother-deprived primates and aggressive
human populations may reflect an extremely early adaptive reliance upon analgesic opioid
defense mechanisms that predate maturation o f the amygdala, fear response, and other
components o f the HPA stress circuit. Initially, this may be quite adaptive by prolonging
the brains plasticity if the particular type o f experience required to spur further
development is not forthcoming. If, for instance, NE is reduced in a grouping of neurons
during a period devoid o f its expected experience, an organizational pattern for this
grouping may be delayed (Greenough, Black, & Wallace, 1987). As previously
discussed, cortisol must be kept within an optimal range during brain development, to
prevent damage to emergent structures such as the hippocampus (Gunnar, M. R., 1998;
Lombroso & Sapolsky, 1998; McEwen, 1999; Rosenfield, Suchecki, & Levine, 1992).
And, experience-expectant brain structures and circuits hold out hope, and hang on, if they
get even minimal amounts o f the specific kinds o f stimulation required to spur their
development.
But, the brain cant wait forever in an unaltered state. Indeed, as previously
discussed, many areas o f the brain are progressing at various developmental stages
simultaneously. Structures that are delayed may lose out on their rightful, appropriately
influential place within a circuit; the circuit may become abnormal by components that are
out o f sync developmentally. Thus, protracted exposure to opioids, inhibiting normal
activation o f DA, NE, and cortisol, may prevent these neurotransmitter systems from
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gaining the sufficient developmental experience needed to obtain mature levels. Low
DBH levels seen in aggressive children and blunted HP A functioning seen in motherdeprived primates would be consistent with this hypothesis.
Should an infant, during a critical developmental period, spend an inordinate
amount o f time in either an opioid dominated or opioid depleted state, the neurobiological
system may readjust itself, in alignment with its experience, to that particular state as its
normal set point range or baseline. Hence, this aberrant (originally state-like adaptive)
patternuncorrected for the duration of the developmental windowcould become
intractable and, therefore, trait-like.
Summary: Nature o f Psychopathology Arising from Developmental Period:
Birth to Two Months
To summarize, projected psychopathology resulting from attachment deficits,
distortions, and abuse during the first two months of life would arise from extraordinary
adaptations required to establish organismic homeostasis under extremely abnormal
environmentally imposed conditions. Based on the infants available brain structures and
emotion circuits on-line and functioning during this period, such adaptations would show
themselves as abnormalities in arousal management, autonomic nervous system
functioning, and hypothalamic activities. Developmental aberrations would also be
expected to occur in the emergent amygdala, fear circuit, and stress response which are in
the process of coming on-line and, therefore, require specific types of experiences to drive
their development. Infants subjected to deprivation and abusive conditions early in life
receive a double blow to their fragile central nervous systems. N ot only are these babies
having to contend with traumatic stress while at their most vulnerable, least equipped
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developmental state; they are not getting augmentation o f their nervous systems by warm,
soothing, sensitive maternal care as required even under normal conditions.
Those infants with less developed parasympathetic nervous systems or whose
adverse experiences are not o f sufficient magnitude to trigger emergency neurobiological
defenses are going to be at increased risk for sympathetic hyperactivation, resulting in
rapid heart rate, increased N E and cortisol levels, and precocious engagement o f the stress
response (even before all its components have formed). Such infants would feel aversive
sensations from extreme arousal with reduced opportunities to obtain pleasurable states
with arousal reduction. Euphoric opioids and exhilarating dopamine would be notably
deficient. Reduced opportunities for building up a stock pile o f good feeling outcomes
would diminish motivation to approach and explore the environment with eager
anticipation, optimism, and hope.
Bombarded by impingements coupled with poor maternal responding, these babies
would feel powerless and ineffectual in getting needs met, fostering dependency on others,
but with low expectations. Hypersensitized reactions to sensory stimuli (either from
under- or overstimulation) would exacerbate arousal, making it even more difficult to get
heart rates under control, required for sustaining attention to and incorporating
environmental stimuli. Such infants may be especially prone to irritability or rage due to
unmet needs that have resulted in increasing arousal over extended periods o f time.
Violations o f primed stimulus and outcome expectancies would also produce rage.
Self-directed defenses available to these infants would include compulsive
nonnutritive sucking to displace excessive seeking system arousal and sleep to shut off
stimulation. Fussiness and inconsolable crying may become annoying to others. These
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infants would have difficulty becoming calm, engaging parasympathetic restorative states,
and buffering stress due to reduced opportunities for obtaining mothers soothing opioidmediated comfort. Over time, chronic stress response activation may result in proneness
to autoimmune disorders. With excessive amounts o f time spent in sympathetic vs.
parasympathetic states, infants may become energy depleted and lethargic.
Infants o f depressed or angry mothers would gain excessive experience with flat or
threatening faces and insufficient experience with happy, expressive facesstimulating
right vs. left amygdala and cortical regions and setting the infant up for future
predominance o f negative vs. positive stimulus expectations and mood states. These
youngsters may become overly fearful, developing inhibited temperaments and behaviors.
Flat or negative facial expressions, similar to those of their mothers may be off-putting to
others, contributing to rejection. Reliant upon maternal feedback, these little ones may
develop negative self viewsnot only because they generally feel bad, ineffective, and out
o f controlbut because they do not see happy, excited, enraptured mother faces to convey
that they are safe, loved, wanted, prized, and worthy o f belonging.
Infants subjected to conditions of maternal deprivation, distortion, or abuse may
experience an unbearably agitating All Alone trauma, which may become triggered during
other stressful life events as flashbacks. Self-injurious behaviors may be employed to
induce opioid mediated analgesic quelling. Infants with well-developed parasympathetic
and opioid systems can trigger two emergency defense mechanisms for coping with
unbearable arousal: brainstem sympathoinhibitory and analgesic responses. Because these
responses are extremely effective for regaining homeostasis and can be induced
independent o f assistance from another human being, they may become preferred. Thus,
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infants spending excessive amounts of time under their influence would have
hypoactivated sympathetic systems (i.e. slowed heart rates) with little opportunity to
benefit from felt emotion. Any type arousal may become routinely dissociated from the
experience giving rise to it affording little opportunity to learn tolerance for discomfort or
to modulate raw, pure infantile emotion by bringing it under the regulatory influence o f
other emotion systems or effects o f experience. Such individuals may feel depersonalized,
deny having feelings, or appear devoid of normal human emotions.
Chronic exposure to opioids may permanently suppress DBH and NE levels due to
insufficient experience. Opioid suppression of immune system functioning may result in
proneness to infections. With high opioid levels in the system and a heart rate that is
already slowed, the effectiveness o f brain mechanisms mediating sustained attention and
classical conditioning is reduced. Chronic numbing may result in excessive stimulus
barrier, insufficient engagement of the stress response, fearlessness, poor fear conditioning
(i.e. to serve as a deterrent), and stimulus seeking behaviorseven risky survivalthreatening behaviors. High opioid levels in the system would reduce motivation to seek
out, form an emotional bond with, or value relationships with others. Individuals who
lack pain or fear feelings would lack ability to experience empathy for such emotions in
others.
It is axiomatic in these matters of maternal care o f the holding variety that when
things go well the infant has no means o f knowing what is being properly provided
and what is being prevented. On the other had it is when things do not go well
that the infant becomes aware, not of the failure o f maternal care, but o f the
results, whatever they may be, of that failure; that is to say, the infant becomes
aware o f reacting to some impingement. As a result o f success in maternal care
there is built up in the infant a continuity o f being which is the basis o f egostrength; whereas the result of each failure in maternal care is that the continuity
of being is interrupted by reactions to the consequences o f that failure, with
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resultant ego-weakening. Such interruptions constitute annihilation, and are

evidently associated with pain o f psychotic quality and intensity. In the extreme
case the infant exists only on the basis o f a continuity o f reactions to impingement
and o f recoveries from such reactions. This is in great contrast to the continuity o f
being which is my conception o f ego-strength. (Winnicott, 1965, p. 52).
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CHAPTER IV
RESULTS
PART II: SUMMARY OF PROJECTED PSYCHOPATHOLOGY RESULTING FROM
ATTACHMENT DEFICITS AND DISORDERS DURING SEQUENTIAL AGE
PERIODS FROM AGE 2-36 MONTHS
2-5 Months: Symbiosis 2
Brain Available: 2-5 Months
From age 2-5 months, brain structures in place and fully functioning include the
brainstem and hypothalamus. Emotion circuits up and running include the autonomic
nervous system, pleasure, seeking, and rage circuits. The prominent structure coming on
line at this time, fully functioning by 4-6 months, is the amygdala. The amygdala,
utilizing the motivating energy o f the hypothalamus, not only intensifies but sustains felt
emotion (i.e. pleasure, seeking, and rage). With the amygdala come fear, a more fully
functioning stress circuit, and the capacity for anxiety. Fear and fear conditioning,
which can result in behaviors to avoid threatening conditions, represent a first step in
curbing emotion driven behavior. Less mature, but emergent emotion structures include
the septal nucleus (which will add abilities for discrimination and, therefore, selective
attachment; emotional dampening or inhibition; and behavioral inhibition) followed by
the cingulate, hippocampus, and cortex.
Special headings for the six sequential age periods: Autism, Symbiosis, Selective Attachment,
Practicing, Rapprochement, and Object Constancy, are terms formulated for these developmental periods
by Mahler, Pine, & Bergman (1975) in The Psychological Birth o f the Human Infant.
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Prominent Emotion Structure: Amygdala

The amygdala, considered the most influential emotion structure in the brain, is
now rapidly maturing and will become fully functioning prior to six months o f age
(Joseph, 1996). Amygdala are bilateral and located deep in the anterior-inferior temporal
lobes o f both hemispheres, under the neocortex, where they share rich interconnections
with the hypothalamus, hippocampus, septal nuclei, cingulate gyrus, basal ganglia,
thalamus temporal lobes, orbital and medial frontal lobes, and parietal cortex. There is
recent evidence showing interconnections with the nucleus accumbens that may
contribute to extreme pleasurable feelings and/or cravings (Heimer et al., 1997; Koob,
2000). The amygdala will be able to override (even an adult) cortex with emotion
(Joseph, 1996; LeDoux, 1996). The right is larger than the left in humans, and thus,
probably plays a primary role in the right hemispheres dominance for emotion.
Amygdala are larger in human males (Joseph, 1996).
Currently, the amygdala can be considered to be at its critical experienceexpectant developmental peak. It craves social and emotional sensory stimuliespecially
animated, expressive faces; expressive voices; kinesthetic experiences like being carried
about through space; and tactile sensations. This structure assigns meaning to emotion;
its neurons monitor, appraise, interpret, and abstract from the sensory array those
especially tactile, visual, auditory, and socialstimuli that are motivationally significant.
In this capacity, through its connections with the hypothalamus, it helps regulate the
autonomic mechanisms for getting biological needs met and maintaining homeostasis
(Joseph, 1996; Van der Kolk, 2000). The amygdalautilizing the emotional energy
generated by the hypothalamusintensifies and sustains pleasure, seeking, and rage
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feelings; it also creates the capacity to recognize danger and feel fear. The experience o f
fear (and anxiety) involves an intensification and sustenance of arousal, which four to six
month old infant nervous systems are better equipped to handle than those o f newborns.
A particularly critical capacity coming on line with the amygdala is the brains
first long-term memory processing system. The amygdalas subconscious, implicit
emotional memory system is produced by a long-term potentiation (LTP) mechanism
especially geared toward remembering sensory aspects of socially and emotionally
significant stimuli to include the contexts in which they occur. LeDoux (1996) believes
this memory is readily conditioned by primed, biologically significant stimuli. This
mechanism permits the development of expectancies/anticipations connected to stimuli
evoking punishment and reward (LeDoux, 1996; Purves et al, 1997). Amygdala
mechanisms add additional capacity for classical conditioning o f stimuli or conditions
associated with aversive feelings as well as extraordinarily pleasurable sensations.
Unlike the hypothalamus, feeling states processed by the amygdala, can become
sustained past removal o f the stimulus producing them, giving rise to mood. Feelings
sustained or building over time can elicit behavior toward an actual target goal in the
environment. Sustained emotion underpins the capacity for a longer term relationship
such as mother-infant attachment. The amygdala organizes appropriate emotional
behaviors and vocal responses, contributes to dreams, and generates the capacity to feel
fear, anxiety, hate, happiness, love, and joy (Joseph, 1996; Koob, 2000; LeDoux, 1996).
Emotion Circuit: Fear
With the emergence o f the amygdala, a new emotion system comes on board: fear
(Panksepp, 1998; Joseph, 1996; LeDoux, 1996). Panksepp (1998) defines fear as
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an aversive state o f the nervous system, characterized by apprehensive worry,

general nervousness, and tension, which tells creatures that their safety is
threatened. It is accompanied by specific forms o f autonomic and behavioral
arousal. The most common clinical symptom o f fear is generalized anxiety, (p.
207)
Fear circuitry runs from the lateral, central amygdala through the ventral-anterior
and medial hypothalamus to the PAG in the midbrain portion of the brainstem. From
here the pathway continues through the lower brainstem into the spinal cord, activating
the sympathetic nervous system (LeDoux, 1996; Panksepp, 1998). Ultimately, with CNS
maturity, this circuit will involve practically every structure in the brain (Panksepp,
1998). The thalamus sends incoming sensory inputs directly to the amygdala. Therefore,
although the maturing cortex will also eventually send sensory inputs, the amygdala may
not wait to process the more refined, but slower cortical information before triggering a
rapid response to perceived threat (Spiegel, 1999). Subjective feeling states associated
with fear are a sense o f dread and sense o f disconcerting uncertainty. As with anger, fear
sensation varies in intensity along an arousal continuum with mild apprehension on the
low end, ranging up to terror near the top.
Neurobiologists, particularly those who have conducted animal research, draw
striking parallels between behavioral markers associated with fear in animals and anxiety
in humans: tachycardia (both), dry mouth (both), stomach upset (ulcers in animals), fast
and shallow breathing (both), scanning and vigilance (both), increased startle (both),
frequent elimination in both (urination, defecation or diarrhea), agitation (grooming in
animals; restlessness in humans), and apprehension (freezing behavior in animals)
(Panksepp, 1998; Purves, et al., 1997). However, recent evidence suggests that the stria
terminalis portion o f the extended amygdala, septal nucleus, hippocampus, and cingulate
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give rise to anxiety while the central, lateral amygdala gives rise to fear (Davis & Shi,
1999; Panksepp, 1998; Spiegel, 1999; Van Bockstaele, Peoples, & Valentino, 1999; van
derK olk, 2000).
Neurophysiology mediating fear (and anxiety) has been especially difficult to
tease out since so many different neurotransmitter receptor sites run along this pathway.
These include an abundance o f NMD A receptors for glutamate, NE receptors (both likely
involved in consolidation of fearful memories), CRF, ACTH (both o f which have been
associated with aversive sensation), and others (LeDoux, 1996; Panksepp, 1998).
Abundant receptor sites for GABA (brains most pervasive inhibitor (Panksepp, 1998,
p. 217), serotonin, oxytocin, and opioids mediate fear suppression (Panksepp, 1998).
With fear and the amygdala comes a new type of learning and memory; the
ability to remember at a sensory level, and, therefore, avoid painful punishing,
dangerous, and other survival-threatening conditions in the environment. Unconditioned
and/or primed stimuli that elicit fear in infants include pain, sudden or loud noises,
sudden movements, unexpected changes, strange objects, loss o f physical support, and
scary (angry) faces (LeFrancois, 1984; Panksepp, 1998). Previously neutral stimuli can
become classically conditioned as aversive (dangerous) if they occur at the same time
as unconditioned punishing or fear eliciting stimuli; cells that fire together wire
together (LeDoux, 1996, p. 214). The stronger the neuronal firing response (intensity,
quantity o f neurons involved), the stronger the memory. This, o f course, is a different
classical conditioning mechanism from the opioid mediated, arousal quelling
conditioning at brainstem mu receptors producing a pleasurable or soothing effect.
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The amygdalas specialty is storing and remembering discrete bits o f sensory

information o f emotional significance to the individualparticularly social information
such as faces, voices, smells, or touch. This includes remembering aversive or dangerous
as well as rewarding stimuli. Fear expert, psychobiologist Joseph LeDoux 1996) believes
that the amygdalas implicit (encoded at the subcortical level and therefore subconscious)
memory is extremely accurate, lasts life long, and is most resistant to modulation or
reconfiguration by higher brain systems (i.e. the cortex). Based on his extensive body of
research, he has concluded that fear conditioning is particularly resilient, and in fact may
represent an indelible form o f learning (p. 204). PET and MRI scans o f brains of
adults with PTSD consistently show that the amygdala become hyperactivated while
cortical frontal lobes (which normally exert some degree of inhibition over the amygdala)
shut down during presentations o f fear eliciting stimuli (Bremner et al., 1999; Rauch et
al., 1996; Rauch et al., 2000). Trauma expert Bessel van der Kolk (2000) would agree
that emotional memory may be forever (p. 16)
This would be especially true for emotional memories encoded in the amygdala
prior to the emergence of the hippocampus and language centers in the cortex, as would
be the case for very young infants. That most o f us cannot recall any memories back past
age three (LeDoux, 1996) bears this out. Therefore, you do not have to recall an
experience within conscious awareness to have become conditioned by it. LeDoux has
concluded, based on a large body o f neurobiological research, that
absence o f (conscious) awareness is the rule o f mental life, rather than the
exception, throughout the animal kingdom...Emotional responses are, for the
most part, generated unconsciously. Freud was right on the mark when he
described consciousness as the tip o f the mental iceberg, (p. 17)
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Through conditioning, feared stimuli come to elicit avoidance behaviors. The

amygdala, by detecting threatening stimuli, also has the pivotal role in triggering the
stress response, setting off a cascade o f neurobiological events that enable the organism
to take rapid actions to protect its survival.
Emotion Circuit: Stress Response
The purpose o f a mature stress response is to prepare the individual to take quick
action (fight, flee, elicit others, freeze, submit) when faced with threat. The ability to
appraise danger and, thus, experience fearthe emotion that drives this circuitcomes
with maturation o f the amygdala. Fear requires an upgrade in arousal tolerance for both
intensity and duration that a six month old nervous system is more equipped to handle.
The stress circuit is comprised o f the amygdala; hypothalamus, pituitary gland, and
adrenal cortex (known as the hypothalamic-pituitary-adrenal axis or HP A); the locus
coeruleus in the brain stem; and the sympathetic nervous system. Sensing threat, (and
stimulated by NE), the amygdala rapidly appraised the stimulus, using its memory
system, then triggers the cascade o f neurobiological activities known as the stress
response (previously described in RESULTS: PART I). Examples of behaviors or bodily
changes set into motion with moderate release o f CRF include increased heart rate and
blood pressure, heightened arousal, increased vigilance, cautious restraint, and reduced
appetite. These changes are well suited for dealing with short term stress. However,
examples o f bodily changes set into motion with excessive release of CRF (which might
occur in conditions o f extreme or chronic stress) include anxiety, hyper-responsiveness to
sensory stimuli, decreased exploration in unfamiliar environments, and assumption o f a
freeze posture. (Chrousos and Gold, 1992).
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Hypoactivity o f an immature HP A and cortisol suppressing effects, mediated

through CRF inhibition by endogenous opioids, are especially adaptive at this young age
in that cortisol levels must be kept within a narrow range o f concentrations required for
normal development (Rosenfield, Suchecki, & Levine, 1992). Animal evidence shows
that chronic exposure to cortisol has been implicated in dendritic atrophy and even cell
death in the hippocampus (Gunnar, 1998; Lombroso & Sapolsky, 1998; McEwen, 1999),
which could have dire consequences for the developmental outcome o f this structure that
will become so vital to memory and learning, during its current experience-expectant
window (Chugani, 1998). Gunnar (1998) has found that cortisol levels become
suppressed during this period, at about age three months and remain low for up to two
years. She has concluded that the infants relationship with mother buffers stress during
this time. As already discussed (Panksepp, et al., 1978), upon comforting contact with
mother, B-endorphins are released in the hypothalamus which inhibit CRF, calming both
the Locus coeruleus and HPA circuits, thereby inhibiting cortisol release.
Developing Brain: 2-5 Months
Septal Nucleus (Alias Septum!
The next emotion structure coming on line, at about five months, is the septal
nucleus. It effects an inhibitory or dampening effect on felt emotion arising in the
amygdala and hypothalamus, placing some brakes on emotion driven behavior. The
septal nuclei specialize in the ability for discrimination, and therefore promote a selective
attachment to one particular person-m other. The emotion that arises with the ability to
discriminate is the ability to experience emotional pain (i.e. sadness) or loss (i.e.
grieving) when an object is unavailable. An infant at this age, due to lack o f capacity for
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sustained internal representation, will likely experience the absence o f mother as loss
going on forever, no matter how long the separation. The ability to feel loss results in
grieving or sadness. Jaak Panksepp (1998) associates the emotion circuit giving rise to
panic with loss.
Cortex: Temporal Lobes
The temporal lobes will have increased from 22 % at birth to 83% o f adult
capacity by two years o f age (Joseph, 1996). The innermost, inferior portion emerges
slightly faster than the outer, superior portions closer to the skull. Deriving from the
amygdala, hippocampus, and occipital lobe, the temporal lobes have been stimulated by
and maintain rich interconnections with these structures. In fact, the amygdala lies deep
inside this lobe. Temporal lobe processing specializations include awareness o f visual,
auditory, visceral, and emotional sensations; memory encoding, storage, and recall; facial
recognition; visual discrimination, analysis, and integration; perception o f shapes, colors,
textures; contextual aspects o f memory; temporal sequencing; short-term emotional,
visual, auditory, and cognitive memory retention; receptive language; perceiving the
emotional, expressive aspects o f auditory stimuli such as speech, nature, or music;
auditory cortex; language; and thought (Joseph, 1996; Lezak, 1983). In addition to the
sensory inputs the temporal lobes receive from the thalamus and visual cortex, inputs
from the amygdalaas the amygdala themselves obtain their expected environmental
stimuliwill promote rapid growth in these areas of the neocortex. Temporal lobe areas
become highly activated when MRI subjects experience fear, rage, and lust (Panksepp,
1998) and are generally more active in male than female brains (Panksepp, 1998).
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Observable Infant Capabilities: 2-5 Months

Beginning at about three months o f age, infants noticeably become more sociable.
Contact with others is an extremely potent and necessary stimulus at this point in
development (Joseph, 1996), and, although infants still prefer their parents, right now
they are not particularly choosy. By five months, that will begin to change as they begin
to develop a more exclusionary preference for their mothers, while becoming wary o f
strangers (Bowlby, 1969; Mahler, Pine, & Bergman, 1975).
Infants are especially hungry for tactile, visual, auditory, and socially, emotionally
significant stimuli, extending their interests to novel as well as familiar stimuli (Geva,
Gardner, & Karmel, 1999). The experience-expectant amygdala is primed for social
contact. Joseph (1996) suggests that evolution has maximized infants chances o f getting
this by the indiscriminate contact-seeking they display with emergence o f the amygdala.
Vision is starting to clear up and babies can focus on more around them than just their
moms face an arms length away (LeFrancois, 1984). In fact, they love looking at faces
(as long as theyre not scary, angry ones) and can spot them across a crowded room.
Babies, although reliant on milk feedings, will begin to eat solid foods at around
five months, as their digestive tracts mature. Beginning about four-five months, the
infant will often abruptly stop feeding to pay attention to all sorts o f new sights and
sounds in the environment as focus is redirected outward. Feeding times will also be
good play/interaction times (Brazelton, 1992).
Over the period spanning 2-6 months, infants will be able to pull up their chests;
reach, but miss; eventually sit with support; come to sit by self in a high chair; and grasp
a dangling object (LeFrancois, 1984; Brazelton, 1992). Babies at this age are gaining
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more volitional control over their hands, arms, legs, and physical movements with
behaviors looking m uch less reflexive (Brazelton, 1992).
Brazelton (1992) has observed that two-month old infants begin to alert
themselves when placed in the position in which they have come to expect interaction.
The fussy state generally diminishes and then drops out as one o f the normal states by
about three months (Brazelton, 1992). Infants stretch out their sleep states longer (up to
8-12 hours) and gradually adjust to their parents schedule (Brazelton, 1992). By age
four months they are on a fairly predictable schedule. They are also learning to alternate
their deep and light (REM ) sleep cycles. As part o f this process infants will need to settle
themselves back down two or three times over the course o f their sleepingsomething
they will, hopefully, learn how to do on their own by about five months (Brazelton,
1992).
In addition to intensified and sustained pleasure, excitement, and rage, infants will
also be able to experience fear feelings. Unconditioned and/or primed stimuli that elicit
fear in infants include pain, sudden or loud noises, sudden movements, unexpected
changes, strange objects, loss o f physical support, and scary, angry faces (LeFrancois,
1984; Panksepp, 1998). However, even though fear is coming on board, positive, happy
affectssmiling and laughingdominate this exciting period. Infants start to smile even
more at familiar faces. By age four months they are laughing, at first to physical
stimulation, but increasingly in response to social encounters (LeFrancois (1984).
LeFrancois suggests the function o f laughter is to release tension, whereas fear signifies a
build-up o f tension.
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By age three months there is markedly less crying, but infants do have a repertoire
o f several kinds of cries to communicate what they need (Brazelton, 1992; LeFrancois,
1984). Babies are even better able to comfort themselves with their thumbs o r pacifiers;
they also may calm themselves by listening to people talk, rooting around in bed (p.
74), or by rocking their heads (Brazelton, 1992).
Classical conditioning to both rewarding and frightening experiences occurs
during this time. Potent reinforcement comes on board with emergence o f the extended
amygdala-nucleus accumbens circuit, infused with dopamine co-mingled with opioids
(Berridge, et al, 1997; Heimer, 1997; Koob, 2000; Panksepp, 1998). Fear conditioning to
aversive punishing or frightening stimuli can result in future avoidance o f these stimuli.
Subconscious, implicit memory comes on board, which retains the sensory-social aspects
o f emotionally significant experience (LeDoux, 1996). Age 2-5 months, language is still
in the prespeech stage with every sound from any culture in the world still possible
(Gopnik, Meltzoff, & Kuhl, 1999). By about six months, babbling begins to sound like
monosyllable consonant-vowel combos, such as da, ma, or di (LeFrancois, 1984).
Developmental Theories o f Psychology Grounded in Observable Phenomena:
2-5 Months
Piaget places an infant o f this age in the Primary Circular (pleasurable habit
forming ) substage o f the Sensorimotor Stage as previously described (LeFrancois, 1984;
Piaget & Inhelder, 1969). This second substage lasts to approximately 4 months. The
Secondary Circular Reactions substage kicks in at about 4 months, lasting to 8 months.
Activities (i.e. kicking) leading to interesting sights and sounds (i.e. dancing mobile) are
repeated; and baby reaches and grasps at everything in sight. The infant can be observed
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to use the same means to achieve different ends, mirroring Panksepps observations o f
seeking system mechanisms as previously described (Panksepp, 1998).
Freud would continue to place an infant this age in the Oral stage (Feist, 1990).
At this time, baby may be most id-like and pleasure focused~in love with all, excited
about and eager to take in every new sight and sound. An infants increased volitional
ability to grasp objects and bring them into the mouth enhances orality.
The infant also continues in Ericksons initial Trust vs Misturst (oral-respiratory,
sensory-kinesthetic) stage. The radius of relationship is mother. With adequate
negotiation o f this period of development the strength o f hope emerges. The core
pathology that would emerge from inability to negotiate this stage (i.e. from excessive
fearfulness) is w ithdraw al. (Feist, 1990).
Mahler (Mahler, Pine, & Bergman, 1975) calls the period from two to about fivesix months Symbiosis: The normal symbiotic phase marks the all-important
phylogenetic capacity o f the human being to invest the mother within a vague dual unity
that forms the primal soil from which all subsequent human relationships form (p. 48).
Mahler hypothesized that
images o f the love object, as well as images of the bodily and later the psychic
self, emerge from the ever-increasing memory traces of pleasurable (good) and
unpleasurable (bad) instinctual, emotional experiences, and the perceptions with
which they become associated...Even the most primitive differentiation,
however, can only take place if a psychophysiological equilibrium can be
attained. This depends first on a certain matching of the discharge patterns o f the
mother and the young infant, and later, on their interactional patterns,
behaviorally discernible in mutual cueing, as well as in the infants earliest
adaptive patterning and in his receptive capacities with the good enough holding
behavior o f his symbiotic mother, (p. 49)
She stressed that normal autism and symbiosis must be successfully achieved to permit a
normal separation-individuation process, which she believes begins about age six months.
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Per Kohlbergs Moral Development theory, all infants are in the Pre-Moral stage.
(LeFrancois, 1984). The purpose o f babys behavior during this stage is to obtain
immediate pleasure and avoid pain.
Developmental Tasks and Mechanisms o f Mother-Infant Attachment: 2-5 Months:
Falling in Love
Key maternal-infant tasks during the three to five month age period include
intensification o f the pleasure feelings arising from their interactions; assuring infants get
an abundance o f especially positive, happy social, emotional sensory stimulation (i.e.
animated faces, expressive voices, getting held and carried about) from multiple people;
and ongoing sensitive maternal responses to infant communications to maximize
environmental approach and exploration, omnipotence, trust, optimism, and selfeffectance while minimizing fearfulness.
Intensified Pleasure and Pleasure Seeking
From about age thee to five months marks what can be considered a hedonistic
period for infants. Interesting changes are beginning to occur. As previously discussed,
Gunnar (1998) found that cortisol levelsnormally stimulated by CRF activation o f the
stress responsebegin to drop about this time. Also, at about age three months there is
markedly less crying (Brazelton, 1992; LeFrancois, 1984) which is also activated by CRF
(Panksepp, 1998). These observations would be consistent with inhibition o f CRF by
potent B-endorphins released in the infants hypothalamus upon contact with mother,
serving to buffer stress (Panksepp et al., 1978). Sleep times are prolonged and schedules
obtained. Babies are also beginning to smile a lot more, especially at their mothersa
sure fire way to get most mothers hooked. Frodi and Lamb (1980) found that some
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parents even experience calming effects when their babies smile at them. It is about this
time that Brazelton (1992) finds that parents have become quite attached, falling in
love with their infants (p. 84). Babies are getting to be very fun to have around.
B-endorphin opioid bursts obtained from contact with mother activate mu
receptors (which mediate Morphine addiction) and appear to provide euphoric as well as
quelling sensations (Nelson & Panksepp, 1998; Panksepp, 1998). According to Joseph
(1996), the human amygdala contains the highest concentration of opioid receptors o f all
brain regions. Another neurobiological factor that may be strengthening the infants
attraction to mom is the emergence o f the extended amygdala-nucleus accumbens circuit
which has recently been pin-pointed as the hot-bed o f addiction for most drugs o f abuse
to include opiates and cocaine (Heimer et al., 1997; Koob, 2000). With activation of this
circuit the infant may be getting a heady rush o f opioid co-mingled with dopamine,
producing extremely exciting, euphoric feelings (Berridge, et al, 1997; Koob, 2000;
Panksepp, 1998). By four months, infants are not only smiling, but laughing. The
amygdala sustains feeling states, giving rise to happy baby moods. In fact babies are
feeling so good, they now actively turn their attention outward to explore their new
worlds, seeking out novel as well as familiar stimuli (Geva, Gardner, & Karmel, 1999).
The brain appears primed to reinforce the social-emotional sensory experiences it
requires at this point in its development. With the amygdala comes gregariousness
(Panksepp, 1998, p. 271) and indiscriminant social contact seeking (Joseph, 1996).
Amygdala neurons are prepared for learning species specific cues, i.e. from faces
(LeDoux, 1996), eyes, others gaze, and smiles (Joseph, 1996); are polymodal,
responding to a variety of stimuli from different modalities simultaneously (Joseph,
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1996, p. 178); and are especially sensitive to somesthetic input and physical contact.
(Joseph, 1996). Babies cant get enough o f expressive faces, especially happy faces,
exciting voices, and animated bodies. Infants own smiles and rapt attention naturally
reinforce those interacting with them to do it even more. Babies at this age seem to enjoy
being handed from person to person and carried about to get all sorts o f interesting new
views.
Daniel Stems (1985) observation o f maternal affect attunement is extremely
consistent with infant multi-modal sensory stimulation requirements during this period.
The process he describes involves parental resonance with the infants feeling state which
is more often than not expressed back to the infant through a different sensory modality
or combination o f modalities than the one initially utilized by the infant. And, with
heightened sensitivity to touch, infants are likely developing a sense o f skin boundary,
strengthening the demarcation between the me and the not-me as observed by
Winnicott (1965, p. 61), preparing them for the onset o f their individuation process at
about age five to six months (Mahler, Pine, and Bergman, 1975). If mothers continue to
respond in a sensitive, timely manner to infant overtures, their babies, through repeated
experiences, are stock-piling sensations o f omnipotence, trust, optimism, and selfefficacy. Indeed, infants have likely set up great expectations regarding self in relation to
their environment.
When infants do become overstimulated by too much social contact, they utilize
an avoidance strategy, gaze aversion, as a way to terminate their interaction, reducing
arousal (Toda & Fogel, 1993). Infants also utilize gaze aversion to cope with the
negative overstimulating effects o f unresponsive mother faces, as seen consistently in
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numerous replications of Edward Tronicks still face experiments (Tronick, 1978;

Tronick, Cohn, & Shea, 1986; Kogan & Carter, 1996; Toda & Fogel, 1993; Mays &
Carter, 1990). Three month old infants, however, will spend longer looking at mothers
face in these studies than do older infants (Toda & Fogel, 1993), and girls show a more
negative response to lack o f facial feedback from their mothers than do boys (Mayes &
Carter, 1990). Those infants with sensitive mothers reengage with their mothers more
readily, show more positive affect upon reengagement, and remain more organized than
infants who do not (Kogan & Carter, 1996; Tronick, 1986). Needless to say, face-toface mother-infant interactions (i.e. vs. mothers bypassing babys gaze to watch her
soaps on TV during feedings) are critical for maintaining homeostasis within infant
arousal tolerance zones. Infants who do not get facial feedback from their mothers can
even become disorganized (Mayes & Carter, 1990).
Healthy Fear Conditioning
LeFrancois (1984) described findings of a longitudinal study by G. W. Bronson
(1972) o f fear in 32 infants: when faced with novel stimuli the most prevalent class of
responses for three- and four-month-old infants is one o f smiling rather than one of being
uneasy or o f crying (p. 150). This same study also showed that infants, especially boys,
take their cues from their mothers; those with sensitive (vs. indifferent) mothers were less
apt to become fearful of novel stimuli or strangers.
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Psychopathology Resulting from Attachment Deficits and Distortions: 2-5 Months:

Unrequieted Love: Unloved and Ail Alone
Unrequieted Love
Three month old infants o f depressed mothers show more sad and angry facial
expressions and fewer expressions o f interest than infants o f healthy mothers (Pickens &
Field, 1993). These infants are also less responsive to their depressed mothers. This sets
up an extremely problematic set o f reciprocal dynamics: infants who look sad, angry, and
uninterested are certainly less beguiling, attractive, reinforcing, and desirable than are
happy, excited, wide-eyed, smiling babies showing rapt attention; depressed mothers
tend to distort their infants as more difficult and less attractive than nonbiased reporters
(Gunnar et al., 1990; Lyons-Ruth, Easterbrooks, & Cibelli, 1997; Martinez, et al., 1996;
Mebert et al., 1991); depressed mothers are going to be less motivated to show warmth
toward, engage, or meet the demands o f an unattractive, disinterested baby; mother faces
are even more likely to display disinterest, sadness, frustration, irritability, or disgust as
they provide mirroring feedback to their infants. Expected happy, exaggerated,
enraptured mother faces are not sufficiently forthcoming during the emerging amygdalas
developmental window, producing stressful, angry, overstimulating infant feelings
managed by infant disengagement (even in normal infants) (Tronick, 1986); and, infants
with generally negative relationships with their mothers try less hard and give up easier in
attempting to re-engage their mothers than do babies with good relationships (Tronick,
1986).
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Feeling Unloved and All Alone

I f emotionally unfulfilled, depressed mothersvia role-reversalmay be looking
for mirroring to establish themselves as competent, appreciated, desired, and loved; they
are likely to become further depressed, avoidant, rejecting, or angered by the negative,
disinterested, even angry affective feedback they are getting from their infants. Based on
propensity to notice disgusted, surprised, angry, or frightening faces vs. sad, happy, or
interested faces (Rubinow & Post, 1992), depressed mothers may even come to view
their infants as threateninginvesting them with way too much power over their own
adult feelings and behaviors. Because the baby becomes blamed for mothers bad
feelings, the baby becomes responsible for their negative relationship and mothers
insensitive, harsh treatment is thus justifiable. Seeds are in place for emergence o f a
strifeful, coercive relationship in which the threatening infant must be controlled.
Unpredictable. Disorganized Maternal Environment
Ambivalent, inconsistent, distorting mothers, who can swing from loving and/or
overprotective to rejecting and/or dangerous, may pose enormous risks to their infants.
These babies may be able to get enough good feeling supplies that they are able to
activate the extended amygdala-nucleus accumbens circuit. However, if supplies are not
consistently forthcoming, opioid and dopamine receptors might become upgraded or
hypersensitized to make up for the deficits. As a consequence, contact with mother may
be experienced as excessively potenteither extremely reinforcing or over the top and
overstimulating as the infants arousal tolerance range is exceeded. During supply
deprivation periods, these infants may experience withdrawal reactions that are
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proportionately extreme, exacerbating already intense sympathetic arousal that would

occur from either deprivation or dangerous conditions, resulting in intensified rage pains.
Because an infants contact with an unpredictable mother may be potently
reinforcing some times, but punishing at other times (when her responses are harsh),
classical conditioning to the maternal environment my become extremely mixed and
inconsistent. An infant in such circumstances would have great difficulty in forming a
secure, organized attachment but, due to the unpredictable, inconsistent reinforcement
schedule, have a very difficult time extinguishing a dependency on her in order to
become individuated. Matters are made worse by arbitrary and/or inappropriate maternal
responding to infant gestures, resulting in grossly deficient sensations of self-effectance,
internal locus o f control, omnipotence, trust, or hope.
Because mother is unpredictable and inconsistent in the availability or intensity of
her responses, an infant at the mercy o f her changeable mood states would not be able to
achieve a reliable set of expectancies that would otherwise impose order on the chaotic
new environment outside the womb. This infant, if attempting to utilize her as an
auxiliary nervous system to achieve homeostasis, would not only be swung far and wide
perhaps way out o f a tiny nervous systems tolerance rangesuch an infant might have to
become hypervigilant (i.e. for threatening mother faces and voice tones) as well as
sympathetic dominant to accommodate impingement at a moments notice. Therefore,
this infant would have little, if any, opportunity to establish (let alone re-establish) a
homeostatic baseline or usual set-point range, resulting in few opportunities to
experience calm, restorative parasympathetic states. To relax into a calm state may even
pose too great a risk of annihilation should the infant be caught off guard.
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Aberrant Development o f the Amygdala and Corresponding Areas o f the Cortex

Infants with physically or emotionally unavailable mothers may be unable to
obtain sufficient primed expected experiences required for normal development of the
amygdala during its developmental window. Traumatized infants who have become
dependent on brainstem opioid mediated dissociating defenses (sympathoinhibitory and
analgesic responses) may have also thus become deprived o f required experiences. An
insufficiently or abnormally developed amygdala might result in developmental
anomalies or deficiencies resembling those observed in Kluver-Bucy syndrome, a
disorder that occurs with removal, lesions, or other abnormalities o f the amygdala.
Kluver-Bucy type presentations include inability to recognize the emotional significance
o f stimuli, especially social stimuli; inability to recognize faces, interpret facial
expressions, or pick up on other affective social nuances conveyed by others;
inappropriate behavioral responses to social stimuli or to social context; emotional
blunting; lack of interest in others; ostracism by others; excessive orality (mouthing of all
sorts o f objects); hypersexuality; and/or fearlessness. Should females become mothers,
their maternal behavior may become grossly disturbed. (Joseph, 1996; Panksepp, 1998;
Rubinow & Post, 1992). Mother-deprived primates have been found to show similar
gross social deficiencies, have poor ability to send or interpret affectively-conveyed
social communications, display aggression toward inappropriate targets (Deets &
Harlow, 1971; Miller, Caul, & Mirsky, 1967 in Buck, 1988), and experience frequent
rejection by peers (Suomi, 1995). Those deprived monkeys who later became mothers
grossly neglected, attacked, or killed their own infants (Harlow, 1962 in Buck, 1988;
Suomi, 1995).
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Excessive or Insufficient Fear Conditioning

Excessive fear conditioning.
Infants of unavailable, rejecting, or dangerous mothers are likely deficient in Bendorphin (triggered by positive maternal contact) which inhibits CRP, instigator of the
stress response. Elevated levels o f NE and cortisol (Lundy, et al., 1999; Field, 1998) in
infants o f depressed mothers, particularly at a time when cortisol levels have been
observed to drop during normal development, show precocious utilization o f the stress
circuit. Amygdala mechanisms for designating fearful stimuli, feeling fear/anxiety, and
activating the stress circuit may gain excessive experience. Infants suffering from
neglect, distortion, or abuse who have not been able to activate sufficient parasympathetic
heart rate control or analgesic stimulus barrier from opioid mediated brain stem defenses
would spend excessive time in predominantly sympathetic, hyperaroused states while
lacking maternal assistance to regain calming homeostatic control. Female infants, who
are more susceptible to pain (LeFrancois, 1984; Olkkola, Hamunen, & Maunuksela,
1995) and, based on animal findings, may have weaker brainstem analgesic effects than
males (Krzanowska & Bodnar, 1999; Tershner, Mitchell, & Fields, 2000), may become
particularly susceptible to chronic stress and fearfulness.
Amygdala specialtiesacute and sustained aversive fearful or anxious feelings,
fear conditioning, avoidance and inhibited behavior in the face o f threatare extremely
adaptive for curbing emotion driven behaviors that, unchecked, could result in survivalthreatening risky behaviors or minimized adaptation to the give and take requirements for
survival in social environments. However, if taken to extreme, these specialties can come
to dominate (i.e. through strengthened, oft-traveled pathways) at the expense of critical
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pleasure or seeking system mechanisms that serve energy conservation, restorative,

integrative, rewarding, motivational, approach, exploratory, and biologically significant
resource obtainment functions. Experiences with feeling calm, safe, secure, pleasured,
euphoric, excited, optimistic, hopeful, effective, powerful, and loved would be tragically
diminished. Findings that young infants of depressed mothers are less robust, spend
more time in restless sleep, lack social interest, have lower dopamine levels, lack
sustained energy, are less expressive, are less excited, show reduced exploration o f novel
stimuli, and are more withdrawn than infants of healthy mothers are consistent with these
projections (Field, 1998; Lundy et al., 1999).
Schmidt and colleagues (1997) found that children with high negative affect and
motor activity at age four months were more likely to become inhibited toddlers. They
also found these children to have elevated cortisol levels, leading these investigators to
conclude that cortisol may have effected changes in the amygdala to enhance fearfulness.
MRI studies o f children with Generalized Anxiety Disorder show greater overall
amygdala volume, particularly for the right amygdala, in contrast to controls, but little or
no differences in the size o f the hippocampus and other brain regions (De Beilis et al.
2000 ).
Traumatized infants.
As previously discussed, individuals subjected to even one traumatic event can
develop (receptor) hypersensitivity to future, even less stressful (perhaps previously
manageable)events, lowering their arousal tolerance thresholds (Chamey et al., 1993).
Exaggerated startle, showing increased magnitude coupled with decreased latency, is one
o f the most recognizable and well-documented examples o f this phenomenon. Numerous
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studies have also determined that when animals are subjected to uncontrollable and
inescapable punishment (electric shock), opioid is released that mediates an escape deficit
and fear conditioning, reversible with naloxone (Grahn et al., 1999). Opioids responsible
for these learned helplessness effects arise from the dorsal raphe nucleus (Grahn, et al.,
1999), where serotonin neurons are produced. Here opioids again reduce the complexity
o f an extremely threatening, hyperarousing condition to a more manageable level, but
through a different set o f opioid mediated receptors than those previously described for
the 0-2 month period.
A proposed opioid-mediated circuit-breaker theory for dissociation.
Panksepp proposes (1986) that the global function o f opioid systemsespecially
those involving mu receptors (which mediate pain) and perhaps delta receptors (found in
the limbic system) is to counteract the influence of stress (p. 95).The author o f this
dissertation likewise agrees that the general role of opioids in the central nervous system
is to maintain homeostasis. Not only do opioids soothe arousal, they appear to mediate
disconnects or dissociations in a variety of emotion brain structures at various levels in
emotion circuitry, all the way from the brainstem to the cortexacting in essence very
much like circuit breakers to reduce current conditions to bearable levels. Opioids colocalize with a variety o f neurotransmitters throughout the emotion circuits, most often
inhibiting or dampening their effects. Mechanisms and the nature o f dissociations would
vary depending on how low or how high up in the system they are triggered to break the
circuit. More primitive forms o f dissociations are organized at brain stem and peripheral
levels. Higher order dissociations may maintain some higher order functions, while
uncoupling others. For instance, disconnects may occur between hemispheres
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(presumably through the corpus callosum) keeping frightening sensory material in the
right out o f left hemisphere awareness so an adult individual can attend to activities o f a
daily routine without becoming immobilized by overwhelming arousal.
MRI studies by De Beilis and colleagues (1999b) on the brains o f 44 children
with PTSD, showed that brain volumes were robustly and positively correlated with age
o f (trauma) onset and negatively correlated with duration o f abuse (p. 1271) for both
girls and boys, with boys showing an even worse trend. Those with less brain volume
(and larger ventricals), the children whose abuse started the earliest and lasted longest,
were more prone to intrusive thoughts, avoidance, hyperarousal, or dissociation (p.
1271) in a significant negative correlation. The corpus callosum was significantly
smaller in these children. Boys faired significantly worse than girls, with an even more
underdeveloped or reduced corpus callosum. (O f note, the hippocampus was not reduced
in volume as these investigators had predicted.)
Where disconnects occur and their degree o f severity would depend on the
magnitude o f arousal generated in lower emotion circuits, the age at which original
trauma occurred, and the degree of endangering deprivation or injury resulting in
excessive, rapid arousal build-up coursing through over-used (extremely strong) circuits.
Should such circuits be laid down during experience expectant developmental windows,
they may remain quite thick or activate a broader network o f neurons than would be
expected for normal development. It is quite conceivable that portions o f fear circuitry
neurons could be accessed or even overtaken by highly activated rage circuits during
traumatizing events in early infancy, particularly in that fear and rage circuits run so close
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together at the hypothalamic and brainstem levels. Therefore, activated fear circuitry
might also elicit rage if these circuits share neurons.
Making matters worse, protective social-emotional circuitsstarved for sufficient
experience expectant developmental stimuli acquired from within the context o f a healthy
attachment relationship with a warm, loving mothermay be quite underdeveloped
(underused, thin, and weak). When previous arousal magnitude (generated by lower
level emotion structures) has been extremely intense, arousal break-through may occur at
any point in lifeeven after sophisticated cortical structures affording some control have
come on boardparticularly under stressful circumstances that exacerbate sympathetic
activation, further outstripping underdeveloped coping mechanisms. Arousal break
through could also be triggered if the amygdala detects stimuli it associates with
previously dangerous conditions, plunging the individual right back into the original
trauma (i.e. All Alone state), as will be discussed below regarding blind rages.
Insufficient fear conditioning.
Infants who may have developed reliance on automatic (passive) brainstem opioid
mediated defenses to slow heart rate and quell any type o f aversive arousal feelings,
effectively dissociating feelings from the stimuli giving rise to them, may lack sufficient
experience with intensification or sustenance of arousal needed to feel fearful when
confronted with normally threatening stimuli. Brainstem defenses may also usurp the
need to activate the stress response due to excessive stimulus filtering. Amygdala
mechanisms for experiencing fear or anxiety, fear conditioning, assessing threat, fear
motivated avoidance or inhibited behaviors, and triggering the stress response may
remain underdeveloped should brainstem opioid defenses become maintained throughout
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the course o f the amygdalas developmental window. These less reactive infants, who
perhaps experience prolonged numbing as well, would, therefore, be less inhibited or
avoidant in the presence o f potentially threatening stimuli resulting in more approach
behaviors. These babies will also have minimized opportunities for learning normal,
more active self-regulatory strategies for coping with stressful conditions if and when
they should become exposed to them.
Withdrawal. Cravings, and Intensified Rage
As previously discussed, the amygdala adds intensity and sustenance to rage.
According to Rhawn Joseph (1996) the medial portion o f the amygdala that contributes to
rage is phylogenetically ancient, predating the lateral portion that gave rise to fear.
Utilizing animal studies, neurobiologists have now identified components of the
defensive rage circuit which runs from the medial amygdala through the stria terminalis
(a connecting cord o f fiberslarger in malesthat forms a large portion o f the extended
amygdala) to the medial hypothalamus. From the medial hypothalamus the circuit
extends to NM DA glutamate receptors in the periaqueductal gray (PAG) in the midbrain
portion o f the brainstem, activating the sympathetic nervous system (Joseph, 1996;
Panksepp, 1998; Siegel et al., 1999; Siegel, Schubert, & Shaikh, 1997). Panksepp (1998)
has observed that the circuit mediating rage is very similar to, if not one in the same as,
the circuit mediating opiate withdrawal.
Siegel and colleagues have determined that rage is mediated by substance P
receptors (more commonly known for roles in pain and depression) co-localized with
glutamate neurons within the medial hypothalamus that receive substantial inputs through
the stria terminalis from the medial amygdala (Siegel, Schubert, & Shaikh, 1997; Yao et
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al., 1999). Siegel and colleagues (1997) have also identified a powerful rage suppression
circuit comprised o f enkephalin opioids, arising from the central nucleus o f the amygdala,
that achieve their effect by activating mu receptors in the PAG. Not only is the stria
terminalis involved in mediating rage; it also mediates addiction, withdrawal, and
cravings (Koob, 2000) lending support to Panksepps opiate theory o f attachment
(Panksepp, 1998). Withdrawal activates the stress response, triggering increased
amounts o f CRF and NE.
Opioid deficient, but especially opioid depleted, mother-deprived individuals
would be expected to display excessive seeking system behaviors (cravings, frantic
contact seeking) to obtain supplies and to experience intensified arousal rage pain
feelings should such supplies not be forthcoming. With increasing capability for
volitional movement and the amygdalas ability to direct behavior toward a target goal,
intensified arousal might soon become directed at mother as primed expectancy violator,
goal thwarter, and withholding source o f desired supplies~or displaced onto another
tangible target. Eventually self-injurious behaviors may be utilized to induce analgesic
opioid, effectively quelling unbearable agitation.
Blind rages.
Traumatized infants may become susceptible to developing blind rages triggered
by discreet sensory stimuli similar to those that were contained (and wired together) in
their initial trauma scenes, encoded as extremely dangerous in the amygdalas implicit
memory system. A harsh voice similar in quality, tone, or intensity to that o f a
frightening, painful parent; an angry face; or visceral arousal sensation produced by being
left alone for prolonged periods may trigger fear and rage simultaneously, eliciting a
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stress circuit survival response and escalating arousal into an extreme range, resulting in a
surge o f defensive rage aimed at the source of the stimulus-even in an otherwise low- or
non-threatening circumstance. Blind rages, which can occur throughout life, are
agonizing to individuals who can instantaneously lose volitional control o f their anger,
but are helpless to prevent their outbursts because they cannot identify (and therefore
cannot consciously avoid becoming influenced by) the triggers that cause them. Such
triggers are not accessible to, remain disconnected from, and are therefore blind to
conscious awareness. I f these sensory triggers are laid down prior to development of
explicit memory systems that emerge with the hippocampus and cortical associative
systems, they may never get connected to the specific events giving rise to them and,
therefore, operate unchecked by higher order processing and regulatory mechanisms that
could otherwise be utilized to bring them under some degree of conscious control.
Sensory trauma components laid down in infancy may operate in the same way
that makes it possible for the smell of burning diesel fuel to transport a middle-aged
Vietnam vet with PTSD back into the initial traumatic event as if it were happening now
(flashback). The difference is that the 19-22 year old soldier at the time was able to
encode aspects o f the trauma in explicit as well as implicit memory systems, making
them more accessible and connectable for conscious processing. Tapping into traumatic
sensory components laid down during infancy might also plunge an individual back into
a flashback o f their original trauma. The infantile flashback may remain equally
accurate, if not more so, uncontaminated by exposure to dynamic, reformulating
conscious processing systems. Thus, the individual would be thrust back to the same
developmental age and state in which their original trauma was experienced (i.e.
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nonconscious awareness; fuzzy vision; unmyelinated, uncontrollable arms and legs;

inability to get away from the danger; complete powerlessness in the full face of
annihilation; racing heart; hyperactivation o f the sympathetic nervous system producing
intensely unbearable, escalating arousal probably experienced viscerally as raw,
unmodulated rage pain). The difference is that the older the individual gets, their other
developing capacities (i.e. size, coordination, muscular strength, mobility, access to
weapon, ability to direct behavior at target) can automatically become enlisted to release
this powerful emotion, rapidly triggered out o f conscious awareness.
Many individuals who have committed impulsive acts of violence triggered by
rage report no memory o f the act itself or its causethey only recall becoming enraged,
then blanking or blacking out during the rage release (hence the term blind rage). This
suggests activation o f opioid mediated sympathoinhibitory or analgesic dissociative
defenses that uncouple stimulus and arousal (making the situation more manageable) as
previously described. In addition, because there is such a drastic reduction in arousal
with release o f intense rage, a rush of opioid signaling return to homeostasis may also
produce a dramatic calming or euphoric effect that could serve to reinforce future rage
releases. A 1984 study by R_ M. Post et al., reported in Emil Coccaros (1996) review of
Neurotransmitter Correlates of Impulsive Aggression in Humans lends some credence
to this latter hypothesis, showing a positive correlation between CSF opioid binding
protein and the Buss-Durkee subscale assaultiveness (r = 0.77, n = 18, p < 0.0002) in
healthy male volunteers (p. 85).
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Summary: Nature o f Psychopathology Arising from Developmental Period: 2-5 Months

Projected psychopathology arising from this period would reflect aberrant
am ygdala functioning and fear conditioning. Amygdala deficiencies would likely result
in p o o r ability to process social-emotional sensory stimuli (inability to pick up on social
nuances for communicating or adjusting behavior in relationships with others) or even a
disinterest in others. Other aberrant amygdala adaptations would be excessive processing
o f threatening social-emotional sensory stimuli for hair-trigger responses to perceived
dangers processed at the subcortical level, obsessive or compulsive behaviors, excessive
contact seeking or craving o f others, and intensified rage. Excessive use o f amygdala and
right cortical social-emotion circuits, at the expense o f left cortical areas, could result in
an absence o f social desire, joy, and ability to benefit from social rewards.
Excessive fear conditioning with hyperactivation o f the stress response (and
excessive sympathetic arousal) could result in generalized anxiety, inhibited behaviors,
learned helplessness, dissociation tendencies, intensely agitating All Alone states with
exaggerated fight, flight, or state altering responses (i.e. aberrant aggression directed even
at inappropriate targets, self-injurious behaviors, or dissociations). Opioid dominated
individuals (See RESULTS: PART I. ) could have insufficient fear conditioning resulting
from chronic numbing or failure to achieve arousal intensity into punishing, fearful
range; and therefore would show failure to learn from past, negative experiences or to
curb behavior for fear of losing social rewards. Such individuals would likely approach
potentially risky or high drama situations, seeking the heightened stimulation required to
feel more alive.
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5-8 Months: Selective Attachment

From age 5-8 months, brain structures in place and fully functioning include the
brainstem, hypothalamus, and amygdala. Emotion circuits up and running include the
autonomic nervous system, pleasure, seeking, rage, fear, and stress response circuits.
Homeostatic, rewarding, energizing, motivating, intensifying, sustaining, signaling,
punishing, multi-modal sensory processing, and social-emotional sensory memory
components o f emotion are in place. Classical conditioning mechanisms attaching
rewarding and aversive sensations to social, emotional sensory stimuli can now promote
both approach and withdrawal behaviors. Babies with healthy facilitating social
environments have been able to stock pile repeated gratified, pleasure-producing,
exciting, and otherwise good-feeling experiences generating an ample cushion o f selfeffectance, trust, optimism, and omnipotence that permits them to begin to confront less
savory aspects of reality imposed by their environments. The next structure coming on
board during this time will now impose limits on the infants heretofore id-like existence.
Prominent Emotion Structure: Septal Nucleus (Alias Septum)
At about five months o f age, the septal nucleus begins to emerge, probably
obtaining maturation by about age 7-8 months (Joseph, 1996). It adds the capacity to
discriminate, and therefore the ability to form a selective social attachment with one
particular person, i.e. mother. For the first time the infant will now have the capacity to
dampen or inhibit otherwise intensely felt emotion arising in the hypothalamus and
amplified and sustained by the amygdala. In this manner it provides a homeostatic
function by counterbalancing the amygdalas influence on the hypothalamus.
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Specifically, the septal nuclei exert direct inhibitory influences on the medial
hypothalamus (Joseph, 1996). In addition, the septal nuclei also exert inhibitory effects
on the amygdala; whereas the amygdala can both stimulate or inhibit septal functioning
(Joseph, 1996). The septal nucleus, in partnership with the emergent hippocampus,
mediates inhibition o f emotion driven behaviorone o f the first steps in gaining control
over emotion (Spiegel, 1999). This may occur through generation o f aversive mood
mediated by amygdala activation o f the lateral hypothalamus coupled with septal
stimulation o f the hippocampus and medial hypothalamus (Joseph, 1996).
With the ability to discriminate, infants are beginning to distinguish self as
separate from other (i.e. mother). Because babies can now develop a selective attachment
to mother, this desired person outside themselves, they can also become acutely aware of
her absence. Therefore, the new emotion circuit that arrives with the septal nucleus is the
experience o f emotional pain produced by social loss or the ability to grieve.
Emotion Circuit: Emotional Pain (Sadness. Loss. Separation Distress, and Panic)
Jaak Panksepp (1998) proposes that there is a separate emotion circuit that
mediates emotional loss pain. Feeling states arising from this circuit include sadness,
loneliness, and grieving. He suggests that panic occurs when this system is activated to
an extreme degree, eliciting brainstem mediated sensations o f racing heart and
suffocation (Panksepp, 1998). Due to his own landmark studies, elucidating opioid
mechanisms for quelling infant separation distress, Panksepp has concluded that
emotional pain has derived from the same mechanisms giving rise to physical pain
(Panksepp, 1998; Panksepp et al., 1978). This would be in keeping with typical
evolutionary processes for enlisting older systems in the service o f new, adaptive survival
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functions. An evolutionary purpose for feeling emotional pain with separation or social
loss would be to promote proximity seeking and maintenance o f emotional social bonds.
This would be particularly critical for vulnerable infants who require others to assure
their survival. Indeed, infant separation distress has been well-documented throughout a
wide range o f mammalian species.
Although this circuit is far from clarified at this point in time, he suggests it
includes the emerging cingulate, ventral septal nuclei, stria terminalis (extended
amygdala), preoptic area o f the hypothalamus, thalamus, and PAG (Panksepp, 1998).
He notes a remarkable resemblance o f the neuroanatomy o f this pathway to that
containing CRF and B-endorphin. He has also demonstrated that CRF mediates distress
cries with B-endorphin quelling them (Panksepp et al., 1978).
Hippocampus
Although the hippocampus shows activity from birth (Chugani, 1998), it is just
now starting to come into its own, reaching functional maturity between 12-15 months of
age (Joseph, 1996; Nelson, 1997). This structure is largely responsible for encoding
explicit, working memoryparticularly the contextual aspects o f memory (i.e. body or
events in time and space). The hippocampus shares rich interconnections with the
amygdala, septal nucleus, temporal, (especially) parietal, and frontal lobes. The septal
nucleus forms a circuit with the hippocampus that mediates the inhibition o f emotion
driven behaviorone o f the first steps in gaining control of emotion (Spiegel, 1999). It is
also implicated in giving rise to anxiety feelings. (Spiegel, 1999). Current evidence has
determined this structure is extraordinarily plastic (certain o f its neurons can atrophy
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under temporary adverse conditions, then recover) (McEwen, 1999b) and may continue
its development past the sixth decade o f life (Joseph, 1996).
Cingulate
The cingulate, an evo lu tio n ary early cortical layer (Joseph, 1996; Panksepp,
1998), forms an interface between subcortical emotion systems and the cortex-particularly the frontal lobes. This structure permits conscious awareness o f emotion
sensations and mood states andfor the first timeexertion o f willed control over
emotion behaviors. Because o f awareness, the individual is afforded flexibility, i.e.
choices, for responding to internal feeling states. It plays a major role in perception o f
pain, anxiety, sadness, loss, panic, and depression.
Cortex: Parietal and Frontal Lobes
Portions o f the parietal and frontal lobes, receiving major inputs from the
amygdala, hippocampus, and cingulate as well as sensory inputs from the thalamus and
intracortical networks will rapidly form synaptic connections spurring growth during this
time. It is important to bear in mind that development o f these two cortical regions is
quite long term, with sophisticated functions for the parietal lobe emerging as late as 10
years (Joseph, 1996) and for the frontal lobes as late as 16-18 years (Chugani, 1998).
Starting from 5-6 months, infants will start to develop a more exclusionary
preference for their mothers, while becoming wary o f strangers (Bowlby, 1969;
Brazelton, 1992; Mahler, Pine, & Bergman, 1975). Infants will also begin to show
protest becoming separated from their mothers, fussing at them upon their return
(Bowlby, 1969; Brazelton, 1992).
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By five months o f age the desire for visual exploration is so strong, that infants
disregard unpleasant sensations (Brazelton, 1992, p. 102). This intensified interest
corresponds to vision acuity that begins to attain an adult level by age six months
(LeFrancois, 1984). Birch and Petrig (1996) have found that stereoacuity matures by
about age 6-7 months. Advances in eyesight, in combination with septal maturation,
permit the infant to begin to discriminate.
By age six months a baby will be able to sit on your lap or in a high chair-even
twisting around to get a better look. Although, feeding may take a back seat to exploring
(Brazelton, 1992), this is the time when a baby begins to eat solid foods. This infant can
grasp even a dangling object and will be able to release one thing if handed another.
Sitting up all alone is possible by seven months. At eight months look for this youngster
to stand up (with a little help) while holding on and to be able to pick up even tiny objects
using thumb opposing fingertips. Although putting objects in the mouth is still a favorite
form of exploring, babies will now begin to use their hands and fingers, as well. By age
eight months, infants begin to scoot forward on their tummies (Brazelton, 1992;
LeFrancois, 1984).
At this point, babies should be able to regulate their own sleep, alternating deep
and light (REM) sleep-getting themselves back to sleep should they awaken during the
night. They may fight going to sleep, however, not wanting to miss out on anything and
continuing to try out all their new abilities (Brazelton, 1992).
Infants at this age are capable of feeling pleasure, excited anticipation, joy, anger,
fear, and stress. Anxiety, sadness, loss, and loneliness are becoming added to their
repertoire. At this time babies will begin to smile more selectively at familiar persons
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and less frequently at unfamiliar ones (LeFrancois, 1984; Brazelton, 1992). This
corresponds with an increasing wariness of strangers that may continue up through 24
months o f age (LeFrancois, 1984). Infants will cry out in distress upon separation from
their mothers, may show withdrawal and other signs o f anxiety during her absence, and
display angry protests to her upon her return (Brazelton, 1992; Bowlby, 1969). By age
six months, infants not only have distinct cries for distress, anger, and fear (even
distinguishable to strangers inexperienced with babies); but these cries have become
significantly more intense (Leger et al., 1996). Babies can suck their thumbs or pacifiers
to comfort themselves (Brazelton, 1992) and utilize gaze averting and avoidance to
reduce overstimulation (Weinberg & Tronick, 1994).
By age seven months healthy infants will generally show fairly stable,
characteristic temperamental traits. Nine specific traits giving rise to individual
temperament were identified by Thomas, Chess, and Birch (1970) in their classic
longitudinal study tracking persistent personality features in 140 individuals beginning in
1956. As summarized by Brazelton (1992), these include activity level, distractability,
persistence, approach vs. withdrawal tendenciesparticularly in novel and stressful
conditions, intensity, constitutional regularity (i.e. sleep pattern, bowel movements,
rhythms), sensory threshhold (i.e. sensitivity, arousal range), and generally positive vs.
negative mood.
Beginning about age five months, infants will take a step toward understanding
cause and effect by trying out something and noticing what happens. For example they
learn to cry more deliberately, to wait to see whether anyone is coming, then to cry out a
second time (Brazelton, 1992, p. 95). By about age 7-8 months, babies will begin to
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realize an object isnt gone just because they cant see it, heralding the emergence o f
object permanence in infant internal representations (Brazelton, 1992). Along these lines,
infants can begin to play peekaboo games not only with objects, but people. Babies
become classically conditioned to aversive and well as rewarding stimuli, showing
avoidance and approach behaviors, respectively. During this time, infants will gain
ability for discrimination.
At six months babbling begins to sound like mono-syllable utterances that may
join consonant type sounds with vowel sounds (i.e. da, ma, di). By 7-8 months, babies
are babbling, stringing multiple consonant-vowel combinations together (i.e. dadada).
When babbling begins, universality (ability to hear or m ake any sound from any culture)
ends (Gopnik, Meltzoff, & Kuhl, 1999). Some would argue that babys vocabulary now
has at least one meaningful word. By eight months infants utter more frequent,
continuous repetitions with distinct intonation patterns. Vocalizations can show
emphasis or signal emotions. (LeFrancois, 1984).
5-8 Months
Piaget places 4-8 month old infants in the Secondary Circular Reactions (3rd)
substage o f the Sensorimotor period as previously described (Piaget & Inhelder, 1969;
LeFrancois, 1984). Activities leading to interesting sights and sounds are repeated, with
the child using the same means to achieve different ends.
Freud would continue to place an infant at this age in the Oral stage, because
mouthing continues to be a primary means of exploring. Although the id still dominates,
a portion o f it is now becoming organized into the ego through repeated encounters with
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the realities o f the external environment. The egos function will be to mediate
homeostasis by finding ways to balance increasing environmental demands with the
arousal driven demands o f the id. Anxiety will become a tool for the ego, signaling a
threat and therefore the need to make some accommodation to either cope with or avoid
the threat. The primary threat producing anxiety is the possibility o f becoming separated
from mother. The ego heralds the emergence o f the infants first attempts to gain
emotional, psychological, and behavioral control in order to reduce the extremely
arousing threat o f that loss (Feist, 1990; Freud, 1932 translated in Gay, 1989).
During this period, infants continue in Ericksons Trust vs. Misturst (oralrespiratory, sensory-kinesthetic) stage. The radius of relationship is mother. If the infant
is successful during this stage, the strength o f hope will emerge. Insufficient negotiation
o f this stage results in its core pathology, withdrawal (Feist, 1990).
It is inevitable that baby will eventually fall on hard times, times of frustration
when needs are not met in the desired manner. Jacobson believed that these periods o f
frustration foster an awareness o f not me andin optimal dosesfoster growth
(individuation). When baby is gratified, internal representations o f self and fulfilling
object (mom) merge. When baby is frustrated, the internalized representations o f self and
object separate (St. Clair, 1996). This concept mirrors the homeostatic relationships
between attachment and optimal doses o f growth producing separations; parasympathetic
(restorative) and sympathetic (activating) nervous system functions; and assimilating
familiar, arousal reducing experiences, alternated with accommodating exciting, novel
experiences.
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Mahlers Psychological Development Stage o f Separation/Individuation is

heralded by selective attachment with one particular parent, usually mother, at about age
6-8 months (Mahler, Pine, & Bergman, 1975). (Mahler and colleagues may have
underestimated infants in that they are probably beginning this stage as early as five
months.) Selective attachment begins the process o f Differentiation, whereby the infant
begins to develop a separate identity from mom by focusing attention outward toward the
environment, while at the same demanding mothers company~and, lets it be known that
only her company will do.
In Kohlbergs Moral Development theory, the 5-8 month old infant is, o f course,
in the Pre-Moral stage. (LeFrancois, 1984). The purpose o f behavior during this stage is
to obtain immediate pleasure and avoid pain.
Developmental Tasks and Mechanisms o f Mother-Infant Attachment: 5-8 Months
The developmental tasks of mother-infant attachment during the 5-8 month age
period include the infants forming a selective attachment to (usually) mother,
experiencing some emotional pain that comes with her absence during separations,
developing healthy separation anxiety as a signal for threat o f aloneness (threatened
relationship), and developing an egothe infants own ability to achieve emotional
homeostasis by managing the heightened anxiety arousal. Seeds are also planted for
putting off ones own immediate desires in order to please another in the service of
sustaining relationships. Mother continues to build up infant trust through reliable,
sensitive responses to infant signals, assisting her infant to achieve homeostasis by
optimizing, but not overwhelming a fragile, emerging ego.
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Selective Attachment to Mother: The Septal Nuclei Expect Nothing Less

By now, babies are able to physically push their bodies a bit further away from
mom to get a better look at her (Mahler, Pine, & Bergman, 1975). Eyes have obtained
binocular acuity and are accommodating visual-spatial adjustments, so babies can see
with clarity and track moving objects, to include people, better. They are also developing
visual-spatial capacity, i.e. by being picked up and carried about while looking at still or
moving objects in their immediate vicinity. They can also now sit up in their high chairs,
twist around, and look at mom no matter where she is in the room. As previously
discussed in the 2-5 month period, the infant has been able to shift focus outward to
actively explore a wide array o f sensory stimuliespecially social stimulifrom the
environment.
Its been a grand rush taking in all sorts of exciting animated faces, expressive
voices, and good feeling touches as well as tracking moving objects, colors, shapes and
sounds from all sorts o f interesting directions. With repeated experiences of
environment- directed exploration and the emergence of the septal nucleus, the infant is
now becoming able to discriminate, which includes singling mother out from all the rest
as most desired. The infant does not do this passively, but lets it be known that it is her
company that is required. Such behavior signals that a selective attachment to mother has
been formed. In their study o f 50 healthy six-month-old infants, Weinberg and Tronick
(1994) found that
When looking at their mothers, facial expressions o f joy, positive vocalizations,
and mouthing body parts are most likely to occur. By contrast, when the infants
are looking at objects, they are most likely to display facial expressions o f interest
and to mouth objects (p. 1512).
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Development o f Healthy Separation Anxiety to Signal Potential Danger

Freud articulated his concept o f anxiety (Freud, 1932 translated in Gay, 1989) as a
signal for a very real potential threat based on similarities to a previous endangering
experience that actually occurred. The nature o f that original threat was a traumatic
experience, trauma defined as hyperstimulation o f the organism, without the ability to
attenuate that extreme arousal (which has previously been discussed in this dissertation as
extremely unbearable). He considered the infants birth and separation from mothers
womb to be the original traumatic experience for all o f us.
The essential thing about birth, as about every situation o f danger, is that it calls
up in mental experience a state o f highly tense excitation, which is felt as
unpleasure and which one is not able to master by discharging it. Let us call a
state o f this kind...a traumatic moment... What is feared, what is the object of
the anxiety, is invariably the emergence o f a traumatic moment, which cannot be
dealt with by the normal rules o f the pleasure principle.... It is only the magnitude
o f the sum o f excitation that turns an impression into a traumatic moment,
paralyses the function of the pleasure principle and gives the situation o f danger
its significance. (Freud, 1932 translated in Gay, 1989, p. 782)
Freuds definition o f the pleasure principle appears to be one in the same with achieving
homeostasis:
The pleasure principle... is a tendency operating in the service o f a function
whose business it is to free the mental apparatus entirely from excitation or the
keep the amount o f excitation in it constant or to keep it as low as possible, (p.
625).
Traumatic hyperarousal occurs when the physically helpless infant is all alone and
thus becomes extremely vulnerable. Traumatic hyperarousal, therefore, outstrips
homeostasis (which the baby cannot initially achieve without the help o f mother) and
therein lies the danger. ( consistent with the definition for trauma as proposed in
RESULTS PART I).
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Anxiety has two origins: one as a direct consequence o f the traumatic moment
and the other as a signal threatening repetition o f such a moment (Freud, 1932 translated
in Gay, 1989, p. 783). Therefore, the first situation in which both criteria can be met to
qualify as normal anxiety is the developmental event in which the infant becomes
threatened by the loss o f mother whom he or she has come to lovewhich is exactly what
is happening during this period. In order to miss her, the infant has to be able to know
what he or she is missing. The septal nucleus, along with increasing visual ability, and an
emotional pain circuit permits this to occur. The infant starts to become acutely aware of,
moms presence and her absenceaware o f the luscious feelings when shes there and
by stark contrastthe lonesome, hungry feelings when shes not. This second experience
signals its own realistic threat, but because its so similar to the first separation
experience (birth per Freud), it also triggers the infant back into the same extreme
sensationsengrained in conditioned memoryexperienced in the original traumatic All
Alone state.
Mothers can minimize anxiety by preparing their infants for goings and comings
(i.e. through peekaboo games) while still in their infants presence (Brazelton, 1992).
They can establish reliable routines, i.e. by saying By-By to signal short, manageable
separations, followed by exuberant, exaggerated, joy-filled reunions. A jubilant, excited
mom or dad face that genuinely conveys I m sure glad you are hereand with me may
be the best gift a parent can ever give a child.
W hat Does One Do When Moms Gone? Develop an Ego to Achieve Own Homeostasis
Displacing anxiety onto other non-threatening targets, i.e. thumb, in repetition
activities permitting mastery, or in a wish-fulfilling dreams spurring mental imagery, can-
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-as previously describedbecome the "mother o f invention" for developing much more
sophisticated long-term survival skills. While not as satisfying as obtaining the real
McCoy (i.e. contact with mother), this represents a compromise to make due~to delay
gratificationuntil that joyful event occurs. Because of mothers consistent, timely
reappearances the infant is gaining some sense that she will come back and anxiety is
minimized to a tolerable range. Getting a good supply of B-endorphins from contact with
her when she is around helps this along. In the meantime, to be able to release some of
that mounting contact seeking energy (tension) on your own still feels better than letting
it build up, signaling that some degree o f homeostasis has been achieved.
Separation: Individuation Begins. But Not Without Protest
John Bowlby observed that, upon achieving the developmental milestone of
selective attachment, human children who have been separated from their mothers for
extended periods (i.e. for hospitalizations) reliably show three phases, each characterized
by specific, predictable behaviors: protest, despair, and detachment. Detachment can
continue, even after reunification with mother, with the duration o f the detachment
positively correlated with the length o f the separation. (Bowlby, 1969; Bowlby, 1973).
Intense longing during separations can produce intense contact seeking arousal. Intense
arousal can produce rage. When mom returns, that arousal (and its rage) gets released.
This appears to be the case with the angry protests Bowlby observed in infants even
following reunification with their mothers, beginning at about this agebut increasing
over the next several months.
Releasing this energy is the best way to get rid of anxiety. However, the target of
that rage may become threatened and either attack or reject the infant. Either outcome,
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needless to say, threatens survival. The now painful sensation o f becoming separated
from mother is unbearable. Therefore, the infant will need to somehow inhibit the release
o f seeking arousal energy onto mother and displace it instead onto a safer target. A fear
o f losing ones love objectparticularly when youve only just discovered herprovides
motivation for overriding the potent self-centered demands o f the id in order to please her
so she will stick around. This relationship-preserving process plants adaptive seeds for
the give and take requirements o f survival in the social environment. Babies at this age
can pretty much get by with simply releasing their rage, because most o f us understand
they have not matured to the point o f withstanding strong arousal and developing the
mechanisms that get their emotions under better control any more than they can get their
bladders under control. Healthy mothers (who have a good understanding o f normal
child development as well as an awareness of their inherent parental power) do not take
these protests personally, and therefore do not attack, reject, or over-control their infants.
Anxiety in the Service o f Becoming Social
Infants who have had a good experience with their mothers, fear losing them. Just
anticipating that possibility is anxiety provoking. Anxiety resulting from fear o f losing
mother inhibits behavior, bringing ability to exert some behavioral control over negative
emotion to meet a goal. I f the infant does this, a healthy mother notices and holds up her
end o f the bargain by showing lots o f love and appreciation. Because its proven to be
such a good deal, infants are more likely to be compliant with mothers requests later (i.e.
at 10 and 18 months). Stifter, Spinrad, and Braungart-Rieker (Stifter, Spinrad, &
Braungart-Rieker, 1999) found that toddlers who were most compliant were those who
had moderate biological regulation over their emotion and who, because they had good
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relationships with their mothers, were eager to accept maternal goals as a way o f
maintaining the relation (p. 29).
The use o f anxiety to signal potential threat of separation or other dangers enables
one to curb or modify behaviors ahead o f time in order to avoid or reduce the likelihood
o f encountering the feared situations (i.e. to be more pleasing to others so they will keep
us). The trade-off, however, is that unsatisfied id-based homeostatic demands result in
seeking system arousal build up. Eventually young children will need to find ways to
cope with that arousal (i.e. redirect it onto a safer target).
The ego notices that the satisfaction o f an emerging instinctual demand could
conjure up one o f the well-remembered situations o f danger. This instinctual
cathexis must therefore be somehow suppressed, stopped, made powerless. We
know that the ego succeeds in this task if it is strong and has drawn the instinctual
impulse concerned into its organization. (Freud, 1932 translated in Gay, 1989, p.
779)
Psychopathology Resulting from Attachment Deficits and Distortions: 5-8 Months
Severe developmental problems would be expected to arise for infants who are
unable to form healthy, selective attachments to their mothers due to unmanageable
physical and especially emotional separations, distortions, or abuse as previously
describedcreating tremendous deprivation arousal pangsnow felt as emotional painas
these infants become acutely aware o f their aloneness. Aberrant septal development
would likely result in the socially uninhibited behaviors and indiscriminate contact
seeking seen in humans and other animals with septal lesions (Joseph, 1996; Panksepp,
1998).
Insufficient B-endorphin triggering maternal contactscoupled with intense,
unrequieted withdrawal cravings (grieving), perhaps triggering substance P inputs from
the medial amygdala via the stria terminalis to the medial hypothalamus, in turn
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activating glutamate PAG receptorswould likely produce extremely intensified

deprivation rage. Opioid deficiencies resulting in hyperactivated sympathetic arousal
would exacerbate frenzied contact seeking or infuse other types o f compulsive behaviors-not unlike behavior seen in drug deprived opiate addicts. If, due to inconsistent
parenting, these infants have some, but insufficient positive contacts with their mothers,
these are likely to be extremely salient due to hypersensitized or upgraded receptor sites
attempting to catch every drop of otherwise deficient opioid. In addition, only partially
satisfied deprivation needs can make cravings even worse (Panksepp, 1998), leaving the
sensation o f a gaping black hole inside the gut that never gets filled up. Separations
would produce extreme anxiety, plunging persons right back into the unbearably agitating
All Alone state trauma just as Freud described. Under these conditions, a baby could not
begin to establish an ego to obtain self-induced homeostasis; a fragile ego would simply
be swamped by an ocean o f arousal.
By contrast, those who have come to rely on brainstem opioid mediated defenses
will probably not have gained enough noticeable pleasure from relationships with their
mothers to have become conditioned by social reward. Therefore, self-serving behaviors
would not be curbed for fear o f losing a valued relationshipsomething theyve never
experienced. Due to insufficient experience with heightened, aversive arousal these
infants would continue to lack the fear conditioning it takes to benefit from anxiety.
Reduced capacity to feel emotional pain, due to chronic numbing, may contribute to
inability to develop empathy for others pain.
Along these lines, some intriguing compliance differences begin to emerge in
infants depending on reactivity levels. A study by Stifter, Spinrad, and Braungart-Rieker
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(1999) found that five-month-old infants who were low in both reactivity and ability to
regulate frustration (as might be expected for infants who are excessively reliamt on
opioid mediated brainstem defenses) were most noncompliant as 18-month-old toddlers,
simply ignoring their mothers commands to pick up toys. These investigators suggest
that infants who are not easily frustrated may not experience levels o f emotiomal arousal
that require regulation and consequently may not develop, refine, or have the opportunity
to practice the skills needed to control behavior (p. 29). Young et al. (1999) tfound that
unreactive four-month-old infants showed less empathy toward unfamiliar individuals at
age two years. By contrast, those infants who were high in sympathetic reactivity as well
as deficient in frustration regulation showed high levels of defiant (angry) nonoompliance
as toddlers (Stifter, Spinrad, and Braungart-Rieker, 1999).
Researchers have found a major difference between those children who eventually
develop Conduct Disorder (CD) vs. those who are classified as having OppositLonal
Defiant Disorder (ODD). Those with ODD generally have been found to have Ihigh
anxiety, a factor which may actually inhibit them from developing a more severe
antisocial presentation (i.e. due to fearing rejection, punishment). By contrast, children
with Conduct Disorder have a marked absence of anxiety that would serve to inhibit their
behavior (American Psychiatric Association, 1994; Lahey, et al., 1987; Pliszka^ 1989;
1992; Wenning, Nathan, & King, 1993). The hostility seen in children with ODD is
likely due to heightened sympathetic reactivity, dysthymia (or depression), and extreme
frustration tracked to negative, coercive maternal parenting patterns beginning in infancy
(Barkley et al., 1991; Barkley, et al., 1992; Wenning, Nathan, & King, 1993).
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8-18 Months: Practicing

By eight months o f age, an infant has a fully functioning brain stem,
hypothalamus, amygdala, and septal nuclei. All primary emotion circuits are on board,
including the autonomic nervous system, pleasure, seeking, rage, fear/anxiety, and
emotional pain (sadness, grieving, panic). Structures coming on line during the 8-18
months period will permit conscious awareness o f emotion sensations or feeling states.
They will also increase capacity for emotion regulation by adding willed control over
emotion and behavior, bringing influence to subcortical emotion components through
rich interconnections that include efferent, descending (as well as afferent) pathways.
Two emotion structures coming on line at this time include the hippocampus and
cingulate both well on their way to maturation by age 12 months (Joseph, 1996; Nelson,
1995). The cortex will develop at a rapid rate during this 8-18 months period, achieving
up to 57% o f its capacity by 12 months, increasing another 18% over the next twelve to
75% by two years o f age (Joseph, 1996). Cortical areas receiving sensory input and
controlling motor activity are fully functional by 12, months, forming the bases for
subsequent association interconnections that will integrate modality-specific perceptual
information.
Prominent Emotion Structures
Hippocampus.
The dynamic, highly plastic hippocampus obtains functional maturity some time
between 12-15 months (Nelson, 1995; Joseph, 1996). However, myelination can
continue up past 50-60 years o f age (Joseph, 1996), and the hippocampus can
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periodically decrease or increase in volume (McEwen, 1999b). Animal evidence shows

that new cells can be generated in this structure even in adult years (McEwen, 1999b).
Hippocampal dendrites can atrophy with stress; however, they can also recover from their
atrophy if stress is not too severe or prolonged (McEwen, 1999b). Explicit (conscious,
working) memory is believed to be mediated in large part by the hippocampus, although
memory mechanisms are extraordinarily complex and remain poorly understood (Nelson,
1995).
The hippocampus is generally believed to have a role in encoding information,
sharing rich interconnections with the amygdala, septal area and the temporal,
(especially) parietal, and frontal lobes o f the cortex. It acts in conjunction with the
amygdala in attending to and forming memories o f emotionally significant stimuli and in
generating emotional imagery (Joseph, 1992). The left amygdala-hippocampus circuit
processes verbal information, whereas the right processes nonverbal, visual-spatial,
environmental, emotional, motivational, tactile, olfactory, and facial information
(Joseph, 1992, p 435). The hippocampus specializes in contextual memories related to
the positioning o f the body in space as well as in localizing incoming stimuli in visual
space (i.e. while moving about in the environment) and time (Joseph, 1996). In this way
it may create an integrated cognitive map that connects evaluation and categorization
o f experience with other autobiographical information (van der Kolk, 2000, p. 13).
However, if the amygdala and/or hippocampus become overstimulated (i.e. from high
fear or seizure activity), memory processing in the hippocampus can become disrupted or
impaired (van der Kolk, 2000).
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Interacting with the amygdala and septal area, the hippocampus becomes very
involved in modulating response to frustration and punishment, but can also generate
negative mood such as anxiety. Interacting with the septal nucleus, it enhances selective
attention capacity. Another primary function of the hippocampus, in conjunction with the
septal nucleus, is exerting inhibitory influence on emotion and emotion driven behavior
(Joseph, 1996; Van der Kolk, 2000).
Cineulate.
The cingulate (alias cingulate gyrus), which matures at about 12 months o f age
(Joseph, 1996), will add capacities for self-awareness and willed behavior. It permits the
conscious perception of social-emotional sensations and feeling states to include pain,
separation distress, and panic, thereby becoming an integral part of the mother-infant
attachment circuit (Panksepp, 1998). The cingulate gives rise to the sensation of psychic
tension implicated in anxiety disorders such as panic disorder and agoraphobia (which are
diminished with cingulate lesions) as well as depression (Panksepp, 1998). It plays a role
in maintaining attention in the midst of competing stimuli (Levitt, Reinoso, & Jones,
1998), however infants and young children may have great difficulty enlisting this
function. An MRI study by Casey et al. (1997) o f children ages 5-16 years showed that
attentional latencies were reduced as children aged.
Emergence of the cingulate heralds ability for willed, volitional control over the
emotions, permitting flexibility and variability for responding (Joseph, 1996; Panksepp,
1998; Devinsky, Morrell, & Vogt, 1995). It contains groupings of neurons that stimulate
motor activities to carry out these responses (Devinsky, Morrell, & Vogt, 1995). It
mediates vocalizations expressing internal feeling states (Devinsky, Morrell, & Vogt,
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1995), and, due to its flexibility, it also permits vocalizations that do not correspond to
mood (i.e. to intentionally fool predators) (Joseph, 1996).
It shares interconnections with the frontal lobes (Joseph, 1996) as well as
subcortical structures to include the amygdala, PAG, brainstem autonomic nuclei, and
spinal cord. (Devinsky, Morrell, & Vogt, 1995). It is involved in regulation o f autonomic
and endocrine activity (Joseph, 1996), assessing and assigning significance to internal as
well as external stimuli, andlike the septal nucleiexerts dampening or inhibitory
effects on emotion driven behaviors. The cingulate, which integrates emotional and
cognitive aspects o f experience, becomes very active during MRIs when persons are
asked to contemplate se lf (van der Kolk, 2000).
A primary structure for nurturance and social-emotional communication, the
cingulate will ultimately become much more active in female brains, whereas temporal
lobe areas (i.e. for aggression) will become more active in males (Panksepp, 1998;
Joseph, 1996). Rhawn Joseph (1996) credits this structure as providing the evolutionary
impetus for long-term mammalian mother-infant attachments through interactions such as
mutual vocalizations, thereby ultimately giving rise to human language (i. e. Brocas
area.).
Emotion Circuits
Elaboration o f emotional pain fsadness. loss, separation distress, panic) circuit.
Jaak Panksepp (1998), who discovered the emotional pain circuit in his extensive
research delineating the neurobiological substrates o f mother-infant attachment, suggests
that it derived from the same mechanisms that produced physical pain. In fact, this same
circuit gives rise to conscious pain perception and, at a highly activated state, panic. The
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circuit includes the cingulate, ventral septal nuclei, stria terminalis (extended amygdala),
preoptic area o f the hypothalamus, thalamus, and PAG (Panksepp, 1998). Panksepp has
observed that the neuroanatomy o f this circuit bears a remarkable resemblance to
neuroanatomy containing CRF and B-endorphin. He has also demonstrated that CRF
mediates distress cries, whereas B-endorphin quells them (Panksepp et al., 1978). Bendorphin also suppresses pain and panic. The punishing painful feelings produced by
this circuit can activate fear; however, the converse is not so (Panksepp, 1998). An
evolutionary purpose for emotional pain would be to promote contact seeking, social
cohesiveness, maternal behaviors, and selective attachment for enhanced development
and protection o f offspring. Perhaps it is the cingulate, with its dual role in forming
maternal as well as infant attachments, that arguably makes the death o f ones child the
most painful experience of all.
Anxiety.
Interacting with the amygdala and septal area, the hippocampus can contribute to
the generation o f tension and negative mood. The cingulate, sharing interconnections
with the amygdala can give rise to consciously perceived sensations o f psychic tension,
anxiety, sadness, and negative mood. In collaboration with the frontal lobeswhich will
come to specialize in the ability to anticipate and plan for the future (utilizing learning
from past experiences), the cingulate will contribute to worry or anticipation o f aversive
feelings connected to specific types o f events (triggered by memories o f actual hurtful or
frightening past events), generating anxiety even without an obvious external stimulus.
In this way, anxiety can take on a life o f its own, triggered and intensified by internal
mental representations. Arousal energy may fuel heightened contact seeking behavior, be
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released onto the target perceived as causing the threat, or be willfully redirected onto
another, safer target. The septal area, hippocampus, and cingulatethrough
interconnections with the hippocampus, amygdala, and frontal lobescan exert inhibitory
effects over behavior, in this case using reduction of anxiety as a reinforcement for
conditioning avoidant behaviors.
The abilities to dampen more highly arousing fear feelings into anxiety and to
inhibit behavior have a tremendous evolutionary advantage, enabling the individual to
enlist the more refined (but slower) cortical capacities for contextual appraisal, working
memory o f past experiences applied to present conditions, contemplation o f potential
outcomes using a variety o f strategies, andintegrating all informationultimately
selecting a best response choice given the current situation. This provides much more
flexibility and, therefore, a sense o f willed control over emotion, in selecting responses
that are a more appropriate fit to the particular situation at hand than would be available
to the individual in an intensified, automatic one-size-fits-all response rigidly applied to
all threatening situations, regardless o f the degree of potential danger. One can even
plan in advance to take measures to avoid threats, even before they arrive on the scene, at
which time they would pose immediate danger, escalating arousal and the need to take
more drastic, energy demanding measures. The advantages of the automatic response,
geared toward taking no chances with survival, is that the appraisal o f the amygdala is
extremely sensitive to danger, it can trigger reactions ASAP, and it can err on the side of
false positivescasting a larger net for threats to the organism.
Another evolutionary advantage o f inhibited behavior is that it permits delay o f
self-gratification in the service of obtaining longer term, but tremendously enhanced
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survival goals. A primary exampUe is that some degree of inhibited self-gratification is

necessary to assure that social relationships are mutually beneficial, increasing the
likelihood o f sustaining and optim izing relationships and, therefore, their more powerful
advantages for enhanced resource acquisition, protection against threat, and other
survival outcomes.
Elaboration o f stress respomse.
The stress response becom es much more complex with the additions o f abilities
for conscious awareness o f fearful, anxious, and painful separation distress feelings;
awareness o f the co-occurrence off specific events with those feelings; appraisal o f threat
(based on contextual memories o r outcomes o f previous experiences); anticipation of
threat; conditioned avoidance or iaihibited behavioral strategies; as well as development
o f more sophisticated motoric capabilities for taking action in the face o f threat. With the
addition of the hippocampus, cingulate, and cortical areas such as the temporal and
frontal lobes; infants at this age nnay become more aware o f events associated with threat
(i.e. mother putting on coat associated with her leaving), become able to form mental
images of threat based on memories from past experiences (with hippocampus), and
anticipate negative consequences (with cingulate)permitting previously neutral triggers
to elicit the stress response. In tinne, the toddlers own mental images (without the direct
influence o f current environmental stimuli) might elicit the stress response. Sustained
negative mood states such as anxi ety or separation distress, interpreted as ongoing threat,
would prolong activation o f the stress circuit.
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The experience expected at this age is the infants ability to practice movement,
particularly standing up, sitting down, crawling, and walking. Integration of sensory and
body positioning information from a variety o f spatial perspectives will flesh out threedimensional processing. Toward these ends, the infant will be very goal directed,
tolerating little interference (Brazelton, 1992).
Cortex
The human cortex will have grown from to 57% o f its adult capacity during the
infants first year, increasing by an additional 18% over the next twelve months,
achieving 75% by age two years (Joseph, 1996). Synaptic pruning is in full bloom, and
the use it or lose it principle applies. All areas of the cortex (i.e. occipital and temporal
lobes) are continuing their rapid development with growth stimulated by sensory inputs
via the relay station known as the thalamus and by inputs from the subcortical emotion
structures that interconnect with them. Therefore, the same required stimuli driving the
development o f the hippocampus and cingulate at this time will, in turn, drive
development o f corresponding areas o f the parietal and frontal lobes, respectively.
Parietal lobes.
The parietal lobes will have increased from 14% o f adult capacity at birth to about
75% by age two years (Joseph, 1996). Many parietal functions will elaborate those o f the
hippocampus, the structure from which they (in large part) derived and with which they
continue to develop and maintain rich interconnections. Specializations--many of which
correlate to behavioral observations o f infants during this periodinclude visual
convergence, accommodation, depth perception, fixation and tracking (especially of
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motivationally significant objects like mother); ability to interpret and make use o f the
body language o f others (i.e. gestures such as pointing or looking in the direction o f
something); and multi-modal sensory integration and analysis, particularly o f the body in
space, generating
an internal neural construction o f the immediately surrounding space, o f the
location and movements o f objects within it in relation to body position, and of
the position and movements o f the body in relation to that immediately
surrounding space...continually updating information regarding the relation
between internal and external coordinant systems (Joseph, 1996, p. 449).
The parietal lobes also contain specialized neurons that permit expansion o f the visual
field to include the peripheryparticularly the lower periphery where hands, feet, and
ground are more likely to be viewed (Joseph, 1996, p. 449).
Frontal lobes.
The frontal lobes will take the longest to mature of all the brains componentsup
to 16-18 years o f age (Chugani, 1998). However, portionsparticularly the primary
motor stripare still rapidly developing at this time, increasing frontal lobe functioning
from 11% at birth to 73% by two years o f age (Joseph, 1996). The cingulate is the
prominent emotion structure giving rise to and interacting with the frontal lobes. Frontal
lobe functions reflect this relationship. Specializations relevant to infants and young
toddlers include eye-hand coordination; visual scanning (using saccadic eye movements);
sustaining attention over time and space; ability to anticipate events; self-organization;
goal formulation; motivation; exerting free will and intent; language production, ability to
take the initiative; flexible vs. rigid problem solving (i.e. considering alternative choices);
capacity to redirect attention from one stimulus to another; and self awareness with
ability to self correct (Joseph, 1996; Lezak, 1983).
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The orbital frontal lobes, which permit awareness o f emotion sensations and
feelings states, are intimately associated with the anterior cingulate and amygdala
(Joseph, 1996). MRI studies have repeatedly demonstrated that left frontal areas are
activated with happiness; right frontal areas are activated when feeling depressed or
anxious (Panksepp, 1998).
Integrative Processing Status
For the infant and young toddler, splitting of experience (involving left vs. right
hemisphere processing) and compartmentalizing experience (laid down in pockets of the
neocortex) predominate. Mechanisms for integrating experiencemyelination that
speeds information sharing, the corpus callosum that connects the two hemispheres, and
the multitude of interconnecting pathways that permit integration o f experience in
cortical association areasare still in the early stages of their formation. However,
bilateral abilities developed during this period (i.e. crawling, walking, using eyes together
from various spatial perspectives) will provide lots o f practice for cooperation between
hemispheres.
During the 8-18 month period, infants and young toddlers make extensive use of
social referencing devices that include looking at where another person is pointing
(instead of merely at their hand), being able to point at something to get and direct
anothers attention, and looking at another persons facial expression during an uncertain
situation to get feedback as to whether to approach or retreat. However, it will be
mothers feedback that is most trusted and sought after, therefore most o f these behaviors
will be directed at her specifically (Gopnik, MeltzofF, & Kuhl, 1999; Mahler, Pine, &
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Bergman, 1975; Brazelton, 1992). By the end o f this period, young toddlers also use
watching, then modeling the behaviors o f others as a social reference when uncertain for
how to proceed. This shows up in increasing imitations o f mom, dad, siblings, and others
in the childs own actions or in symbolic play. Separation protests as well as discomfort
with strangers intensify (Brazelton, 1992).
Mealtimes may become power struggles with infants insisting on making their
own choices regarding foods or whether they will even eat them at all. By age 18
months, the young toddler will have mastered the use o f a cup and spoon (Brazelton,
1992).
From 6-12 months, visual acuity obtains a normal level (LeFrancois, 1984). By
nine months, babies can tell the difference between facial expressions o f happiness,
sadness, and anger in others. They also prefer that others show congruent visual and
auditory emotional expressions, i.e. a happy face paired with a happy voice (Gopnik,
Meltzoff; & Kuhl, 1999).
This is the hallmark period for achieving the major locomotor milestones.
Milestones generally occur in the following sequence: standing with help, while holding
on (eight months); creeping; crawling (ten months); taking side steps while holding on
(twelve months); creeping up stairs (13 months); standing alone; walking alone with wide
based gate (14 months); walking, turning, and squatting (15 months); walking with
narrower, more confident gait; speedy walking away (18 months) (Brazelton, 1992;
LeFrancois, 1984). The infant has developed an adult-like grasp by 15 months
(LeFrancois, 1984). Mouthing o f objects as a means o f exploration subsides (LeFrancois,
1984).
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While moving about learning new skills, infants can appear drivenif not manic.
Excited and overstimulated by new physical skills, infants will have difficulty going to
sleep. They may also wake during the nightstanding up in bed (Brazelton, 1992).
Infants at this age, however, can be responsible for getting themselves back down to sleep
(Brazelton, 1992). As new skills become mastered, at about 15 months, young toddlers
sleep will begin to settle back down. Also by age 15 months, toddlers will demonstrate
good attention to objects o f interest (Brazelton, 1992).
Teething begins at the time infants are becoming aware o f pain. Fear and rage
feelings become more intense. Strangers continue to be the most potent stimulus for
inducing fear (LeFrancois, 1984; Brazelton, 1992). Violations o f the babys personal
space or restricting, interfering with, or inhibiting the babys movements or vision induce
rage (Brazelton, 1992). Although basically fearless when it comes to potential physical
dangers (Brazelton, 1992); a fear o f heights will emerge by 13-18 months (LeFrancois,
1984). Anxiety stemming from separations (or threats o f separations) from mother will
intensify.
Infants will continue to save their smiles for nearest and dearest persons, like
mom and dad; while becoming increasingly wary o f strangers evidenced by decreasing
smiles, body stiffening w hen held or touched by strangers, crying, retreating, or other
anxiety behaviors. However, infants will become most angry at their mothers, i.e.
following separations, not only because the separations are moms fault, but because
infants probably feel safest releasing such frightening emotion in her trusted company
(Brazelton, 1992; Bowlby, 1969). Rage will be expressed in fussiness or loud protest
cries. Initial deliberate acts o f aggression (i.e. biting or scratching another child;
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throwing a block out o f anger) emerge by 12 months (Brazelton, 1992). Temper

tantrums, most likely to occur following a period o f overstimulation (i.e. when the
familys out at a restaurant) or at the end of a busy day, have emerged by 18 months
(Brazelton, 1992).
Infants continue to rock themselves to sleep. They are also able to self-comfort by
hugging or clinging to stuffed toys, snuggling up with them in bed at night. Babies bite
or chew down on hard rubber toys (and lots o f other items) to alleviate teething pain and
tension build-up (Brazelton, 1992).
Characteristic inhibited or extroverted tendencies become more pronounced at
this time. Inhibited behaviors can be especially problematic during this developmental
period that requires approach (vs. withdrawal), attempting to master new skills, selfassertion, and exploration o f ones world (Brazelton, 1992).
Both implicit, emotional memory and explicit, working memory mechanisms are
now in place. Abilities for object and person permanence (holding them in mind) are
becoming stronger. The infant is in an intensive training period, practicing separate
motor skill segments over and over, then linking them into a chain o f behaviors, which
they also practice over and over until a more complex skill emerges with lessening effort.
Babies appear driven in their quest for mastery during this time. By age 15 months,
infants will begin symbolic play showing they can imitate their parents or demonstrate
new learnings by manipulating their dolls and other toys. They have learned to set aside
or stock up toys for later use. Some initial understanding o f causality emerges
(Brazelton, 1992).
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Infants at this age indicate good understanding o f receptive language (emerging

with temporal lobe development), to include the ability to comprehend gestures, speech,
and commands o f others (Brazelton, 1992). Productive language (with comes with
frontal lobe development) begins to emerge first with gesturing (i.e. pointing) (Brazelton,
1992). At eight months infants utter more frequent, continuous repetitions with distinct
intonation patterns. Utterances can convey emotions and emphasis. Consonant-vowel
sound sequences will be repeated more deliberately, and first words, generally nouns (i.e.
mamma, dadda, or names o f things), will emerge by 12 months. By 18 months, the
young toddler may have a repertoire of up to 50 w ords (LeFrancois, 1984) and no has
become a favorite (Brazelton, 1992). Two or more words (i.e. thank you) might be put
together in simple phrases (LeFrancois, 1984).
8-18 Months
The Purposeful Coordinations (4th) substage o f Piagets Sensorimotor period
begins at about 8 months and lasts to about age 11-12 months (Piaget & Inhelder, 1969).
During this period, toddlers begin to anticipate predictable events based on what have
become familiar patterns. From 12-18 months, youngsters shift into the Tertiary Circular
Reactions (5th) substage o f the Senorimotor period in which they begin to discover,
through their growing interest in experimentation, the relationship between means and
their effects on an object-m oving in the direction o f linking cause and effect. (Piaget &
Inhelder, 1969).
At about age one, the infant moves out o f the Oral stage into Freuds SadisticAnal Phase. This stage emerges with the breakthrough o f first teeth and focuses on
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power struggles, particularly around toilet training, as parents begin to impose restrictions
on the ids impulsive demands in order to socialize their infants (Feist, 1990).
The 8-18 month old infant continues in Ericksons initial Trust vs. Mistrust (oralrespiratory, sensory-kinesthetic) stage. The radius o f relationship continues to be mother.
With adequate negotiation of this period o f development the strength o f hope emerges;
failure to negotiate this period results in its core pathology, withdrawal. (Feist, 1990).
At about eight months, babies enter into what Margaret Mahler has termed the
Practicing Period, ushered in by the infants earliest ability to move away physically
from mother by crawling, paddling, climbing, and righting himselfyet still holding on.
(Mahler, Pine, & Bergman, 1975, p. 65). Mahler credits the infants learning howto
walk as the single most significant event facilitating psychological individuation. She
has observed, however that
how the new world is experienced seems to be subtly related to the mother, who
still is the center o f the childs universe from which he only gradually moves out
into ever-widening circles (p. 66).. .It should be noted...that during the entire
practicing subphase mother continues to be needed as a stable point, a "homebase" to fulfill the need for (emotional) refueling through physical contact, (p.
69)
In Kohlbergs Moral Development theory, a child at this age continues in the PreMoral stage. The purpose o f babys behavior during this period is to obtain immediate
pleasure and avoid pain (LeFrancois, 1984).
Developmental Tasks and Mechanisms o f Mother-Infant Attachment:
8-18 Months
M ahler (Mahler, Pine, & Bergman, 1975) named the developmental period
spanning 9-18 months o f age the Practicing Stage. Baby begins to explore the world
while sharing in m om s magical powers. This period is marked by the young childs
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ability to crawl, stand up, and walk upright. Mahler remarked that walking upright and
unaided is the greatest single step in human individuation (p. 70), not only permitting
the child to separate further from mother, but to become intoxicated (p. 71) with his or
her newfound magical abilities for movement and exploration. Mahler described
youngsters at this age as having a love affair with the world (p. 70). Amazingly, these
little ones appear impervious to knocks and spills in the service o f mastery and
discovery. Narcissism reigns as the child becomes exhilarated with his own grandeur
and omnipotence (p. 71). While maintaining contact with mom through sight and sound
o f her voice, the child begins to gain psychological, as well as physical, distance from
her.
Falling in Love with the World: Normal Mania
Just as the 2-5 month old infant was protected from becoming overexposed to
new, intensely arousing fear feelings when they arrived on the sceneby the socially
mediated euphoric rush o f opioids and dopamine coursing through the extended
amygdala-nucleus accumbens circuit; the 8-18 month old infant is protected from
experiencing the full force of newly emergent physical and emotional pain sensations by
another intoxicating rush o f opioid and dopaminethis time coursing up from the
ventral tegmental area o f the brainstem, through the nucleus accumbens, infusing a
mesocortical tract that culminates in the frontal lobes (Panksepp, 1998; Schore, 1994).
Some physical and emotional pain experiences would be extremely beneficial for
motivating the infant to make self-corrective adjustments in the service of acquiring new
locomotor, social, and self-organizational skills during this period o f rapid development.
However the exciting, euphoric rush would serve to motivate the youngster to keep
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practicing to learn how to walk, although taking lots o f spills, and to develop a sense of
self as separate from mother, despite the breakthrough o f extremely agitating separation
distress feelings into conscious awareness. For the most part, however, this is a buoyant,
giddy timewhen this exciting new world is the babys oyster.
Falling in Love with the Self: Normal Narcissism
Consistent with the emergence of the cingulate, infants become self-aware. For
instance, they are able to recognize themselves in mirrors, notice smudges on their noses,
and wipe off the smudges from their noses while looking in the mirror (Lewis, in
Brazelton, 1992). As infants master new skills, becoming quite taken with themselves
(healthy narcissism), they relish their new-found sense o f power. They want to be in
chargeo f their movements, personal space, and mothers comings and goings.
Interfering with their movements or vision or violating their personal space will
provoke anger. Anger, of course, is triggered as expected outcomes are thwarted or
stimuli are not forthcoming (Shapiro, et al., 1998). However, infants at this age are
particularly fearful o f personal space violations to the point that direct eye contact with an
unfamiliar person can produce intense anxiety (Brazelton, 1992). It is conceivable that,
with a new, fragile, ephemeral (and thus, highly vulnerable) sense o f selfespecially
during a time when the brain is undergoing major, rapid reorganizationsa stranger
entering the self through the eyes (like mom) could be extremely threatening. Plus, with
all this moving about, eyes have to remain available to catch moms eyes, for periodic
check-ins regarding survival status. Shes the trusted one, whose feedback is most prized
and whose supplies are most desired.
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Using Mom as a Secure Base for Refueling

Babies make extensive use o f facial expressions, particularly mothers or dads, to
gain cues for how to proceed in uncertain situations. A terrific illustration is provided in
Robert Emdes experiments in which an infant is placed on a clear plastic table top, under
which a solid portion drops away forming the edge o f a visual cliff. Babies will crawl
along the table until they get to the place that looks like it's dropping o ff at which time
they will look at their parents face for cues as to whether to proceed. If parents are
smiling like its safe, babies will proceed; if parents frown or look frightened, babies will
stop. (Emde in Brazelton, 1992).
Although just hearing the sound of moms voice may be enough to feel safe and
secure while moving about, at times a brief physical contact with her is required for
refueling (i.e. a touch o f her knee). Its all right for the baby to move away from mother,
because the choice to return is under the infants control. However, the converse is not so
(as is true for all narcissistic relationships). With a growing awareness that mother and
the self are not one, this youngster is starting to realize that mother is in charge o f her
own comings and goings, and that it is up to her when or even if she returns. Add a
maturing hippocampus, cingulate, and frontal lobe to the mix, and separation anxiety
intensifies. Protests are also more intense. However, if all has gone well in the
attachment relationship thus farbuilding up a good stock pile of pleasurable, gratifying,
trust engendering experiences, trustworthiness becomes the predictable, expected pattern.
The mother-infant relationship will remain quite secure and enjoyable with minimal
distress. And, the infant will be able to utilize mother as a secure base from which to
depart on countless exploring expeditions (Ainsworth et al., 1978).
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Attachment theorist Allen Schore (1994) believes that the attachment relationship
peaks during the period spanning 8-18 months, sighting stimulation o f frontal lobe
development as attachments primary purpose. This process is fueled by the visuoaffective connection between mother and child, which permits the youngster to maintain
the safe as well as exhilarating feelings triggered by her proximity, while at the same time
gaining distance (and separateness) from her. Per Schore, the connection through the
eyes stimulates a rush o f euphoric dopamine (via the mesocortical tract) that strengthens
synaptic connections in the frontal lobes in addition to the dopamine that infuses new
found muscular movements. O f note, one o f the sites for dopamine producing neurons is
the retina (Panksepp, 1998).
Developmentalists Gopnik, Meltzoff, and Kuhl (1999) have observed an even
more sophisticated utilization o f mothers (and other people) at this age:
When babies are around a year old, then, they seem to discover that their initial
emotional rapport with other people extends to a set o f joint attitudes toward the
world. We see the same objects, do the same things with those objects, even feel
the same way about those objects. This insight adds a whole new dimension to
the babies understanding o f other minds. But it also adds a whole new
dimension to babies understanding o f the world. One-year-old babies know that
they will see something by looking where other people point; they know what
they should do to something by watching what other people do; they know how
they should feel about something by seeing how other people feel. The babies
can use other people to figure out the world. In a very simple way, these one-year
olds are already participating in a culture. (Gopnik, Meltzoff, & Kuhl, 1999, p.
34).
Because the need for unrestricted movement, self-discovery, and control become
so important during this developmental period, parents who overcontrol their children
may be putting them at risk for becoming extremely angry, defiant, and prone to negative
mood. Perceptive youngsters looking to parental affect for cues to avoid or approach the
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novel, uncertain environment may catch anxiety from depressed (frowny), overanxious,
or overprotective parents. Inhibited behaviors would be especially problematic at this
age that requires active exploration to spur the brains development.
Primary psychopathology predicted to arise from this period, given the emergence
o f the hippocampus and cingulate, would be anxiety and negative mood disorders.
Anxiety and mood disorders have been associated with the cingulate in particular. This
structure adds awareness, intensifying separation distress. The same cingulate circuit that
produces separation distress, mediates panic, which Panksepp (1998) views as an extreme
point on the same continuum. Panic produces sensations o f racing heart and inability to
breathe, events triggered with hyperactivation o f the sympathetic nervous system that
would occur in survival-threatening, i.e. All Alone, helpless states. (These sensations are
directly opposite o f those produced by the opioid mediated sympathoinhibitory defense).
Because the cingulate is generally more active in females, girls may become more
susceptible to anxiety and depressive disorders, whereas males may become more
susceptible to aggressive disorders due to generally greater temporal lobe activation than
females (Panksepp, 1998). Excessive cingulate activity has been implicated in tics,
obsessive-compulsive behaviors, sociopathic behaviors, and abnormal social behaviors;
whereas reduced activity (i.e. from lesions) can result in diminished self-awareness,
depression, impaired initiation o f motor activities, and reduced pain reactivity, as well as
abnormal social functioning (Devinsky, Morrell, & Vogt, 1995).
Frontal lobe development may be adversely affected by excessive stress, anxiety,
or negative mood. During hyperactivation o f the sympathetic nervous system under
acute or chronic stressful conditions, resultant overload o f catecholamines can take the
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preffontal cortex off-line, to permit faster organism regulation by subcortical systems

(Amsten, 1999, p. 221). Stress can also disrupt cortical myelination (going on at this
time) required to speed communication between neurons and brain regions. Right frontal
lobe dysfunction is associated with manic type excitement, impulsivity, dysregulation o f
arousal, and attention problems; whereas left dysfunction is implicated in depression,
apathy, and reduced language production . A nM R I study by Steingard et al. (1996)
found reduced brain volumes in children hospitalized for depression, with a significant
inverse relationship between age and frontal lobe volume. EEG studies have found that
adults susceptible to depression show more right frontal arousal; whereas those who feel
happy with their lives show more left arousal (Panksepp, 1998). Along these lines,
inhibited babies show more right arousal; whereas extroverted babies show more in the
left (Panksepp, 1998).
Surprisingly, the hippocampus itself appears somewhat protected in children even
under traumatic conditions (De Beilis et al., 1999b). However, MRI studies o f adult
survivors o f childhood trauma (Bremner, 1999) show reduced left hippocampal volumes
contrasted with reduced right hippocampal volume in adults experiencing trauma later in
life. Although mechanisms have not yet been determined, Bremner et al. (1996) suggest
that the hippocampus may be involved in mediating dissociation of traumatic memories
(particularly those from childhood) due to its function as contextual integrator for various
memory components stored in multiple cortical locations. Dissociations would result
from inability o f the hippocampus to perform its normal integrative function. As
previously discussed, De Beilis et al. (1999b) demonstrated that those children subjected
to trauma earliest in life and for the longest periods had the most reduction in overall
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brain volume (although not in the hippocampus), with the corpus callosum notably
reduced in size. These same children were also most likely to experience dissociations.
Due to hypersensitivity to personal space violations at this age, physical abuse
would probably induce intense rage at a time when aggressive behaviors also emerge.
One can only imagine that sexual abuse would result in feelings o f profound engulfment
coupled with pain and terror.
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18-24 Months: Rapprochement

By eighteen months o f age, the young toddler has a fully functioning brain stem,
hypothalamus, amygdala, septal nuclei, hippocampus, and cingulate. All primary
emotion circuits are on board, including the autonomic nervous system, pleasure,
seeking, rage, fear, anxiety, and emotional pain (sadness, grieving, panic). Not only is a
youngster now able to experience emotion sensations and mood states in conscious
awareness, but some degree o f willed control over emotion motivated behavior is now
possible. By two years of age the occipital lobes will have obtained 70 % o f their adult
size; the temporal lobes, 83%; the parietal lobes, 75%; and the frontal lobes, 73%
(Joseph, 1996). As the neocortex continues to mature, it will add increasing
sophistication to the quality, interpretation, expression, and regulation o f emotion.
For the toddler, splitting o f experience (involving right vs. left hemisphere
processing) and compartmentalizing experience (laid down in pockets o f the neocortex)
predominate. Mechanisms for integrating experiencemyelination that speeds
information sharing, the corpus callosum that connects the two hemispheres, and the
multitude o f interconnecting pathways that permit integration o f experience in cortical
association areasremain quite immature.
Testing limits imposed by others (as the childs exploratory interests expand) is
characteristic o f this age, and power struggles become a common occurrence. Aggressive
behaviors (i.e. hitting, biting, scratching) emerge, particularly with tension build-up or
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overstimulation. Temper tantrums can be used as a social manipulation device,

particularly if the youngster learns that they work (i.e. garnering attention by turning
volume up, getting desired toy by wearing mom down). Separation anxiety becomes
even more intense, with protests becoming most violent during this age (Brazelton,
1992, p. 172).
Extending exploration to learning how people work, many provocative behaviors
are experimental in nature and not intended as aggressive acts (Gopnik, Meltzoff, &
Kuhl, 1999). Imitating the behavior of others is in full swing with boys modeling their
dads and girls their mothers (Brazelton, 1992). These youngsters can make use of
parallel (side-by-side) play with other children (Brazelton, 1992). The childs social
circle is broadening to include not only parents, but siblings and other children.
Two year olds are becoming quite mobile, although still a bit awkward at times.
They can run about, walk up or down stairs with the same foot forward, and have good
coordination o f hands, thumbs, and fingers (Brazelton, 1992; LeFrancois, 1984). They
can even put their toys away (Brazelton, 1992). It is during this time that youngsters
achieve physiological control through toilet training.
Negative feelings such as longing for mother in her absence, excessive fear, and
anger are prevalent. Triggers for anger include goal thwarting or restriction of
movement, i.e. now by verbalized commands inherent in parental limit-setting. Toddlers
at this age are especially afraid of losing control over their own powerful emotions (i.e.
their rage) and o f losing their mothers to a new sibling. Jealousy emerges (Brazelton,
1992). This age is often marked by increased negativity. Infant ambivalenceswinging
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from negative to positive moodmay be dramatic (i.e. enraged one minute, loving and
clinging to mom the next) (Brazelton, 1992).
A toddler makes good use of soft stuffed animals as transitional objects,
permitting increased distancing from mother and dad. This child may be overheard
comforting a teddy bear, using the same words parents previously used to comfort the
child. This is a stepping stone to internalizing parents words in soothing self-talk
(verbalized thoughts). These youngsters can also work through stressful conflicts or gain
mastery through symbolic play.
Children at this age have become quite aware o f themselves as separate human
beings. Self-exploration o f their bodies, especially genitalia, is a natural by-product o f
toilet training. Toddlers can make appropriate use o f mirrors, i.e. to experiment with
application o f mothers lipstick to ones face. Gender identification, expressed in play
and imitation, is becoming important.
Receptive language is developing rapidly, with two year olds understanding more
complex (even three-part) commands. Vocabulary increases to up to 300 words to
include a sprinkling o f adjectives and adverbs along with nouns and verbs, and the child
begins to speak simple two-word sentences. Two year olds appear to understand
everything said to them, and they become frustrated if not understood by others
(LeFrancois, 1984; Brazelton, 1992). Although toddlers now have working memory
systems in place, they will still find it difficult to transfer information between
hemispheres (i.e. from sensory-emotional right to verbalizing left) due to an immature
corpus callosum.
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18-24 Months
Mental Representation, the 6th and final sub stage o f the initial Sensorimotor stage
o f Piagets cognitive development theory peaks at about 18-24 months. Marked by the
childs internalization o f activity and events, this substage represents a transition to a
more cognitive intelligence. In this stage the child becomes capable o f finding new
means not only by external or physical groping but also by internalized combinations that
culminate in sudden comprehension or insight (Piaget & Inhelder, 1969, p. 11). For
example, an activity can be internalized so its consequences can be anticipated prior to
actually doing it. A childs imitating a person or calling their name when that person is
absent is evidence that the child can represent that person mentally (LeFrancois, 1984)
(Piaget & Inhelder, 1969). Simply put, there has been a transition form sensation to
representation (LeFrancois, 1984).
Also at this time toddlers can make use o f signs that signal something is about to
occur (Piaget & Inhelder, 1969). However, the sign itself is often taken for the cause,
i.e. getting a bath is the cause o f going to bed (LeFrancois, 1984) due to the temporal link
o f one right after the other in immediate or rapid succession. (Piaget & Inhelder, 1969).
Children are not yet to the point they can conservehold onto the concept o f a fixed
amount across space, time, or changing conditions.
The two year old is at the peak o f Freuds Sadistic-Anal Phase. Power struggles
emerge, particularly around toilet training, as parents begin to impose restrictions on the
ids impulsive demands in order to socialize their toddlers. The ego has the awesome
task o f balancing the potent demands o f the internal world of the id with those o f the
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external world, a feat that is necessary for physiological and psychological survival. I f
this does not occur, and the id wins out, the child could suffer annihilation from
displeased and powerful outer forces. The outer world is encountered as an inhibiting
power, hostile to the childs own desires. Freud described this dilemma:
Thus the ego is fighting on two fronts: it has to defend its existence against an
external world which threatens it with annihilation as well as against an internal
world that makes excessive demands. It adopts the same methods o f defence
against both, but its defence against the internal enemy is particularly inadequate.
As a result o f having originally been identical with this latter enemy and o f having
lived with it since on the most intimate terms, it has great difficulty in escaping
from the internal dangers. They persist as threats, even if they can be temporarily
held down (Freud, 1940 in J. Strachey, ed. and trans., 1964, p.200, in Miller,
1989, p. 131).
A youngster now enters Ericksons second, Early Childhood stage which parallels
Freuds Anal stage. This stage is characterized by the psychosocial crisis Autonomy vs.
Shame and Doubt that emerges while learning to control ones body during the process of
toilet training. If trust was not established during the previous stage, the child will likely
experience shame (feelings of self-consciousness and exposure) or doubt (feelings of
uncertainty. The basic (ego) strength that emerges from this conflict is free will;
compulsion, the core pathology of this stage, arises from inadequate will. Erickson
believed that young children should have more experiences with autonomy vs.
submission to prevent undermining their initiative (Feist, 1990).
As the Practicing period wanes, the stage Mahler named Rapprochement begins.
Rapprochement represents the juncture at which the toddler comes face to face with the
hard, cold reality that she/he is a separate person from mother and not at all powerful; the
child can no longer claim her magical powers as ones own (Mahler, Pine, & Bergmen,
1975). Frustration sets in when needs and wants are not readily met. Mood swings ensue
as the ambivalent child alternates between clinging to mom on the one hand or becoming
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enraged when desires are thwarted on the other. Mother is split into bad (when she
imposes demands) or good (when she provides loving affection). This youngster is not
yet able to entertain these disparate sides o f her in one place within the mind. However,
the frustration that emerges from the childs dilemma continues to bring about
individuation. The downside is that the child is particularly vulnerable at this stage,
finding self in yet another version o f the frightening separation crisis. No longer
equipped with magical powers, the child seeks frequent reassurance and contact comfort
from mother. (Mahler, Pine, & Bergmen, 1975).
Jacobson proposed that optimal units o f frustration serve to push the child into
doing for self what was previously done by others, providing growth experiences and
fostering ego development. The ability to do for oneself forms the basis for self efficacy,
which is rewarding and, therefore, stimulates the child to seek more mastery obtaining
experiences. She observed that the childs boundaries between self-representation and
object-representation are still quite weak. Images o f self and object can rapidly merge
and separate. In addition, the child invests libidinal and aggressive energy in the self and
object representations. This is manifested as introjections based on the childs
phantasy o f incorporating the love object when times are good and projections based
on the childs phantasy o f ejecting the love object when times are bad (St. Clair, 1996).
Kemberg described this process o f splitting the self or object representation into
good associated with joyful, love feelings and bad associated with angry, hate
feelings . He noted that the child will eventually be able to blend or metabolize split off
experiences unless those experiences (particularly negative, deprived ones) have been
extreme (St. Clair, 1996).
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In Kohlbergs Moral Development theory, the two-year-old continues in the

initial, Pre-Moral stage, whereby the purpose o f behavior is to obtain immediate pleasure
or avoid pain. As a childs cognitive capacity emerges, children will initially
comprehend right and wrong based on experiences with obedience and punishment (i.e. if
I get caught and am punished, I did something wrong). This stage may last up to age five
(LeFrancois, 1984).
Rapprochement represents a critical life-altering juncture in the childs
psychological development: the realization that he or she has become a free-standing,
separate human being. It also represents yet a third, reorganized twist on the separation
dilemma, in that way the brain has o f retooling itself when more sophisticated processing
systems come on-line. What the child brings to the separation experience this time,
however, is a good dose of reality brought about by new found abilities for conscious
perception o f potent, as of yet undiluted emotion feelings; awareness o f free-will with
the desire (fueled by these potent feelings) to impose it; and a clarified view that one is
very small without much power at all. Protective, magical delusional beliefs begin to
subside as fledgling scientific observations, problem solving skills, and other mental
abilities begin to emerge. Once again necessity becomes the mother o f invention.
Because the child is placed in a context in which one must sink or swim, the child learns
to swim.
O f course, this context is a social one with a new twist, as well. Because o f the
childs growing independence and increasingly sophisticated abilities, mother is
expecting that her child not only do more self-maintenance, but set self desires aside for
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hers. This is not fair. Who wins in the war o f the wills? She does, o f course, because
shes bigger and because she remains an incredibly important source o f supplies.
Without her the child is all alone, really all alone and acutely aware o f that fact. Because
a budding sense of self remains fragile, especially in this jolting new and precarious state
o f affairs, the child becomes extremely dependent on mothers affective feedback to
fortify the self. With growing ability for anticipation and imagination, the child can now
even miss mother before shes gone. A frightening phenomenon o f the childs own
making, anticipatory anxiety, emerges.
Parents have a tough job at this juncture. They must walk a narrow line between
making demands that foster growth (even though it makes their youngster extremely
upset or angry) and taking care not to overestimate, and thus outstrip, their childs
coping. Providing ample unconditional reassurance o f their love and enjoyment o f their
childnot anchored to the childs good behavior, but just becauseis essential. Parents
who have come to know their babies and who can remain grounded adults through the
tempests, will be able to make these homeostatic adjustments.
Attachment Deficits and Distortions: 18-24 Months
Types of psychopathology likely to arise from this period would involve the
inability to maintain sturdy, internalized self and other representations; continued
splitting o f highly charged, unmanageable emotional material and feeling states;
anticipatory anxiety that takes on a life o f its own; issues of having too much or too little
power; and development of reciprocal coercive relationship patterns characterized by
power battles and excessive negative affect. Parents who undercontrol their children at
this juncture deprive them o f badly needed boundaries or limits at a time when they need
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help getting powerful, frightening emotions under control. They also deprive their
children o f learning the social rules that make them acceptable to others. Parents who
disrespect and overcontrol their children, undermine their childrens self-esteem,
competency, and motivation. These children will either become underdeveloped and
overcompliant or defiant, angry, and depressed.
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24-36 Months: Object Constancy

By thirty-six (36) months o f age, the young child has a fully functioning brain
stem, hypothalamus, amygdala, septal nuclei, hippocampus, and cingulate. All primary
emotion circuits are on board, including the autonomic nervous system, pleasure,
seeking, rage, fear/anxiety, and emotional pain (sadness, grieving, panic). Not only is a
youngster now able to experience emotion sensations and mood states in conscious
awareness, but some degree o f willed control over emotion motivated behavior is now
possible. As the neocortex continues to mature, it will add increasing sophistication to
the interpretation, expression, and regulation o f emotion.
What the cortex cannot contribute, however, is the felt experience that we call
feelings. Felt experience cannot be achieved by stimulation o f any portion of the
neocortex (Panksepp, 1998). What the cortex can provide are sophisticated integrative,
perceptual, appraisal, memory, contemplative processing mechanisms and behavioral
response systems for gaining self-understanding, self-regulation, flexibility, and willed
choice in the service o f optimizing survival outcomes.
Two particular ways these more sophisticated mechanisms are coming to show
themselves during this 24-36 month period are through (1) increasing ability for utilizing
left hemisphere processing systems and (2) increasing capacity for intercommunication
between the brains two hemispheres. In this way, disparate feelings can be entertained
in mind simultaneously. Through this process, emotions can become mixed, modulated,
and manageable.
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Lateralization
Corresponding areas o f the right and left hemispheres have been developing at
differing rates (Joseph, 1996; van der Kolk, 2000). Spurred by rich interconnections with
subcortical emotion structures, the right hemisphere emerges earlier, takes longer to
mature, and remains larger throughout life (van der Kolk, 2000; Joseph, 1996; Barkely,
1997). It will continue to specialize in social-emotional functions and related sensory
perceptions.
By contrast, the motor cortex in the left hemisphere has been developing faster
than motor cortex in the right (in most individuals), with these neurons gaining
competitive synaptic advantage, accounting for right handedness (Joseph, 1996). In
addition, the practical left hemisphere has been developing sophisticated systems that will
permit individuals to gain conscious control o f their emotionsmany of which are
coming into their own during this 24-36 month developmental period. Left hemisphere
specializations emerging at this time include symbolic processing; language perception,
interpretation, conceptualization, and production; sequential sense of time with
beginnings and endings; linear information processing; verbal thought; rational,
deductive reasoning; ability to categorize and label experience (i. e. internal states);
ability to develop meaningful, sequential narrative for experience; emotion modulation
through reflection; and conscious awareness as we recognize it (Joseph, 1996; Lezak,
1983).
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Temporal Lobes
The temporal lobes will increase from 83% o f their adult size at two years o f age
to 88% by four years o f age (Joseph, 1996). Deriving from the amygdala, hippocampus,
and occipital lobe, the temporal lobes have been stimulated by and maintain rich
interconnections with these structures. The amygdala, o f course, lies deep inside this
lobe. Left temporal lobe processing specializations include awareness o f visual, auditory,
visceral, and emotional sensations; memory encoding, storage, and recall; temporal
sequencing; receptive language (Wernickes area); and thought (Joseph, 1996; Lezak,
1983).
Parietal Lobes
O f all cortical regions, the parietal lobes are one of the last to anatomically and
functionally mature, taking up to 8 or more years (Joseph, 1996). During the period
spanning 2-4 years o f age, the parietal lobes appear to undergo a reorganizational shift
with decreasing inferior, but increasing superior regions, resulting in no net increase in
size (Joseph, 1996). Left hemisphere parietal specializations evident in young children
during this period reflect its rich interconnections with the hippocampus (from which it
derives) and include simultaneous cross-modal analysis o f incoming auditory, visualspatial, somesthetic, and visual inputs; word-finding; and sequential as well as spatial
organization (Joseph, 1996; Lezak, 1983).
Frontal Lobes
The frontal lobes will take the longest to mature of all the brains components~up
to 16-18 years o f age (Chugani, 1998). However, they continue to develop rapidly,
increasing from 73% to 80% of their adult size between 2-4 years o f age (Joseph, 1996).
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Functions reflect the cingulate, the prominent emotion structure giving rise to and
interacting with the frontal lobes. Specializations relevant to young children include eyehand coordination; visual scanning (using saccadic eye movements); sustaining attention
over time and space; ability to anticipate events; self-organization; goal formulation;
motivation; exerting free will and intent; language production (Brocas area), ability to
take the initiative; flexible vs. rigid problem solving (i.e. considering alternative choices);
and ability to self correct (Joseph, 1996; Lezak, 1983). The orbital frontal lobes, which
permit awareness o f emotion sensations and feelings states, are intimately associated with
the anterior cingulate and amygdala (Joseph, 1996). Left frontal areas are associated
with producing happy feelings and positive mood, as repeatedly demonstrated in MRI
studies (Panksepp, 1998).
Another emerging specialty o f the cingulate and frontal lobes is the ability to
delay an emotion-driven behavioral response in order to achieve longer-term goals
(Panksepp, 1998; Joseph, 1996; Lezak, 1983). Attention Deficit Disorder expert Russell
Barkley (1997) considers the ability to employ behavioral inhibition to be a primary
achievement. He defines this complex skill as involving
three interrelated processes: (1) inhibiting the initial prepotent response to an
event; (2) stopping an ongoing response or response pattern, thereby permitting a
delay in the decision to respond or continue responding; and (3) protecting this
period o f delay and the self-directed responses that occur within it from disruption
by competing events and responses (interference control), (p. 47)
This capacity will start to take hold during this period.
Integrative Processing Status
Splitting o f experience (involving right vs. left hemisphere processing) and
compartmentalizing o f experience (laid down in pockets o f the neocortex) continue to
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predominate. Mechanisms for integrating experiencemyelination that speeds

information sharing, the corpus callosum that connects the two hemispheres, and the
multitude o f interconnecting pathways that permit integration o f experience in cortical
association areasstill have a long way to go. Although it will take up to 10 years for
maturation o f the corpus callosum, during this 24-36 month developmental period,
youngsters will show emergent capacity for interhemispheric integration o f experience.
Feeling Combinations
Increasing awareness coupled with more sophisticated cortical appraisal, cause
and effect, reflection, and anticipation systems may elicit emotions or even complex
combinations o f emotions from the top down to lower structures in the circuit. For
instance, jealous feelings eliciting separation distress, fear, and rage simultaneously,
while triggering the stress circuit, may have been provoked by mothers attention to a
new baby brother. That rage could be directed at the threat, baby brother.
Two year olds are capable o f genuine empathy for others and may even attempt to
allay their pain. Gopnik, Meltzoff, and Kuhl, (1999) elaborate the degree of ability this
requires, demonstrating just how far these children have come:
to be genuinely empathic, you have to understand how other people feel and know
how to make them feel better, even when you dont feel that way yourself.....Real
empathy isnt just about knowing that other people feel the same way you do; its
about knowing that they dont feel the same way and caring anyway. Babies
arent bom with this deep moral insight, but by the time they are two, they already
have begun to understand it. (p. 39).
Youngsters this age demonstrate a spirit of cooperation and enjoy helpingmaking
genuine contributions to the family, which adds to a growing sense o f competence. They
can also make good use o f others, especially parents, as teachers and role models.
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Imitation, especially o f the same-sexed parent, increases. They are able to play well
within a small group o f their peers. These youngsters are beginning to learn how to share
and work out problems with siblings (without parental help).
By three years o f age, a child can jump into the air with both feeta foot high,
stand on one foot, walk on tiptoe, run smoothly (speeding up or slowing down at will),
walk up or down steps with alternating feet, dance, twirl, and pedal a three-wheeler.
(LeFrancois, 1984; Brazelton, 1992). With good finger and hand control, this child has
greatly improved ability for manipulating objects (i.e. can build tower o f six cubes)
(LeFrancois, 1984) and preferred handedness becomes permanent (Brazelton, 1992).
They have mastered their utensils, and prefer to feed themselves, thank you. (Messiness
is not a concern.) Although children at this age may have difficulty getting through the
night without wetting, they will have achieved daytime toilet training during this
developmental period (Brazelton, 1992).
Although still prone to dramatic mood swings and temper tantrums (to which they
can apply frightening new skills such as breath-holding), children at this age are capable
o f regaining control and calming back down by themselves. Phobias may develop from
real life encounters (i.e. with a snap from the neighbors dog). With increased capacities
for mastery and self-containment come feelings o f self-confidence. Youngsters may
masturbate for pleasure or to reduce tension.
This period is marked by the childs becoming self-contained. Effective use of
transitional objects continues. However, there is a fascinating new development whereby
youngsters engage in personal narratives or monologuestalking out loud to themselves
about their experiences to process stressful events and feelings or to talk themselves back
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down t o sleep (Nelson, 1989 in Brazelton, 1992). This device is a heart-beat away from
utilization o f internal, reflective verbalized thought.
This youngster shows good attention to task, ability to select stimuli that fit the
current activity while screening out irrelevant stimuli. The child now has vivid internal
representations consisting o f an active fantasy life that becomes revealed in play.
C hildrens play at this age demonstrates comprehension of basic cause and effect, good
understanding o f the meaning o f the activities going on around them, even subtle social
nuances, and sex differences, as well as continued imitation (Brazelton, 1992). They may
even invent and interact with an imaginary friend (Brazelton, 1992).
It is during this period that children experience their fastest spurt in language
development. Vocabulary grows by leaps and bounds as the child acquires up to 1000
new w ords. This youngster now speaks in sentences using up to five words, to include
nouns, verbs, adjectives, and adverbs. Typical child grammar is imposed. Receptive
language has also developed to the point the child can follow more complex, three-part
commands (Brazelton, 1992). All components o f language will be in place and fully
functional by age four years.
24-36 Months
Piagets Pre-operational Stage, running from age 2-7 years is characterized by
egocentric thought, reason dominated by perception, intuitive vs. logical solutions, and
inability to conserve. It is during this 24-36 month period that children will develop the
ability to hold mental representations o f self and others in mind over time, hence the term
object constancy. An important way the child becomes able to do this is by first
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physically acting out or imitating others. Piaget (Piaget & Inhelder, 1969) identified five
forms o f imitation in developmental order: deferred imitation which starts after the
disappearance of the model, symbolic play or pretending, drawing an image (emerging
at about age 30 months), internalized imitation via mental image, and (with emergence of
language) verbal evocation o f events that are not occurring at the time (p. .55).
Freuds pre-oedipal period o f psychological development will draw to a close at
about age 36 months when the Anal stage ends, giving rise to the Phallic stage. The child
at this point is developing a pretty sturdy ego, able to delay gratification toward
becoming self-contained and, therefore, independent (Feist, 1990).
This youngster continues through Ericksons second, Early Childhood stage,
characterized by the psychosocial crisis o f Autonomy vs. Shame and Doubt. The basic
(ego) strength that emerges from this conflict is free will; the core pathology resulting
from failure to negotiate this stage is compulsion (Feist, 1990). At about age 36 months,
the child will enter the Play Age with its psychosocial crisis, Initiative vs. Guilt.
M ahlers (Mahler, Pine, & Bergman, 1975)s fourth and final substage o f the
separation-individuation process, Object Constancy, derives its name from Piagets work
regarding internal representations:
The last subphase (roughly the third year of life) is an extremely important intra
psychic developmental period, in the course o f which a stable sense o f entity (self
boundaries) is attained.. .But the constancy o f the object implies more than the
maintenance o f the representation o f the absent love object. It also implies the
unifying o f the good and bad object into one whole representation, (p. 9-10)
Obtainment of this milestone means that the young child can now achieve a realistic and
unified internal representation o f mom who becomes available internally for sustenance,
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comfort, and love just as she used to do externally. Mom has now become integrated in
the childs mind; she can be both good and bad and still be mom.
In Kohlbergs Moral Development theory, the three-year-old continues in the
initial, Pre-Moral stage. Children at this age comprehend right and wrong based on
experiences with obedience and punishment. For instance, if I get caught and am
punished, I did something wrong. If I didnt get caught, I did nothing wrong. This stage
may last up to age five (LeFrancois, 1984).
The parent-child task at this time is to encourage the childs autonomy by trusting
emergent capacity for self-control. Providing limited choices, asking open ended
questions to assist the child to explore their world or to come up with their own solutions
for problems (vs. telling the child what to do), reframing mistakes as good things that
help you learn, letting siblings fighting over a toy work it out among themselves, and
permitting a youngster to regain emotional control alonewithout interference and in
calm surroundingsfollowing a temper outburst signal to children that they can be trusted
to find their own way. Again, sensitive parents who know their children well, will be
able to determine if youngsters are in over their heads and step in. Parents are also
modeling emotional behavior for their children, whether they intend to do so or not (i.e.
by showing empathy for the childs feelings, safely expressing dangerous, scary emotions
like anger, showing how men and women act to each other).
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Problematic Modeling Becomes Imitated, then Internalized
Particularly problematic at this age is parental modeling o f poor emotional
control. When a grown-up loses control of a dangerous emotion like rage, the childs
own anger becomes feared and kept at bay, preventing opportunities for gaining
experience and self-effectance in expressing it safely. Children exposed to violence
perpetrated against their mothers or other family members, are especially at risk. Parents
who hit their children out o f anger in order to discipline them are providing a vivid
demonstration that those who are bigger, stronger, and exert more force are more
powerful. Modeling aggression sends a releasing signal to the child that aggression is
OK. This is a period in which children are actively internalizing their parents, especially
same sexed parents.
Trauma is Processed in the Right Hemisphere: Trauma and the Corpus Callosum
Bessel van der Kolk (2000) notes that psychological trauma is processed in the
right hemisphere in both children and adults. Joseph (1996) summarizes the contribution
of the right hemispheres role in human emotion:
Although there is evidence o f considerable overlap as well as inter-hemispheric
cooperation on a number o f tasks, it certainly appears that the mental system
maintained by the right cerebral hemisphere is highly developed, socialemotional, bilateral, and in many ways dominant over the temporal-sequential,
language-dependent half o f the cerebrum. Indeed, the right cerebrum can
independently recall and act on certain memories with purposeful intent; is the
dominant source o f our dreams, psychic conflicts, and desires; and is fully capable
o f motivating, initiating, as well as controlling behavioral expressionoften
without the aid or even active (reflective) participation o f the left half o f the brain.
(P- 117)
The corpus callosum is comprised o f axons that interconnect, and thus permit
information transmission across, the brain's two hemispheres. It arises from immature
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neurons in the superficial layers o f the neocortex (the last layers to come on line) and
parallels neocortical development patterns. Myelination o f the corpus callosum can take
well over 10-12 years to complete (Joseph, 1996). For the young child, the
dissociation o f experience (involving right vs. left hemispheric processing) appears, in
many respects, to be the normal and natural state of affairs. The mechanisms that
integrate emotional and cognitive aspects o f experience will remain immature for so long
that Rhawn Joseph (1996) predicts children as old as age seven will normally continue to
display transfer deficits in their information processing.
This is especially problematic for young children who have experienced trauma,
preventing them from integrating their experience by bringing to bear left hemisphere
narrative, rational thought; time-limiting perspective; or ability for putting their
experience into words to convey it to others. Thus, the nonverbal sensory components,
pain, and terror o f trauma can remain fresh, powerful, and isolating as they dwell in the
timeless regions o f the right cortical hemisphere and amygdala.
Making matters worse, recent MRI studies by De Beilis and colleagues (1999b)
showed that children who have PTSD not only have reduced overall brain volumes, but
the corpus callosum is significantly smaller in these youngsters. Boys faired significantly
worse than girls, with an even more underdeveloped or reduced corpus callosum. Those
with less brain volume (and larger ventricals), the children whose abuse started the
earliest and lasted longest, were (in a significant negative correlation) more prone to
intrusive thoughts, avoidance, hyperarousal, or dissociation (p. 1271).
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Figure 1: Emotional Brain Development: Ages 0-36 Months
Age
Available Brain
Emotion
Developing Cortex
Mixtures
Integrative
Processing
Happiness
Left Hem
24-36
18-24
Developing Cortex
Right Hem
Ambivalent/Pure
(Love vs. Hate)
Developing Cortex
Intensified Emot. Pain,

Separation Distress,
Panic
Negative Mood
Anxiety
8-18
Cingulate
Hippocampus
5-8
Septal Area
2-5
Amygdala
0-2
Hypothalamus
Brainstem
Emotional Pain
Separation Distress
Sadness
Longing/Grieving
Stress Response
Fear (Anxiety)
Intensified Rage
Excited Anticipation
Euphoria
Rage
Seeking
Pleasure
Aut.Nervous System.
Influence
Self Containment
Emotion Modulation
Holds Two Feelings
in Mind at Once
Int.Self/Other Reps
Sust. Over Time
Language/Time Persp.
Ephemeral Self
Split processing
ConsciousAnticipation
Self Awareness
Willed Emot. Behavior
Awareness o f Feelings
Contextual, Autobiog.
Memory
Behavioral Inhibition
Selective Social
Attachments
Dampening of Felt
Emotion
Danger Avoidance
Social/Emotional
Memory
Social/Emotional
Processing
Social Desire
Amplified/Sustained
Felt Emotion
Approach
Motivation
Sustained Attention
Stimulus Dependent
Arousal (Felt Emotion)
Homeostasis
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CHAPTER V
DISCUSSION
Effectiveness o f the Biopsychosocial Model for Projecting Psychopathology Resulting
from Attachment Deficits and Distortions: Demonstration Findings
The purposes o f this dissertation were to (1) delineate the biopsycho social roles o f
mother-infant attachment in emotion regulation, (2) devise a developmental model for
projecting psychopathology resulting from attachment deficits and distortions, and (3)
provide a detailed demonstration o f the models effectiveness. Inherent goals were to
identify necessary factors for establishing a healthy psychological foundation and to
provide plausible explanations for resistant, long-standing psychopathology.
Essential Model Components
Model steps (CHAPTER HI: METHODOLOGY) were followed to develop the
demonstration for Ages 0-2 Months. Multiple literature reviews synthesized six strands
o f data (available brain, developing brain, observable infant phenomena, relevant
developmental theories of psychology, mother-infant attachment mechanisms,
psychopathology) from which a list o f projected enduring traits o f attachment deficits and
distortions were formulated. Dataselected for consistency across neurobiological,
developmental, behavioral, and clinical vantage pointswere pulled together for the
purpose o f bringing a bigger (biopsychosocial) picture into view.
Essential components o f this model are (1) its adherence to the principles of
General Systems Theory to include evolution; (2) mapping individual and social systems
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data over neurobiological data bones; (3) formulation o f projections for attachment
related psychopathology by working forwardsequentially and additively (consistent
with brain structures and circuitry coming on-line)from the emergent end o f the
developmental trajectory; and (4) reliance on data derived from measures of
neurobiological or clearly observable events vs. abstract, elusive intervening variable
stand-inswhenever possible.
Nature o f the Process
This process o f following model steps to construct the demonstration was not
unlike the brains development described herein. In the beginning, the sheer amount o f
available data was overwhelmingakin to the tremendous flexibility afforded by
overabundant synapses. The decisions to organize the data per sequential age periods
(vs. by topic) and to use neurobiological findings as the bones became the keys for the
entire project. As strands o f data were pulled together within the confines o f incremental
age periods, much o f the data popped out as harmonious or consistent; other data did
not. This provided a mechanism for weeding out irrelevant information. As data
collection and synthesis continued, it became necessary to reorganize periodically, but
the process became increasingly streamlined and efficient as relevant connections were
established and irrelevant ones discarded. Gaps in the big picture became much smaller,
and to solve problems necessary to fill in the gaps, the search for additional data became
very honed and precise.
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Advantages and Disadvantages

Advantages
(1)
A sequential, epigenetic developmental approach permits a big, additive
picture across time, affording a new, more precise view o f attachment phenomena and
related psychopathology. To rethink long-standing psychopathology from its emergent,
mysterious front end, vs. extrapolating backward from adulthood where it shows itself,
seemed at first to be a daunting, if not impossible task. The second task was to see if it
was connected to attachment deficits or distortions. The only way to do this was to pull
together a great deal o f data about infants during their attachment periods. An initial
problem right off the bat was that differing theorists had focused on different aspects of
attachment (i.e. Bowlby started with the sixth month old infants protest upon separation
from mother; Allen Schore is convinced that attachment is about frontal lobe
development in the 8-18 month old infant; Edward Tronick, Jacobson, and Winnicott
suggested that mother serves as a kind o f auxiliary nervous system for even youngest
infants; Jaak Panksepp had discovered a biological opioid substrate mediating
attachment). Could they all be right? Were they all talking about the same thing? To
make any definitive statements, such diverse material would have to be organized into
some cohesive, unified entity.
As much sense as it makes now (especially in light of evolution and General
Systems theories), the idea o f using a sequential, developmental frame for pinning down
these data finally seemed to be the only way to approach this monumental project.
Having now used the sequential, additive process mapped to human brain development
this author cannot imagine going back to another type approach (i.e. topical) to elucidate
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or describe developmentally emergent phenomena such as attachment or long-standing

psychopathology that occur while the brain is still forming and reorganizing itself. It
forces one to begin at the beginning where any etiological process needs to begin:
permitting a baseline view; catching, pinpointing, or circumscribing the precipitant; and
tracking its sequelae through subsequent changes over time. Jumping into the middle of
the process could result in missing, misidentifying, or misinterpreting data. The
epigenetic format provides a coherent, organized flow for synthesized descriptions of
diverse and complex data.
(2)
Data from diverse disciplines can be mapped together, pinned to
neurobiological bones. Once the sequential neurobiological bones were in place, other
data fell into place over top o f them and the bigger picture afforded by corroborative data
from across numerous vantage points started to come into view. This process laid the
ground work for further honing and refinement. Eventually definitive statements could
be pulled together with some precision and confidence. Extensive use o f neurobiological
and observational studies precluded overreliance on intervening variables (James,
1999, p. 19) to describe phenomena.
This approach permits utilization, incorporation, and synthesis o f all sorts of
studies (i.e. theoretical, behavioral), and therefore vantage points, so long as they are
consistent with General Systems Theory principles and can be accounted for by
neurobiological mechanisms. Hopefully this dissertation demonstrated that when
various views (elephant parts) are pulled together in one place, a bigger picture (elephant)
can emerge. This approach does screen out studies (i.e. re: etiology o f psychopathology)
that are off the mark, no matter how articulate or elegant, because they violate principles
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of nature (i.e. cannot be accounted for by biological subsystem processes) and therefore
must employ intervening variables that have strayed too far from the phenomena they are
attempting to describe.
(3) Fresh vantage points lead to new insights. Giving up preconceived notions of
psychopathology to follow model steps led to fresh, new insights. By plotting what
would occur if certain types o f maternal mediated environmental conditions obtained at
various points along the developmental trajectory-based on the developmental status of
the brainone could begin to make ballpark projections o f the types o f coping options
that would be available to the infant. This process led to an unexpected new theory for
the emergence o f aberrant aggression from early infant trauma based on evidence of
opioid mediated adaptations, depletions, and deficiencies. By looking at the progression
of unfolding brain mechanisms over time, patterns began to emerge. For instance, it
appears that endogenous opioids may play a role in modulating arousal (i.e. through a
variety o f dampening or dissociation mechanisms befitting the emotion structure) at
various points along emotion circuitsfrom lowest levels (brainstem, vagal nerve) all the
way to more sophisticated levels (i.e. hippocampus).
Disadvantages
(1)
Currently, this type approach involves tedious, time-intensive work upfront to
locate and organize corroborative data from various disciplines by developmental period
simply because such data are not generally organized this way, nor are they located in
one convenient central location. However, as data were collected and gaps filled in, as
previously discussed, the process became more precise, streamlined, and quicker. The
pay-off was well worth the initial effort, providing a fresh, new developmental view of
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the multiple, changing influences o f the mother-infant attachment relationship on a

dynamic, developing brain and what can go wrong-leading to long-standing
psychopathologywith deficits or distortions in those attachment processes.
(2) Language barriers across disciplinesor even within the same discipline
contribute to having to spend incredible amounts o f time reading, deciphering, re-reading,
and cross-checking. Especially problematic were all the differing names o f brain parts,
differing names for the same brain parts, and the use o f anagrams or initials as short cuts
in extremely technical studies. Much o f the biological research was indecipherable out of
its ow n niche, and it was cast aside out of frustration. This sadly prevents some
obviously hard work from becoming useful to those busy people (with less patience) who
m ight have ultimately linked the data to their own efforts at making the world a better
place.
(3) Synthesizing complex, multi-disciplinary data into clear, concise, useful
statements is hard work. It requires enormous effort to take complex strands o f data
described in various, inconsistent, technical terminologies and weave them together into
common-denominator statements that capture their synthesized essence or demonstrate
their consistency. In order to hone information into clear, concise statements, complex
material had to be pulled together, sifted through, cross-checked, and mastered . This was
a process that refused to be rushed, resulting in an initially lengthy work that lends itself
to on-going refinement. Otherwise, not unlike the 2000 presidential election, a rush to
judgm ent risks making false or misleading conclusions.
Having become engaged in this process, it also gave this author a way to think
about the status o f the data being collected. For example many particularly obtuse
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studies were grappling with elusive, complex, as o f yet poorly understood, and, therefore
unmastered phenomena. These studies provided search limiting boundaries
demarcations for the drop-offs in reliable information about the human brain about which
so much remains unknown. Some studies attempted the daunting task o f laying out all
known details o f incredibly complex neurobiological phenomena to date, i.e. for
Posttraumatic Stress Disorder (PTSD) (Chamey et al., 1993) or the human stress response
(Chrousos & Gold, 1992). And, many o f the very best, most meaningful studies, such as
the award-winning research on the effects of PTSD on children by De Beilis and
colleagues (De Beilis et al., 1999a, 1999b) and the excellent review by Scarpa and Raine
(1997) on the Psychophysiology o f Anger and Violent Behavior, have taken extremely
complex data, methodologies, and findings and honed them into clear, clean, precise,
understandable descriptive language which makes them useful across disciplines. Such
honing requires effort and mastery, but its a critical extra step if the work is to have
meaning and usefulness beyond a narrow niche.
Implications for Research
Helpful vs. Unhelpful Existing Data
Most helpful.
Studies that described or measured the Real McCoy, particularly biological
studies, vs. studies that attempted to measure intervening variable stand-ins for elusive
concepts, became favorites. Studies that linked biological findings to behavioral
phenomena had the advantage o f mapping two systems levels (and types o f data bases)
together in one place. Examples are Tiffany Fields (1998) work utilizing biological as
well as behavioral measures with infants o f depressed mothers and studies by Rogeness,
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Galvin, and their colleagues reliably linking low dopamine-B-hydroxylase (DBH) levels
to aberrant aggression in children (Rogeness et al., 1986; Rogeness et al., 1988; Galvin et
al., 1991; Galvin et al., 1995). Animal studies vs. human studies did not become the
barrier one might suppose; there are many more consistencies than inconsistencies. That
individuals who have just completed detailing the human gene code have found mice
brains to be quite similar to human brains was most reassuring (or not, depending upon
your point o f view) (National Institutes o f Health & Celera Genomics Corporation,
2001). Ontogeny studies on any aspect o f normal neurobiological or behavioral
development, such as Harry Chuganis (1998) PET scans to track the course of human
brain development or Gunnars (1998) finding that cortisol levels are subdued in 3-24
month old infants were treasures. For instance, Chuganis work shows that we may be
overestimating ability to utilize frontal lobes (due to lack of maturity) for emotion
regulation even in teenagers, let alone during infancy and early childhood.
Least helpful.
Studies that utilized behavioral observations as evidence for abstract
conceptualizations were somewhat more problematic, because a lot o f different
neurobiological processes can account for behaviors that look similar. Data from
contemporary studies attempting to link patterns of attachment, particularly the newest
Disorganized attachment category, to child outcomes or particular parental styles have
been surprisingly broad or even conflictualrendering them somewhat problematic for
drawing definitive comparisons or conclusions.
Older generation genetics studies that look at psychological and
psychopathological characteristics (i.e. aggressive tendencies) handed down through
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generations based on interview, self- or other-report measures, or even twin studies do

not rule out problematic variables such as prenatal factors (i.e. aberrant fetal CNS
development due to maternal alcohol abuse during pregnancy), brain developmental
status at time o f adoption, separation effects from splitting up twins who have spent
perhaps protective time together in utero and following birth, or parental bias.
Current concepts o f genetically predetermined temperaments are problematic.
Concepts o f genetically predetermined temperaments are especially problematic.
For example difficult child temperament is predicted by maternal depression time and
again (Campbell, Cohn, & Meyers, 1995; Gunnar, et al., 1990; Kogan & Carter, 1996;
Lyons-Ruth, 1996; Lyons-Ruth, Easterbrooks, & Cibelli, 1997; Mebert, 1991). Those
temperament studies reliant upon maternal report measures are particularly susceptible to
parental bias in that depressed mothers tend to rate their infants more negatively in
general, even when neutral observers do not (Lyons-Ruth, 1996; Martinez et al., 1996).
This author believes that it does infants a tremendous disservice to label them
difficult, particularly i f they are responding in extremely predictable ways to abnormal
maternal affect and behavior (maternal psychopathology). Infants receiving negative
labels are treated differently and perceived more negatively, even if there is nothing
wrong with them (Martinez, et al., 1996). Unfortunately, tiny infants are so exquisitely
attuned to~even depressed or rejectingmaternal affect, that they begin to develop
corresponding abnormal patterns o f relating, unwittingly becoming players in their own
differential treatment by others, as will be described below. To ascribe a difficult label
to these little ones appears to be subjecting them to role-reversing distortionholding
infants accountable for negative adult behaviors and feeling states. What a terrible way
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to begin life. No one should be surprised to see these youngsters develop entrenched
shame-based self-concepts, convinced that they are inherently defective, ineffective,
harmful to others, undesirable, unlovable, and worthy o f rejection.
Conceptualizations o f inherited inhibited (shy, fearful) and uninhibited
(sociable, fearless) temperaments (Kagan, 1989, p. 669) are elusive, based on this
dissertations findings o f alternative explanations for inhibited and uninhibited infant
reactions arising from their adaptations to abnormal experiences inherent in aberrant
maternal environmentseven in the first eight weeks following birthas described in
CHAPTER IV: RESULTS PART I. Indeed, especially during the first weeks of life
when the goal is to get arousal and autonomic nervous system functioning under control
by fragile, tiny new nervous systemsit would be expected that infant adaptations in the
face o f adversity would result in adjustments to arousal tolerance. Those infants who rely
upon opioid mediated brainstem defenses to quell arousal would become uninhibited
(undeterred by arousal), whereas those infants who lack such defenses would be left with
having to actively avoid or ward o ff stimuli to minimize ongoing sympathetic
hyperarousal (i.e. through sleeping, head averting, frowning, fussing, crying).
Repeated abnormal experiences not only violate primed infant expectancies, but
probably serve to readjust infant expectations to fit the demands o f the environment in
which he or she must now exist. Infants come to anticipate outcomes perhaps as an
attempt to utilize reliable patterns to impose order on an initially chaotic world outside
the womb. Therefore, how infants filter in future incoming stimuli (i.e. as familiar or
novel) based on the build-up o f previous experiences (schemes) together with subsequent
infant response sets for dealing with future stimuli based on those schemes can quickly
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become well-established patterns even by three months o f ageabout the time that initial
behavioral signs o f temperamental traits begin to emerge (Brazelton, 1992).
A 1998 study by Weinberg and Tronick demonstrates that three-month old
infants revised expectations and adaptations to the aberrant interaction style of their
depressed mothers carry over into their interactions with unbiased, nondepressed, novel
adults. Interactions of depressed mothers in this study were characterized as deficient
across three channels o f communication: face, voice, and touch. These mothers talked
less to their infants, showed fewer facial expressions o f interest, were less likely to share
the infants attention to objects, and touched their infants less than control mothers (p.
57). These mothers also found it difficult to repair their interactions following disruption
by the stressful (to infants) still face intervention, viewing themselves as less competent,
their infants as negative toward them, or both. Infants interacting with their depressed
mothers following the stressful still face intervention, in turn, showed less interest, more
anger and sadness, and a greater tendency to fiiss and cry than controls (p. 57).
Authors attributed negative infant reactions to maternal inability to regulate infant
emotion states following the stressful intervention.
What is even more troubling is that the novel adults who interacted with these
same infants (who were blind to whether these infants had depressed or nondepressed
control mothers) appeared to follow the infants leads, significantly reducing their degree
o f engagement (resulting in minimal physical touching while maintaining physical
distance) with these infants compared to controls. This same dynamic has been
corroborated in other studies o f infants with depressed mothers (Martinez et al., 1996).
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Thus, infants expectations that the world is withholding get confirmed-through

their own nonconscious behavioral adaptations to minimize anticipated overstimulation.
The tragedy is that the unavailability o f sufficient maternal interaction (i.e. to confirm
normally innate infant interaction expectancies, to quell stress with release o f Bendorphin) appears to be the source of the infants hyperarousal in the first place. Now
the infant has become a player in undermining his or her own normal developmental
opportunities by avoiding them or warding them off. Indeed, such infants appear to have
developed an inhibited pattern o f relating.
This does not mean that genetic factors arent responsible for human
characteristics (i.e. for slow, fast heart rates; extroverted vs. inhibited tendencies). It
simply means that there are too many ways that other early environmental factors can
account for these traits. Jerome Kagan (1997) makes the point that even genetically
predetermined tendencies unfold within, and are thus tempered by, environmental
experience. With recent delineation of the human gene code, new technology will
undoubtedly begin to clarify these issues. However, one o f the first observations made
by the scientists who carried out this monumental feat is that genetic expression unfolds
within the context of environmental influence and thus, these two formative sources are
inextricably linked in individual phenotypic expression (National Institutes o f Health &
Celera Genomics Corporation, 2001).
Data Gaps
Aside from obvious, understandable ones regarding the human brain, some data
gaps are surprising. Neglected subjects include biopsychosocial effects for infants raised
by human (even other animal) fathers; state o f the art research that directly links genes to
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aggression or temperament; biopsychosocial effects of day care tied to precise

incremental infant ages from birth to age 36 months; and effects o f traumatic experience
(prolonged separations, rejection, deprivation, abuse) on infants ages 0-36 months
especially while they are still infants.
Ideally infant trauma studies would use similar biological and behavioral
measures to the ones Tiffany Field (1998) and colleagues have employed to study infants
o f depressed mothers with early, startling resultspermitting timely interventions.
Studies o f traumatized infants that utilize sequential age groupings from ages 0-36
months to track ontogeny o f trauma effects would be extremely valuable. If ontogeny
studies would also follow these babies longitudinally, it may be possible to pinpoint
which environmental and developmental neurobiological factors (in combination) give
rise to children who have the more familiar trauma characteristics (elevated NE and
cortisol) identified in the De Beilis studies or exact opposite patterns (low NE and
cortisol) generally seen in aggressive children, many of whom have been identified as
having severe attachment deficit, distortion, and abuse historiesproviding clear targets
for intervention, and thus prevention. Interventions could be targeted early and
effectively, focusing on environmental adjustments (instead o f fixing the child,
particularly after the brain is set in its ways).
In addition, biological markers may be identified that could render precise
diagnoses through laboratory tests or lead to the discovery o f effective new
psychopharmacological treatments. Retroactive studies, which are currently available,
may be misleading in the same way other types o f child abuse studies have been, because
there is no way to capture individuals who did not end up in a system (i.e. psychiatric
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treatment facility, prison, community mental health center, social services) and who may
not have suffered adverse developmental consequences.
Although identifying healthy individuals who have lived relatively successful,
psychologically balanced, and emotionally fulfilled lives in spite o f deficient or distorted
attachment histories would present similar logistic problems; elucidation o f their
protective factors would provide invaluable insights. Such insights could not only be
used to identify factors leading to positive preventive or treatment outcomes; they may
provide welcomed evidence that harmful neurobiological, psychological, and/or social
effects from attachment deficits and distortions are not inevitable.
Implications for Clinical Practice
Assessment
Findings in this dissertation argue for taking thorough, early developmental
historieswhenever possiblein addition to relevant current (or recent) information when
assessing clients of any age. This is particularly critical if psychopathology (i.e.
personality disorder, dysthymia, depression, anger; posttraumatic stress, self-injurious
behavior) has been long-lasting, does not remit with treatment, or undermines current
treatments for other types of problems (i.e. substance abuse, pain management). Indeed,
it is suggested that a thorough interview during the initial visit provides insights and
treatment direction that will likely save time and resources down the road (i.e. through
more realistic prognosis, treatment goals, expectation-setting; more precisely targeted,
and, therefore, effective treatment strategies).
If it can be determined that the onset o f an individuals psychopathology occurred
later in life, i.e. in adulthood after the brain was formed, and had an identifiable trigger;
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prognosis may be much more optimistic and utilization of short-term protocol-driven (i.e.
substance abuse, cognitive-behavioral, grief counseling) treatments can be extremely
effective. If a person presents with more typical biological vs. developmental symptoms
(i.e. for classic vegetative depression; bipolar disorder; schizophrenia),
psychopharmacological treatments would be most effective. However, if a patient
reports (for example) chronic pain for which a clear-cut identifiable cause is not
sufficient to explain the magnitude o f the pain or remains elusive, a thorough history may
reveal other exacerbating or causal factors such as premorbid depression or somatization
o f childhood sexual abuse trauma.
Ideally, assessment interview questions need to tease out type(s), age o f onset,
precipitating factors, or other circumstances relevant to the psychopathology; the quality
and circumstances of the clients attachment to their primary caregiver (especially up to
age three); as well as any evidence o f overwhelming stress. If traumatic stress has
occurred, it is important to note the intensity, duration, frequency, quantity, and timing of
the stressor, its meaning to the client, and the age(s) at which it occurred. It is also
critical to pay close attention to what is significant or meaningful to clients as they
describe their presenting problem and begin to convey their self and world views
(primary sources of developmental clues).
If the client presents with a self view (i.e. shame-based, powerless victim, external
locus o f control), world view (i.e. harsh, withholding, noncontingent), defense
mechanisms (i.e. projection, denial, repression), (i.e. all-or-nothing, either-or) thinking
errors, verbalizations, behaviors, affect, or life event descriptions that appear incongruent
or out o f sync with (very young for) the individuals age, rethinking those valuable bits of
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information within the developmental context (age) in which they would most typically
occur may provide clues as to when the clients psychological wounds were incurred.
(Data from the Observed Infant Capabilities and Psychopathology sections within each o f
the six incremental age periods delineated in this dissertation can be utilized to make
these determinations.)
I f an age can be pinpointed for the onset o f psychopathology, the nature of the
initial wounds can be determined in relation to the brains developmental status at that
time. For instance, was a traumatic experience processed in subcortical structures (i.e.
brainstem, amygdala) or circuits (i.e. rage) prior to emergence o f integrative cortical
conscious, rational, verbal, or working memory processing systems? If yes, then, not
only does this have serious ramifications for prognosis, but it suggests types o f
interventions (i.e. visceral, nonverbal, guided imagery, EMDR) that may need to be
employed to effect an adjustment in those affected structures, circuits, and processing
systems. (See Available Brain and Developing Brain sections in CHAPTER IV:
RESULTS: PARTS I and H )
Determining injury age would also permit identification o f those social-emotional
tasks that were missed or distorted during the clients development. (See Mechanisms
o f Mother-Infant Attachment in CHAPTER IV: RESULTS: PARTS I and II.)
Identification o f missed or distorted developmental tasks not only provides insight into
vulnerabilities, but can provide direction for selecting the types o f ego strengthening
interventions that could best shore up these gaps. It is important to note thatdue to
profound shame and trust issues generally associated with poor attachment histories
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clients may not reveal most troubling concerns until they feel sufficiently safe with the
therapist, which can take several weeks, even months, into therapy.
Due to problems with bias in parental reporting o f child emotional and behavioral
problems, particularly if parents are depressed (as previously discussed), observation of
child clients by neutral observers is a must. Children need to be observed on their own
(i.e. in play or during the interview process), in interaction with the primary attachment
figure, with other family members (i.e. father, siblings, grandmother), and with the entire
family at once, if possible. Observing the youngsters play is an incredibly rich
assessment tool, in that imitation or symbolic play may lay out the very dynamics with
which the child is struggling.
Treatment
Treatments for infants.
Ideally, infants who have suffered or are at risk for attachment deficits and
distortions would be identified ASAP and thus receive immediate intervention. Needless
to say, interventions must be targeted at making the infants 24-hour, seven-days-a-week
facilitating environment healthy. Kentucky is fortunate to have psychiatrists and
psychologists who focus on infant (vs. child) mental health by targeting parental-infant
interactionsthe attachment relationship itselffor intervention. In a review of
interventions (utilizing a variety o f strategies) for infants o f depressed mothers, Field
(1998) found that nondepressed fathers and nursery school teachers were effective in
increasing positive infant interaction patterns; infants receiving massage therapy (vs.
rocking) increased time spent in active, alert states, cried less, had reduced cortisol levels
(suggesting reduced stress), gained more weight, showed increased positive emotion,
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were more sociable, and were easier to soothe; interactive coaching o f depressed mothers
to imitate or pace their infants increased infant responsivity; andeven though depressed
mothers had difficulty increasing facial and vocal expressivenessinterventions were
effective in increasing maternal touching behaviors which, in turn, improved maternalinfant interaction patterns.
Other types o f effective treatments include individual psychotherapy,
psychopharmacological treatment, and/or outpatient substance abuse treatment for
mothers (or fathers); marital therapy; family therapy (if there are other children or
extended family in the home); and parent training (vs. education). Training programs,
such as the Nurturing Parent series (Bavolek & Comstock, 1991)that emphasize
parental empathy and nurturance and provide intensive opportunities for parents to
incorporate these insights while practicing new skills in interactions with their infants
under experienced, professional supervisionare most effective. Good training
programs run for an extended period o f time (i.e. 2 hrs. x 12-16 weeks), not only
immersing parents in skill-building, but affording them opportunities to experience selfefficacy producing successes with their infants; badly needed nurturance,
acknowledgment, and reinforcement o f their own; and development o f supportive bonds
with other parents in their group.
If multiple agencies are involved with the family (i.e. day care, social services,
parental psychiatric hospital or day treatment program), the parents primary therapist or
case worker needs to coordinate a unified strategy plan so treatments across all spheres
are on the same pageand effective vs. creating confusion, turf battles, overwhelming
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parental time and transportation demands, o r other problems that undermine; effectiveness
(and waste human and financial resources).
Treatments for children and youth.
Generally, treatment recommendations for children with attachment deficit,
distortion, deprivation, and abuse histories are the same here-and-now kiimds of
environmental interventions listed in the previous section for infants. I f the environment
becomes healthy, the child adapting to that environment will, in turn, becom e healthier.
To conduct individual psychotherapy with the child as the only intervention, is to deny the
existence and influence o f the power structure inherent in that childs untreated 24-hour,
seven-day-a-week environment, which will inevitably suck that child right back in to its
familiar patterns of relating. Should that child deviate from such patterns w ithout
parental knowledge or support, he or she may suffer adverse survival consequences
within the context of that environment whichat least for nowcannot be escaped. This
sets the child up to fail, dashing any fragile hopeful expectations that might have been
established. It is also wasteful o f human and financial resources.
Most effective programs for treating angry and/or aggressive children are
intensive parent-child interaction training programs, particularly if augm ented with other
types o f therapies or interventions (Schroeder & Gordon, 1991; Kazdin, 1987a, 1987b),
such as treatment focused on mothers perceptions of child behavior, parental mental
health problems, marital and extramarital relationships (Griest et al., 1982); training
parents to attend to, accurately observe, and appropriately respond to their childrens
behavior (Wahler & Dumas, 1984); and self-control and problem solving training for
parents on issues unrelated to child behavior (Pfiffner et al., 1990). As memtioned
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previously, parent-child interaction training programs that foster parental empathy and
nurturance, as well as effective discipline (vs. punishment) skills, such as the Nurturing
Parent programs (originally designed as treatment programs for abusive parents) can be
extremely effective.
The Response Program, an intensive multi-modal community-based treatment
program specifically designed to increase the quality (i.e. sensitivity, warmth) and
quantity o f attachment/affiliation interactions o f 257 participating youths diagnosed with
Conduct Disorder and their current caregivers (i.e. birth families, adoptive families, foster
families, group home staff) showed a significant decrease in externalizing, antisocial
behaviors at six month follow-up. Interestingly, caregivers also reported significant
decreases in youth depressive symptoms, whereas the youths themselves did not
(Holland, et al., 1993). An interpretation is that the program was effective enough to
reduce the anger through sensitivity, caring, and relatedness, but not effective (or long)
enough to address the gaping hurt underneath the anger. When the anger subsided, so did
the distraction it may have been providing to deflect attention away from the pain.
Findings in this dissertation would argue against conducting unproven, drastic,
intrusive holding therapies (especially those in which the child is sandwiched between
two prone parents) with children who already have extreme vulnerabilities stemming
from severe attachment deprivation, distortion, or abuse as potentially traumatizing.
Restriction o f movement produces intense rage at the most basic, hard-wired,
evolutionary levels o f our brains. If these children were subjected to previous movement
restriction as infants (i.e. tied down in crib, held down during sexual abuse); such
interventions may retraumatize these youngsters at the visceral level, escalating arousal to
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an extreme degree, resulting in opioid mediated analgesic quelling, dissociation,

decompensation, or spirit-breaking that could be mistaken for the childs calming down
o f his or her own volition.
Children who present with extreme emotion dysregulation and behavior problems
stemming from extraordinary attachment deprivation conditions (i.e. abandoned as
infants, then housed in Eastern European orphanages prior to adoption, who display high
aggression to self and others by age three) have in all likelihood suffered permanent
alterations to their nervous systems not unlike Harlows maternally deprived monkeys.
Treatments should not be targeted at curing these childreninstilling false, unattainable
expectations in all concernedbut at making marked progress, measured in small
incremental steps, along the developmental trajectory. Assisting parents to implement
approximations o f attachment mechanisms (in roughly the same developmental order) as
delineated in this dissertation utilizes the facilitating environment to pull for adaptive
changes in the child.
Due to missing the brains developmental schedule, however, these mechanisms
may need to be consistently and repeatedly employed over an extended period of time in
order to counter visceral, subcortical conditioning and to strengthen, retrain, or establish
neural pathways. Until we learn more (i.e. how to reset homeostatic brainstem,
hypothalamic, or amygdala feedback and implicit memory mechanisms; recreate brain
tissues; rewire established neuronal pathways; alter neurotransmitter functions at various
subcortical emotion system levels) environmentally imposed interventions for these
children and their families will likely be limited, slow-going, and long-term.
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Treatment for adults with attachment deficit, distortion, and abuse histories.
Individual psychotherapy is recommended as the treatment modality o f choice for
adults, at least initially. This is especially critical for those individuals whose childhood
trauma memories are murky or dissociated. They deserve to be able to tell their own
story, if and when it emerges, uncontaminated by material from others trauma stories
that can so readily fill in for disconcerting memory gapsas would most likely occur
during group therapy. More importantly, individual therapy provides an opportunity to
establish an intimate dyadic relationship that can operatein many ways and on multiple
levelsas an alternative therapeutic attachment relationship.
The one critical difference, however, is that adult clients must be treated,
respectfully, as adults. The therapist mustfrom the get-go (1) clarify with the client that
this relationship cannot erase damage done nor take the place o f a (full-time, ongoing,
exclusive, every need-fulfilling) maternal-child relationship; (2) instill realistic
expectations in the clientnot only regarding the roles or limitations of the therapistbut
that the client is expected to be a full partner in producing the work of therapy; and (3)
establish clear, firm boundaries that will likely be tested by any client with a poor
attachment history (i.e. due to numerous personal crises, longing for an exclusive
maternal type relationship, fears of abandonment).
Because the therapy relationship itself will become the facilitating environment
that effects change, it may take up to six months, a year, or even longer for intervention
results to take root. Due to inherent issues of safety, trust, and shame, or fears of
rejection with exposure, clients may remain well-defended or avoid revealing most
troubling concerns for an extended period of time. Gaining understanding o f the
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developmental nature o f the clients psychopathology provides direction for setting

treatment goals, establishing realistic expectations, and selecting strategic, effective
interventions targeted at affected emotion processing systems. Interventions not only
address current life problems, but shore up developmental vulnerabilities that repeatedly
undermine social and emotional functioning. During the course o f treatment, the
therapist can (and usually does) employ strategies that approximate attachment
mechanisms delineated in this dissertation to develop the clients ego strength.
The therapist.
Key to treating attachment related psychopathology is the therapists judicial use
o f self. Therapist facial expressions, tone of voice, and body language will convey potent
feedback that can be used by the client as mirroring to establish a sense of self; to gain
direction for how to proceed in uncertain, threatening social situations; to risk
establishing emotional connection with another human being; or to effect a corrective
emotional experience that punches holes in pathological self or world views. Being able
to look at the therapists face to connect through the eyes (which can take tremendous
courage) and see genuine caring, warm regard, empathy, acceptance, and respect after
sharing incredibly shame-evoking material can be a profoundly healing event. The
therapist also serves as a role model with aspects o f the therapist (i.e. what the therapist
would probably say about this situation) becoming incorporated into the clients
internalized representations. Because developmental dynamics are so complex and
operating on so many levels, only well-trained, credentialed, and experienced
professionals should attempt to conduct this type treatm ent Therapists should be well-
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grounded in transference and countertransference dynamics. They should also be ethical,

honest, reliable, consistent, steadfast, and centered, (undistracted by personal issues).
Implications for Prevention
Characteristics o f Mothers with Securely Attached Infants
Mothers o f Secure infants are sensitively responsive to infant signals across all
contexts to include feedings, face-to-face interactions, close bodily contact, and responses
to infant cries (Ainsworth, et al., 1978). In a 1997 meta-analysis o f 21 Strange Situation
attachment studies, De W olff and van IJzendoom found that, in addition to sensitivity
which they define as the ability to respond appropriately and promptly to the signals of
the infant (p. 584)mutuality, synchrony, positive attitude, and emotional support also
characterize the interactions of mothers with secure infants. Mary Mains work revealed
that mothers o f secure infants are autonomous, self-reflective, nurturant, sensitive, and
noncontrolling. These women value their relationships with their infants, maintain a
balanced view o f their own roles in relationships, demonstrate tolerance for imperfection
in themselves and others, do not idealize their own parents, and are able to re-examine
their past with objectivity and perspective (Main & Goldwyn, 1984 ; Main, 1995).
M others Mental Health Status is Pivotal Factor
A critical finding by Mary Main was that even mothers with adverse childhoods
o f their own could form healthy attachments with their infants, as long as they had
worked through troublesome past issues in advance. These women, freed up from unmet
needs o f their own, can view their babies with much less distortion, enabling them to tune
into and respond more accurately and effectively to their infants signals. Women who
plan to have children need to be mentally as well as physically healthy. If suffering from
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depression, substance abuse, or childhood trauma a woman needs to seek appropriate,

qualified treatment, ideally before becoming pregnant. Should a prospective mother
require psychotropic medication, she should consult with her psychiatrist regarding the
safety o f continuing medications during pregnancy. Newer SSRI antidepressants are
generally considered safe to unborn fetuses.
Depressed mothers pose tremendous risks to the healthy social-emotional
development o f their infants. Whether suffering long-term major depression or newly
emerging postpartum depression, these individuals need to seek qualified professional
help ASAP. Fathers (or other primary care takers) need to step into the nurturing,
primary attachment role if their partners, for whatever reason, are emotionally
unavailable to their babies. Many women arent cut out to be nurturers; many fathers are.
Marital Conflict; Divorce
Marital conflict during pregnancy and following the birth o f a child is a risk to
healthy attachment. New mothers involved in marital conflict are likely to be extremely
stressed, if not depressed, exacerbating already stressful conditions inherent in tending to
a new baby. If at all possible marital conflict needs to be resolved prior to pregnancy.
Not only does marital distress deplete the mothers energy, it distracts her attention away
from her infant. Loud yelling and screaming, as well as scary, angry faces are innately
frightening to infants. If a divorce occurs, custody o f the infant should go to the parent
with whom the infant has developed a primary attachment. Although it may sound good
on the surface, joint-custody would not be recommended for an infant younger than age
five, because young (if not all) children need to settle into the routine o f one home, and
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infants need to Lave full-time availability o f the parent with whom theyve formed their
primary attachment.
Parent Education. Training, and Support
If prospective or new mothers and fathers lack experience with babies, parent
education or nurturing parent training programs can provide nuts and bolts information or
skill-building op-portunities. Especially important is a good understanding o f normal
infant development to allay misinterpretations of infant behavior and to provide optimal
types o f experiences required by the brain over the course o f its development.
Community resources include hospitals, pediatricians, pediatric nurses, child
psychologists, child psychiatrists, school-based parent education programs for high
school students a s well as new parents o f future elementary school students, health
departments, community mental health centers, and social service agencies.
Avoidance o f Role-Reversal and Other Distortions
Parents a_re responsible, not babies, for assuring normal, healthy biopsychosocial
development; na_ture (if not common sense) has set things up this way. Evolution has
assured that indi-viduals who have biologically matured to the point o f being able to
reproduce are bigger, stronger, more competent and capable than their infants. Evolution
has even built in_, through our genetic code, some pretty good parenting tools and special
effects for rearimg offspring over the extended period o f time it takes them to obtain
developmental maturity. Parents must meet the developmental requirements o f their
infants. Babies d o not enter the world for the purpose of filling parents unmet needs.
Its not their job_ Even if they wanted to, they are simply not equipped to do that.
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Such parental distortion is called role-reversal, and role-reversal is a set-up for

unhealthy distortion incorporated into the childs psychological development. Ready or
not, parenting is a critical stage in a grown-ups own development. Dire consequences
can result when a parent is unable to successfully negotiate this developmental task.
There is no shame in asking for help. However, devastating shame can take root in
children who have been subjected to distorted parenting.
Resiliency Issues
Studies regarding resiliency observed in individuals surviving adverse childhood
conditions do not link resiliency to the specific conditions addressed in this study:
maternal emotional unavailability, distortion, deprivation, rejection, or abuse occurring in
early infancy from birth to three years of age. By contrast, a review o f resiliency risk
factors by Schroeder and Gordon (1991) would suggest that attachment deficits and
disorders exacerbate untoward effects o f negative life events in general. Neurobio logical
studies o f psychological trauma effects have revealed that individuals who are subjected
to even one traumatic event can lose resiliency for recovery from subsequent, even less
severe traumatic eventsparticularly if initial traumas occurred during childhood
(Chamey et al., 1993; van der Kolk, 2000). Indeed, early life traumas have been linked
to extremely severe PTSD presentations (van der Kolk, 2000). Recent MRI studies of the
effects o f childhood trauma and depression have revealed dire consequences for
childrens brains, showing significantly reduced overall brain volumes (and enlarged
ventricals) compared to those o f controls (De Beilis, et al., 1999b; Steingard et al., 1996).
Given the findings in this dissertation, attachment deficits and distortions would not only
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give rise to traumatic stress, but by their very nature, deprive infants of the protective
homeostatic processes inherent in and instilled by healthy mother-infant attachment.
Protective Factor
For the child whose parenting has been neglectful, distorted, rejecting, or abusive;
the availability o f one healthy, caring, warm, kind, sensitive adult (i.e. grandmother,
therapist, neighbor, teacher, police officer, school aid, mentor) who takes an interest in
the childs life and who can provide a safe emotional connection with that youngster,
may prove to be the saving grace for that childs healthy, adaptive development. Having
such a person in ones life punches critical holes in the childs negative self and world
views, affording a corrective emotional experience that instills hope. A word of caution:
this type relationship is no substitute for the primary parental attachment relationship and
cannot undo all damage thus incurred. There is a danger that the child will desperately
want this alternative relationship to fill that unmet aching hole inside, but it is destined to
fall woefully short o f the mothering the child should have received in infancy. This
longing can also make children with poor attachment histories easy marks for sexual
predators who exploit their vulnerabilities in order to seduce them.
Implications o f Placements in Child Dav Care During Infancy
Studies o f biopsychosocial outcomes for young infants placed in child care are
lacking, particularly for specific early incremental age periods (i.e. age 0-2 months, 2-5
months, 5-8 months). Those studies that do exist suggest that the two strongest predictors
for child outcomes, regardless o f whether children have been placed in child care or not,
are the mothers sensitivity in responding to her infant and the status of mothers mental
health. Unfortunately for those infants whose mothers lack sensitivity or have serious
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mental health problems, current evidence indicates that placement o f these infants in even
highest-quality child care programs may do little to overcome or compensate for these
adverse factors.
One study by the NICHD Early Child Research Network (1997) provides a
limited review in addition to findings from this organizations own ambitious study o f the
effects o f early child care during the first year o f life on the quality o f mother-infant
attachment for 1153 infants and their mothers. Review data showed mixed results, with
three studies (of 1738 infants combined) finding significant increased risk ofinsecureavoidant attachment patterns and another major study (o f 105 infants) finding no
significant relationship between early child care and infant attachment pattern. NICHD
findings revealed that the most significant predictors o f attachment security were (1) the
sensitivity o f mothers response in interaction with her infant and (2) mothers mental
health status. Early child care placement in and o f itself produced no significant
relationship findings to attachment pattern. However, early child care in combination
with maternal factors did. Significant interactive findings include:
(1) Children whose mothers were least sensitive coupled with insensitive child
care providers had the worst (most insecure) attachment outcomes o f all.
(2) Children whose mothers were least sensitive coupled with more time spent in
child care or more child care arrangements over time had the next poorest
attachments, (only slightly less pronounced than the previous finding).
(3) Children in low-quality child care were even more strongly affected by their
mothers behavior than children in high-quality child care; i. e. children whose
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mothers were sensitive had even more secure attachments to their mothers;
children whose mothers were insensitive had even more insecure attachments.
(4) Children in high quality child care experienced some modulating effects on
their attachments, whereby their mothers behavior was less significant for
both securely and insecurely attached children.
(5) Children with less sensitive mothers increased the security o f their
attachments if they simply spent more time with their mothers (and less in
child care); whereas children with sensitive mothers required less time with
their mothers to maintain their secure attachments.
(6) Boys were more adversely affected by increased amounts o f time spent in
child care; whereas girls who had no child care experience at all were more
insecure than those who did.
(7) And, although attachments o f children with the least sensitive mothers were
more secure if they participated in high- vs. low-quality child care; there was
no evidence that time spent in even high-quality child care could compensate
for the mothers lack o f sensitivity.
An eight year longitudinal study o f 985 infants in the Infant Health and
Development Program (McCormick et al., 1998), to determine the cognitive and socialemotional effects o f a high-quality early child care intervention program for at-risk low
birth weight and premature infants, produced only modest (insignificant), if any, positive
outcomes as originally hoped. Initial differences between participants and controls
disappeared by the time the children had reached five years o f age. This study found that
only poor maternal mental health at the time o f the infants birth (and not infant prenatal
or neonatal health risk factors) predicted child behavior problems at five years o f age.
Implications for Public Policy
Human brain development waits for no one. Maternal deprivation, distortion, and
abuse, or disruptions to an infants healthy attachment relationship, which for the young
infant, mean corresponding disruptions to brain development, have dire, even lifelong
consequences. Interventions, or non-interventions, can have profound environmental
influence during the initial, critical first three years o f life. Therefore, infant needs must
be placed above the needs o f their parents (and other grown-ups) whose brains have
already formed, for better or worse.
Courts
Infants are people, not property. Decisions regarding interventions must be made
from the infants developmental point of view. For example, removing an infant at any
age between birthespecially from age four monthsto 36 months from a loving, healthy
adoptive family just because a birth parent wants that child back is cruel. Putting
oneself in the infants place, what must it feel like to have a powerful stranger came to
your home and take you away from all the familiar people you ever loved or even knew,
never to see them again? This would be traumatizing, not unlike losing your whole
family all at once in an earthquake, war, or car crash, which even mature adult brains are
ill-equipped to handle. Terrified infant faces and hair-raising distress cries when babies
are ripped away from their parents reflect very real, potent feelings for very real, potent
biopsychosocial reasons.
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Social Service Agencies and Courts

There are instances, however, when the young infant needs to be removed from
dangerous parents (even if they dont mean to be) or nonprotective parents who expose
their babies to danger (i.e. from potentially violent boyfriends). Simply supervising such
parents or placing them into required counseling or education programs may not be
sufficient. The decisions benefit to the infant must outweigh the risks, with infant needs
prioritized over those o f parents. If an infant must be removed from the home, that baby
needs to be placed as rapidly as possible into one particular secure environment for a
period o f at least three years or longer (ideally adopted) in which he or she can settle and
thus form a full fledged attachmenton the brains normal developmental schedulewith
a consistent, warm, loving, affectionate, and sensitive primary caregiver.
Social Service and Private Adoption Agencies
Because o f the brains rapidly changing developmental status and its demands for
specific types o f experience to spur normal development o f sequentially emergent brain
structures and circuits during their various time-limited windows, the age at which a child
is placed for adoption is critical. The closer to birth, the better. A child placed between
ages 4-36 months may experience disrupted attachment (and therefore brain socialemotional) processes that need to occur within the context o f a settled dyadic relationship
with one other particular personusually mother. However, if an infant is in an
attachment deprivation or life-threatening condition (i.e. understaffed orphanage;
neglecting or abusive parent), that baby needs rescuing and rapid placement no matter
what age.
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Adoptive parents need to be armed with all known information regarding the
history o f their adopted child b y the agency that has facilitated that placement. This is
particularly critical if that infant or child was placed at a later than optimal age. Birth
parent information (for both mother and father) that includes age, pregnancy/birth
information, parental physical health status or concerns, psychopathology (i.e. history of
depression, bipolar disorder, schizophrenia, antisocial personality disorder, substance
abuse, medications, psychiatric hospitalizations), education (high school drop-out vs.
college student, learning disabil ities) and social history (i.e. domestic violence,
incarcerations, family o f origin, reasons or circumstances re: giving up the child for
adoption) should also be provided to adoptive parents. Parents considering adoption
should always be thoroughly forewarned of any known or potential physical and mental
health problems in their prospective children (i.e. prenatal exposure to opiates, alcohol,
cocaine; shaken baby incidents; foreign orphanage conditions; attachment deprivation,
distortions; sexual, physical, enaotional abuse). If such information is not forthcoming,
blindsided parents are more likely to become frustrated, fall out o f love with their
children, detach, then disrupt th e adoptiondisastrous for the child.
Parents who adopt children with such special needs w ill also need education,
referral to appropriate, qualified mental health professionals, and support to optimize the
viability o f their family. High quality adoption placement programs provide thorough
screenings o f and preadoption training to prospective parents as well as postadoption
education, support, and linkage to needed clinical services. Foster parents who have
formed healthy attachments w ith infants and children should be permitted to adopt them,
if they so desire.
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Parental Treatment Providers. Social Service Agencies, and Courts

An infant doesnt need to languish in foster carelet alone further
developmentally disruptive multiple placementswaiting for a birth parent to get her act
together (i.e. in a 30-day substance abuse treatment program, psychiatric hospital, or
correctional facility that excludes infants and children). I f the goal is to return a baby to a
substance abusing, mentally ill, or incarcerated mother, permit the mother to bring her
baby to stay with her at the facility and have mom participate in intensive nurturing
parent training (vs. education), practicing healthy interactions with her infant under
professional supervisionas a required program component. At some point, however, a
tough decision has to be rendered regarding the viability o f the infants current
environment weighed against the risks it poses for the infants healthy development.
Legislators. Policy Makers. Funders. Researchers. Advocates. Criminal Justice Systems.
Employers. Child Care Providers. School Systems. Health and Mental Health Providers.
Social Service Agencies. Courts
Based on the severity and long-standing nature o f the types o f maternal stressors
and psychopathology that jeopardize the healthy biopsychosocial development o f their
infants, even mothers who seek treatment may not be well-equipped to provide a
sensitive, nurturing, joyful, child (vs. self) focused environment for their babies for some
time to come. Meanwhile the clock is ticking away in the developing infants brain. Atrisk newborn infants and their mothers (and dads) need to be identified, encouraged to
seek help, and supported throughout the first three critical years to optimize healthy
neurobio logical, psychological, and social development. Human and financial resources
372
need to be focused on this critical initial period o f development that sets the stage for a
lifetime. And, it may indeed take the whole village to get the job done.
373
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Bell & Howell Information and Learning

THE BIOPSYCHOSOCIAL ROLE OF MOTHER-INFANT ATTACHMENT

A DISSERTATION SUBMITTED TO THE FACULTY

IN PARTIAL FULFILLMENT OF THE

MARCH 26, 2001

UMI Number. 9999989

UMI Microform 9999989

Bell & Howell Information and Learning Company

Copyright 2001 by Vicki L. Hayes

THE BIOPSYCHOSOCIAL ROLE OF MOTHER-INFANT ATTACHMENT

A DISSERTATION SUBMITTED TO THE FACULTY

VICKI LYNN HAYES

IN PARTIAL FULFILLMENT OF THE

David L. Morgan, J h.D

David W. Richart, Ph.D.

provided the freedom, respect, encouragement, mentoring, and mirroring I needed to

Questions Addressed by Dissertation..................................................................

REVIEW OF ATTACHMENT THEORY MILESTONES..............................

A Biopsychosocial Model for Projecting Psychopathology Resulting from

Adherence to General Systems Theory (and Evolution) Principles.................

Interaction of Stress and Ability to Achieve Homeostasis.................................

Systematic Biopsychosocial Steps for Projecting Psychopathology

RESULTS PART I: DETAILED DEMONSTRATION OF MODELS

Psychopathology Resulting from Attachment Deficits and Distortions:

RESULTS PART II: SUMMARY OF PROJECTED PSYCHOPATHOLOGY

Emotional Brain Development: Ages 0-36 Months..................................338

conditions must be pinned down. Psychopathology might, therefore, be projected by

will be formulated by working forwardin a sequential, additive fashionfrom the

To tease out characteristics o f psychopathology arising from attachment deficits

Questions Addressed by this Dissertation

Review of Attachment Theory Milestones

children survived, a new problem emerged: institutionalized children practically without

haven o f safetythe attachment figure. Later in infancy the baby is capable o f

4. Stranger & baby. (3 min.) First separation episode. Strangers behavior is

proximity-seeking and avoidant behaviors or ignoring her altogether...Group A

20% in infancy; and Anxious/Ambivalent: 19-20% in adulthood vs. 20% in infancy).

instructed to go still-faced (remain impassive and emotionafly expressionless). Typically

neuron, migration o f neurons to target sites, grouping o f neurons with harmonious

the development o f motoric abilities from sitting up by self, to crawling, walking,

their ultimate purposes o f survival and reproduction, developmental phenomena

from the environment to reduce inefficient redundancy; the cascade o f neurobiological

return o f parametric values to a range o f function values, rather than a precise,

increasing perturbation. Adaptation to appropriate degrees of perturbation induces

Properties o f Those that Comprise Them

(7) A System Becomes Disorganized Through the Process o f Entropy

Variables Taken into Account to Project Psychopathology

0-2 Months: (Anything But) Autism

2-5 Months: Symbiosis

Using the proposed model, a demonstration o f its effectiveness, to include a

Separation: Period when mother is physically and/or emotionally unavailable to her

Stress: A state o f disharmony, or threatened homeostasis (Chrousos & Gold, 1992, p.

mother-infant attachment, their essential contributions at various points along the

experience and intrinsic factors such as broadly acting neurochemical

Genie: A psycholinguistic Study o f a M odern-Day W ild C hild by Curtiss, Maya Pines

cool, even enjoyable predatory (instrumental) aggression (i.e. cat-like stalking) in

For normal, healthy, optimal functioning an individual would appropriately

Seeking fAppetitive) Circuit

Good descriptions o f the human subjective experience generated by the seeking

the appetitive urge to move forward ceases temporarily. It is hypothesized that