The 20th Congress of RSCANP,

Băile Felix, 18-21.09.2019

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The 42st National Conference of Child and Adolescent Neurology and Psychiatry and Allied Professions with international participation


Autor: Stefan Milea
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1.The paper states and presents arguments to sustain the idea that attachment and separation are one entity which is indivisible, transgenerational, complex, common, active within itself, and a process with a maturing role.



You separate yourself only from what you are attached to.

Generally speaking, attachment and separation(through their effects) cover an important area of emotional relationships between an individual and a part of his animated and inanimate environment, which he or she comes into contact with and which is not easy for them to separate from. In particular, the focus is primarily on the emotional interrelationship, especially the early one between the child and his mother or a valid substitute for her (the main figure of attachment and separation) and then with some of the beings or things existing around the child.

Typically, attachment and separation are treated as separate entities. In reality, they constitute together an indivisible whole. This is because attachment and separation are rather two interrelated facets that define and condition each other. In addition, they are the expression of a phenomenon that is • trans-generational, • complex, • common, • intra-active, • procedural, • maturing.

1 – The character of unitary, indivisible entity is supported by, at least, three arguments. First, it is determined by the fact that separation cannot exist outside the attachment relationship. In other words, humans do not really live the separation, unless they break away from what they are attached to and they are not really attached unless they feel it is not easy to separate.

Secondly, it is clear that one does not separate oneself permanently from anything one loves, but remains attached to it all one’s life. The phenomenon is determined by subtle processes: on the one hand, it is the separation process, and on the other hand, it is the internalization of both the main attachment figure and of the secondary ones. In this way, these figures are processed into subjective images, both separate and simultaneously related to the original, which are invested with the capacity to replace the original figure(s) and provide security by themselves. Then, the phenomenon is doubled by our memories that affect us the most, in proportion to the degree of our attachment to them. The substituting value of memories is meaningfully evoked by Simonov, in the poem “No, it’s much better this way “ (Collection “The most beautiful poems,” Youth Publishing House, 1961) who writes: “No, it’s much better this way: while you in my thoughts remain, I’ll write, my dear, rarely, more rarely, from time to time”. Meanwhile, we must not forget that many other elements (objects, gifts, letters, phone calls etc.) interpose between the real presence of the object of attachment and its memory and they make the total separation impossible.

Thirdly, on the one hand, both attachment and separation are related to the same “object”, a target and often a receptor, and on the other hand, both phenomena are experienced at the same time, as a synthesized product in the privacy of the same subject. In this way, in order to be functional and useful, the attachment must learn to accept to separate.

2 – The attachment-separation relationship is a transgenerational phenomenon because both the child and his mother, or a valid substitute for her, as the main “actors” who generate the phenomenon, inherited its fundamental premises from their predecessors and they transmit these premises to the future generations. In what concerns the child, the dispute between today’s different views on attachment is resolved solidly in favour of the view expressed by Bowlby and his school. It is known that, in one way or another, all other views look upon attachment as a secondary phenomenon concerning the child’s response to the “benefits” provided primarily by his mother or by a valid substitute for her. For example, the theory of learning is based on the conditioning model. The psychoanalytic concept, in turn, considers the child’s attachment as a process initiated by the mother who, due to the many gratifications, especially oral ones, provided to the child becomes the object of his love.

On the contrary, Bowlby (1907-1991) and his school did not dispute the role of mother or of her valid substitute. But rather, they assign mother the role of both receiver and securing element; they believe that the child’s attachment is a psychobiological phenomenon that expresses a mutual primary relationship. This is because the child has got an innate matrix, which he uses when he welcomes those to whom he becomes attached. She is represented by the child’s own resources, consisting, on the one hand, in:

  • The need for security, communication, physical contact and especially for emotional positive interaction respectively, to receive and, in turn, to provide affection in the first place;
  • The interest for the human voice and figure;
  • The ability to search for partners and to turn to those capable and interested to respond adequately and in particular, toward the source of his salvation, his mother’s love and her need to fulfil and valorise herself through him.

On the other hand, the innate attachment matrix has got an interactive system, receiver and source of affection and two-way communication through a network of channels and means of transmission-reception. Within this system, the smile, namely the ability to easily achieve what Stern (1989) calls emotional attuning and to express gratitude, as well as the libidinal charge of the relationship with the reference person having a privileged place. So that vocalizations, affectionate glances, smiles, motor and cognitive achievements, protests if he is left alone are absolute proofs of gratitude that he recognizes and appreciates the sacrifices made for him and that he defends his place in the relationship. All these are particular lines of force that guide the child, make him meet the bearers of maternal feelings, help the child express his gratitude and keep them. This means that in the equation of the attachment relationship both parties are active. They seek each other and, from the outset, they satisfy each other’s basic needs. In this way, the attachment and separation relationship does not express a dependency but, as stated by Ainsworth (1973), it is rather a dyadic relationship than an individual trait.

It is a view supported by ethology and by the data of the last decade. They reinforce the view of both Gillberg et al. (1990) that autistic disorder (one of the most relevant attachment disorder) has mainlyan organic base, and of the authors who studied the multifactorial nature of the causes and the involvement, in many cases, of a genetic defect. For example, Sutcleffe and Nurmi (2003) state that, in various combinations, from one case to another, 10 or more genes are responsible for the susceptibility to autism. There are also arguments made about the involvement of defective genes located at the level of chromosomes6-7-15-16 or 17. It goes without saying that, in all cases of autism with genetic substrate, the “fault”, if one may call it like that, lies with the child’s inability to capitalize on the supply of affection offered by his immediate entourage.

Of course, the mechanism of autistic disorder differs in those forms resulting from emotional deficiency, which obliges us to approach the diagnosis of autism, not only as a combination of representative symptoms, as it is preferred today (DSM-IV-R), but also in terms of mechanisms which lead to them.

All these do not mean that the psychoanalytic mechanisms are excluded but that they have a complementary role, since the attachment-separation relationship can no longer be understood as a fact limited merely to what the mother offers, but it is, at the same time, a phenomenon expected and sought by the child who is able, in his turn, to get actively involved in it.

In fact, today we know that, ever since the intra-uterine development period, the foetus is able to establish mutual sensory and emotional relations with his mother. This is what Mahler M. (1975) calls primary symbiotic relationship because the mother is not perceived as a separate external reality. This means that such a relationship is maintained for a period of time after birth, helping the newborn to surpass its first experience of separation which consists in the loss of the in utero comfort and in the conf rontation, accompanied by anxiety, with the reality of the external world. However, O. Rank (1973), speaking of the trauma of birth, believes that it is an experience that will never be forgotten. This assertion is supported by the newborn’s calming reaction if it is held at its mother’s breast so as to hear her heart beating, by the pleasure a child takes in sitting huddled, to wallow and be swayed, by the soothing effect of monotone stimuli, by the desire of the individual to seek comfort and security, by his penchant for idealization of the past or of the childhood, as well as by the refuge in regressive reactions as answers to insurmountable situations.

After birth, the child is faced with a more demanding reality, with the burden of expectations placed on his shoulders and with his inability to fend for himself. To meet these new demands he summons, this time in full sight, his own, innate attachment matrix that will hallmark the child’s and, later on, the adult’s incessant game of the attachment-separation relationships, his way of being and the content of his primarily affective interactions with everything around him.

The above considerations do not in any way minimize the role of the parents, and in the first place of the mother or of her privileged substitute as key partners of primary attachment-separation relationship. In this part of the relationship, the primary constituent involved, at the same time a source and a receiver, is represented by the parental feeling in which the role of the maternal one is essential. Combining instinctual origins, with experiential and socio-cultural ones (Brazelton and Cramer -1990, Milea, 1998), the parental feeling begins to emerge from the moment when the child, while practicing separation from his own parents, whose image he continues to preserve in his privacy, engages in the long and tortuous labour to internalize models and to build the phantasm of the child and of the ideal parent. Compared to these, a symbiotic relationship of attachment is constituted because it has a discretionary nature. This means that the future parent, under the influence of his own experiences and also of his socio-cultural background, models and remodels, at will, pictures of the ideal child and parent, relentlessly separating the new ones from the former images and attaching new ones. In turn, the new fantasies that are attached assume, in retaliation, the role of the master over their creator, forcing him to change his behaviour and adapt himself to their requirements. In other words, obliges the child to prepare for parenthood.

Pregnancy, with all that this means for those involved, is an important moment in the evolution of the parental feeling. First, it brings with it labour which generates the separation from the phantasms of the ideal parent and child, the entry into real parenthood, and the attachment transfer to the new identity, the day that the foetus acquires the contours which can no longer be controlled discretionarily. This labour is a challenge, and calls for change, requiring, sometimes dramatically, on the parents’ side, the contents of emotional resources needed for the attachment-separation relationship. It is the beginning of a new type of attachment-separation relationship that will require full attention with the birth and “face to face” meeting with offers of attachment, and with increasingly higher and higher requests and also with real failures or ones resulting from exaggerating expectations. In this context, the new form of relationship will engage itself in a new and long dialogue consisting of offers and frustrations, of the mutual experiences of separation and retrieval of two partners always the same and always different. This phenomenon is marked by the fact that, in turn, the parent wants to be strengthened and even rewarded, by the child’s responses who is also actively engaged in the relationship. It is true that the child’s inability to fend for himself, his great need for help and protection preserves, for a while, the symbiotic relationship with his mother, helping to alleviate mother’s mourning for the loss of the ideal child phantasm.

Gradually, as time passes by, attachment – separation experiences diversify and engage in a complicated process. On the one hand, for both parts, this involves options, ambivalent attitudes and feelings, benefits, satisfactions, sacrifices, frustrations and, not the least, suffering. On the other hand, for the future child and adult, this process will lead to the establishment of the image of the ideal child and parent, under the influence of instinctual resources, of processing one’s own childhood experience and that of the environment, of the image of the ideal child and parent who at maturity will enable the resumption of cycle.

3 – The binomial attachment – separation is a complex phenomenon as it involves:

  • its two sides;
  • two active partners who meet each other’s different needs, but who have, individually, both problems and conflicting interests;
  • two levels of development, a real one and an imaginary one. In addition, the binomial contains primary and secondary attachment-separation relationships. The primary attachment-separation relationships are the most often considered. They include the child’ and the mother’s (or of her valid substitute’s) mutual and deep positive experiences. Being far more numerous, more varied and more mobile, the secondary relationships, concern relations of attachment – separation from other beings or objects, capable of being substituted by the primary relationships. Let us add that the attachment – separation binomial involves all forms of the participants’ psychic, including the deepest mechanisms of defence and its structuring.

4 – The attachment – separation relationship is a common phenomenon. It is common because it does not belong only to the psychology of the young child, and even less to the area of young child psychopathology, which is usually associated with. It is a reality involved in everyday life, throughout the whole life span because each moment we attach to and separate ourselves from something that has been close tous, whose absence makes us uncomfortable. We start our existence by separating us in order to attach to a different level to the one who gave us our lives and we continue our existences by getting closer and then separating us (sometimes temporarily, without ever being either totally or permanently separated) from what surrounds us, from those whom we like or love, from our birthplace, from the happenings and events of the past, from ourselves, childhood, adolescence, our first love, and those that followed it, our deeds and our aspirations, from the preceding day and so on. Within this broad framework, the primary attachment relationship (centred on the mother or on a valid substitute for her) is just one component, even if a very important one. Its particular importance lies in the fact that in its interaction with the separation times, which put it to the test, it is the starting point of all development and diversification of secondary attachment relationships, including the great passions. As such, its abnormal aspects form only a part, and not even the most important one. These latter abnormal aspects of the primary attachment are essential only from the viewpoint of the psychiatrist.

5 – The binomial attachment – separation is an intra-active couple. Among other things, this means that the two sides is the whole influence and especially activate, stimulate and reward each other. On the one hand, the attachment relationship mediates, facilitates and protects the practice of segregation and of the ability to explore the environment by giving security. On the other hand, in their turn, the experiences of separation diversify the contacts and facilitate the process of transfer and investing the primary attachment into various other beings or objects available to receive it, and to offer, in their turn, different degrees of security and to replace it if needed.

6 – The procedural nature of attachment-separation relationship is represented by the fact that, on the one hand, the phenomenon is evolving, growing,developing, and getting diverse and nuanced in time.Thus, it starts with the couple: primary attachment– deprivation of interaction, which is first of all an affective one and of early stimulation; then the process continues and it is to be found in individual’s mainly emotional relationships with everything that he comes into contact with, beings or things which he attaches to. On the other hand, the attachment-separation relationship has immediate effects on medium and long term levels, marking the destiny of everything that it engages. At the same time maintaining a common denominator, the components of attachment-separation relationship alter fundamentally, separate themselves from one another, we may say, in order to acquire a new countenance , to enrich, to shade, to diversify and individualize. Mutual relations of friendship, empathy, love, passion, the burden of separations, and grief reactions are just a few facets of the great diversity of these evolving forms.

7 – The attachment-separation binomial has especially a maturation role. Normally, the positive side of attachment, is usually pointed out, the good quality of attachment relationship is widely acknowledged as a protective factor of first magnitude. This is because: it satisfies the child’s need for security (Ainsworth -1973 has the credit to have emphasized this aspect) for receiving and giving affection; it grants safety and confidence, it helps the child to approach the external world and explore it, to develop skills; it subordinates the child to the world; it makes him familiar with the relations of reciprocity, it integrates and harmonizes his relations with others making him a partner; and very importantly, it facilitates the development of his empathic capacity; in a word , it transforms the child into a social being.

Today, it is clear that the unmediated presence of the mother, or of the person who is a valid substitute, directly and visibly contributes to the socialization of the child, both by the security it offers and by her ability to transfer her role to beings or objects willing to take it and thus become new sources capable of providing security to protect an individual’s separation from the main attachment figure. It is the status earned by some persons in the entourage of the child, or the transitional object or the ones which the child was already familiar with. They are called secondary attachment figures, not because they have only a modest role but in order to emphasize that they are part of the second echelon. In fact, without them, everything would be limited to a relationship of symbiotic attachment.

If the direct contribution of the primary attachment to the socialization of the children is primarily emphasized, the existence and importance of indirect mechanisms that contribute to the diversification of secondary attachment figures, the separation experiences and the relationships with others should not be overlooked. Through them, the individual opens to the outside world. We consider two such mechanisms which are based, in one way or another, on the interplay of certain secondary attachment – separation phenomena.

The first includes processes of building a mental image of the main attachment figure, of its separation from the model, its internalization, of investing it with the role of securing substitute and of the child’s attachment to this subjective structure which becomes capable to represent the original and thus to replace it. In other words, with its help, the mother, or her valid substitute, may go away from her baby for shorter or longer periods of time without negative consequences. On the contrary, it facilitates the practice of separation from the main attachment figure.

The second, indirect mechanism that contributes greatly to the socialization of the individual is the ability of secondary attachment figures (alone or in combination) not only to secure the child, but also to transfer their protective role on other available familiar beings and objects. Moreover, in their turn, they may substitute one another. In this way, both the range of security sources and the forms of protected separation are substantially more diverse, so that, in tandem with the separation, the attachment provides more autonomy than dependency.

On the contrary, if the attachment has a recognized constructive role, in the event of unjust separation, the focus is on its negative consequences, separation being considered primarily a major psycho trauma. The fact is a consequence of the psychiatrists’ interest in anxiety and in the deprivation of stimulation, which separation generates, especially when it is uncontrolled and precocious, and involves the main attachment figure. It is also the justified explanation given by Wolk and Rutter (1990) who consider the separation as one of the key issues of the child’s psychological development and of child psychiatry. In reality, the stimulating interaction between the experiences of separation and the attachment relationship contributes directly and fully to the normal psychological development of children, having a unique role.

We have mentioned above two of the earliest, often ignored, forms of separation, perhaps because they have only a positive role. Primarily, it is the process of image separation of the main attachment figure with the aim of internalizing and building representative subjective structures. Secondly, we consider the phenomenon of separation, transfer and attachment of the secure capacity of the main attachment figure both on its subjective image and on beings or objects from the external environment available to accept it. Thirdly, we also stress the separation, transfer and secure attachment of the role of secondary attachment figures to some other beings or objects in the child’s family. As I pointed out, all these phenomena of separation-attachment contribute mainly to the diversification of security. Moreover, they are also at the basis of essential mental functions considered representative for the human psyche, such as the capacity for symbolization, which is growing with maturation.

To the above mentioned enumeration, one might add the well-known role of the numerous experiences of separation (be they accidental or not) from the various figures of attachment, which, well-dosed and supported by substitute security sources offer the opportunity:

  • to explore the environment and to confront the unknown;
  • to enrich the emotional sphere (where the separation anxiety occupies a special place) by dealing with frustration and above all by opening the primary attachment relationship to the outside and offering possible secondary attachment figures (transitional objects, grandparents, the nanny, brothers, sisters, friends , etc.)
  • to diversify relationships by encouraging the phenomenon of attachment transfer of the internalized main figure to new beings and objects and investing them with an ability to represent themselves and provide security;
  • to diversify the separation experiences generated by the temporary missing of new sources of security;
  • to diversify the contacts with the outside world.

Here it should be noted what D. Winnicott (1896-1971) called the transitional object. It is nothing but a secondary attachment figure represented by a favourite object, always the same (a doll, a piece of bed sheet, usually a fluffy toy, etc.) which has a special value for the child because it is invested with the role of a secure substitute to the main attachment figure. As a result, the child can be left alone with it, he does not go to bed without it, he chooses it as confessor whenever he feels threatened, or he expects and receives relief from if. It is called a transitional object because, on the one hand, at first, it is recognized by the infant as neither belonging entirely to the external world nor as part of his own body, just lying in the transition zone between the two realities. On the other hand, while in reality it is an object of the outside world, its presence helps to reduce anxiety of separation from the main figure of attachment and hence from the dependence on it. When the anxiety is reduced, the symbiotic links are relaxed and the relationship with the outside world is enhanced. In other words, a transitional object facilitates the transition to objective reality. This is because, in the infant, it mediates the contact with others and contributes to the multiplication of secondary sources of security, to the enhancement of relationships with the real world and to the awareness of its boundaries.

The transitional object is not only the preserve of the first years of life. In various shapes and meanings, a transitional object is found during the entire existence of the individual who uses both gifts, photos, memories received, taken or left by his peers to alleviate suffering, remoteness or separation from loved ones and objects that secure good luck or protect from dangers. It is also reflected in processes of investing, objects and phenomena with roles and functions, in the capacity of symbolization, in the sphere of imagination, of play and of artistic and scientific creation. Summarizing the above, it should be noted that in interaction with the relationship of attachment, separation contributes directly to the diversification of the emotional sphere, to the acquisition of self-security over fears, born out of victories over frights, to the development of processes such as decentring, individuation, knowledge of the world and of oneself, defining the individual side of personality, and allows the individual to assert his identity and independence.

All these mean that, for a balanced development, the child needs someone to receive affection from and whom he might give his love and gratitude to, someone he might attach to and detach himself from and with whom he could communicate in full security and, very importantly, he needs someone to mediate and to stimulate him and support his separation experiences. In other words, it is indispensable to have not only a secure attachment, which is a truth that is usually insisted on, but also an active and balanced attachment-separation binomial.



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Correspondence to:
Stefan Milea, Clinic of Child Psychiatry, no 10-12 Berceni Street, Bucharest, sector 4, cp 041915