05: Bonding – Psychosocial Pathology

Disorders of behaviour fall into two main groups – those where there is some physiological anomaly in the brain (still awaiting full understanding) that are termed the major mental (psychiatric) disorders, and these are the schizo-affective disorders, endogenous depression and the dementias. They may be treated with physical or psychological means.                                The other group is all the behavioural disorders, and it is this group that arise because of failures in meeting the Bonding needs for Approval, Acceptance and a sense of ‘Belonging’. Apart from medication to reduce severe anxiety, communal psycho-social organized activities provide the best means of enabling lost social skills that lead to self confidence, friendships and contentment.

In an ideal world, the Bonding Process enables communities of people to live in harmony as they ensure all their physiological needs for nourishment and safety are met contentedly.

The other pages have given accounts of the knowledge and understandings about the Bonding Process, but there are a variety of factors that can lead to some individuals failing to have their Social Needs met adequately at various stages in their lives.

There may be a range of failings in the initial Bonding Process, stemming from maternal problems or anomalies in the infant; there may be problems with the social milieu in which the child is living; and the individuals temperament will play some part in determining the nature and extent of any pathology.

In the modern world, there are many factors that can limit the success of the Bonding Process and/or the social learning opportunities.  Where the individual lacks a sense of worth, feels an outsider and experiences constant anxiety, this will seriously limit their ability to negotiate their way through a life where other people become threats, rather than kindly, and this includes doctors and carers.

Attention Seeking Behaviour

Constant distress is intolerable and it triggers an instinctive response of aggravating ‘pity me’ behaviour,which draws attention to the suffering, but elicits reflex annoyance and anger in those to whom it is directed, or challenging rule breaking activity.  The initial response to this, from the people around, takes the form of teasing, banter and sarcasm, and then become unkindness and rejection and punishment. 

These reflex mechanisms would have protected the integrity of the group in the early days of human life on earth, and anyone who could not, or would not cooperate would have been caste out.  Nowadays, this is not acceptable, and where this is occurs, some mechanisms come in to play at a subconscious level, that attempt to reduce the anxiety. These are termed ‘Mental Mechanisms’., and they can have some effect, but they do nothing to ensure Social Needs are met.

Mental Mechanisms

These are sub-conscious strategies by which the mind adjusts to the reality of social experiences which have, in some degree, threatened or damaged an individual’s self-esteem or confidence, so that they can ‘live with themselves better’. There is a range of strategies that have been identified and described, and there are many lists of them. No two lists are identical and the definitions can not be exact, because the mechanisms are initiated at an unconscious level and can only be guessed at from observable individual behavious. It is agreed that there is a hierachy in terms of how severe the poor self-image is, that the mechanism is called upon to restore. The following lists a few of the most commonly described mechanisms, starting with the most benign.

Repression This is where small knocks to our esteem are side-lined and ‘forgotten’. It is the process that is the first stage to all the other mechanisms.

Rationalisation This is the most commonly used mechanism, and is where we give ourselves an explanation for why we ‘failed’ to live up to our ideals or our hopes in some way. For example – a contented person fails to get a job they applied for and the mechanism comes up with ‘I did not really want it anyway, because it would have meant more paper work’

Sublimation This is replacing unacceptable or unachievable desires into another activity. For example a frustrated wife can do a lot of knitting for charity, or the frustrated husband can build a model railway in the attic.

Projection This is attributing to others, shortcomings that we are unaware of in ourselves. For example, a person who is sidelined in a group, might charge a popular person with being petty and mean.

Displacement This is where the feelings from a negative experience are attributed to another person, who is then treated in the same manner that caused the problem. For example, someone made to feel resentful or belittled at work, goes home and humiliates his wife, or ‘kicks the cat’

Suppression This is where some humiliating episode, that can not be managed with any of the other mechanisms, is prevented, at a subconscious level, from being recalled. For example, someone with very low status in an office, suddenly realises the implications of having forgotten to carry out an important task, can completely forget they were asked to do it.

Denial This is where some experience or action overwhelms self-cofidence and acceptance, and becomes completely ‘forgotten’. This is the most extreme of the mechanisms, being on the borderline between being normal and neurotic. This stage is now referred to as ‘somatoform dissociative disorder. (Barradon, T. 2010: Relational Disorder in Infancy. Routledge.)

All these mechanisms help us to handle our anxieties, and feel better about ourselves. They are useful when used in moderation, but the more extreme ones lead to psychosocial pathologies.

THE NEUROTIC PARADOX

This is elicited when mental mechanisms fail to help someone feel comfortable in social situations where they are being rejected or diminished.

The neurotic paradox is a term that describes a reflex response that occurs when an individual fails to gain approval in a social situation and feels ignored and rejected. This unconscious reflex sets in action a range of behaviours (termed ‘attention seeking’ or ‘difficult’ behaviour) which, far from being useful, have the effect of alienating those from whom the individual most needs approval. The ‘paradox’ is, that the more a person needs to be liked and approved by the people around, the more these people become threats that have to be countered or avoided. The more this reflex is called into play, the more extreme the behaviours become, eventually leading, over time, to ‘neurotic’ disorders. When these disorders are severe enough to warrant treatment, it is understandable that the ‘paradox’ engenders severe ambivlence for the sufferers in their relationship with the treatment and care team, and equally, for the members of the treatment and care team.

People undertaking the care of others have to learn to recognise both attention-seeking behaviours and their own attention-rejecting behaviours and, through understanding, gain the skills that will enable them to be kind and accepting, thus meeting the others’ Social Needs, raising their self-esteem, and giving them social confidence. Where the problem is severe it takes time and good teamwork, and much testing by the patient, before the strategy can be effective, and this is the core skill of Mental Health Nursing/Caring.

PSYCHOSOCIAL-PATHOLOGY

When there is severe lack of, or threat to the physical need system, the reflex response is to fight or to flee, and the same response is triggered when there is severe lack of, or threat to the social needs system, but in social settings it is not appropriate or helpful to attack or run away from others. The strategies outlined above are therefore called into play, and will increasingly alienate (and perplex) the people they have to interact with, and the symptoms will become more severe.

BEHAVIOUR  DISORDERS

These all arise to prevent a conscious awareness that the individuals feel unloved and unliked to such a degree, that the protective strategies are insufficient to allay the anxiety, which then progress to ‘pathological strategies’, These may be attempts to ‘flee’ from the anxiety, or attempts to ‘fight’ or control the anxiety. There are also the addiction disorders that attempt to allay or deny the distress.

The disorders that arise from the attempt to ‘flee’ from the threat of social situations are Personality Disorder, various AnxietyStates and Panic Attacks. They are extreme expressions of the ‘attention seeking’ reflex, and they all trigger the ‘rejecting’ reflex in those from whom they seek help.

The disorders that arise from the ‘fight’ response are the Obsessional, the Phobic and the Compulsive Disorders, (eating disorders probably fit here), where mental mechanisms are over used to control the conscious awareness of the individual’s low self-esteem and social alienation, and avoid interaction with people, whose rejection is dreaded.

The Addiction Disorders arise from a denial of Social Needs deprivation. There are a variety of things to which people can become addicted. Prescription and non-prescription drugs and alcohol form a major group. By their action on the chemistry of the brain they can counter the distress producing effects of adrenalin and cortisol and provide temporary relief, but they do nothing to help to ensure the meeting of Social Needs and increase self-esteem. It is the nature of addictive substances that it takes increasing amounts to achieve the same relief, and over time if they are withdrawn there is a ‘rebound’ of circulating adrenaline and cortisol that is experienced as an extreme level of anxiety. There are other forms of addiction that stimulate endorphin release in the brain, which provide a temporary feeling of pleasure. The excitement of gambling and promiscuous sexual congress in the absence of love or friendship, are two such triggers.              It has only recently been shown that the endorphins released in the brain by addictions, are those that control all reproductive behaviours, and they have no effect in meeting Social Needs.  Because addictive behaviour is so anti-social it adds further depletion to the meeting of them.    

It is interesting that adequately met social needs ensure contentment and enough is enough.      In social situations, where people are driven to seek more and more fame, status or wealth in an addictive manner, whatever ‘reward’ they experience, it is never enough.

Psychopathic Personality

” The prototypical psychopath has deficits or deviances in several areas, interpersonal relationships, emotion, and self-control. Psychopaths gain satisfaction through antisocial behavior, and do not experience shame, guilt, or remorse for their actions. Psychopaths lack a sense of guilt or remorse for any harm they may have caused others, instead rationalizing the behavior, blaming someone else, or denying it outright. Psychopaths also lack empathy towards others in general, resulting in tactlessness, insensitivity, and contemptuousness. All of this belies their tendency to make a good, likable first impression. Psychopaths have a superficial charm about them, enabled by a willingness to say anything without concern for accuracy or truth. Shallow affect also describes the psychopath’s tendency for genuine emotion to be short lived and egocentric with an overall cold demeanor. Their behavior is impulsive and irresponsible, often failing to keep a job or defaulting on debts. Psychopaths also have a markedly distorted sense of the potential consequences of their actions, not only for others, but also for themselves. They do not, for example, deeply recognize the risk of being caught, disbelieved or injured as a result of their behaviour.”

The above passage is one of many similar ones, taken from the internet. There is a common understanding of the behaviours that psychopaths show, but no agreement as to their causation. There is also no understanding of what the experience of ‘being’ a psychopath feels like. 

It happens that, for whatever reason, some infants fail to have the Bonding Process initiated during the vital months of opportunity for it to be established. This may be for a variety of reasons, such as the mother or the baby being too ill, or a cultural practice of taking babies away from ‘unsuitable’ mothers. There may well be others to provide physical care and nourishment, but it is likely to be with limited time given by several people, and will not give the unstinted time, close physical contact  and repetitive input of sight, sound and touch that facilitates the bonding process. The result is that the monitoring system which initiates pleasure when Social Needs are met, and distress when they are not, is not functional and the infant has to grow up without ever experiencing the full pleasure of social approval and love. Equally they do not experience the negative feelings of humiliation, punishment and rejection. The only feelings they do have are the buzz of excitement that can come alongside fear, e.g. rollercoasters, and the physiological ‘high’ of sexual arousal. They may well realise that other people have something that they lack, and can try imitating behaviour that they see, but it is never emotionally rewarding or punitive.

Major mental disorders

Schizophrenia, in its various manifestations, and ‘endogenous’ depression are still not fully understood, but it is accepted that they are caused by disorder of some neuro-chemicals, which can be countered in some degree with various drugs.

What is not always recognised is that, because the symptoms alienate other people, the sufferers Social Needs are not met, which leads to an additional release of adrenalin and cortisol. This exacerbates the symptoms and the distress, makes communication more difficult, and makes medication less effective.  Understanding that the social aspect is part of the problem, suggests that enabling social engagement with sufferers from psychotic disorders should have priority in management and care.

To understand that inside every rejecting or withdrawn patient, there is a lonely frightened person, longing for comfort and help, can motivate the carers to learn the skills that can side-step the psychotic symptoms and enable them to make contact. It is sad that ‘mental illness’ is still stigmatised, – and calling it ‘mental health problems’ does not seem to have helped – because stigma makes it much more difficult to enhance an individuals self-esteem and self-confidence. This can also make much well intentioned caring from professionals, come across as ‘patronising’, which does more harm than good. It is an ongoing dilemma, to persuade individuals and ‘the community’ to be more accepting and kind, and it is good to be able to say that in some local situations this is being achieved, so there is hope.

Last edited April 2016