Ellis Amdur, M.A., N.C.C., C.M.H.S.
I. What is a Psychiatric Diagnosis
Psychiatric diagnosis, despite wishful thinking to the contrary, cannot be termed a pure science. Although the scientific method plays a considerable part, there is also a significant element of ‘human science’ – making informed decisions that are validated by their utility, rather than proven by physiological evidence. With the exception of disorders of the brain (truly more the concern of neurology), psychiatric diagnoses are established by the observation of behavior: attempting to describe certain patterns as unique, as recognizable and as pathological. For example, although we can make a general assumption that kind people help old ladies across the street far more often than cruel or selfish individuals do, and furthermore, that this is almost surely statistically significant data, there is no need to make a diagnosis of ‘nice guy personality disorder.’ The behavior is not pathological. However, a compulsion to wash one’s hands over-and-over, despite knowing it is patently absurd, or a need to tap the television screen seventy-seven times with the right index fingernail before brushing one’s teeth are examples of activities known as compulsions. When coupled with a set of other related behaviors, we establish a diagnosis of Obsessive-Compulsive Disorder (OCD). Through repeated observations and further research, the diagnosis is both pared ‘down’ (cutting extraneous information) and expanded (to cover new data) until we can describe a group of people who all suffer from roughly the same symptoms due to, as far as we can tell, roughly the same reasons.
Often, however, several disorders can share the same symptoms. People with schizophrenia, manic-depressive illness, alcoholism, severe depression, or those suffering from the after effects of severe abuse can all hear auditory hallucinations. But they do not have the same mental illness.
We can sometimes pinpoint down the specific diagnosis by noting specific idiosyncratic characteristics of the symptom. It is, in fact, true, for example, that the human figures in the visual hallucinations of those suffering from Alcohol Hallucinosis are almost always diminutive – unlike those experiencing other syndromes, such people really do see ‘little green men.’ People who experience that characteristic type of visual hallucination are far more likely to have a syndrome provoked by severe abuse of alcohol.
II. How are Diagnosis Created?
Sometimes diagnoses are created from the most concrete of evidence. A person shows psychotic symptoms, and a spinal tap reveals that they have meningitis in the cerebral-spinal fluid. They are given high doses of antibiotics and recover.
Other times, diagnoses are created after years observing a multitude of individuals. Diagnoses can be quite mutable, as our observations continue over the years. Schizophrenia and its subsets, for example, change with each new edition of the Diagnostic and Statistics Manual (DSM-V), currently in its fifth version) as researchers and clinicians continue to more accurately (hopefully) delineate the subsets. One of the defining characteristics of a good diagnostic category is utility, with limited over-lap with other diagnoses. It does not help suffering people when you have too many diagnoses, each describing roughly the same behaviors. For example, with each edition of the DSM, the section on depression keeps expanding into more and more subsets, with no obvious utility, given that the treatments for most of the subsets are so similar, both in terms of therapeutic interventions and in regards to medication. At a certain point, it is better simply to describe an individual in narrative form rather than offering a plethora of labels of type of depression, given that another clinician might pick another subset to describe the same person’s condition.
Another way that diagnoses can be established and ‘proven’ is to create an assessment tool that shows a certain population of individuals will show a recognizable pattern of behavior (though observation, self-reports, or collateral interviews, etc).
An individual’s diagnosis can also be ‘disproved’ when there is a generally accepted method of treatment for a particular syndrome. If the treatment doesn’t work, and there is no evidence that the clinician is incompetent, this suggests that another diagnosis is driving the behavior.
Still other times, one or a few clinicians assert the existence of a new diagnosis based on a theory they have created to explain a set of behaviors. This is often how psychiatric knowledge increases, but several problems can emerge along with the new diagnosis:
- Clinicians have enormous power in regards to their patients. For example, there is no doubt that people can lose, perhaps even repress many events in their past, including traumatic incidents. However, the theory of the ‘repressed memory’ of trauma has spawned an inchoate movement passing itself off as science, often contrary to established, research-based information on memory and trauma.[1] This has further spawned a flood of poorly trained therapists reading poorly thought-out theory and poorly researched books, attending seminars by charismatic speakers, these therapists then looking for and treating repressed memory in both children and adults. Much of this therapy, counter to the best research we have on memory, has caused terrible harm. Because vulnerable people become very suggestible, particularly in the face of a powerful, ostensibly benign therapist, they often can end up inadvertently ‘constructing’ a memory to support the suggestions of the therapist. The best outcome studies show that the majority of people who go through this type of therapy are far worse of than when they started. Simply put, such a diagnosis can become a self-fulfilling prophecy.[2]
- A diagnosis can be real, but the clinician’s explanation is not. For decades, the subject of autism, a mysterious condition, which now is believed to have a neurological basis, was under the thrall of psychoanalytic theory, which claimed that autism was caused by ‘refrigerator mothers’ – cold, unloving women who psychologically devastated their child. This patent nonsense destroyed families, and did nothing to help the children.
- Conversely, the behavior may be real, but the diagnosis is erroneous. Early in the last century, there was a particular, well-studied type of psychosis called general paresis. Many explanations of its etiology were given for it. Then it was discovered that it was third-stage syphilis, and the whole theoretical house of cards collapsed. Another example: a child hears voices, telling her to kill herself. She is diagnosed and treated for schizophrenia. Then it turns out she is being horribly sexually abused, or has a toxic condition in the brain due to an infection or a medication side-effect. The observation is correct – the child is psychotic. But the original treatment may be useless.
- Diagnoses are discarded when they are found to not be clinically useful, when there is too much overlap with other diagnoses, or when they are ‘put on ice’ until more research can either support or deny its validity. One example of the latter is ‘passive aggressive personality disorder.’ There is no doubt that there are profoundly passive-aggressive people, but it has not been established that there is a set of individuals who have a fixed, almost unbreakable ‘habit’ of being passive-aggressive more or less independent of the circumstances that they find themselves. It may be true. It sounds like common sense. But it has not been established.
Among the limitations of the aforementioned Diagnosis and Statistical Manual is that there is also a political element to it – politics being the manifestation of conflicting people seeking compromise and agreement. Thus, there are often diagnoses that are still subjects of controversy, and the various clinicians come to a compromise, common-mean, so that they have enough agreement to go forward.. For example, multiple personality disorder, now called Dissociative Identify Disorder, is entered in the DSM-V, but many clinicians believe that this syndrome is almost always the result of suggestion by certain clinicians following certain types of therapy that tend to evoke the symptoms in a subset of vulnerable patients. There have been ‘epidemics’ of Dissociative Identify Disorder in various geographical areas after a charismatic presenter offers seminars on diagnosis and treatment of this controversial condition.
Finally, pioneers often discover new diagnoses, believing – sometimes correctly – that they have observed an unnoticed syndrome with a cause and hopefully, a treatment. For example, high-functioning autism has surely been part of humanity’s psychological diversity since we became humans, but it was first noticed as a discrete array of behaviors – a diagnosis – by Hans Asperger in the mid-twentieth century.
However, not every ‘pioneer’ is accurate in his or her observations – or at least in the conclusions he or she draws from those observations. This is the case with the at least one definition of Reactive Attachment Disorder.
III. Reactive Attachment Disorder (RAD)
The Orthodox View
Reactive Attachment Disorder (RAD) is a relatively new, equivocally researched diagnosis. In orthodox psychiatry, this diagnosis is mostly given to infants and young children who show a significantly disturbed way of relating to others. They can be excessively inhibited, hypervigilant or may respond to caregivers in a strange mixture of avoidance, resisting comforting, and a frozen watchfulness. Paradoxically, some may exhibit an uninhibited, apparently fearless approach to strangers. (NOTE: In the DSM – V, these behaviors now ‘split’ the diagnosis into two: reactive attachment disorder and disinhibited social engagement disorder. Therapeutic interventions are somewhat different for each sub-type).
The general theoretical assumption that the cause of this disorder is terribly inadequate parenting, associated with neglect, abandonment or abuse. The quite reasonable assumption is that if a child is deprived of love and protection, or even worse, terrorized before they have the cognitive ability to even find an explanation for what is happening to them, their ability to love, to trust and to form solid emotional attachments will be severely impaired. As a result, the child might be either ‘indiscriminately social’ or predominantly asocial (or both, depending on the circumstances he or she is in).
- It should be noted that there is no definitive research that has established such abuse or deprivation as the sole cause of impaired attachments, although that is a logical assumption.
- We also do not know if some children develop this condition in the absence of abuse or neglect.
- Furthermore, we also do not know why some children develop severe attachment problems while other children, brought up in the same situation do not; one theory is that the children who survive more-or-less intact have found some person, inside or outside their family, who valued them. Through this, the child who does not display reactive-attachment disorder not only develops a sense that they matter, but that they actually exist as human beings. Another theory is that some children are innately more resilient than others.
Children with attachment problems may be otherwise quite ‘normal’ – they can be bright and articulate. Unlike the child with high functioning autism, who has a neurological condition that affects behavior in a ‘pervasive way,’ children with attachment problems usually do not present as otherwise odd or eccentric. Such children can be articulate, and very charming; the only anomaly is either their inordinately affectionate behaviors with unfamiliar people, or a cool un-bonded distance, particularly with their caregivers.
There is recent evidence that severe abuse and even more so, neglect, actually affects brain development – sometimes in a life-long way. This is not due to head-injury. It is simply that if certain experiences do not happen to an infant or small child in proper time, the brain is not ‘cued’ to develop certain nerve pathways, or even, in severe cases, whole areas of the brain. Karr-Morse and Wiley state in Ghosts from the Nursery, [3]
Schore . . . , believes that there are neurochemical and structural processes in a specific area of the baby’s brain – the orbitofrontal cortex that are designed to be receptive to and programmed by the interactive emotional relationship between the baby and the . . .primary caregiver. This area of the brain appears to link sensual input from the cortex. . . with the child’s emotionally reactive limbic system and with his internal physical processes . . . . By experiencing the joyful and soothing responses of the caregiver to basic needs, the baby experiences connection and pleasure and confidence in the presence of the caregiver . . . .the infant learns that strong emotional states can be entrusted to another and ultimately balanced or resolved, in the context of relationship . . . In the case of children with type D attachment patterns, instead of a sensitive “attuned” emotional exchanged, . . there is “misattunement.” Signals intended by the infant to elicit comfort have been met with pain or unpredictable responses that did not lead to pleasure and soothing for the child. . . . Not only does the child experience a lack of excitement, closeness and warmth in this early relationship, but the child’s basic brain biology shifts for self-preservation to a dampened level. . . . Over time, these children become individuals who may show little concern for relationships. . . . In extreme instances of misattunement, scientists . . .believe that the results is developmental sociopathy. If the synapses in this area of the brain are never built . . . .the individual may be left without the ability to connect, to trust and ultimately to experience empathy.
Orthodox interventions for attachment disorders include psychotherapy, and good, loving parenting. It is clear that the latter is most important. Children who have been so profoundly hurt need parents who are both strong and powerfully calm, who do not take it as a personal affront when such children maintain their distance, or only engage with them on a superficial level. They need predictable rules, firm (but not harsh) discipline. In a sense, they need parents who are consistent and sure as the heartbeat they felt when they were in their mother’s womb, perhaps the last safe place they have ever experienced.
IV. The Expanded View of Reactive-Attachment Disorder
(I will refer to this as ‘Nouveau-RAD’ to delineate from the orthodox diagnosis)
Pioneering clinicians, most notably Foster Cline, have vastly expanded the definition of RAD, in a manner that is, in some ways, congruent with the neurological data quoted above. They have observed what seems to be a great increase in foster and adopted children, taken into apparently nurturing homes, who begin to behave in appalling, frightening ways: calculated aggression, lying, theft, and manipulation. Since the flourishing of substance abuse in America, particularly crack, heroin and methamphetamine, more and more children are being raised in unbelievably neglectful and abusive families. Within the last fifty or sixty years, we have increasing numbers of very impaired teens raising very impaired babies who become impaired teens who raise . . . . We have cascade of three or four generations of damaged and profoundly hurt children within only a few decades. In addition, we have a great increase in adoptions from abroad, and sadly, many of these children have been grossly neglected or even beaten and raped while still infants. Love does not seem to be enough for at least some of these children. They kill family pets, try to poison family members, urinate in food (all cases which I have had some involvement), and show a number of other severely pathological behaviors.
The theorists of Nouveau RAD assert that these children, given no opportunity to love or trust – to attach to any caregiver with any assurance of reciprocal, nourishing love in return – give up on humanity. The metaphor often used is this: A child falls through the ice, almost dies, but makes it to the woods to hide out on the other side of the lake. The only way back to a real home is to return over the ice. That’s so scary they’d do anything to stay in the woods, where they believe that they won’t perish utterly. They view kindly parents and supportive therapists as seducers who will make them vulnerable, entice them back over the icy waters and let them drop again. They are filled with rage and hidden fear, and they do anything to undermine relationships, which they define as dangerous vulnerability. They will do anything possible, no matter how horrific or disgusting, to maintain their control over their own destiny, no matter how impoverished, lonely or nasty their existence might be. Their ugly and frightening behaviors cause caregivers to give up on them, over and over again, this confirming how unlovable they are and that no one can be trusted. There has been no research to establish that this is true, although it makes logical sense. At this time, however, it is a theory that is only proved by the information its exponents say they get from the children, or often more importantly to the researcher/clinicians, from their caregivers. They further claim that their theories are proven by the success of the treatment they provide.
I have observed a basic training tape of at least four hours by a noted figure in the field, a foster mother by the name of Nancy Thomas. As explained in the tape, and corroborated by other clinicians I have consulted over the years, the parent (who is often a new foster or adoptive parent) must take total control of the child’s life. This is not done through punishment, per se, but through very firm boundaries and rules, that allegedly replicate the child’s missing experience as an infant, of being utterly dependent and safe in the arms, literal and figurative, of their mother.
There are a number of procedures to accomplish this. One essential element is that this procedure is all-encompassing; there is no moment that the child is not wrapped in psychological swaddling, under the complete control of their caregivers. Every action must be geared towards ‘reattachment.’ For example, the child must learn to sit facing a wall, without moving for two minutes, upon entry into the foster home. They will be required to do this through the day(s) until they succeed. They may be required to play in one area with Legos, and if they speak or move from the area, the toys are taken away. They have graduated chores to do, which must be done perfectly (toothbrush scrubbing the corners of the room, while washing the floor). The child answers, “Yes, mom,” rather than “Uh huh.”
When the child whines or is oppositional, the parent does a kind of verbal aikido, through which he or she tries to pre-empt the child’s taking control through negative behavior. Some of this is elegantly done: For example, “You can go to your room for one-half hour by yourself, or you can go with me helping for two hours. Oh, you are going to your room by yourself. Good. You are getting so strong! And I’m sure you’ll want to slam the door on your way. Good slam!” My question regarding the last couple phrases: Is this an adroit blending with the child’s energy, or merely a satisfying sarcasm that enables the parent to ‘win’ the power struggle?
In the first stages, they cuddle three times a day, whether the child wants to or not, and the parent must require eye contact; theirs should be warm and loving. The intention is to create an environment in the home in which the child gets what they, allegedly, never received before: a sense of their parents as “Awe-some!” (their phrase). The child learns limits and trust when they have limits and rules.
There is a proper way to hug: both the parents’ arms should be over the child’s, as the parent is in control. Continuing the focus on control, parents must initiate all hugs – all nurturing behavior must be given by the parents, even though this is not substantiated by research on early child development where the baby does a lot initiation of the sequence of nurturance. A particular model of parenting is established that very much resembles that of 1950’s American television shows. For example, Ms. Thomas says that she teaches her children to cook only if they have grown up in her home long enough to be ready to leave – she maintains dependency rather than encourages independence, seeing the former as the missing developmental experience.
Ms. Thomas presents some effective parenting strategies. Responsibility is placed on the children. Rather than being told to do homework, the child gets natural consequences from not doing it. The child doesn’t have ‘bedtime’ – they have ‘go to your room time’ at 8:00 p.m., where they can do homework, read, whatever. The idea is that the child, so out-of-touch with his or her own organic needs, learns to self-regulate – he or she must get up at the same time every morning, no matter what time they fall asleep.
On the other hand, some of her suggestions are an open manipulation of power through the ability to use language to define reality. An unmade or poorly made bed, for example, is interpreted as a desire to sleep in, and so the child is told to get back in bed. Every fifteen minutes or so, the parent checks again, and if the bed is still unmade, back to bed they go. The child may not leave his or her room in the morning unless it is perfectly arranged and clean.
Discipline strategies generally use this ‘power to define.’ When the child breaks a rule, there are ‘consequences as privileges.’ They are awarded the chance to wash the bathroom or the kitchen floor, using a toothbrush to get the corners, perhaps, to “help them get stronger,” because they must have been feeling weak to call their brother a “goat sucker.” The presenter has the child offer restitution for some things by giving her a foot or shoulder massage.
The child is seen as manipulative and untrustworthy at any and every moment – incessantly striving for any advantage. The parent’s task is to “care enough” about the child to take control now, to replicate the alleged missing experiences of the earlier stages of life so that the child can move on. Parents are encouraged be strong now, setting limits for the child, because if they don’t, these children will, it is asserted, grow up to be psychopaths, criminals or marginal individuals. They are trying, in essence, to cause the child to experience his or her life as they should have as an infant and small child. It has never been established that it is possible to heal through such regressive experience, but this is the theoretical basis of the therapy. Furthermore, there is no evidence that the definitions attached to the child’s behaviors are, in any way congruent with early childhood experience.
The most controversial aspect of Nouveau–RAD treatment is called Holding Therapy, a method which has rather bizarre antecedents. It was first used with schizophrenic or autistic children. The originator, Robert Zazlow, believed that these conditions, too, were manifestations of poor attachment, something absolutely counter to current psychological knowledge. In his Z-Process, these vulnerable, psychotic or autistic people were pinned down by a number of people who ‘loved’ them. And then they were tormented, tickled and poked, sometimes for hours. The idea was that the core of their psychiatric disorder was rage that had to be released. When it finally was, along with fear, helplessness and panic, it supposedly replicated the birthing experience, and in that utterly dependent state, they would meet the eyes of the people who loved them, and make a reparative bond. This, it was claimed, would cure their schizophrenia or autism.
This method was adopted by the Nouveau–RAD theorists. It has undergone gradual development over the years. However, some therapists still use what should be regarded as torturing the child, either with tickling, pinning them with one’s whole body weight, or pushing on their abdomen with an elbow. The caregiver looks in the child’s eyes, once the ‘break-through’ is reached, and tells the child how much he or she loves them, therefore allegedly establishing a bond when the child is in such a vulnerable state.
Others, ostensibly more humane, though still quite intrusive, make an allegedly voluntary contract with the child in which he or she agrees to be held. ‘Voluntary’ is an interesting word, under the circumstances. By their own assertions, these are children who were deprived, neglected or brutalized in their earliest years. Now the person who controls their fate: whether they will remain in the home, when and how they will be fed, or whether they will spend hours scrubbing the corners of the bathtub with a toothbrush, ‘requests’ that they volunteer.
The therapists and aides hold and restrain the child in their laps, and for a long period of time, attempt to evoke ‘core emotions’ and memories through insistent verbal probing. The therapists repeat over and over how miserable and unloved the child was – so they assume – in their earliest years, trying to get the child to powerfully express his or her pain, rage, fear etc. And when he or she does explode into tears or rage, the parent enters the room to hold them with love and caring, thereby establishing a bond imagined to be similar to that a baby and mother experience, eye-to-eye, at the moment of birth.
Problems with Nouveau RAD
There are a number of areas of concern regarding this diagnosis and its treatment:
- There has been no legitimate research on this Nouveau RAD diagnosis and its treatment modality. There is anecdotal evidence from parents and clinicians on how much it helped a certain child. Even postulating that this is true, we don’t know how long it helps nor really why it helps. The treatment requires a very parent-intensive way of life. The Nouveau-RAD parents are far more involved with their children than most other parents are. To be fair, some of their suggestions are a good model of authoritative parenting. An authoritative parent is one who does not try to break the child’s will, nor ignore his or her own parental responsibility by adopting a lese’ faire attitude. All available evidence shows that success in parenting is less due to any specific rules or methods than the assumption of strong, loving parental authority. It may be that the children who allegedly do well in attachment therapy do so simply because all the procedure advocated for the home give a parent one possible framework to take authority. It is therefore conceivable to me that some essentially loving people can use these techniques, and the child perceives the love and nurturance despite the method. There is a very believable possibility that any loving parent who can adopt a consistent authoritative stance with firm limits and boundaries could do as well (or far better), even though they do not adopt the procedures advocated by the Nouveau–RAD theorists. As far as I can see, one could establish a far less bizarre and loving set of rules that could provide all the consistency necessary without Nouveau-RAD’s bizarre ways of interacting with the child. One example of this can be found in the book, Transforming the Difficult Child.[4]
- Screening – One of the primary methods of ‘diagnosing’ these children is the parents’ reports, coupled with the therapist’s observation of the child. Their diagnostic criteria are an inescapable Catch 22. One of the diagnostic criteria is the parent’s anger at the child; another is that they always lie; and a third is that they can charm outsiders so that only the parents can see the trouble. The belief in the diagnostic powers of the therapist can be quite grandiose. Ms. Thomas, for example, states in her tape that she visited a school classroom and saw eight kids there with attachment disorder. Her criteria, I can only assume, must be that she saw some children acting up, sullen, or otherwise being unpleasant teen-agers. It is one thing to say that she saw a class with eight obnoxious kids, maybe even with bad hair and pierced tongues – but it is quite another to then assert that each is suffering from a condition that is more-or-less equivalent, to the Nouveau-RAD theorists to psychopathy. My first question when a parent presents with complaints about a child is to wonder if the child’s behavior is, in any way, related to the way the parent treats the child. My second question is if there is a medical cause for the behavior. Several years ago, I worked with a family, the father of whom was convinced that his adoptive son had attachment disorder. The son was, indeed, a somewhat sullen, untalkative, angry kid, who had gotten in a little trouble with the law. However, within only a few sessions, it became clear that the father had always regarded the son as an intruder who stole his wife’s attention away from him. He hated the boy, and expressed that in a myriad of ways. His wife substantiated that to me. The father stated that on the boy’s 16th birthday, he was going to buy him the most powerful motorcycle he could find and then the ‘problem’ would take care of itself. The father displayed profound paranoid and narcissistic behaviors. Nonetheless, based on this father’s report and a single observation by a very well known Nouveau-RAD therapist, who cited the boy’s sullenness towards her, a stranger, as a prime diagnostic characteristic, the boy got the diagnosis. (On the contrary, my intervention was to support the mother in getting the father out of her home and her child’s life. The boy’s behaviors quickly improved.) A child may certainly come into a home with some degree of difficulty in either loving or bonding. If the parents do not genuinely love their child, if they see the child as an extension of or reflection on themselves, if they feel outraged and betrayed that their adoptive darling turned out to have some problems, they can often become belittling, cold, insulting or abusive. And the child will respond in kind. The situation gets worse and worse, and eventually, the parents present their child a Nouveau-RAD therapist’s office. In these cases, there may certainly be an attachment disorder – but it is primarily that of the parent.
- Inauthentic Consequences – One troubling aspect of Ms. Thomas’ tape was interventions like this: The child whines and the mother says, “I see you are whining and therefore feeling weak. You need to get strong. Do ten push-ups” (or jumping jacks). The exercises have to be done in the precise manner prescribed by the parent; if not, this shows they are still weak and need to do some more. Their theory is that the bobbing movement circulates the blood and stimulates the brain, and that it gets the kid in touch with his or her body, AND it is a consequence of negative manipulative behavior. However, there is no real connection between whining and jumping jacks, much less any proof that jumping jacks or push-ups improve either behavior, circulation of blood to the brain or neurological functioning. As the parent has an ulterior agenda, it is also manipulative. It is my firm belief that children, particularly disturbed children, need very firm structure and limits. But the parent must be absolutely authentic, and their communication must be ‘clean’ – unambiguously connected in a concrete way to the problem behavior. If the parent is trying to do ‘therapy’ as opposed to being a pure (definitely strong!) parent, they are ‘doing’ the child, rather than being with the child. The parent must demonstrate to the manipulative child that there is a radically different way of communication that the one that the child is using, one that is nourishing to both parties. In addition, while observing the tapes of parenting techniques for such children, I was struck over and over again how the same action could be benign or hateful. Teaching a child to sit two minutes still facing a wall is the basics of meditation. Teaching a child, thereby to follow a parent’s instruction is excellent. Requiring them to persist when they undermine one’s authority by silliness, whining, or squirming could be good education. But it can also be a cold, punitive, controlling action. The techniques of ‘verbal aikido’ for setting limits can be an amusing, humorous way of turning the tables to the child’s benefit. It can also be a nasty, sarcastic, snide put-down, masked as caring and love, by someone who can control the definitions of reality by verbal skill. Such a theory can take parents off the hook. In both the literature and in person, I have heard parents refer to their children in terms most of us use only for vile criminals – even though they try to add the caveat that they love the child. In some of the most prominent books, they describe mini-psychopaths, and nascent serial killers, or even children with the devil inside them. Several of the most prominent authorities of Nouveau–RAD therapy have promoted the absolutely debunked fantasy of ritual Satanic abuse, that is, per the proponents, endemic throughout our society, particularly in daycares. A corollary of adequate screening of the child, particularly when considering such a pervasive life-style change and radical therapy, is how are you screening the parents? And to the best of my knowledge, most Nouveau-RAD treatment facilities do not spend nearly enough time assessing how intact or impaired the parents are, and how their deficits affect their very hurt and vulnerable children. Instead, they often make the unsubstantiated assumption that the parent’s anger, frustration, even hatred and poor disciplining was evoked in nice people by these horribly disturbed, sociopathic manipulating kids.
- The ‘religious character’ of the movement – Like any controversial area, particularly when people feel so beleaguered and misunderstood, Nouveau-RAD parents have banded together in support groups and study groups. There is often an ‘us-against-them’ attitude. For such parents, nothing that they tried for their children worked. This procedure offers hope, or at least an explanation. The worst aspects of this in-group attitude have appeared in several cases where parents or therapists killed a child, such as one case where a foster father tried to do holding therapy at home, and pushed his fist in his three-year-old’s abdomen until she died. Many Nouveau-RAD advocates have flocked to each of these people’s defense, saying that the children were attachment- disordered kids, and the loving parent was trying to save them. I’ve not read one word from these parents that expresses the slightest sympathy for the anguish that little girl must have felt being literally crushed to death by her foster father’s fist. This us-against-them stance also shuts out alternative views, including those research-based, if they are at variance with the catechism of Nouveau-RAD. One preaches to the choir and doesn’t allow access to independent opinion or information.
- Inadequate or incorrect understanding of childhood development – The Nouveau-RAD theorists make much of eye contact between parent-and-child, and how important that is for bonding. True. But, the most current observation of infants finds that, when in a parent’s embrace, the healthy baby spends one-third of the time actively gazing in their eyes, one-third looking around, and one-third actively looking away from their caregiver (in other words, a healthy individual needs a break from constant intimacy). The method of snuggling embrace that the attachment therapy theorists advocate is constant eye contact. And this is reflected in the method of child-rearing – the child is under the gaze, so to speak of the parent at all times. This is, therefore, contrary, to how people really develop, because this 1/3, 1/3, 1/3 view of the infant shows that privacy is as essential as bonding to develop a self. Even at the earliest stages of development, character is created by differentiation as much as by bonding. Extrapolating this to living with teenagers, many people, clinicians as well as parents, have found that they often get far more open communication with pre-teens and teens when sitting or standing side-to-side, with no eye-contact, the youth finding eye-contact to be too penetrating. The aspect of control in at least some interpretations of the Nouveau-RAD method bears an uncanny resemblance to a 19th century theory of penology by Jeremy Bentham, called the Panopticon. The idea was that the prisoners should experience themselves twenty-four hours, exposed as naked sinners, under the eye of God, as embodied by their jailers. They could not speak, could not eat, speak or move, literally could not do anything without permission. And in their case, the lights were always on. There was no privacy. I have observed something chillingly analogous in many homes following the Nouveau-RAD regimen – the child has NO psychological privacy.
- The question of a reorganization of brain structure – returning to the quote above from Ghosts from the Nursery, if a ‘developmental sociopathy’ exists and results in actual changes in brain structure, then any therapy that works must help the child reorganize on a neurological level. This is possible, as recent research on OCD shows.[5] I am not aware of any research, however, that attempts to correlate therapeutic outcome with neurological changes, or if anyone has attempted to screen children based on neurological deficits, as described above. Even if it is conceivable that Nouveau-RAD therapy does aid in neurological reorganization, a therapy this powerful would be, I believe, quite devastating to a child who does not have this (theoretical) disorder. Does one give chemotherapy to someone who doesn’t have cancer? No one in either the literature or the field has satisfactorily answered to me what the effects of an absolutely controlled and very eccentric form of communication would have on either a normal child or one with other problems. I asked a prominent therapist this question, and she replied that she didn’t know – she had never used the therapeutic procedures on a normal child, nor, she said, had anyone in the field.
- Holding therapy is, to me, of most concern. First of all, holding down a victim of assault, particularly sexual assault is a violation of extreme consequence. To replicate the experience of absolute helplessness is appalling cruelty. As the assault may have happened to be pre-verbal child, how can they report if they suffered this when screened for therapy. In other words, the parents and therapists may have no idea of what the child suffered, and they are using an intense physical method that may exactly replicate experiences of abuse. There is a quite troubling parallel between the holding procedure, even in its more humane form, and grooming behavior to molest children. To groom a child for molestation, one shifts between doing something that makes the child vulnerable and stressed and then offers reassurance (accompanied by abuse). This is true, whether or not the child ‘volunteers,’ given that a caregiver or trusted ‘big person’ says they should. Thus, you, the object of fear become an object of gratitude when the fear is removed. And playing this back and forth, from fear to relief and back again makes the child pliable, easy to manipulate, intimidate or mold. Another example of this is the Stockholm Syndrome, where dependent and fearful hostages bond with the ‘kind’ hostage taker, who provides them with food and reassurance in the context of the dependent state that he created. In general, this should be considered a form of pseudo-religious conversion, in which an individual, in this case, a child, is subject to being made totally vulnerable, and in this state, ‘imprinted’ with a new template of relationship, like baby ducks imprinting on the first moving creature which enters their visual field. Even if this, unproved to date, were possible, something this powerful requires that all involved are totally loving towards the child, and have absolute knowledge that this is what the child needs. Given my concerns enumerated above, I have not seen that this evaluation of parent and child can be satisfactorily done. In sum, you have a child, held in the arms over the laps of therapist/practitioners, or worse, pinned down by them. These powerful adults know a lot about the child. They probe, at least with words, to evoke the experience of loneliness, anger, fear or deprivation, which the therapists honestly believe, is ‘encapsulated’ within the child. It is no wonder that such children often call out that “I want my mommy!!!”, and collapse in their arms. The child often regresses into a dependent state – as many people do in either conversion experiences or brutal interrogations. Even more than the possibility that such procedures will not create a bond between parent and child, there is an even more risk that a bond will be created – a traumatic bond forged of vulnerability created by the therapy.
Conclusion
How does one reply to anecdotal claims that severely disturbed children have been helped by these procedures? Let us imagine that a child is present who underwent such procedures, and s/he is clearly happier and healthier than s/he was before. Even then, we still would not know if it was the techniques or the quality of strength and love and authority that a specific parent had. If, as I believe, it is the latter, then the techniques would be unnecessary, rife, as they are, with misunderstandings of neurology and early childhood development. Furthermore, the potential is very high that such parents who present with the self-fulfilling ‘diagnostic’ criteria of a) anger at the children, b) that the children always lie, and c) only the parents can see the behaviors are not bonded or loving to the children. Nouveau RAD thereby provides sanction to a cold view of the child as damaged goods, only able to be fixed through a psychological technology that does not make the parents responsible in the slightest for their own angry or hateful feelings.
Unless research, using the scientific method, is presented comparing loving strong, psychologically-healthy authoritative parents using normal parenting techniques with loving, strong, psychologically healthy parents following Nouveau-RAD, establishing the latter to provide significantly better outcomes for the children, this theory should be regarded as pseudo-science and this ‘therapy’ as quackery. The sum of this is nothing less than abuse of children under the guise of treatment.
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[1] Loftus, Elizabeth, &Ketchum, Katherine, THE MYTH OF REPRESSED MEMORY: False Memories and Allegations of Sexual Abuse, St. Martins Press, New York, NY, 1994
[2] Ofshe, Richard & Watters, Ethan, MAKING MONSTERS: False Memories, Psychotherapy and Sexual Hysteria, Charles Scribner’s Sons, New York, N.Y., 1994
[3] Karr-Morse, Robin & Wiley, Meredith S. GHOSTS FROM THE NURSERY: Tracing the Roots of Violence, Atlantic Monthly Press, New York, N.Y. 1997
[4] Glasser, Howard & Easley, Jennifer, TRANSFORMING THE DIFFICULT CHILD: The Nurtured Heart Approach, Published by Howard Glasser, Tucson Arizona, 1999 (www.difficultchild.com)
[5] Schwartz, Jeffrey (with Beverly Beyette) BRAIN LOCK: Free Yourself from Obsessive-Compulsive Behavior, Regan Books, New York, N.Y., 1996