Adam Lukeman, LCSWCase of Jane May in the Context of John Bowlby’s Attachment Theory
by Adam Lukeman
Case of Jane May in the Context of John Bowlby’s Attachment Theory
This paper presents a case of an elderly woman, Jane May, who had her first psychotic break at the age of 79 years old not long after the death of her mother. Through the lens of John Bowlby attachment theory, as presented in his book A Secure Base: Parent-Child Attachment and Healthy Human Development, I will examine the nature of attachment Jane May had with her mother, and how this had played a part in her eventual psychotic episode.
“It will be remembered that attachment theory was formulated to explain certain patterns of behavior, characteristic not only of infants and children but also adolescents and adults (Bowlby 1988).” Opposed to providing a linear presentation of the patient’s life, or even discussing the patient’s initial attachment with her mother, I will focus primarily upon the patient as an adult, and her relationship with her mother at this time. Not discussing the patient’s relationship with her mother during early stages of development can seem like an oversight if not for the idea that, “…each pattern of attachment, once developed, tends to persist. One reason for this is the way the parent treats a child, whether for the better or for worse, tends to continue unchanged (Bowlby 1988).”
Bowlby states that “A secure home base remains indispensable nonetheless for optimal functioning and mental health (Bowlby 1988).” To provide examples of how the patient’s mother, during the patient’s late teen life, did not provide a secure base, the following happenings can be taken into consideration. The patient, in her late teens, had fallen in love with a man, Thomas. She had the desire to marry and pursue her life with him. They had a child together. However, the patient’s mother viewed this man as unfit to marry her daughter, for reasons beyond explanation to the patient. As a result, the patient’s mother “manipulated my relationship,” stated the patient. “She told Thomas that I no longer cared about him, while telling me lies about me to Thomas…It was very confusing. Also, my mother took my child, insisting that my child address her as mom. My mother then acted quickly to marry me to another man, a man whom I didn’t even like. I had no choice, I accepted this arranged marriage, and my relationship with the person I loved came to an end. Soon after I was forced to move away with my new husband, and had no choice but to leave my child to be raised by my mother.” Finally, the patient said, “I don’t know why I didn’t fight back against my mother then. I guess it was because I was raised to respect her, not to question her. She was very controlling, smart, and more than I could handle.”
Though the patient moved away for a period of time with her new husband, it was not long before she ran away from her husband, and ran back to her mother. The patient did not feel that her mother was always caring. In fact, she felt as though her mother had done her wrong and, despite this, still returned home. “I felt safe with my mother,” the patient said. “Despite how she treated me, I still loved her.”
The patient ended up living with her mother for the next 35 years. They worked in the same place, a nursing home. The patient’s mother was a nurse, and the patient, her mother’s assistant. The patient’s son grew up, knowing his grandmother to be his mother, and patient to be his aunt. The patient was never to marry, or even date, again. “The anxious resistant attachment in which the individual is uncertain whether his parent will be available or responsive or helpful when called upon. Because of this uncertainty he is always prone to separation anxiety, tends to be clinging, and is anxious about exploring the world. This pattern, in which conflict is evident, is promoted by a parent being available and helpful on some occasions but not on others, and by separations and, as clinical findings show, by threats of abandonment used as a means of control (Bowlby 1988).”
It can be theorized that the patient was terrified of living on her own, without the safety of her mother who, when the patient was a teenager, provided an insecure base from which the patient was to grow from. As long as the patient obeyed the mother’s rules, she received such support. The patient couldn’t questions her mother, who was “smart” and “controlling.” This suggests that deviation from the mother’s demands would lead to the loss of the mother’s support and perhaps love. This rather severe case certainly is worthy of considering, in addition, a disorganized form of attachment. Also, it seems clear that other dimensions of attachment and dynamics between the mother and patient need consideration. However, for the sake of this paper, the foundation of, at least, an anxious resistant attachment, seems evident in their relationship.
When the patient was 79 years old her mother died. Not have any other caregivers to turn to, the patient fell into a yearlong depression. It should be also mentioned that the patient, despite having a son, was rarely, if ever, in the caregiver role either. At 79 years old she was alone, without bearings to discover another form of “safe” attachment. Essentially, the patient presented as a child, completely lost and unable to care for herself. The depression eventually turned into a psychotic episode and eventually psychiatric inpatient hospitalization.
References
Bowlby, J. (1988). The Role of Attachment Theory in Personality Development. In A Secure Base: Parent-Child Attachment and Healthy Human Development (p. 119). London: Basic Books.