It was as if the boy did not know how to play. When he played shop games with other children, it was ‘the functioning of the till that interested him, not the game around it. [He] lacks imagination and empathy.’ Although his language was ‘well developed’, the SSBU concluded that ‘he has difficulties expressing himself emotionally […] and is almost entirely lacking in spontaneity or elements of joy or pleasure’. An inability to express emotions is known by psychologists as alexithymia.
How could it be that this little boy, who otherwise had ‘well-developed language’, was not able to put words to his feelings? Was it because he was unable to articulate himself, or was it because he had nothing to articulate?
In child psychiatry, there has been an increasing focus on the concept of attachment.12 In short, attachment theory is a theory of psychological development which claims that children undergo a critical phase of development in the period from when they are about six months old until they are about three. During this period, the brain develops quickly and the foundations are laid for how the child, and later the adult, will relate to other people. A child's relationships with its parents or other central care-givers are decisive factors in this developmental stage. When a parent comforts an anxious child, this gives the child security, but if the child seeks out its mother (or father) in order to be comforted, and experiences rejection, neglect or punishment, this creates insecurity.
If in this critical phase children consistently receive inadequate responses to their needs, the probability dramatically increases that they will be given a serious psychiatric diagnosis later in life. This phenomenon is known as a lack of maternal care (even though the primary care-giver does not necessarily have to be the mother – it could be the father or other adults). Play observation was one of the tests that indicated that Anders lacked basic security and had poor attachment; he was ‘contact-adverse’, as the psychologist wrote. He lacked a strategy for relating to his mother or other adults, and would wander around. In psychiatry, this is called a disorganized attachment pattern, a relatively typical form of behaviour when ‘the harbour of security is, at the same time, the source of fear’.13 There was nothing wrong with the boy's intelligence; he was not mentally impaired. His problem lay elsewhere, and was reminiscent of what would later be found in studies of Romanian orphans.
Anders was not given any diagnosis by the SSBU, but he was described as a ‘divergent’ child, and the picture the team painted of the little boy brings to mind partly what is today described as reactive attachment disorder (RAD), a relatively rare and serious diagnosis.14 There is little research into how children with attachment disorders develop over their childhood and adolescence and on into adulthood. The little that has been done suggests that, although most have problems (it appears that there is a tendency towards narcissism and lack of empathy), there is considerable variation in the effects of poor attachment.
One of the interesting aspects of attachment theory, according to the psychoanalyst Peter Fonagy, is that it can explain transgenerational effects – in other words, why parents’ (especially mothers’) attachment patterns are inherited.15 Fonagy also links empathy to attachment. He claims that attachment is a decisive factor in the development of a self-image and an ability to think about internal mental states, both those of others and one's own.16 Fonagy calls this ability ‘mentalizing’. As soon as a child understands that its mother is a separate individual from itself, it tries to anticipate or understand what its mother thinks and feels. The child mentalizes. This is the first step in the development of empathy, but, if a child does not feel that it is safe to imagine what its mother is thinking or feeling, this development will stall. A poor mentalizing ability can lead to misunderstanding social situations, a lack of empathy, and perhaps seeing oneself as empty or as a zombie.
The observation team from the SSBU described Anders as ‘mildly pedantic’ and ‘extremely neat’, thereby hinting at a nervous boy with signs of compulsive behaviour. But, although he was a ‘slightly anxious, passive child’, they still thought that he could function ‘relatively normally’ together with other children and with adults. The SSBU concluded that ‘Anders has contact abilities’, which ruled out extensive developmental disorders such as classic autism. Their concerns about him were due mainly to his home conditions – in other words, his relationship with his mother. Since Anders grew up without his father, his mother was his only carer.
Even though the focus of this old case was on Anders, it also painted a picture of an unsettled and possibly unbalanced woman. When the little boy's mother described him as ‘aggressive’ and ‘clingy’ – which he may have been, although this was not observed by others – perhaps she was also painting a kind of self-portrait. This self-portrait was confirmed by the SSBU, which described how she confused the boy by alternately pushing him away and pulling him towards her. The mother was ‘uncritical’, unable to see herself in the situation: everything was other people's fault. She was not able to set predictable boundaries and limits for her little boy. There was often a lot of noise at home, as if from partying, while at other times the young children were left home alone. Either one thing or its polar opposite. Black and white. Rage and remorse. For a child, unstable and unpredictable behaviour from their closest care-giver can be just as emotionally destructive as living with an aggressive or violent parent.
Psychiatrists call this emotional abuse, and research suggests that the long-term effects of such a ‘deficit of care’ can be just as serious as physical abuse. In later life, these children are at much greater risk of mental illnesses and suicide. Even when child welfare and child psychiatrists perform major interventions, the results are relatively poor. Children who have experienced poor attachment in the first years of their life will by the age of eight normally be restless and unpopular, with poor social skills. In adolescence, they will frequently become ‘aggressive towards friends, also when they eventually fall in love, and they will often be rejected. They will nonetheless describe themselves as much more popular than they are, and there is much to suggest that they have particular problems understanding social interactions and reading other people's feelings.’17 The consequences of poor attachment are not always easy to spot. Intelligent people may periodically be able to hide their problems, either partially or completely. Disciplined people unable to read social interactions can still train themselves in social skills. Sooner or later, however, the consequences are brought to light.
The SSBU thought that Anders was subject to a deficit of care from his mother. They recommended the most drastic measure at the disposal of child welfare: taking him into care. Taking children away from their parents into care is something that happens in Norway only in exceptional circumstances. It can be traumatic for parents and children alike, and is recommended only in emergencies. In 2006, there were 7,292 children living in foster homes and 1,386 in child welfare institutions,18 which equates to approximately 0.5 per cent of children in the country. Many of them, however, were moved out of their homes without having to resort to compulsory care orders or intervention by child welfare. In 1983, it is likely that the figures were considerably lower.