This is an excerpt from a book I´m currently writing on the subject of AD - please read and comment.
To communicate with author: npr@erhvervspsykologerne.dk
Homepage: www.sitecenter.dk/www.npr-attachment.dk
The present homepage is a temporary one, until then e-mail me. I have written other articles about practical problems and theoretical issues, such as AD adoption problems and how to cope, how to make the classroom work with AD children, etc. Ask for subjects not mentioned here.
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INTRODUCTION




ATTACHMENT DISORDER: A WORLDWIDE PROBLEM


This article presents a general view of emotionally severely disturbed children. It is a guide trying to answer some common questions put to me by people working with Attachment Disordered children and (psychopathic) Antisocial personality Disorder juveniles.

- Why are there an increasing number of AD children?

- What are the causes of an AD development in children?

- How does it show in behaviour and personality?

- How do you practice treatment or therapy at different stages in childhood
development?

- What can you do to prevent AD development, or to minimize the
symptoms?

- How do you develop and maintain your therapeutic attitude and the structure
of treatment?

- What happens to people, groups and organizations working with these chil
dren?

Welcome!

Meet the Antisocial Personality (Duke) - and a therapist (Anne). He explains to her how his childhood made him a psychopath, and what that really is. He even describes low birth weight as a component of his emotional deficit:

"I, that am curtail’d of this fair proportion,
cheated of feature by dissembling nature,
Deform’d, unfinished, sent before my time
Into this breathing world scarce half made up,
And that so lamely and unfashionable
That dogs bark at me as I halt by them;
Why, I, in this weak piping time of peace,
Have no delight to pass away the time,
Unless to spy my shadow in the sun,
And descant on mine own deformity:
And therefore, since I cannot prove a lover,
To entertain these fair well-spoken days,
I am determined to prove a villain,
And hate the idle pleasures of these days.
Plots have I laid, inductions dangerous..."
*
Anne: "Villain, thou knowest no law of God nor man: no beast so fierce
but knows some touch of pity".
Duke of Gloucester: "But I know none, and therefore am no beast".
Anne: "O wonderful, when devils tell the truth!"

From: W. Shakespeare: Richard III.


CHILDHOOD ATTACHMENT: A WORLDWIDE CHALLENGE

We spent 2.000.000 years in refining the mother/ child relationship – and 15 in years breaking it down.
From World War II and onwards, accelerating about 1960 - 75, we started the greatest social experiment ever undertaken in the western world - mothers of preschool children and babies went to work, separating from their babies. This not only changed our whole culture: religious beliefs, family patterns, traditions, eating habits, number of children in a family, family income, but it also broke up the mother and child relationship into a whole new way of being raised. The conditions for learning how to become human through childhood were turned upside down. Today, we are probably the only species of mammals, where mother and baby do not stay together, inseparable, for at least the first three years after birth.

In my country, it only took fifteen years (1960-75) to sweep 80% of all women out of their homes in the daytime and into factories and offices. The great stabilizers of society - the working class culture and the country life culture - disappeared almost overnight. As a cultural pivot the family was split up into members-meeting-between-other-activities. As a first result, the number of children being born at home, and not in a hospital or a clinic, fell from 85% in 1955 to less than 1% in 1975. The first physical contact for the baby was no longer a decision of autonomous parental judgment, but a staff decision, with the parents as spectators, sometimes from behind a glass wall. To say the least, staff decisions were not always wise, and today many adults suffer from the consequences of early separation. And so do their mothers. You may not know this, but early separation not only produces disturbed infants, but also disturbed parents. Mothers, who are physically separated from their newborns, even for very short whiles, often experience lasting intense, irrational feelings of guilt, tend to feel detached and alienated towards the baby, and feel incompetent and insecure trying to interpret the baby's signals and needs and deciding how to act towards the baby. This of course will often provoke a reciprocal loop of misunderstanding and unfulfilled needs between mother and baby. Not to mention how a father, excluded from the birth experience, should feel any devotion to a baby arriving from hospital long after birth, and without the possibility of contributing to his child’s start in life, except with flowers for Mom.

The next result of the changes in working patterns, and delayed some 5 years (parallel to women leaving home for work) were the exploding number of divorces, producing a new role in Danish families: the unprotected and overworked single mother. In many ways, this became a disruption of a lot of families rather than an exciting lifestyle renewal and adequate re-orientation.
And finally (if you are still with me), the grandparents disappeared from the vicinity or the home, taking with them all their irritating traditional knowledge of how to cope with 8 children, incessant births, child disease and good cooking, leaving behind their bewildered offspring to become parents as best they could. Consultants, baby magazines and other substitutes replaced them. There are no longer dominant-mother-in-law jokes - she dropped the apron and went to Florida with her plastic surgeon.

Summing up this sudden change: Today's average parents are relatively old, they were separated from their own mother at birth, they never had to be responsible for baby sisters and brothers, they met a lot of new people early on in life, they didn't see their parents or grandparents much, and when they hold their firstborn in their arms, they don't know a thing about what to do - except being extremely ambitious on their own and on the child's behalf!
The neurotic personality (emotionally sane, but caught in the age 3-5 conflict between self-realization and a strict superego) also disappeared with the dissolving family structure, and was replaced by the intelligent, spoiled, emotionally confused child, without a few solid role models, prone to following it's own mind and unaffected by authorities. Later to become ludomanic, narcissistic, compulsively running for 2 hours a day, or just plain exhausted by exaggerated ambition and illusions of eternal youth.
Child psychology theory has been hesitant in adjusting to this change. In fact, our treatment philosophy, methods (such as play therapy and talking therapies) and general ideas about what children need, is still mostly directed towards neurosis problems, that have become quite rare in daily practice.
And sadly so, these methods in my experience are often downright anti-therapeutic when addressing severe Attachment Disorder (hence: AD) problems.

Today, 90% of all Danish children age 1-3 spend most of their waking hours in day care or in a kindergarten. These figures are, more or less, applicable to all industrialized countries. In 1948 Denmark, children’s income constituted 25% of the average family income. Now children have become an expense, a problem and also a luxury - that's why we have so few, and so late in life. Today, the infant must, from an early age, face a more or less predictable number of adults and other children, who often are interchanged kaleidoscopically during the day. Science tells us, that a newborn, with any luck, can attach to 4-5 persons before the age of 3, and still turn out as a normal, healthy adult.

How many children did we loose in the revolution of pre-school attachment conditions? Still using Denmark as an example, we have a system where every new mother has several free visits from a district health nurse from birth until the child is aged 3. These nurses state, that in general 80% of all infants are feeling psychologically safe and thrive well - they cope with the many early contacts, because of a stable relation to relatively harmonious parents. So, for society in general, we haven't reached the panic level - yet. But - and that is serious enough - 15% have minor signs of deprivation, such as slight malnutrition, and signs of feeling too insecure to spend their time learning, in something they could perceive as a safe environment. They have experienced too many divorces, institutions, and shifting persons to attach to, to make life a happy experience. In spite of rocketeering school expenses, all paid by the state, 1/3 of all children who are leaving school describe themselves as losers in the system, and have a generally low self-esteem. In the last ten years, special school classes for children with socio-emotional problems have increased 300 %, according to the state office of statistics.

5% of all Danish infants show clear signs of massive early deprivation, seriously lack contact ability, suffer from sequelae of violence, sexual abuse, malnutrition, etc. These children practically always grow up suffering from an array of severe personality disorders or psychosis. Adding to this group are some groups new to Danish society: adopted children (some of whom come with severe AD), and the very premature children, who earlier died but now survive birth (some of these have bonding problems because of neurological problems and separation from the mother due to frequent hospitalisations).

(In the U.S., the Child Welfare League estimates (1998), that 3.000.000 children were formally registered as having been molested or severely deprived. This figure is supposed to cover a much larger un-recorded number of children).

We might have absorbed and adjusted to the change in patterns of raising pre-school children, had it not happened so fast. Disrupted bonding is probably not resulting only from the nature of such changes (children in some old cultures are successfully raised in groups), but from the very speed of change, preventing the gradual adaptation to new life conditions.

Let me exemplify this by describing the experiences of the English anthropologist Turnbull: He lived with the Ik-tribe in the highlands of Uganda and found a people, who stole from each other, who ignored the needs of the elderly and the children, who apparently considered cheating and deceit to be an art form. He only found one single girl, who made any attempt to attach, but the parents incarcerated her, considering this behaviour to be highly abnormal. Eventually she died, and the parents threw the carcass out to the animals. In general, children from the age of 3 grew up in gangs without role models, and from the age of 2 were stealing food in order to survive. Well, you might say, this is somewhere far away, but Turnbull wanted to know, why this culture had so many psychopathic members. He studied their history and found that 40 years earlier, this had been a much larger, kind and social jungle tribe.
Overnight, they had been deprived of their hunting grounds by the government and had been moved to the unfamiliar highlands. With no time to adjust, the culture as a whole had deteriorated.

In Greenland, the eskimo tribes had for thousands of years adjusted to a life in small hunting communities along the coast. They had rich traditions for infant care and upbringing. Among these were, that in spring the whole tribe made a three-day picnic in the mountains, where those born in winter would learn how to walk, and all walking attempts were celebrated by the members of the tribe. Around 1960, the Danish Government, by "persuasion," moved almost all natives into newly built towns. 15 years later, the next generation suffered an enormous percentage of maladjusted, alcoholised, psychotic and identity-bereaved youngster, shooting in the streets - as they still do. Today, some of the young generation struggle to create a useful culture.

The breakdown of Communism and of society in general in Russia, Rumania and other countries, have produced a host of abandoned children, surviving in street gangs, and of adopted children who are frustrating countless adoptive parents, who had expected that love would heal any wound, and who as a consequence have been hurt themselves. I remember a lunch break at my work in 1988, where one of the staff members uttered:
"Let's build a new wing for Rumanian children from adoptive families" - sadly, his doomsday vision was largely correct.

At the other end of the change/ tradition scale, we find societies that have abandoned development in favour of stability and a tight social network, such as the Amish of North America, who with a stable lifestyle have very few overtly psychopathic or otherwise seriously personality disturbed members. Even those psychopaths, who according to the laws of genetics should be there, are encapsulated by the overlying traditions and strong social codes of everyday life.

These examples from different cultures illustrate the idea, that any very fast change in society can overrule the adaptation capacity of many families and individuals, and destroy the bonding process for many young families. In some cases this will result - in the next generation - in some easily recognizable physical symptoms and personality disturbances. The gap between those who adapt, thanks to stable parents, and those who do not, is widening.

Also, I haven’t mentioned the greatest threats of all to early attachment: poverty and famine.
These two powers have a discrete negative effect on personality development via the effects on the growing nervous system of the unborn and the babies.
Let alone the more visible result of many abandoned children.


WHAT HAPPENS WHEN THEY GROW UP?

Statistics show, that some 15 to 20 years after the abovementioned change in the mother's place of work - that is, when the babies exposed to early random contact with persons other than the mother grew up - the following youth problems accelerated intensely:

- Self-infliction of wounds, withdrawal, aggressive or stereotype, meaningless behaviour.

- Addiction Problems.

- Altered activity levels (hyper-and hypo activity).

- Eating Disorders (anorexia nervosa, bulimia).

- Personality Disorders (Attachment Disorders, Borderline).

- Severe Identity Problems, feelings of meaninglessness and lack of lust for living.

- Depressive states and suicide attempts.

- Autoimmune diseases (such as certain forms of rash, arthritis and asthma).


(You may wonder, why some autoimmune diseases are added to this list. As we shall consider in depth later, missing the mother early in life can produce not only psychological disturbances, but also disturbed basic body rhythms such as heart rate, respiration rate, digestion pattern, sleep, activity level, brain cell connections, attention patterns and immune system function, as well as hormonal and transmitter substance imbalances)

The problems of temporary unstable personality function have always been part of the jvenile crisis - but now, more youngsters cross that line and reach a regular state of dysfunction and are in need of treatment.
Exactly the above-mentioned youth disorders have one striking feature in common - they resemble the reactions of babies separated for too long from their mothers! Could it be, that those who have had discrete symptoms of bereavement as infants, repeat these symptoms more intensely in the juvenile crisis? And, that this crisis, instead of leading to a transformation into adulthood, leads to a domino-effect imbalance and subsequent regression? I think so.

IT'S NOT ONLY YOUR PROBLEM - IT'S OURS.

The increasing number of children with psychopathic behaviour patterns are, in my opinion, only the tip of the iceberg, and I would like the troubled reader in custody of such a child to remember, that you are not entirely alone and totally responsible, you are also facing a small facet of a general problem in society, that should not remain hidden and private. I say this, because my supervision practice has shown me, that people working with these children (especially adoptive parents with no background knowledge of AD) tend to torment themselves with blame, exhausting illusions about miracles, and feelings of anger, hopelessness and incompetence. In other words: they fall prey to the same emotional dynamics as the child in their care, and therefore are sometimes of little help to it.

It is extremely important for an efficient treatment, that you see the general aspects of attachment problems and limit your efforts to goals that are possible to achieve, and not detrimental to your own health. If not, you will burn out and have to let go of the stable, long-term, calm and down-to-earth environment that is so important for the optimal function of these children. The child would then experience a new rejection and separation.

WHAT CAN THIS BOOK GIVE YOU?

The most negative outcome of AD development is the adult diagnosis of Psychopathy (or: Antisocial Personality Disorder). I have deliberately labelled this book The Psychopathic Child, because the term Psychopathy is the most common in describing a set of social and emotional deficits: lack of conscience, remorse, “charming” and seductive behaviour, superficial and short relationships, impulsive and often aggressive behaviours, etc. etc. I am aware that this term is incorrect when describing children, and I hope you will understand my choice of the most common term.

In this book a lot of effort has been put into making psychopathic behaviour
patterns in childhood comprehensible and de-mystified. This is because you cannot solve a problem, unless you profoundly understand the nature of it - and psychopaths have a tendency to distort our sense of proportion. A lot of everyday examples are used to illustrate symptoms, theory and practice.
If I have succeeded, the contents of this book should not be difficult to understand, whereas working with the psychopathic child in practice is a constant challenge to your convictions and responsibility.

OUR CONCEPTS OF CHILDREN AND CHILDHOOD

In therapy with the psychopathic child, the greatest hurdle is the therapist. The psychopathic child will immediately agree to this point, and the therapist will experience it. Our usual methods fail to succeed, and this introduction is to stress, that success is born out of failure.
Be patient with yourself when frustrated (from latin, frustrare: to fool, cheat, disappoint, etc.). And be ready to re-organize your emotional, cognitive and ideological attitudes.

When speaking of psychopathy, we usually visualize either a highly intelligent, shrewd and deceitful person on Wall Street - or a bragging, muscle-wired bully who feels inclined to beat you up if you ask him for a match. Someone, who in one way or another is not exactly comforting company.
What we do not, is to associate these visions with something as "innocent" as childhood. Our general ideas about childhood contain an unconscious personal experience of love and care. Adult psychopaths, however, started their lives somewhere, and neither love nor care are common ingredients of that start. Sometimes nobody gives it; sometimes the child is not able to incorporate the gift, due to inborn defects. The mother-and-child myth is an interwoven part of our religious, moral and emotional structure. As therapists, we often fail to understand the negation of this structure: how can you understand a child, whose mother-and-child recollections contain e.g. being burned with cigarettes or regularly being beaten up by a hostile adult, or living for the first year in an incubator, or being totally ignored? And if you could imagine this, how would you react to intimate contact later in life?

Especially when working with children, we tend to perceive our job as providing the love and care to a child, that it was deprived of earlier.
But from a very early stage (in my experience, from the age 1-3), this intention may sometimes prove to be a hopeless venture. When dealing with children, most social workers and therapists are also motivated by a little megalomaniac, who believes that everyone can become sane, loving and trustworthy through the magic touch of a persistent therapeutic wand. If nothing else, many an ulcer stems from such deeply rooted notions, produced by our own positive experiences before the age of 3. "If love is not enough, we must give more" seems to be the underlying idea. But perhaps love is not the first issue to be dealt with in treating an AD child?

What are the elements that constitute the ability to love and experience affection? Let us make a philosophical experiment:
Imagine a newborn baby having difficulties in organizing sensory input (sounds, sights, smells, touches, balance changes, etc.). If the sensory development is reduced, the child will be hindered in creating concepts to grasp the underlying meaning of all sane contact: the message, that somebody loves you and wants to care for you. Many children, who later become psychopathic, suffer from sensory defects or sensory organization deficits in early childhood. Imagine also, that this baby experiences a mother, who may love or not love her child, but she is unable to touch the child frequently in proper ways and to give it regular physical care and contact. If she does, she is not able to read the baby's signals and will over-stimulate or deprive it. Often she leaves looking after the baby to random persons such as neighbours or others, whom the baby does not know. Imagine the father as a) absent, b) violent or in other ways dangerous to the child or c) constantly being replaced by new "fathers".

Will this child be able to feel attached to anyone, or to form meaningful relationships later in life? And how will this child perceive the approaching therapist or adoptive parent: “Don’t sneak up on me!”.

It is, in other terms, the hypothesis of this book, that being able to love and to feel attached to others depend very much on what physical (and thereby emotional) contact you have had (and have been able to experience) early in life. The psychopathic child has had so little contact or has been unable to experience contact to a degree, that it is unable to form lasting mutual relationships later in life. This is probably why normal psychotherapy (which is always based on the mutual emotional relation between client and therapist) fails with these clients.

The beginner, who valiantly sets out to prove that he or she can ”break through” to the emotions of the child, inevitably wastes much good time. The price of the defeat is hopefully a little more patience (including our humble self), a more professional attitude - and the surprising insight, that not everybody feels, acts and loves as we do ourselves. Therapy with AD children is seldom a question of kissing the frog and seeing it turn into a valiant prince. It is a question of recognizing the fact, that early deprivation can slow down or sometimes stop psychological and social development in a child. However, a child arrested in early phases of development may progress more or less, according to the therapeutic environment provided. Transformation is the result of developing that which is already there, and transformation is not produced by an illusive effort to shape reality according to our own scale and expectation.

In working with children, it is usually evident, that they grow by their own patterns in spite of our effort to change or predestine them. Working with psychopathic children it becomes painfully clear, that they only grow when the therapist is able to recognize their basic nature and to help this nature to grow slowly out of immaturity. Anyone who expects a psychopathic child to be grateful or to confirm the professional ego by rapidly changing will become a victim of the client, and the client once again will be victimized by his or her own limitations.

"Therapy" comes from Greek (theraps) meaning "servant", and the professional therapist provides an environment serving the development of the child. As put by the philosopher Kierkegaard, you cannot help anyone, unless you make an effort to understand how the other person sees the world. A psychopathic child may very well see you as a naive enemy who is easily fooled by the simplest lie, who works hard instead of letting others work, who is limited by fear, conscience, love and other inferior sentiments disturbing immediate satisfaction. He or she might not even perceive you as a person, but rather as a thing like a toy or a tool, and just for fun take you apart or make funny experiments with your precious emotions: A 12-year old boy comes into the staff room and says: "I've just killed Thomas!” We rush out to save the remnants of Thomas - however, Thomas is happily painting a fence. We go back, and the boy calmly says: "I didn't do anything - I just wanted to see how you reacted…"

The most common initial reaction to such encounters is disgust, rage, suspicion and mindless action on behalf of the therapist. In short, a temporary psychopathic behaviour pattern, aroused by the feeling of being threatened to the core. This feeling stems partly from reality (if you persistently annoy the psychopath with therapeutic demands for emotional response, he might fulfil your wish by doing away with you in a fit of rage). The other, more diffuse threat comes from the insight that, provoked by the client, you contain such depths of inhumanity, and that your very identity may be challenged in the course of the process.

Why make the therapeutic effort at all? When discussing treatment at a conference, a Texan psychiatrist ironically uttered to me: "Well, you Europeans talk a lot about psychopaths - we don’t treat ‘em - we shoot ‘em!” This solution will probably make us victims of our own psychopathic tendencies, rather than the masters of a humane society. And eliminating the symptoms will not necessarily eliminate the causes.

In return for lost illusions of therapeutic omnipotence and the resulting hopelessness, we may, through experience, get the feeling of living closer to reality, and thus be able to pose more interesting and fruitful questions. Such as: how to take responsibility for another person (and thereby for yourself), how to build a environment that makes the psychopathic child function in a reasonably calm and stable way, and how to help a handicapped person - through recognizing the nature of the handicap instead of trying to erase it. Unknowingly, the psychopathic child holds a key to understanding the development of emotion and social skill in the normal child, and we learn what actions towards children are truly social - when detecting the events that threw a child off from the normal evolvement of attachment.

MY OWN EXPERIENCE

For many years, I have spent most of my time in a foster home with psychopathic children, and this of course has altered my view several times. For example when a child climbed the icy roof of a 3-floor building during winter and threatened to jump in desperation. In a burst of tears he cried, that his life was useless, he missed his mother, the staff was cold, and that he wanted to die. After some hesitation, I gallantly climbed out to save him - only to discover halfway, that he had arranged this scene to entertain himself and 20 little companions on the ground. Beforehand, he had even made a bet with the other children as to whether he could lure me up on the roof or not! Afterwards, the little bookmaker unaffectedly collected his money from the others, while I sat in my office wondering about the nature of psychopathy, and how to help staff members obsessed with paranoid control aspects.

Or, walking with a six-year old little girl with curly blonde hair and blue eyes, who enthusiastically informs me, that: "I can make the new teacher change colours!” I ask her to do so. We sit down with the teacher, and the girl points to me and says: "That ugly man put his hand down in my panties just now! – can he really do that?" - the new teacher turns pink/ red, consuming this interesting piece of information. The girl smiles happily, then looks sternly at her and says: "I know what you did yesterday to Tommy - I could tell the grown-ups all about it!" The now quite pale woman had forgotten to pick up a child at the bus stop and had been too embarrassed to tell the other staff members. Thus the girl went on, and after a while she turned to me and triumphantly announced with innocent enthusiasm: "You see - I can make her change colours any time!” I told the girl to stop playing with the woman and go play with her bike instead, while I put the woman together again (with little luck). This girl is aged six, and still cannot tell a person from a thing. To her, a staff member is an advanced slot machine. A week later, the girl hands me a dead pet rabbit, which she has just sliced into four pieces, and says unaffectedly: " It doesn't work any more, and it bleeds all the time - can't you put it together again?” So much for happy childhood.

On the scientific side: in my studies of these children were the detrimental effects of combined neurological deficits inflicted during pregnancy and birth, and parents unable to give the newborn normal contact from birth to age 2-3 years.

REALISM: THIS IS A HANDICAP LIKE ANY OTHER

What remains from these years is the impression of children truly handicapped - suffering from profound social and emotional immaturity. Imagine yourself without the faculty of inhibition. Any feeling, whim or tendency would then be amplified in an endless loop to the point of chaos. Perhaps you have the thought, that New York is a nice place, and in no time you find yourself in a bus to New York (if your attention was not attracted by something else on the way to the bus station). Or an innocent remark from someone annoys you, and your mood accelerates rapidly into a fit of rage. Or, the teacher has a monotonous voice, and after 2 minutes you simply fall asleep.

A psychopathic child is handicapped in the sense that it has little or no ability to inhibit or modify a sensation or an impulse, once the impulse has started. It cannot contain or stabilize emotional energy for long. The consequence of this defect is, that a sense of time, space, proportions and target direction only exist at a very low level, and certainly not at the level expected by society. Facing the dichotomy between ability and demand, the child usually copes by constructing a skilful defensive surface of imitated behaviour patterns, designed to bridge the gap. In some cases, this defence is not just a part of personality; it is the total personality per se. The child learns to imitate any role, behaviour pattern and emotion without any internal experience of the same. It is obsessed with controlling the perceived hostile world, as was the Duke of Gloucester (who by the way ended his career as a king and a serial killer, not unlike many present rulers).

ABOUT TERMINOLOGY

We are interested in children, who do not gradually develop the capacity of love and mutual affection, and therefore have no conscience or ability to devote themselves to anyone or anything for very long. They have had many labels in the past 300 years. In this text, I use the term "Psychopathic Children", because the meaning and scope of this book thereby becomes instantly comprehensible to almost anyone. "The child with severe early attachment disturbances" is much more correct, but is also harder to grasp. Child psychiatry has become a discipline of its own, and the term "Psychopathic child" dates from the time, when adult diagnoses were just transferred to children, assuming no differences between the two. In the fifties, the term would be "Character neurosis", stemming from a Freudian perspective. In Denmark, the term "The early frustrated child" has been in use for about 20 years. AD is a very precise term, but to make things easy, the term "Psychopathic Child" will be used in this text to describe children with clear psychopathic tendencies.

There is one very important reason as to why I insist of using the term "psychopathic". "AD" implies some kind (however negative) of a disappointed or otherwise distorted idea in the child about attachment. The truly psychopathic child has no such concept. Let me give you an example: the abovementioned (previous page) little girl. She had normal parents, but a very difficult birth, and on top of that she was born with a skin disease, preventing her from absorbing oxygen. She was placed in an incubator, where she stayed for 12 months. This was in the 70'es, and the staff did not know how important human contact is to the newborn. As a consequence, she received almost no contact during her stay. The old versions of incubators were just humming to the outside ear, but inside the noise level in some models - including hers - reached a 110 DB. You can experience the equivalent of 110 DB by standing beneath a Jumbo Jet warming up. Does this girl regard people as anything different at all from things around her? Does she hate or love anyone (nothing in her behaviour indicates that)? Does she have sentimental feelings, when she hears a ventilator? Perhaps. This example of total deprivation is not as exotic as you may think, considering for example some of the Rumanian foster home children I have seen in a similar environment. After leaving the incubator, she was stimulated intensely by her foster parents, and had this not happened, she would probably have appeared psychotic rather than psychopathic - at least she had an intellectual structuring capacity at the age of 6.

In modern psychiatry, the adult psychopathic person is sometimes denoted as suffering from "antisocial personality disorder", but I prefer the old term. "Social" stems from "socius", meaning "ally". Being antisocial means deliberately destroying your allies and their network - and in my opinion, psychopaths are in a deeper sense not emotionally deliberate- not “anti” – anything, just ignorant as to what a relation is.
"Psychopathy" comes from the Greek, "psyche" for soul, and "pathia" for disease, a disease of the soul. This disease is best described as an emotional blindness, caused by certain early events to be mentioned later in this text. Redl (1952) named his book "Children who hate" - but this is true only of those who have experienced love long enough to feel deprived of it, as is sometimes the case. Those isolated from contact at even earlier stages display emotional differentiation of neither love, nor hate. These terms make no sense to them later in life. They are as innocent as Adam and Eve, and their only frightening concern about the world is how to consume, control or manipulate it as fast as possible.

From the viewpoint of society, psychopathic children do behave in an antisocial manner. From the viewpoint of a clinical psychologist, such as I, their personality never develops to a point, where they can separate what is social or what is not, they are pre-social rather than consciously anti-social. "A-social personality" (absence of social understanding) would be a more correct term for these children.
They do not understand the complexity of even the smallest group, and in controlling their own energy they are as helpless as a baby on a motorbike (hence the cover illustration). It takes some level of maturity to be aware of (and thereby part of) oneself in a social system. When possessing normal intelligence and an immature personality, the solution for contact is often a pseudo-social surface: the client can take on any social role or behaviour at random.

There are many good reasons to acquaint oneself with the nature of psychopathy. One reason is that they tell us about society's diseases in general; another, that our studies provide an infinite source of understanding the conditions and limitations for developing healthy attachment throughout life.

NB: In the text, the word "mother" is used often, but this is really an abbreviation. In many normal families, the father, grandparents or other stable persons such as foster parents successfully provide a safe emotional attachment framework for the baby. "Mother" in this text refers to a function, not necessarily biological kinship. It is "the main person responsible for the first two years of upbringing, to whom the child can become attached, often in combination with secondary role models". It is generally believed, that a baby can attach successfully to a combination of 4-5 stable persons, e.g. mother, father, day-care, a sister and a brother or any other group constellation providing "mothering" behaviour.

CONTENTS

If you have an acute need of knowing what to do about a specific child, you can download a text from the list, but I strongly recommend that you download the entire book. In the long run, a deeper understanding will give you endurance, versatility and independence in your work.

The first articles are concerned with THEORY, CAUSES and SYMPTOMS: What is the basic theory you need to know in order to understand the AD child? What can disrupt contact between the child and the environment? What is contact, not only in the psychological sense of the word, but also in the physical stages from embryo to birth? The text follows the chronology of child development.
Data from genetics, embryology, neurology and psychology are considered in describing causes and symptoms.

The next articles describe TREATMENT at different stages of development. In early phases (e.g. during pregnancy) treatment may be to keep the mother from drinking, at later stages treatment may be helping the child to build and stabilize sensory functions, and yet later to master the social environment. A child will transform its internal organization many times during pregnancy and childhood, and for each internal state, treatment also transforms. Methods appropriate at one age can be useless or devastating at another.

The final set of articles suggests GUIDELINES FOR ORGANIZING THE THERAPEUTIC MILIEU. The psychopathic child is utterly dependent on perception of the immediate field, so you must organize the environment meticulously. Emotional, physical and social frames are discussed to inspire your planning of the therapeutic setting. Practical solutions for frequent issues are provided: overcoming individual crises in the therapist or adoptive parent, group defence mechanisms in foster families/staff groups and means for their resolution, how to organize the classroom practically and emotionally, suggestions for communities where antisocial child and juvenile behaviour is a general problem.