“Life doesn’t make any sense without interdependence. We need each other, and the sooner we learn that, the better for us all.” — Erik Erikson
“No road is long with good company.” — Turkish Proverb
Research repeatedly finds that the quality of early life relationships correlates with later social, emotional, economic and physical health outcomes. Over 50 years of research into the notion of ‘attachment relationships’ directly links reliable, consistent, empathic and safe family relationships with optimum health outcomes (Allen, Moore, Kuperminc et al, 1998; Mikulincer and Shaver, 2019; Puig, Englund, Simpson et al, 2013; Sroufe and Siegel, 2011) . Consistent with this is also the finding that higher measures of social isolation correlate with greater illness, mortality and poorer mental health (Leigh-Hunt, Bagguley, Bash et al, 2017). Safe, respectful communication builds and nurtures the heart of connected relationships. Central concepts related to this include the notion of validation (See related fact sheet and a more recent psychosomatic concept of ‘interoception’ (See related fact sheet on Relationships, communication and connection: validating the valid)Neuroception and the Body/Mind System.)
There have been many criticisms of the notion of family recently as rigid views regarding gender and sexuality have been challenged to better honour the natural diversity that is present in our communities. The Family Project team value this diversity and are all too aware that sometimes people don’t feel they belong at all. For the purposes of understanding the importance of relationships, in this fact sheet family is defined as those you live and love with the most. This may be your biological relatives, or your closest friends; it may mean your animals or next door neighbours. Family are the people you rely on; those you are interdependent with.
The quality and importance of real relationships emerged as a central area of interest in mental health from the 1930s onwards. Harry Stack Sullivan, an American psychiatrist, focussed on the need for validation and recognition to enhance self-esteem and reduce anxiety and defensiveness (Cortina, 2020). In the 1950s onwards psychiatrist John Bowlby, considered the father of attachment theory, worked with troubled adolescents in post WW2 London. He also engaged with children who had been separated from their families to keep them safe from the London bombings. He realised that the troubled teens often emerged from families with hostile, absent or neglectful environments, and the children who were separated from their families paradoxically struggled with anxiety even though they were physically safer. With further elaborations he proposed a new theory of human behaviour called attachment theory. He argued that infants, children and adults all require an experience of being understood, enjoyed and valued, and that as humans we seek proximity to the security that comes from reliable, consistent emotional support. If this is available we internalise a sense of being ‘good enough’. If it is absent the growing mind can harbour doubts and have difficulties trusting others and their own worth. This then limits confidence in exploring the environment or ‘leaving the nest’ (Bowlby, 1988).
A recent study involving over 20 000 adolescents moving through to adulthood in the US confirms this core idea. The study recruited adolescents in the 1990s and followed them at four further time points, the latest being in 2016/17. They measured family cohesion by asking the adolescents if they felt that they were understood by their family, had fun with them, and that their family paid attention to them. These questions match closely core features of a secure attachment relationship. Those who scored more positively on these questions had lower rates of depression in adulthood (Chen and Mullan Harris, 2019).
The research is very clear – we all need consistent, reliable emotional connections to feel valued and secure and this is linked with better social, physical and emotional outcomes. Communicating with others is essential to maintaining understanding and sharing experiences – this can be difficult in times of distress or when there is disagreement. An associated fact sheet looking at the concept of validation can offer some further information on how this could be managed – see Relationships, communication and connection: validating the valid)
- Allen, Moore, Kuperminc et al. “Attachment and Adolescent Psychosocial Functioning.” In Child Development, 1998, October, Volume 69, Number 5, Pages 1406-1419
- Bowlby, John. A Secure Base Routledge Press, London, UK, 1988
- Chen and Mullan Harris. “Association of Positive Family Relationships With Mental Health Trajectories From Adolescence to Midlife.” In JAMA Pediatrics, 2019, Volume 173, Number 12, published online October 7, 2019.
- Cortina, Mauricio. “Harry Stack Sullivan and Interpersonal Theory: A Flawed Genius.” In Psychiatry 2020, January, Volume 83, number 1, pp. 103-109
- Mikulincer and Shaver. “Attachment orientations and emotion regulation.” In Current Opinion in Psychology 2019, Volume 25, pp 6–10
- Leigh-Hunt, Bagguley, Bash et al. “An overview of systematic reviews on the public health consequences of social isolation and loneliness.” In Public health, 2017, November, Volume 152, pp.157-171
- Puig, Englund, Simpson et al. “Predicting Adult Physical Illness from Infant Attachment: A Prospective Longitudinal Study.” In Health Psychology, 2013, April, Volume 32, Number 4, pp . 409–417.
- Sroufe and Siegel. “The Verdict Is In: The case for attachment theory.” In Psychotherapy Networker, March/April 2011, Volume 35, Number 2.
Author: Dr Alice Dwyer BA (Hons) MBBS (Hons) MPsych FRANZCP