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Tratamentul prost al copiilor determin dificulti n formarea

reprezentrilor mentale ale acestora despre strile mentale ale altor


persoane (Fonagy et al., 2011), despre emoiile i tririle pe care le pot
tri i experimenta alte persoane. Copiii abuzai se angajeaz mai puin
n jocuri simbolice sau n interaciuni de joac (Alessandri, 1991);
eueaz n a manifesta rspunsuri empatice n situaiile manifestrii unor
emoii negative ale altor copii (Howes i Espinosa, 1985; Klimes-Dougan
i Kistner, 1990; Main i George, 1985); realizeaz mai puine referine la
stri interne (chiar mamele care i abuzeaz copii discut mult mai puin
frecvent despre emoiile proprii sau ale copiilor lor (Beeghly i Cicchetti,
1994; Shipman i Zeman, 1999)); manifest prezena nelegerii teoriei
minii mult mai trziu dect ali copii (Cicchetti et al., 2005). Precolarii
abuzai dau dovad de o slab nelegere a modului n care funcioneaz
mental i acioneaz adulii (During i McMahon, 1991) sau de nelegere
a expresiilor faciale ale emoiilor (Camras et al., 1983; Camras et al.,
1990) i demonstreaz limitri clare n relaiile i modul cum neleg i
proceseaz interaciunile sociale (Macfie et al., 2001; Macfie et al.,
1999). De asemenea, acetia manifest o ntrziere n reprezentarea
mental a strilor emoionale (Frodi i Smetana, 1984; Pears i Fisher,
2005; Rogosch, Cicchetti i Aber, 1995; Smith i Walden, 1999), i o
performan slab ce prezice competenele sociale pe care copii le vor
manifesta la vrsta de 8 ani (Rogosch et al., 1995). Abuzul i neglijarea n
copilrie a fost corelat cu diagnosticul de tulburare de tip borderline n
perioada adult (Holm i Severinsson, 2008), mai exact cu sentimentele
de respingere, abandon i izolare specifice acestei tulburri de
personalitate (Stiglmayr et al., 2008), implicnd un sentiment intens de
ruine (Levy et al., 2007; Rusch et al., 2007) putnd declana disocieri de
personalitate (Philipsen et al., 2004) i auto rnire (Coid, 1993).
O serie de funcii adaptative critice se formeaz nc din al doilea
an de via i in de dezvoltarea corespunztoare, prin intermediul
ataamentului dintre copil i persoana de ngrijire primar, a emisferei
drepte a creierului i toate aceste achiziii reprezint manifestri ale unei
snti mentale timpurii a individului. Aceste achiziii constau n
meninerea unei imagini coerente, continue i unificate despre sine; n
identificarea unei imagini corporale a propriei persoane i a relaiei
acesteia cu mediul, distingerea propriei persoane de alii, recunoaterea
indivizilor din aceeai specie i a altor organisme, obiecte sau locuri
familiare, reamintirea informaiei biografice, nelegerea emoional i
reacia la stimulii de mediu (Devinsky, 2000). Atunci cnd copiii se
confrunt, de exemplu, cu lipsa sensibilitii i responsivitii paternale,
aceasta conduce la dezorganizarea sinelui, caracterizat prin lipsa de
coeziune a acestuia, la ndoieli n legtur cu coerena intern i
continuitatea peste timp a propriei identiti, cu o stim de sine instabil
i supradependena de aprobarea celorlali (Bartholomew i Horowitz,
1991 i Park et al., 2004 n Mikulicer i Shaver 2012). Aa a fost
demonstrat c practic, reprezentrile despre sine reprezint o alt cale
mediatoare ntre stilul de ataament i patologie (trecnd prin nivelul de
distres provocat de acestea) fiind responsabile pentru nivelul patologiei

dezvoltate (Mikulicer et al., 2010). n plus, Shaver i Hazan (1993) citai


n Mikulicer et al., 2010) argumenteaz faptul c, figurile de ataament
indisponibile slbesc sentimentul de securitate al unei persoane i
contribuie la formarea unei viziuni negative despre ceilali.
Acestea nu sunt singurele domenii de funcionare dependente de
calitatea relaiei de ataament stabilit n primii ani de via, nivelul de
inteligen de pild, la rndul su depinde de nivelul de securitate din
perioada ataamentului timpuriu (Cicchetti, Rogosch i Toth, 2000;
Jacobsen et al., 1994; Jacobsen i Hofmann, 1997; Jacobsen et al., 1997;
van Ijzendoorn i van Vliet-Visser, 1988). n plus, alte studii au atras
atenia asupra impactului ataamentului timpuriu asupra sistemelor
atenionale (Belsky i Fearon, 2002; Fearon i Belsky, 2004; Jacobsen et
al., 1997).
Persoanele diagnosticate n adolescen cu tulburarea de
personalite de tip borderline percep mai frecvent pericolul de a fi respini
i mai ales situaia de abandon i neglijare comparativ cu media
populaiei. Acest dezavantaj se combin cu praguri reduse la care se
dezactiveaz capacitatea de a controla reprezentrile mentale, n special
de a distinge starea mental proprie de cea a celorlali, aceste dou
efecte conducnd mai departe la o mai dificil nelegere de ctre ceilali
i chiar ei nii, att a reprezentrilor despre lumile interne ct i a
raporturilor interpersonale, genernd drept consecin, o cascad de
dificulti n legtur cu reprezentarea mental a altor aspecte (Fonagy
et al. 2011). Aa se explic tendina acestora de a se implica n cercuri
vicioase interpersonale caracterizate printr-o evident dereglare afectiv.
Drept urmare, ntreruperile i dereglrile sistemului de ataament i
neclaritatea propriei identiti sunt puternic legate de aceste dereglri n
ataament i stau la baza patologiei borderline. Comportamentele pe
care le angajeaz acetia pentru a face fa consecinelor
disfuncionalitilor interpersonale (mecanismele de coping) ce produc
emoii negative i stres, impulsivitate, dereglri afective i sentimente de
durere interioar sunt la fel de disfuncionale, ei bazndu-se pe
mecanisme de autoreglare emoional precum auto-provocarea durerii,
abuzul de substan sau hipersexualitate (Fonagy et al., 2011).
n concluzie, n primul an de via comunicarea emoional
dintre mam i copil este ntiprit n dezvoltarea reelelor corticale
laterale ale creierului bebeluului, acestea fiind specializate n analiza
feelor familiale i orientarea privirii i n procesarea semnalelor
emoionale vizuale sau auditive. Dezvoltarea structural i funcional a
sectoarele corticale aflate n dezvoltare nainte de trei ani depind de un
mediu social care faciliteaz i stimuleaz creterea creierului
bebeluului i permite maturizarea unui sistem reglator responsabil
pentru autoreglarea unor compartimente cruciale ale vieii viitorului adult
(de supravieuire, emoional, social etc.) situat n cortexul orbitofrontal al
acestuia.
Responsabilitatea major pe care ntreruperea sau
disfuncionalitatea timpurie a relaiei de ataament mam-copil o poart
pentru reducerea plasticitii creierului acestuia i predispunerea la

dezvoltarea unei patologii psihologice i fiziologice a copilului este bine


documentat prin intermediul studiilor (Schore, 1994; Caldji et al., 1998;
Cirulli, Berry i Alleva, 2002; Graham, 1999; Schore, 1999, 2001). Strile
emoionale i biologice disruptive, negative ale copilului ce rmn n mod
repetat, nerezolvate de ctre mam sau relaiile sociale timpurii
generatoare de stres pentru copil, pun bazele unui ataament denumit
insecurizant, a deficitelor n sistemul autonom limbic drept (responsabil
pentru autoreglare emoional) i dezvoltarea unei predispoziii pentru
tulburri psihiatrice i psihosomatice ulterioare (Schore, 2005). Bowlby
consider chiar c deprivarea de ngrijire matern are urmtoarele
consecine: dezvoltare ntrziat, agresivitate, anxietate dependent
(comportamentul de agarea copilului de mam), ntrziere n
dezvoltarea intelectual, inadaptare, psihopatologie emoional, depresie
i delicven (Speltz et al., 1990; Champagne et al., 2001). Tipul de
ataament prezentat de ctre mam, ca rezultat al proprilor sale
experiene de via n relaiile de ataament, reprezint un alt aspect
problematic ce poate impacta prin natura raporturilor imprimate n
relaia cu propriul copil, dezvoltarea cortical a bebeluului, dou dintre
cele trei stiluri de ataament identificate n rndurile adulilor
reprezentnd mai degrab o premis negativ n startul unei bune
interaciuni propice dezvoltrii optime. Veste bun este aceea c odat
cunoscute aceste particulariti ale stilului de ataament pot fi suplinite
sau corectate cel puin n raport cu bebeluul aflat n perioada cea mai
critic de dezvoltare a sa.
Simona Mlescu, Psiholog clinician i psihoterapeut autonom
www.clujpsihoterapie.ro, Tel. 0745366754
Str. Clinicilor Nr. 50, Et. 1, Cluj Napoca
Skype:cabinetsimonamalaescu
(Credit for the image: Ovtscharoff i Braun, 2001 n Schore, 2010)
[1] Pentru un rezumat al studiilor care demonstreaz acest lucru vezi
Schore, 2000, 2005.
[2] Teoria minii (Theory of mind) Formarea conceptului despre
mintea unei alte persoane i funcionarea independent a acesteia fa
de cea proprie. Abilitatea de a-i reprezenta mental faptul c ceea ce
vede, experieniaz, crede i tie el nu coincide cu ceea ce vede crede
sau deine ca informaie o alt persoan, faptul c modul n care percepe
el realitatea nu este identic pentru toate persoanele.
[3] Un sistem bio-psihosocial, activat de copil n scopul obinerii i
pstrrii siguranei n condiiile n care nu se simte n siguran sau ntrun mediu familiar sau n condiiile n care exist vre-un pericol de
ndeprtare a figurii principale de ataament (cel mai adesea mama),
sistem necesar i care faciliteaz iniial supravieuirea i apoi dezvoltarea
cognitiv i emoional corespunztoare a copiilor n primii ani de via.
Bowlby (1982:179) i-a definit ataamentul printe-copil drept
comportamentul social instinctiv biologic activat n mod special la
ndeprtarea mamei (sau orice alt eveniment amenintor la dresa
relaiei cu persoana de care este ataat) i constituie rezultatul unei serii
de sisteme ce au ca rezultat apropierea mamei (stimulii care linitesc cel

mai rapid sistemul de ataament sunt reprezentai de ctre sunetul,


vederea sau atingerea de ctre mam).
[4] Stilul de ataament caracteristic unei persoane adulte reprezint un
tipar utilizat sistematic, de reprezenti i ateptri din partea unei relaii
i a celuilalt implicat, emoii i comportamente aferente acestui tipar,
care rezult din internalizarea/nsuirea unei anume istorii de experiene
de ataament pe care individul le-a trit din copilrie i pn n viaa
adult. (Fraley i Shaver, 2000). Un alt argument pentru care am decis ca
sistemul de ataament va face obiectul altui articol l costituie tocmai
faptul c nu doar ntre mam i copil se pot stabili diferite relaii de
ataament care i vor pune amprenta asupra copiilor lor, ci mamele, ca
orice individ, la rndul lor sunt caracterizate de un stil anume de
ataament i reacioneaz diferit n funcie de acesta la manifestrile
bebeluului fapt ce complic foarte mult discuia despre importana
ataamentului n primii ani de via.
[5] Reprezentri despre cum funcioneaz sau actioneaz ceva/cineva
care aproximeaz realitatea atunci cnd nu e cunoscut suficient.
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*** Young Minds. The voice for young people`s mental health and
wellbeing acces in december 2014.