Improving Mental Health: Four Secrets in Plain Sight

CHAPTER 2 THE POWER OF ATTACHMENT

Being deeply loved by someone gives you strength, while loving someone deeply gives you courage.

Lao Tsu

The French film, L’Enfant Sauvage (The Wild Child, 1970), directed by François Truffaut, begins with a black and white screen that reads: “This story is authentic: it opens in 1798 in a French forest.” We see a naked boy, prepubescent, in a forest in the Aveyron, a very rural Département in La France Profound (deepest France). A woman harvesting wild mushrooms spots him, runs away in fear, and finds some men to hunt him down. They use dogs to track his scent. They find his hiding hole, smoke him out, and capture him. He is feral and thrashes wildly against his captors. When alone, he rocks himself with the self-soothing behavior seen in children with autism.

The primitive child is without language. He is soon brought to Paris to a residential school for the “deaf and dumb,” where he proves himself to be neither. But, he had lived a life without human attachment dating back to an uncertain time when he was very young. The consequences were painfully obvious. He was named Victor by the medical student who brought him into his home to raise and to attempt to civilize, with the help of a kindly housekeeper.

Three waves of psychological studies, from the 1920s to the 1960s, focused extensively on human attachments and the debilities that resulted from their absence. The first wave was led by Anna Freud (the youngest of Sigmund Freud’s six children) and Melanie Klein, an Austrian-British analyst; the second by René Spitz; and the third by John Bowlby and Harry Harlow.

Anna Freud worked with children. She (like Melanie Klein, another psychoanalyst) helped lift psychoanalysis out of its preoccupation with sex and aggression that her father, Sigmund, had promulgated. Anna emphasized the role of attachments to others (so-called objects, a term which worked then but is hardly an ideal term today to refer to human beings). World War II introduced Anna Freud to children deprived of their parents, and the need—when they were in foster care—to sustain close attachments to parental figures, even if they were not the biological parents. Melanie Klein is regarded as one of the founders of object relations theory, which holds that the early relationships in a child’s environment are incorporated into the development of the psyche and fashion the future of his or her relationships and character.

René Spitz was an Austrian by birth, who moved to Paris, where he studied and practiced psychoanalysis, and then immigrated to the United States in 1939. He observed infants in foundling homes (orphanages) and discovered that when emotionally deprived because of the lack of maternal attention, these children developed what he called anaclitic depression (when the child becomes apathetic, listless, withdrawn, and disinterested in eating); anaclitic alludes to how an infant is emotionally propped up by the mother and figuratively falls over, actually becomes depressed, should she disappear. He also noted that if the “lost object” (namely, the mother or caretaker) was restored to the child within 5 months, there was still a chance of recovery. However, prolonging the deprivation beyond that time resulted in a state he termed “hospitalism,” a deterioration in relationships and functioning that could be irrevocable.

The studies of John Bowlby, during World War II, of children who were thieves revealed that a good proportion had suffered early and prolonged separations from their mother or primary caregiver sometime during their first 5 years (Bowlby 1969). He too described the critical importance of a young child’s caretaking environment and how lives can go awry if attachments are disrupted. Bowlby also emphasized the adverse, multigenerational impact on childhood development that resulted from the loss of attachment.

Harry Harlow, an American psychologist, is renowned for his rhesus macaque monkey studies. He subjected infant primates to maternal deprivation. Separated from their biological mothers, they were placed in a nursery with surrogates made from wire and wood, either bare or covered with cloth. He was able to show that the young macaques chose the cloth mother over the wire mother, even when the latter was a source of food. Contact—comfort—from a caregiver was, thus, a primary need that could override the need for food. Moreover, the cloth mothers became a basis for the capacity to explore, to seek change; they were also what the infants ran back to when subjected to fearful stimuli. Without the surrogate, the monkeys succumbed to fear, huddling and sucking their thumbs. It was the cloth surrogates, the soft blankies if you will, which provided security and were soothing for the stressed macaques. In later experiments, Harlow demonstrated the consequences for monkeys isolated from caregivers for 6 months, namely, they became debilitated, and 12 months of isolation destroyed their social capacities. Notably, by demonstrating that there is a critical time for forming attachments, he showed that monkeys isolated for a comparable period of time in later life did not experience the same adverse effects. In other words, attachment and normal social development are achieved early and provide a foundation for life, when a child’s environment includes that opportunity (Suomi and Leroy 1982).

These brief sketches of these great investigators into human development cannot do justice to the breadth and value of their work or to their influence on many other gifted psychologically oriented practitioners and researchers. But even such a limited glance gives us a basis for appreciating the power of attachment, of human (object) relationships and how they serve as the soil in which the members of the human community are rooted. It is the power of attachment that fashions our personalities, underlies many of our motivations, and explains a host of our behaviors.

When my son was about 1 year old, he selected from among a heap of stuffed animals, blankets, and other cuddly items a rabbit hand puppet, gray with white markings and about a foot long, to be his constant companion. We called him rabbit-rabbit. He (the rabbit) was dragged about everywhere and of course slept bunched up against my son’s cheek.

While not every child has a cuddly companion (and some suck their thumbs instead or as well), it is more common than not. Child psychologists call these transitional objects, a term conceived by D. W. Winnicott, a British pediatrician and analyst whose work gained prominence and influence in the 1930s. Winnicott believed that the transitional object served a critical role for children up to 3 years of age when they begin to separate from their primary caregiver, their mother. Early attachment is so powerful he concluded that the child needs a way of tolerating separation from mother, a necessary developmental step in all our lives. The transitional object, the rabbit in my son’s case, enables a young child to be without his or her mother yet not panic at being alone. You can see how blankies (as well as stuffed animals and the like) came to be called security blankets and how some adults even adopt a similar such item (like a scarf or T-shirt) that continues to serve the same comforting function.

When my son was about 4, and still carrying the now very ragged rabbit, we accidentally left it in a taxi. Upon discovering its loss later that day (it was I who did—not my son), I was in a state. I called every taxi company and labored to find it. I was more upset than my son! We did not find it. I finally quieted down, and my son seemed to never look back.

Infancy.

© Kiselev Andrey Valerevich. Used under license from Shutterstock.com.

Attachment Theories and Styles

Theories about attachment posit that as individuals we vary in our early predispositions to the caretakers in our lives (like mothers or other primary parental figures). The child encounters his or her world of primary caregivers, some of whom can help to foster a sense of safety and security and some do the contrary because of emotional unpredictability, indifference, or actual physical harm or cruelty. Temperament and exposure, nature and nurture, shape the child’s inner emotional states and capacity to regulate them.

Children thus develop varied styles of attachment, which reflect what inner emotional security or lack of it they have established. The two principal styles of attachment are called secure and insecure, and they can be recognized as early as 1 year of age. The child’s attachment style will determine how he or she responds to the challenges of development, including the ability to be alone, the facility to act with some confidence in relationships and self-expression, and the capacity for intimacy with others. Early insecurity becomes ingrained and persists into adulthood if there are no experiences to alter it.

Secure attachments in adults are marked by a person’s capacity to put into perspective disappointments, frustrations, separations, and minor traumas. People with secure attachments are resilient to life’s slings and arrows. They have the ability to be emotionally close to others, to be intimate with others, and to permit themselves both to depend upon others and be responsibly dependable themselves.

Insecure attachments manifest in three principal forms, although more than one form can exist in any individual.

Individuals with dismissive/avoidant behavioral styles tend to distance themselves from others. They do not seem to place significant value on relationships, and they have a type of faux independence that can make them appear strong—at least on the surface. When reliable information about their early lives can be obtained, there is often evidence of parental neglect or rejection.

Individuals who are preoccupied and/or anxious are highly focused on their relationships and whether they can depend on them, as well as how others may see them (and thus treat them). They are unable to reflect on and learn from their past experiences with others; they tend to remain connected to and reliant on parents and others who served in caregiving roles in their lives. They can seem emotionally starved, desperate for connection, and given to acting in dependent, child-like ways.

Individuals who are disorganized have the greatest problems with adult relationships. Like Karen Anderson (described below), they can be dramatic and unstable in their relationships. Many with this form of insecure attachment suffered early trauma (abuse or neglect) or loss of parents, home, or safety (e.g., forced refugees). The insecurity leads to intense, abortive relationships, as illustrated in Karen’s story, and at times desperate, self-destructive efforts to maintain contact. Their problems often echo through generations, with the insecure child becoming a troubled mother to her child.

Karen Anderson was 20 when I was asked to consult with her. She was a patient on a psychiatric ward of a general hospital. She had cut her wrists after her boyfriend left her. Intellectually gifted and creative, she had a stormy adolescence with early alcohol and drug use, impulsive and risky behaviors (including going to sketchy clubs late at night, picking up strangers, and having unprotected sex), and angry outbursts when she felt she was not “getting enough” from her parents, friends, or in the transient relationships she had with young and older men.

Her moods were as varied as what has been said about Chicago: If you don’t like the weather, wait 5 minutes. Minor frustrations produced dramatic tears and tantrums when the need for immediate and continuous contact was not met by whomever she was attached to, often in a clingy way. When she met someone she was drawn to, Karen leapt into an emotional relationship, which was usually of quite brief duration because of her unbearable neediness (and because she could not tolerate actual intimacy or a mutually rewarding relationship; in fact, what she needed was to be cared for). This pattern of neediness and an inability to be satisfied traced back to when she was a little girl, her foster parents reported.

Drives and Higher Needs

In psychology, drive theory holds that humans, and other living creatures, are born with certain inherent needs. These include satisfying hunger, self-preservation, sex (procreation), attachment, exploration, and some say aggression. When a drive (sometimes synonymous with an instinct) is not satisfied, a person, or animal, enters a state of physical and psychological disequilibrium, which can be felt as distress and which presses for whatever action is needed to reduce the distress and return to a state of equilibrium (or put more positively, to a state of relief or even satisfaction).

Drives operate automatically and are more or less universal within a species (although there can be individual exceptions in a diverse world). There is no training needed to learn to express these drives, but significantly, any number of learning theorists and social psychologists assert that as we progress through the mammalian chain to primates, instincts can be modified by experience and training.

Abraham Maslow’s hierarchy of human needs exemplifies the developmental progression from foundational basic instincts or drives to higher-order human needs. When our most fundamental needs for food, shelter, and safety are realized, Maslow believed that humans can mature and fulfill higher-order needs such as love and belonging (attachment), self-esteem, and the capacity for self-actualization (to experience competence and worthiness). Whereas behaviorists, dating back to the early work of B. F. Skinner, may explain these higher-order needs in other ways, what matters is that as the primate and then human cerebral cortex evolved, our basic drives came under (to greater or lesser degrees) its control. Neurological case studies in which there is damage to the cortex, especially the frontal lobes, reveal how more basic, primitive drives without cortical control become unfettered and can render a person impulsive, aggressive, voracious, and sexually unconstrained.

The matrix for human development, even for learned behavior, is an interpersonal relationship. We learn, we grow, and we surpass our basic drives and self-absorbed behaviors in the milieu of and through human relations. Here is where attachment comes in and demonstrates its power.

Primacy of Attachment Over Drives

The instinct or drive for self-preservation is perhaps as early and fundamental a force as exists in human nature. Yet it is hardly absolute. Self-preservation can be subordinated to other needs, especially the need for attachment—attachments that can be seen in examples as varied as the mother-child bond, destructive relationships, and heroic acts.

All of us who have been witnesses to a birth and to the moments that ensue appreciate how that infant now has a protector who will sacrifice her life for the safety of her child. Of course, there are instances where this is not the case, where that bond does not form because of the limitations or psychopathology of the mother, but few rules don’t have some rare exception (or include deviance). Typically, however, a physiological and psychological event occurs whereby the mother’s attachment to her child supersedes her own self-interests, including her self-preservation. The rupture through death or unwanted separation of a mother’s attachment to a child thus evokes an almost inconsolable grief and heartbreaking agony.

Luisa Caper appeared for her third visit that year to an urban emergency department bleeding from facial wounds and a likely broken arm. She was 29 years old, the mother of a 1-year-old daughter (who was being cared for by her grandmother), and a waitress in a chain restaurant. For the past several years, on and off, she lived with Frank, the father of her child and an unemployed man in his late 30s who was a binge drinker. His drinking, however, had become more frequent, and when under the influence, he was an angry, aggressive drunk, especially to Ms. Caper. She never pressed charges against him and more so never insisted he get out of her home. At each emergency department visit, the nursing and medical staff always introduced her to social workers, who tried to help her protect herself through an order of protection or through temporary and safe housing designed particularly for battered women. But she repeatedly, if ashamedly, did not take them up on their offers.

In my work, I have met battered women, victims of domestic violence (beaten and traumatized children too, but that is another matter that will be touched on in Chapter 4, “Chronic Stress Is the Enemy”). Many cities and counties have developed special programs and services to assist these women in exiting the grip of perilous attachment to abusive men. At times, victims of violence (and they can be men and youth as well) respond with violence, and they become involved with the correctional system, which is of course no solution. The attachment of abused women to their abuser, however, many times overrides their safety and sometimes puts them at mortal risk. They can succeed in breaking free from the abusive relationship, but it usually takes time and developing the capacity to seek a different way of meeting their emotional needs.

Linda Mills’ remarkable work, including her book Violent Partners, offers many insights into who enters and cannot leave violent relationships (Mills 2008). She points to early lives with unstable caregivers and attachments, which also may account for the multigenerational nature of this problem. Additional problems in relationships, especially with other family and friends, leave these troubled people with no sense of group or community, which is essential to believing that there are other ways to live and people to turn to. She writes about shame in those who expose themselves to violence, which can leave a person with the feeling “I don’t deserve any better.” She refers to this phenomenon as “damage seeking damage.” There is even the paradoxical experience of enduring abuse as a means of demonstrating a form of connection and loyalty that serves the victim’s needs for pride and self-respect, not just attachment. Finally, certain cultures either explicitly or implicitly support subordination and abuse especially of women as socially acceptable; these cultures can create pariahs of those who try to escape the cycle of subjugation and violence.

An appreciation of each and all of the forces at work in violent attachments, ones that subordinate safety to maintain an attachment, leads to an awareness of the complexity of this problem and emphasizes how solutions must respond to the multiple forces at work to break such “fierce attachments.” At the very least, new and safe relationships and community are needed for a person to realize that respect and mutual gratification can be achieved by pursuing a path away from violence.

On June 21, 2000, President Bill Clinton awarded George Sakato the Medal of Honor, our nation’s highest award for valor.¹ Private Sakato served in World War II as an infantryman. In combat in the fall of 1944, his squad was besieged by German gunfire. Under heavy attack, Sakato killed five enemy combatants and captured four others. Despite his diminutive stature (he was 5 feet 4 inches tall), on his own he rushed a hilltop stronghold enabling his fellow soldiers to destroy the site. When his squad leader was killed in the ongoing battle, Sakato continued to place himself in mortal danger, killing another seven enemy soldiers and assisting in the capture of many others.

Heroes may not be common, yet they regularly appear, especially in war. They also valiantly appear in disasters and other emergencies. What characterizes them is their capacity to place the lives and the interests of others before their own need for preservation and safety. It is not glory that drives this type of heroism, though glory may be one of its rewards (although we often hear an authentic hero say he or she was “just doing my job”). The drive that explains the capacity to overcome mortal danger is the bond to others, an attachment to a “brother,” a fellow soldier, a team, a family, a community, and even a nation. While not everyone can overcome the instinctive need to flee, to survive, the examples we witness and read about and admire are testaments to the power of attachment.

Addictions and the Power of Attachment

Psychologist Bruce Alexander developed in the 1970s what came to be called the Rat Park experiment (Alexander et al. 1981). Previous studies of rats had demonstrated that when a rat was put in a cage alone with two water bottles—one filled with water and the other with heroin or cocaine—the rat would repetitively drink from the drug-laced bottle until it overdosed and died. Alexander wondered: Is this the result of the drug or the setting? He put rats in “rat parks,” where they were among others and free to roam and play, with access to the same two types of bottles. Remarkably, the rat park rodents preferred the plain water, and when they did imbibe from the drug-filled bottle they did so intermittently, not obsessively, and never overdosed. Attachment and social community beat the power of drugs.

Norman Zinberg, M.D., a former colleague at Cambridge Hospital in Massachusetts, was tasked during the Vietnam War with investigating the high rates of heroin (and other drug) use among soldiers deployed to the war. One in five soldiers on duty in Vietnam was regularly using heroin (Zinberg 1984). There was great concern within the U.S. Army not just about this drug use but also about what would happen when these soldiers returned home. Would they go into withdrawal? Would they continue to use and destroy their family relationships and their prospects for a future? Would they resort to criminal activities to fund a drug habit? Dr. Zinberg said no. Upon return, he predicted that this group of men would have no greater rates of drug addiction than the general (nonmilitary) population. He was right. Their families, communities, and other attachments prevailed, and they left their drug use in the jungle where the horrific circumstances of terror and deadly combat were the “cage” that fostered their use of drugs. They no longer needed to rely on drugs to tolerate the setting they were in, and they built a life free of drug abuse once again (Zinberg 1984).

Therapeutic Alliance

The therapeutic alliance is one of the most important, yet often overlooked, aspects of psychotherapy, counseling, and even general medical care. At the heart of the therapeutic alliance is the patient’s trust that the doctor or counselor has the patient’s interests in mind: that the patient’s needs truly come first, not those of the professional or institution providing care.

A clinician, physician, or other professional must earn the trust of a patient. For some patients, that trust can come early; it is based on their past experience of people who cared for them without exploiting them. Other patients have lived a life in which early and important caregivers were unstable or narcissistically self-absorbed, making development of trusting relationships either largely impossible or fraught with doubt. Still other patients have serious mental disorders in which paranoia colors their perceptions and makes trust highly elusive.

Some mental health professionals and doctors have what can seem like an innate capacity to foster trust in their patients. I am not talking about psychopaths who engender trust but do so falsely and manipulatively. I mean the kind of caregiver we all want—someone whom we experience as trustworthy, putting our interests above his or her own, above his or her convenience or profit or the rigid demands of the bureaucracy in which they work. A hallmark of these professionals is that their patients return for appointments. Moreover, the mental health clinicians and physicians (in all branches of medicine) who are experienced as trustworthy, as likeable, by their patients are far less likely to be sued, even if they were negligent in their provision of care. Medical liability cases are usually a blend of bad outcomes and the bad feelings generated when a doctor does not seem to care about the patient or behaves in cold and evasive ways.

When I was in psychiatric training, I learned that one of the best predictors of outcome in the psychotherapy that I would provide was whether a therapeutic alliance had been developed and maintained. Those patients who experienced a strong therapeutic relationship would tend to do better in “love and work” (the principal aims of therapy, a reference often attributed to Freud). I would need to be alert to those moments in my work with patients when the alliance was at risk, from events in the patient’s life or times when therapy was not helping. The work of understanding and repairing a rupture in the alliance could not only restore the emotional safety necessary for psychotherapy, but it could create moments of what has been called a corrective emotional experience. That’s when, in many a relationship, the challenges to trust are stirred up and an honest inquiry into what happened enables its restoration.

What is the source of the therapeutic alliance? At the risk of oversimplifying, it is the capacity for attachment, for developing a healthy bond with another person that is the foundation, the soil, for the trust needed for an alliance. From that soil can grow the ability of a person to put himself or herself in the hands of another person, to take the risks and to sustain the work needed for productive psychotherapy. I imagine it is not unlike when a child is ready for his or her parent to let go of the bicycle for the first time; the child trusts and dares to go free and be autonomous. Achieving a healthy, trusting attachment in mental health treatment, as well as in medical care, thus needs to be a goal in itself for the clinician/doctor–patient relationship. Part of the cure lies in and derives from the sustained capacity to trust the caregiver, when it is genuinely earned. That’s the power of the attachment, and that’s why the therapeutic alliance is a good predictor of clinical outcome.

Managing Our Emotions

My friend and colleague at Columbia, Dr. Deborah Cabaniss, a professor and author, writes about attachment in her book about psychotherapy (Cabaniss et al. 2013). She points out that the attachment styles mentioned earlier in this chapter are often passed on from parent to child. Our capacity for secure attachment may offer us resilience in the face of everyday slings and arrows as well as when we face even more disruptive traumas and losses.

All children and adults must develop the capacity to manage their emotions, including fear, insecurity, doubt, anxiety, excitement, and frustration. This capacity, often called affect regulation, is instrumental to functioning in relationships, in school, in work, and even in play. Those youths who begin with insecure attachments are often limited in their ability to regulate these feelings and thus to proceed with healthy emotional and interpersonal development. A faulty foundation may breed problems in living, which, in turn, reinforce insecurity and compound the frailties a person may have.

Signs of poor affect regulation, one of the potential consequences of insecure attachment, include labile moods, impulsivity, poor self-esteem, and identity problems. Empathy, the capacity to appreciate how others see themselves and the world, is also compromised and undermines the achievement of mutual, caring relationships.

The insecure attachment of the child can be seen and felt years later in the actions of the adult. For example, a parent whose early life was beset with inconsistency or abuse, who did not form critical strong bonds with caregivers may fear change and loss and be too restrictive with his or her children, stifling their quest for independence and autonomy and impairing his or her own family relationships.

We can expect that this patient will also live out his insecure attachment in psychotherapy, which will permit an opportunity for him to understand his reactions, create new narratives (about himself), and work to achieve more secure attachments with his family and others in his life. The therapeutic experience is in itself a microcosm, an interpersonal opportunity for insight and the creation of new, more secure attachments to the therapist and then to the important people who populate a person’s life. Those changes in attachment, step by step, enable more effective regulation of feelings, which, in turn, build an even stronger and more secure attachment style. A similar process, though one that will likely be more tumultuous and protracted, could occur in a successful treatment for Karen, the young woman described earlier in this chapter.

What Makes for a Good Life

In 1938, a research study began at Harvard College, enrolling 268 college sophomores and then a few years later 456 young men from Boston’s inner city living in underprivileged neighborhoods and circumstances. The Harvard Study of Adult Development continues today.

Some of the original research subjects, privileged Harvard undergraduate men, many of whom went on to become professionals and successful businessmen and one who became a president of the United States, were entered into an ongoing study of their lives. The young men from the inner city were added to create a comparison group. The aim of the study was to answer this question: How can we live a long and happy life?

Robert Waldinger, M.D., the study’s current director and a professor at Harvard Medical School (who succeeded George Vaillant, M.D.), continues to ask the study participants what makes them happier and healthier (Waldinger 2015). The answers are not money and fame. They are the ongoing presence of good relationships with spouses, family, and friends. It turns out that quality relationships, even those that have their conflicts but are characterized by a deep sense that the other person is there for them—that they can truly depend on the other person if and when needed—are protective. Those with quality relationships lived longer and even had better cognitive functioning (as measured by memory tests). Unwelcome isolation and loneliness as well as high-conflict relationships were toxic, at least to the men in this study. Loneliness kills, a finding replicated in a multitude of sociological studies. Loneliness, by the way is different from solitude, a chosen state of being alone, which can be for some a very rewarding lifestyle.

Women were also studied in the Harvard longitudinal study, which included them later. For women, it was learned that greater security in relationships predicted better memory and well-being (Waldinger et al. 2015).

The power of attachment keeps making its case. If we want to add life to our years rather than simply more years to our lives, we can succeed by attending to what makes us human, namely, our healthy connections with those we love and honor. The implication for our professional efforts, as well, for mental health and medical care is clear: to enable those who seek help (and sometimes those who do not) to live happier and healthier lives (see Fries 1980).

References

Alexander BK, Beyerstein BL, Hadaway PF, Coambs RB: Effect of early and later colony housing on oral ingestion of morphine in rats. Pharmacol Biochem Behav 58(4):571–576, 1981 7291261

Bowlby J: Attachment and Loss, 2nd Edition, Vol 1: Attachment. New York, Basic Books, 1969

Cabaniss DL, Cherry S, Douglas CJ, et al: Psychodynamic Formulation. Hoboken, NJ, Wiley-Blackwell, 2013

Fries JF: Aging, natural death, and the compression of morbidity. N Engl J Med 303(3):130–135, 1980 7383070

Mills LG: Violent Partners: A Breakthrough Plan for Ending the Cycle of Abuse. New York, Basic Books, 2008

Suomi JS, Leroy HA: In memoriam: Harry F. Harlow (1905–1981). Am J Primatol 2:319–342, 1982

Waldinger RJ: “The Good Life,” TEDx video, 15:03. Posted November 30, 2015. Available at: https://www.youtube.com/watch?v=q-7zAkwAOYg&feature=youtu.be

Waldinger RJ, Cohen S, Schulz MS, Crowell JA: Security of attachment to spouses in late life: concurrent and prospective links with cognitive and emotional wellbeing. Clin Psychol Sci 3(4):516–529 2015 26413428

Zinberg NE: Drug, Set, and Setting: The Basis for Controlled Intoxicant Use. New Haven, CT, Yale University Press, 1984

¹By the way, Private Sakato did receive a Distinguished Service Cross after his heroic actions. He was recommended for the Medal of Honor also, but he did not receive it because of his Japanese ancestry and the fact that we were at war with Japan. President Clinton made that right—awarding him his due honor at the White House, along with 21 other Asian Americans, 15 posthumously.