Transcription
Peter, in simple terms, I wonder, can you tell us what mentalization is?
Mentalizing is a form of imaginative mental activity. It's, uh, perceiving, interpreting human behavior in terms of intentional mental states, as they are called, thoughts, feelings, beliefs, wishes, desires, reasons, and so on. It's something that's, uh, uh, common sense would describe like seeing oneself from the outside and others from the inside, or how you understand misunderstanding, or having someone's mind in mind. It's at one level introspection, looking into yourself, seeing what it is that you're thinking, but also by that very process, really understanding how others are thinking or feeling.
Okay, so how does it differ then from terms like emotional intelligence or empathy?
Well, empathy, uh, is, uh, something that you might feel towards somebody else. Mentalizing is both about self and other. So mindfulness is usually a term that's used about mental states in relation to the self. Empathy about the other. Mentalizing sits in between the two, you may say. Emotional intelligence, which relates to, uh, feelings, by and large, or you see psychological mindedness, relates to cognition. Mentalizing sits in between the two. So if mentalizing is really at the fulcrum between empathy, mindfulness, emotional intelligence, and, uh, psychological mindedness.
Okay, so can anybody do it then? How do we learn to mentalize?
Well, uh, no animal, uh, not even the most intelligent non-human primate, can really discern the difference between a consp specific and other member of the species who does something by accident, by serendipity, versus doing it intentionally. So if I drop something, you'll immediately know without thinking about it whether I did that intentionally or on purpose, because you're mentalizing me, because you are anticipating what my reasons might be for doing something. So the capacity to mentalize, uh, is perhaps linked to what is essential about us as, as human beings. Once we try started using tools and developed a certain level of sophistication, we at the same time developed self-awareness. Perhaps we developed self-awareness in order to understand how other people were thinking or feeling, so we could collaborate with them. Um, but, but as, uh, primates can collaborate with one another, they, on the whole, do not do it by putting themselves into the shoe of the, uh, other animal. They don't have shoes, so, uh, it'd be hard for them to do so. But, uh, the most important aspect of this is that the social processes, the way we understand ourselves, is intrinsically linked of to us understanding others, and others understanding us. So the way mentalizing develops is probably through the experience of feeling understood by somebody else. There is an overlap between the neural locations where understanding oneself as a mental entity and where understanding others in psychological terms reside, and that's a little bit of a clue about how we acquire mentalizing. It seems that, uh, we find our mind initially in the minds of our parents, and later on in other attachment figures. So what we think of ourselves, in a sense, is born of what we were thought about, uh, in the minds of, uh, uh, the people that we cared about. We scrutinize the minds of others and we find, try to find ourselves within, and that's how we guess at our own feelings and, uh, our own thoughts.
Now, this happens, obviously, a very subtle process that occurs, uh, over a long period of time, but it does depend on the parent's capacity to mirror effectively the child's mental states. If a parent can mirror, uh, how the child feels, the child will be able to organize their own feelings according to what they see outside, and that sense of being organized is actually what we then experience ourselves as, uh, mental entities. If we do not have that experience, if we do not have someone around us who is, uh, able to, uh, think about us accurately, uh, as we are, we will have an enfeebled sense of ourselves. We'll never really be certain exactly who we are, or we'll just misperceive ourselves. If I'm, as a little baby, I feel anxious, uh, I do not understand what that feeling is, and I look to my mom to make sense of it, and my mom reflects, mirrors back to me a sense of anxiety, I will, that will help me organize, uh, what I feel. If she exaggerates that, and what she mirrors back to me is terror, then I will exaggerate my own, uh, experience of my constitutional self, my physiological reactions, and I will end up, uh, perhaps throughout my life, exaggerating feeling. I'd become one of those really anxious people who always, at the slightest sign, uh, slightest cue of, of will have a sense of panic or a sense of terror.
So, um, the same process of mirroring between two people occurs in a therapeutic relationship as well. What I'm looking for in therapy, but I've lost, really, if you like, lost calibration over my own sense of who I am or what I'm feeling, what I look for is a relationship. I look for someone who I can talk to about my own feelings, and if I can, if I can find a person like that, I will then, in their reactions to me, uh, find, uh, a sense of, uh, calibration, a sense of the degree to which I should be upset, uh, about, uh, uh, whatever it is that I'm upset about. And, uh, that interpersonal, uh, aspect of mentalizing really stays with us, uh, throughout life.
What difference does knowing about mentalizing make to the way we might try and work with children and families? We tap into this process. So if you, if I, um, uh, ask, uh, you, or if I ask anyone else, uh, uh, what do you do, uh, when you are upset about something? The most likely response that you'll give me is that I go and talk to a friend. Now, why the reason is because when you're upset, in a way, you've lost, uh, a sense of calibration over your internal experiences. You need to set up that interpersonal process with another human being, just like you did, uh, when you were a little baby, someone who actually mirrors back your feelings, in a way, gives you, uh, an idea about what it is, uh, that you are experiencing. And understanding that, understanding that what therapy, in part, is about is someone else who has your mind in mind, who you can go to to find yourself therein and acquire a better understanding, uh, for you. This opens up to us, all of us, a way of working as therapists. So at a very profound level, what we need to be able to do is to be available, to be there for our patients, to present our minds to them, as really, as, as a space for exploration, where we try and our best, our hardest, to sit side by side with them, to try to see the world through their eyes, to create an image of their minds, not really so that we can explain to them who they are, but for them to find themselves in the picture that we've constructed of them. The way we relate to them, if we really genuinely do understand them, is what they need in order to find themselves in our minds as mentalizing, thinking, feeling, believing, uh, people.
Can anybody mentalize? How do we sort of learn to do it? But initially, uh, we do not understand, uh, as little babies, we do not really understand, uh, our own feelings. Uh, we are, when we are anxious or aroused for some other reason, we are in a state, uh, of bodily arousal, a constitutional state, uh, of arousal. What we do is we signal, uh, that effect to our caregiver, who resonates with it, reflects on it, and then expresses it, uh, in a contingent display, uh, of understood effect. So they respond in the same appropriate tone, they respond in a timely way, they respond as if they understood it. But in responding, they create a, a representation of our internal state, and that representation becomes, as it were, a symbol for us, for ourselves in a constitutional, uh, state of arousal. And that second-order representation is what we call mentalizing. And that second-order representation serves for all of us as a way of knowing what it is that we feel. And that knowing what it is that we feel helps us regulate that feeling, so we don't have to act on it. We can know, ah, what I'm feeling is angry, or what I'm feeling is sad, or what I'm feeling is anxious. And that helps, uh, uh, regulate our feelings and, uh, ultimately, we build a sense of self, a sense of subjectivity out of these little building blocks.
So what would happen then if the caregiver or parent wasn't accurately reflecting back the emotion that the child was feeling?
That happens, uh, I think with all of us at certain times. But if the caregiver is consistently inaccurate, is consistently absent, like in a child who's experiencing emotional neglect, that child cannot develop the second-order representation of the, uh, internal world and will be much more likely to enact those experiences, uh, rather than be able to regulate it, uh, themselves. They will not have, uh, the second-order representations, the, uh, psychological self, if you like, that helps them think about feeling angry rather than just acting being angry.
Okay, so that's how it starts with babies, how they begin to learn. But how does it then develop?
Well, actually, mentalizing gets more and more sophisticated, uh, as we get older. So, uh, as I said, uh, from the very beginning, babies are more aware of what people think or feel, and what they, uh, are expressing, uh, in terms of mental states, than they are, uh, in their physical states from about three months on. But gradually, this gets more and more sophisticated. So, we learn, uh, to pretend and to lie and to cheat. By two and a half, a child can be completely self-serving and say, you asking, did you eat that biscuit? Said, no, I, it's nothing to do with me. And they are trying to manipulate your mental state, trying to make them, make, uh, you believe that, uh, uh, they actually had nothing to do with them. Now, that process gets ever more sophisticated as things go on. It takes a real hike forward in adolescence. Um, then mentalizing becomes much more sophisticated. It becomes so sophisticated that it becomes very confusing, initially for adolescents, and they get quite upset about suddenly starting to understand just how complicated people's minds are. And things that they thought was straightforward and and simple, they realize are incredibly complicated. So they get more upset about their parents' arguments, they get, uh, more upset about people loving or hating each other. Um, and it develops in adolescence, uh, right up to the age of 25. After 25, I think it just goes downhill. Um, but the sophistication, uh, of mentalizing, um, is, uh, something that probably follows the elaboration of connections to the frontal lobes of the brain, and, and these complex, uh, uh, more highly developed, uh, parts of the brain. As our mentalizing gets, uh, uh, more sophisticated, in some ways, problem psychological problems are associated with problems of mentalizing also become more prominent. So, um, things like, uh, depression, things like, uh, self-harm, that are associated with failures of mentalizing or difficulties in mentalizing, appear based probably on vulnerabilities that are, are either built in or much earlier, but appear when these more complicated mentalizing capacities suddenly get developed, uh, called upon in adolescence.
What difference does it make then knowing about mentalizing in the work that we might do with children and families?
The family, uh, is probably the place where mentalizing is normally developing, is because its evolution has intended mentalizing to develop. So families are the social situation where the child looks around and tries to find their thoughts and feelings in all the, uh, in their sister, in their mother's mind, in their sister, in their father's mind, in everyone's mind. The more mentalizing a family is, the more the family, actually as a unit, as a system, is concerned with how people think, feel, wish, believe, or desire. The healthier that is, uh, for that child. The more that family promotes that child's resilience and that child's well-being, and the child's capacity to withstand emotional, uh, turmoil and, and, and tension. If we work with families, what we need to do, perhaps more than anything else, is to get that family back onto a, a process of mentalizing here. Because what can happen in a family is that one, one person is acting up, is acting out, that upsets everybody else. As everybody else is feeling upset, um, they stop mentalizing. And because they've stopped mentalizing, they're not able to understand, uh, each other's difficulty in understanding each other. And so the whole family goes down this cycle, uh, of, uh, uh, not understanding one another, uh, leading to family arguments, shouting, screaming, you know, these things happen in families. So what we've got to do with families is just to stop that, stop that, uh, really very vicious cycle where one person's thoughtlessness leads to the whole family, uh, having no consideration for each other's, uh, thoughts or feelings. And as if we just stop that process, and we get the family to start thinking, uh, about, uh, one another, thinking about what made that storm, what made thinking about each other's storm. I think we actually can regenerate a very natural process that's there in most of our families, uh, or actually wanting to think about, uh, uh, and wanting to be concerned, uh, about each other.
Interestingly enough, sometimes the very intensity of a relationship can undermine the capacity to think about, uh, one another in terms of mental state. So when you're in love, there's not the best state to ask people to think whether the person that they're in love with is socially trustworthy or not, because they really are not able at that moment to think about them, uh, their thoughts or their feelings. Mentalizing goes down the tube with the, uh, intensification of arousal, as for example, arousal associated with being in love. But the intensity, particularly in conflictual family relationships, can also drive down mentalizing. So activating attachment, activating, uh, uh, attachment by, for example, threatening abandonment, will stop a person being able to think about, uh, someone's mental state. But so what you need to do, strangely, is rather than intensifying, uh, attachment, as one sometimes does in, in, in, uh, uh, family working with families, make people a little bit cooler towards each other. And what we have found, for example, is that during family, uh, therapy in groups of families, is often easier because although you preserve this natural habitat for mentalizing, but other families commenting on my family can maintain a little bit of a distance, whilst at the same time be able to empathize, be empathic about the nature of the relationship, uh, that I might have, uh, with my son that I'm having difficulty in understanding. But another father there can actually see the things that are going wrong, uh, between me and my son and be able to help me see things from my son's point of view, whereas I am completely unable to, uh, once he has started having, uh, one of his turns.