Transcription
Lives of the Unconscious: A Podcast on Psychoanalysis and Psychotherapy
Episode Six: Mentalization or "I am what I think you think I am"
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For most of us, it seems perfectly natural to live in a world in which we have our own thoughts and feelings, which cannot be simply read just like that. By the same token, other people, in turn, have their own thoughts and feelings, about which we can communicate or make assumptions. Whereby, in the final analysis, the thoughts of others will always remain a hidden place, and yet a place that makes our own behavior, as well as that of others, comprehensible and predictable.
The ability to interpret ourselves and others on the basis of inner psychic states, thoughts, and feelings, is what is meant by mentalization. We can illustrate this with a very simple example. Imagine Anna, an excellent baker, has baked a delicious cake, which once it is ready, she puts on the balcony to cool off. However, because she has forgotten the candles for the cake, she leaves the house once more to buy some. In the meantime, Tom, a professed cake lover, comes home and discovers Anna's delicious cake on the balcony. He takes the cake inside, tastes a piece, and then, instead of putting it back on the balcony, puts it into the fridge. Then he goes to his room to lie down a bit. An hour later, Anna comes home and wants to put the candles on the cake. Now, what do you think? Where will Anna go? To the balcony, or perhaps to the fridge?
Of course, the answer is: Anna goes to the balcony. For if we, as listeners or observers, know where the cake really is, we also know that Anna couldn't know this. We can put ourselves in Anna's shoes and see the situation from her perspective. But if we were to ask children around the age of three or four the very same question, we would hear a rather surprising answer. Most children would say: Anna looks in the fridge. They still find it difficult to distinguish between what they themselves think and know, and what others think and know. They have yet to learn that what they think and feel is not necessarily the same as that which others think and feel.
The example is based on the renowned false belief experiment in developmental psychology, which originated in the so-called theory of mind field of research. But it also shows an essential aspect of what is meant by mentalization. Whereas the theory of mind is primarily concerned with the development of cognitive abilities, mentalization refers to a broad spectrum of thinking processes that are physical, emotional, and especially interpersonal. The older children become, the more successful they are at adequately attributing certain mental states to the social world and to the behavior of other people, but also at understanding themselves on the basis of psychological states, as in, for example, "My heart beats fast because I am in love," "It's because I am sad that I can't really get going today," etc.
Now, what is astonishing is that it is by no means self-evident that we can acquire these skills. That they do not simply correspond with some automatic program that takes place in brain development. The capacity to mentalize is based on very specific social experiences, namely on our early childhood attachment, about which we have heard in episode five. Mentalization is a concept that was first described by the research group led by the contemporary psychoanalysts Mary Target and Peter Fonagy.
But why is the capacity to mentalize, that is, to interpret the world and ourselves on the basis of psychological states, connected to experiences with attachment in early childhood? And what, in that process, does it depend upon? An essential instance of parental attachment involves their ability to understand the external behavior of one's child in connection with its mental processes and inner states. The thought: "My child is crying, so I have to do something to stop it from crying, such as put a pacifier in its mouth or distracting it with a video," describes a less mentalized interaction. On the other hand, the thought: "My child is screaming, it sounds angry. Why is that? Oh well, maybe because its diaper is wet and it doesn't feel comfortable in it." This thought is an example of a mentalizing interaction. The child's behavior, the crying, is meant to be explained on the basis of certain psychological processes, being angry. The adult speculates on the cause and tries to empathize with what the child is feeling. He may be uncomfortable. However, the adult also acknowledges that one cannot be completely sure of this. After all, they cannot read the child's thoughts.
That last point is essential. For part of mentalizing involves the ability to pick up on a person's needs independently of one's own needs. This is all the more important with small children, as they do not yet have a stable concept of their own thoughts and feelings. They are still very dependent on that which their parents attribute to them. They must still learn, first and foremost, how to understand what they feel at a particular moment, how to reflect upon those feelings, and how to integrate them. Differentiated self-attributions, such as "I have a bellyache" or "I am sad," I relate acquisition in psychological development, and sometimes this does not happen at all.
Anyone who has observed newborn children can see that they seem to know very little about themselves. Not even that their little arms belong to them and that, with a little practice, they can intentionally control them. This also appears to be the case with their emotional states. When infants feel pain or are afraid, they initially experience these feelings quite diffusely and undifferentiated, and this general discomfort leads to correspondingly strong expressions of distress. The infant cries. At this point, it is important that a caregiver is sensitive to and grasps the child's affects, mirroring his or her feelings in an appropriate manner. As a general rule, this happens quite intuitively, say along the lines of: When a mother or father understands that their child is crying because they feel something specific, the parents then tell him or her, for example, "Oh, you're scared of the loud dog," or "Someone must be very hungry." As the parents treat their child as an independent, feeling, and thinking being, it learns little by little that this unpleasant, initially diffuse, felt condition has a specific meaning, namely hunger, which, after all, feels very different from fear, and still yet different from grief.
The fact that children acquire self-attributions by way of attributions by third parties, i.e., in most cases, at first by way of their parents, becomes touchingly evident in that children often first address their needs and thoughts only in the third person: "Paul is sad." Whereas the self-attribution in the first-person perspective, "I am sad," already signals the full acquisition and internalization of a concept of emotional states, in this case, sadness.
In order, however, for parents to adequately recognize and respond to their child's inner state, they must not only summon the necessary attention but must also have the notion of a mental other, separate from them. They must thus have the ability to mentalize themselves. They must, in a way, be capable of the three steps: "I think that you think that I think," and not, for instance, "I think, thus you must think the same."
A limited ability to mentalize could, by way of example, consist of one parent who does not sufficiently understand themselves as separate from the child. Whenever the child is angry or sad, for example, the mother becomes literally affected by her child, almost as if the affects were contagious, so that she too becomes correspondingly angry or sad, indeed, perhaps even angrier, even sadder than the child originally was. Say, for instance, because she unconsciously links the child's anger and sadness to unbearable feelings of inadequacy. Here, two important emotional learning experiences are withheld from the child. To begin with, that there can be differences in the experience of affects, such as "What I feel, another may feel differently." And secondly, that affects can be regulated, meaning they can also be processed, as in "My bad feelings can be calmed down by someone else instead." The affects remain in the child undifferentiated and unattenuated. They may even be intensified. If such parent-child interactions constitute the rule rather than the exception, this can have critical consequences for dealing with one's own thoughts and feelings, as well as for psychological resilience later in life.
As in the following example: Hannah goes for a walk through the city. Her friend Paul walks past her but does not greet her. Why didn't Paul greet her? If Hannah has a well-developed ability to mentalize, she might think to herself: "Oh, I have done something stupid. Does he not like me anymore? But maybe he just didn't see me or was lost in thought." If the ability to mentalize is not very well developed, one's own inner emotional state, such as a strong fear of judgment or a bad self-image, is often short-circuited by the interpretation of the social situation. "Paul doesn't greet me because he doesn't like me, probably because I've gained 10 pounds and I embarrass him." This belief can then hardly be corrected.
The inseparability of psychic states, i.e., that which I think and that which I believe others think, is, by the way, also the gateway to the mechanism of projection. This means that one's own inner states have been ascribed to others, especially those that had to be cast off because of their unpleasant qualities. Out of "I am full of hate and furious anger" becomes "Paul hates me and probably wants to do something bad to me." This is often characteristic of so-called borderline personality disorder or narcissism.
It is therefore important that the primary caregivers, such as the mother or the father, attribute to their child its own thoughts and feelings, and also mark and mirror this in their interactions. In this way, the child can learn: "What I feel is not identical with what others feel." It is thereby important, however, that the child feels understood, that its states of mind have been mirrored congruently. A successful exchange consists, among other things, of two components: the marking and mirroring of affect, and the mixture of affect.
Affects are marked and mirrored, for example, when a mother allows herself to be thoroughly moved by her child's crying. When her heart grows heavy, perhaps she becomes choked up a bit, her voice sounds glum. When she speaks, she articulates for the child what arises in her as well, namely: "You are so sad because Teddy is gone." The mother labels the whole situation for her child as a sad one, while at the same time, she knows and senses other things as well. And this is where the affect mixture comes into play. She can empathetically maintain a cool head, as it were, because it is not she who has lost her beloved Teddy. She assumes that the feeling may only be limited because the lost teddy bear must be lying around here somewhere in the apartment. The grazed knee is not so deep and will soon stop burning, etc. Hence, she may intuitively mix hope into her voice, comfort, maybe even some joy, anticipating that her child will feel better right away.
On the other side, the child feels, for one, understood by the mother through the congruent mirroring of affect. But what is also conveyed to the child through the varying mixture of affects is the possibility of gaining distance from the affect, enough distance, for example, in order to think about it, understand it, and not to lose oneself in an endless loop of grief. So, it is initially the parents who impart to their child what it means when it experiences a certain effectual state. Out of the parents' external reflection: "Why are you so restless today? You're probably sad," develops an internal reflection, in other words, a self-reflection: "Why am I so restless today? I'm sad."
If a child does not learn to understand its own mental states, it will, in turn, have difficulty understanding other people, which can then often lead to problems and difficulties in relationships. Studies have shown that a secure attachment between parents and their children goes hand in hand with a good ability to mentalize. This is not entirely surprising. Those who understand others as persons with their own thoughts, feelings, and needs will most likely try to connect or engage with exactly these other feelings, wishes, and thoughts. Will try to understand the other person's point of view, knowing there must be a reason behind their actions. Those who cannot understand the behavior of other people in relation to inner psychological processes, or who do so only with difficulty, can, in fact, only behave more or less passively within a situation that appears to them to be unfolding mechanically.
Many mental illnesses are connected with a more or less fragile ability to mentalize. Indeed, we just heard about borderline or narcissism, but often this even plays an important role with psychosomatic illnesses. As an example, a patient with a binge eating disorder might not be able to adequately differentiate mentally the bodily sensation that triggers grief from that which triggers hunger. In both cases, the person feels empty, and this emptiness is then literally stuffed full, filling themselves up with food in order to feel better.
But ultimately, everyone's ability to mentalize temporarily fails from time to time. Ordinarily, we are quite successful at clearly distinguishing between, say, what we may fear inside and what others might think of us. Take, for example, when we give a lecture or a presentation. We know that so long as we remain relatively calm inside, although we may admittedly fear the audience won't take us seriously, at the very same time, we also know that others will not perceive it as so dramatic if we get muddled or misspeak. Although, if we become particularly stressed, say because of a strong fear of being judged, then this ability to mentalize will in part break down on us. We are then firmly convinced of making a complete fool of ourselves, only talking nonsense while the audience laughs because they are embarrassed. That which we fear in our own thoughts is short-circuited by that which others supposedly really think of us.
The research group headed by Peter Fonagy, Mary Target, and Anthony Bateman has developed their own therapy concept, the so-called mentalization-based therapy, which has been proven in studies to have very good success rates, in particular with those disorders that are difficult to treat, such as borderline personality disorders. There exists a great deal of research, and we have attached to this episode references to the literature.
However, after speaking about mentalization in this episode in such complementary terms, we must nevertheless draw attention to a questionable feature with which the ability to mentalize likewise equips us. For through advanced mentalization, we also acquire an ability for advanced lying. Lying, unlike say mere denial, as in "No, I didn't do that," includes the ability to project oneself into another's thoughts, to anticipate the situation from their perspective, and to intentionally deceive them at exactly this point. For example, by saying to Anna: "Go look for your cake again. It's got to be on the balcony," and we send her on her way unsuspectingly so that we can tamper with the fridge unhindered. However, the art of deception is indeed perhaps also part anthropology. To borrow from the philosopher Georg Wilhelm Friedrich, one could perhaps even say: "All reason emanates from cunning."
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This podcast was written and produced by Cecile Lutz and Jakob Müller. It has been translated by Soliman Lawrence and is read by Rebecca Dyson Smith.