IMPAIRMENT OF ABILITY TO MENTALIZE

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

Mentalization Is the ability to make assumptions and reflect on one's own mental states and the states of others. Mentalization is mainly preconscious and is aimed at understanding or interpreting one's own behavior and the behavior of other people in terms of mental states. In other words, the ability to mentalize allows a person to use ideas to perceive, describe and express inner life, regulate affect, and develop a coherent sense of self. The foundation of mentalization is laid early in life when interactions with attachment figures are encoded and internalized.

Ability to mentalize is created through interaction with a parent who reflects the inner states of the child, and who treats him as a person who has his own mental states. Therefore, the development of mentalization in a child is largely determined by the ability to mentalize attachment figures.

Parents should be able to accept the child's mental states, which he non-verbally expresses, respect the separateness of his inner world. The parental ability to mentalize the inner world of the child, which is filled with his own content, includes the ability to give meaning to the strong affects of the infant.

If the caregiver is unable to reflect on the child's inner experiences and respond accordingly, he thereby deprives him of the basic experience that is necessary to build a stable sense of self.

Significant impairments in childcare can severely damage mentalization abilities, care that meets the needs of the child, on the contrary, contributes to the development, differentiation and integration of affective states of the self, creating the basis for mentalization. Such a child, becoming an adult, is able to understand his inner states and think about them. He is also able to understand the experiences that are the basis of the actions or reactions of other people. Such people distinguish well between internal and external reality, they are aware of their motives, emotions, behavior, are able to be discerning about themselves and other people.

Disturbed relationships both disrupt mentalization and are themselves undermined by disrupting it. Mentalization is often context dependent, a person can successfully mentalize in most interpersonal situations, but the ability to mentalize may not be available in those interpersonal contexts that evoke strong emotions or activate ideas that are associated with attachment. Typical examples of absent mentalization are as follows.

- overabundance of details in the absence of motivations of feelings or thoughts

- emphasis on external social factors such as school, neighbors, etc.

- emphasis on physical or structural labels (lazy, quick-tempered, quick-witted)

- preoccupation with rules

- denial of involvement in the problem

- nitpicking and accusations

- confidence in the thoughts and feelings of others.

The lack of mentalization is not always revealed in the content of what is said, it can also manifest itself in the style of statements.

One of the forms of mentalization disorder is pseudo-mentalization, which is divided into three categories:

- obsessive pseudo-mentalization, which occurs when the principle of separateness or opacity of someone else's inner world is not observed, a person believes that he knows what the other person feels or thinks. This kind of mentalization occurs in a context of relatively intense attachment in which the pseudo-mentalizing person speaks out about his partner's feelings but leaves the specific context or states them in a categorical manner (“I just know and that's it”);

- hyperactive pseudo-mentalization - characterized by overly invested energy in thinking about what the other person thinks and feels; a person who produces such pseudo-mentalization may be surprised by the lack of interest in the concept that he has developed;

- destructively imprecise mentalization - characterized by a denial of objective reality, inaccuracy consists in denying the feelings of another person and replacing them with a false concept, often such pseudo-mentalization pops out in the form of an accusation (“I asked for it myself”).

The most common form of bad mentalization is specific understanding. It often testifies to a total inability to attach importance to internal states. A person fails to establish a connection between thoughts and feelings on the one hand, and his and his partner's actions, on the other. A distinctive feature of this mentalization is the lack of flexibility and thinking in the categories of "black" and "white". In this case, there is a deficiency in the ability to observe your thoughts and feelings, which creates problems with recognizing that your own thoughts and feelings affect other people. If a person is unable to understand that he is often angry, it is difficult for him to understand the reactions of others to his permanent hostility. Another feature of such mentalization is the inability to recognize the emotions of other people, such an inability can cause a person to go in pursuit of ghosts when he is trying to understand the emotion of a partner, which was not there. Failure to conceptualize mental states can lead to overgeneralization based on a single expression of intent on the part of the other person. For example, a compliment made may be misinterpreted as a manifestation of passionate love.

A significant number of people with severe personality disorder have excessive mentalization abilities. This impression is created because they use mentalization in order to control the behavior of others. The reactions they get when "pushing buttons" are usually negative, such as manipulation to provoke anger. Such knowledge of other people's "buttons", pressing which triggers the expected reaction, can give the impression of an exceptional ability to mentalize. However, for such people, "reading the minds" of other people often goes to the detriment of the ability to mentalize their own thoughts and feelings. Most often, such mentalization is aimed at manipulation, which concerns certain social circumstances.

An extreme case of excessive mentalization is presented in antisocial (psychopathic) personalities who use their knowledge of the feelings of others in a sadistic way, this kind of manipulation is used in order to build trust and then exploit relationships.

An example of excessive mentalization is instilling feelings of anxiety, guilt, shame in order to keep the other person under control. I will give an example of the emphasized empathy of my client's psychopathic aunt, who for a number of years “accurately” understood the states of a little girl who is difficult to learn, and then of a teenage girl who is experiencing the agony of love. The contrast with the "rude" and "non-empathic" mother made the aunt a real idol of affection. At the same time, as it turned out much later, the aunt used the same tricks in relation to the mother of my client, instilling in her feelings of anxiety and inducing a feeling of shame for her own "sweet" child, which resulted in increased control over her daughter, who with even greater zeal strove for an "understanding" aunt. Thus, both (mother and daughter) were turned into comfortable helpers in the endless financial difficulties that my client's aunt was experiencing, which ultimately ended up in prison for her.

A special form of this violent abuse of mentalizations is the destruction of the other's ability to think. To a person who is not capable of mentalization, the presence of another person who is endowed with this ability seems to be a serious threat. Then, in order to avoid danger, he resorts to a simple method of destroying the ability to mentalize - leads the other into a state of excitement through threats, humiliation, screaming, physical impact of excessive verbal activity.

W. Bateman and P. Fonagy point out that mentalization abuse is associated with trauma and abuse. Children, in response to the destructive intention of an adult towards them, inhibit their ability to think about the mental states of their abuser. In this context, the need of a traumatized person to recreate a state of emptiness or panic in people is more appropriate in order to get rid of mental pain himself. One of the manifestations of post-traumatic mentalization disorder is the fear of one's own thoughts and of the mental in general. There are also reliable ways to give up thinking - alcohol, drugs, other forms of addiction.

The authors cited above emphasize that people with BPD tend to be “normal” mentalizers in various communication contexts, but this ability is impaired in the context of attachment relationships. They are unable to carry out mentalization when emotionally aroused, and as their relationship shifts into the sphere of attachment, their ability to imagine the mental states of the other quickly disappears.

Literature

Bateman, Antony W., Fonagy, Peter. Psychotherapy for Borderline Personality Disorder. MentalizationBased Treatment, 2003.

Bateman U., Fonagy P. Treatment of Borderline Personality Disorder Based on Mentalization, 2014

Linjardi V., McWilliams N. Psychodiagnostic Manual, 2019