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Related Topics
Mind to MindReview - Mind to Mind
Infant Research, Neuroscience, and Psychoanalysis
by Elliot L. Jurist, Arietta Slade, and Sharone Bergner (Editors)
Other Press, 2008
Review by Jason Thompson
Mar 24th 2009 (Volume 13, Issue 13)

In the short story Tlön, Uqbar, Orbis Tertius (1940), Jorge Luis Borges imagines the world viewed through the perceptual lens of a fabular country possessed by a parodically exaggerated form of Bishop Berkeley's idealism: "The world for [the Tlönians] is not a concourse of objects in space; it is a heterogeneous series of independent acts." Standard suppositions of Newtonian causality thus hold the same value for the philosophers of Tlön that, say, crop circles or astrology hold for 21st century scientists. "In other words, they do not conceive that the spatial persists in time," Borges writes of the Tlönians. "The perception of a cloud of smoke on the horizon and then of the burning field and then of the half-extinguished cigarette that produced the blaze is considered an example of association of ideas." In this topsy-turvy land, empiricism is magical thinking and magical thinking its analytical gold standard: "The metaphysicians of Tlön do not seek for the truth or even for verisimilitude, but rather for the astounding. They judge that metaphysics is a branch of fantastic literature."

There is a Tlönian echo in the developmentally disrupted mental worlds brilliantly investigated in "Mind to Mind," an anthology of papers derived from a 2004 conference that explored Peter Fonagy and Mary Target's location of the other-mirroring processes (termed by those researchers "mentalization" and "reflective functioning") as the psychic center of gravity around which emotional self-insight and empathic relational attunement (and myriad form of their pathological inverse) can be said to orbit. The root of this disruption, for Fonagy and Target, lies in the fracture or non-emergence of the child's nascent "theory of mind" (ToM), her capacity to create plausible and causally reliable interior simulacra of the intentions and feelings of other people. In contrast to the developmental trajectory studied by Gyorgy Gergely et al (who found in 1995 that children as young as one year had a basic ToM), traumatized children are less likely to model other people as predictable agents than as the elliptical authors of a Borgesian "heterogeneous series of independent acts." Absent reliable, non-traumatic models of an effectively self-regulating self, the child's own psyche develops a capacity for self-insight only falteringly or not at all. The book's introductory example: an adult replies to a query about how his personality might have been affected by his severe childhood abuse, "I cannot explain it, I can't, it's not even up there for me to explain."

The first of the book's three parts comprises papers on the link between mentalization and attachment. Gergely and Zsolt Unoka report on the evolutionary adaptive value of mentalization in the emergence of the human social brain. Elliott Jurist proposes the new term "mentalized affectivity," defined as "the capacity to reflect on affect states and to regulate them." Miriam Steele, Jeanne Kaniuk, Jill Hodges, Kay Asquith, Saul Hillman and Howard Steele then present empirical results that show the importance of a parent's capacity to mentalize about his or her own early childhood experience as a predictor of effective parenting relationships (in this study, specifically with adoptive children.)

The book moves in its second section to present papers on discoveries in the clinical and neuroscientific research on mentalization. Peter Fonagy and Anthony Bateman describe the efficacy of "mentalization based treatment" (MBT) in treating Borderline Personality Disorder (BPD). MBT is a therapy whose objective is to help a patient afflicted by unresolved early trauma and consequent maladaptive behavior patterns (as a result of deficits in reflective functioning) "find out more about himself and others, how this dictates his responses, and how 'errors' in his understanding of himself and others lead to actions that are attempts to retain stability and to make sense of incomprehensible feelings."

Later in section II, Otto F. Kernberg, Diana Diamond, Frank E. Yeomans, John F. Clarkin and Kenneth N. Levy describe the greater efficacy of Transference Focused Psychotherapy (TFP), relative to two comparison therapies (MBT and DBT), in reducing symptoms of anxiety and depression in BPB patients by developing patients' capacity for reflective functioning. TFP differentiates from the study's control therapies in the former approach's focus on interpretation, which is generally contraindicated in MBT and DBT. Kernberg et al characterize TFP's mechanism of psychotherapeutic change as the therapist and patient's co-creation of a stable autobiographical narrative that enables the patient to "observe, modulate and integrate the split sectors of [traumatic] experience into unified coherent representations of self and other," through an incremental reorganization of the patient's internal object relations dyads. Next, Glen Gabbard, Lisa Miller and Melissa Martinez identify the neurological correlates of BPD's hallmark object relations disruption in hyperactivity of the HPA axis and amygdala, decreased activity in the prefrontal cortex, hippocampal abnormalities and dysfunctional reward circuitry, which in sum the authors link to impaired neural representations of others' feeling states through the (in)action of mirror neurons.

The Case of Mr. N, a clinical narrative presented by Karen Gilmore in the paper "Birth Mother, Adoptive Mother, Dying Mother, Dead Mother," forms the focus point of the penultimate chapter of the book's third and concluding section and perhaps the book's most vivid illustration of mentalization's impressive explanatory power for practicing clinicians. Mr. N, a 28 year-old college graduate, came to therapy afflicted by a state of "paralyzing ruminations and doubting" which the author traces to N's compulsive need to self-sabotage in an unconscious spirit of avenging the internalized image of his disapproving father. Mr. N supposes that his own accomplishments can never match the imaginary triumphs of the biological son he believes his own existence as an adoptive child represents to his father. During N's adolescence, his mother died. N soon formed an identity around a pattern of auguring great promise in a range of activities (athletic, academic and professional) which he perpetually undermined. The pattern repeats itself in his five years of analysis and psychotherapy with Gilmore, until the self-defeating cycle eventually becomes sufficiently available via his transference with Gilmore that her voice as therapist began to "vie with [Mr. N's] father's and…often hold sway against meaninglessness and despair."  

Quoting a phrase from Bertram Lewin (1955), Gilmore describes her role in relation to Mr. N as the "external waker of disturber" of Mr. N's comatose dream-state. What wakes him is her threat to end the therapeutic relationship, which leads N to realize not only that the relationship matters to him but also, crucially, that his own actions have a direct causal impact on potentially keeping his therapist in his life. This is the type of causality considered fantastical in Tlön, and unknowable to the Tlönians' real world clinical analogues, for whom chains of interpersonal cause and effect are broken or brittle. Dr. Gilmore's five years of analytic work with Mr. N are not quite a match with Dr. Johnson's infamous attempt to refute Berkleyan idealism by kicking a rock ("I refute it thus!"), but the Case of Mr. N -- and the overarching theme of this book -- is that the painfully circular self-enclosure of developmentally traumatized minds is an escapable prison if the mind learns to create internal objects that are if not rock-like, at least trustworthy.

© 2009 Jason Thompson

Jason Thompson teaches children with special needs in an Oakland public elementary school. He is studying for a MA in Special Education at San Francisco State University and a MA in Buddhist Studies at Sunderland University in the UK. He has a MA in English Literature from Oxford University. His research interests include developmental psychopathology, and the intersection of Buddhist thought with the western mind sciences. He has published journalism in the British and American media, and recently had a paper accepted for publication in "Philosophy, Psychiatry and Psychology."


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