Emociones

this role. _________________________________ —

Infants initially understand themselves as teleological agents. They learn to differentiate actions from their outcomes and think about actions as a means to an end. At this stage they largely experience themselves as physical beings. Thoughts become linked with objects in the infant’s mind. In psychic equivalence mode the infant believes that what is in the mind must also exist outside. There is no ‘as if experience, as concreteness of thought denies alternative perspectives. As thinking becomes more sophisticated, the pretend mode allows a decoupling between internal and external reality. The pretend and psychic equivalence modes are therefore opposites. The infant whose thinking is dominated by the pretend mode feels things as too unreal, whereas in the psychic equivalence mode things feel too real.

Before these two modes of experiencing reality are bound together the teleological stance of the infant means he is governed by primary representations of his physical self. This ‘constitutional self is as yet non­ verbal and unable to make sense of the world around. In order to achieve a self-aware, integrated psychological self, this first order of experience must be bound to second order representations, i.e. symbolic thought and verbal expression. The binding of first and second order representational systems is regulated by the mother’s ability to contain and return in a metabolized form the infant’s expressions of his internal state. Once second-order representations of emotional experience have been established, affect regulation and impulse control become possible, both essential building blocks for mentalization development. It is in this intersubjective space between himself and the mother that a child develops an agentive ‘psychological self (Figure 1, from Bateman & Fonagy, 2004).

Psychological self: 2nd order Representations Representation of self-state: internalization of object’s image Mirroring display Expression of metabolized affect

Symbolic binding of internal state

Physical self: Primary Representations Constitutional self in state of arousal Non-verbal expression Marked expression Reflection Resonance Child Caregiver

Figure 1. Intersubjective space and the symbolization of emotion

This facilitates the integration of three pre-mentalistic modes of thinking into a mentalizing self-concept. As Bateman and Fonagy (2004) say:

‘In normal development the child integrates these...modes to arrive at mentalization, or reflective mode, in which thoughts and feelings can be experienced as representations. Inner and outer reality are seen as linked, but separate, and no longer have to be either

equated or dissociated from each other’(p.70).

Developmental failures in mentalization

When a caregiver’s facial expressions and vocal intonation reflect her own preoccupations, possibly due to unresolved trauma or loss, the infant fails to ‘find himself in her face. He internalises his caregiver’s image as part of

his self-representation. As this does not match the infant’s constitutional self, the internalised caregiver is experienced as ‘alien’ (Figure 2, from Bateman & Fonagy, 2004).Thus even small failures on the caregiver’s part, if repeated over a period of time, can have a traumatising effect on the child. The lack of internal coherence and introjection of an alien self may lead to the anxiety and depression of those whose ‘false self (Winnicott, 1960) causes them to feel strangely out of touch with their actual feeling states. In more extreme cases, when the child is abused or neglected, he must face the fact that his object is malevolent. There is no playful mutual exploration of minds, as to comprehend the mind of one’s abuser is threatening. The child therefore withdraws, suppressing his mentalizing capacity to defend himself against the full knowledge of the danger. There is a form of decoupling and inhibition of mentalizing.

The caregiver’s perception is inaccurate or unmarked or both

A b s e n c e o f a re p re s e n ta tio n o f th e

in fa n t’s m e n ta l s ta te _{M irro rin g p a rtly fails}

T h e c h ild ’s s e lf re p re s e n ta tio n a l s tru c tu re

T h e A lie n S e lf

In fa n t A tta c h m e n t fig u re _{In te rn a liz a tio n o f a n o n -c o n tin g e n t m e n ta l}

s ta te a s p a rt o f th e s e lf

The child, unable to ‘find’ himself as an intentional being, internalizes a representation o f the other into the self

Figure 2. Birth of the 'alien' self

Empirical support for mentalization theory comes from a number of attachment studies. Fonagy et el. (1991) found that RF mediated the effect of parental early adversity on children’s attachment status. Mothers who had adverse histories but who were able to mentalize their child had children who were securely attached. Flowever, mothers with similarly adverse early experiences but who had low RF had mainly insecurely attached children. In a study at the Cassel hospital by Fonagy et al. (1996) mentalization alone did not predict personality pathology, but when low RF was combined with a history of sexual abuse, it was predictive of BPD.

Grienenberger et el. (2005) used the RF scale to code Parent

Development Interview narratives and found that maternal representations of the infant predicted infant attachment status. Ward and colleagues (2001) administered the M l with RF scoring to mothers and their anorexic daughters. Mothers’ RF was shown to significantly relate to that of their daughters. In a study by Fonagy and his team (Fonagy et a/., submitted)

the effect of childhood maltreatment on the development of BPD was found to be mediated by mentalization. It appears that how the mother holds in mind the mind of her child is crucial in the letter’s emotional development. Mentalization effectively operates as an ‘immune system’ (Lecours & Bouchard, 1997) as it can help the infant resiliency make sense of and psychically survive adversity (Fonagy et al., 1994).