Mental(izing) Health

Newsletter, #57

DEMOCRACY OR AUTHORITARIANISM?

MENTALIZATION & DEMOCRACY?

MENTALIZATION & AUTHORITARIANISM?

Taking stock, this newsletter has sought to address a broad-spectrum of issues that mental health professionals face, with a particular emphasis on how social, cultural and political phenomena are manifest in our work.  In addition, I have often discussed recent books that are worthy of the attention of anyone with interests in mental health, especially memoirs, which form the subject of a book that I am completing about memoirists who reflect upon their experiences of being in therapy.

Occasionally, I have referred directly to the theory and practice of mentalization and to my research on mentalizing emotions (mentalized affectivity).  However, I realize, with new readers in mind, that it might be beneficial to clarify my intent to use this newsletter to broaden the scope of mentalization.  Mentalization has a rich and colorful history and has ramifications that extend well beyond treatment. 

Let’s begin with the convoluted history of mentalization, which over time has become recognized as an umbrella construct.  Two different, main sources can be identified for the construct: French psychosomatic thinkers from the 50s and 60s and Cognitive psychologists from the 70s and 80s.  A brief characterization of their meanings reveals profound different between them.  For the French psychosomatic thinkers, mentalization is rooted in bodily experience (and how it becomes represented); it is strongly affective and concerns the self’s relation to itself, whereas for cognitive psychologists, mentalization is mainly cognitive and is concerned with making sense of the minds of others.[i] 

Fonagy and colleagues’ contribution is to embrace both perspectives, as well as locating mentalization as a developmental construct.  Mentalization involves the dimensions of affect and cognition and the self and other.  Mentalized affectivity is the term that denotes how affect and cognition can be integrated and helps us to illustrate that mentalizing differs from cognition.   It is akin to emotion regulation but is distinct in underscoring how autobiographical memory impacts our experience of emotions and how affect is preserved when cognition and affect are modulated.  

Mentalization can be about the self or it can be about others, and perhaps more specifically it can be about using someone’s else knowledge in order to benefit oneself.  Given that mentalization occurs in embodied beings, it has been linked to interoception and to our ability to maintain homeostasis.[ii]

We mentalize about ourselves, if caregivers have mentalized about us.  Epistemic trust develops, and this provides a welcoming path to social knowledge and leaning toward salutogenesis.  When this does not happen, there is a risk of psychopathology, and mentalization theory has focused, in particular, on the emergence of severe personality disorders.  Mentalization has been brought into the realm of practice as an evidence-based therapy, mentalization-based therapy (MBT), for severe personality disorders.  MBT has been applied in new directions, too, for different populations (children, adolescents, and families) and for different psychopathologies (depression, trauma, addiction, sex addiction, eating disorders, anti-social personality, and even psychosis). 

The literature in the field has suggested that mentalization is a product of evolution, enhancing our ability to cooperate and to negotiate conflict.  A new line of thinking is just starting to emerge, however, about the relation between mentalization and culture.  Do all cultures mentalize in the same way?  If not, how are they different and can mentalizing be optimal in one culture and dismissed in another?  Some research exists, but it is still at an early stage of development.

In a recent, promising article, Aival-Naveh, Rothschild-Yakar, and Kurman (2019), conducted a meta-analysis of terms that are related to mentalization (theory of mind, empathy, perspective-taking, alexithymia, and mindfulness) as a first step in addressing how culture impacts mentalization.[iii]  The authors note, for example, that there is research, which suggests that people in the West acquire theory of mind capacities earlier than people in East Asia.  This makes sense, given the emphasis on autonomy in the West versus collectivism in East Asia.  Related to this, perspective-taking apparently differs in that people in the West tend to prioritize mentalizing about the self, whereas people in East Asia tend to prioritize mentalizing about others.  

Aival-Naveh, Rothschild-Yakar, and Kurman take account of these findings but wish to move beyond putting too much stock in such simple dichotomies.  They argue that we need to clarify what culture can affect versus what it cannot, locating the distinction between the implicit and non-verbal, which is not easily influenced by culture, and the explicit and verbal, where culture really matters. They then propose that we can explore the relation between mentalization and culture by looking closely at language, values, and parenting.  This seems like a fruitful direction to be able to understand mentalization on a deeper level.  I would add that the growing literature on cross-cultural emotions also provides helpful data for acquiring a more fine-grained sense about cultural variations in mentalizing.[iv]

A different application of mentalization is found in Kirkland Vaughans and Lisa Harris’ article, The Police, Black and Hispanic Boys: A Dangerous Inability to Mentalize (2016).[v] Vaughans and Harris argue that the police fail to mentalize Black and Latino boys, reflecting the views of the larger society, which is punitive and not open to seeing this group of kids as needing guidance and support.  They track how the perceived threat of violence is often a projection of the violence that is justified as necessary to maintain the social order, where White people retain power and privileges over Black people. 

The past of slavery is not so past.  Nor are Jim Crow laws, which were spurred by the emancipation of Blacks from slavery, reflecting the increased fear and need to shore up the old social order.  Vaughans and Harris cite the work of Michelle Alexander on how the mass incarceration of Black people now can be understood as constituting a new version of Jim Crow.  They conclude their article by emphasizing that overcoming racism entails facing how our failure to mentalize minoritized youth functions to preserve white supremacy.  Mentalizing “them” requires a change in how White people mentalize themselves.

The success of the Black Lives movement was to push White people to recognize the extent to which they are complicit in tolerating a social order in which Black people are not accorded equal status.  Daniel Gaztambide (2022) documents how the pandemic served to confirm what the Black Lives movement had stressed, as minoritized communities were unfairly devastated by COVID.[vi]  Gaztambide sharpens this argument by claiming that anti-Blackness is at the source of the refusal to mentalize minoritized people, and, more assertively, that “political mentalizing” is a necessary part of therapeutic action. What he means by this is that psychotherapy must incorporate and cultivate, not just awareness of one’s identities, but the will to be consistent with one’s values and to face hypocrisies.  Political mentalizing in Gaztambide’s account is not just an optional, recommended component of psychotherapy; it provides a necessary supplement to our understanding of interpersonal, attachment dynamics.

Gaztambide draws from Isabel Wilkerson’s theory that racism is informed by a caste system with Whites on the top, non-Blacks in the middle, and Blacks on the bottom.  He argues that anti-Black racism, therefore, inevitably a factor for White people in psychotherapy, as their status depends upon others being assigned an inferior status.  The inferior status for Black people means that they must contend with a traumatic reality. 

Mentalizing stigma must become part of the work for everyone.  Gaztambide eloquently describes the challenge of mediating between a loving family and a hateful world, which can produce alien versions of the self or a turning against the self: “Collapsed mentalizing produces an internalized oppressor that takes up inner space where human minds should be.”

Using clinical examples, Gaztambide illustrates how difficult it is to mentalize as a minoritized person who is not mentalized by others, that is, by White people.  One patient, “Jessie,” works in tech, and used humor as a way not to be less invisible to her colleagues.  She is dismissive about race initially in psychotherapy, but gradually begins to voice memories, like when she complained to her parents that her teacher refused to call on her in class, and her mother responded by saying that “the world can’t handle a smart, beautiful girl like you.”  While her parents meet with the teacher, Jessie sits outside the classroom, chatting with friends and making jokes at her own expense about her parents being worried that she was flunking math. 

The conflict between the message she was getting from her parents and from the rest of the world became exposed, and her therapist tuned into how impossible it must feel to experience that incongruence.  With the encouragement of her therapist, Jessie to become aware of the anger she feels toward her parents for not being able to protect her, and for feeling stuck between love and hate.  In more fully experiencing anti-Blackness, Gaztambide suggests that Jessie moves in the direction of self-acceptance and the potential for love to prevail over hate.

Where are we now?  Some of the energy around Black Lives Matter has diminished, a prediction one might have in maintaining that white supremacy is at stake.  White supremacists also have come out of the closet, which is apparent in discourse from Republicans, which is part of a larger reaction globally.  Vaughans and Gaztambide’s points are arguably more relevant and ominous.

As the pandemic has receded, we might have expected more opportunity to face anti-Black racism.  This has not happened, and the supreme court’s decision limiting consideration of diversity is a further disincentive.  New global developments have also distracted our attention, like the war in Ukraine and the Middle East.  We are now contending with the immanent possibility that the United States could elect an authoritarian leader as president.

It would not be easy to find an example of an authoritarian regime that exemplified or was welcoming to mentalization.  There is a natural fit between democracies and mentalization: valuing others’ opinions, being open to entertain (and tolerate) opinions that differ from your own and being willing to revise your opinions in the face of convincing evidence.  There is also reason, however, to hesitate in imagining a link between democracies and mentalization, as our public discourse has shifted to become less receptive to valuing mentalizing perspectives. 

Nonetheless, it seems legitimate to fear that under an authoritarian regime, mentalizing would be regarded as a threat, and that our profession is likely to be regarded with more suspicion.  It seems perfectly legitimate, too, to worry if someone running for office, especially higher office, fails to exhibit mentalizing abilities and proudly embraces a dementalizing stance.

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[i] There is a fuller account in my book, Minding Emotions (2018).

[ii] Fotopoulou, A., & Tsakiris, M. (2017). Mentalizing Homeostasis: The Social Origins of Interoceptive Inference. Neuropsychoanalysis, 19(1), 3–28. https://doi-org.ccny-proxy1.libr.ccny.cuny.edu/10.1080/15294145.2017.1294031.

[iii] Aival-Naveh, E., Rothschild-Yakar, L., & Kurman, J. (2019). Keeping Culture in Mind: A Systematic Review and Initial Conceptualization of Mentalizing from a Cross-cultural Perspective. Clinical Psychology: Science and Practice, 26(4), 25. https://doi-org.ccny-proxy1.libr.ccny.cuny.edu/10.1037/h0101757.

[iv] See my commentary with Michael Perez Sosa on Aival-Naveh, et al: Jurist, E., & Sosa, M. P. (2019). Commentary on Mentalization and Culture. Clinical Psychology: Science and Practice, 26(4). https://doi-org.ccny-proxy1.libr.ccny.cuny.edu/10.1111/cpsp.12302.

[v] K. Vaughans and L. Harris (2016). The Police, Black and Hispanic Boys: A Dangerous Inability to Mentalize. (2016). J. Infant Child Adolesc. Psychother., (15)(3):171-178.

[vi] D. J.Gaztambide (2022). Love in a time of anti-Blackness: Social rank, attachment, and race in psychotherapy. Attachment & Human Development, 24(3), 353–365. https://doi-org.ccny-proxy1.libr.ccny.cuny.edu/10.1080/14616734.2021.1976935.