Infant Parent Mental Health Course Summary


Peter Fonagy’s Presentation:

I will begin with the presentation by Dr. Peter Fonagy on “Mentalization”. I will give the summary in two parts. This is the first. 


Fonagy started by “tracing the developmental roots of mentalization”. In fact, he began even before by tracing the evolutionary roots. Pointing out that humans have the skill to perceive intentionality in one another’s acts, he noted that even chimpanzees cannot reliably distinguish between when someone accidentally drops an object and when he intentionally lets it fall. I was pleased to hear that dogs actually are very good at that. I imagine this is because dogs were domesticated so early in evolutionary history and have learned things from humans that then become inherited. The capacity to mentalize has also been argued to account for other differences between humans and ages – the social emotions of embarrassment, shame, and guilt, and spirituality and art. It is interesting that mentalizing, the capacity to understand acts in terms of intentions, emerged in good times but not in times of hardship. The most persuasive argument for this, Fonagy says, is that when the environment does not put pressure on us from the point of view of survival, the only way our genes could survive is through outsmarting other people! 

A working definition of mentalization: “Mentalizing is a form of imaginative mental activity, namely, perceiving and interpreting human behavior in terms of mental states (for example, needs, desires, feelings, beliefs, goals, purposes, and reasons). 

There are shared neural circuits for mentalizing about the self and about the other. Mental states represented in the brain about the self are co-located with mental states represented in the brain about the other. They are mediated by the same part of the brain. The development of these capacities occurs in tandem. An infant’s capacity to understand another arises from their ability to understand themselves, which in turn arises from the other’s communication of their ability to understand the infant, in a beautiful cycle. We initially learn to mentalize in our relationships with our parents. The parents’ capacity to mirror effectively her child’s internal state is at the heart of affect regulation. The infant is dependent on contingent responses from the caregiver, which in turn depends on the caregiver’s ability to be reflective about her child as a psychological being.  Failure to find the self in the mind of the other can result in a profoundly distorted self-representation.  

Mirroring: The caregiver “mirrors” the infant’s affective states, in a “marked” (not totally exact but recognizable) way and that makes the child feel known or sensed in the caregiver’s mind, giving rise to an emerging sense of self as a person with feelings. The capacity of the caregiver to mirror the infant’s states is correlated with the child’s capacity for pretend play at 3-years. This is why kids who are neglected have trouble with self-representation and often don’t know what they are feeling. Some infants are difficult to mentalize and some caregivers (CG) are unable to understand them, and it becomes a cascade of trouble. There are lots of ways this process can go wrong; it is a vulnerable system. 

The development of mentalizing has bidirectional influences. Poor affect regulation in the infant makes sensitive caregiving difficult. The inability to mentalize disrupts the attachment relationship, which undermines further development. The very process that could help the child to overcome these interpersonal challenges – psychotherapy – is sometimes undermined by the difficulties in the attachment system. An example is the children who cannot allow the therapist to engage with them in therapy and the therapist misattributes this failure as intentional behavior in the children. Sometimes children cannot benefit from benign new relationships because they disrupt them. (This reminds me of the traumatized children Bruce Perry talks about.)

 Fonagy believes that genetics has a great deal to do with this. This genetic influence is not straightforward, however. Most psychopathology involves an individual losing calibration over what is happening in their brain. That is, there is neural activity but the process (secondary process) by which you attribute meaning to that activity, has gone wrong. What has an individual been programmed to do I that situation? The individual is programmed to do what humans did to originally get that capacity – talk to somebody. Freud made a contribution by making a profession out of this. The process is an evolutionarily driven process. We try to understand our mental experience through attributing meaning to it. Mentalizing is the process. Attachment is involved. Compassion is the valence.

There are many studies that demonstrate the early awareness of infants’ mentalizing capacities. And infants are also biologically wired to think that the world behaves in a decent way. Violations of these expectations are toxic because not only do they teach inappropriate content but they undermine mechanisms for the social acquisition of knowledge and the emergence of the agentic sense of self. The role of the environment is to facilitate a biologically prepared process for the acquisition of knowledge.   If the environment is good enough the process will become active. But if it is systematically hurtful or depriving it won’t. The significance of disconfirming legitimate expectations – The more we learn, it is the disconfirming of legitimate biological expectations that is important.  The system has been constructed to ignore the bad experiences as part of the culture because of the way the CG behaves. If the CG behaves badly, then the child will come to expect bad things from the culture. 


Read this blog in Spanish.


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