Peter Fonagy is the leading psychoanalytic theorist of our time. In this book he assembles a team of co-authors to elaborate and defend his main theses with evidence from genetics, neuroscience, infant observation, and philosophy of mind, among other fields. These three theses are captured in the tripartite title – Affect Regulation, Mentalization, and the Development of the Self – whose...
more Peter Fonagy is the leading psychoanalytic theorist of our time. In this book he assembles a team of co-authors to elaborate and defend his main theses with evidence from genetics, neuroscience, infant observation, and philosophy of mind, among other fields. These three theses are captured in the tripartite title – Affect Regulation, Mentalization, and the Development of the Self – whose awkwardness foreshadows the stilted style of its psychoanalytic writing. But we should overlook this general flaw, and the inevitably uneven quality of chapters written by different hands, because this is a very important book. Indeed, it should revolutionize the field (in the manner of the revolutions effected before it by Kernberg, Kohut, Winnicott, and Klein).
The principal thesis is that children must develop the ability to "mentalize." To have this ability is to have a sense of the separate contents of other minds besides one’s own, and to act accordingly. Experimental psychology has pinpointed this development to ages 3-4, when children are first able to pass the so-called false-belief test. Children who pass this test can predict the behavior of someone whom they know to have a false-belief, based on their belief about the contents of the other’s mind, rather than based on their own true belief about reality. In other words, children who mentalize see minds as part of reality, whereas children who cannot are “mind-blind.” Borrowing terms from the philosopher Dennett, the authors distinguish between children who operate with the "intentional stance" versus those who manage with the simpler "teleological stance."
To acquire this ability, Fonagy et al. argue, children must be properly "mirrored" by a caretaker. That is to say, their affects must be reflected by the caretaker, so that they can perceive in the reactions of the other a reflection of what they are feeling. Direct introspection is not available to infants, despite Cartesian prejudices about the mind that still bedevil philosophy, for infant observation shows this to be an ability we acquire from the perception of our reflections in the reactions of others towards us. (Hegel is thus vindicated against Descartes, but the first intimations of this view are in Plato’s First Alcibiades.) To succeed as reflections, however, these reactions must be “contingent” and “marked.” Contingent reactions are reactions to the affects of the baby; marked reactions make clear that the reactions are not those of the caretaker. For example, a mother reflects her baby’s angry face (contingent), but gives it an ironic cast (marked) in order to show that her expression is not a signal of her own anger but rather of her baby's. Growing up with a steady diet of such reflection, a children gain accurate representations of their affects. These representations allow them to regulate these affects better, and from all of these representations combined they gain a sense of who they are, a self.
Affect-mirroring can go wrong in two ways: when the caretaker reacts to his baby in ways that are not contingent, first of all, or, secondly, when his reactions are not marked. Children who grow up with non-contingent caretaking, on one hand, internalize a false self, a projection of their caretaker’s affects, so that their self-representation is thus detached from their authentic affects. Such children typically become narcissists (NPD, Narcissistic Personality Disorder, in the diagnostic categories of the DSM-IV), seeking public validation of their fragile false-self in a futile effort to buttress it. Children who grow up with non-marked caretaking, on the other hand, learn that affects are contagious, and thus have trouble distinguishing between themselves and others. Such children typically become borderlines (BPD in the diagnostic categories), misreading the contents of their own mind as well as the minds of others, confusing the two and thus manipulating others – whose presence they need to feel whole, but whom they alienate by their desperate efforts to achieve control. Both pathologies involve defects in self-representation and affect-regulation, and the theory of mentalization can explain this coincidence neatly.
The book is rich with clinical examples, and the authors are full of helpful techniques for analyzing patients with these personality disorders. Essentially, the analyst must forego the analysis of defenses and conflicts, because this traditional technique will be perceived by borderlines and narcissists as an assault on their fragile selves, with dangerous consequences both for the treatment and for the patients themselves. Instead, she must replicate in the consulting room what these patients did not receive in early childhood, namely an education in mentalizing. Far from being didactic, of course, this technique will often involve a contingent participation in projections, whenever this can be done without violating the ethics of analysis, while subtly marking this participation as coming not from the analyst but from the patient. If this sounds difficult, it is, and requires great wisdom and much luck. If it sounds paradoxical, it may be, but the case reports suggest that it is possible, with limited success.
Even were its clinical technique a failure, however, this book’s theory of the human mind now stands as the best that psychoanalysis has to offer. These authors have taken what was valuable from Freud and his tradition, but they have also bolstered, elaborated, and at times corrected it with evidence from a wide range of overlapping fields. With their admirable book, they have underwritten the testimony of Eric Kandel (Nobel prize winner for 2000 in medicine and physiology), that psychoanalysis outlines “by far the most coherent, interesting, and nuanced view of the human mind.”
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