One of the current theories about what creates borderline personality disorder is that somehow they are defective in their ability to mentalize, or have an accurate “theory of mind.” This means they do a poor job of figuring out what is going on in the heads of other people. In studies, this is mostly found on tests where they are supposed to read faces or interpret videos of people in various activities.
I always thought this
idea was very amusing in light of the fact that, in my extensive experience speaking with other therapists as well as in my own experiences, these very same people are so
good at drawing three particular responses from therapists: a sense of anxious
guilt, anxious helplessness, or fury. They are so good at it that they make
most therapists hate them. They can ascertain the therapist’s weak points, and then
go right for the jugular. How can they be bad mentalizers if they can do that?
When you live in an
unstable, confusing environment in which double messages are flying back and
forth and you can’t really predict what mood a parent is going to be in when
they drop in on you, you become better at reading others than most people so
you can quickly adjust to any new contingencies. And as I have repeatedly
pointed out, error management theory would predict that you would err on the over-reacting
rather than under-reacting, because the consequences of minimizing parental guilt
and hostility are so frightful. This normal tendency is then mistakenly seen as something pathological.
Another big issue in
research in personality disorders that bears upon this issue is that when
patients are in studies responding to various stimuli in the study situation, they
may be responding with a false self or persona (as described by psychoanalysts Jung and Winnecott)—in this case, the spoiler.
This is, as my readers know, a role I believe they are playing to maintain smooth family
functioning (family homeostasis). This
makes them look impaired when in fact they are not. Performance is not the same
as ability, as I described in a previous post.
If you are not a good actor in situations in which fooling people is paramount,
you wouldn’t be very good at doing so.
And to effectively
play the role of spoiler, you have to make
yourself to be way more impaired than you actually are. In particular, you have
to pretend that you lack the ability to see both the good and bad in people
simultaneously (so-called “splitting”), or evaluate both their strengths belied
by their reputation among therapists for being master manipulators!! Deficient
mentalization, huh?
One new study (Bora, “A meta-analysis
of theory of mind and 'mentalization' in borderline personality disorder: a
true neuro-social-cognitive or meta-social-cognitive impairment?, Psychological Medicine.
51(15):2541-2551, 2021 11). of
so-called mentalization “abnormalities” was based on a review of the existing
literature. The author just assumes that what the studies see is “maladaptive”
and therefore abnormal, but found no evidence of any primary
neuro-social cognitive deficit! Hardly surprising in light of what I just
wrote about. Instead, the author attributes the imaginary abnormality to their
“meta-social cognitive style,” whatever that is. Again, it’s as if these
patients exist in some social vacuum where certain assumptions would always be
completely highly adaptive for anyone who didn’t have a deficient “theory of
mind.”
A second study (McLaren, V. et. al. "Hypermentalizing and Borderline Personality Disorder: a Meta-Analytic Review, American Journal of Psychotherapy 75(1): 21-31) looked at "hypermentalizing" - the tendency to overattribute mental states to other - and found it was common in a wide range of disorders rather than in borderline personality disorder in particular.
I'm going to offer a response as a non-specialist, FWIW. But I typically see the deficit described as *context-dependent* failures of mentalization. We might have a normal ability to mentalize, but revert to splitting because we feel under threat - as humans normally do. The so-called failure is mediated by arousal, and in this light, it's not really a failure at all.
ReplyDeletePerhaps the therapy teaches us that, regardless of the feeling that we are facing an enemy or someone who wants to harm us, we should act against instinct and treat them like a friend or genuine romantic partner. This is a strategy to adapt to a new environment where most people actually are friends, or at least benign. Hence the DBT strategy of benign interpretation. We switch from the acquired habit to assume the worst (e.g. abandonment, infidelity) to make the assumptions typical of people with healthy relationships, thus expanding our circle and solidifying the relationships we are trying to form. Fake it until you make it?
I agree with you that they split when they feel under threat (massive family invalidation), but also (and more importantly) because they are trying to give the parent what they seem to need to maintain stability - to oversimply just a bit: they make them feel guilty when they start to get too angry and angry when they start to get too guilty.
DeleteIt just occurred to me that your preferred interventions don't really dwell on mentalization because the goal is systemic change. If new patterns can be established in the family system, then congruent mental habits should follow, and these will benefit relationships outside the family as well.
ReplyDeleteAbsolutely!
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