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Sessions:
Attachment: Session 10
Attachment and Mentalization Continued
Jeffery Smith, MD
jssmith@me.com
Reading: Fonagy, Chapters 4 and 10. You are welcome to read others. I think these best catch the essence of Fonagy's thinking.
Written Assignment: After each session, please write a 1 page reacton: "What struck you about this reading." Bring your paper to share at the beginning of class.
A Few Key Points-- Same as last week, continued.
Look for how attunement affects the child's development of a "theory of mind."
How does Fonagy see poor attunement as the cause of borderline and other severe characther pathology. Specifically, how does a faulty theory of mind cause specific patterns observed in patients?
What do you think of Fonagy's lumping the development of a sense of security in with the development of a theory of mind? Are these so intermingled that they should be seen as one?
What do you think of Fonagy's lumping the development of the Superego in with mentalization, seeing them as the same.
Session Highlight: Fonagy maps the content of mother-child interactions to pathology. He says that the non-marked, or literal responses of the borderline mother who only expresses her personal feeling and doesn't take the child into account, map to later borderline personality with projective identifications predominating. He maps abuse and neglect to narcissistic pathology with the explanation that an innacurate mirroring to the child gives the child no validation of his or her own inner state and, instead, encourages introjection of a false self taken from the caregiver.
I take some issue with this mapping, feeling that Narcissism and Borderline states are more related to specific and distinct developmental issues. We can conceive of three early developmental stages:
1. Development of self-other boundaries (maps to schizophrenic pathology) and to tolerate separateness.
2. Development of sense of self as valued. Think of the normal 1 year old, who is in love with self as reflected in the eyes of loving parents. Think of the child who is hated or abused or has been set up for failure by overindulgence. This maps to narcissistic pathology.
3. Merging of good self-object and bad self-object. One and two above take place in the sphere of the good self, but this developmental phase now must integrate the other part of experience. This maps to borderline pathology.
In fact I think the way to make sense of both Fonagy's and this way of looking at the development is to say that at stage one, children are susceptible to damage from innacruate mirroring, where in stage 3, they are more vulnerable to mirroring that does not reflect the child but reflects the parent's mental state unmodulated.
Borderlines' trouble allowing different states to be experienced at the same time is compared to DID patients' being spared from this damage by keeping incompatible experiences more comfortably and completely separated by dissociation, and therefore not suffering the same kind of damage.