Affect regulation, mentalization, and the development of the self

Affect

Regulation,

Mentalization, a n d

t h e

D e v e l o p m e n t

of the

Self

/ A f f e c t

R e g u l a t i o n ,

M e n t a l i z a t i o n , a n d

t h e

D e v e l o p m e n t

Peter

Fonagy

Gyorgy Elliot Mary

Gergely L.

Jurist Target

m OTHER Other Press New York

o f

t h e

S e l f ,

3 7 H S o o 2

Copyright © 2002 by Peter Fonagy. Gy6rgy Gergely. Elliot L. Jurist, and Mary Target This book was set in ITC Bookman. 1098765432 All lights reserved, including the right to reproduce this book, or parts thereof, in any form, without written permission from Other Press, LLC, except in the case of brief quotations in reviews for inclusion in a magazine, newspaper, or broadcast. Printed in the United States of America on acid-free paper. For information write to Other Press. LLC, 307 7"1 Ave.. New York, NY 10001. Or visit our website: www. otherpress .com. Library of Congress Cataloging-ln-Publicatlon Data Affect regulation, mentalization and the development of the self / by Peter Fonagy ... [et al.]. p. cm. Includes bibliographical references and index. ISBN 1-892746-34-4 1. Affective disorders. 2. Affect (Psychology). 3. Self, I. Fonagy, Peter. 1952RC537 -A283 2002 616.89—dc21 2001058026

C o n t e n t s

ABOUT THE AUTHORS

vii

ACKNOWLEDGMENTS

xi

INTRODUCTION

PARTI THEORETICAL PERSPECTIVES CHAPTER 1 Attachment and Reflective Function: Their Role in Self-Organization

23

CHAPTER 2 Historical and Interdisciplinary Perspectives on Affects and Affect Regulation

65

CHAPTER 3 The Behavior Geneticist's Challenge to a Psychosocial Model of the Development of Mentalization

97

vi /

Contents

PART II DEVELOPMENTAL PERSPECTIVES CHAPTER 4 The Social Biofeedback Theory of Affect-Mirroring: The Development of Emotional Self-Awareness and Self-Control in Infancy

145

CHAPTER 5 The Development of an Understanding of Self and Agency

203

CHAPTER 6 "Playing with Reality": Developmental Research and a Psychoanalytic Model for the Development of Subjectivity

253

CHAPTER 7 Marked Affect-Mirroring and the Development of Affect-Regulative Use of Pretend Play

291

CHAPTER 8 Developmental Issues in Normal Adolescence and Adolescent Breakdown

317

PART III CLINICAL PERSPECTIVES CHAPTER 9 The Roots of Borderline Personality Disorder in Disorganized Attachment

343

CHAPTER 10 Psychic Reality in Borderline States

373

CHAPTER 11 Mentalized Affectivity in the Clinical Setting

435

EPILOGUE

469

REFERENCES

481

INDEX

549

About the

Authors

Peter F o n a g y , Ph.D., F.B.A., is F r e u d Memorial Professor of Psychoanalysis a n d Director of t h e S u b - D e p a r t m e n t of Clinical Health Psychology a t University College London. He is Director of t h e Child a n d Family Center a n d of t h e Clinical O u t c o m e s Res e a r c h a n d Effectiveness Center, b o t h a t t h e Menninger F o u n d a tion, K a n s a s . He is also Director of Research a t t h e A n n a Freud Centre, London. He is a clinical psychologist a n d a training a n d supervising a n a l y s t in t h e British Psychoanalytical Society in child a n d a d u l t analysis. He is Chair of t h e Research Committee a n d Vice-President of t h e International Psychoanalytic Association, a n d a Fellow of t h e British Academy. He is on t h e editorial board of a n u m b e r of major j o u r n a l s , including Development and Psychopathology a n d t h e Bulletin of the Menninger Clinic. He h a s p u b l i s h e d over 2 0 0 c h a p t e r s a n d articles a n d h a s a u t h o r e d or edited several books. His m o s t recent b o o k s include What Works for Whom: A Critical Review of Psychotherapy Research (with A. Roth; p u b l i s h e d in 1996 by Guilford Press), Psychoanalysis on the Move: The Work of Joseph Sandler (coedited with A. Cooper a n d R. Wallerstein; p u b l i s h e d in 1999 by Routledge), Attachment Theory and Psychoanalysis (published in 2 0 0 1 by O t h e r Press), a n d Evidence-Based Child Mental Health: A Comprehensive Review of Treatment Interventions (with M. Target, D. Cottrell, J . Phillips, a n d Z. Kurtz; to b e p u b l i s h e d by Guilford Press). vii

viii /

About the Authors

Gydrgy Gergely, Ph.D., is Director of t h e Developmental Psychology Laboratory of t h e Psychology I n s t i t u t e of t h e H u n g a r i a n Academy of Sciences a n d Senior Lecturer a t t h e Cognitive Developmental Doctoral Program of t h e E6tvos Lorand University in Budapest. He is a clinical psychologist a n d is o n t h e visiting faculty of t h e Max P l a n c k I n s t i t u t e for Psychology in M u n i c h , t h e Child a n d Family Center a t t h e Menninger Clinic, t h e Departm e n t of Psychology a t University College London, a n d t h e Dep a r t m e n t of Psychology a t Berkeley. He is on t h e Panel of t h e E u r o p e a n Cognitive Neuroscience Initiative a t Trieste, Italy. He is t h e a u t h o r of Free Word Order and Discourse Interpretation (published in 1991 by Academic P r e s s of Budapest) a n d h e serves on the editorial b o a r d s of several major j o u r n a l s . Elliot L. Jurist, Ph.D., Ph.D., is a Professor in t h e D e p a r t m e n t of Philosophy, Hofstra University, a n d a Lecturer in t h e Departm e n t of Psychiatry, College of Physicians a n d Surgeons, Columbia University. He is t h e a u t h o r of Beyond Hegel and Nietzsche: Philosophy, Culture and Agency (published in 2 0 0 0 by MIT Press) a n d of n u m e r o u s articles in philosophy a n d psychoanalysis. He is a Member of t h e Neuropsychiatry Service, New York Presbyterian Hospital, a n d a Member of t h e Ethics Committee of t h e New York S t a t e Psychiatric Institute. Mary Target, Ph.D., is a Senior Lecturer in Psychoanalysis a t University College London a n d a n Associate M e m b e r of t h e British Psychoanalytical Society. S h e is D e p u t y Director of Research a t the A n n a F r e u d Centre, Member of t h e C u r r i c u l u m a n d Scientific Committees, C h a i r m a n of t h e Research Committee of t h e British Psychoanalytical Society, a n d C h a i r m a n of t h e Working Party o n Psychoanalytic E d u c a t i o n of t h e E u r o p e a n P s y c h o a n a lytic Federation. S h e is C o u r s e Organizer of t h e UCL Master's Course in Psychoanalytic Theory a n d Academic C o u r s e Organizer of t h e UCL/Arma F r e u d Centre Doctorate in Child a n d Adolescent Psychotherapy. S h e is on t h e editorial b o a r d of several j o u r n a l s , including t h e International Journal of PsychoAnalysis, a n d s h e is J o i n t Series Editor for psychoanalytic books a t WhuiT Publishers a n d a n Associate Editor for t h e New Library of Psychoanalysis, Routledge. S h e h a s active r e s e a r c h collabora-

About the Authors

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ix

t i o n s in m a n y c o u n t r i e s in t h e a r e a s of developmental p s y c h o p a thology a n d p s y c h o t h e r a p y outcome. S h e is a u t h o r a n d editor of several books, including Attaccamento e Funzione Riflessiva (with P. Fonagy, p u b l i s h e d in 2 0 0 0 by Raffaello Cortina Editore of Milan) a n d The Outcomes of Psychoanalytic Treatment (edited with M. Leuzinger-Bohleber; to b e p u b l i s h e d b y Whurr).

Acknowledgments

We would like to acknowledge first of all o u r g r a t i t u d e to o u r patients; s o m e of t h e ideas in t h i s book h a v e b e e n p r o m p t e d by o u r clinical work, a n d one i m p o r t a n t yardstick in j u d g i n g t h e ideas is w h e t h e r t h e y c a n help u s better to u n d e r s t a n d o u r experiences w i t h p a t i e n t s p a s t , p r e s e n t , a n d future. We h o p e t h a t o u r efforts toward n e w theoretical u n d e r s t a n d i n g have sometimes benefited t h e m in t u r n . This b o o k could n o t a n d would n o t h a v e b e e n p r o d u c e d without t h e o u t s t a n d i n g contribution of Dr. Elizabeth Allison, t h e Publications Editor of t h e Psychoanalysis Unit a t UCL. Her contribution w e n t very significantly over w h a t might be expected from s o m e o n e in t h i s role. S h e effectively conceived a n d organized t h e project, a s well a s offering s u p e r b advice on t h e integration of t h e c h a p t e r s a n d t h e dovetailing of a r g u m e n t s . We a r e s u r e t h a t m a n y g a p s h a v e r e m a i n e d , b u t t h e level of integration we were able to achieve is in large p a r t d u e to h e r r e m a r k a b l e intellectual abilities a n d brilliant editorial skills. W h a t is more, s h e w a s able to impose h e r editorial a n d intellectual discipline on all of u s with c h a r m a n d sensitivity. Liz, we a r e all immensely indebted to y o u . In writing t h i s b o o k we h a v e b e e n immensely fortunate. Liz's predecessor in t h e Publications Editor p o s t w a s Kathy Leach, xi

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Acknowledgments

whose contribution w a s enormously valuable, n o t only in t h e planning p h a s e s of t h e project, b u t also in p r e p a r i n g for publication m a n y of t h e pieces on which t h e p r e s e n t work relies. O u r only regret is t h a t despite ingenious, tactful, a n d s o m e t i m e s desperate efforts to k e e p t h e production of t h i s book to schedule, we were not able to reward h e r with a complete m a n u s c r i p t . We are also grateful to o u r publisher. Dr. Michael Moskowitz, whose vision a b o u t a n e w kind of psychoanalytic p r e s s we s h a r e a n d are extremely pleased to be participating in. We a r e p a r t i c u larly grateful for h i s patience, a s t h i s book, b o r n of work in four countries a n d on two c o n t i n e n t s , slowly progressed to final completion. In t e r m s of intellectual debt, m o r e people deserve acknowledgment t h a n we could possibly list. The contributions of two people, however, h a v e b e e n clearly formative: J o h n Watson of t h e University of California a t Berkeley h a s collaborated for m a n y y e a r s with o n e of u s (GG), b u t all of u s h a v e benefited from h i s writings a n d wisdom. Even in t h e s e d a y s of virtual workplaces, t h i s collaboration would n o t h a v e b e e n possible without a c o m m o n workplace t h a t a t least t h r e e of t h e four of u s s h a r e . Dr. Efrain Bleiberg's leadership of t h e Menninger Clinic d u r i n g t h e time t h a t t h e work reported h e r e w a s u n d e r t a k e n h a s m a d e it possible for u s to work together in t h e Child a n d Family Center of t h e Menninger Clinic, w h i c h Dr. Bleiberg created a n d supervised in a truly free intellectual spirit. O t h e r s a t t h e Child a n d Family Center, particularly Dr. J o n Allen a n d Dr. Helen Stein, h a v e offered inspiration a n d advice. Two additional colleagues h a v e b e e n a s o u r c e of inspiration a n d guidance: Dr. S u s a n Coates h a s followed o u r work over t h e years, a s indeed we have followed h e r s with admiration. S h e h a s s e t a p a t h in developmental clinical p s y c h o a n a l y s i s t h a t h a s b e e n a t r u e inspiration. Dr. Arietta Slade h a s inspired u s n o t only in h e r r e s e a r c h work, clinical skills, a n d scholarship, b u t t h e Integration of all t h e s e into one personality with exceptional spirit a n d charm. We a r e grateful to h e r for h e r friendship a s well a s h e r guidance. Earlier b u t s o m e w h a t different formulations of some of t h e ideas contained in this book h a v e a p p e a r e d , or will shortly appear, in t h e following publications:

Acknowledgments

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xiii

C h a p t e r 1 incorporates s o m e material from "Attachment a n d reflective function: Their role in self-organization" by Peter Fonagy a n d Mary Target, w h i c h a p p e a r e d in Development and Psychopathology, 9 (1997), 6 7 9 - 7 0 0 . C h a p t e r 4 incorporates some material from "The social biofeedback model of p a r e n t a l affect-mirroring" by Gyorgy Gergely a n d J o h n W a t s o n , w h i c h first a p p e a r e d in t h e International Journal of Psycho-Analysis, 77(1996), 1 1 8 1 - 1 2 1 2 . A s h o r t e r version of c h a p t e r 5, T h e development of u n d e r s t a n d i n g of self a n d agency" by Gyorgy Gergely, will a p p e a r in U. G o s h w a m i (Ed.), Handbook of Childhood Cognitive Development. Oxford: Blackwell (in press). C h a p t e r s 6 a n d 9 incorporate material from Peter Fonagy a n d Mary Target's "Playing with reality" series of p a p e r s , which a p p e a r e d in t h e International Journal of Psycho-Analysis, 77(1996), 2 1 7 - 2 3 3 ; 7 7 ( 1 9 9 6 ) , 4 5 9 - 4 7 9 ; 81 (2000), 8 5 3 - 8 7 4 . C h a p t e r s 1 a n d 8 incorporate some material from "Attachm e n t a n d borderline personality disorder: A theory a n d some evidence" by Peter Fonagy, Mary Target, a n d Gyorgy Gergely, w h i c h first a p p e a r e d in Psychiatric Clinics of North America, 23 (2000), 1 0 3 - 1 2 2 . T h e concluding c h a p t e r incorporates some material from "An i n t e r p e r s o n a l view of t h e infant" by Peter Fonagy a n d Mary Target, w h i c h first a p p e a r e d in A. H u r r y (Ed.), Psychoanalysis and Developmental Theory {pp. 3-31). London: Karnac, 1998.

Introduction

N u m e r o u s p a t h s come together in t h i s book. Drawing from a wide r a n g e of sources, we ambitiously aim to a d d r e s s multiple a u d i e n c e s : r e s e a r c h psychologists, clinical psychologists, a n d p s y c h o t h e r a p i s t s , b u t also developmentalists from a c r o s s other disciplines. From t h e m o s t general perspective, we w i s h to highlight t h e crucial i m p o r t a n c e of developmental work to p s y c h o t h e r a p y a n d psychopathology. We offer a n a c c o u n t of p s y c h o t h e r a p y t h a t s e e k s to integrate o u r scientific knowledge of psychological development with o u r experience a s clinicians, working with children a n d a d u l t s . We believe t h a t t h e i n t e r e s t s of o u r p a t i e n t s a r e b e s t served by a c o n s t a n t effort on t h e p a r t both of individual t h e r a p i s t s a n d of t h e profession collectively to bring a b o u t s u c h a n integration. T h e value of t h i s kind of integration is by n o m e a n s immediately accepted (see Green 2000; Wolff 1996), n o r s h o u l d it be. T h e p s y c h o t h e r a p i s t offers clinical help, mainly t h o u g h language, to people looking for help n o t (just) from medication, b u t from s o m e o n e w h o is willing to h a v e their m i n d s in m i n d . It c a n n o t be a s s u m e d t h a t scientific progress in adjacent disciplines will benefit p s y c h o t h e r a p e u t i c practice. For example, we c a n well imagine t h a t progress in Hullian or S k i n n e r i a n learning-theory r e s e a r c h in t h e 1940s a n d 1950s would h a v e b e e n of little help to p s y c h o d y n a m i c t h e r a pists a t t h a t time. Learning t h e o r y benefited q u i t e a different

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Introduction

kind of psychological therapy, less concerned with m e a n i n g a n d t h e person t h a n with behavior a n d t h e environment. O u r work c a n b e located within t h e well-established tradition of interest within p s y c h o a n a l y s i s in developmental theory a n d r e s e a r c h found a m o n g g i a n t s like A n n a Freud, Melanie Klein, Mahler, Brody, Emde, Stern, a n d m a n y others. A particularly inspiring example of t h e s e a m l e s s integration of developmental a n d clinical t h o u g h t m a y b e found in a book by Anni B e r g m a n (1999), Margaret Mahler's well-known collaborator. Many of t h e ideas in B e r g m a n ' s b o o k will be found here, p e r h a p s c a s t in somewhat different perspective. All developmental orientations to p s y c h o t h e r a p y m u s t s h a r e m a n y i m p o r t a n t features a s t h e y are all b a s e d on t h e observation of h u m a n development. At t h e s a m e time, we believe t h a t a n u m b e r of t h e ideas d i s c u s s e d in this book—such a s t h e social biofeedback theory of p a r e n t a l mirroring, t h e teleological a n d Intentional s t a n c e , reflective function, t h e psychic equivalence a n d p r e t e n d m o d e s of psychic reality, t h e alien self, mentalizing, affectivity, a n d , of course, affect regulation a n d mentalization—suggest a genuinely n e w direction for p s y c h o a n a l y s i s a n d psychotherapy. From a n o t h e r perspective, however, t h i s book is n o t limited to psychoanalytic ideas a n d c o n c e r n s . We apply a philosophy-ofmind a p p r o a c h in order to c a p t u r e a n d specify t h e p r o c e s s by which infants fathom t h e m i n d s of o t h e r s a n d eventually their own m i n d s . T h e notion t h a t we fathom ourselves t h r o u g h o t h e r s h a s its s o u r c e in G e r m a n Idealism a n d h a s b e e n articulated further by analytic p h i l o s o p h e r s of m i n d (Jurist 2000). T h e u s e of philosophy of m i n d in t h i s way is c o m m o n in t h e field of social cognition. W h a t differentiates o u r a p p r o a c h is t h e a t t e n t i o n we give not j u s t to cognition, b u t to affects a s well. In t h i s regard, we rely on a t t a c h m e n t theory, w h i c h provides empirical s u p p o r t for the notion t h a t a n infant's s e n s e of self emerges from t h e affective quality of relationship with t h e p r i m a r y caregiver. Indeed, o u r work does n o t j u s t borrow from a t t a c h m e n t theory, b u t offers a significant reformulation of it. We shall a r g u e t h a t att a c h m e n t is n o t a n e n d in itself; r a t h e r , it exists in order to produce a r e p r e s e n t a t i o n a l s y s t e m t h a t h a s evolved, we m a y p r e s u m e , to aid h u m a n survival. A n o t h e r way to t h i n k a b o u t t h e contribution of t h i s book, therefore, is a s a n effort to resolve

Introduction

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3

some of t h e historical t e n s i o n s between psychoanalysis a n d a t t a c h m e n t theory (Fonagy 2001). Let u s s a y a little m o r e a b o u t t h e m a i n t h e m e of t h i s work a n d its relation to t h e trio of t e r m s found in o u r title. O u r m a i n focus t h r o u g h o u t is on -the development of r e p r e s e n t a t i o n s of psychological s t a t e s in t h e m i n d s of infants, children, adolescents, a n d a d u l t s . Mentalization—a concept t h a t is familiar in developmental circles—is t h e p r o c e s s by w h i c h we realize t h a t having a m i n d m e d i a t e s o u r experience of t h e world. Mentalization is intrinsically linked to t h e development of t h e self, to its gradually elaborated i n n e r organization, a n d to its participation in h u m a n society, a n e t w o r k of h u m a n relationships with other beings w h o s h a r e t h i s u n i q u e capacity. We have u s e d t h e t e r m "reflective function" to refer to o u r operationalization of t h e m e n t a l capacities t h a t g e n e r a t e mentalization'(Fonagy, Target, Steele, a n d Steele 1998). Mentalization is intimately related to t h e development of b o t h t h e agentive a n d t h e r e p r e s e n t a t i o n a l a s p e c t s of t h e self: b o t h t h e "I" a n d t h e "Me" described by W. J a m e s (1890). A great deal of a t t e n t i o n h a s b e e n paid to t h e development of self-representation, J a m e s ' s "Me" or t h e "empirical self" (Lewis a n d BrooksG u n n 1979), w h i c h e n c o m p a s s e s t h e development of t h e set of characteristics t h a t we believe to be t r u e of ourselves even if this knowledge is inferred from t h e reactions to u s from o u r social environment (Harter 1999). T h u s , this a s p e c t of mentalization is a concept with a rich history in b o t h psychoanalytic theory (Fonagy 1991) a n d cognitive psychology (Morton a n d Frith 1995). However, t h e self a s a m e n t a l agent—or, a s we h a v e referred to it elsewhere, t h e psychological self (Fonagy, Moran, a n d Target 1993; Fonagy a n d Target 1995)—is a relatively neglected subject of study. T h e relative neglect by psychologists a n d p s y c h o a n a lysts of t h e developmental p r o c e s s e s t h a t u n d e r p i n t h e agentive self m a y be s e e n a s a r e s i d u e of t h e traditionally powerful Cartesian doctrine of first-person a u t h o r i t y t h a t claims direct a n d infallible introspective a c c e s s to intentional m i n d s t a t e s , r a t h e r t h a n seeing t h i s a c c e s s a s a h a r d - w o n developmental acquisition. T h e work of Marcia Cavell (1988, 1994, 2000), a m o n g others, serves a s a r e m i n d e r of t h e limited extent to which psychoanalytic metapsychology h a s b e e n able to d i s t a n c e

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Introduction

itself from Cartesian doctrine. Both p s y c h o a n a l y s i s a n d developm e n t a l science h a v e often a d h e r e d to t h e Cartesian tradition in their a s s u m p t i o n t h a t t h e experience of m e n t a l agency is innately given. In t h i s book we a t t e m p t a radical b r e a k with this d o m i n a n t philosophical tradition, a r g u i n g t h a t m e n t a l agency may be m o r e usefully s e e n a s a developing or c o n s t r u c t e d capacity. Developmental a n d philosophical s t u d i e s of t h e r e p r e s e n t a tion of intentional action h a v e revealed t h a t t h e r e p r e s e n t a t i o n of intentional m i n d s t a t e s m a y have a r a t h e r complex i n t e r n a l s t r u c t u r e . Conscious a c c e s s to t h e s e s t r u c t u r e s m a y b e a t b e s t partial a n d could be totally a b s e n t . It s e e m s to u s i m p o r t a n t t h a t we m a p t h e p r o c e s s by m e a n s of w h i c h t h e u n d e r s t a n d i n g of t h e self a s a m e n t a l agent grows o u t of interpersonal experience, particularly primary-object relationships. Mentalization involves b o t h a self-reflective a n d a n interpersonal c o m p o n e n t . In combination, t h e s e provide t h e child with a capacity t o d i s t i n g u i s h inner from outer reality, i n t r a p e r s o n a l m e n t a l a n d emotional processes from interpersonal c o m m u n i c a t i o n s . In t h i s book we p r e s e n t b o t h clinical a n d empirical evidence in conjunction with developmental observation to d e m o n s t r a t e t h a t t h e b a b y ' s experience of himself a s a n o r g a n i s m with a m i n d or psychological self is n o t a genetic given. 1 It is a s t r u c t u r e t h a t evolves from infancy t h r o u g h childhood, a n d its development critically dep e n d s u p o n interaction with m o r e m a t u r e m i n d s , w h o a r e b o t h benign a n d reflective in their t u r n . O u r u n d e r s t a n d i n g of mentalization is n o t j u s t a s a cognitive process, b u t developmentally c o m m e n c e s with t h e "discovery" of affects t h r o u g h t h e primary-object relationships. For t h i s reason, we focus on t h e concept of "affect regulation," w h i c h is i m p o r t a n t in m a n y s p h e r e s of developmental theory a n d theories of psychopathology (e.g., Clarkin a n d Lenzenweger 1996). Affect regulation, the capacity to m o d u l a t e affect s t a t e s , is closely related to mentalization in t h a t it plays a f u n d a m e n t a l role in t h e unfolding of a s e n s e of self a n d agency. In o u r a c c o u n t , affect 1

For economy and clarity, we refer to the child as "he" and to either the parent or the therapist as "she." This is not meant to suggest any difference between male and female babies or male and female parents or therapists.

Introduction

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5

regulation-is a p r e l u d e to mentalization; yet, we also believe t h a t once mentalization h a s occurred, t h e n a t u r e of affect regulation is transformed. Here we distinguish between affect regulation a s a kind of a d j u s t m e n t of affect s t a t e s a n d a more sophisticated variation, w h e r e affects a r e u s e d to regulate the self. T h e concept of "mentalized affectivity" m a r k s a m a t u r e capacity for t h e regulation of affect a n d d e n o t e s t h e capacity to discover t h e subjective m e a n i n g s of one's own affect states. Mentalized affectivity lies, we suggest, a t t h e core of t h e p s y c h o t h e r a p e u t i c enterprise. It r e p r e s e n t s t h e experiential u n d e r s t a n d i n g of one's feelings in a way t h a t e x t e n d s beyond intellectual u n d e r s t a n d i n g . It is in t h i s realm t h a t we e n c o u n t e r r e s i s t a n c e s a n d defenses, n o t j u s t against specific emotional experiences, b u t a g a i n s t entire m o d e s of psychological functioning; n o t j u s t distortions of m e n t a l repres e n t a t i o n s s t a n d i n g in t h e w a y of t h e r a p e u t i c progress, b u t also inhibitions of m e n t a l functioning (Fonagy, E d g c u m b e , Moran, Kennedy, a n d Target 1993). T h u s we c a n m i s u n d e r s t a n d w h a t we feel, t h i n k i n g t h a t we feel one t h i n g while truly feeling a n other emotion. Moreover, it is even possible t h a t we c a n deprive ourselves of t h e entire experiential world of emotional richness. For example, t h e inability to envision psychological a n d psychosocial c a u s a t i o n m a y b e t h e c o n s e q u e n c e of t h e pervasive inhibition a n d / o r developmental malformation of t h e psychological p r o c e s s e s t h a t u n d e r p i n t h e s e capacities. O u r theory of affect regulation a n d mentalization enables u s to enrich t h e a r g u m e n t s a d v a n c e d by t h e o r i s t s s u c h a s J o h n Bowlby a b o u t t h e evolutionary function of a t t a c h m e n t . We a r g u e t h a t a n evolutionary function, of early object relations is to equip the very y o u n g child with a n e n v i r o n m e n t within which t h e u n d e r s t a n d i n g of m e n t a l s t a t e s in o t h e r s a n d t h e self c a n fully develop. We p r o p o s e t h a t self-reflection a s well a s t h e ability to reflect on o t h e r m i n d s a r e c o n s t r u c t e d capacities t h a t h a v e evolved (or not) o u t of t h e earliest-relationships. Since mentalization is a core a s p e c t of h u m a n social functioning, we c a n infer t h a t evolution h a s placed p a r t i c u l a r value on developing m e n t a l s t r u c t u r e s for interpreting i n t e r p e r s o n a l actions. Language is, of course, t h e major c h a n n e l for symbolic interaction. Yet, in order for language to function adequately, t h e subjective world requires organization. Internal s t a t e s m u s t have a m e a n i n g in

6

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Introduction

order to be c o m m u n i c a t e d to o t h e r s a n d interpreted in o t h e r s to guide collaboration in work, love, a n d play. It should be readily a p p a r e n t t h a t t h i s book places considerable e m p h a s i s on early social experience a s a p r i m a r y m o d e r a t o r of t h e m e n t a l capacities centrally involved in psychological disorders a n d their p s y c h o t h e r a p e u t i c t r e a t m e n t . In t h i s respect t h e work is a c o n t i n u a t i o n of a psychosocial tradition t h a t h a s s e e n parenting practices a n d t h e early social e n v i r o n m e n t a s t h e key to developmental psychopathology (Cicchetti a n d Cohen 1995; A. Freud 1981; M a s t e n a n d Braswell 1991; R u t t e r 1993; Sameroff 1995; Sroufe 1996). We recognize t h a t t h i s perspective, while u n d o u b t e d l y d o m i n a n t in psychiatry a n d social science d u r i n g m o s t of t h e p a s t century, h a s come u n d e r increasing critical scrutiny in t h e light of more recent evidence from behaviorgenetic adoption a n d twin s t u d i e s (Eaves et al. 1997; Hewitt et al. 1997). It is very probably t r u e t h a t p a s t s t u d i e s m i g h t have overestimated t h e influence of t h e social e n v i r o n m e n t on develo p m e n t b e c a u s e t h e y failed to control for genetic influences. We note, however, t h a t c u r r e n t psychiatric literature is showing signs of a r e t u r n of a naively nativist perspective, w h e r e genetic d a t a a r e viewed a s indicating t h a t a psychological level of analysis c a n n o t be productive. Consequently, early e n v i r o n m e n t is given little significance, a n d s u c h significance a s is accorded to it is from a physical r a t h e r t h a n a psychological perspective (e.g., Marenco a n d Weinberger 2000). While it is clear t h a t psychological principles c a n n o t violate the limitations set by t h e neurophysiological capabilities of t h e s y s t e m s t h a t s u b s e r v e t h e m , .this does n o t imply t h e r e d u c t i o n of psychology to biology. In t h i s b o o k we t a k e i s s u e with t h e "geneticization" of h u m a n behavior. We a d o p t a position in line with t h a t of t h e evolutionists D o b z h a n s k y (1972) a n d Gould (1987). We consider t h a t n a t u r e (genetics o r genes) o p e r a t e s a s a "potentialist" r a t h e r t h a n a s a "determinist." Since biological determinism is frequently clothed in t h e l a n g u a g e of malleability a n d interactionism, we note t h a t in reality, b e h i n d t h e s e m o r e palatable portrayals of biology, genes a r e still considered t h e primaryruling force. While changeability of evolved dispositions is acknowledged, t h e s e inherited t r a i t s a r e t h e n s e e n a s predomi-

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7

n a n t . We suggest t h a t t h i s t e n d e n c y c a n occur b e c a u s e of t h e a b s e n c e of convincing d a t a on g e n e - e n v i r o n m e n t interaction. Yet m o d e r n genetics h a s provided ample room for t h e contention t h a t biology h a s c u l t u r e on a "loose" r a t h e r t h a n a "tight leash" (Gould 1987). We a t t r i b u t e t h e failure of behavior geneticists to find convincing evidence for g e n e - e n v i r o n m e n t interaction to their predisposition to s t u d y the "wrong" environment: t h e physical r a t h e r t h a n t h e psychological. We suggest t h a t t h e decline of interest in subjectivity, in t h e m e c h a n i s m t h a t interprets t h e social world, is partly to b l a m e for t h i s g a p in o u r knowledge. We a r g u e t h a t it is t h e m a n n e r in w h i c h t h e e n v i r o n m e n t is experienced t h a t a c t s a s a filter in t h e expression of genotype into phenotype. T h e i n t r a p s y c h i c r e p r e s e n t a t i o n a l p r o c e s s e s t h a t u n derpin t h e agentive self are n o t j u s t t h e c o n s e q u e n c e s of b o t h environmental a n d genetic effects. They m a y acquire additional i m p o r t a n c e a s moderators of t h e effects of t h e environment u p o n t h e unfolding of genotype into p h e n o t y p e . We place mentalization a t t h e h e a r t of t h i s p r o c e s s of moderation, since it is t h e interpretation o f t h e social e n v i r o n m e n t r a t h e r t h a n t h e physical environment t h a t governs genetic expression. T h e s e c o n s i d e r a t i o n s h a v e led u s to reformulate o u r u n d e r s t a n d i n g of t h e i m p a c t of early social relationships on later experience. We move away from t h e model w h e r e a n early relationship is principally s e e n a s t h e g e n e r a t o r of a t e m p l a t e for later r e l a t i o n s h i p s (e.g., Bowlby 1980). Instead, we a r g u e t h a t early experience, n o d o u b t via its i m p a c t on development a t b o t h psychological a n d neurophysiological levels, d e t e r m i n e s t h e "depth" to w h i c h t h e social e n v i r o n m e n t m a y be processed. S u b o p t i m a l early experiences of c a r e affect later development by u n d e r m i n i n g t h e individual's capacity to process or i n t e r p r e t information c o n c e r n i n g m e n t a l s t a t e s t h a t is essential for effective functioning in a stressful social world. Insecurity in a t t a c h m e n t r e l a t i o n s h i p s is a signal of limitation in mentalizing skills. We find t h a t t h e traditional classification of a t t a c h m e n t p a t t e r n s m a y be helpfully reinterpreted in t h i s context a s indication of a relatively good (secure a t t a c h m e n t ) , or relatively poor (insecure a t t a c h m e n t ) capacity to m a n a g e or cope with i n t i m a t e Inter-

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Introduction

p e r s o n a l relationships. An a b s e n c e of mentalizing capacity u n der s t r e s s is signaled by t h e disorganization of t h e a t t a c h m e n t system. So w h a t aspect of t h e e n v i r o n m e n t c a n b e specified a s critical to t h e healthy development of a n agentive or psychological self? Attuned interactions with t h e p a r e n t (Jaffe, Beebe, Feldstein, Crown, a n d J a s n o w 2001; S t e r n 1985) often involve affect-mirroring—that is, t h e p a r e n t ' s u s e of facial a n d vocal expression to represent to t h e child t h e feelings s h e a s s u m e s h i m to h a v e in s u c h a way a s to r e a s s u r e a n d calm r a t h e r t h a n intensify h i s emotions. We see p a r e n t a l affect-mirroring a s i n s t r u m e n t a l in fostering t h e capacity for affect regulation, t h r o u g h t h e creation of a second-order r e p r e s e n t a t i o n for constitutional affect s t a t e s . The image of t h e caregiver mirroring t h e i n t e r n a l experience of t h e infant comes to organize t h e child's emotional experience. T h u s t h e self is n o t merely open to environmental influence: it is in p a r t constituted t h r o u g h its interactions with t h e social envir o n m e n t . Freud, arguably, s a w infancy a s a time w h e n t h e self s a w o t h e r s a s extensions of itself (e.g., F r e u d 1900a). O u r emp h a s i s is t h e reverse—we see t h e self a s originally a n extension of experience of t h e other. We propose two intimately connected developmental theories. Both concern t h e relationship between t h e acquisition of a n u n d e r s t a n d i n g of t h e r e p r e s e n t a t i o n a l n a t u r e of m i n d s on t h e one h a n d a n d affect regulation on t h e other. The social biofeedb a c k theory of p a r e n t a l affect-mirroring explores t h e way in which t h e infant's a u t o m a t i c emotion expression a n d t h e caregiver's c o n s e q u e n t affect-reflective facial a n d vocal displays come to be linked in t h e infant's m i n d t h r o u g h a contingency-detection m e c h a n i s m Identified by J o h n W a t s o n a n d colleagues (Bahrick a n d W a t s o n 1985; Gergely a n d W a t s o n 1996; W a t s o n 1972, 1994). (This m e c h a n i s m is described quite fully in c h a p t e r 4.) The forging of this link h a s two i m p o r t a n t effects: (a) The infants come to associate t h e control t h e y h a v e over their p a r e n t s ' mirroring displays with t h e resulting improvement, in their emotional state, leading, eventually, to a n experience of t h e self a s a regulating agent, (b) T h e e s t a b l i s h m e n t of a second-order representation of affect s t a t e s c r e a t e s - t h e b a s i s for affect regulation a n d impulse control. Affects c a n be m a n i p u l a t e d a n d discharged

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9

internally a s well a s t h r o u g h action; t h e y c a n also b e experienced a s s o m e t h i n g recognizable a n d h e n c e s h a r e d . Affect expressions by t h e p a r e n t t h a t a r e n o t contingent on t h e infant's affect will u n d e r m i n e t h e a p p r o p r i a t e labeling of internal states, w h i c h may, in t u r n , r e m a i n confusing, experienced a s unsymbolized, a n d h a r d to regulate. For affect-mirroring to serve a s t h e b a s i s o f t h e development of a r e p r e s e n t a t i o n a l framework, t h e caregiver m u s t s o m e h o w indicate t h a t h e r display is n o t for real: it is n o t a n indication of how t h e p a r e n t herself feels. We describe this characteristic of t h e p a r e n t ' s mirroring behavior a s its "markedness." A display t h a t is c o n g r u e n t with t h e b a b y ' s s t a t e b u t lacks m a r k e d n e s s m a y overwhelm t h e infant. It is felt to b e t h e p a r e n t ' s own real emotion, m a k i n g t h e infant's experience seem contagious, or universal, a n d t h u s m o r e d a n g e r o u s . In t h e s h o r t term, t h e infant's perception of a corresponding b u t realistic negative emotion is likely to escalate r a t h e r t h a n regulate t h e infant's state, leading to t r a u m a t i z a t i o n r a t h e r t h a n c o n t a i n m e n t . O u r second theory c o n c e r n s t h e n a t u r e of subjectivity before recognition o f t h e r e p r e s e n t a t i o n a l c h a r a c t e r o f t h e h u m a n mind. We suggest t h a t t h e infant's a n d y o u n g child's early a w a r e n e s s of m e n t a l s t a t e s is characterized by t h e e q u a t i o n of t h e internal with t h e external. W h a t exists in the m i n d m u s t exist o u t there, a n d w h a t exists o u t t h e r e m u s t invariably also exist in t h e mind. Psychic equivalence, a s a mode of experiencing t h e internal world, c a n c a u s e i n t e n s e distress, since t h e projection of fantasy to t h e outside world c a n b e terrifying. T h e acquisition of a s e n s e of pretend in relation to-mental s t a t e s is therefore essential. T h e repeated experience of affect-regulative mirroring helps t h e child to learn t h a t feelings do n o t inevitably spill o u t into t h e world. The child's m e n t a l s t a t e is decoupled from physical reality. We suggest t h a t children w h o s e p a r e n t s provide more affect-congrue n t contingent, a n d appropriately m a r k e d , mirroring displays facilitate t h i s decoupling. In c o n t r a s t , t h e displays of p a r e n t s who, b e c a u s e of their own difficulties with emotion regulation, are readily overwhelmed by t h e infant's negative affect a n d prod u c e a realistic u n m a r k e d emotion expression d i s r u p t t h e develo p m e n t of affect regulation. A major opportunity for learning a b o u t t h e difference between r e p r e s e n t a t i o n a l a n d a c t u a l m e n t a l

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Introduction

s t a t e s is lost. We a r g u e t h a t t h e e q u a t i o n of external a n d i n t e r n a l c o n t i n u e s to d o m i n a t e t h e subjective world of individuals with severe personality disorders. Affect-mirroring c a n t a k e pathological p a t h w a y s , b e c a u s e t h e caregiver is overwhelmed by t h e negative affect generated in r e s p o n s e to t h e infant's reaction a n d p r e s e n t s a n overly realistic emotionally a r o u s i n g display. This u n d e r m i n e s n o t only t h e infant's possibility of creating a s e c o n d a r y representation, b u t also t h e s e n s e of a. b o u n d a r y between self a n d o t h e r — a n i n t e r n a l experience s u d d e n l y b e c o m e s external t h r o u g h t h e experience equivalent to contagion. We believe t h a t t h i s c o r r e s p o n d s to t h e clinical characterizations of projective identification, t h e h a b i t ual defense particularly associated with borderline personality disorder (BPD). S u s t a i n e d experience of t h i s kind might, we argue, play a n i m p o r t a n t role in establishing projective identification a s t h e d o m i n a n t form of emotional experience in t h e development of borderline personality. It should be noted t h a t we u s e t h e t e r m "borderline" in t h i s book in t h e s e n s e of a form of pathological personality organization t h a t could b e a likely factor in all serious personality disorder, r a t h e r t h a n j u s t t h e m o r e specific DSM-IV category of personality disorder. Borderline Personality Disorder. T h e model a d v a n c e d in t h i s book is i n t e n d e d to explain borderline p h e n o m e n a in m a n y patients, n o t j u s t t h o s e who meet formal diagnostic criteria. O u r a i m is to c a s t light on t h e n a t u r e of t h e m e n t a l functioning of a larger g r o u p of p a t i e n t s — p e r h a p s t h o s e w h o fit Otto Kernberg's (1967) classical description of borderline personality organization—whose t h i n k ing a n d emotional experience often b e c o m e s massively disorganized a n d regressed in t h e clinical setting, evoking i n t e n s e feelings in t h e t h e r a p i s t (e.g., Rey 1979). T h e emotional lability t h a t is a h a l l m a r k of t h e s e patients.is generally regarded to be a clue to t h e n a t u r e of their d i s t u r b a n c e . Their t h e r a p y rarely takes place w i t h o u t d r a m a t i c e n a c t m e n t s — t h e i r own a n d sometimes their t h e r a p i s t s ' — a n d their i n t e n s e d e p e n d e n c e on t h e therapist increases t h e difficulties o f t h e t r e a t m e n t process. A second type of deviant mirroring s t r u c t u r e is o n e t h a t we feel predisposes to narcissistic personality disorder r a t h e r t h a n to borderline states. W h e n affect-mirroring is appropriately

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11

m a r k e d b u t is n o n c o n t i n g e n t , in t h a t t h e infant's emotion is misperceived by t h e caregiver, t h e b a b y will still feel t h e mirrored affect display to m a p onto h i s p r i m a r y emotion state. However, a s t h i s mirrored s t a t e is i n c o n g r u e n t with t h e infant's a c t u a l feelings, t h e s e c o n d a r y r e p r e s e n t a t i o n created will b e distorted. T h e infant will mislabel t h e primary, constitutional emotional state. T h e self-representation will n o t have strong ties to t h e underlying emotional state. T h e individual m a y convey a n imp r e s s i o n of reality, b u t a s t h e constitutional s t a t e h a s n o t b e e n recognized by t h e caregiver, t h e self will feel empty b e c a u s e it reflects t h e activation of s e c o n d a r y r e p r e s e n t a t i o n s of affect t h a t lack t h e c o r r e s p o n d i n g c o n n e c t i o n s within t h e constitutional self. 2 Only w h e n p s y c h o t h e r a p y g e n e r a t e s mentalized affectivity will t h i s fault line in t h e psychological self be bridged. We h a v e a t t e m p t e d to specify In greater detail t h e psychological m e c h a n i s m t h a t u n d e r p i n s t h e p r o c e s s e s by which p a r e n t a l affect-mirroring deviates from its n o r m a l c o u r s e in t e r m s of o u r concept of t h e alien self. In general we m i g h t say t h a t t h e self a s agent a r i s e s o u t of t h e infant's perception of h i s p r e s u m e d intentionality in t h e m i n d of t h e caregiver. Where p a r e n t a l caregiving is extremely insensitive a n d m i s a t t u n e d , we a s s u m e t h a t a fault is created in t h e construction of t h e psychological self. We follow Winnicott's (1967) suggestion t h a t t h e infant, failing to find himself in t h e m o t h e r ' s m i n d , finds t h e m o t h e r instead. T h e infant is forced to internalize t h e r e p r e s e n t a t i o n of t h e object's state of m i n d a s a core p a r t of himself. B u t in s u c h c a s e s t h e internalized o t h e r r e m a i n s alien a n d u n c o n n e c t e d to t h e s t r u c t u r e s of t h e constitutional self. In t h e case of chronically insensitive or m i s a t t u n e d caregiving, a fault is created in t h e construction of t h e self, whereby t h e infant is forced to internalize t h e r e p r e s e n t a t i o n o f t h e object's s t a t e of m i n d a s a core p a r t of himself. In early development t h i s "alien s e l f is dealt with by externalization; a s mentalization develops, it c a n be increasingly 2

By "constitutional self we mean an individual's biologically determined experiences associated with emotional expressivity as well as temperamental manifestations of affect.

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Introduction

woven into t h e self, creating a n illusion of cohesion. T h u s , t h e y o u n g child showing disorganized a t t a c h m e n t will frequently control a n d m a n i p u l a t e t h e p a r e n t ' s behavior. This is p a r t of a projective identificatory.process whereby h e achieves h i s need to experience his self a s coherent, a n d t h e alien .part of h i s selfs t r u c t u r e a s outside h i s m i n d , by perceiving t h e s e elements within other selves, normally within a p a r e n t . T h e disorganization of t h e self disorganizes a t t a c h m e n t r e l a t i o n s h i p s b y creating a c o n s t a n t need for t h i s projective identification—the externalization o f t h e alien self—in a n y a t t a c h m e n t relationship. The alien self is p r e s e n t in all of u s , b e c a u s e t r a n s i e n t neglect is p a r t of ordinary caregiving; with t h e development of mentalization, a n d given a mid-childhood e n v i r o n m e n t relatively free of t r a u m a , t h e g a p s in t h e self corresponding to n o n c o n t i n g e n t p a r e n t i n g are covered over by t h e self-narratives t h a t t h e r e a s o n ably functioning rnind c a n create. The alien self is mostly pernicious w h e n later experiences of t r a u m a in t h e family or t h e peer g r o u p force t h e child to dissociate from p a i n by u s i n g t h e alien self to identify with t h e aggressor. In t h e s e c a s e s t h e g a p s come to be colonized by t h e image of t h e aggressor, a n d t h e child comes to experience himself a s destructive a n d , in t h e extreme, m o n s t r o u s . T h u s we see i n a d e q u a t e early p a r e n t i n g a s creating a vulnerability t h a t m a y become destructive of development a n d seriously pathogenic if later experience is unfavorable, either in t e r m s of failing to facilitate t h e later development of mentalization or explicitly calling for t h e u s e of t h e faults in selfdevelopment for defensive p u r p o s e s . T h e s e factors interact, a n d the likelihood of surviving psychological a s s a u l t improves if mentalizing is freely available to interpret t h e p e r p e t r a t o r ' s behavior (Fonagy, Steele, Steele, Higgitt, a n d Target 1994). However, brutalization in t h e context of a t t a c h m e n t relationships generates i n t e n s e s h a m e . This, if coupled with a history of neglect a n d a c o n s e q u e n t w e a k n e s s in mentalization, b e c o m e s a likely trigger for violence against t h e self or others, b e c a u s e o f t h e intensity of t h e humiliation experienced w h e n t h e t r a u m a c a n n o t be processed a n d a t t e n u a t e d via mentalization. Unmentalized s h a m e , which r e m a i n s u n m e d i a t e d by a n y s e n s e of d i s t a n c e between feelings a n d objective realities, is t h e n experienced a s

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13

t h e d e s t r u c t i o n of t h e self. We have called it "ego-destructive s h a m e . " T h e u s e of t h e alien, dissociated p a r t of t h e self to c o n t a i n t h e image of t h e aggressor a n d t h e u n t h i n k a b l e affect generated by their a b u s i v e a c t i o n s is a survival strategy for m a n y individuals, s o m e of w h o m we try to describe in this book. T h e defensive u s e of t h e alien p a r t of t h e self is deeply pathogenic, a l t h o u g h initially adaptive. In o u r view it m a r k s t h e development of s e r i o u s personality problems. It involves t h r e e i m p o r t a n t c h a n g e s : (a) a further r e p u d i a t i o n of mentalization, a t least in a t t a c h m e n t contexts, (b) d i s r u p t i o n of t h e psychological self by t h e emergence of a t o r t u r i n g other within t h e self, a n d (c) vital d e p e n d e n c e on t h e physical p r e s e n c e of t h e other a s a vehicle for externalization. T h e s e features, in combination, acc o u n t for m a n y a s p e c t s of disordered functioning in borderline p a t i e n t s . A b u s e d a n d t r a u m a t i z e d individuals, u n a b l e to conceive of t h e m e n t a l s t a t e s t h a t could explain t h e actions of t h e a b u s e r , voluntarily a n d defensively sacrifice their thinking a b o u t i n t e r n a l s t a t e s . While able to t h i n k of m e n t a l s t a t e s in self a n d o t h e r in t h e context of ordinary social relationships, t h e y inevitably b e c o m e conflicted a n d entangled once a relationship b e c o m e s emotionally intense, organized by m e n t a l s t r u c t u r e s t h a t a r e involved in a t t a c h m e n t relationships. T h e a b a n d o n m e n t of mentalizing leaves t h e m with a n i n t e r n a l reality t h a t is domin a t e d by psychic equivalence. T h e s e individuals, like all other patients, organize t h e t h e r a p e u t i c relationship to conform to their u n c o n s c i o u s expectations, except t h a t for t h e m t h e s e expectations h a v e t h e full force of reality a n d t h e r e is n o s e n s e of alternative perspectives. T h e inability to t h i n k a b o u t m e n t a l s t a t e s removes t h e possibility of "narrative smoothing" of t h e basic g a p s in t h e self-structure, a n d t h e alien self emerges in a m a n n e r m u c h clearer for t h e t h e r a p i s t to see a n d experience. Splitting b e c o m e s a d o m i n a n t defense a n d projective identification—the externalization of t h e alien self—an essential p a r t of survival. T h e vehicles for t h e projective identification m u s t be p r e s e n t for t h e p r o c e s s of externalization to function, a n d total d e p e n d e n c y on t h e s e individuals t u r n s into a d o m i n a n t t h e m e . O u r reformulation of t h e significance of t h e early social environment h a s i m p o r t a n t clinical implications. Psychotherapy

14 /

Introduction

with individuals whose early experiences h a v e led to a compromised mentalizing capacity should b e focused on helping t h e m to build this interpersonal interpretive capacity. O n e way of conceptualizing t h e entire p s y c h o t h e r a p e u t i c enterprise m a y . b e a s a n activity t h a t is specifically focused on t h e rehabilitation of this function. The w o r k of m a n y previous theoreticians c a n b e reread in t h e light of o u r reformulation. T h r o u g h o u t t h e b o o k we often point o u t t h a t t h e ideas being advanced h e r e were anticipated in t h e work of great psychoanalytic theoreticians, n o t least those in t h e object-relations tradition. For example, we m a k e m a n y connections with Bion's (1959) t h i n k i n g a b o u t containment. The interpersonal interpretive s t a n c e of t h e h u m a n b r a i n is a n overarching biological c o n s t r u c t (Bogdan 2001): Its limits are a s yet unexplored. O u r c o n c e r n s in t h i s book a r e principally with reflective function a n d mentalization—capacities t h a t a r e likely to t u r n o u t to be specific i n s t a n c e s of t h i s m o r e general capacity. An i m p o r t a n t aim of p s y c h o t h e r a p y , t h e n , if n o t its central aim, is t h e extension of mentalization. With s o m e p a t i e n t s , p a r ticularly t h o s e a t t h e borderline e n d of t h e s p e c t r u m , t h e t h e r a pist's t a s k m a y be considered to be similar to t h a t of t h e p a r e n t who intuitively engages with t h e child's world of psychic equivalence to e m p h a s i z e its r e p r e s e n t a t i o n a l c h a r a c t e r . Integrating the concrete a n d dissociated (pretend) m o d e s of functioning c a n only be a c h i e v e d . t h r o u g h focused work on t h e p a t i e n t ' s c u r r e n t experience of t h e transference. S o m e e n a c t m e n t s on t h e p a r t of b o t h t h e r a p i s t a n d patient are a n inevitable p a r t of t h i s work, since t h e p a t i e n t c a n n o t r e m a i n psychologically close to t h e therapist w i t h o u t externalizing t h e alien p a r t s of t h e self. It is a t these m o m e n t s , w h e n t h e t h e r a p i s t is enacting t h e split-off p a r t of the patient's experience, t h a t t h e p a t i e n t ' s t r u e self m a y b e most accurately observed. Sadly, a l m o s t invariably t h e t h e r a p i s t will have extreme difficulty in c o m m u n i c a t i n g insight a n d u n d e r r standing at s u c h times. It is far m o r e likely, in t h e middle of s u c h turmoil, t h a t t h e t h e r a p i s t ' s rage or terror or b o t h will o b s c u r e h e r vision of t h e patient. Nevertheless, p e r s i s t e n c e a n d a determined focus on u n d e r s t a n d i n g t h e m o m e n t - t o ^ m o m e n t c h a n g e s in t h e patient's experience u s u a l l y p a y s off, a n d t h e p s y c h o t h e r a peutic t r e a t m e n t of even quite severely impaired p a t i e n t s c a n be

Introduction

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15

surprisingly effective ( B a t e m a n a n d Fonagy 1999) a n d lasting (Bateman a n d Fonagy 2001). Not all borderline p a t i e n t s a r e a s severely d i s t u r b e d a s t h e above description implies, a l t h o u g h m o s t have features cont a i n e d in it. If t h e caregiver h a s p r e s e n t e d affect displays to t h e infant t h a t correspond poorly to t h e child's constitutional self-state, affect regulation will b e b a s e d on second-order repres e n t a t i o n s of affects t h a t do n o t have s t r o n g c o n n e c t i o n s with constitutional self-states. I n a c c u r a t e mirroring by t h e caregiver will lead to emotional experiences t h a t c a n n o t be experienced a s "true." Consequently, t h e s e c o n d a r y representational s t r u c t u r e s will not.provide a m e a n s for accessing a n d attributing emotion s t a t e s to t h e self. So w o r d s will n o t form t h e b a s i s for t h e child's emerging ability to t h i n k aboui: h i s or h e r real t h o u g h t s a n d wishes. T h e a i m of p s y c h o t h e r a p y for t h e s e individuals is to r e g e n e r a t e t h e connection between t h e c o n s c i o u s n e s s of a n affect s t a t e a n d Its experience a t t h e constitutional level. We have labeled t h i s "mentalized affectivity"—a t e r m intended to indicate t h e capacity to c o n n e c t to t h e m e a n i n g of one's emotions. The clinical e m p h a s i s on experiential u n d e r s t a n d i n g of one's feelings in a way t h a t e n s u r e s "meaningfulness" is crucial b e c a u s e it serves to establish c o n g r u e n t c o n n e c t i o n s between primary a n d s e c o n d a r y affect-representational s t r u c t u r e s . The focus on emotion e n s u r e s t h a t t h e s e c o n d a r y r e p r e s e n t a t i o n a l s t r u c t u r e s u s e d to t h i n k a b o u t or to reflect o n affect a r e reconnected a n d t h a t m i s c o n n e c t i o n s w h e r e displayed affect w a s tied to a differe n t n o n c o n s c i o u s affect s t a t e a r e corrected. This b o o k is divided into t h r e e p a r t s . T h e first p a r t (chapters 1-3) is theoretical; t h e second p a r t (chapters 4-8) is developmental; t h e third p a r t (chapters 9-11) is clinical. T h e book concludes with a n Epilogue. T h e tripartite division is primarily a m a t t e r of convenience; it is n o t m e a n t to convey t h a t t h e c o m p o n e n t s of t h e c o n t e n t a r e s e p a r a t e . T h e r e a d e r will find, for example, t h a t in t h e theoretical p a r t t h e r e is considerable d i s c u s s i o n of developmental material; t h a t in t h e developmental p a r t t h e r e is import a n t theoretical m a t e r i a l on. t h e self a s well a s t h e introduction of some clinical material. This is deliberate. T h r o u g h o u t t h i s work, we a t t e m p t to integrate theory, development, a n d t h e clinical sphere. We a r e committed to forging a theory t h a t is inspired by

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Introduction

clinical observation a n d rooted in t h e findings of s y s t e m a t i c research. O u r aim is to bring b o t h theory a n d r e s e a r c h to b e a r on clinical practice. The content of t h e c h a p t e r s is a s follows: C h a p t e r 1 offers a n overview of t h e major t h e m e s to be covered in t h e book. We survey t h e links between a t t a c h m e n t theory, s t u d i e s of early social development, a n d s t u d i e s of. cognitive development t h a t focus on one a p p r o a c h to mentalization—the s t u d y o f t h e acquisition of a "theory of mind." We s k e t c h a n outline (to be filled in later) of w h a t we k n o w a b o u t t h e developmental c o u r s e of selforganization a n d t h e developmental deviations t h a t c a n r e s u l t from a n adverse early environment, later t r a u m a , or b o t h . We introduce t h e notion of mentalization a s a potential mediator of psychosocial risk. In c h a p t e r 2, we consider b r o a d intellectual t r e n d s in theories of affect, a c r o s s a r a n g e of disciplines. We suggest t h a t t h e dialectic between t h o s e who see affect a s inevitably disorganizing a n d external to cognitive influence a n d t h o s e w h o a t t e m p t to integrate affect a s a form of cognitive activity m a y be a d d r e s s e d t h r o u g h t h e concept of mentalization a n d — m o r e narrowly— mentalized affectivity. We i n t r o d u c e a distinction between firsta n d second-order r e p r e s e n t a t i o n of affect a n d a r g u e t h a t t h i s distinction is c o n s i s t e n t with d a t a from psychology, n e u r o p h y s i ology, a n d psychoanalytic theories. In c h a p t e r 3, we a d d r e s s t h e challenge posed by r e c e n t a r g u m e n t s a b o u t t h e relative i m p o r t a n c e of g e n e s a n d t h e early environment to a mainly psychosocial model of personality development. It m a y s e e m foolhardy to a d v a n c e a model in w h i c h the capacity for mentalization is rooted in a n a t t a c h m e n t relationship, a t a time w h e n social cognitive capacities a r e increasingly s e e n a s being genetically determined r a t h e r t h a n a s p r o d u c t s of t h e early environment. We c o u n t e r t h i s challenge by arguing t h a t t h e h u m a n capacity for interpreting t h e social environment is a key m o d e r a t i n g influence in t h e expression of genes in p h e n o t y p e s . Mentalization a n d the, family-of capacities to which it belongs (deriving from t h e "interpersonal interpretive mechanism") c a n be either facilitated or r e t a r d e d by a t t a c h m e n t experiences a n d c a n play a key role in creating a n experienced environment. As p a r t of t h i s a r g u m e n t , we p r o p o s e a reorienta-

Introduction

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17

tion of a t t a c h m e n t theory, from a n e m p h a s i s on t e m p l a t e s for relationships, fixed in early infancy, to a model t h a t views att a c h m e n t a s t h e context provided by evolution for t h e developm e n t of i n t e r p e r s o n a l u n d e r s t a n d i n g . C h a p t e r 4 p r e s e n t s in detail o u r developmental model of how a n i n t e r p e r s o n a l interpretive m e c h a n i s m for affect might evolve intersubjectively, in t h e context o f t h e infant-caregiver relationship. T h i s is a p a r s i m o n i o u s model. Traditionally, p s y c h o a n a lytic developmental models h a v e m a d e extravagant a s s u m p t i o n s a b o u t infants' capacities. This w a s one of t h e major foci of the Controversial D i s c u s s i o n s between A n n a F r e u d a n d Melanie Klein (King a n d Steiner 1991). In contrast, o u r m o r e parsimonio u s model is b a s e d on Gergely a n d W a t s o n ' s (1996) Social Biofeedback Theory, w h i c h is, in t u r n , rooted in W a t s o n ' s work on t h e developmental functions of t h e h u m a n infant's sensitivity to contingent r e l a t i o n s h i p s between h i s proprioception (of intentional movement) a n d t h e external world. We a r g u e t h a t t h e internal r e p r e s e n t a t i o n of affect develops a r o u n d t h e m o t h e r ' s mirroring of the infant's e x p r e s s i o n s of affect. T h e caregiver's mirroring display is internalized a n d comes to r e p r e s e n t a n internal state, b u t it c a n do so only in certain conditions, which include sufficient a t t u n e m e n t , together with signaling to t h e infant t h a t t h e affect t h e caregiver is expressing is n o t her own b u t t h e child's. T h i s a c c o u n t will help u s to u n d e r s t a n d a r a n g e of severe pathologies. In c h a p t e r 5, we review developmental r e s e a r c h concerning t h e development of t h e self a s a g e n t r a t h e r t h a n a s r e p r e s e n t a tion. We consider a five-phase model of gradually Increasing sophistication concerning t h e m e n t a l world, b o t h of t h e self a n d of others. In t h i s c h a p t e r we confront t h e critical i s s u e of intersubjectivity, a fraught notion within developmental theory. We a r g u e t h a t i n t e r p e r s o n a l a w a r e n e s s is a relatively late developm e n t a l acquisition. A s s u m i n g a developmental progression toward full i n t e r p e r s o n a l a w a r e n e s s offers u s a rich r a n g e of developmental e x p l a n a t i o n s for psychological d i s t u r b a n c e s . In general, we m a i n t a i n t h r o u g h o u t t h i s volume t h a t personality d i s t u r b a n c e s often reflect t h e reemergence of r u d i m e n t a r y forms of interpersonal a w a r e n e s s — a n a r g u m e n t t h a t is incompatible with t h e a s s u m p t i o n of a n i n h e r e n t (primary) intersubjectivity.

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Introduction

In c h a p t e r 6, we a t t e m p t to apply t h e findings from early developmental r e s e a r c h m o r e directly to c o n s t r u c t a p s y c h o a n a lytic model o f t h e growth of subjectivity. Using clinical a s well a s empirical evidence, we identify two incompatible a n d probably alternating ways in w h i c h y o u n g children t r e a t their i n n e r experiences. The m e n t a l world c a n feel either totally real or totally u n r e a l to a y o u n g child, a n d we suggest t h a t playing with reality, making t h e real u n r e a l a n d vice versa, is t h e principal a v e n u e for the development of mentalization. We i n t r o d u c e t h e c a s e s of two y o u n g children, b o t h treated in psychoanalytic t h e r a p y . "Rebecca" w a s t h e loved child of y o u n g single m o t h e r , a child w h o learned in t h e r a p y to play with h e r painful image of h e r father. This idea h a d initially b e e n too real to b e played with, a n d t h e feelings it generated o b s t r u c t e d h e r otherwise n o r m a l development. In c h a p t e r 7, we i n t r o d u c e "Mat," a far m o r e deprived child. Mat's experience of i n a d e q u a t e mirroring left h i m with u n c o n tained a n d u n c o n t a i n a b l e affect, w h i c h h e experienced a s p a r t of h i s bodily self, in a n effort to create a n illusion of self-control. His encopresis a n d h i s q u a s i - a u t i s t i c features b o t h r e s p o n d e d to a playful t h e r a p e u t i c stance.. In c h a p t e r 8, we consider t h e special c a s e of adolescence, a time of high risk for t h e emergence of s e r i o u s d i s t u r b a n c e . We argue t h a t t h i s is t h e c o n s e q u e n c e of a n increased load on t h e m e n t a l world o f t h e adolescent, b r o u g h t o n by t h e s u d d e n leap in cognitive complexity, s i m u l t a n e o u s l y with p r e s s u r e for separation from t h e p r i m a r y a t t a c h m e n t figures. We consider two cases, 'Tony" a n d "Glen." Both were challenged by t h e s h a r p l y increased complexity of their i n t e r p e r s o n a l worlds, b u t once again they followed quite different p a t h s . We m a i n t a i n t h a t t h i s reflected: critical differences in their early experience, w h i c h equipped one with a far more r o b u s t mentalizing capacity t h a n the other. In t h e two following c h a p t e r s , we d i s c u s s severe personality disorder in a d u l t s , w h i c h we see a s t h e developmental c o n t i n u a tion of poorly established mentalized subjectivity. In c h a p t e r 9, we outline t h e theory t h a t borderline personality disorder r e s u l t s from t h e inhibition of mentalizing d u e to malt r e a t m e n t in childhood. We expect t h a t t h i s kind of inhibition is

Introduction

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19

more likely to o c c u r if, b e c a u s e of i n a d e q u a t e early parenting, t h e p r e c u r s o r s of mentalization were n o t firmly established. Interpersonal interpretive p r o c e s s e s t h a t developmentally anted a t e mentalization a p p e a r to govern t h e behavior of individuals with BPD, a t least within a t t a c h m e n t relationships. In c h a p t e r 10, we link t h e failure of mentalization to a distortion in t h e s t r u c t u r i n g of t h e self; failures of early a t t u n e m e n t a r e expected to c a u s e disorganization within t h e s t r u c t u r e of t h e self-representation. Combined with t r a u m a , t h e s e limitations in t h e integrity of t h e self c a n c a u s e massive d i s r u p t i o n in relationships. Two c a s e s a r e p r e s e n t e d . In t h e first case, "Emma," lack of mentalization w a s evident in h e r t r e a t m e n t of h e r own body—her suicidality a n d m i s m a n a g e m e n t of h e r chronic physical illness. T h e disorganization of h e r self-structure, w h e n externalized onto her body, led to a profound distortion of t h e link to h e r physical experiences. T h e second case, "Henrietta," h a d a history of violence a g a i n s t a lover, a s well a s self-destructiveness. Her functioning a t a prementalistic level profoundly colored h e r analytic relationship. In t h i s c h a p t e r we also consider t h e implications of a disorganized self-structure, with very limited capacity for m e n talization, for o u r u n d e r s t a n d i n g of certain transference a n d countertransference phenomena. Finally, in c h a p t e r 11, we consider four m o r e t h e r a p e u t i c e n c o u n t e r s . E a c h illustrates in a different way t h e centrality of mentalized affectivity in t h e c o u r s e of psychoanalytic therapy. The a i m of t h i s c h a p t e r is to illustrate t h e way misconnections between p r i m a r y a n d second-order r e p r e s e n t a t i o n of affect c a n generate d i s t u r b a n c e s of self-development, which were earlier argued to be t h e c o n s e q u e n c e s of i n a c c u r a t e mirroring. To a d d r e s s s u c h pathologies, t h e t h e r a p y m u s t s i m u l t a n e o u s l y activate p r i m a r y a n d s e c o n d a r y r e p r e s e n t a t i o n s of affect. T h e c a s e s illustrate t h e i m p o r t a n c e of t h e integration of affect a n d cognition in t h e practice of psychoanalytic psychotherapy. T h r o u g h developing s e c o n d - o r d e r r e p r e s e n t a t i o n s for emotional s t a t e s we c a n come to experience o u r subjectivity in a way t h a t bridges two f u n d a m e n t a l n e e d s in h u m a n beings. O n t h e o n e h a n d , we n e e d to m a i n t a i n a s e n s e of t h e internal equilibrium between m e n t a l forces—a struggle t h a t w a s a t t h e h e a r t of F r e u d ' s j o u r n e y of discovery. O n t h e other, we need to be integrated into t h e social

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Introduction

world, in which we m u s t respect t h e s e p a r a t e n e s s of other minds, while being able also to build flexible bridges a c r o s s t h a t s e p a r a t e n e s s , to create close emotional a n d working relationships. Therapy only w o r k s w h e n b o t h intrapsychic a n d interpersonal a i m s are achieved, a n d t h i s is w h e r e we believe t h a t mentalizing affectivity plays a vital role. The Epilogue explores s o m e of t h e implications of o u r ideas for psychopathology a n d p s y c h o t h e r a p y in general.

PART

T H E O R E T I C A L

P E R S P E C T I V E S

In Part I, we offer an introduction to some of the main theoretical concepts used in this book. The first chapter can be thought of as an overture. We offer definitions of self-reflective function and mentalization and, in particular, make the argument that the capacity to mentalize is a key determinant of a psychological sense of self. Yet, mentalization is not simply a cognitive concept, and thus we turn in the second chapter to focus in detail on different perspectives on affects and affect regulation. We clarify the meaning of affect regulation and emphasize the distinction between a basic form of affect regulation where the object is needed to modulate an affect or affects and a more complex form, altered by the development of mentalization, where the aim is to be able to regulate the self. Finally, in the third chapter, we stake out a defense of an environmental position concerning early development, which does not contest the evidence for a geneticbtological position but does challenge some ofthe inferences that are made from it—especially as they are mistranslated into the clinical realm. We also propose here a crucial reformulation of attachment theory: according to our view, a major goal of attachment is to produce a representational systemfor self-states through mentalization.

A t t a c h m e n t a n d Reflective Their Role in

Function:

Self-Organization

This c h a p t e r i n t r o d u c e s t h e idea of a relationship between att a c h m e n t p r o c e s s e s a n d t h e development of t h e capacity to envision m e n t a l s t a t e s in self a n d others—the capacity t h a t is referred to in t h i s book a s mentalization or reflective function. T h r o u g h o u t t h i s book, w e develop t h e a r g u m e n t t h a t t h e capacity to mentalize is a key d e t e r m i n a n t of self-organization a n d affect regulation, a n d we m a i n t a i n t h a t t h i s capacity is acquired in t h e context of t h e child's early social relationships. Here we give a n overview of t h e evidence for a n association between t h e quality of a t t a c h m e n t relationship a n d reflective function in t h e p a r e n t a n d t h e child. We offer some h y p o t h e s e s a b o u t t h e develo p m e n t of reflection in t h e context of t h e infant-caregiver relationship. We t h e n i n t e r p r e t t h e s e d a t a a n d speculations in t h e context of c u r r e n t models of theory-of-mind development.

REFLECTIVE FUNCTION OR MENTALIZATION: A HISTORICAL CONTEXT C o n c e p t s a n d i d e a s a r o u n d t h e notion of affect a n d self a b o u n d a n d have a n extraordinarily rich history in philosophy a n d psychology. Even w i t h o u t a c o m p r e h e n s i v e historical perspective, it 23

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Theoretical Perspectives

s e e m s a p p a r e n t t h a t t h e concept of t h e self a n d allied ideas have, more recently, b e e n experiencing a considerable revival of interest from social scientists a n d developmentalists (e.g., Bracken 1996; Cicchetti a n d Toth 1994). Psychological interest in t h e self is u s u a l l y traced to W. J a m e s ' s (1890, 1892) distinction of two a s p e c t s of t h e self: t h e "I" (self a s subject) a n d t h e "Me" (self a s object). T h e "I" is t h e active a g e n t responsible for constructing t h e self-concept of "Me." To p a r a p h r a s e in t h e t e r m s of c u r r e n t cognitive neuroscience, t h e "Me" is t h e m e n t a l representation, while t h e "I" embodies t h e self a s agent, t h e m e n t a l p r o c e s s e s or functions t h a t u n d e r p i n r e p r e s e n t a t i o n s of t h e self (Mandler 1985). T h e "I" organizes a n d i n t e r p r e t s experience, e n s u r e s t h e experience of continuity t h r o u g h time, c r e a t e s a s e n s e of freedom or initiative, a n d g e n e r a t e s t h e experiences leading to t h e d i s t i n c t n e s s of oneself a s a p e r s o n (see c h a p t e r 5). Modern developmental psychology h a s b r o u g h t u s closer to a full u n d e r s t a n d i n g of t h e m e n t a l p r o c e s s e s t h a t combine to organize t h e r e p r e s e n t a t i o n of selfhood. Developmentalists over t h e p a s t t e n y e a r s h a v e d r a w n o u r attention to t h e n e a r - u n i v e r s a l a n d r e m a r k a b l e capacity of y o u n g children to interpret their own a n d others' behavior by attributing m e n t a l s t a t e s (see c h a p t e r s 3 a n d 4). Reflective function, referred to in developmental psychology a s "theory of mind," is t h e developmental acquisition t h a t p e r m i t s children to respond n o t only to a n o t h e r p e r s o n ' s behavior, b u t to t h e children's conception of others' beliefs, feelings, attitudes, desires, hopes, knowledge, imagination, p r e t e n s e , deceit, intentions, plans, a n d so on. Reflective function, or mentalization, e n a b l e s children to "read" o t h e r people's m i n d s (Baron-Cohen 1995; Baron-Cohen, Tager-Flusberg, a n d C o h e n 1993; Morton a n d Frith 1995). By doing this, children m a k e people's behavior meaningful a n d predictable. Their early experiences with other people enable t h e m to build u p a n d organize multiple s e t s of self-other r e p r e s e n t a t i o n s . As they learn to u n d e r s t a n d other people's behavior better, t h e y become able flexibly to activate t h e representation(s) from t h e s e multiple s e t s t h a t are b e s t suited to respond to particular interpersonal t r a n s a c t i o n s . T h e t e r m "reflective function" (RF) refers to t h e operationalization of t h e psychological p r o c e s s e s underlying t h e capacity to mentalize—a

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concept t h a t h a s b e e n described in b o t h t h e psychoanalytic (Fonagy 1989; Fonagy, E d g c u m b e , Moran, Kennedy, a n d Target 1993) a n d cognitive (e.g., Morton a n d Frith 1995) psychology literatures. Reflective functioning or mentalization is t h e active expression of t h i s psychological capacity intimately related to t h e r e p r e s e n t a t i o n of t h e self (Fonagy a n d Target 1995, 1996; Target a n d Fonagy 1996). RF involves b o t h a self-reflective a n d a n i n t e r p e r s o n a l c o m p o n e n t t h a t ideally provides t h e individual with a well-developed capacity to distinguish inner from o u t e r reality, p r e t e n d from "real" m o d e s of functioning, a n d intrap e r s o n a l m e n t a l a n d emotional p r o c e s s e s from interpersonal communications. T h e i n t e r d e p e n d e n c e of u n d e r s t a n d i n g applied to o t h e r s a n d to t h e self w a s highlighted by t h e second pioneer of psychological self theory, Cooley (1912): "The t h i n g t h a t moves u s to pride a n d s h a m e is n o t t h e m e c h a n i c a l reflection of ourselves, b u t a n i m p u t e d s e n t i m e n t , t h e imagined effect of t h i s reflection u p o n a n o t h e r ' s mind" (p. 153). Developmentally, t h i s m a y be t h o u g h t to imply t h a t a m e n t a l operation is required in early childhood to derive t h e self-state from t h e apperception o f t h e m e n t a l state of t h e other. Exploring t h e m e a n i n g of others' actions is t h e n a p r e c u r s o r of children's ability to label a n d find meaningful their own psychological experiences. This ability arguably underlies the capacities for affect regulation, i m p u l s e control, self-monitoring, a n d t h e experience of self-agency—the building blocks of the organization of t h e self. This b o o k a t t e m p t s to trace t h e stages of acquisition of reflective function or mentalization, its roots in a t t a c h m e n t , t h e relationship with t h e development of self-organization, a n d t h e p a r t i c u l a r role of emotional experience. T h i s is highlighted in t h e final chapter, on mentalized affectivity. The notion of reflective function is rooted in D e n n e t t ' s (1978, 1987, 1988) p r o p o s a l t h a t t h r e e s t a n c e s are available in t h e prediction of behavior: t h e physical stance, t h e design stance, a n d t h e intentional s t a n c e . He t a k e s predicting t h e behavior of a chess-playing c o m p u t e r a s h i s example. At its simplest this c a n be b a s e d on knowledge of t h e physical properties of t h e m a c h i n e (the physical stance). T h e design s t a n c e would be b a s e d on knowledge o f t h e design o f t h e c o m p u t e r , including t h e program-

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ming t h a t h a d gone into its development. T h e third a p p r o a c h consists of predicting w h a t might be t h e c o m p u t e r ' s m o s t rational move. Here we a t t r i b u t e to t h e c o m p u t e r certain beliefs a n d desires—in other words, regulation by intentional; s t a t e s . Dennett's t h e s i s is t h a t explanation in t e r m s of s u c h s t a t e s of m e a n i n g provides good g r o u n d s for predicting h u m a n behavior— t h e only g r o u n d s accessible to all of u s — t h i s knowledge is embodied in t h e theory of m i n d of folk psychology ( C h u r c h l a n d 1986; Fodor 1987; Mele 1992). l T h e o r y of mind" is a n interconnected set of beliefs a n d desires, a t t r i b u t e d to explain a p e r s o n ' s behavior. T h e theory-ofmind concept h a s great explanatory value. Philosophers of m i n d (Hopkins 1992; Wollheim 1995) h a v e extended D e n n e t t ' s approach to e x a m i n e u n c o n s c i o u s processes. They illustrated t h a t one of F r e u d ' s s u b s t a n t i v e c o n t r i b u t i o n s w a s to extend folk psychology to u n c o n s c i o u s m e n t a l s t a t e s , a theory of u n c o n scious mind, t h u s m a k i n g t h o s e a s p e c t s of behavior meaningful t h a t — u s i n g t h e ordinary c o n s t r u c t s of intentionality—make little s e n s e (e.g., d r e a m s , n e u r o t i c s y m p t o m s , h u m o r ) . T h e s e behaviors m a y be u n d e r s t o o d if we a d d u n c o n s c i o u s beliefs, t h o u g h t s , feelings, a n d desires to o u r everyday model of t h e mind. For r e s e a r c h p u r p o s e s , we h a v e operationalized mentalization a s reflective function (Fonagy et al. 1998): we h a v e developed a tool by m e a n s of w h i c h t h e ability to give plausible interpretation of one's own a n d others' behavior in t e r m s of underlying m e n t a l s t a t e s c a n be m e a s u r e d . This implies a w a r e n e s s t h a t experiences give rise to certain beliefs a n d emotions, t h a t p a r t i c u l a r beliefs a n d desires tend to r e s u l t in certain k i n d s of behavior, t h a t t h e r e are t r a n s a c t i o n a l relationships between beliefs a n d emotions, a n d t h a t p a r t i c u l a r developmental p h a s e s or relations h i p s are associated with certain feelings a n d beliefs. We do n o t expect a n individual to articulate t h i s theoretically, b u t to demo n s t r a t e it in t h e way they interpret events within a t t a c h m e n t relationships w h e n a s k e d to do so. Individuals differ in t h e

1

Dennett's formulation is perhaps unnecessarily restrictive (Bolton and Hill 1996). It does not address predicting the behavior of systems that do not function rationally.

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extent to which they a r e able to go beyond observable p h e n o m e n a to give a n a c c o u n t of their own or others' actions in t e r m s of beliefs, desires, p l a n s , a n d so on. This cognitive capacity is a n i m p o r t a n t d e t e r m i n a n t of individual differences in self-organization a s it is intimately involved with m a n y defining features of selfhood s u c h a s self::consciousness, a u t o n o m y , freedom, a n d responsibility (Bolton a n d Hill 1996; C a s s a m 1994). Intentional s t a n c e , in t h e b r o a d s e n s e considered h e r e (i.e., including a p p a r ently irrational u n c o n s c i o u s acts), c r e a t e s t h e continuity of selfexperience t h a t is t h e u n d e r p i n n i n g of a c o h e r e n t self-structure. It is i m p o r t a n t n o t to conflate reflective function with introspection. Bolton a n d Hill (1996) note t h a t t h e w e a k n e s s of introspection is to define m e n t a l s t a t e s in t e r m s of c o n s c i o u s n e s s or self-report r a t h e r t h a n , a s here, in t e r m s of their capacity to m a k e s e n s e of, a n d t h u s regulate, behavior. Introspection or selfreflection is quite different from reflective function a s t h e latter is a n a u t o m a t i c procedure, u n c o n s c i o u s l y invoked in interpreting h u m a n - action. We see introspection a s a n overlearned skill, which m a y be systematically misleading in a way t h a t is m u c h more difficult to detect a n d correct t h a n m i s t a k e s in c o n s c i o u s a t t r i b u t i o n s would be. T h e s h a p e a n d coherence lent to selforganization b y reflective function is entirely outside a w a r e n e s s , in c o n t r a s t to introspection, w h i c h h a s a clear impact on experience of oneself. Knowledge of m i n d s in general, r a t h e r t h a n self-knowledge, is,the defining feature; introspection is t h e application o f t h e theory of m i n d to one's own m e n t a l states.

The P s y c h o a n a l y t i c C o n c e p t of R e f l e c t i v e F u n c t i o n Various n o t i o n s h a v e b e e n introduced in t h e psychoanalytic literature to d e n o t e m e n t a l p r o c e s s e s t h a t overlap with t h e cons t r u c t of mentalization, u n d e r p i n n e d by RF. S p a c e does n o t permit a n e x h a u s t i v e review, b u t some of t h e s e should be mentioned, a s t h e y m a y a s s i s t t h e r e a d e r in m a k i n g links between t h e c u r r e n t c o n s t r u c t s a n d t h o s e proposed by other writers. Mentalization h a s b e e n described in t h e psychoanalytic literat u r e u n d e r v a r i o u s h e a d i n g s (see t h e excellent review by Lecours a n d B o u c h a r d 1997). All s u c h notions derive from

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F r e u d ' s initial concept of "Bindung" or linking. In h i s distinction between primary a n d s e c o n d a r y processes, F r e u d (1911b) stressed b o t h t h a t "Bindung" w a s a qualitative c h a n g e from a physical (immediate) to a psychic associative quality of linking a n d t h a t t h e psychic working o u t or r e p r e s e n t i n g of i n t e r n a l state of affairs (conceived of in energic terms) failed in v a r i o u s ways (Freud 1914c). Some m i g h t a r g u e t h a t Melanie Klein's notion of t h e depressive position (Klein 1945) is a t least analogous to t h e notion of t h e acquisition of RF, w h i c h necessarily entails t h e recognition of h u r t a n d suffering in t h e other a s well a s t h a t of one's own role in t h e process. Wilfred Bion (1962a, 1962b), in describing t h e "alpha-function," delineated t h e t r a n s formation of i n t e r n a l events experienced a s concrete ("beta-elements") into tolerable t h i n k a b l e experiences. Similarly to t h e c u r r e n t conception, Bion also s a w t h e m o t h e r - c h i l d relationship a s a t t h e root of t h e symbolic capacity. Winnicott (1962) also recognized t h e i m p o r t a n c e of t h e caregiver's psychological und e r s t a n d i n g of t h e infant for t h e emergence of t h e t r u e self. Winnicott w a s also foremost a m o n g psychoanalytic t h e o r i s t s of self-development (e.g., Fairbairn 1952; Kohut 1977) in recognizing t h a t t h e psychological self develops t h r o u g h t h e perception of oneself in a n o t h e r p e r s o n ' s m i n d a s t h i n k i n g a n d feeling. P a r e n t s w h o c a n n o t reflect with u n d e r s t a n d i n g on their child r e n ' s i n n e r experiences a n d r e s p o n d accordingly deprive their children of a core psychological s t r u c t u r e , w h i c h t h e y n e e d to build a viable s e n s e of self. Independently, F r e n c h p s y c h o a n a l y s t s developed a notion of mentalization t h a t w a s largely formulated from t h e economic point of view. Pierre Marty d i s c u s s e d mentalization a s a protecr rive buffer in t h e p r e c o n s c i o u s s y s t e m t h a t p r e v e n t s progressive disorganization (Marty 1968). He considers mentalization a s connecting drive excitations a n d m e n t a l r e p r e s e n t a t i o n s a n d thereby creating b o t h "fluidity" a n d "constancy" (Marty 1990, 1991). Mentalization e n s u r e s freedom in t h e u s e of a s s o c i a t i o n s a s well a s p e r m a n e n c e a n d stability. At t h e s a m e time Pierre Luquet (1981, 1988) d i s c u s s e d t h e development of different forms of thinking a n d t h e reorganization of i n n e r experience alongside t h i s development. In h i s c h a p t e r on a theory of language (Luquet 1987), h e distinguished p r i m a r y mentalization

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(which we would consider t h e a b s e n c e of RF) from s e c o n d a r y symbolic mentalization. While this form of mentalization w a s still seen a s closely connected to sensory d a t a a n d primary u n c o n scious fantasies, it w a s nevertheless also s e e n a s representative of t h e s e p r o c e s s e s a n d observable in d r e a m s , art, a n d play. His third level w a s verbal t h o u g h t , w h i c h h e considered m o s t d i s t a n t from bodily processes. Similar ideas were proposed by Andre Green (1975), H a n n a Segal (1957), a n d J o y c e McDougall (1978); a n d , m o r e recently, by A u e r b a c h (1993; A u e r b a c h a n d Blatt 1996), B u s c h (1995), a n d F r o s c h (1995).

T h e o r i e s C o n c e r n i n g t h e D e v e l o p m e n t of M e n t a l i z a t i o n B a r o n - C o h e n a n d S w e t t e n h a m appropriately a s k : "how o n e a r t h c a n y o u n g children m a s t e r s u c h a b s t r a c t c o n c e p t s a s belief (and false belief) w i t h s u c h ease, a n d roughly a t t h e s a m e t i m e t h e world over" (1996, p. 158)? Their a n s w e r is t h a t of modularity theorists, along t h e lines of C h o m s k y ' s solution to t h e problem of t h e acquisition of a knowledge of syntax. They p o s t u l a t e a n i n n a t e (learning) m e c h a n i s m with a specific location in t h e b r a i n (see also B a r o n - C o h e n 1995; Leslie 1994; G. Segal 1996). Other c u r r e n t psychological theories s t r e s s t h e cognitive p r e c u r s o r s of theory of m i n d . S o m e favor t h e folk-psychology, theory-theory, a p p r o a c h , w h i c h a s s u m e s t h a t t h e child evolves a scientifictheory-like n e t w o r k of i n t e r d e p e n d e n t propositions a b o u t t h e mind on -the b a s i s of experience (e.g., Botterill 1996; Gopnik 1996). O t h e r s a s s u m e t h a t theory of m i n d is acquired via simulation of t h e m e n t a l s t a t e of t h e other, either t h r o u g h m a k i n g inferences from w h a t we ourselves would do in t h e imagined c i r c u m s t a n c e s (e.g., G o l d m a n 1993; P. L. Harris 1992) or a n even m o r e radical a s s u m p t i o n of imagined transformation into t h e o t h e r w h i c h does n o t involve introspection or inference (Gordon 1992, 1995). These, a n d o t h e r theories, a r e considered in greater detail in c h a p t e r 5. Both s i m u l a t i o n a n d t h e o r y - t h e o r y models m a y a t first glance a p p e a r to e m p h a s i z e social-learning a s p e c t s of t h e development of mind-reading, b u t on closer s c r u t i n y their focus is a t t h e level of m e c h a n i s m r a t h e r t h a n content. They question h o w a n d w h e n

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t h e child acquires knowledge of other m i n d s in a n a b s t r a c t s e n s e a n d do not a s k w h a t t h e child feels a b o u t t h e m e n t a l s t a t e s h e e n c o u n t e r s in others. Yet, in this context a t least, t h e q u e s t i o n of knowledge a n d t h a t of emotional investment a r e evidently closely related. The child m a y k n o w w h a t t h e o t h e r feels b u t care little or n o t a t all a b o u t this; alternatively, t h i s information may, for some y o u n g s t e r s , be a n i s s u e of survival. T h e emotional significance of m e n t a l s t a t e s d e t e r m i n e s t h e evolution of t h e capacity or s t r u c t u r e available for processing, b u t t h i s is n o t u s u a l l y a d d r e s s e d . C u r r e n t models of theory-of-mind development t e n d to portray t h e child a s a n isolated processor of information, w h o c o n s t r u c t s a theory of m i n d u s i n g biological m e c h a n i s m s t h a t have a n expectable failure r a t e w h e r e t h e child's e n d o w m e n t is less t h a n optimal. From t h e viewpoint of developmental psychopathology a n d its psychosocial t r e a t m e n t , this is a b a r r e n picture, w h i c h ignores t h e central role of t h e child's emotional relationship with t h e p a r e n t s in fostering t h e capacity to u n d e r s t a n d interactions in psychological t e r m s . T h e development of children's u n d e r s t a n d ing of m e n t a l s t a t e s is e m b e d d e d within t h e social world of t h e family, with its network of complex a n d often intensely emotionally charged relationships, w h i c h are, after all, m u c h of w h a t early reflection n e e d s to c o m p r e h e n d . Therefore it s h o u l d n o t s u r p r i s e u s t h a t t h e n a t u r e of family interactions, t h e quality of p a r e n t a l control (Dunn, Brown, Slomkowski, Telsa, a n d Youngblade 1991), p a r e n t a l talk a b o u t emotions (Denham, Zoller, a n d C o u c h o u d 1994), a n d t h e d e p t h of p a r e n t a l d i s c u s s i o n involving affect (Dunn, Brown, a n d Beardsall 1991) are all strongly associated with t h e acquisition of t h e intentional s t a n c e in observational studies. T h e involvement of t h e family in t h e child's acquisition of a theory of m i n d is further highlighted- by t h e r o b u s t finding t h a t t h e p r e s e n c e of older siblings in t h e family a p p e a r s to improve t h e child's performance on a r a n g e of falsebelief t a s k s (Jenkins a n d Astington 1996; Perner, Ruffman, a n d Leekam 1994; Ruffman, Perner, Naito, Parkin, a n d Clements 1998). Modular a c c o u n t s of theory-of-mind development h a v e difficulty with s u c h d a t a . Neither t h e t h e o r y - t h e o r y n o r t h e simulation a c c o u n t adequately covers t h e social origins of t h i s critical

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a s p e c t of self-organization. In t h e theory-theory a c c o u n t , m e n t a l c o n c e p t s a r e t h o u g h t to develop within a n e t w o r k of interdep e n d e n t c o n c e p t s on t h e b a s i s of d a t a from t h e social world, b u t t h e s o c i a l w o r l d does n o t generally "give" concepts to t h e child; r a t h e r , it provides h i m with d a t a for concept-building. In t h e simulation model, m e n t a l - s t a t e c o n c e p t s a r e t h o u g h t to arise from introspection, b u t t h i s begs t h e question of how children come to t h i n k of their own m e n t a l s t a t e s a s feelings, beliefs, wishes, a n d so on. This c h a p t e r a n d t h e book a s a whole explore t h e role of p a r e n t - c h i l d relationships in t h e transformation of prereflective experience of m e n t a l s t a t e s into reflective u n d e r s t a n d i n g of t h e m . Both social models of m i n d - r e a d i n g m a y have their place here; t h e p r e d o m i n a n c e of one or other r o u t e to u n d e r s t a n d i n g t h e m i n d m a y be a function of individual differences between children, b u t , in o u r view, a satisfactory model m u s t b e rooted in t h e child's relationships with a t t a c h m e n t figures.

T H E DEVELOPMENTAL ROOTS OF REFLECTIVE FUNCTION IN INFANCY The "Teleological" S t a n c e There is general a g r e e m e n t t h a t self-organization initially entails t h e integration of body-related experiences, defining t h e physical b o u n d a r i e s of self a n d world (e.g., Brownell a n d Kopp 1991). Once t h e physical self h a s b e e n established, social exchanges, t h e identifications of social b o u n d a r i e s , a n d , s o m e w h a t later, the identification of social causality become central self-functions. T h e p a r e n t ' s recognition of t h e child's intentional s t a n c e (Dennett 1978), however, is c o m m u n i c a t e d nonverbally, beginning a t birth. Between b i r t h a n d t h e age of 5 m o n t h s , face-toface e x c h a n g e s of affective signals between infant a n d caregiver (Beebe, L a c h m a r m , a n d Jaffe 1997; Tronick 1989) play a key role in the development of t h e child's r e p r e s e n t a t i o n of affect. For example, u s i n g a microanalytic observational paradigm, t h e p r o g r a m of w o r k reported by Beatrice Beebe, F r a n k Lach^

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m a n n , a n d J o s e p h Jaffe over t h e p a s t two d e c a d e s h a s d e m o n strated, a m o n g o t h e r things: 1. t h a t t h e h u m a n infant e n t e r s into interaction with t h e caregiver, w h i c h involves b o t h self-regulation a n d sensitivity to t h e s t a t e of t h e other; 2. t h a t a t t h e level of facial expression t h e r e is a rapid, m u t u a l l y influencing p r o c e s s w h e r e t h e infant's behavior over a twelfth- of- a-second time period is predicted by t h e m o t h e r ' s a n d vice versa, p r e s u m a b l y on t h e b a s i s of s c h e m a t a of t h e anticipated reaction of t h e other; 3. t h a t t h e s p a c e a n d degree of c o n t a c t between infant a n d caregiver is systematically altered by b o t h , again a p p a r e n t l y on t h e b a s i s of expectancies; 4. t h a t a higher degree of coordination predicts precocious cognitive performance, w h e r e a s lower levels of coordination a r e optimal for s e c u r e a t t a c h m e n t a n d e a s y t e m p e r a m e n t ; 5. t h a t interaction (coordination) with a s t r a n g e r a t 4 m o n t h s is more predictive of t h e infant's behavior with t h e m o t h e r in t h e S t r a n g e Situation (SSn) 2 a t 1 year t h a n is t h e s a m e m e a s u r e with t h e r m o t h e r herself. Interactions a t t h i s stage m a y be a r g u e d to be presymbolic in t h a t t h e y a r e n o t mentalized; t h e infant is n o t required to repres e n t t h e t h o u g h t s or feelings of t h e caregiver. However, t h e y involve reference to future s t a t e s , s u c h a s goals, in explaining t h e behavior of t h e other. T h u s t h e y c a n b e u s e d to predict behavior, a l t h o u g h t h e s e s t r u c t u r e s would b e limited in their capacity to modify behavior. The m e n t a l models t h u s created (Johnson-Laird a n d Byrne 1991, 1993) do n o t have t h e informa-

2 The Strange Situation is a 20-minute laboratory test where the child Is exposed to two "minuscule separations" of a maximum of 3 minutes each. Mary Ainsworth and her colleagues (Ainsworth et al. 1978) found that the majority of middle-class 1-year-old children respond to the mother with proximity-seeking and relief at reunion (securely attached—B infants), but about 25% respond with subtle signs of indifference (anxious avoldantly attached—A infants), and a further 15% respond with proximity-seeking but little relief at reunion (anxious reslstantly attached—C infants).

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tion required to c h a n g e t h e other's s t a t e of m i n d . This would require a n intentional s t a n c e (Dennett 1983) where, in addition to prediction, t h e p e r s o n ' s beliefs a n d desire s t a t e s a r e represented. Work by Gergely a n d Csibra (1996; Gergely, Nadasdy, Csibra, a n d Biro 1995) s u g g e s t s t h a t by t h e second half of t h e first y e a r infants' perception of social contingencies is "teleologicaT in t h a t t h e y m a k e reference to future s t a t e s (goals) a s explanatory entitles in t h e interpretation of behavior b a s e d on t h e principle of "rational action." (This work is reviewed in full in c h a p t e r 5.) Infants apply t h e ideological s t a n c e t o . h u m a n a n d n o n h u m a n objects alike. S t u d i e s by Gergely a n d Csibra (1997) d e m o n s t r a t e t h a t infants e x p r e s s s u r p r i s e w h e n n o n h u m a n b u t moving objects (e.g., various-sized d i s k s in a computer-generated a n i m a t e d display) a p p e a r to a c t "irrationally"—not choosing the optimal action, given specific goals a n d reality constraints. The infant is a s s u m e d to extend teleological models beyond the prediction of h u m a n behavior. Teleological models, however, evolve into mentalizing o n e s in t h e restricted d o m a i n of h u m a n action. They b e c o m e fully mentalizing once r e p r e s e n t a t i o n s of future goal s t a t e s come to be t h o u g h t of a s desires a n d cons t r a i n t s on reality come to be t h o u g h t of in t e r m s of t h e agent's belief a b o u t physical reality. T h e infant's behaviors in dyadic interactions a r e u n d e r p i n n e d by their evolving model of rational action on t h e p a r t of t h e caregiver. We a r g u e t h a t t h e developm e n t from teleological to mentalizing models will depend on t h e quality of i n t e r p e r s o n a l interactions between t h e infant a n d t h e parent. It s h o u l d b e noted t h a t while s u c h models m a y merely represent rational action, it is t h e perceived r a t h e r t h a n a c t u a l rationality of a n a c t t h a t defines t h e teleological model. T h u s , m i s a p p r e h e n s i o n of reality c o n s t r a i n t s (e.g., a s s u m e d dangerousness) will provide a n d create a model where action t h a t is clearly irrational from a n external s t a n d p o i n t is nevertheless seen a s b a s e d on t h e principle of rational action. The predictive significance o f t h e infant's r e s p o n s e , t o a s t r a n g e r (Beebe et al., 1997) s u g g e s t s t h a t r e p r e s e n t a t i o n s (working models) of selfother relations, even w h e n n o t yet mentalized, begin to vary in quality in t h e first year, a n d t h i s quality is related to i n f a n t p a r e n t interactions, a s observed in t h e laboratory situation. If sufficiently c o h e r e n t to be generalized to other relationships in

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characteristic ways, they m a y index p r o c e s s e s t h a t a r e crucial to t h e creation of a s e c u r e m o t h e r - i n f a n t b o n d .

Representational Mapping Representational m a p p i n g is likely to u n d e r p i n t h e g r a d u a l move in infancy from teleological to mentalizing models of m i n d . Between t h e ages of 6 a n d 18 m o n t h s , t h e child b e c o m e s increasingly able to m a t c h h i s m e n t a l s t a t e with t h a t of t h e caregiver vis-a-vis a third object or person, as, for example, in requesting joint attention (Bretherton 1991a). T h e c o m m u n i c a t i o n is evidently deliberate (goal-oriented) since children m a y b e observed a t this p h a s e trying to repair failed communicative b i d s (Golinkoff 1986) a n d t h u s showing a t least r u d i m e n t a r y recognition of a w a r e n e s s a n d agency in self a n d other, including feelings, perceptions, a n d i n t e n t i o n s (Wellman 1993). Neisser (1991) suggested t h a t , b a s e d on p e r c e p t u a l processes, two p r e c o n c e p t u a l a s p e c t s of t h e self emerge: t h e ecological a n d t h e interpersonal. While t h e former involves self-awareness in reference to visuospatial, tactile, auditory, a n d other p e r c e p t u a l information concerning t h e child's nonsocial s u r r o u n d i n g s , t h e latter is generated via t h e coperception of a c t i o n s of t h e self a n d related contingent actions of others. Taking S t e r n ' s (1985) a n d Neisser's formulation of t h e interpersonal self together, we c a n identify t h r e e a s p e c t s of t h e intersubjective development of t h e self, which M u n d y a n d Hogan (1994) t e r m " i n s t r u m e n t a l action states," "sensory or perceptual action states," a n d "affective action states." Rogers a n d Pennington (1991) offered a model o f t h e cognitive b a s i s for s u c h a n intersubjective p r o c e s s i n . t h e i r concept of r e p r e s e n t a t i o n a l m a p p i n g (the p r o c e s s of coordinating r e p r e s e n t a t i o n s of self a n d other), w h i c h is t h o u g h t to underlie t h e s h a r i n g of affect, attention, a n d higher-order a s p e c t s of cognition s u c h a s beliefs. T h e existence of imitation skills from t h e n e o n a t a l stage r e p r e s e n t s s t r o n g evidence for t h e model (Meltzoff a n d Gopnik 1993). T h e acquisition of a n appreciation of m e n t a l s t a t e s , however, goes b e y o n d mirroring. T h e development of a n u n d e r s t a n d i n g of affect in self a n d other m a y be a good illustration of t h e role of r e p r e s e n t a t i o n a l at

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m a p p i n g in t h e development of reflective abilities (Gergely a n d Watson 1996; Target a n d Fonagy 1996). Anxiety, for example, is for t h e .infant a "confusing m i x t u r e of physiological c h a n g e s , ideas, a n d behaviors. W h e n t h e m o t h e r reflects, or mirrors, t h e child's anxiety, t h i s perception organizes t h e child's experience, a n d h e n o w "knows" w h a t he is feeling. T h e m o t h e r ' s r e p r e s e n t a tion of t h e infant's affect is r e p r e s e n t e d by t h e child a n d is m a p p e d o n t o t h e r e p r e s e n t a t i o n of its self-state. T h e discrepancy between t h e s e is helpful insofar a s it provides organization for the self-state, a n d t h u s t h e caregiver's mirroring c a n become t h e higher-order r e p r e s e n t a t i o n o f t h e child's experience. Within this model, mirroring would b e expected to fail if it is either too close to t h e infant's experience or too remote from it. If t h e mirroring is too a c c u r a t e , t h e perception itself c a n become a s o u r c e of fear, a n d it loses its symbolic potential. If it is a b s e n t , n o t readily forthcoming, o r c o n t a m i n a t e d with t h e m o t h e r ' s own p r e o c c u p a tion, t h e p r o c e s s of self-development is profoundly compromised. We m a y p r e s u m e t h a t individuals for w h o m t h e s y m p t o m s of anxiety signify c a t a s t r o p h e s (e.g., h e a r t a t t a c k , i m m i n e n t d e a t h , etc.) have m e t a r e p r e s e n t a t i o n s of their emotional r e s p o n s e s which c a n n o t limit their intensity t h r o u g h symbolization, perh a p s b e c a u s e t h e original mirroring by t h e primary caregiver exaggerated t h e infant's emotions. Although this idea is speculative, it is empirically testable. It might help to a n s w e r t h e t h o r n y question of why individuals with p a n i c disorders a r e so t h r e a t e n e d by physiologically relatively mild d i s t u r b a n c e s of their equilibrium. T h e suggestion here is t h a t t h e m e t a r e p r e s e n t a t i o n , or symbolic representation, of affect in t h e s e c a s e s c o n t a i n s too m u c h of t h e p r i m a r y experience; hence, i n s t e a d of labeling t h e experience in s u c h a way a s to enable t h e individual to a t t e n u a t e its intensity, it t e n d s to stimulate a n d exacerbate s y m p t o m s of t h e affect state, which in t u r n a c c e n t u a t e s t h e s e c o n d a r y expression, in a cycle of escalating panic. 3 In o n e s t u d y (Fonagy, Steele, et al. 1995), we h a v e confirmed t h a t m o t h e r s w h o soothe their distressed 8 - m o n t h olds m o s t effectively following a n injection rapidly reflect t h e 3 In terms of linguistic theory, one may say that the slgnifler is not sufficiently "demotlvated"—in other words, it resembles the signified too closely.

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child's emotion, b u t t h i s mirroring is c o n t a m i n a t e d by displays of affect t h a t a r e incompatible with t h e child's c u r r e n t feeling (smiling, questioning, mocking display, a n d t h e like). In displaying s u c h "complex, affect" (Fonagy a n d Fonagy 1987), t h e y ens u r e t h a t t h e infant recognizes their emotion a s analogous, b u t not identical, to their experience, a n d t h u s t h e p r o c e s s of symbol formation m a y begin. In t h i s way, t h e r e p r e s e n t a t i o n a l m a p p i n g between affect of self a n d emotions of others, t h e e x c h a n g e of affect between y o u n g child a n d caregiver, provides a u n i q u e s o u r c e of information to t h e child a b o u t h i s own i n t e r n a l states. We suggest t h a t t h e m e a n i n g or s e n s e of affect develops o u t of t h e integrated r e p r e s e n t a t i o n of t h e affect in self a n d other. The combination of t h e r e p r e s e n t a t i o n of self-experience a n d t h e r e p r e s e n t a t i o n of t h e reaction of t h e caregiver e l a b o r a t e s t h e child's teleological model of t h e m i n d a n d ultimately e n a b l e s h i m to u n d e r s t a n d affective displays in others, a s well.as arriving a t t h e regulation of h i s own emotions. T h e r e p r e s e n t a t i o n a l m a p ping of emotion displays a n d self-experience is s e e n here a s a prototypical i n s t a n c e of caregiver sensitivity, which, a s we att e m p t to d e m o n s t r a t e , is likely to be a n i m p o r t a n t c o m p o n e n t of t h e development of mentalizing. T h e sensitivity of t h e caregiver p r o m p t s t h e child to begin organizing self-experience according to c l u s t e r s of r e s p o n s e s t h a t will eventually come to be verbally labeled a s specific emotions (or desires). T h e high contingent r e s p o n s e is t h e m e a n s by w h i c h t h i s m a p p i n g c a n t a k e place. T h e child's affective experiences a r e given further m e a n i n g by becoming associated with c l u s t e r s of reality c o n s t r a i n t s within t h e p a r e n t - i n f a n t interaction (leading to r u d i m e n t a r y beliefs a b o u t t h e c a u s e s a n d c o n s e q u e n c e s of h i s emotional state).

REFLECTIVE FUNCTION AND ATTACHMENT SECURITY IN T H E PARENT A t t a c h m e n t theory, developed by J o h n Bowlby (1969, 1973, 1980), p o s t u l a t e s a universal h u m a n need to form close affectional b o n d s . At its core is t h e reciprocity of early relationships, which is a precondition of n o r m a l development probably

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In all m a m m a l s , including h u m a n s (Hofer 1995). T h e a t t a c h m e n t behaviors of t h e h u m a n infant (e.g., proximity-seeking, smiling, clinging) a r e reciprocated by a d u l t a t t a c h m e n t behaviors (touching, holding, soothing), a n d t h e s e r e s p o n s e s s t r e n g t h e n t h e a t t a c h m e n t behavior of t h e infant toward t h a t particular a d u l t . T h e activation of a t t a c h m e n t behaviors dep e n d s on t h e infant's evaluation of a r a n g e of environmental signals, w h i c h r e s u l t s in t h e feeling of security or insecurity. T h e experience of security is t h e goal of t h e a t t a c h m e n t system, which is t h u s first a n d foremost a regulator of emotional experience (Sroufe 1996). In t h i s s e n s e it lies a t t h e h e a r t of m a n y forms of m e n t a l disorder a n d t h e entire p s y c h o t h e r a p e u t i c enterprise. None of u s is b o r n with t h e capacity to regulate o u r own emotional reactions. A dyadic regulatory s y s t e m evolves where the infant's signals of m o m e n t - t o - m o m e n t c h a n g e s in h i s s t a t e are u n d e r s t o o d a n d r e s p o n d e d to by t h e caregiver, thereby achieving their regulation. T h e infant l e a r n s t h a t a r o u s a l in t h e presence of t h e caregiver will n o t lead to disorganization beyond his coping capabilities. T h e caregiver will b e t h e r e to reestablish equilibrium. In s t a t e s of uncontrollable arousal, t h e infant will come to seek physical proximity to t h e caregiver in t h e h o p e of soothing a n d t h e recovery of h o m e o s t a s i s . T h e infant's behavior by the e n d of t h e first year is purposeful a n d a p p a r e n t l y b a s e d on specific expectations. His p a s t experiences with t h e caregiver are aggregated into r e p r e s e n t a t i o n a l s y s t e m s t h a t Bowlby (1973) termed "internal working models" (IWM). T h u s , t h e a t t a c h m e n t system is a n o p e n biosocial h o m e o s t a t i c regulatory system.

P A T T E R N S O F A T T A C H M E N T IN I N F A N C Y The second great pioneer of a t t a c h m e n t theory. Mary Ainsworth (1985; Ainsworth, Blehar, Waters, a n d Wall 1978), developed t h e well-known laboratory-based p r o c e d u r e for observing infants' internal working models in action. Infants, briefly s e p a r a t e d from their caregiver in a situation unfamiliar to them, s h o w one of four p a t t e r n s of behavior: (a) Infants classified a s secure

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explore readily in t h e p r e s e n c e of t h e primary caregiver, are a n x i o u s in t h e p r e s e n c e of t h e s t r a n g e r a n d avoid her, are distressed by their caregiver's brief a b s e n c e , rapidly seek contact with h e r afterwards, a n d a r e r e a s s u r e d by t h i s contact, r e t u r n ing to their exploration, (b) Some infants, w h o a p p e a r to be m a d e less a n x i o u s by separation, m a y n o t s e e k proximity with -the caregiver following s e p a r a t i o n a n d m a y n o t prefer h e r over t h e stranger; t h e s e infants a r e designated anxious /avoidant (c) Anxious/resistant infants s h o w limited exploration a n d play, t e n d to be highly d i s t r e s s e d by t h e separation, a n d have great difficulty in settling afterwards, showing struggling, stiffness, c o n t i n u e d crying, or fuss in a passive way. T h e caregiver's p r e s e n c e or a t t e m p t s a t comforting fail to r e a s s u r e , a n d t h e infant's anxiety a n d a n g e r a p p e a r to prevent h i m from deriving comfort from proximity. S e c u r e infants' behavior is b a s e d on t h e experience of well-coordinated, sensitive i n t e r a c t i o n s w h e r e t h e caregiver is rarely overarousing a n d is able to restabilize t h e child's disorganizing emotional r e s p o n s e s . Therefore, they r e m a i n relatively organized in stressful s i t u a t i o n s . Negative emotions feel less t h r e a t e n i n g a n d c a n be experienced a s meaningful a n d c o m m u nicative ( G r o s s m a n n , G r o s s m a n n , a n d S c h w a n 1986; Sroufe 1996). A n x i o u s / a v o i d a n t l y a t t a c h e d children a r e p r e s u m e d to h a v e h a d experiences where their emotional a r o u s a l w a s n o t restabilized by t h e caregiver, or w h e r e t h e y were overaroused t h r o u g h intrusive parenting; therefore, t h e y overregulate their affect a n d avoid s i t u a t i o n s t h a t a r e likely to be distressing. A n x i o u s / r e s i s t a n t l y a t t a c h e d children underregulate, heightening their expression of distress, possibly in a h effort to elicit t h e expectable r e s p o n s e of t h e caregiver. There is a low t h r e s h o l d for threat, a n d t h e child b e c o m e s preoccupied with h a v i n g contact with t h e caregiver b u t is frustrated even w h e n it is available (Sroufe 1996). (cfl A fourth g r o u p of infants exhibits seemingly undirected behavior, s u c h a s freezing, h a n d - c l a p p i n g , headbanging, a n d t h e w i s h to escape t h e s i t u a t i o n even in the p r e s e n c e of t h e caregiver. T h e s e infants a r e referred to a s disorganized/disoriented (Main a n d Solomon 1990). It is generally held t h a t for s u c h infants t h e caregiver h a s served a s a s o u r c e of b o t h fear a n d r e a s s u r a n c e , a n d t h u s a r o u s a l of t h e a t t a c h m e n t behavioral s y s t e m p r o d u c e s s t r o n g conflicting motivations.

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Not surprisingly, a history of prolonged or repeated s e p a r a t i o n (Chisolm 1998), i n t e n s e m a r i t a l conflict (Owen a n d Cox 1997), and severe neglect or physical or sexual a b u s e (Carlson, Cicchetti, B a r n e t t , a n d B r a u n w a l d 1989) is often associated with this p a t t e r n .

THE ATTACHMENT SYSTEM A S A DETERMINANT OF LATER INTERPERSONAL RELATIONSHIPS Bowlby proposed t h a t i n t e r n a l working models of t h e self a n d others provide prototypes for all later relationships. S u c h models are relatively s t a b l e a c r o s s t h e lifespan (Collins a n d Read 1994). Because i n t e r n a l working models function outside a w a r e n e s s , they are c h a n g e - r e s i s t a n t (Crittenden 1990). T h e stability of a t t a c h m e n t is d e m o n s t r a t e d by longitudinal s t u d i e s of infants assessed with t h e S t r a n g e Situation a n d followed u p in adolescence or y o u n g a d u l t h o o d with t h e Adult Attachment Interview (AAI) (George, Kaplan, a n d Main 1985). This s t r u c t u r e d clinical i n s t r u m e n t elicits narrative histories of childhood a t t a c h m e n t relationships. T h e AAI scoring s y s t e m (Main a n d Goldwyn 1994) classifies Individuals into Secure/Autonomous, Insecure/Dismissing, Insecure/Preoccupied, or Unresolved with respect to loss or t r a u m a — c a t e g o r i e s b a s e d on t h e s t r u c t u r a l qualities of narratives of early experiences. While autonomous individuals value a t t a c h m e n t relationships, coherently integrate memories into a meaningful narrative, a n d regard t h e s e a s formative, insecure individuals a r e poor a t integrating memories of experience with t h e m e a n i n g of t h a t experience. Those dismissing of a t t a c h m e n t s h o w avoidance by denying memories a n d by idealizing or devaluing early relationships. Preoccupied individuals tend to be confused, angry, or fearful in relation to a t t a c h m e n t figures, s o m e t i m e s still complaining of childhood slights, echoing the p r o t e s t s of t h e r e s i s t a n t infant. Unresolved individuals give indications of significant disorganization in their a t t a c h ment-relationship r e p r e s e n t a t i o n in s e m a n t i c or syntactic confusions in their n a r r a t i v e s concerning childhood t r a u m a or a recent loss.

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Major longitudinal s t u d i e s (C. Hamilton 1994; M. Main 1997; Waters, Merrick, Albersheim, Treboux, a n d Crowell" 1995) have s h o w n a 6 8 - 7 5 % c o r r e s p o n d e n c e with a t t a c h m e n t classifications in infancy a n d classifications in adulthood. This is a n unparalleled level of consistency between behavior observed in infancy a n d o u t c o m e s in a d u l t h o o d , although, obviously, s u c h behavior m a y well be m a i n t a i n e d by c o n s i s t e n t e n v i r o n m e n t s a s well a s by p a t t e r n s laid down in t h e first year of life. Moreover, a t t a c h m e n t relationships play a key role in t h e t r a n s g e n e r a t i o n a l t r a n s m i s s i o n of deprivation. S e c u r e a d u l t s a r e t h r e e or four times m o r e likely to have children w h o are securely a t t a c h e d to t h e m (van IJzendoorn 1995). This is t r u e even w h e r e p a r e n t a l a t t a c h m e n t is a s s e s s e d before t h e b i r t h of t h e child (Steele, Steele, a n d Fonagy 1996; Ward a n d C a r l s o n 1995). Parental a t t a c h m e n t p a t t e r n s predict v a r i a n c e in addition to temperam e n t m e a s u r e s or contextual factors, s u c h a s life events, social s u p p o r t , a n d psychopathology (Steele, 1991). T h e a t t a c h m e n t s y s t e m (Bowlby 1969, 1973, 1980) is intimately c o n n e c t e d w i t h t h e p r o c e s s of r e p r e s e n t a t i o n a l m a p p i n g a n d t h e development of t h e reflective function of t h e self. There is general a g r e e m e n t that, a s t h e self exists only in t h e context of t h e other, t h e development of t h e self is t a n t a m o u n t to the aggregation of experiences of self in relationships (e.g., Crittenden 1994; Sroufe 1990). Psychoanalytic object relations (Kernberg 1982; Winnicott 1965) a n d a t t a c h m e n t (Bowlby 1980) t h e o r i s t s a r e in a g r e e m e n t t h a t repeated, invariant a s p e c t s of self-other relations a r e a b s t r a c t e d into i n t e r n a l r e p r e s e n t a t i o n a l m e n t a l models (Johnson-Laird 1983) a n d s t r u c t u r e d , to u s e Kernberg's term, into self-other-affect t r i a d s or i n t e r n a l working models, according to Bowlby. Although in its original formulation t h e concept of internal working model lacked specificity (Dunn 1996), m o r e r e c e n t empirical work by psychoanalytic clinicians h a s greatly improved t h e specificity of t h i s c o n s t r u c t (Horowitz 1995; Luborsky a n d Luborsky 1995). At t h e s a m e time, cognitive scientists have elaborated the notion of p r o c e d u r a l m e m o r i e s b a s e d on t h e n o n c o n s c i o u s implicit u s e of p a s t experience ( J o h n s o n a n d M u l t h a u p 1992; Kihlstrom a n d Hoyt 1990; Pillemer a n d White 1989; S c h a c h t e r 1992; Squire 1987; Tobias, Kihlstrom, a n d S c h a c h t e r 1992).

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There is general a g r e e m e n t t h a t t h e m e m o r y s y s t e m is a t least of a d u a l n a t u r e with two relatively i n d e p e n d e n t , neurologically and psychologically h o m o g e n e o u s s y s t e m s u n d e r p i n n i n g it. In addition to t h e autobiographical memory, which is a t least in p a r t accessible to a w a r e n e s s , a n i m p o r t a n t additional component to m e m o r y is a n o n v o l u n t a r y s y s t e m t h a t is implicit, principally perceptual, nondeclarative, a n d nonreflective (D. L. S c h a c h t e r 1992; Squire 1987). It is possible t h a t it is, a t least in certain respects, m o r e d o m i n a t e d by emotional a n d impressionistic information t h a n its autobiographical c o u n t e r p a r t (Pillemer a n d White 1989; Tobias et al. 1992; v a n der Kolk 1994). It stores the "how" of executing s e q u e n c e s of actions, motor skills being prototypical i n s t a n c e s . The p r o c e d u r a l knowledge t h a t it contains is accessible only t h r o u g h performance. It manifests itself only w h e n t h e individual engages in t h e skills a n d operations into w h i c h knowledge is e m b e d d e d . Given t h e s e features, it seems likely thatSthe s c h e m a t i c r e p r e s e n t a t i o n s postulated by a t t a c h m e n t a n d object-relations t h e o r i s t s a r e m o s t usefully cons t r u e d a s p r o c e d u r a l memories, t h e function of w h i c h is to a d a p t social behavior to specific interpersonal contexts. The classification of p a t t e r n s of a t t a c h m e n t in infancy (Ainsworth et al. 1978) t a p s into p r o c e d u r a l m e m o r y (Crittenden 1990; Fonagy 1995a). The s t r e n g t h o f t h e S t r a n g e Situation a s a method of psychological a s s e s s m e n t is t h a t it provides a powerful a n a l o g u e of p a s t situational contexts within w h i c h knowledge concerning t h e "how" of behavior with a specific caregiver is accrued. In t h i s s e n s e a t t a c h m e n t is a skill, one t h a t is acquired in relation to a specific caregiver a n d encoded into a teleological model of behavior. In t h e London P a r e n t - C h i l d S t u d y we investigated t h e q u e s t i o n of h o w well t h e Adult A t t a c h m e n t Interview, administered before t h e b i r t h of t h e first child to 100 predominantly middle-class p r i m i p a r o u s p a r e n t s , could predict t h e classification of t h e infant's a t t a c h m e n t a t t h e age of 12 m o n t h s to mother a n d a t 18 m o n t h s to father (Fonagy, Steele, a n d Steele 1991). There w a s only a marginally significant association between t h e a t t a c h m e n t classification with m o t h e r a n d t h a t with father. However, b o t h t e s t r e s u l t s were powerfully predicted by the a t t a c h m e n t classification of t h e respective p a r e n t on t h e AAI (Steele et al. 1996). T h e small overlap between t h e two s e t s of

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classifications could be equally well a c c o u n t e d for by a s s u m i n g a t e m p e r a m e n t factor or by t h e generalization of t h e child's behavior with t h e m o t h e r (reflecting h e r a t t a c h m e n t classification) on h i s behavior with t h e father. T h e r e s u l t s suggest t h a t t h e infant develops i n d e p e n d e n t models (self-other s c h e m a t a ) for its major a t t a c h m e n t relations b a s e d on its p a s t history of interactions with e a c h of t h o s e individuals. T h e s e interaction experie n c e s are, in t u r n , indexed^ by t h e caregiver's r e p r e s e n t a t i o n of their a t t a c h m e n t history. There h a s b e e n considerable r e s e a r c h on t h e m a n n e r in which r e p r e s e n t a t i o n s of a t t a c h m e n t might influence t h e caregiver's behavior with t h e child. Van U z e n d o o r n ' s (1995) comprehensive review identifies a "transmission gap," to t h e extent t h a t t h e variability t h a t AAI n a r r a t i v e s a n d S S n classifications s h a r e is n o t a c c o u n t e d for by observational d a t a concerning the sensitivity of caregiver behavior. Indeed, s t u d i e s o f t h e AAI-SSn association, w h i c h c o n c u r r e n t l y m e a s u r e d t h e sensitivity of caregiver-infant interaction; h a v e yielded negative (Ward a n d Carlson 1995) or inconclusive (van U z e n d o o r n , Kranenburg, Zwart-Woudstra, V a n B u s s c h b a c h , a n d L a m b e r m o n 1991) res u l t s . Previously, we h a v e suggested t h a t t h e t r a n s m i s s i o n g a p m a y be a c o n s e q u e n c e of t h e limitations of m e a s u r e s of sensitivity (Fonagy, Steele, Moran, Steele, a n d Higgitt 1992; Fonagy, Steele, et al. 1995). Sensitivity is a generic c o n s t r u c t covering a wide r a n g e of p a r e n t a l behaviors (Belsky, Rosenberger, a n d C m i c 1995). Not all of t h e s e m a y be equally relevant in engendering s e c u r e a t t a c h m e n t . If s e c u r e a t t a c h m e n t is conceived of a s t h e acquisition of p r o c e d u r e s of goal-oriented rational action for t h e regulation of aversive s t a t e s of a r o u s a l within a n a t t a c h m e n t context (Carlson a n d Sroufe 1995; Cassidy 1994; Sroufe 1996), we a r g u e t h a t t h e s e would b e m o s t consistently acquired a n d coherently r e p r e s e n t e d w h e n t h e child's a c u t e affective state is accurately, b u t n o t overwhelmingly, reflected b a c k to t h e child. The child who looks for a w a y of m a n a g i n g h i s d i s t r e s s finds in • t h e r e s p o n s e of t h e caregiver a r e p r e s e n t a t i o n of h i s m e n t a l state t h a t h e m a y internalize a n d u s e a s p a r t of a higher-order strategy of affect regulation. T h e s e c u r e caregiver s o o t h e s by combining mirroring with a display t h a t is incompatible with t h e

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child's affect ( t h u s p e r h a p s implying coping). This formulation of sensitivity h a s m u c h in c o m m o n with t h e notion of British psychoanalyst Wilfred Bion (1962a), of t h e role of t h e m o t h e r ' s capacity to mentally "contain" t h e affect state t h a t feels intolerable to t h e b a b y a n d r e s p o n d in t e r m s of physical care in a m a n n e r t h a t acknowledges t h e child's m e n t a l state, yet serves to modulate u n m a n a g e a b l e feelings. The finding t h a t t h e clarity and coherence of t h e m o t h e r ' s r e p r e s e n t a t i o n of t h e child mediates between t h e AAI a n d m o t h e r ' s observed behavior is certainly consistent with t h i s model (Slade, Belsky, Aber, a n d Phelps 1999). Ratings of t h e quality of t h e reflective function of e a c h caregiver were found i n d e p e n d e n t l y to predict t h e child's security of a t t a c h m e n t in t h e London Parent-Child S t u d y (Fonagy, Steele, Moran, Steele, a n d Higgitt 1991). If s e c u r e a t t a c h m e n t is t h e o u t c o m e of successful containment, i n s e c u r e a t t a c h m e n t m a y be seen a s t h e infant's identification with t h e caregiver's defensive behavior. Proximity to t h e caregiver is m a i n t a i n e d a t t h e cost of reflective function. A dismissing (Ds) caregiver m a y altogether fail to mirror t h e child's distress b e c a u s e of t h e painful experiences this evokes for her or because s h e lacks t h e capacity to create a c o h e r e n t image of t h e child's m e n t a l s t a t e . In c o n t r a s t , t h e preoccupied (E) caregiver may r e p r e s e n t t h e infant's s t a t e with excessive clarity or in a way that is complicated by r e s p o n s e s to t h e p a r e n t ' s ambivalent preoccupation with h e r own experience, so m u c h so t h a t t h e symbolic potential of t h e exchange is lost. In b o t h c a s e s t h e infant internalizes t h e caregiver's attitude a n d "this dysynchrony becomes t h e c o n t e n t of t h e experience of t h e s e l f (Crittenden 1994, p. 89). We m a y s p e c u l a t e a s to t h e i m p a c t of s u c h a state of affairs on the development of t h e child's s e n s e of self. We k n o w t h a t avoidant infants r e s p o n d to s e p a r a t i o n with minimal displays of distress while experiencing considerable physiological a r o u s a l (Spangler a n d G r o s s m a n n 1993). Crittenden (1988; Crittenden and DiLalla 1988) r e p o r t s t h a t 1-year-old maltreated children display falsely positive affect t h a t does n o t m a t c h their t r u e feelings. At a n extreme, t h e internalization of t h e caregiver's defenses c a n lead n o t only to a failure to r e p r e s e n t a n d display

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a c t u a l emotional experience adequately, b u t also to t h e construction- of a n experience of self a r o u n d t h i s false internalization (Winnicott 1965). While t h e c o n s c i o u s experience of "putting on a n act" m a y be a fairly general experience, particularly in adolescence (Harter, Marold, Whitesell, a n d Cobbs 1996), in t h e c u r r e n t context we a r e referring to t h e highly distressing experience of severely personality-disordered children w h o experience a s e n s e of alienation from their core self (Bleiberg 1984, 1994). A strategy adopted by m a n y s u c h children s o m e w h a t later in development is to a t t e m p t to externalize this false p a r t of their self-representation a n d m a n i p u l a t e t h e behaviors of o t h e r s a r o u n d t h e m so t h a t t h e s e m a t c h t h e i n c o n g r u e n t self-representation. We would a r g u e t h a t t h i s model explains t h e strangely coercive behavior with t h e caregiver of preschool children w h o s e a t t a c h m e n t a t t h e stage of infancy w a s classified a s disorganized (Cassidy, Marvin, a n d T h e MacArthur Working G r o u p on A t t a c h m e n t 1989; Critt e n d e n 1992; Main a n d Cassidy 1988). T h e s e children—and adults—become quite skilled a n d sensitive in m a n i p u l a t i n g othe r s to get t h e m to b e h a v e consistently with their internal repres e n t a t i o n s . T h e s e a r e n o t their r e p r e s e n t a t i o n s of self-other relationships, w h i c h we all try to actualize. In a far m o r e desperate way t h e s e children a n d a d u l t s try to provoke behavior cons i s t e n t with a p a r t of t h e self-representation experienced a s "alien," which they feel forced to externalize in order to achieve a more coherent perception of t h e r e s i d u a l self (Fonagy a n d Target 1995).

A T T A C H M E N T S E C U R I T Y IN T H E C H I L D A N D REFLECTIVE FUNCTION There is general a g r e e m e n t t h a t t h e " h a r m o n i o u s n e s s of the mother-child' relationship c o n t r i b u t e s to t h e emergence of symbolic t h o u g h t " (Bretherton, Bates, Benigni, Camaioni, a n d Volterra 1979, p. 224), a n d t h e idea h a s a long a n d distinguished history (Mahler, Pine, a n d B e r g m a n 1975; Vygotsky 1978; Werner a n d Kaplan 1963). Bowlby (1969) recognized the

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significance of t h e developmental step entailed in t h e emergence of "the child's capacity b o t h to conceive of h i s m o t h e r a s having her own goals a n d ' i n t e r e s t s s e p a r a t e from h i s own a n d to t a k e t h e m into a c c o u n t " (1969, p. 368). Moss, Parent, a n d Gosselin (1995) reported t h a t a t t a c h m e n t security with m o t h e r w a s a good c o n c u r r e n t predictor of metacognitive capacity in t h e child in t h e d o m a i n s of memory, c o m p r e h e n s i o n , a n d c o m m u n i c a t i o n . The S e p a r a t i o n Anxiety Test, a projective t e s t of a t t a c h m e n t security, h a s b e e n s h o w n to be a good predictor of belief-desire reasoning capacity in 3V4- to 6-year-old children w h e n age, verbal m e n t a l age, a n d social m a t u r i t y were all controlled for (Fonagy, Redfern, a n d C h a r m a n 1997). In a prospective s t u d y o f t h e relationship of a t t a c h m e n t security to m o t h e r (12 m o n t h s ) a n d to father (18 m o n t h s ) a n d performance on t h r e e t e s t s of theory of mind a t 5V4 y e a r s (Fonagy 1997), 9 2 of 9 6 children tested in t h e S t r a n g e Situation a t 12 and 18 m o n t h s were seen. Of t h o s e classified a s s e c u r e a t 12 m o n t h s with m o t h e r , 8 2 % p a s s e d t h e belief-desire reasoning task, in w h i c h t h e child is challenged to predict w h a t a c h a r a c t e r would feel, b a s e d on h i s or h e r knowledge of t h e c h a r a c t e r ' s belief. (If Ellie t h i n k s t h e c a n h a s coke in it, a n d likes coke, will she w a n t t h e drink—even t h o u g h it is really milk?) In c o n t r a s t , 46% of t h o s e w h o h a d b e e n classified a s Insecure failed. Infantfather a t t a c h m e n t (at 18 m o n t h s ) also predicted t h e child's performance, with 77% of infants classified a s s e c u r e p a s s i n g t h e test, compared to 5 5 % of children classified a s insecure. There was some indication of a n additive relationship, in t h a t 8 7 % of children with two s e c u r e relationships p a s s e d t h e belief-desire task, a n d 6 3 % of t h o s e with only one s e c u r e relationship a n d only 50% of t h o s e I n s e c u r e with b o t h did so. A similar b u t somewhat w e a k e r p a t t e r n could be observed with t h e secondorder false-belief t a s k , w h i c h r e q u i r e s t h e child to r e a s o n on t h e basis of w h a t one c h a r a c t e r k n o w s a b o u t a n o t h e r c h a r a c t e r ' s wrong belief. Of t h o s e s e c u r e with b o t h p a r e n t s , 36% p a s s e d , compared with 2 3 % w h o were s e c u r e with one a n d 9% w h o were insecure with b o t h . In a s o m e w h a t smaller b u t nevertheless careful longitudinal study of m o t h e r - i n f a n t dyads, Meins a n d colleagues (Meins, Fernyhough, Russel, a n d Clark-Carter 1998) reported t h a t 8 3 %

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of children who were securely a t t a c h e d in infancy p a s s e d a falsebelief t a s k a t t h e age of 4, in c o m p a r i s o n with 3 3 % of insecurely a t t a c h e d peers. At age 5, 85% of securely a t t a c h e d children a n d 50% of insecurely a t t a c h e d o n e s p a s s e d a t a s k requiring a n u n d e r s t a n d i n g of information access. Although t h e s t u d y w a s n o t .able to replicate o u r r e s u l t s on t h e false-belief a n d emotion t a s k (probably b e c a u s e of its small sample), t h e general trend of t h e findings confirms t h a t security of a t t a c h m e n t is significantly linked to symbolic abilities in general a n d to precocious m e n talizing in particular. Both trivial a n d s u b s t a n t i v e explanations could b e offered to a c c o u n t for t h e s e findings. They would be trivial if t h e association of s e c u r e a t t a c h m e n t a n d false-belief u n d e r s t a n d i n g were d u e to a n a s yet u n k n o w n a n d u n m e a s u r e d third factor, s u c h a s temp e r a m e n t . More plausibly, it could be a r g u e d t h a t t h e facilitative effect of s e c u r e a t t a c h m e n t is d u e to a m o r e relaxed, t a s k oriented attitude, to a general facility to engage in a cognitively d e m a n d i n g task, or to a n ability to relate to a n a d u l t experim e n t e r in a playful, exploratory way. All t h e s e explanations reflect child performance r a t h e r t h a n competence. This suggestion could be tested u s i n g a false-belief t a s k w h e r e implicit a n d explicit knowledge of false belief is separately a s s e s s e d (Clements a n d Perner 1994). If a t t a c h m e n t security relates to performance, t h e n securely a t t a c h e d children would be expected to do better only on t h e explicit (verbal/pointing) t a s k . Implicit, p r o c e d u r a l false-belief r e a s o n i n g would b e expected to be facilitated by s e c u r e a t t a c h m e n t only if t h i s w a s associated with superior reflective capacity. This r e m a i n s to b e s t u d i e d . In w h a t follows, we shall cautiously a s s u m e t h a t t h e relationship between falsebelief r e a s o n i n g a n d security of a t t a c h m e n t is nontrivial. There a r e two alternative explanations for this relationship: (a) One class of models would suggest t h a t security of a t t a c h m e n t in infancy p r e d i s p o s e s children to benefit from certain social p r o c e s s e s t h a t m a y be directly involved in t h e development of reflective abilities a n d social u n d e r s t a n d i n g , (b) T h e second class of models would suggest t h a t security of a t t a c h m e n t is a n indicator of t h a t quality of infant-caregiver relationship which generates psychological u n d e r s t a n d i n g . In t h i s second model t h e

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social p r o c e s s e s t h a t accelerate t h e mentalizing quality of selforganization a r e t h e very s a m e a s t h o s e t h a t e n s u r e security of attachment. Mediatlonal models would require t h a t two conditions be satisfied: (a) compelling evidence t h a t a specific set of social processes is involved in t h i s a s p e c t of t h e development of selforganization, a n d (b) t h a t s u c h social p r o c e s s e s a r e e n h a n c e d in securely a t t a c h e d individuals. At least t h r e e c a n d i d a t e s meet these criteria. 1. The first is pretense. There is evidence t h a t children in their thtrd year w h o engage m o r e readily in cooperative interaction (Dunn et al. 1991), a n d specifically in joint p r e t e n d play (Astington a n d J e n k i n s 1995; Taylor, Gerdw, a n d Carlson 1993; Youngblade a n d D u n n 1995), s h o w superior m i n d - r e a d i n g a n d emotion u n d e r s t a n d i n g performance. A s e p a r a t e body of observations from longitudinal s t u d i e s of a t t a c h m e n t indicates t h a t preschool children w h o were securely a t t a c h e d to their m o t h e r in infancy manifest s t r o n g e r e n g a g e m e n t in fantasy play t h a n do avoidant children, w h o s e level of e n g a g e m e n t is low a n d w h o s e p r e t e n d play is impoverished (Rosenberg, cited in Carlson a n d Sroufe 1995; Main, Kaplan, a n d Cassidy 1985). Children rated a s securely a t t a c h e d to their m o t h e r s d u r i n g infancy h a v e b e e n reported to engage in more frequent a n d sophisticated solo pretense, (Belsky, G a r d u q u e , a n d Hrncir 1984; B r e t h e r t o n et al. 1979; Matas, Arend, a n d Sroufe 1978). Slade (1987) found t h a t m a t e r n a l involvement in 3-year-olds' play served a facilitating function only for securely a t t a c h e d children. Meins a n d colleagues (Meins et al. 1998).demonstrated t h a t children w h o were classified a s securely a t t a c h e d in infancy were better able to incorporate t h e p r e t e n s e suggestions of a n experimenter in their play a t 31 m o n t h s . It is probable t h a t joint p r e t e n d play or playfulness fosters t h e u n d e r s t a n d i n g of m e n t a l s t a t e s . Deliberate role-taking is seen a s being integral to t h e "off-line simulation" model of t h e performance of m i n d r r e a d i n g t a s k s (Currie 1995; G o l d m a n 1989). Within other models, p r e t e n d play is a n early manifestation of t h e theory-of-mind m e c h a n i s m s (Leslie 1987). T h e question of why

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3-year-olds c a n u n d e r s t a n d t h a t s o m e o n e is e n t e r t a i n i n g a pretend representation b u t n o t a false belief (Harris a n d K a v a n a u g h 1993; Harris, Kavanaugh, a n d Meredith 1994), a p r e t e n d / r e a l distinction b u t n o t a n a p p e a r a n c e / r e a l i t y one (Flavell, Flavell, a n d Green 1987) is a n i m p o r t a n t puzzle. In t h e case of pretend, t h e r e p r e s e n t a t i o n s , while t h e y a r e different from reality, are s h a r e d by t h o s e engaged in t h e pretend game. As Astington p u t it: "they are intermental, n o t intramental" (1996, p. 193). The s h a r i n g of r e p r e s e n t a t i o n s t h a t are different from reality may help in u n d e r s t a n d i n g s i t u a t i o n s where r e p r e s e n t a t i o n s are n o t only" different from reality b u t a r e n o t s h a r e d in a social pretend d o m a i n . In joint p r e t e n d play or playfulness t h e a d u l t a d o p t s t h e child's m e n t a l s t a n c e a n d r e - p r e s e n t s it to t h e child in relation to a third object, w h i c h is symbolically held in m i n d by both. Pretending requires a m e n t a l s t a n c e involving t h e symbolic transformation of reality in t h e p r e s e n c e of, a n d with a view to, t h e m i n d of t h e other. T h e adult, o r p e r h a p s t h e older sibling, holds t h e frame of external reality while accurately r e p r e s e n t i n g t h e child's m e n t a l state. T h e scaffolding provided by t h e child's playmate in p r e t e n d play (Vygotsky 1967) n o t only p r o m o t e s earlier s u c c e s s b u t is t h e m e c h a n i s m w h e r e b y t h e development of reflection comes a b o u t . Lillard (1993) a r g u e d t h a t symbolic play m a y offer a "zone of proximal development" for t h e skills t h a t s u b s e r v e m i n d - r e a d i n g ability. Children with a s e c u r e att a c h m e n t history m a y b e m o r e likely.to engage in a n activity t h a t p r e s u m e s a degree of t r u s t , insofar a s t h e child relies o n t h e other's version or perception of reality. 2. The second is talking. There is evidence t h a t conversations a b o u t feelings a n d t h e r e a s o n s b e h i n d people's actions a r e linked to t h e relatively early achievement of reflective function (Brown, Donelan-McCall, a n d D u n n 1996; D u n n a n d Brown 1993). Mothers who s p o n t a n e o u s l y explained their emotions to 3V£year-olds d u r i n g laboratory simulation were s h o w n to have child r e n with e n h a n c e d emotion u n d e r s t a n d i n g over t h e s u b s e q u e n t 15-month period ( D e n h a m et al. 1994). Conversational opportunities concerning m e n t a l s t a t e s a p p e a r to improve children's mentalizing performance in experimental s t u d i e s (Appleton a n d Reddy 1996). a

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Strage a n d Main (cited in Carlson a n d Sroufe 1995) reported t h a t discourse p a t t e r n s between m o t h e r s a n d children a t age 6 could b e predicted from early a t t a c h m e n t classification. S e c u r e dyads were m o r e fluent a n d able to d i s c u s s a wider r a n g e of topics t h a n t h o s e classified a s avoidant, w h o showed little topic elaboration. P a t t e r n s of m o t h e r - c h i l d interaction characteristic of secure d y a d s — s h a r e d play, comforting, or joking—also define the contexts within w h i c h t h e m o t h e r ' s explanations of m e n t a l states are found to be particularly facilitative of reflective function (Dunn 1996). S e c u r e children find it easier to deal with emotional i s s u e s in a n open a n d free w a y (Bretherton, Ridgeway, and Cassidy 1990; Cassidy 1988). Mother-child verbal interactions associated with t h e early acquisition of reflective capacity predominantly c o n c e r n emotionally charged m a t t e r s ( D u n n 1996). S e c u r e a t t a c h m e n t m a y t h e n e n g e n d e r p a t t e r n s of verbal interaction b e t w e e n child a n d caregiver, w h i c h in t u r n s u p p o r t thinking a b o u t feelings a n d intentions. P. K. S m i t h (1996) forcefully a d v a n c e d t h e central role of language in t h e acquisition of mentalizing capacity. Using primate evidence, h e suggested t h a t t h e availability of symbolic codes (words) for m e n t a l s t a t e s w a s crucial for t h e developing individual to acquire m i n d - r e a d i n g abilities, a n d t h e explicit u s e of s u c h codes by caregivers w a s therefore likely to be important. Even more p e r t i n e n t in t h i s context is Harris's (1996) proposal t h a t t h e experience of engaging in conversations per se alerts children to t h e fact t h a t people a r e receivers a n d providers of information, irrespective of w h e t h e r t h a t conversation involves reference to m e n t a l s t a t e s (knowing, thinking, desiring, etc.). T h e s t r u c t u r e of information-bearing conversations (e.g., being told about a p a s t event t h a t one h a s n o t witnessed, challenging of information in d i s s e n t a n d denial, or filling in information g a p s in questions or w h e n information exchange misfires a n d repair is needed) strongly implies t h a t p a r t n e r s in a conversation differ in what they k n o w a n d believe a b o u t a s h a r e d topic. Effective conversation r e q u i r e s t h a t g a p s in s h a r e d knowledge a n d belief are acknowledged a n d a d d r e s s e d . The m e a s u r e m e n t of a t t a c h ment in a d u l t s (Main a n d Goldwyn 1994) strongly e n d o r s e s t h e suggestion t h a t s e c u r e a t t a c h m e n t is associated with greater sensitivity to t h e r u l e s of conversation a s defined by Grice (1975).

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3. T h e third potential mediator is peer group interaction. We have already noted t h a t t h e possibility of interaction with siblings is likely to e n h a n c e theory-of-mind performance ( J e n k i n s a n d Astington 1996; Perner et al. 1994; Ruffman et al. 1998). Importantly, t h e child's u s e of m e n t a l - s t a t e t e r m s with siblings or friends is a b e t t e r predictor of performance on false-belief t a s k s t h a n is mother-child conversation (Brown et al. 1996). Likewise, Lewis a n d colleagues (Lewis, F r e e m a n , Kyriakidou, Maridaki-Kassotaki, a n d Berridge 1996) d e m o n s t r a t e d t h a t false-belief u n d e r s t a n d i n g w a s related to t h e a m o u n t of time t h a t children s p e n t with older siblings, older friends, a n d older kin, b u t n o t with y o u n g e r p e r s o n s . There is a n i n d e p e n d e n t body of evidence t h a t s u p p o r t s a s t r o n g link between s e c u r e a t t a c h m e n t in infancy a n d ratings of peer competence (Elicker, E n g l u n d , a n d Sroufe 1992). Children with s e c u r e a t t a c h m e n t histories are consistently observed a n d r a t e d more socially oriented, capable of reciprocity, popular, a n d e m p a t h i c t h a n t h o s e with i n s e c u r e histories (Lieberman 1977; P a n c a k e 1985; P a r k a n d W a t e r s 1989; Sroufe 1983). Both simulation theory a n d t h e o r y - t h e o r y e x p l a n a t i o n s of the development of m i h d - r e a d i n g offer good explanations o f t h e facilitative effect of m o r e i n t e n s e peer-group interaction (Ruffman et al. 1998). Peer-group interaction should increase t h e opportunities t h a t children h a v e for simulation, imagining w h a t they would see, think, feel, a n d so on if t h e y were in a n o t h e r person's situation. Equally, interaction with p e e r s or older siblings could be s e e n from a theory-theory perspective a s a rich s o u r c e of ideas a b o u t how t h e m i n d works. An alternative view m a y be t h a t e n c u l t u r a t i o n is itself t h e source of t h e child's m e n t a l - s t a t e concepts (Astington 1996). B r u n e r (1983) proposed t h a t p a r e n t s ' t e n d e n c y to t r e a t t h e infant's s p o n t a n e o u s g e s t u r e s as if they were intentional c o m m u n i c a t i o n s leads to infants seeing themselves a s having i n t e n t i o n s a n d s t a r t i n g to c o m m u n i c a t e intentionally. T h e social world—in t h e first i n s t a n c e , t h e parent—fosters t h e child's s e n s e of h i s m e n t a l self t h r o u g h complex linguistic a n d interactional processes, b e h a v i n g toward t h e infant in a way t h a t leads h i m eventually to s h a r e t h e a s s u m p t i o n t h a t h i s own behavior a n d (by simulation or t h e observation of

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similar i n t e r a c t i o n s between t h e caregiver a n d others) t h a t of others m a y b e b e s t u n d e r s t o o d in t e r m s of m e n t a l s t a t e s . T h r o u g h participation in activities of their c u l t u r e t h e y c o m e t o s h a r e their c u l t u r e ' s way of regarding others' a n d their own actions. If children's e n t r y into t h e folk psychology is viewed a s a process of "apprenticeship" in w h i c h senior peers a n d caregivers are seen a s e n c o u r a g i n g t h e child's adoption of mentalizing concepts (Astington 1996; Lewis et al. 1996), t h e n s e c u r e attache m e n t m a y b e considered a s a k i n d of catalyst to t h i s l e a r n i n g process. The g r e a t e r r e a d i n e s s with w h i c h s e c u r e children a r e willing to explore a n d engage with t h e social world could t h e n account for their relative c o m p e t e n c e in mentalizing abilities. There is n o t h i n g m u t u a l l y exclusive a b o u t t h e s e t h r e e rnediational models. P r e t e n s e often involves t h e u s e of m e n t a l - s t a t e language. Interaction with p e e r s often involves b o t h l a n g u a g e and pretense. In general, t h e s e mediational models suggest t h a t propensity for social e n g a g e m e n t a c r o s s a n u m b e r of contexts e n h a n c e s t h e development of social u n d e r s t a n d i n g a n d t h a t s u c h social e n g a g e m e n t is m o r e readily accessible in t h e families of securely a t t a c h e d y o u n g children. However, t h e r e is a major problem with s u c h a singular model. Evidence from D u n n ' s work suggests t h a t t h e s e different contexts correlate poorly with one another (Dunn 1996). For example, observational d a t a indicate t h a t individual differences found in pretend play, m a n a g e m e n t of conflict, a n d d i s c o u r s e a b o u t m e n t a l s t a t e s are n o t correlated among social s i t u a t i o n s (mothers, siblings, close friend), alt h o u g h e a c h correlates with socio-cognitive a s s e s s m e n t s (Brown et al. 1996; Slomkowski a n d D u n n 1992; Youngblade a n d D u n n 1995). T h e fact t h a t children's behavior correlates poorly a c r o s s social p a r t n e r s a n d s i t u a t i o n s , a l t h o u g h e a c h of t h o s e s i t u a t i o n s relates to t e s t performance, could suggest t h a t t h e r e a r e several independent, s i m u l t a n e o u s l y operating p a t h w a y s between att a c h m e n t a n d social s i t u a t i o n s . Alternatively, it is possible t h a t t h e variables t h a t prima facie may be considered to b e mediating t h e a t t a c h m e n t / m i n d - r e a d ing relationship a r e n o t on t h e c a u s a l p a t h a t all, t h a t their correlation with t h e r a t e of acquisition of m i n d - r e a d i n g is spuri-

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ous, a n d t h a t t h e c a u s a l s e q u e n c e of t h e relationship d o e s n o t involve t h e s e social experiences b u t is directly related to the child's a t t a c h m e n t s t a t u s . T h e early experience with t h e caregivers in t h e first year of life m a y create t h e bedrock of theory-ofm i n d competence, e n s u r i n g t h e child's move from a teleological to a mentalizing model of behavior. W h a t evidence do we have to s u p p o r t s u c h a c o n t e n t i o n ? First, it is i m p o r t a n t to n o t e t h a t in t h e London d a t a , a m o t h e r ' s a t t a c h m e n t classification before the birth of t h e child w a s a powerful predictor of t h e child's theoryof-mind c o m p e t e n c e a t 5 years; 75% of children of secure, a u t o n o m o u s m o t h e r s p a s s e d t h e cognitive-emotion t a s k , w h e r e a s only 16% of children of preoccupied m o t h e r s a n d 25% of t h o s e of unresolved m o t h e r s did so (Fonagy 1997). Although on t h e face of it this could be a c c o u n t e d for by t h e models already discussed, we believe t h a t t h e r e is now evidence t h a t t h e caregiver brings s o m e t h i n g to t h e p a r e n t - c h i l d relationship, evident even before t h e birth'of t h e child, w h i c h m a y b e critical in t h e child's establ i s h m e n t of b o t h s e c u r e a t t a c h m e n t a n d mind-reading. W h a t might t h i s b e ? It is well established t h a t , in infancy, m o t h e r s of securely a t t a c h e d children a r e m o r e sensitive to their children's n e e d s (Ainsworth, Bell, a n d S t a y t o n 1971; Isabella 1993). We have already t o u c h e d on t h e fact t h a t t h e caregiver's capacity to envision t h e m e n t a l s t a t e s of h e r own p a r e n t s is predictive of t h e infant's security of a t t a c h m e n t to e a c h of his caregivers (Fonagy, Steele, Moran, et al. 1991). In t h e London project, m o t h e r s w h o were more likely to invoke m e n t a l s t a t e s in their a c c o u n t s of their childhood a t t a c h m e n t experiences h a d children with superior m i n d - r e a d i n g abilities (controlling for verbal fluency in t h e child). Ratings on t h e RF scale were found to predict t h e child's performance on cognitive-emotion t a s k s also for fathers. Even m o r e important, a p a t h a n a l y s i s revealed t h a t a m o t h e r ' s capacity to reflect on h e r own childhood in t h e AAI s h a r e d t h a t portion of t h e variance with t h e child's theory-ofm i n d performance t h a t w a s predicted by t h e quality of m o t h e r infant a t t a c h m e n t . In a more complex p a t h analysis, we found t h a t t h e m o t h e r ' s mentalizing ability h a d a direct a s well a s indirect relationship with t h e child's theory of m i n d . T h u s , the child's a t t a c h m e n t security w a s n o t t h e only predictor. The

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m o t h e r ' s c a p a c i t y to envision t h e child a s a m e n t a l entity also seemed to b e i m p o r t a n t . S u c h d a t a suggest t h a t c o m m o n m e c h a n i s m s u n d e r p i n att a c h m e n t organization in t h e caregiver a n d t h e infant a n d t h e precocious e m e r g e n c e of mentalizing. It should be r e m e m b e r e d t h a t n o unequivocal c a u s a l p a t h s were identified a m o n g mediational models. T h e relative i m p o r t a n c e of v a r i o u s potential mediational m e c h a n i s m s for t h e a t t a c h m e n t - t h e o r y - o f - m i n d relationship varies according to context, b u t intergenerational d a t a may be c o n s i s t e n t with a t l e a s t two of t h e models (pretense, language). F u r t h e r experimental r e s e a r c h t h a t m a n i p u l a t e s parental behavior a n d explores a t t a c h m e n t a n d theory-of-mind task performance (van U z e n d o o r n , Juffer, a n d Duyvesteyn 1995) will be n e c e s s a r y to d e t e r m i n e w h e t h e r specific behaviors t h a t engender s e c u r e a t t a c h m e n t s i m u l t a n e o u s l y e n h a n c e mentalizing. In order for s u c h a s t u d y to be feasible, we need a model of how a t t a c h m e n t m a y directly relate to theory-of-mind performance. Next, therefore, we offer one model of h o w s u c h a m e c h a nism m a y operate. O u r stipulation is b a s e d on t h e a s s u m p t i o n t h a t t h e acquisition of t h e theory of m i n d is p a r t of a n intersubjective p r o c e s s between t h e infant a n d caregiver (see Gopnik 1993, for a highly elegant elaboration of s u c h a model). In o u r view, t h e caregiver facilitates t h e creation of mentalizing models t h r o u g h complex linguistic a n d q u a s H i n g u i s t i c processes, primarily by behaving toward t h e child in s u c h a way t h a t t h e child is eventually led to postulate t h a t h i s own behavior m a y b e b e s t u n d e r s t o o d if he a s s u m e s t h a t h e h a s i d e a s a n d beliefs, feelings a n d wishes, t h a t determine h i s actions, a n d t h e reactions of o t h e r s to h i m c a n t h e n be generalized to other similar beings. T h e caregiver approaches t h e crying infant with a q u e s t i o n in h e r mind: "Do you want your n a p p y changed?" "Do you n e e d a cuddle?" T h e sensitive caregiver is unlikely to a d d r e s s t h e situation without having the p e r s o n in mind, so is unlikely to say to herself, "Are you wet around y o u r bottom?" or ".Have you b e e n s t a n d i n g alone too long?" T h e sensitive caregiver c a n bridge t h e focus on physical reality a n d internally directed attention sufficiently for t h e child to identify contingencies between i n t e r n a l a n d external expert-

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ence. Ultimately, t h e child arrives a t t h e conclusion t h a t the caregiver's reaction to h i m m a y be u n d e r s t o o d a s rational, given t h e a s s u m p t i o n of a n internal s t a t e of belief or desire within himself. Unconsciously a n d pervasively, t h e caregiver a s c r i b e s a m e n t a l s t a t e to t h e child with h e r behavior, t r e a t i n g t h e child a s a m e n t a l agent. This is ultimately perceived by t h e child a n d u s e d in t h e elaboration of teleological models a n d p e r m i t s the development of a core s e n s e of selfhood*organized along mentalistic lines. We a s s u m e t h a t this, by a n d large, is a m u n d a n e process, in t h e s e n s e of h a p p e n i n g every day t h r o u g h o u t early life, a n d t h a t it is a p r o c e s s t h a t is p r e c o n s c i o u s to b o t h infant a n d caregiver, inaccessible to reflection or modification. Caregivers, however, execute t h i s m o s t n a t u r a l of h u m a n functions in different ways. S o m e m a y be particularly alert to t h e earliest indications of intentionality, while o t h e r s m a y need stronger indications before they c a n perceive t h e child's m e n t a l s t a t e a n d modify their behavior accordingly. T h e child's development a n d perception of m e n t a l s t a t e s in himself a n d o t h e r s t h u s d e p e n d s on h i s observation of t h e m e n t a l world of h i s caregiver. He develops a concept a n d is t h u s able to perceive m e n t a l states, to t h e extent t h a t h i s caregiver's behavior implies s u c h s t a t e s . He does t h i s w h e n t h e caregiver is in a s h a r e d pretend m o d e of "playing" with t h e child (hence the association.between pretend a n d early mentalization), a n d m a n y m o r e m u n d a n e interactions (such a s conversations a n d peer interaction) will also involve s u c h s h a r e d m e n t a t i o n . This is w h a t m a k e s m e n t a l - s t a t e concepts s u c h a s t h i n k i n g inherently intersubjective; s h a r e d experience is p a r t of t h e very logic of mentals t a t e concepts. We believe t h a t t h e caregiver's capacity to observe t h e mom e n t - t o - m o m e n t c h a n g e s in t h e child's m e n t a l s t a t e is critical in t h e development of mentalizing capacity. T h e caregiver's perception of t h e child a s a n intentional being lies a t t h e root of sensitive caregiving, which a t t a c h m e n t theorists view a s t h e c o r n e r s t o n e of s e c u r e a t t a c h m e n t (Ainsworth et al. 1978; Bates, Maslin, a n d F r a n k e l 1985; Belsky a n d Isabella 1988; Egeland a n d Farber 1984; G r o s s m a n n , G r o s s m a n n , Spangler, S u e s s , a n d Unzner 1985; Isabella 1993; Isabella a n d Belsky 1991).

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Secure a t t a c h m e n t , in its t u r n , provides t h e psychosocial b a s i s for acquiring a n u n d e r s t a n d i n g of mind. The s e c u r e infant feels safe in m a k i n g a t t r i b u t i o n s of m e n t a l s t a t e s to a c c o u n t for t h e behavior of t h e caregiver. In c o n t r a s t t h e avoidant child s h u n s to some degree t h e m e n t a l s t a t e of t h e other, while t h e r e s i s t a n t child focuses on its own s t a t e of distress, to t h e exclusion of close intersubjective exchanges. Disorganized infants m a y represent a special category: hypervigilant of t h e caregiver's behavior, they u s e all c u e s available for prediction; t h e y m a y be acutely sensitized to intentional s t a t e s a n d t h u s m a y be m o r e ready to construct a mentalized a c c o u n t of t h e caregiver's behavior. We would a r g u e (see below) t h a t in s u c h children mentalization m a y be evident, b u t it does n o t h a v e t h e central role in self-organization t h a t c h a r a c t e r i z e s securely a t t a c h e d children. We believe t h a t w h a t is m o s t i m p o r t a n t for t h e development of mentalizing self-organization is t h e exploration of t h e m e n t a l s t a t e of t h e sensitive caregiver, w h i c h enables t h e child to find in t h e caregiver's m i n d (that is, in t h e hypothetical r e p r e s e n t a t i o n of h e r mind t h a t h e c o n s t r u c t s to explain h e r behavior toward him) a n image of himself a s motivated by beliefs, feelings, a n d intentions. In contrast, w h a t t h e disorganized child is s c a n n i n g for so intently is n o t t h e r e p r e s e n t a t i o n of h i s own m e n t a l s t a t e s in t h e mind of t h e other, b u t t h e m e n t a l s t a t e s of t h a t other t h a t t h r e a t e n to u n d e r m i n e h i s own self. They c a n constitute within the child's self-representation a n alien p r e s e n c e t h a t is so u n b e a r a b l e t h a t h i s a t t a c h m e n t behavior b e c o m e s organized around reexternalizing t h e s e p a r t s of t h e self onto a t t a c h m e n t figures, r a t h e r t h a n a r o u n d t h e internalization of a capacity for c o n t a i n m e n t of affects a n d o t h e r intentional states. There is considerable evidence to s u p p o r t t h e view t h a t s e c u r e a t t a c h m e n t e n h a n c e s t h e development of t h e self, i n n e r security, feeling of self-worth, self-reliance, a n d personal power of t h e emerging self a s well a s t h e development of a u t o n o m y (Bates et al. 1985; Gove 1983; Londerville a n d Main 1981; M a t a s et al. 1978). Disorganized infants, even if they acquire t h e skill of mind-reading, fail to integrate t h i s w i t h their self-organization. There m a y b e a n u m b e r of linked r e a s o n s for this: (a) The child n e e d s to u s e disproportionate r e s o u r c e s to u n d e r s t a n d

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t h e p a r e n t ' s behavior, a t t h e expense of reflecting on self-states, (b) The caregiver of t h e disorganized infant is less likely to be reliably contingent in r e s p o n d i n g to t h e infant's self-state a n d , further, to s h o w systematic b i a s e s in h e r perception a n d reflection of t h e child's state, (c) The m e n t a l s t a t e of t h e caregiver of t h e disorganized infant evokes i n t e n s e anxiety either t h r o u g h frightening behavior suggesting malevolence toward t h e child or t h r o u g h behavior suggesting fear, including inexplicable fear of t h e child himself. These factors m a y combine to m a k e disorganized infants become k e e n r e a d e r s of t h e caregiver's m i n d u n d e r certain circ u m s t a n c e s b u t , we suggest, poor r e a d e r s of their own m e n t a l states. T h u s , in t e r m s of t h e rival models of theory-of-mind development, s u c h children m a y acquire a t h e o r y - t h e o r y of mind b u t be u n a b l e to u s e simulation of mentalizing with t h e s a m e confidence a s c a n children w h o s e a t t a c h m e n t (albeit insecure) is coherent a n d organized. T h e alternative models m a y be more usefully t h o u g h t of a s alternative r o u t e s to mentalization, the first (theory-theory) accessible to all, t h e second (simulation) more readily available to children w h o s e early a t t a c h m e n t relat i o n s h i p s m a d e s u c h a strategy m o r e attractive a n d desirable. In c h a p t e r 6, we a t t e m p t to describe t h e n o r m a l development of reflective function in t h e child aged 2 to 5 years. We suggest t h a t t h e r e is a transition from a d u a l m o d e of experience i o mentalization. Primarily from a clinical perspective, we a d v a n c e a n u m b e r of propositions concerning t h e development of the psychological p a r t o f t h e self. These are: 1. In early childhood, reflective function is characterized by two m o d e s of relating i n t e r n a l experiences to t h e external situation: [a] In a serious frame of mind, t h e child expects t h e internal world in himself a n d o t h e r s to correspond to external reality, a n d subjective experience will often be distorted to m a t c h information coming from outside—psychic equivalence mode (e.g., Gopnik a n d Astington 1988; Perner, Leekam, a n d W i m m e r 1987). (b) While involved in play, t h e child k n o w s t h a t i n t e r n a l experience m a y n o t reflect external reality (e.g., B a r t s c h a n d Wellman 1989; Dias a n d Harris 1990), b u t t h e n t h e i n t e r n a l s t a t e is t h o u g h t to

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have n o relationship to t h e outside world a n d to h a v e n o implications for it {pretend mode). 2. In n o r m a l development, t h e child integrates t h e s e two m o d e s to arrive a t t h e stage of mentalization—or reflective mode—in which m e n t a l s t a t e s c a n be experienced a s r e p r e s e n t a t i o n s . Inner a n d o u t e r reality c a n t h e n be seen a s linked, yet t h e y a r e accepted a s differing in i m p o r t a n t ways a n d n o longer h a v e to b e either e q u a t e d or dissociated from e a c h other (Baron-Cohen 1995; Gopnik 1993). 3. We h a v e hypothesized t h a t mentalization normally comes a b o u t t h r o u g h t h e child's experience of h i s m e n t a l s t a t e s being reflected on, prototypically t h r o u g h experience of s e c u r e play with a p a r e n t or older child, w h i c h facilitates integration o f t h e pretend a n d psychic equivalence modes, t h r o u g h a n interpersonal p r o c e s s t h a t is p e r h a p s a n elaboration of t h e complex mirroring of t h e infant by t h e caregiver. In playfulness, t h e caregiver gives t h e child's ideas a n d feelings (when he is "only pretending") a link with reality by indicating t h e existence of a n alternative perspective, w h i c h exists outside t h e child's m i n d . The p a r e n t or older child also s h o w s t h a t reality m a y be distorted by acting u p o n it in playful ways, a n d t h r o u g h this playfulness a pretend b u t real m e n t a l experience m a y be introduced. 4. In t r a u m a t i z e d children, i n t e n s e emotion a n d associated conflict c a n b e t h o u g h t of a s having led to a partial failure of this integration, so t h a t a s p e c t s of t h e p r e t e n d m o d e of functioning become p a r t of a psychic equivalence m a n n e r of experiencing reality. This m a y be b e c a u s e w h e r e m a l t r e a t m e n t or t r a u m a h a s occurred within t h e family, t h e a t m o s p h e r e t e n d s to be incompatible with t h e caregiver "playing with" t h e m o s t p r e s s i n g aspects of t h e child's t h o u g h t s ; t h e s e are often d i s t u r b i n g a n d u n a c c e p t a b l e to t h e adult, j u s t a s t h e y a r e to t h e child. T h e rigid and controlling behavior of t h e preschool child with a history of disorganized a t t a c h m e n t is t h u s s e e n a s arising o u t of a partial failure on t h e p a r t of t h e child to move beyond t h e mode of psychic equivalence in relation to specific ideas or feelings, so

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t h a t he experiences t h e m with t h e intensity t h a t m i g h t b e expected h a d they b e e n c u r r e n t external events.

THE IMPLICATIONS OF REFLECTIVE FUNCTION FOR SELF-DEVELOPMENT "Mind-reading" m a y n o t be a n unequivocally positive experience. J u d y D u n n ' s work, however, gives u s a n indication t h a t a t least t h e u n d e r s t a n d i n g of emotion a t t h e age of 3V4 predicts a positive perception of social relations, m a t u r e moral sensibility, a n d the u n d e r s t a n d i n g of complex emotions (Herrera a n d D u n n 1997). S t e r n (1985) pointed o u t t h a t a s e n s e of ownership of one's actions—whether derived from t h e experience of forming plans, proprioceptive feedback, or t h e objective c o n s e q u e n c e s of physical actions on t h e e n v i r o n m e n t — c o n t r i b u t e s significantly to t h e s e n s e of self-agency. In o u r view, s u c h agency also crucially d e p e n d s on t h e quality a n d reliability of reflective function, a s ownership of action is intimately tied to t h e m e n t a l s t a t e (belief or desire) t h a t initiated it. It is impossible to conceive of selfagency a s fully established by t h e a c t u a l a c t i o n s of t h e child, a s s u c h a large proportion of t h e s e will fail to achieve their intended objective b e c a u s e of t h e child's i m m a t u r e physical a n d cognitive capacities. In fact, it could be a r g u e d t h a t if t h e s e n s e of selfagency were uniquely b a s e d o n feedback from i m m a t u r e action systems, deficiency in this s p h e r e would be universal. T h e recognition of t h e child's intentional s t a n c e by (older) o t h e r s m u s t , t h e n , be critical in m a k i n g t h e t h o u g h t "real" for t h e child. Interpersonal interaction t h a t p e r m i t s t h e registration of perceptions, t h o u g h t s , a n d emotions a s c a u s e s a n d c o n s e q u e n c e s of action a n d t h e contemplation of t h e s e m e n t a l s t a t e s w i t h o u t fear m u s t constitute a n i m p o r t a n t p a r t of t h e foundation of selfagency. T h e earliest foundation is p r e s u m a b l y t h e b a b y ' s sense t h a t h e brings a b o u t t h e caregiver's mirroring behavior (Gergely a n d W a t s o n 1996). This idea is a t t h e core of c h a p t e r 4. Of course, t h e core of self-agency m u s t lie in t h e body, where t h e infant's effort to be in control often s u c c e e d s after t h e earliest times. However, more complex actions, particularly those

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t h a t involve o t h e r s in t h e child's world, frequently require t h e reflective caregiver to m a k e s e n s e of t h e y o u n g child's w i s h e s a n d to e x p r e s s these, if t h e two-way connection between intentions a n d action is to be established. Hence, t h o s e w h o have experienced severe neglect or coercive, rigid, frightening, a n d , a t a n extreme, a b u s i v e p a r e n t i n g will frequently experience their sense of self-agency a s massively curtailed a n d confined to t h e more finnly established bodily d o m a i n (see c h a p t e r s 9 a n d 10 for a full exploration of t h i s idea). The model of t h e development of mentalizing capacity t h a t we propose h a s considerable clinical implications. For example, in a s t u d y of a t t a c h m e n t classification in p a t i e n t s with severe personality disorders, Fonagy et al. (1996) found t h a t t h e AAI narratives of borderline-personality-disordered p a t i e n t s h a d lower reflective function, coupled with histories of severe t r a u m a , which w a s a p p a r e n t l y unresolved. The findings suggest t h a t , given a sensitive a t t a c h m e n t relationship, w h i c h provides t h e intersubjective b a s i s for t h e development of mentalizing capacity, t r a u m a (even if severe) is m o r e likely to be resolved. Severe distortion of personality follows w h e n a b u s e or neglect leads to a defensive inhibition of mentalization. Similarly, evidence is accumulating t h a t a m o n g juvenile offenders, w h e r e histories of malt r e a t m e n t a r e c o m m o n , capacities for mentalization are severely restricted (Blair 1995; Levinson a n d Fonagy 2000). The evidence on d i s t u r b a n c e s of mentalization a m o n g clinical g r o u p s is elaborated m o r e fully in later c h a p t e r s (see c h a p t e r s 10 a n d 11 in particular).

A DEVELOPMENTAL FRAMEWORK FOR ABNORMAL REFLECTIVE FUNCTION It would b e u n d o u b t e d l y overly simplistic to m a k e a n a b s o l u t e connection between developmental disorder a n d nonreflectiveness. There a r e variations a c r o s s situations, or, p e r h a p s m o r e accurately, a c r o s s relationships. The delinquent adolescent is well aware of t h e m e n t a l s t a t e s of other g a n g m e m b e r s , a n d t h e borderline individual a t times s e e m s hypersensitive to t h e affec-

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tive s t a t e s of m e n t a l h e a l t h professionals a n d family m e m b e r s . These "anomalies" m a y be clarified by more sophisticated developmental theory. O u r c h o s e n framework is provided by "dynamic skills theory" (Fischer a n d F a r r a r 1987; Fischer, Kenny, a n d Pipp 1990), which depicts development a s a p e r s o n ' s elaboration of progressively more complex control s y s t e m s (skills). Reflective function m a y be readily conceived of a s one s u c h control system, critical to the organization of t h e self. Within d y n a m i c skills theory, reflective function would be seen a s n o t simply a property of t h e person, b u t o f t h e p e r s o n a n d situation together, b e c a u s e all skills are composed of b o t h t h e p e r s o n ' s activities a n d t h e s i t u a t i o n s or context within w h i c h t h e s e occur. Particular t a s k s , specific events, other people, a s well a s c u l t u r e are s e e n a s p a r t of the skill. F u r t h e r m o r e , t h e development of a skill is n o t s e e n a s progression along a n y singular p a t h , determined by m a t u r a t i o n . Rather, reflective function, a s a skill, evolves t h r o u g h varied pathways, molded by m a n y dynamically interacting influences, s u c h a s t h e individual's emotions, social interaction, family relat i o n s h i p s a n d environment, i m p o r t a n t social g r o u p s , t h e reactions o f t h e wider social world,, a n d so forth (Fischer.Knight, a n d V a n P a r y s 1993). Reflective function is a s t r a n d within t h e developmental web, one of t h e m a n y distinct control s y s t e m s t h a t a r e neither strongly connected with e a c h other n o r coordinated or integrated (Fischer a n d Pipp 1984). T h e "fractionation" or splitting of all abilities a s a function of t a s k s a n d d o m a i n s is well d e m o n strated, a n d we m i g h t expect reflective function to b e subject to t h e s a m e k i n d of developmental decalage [unevenness] t h a t characterizes t h e r e s t of cognitive development (Flavell 1982). "Fractionation" refers to t h e t e n d e n c y for a p e r s o n n o t to coordin a t e skills or experiences t h a t a r e - n a t u r a l l y s e p a r a t e b u t may be t h o u g h t of a s belonging together by s o m e external criterion (Fischer a n d Ayoub 1994). J u s t a s t h e u n d e r s t a n d i n g of conservation of liquid does n o t generalize to conservation of area, reflective capacity in o n e d o m a i n of interpersonal interaction should n o t be expected to generalize to others. Reflective function does n o t begin a s a general capacity, b u t is a p a r t i c u l a r skill tied to t h e t a s k a n d d o m a i n w h e r e it is learned—a specific &

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category of relationship. Reflective function a s a skill m a y be more or less p r e s e n t in s i t u a t i o n s a s a function of contextual s u p p o r t a n d emotional s t a t e s t h a t p u s h a n individual u p or down a developmental s t r a n d . Differences in t h e m e a n i n g of a n interaction a s well a s its physical context c a n lead to fractionation. For example, t h e concept of conservation of liquid m a y n o t generalize b e t w e e n t h e experimental t a s k a n d o n e t h a t involves helping a thirsty friend, even if b o t h involve p o u r i n g a glass of orange j u i c e (Rogoff 1990). We have noted above t h a t t h e child's observed u s e a n d experience of m e n t a l - s t a t e l a n g u a g e c a n differ markedly a c r o s s social contexts ( D u n n 1996). Fractionation does not d i s a p p e a r entirely with development, either in general or in the specific c a s e of reflectiveness. It is clearly possible for t a s k based skills s u c h a s reflective function to come to b e coordinated, b u t t h i s s h o u l d n o t be s e e n a s a u t o m a t i c . U n e v e n n e s s across s i t u a t i o n s is likely to r e m a i n prevalent even in adults, especially w h e n t h e y are emotional (Fischer a n d Ayoub 1994). Normal development proceeds from fractionation toward integration, w h i c h involves t h e construction of specific coordinations among previously s e p a r a t e skills a n d provides t h e foundation for more complex, sophisticated control s y s t e m s (Bidell a n d Fischer 1994). Abnormalities of reflective function, t h e c o n t i n u e d u s e of a teleological r a t h e r t h a n a mentalizing model for predictive behavior, s h o u l d not, t h e n , be s e e n a s either a c o n s e q u e n c e of "arrest a n d fixation" a t a n early stage or a "regression" to t h a t stage. Pathologies in t h e reflective function of t h e maltreated child m a y b e expected to develop increased complexity with age and time, in a m a n n e r similar to other skills. T h e skill for limited reflectiveness developed by t h e child to anticipate a n d forestall m a l t r e a t m e n t a n d its painful physical a n d psychological i m p a c t would be adaptive in their p a r t i c u l a r world b u t would b e expected to p r o d u c e sophisticated forms of difficulty r a t h e r t h a n straightforward a d a p t a t i o n s in o t h e r contexts (Noam 1990). T h e ability to be reflective in general, b u t to s h o w only minimal reflectiveness in t h e context of one's own childhood with reference to the m e n t a l s t a t e s of "caregiving" o t h e r s or in specific relationships t h a t reactivate t h e s a m e s c h e m a t a , could be a r e s u l t of n a t u r a l fractionation. U n e v e n n e s s or splitting of reflective ability could also be t h e c o n s e q u e n c e of a n active (purposeful, con-

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scious, or unconscious) a t t e m p t on t h e p a r t o f t h e individual n o t to coordinate or generalize reflective function to specific relationship d o m a i n s . Here t h e u n e v e n n e s s is "a developmental achievement," in t h a t t h e p e r s o n m u s t create a coordination in order actively to m a i n t a i n t h e s e p a r a t i o n of contexts t h a t would n a t u rally move toward integration. The family might, of course, s u p port s u c h splits with s h a r p dissociations between their public, proper world a n d their private tyrannical one. T h e split is context-: a n d affect-dependent, a n d skills developed within one context will n o t necessarily be m a t c h e d by similar abilities in others. Within a n a t t a c h m e n t - t h e o r y framework we m i g h t s a y t h a t t h e self is organized so t h a t certain internal working models include considerable reflective c o m p o n e n t s — e x p e c t a t i o n s incorporating t h e m e n t a l s t a t e s of self a n d other—while other working models of relationships a p p e a r impoverished, indicating only minimal mentalizing skills. In t h e latter contexts t h e subject will offer only stereotyped, simple, concrete, low-level descriptions. This does not imply developmental delay or regression; r a t h e r , it suggests a r e m a r k a b l y complex ability to coordinate two distinct levels of functioning. It is t h e function of t h e abusive or emotionally depriving world within w h i c h they developed t h a t engendered in t h e m t h e sophisticated skills required for s u c h a n a d a p t a t i o n . T h u s to talk of deficit or a b s e n c e of a capacity in s u c h individuals would u n d o u b t e d l y be a n oversimplification. M e a s u r e s of global abilities will n o t yield difference between t h e s e individuals a n d other groups. Efforts a t going beyond m e r e clinical i m p r e s s i o n in t e r m s of m e a s u r e m e n t a n d quantification h a v e to t a k e on .board t h e u n e v e n n e s s of their abilities a n d the situational a n d interpersonal specificity of t h e failure of reflective function. In o u r view, nonreflective internal working models come to d o m i n a t e t h e behavior of personality-disordered a d u l t s a n d children w h e n a n e l e m e n t of conflict is p r e s e n t within a n interpersonal relationship. Conflict—or, r a t h e r , its adaptive resolution-^-prototypically calls for t h e perception b o t h o f t h e self a n d of t h e other in relation to t h e self, requiring individuals to reconcile their own legitimate claims with c o n c e r n for t h e other (Killen a n d Nucci 1995). T h u s , for example, t h e a b n o r m a l i t y of t h e early family environment of individuals with severe p r o b l e m s of con-

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duct h a s b e e n m o s t evident in t h e context of normally expectable conflicts (Patterson 1982; Perry, Perry, a n d Kennedy 1992). In this context t h e child with a vulnerable capacity for mentalization experiences n o affirmation of h i s intentional s t a n c e a n d fails to acquire t h e s e n s e of ownership or i n n e r e n d o r s e m e n t of his actions t h a t is essential for a s e n s e of self-agency. Consequently, his s e n s e of a u t o n o m y b e c o m e s vulnerable, a n d t h e i m p o r t a n c e of his original i n t e n t i o n is exaggerated. T h e characteristics of oppositional defiant disorder (e.g., negativity, disobedience, aggression) m a y in p a r t be s e e n a s a t t e m p t s a t r e a s s e r t i n g selfagency in a relationship w h e r e t h e connection between m e n t a l state a n d action within t h e self h a s b e e n u n d e r m i n e d by insensitive a n d coercive parenting. ^ Abnormalities of p a r e n t i n g r e p r e s e n t b u t o n e route to limitations on reflective function. T h e child's biological vulnerabilities, s u c h a s hyperactivity, i n a d e q u a t e attentiveness, deficiencies in impulse control, a r e all likely to o b s t r u c t h i s opportunity for evolving a mentalized reflective model of conflictual interpersonal situations. Within a dialectic or t r a n s a c t i o n a l model t h e r e is a bidirectional causality i n h e r e n t to s u c h biological vulnerabilities: t h e y b o t h provoke s i t u a t i o n s of conflict a n d gravely limit t h e child's capacity to h a n d l e t h e m flexibly (see c h a p t e r 9). The s e p a r a t i o n of action from intention u n d e r m i n e s t h e emotional reaction individuals m a y b e expected to h a v e in relation to the c o n s e q u e n c e s of their action, since, a s Hart a n d Killen pointed out, t h e acquisition of moral emotions r e q u i r e s t h a t individuals a r e "active c o n t r i b u t o r s to their own development, interpreting their world a n d m a k i n g j u d g m e n t s t h a t determine their actions in it" (1995, p. 7). S u b s e q u e n t l y , t h e p r e d o m i n a n t response to s i t u a t i o n s charged with emotion will be a nonreflective one, readily disowned by t h e self. Naturally t h e a b s e n c e of reflective function in s u c h s i t u a t i o n s will give t h e a p p e a r a n c e of rigidity to t h e p e r s o n ' s behavior, a s if only a singular p a t t e r n of response were accessible. F u r t h e r m o r e , t h e r e s p o n s e m a y frequently be in conflict with social n o r m s b e c a u s e t h e t e n d e n c y to take t h e perspective of o t h e r s h a s b e e n a b a n d o n e d in t h a t context, a n d c o n s e q u e n t l y t h e "moral emotions" u s e d to m a k e j u d g m e n t s a b o u t t h e c o n s e q u e n c e s of actions a n d to regulate behavior (Arsenio a n d Lover 1995) a r e a b s e n t . T h e a b s e n c e of

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reflective function m a y further exaggerate a n antisocial r e s p o n s e by forcing t h e individual to see t h e other n o t a s a n o t h e r intentional agent, b u t , r a t h e r , in n o n h u m a n t e r m s , a s a body, a s representing a social position or agency, or a s a n a n o n y m o u s m e m b e r of a group. Maltreatment, or m o r e broadly t r a u m a , is seen a s interacting with t h e domain- a n d situation-specific restrictions on reflective function a t two levels: (a) As we have argued, m a l t r e a t m e n t p r e s e n t s t h e y o u n g child with a powerful emotional disincentive for t a k i n g t h e perspective of o t h e r s b e c a u s e o f t h e a c t u a l hostility o f t h e intentional s t a n c e o f t h e a b u s e r , a s well a s t h e c o n s t r a i n t s u p o n self-development imposed by a n older p e r s o n ' s failure to u n d e r s t a n d a n d acknowledge t h e child's b u d d i n g s e n s e of intentionality. (b) T h e child is deprived of t h e resilience provided by t h e capacity to u n d e r s t a n d a t r a u m a t i c interpersonal situation (Fonagy et al. 1994). T h u s individuals t r a u m a t i z e d by their family environment are vulnerable in t e r m s b o t h of t h e long-term maladaptive effect of their reaction to t h e t r a u m a a n d of their reduced capacity to cope with it. The p r e d o m i n a n t l y n o n m e n talizing s t a n c e adopted in s u c h s i t u a t i o n s therefore further impairs t h e individual a n d , in t h e extreme, their nonmentalizing a p p r o a c h will come to d o m i n a t e all i n t i m a t e interpersonal relationships. It is a t t h i s stage t h a t severe developmental psychopathology—ultimately e n t r e n c h e d personality disorder—becomes t h e likely outcome.

Historical a n d I

Interdisciplinary

Perspectives o n a n d Affect

Affects

Regulation

In this c h a p t e r , we follow o u t t h e implications of t h e a r g u m e n t in the first c h a p t e r concerning t h e developmental m e c h a n i s m s t h a t produce mentalization a n d reflective function. Here we examine the relationship of early object relations with mentalization t h r o u g h t h e l e n s of affects a n d affect regulation. T h i s c h a p t e r provides a historical overview of academic traditions concerning affects a n d affect regulation from t h e perspective of mentalization. T h e c h a p t e r is n o t intended a s a n y kind of exhaustive review—an ambition t h a t is s u b s t a n t i a l l y beyond t h e scope of this work. O u r a i m h e r e is to point to key controversies in t h e study of emotion. T h e review highlights t h e fact t h a t a n a l o g o u s dichotomies exist a c r o s s a n u m b e r of disciplines. Both philosophical a n d psychological traditions t e n d to regard affects in one of two ways: (a) ideally a s integrated with cognition, a n d (b) a s inherently i n d e p e n d e n t of, opposed to, a n d o u t of t h e control of rational t h o u g h t . Certain n e u r o s c i e n t i s t s have suggested t h a t both traditions m a y have s t r o n g foundations in t h e b r a i n structures a s s u m e d to m e d i a t e emotional experience. Psychoanalysts, including F r e u d , h a v e also p u r s u e d b o t h lines of t h o u g h t , with notable individual exceptions. We review t h e contribution of a t t a c h m e n t t h e o r i s t s in some detail, since t h i s framework represents t h e s t a r t i n g point for m a n y of t h e ideas in t h e c u r r e n t 65

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m o n o g r a p h . In t h e a t t a c h m e n t theory tradition, t h e r e is a comm i t m e n t to explore precisely how affective experience contribu t e s to t h e acquisition of self-regulation b y v i r t u e of coregulation between caregiver a n d infant. T h e p r e s e n t c h a p t e r places our a p p r o a c h , w h i c h is also b a s e d in t h e developmental tradition already outlined briefly in c h a p t e r 1, into a historical frame of reference,, insofar a s we a t t e m p t to integrate t h e two major intellectual traditions concerning affect.

INTRODUCTION There is a n e n o r m o u s a n d growing interest in affects across disciplines. Both in a t t a c h m e n t theory a n d in m a n y other dom a i n s in psychology, one i m p o r t a n t c o m p o n e n t of t h i s interest in affects c e n t e r s on affect regulation. Yet, a s m a n y scholars have observed, t h e concept of affect regulation h a s never b e e n well d e n n e d (Gross 1998, 1999; Magai 1999; R. T h o m p s o n 1990, 1994). For some theorists, affect regulation, or w h a t is sometimes referred to a s "emotion regulation," d e n o t e s a process wherein t h e object of regulation is t h e affect/emotion itself (Eisenberg a n d F a b e s 1992; N. Fox 1994; G a r b e r a n d Dodge 1991). For a t t a c h m e n t t h e o r i s t s a n d p s y c h o a n a l y s t s , however, t h e object of regulation is m o r e complex: t h e regulation of affects is linked to t h e regulation of t h e self. More precisely, affect regulation plays a crucial p a r t in t h e explanation of h o w infants move from a state of coregulation to self-regulation. T h e s t a k e s a r e greater in t h e way p s y c h o a n a l y s t s a n d a t t a c h m e n t theorists conceive of affect regulation. Affects a n d affect regulation a r e n o t necessarily complementary concepts. Affect regulation entails t h e capacity to control a n d m o d u l a t e o u r affective r e s p o n s e s . However, we shall consider s o m e of t h e a r g u m e n t s of t h o s e w h o do n o t agree t h a t affects c a n be b r o u g h t u n d e r regulation. It is i m p o r t a n t , therefore, to begin t h i s inquiry by t a k i n g a look a t various s o u r c e s a n d d e b a t e s concerning t h e n a t u r e of affects a n d affect regulation. This historical b a c k g r o u n d illuminates t h e w a y in w h i c h certain

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beliefs a b o u t affects c o n t i n u e to inform c o n t e m p o r a r y perspectives. We begin, in t h e first p a r t of t h i s chapter, with philosophical perspectives o n affects a n d affect regulation; w e move o n to psychological perspectives a n d t h e n t u r n to neuroscientific perspectives. In t h e second part, we examine affects a n d affect regulation in p s y c h o a n a l y s i s a n d t h e n a t t a c h m e n t theory.

PHILOSOPHICAL PERSPECTIVES In t h e W e s t e r n philosophical tradition, t h e c o m m i t m e n t to rationality a s t h e ideal s t a n d a r d to guide action m e a n t t h a t affects were minimized in importance. At t h e s a m e time, m o s t major philosophers h a v e felt t h e need to try to h a v e s o m e a c c o u n t of affects, a n d even philosophers w h o a r e s t a u n c h defenders of rationality, like Descartes, h a v e h a d profound t h i n g s to say a b o u t affects. 1 We do n o t a t t e m p t to p r e s e n t a detailed inquiry a b o u t h o w affects have b e e n u n d e r s t o o d in t h e history of philosophy in t h i s context. For o u r p u r p o s e s , it will be sufficient to emphasize a crucial d e b a t e concerning t h e n a t u r e of affect within t h e history of philosophy t h a t r e m a i n s extremely relevant today for u n d e r s t a n d i n g affects a n d affect regulation. In c h a p t e r 5, on t h e self a s agent, we a d d r e s s c o n t e m p o r a r y ideas from t h e philosophy of m i n d in connection with t h e t h e m e of intersubjectivity. For Aristotle, affects a r e f u n d a m e n t a l for t h e p u r s u i t a n d a t t a i n m e n t of a good a n d h a p p y h u m a n life. He regards affects as beliefs; a s s u c h , t h e y provide j u d g m e n t s a b o u t t h e world t h a t can be justified or not. This m e a n s t h a t , by themselves, affects are n e i t h e r h a r m f u l n o r opposed to r e a s o n . As Aristotle s e e s it, affects b e c o m e h a r m f u l only insofar a s o u r c h a r a c t e r s a r e too 1

Descartes is often singled out for criticism concerning his belief that reason, and reason alone, guarantees knowledge. However, Descartes' treatise The Passions of the Soul is devoted to the treatment of affects, stressing the importance of the role of the body in affects. For an original perspective on just how seriously Descartes and other seventeenth-century philosophers took affects, see S. James 1997.

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w e a k to c o u n t e r a c t a n d m o d e r a t e t h e m . 2 He does n o t deny t h a t affects c a n become excessive; r a t h e r , h e s t r e s s e s t h a t t h r o u g h practice we c a n learn to have t h e m in t h e a p p r o p r i a t e way—that is, a t t h e right time, in t h e right way, a n d toward t h e right people. Aristotle is t h e first philosopher who, it is fair to s u r m i s e , p o s t u l a t e d a theory of affect regulation. For him, regulating affects d e p e n d s u p o n crafting t h e m to occur within t h e intermediary c o u r s e between t h e extremes of either excess or deficiency. In other words, we c a n d i s t i n g u i s h between a n g e r a s conforming to t h e m e a n a n d its extremes—excess, w h i c h we c a n call irascibility; a n d t h e deficiency, w h i c h we c a n call irritation (Barnes 1984;. Rhetoric 1378a31). 3 Aristotle w i s h e s to u r g e u s to cultivate o u r c h a r a c t e r s in order to b e able to discern how to act in a way t h a t places affects u n d e r o u r control. He a p p r e c i a t e s t h e values of affects, a n d h e particularly s t r e s s e s how integrally connected p l e a s u r e is with affective experience (Gosling a n d Taylor 1982; J u r i s t 1998; Stocker a n d H e g e m a n 1996). P e r h a p s , m o s t importantly, h e fashions a n ideal for h u m a n a g e n t s of integrating r e a s o n a n d feeling. Countering Aristotle, t h e Stoic p h i l o s o p h e r s challenge the notion t h a t affects c a n be m o d u l a t e d . In their view, affects are beyond o u r control a n d necessarily elude cultivation; t h i s explains why we often feel t h a t affects h a p p e n to u s , r a t h e r t h a n t h a t they are c h o s e n by u s . T h e Stoics regard affects a s false j u d g m e n t s a n d h e n c e a s c o r r u p t i n g forces t h a t lead u s a s t r a y . It behooves u s , therefore, to d i s t a n c e ourselves from affects a n d to strive to a c t on t h e b a s i s of rationality alone. If we m a n a g e to withhold o u r c o n s e n t to t h e overpowering force of affects, we c a n achieve t h e "detachment" a n d "self-sufficiency" by virtue of which we are able to flourish.

"The Ancient Greek virtue, sophrosune, concerns the regulation of pleasure and bodily appetites. Sophrosune has to do with finding the right amount of pleasure, not restricting or devaluing it. 3 Aristotle makes the point that it is difficult to find the, right word for the deficiency of anger, thereby acknowledging that anger is the kind of affect that is more likely to be excessive.

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The Stoic view h a s h a d a d o m i n a n t influence o n t h e history of philosophy. T h i s is particularly striking in t e r m s of t h e philosophical propensity to c o n s t r u e irrationality strictly in t e r m s of being a failure of rationality, r a t h e r t h a n a s having a m e a n i n g in its own right. Moreover, Stoic philosophy h a s h a d a n i m p o r t a n t influence on early C h r i s t i a n thinking, wherein affects a n d t h e body a r e portrayed in negative t e r m s . T h e ambivalence in Christianity toward affects is illustrated by D e S o u s a in t h a t five o u t of the seven m a i n vices are affects (pride, lust, envy, gluttony, anger, a n d sloth, b u t n o t avarice a n d greed), a n d three o u t o f t h e four c a r d i n a l virtues concern resisting emotional t e m p t a t i o n s (prudence, fortitude, a n d t e m p e r a n c e , b u t n o t justice) (1987, p. 17). Reflecting on t h e history of philosophy h a s m o r e t h a n a n t i q u a r i a n interest: t h e influence of t h e Stoic view h a s h a d real c o n s e q u e n c e s for t h e self-understanding of o u r culture. Generally a n d s o m e w h a t bluntly stated, Aristotelians are friendly toward affects, w h e r e a s Stoics a r e wary of t h e m . 4 Alt h o u g h t h e s e a p p e a r to b e m u t u a l l y exclusive paradigms, caution ought to b e exercised n o t to r e a c h s u c h a conclusion p r e m a turely. Indeed, in t u r n i n g to Spinoza, we find a philosopher who a c c o m m o d a t e s different a s p e c t s of b o t h p a r a d i g m s . Spinoza w a s greatly influenced by t h e C a r t e s i a n revolution a n d w a s particularly a t t r a c t e d to t h e a i m of rendering philosophy m o r e scientific, a s is evident from t h e geometrical form of t h e Ethics (Spinoza, 1677). He d e p a r t e d from Descartes' dualism, however, in conceiving of h u m a n s a s embodied m i n d s . Descartes' work, The Passions of the Soul, h a d t h e merit of portraying affects both- a s s e n s a t i o n s t h a t a r e in t h e body a n d a s mentalistic; in fact, t h e e m p h a s i s on affects a n d t h e body initiates a n i m p o r t a n t new direction, w h i c h a n t i c i p a t e s psychology, away from Aristotle's conception of t h e m a s beliefs. Yet a problem arises for Descartes in having to give a n a c c o u n t of h o w t h e mind i n t e r a c t s with t h e body. Spinoza neatly b y p a s s e s t h i s problem b e c a u s e h e insists t h a t bodily experience is directly accessible.to t h e m i n d (1677, p. 12). 4 For an excellent discussion of the relation between Aristotelians and Stoics, see Nussbaum's The Therapy of Desire (1994).

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Spinoza w a s strongly influenced by t h e Stoics' view of affects. He regards affects a s false j u d g m e n t s a n d , hence, u r g e s u s to strive to resist acting u p o n t h e m a n d to accept t h a t t h e y elude o u r control. Nonetheless, in Part III o f t h e Ethics, Spinoza a r g u e s t h a t we o u g h t n o t simply to reject or forsake affects; r a t h e r , reason s h o u l d be -used to correct affects w i t h o u t dismissing them. O u r self-understanding is improved, according to Spinoza, by u n d e r s t a n d i n g o u r affects. From a clinical point of view, w h a t is especially interesting a b o u t Spinoza is h i s suggestion t h a t the affective s t a t e m u s t be preserved in t h e way r e a s o n is applied to it. (We r e t u r n to t h i s idea later in t h e chapter.) In appreciating t h a t affects enrich o u r lives, h e exhibits s y m p a t h y for t h e Aristotelian h o p e of integrating feeling a n d r e a s o n . T h u s , it is impossible to place Spinoza neatly into either t h e Aristotelian or the Stoic c a m p . T h e d e b a t e between Aristotelians a n d Stoics h a u n t s t h e history of t h i n k i n g a b o u t affects. C a n affects be cultivated? Do they give m e a n i n g to h u m a n life, a n d a r e t h e y i n d i s p e n s a b l e to the way we imagine h u m a n thriving? Or a r e t h e y primitive forces t h a t are d a n g e r o u s to o u r well-being? One kind of philosophical a p p r o a c h to t h i s d e b a t e is primarily to c o n c e n t r a t e o n t h o s e affects t h a t one d e e m s a s valuable a n d a s c o n t r i b u t i n g to moral c o n d u c t . H u m e t a k e s s u c h a position: h e does n o t claim t h a t all affects should be regarded a s c o n t r i b u t i n g to morality, b u t he m a i n t a i n s t h a t morality is b a s e d u p o n feelings a n d could never be legislated by r e a s o n alone. More recently, m o r a l psychologists in philosophy like Stocker a n d H e g e m a n (1996), Oakley (1992), Rorty a n d F l a n a g a n (1990), G r e e n s p a n (1988), D e S o u s a (1987), a n d C. Taylor (1985) h a v e a r g u e d ' t h a t affects c o n t r i b u t e to morality a n d t h a t it is m i s t a k e n to conceive of affects a s u n d e r mining rationality. In s u m , t h e r e is a growing appreciation b y philosophers of t h e value of r e t h i n k i n g affects. T h i s does not m e a n , of course, t h a t t h e r e is a g r e e m e n t a m o n g philosophers. There r e m a i n s a divide between t h o s e t h i n k e r s w h o w i s h to define affects in t e r m s of beliefs (like Wollheim 1999) a n d others who w a n t to reformulate t h e bodily contribution of affects who are captivated by t h e b u r g e o n i n g scientific r e s e a r c h on affects (e.g., Griffiths 1997).

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PSYCHOLOGICAL P E R S P E C T I V E S In c o m p a r i s o n to philosophy, t h e field of psychology h a s always exhibited a k e e n interest in p h e n o m e n a besides r e a s o n , s u c h a s motivation. Nevertheless, d u r i n g t h e e r a of behaviorism a n d even in t h e early p h a s e s of t h e cognitive revolution, affects h a v e hardly b e e n a t t h e center of r e s e a r c h in psychology. T o m k i n s (1995a, 1995b) stood a s a relatively lone voice in American psychology d u r i n g t h e 1950s a n d 1960s in working to develop Darwin's view t h a t affects a r e revealed t h r o u g h facial expression* and are designed to lead u s to action. T o m k i n s s t r e s s e d t h a t affects o u g h t to b e studied in their own right, a n d t h a t t h e y constitute a n i n d e p e n d e n t s p h e r e of knowledge—distinct from perception, cognition, a n d memory. According to Tomkins, affects are p r i m a r y biological motivating m e c h a n i s m s a n d can, t h u s , be u n d e r s t o o d a s having primacy in h u m a n agency. Tomkins's work highlights t h e link between affects a n d facial expressions, a n d , in h i s later writings, h e included t h e importance of skin r e s p o n s e s (Tomkins 1995b). Inspired by h i s t e a c h e r Tomkins, E k m a n (1992a; E k m a n a n d Davidson 1994) h a s , from t h e 1970s to t h e p r e s e n t , c o n d u c t e d research t h a t d e m o n s t r a t e s t h a t emotions are universal a n d can be recognized cross-culturally t h r o u g h facial expressions. 5 E k m a n a r g u e s t h a t t h e r e are five "basic emotions"—happiness, sadness, anger, fear, a n d disgust. T h e s e b a s i c emotions a r e defined in t e r m s of t h e following n i n e characteristics: distinctive universal signals, p r e s e n c e in other p r i m a t e s , distinctive physiology, distinctive u n i v e r s a l s in a n t e c e d e n t events, coherence among emotional response, q u i c k onset, brief duration, a u t o matic appraisal, a n d u n b i d d e n occurrence (Ekman 1992a). E k m a n concedes t h a t t h e evidence s u p p o r t i n g t h e s e n i n e c h a r acteristics varies: evidence exists for distinctive p a t t e r n s of autonomic n e r v o u s s y s t e m r e s p o n s e s for anger, fear, disgust, a n d

5 A word about terminology: emotions are biological and universal, whereas feelings are subjective and particular (influenced by culture, family, and individual idiosyncrasy). Affects are inclusive of both emotions and feelings.

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(tentatively) s a d n e s s , a n d h e claims t h a t u n i q u e p a t t e r n s exist for e a c h emotion in t h e central n e r v o u s s y s t e m . Like t h e Stoics, basic-emotions p r o p o n e n t s e m p h a s i z e t h a t affects happen to u s . It is t h e rapid o n s e t of emotions, according to E k m a n , t h a t explains w h y we perceive t h e m a s h a p p e n i n g to u s , a s opposed t o p e r c e i v i n g ourselves to be choosing t h e m . Yet, unlike t h e Stoics, basic-emotions p r o p o n e n t s value affects a s contributing to survival a n d a t least in this s e n s e regard t h e m a s salutary. The basic-emotions p a r a d i g m offers one possible p a t h to c o n d u c t r e s e a r c h a b o u t affects. There a r e other p a r a d i g m s in psychology, growing o u t of t h e J a m e s - L a n g e theory (W. J a m e s 1884; Lange 1885), w h i c h h a v e b e e n influential a n d which we need to consider. Before doing so, however, two criticisms against E k m a n ' s work need to b e acknowledged. T h e first criticism of b a s i c emotions p r e s s e s t h e question of w h e t h e r affects form genuinely discrete categories or w h e t h e r w h a t is really "basic" a b o u t affects is their d i m e n s i o n s : levels of arousal, pleasure, a n d activity. For example, Davidson (1992) a r g u e s in favor of t h e d i m e n s i o n s of "approach a n d withdrawal" a s basic, t h u s posing a n explicit challenge to E k m a n ' s u n d e r s t a n d i n g of basic emotions strictly in t e r m s of facial expressions. Davidson rightly n o t e s t h a t n o t h i n g in E k m a n ' s s t u d i e s s u s t a i n s t h e invariability of prototypical expressions—especially w h e n t h e s e emotions occur s p o n t a n e o u s l y (as opposed to in t h e laboratory). As Davidson a d d s , t h e r e is n o compelling r e a s o n simply to a s s u m e t h a t a n isomorphic relationship exists between emotions a n d their expressions—there m a y well be a s m u c h variability within emotions a s a c r o s s t h e m . The second criticism of E k m a n ' s w o r k c o n c e r n s its crossc u l t u r a l validity. J . Russell (1991) observes t h a t while E k m a n ' s work on facial expressions s h o w s t h a t emotions a r e similar a c r o s s c u l t u r e s , we s h o u l d n o t a s s u m e t h a t emotions are identical in different c u l t u r e s . In a similar vein, Averill (1994) h a s emphasized t h a t b a s i c emotions are, in essence, a form of classification, a n d h e w a r n s t h a t t h e adoption of s u c h "prototypes" too often r e s u l t s in overlooking s e c o n d a r y a n d u n u s u a l emotions. Shweder, a n anthropologist, develops a n even m o r e radical critique of t h e basic-emotions view. Shweder c o n c u r s t h a t some

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emotions lack characteristic facial expressions a n d suggests t h a t we o u g h t to u n d e r s t a n d t h e m a s "complex narrative s t r u c t u r e s t h a t give s h a p e a n d m e a n i n g to somatic a n d affective experiences" (1994, p. 37). Like Russell a n d Averill, Shweder rejects the basic-emotions view, regarding it a s a c o n s t r u c t of language t h a t relies o n a p p r a i s a l s of value r a t h e r t h a n on a n y t h i n g t h a t is found in n a t u r e . In raising q u e s t i o n s a b o u t h o w beliefs c a n influence affects, the c r o s s - c u l t u r a l criticism d r a w s o u r attention to t h e subjective experience of affects a n d implicitly to o u r potential to alter a n d craft t h e m . E k m a n m a k e s it clear t h a t h e is primarily concerned with t h e i n n a t e a n d universal a s p e c t s of emotions; h e avers t h a t this is t h e p a t h w h e r e b y r e s e a r c h c a n m a k e t h e m o s t progress. E k m a n specifically disavows t h e subjective experience of affects a s u n a m e n a b l e to s t u d y " b e c a u s e too little is k n o w n a b o u t how subjectivity m a p s on to other a s p e c t s of a n emotional experience" (1992a, p. 175). However, we m a y w o n d e r to w h a t extent the p r e s e n t a t i o n of affective experience a s found s t a t e s within the mind is a distortion of its n a t u r e , w h i c h ignores o u r capacity to p r o c e s s a n d regulate affects. Many psychologists h a v e focused a t t e n t i o n on how cognition determines affective experience. Emerging a s a r e s p o n s e to t h e J a m e s - L a n g e theory, w h i c h stipulated t h a t affects are t h e perceptual recognition of physiological reactions to t h e outside world, S c h a c h t e r a n d Singer (1962) a r g u e d t h a t cognition is necessary in o r d e r to help u s to label s t a t e s of general physiological a r o u s a l . T h i s perspective s h a r e s with t h e basic-emotions view t h e f u n d a m e n t a l b a s i s of affective experience in t h e body; however, it differs from basic emotions on t h e i s s u e of w h e t h e r affects c a n be linked to distinctive physiological signs. More recently, L a z a r u s (1984, 1991, 1994) h a s stressed t h e cognitive contribution to affects by a r g u i n g t h a t t h e r e is no s u c h thing a s affective experience w i t h o u t cognition. As h e sees it, t h e startle response differs from t h e affect of fear precisely on t h e b a s i s t h a t cognition m u s t a c c o m p a n y t h e latter. T h e primacy of cognition over affect w a s a c o r n e r s t o n e of t h e theoretical framework t h a t organized t h e work of early cognitive behavioral t h e r a p i s t s (see, for example, Beck 1967; M a h o n e y a n d F r e e m a n 1985; Meichen-

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b a u m 1997). The notion t h a t cognition d e t e r m i n e s t h e n a t u r e of t h e affect is, however, rejected by other psychologists like Zajonc (1984), who, in a widely read d e b a t e with L a z a r u s (1984), m a i n t a i n s t h a t it Is possible to h a v e affects w i t h o u t a n y a c c o m p a n y ing cognition. M u c h of t h e Zaj o n e - L a z a r u s d e b a t e h a n g s on t h e i s s u e of w h a t is implied by t h e t e r m "cognition"—whether it is s o m e t h i n g fairly minimal, like a w a r e n e s s , or s o m e t h i n g fancier, closer to logical inference (e.g., Mandler 1984). If cognition indicates n o t h ing more t h a n a n accompanying a w a r e n e s s of t h e affect, it is less controversial t h a n if it is s u p p o s e d to denote logical thinking. The cognitive view of affects n a t u r a l l y s h a r e s a n affinity with t h o s e who w i s h to e m p h a s i z e t h e concept of affect regulation (Oatley a n d J o h n s o n - L a i r d 1987; Power a n d Dalgleish 1997). Indeed, for a n u m b e r of psychologists working o n "emotion regulation," t h e basic-emotions p a r a d i g m is n o t wrong a s m u c h a s it is viewed a s telling only p a r t o f t h e story a b o u t affects. However, n o t m a n y of t h e s e psychologists h a v e t a k e n on t h e very difficult question of t h e knower w h o k n o w s — t h a t is, t h e n a t u r e of t h e subject w h o performs t h e cognitive evaluation t h a t d e t e r m i n e s t h e n a t u r e of t h e affect. In seeking a n s w e r s to s o m e of t h e q u e s t i o n s raised by philosophical a n d psychological perspectives, it is helpful to t u r n to neuroscience.

NEUROSCIENTIFIC PERSPECTIVES Neuroscience is>a n e w a n d exciting field for t h e s t u d y of affects. One r e s e a r c h e r w h o h a s become p r o m i n e n t in t h e emerging subfield of "affective science" is LeDoux (1994a, 1994b, 1994c, 1995, 1996). His work h a s dwelt on t h e emotion of fear in rats, which, h e believes, is more or less similar a c r o s s species, a n d he h a s d r a w n a t t e n t i o n to t h e i m p o r t a n c e of t h e a m y g d a l a a s t h e focal point in t h e b r a i n t h a t d e t e r m i n e s emotional significance. According to LeDoux, t h e r e are two emotional r e s p o n s e s y s t e m s in t h e brain: t h e first, w h i c h h a s its origin in t h e amygdala, is described a s "quick a n d dirty" b e c a u s e it o c c u r s automatically

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and is r a t h e r c r u d e in n a t u r e ; t h e second, w h i c h involves t h e neocortex, refines o u r capacity to r e s p o n d by featuring a cognitive c o m p o n e n t . LeDoux does n o t w i s h to locate emotion exclusively in t h e s e two s e p a r a t e p a r t s o f t h e b r a i n . He is attentive to t h e interaction between t h e a m y g d a l a a n d t h e neocortex a s well a s to t h e crucial role of other p a r t s , like t h e h i p p o c a m p u s . In h i s book The Emotional Brain (LeDoux 1996), h e e m p h a s i z e s repeatedly t h a t t h e r e is n o single place in t h e b r a i n where emotion resides. There are pathways from a n d to t h e neocortex in t h e amygdala, w h i c h can be activated by t h a l a m i c s e n s o r y processing (without going t h r o u g h t h e cortex) a t t h e s a m e time a s t h e cortex is activated from t h e t h a l a m u s . T h e r e p r e s e n t a t i o n of objects o c c u r s simultaneously, b u t distinctly from emotional r e s p o n s e . As LeDoux p u t s it: "We c a n , in o t h e r words, begin to r e s p o n d to t h e emotional significance of a s t i m u l u s before we fully r e p r e s e n t t h a t stimulus" (1994a, p. 221). Emotional processing, t h u s , h a s a n i m m e d i a t e a n d a m e d i a t e form—the former, while distinct, c o n t r i b u t e s to t h e latter. T h e s e two r e s p o n s e s y s t e m s a r e labeled "Type I a n d II" (LeDoux 1994a, 1994b). Type I emotional r e s p o n s e s a r e i m m e d i a t e a n d a r e a product of t h e evolutionary experience of t h e species; indeed, LeDoux likens t h e m to fixed action p a t t e r n s in a n i m a l s . Basically, in Type I, e m o t i o n s a r e a u t o m a t i c r e s p o n s e s t h a t occur from a n initial, c u r s o r y evaluation; t h e y a r e n o t u n d e r o u r voluntary control. Type II emotional r e s p o n s e s , r a t h e r t h a n being elicited, are emitted. They a r e specific to t h e individual, n o t the species, reflecting p a s t experience a n d j u d g m e n t a b o u t t h e applicability of t h e p a s t to t h e c u r r e n t situation. In c o n t r a s t to Type I r e s p o n s e s , Type II r e s p o n s e s a r e subject to o u r volitional control. LeDoux p r e s s e s t h e distinction between older, more primitive emotional r e s p o n s e s t h a t have t h e function of being a n "early warning system"—allowing u s to w a r d off t h r e a t e n i n g stimuli, despite being s o m e w h a t limited in n a t u r e — a n d more recent a n d complex emotional r e s p o n s e s t h a t h a v e differentiated functions; these more differentiated r e s p o n s e s enjoy t h e benefit of perceptual completeness a n d a r e subject to o u r control. According to

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LeDoux, emotional r e s p o n s e s c a n o c c u r in t h e a b s e n c e of cognitive systems, since t h e n e u r a l circuits for emotion a n d cognition, while interactive, a r e distinct. Thus, LeDoux's view overlaps with t h e b a s i c - e m o t i o n s view, a l t h o u g h it p o i n t s t h e w a y to a richer a c c o u n t of affective experience by introducing Type II emotional r e s p o n s e s , w h i c h are variable, flexible, a n d voluntary. LeDoux w i s h e s to emphasize t h a t m u c h of emotional processing o c c u r s outside o u r awaren e s s , a n d t h a t in h i s j u d g m e n t "feelings" emerge merely a s a byproduct—"frills t h a t h a v e a d d e d icing to t h e emotional cake" (1996, p. 302). Like basic-emotions p r o p o n e n t s , LeDoux minimizes t h e subjective experience of affects, viewing it a s a conseq u e n c e of behavioral a d a p t a t i o n t h a t h a s b e e n preserved t h r o u g h evolution, r a t h e r t h a n having to do with t h e "primary b u s i n e s s " of affects (LeDoux, 1994c). 6 As a behaviorist a n d sociobiologist, LeDoux is wary of a n d refrains from exploring selfreflection. Although h e affirms t h a t affects occur unconsciously, h e d i s m i s s e s t h e psychoanalytic u n c o n s c i o u s a s "a darker, more malevolent place" (1996, pp. 29-30). T h e two-systems view of emotional r e s p o n s e described by LeDoux is valuable for mitigating t h e t e n s i o n between t h e Aristotelian a n d Stoic p a r a d i g m s . At t h e risk of oversimplification, we c a n say t h a t t h e first s y s t e m of emotional r e s p o n s e c a p t u r e s t h e Stoic position t h a t affects h a p p e n to u s a n d elude o u r control. T h e second s y s t e m of emotional r e s p o n s e described by LeDoux h e l p s to clarify t h a t t h e first s y s t e m is n o t t h e only o n e a n d that, a s Aristotelians have emphasized, we need to p a y a t t e n t i o n to o u r capacity to craft affects once they occur. LeDoux is a w a r e t h a t h i s evolutionary a c c o u n t of affects is only a s t a r t i n g point. He casually notes, for example, t h a t Type II emotional r e s p o n s e s d e p e n d on t h e existence of s o m e kind of self-organization. Without elaborating, LeDoux observes t h a t "the capacity to h a v e feelings is directly tied to t h e capacity to be consciously a w a r e of one's self a n d t h e relation of oneself to the 6 Not all neuroscientists would agree with LeDoux on this point; in fact, Panksepp has criticized LeDoux for minimizing the importance of emotional feelings (Panksepp 1998, p. 341).

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rest o f t h e world" (1996, p. 125). This s t a t e m e n t tacitly acknowledges t h e n e e d to b r o a d e n t h e basic-emotions a p p r o a c h in t h e direction of affect regulation. In invoking t h e self, LeDoux is on the verge of opening a door t h a t h e o p t s n o t to enter. O t h e r n e u r o s c i e n t i s t s , like P a n k s e p p a n d Damasio, h a v e taken u p t h e challenge of a d d r e s s i n g t h e relation of affects a n d the self. For r e a s o n s of space, we will c o n c e n t r a t e on D a m a s i o ' s work, a l t h o u g h t h i s is n o t m e a n t to minimize t h e contribution of P a n k s e p p ' s Affective Neuroscience (Panksepp 1998) to t h e field.7 Damasio's neurological r e s e a r c h c o n c e r n s p a t i e n t s with prefrontal b r a i n d a m a g e w h o exhibit a n a p p a r e n t inability to feel, alt h o u g h they a r e able to reactivate p a s t events into working memory. In c o n t r a s t to the. n a r r o w focus of LeDoux's a n i m a l research, w h i c h a d m o n i s h e s u s to look a t very specific functions in o u r a p p r o a c h to t h e relationship between emotion a n d cognition, D a m a s i o welcomes large philosophical q u e s t i o n s . As t h e title of h i s first book, Descartes' Error (Damasio 1994a), suggests, D a m a s i o w a n t s to reject m i n d - b o d y d u a l i s m a n d especially t h e a s s u m p t i o n m a d e by philosophers w h o wish to affirm rationality b y rejecting affects. D a m a s i o ' s a r g u m e n t is t h a t , from the n e u r a l perspective, emotions a r e constitutive of rationality itself. As h e observes: "Nature a p p e a r s to have built t h e a p p a r a t u s of rationality n o t j u s t on top of t h e a p p a r a t u s for biological regulation, b u t also from a n d with it" (p. 128). Rationality is shaped by a n d m o d u l a t e d by body signals; t h u s , t h e body provides c o n t e n t to t h e m i n d , n o t j u s t life s u p p o r t in being aware of the condition o f t h e visceral a n d m u s c u l o s k e l e t a l state (p. 160). Damasio's claim is n o t merely .that t h e body a n d emotions contribute to rationality; h e w a n t s to go further a n d suggest t h a t t h e reduction of emotion, evident in h i s brain-injured patients, severely impinges u p o n t h e capacity to r e a s o n . Damasio's m a i n t h e s i s is t h a t t h e r e is interconnection between cognition a n d emotion within t h e b r a i n system, s u c h t h a t

"Panksepp argues that affective states provide essential scaffolding for all other forms of consciousness; he suggests that the self has its source in the selfrepresentation that comes from primitive motor representation within the brainstem (Panksepp 1998, p. 309).

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it is artificial to insist on t h e difference b e t w e e n t h e m . This s t r e s s on interconnection might s e e m to imply t h a t D a m a s i o ' s position d e p a r t s from those—like Tomkins, E k m a n , Zajonc, a n d LeDoux—who a s s e r t t h e primacy of affects. 8 However, while Damasio highlights t h e interaction between emotion a n d cognition, he would n o t deny t h a t emotions c a n exist w i t h o u t cognition- He e n d o r s e s a m u l t i p l e - s y s t e m s a p p r o a c h to emotions. In order to clarify t h e originality of D a m a s i o ' s view, we need to explore it in m o r e detail. He i n t r o d u c e s h i s own distinction between p r i m a r y a n d s e c o n d a r y emotions, w h e r e t h e latter come from acquired r a t h e r t h a n i n n a t e dispositional r e p r e s e n t a t i o n s . Secondary emotions utilize p r i m a r y emotions, b u t t h e y also give rise to "feelings''—a technical t e r m t h a t characterizes t h e experience of c h a n g e s in t h e body l a n d s c a p e reflected in t h e m e n t a l images thereby invoked (1994a, p. 145). D a m a s i o p o n d e r s why it is t h a t feelings arise, a s merely a c c o u n t i n g for n e u r o c h e m i c a l c h a n g e s or t h e notion t h a t they are n e u r a l r e p r e s e n t a t i o n s o f t h e body l a n d s c a p e a t t h e m o m e n t s e e m s insufficient. He concludes t h a t we n e e d to u n d e r s t a n d t h e m a n y levels of n e u r a l circuitry in t h e body, all of w h i c h enable rationality a n d give rise to t h e self (pp. 147, 161). D a m a s i o elucidates t h e n e u r a l b a s i s of t h e self by probing h o w emotions are integrated in rationality itself—which h e t e r m s t h e "somatic m a r k e r hypothesis." T h e somatic m a r k e r hypothesis s h o w s t h a t o u r decision-making p r o c e s s incorporates gutlevel r e s p o n s e s t h a t are, in fact, a u t o m a t i c signals from t h e body t h a t protect a n d help u s to limit a n d choose a m o n g possible options. Somatic m a r k e r s — p a r t o f t h e n e u r a l s y s t e m located in t h e prefrontal cortices—are "a special i n s t a n c e of feelings generated from s e c o n d a r y emotions . . . connected, by learning, to predicted future o u t c o m e s of certain scenarios" (1994a, p. 174). B u t they also serve a s a p r e l u d e to m o r e a b s t r a c t decision8 LeDoux cites Damasio several times in his book, and Damasio. in turn, cites LeDoux's work on the importance of the amygdala for emotional experience. Both concur that emotions have been given short shrift among cognitive scientists. More significantly, Damasio. like LeDoux, believes that there are two systems of emotions, one subcortical and the other neocortical—which he delineates in terms of primary and secondary emotions. Damasio is also influenced by Edelman's (1992) distinction between primary and secondary consciousness.

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making, u s i n g a t t e n t i o n a n d working memory. They c a n o c c u r in a n "as-if m a n n e r — w i t h o u t outside stimulation a n d coming to our a w a r e n e s s . They help u s to anticipate o u t c o m e s a n d m a k e new goals, negotiating t h e future by m e a n s of t h e perception of pleasure a n d p a i n l a n d s c a p e s . For Damasio, t h e self is implied in a n e u r a l a c c o u n t of emotion a n d especially feelings. He readily acknowledges t h a t t h i s is a biological s t a t e t h a t repeatedly r e c r e a t e s itself—a m e n t a l construction. Nevertheless, h e w i s h e s to affirm o u r s e n s e of experiencing a n ongoing a n d c o n t i n u o u s biological state—of w h i c h we feel like "an owner a n d knower for most, t h o u g h n o t all, contents" (1994a, p. 238). He s e e k s to do so w i t h o u t s o u n d i n g a n a c h r o n i s t i c — t h a t is, m i s t a k e n l y conjuring "a little person, t h e infamous h o m u n c u l u s , inside y o u r b r a i n contemplating w h a t is going on" (p. 227). The concept of t h e n e u r a l b a s i s of a self requires early sensory cortices, s e n s o r y a n d m o t o r cortical associations regions, a n d subcortical nuclei. As D a m a s i o sees it, t h e n e u r a l self does n o t depend on t h e function of language, a l t h o u g h l a n g u a g e does enable, a m o r e refined form of subjectivity by m e a n s of t h e creation of verbal n a r r a t i v e s o u t of nonverbal ones. As he formulates this: "Language m a y n o t b e t h e s o u r c e of t h e self, b u t it certainly is t h e s o u r c e of t h e T" (1994a, p. 243). D a m a s i o does not explore t h i s suggestive distinction between t h e self a n d t h e I and, in fact, h a s little to say in h i s b o o k a b o u t w h a t it m e a n s to be a n "I." We a r e left to w o n d e r how t h e n e u r a l self is related to w h a t we m i g h t refer to a s t h e phenomenological self. D a m a s i o also fails to c o n t e n d with t h e influence of t h e factor of c u l t u r e in this regard; n o r d o e s h e d i s c u s s h u m a n development. In h i s recent book, The Feeling of What Happens, Damasio (1999) elucidates h i s earlier work, m o s t importantly by differentiating between t h r e e distinct s e n s e s of self: t h e "proto-self," t h e "core self," a n d t h e "autobiographical self." T h e proto-self is based on "the e n s e m b l e of b r a i n devices t h a t continuously a n d nonconsciously m a i n t a i n t h e body s t a t e within t h e n a r r o w r a n g e and relative stability required for survival" (p. 22). T h e second self, t h e core self, e n a b l e s u s to be concerned with t h e experience of the here a n d now. Core c o n s c i o u s n e s s , on which t h e core self is based, emerges w h e n "the b r a i n ' s r e p r e s e n t a t i o n devices gen-

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erate a n imaged, nonverbal a c c o u n t of how t h e o r g a n i s m ' s own s t a t e is affected by t h e organism's processing of a n object, a n d w h e n t h i s p r o c e s s e n h a n c e s t h e image of t h e c a u s a t i v e object, t h u s placing it saliently in a spatial a n d t e m p o r a l context" (p. 169). D a m a s i o s t r e s s e s t h e link between t h e core self a n d emotions; a reliable correlate of a defective core c o n s c i o u s n e s s , he informs u s , is t h e a b s e n c e of emotions (p. 100). The autobiographical self is p r o d u c e d by a m o r e complex kind of c o n s c i o u s n e s s , "extended c o n s c i o u s n e s s . " Extended cons c i o u s n e s s provides u s with a n identity a n d s e n s e of personhood; it m a k e s u s a w a r e of being at a point in individual historical time, a w a r e of having b o t h a lived p a s t a n d a n anticipated future. The autobiographical self is predicated o n a n organized record from r e c o n s t r u c t e d images of t h e o r g a n i s m ' s u n i q u e history. Working m e m o r y is crucial for t h e autobiographical self in a way in which it is n o t for t h e core self. T h e autobiographical self, while relying on t h e core self, a d d s t h e d i m e n s i o n s of p a s t a n d future. According to Damasio, t h e core self is t h e foundation of c o n s c i o u s n e s s , a n d t h e autobiographical self is its glory (1999, p. 195). In p a s s ing, D a m a s i o observes t h a t t h e s e n s e of self t h a t h a s preoccupied developmental psychologists, occurring a t a b o u t t h e age of 18 m o n t h s , is t h e autobiographical self. He does n o t a t t e m p t to a d d r e s s in a n y further detail t h e i s s u e of h o w t h e self develops. O u r work a t t e m p t s to fill in t h e s e s t a g e s a n d m e c h a n i s m s , t h e r e b y u n d e r s c o r i n g t h e i m p o r t a n c e of a developmental perspective to u n d e r s t a n d i n g t h e self. There a r e a n u m b e r of key p o i n t s to articulate a b o u t neuroscience before moving on to d i s c u s s affects a n d affect regulation in p s y c h o a n a l y s i s a n d a t t a c h m e n t theory. As we h a v e seen, LeDoux's proposal of two emotional-response s y s t e m s in the b r a i n h e l p s to reconceptualize t h e long-standing a n d seemingly unreconcilable c o n t r a s t between Aristotelians a n d Stoics on affects: t h e first s y s t e m confirms t h e Stoic belief t h a t emotional r e s p o n s e s are beyond o u r control; t h e second s y s t e m s u p p o r t s t h e Aristotelian idea t h a t emotional r e s p o n s e s c a n b e regulated. LeDoux's proposal also offers a potential resolution of t h e debate, briefly m e n t i o n e d above, between t h e psychologists Zajonc a n d Lazarus: t h e first s y s t e m illustrates how affects c a n occur without cognition, a s t h e former argues, a n d t h e second system

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shows h o w affects are influenced by cognition, a s t h e latter argues. LeDoux's view highlights t h e complexity a n d r a n g e of affective experience: it e n d o r s e s t h e basic-emotions view, while offering a m o r e fruitful overall a c c o u n t . Yet in invoking t h e self without building t h i s into h i s theory, LeDoux provides a compelling r e a s o n to p r o d u c e s u c h a n a c c o u n t . Like other psychological perspectives, LeDoux's r e s t s c o n t e n t with t h e description of cognition acting u p o n affects. Damasio h a s u n d e r t a k e n a n a m b i t i o u s project of highlighting the interrelated a r e a s of affects, t h e self, a n d t h e brain. His view is sensitive to t h e interaction between cognition a n d affects, especially t h e w a y in w h i c h affects c a n c o n t r i b u t e positively to cognition (as H u m e a n d c o n t e m p o r a r y philosophers have argued). D a m a s i o develops t h e notion t h a t affects help to create and s u s t a i n t h e self in a n original way. He does n o t a t t e m p t to grapple with t h e i s s u e of how t h e self develops—which we shall do later in t h i s book. More specifically, in c h a p t e r 5, we focus on the t h e m e of intersubjectivity, c o n c u r r i n g with D a m a s i o t h a t aspects of t h e self do n o t d e p e n d on it, b u t t h e n moving on to pinpoint its crucial role in t h e development of t h e self. In conclusion, t h e neuroscientific a c c o u n t s of LeDoux a n d Damasio deepen t h e Spinozistic insight t h a t we a r e embodied minds. At t h e s a m e time, t h e y t a k e u s beyond m o s t of t h e philosophical perspectives on affects a s either physical or m e n t a l (or some c o m b i n a t i o n of both). Neuroscience offers a n a c c o u n t of affects t h a t is indispensable, however m u c h m o r e t h e r e is to clarify. It would be foolhardy to imagine t h a t all of t h e p r o b l e m s concerning affects h a v e b e e n or could be dissolved by neuroscience. No d o u b t , we are still a t a relatively early stage of u n d e r s t a n d i n g t h e relation between affects a n d t h e b r a i n . We have learned e n o u g h , however, to m a k e it impossible for a n y perspective on affects, including psychoanalysis or a t t a c h m e n t theory, to ignore n e u r o s c i e n c e . S u c h a s t a n c e does n o t betoken reductionism. As we shall suggest, t h e s u b t l e a n d sophisticated attention paid by developmental theory to t h e subjective experience of affects a n d affect regulation h a s m u c h to offer t h e neuroscientific a s well a s o t h e r perspectives. With t h e b a c k g r o u n d of philosophical, psychological, a n d neuroscientific perspectives in mind, let u s now t u r n to focus on

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psychoanalytic a n d a t t a c h m e n t perspectives on affects a n d affect regulation. In t u r n i n g to t h e s e perspectives, w e will concentrate on development a s well a s t h e subjective experience of affects. After examining psychoanalytic a n d a t t a c h m e n t perspectives, t h e final section offers a n integration of all of t h e perspectives t h a t h a v e b e e n considered.

PSYCHOANALYTIC P E R S P E C T I V E S It h a s become almost c o m m o n p l a c e for p s y c h o a n a l y s t s to bem o a n t h e lack of a n a d e q u a t e theory of affects. No o n e could d i s p u t e t h a t affects h a v e occupied a n a w k w a r d place in psychoanalysis, a n d t h a t t h e y deserve m u c h closer scrutiny. At t h e very least, it c a n b e observed t h a t a large disparity exists between the marginal role accorded to affects in t h e theory of psychoanalysis a n d their e n o r m o u s i m p o r t a n c e in t h e clinical realm. To unders t a n d why affects a r e only n o w becoming c e n t r a l in p s y c h o a n a lytic thinking, we m u s t begin with Freud. As is well known, F r e u d .never treated affects in their own right, a n d he modified h i s views several times, u s u a l l y without trying to reconcile h i s n e w views with previous ones. Moreover, F r e u d never a d d r e s s e d t h e q u e s t i o n of how affects could be closely tied to drives on t h e one h a n d , a n d yet b e so o m n i p r e s e n t a n d crucial to w h a t o c c u r s in t h e interaction between analyst a n d p a t i e n t in t h e clinical setting on t h e other. Nevertheless, F r e u d does offer n u m e r o u s richly n u a n c e d descriptions of affects—especially in some of h i s writing on aesthetics—even if t h e y a r e n o t t h e centerpiece of a n y of h i s works. There a r e two m a i n competing t e n d e n c i e s in t h e way Freud portrays affects, a n d t h e s e two t e n d e n c i e s h a v e d o m i n a t e d the history of psychoanalysis. According to t h e first tendency, affects discharge energy a n d m u s t be c o m p r e h e n d e d a s t h e psychic manifestation- (along with ideas) of drives. Closely connected to this t e n d e n c y is t h a t , ultimately, affects h a v e their s o u r c e beyond t h e realm of consciousness—in t h e id. In h i s earliest writings, F r e u d developed t h e view t h a t affects discharge energy; he t h e n modified it in t h e metapsychological p a p e r s , in particular

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the essay "The Unconscious" (Freud 1915e), in order to affirm the relation b e t w e e n drives a n d affects (and also to move a w a y from t h e implication t h a t affects h a v e a merely pathological function). 9 Of course, t h e shift to t h e view t h a t affects a r e t h e manifestations of drives left F r e u d to struggle a g a i n s t t h e perplexing notion t h a t affects m u s t b e conscious, w h e r e a s drives are u n c o n s c i o u s . 1 0 Although F r e u d ' s view evolved, t h e overall direction of t h e first t e n d e n c y is to affirm t h a t affects are powerful, elemental biological forces. According to t h e second tendency, affects a r e signals a n d a r e subject—at least to s o m e degree—to t h e control of t h e ego. This certainly carries t h e implication t h a t affects a r e regarded a s contributing to adaptive functioning. The second tendency, which h a s its s o u r c e in F r e u d ' s Inhibitions, Symptoms and Anxiety (Freud 1926d [1925]), h a s b e e n extended further with t h e introduction of t h e l a n g u a g e of t h e self a n d t h e concept of affect regulation in psychoanalysis. It is fair to say t h a t t h r o u g h t h e influence of object-relations theory a n d particularly developmental theory, t h e s e c o n d t e n d e n c y h a s flourished in r e c e n t years. Nonetheless, t h e r e a r e some psychoanalytic t h i n k e r s , like Andre Green, w h o w i s h to question t h e emergence of t h e second tendency, a r g u i n g t h a t only t h e first t e n d e n c y r e p r e s e n t s a uniquely psychoanalytic view. Green (1999) s u g g e s t s t h a t placing too m u c h i m p o r t a n c e on t h e regulatory control of ego obscures t h e power of t h e u n c o n s c i o u s to g e n e r a t e affects. He also worries a b o u t t h e diluting effect on p s y c h o a n a l y s i s of importing ideas from biology a n d / o r developmental theory (Green 1999). In our view, t h o u g h , t h e a s s u m p t i o n t h a t a choice m u s t b e m a d e between t h e first a n d second t e n d e n c y is questionable. Both are important in psychoanalysis. Although o u r i n t e r e s t s a r e mainly consistent with t h e second tendency, we do n o t t h i n k t h a t t h i s entails a n y slight to t h e first one. It is i n c u m b e n t , t h o u g h , u p o n a n y o n e w h o w i s h e s to develop the first t e n d e n c y to reformulate F r e u d ' s ideas within t h e frame-

9

There are good accounts of the development of Freud's view of affects in Green (1999), R. Stein (1990). and Rapaport (1953). l0 Pulver (1971) grapples with this issue and concludes that affects can be unconscious.

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work of c u r r e n t scientific knowledge. Consider, for example, Green's defense of t h e first tendency, w h i c h s t r e s s e s how affects a r e particularly oriented toward t h e inside of t h e body (1999, p. 163). This directly follows F r e u d ' s belief t h a t t h e affect "manifests itself essentially in motor (secretory, circulatory) c h a n g e s of t h e subject's own body w i t h o u t reference to t h e outside world" (Freud, 1915e, p. 179). O n t h e face of it, s u c h a view s e e m s to contradict t h e psychological a n d neuroscientific views t h a t we have e n c o u n t e r e d , which explain affects in t e r m s of r e s p o n s e s to t h e world. It is also relevant in t h i s connection t h a t developmental r e s e a r c h h a s s h o w n t h a t infants a r e t u r n e d o u t w a r d to the world from t h e time of b i r t h in a way t h a t d e p a r t s from the a s s u m p t i o n s of classical psychoanalysis. (Research on t h i s topic is d i s c u s s e d in c h a p t e r s 4 a n d 5 on infant development). Does this m e a n t h a t we m u s t conclude t h a t F r e u d ' s intuitions a b o u t affects are wrong? Not necessarily. It is possible to qualify w h a t h e m e a n s by appealing to D a m a s i o ' s d i s c u s s i o n of the "internal milieu" a n d h i s "somatic m a r k e r hypothesis," wherein t h e b r a i n constantly m o n i t o r s w h a t is occurring in t h e body, a s a way to u n d e r s t a n d t h e internal experience of affects. Although t h i s m i g h t help u s characterize t h e s e n s e in w h i c h affects are internal, it would still n o t be a negation o f t h e idea t h a t they are s t i m u l a t e d externally. Interestingly e n o u g h , one of t h e earliest psychoanalytic t h i n k e r s on affects, Brierley (1937), specifically a d d r e s s e s t h i s point, urging p s y c h o a n a l y s t s to appreciate t h a t affects c a n be either internal or external. As a general point, it is w o r t h s t r e s s i n g t h a t psychoanalysis h a s m u c h to gain from opening itself u p to define a n d develop itself with reference to views from other, related fields. It is our impression t h a t psychoanalysis h a s suffered from being isolated from other perspectives o n t h e subject of affects. As is already a p p a r e n t , m a n y o f t h e i s s u e s a b o u t affects t h a t have b e e n raised within p s y c h o a n a l y s i s echo d e b a t e s from historical a n d other perspectives. For Freud, affects h a v e b o t h physical a n d m e n t a l aspects. They o c c u r within t h e body, b u t t h e y h a v e psychic significance. Like Spinoza, F r e u d defined t h e m i n d a s embodied, a n d he articulated t h e n a t u r e of psychic experience in s u c h a way a s to avoid t h e pitfalls of C a r t e s i a n d u a l i s m . F r e u d ' s a p p r o a c h to the

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study of affects s e e k s to affirm biology without forsaking subjective experience. Although m a n y q u e s t i o n s r e m a i n unresolved about w h a t t h i s really m e a n s , it c o n s t i t u t e s a distinctive a n d fruitful a p p r o a c h to t h e subject. For instance, one m i g h t raise the question of w h e t h e r t h e body is a n e c e s s a r y c o m p o n e n t of all affective experience—or is affect experience possible w i t h o u t it? Freud clearly appreciated t h e biological b a s i s of affects a n d s a w them a s c o n t r i b u t i n g to survival. However, F r e u d also ascribed a mental function to affects—for example, t h a t along with ideas, they are t h e manifestations of drives. He implied t h a t affects play a role in how we i n t e r p r e t a n d find m e a n i n g in t h e world, although h e never v e n t u r e d to explore t h i s point explicitly. Let u s t a k e a step further in formulating how psychoanalysis follows a n d yet c a n b e distinguished from other p o i n t s of view on affects. Insofar a s F r e u d links affects to discharge a n d t h e m a n i festation of drives, we m a y discern t h e Stoic orientation: affects are strong a n d d a n g e r o u s forces t h a t a r e n o t subject to o u r conscious control. B u t insofar a s F r e u d s e e s affects a s signals that are subject to t h e mediation of t h e ego, a n Aristotelian orientation is also p r e s e n t . F r e u d ' s special e m p h a s i s on t h e single affect of anxiety m a r k s h i s view a s quite different from Aristotle. Yet h e is certainly n o t a s s u s p i c i o u s of affects a s t h e Stoics were. Indeed, a psychoanalytic a p p r o a c h to t h e m i n d is often read a s challenging t h e h e g e m o n y of r e a s o n t h a t defines the Western philosophical tradition. 1 1 Some p s y c h o a n a l y s t s , like E m d e (1983) a n d G a e n s b a u e r (1982), explicitly register their a g r e e m e n t with t h e basic-emotions view. T h e position of p s y c h o a n a l y s i s in relation to basic emotions r e m a i n s open to question, however. O n e m i g h t note t h a t psychoanalysis is n a t u r a l l y allied with t h e d i m e n s i o n s criticism of basic emotions, given its c o m m i t m e n t to p l e a s u r e a n d unpleasure a s basic. O n e m i g h t argue, alternatively, t h a t pleasure a n d u n p l e a s u r e a r e transformed into b a s i c emotions—a point of view t h a t is in t h e spirit of J a c o b s o n (1953). In t h i s connection, too, it is w o r t h noting t h a t t h e r e are a n u m b e r of psychoanalysts w h o h a v e b e c o m e interested in neuroscientific 11

Sherman (2000) offers a strong argument on this point, contrasting psychoanalysis with the philosophical tradition.

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views of affects (Kaplan-Solms a n d Solms 2000; Schore 1993, 1999). Freud c o n s t r u e s anxiety in a way t h a t e x p a n d s t h e m e a n i n g of t h i s affect. In o n e sense, it is a l m o s t a s if he conceives of it a s a k i n to a general s t a t e of physiological a r o u s a l . In a n o t h e r sense, he chooses to dwell u p o n this o n e affect b e c a u s e of its clinical prominence. T h e concern with anxiety is problematic in t h a t it l e n d s credence to t h e notion t h a t F r e u d w a s , from t h e time of his original u n d e r s t a n d i n g of affects a s d i s c h a r g e s of energy to his later point of view, preoccupied with negative affect. Indeed, J a c o b s o n (1953) w a s t h e first a n a l y s t squarely to confront t h e fact t h a t a t t e n t i o n to t h e s a l u t a r y d i m e n s i o n of affective experience w a s m i s s i n g from F r e u d ' s theoretical a c c o u n t . Nowhere does F r e u d grapple with t h e Aristotelian appreciation for how affect regulation is crucial, n o t j u s t for survival, b u t for wellbeing. This, is all t h e m o r e c u r i o u s in light of t h e s t r o n g interest t h a t Freud developed in t h e affective b o n d between a n a l y s t a n d patient. Damasio's work is particularly relevant to p s y c h o a n a l y s i s for a n u m b e r of r e a s o n s , s u c h a s h i s interest in t h e neurobiological b a s i s of t h e self, especially h i s e m p h a s i s on t h e relation between affects a n d t h e self (which coincides with t h e second t e n d e n c y in psychoanalysis). Moreover, D a m a s i o ' s work s u p p o r t s t h e idea t h a t we need n o t choose between w h a t we have described a s t h e first a n d second tendencies in psychoanalytic conceptions of affects. Damasio's c o n c e r n s r a n g e from t h e neurobiology of m o m e n t - t o - m o m e n t internal, h o m e o s t a t i c regulation to t h e sophisticated integration of t h e past, p r e s e n t , a n d future autobiographical self. Underlying h i s u n d e r s t a n d i n g of regulation is biology. D a m a s i o persuasively d r a w s o u r a t t e n t i o n to t h e complexity of t h e notion of regulation by d e m o n s t r a t i n g how regulatory p r o c e s s e s a r e n o t necessarily subject to t h e ego or self. In t h e final section of t h i s c h a p t e r , we focus in greater d e p t h on t h e m e a n i n g s o f t h e t e r m "regulation." For now, let u s observe t h a t a psychoanalytic a p p r o a c h to regulation highlights t h e ongoing struggle t h a t it entails. Once achieved, regulation is not automatically m a i n t a i n e d . Characteristically, it is lost a n d regained even for t h e m o s t capable people. While it belongs to the

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n a t u r e of a self to m o d u l a t e affective experience, t h i s is n o t simply a m a t t e r of applying cognition to n a m e a n d d e t e r m i n e t h e n a t u r e of a single affect. U n d e r s t a n d i n g regulation m e a n s heeding t h e subtleties of subjective experience. More specifically, it" m e a n s grappling with t h e elusiveness of o u r affects a n d t h e difficulty of u n d e r s t a n d i n g their meaning. Clinical experience m a k e s it a b u n d a n t l y evident t h a t we do n o t always k n o w how we feel. We are often deceived a b o u t o u r affects, believing t h a t we feel one thing, w h e n in fact it t u r n s o u t t h a t we feel s o m e t h i n g else. Moreover, we c a n a n d often do feel different t h i n g s a t t h e s a m e time. Psychoanalysts h a v e a m p l e experience with t h e subjective experience of affects. This does n o t m e a n t h a t a theory of affects m u s t be clinically b a s e d , a s some h a v e m a i n t a i n e d (Westen 1997). It does suggest t h a t t h e basic-emotions paradigm, however n e c e s s a r y , will n o t be sufficient. Psychoanalysts are comfortable with how u n o b v i o u s a n d complicated affective experience c a n be. Yet t h e a i m of psychoanalytic t r e a t m e n t in all cases m u s t include t h e facilitation a n d m a i n t e n a n c e of affect regulation. It is impossible, we think, to imagine psychoanalysis a s not a d d r e s s i n g itself to one's relation to one's own affects. Regulation goes to t h e very h e a r t of c h a n g e t h a t is p r o d u c e d b y psychoanalysis.

ATTACHMENT THEORY PERSPECTIVES It is s o m e w h a t ironic t h a t in t h e literature on a t t a c h m e n t affects are so f u n d a m e n t a l t h a t q u e s t i o n s a b o u t w h a t they actually are have b e e n overlooked. Affects are crucial to a t t a c h m e n t theory b e c a u s e t h e a t t a c h m e n t relationship between infant a n d caregiver is itself a n affective b o n d . Affect regulation h a s enjoyed, prominence in a t t a c h m e n t theory a n d research; in fact, t h e focus on t h i s concept c a n be u s e d a s a partial explanation of why affects themselves h a v e n o t g a r n e r e d more specific attention. However, t h i s explanation only goes so far. It does n o t satisfac-

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torily explain, for example, how little Bowlby c o n c e r n e d himself with affect a n d motivation in general. Bowlby defined a t t a c h m e n t in t e r m s of a n "affectional" b o n d w i t h o u t explicating w h a t he m e a n t by t h i s t e r m . His c o m m e n t s on emotions, while highlighting their i m p o r t a n c e for a t t a c h m e n t , a r e n o t particularly insightful. For example, Bowlby a s s e r t s t h a t Many-of the most intense emotions arise during the formation, the maintenance, the disruption and the renewal of attachment relationships. The formation of a bond is described as falling in love, maintaining a bond a s loving someone, and losing a partner as grieving over someone. Similarly, threat of loss arouses anxiety and actual loss gives rise to sorrow; while each of these situations is likely to arouse anger. The unchallenged maintenance of a bond is experienced as a source of security and the renewal of a bond as a source of joy. [1980, p. 40] His interesting idea t h a t fear is a n inevitable r e s p o n s e to certain innately encoded stimuli—such a s novelty, s u d d e n n e s s — t h a t triggers t h e a t t a c h m e n t system, w h e r e a s anxiety is t h e s a m e affective r e s p o n s e once t h e a t t a c h m e n t s y s t e m h a s b e e n triggered b u t n o t r e s p o n d e d to adequately by t h e caregiver, is not strongly s u p p o r t e d by r e s e a r c h . There is n o indication t h a t Bowlby fully appreciated how affect regulation e n s u e s from att a c h m e n t . Happily, t h e t e n d e n c y i n r e c e n t a t t a c h m e n t w o r k is to pay more attention to affects in relation to affect regulation, a n d so we t u r n now to examine t h i s development. In a t t a c h m e n t theory, t h e regulation of affects serves to foster t h e emergence of self-regulation from coregulation. Or, p u t into t h e alternative language t h a t Sroufe u s e s , t h i s m e a n s t h a t t h e regulatory s y s t e m of t h e infant is transformed from being "dyadic" to being "individual." Sroufe's focus is o n t h e role of emotions in development. He observes t h a t Bowlby did not adequately conceptualize affects, a n d therefore h e u n d e r t a k e s this t a s k (Sroufe 1996, p. 177). He m a i n t a i n s t h a t emotions arise d u r i n g t h e second half of t h e first year of life. To some extent, t h i s offers a challenge to t h e basic-emotions position. Sroufe specifically rejects t h e view p u t forth by Izard t h a t infants a r e b o r n with b a s i c emotions, s t r e s s i n g i n s t e a d t h a t s u c h emo-

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tions come into being t h r o u g h t h e i n p u t of a caregiver. Sroufe's point is t h a t emotions exist from b i r t h only in a p r e c u r s o r form; a shift t h e n o c c u r s d u r i n g t h e second half-year of life whereby emotions b e c o m e m o r e differentiated a n d less global. E m o t i o n s are thereby experienced subjectively a n d are i m b u e d with m e a n ing in a n e w s e n s e . As Sroufe claims, d u r i n g t h e second half of the first year, "regulation of a r o u s a l a n d emotion no longer depend simply on w h a t t h e caregiver does, b u t on how t h e infant interprets t h e caregiver's accessibility a n d behavior" (p. 170). Sroufe g r o u n d s h i s notion of affect regulation in t h e capacity to m a i n t a i n organization in t h e face of tension. He is careful to emphasize t h a t t h i s is n o t a m a t t e r of cognition influencing affects. Sroufe m a k e s t h e proposal t h a t t h e regulation of affects ought to be s e e n a s a n "Anlage" or prototype of self-regulation. Self-regulation is u n d e r s t o o d a s p a r t of a n e x u s t h a t includes self-reliance a n d self-esteem. Sroufe t r a c e s t h e m o v e m e n t of how "confidence in t h e caregiver b e c o m e s confidence in t h e self with t h e caregiver a n d , ultimately, confidence in t h e s e l f (1996, p. 186). Although Sroufe would seem to be receptive to p o s t u l a t ing intrapsychic s t r u c t u r e s t h a t a r e p r o d u c e d by a t t a c h m e n t — given t h a t h e w a s responsible for t h e shift away from Bowlby's notion t h a t t h e goal of a t t a c h m e n t is proximity to t h e caregiver to the goal of "felt security" (Sroufe a n d W a t e r s 1977a)—he does n o t attempt to articulate w h a t u n d e r l i e s t h e idea of self-confidence. Another a t t a c h m e n t t h e o r i s t w h o s e w o r k h a s focused o n t h e role of affects is Magai (1999). (For h e r earlier work on t h i s topic, published u n d e r t h e n a m e Malatesta, see Malatesta, Culver, Tesman, a n d S h e p a r d 1989.) Like Sroufe, Magai acknowledges t h a t Bowlby did n o t pay m u c h a t t e n t i o n to affects themselves. Nevertheless, s h e p o i n t s o u t some similarities between Bowlby and Tomkins, w h o developed their respective views a t a r o u n d the s a m e time. Although Magai is m o r e s y m p a t h e t i c t h a n Sroufe to the b a s i c - e m o t i o n s position, h e r special interest lies in how parental affective style influences t h e capacity for regulation. A key a s p e c t of Magai's work is d r a w n from Cassidy, who proposes a connection between styles of a t t a c h m e n t a n d regulation. Yet, to h e r credit, Magai cautiously resists t h e supposition t h a t emotional t r a i t s / d i s p o s i t i o n s completely overlap with att a c h m e n t style.

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According to Cassidy, affect regulation c a n be linked to t h e quality of a t t a c h m e n t (1994, p. 247). T h e a n x i o u s / a v o i d a n t style of a t t a c h m e n t t e n d s to minimize affects a n d t h u s c a n be u n d e r stood in t e r m s of t h e overregulation of affect; t h e a n x i o u s / ambivalent style t e n d s to h e i g h t e n affects a n d t h u s c a n be u n d e r s t o o d in t e r m s of t h e u n d e r r e g u l a t i o n of affect. T h e s e c u r e style of a t t a c h m e n t manifests a n open a n d flexible kind of regulation. More specifically, Cassidy m a i n t a i n s t h a t in a n x i o u s / avoidant a t t a c h m e n t , t h e aversion to negative affect m e a n s t h a t negative affect is n o t expressed, b u t n o t t h a t it is n o t felt. In a n x i o u s / a m b i v a l e n t a t t a c h m e n t , it is u n c l e a r w h e t h e r t h e greater r e s p o n s i v e n e s s to negative affect m e a n s t h a t it is expressed to a degree beyond h o w it is actually felt. Cassidy's work offers a promising way to t h i n k a b o u t affective experience for a t t a c h m e n t theory a n d h a s b e e n developed further by Slade (1999), who s u g g e s t s how p r o b l e m s in dysregulation c a n be tied to various types of pathology. As a t t a c h m e n t theory h a s evolved, so t h e concept of affect regulation h a s become increasingly central. Interest in affects themselves h a s b e e n slower to evolve a n d is still in t h e p r o c e s s of developing. There is clearly a n Aristotelian bias in a t t a c h m e n t thinking a b o u t affects—they are, by n a t u r e , u n d e r s t o o d to be subject to modulation. There is n o t m u c h evidence t h a t a t t a c h m e n t theorists give m u c h credence to t h e Stoic orientation to affects. Indeed, a t t a c h m e n t theorists have n o t c o n t e n d e d with t h e first s y s t e m of emotional r e s p o n s e a s depicted by LeDoux a n d s u p p o r t e d by Damasio. Hofer's (1984, 1990; Polan a n d Hofer 1999) work with r a t p u p s a n d m o t h e r s comes closest to doing so, a s it offers a n a c c o u n t of regulation t h r o u g h a t t a c h m e n t t h a t e m p h a s i z e s h i d d e n d i m e n s i o n s t h a t are n o t subject to c o n s c i o u s control. Hofer w a r n s u s , in fact, t h a t regulation should n o t be conceived of strictly in t e r m s of affects. There c o n t i n u e to be differences a m o n g a t t a c h m e n t theorists in t h e way t h e y t h i n k a b o u t affects. S o m e are m o r e explicitly sympathetic to t h e basic-emotions position t h a n a r e o t h e r s . A n u m b e r of a t t a c h m e n t theorists have come to a d o p t w h a t is referred to a s a "functionalist" position. This emphasizes, n o t j u s t t h a t affects themselves a r e regarded a s subject to regulation, b u t t h a t t h e y serve a s regulators a s well (N. Fox 1994).

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Others have tried to articulate a s y s t e m s point of view t h a t features t h e i n t e r d e p e n d e n c e of all p r o c e s s e s (Fogel 1993; Lewis and Granic 2000). W h a t a t t a c h m e n t theorists a n d r e s e a r c h e r s s h a r e is a c o m m i t m e n t to follow o u t in development h o w affective experience c o n t r i b u t e s to t h e acquisition of self-regulation t h r o u g h coregulation between caregiver a n d infant. A problem a r e a in a t t a c h m e n t theory t h a t b e a r s on t h e topic of affects a n d affect regulation h a s b e e n its conception of internal structure, or w h a t is t e r m e d t h e "internal working models." Initially, t h e idea of working models w a s u n d e r s t o o d in a way t h a t w a s close to being a reduplication of external interaction. Mary Main (1991) r e n d e r e d t h e idea of working models more complex with h e r e m p h a s i s on metacognition—the higher-order capacity to a p p r a i s e a n d reorganize memories. T h e notion of internal s t r u c t u r e is developed even further in s u b s e q u e n t c h a p ters with t h e i d e a s of mentalization, a n d particularly t h e unfolding of t h e capacity for mentalization. From t h e s a m e epistemic tradition, t h i s volume a i m s to m a k e a contribution to t h e reconceptualization of a t t a c h m e n t theory beyond Bowlby's notion of proximity to t h e caregiver a n d Sroufe a n d Water's (1977a) important qualification of "felt security." In t h e following c h a p t e r (chapter 3) we a t t e m p t to s h o w t h a t t h e realm of r e p r e s e n t a t i o n is not merely derived from, b u t constitutive of, t h e evolution of a t t a c h m e n t . MacLean's (1990, 1993) theory o f t h e t r i u n e brain, which d i s t i n g u i s h e s t h r e e s t a g e s of t h e b r a i n ' s evolution—the reptilian, p a l e o m a m m a l i a n , a n d n e o m a m m a l i a n — m i g h t be u s e fully applied to t h e difference between Bowlby's idea of proximity to t h e caregiver (which c a n be associated with t h e p a l e o m a m malian brain) a n d o u r focus on mentalization or reflective function (which c a n b e associated with t h e n e o m a m m a l i a n brain). 1 2 In the next section, we elaborate on t h e impact of reflective function on affective experience, i n t r o d u c i n g a n e w term— "mentalized affectivity"—to characterize this. In conclusion,

12 MacLean observes that the paleomammalian brain is distinguished by the separation cry, the most primitive and basic mammalian vocalization; the neomammalian brain is produced through expanded memory and intelligence. MacLean's theory of the "triune brain," while provocative, has not been universally accepted. See, for example, Pinker's (1997) criticism of it.

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a t t a c h m e n t theorists have m a d e progress in focusing on affects themselves, t h o u g h some of t h e t e n s i o n s between affects a n d affect regulation deserve greater exploration.

AN INTEGRATED PERSPECTIVE ON AFFECTS A N D AFFECT REGULATION In this concluding section, we s h a r p e n o u r d i s c u s s i o n of the relation between psychoanalysis a n d a t t a c h m e n t theory on the subject of affects a n d affect regulation, leading u s to reconsider t h e m e a n i n g of affect regulation a n d to reflect u p o n t h e closely related concepts of seUvregulation a n d mentalization. Finally, we move on to i n t r o d u c e t h e notion of "mentalized affectivity," t h e a d u l t capacity to regulate affects, w h i c h will be d i s c u s s e d more fully in c h a p t e r 11 in connection with clinical material. Psychoanalysis a n d a t t a c h m e n t theory dovetail in their depiction of t h e i m p o r t a n t role played by affect regulation in early development, in facilitating t h e emergence of t h e s e n s e of self a n d t h e transformation of coregulation to self-regulation. Both perspectives also c o n c u r in u n d e r s t a n d i n g affect regulation a s a b a l a n c e between positive a n d negative affect; in particular, they u p h o l d t h e value of negative affect a s opposed to a s s u m i n g t h a t it o u g h t to be expunged. Yet, s o m e t e n s i o n s between psychoa n a l y s i s a n d a t t a c h m e n t theory have b e e n uncovered a s well (for a c o n c e p t u a l review see Fonagy 2001). Classical psychoanalysis views affects a s connected with drives, a n d even in m o r e contemporary versions of psychoanalysis t h e r e r e m a i n s a n affinity with t h e notion t h a t affects are powerful, primitive forces. Insofar a s affects a r e located in bodily experience, it m a k e s s e n s e t h a t there will b e limits to o u r a w a r e n e s s of t h e m . A t t a c h m e n t theory, in c o n t r a s t , d i s t a n c e s itself from t h i s w a y of t h i n k i n g a b o u t affects. Affects are regarded a s adaptive, a n d , moreover, affect regulation e n s u r e s t h a t t h i s is t h e case. It is t e m p t i n g to conclude t h a t while affects have primacy for psychoanalysts, affect regulation is c h e r i s h e d for a t t a c h m e n t theorists. However, it would be a m i s t a k e to ignore t h e fact t h a t affect regulation is i m p o r t a n t in p s y c h o a n a l y s i s a s well. As al-

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ready d i s c u s s e d , affect regulation in psychoanalysis is a concept with distinct c o n n o t a t i o n s of struggle. It is subject, a s every mental activity is, to t h e inherently conflictual n a t u r e of the mind: c o n s c i o u s experience is b o u n d to r u n u p a g a i n s t t h e u n c o n s c i o u s . Affect regulation in a t t a c h m e n t theory is conceived of more optimistically: s e c u r e a t t a c h m e n t m e a n s t h a t affect regulation c a n work well—that is, flexibly a n d reliably. Of course, a t t a c h m e n t theory envisions less desirable forms of regulation (or dysregulation) in i n s e c u r e a t t a c h m e n t . Still, t h e r e is a difference between p s y c h o a n a l y s i s a n d a t t a c h m e n t theory in how affect regulation is u n d e r s t o o d . The t e n s i o n between how affect regulation is u n d e r s t o o d in psychoanalysis a n d a t t a c h m e n t theory reflects a larger confusion a b o u t t h e m e a n i n g of t h e concept. As a term, affect regulation is u s e d in n u m e r o u s s e n s e s a n d w i t h o u t m u c h precision. Recent a t t e m p t s in psychology to clarify t h e meaning(s) of affect regulation deserve o u r attention. G r o s s (1999) offers t h e definition of affect regulation a s "processes by which individuals influence w h i c h emotions t h e y have, w h e n t h e y have them, a n d how t h e y experience a n d e x p r e s s t h e s e emotions" (p. 275). He endorses a "process-oriented a p p r o a c h " in w h i c h affect regulation e m b r a c e s s i t u a t i o n selection, situation modification, attention deployment, cognitive change, a n d r e s p o n s e modulation. Underlying Gross's point of view is a n evolutionary perspective that c o n s t r u e s emotions a s "flexible r e s p o n s e systems." The sources of affect regulation lie in b o t h psychoanalysis a n d t h e stress a n d coping tradition, b o t h of which, according to him, emphasize t h e r e d u c t i o n of negative affect. Gross claims, on t h e contrary, t h a t affect regulation o u g h t to include increasing, decreasing, a n d m a i n t a i n i n g positive a n d negative affect. He also argues t h a t affect regulation is b e s t restricted to one's own relation to one's affects, r a t h e r t h a n how one influences others' affects (how others' influence one's affects is n o t mentioned). Gross fails to t a k e seriously t h e developmental ideas we h a v e considered, w h e r e i n t h e infant's own affective experience is determined by t h e interaction between himself a n d t h e primary caregiver. Anticipating Gross, Ross T h o m p s o n (1990, 1994) a t t e m p t s to grapple with t h e lack of a clear definition of affect regulation. He

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claims t h a t we o u g h t to t h i n k of affect regulation a s "heterogeneous," n o t a s a "unitary p h e n o m e n o n . " Nevertheless, T h o m p s o n moves on to formulate a definition t h a t e n c o m p a s s e s all of its m a n y aspects. According to T h o m p s o n , affect regulation "cons i s t s of t h e extrinsic a n d intrinsic p r o c e s s e s responsible for monitoring, evaluating a n d modifying emotional reactions, especially their intensive a n d temporal features, to accomplish one's goals" (1994, pp. 27-28). Affect regulation serves adaptive p u r poses a n d , a s T h o m p s o n m a k e s clear, is closely connected to socialization. T h o m p s o n ' s s y m p a t h i e s for a t t a c h m e n t theory m e a n t h a t h e is n o t willing to d e t a c h t h e i s s u e of one's own relation to one's own affects from t h e i s s u e of others' relation to one's affects. At t h e c e n t e r of T h o m p s o n ' s investigation is a n e n u m e r a t i o n of t h e various objects of affect regulation: (a) neurophysiological p r o c e s s e s underlying emotional a r o u s a l a n d its m a n a g e m e n t , (b) attention processes, (c) informational p r o c e s s e s — s u c h a s t h e reinterpretation of events (which is linked to defense m e c h a nisms), (d) encoding of internal cues, s u c h a s of t h e internal indicators of emotional arousal, (e) e n h a n c i n g a c c e s s to coping m e c h a n i s m s , (/) helping to predict a n d control commonly enc o u n t e r e d settings, a n d [g] expressing emotions in a satisfactory way—that is, c o n c o r d a n t with one's p e r s o n a l goals for t h e situation. This comprehensive list conveys t h e b r o a d r a n g e of a i m s t h a t coincide with affect regulation—from t h e neurobiological b a s i s of regulation to its role in successful a d a p t a t i o n to the social world. Although T h o m p s o n acknowledges a n internal dim e n s i o n of affect regulation {d above), h i s explanation focuses on experiences like t h e reinterpretation of rapid h e a r t rate, b r e a t h i n g rate, a n d / o r perspiration. T h e example h e provides c o n c e r n s a n actor who m a n a g e s stage fright by reinterpreting emotional a r o u s a l to signify t h e expected anticipation of public performance, r a t h e r t h a n i m p e n d i n g dysfunction. T h o m p s o n ' s u n d e r s t a n d i n g of t h e internal d i m e n s i o n of affect regulation is insightful, a s it u n d e r s c o r e s t h a t t h e concept s h o u l d n o t be limited to its manifestation in action. Yet, a s we will show, T h o m p s o n does n o t go far e n o u g h in c a p t u r i n g affect regulation viewed t h r o u g h t h e lens of mentalization.

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O u r contribution to t h e project of clarifying t h e concept of affect regulation consolidates t h e earlier perspectives t h a t have been d i s c u s s e d with t h e views p r e s e n t e d above. At t h e lowest level of regulation, we m u s t t h i n k of t h e organism's equilibrium, to which n e u r o s c i e n t i s t s like D a m a s i o a n d psychobiologists like Hofer h a v e d r a w n o u r attention. O n t h i s level, affect regulation is equivalent to h o m e o s t a s i s ; it o c c u r s approximately a n d largely outside c o n s c i o u s a w a r e n e s s . Regulation p r o m p t s u s to alter o u r state a n d to a c t expeditiously in c i r c u m s t a n c e s where t h i s is n e c e s s a r y — s u c h a s extreme s i t u a t i o n s in w h i c h survival is a t stake. Choice c a n become p a r t of t h i s level of affect regulation, although t h e e n s u i n g action c a n be s p o n t a n e o u s a n d w i t h o u t accompanying reflection. On a n o t h e r level, regulation o c c u r s in connection with o u r relation to o t h e r s . Regulation serves to help u s to craft affects and to c o m m u n i c a t e t h e m (at t i m e s in lieu of acting on them). Indeed, a t t h i s level, we a r e moving to deal with self-regulation a s m u c h a s affect regulation. Affect regulation c o n c e r n s t h e regulation of affects, b u t it h a s implications for t h e self since it helps to bring t h e self into existence (see Gergely a n d W a t s o n 1996, a n d chapter 4). Self-regulation o c c u r s w h e n t h e object of regulation is the self; t h i s c a n be, b u t is n o t necessarily, achieved t h r o u g h affects. In o n e sense, self-regulation c a n b e considered a s a higher kind of affect regulation; in a n o t h e r sense, it c o n s t i t u t e s a change in form. In order to clarify t h e c h a n g e t h a t t a k e s place between affect regulation a n d self-regulation, it will be n e c e s s a r y to say more a b o u t w h a t it m e a n s to be a self. Affect regulation on t h e second level is a b o u t t h e m e a n i n g t h a t affects h a v e for p a r t i c u l a r individuals. Insofar a s regulation involves t h e capacity to r e m a i n within a n affective s t a t e a s one considers it, we h a v e a different model from t h o s e found traditionally in philosophy a n d psychology, w h e r e i n cognition a c t s u p o n t h e affect. A p r e c e d e n t for w h a t we have in mind h e r e is found in Spinoza: while h e s t r e s s e s t h e u s e of r e a s o n over t h e affect, he e m p h a s i z e s t h e value of allowing t h e affect to be felt for self-understanding. Like others, we appreciate t h a t t h e r e m u s t be a cognitive c o n t r i b u t i o n to regulation—whether this is c a s t in t e r m s of a p p r a i s a l , attention, or informational processing—but

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we wish to posit t h e distinctive possibility of doing so while preserving t h e affective state. The s t a t e might b e adjusted upw a r d (increased) or downward (decreased), a n d it m i g h t n o t be altered a t all. O u r point is certainly n o t to challenge the possibility of affect regulation leading to o u t w a r d action. O u r intention is merely to d r a w attention to a specific function of affect regulation t h a t is predicated u p o n mentalization a n d t h a t h a s n o t b e e n described in t h e literature on regulation. Mentalization is t h e larger category t h a t includes self-regulation. Like self-regulation, reflective function does n o t necessarily c o n c e r n affects. However, insofar a s it does concern affects, affective experience will b e processed in a more complex way. J u s t a s reflective function b r i n g s a b o u t a new kind of interest in one's own m i n d , mentalization with affects brings a b o u t a n e w kind of relation to one's own affects. Let u s try to distinguish a n d label t h i s u l t i m a t e form of affect regulation. T h e concept of "mentalized affectivity" m a r k s a n a d u l t capacity for affect regulation in w h i c h o n e is c o n s c i o u s of one's affects, while r e m a i n i n g within t h e affective s t a t e . S u c h affectivity d e n o t e s t h e capacity to fathom t h e meaning(s) of one's own affect states. This is a goal t h a t is n o less significant, evolutionarily speaking, t h a n is t h e goal of acting u p o n one's emotions. It is w o r t h noting h o w close t h e notion of mentalized affectivity is to w h a t h a p p e n s in psychoanalytic (and other k i n d s of) psychotherapy. It is widely appreciated by clinicians t h a t it is crucial to u n d e r s t a n d one's own feelings experientially in a way t h a t is emotionally meaningful (vs. intellectually). There is a n especially deep appreciation in p s y c h o a n a l y s i s for how difficult it c a n be to u n d e r s t a n d one's own affective s t a t e s a n d experiences. Not only do we m i s u n d e r s t a n d w h a t we feel, t h i n k i n g t h a t we feel one t h i n g while we really feel a n o t h e r emotion; b u t we often feel more t h a n o n e emotion, even contradictory emotions, a t the s a m e time. Mentalized affectivity enables u s to be h u m a n — o r , ironically put, to b e c o m e even m o r e h u m a n .

The Behavior Geneticist's

Challenge

to a Psychosocial of t h e D e v e l o p m e n t of

Model

Mentalization

In this chapter, we consider t h e r e c e n t challenges to t h e psychosocial a p p r o a c h t a k e n in t h i s book. T h e a s s u m p t i o n t h a t t h e quality of mentalizing is related to t h e quality of early object relations is a c o m m o n t h r e a d t h r o u g h o u t t h e volume. We a r g u e t h a t m a n y of t h e k n o w n c o n s e q u e n c e s of sensitive a s opposed to neglecting a n d m a l t r e a t i n g early e n v i r o n m e n t s m i g h t be u n d e r stood a s having a n i m p a c t on t h e child's capacity to mentalize. However, s u c h a s s u m p t i o n s concerning t h e influence of t h e child's family e n v i r o n m e n t h a v e recently b e e n challenged by evidence from behavior genetics. Findings from s t u d i e s of twins and from children a d o p t e d early in life are u s e d to claim t h a t past work h a s exaggerated t h e influence of p a r e n t i n g on child development. If s u b s t a n t i a t e d , t h e s e critiques would remove t h e logical foundation of m o s t p s y c h o d y n a m i c or psychoanalytic a p proaches, r e n d e r i n g t h e p r e s e n t proposals, a m o n g others, u n tenable. It is therefore i n c u m b e n t u p o n u s to review t h e s e critiques and to a t t e m p t a vigorous defense of t h e environmentalist position. In t h e c o u r s e of t h i s defense, we will a r g u e t h a t t h e role of early experience is critical in determining gene expression a n d t h a t t h e influence of early environment, a s a m o d e r a t o r of t h e progress from genotypic potential to phenotypic outcome, m a y 97

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therefore be very s u b s t a n t i a l . We place mentalization a t the h e a r t of this p r o c e s s of moderation, a r g u i n g t h a t t h e interpretation of t h e environment r a t h e r t h a n t h e a c t u a l environment governs genetic expression. T h e s e c o n s i d e r a t i o n s lead u s to reformulate t h e influence of a t t a c h m e n t on later development. Moving from a model where t h e early relationship w a s seen a s offering a template for later relationships—a model t h a t a p p e a r s naive in t h e light of m o r e r e c e n t evidence—we a r g u e t h a t it is the quality or "depth of processing" of t h e psychosocial environment t h a t c a n be set by early experience. We posit t h a t t h e evolutionary function of t h e early relationship might indeed be to equip t h e child with t h e mentalizing skills n e c e s s a r y to function effectively in a stressful social world. Insecurity in a t t a c h m e n t relationship m a y be a signal of some limitation in mentalizing skills. T h e self-representation is t h e n n o t so r o b u s t to social relationships, a n d t h e child or a d u l t n e e d s special strategies to cope with intimate interpersonal relations. We recognize t h e s e strategies a s t h e c o m m o n types of insecurity: t h e avoidant or dismissing strategy on t h e one h a n d , a n d t h e r e s i s t a n t or preoccupied strategy on t h e other. T h e complete failure of mentalization is no longer characterized by a clear a t t a c h m e n t strategy. Disorganization of a t t a c h m e n t m a y be t h e indication of exceptionally poor mentalization.

INTRODUCTION Over t h e p a s t t e n y e a r s we—developmental professionals a s well a s t h e lay public—have u n c o n s c i o u s l y switched from a primarily psychosocial model of child a n d a d u l t development to a geneticbiological frame of reference t h a t often a priori excludes consideration of c h i l d - p a r e n t relationships. In a n informal s t u d y , we a s k e d twenty p a r e n t s referred to a n o u t p a t i e n t child c o m m u n i t y m e n t a l h e a l t h clinic consecutively a b o u t t h e likely c a u s e of their child's problems. It s u r p r i s e d n o one t h a t t h e y all p u t brain chemistry a t t h e top of t h e list. It w a s m o r e s u r p r i s i n g t h a t "bad genes" came second, p e e r s third, a n d early life experiences a poor fifth, j u s t a h e a d of food additives. Why is t h i s h a p p e n i n g ? it

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The excitement of novelty, of scientific discovery, m u s t have something to do with it. B u t t h i s is n o t a sufficient explanation. The reduction of t h e m i n d to a genetically prefigured constellation of b r a i n chemicals is appealing. While o u r c o n s c i o u s n e s s , our free will, o u r m i n d is u n d o u b t e d l y o u r m o s t t r e a s u r e d possession, it is also t h e s o u r c e of all o u r s a d n e s s , conflict, pain, suffering, a n d misery. The reduction of models of pathology to a principally genetic m o d e of c a u s a t i o n is u n d o u b t e d l y a relatively comfortable solution for all of u s — b u t like all comforts, it comes at a price. A fault line r u n s t h r o u g h m o d e r n developmental psychopathology. E n v i r o n m e n t a l e n t h u s i a s t s , s u c h a s t h e a u t h o r s of this volume, c o n t i n u e to p u r s u e their a g e n d a of identifying key socializing p r o c e s s e s in development with a view to designing everimproved psychosocial t r e a t m e n t a n d prevention strategies. They work (in a t t a c h m e n t r e s e a r c h , for instance), apparently oblivious to the work of behavior a n d molecular geneticists (the new nativists), w h o h a v e in t h e m e a n t i m e settled t h e entire i s s u e of developmental c a u s a t i o n , a t least in principle, a n d a r e b u s y trying to find t h e g e n e s a n d p r o t e i n s to explain pathological b r a i n development. T h o s e w h o try to bridge t h e gap—Michael Rutter (Rutter, Silberg, O'Connor, a n d Simonoff 1999a, 1999b), David Reiss (Reiss, Neiderhiser, Hetherington, a n d Plomin 2000), Robert Plomin (Plomin, Fulker, Corley, a n d DeFries 1997)—are relatively few in n u m b e r . As p a i d - u p m e m b e r s of t h e gradually thinning g r o u p of environmental e n t h u s i a s t s , we, too, are trying to forge links, while r e m a i n i n g quite a w a r e of w h a t h a p p e n s to those who try to build bridges a c r o s s fault lines. Where h a s all t h e mystery gone? Recently, one of u s s a w three new m a l e c a s e s on t h e s a m e day. They were very different: a depressed j o u r n a l i s t with sexual problems, a y o u n g m a n soon to be married b u t worried a b o u t h i s history of bipolar illness, and a n adolescent with violent behavior problems. During initial a s s e s s m e n t s it is interesting to try to elicit t h e patients' theory of their problems a n d a s k s o m e t h i n g like: "Why do you t h i n k this h a s h a p p e n e d to you?" of "Why do you t h i n k people like you get depressed?" O n t h i s p a r t i c u l a r day, surprisingly, all t h r e e m e n came u p with identical a n s w e r s : "I t h i n k from m y m o t h e r I inherited a t e n d e n c y to look for t h e negative," said t h e journalist;

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"I t h i n k it is well established to be a chemical i m b a l a n c e c a u s e d by m y genes," said t h e groom with t h e bipolar disorder; a n d "I've b e e n told I have b a d g e n e s t h a t m a k e m e hit people," replied t h e adolescent. In e a c h case, a s they answered, time seemed to collapse. There w a s n o s p a c e between t h e m o m e n t t h e i r father's s p e r m p e n e t r a t e d their m o t h e r ' s o v u m a n d t h e p r e s e n t m o m e n t . Of course, in e a c h case it w a s possible to call u p o n t h e n a t u r a l h u m a n desire to create a meaningful life narrative a n d to explore how their experiences h a d a s s i s t e d or h i n d e r e d their capacity to cope with t h e difficulties t h e y b r o u g h t . P s y c h o t h e r a p y is b a s e d on biological forces t h a t a r e rooted m o r e deeply t h a n a n y intellectual conviction a b o u t the origin of a p a t i e n t ' s difficulties. But while t h e y e x p o u n d e d their respective naive nativist views, t h e r e w a s n o room for dialogue. There w a s j u s t o n e simple m e s s a g e : Don't a s k w h a t c a u s e s m y problems, don't probe m y memories or t h o u g h t s or feelings; t h e r e is n o t h i n g to know, t h e a n s w e r lies in m y genes. There w a s n o room for h u m a n mystery! This inability to envision psychological a n d psychosocial c a u s a t i o n is b o t h a t t h e root of t h e psychological p r o b l e m s t h e s e individuals b r o u g h t into t h e consulting-room a n d a t t h e core of t h e naive nativist perspective.

THE DEMISE OF SOCIALIZATION: PARENTING V E R S U S GENETICS There are t h r e e p r i m a r y a g e n t s of socialization of children in Western society: families, peer groups, a n d day-care c e n t e r s or schools (Maccoby 2000). T h e e m p h a s i s , b o t h professional a n d cultural, h a s b e e n on t h e family a s a n a g e n t of socialization. For t h e b e s t p a r t of t h e p a s t century, b o t h psychological theories (e.g., Alexander a n d P a r s o n s 1982; Bowlby 1958; P a t t e r s o n 1976; Winnicott 1963) a n d c o m m o n s e n s e psychological views (Leach 1997; Spock a n d Rothenberg 1985) agreed in Identifying experience with p a r e n t s a s pivotal in s h a p i n g a n individual's values, beliefs, c h a r a c t e r , a n d , naturally, dysfunctions in a d a p tation. It is interesting to note that, of t h e two psychological

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approaches—learning theory a n d p s y c h o a n a l y s i s — t h a t dominated t h e l a s t century, it w a s t h e latter t h a t retained some e m p h a s i s on t h e constitutional delimiters to socialization (e.g., Freud 1 9 1 2 - 1 3 , 1920g; Neu 1992). The l a s t q u a r t e r of t h e twentieth c e n t u r y s a w a d r a m a t i c realignment of developmental theories. T h e emergence of a cognitive m e n t a l science (e.g., B a r a s a l o u 1991; J o h n s o n - L a i r d 1983) prompted t h e t r a n s l a t i o n of s o m e learning a n d m a n y psychodynamic principles into t h e l a n g u a g e of information processing, with p r e s u m e d m e n t a l o p e r a t i o n s on p a s t experience creating predictable b i a s e s a n d distortions (what u s e d to be called psychic defenses) in m e n t a l r e p r e s e n t a t i o n s (e.g., B a n d u r a 1977; Mischel 1973). Cognitive behavioral a p p r o a c h e s to development a n d psychopathology were ultimately saved from tautology a n d circularity by two factors: (a) t h e theory inspired a whole series of brief a n d effective psychosocial interventions (cognitive behavioral therapy—e.g., Beck 1976; M e i c h e n b a u m 1997); a n d (b) t h e introduction of a dialectical model into developmental theory (e.g., C h e s s a n d T h o m a s 1979; Kagan 1989). The views of socialization t h a t emerged from cognitive social learning theory h a v e u n d e r s c o r e d t h a t t h e child plays a n imp o r t a n t role in d e t e r m i n i n g h i s own socialization experience. Clearly, m o t h e r i n g a n infant high in emotionality m u s t elicit quite a different set of m a t e r n a l behaviors t h a n would t h e mothering of a sociable, u n e m o t i o n a l infant. This realization w a s critical in radically a n d helpfully m o d e r a t i n g t h e p a r e n t - b l a m i n g tendency of early psychopathologists. Although t h e s e t r a n s a c tional models of child-to-parent effects were later u s e d to s u p p o r t the a r g u m e n t of t h o s e proposing a nativist revival, for t h e m o s t part cognitive social learning theory m a i n t a i n e d t h e environmentalist tradition of psychoanalytic theories. The s i m u l t a n e o u s ind e p e n d e n t emergence in t h e late 1960s of t h e family s y s t e m s perspective (e.g., M i n u c h i n et al. 1975) a n d Bronfenbrenner's (1979) influential ecological ideas in t h e 1970s increased t h e explanatory power of socialization a n d further reinforced t h e focus of developmentalists on t h e social environment. Developmental psychopathology, p e r m e a t e d with t h e dialectic of social l e a r n i n g theory, c a m e to d o m i n a t e child psychiatric epidemiology, u n d e r t h e leadership of N o r m a n Garmezy, with

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other giants s u c h a s Michael Rutter, Alan Sroufe, Robert Emde, a n d D a n t e Cicchetti. T h e key r e s e a r c h question c a m e to be t h e mysterious unfolding, integration, a n d interaction of p e r s o n a n d environmental characteristics in t h e generation of psychological d i s t u r b a n c e t h r o u g h ontogenetic development. Notwithstanding t h e explicit c o m m i t m e n t to a dialectic t r a n s a c t i o n a l model (e.g., Garmezy, Masten, a n d Tellegen 1984), developmental psychopathology always retained its e m p h a s i s on socialization, p a r ticularly intrafamilial socialization (e.g., Cicchetti 1987; Rutter 1993; Sameroff 1995). A t t a c h m e n t theory b e c a m e o n e of t h e guiding frameworks of t h e a p p r o a c h (e.g., C i c c h e t t i a n d Cohen 1995; Sroufe a n d R u t t e r 1984), a n d J o h n Bowlby w a s , to some degree p o s t h u m o u s l y , recognized by m a n y a s o n e of its pioneers (Sroufe 1986). T h u s , n o t w i t h s t a n d i n g t h e d o m i n a n c e of cognitive psychology a n d social learning theory, developmental psychopathology r e m a i n e d a broad c h u r c h , a n d m a n y p s y c h o d y n a m i c concerns—in p a r t i c u l a r a focus on early relationships (e.g., Cicchetti 1987), on affect regulation (e.g., Sroufe 1996), on relationship r e p r e s e n t a t i o n s (e.g., Dodge 1990), a n d on p r o c e s s e s of identification (e.g., Crittenden 1994), internalization (e.g., Fonagy et al. 1995), a n d self-organization (e.g., Fischer a n d Ayoub 1994)—were retained. In t h e last q u a r t e r of t h e twentieth century, developmental psychopathologists were mostly concerned with risk factors— risk factors associated with t h e family occupying a m o s t import a n t role (e.g., M a s t e n a n d Garmezy 1985). Developmental psychopathology of t h e early y e a r s of development w a s particularly concerned with social a n d c u l t u r a l facets of risk (e.g., M a s t e n a n d Braswell 1991), p a r e n t - i n f a n t relationships, epistemic a n d motivational m e n t a l s t a t e s t h a t influence p a r e n t i n g (e.g., Belsky 1984), t h e interaction of economic a n d social d i s a d v a n t a g e with p a r e n t i n g (e.g., McLoyd 1990; Quinton, Rutter, a n d Liddle 1984), t h e distorting influences of p a s t experience on emotional a n d cognitive s t r u c t u r e s of t h e child (e.g., Fox, Platz, a n d Bentley 1995; Parker, Barrett, a n d Hickie 1992), a n d p a r e n t a l behaviors a s m e d i a t o r s of t h e gross social inequalities t h a t b e c a m e a n increasing s o u r c e of concern for social scientists of t h e T h a t c h e r a n d Reagan y e a r s (e.g., Conger, Ge, Elder, Lorenz, a n d S i m o n s 1994; McLoyd 1998; Petit, Bates, a n d Dodge 1997). Permeating

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all t h e s e i d e a s w a s t h e notion t h a t t h e unfolding of psycho pathology occurred in t h e context o f t h e child's p r i m a r y socialization environment: t h e family. T h e family, t h e p a r e n t s in particular, provided t h e b a c k d r o p a g a i n s t w h i c h t h i s unfolding occurred—rtheir characteristics were crucial to t h e developmental choices t h e child would m a k e , their actions a n d collaboration critical to b o t h t r e a t m e n t a n d prevention. However, over t h e last d e c a d e of t h e twentieth century, perh a p s in p a r t triggered by t h e excitement of t h e h u m a n genome project, b u t also by r e s e a r c h designs of increasing statistical sophistication, quantitative behavior genetics w a s u n l e a s h e d on early development r e s e a r c h . At a certain point it seemed a s t h o u g h r e s e a r c h in genetics h a d all b u t eliminated t h e place for classical socialization theories t h a t placed a n e m p h a s i s on parenting, s u c h a s a t t a c h m e n t theory, a n d h a d refuted all theories t h a t advocated t h e key role of early family experience (see Scarr 1992). For example, t h e behavior geneticist Rowe wrote: "parents in m o s t working to professional class families m a y have little influence on w h a t traits their children m a y eventually develop a s adults" (1994, p. 7). He w e n t on to say t h a t h e doubted w h e t h e r a n y u n d e s i r a b l e trait displayed by a child c a n be significantly modified by a n y t h i n g a . p a r e n t does. In fairness, it should b e noted t h a t t h e s e c o m m e n t s were p u b l i s h e d before data b e c a m e available from r e s e a r c h t h a t gave equal weight to both genetic a n d social influences on development.

The Findings from Behavior G e n e t i c s The biological (genetic) m o v e m e n t of t h e 1990s highlighted a n u m b e r of i s s u e s t h a t s e e m e d to t h r e a t e n t h e validity of t h e kinds of environmentalist claims we a r e m a k i n g in this book. 1. The overall connection between early p a r e n t i n g a n d socialization o u t c o m e s t u r n s o u t to b e quite weak, a n d in longitudinal studies p a r e n t i n g a c c o u n t s for negligible proportions of t h e variance. There is very limited evidence t h a t m i g h t link early relationship experiences to t h e development of personality a n d psychopathology. F u r t h e r m o r e , t h e implicit a s s u m p t i o n t h a t

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genetic influences occur only in early life, a n d therefore t h a t later emerging differences between individuals c a n be safely a s s u m e d to be environmental, t u r n s o u t to be false. Genetic influences a r e j u s t a s c h a n g i n g a n d a s d y n a m i c a s environmental influences. For example, genetic influences on IQ a r e relatively small in early y e a r s b u t increase considerably a s t h e child moves toward adolescence (Rutter et al. 1997) a n d conversely t h e influence of p a r e n t i n g on a p t i t u d e t e s t scores declines (Plomin, Fulker, Corley, a n d DeFries 1997). As we shall see, it is quite possible t h a t a t t h e molecular level s o m e genes a r e dorm a n t in early p h a s e s of development b u t their activity is promoted in s u b s e q u e n t stages. In fact, genetic influences predisposing to t h e s a m e t r a i t — s u c h a s antisocial behavior—can c h a n g e over t h e c o u r s e of development w i t h o u t altering t h e size of t h e genetic c o m p o n e n t . T h u s , t h e heritability of antisocial behavior is 63% in early adolescence a n d 6 8 % in late adolescence, b u t only a b o u t a third of this variability overlaps (i.e., is t h e s a m e p a r t of t h e genetic m a k e u p a t e a c h stage) (Neiderhiser, Reiss, a n d Hetheringtoh 1996). 2. Behavior-genetic models of twin a n d adoption s t u d i e s partition variability into genetic (h) a n d environmental (E) compon e n t s by s u b t r a c t i n g t h e proportion of variability on a specific trait a c c o u n t e d for by genes (h2) from 100 (E = 100 - h 2 ). In m o s t d o m a i n s h 2 is 5 0 - 6 0 % , with less t h a n half left to E. For attention-deficit hyperactivity disorder (ADHD), heritability is estim a t e d to vary from 55% to 8 2 % (Nigg a n d Goldsmith 1998; Smalley 1997) As large-scale s t u d i e s c o n t i n u e to emerge, t h e proportion of variance t h a t is left after s u b t r a c t i n g genetic influence is diminishing. 3. Behavior-genetics r e s e a r c h h a s revealed t h a t influences t h a t h a d previously b e e n considered environmental (such a s children whose caregivers read to t h e m learning to read earlier t h a n those who are n o t read to) were actually mostly mediated by t h e s h a r e d genetic predisposition of caregiver a n d offspring (Kendler et al. 1996). Apparently environmentally mediated family influences are in fact explained by t h e s h a r e d genetic predisposition of caregiver a n d offspring a n d therefore are possibly in t h e m -

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selves u n i m p o r t a n t (J. R. Harris 1998; Rowe 1994). Recently, a n analysis of t h e Colorado Adoption Project showed t h a t m a n y of the milder adverse effects o n social, a d j u s t m e n t associated with p a r e n t a l divorce a r e in fact genetic: children w h o a r e a d o p t e d away from p a r e n t s w h o later get divorced develop a d j u s t m e n t problems even if t h e y are a d o p t e d into nondivorcing families (O'Connor, Caspi, DeFries, arid Plomin 2000). The quality o f t h e e n v i r o n m e n t s t h a t a r e t h o u g h t to b e so i m p o r t a n t to development, including s t r e s s , life events, a n d t r a u m a (and probably also m a t e r n a l a t t u n e m e n t a n d sensitivity), c a n all be inherited. It is likely t h a t personality characteristics t h a t we h a d often t h o u g h t of a s — a n d w h a t t h e child m i g h t experience as—the c o n s e q u e n c e of t h e p a r e n t s ' behavior toward t h e child are in fact genetic predispositions. It might be t h a t t h e p a r t i c u l a r personality trait in t h e child a n d t h e associated form of p a r e n t i n g (criticism, w a r m t h , or even abuse) are b o t h c o n s e q u e n c e s o f t h e s a m e genes in t h e p a r e n t a n d t h e child or t h a t t h e prodromal version o f t h e child's trait might elicit—say, by evocatory projective identification (Spillius 1992)—a p a r t i c u l a r way for t h e p a r e n t to be with t h e child. 4. Correlations between characteristics of early p a r e n t i n g a n d later child behavior c a n be reinterpreted given t h a t a n y association m a y be a t t r i b u t a b l e to t h e 50% of genetic overlap between a p a r e n t a n d a biological child. This h a s b e e n termed passive genotype-environment correlation. As genetic factors influence the i n d e p e n d e n t variables ( m e a s u r e s of t h e social environment) and t h e d e p e n d e n t variables ( m e a s u r e s of social adjustment), there is a potential for confounding. In t h e majority of published socialization s t u d i e s t h i s possibility is n o t acknowledged. Reiss, Neiderhiser, Hetherington, a n d Plomin (2000), in a l a n d m a r k investigation of genetic a n d environmental influences on adolescent development, found t h a t of 52 statistically significant associations between family relationship (e.g., p a r e n t a l w a r m t h or sibling relationships) a n d m e a s u r e s of a d j u s t m e n t (e.g., depression a n d antisocial behavior), 4 4 showed genetic influences t h a t accounted for m o r e t h a n half of t h e covariance. In a l m o s t half of the 52, little association between family relations a n d adolescent functioning r e m a i n e d once genetic influence w a s t a k e n into con-

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sideration. In t h e Colorado Adoption Project, t h e parents* report of w a r m t h v e r s u s negativity in t h e family a n d t h e child's report of achievement orientation a p p e a r associated, b u t achievement orientation t u r n s o u t to be genetically d e t e n n i n e d , suggesting t h a t a s p e c t s of t h e family e n v i r o n m e n t a r e susceptible to the influence of t h e child's genetically rooted c h a r a c t e r i s t i c s ^ - t h e so-called child-to-parent effects (Deater-Deckard, Fulker, a n d Plomin 1999). 5. Insofar a s behavior-genetic s t u d i e s showed family environm e n t to m a t t e r , it w a s t h e e n v i r o n m e n t specific to e a c h child within t h e s a m e family [nonshared environment) t h a t m a t t e r e d (Plomin a n d Daniels 1987). E n v i r o n m e n t m a y b e partitioned into a s h a r e d a n d a n o n s h a r e d c o m p o n e n t . S h a r e d environmental influences m a y b e e s t i m a t e d in adoption s t u d i e s b y comparing t h e correlation of adopted children a n d their adopted siblings with children in other h o u s e h o l d s . If s h a r e d a s p e c t s of the environment, s u c h a s parenting, were indeed formative, t h e n adopted siblings living in t h e s a m e h o m e s h o u l d be significantly more alike t h a n u n r e l a t e d children a c r o s s h o u s e h o l d s . After t h e genetic a n d s h a r e d environmental c o m p o n e n t s a r e estimated, w h a t r e m a i n s is t h e n o n s h a r e d e n v i r o n m e n t (E us = 100 - h 2 - E J . T h e n o n s h a r e d e n v i r o n m e n t a p p e a r s to be t h e b u l k of t h e environmental component; s h a r e d environment, a n i n s t a n c e of w h i c h would b e p a r e n t a l sensitivity, a c c o u n t s for a l m o s t n o variance (Plomin 1994). Adopted children, it seems, are n o more like their adopted siblings t h a n are u n r e l a t e d children growing u p in a different h o u s e h o l d (Plomin a n d B e r g e m a n 1991). This is i m p o r t a n t b e c a u s e t h e relatively weak observed effects of t h e s h a r e d environment have b e e n u s e d to suggest t h a t environm e n t s generally a s s u m e d to be toxic by developmental psychopathology (such a s high level of p a r e n t a l conflict, p a r e n t a l psychiatric d i s t u r b a n c e , or even relative social disadvantage) are either of less i m p o r t a n c e t h a n previously t h o u g h t or, m o r e probably, are actually genetically mediated (Plomin, Chipuer, a n d Neiderhiser 1994). Plomin p u t this quite elegantly: So often we have assumed that the key influences on children's development are shared: their parents' personality and child-

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hood experiences, the quality of their parents' marriage relationship, children's educational background, the neighborhood in which they grow up, and their parents' attitude to school or to discipline. Yet to the extent that these Influences are shared, they cannot account for the differences we observe in children's outcomes. [1994, p. 23] 6. It h a s b e e n a r g u e d t h a t even n o n s h a r e d environmental effects m a y b e b e t t e r u n d e r s t o o d a s being genetic in origin. Genetically influenced a s p e c t s of children's behavior m a y be responsible for provoking specific observed r e s p o n s e s in p a r e n t s and other people. This is s o m e t i m e s termed evocative covariance, when children with different genetic predispositions elicit complementary r e s p o n s e s from t h e caregiver. T h u s , t h e child's n o n s h a r e d (specific) e n v i r o n m e n t m a y s o m e t i m e s have b e e n erroneously a t t r i b u t e d to p a r e n t a l behavior r a t h e r t h a n to h i s genes (O'Connor, Deater-Deckard, Fulker, Rutter, a n d Plomin 1998). S o m e s t u d i e s of adopted children suggest t h a t authoritarian parenting, w h i c h h a s b e e n t h o u g h t to a c c o u n t for oppositional behavior in children, m a y b e elicited by t h e child's resistive or distractible behavior (Ge, Conger, Cadoret, Neiderhiser, a n d Yates 1996). Thus, it s e e m s t h a t over t h e p a s t ten y e a r s we—developmental professionals a s well a s t h e lay public—have unconsciously switched from a primarily psychosocial model of child a n d a d u l t development consistent with p s y c h o d y n a m i c ideas to a geneticbiological frame of reference t h a t often a priori excludes consideration of c h i l d - p a r e n t relationships. We will now a r g u e t h a t t h e case for r e d u c i n g t h e e m p h a s i s on parenting, particularly t h e e m p h a s i s on t h e early a t t a c h m e n t relationships, is b a s e d on false evaluations of behavior-genetic d a t a , a n d t h a t p e r h a p s in the p a s t o u r e m p h a s i s on t h e role of p a r e n t i n g w a s s o m e w h a t naive in trying to see t h e p a r e n t s ' influence simply in t e r m s of relationship quality, internalization, introjection, identification, and so on. We try to s h o w t h a t (a) early a t t a c h m e n t experiences may well be key m o d e r a t o r s of t h e expression of individual genotype, a n d (b) t h e p r i m a r y evolutionary function of a t t a c h m e n t m a y indeed b e t h e contribution it m a k e s to t h e ontogenetic

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creation of a m e n t a l m e c h a n i s m t h a t could serve to m o d e r a t e psychosocial experiences relevant for gene expression.

S c r u t i n i z i n g t h e C a s e for G e n e t i c s As d e m o n s t r a t e d earlier, t h e case for genetic d e t e r m i n a n t s r e s t s on two pillars: (a) t h e w e a k n e s s o f t h e socialization evidence, a n d (b) t h e findings of quantitative behavior genetics. We will j u s t t o u c h on t h e first a n d focus ori t h e second. Classical reviews extensively cited by behavior geneticists (e.g., Maccoby a n d Martin 1983) t e n d e d to reveal w e a k correlations between p a r e n t i n g and- socialization o u t c o m e s open to alternative, genetic interpretations. However, t h e r e h a v e been s u b s t a n t i a l methodological i m p r o v e m e n t s in s t u d i e s of socialization, in t e r m s b o t h of t h e b r e a d t h a n d of t h e d e p t h of measu r e m e n t , a n d correspondingly effect sizes h a v e also increased. For example, Martin M a l d o n a d o - D u r a n a n d h i s colleagues, in a s t u d y a t t h e Menninger Child a n d Family Center (MaldonadoD u r a n , Helmig, Moody, a n d Millhuff, in press; M a l d o n a d o - D u r a n et al. in press), carried o u t operationalized clinical ratings of a l m o s t 150 infants. Over 70% of t h e children have so far been followed u p two to four y e a r s later. Infant behavior problems strongly predicted later behavioral difficulties in a n u m b e r of a r e a s . Parenting observed in infancy predicted preschool emotional difficulties. In particular, p a r e n t s w h o were b o t h neglectful a n d hostile h a d children with m o r e behavioral problems. This r e m a i n e d t r u e even w h e n behavioral p r o b l e m s in infancy were controlled for. Observed neglect a n d hostility toward t h e child correlated 0 . 3 6 with t h e child's behavioral p r o b l e m s noted a t age 4 years, even w h e n infant behavior w a s already controlled for. This implies t h a t p a r e n t i n g h a d a predictable effect beyond t h a t which could be explained in t e r m s of t h e p a r e n t r e s p o n d i n g specifically to t h e p r e c u r s o r s of t h e child's behavioral problems. Better-controlled studies, s u c h a s t h i s one, a r e a c c u m u l a t i n g , a n d c u r r e n t reviews of t h e socialization literature tend to yield more encouraging conclusions (Maccoby 2000). A considerable complexity is introduced into t h e interpretation of social e n v i r o n m e n t to behavioral-outcome correlations by

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the recognition t h a t t h e p a r e n t i n g environment varies in significance a c r o s s development a n d even within e a c h developmental p h a s e a c r o s s time. T h e r a p e u t i c experience shows u s t h e exceptional influence of certain "key m o m e n t s " of interaction between therapist a n d patient, w h e n experience b r o u g h t into clear relief by a confluence of c i r c u m s t a n c e a n d intrapsychic factors s u d denly e n a b l e s t h e r a p e u t i c change. (This idea is fully elaborated in the work of Daniel Stern, Ed Tronick, Karlen Lyons-Ruth, a n d the Boston g r o u p o n t h e r a p e u t i c process—Fonagy 1998; LyonsRuth 1999; S t e r n 1998; S t e r n et al. 1998.) They a r g u e t h a t change in t h e r a p y might be a function of special m o m e n t s of a t t u n e m e n t between t h e r a p i s t a n d patient. More generally, t h e s a m e could apply to special m o m e n t s of influence of p a r e n t s on children—naturally with b o t h a positive a n d a negative valence— m o m e n t s of p a r e n t i n g influence, however key a n d formative, t h a t m i g h t be t h e needles in a socialization h a y s t a c k . It is difficult to imagine h o w observational research, focusing on aggregate or t i m e r s a m p l e d behaviors, c a n h o p e to c a p t u r e significant n u m b e r s of s u c h key m o m e n t s . The correlations between observed p a r e n t i n g a n d child o u t c o m e m a y never reflect the t r u e influence of p a r e n t i n g . In a n y case, however s t r o n g t h e associations between p a renting a n d socialization, t h e possibility t h a t t h e m o r e parsimonious explanation is genetic c a n n o t b e ruled out. It is t h e a p parent s t r e n g t h of genetic findings, t h e massive proportion of variability a c c o u n t e d for, n o m a t t e r how specific t h e trait, t h a t casts s u c h a d a r k s h a d o w over developmental psychopathology. But a r e t h e genetic findings a s unequivocal a s they s e e m ? Let u s offer a brief, r o b u s t r e b u t t a l of quantitative behavior genetics. The evidence from behavior genetics should be interpreted with caution. T h e r e a s o n s are: (a) methodological, (b) conceptual, and (c) empirical. Methodologically, t h e c o n t r a s t of identical a n d fraternal twins confounds genetic similarity a n d environmental influence. It h a s b e e n claimed t h a t identical twins h a v e more similar e n v i r o n m e n t s t h a n do fraternal o n e s (e.g., they have more friends in c o m m o n , t h e y a r e treated m o r e similarly by t h e p a r e n t s ^ R e i s s et al. 2000). T h e s t a t u s of inferring environmental effects by a p r o c e s s of s u b t r a c t i o n u s i n g t h e additive model h a s also b e e n questioned (Elman et al. 1996; T u r k h e i m e r 1998).

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In particular, • E is e s t i m a t e d w i t h o u t a n y direct m e a s u r e of environmental factors. If t h e estimate for heritability, G, is high, E m u s t be low. In reality, G a n d E combine to g e n e r a t e a phenotype. In simple additive models, however, this interaction would be pooled with genetic effects. T h e u s e of p a r e n t s a s a source of d a t a a b o u t themselves a s well a s their child c r e a t e s a n inbuilt genetic bias. Heritability e s t i m a t e s a r e inflated by t h e u s e of p a r e n t s ' r e p o r t s of child behavior r a t h e r t h a n behavioral observation or self-reports. It is n o t s u r p r i s i n g t h a t w h e n p a r e n t s rate a child's aggression, t h e correlation with' t h e p a r e n t ' s aggression should i n c r e a s e (Cadoret, Leve, a n d Devor 1997; Miles a n d Carey 1997). At a c o n c e p t u a l level, we m a y certainly q u e s t i o n t h e notion of n o n s h a r e d environment, since it merely refers to intersibling differences, n o t to their environment. In fact, s h a r e d environm e n t s could a s easily serve to m a k e children in t h e family different from o n e a n o t h e r a s to i n c r e a s e intrafamilial similarity, since s h a r e d e n v i r o n m e n t s m a y b e experienced very differently by two children. A further c o n c e p t u a l problem c o n c e r n s heritability e s t i m a t e s b a s e d solely on individual differences—estim a t e s t h a t remove s h a r e d environmental effects s u c h a s secular t r e n d s a n d are strictly restricted to t h e e n v i r o n m e n t studied. Height, IQ, a s well a s t h e prevalence of a n u m b e r of psychological disorders (such a s delinquency a n d eating disorder) have increased markedly over t h e last century, u n d o u b t e d l y a s a c o n s e q u e n c e of environmental c h a n g e s , yet c u r r e n t behavioralgenetic m e t h o d s of estimating e n v i r o n m e n t a l effects preclude consideration of t h e s e . Empirically, we could point to s t u d i e s w h e r e environmental d e t e r m i n a n t s revealed s u b s t a n t i a l effects after genetic influences h a d b e e n excluded (Johnson, Cohen, Brown, Smailes, a n d Bernstein 1999). We could raise q u e s t i o n s a b o u t t h e a c t u a l — r a t h e r t h a n assumed—differential r e s p o n s i v e n e s s of caregivers to siblings. Evidence on j u s t how differently siblings a r e treated is actually quite mixed. In one o f t h e only behavioral-genetic s t u d ies to actually look a t t h e child's e n v i r o n m e n t r a t h e r t h a n simply infer it, Reiss, Plomin, Hetherington, a n d colleagues found direct evidence for t h e notion of t h e n o n s h a r e d e n v i r o n m e n t (Reiss et

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al. 2000). T h e difference between t h e degree of coerciveness of parenting between a pair of twins w a s m o r e predictive t h a n w a s the a b s o l u t e level of negativity (Reiss et al. 1995). However, J u d y D u n n ' s n a t u r a l i s t i c observational s t u d i e s of siblings actually suggest t h a t while cross-sectionally p a r e n t s m a y a p p e a r to be treating siblings differently, looked a t longitudinally children a t various ages receive c o m p a r a b l e t r e a t m e n t (Dunn a n d McGuire 1994). T h e obvious implication h e r e is for a more systemic approach. Regardless of t h e u l t i m a t e conclusion concerning t h e differing t r e a t m e n t of siblings, t h e fact t h a t s t u d i e s of social development have t e n d e d to look a t single children implied t h a t they have on the whole u n d e r e s t i m a t e d t h e i m p a c t of p a r e n t i n g a n d other shared environmental influences. As we shall see later on, t h e r e may be specific p r e s s u r e s in family s y s t e m s for different responses of siblings a s p a r t o f t h e n e e d for e a c h p e r s o n within t h e system to h a v e a u n i q u e role. Interestingly, t h e p r e s s u r e for difference m a y b e greater w h e n genetic differentiation is least. In a recent study, P a s c o F e a r o n a n d Peter Fonagy a t t e m p t e d to establish t h e role of genetic influence on p a t t e r n s of a t t a c h m e n t (Fonagy, Fearon, a n d Target 1999). The question concerning genetic influence w a s raised by t r a n s g e n e r a t i o n a l s t u d i e s of consistency in a t t a c h m e n t p a t t e r n s (mothers w h o s e a t t a c h m e n t was s e c u r e before t h e birth of t h e child t e n d e d to h a v e b a b i e s securely a t t a c h e d to t h e m o n e y e a r later—van IJzendoorn 1995). Is this a n o t h e r example of a genetic effect? In a s t u d y of identical and nonidentical twins, we found very little evidence for greater concordance of a t t a c h m e n t p a t t e r n s a m o n g monozygotic twins. However, we found t h a t t h e likelihood of concordance in a t t a c h ment p a t t e r n s w a s predicted by m o t h e r s ' a s s e s s m e n t of t h e t e m p e r a m e n t s of their twins. Briefly, t h e m o r e similar t h e mother r a t e d t h e two infants' t e m p e r a m e n t s , t h e more likely it was t h a t t h e twins' a t t a c h m e n t classifications were to be dissimilar. Conversely, t h e m o r e t h e m o t h e r differentiated between the t e m p e r a m e n t s of h e r twins, t h e m o r e likely t h e y would be congruent in t e r m s of their a t t a c h m e n t classification. In inter^ preting t h e s e r e s u l t s , we tentatively suggest t h a t if t h e m o t h e r fails to differentiate between h e r children consciously, s h e is

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m o r e likely to project u n c o n s c i o u s expectations o n t o o n e or other twin, forcing t h e m to be different in relation to her. Alternatively, being s e e n a s different a t some level m a y m e a n t h a t the twins do n o t feel t h a t they h a v e to find a place for themselves in t h e family system. If t h e m o t h e r is able to see their individuality, t h e n they c a n b e h a v e consistently with their predispositions. F u r t h e r m o r e , on occasion experimental m a n i p u l a t i o n s of the environment a s p a r t of t r e a t m e n t a n d prevention interventions have yielded relatively large effects. It is noteworthy t h a t neither of t h e two major a t t a c k s on t h e i m p o r t a n c e of family on socialization (J. R. Harris 1998; Rowe 1994) covers p a r e n t training. The average effect size of p a r e n t training for children with Oppositional Defiant Disorder is a r o u n d 1 (Serketich a n d D u m a s 1996), which m e a n s t h a t t h e average treated child is b e t t e r off at t h e e n d of t r e a t m e n t t h a n a t least 8 4 % of t h e controls. More relevant in t h i s context is t h e fact t h a t a c c u m u l a t i n g evidence s u p p o r t s t h e usefulness of experimental interventions with parents, s u c h a s h o m e visitation (e.g., Olds et al. 1998), with longt e r m beneficial effects in r e d u c i n g t h e risk of criminality a n d delinquency. Of course, t h e impact of e n v i r o n m e n t a l m a n i p u l a tion is often not a s large a s one would hope; moreover, long-term follow-ups in t r e a t m e n t s t u d i e s a r e relatively rare, a n d even quite impressive c h a n g e s initiated by experimental interventions dissipate (Fonagy, Target, Cottrell, Phillips, a n d Kurtz 2000). As clinicians, o u r m a i n objection to behavior-genetic d a t a would n o t be methodological, conceptual, or empirical but, r a t h e r , pragmatic. Genetic effects m a y well b e indirect a s well a s direct. Even a high genetic loading for a certain environmental h a z a r d does n o t m e a n t h a t t h e c o n s e q u e n c e s associated with t h a t risk factor would necessarily be genetically r a t h e r t h a n environmentally mediated. For example, if child a b u s e were found to have a large genetic component, its toxic effects would still be via t h e d e s t r u c t i o n of t r u s t in t h e world for t h e a b u s e d child r a t h e r t h a n via a purely genetic process. T h e implications of behavior-genetic d a t a for clinical intervention a r e t h u s quite limited. B u t t h e continuing t e n s i o n between perspectives based on genetics r e s e a r c h a n d environmental s t u d i e s s h o u l d n o t be played o u t on t h e battlefield of t h e a s s u m p t i o n s underlying the genetic model. The findings from behavior genetics a p p e a r quite

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robust, a n d t h e b u r d e n is o n environmentalists to integrate t h e genetic d a t a with their theories. W h a t follows is a very m o d e s t preliminary a t t e m p t a t t h e integration of selective genetics findings with environmentalist observations arising from t h e field u n d e r consideration in t h i s volume: t h e relationship of m e n t a l ization a n d early a t t a c h m e n t relationships.

SUBJECTIVITY AT T H E INTERFACE OF GENE AND ENVIRONMENT The Role of E x p e r i e n c e in t h e E x p r e s s i o n o f t h e G e n o t y p e It is universally acknowledged t h a t developmental psychopathology involves a g e n e - e n v i r o n m e n t interaction. In t h e case of honeybees, t h e reproductive a n d social roles of colony m e m b e r s are fixed by e v e n t s t h a t o c c u r d u r i n g t h e first few days of larval development. Worker or q u e e n bee s t a t u s is a p p a r e n t l y n o t encoded in t h e genotype b u t follows from t h e differential treatm e n t of larvae by w o r k e r bees, resulting in differential gene expression—both up-regulation a n d down-regulation (Evans a n d Wheeler 2000). S o m e quantitative h u m a n behavior-genetic s t u d ies also strongly suggest interactive p r o c e s s e s whereby environmental e x p o s u r e triggers genetic vulnerability. For example, t h e classic F i n n i s h adoptive-family s t u d y of schizophrenia s u g g e s t s t h a t children with a schizophrenic biological p a r e n t were m o r e likely to develop a r a n g e of psychiatric p r o b l e m s if, a n d only if, they were a d o p t e d into dysfunctional families (Tienari, Wynne, Moring, Lahti, a n d N a a r a l a 1994). B o h m a n (1996) reported t h a t criminality a p p e a r e d to b e associated with a genetic risk only if children w h o s e biological p a r e n t s were criminals were adopted into dysfunctional h o m e s . So genetic risk m a y or m a y n o t become manifest, d e p e n d i n g on t h e quality of t h e family environm e n t to which a child is exposed. B u t if t h i s is s u c h a pervasive process, t h e n w h y is t h e quantitative behavior-genetic evidence for g e n e - e n v i r o n m e n t interaction so s p a r s e ? Empirically, t h i s

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interaction t e r m h a s proved to be quite h a r d to find. Plomin's (Plomin, DeFries, McLearn, a n d Rutter 1997) s y s t e m a t i c review of t h e literature, now admittedly s o m e w h a t dated, found evidence only for relatively isolated examples. We suggest t h a t t h e a n s w e r lies in t h e fact t h a t behavior genetics sometimes s t u d i e s t h e "wrong" environment, b e c a u s e the environment t h a t triggers t h e expression of a gene is n o t objective. Gene expression is n o t triggered by t h e observable, objective environment. The child's experience ofthe environment is w h a t c o u n t s . T h e m a n n e r in w h i c h e n v i r o n m e n t is experienced will a c t a s a filter in t h e expression of genotype into phenotype. And h e r e we t o u c h on t h e pivotal i m p o r t a n c e of psychoanalysis a n d a t t a c h m e n t theory, t h e p r i m a r y concern of which is with t h e interaction of multiple layers of representations in generating developmental o u t c o m e s . D a t a from genetics call for exactly s u c h sophistication in u n d e r s t a n d i n g t h e way genes m a y or m a y n o t be expressed in p a r t i c u l a r individuals. T h e p a t h w a y between genes a n d p h e n o t y p e s is a t o r t u o u s one, with genetics a n d e n v i r o n m e n t constantly interacting (Elman et al. 1996). At t h e molecular level, evidence suggests t h a t positive a n d negative e n v i r o n m e n t s m a y alter gene expression—that is, t h e rate a t w h i c h genes are t r a n s c r i b e d into RNA a n d s u b s e q u e n t protein s y n t h e s i s t h a t can, a t least in principle, influence t h e s t r u c t u r e a n d functioning of t h e h u m a n brain. Internal a n d external stimuli, s t e p s in t h e development of the brain, h o r m o n e s , stress, learning, a n d social interaction all alter the binding of t r a n s c r i p t i o n regulators (Kandel 1998). Of particular interest are a n i m a l s t u d i e s t h a t suggest t h a t various forms of learning in a n i m a l s reflect a p r o c e s s w h e r e b y environmental stimuli—such a s songs a n d calls from, one bird to a n o t h e r — m a y activate t h e t r a n s c r i p t i o n of RNA from d o r m a n t genes, leading to new proteins being synthesized a n d c h a n g e s of synaptic struct u r e a n d function (Chew, Vicario, a n d Nottebohm 1996; Nguyen, Abel, a n d Kandel 1994). The very p r o c e s s of learning m a y be genetically controlled. Environmental stimuli involved in the conditioning of gill reflexes in Aplysia a c t to t u r n off memory s u p p r e s s o r genes (Abel a n d Kandel 1998). P e r h a p s m o r e relevant to u s from a n a t t a c h m e n t s t a n d p o i n t a r e t h e classic s t u d i e s of r a t p u p s s e p a r a t e d from their m o t h e r in t h e first two weeks of

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life, who a p p e a r to i n c u r a p e r m a n e n t increase in t h e expression of genes controlling t h e secretion of CRF (corticotrophm-releasing factor) (Plotsky a n d Meaney 1993). While t h e m a t e r n a l l y deprived r a t p u p s m a y acquire a life-long vulnerability to s t r e s s t h r o u g h t h i s p e r m a n e n t i n c r e a s e in gene expression, d a m s w h o showed increased care of their p u p s by licking a n d grooming t h e m d u r i n g n u r s i n g seemed to provide t h e m with a life-long protection from s t r e s s . This latter p r o c e s s a p p e a r e d to be mediated t h r o u g h t h e e n h a n c e d expression of genes regulating glucocorticoid receptors a n d t h e c o n s e q u e n t s u p p r e s s i o n of genes regulating CRF s y n t h e s i s (Liu et al. 1997). There is s u b s t a n t i a l individual variability in r e s p o n s e to stress a n d adversity. M u c h of t h i s variability is poorly u n d e r stood (Rutter 1999), b u t it u n d e r s c o r e s t h e potential i m p o r t a n c e of intrapsychic variables. W h e t h e r or n o t specific environmental factors trigger t h e expression of a gene m a y depend n o t only on the n a t u r e of t h o s e factors, b u t also on t h e way t h e infant or child experiences t h e m , w h i c h will be a n intrapsychic function t h a t is d e t e r m i n e d by c o n s c i o u s or u n c o n s c i o u s m e a n i n g attribution to t h e s e experiences. T h e quality of t h e experiential filter t h a t a t t a c h m e n t provides may, in t u r n , be a function of either genetic or environmental influences, or their interaction (Kandel 1998). T h u s i n t r a p s y c h i c r e p r e s e n t a t i o n a l p r o c e s s e s are n o t j u s t the c o n s e q u e n c e s of environmental a n d genetic effects—they may be critical m o d e r a t o r s of t h e s e effects. This h a s s u b s t a n t i a l clinical significance, since t h e u n d e r standing of a n e n v i r o n m e n t by t h e child is m o r e readily modifiable t h a n are t h e e n v i r o n m e n t itself or t h e genes with which t h e environment i n t e r a c t s (Emde 1988). An a t t a c h m e n t - t h e o r y intrapsychic perspective m a y be helpful in considering n o t j u s t what precipitates personality a n d its disorders, b u t also w h i c h processes influence t h e c o u r s e of t h e disorder for better or worse. Until t h e l a s t five y e a r s this w a s theory, b u t now t h e collaboration of molecular geneticists a n d a t t a c h m e n t theory is making it a reality. We will offer t h r e e examples of t h i s powerful paradigm. There is excellent evidence from R h e s u s m o n k e y s (Suomi 2000) t h a t individuals w h o carry t h e "short" allele of t h e 5-HTT gene a r e significantly m o r e severely affected by m a t e r n a l depri-

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vation t h a n are individuals with t h e "long" allele (Bennett et al., 2002). Actually t h e full story is s o m e w h a t m o r e complicated. The work of Suomi's laboratory over t h e l a s t d e c a d e d e m o n s t r a t e d t h a t peer-reared (maternally deprived) infants grow u p to be socially a n x i o u s in n a t u r e , to h a v e a reactive t e m p e r a m e n t (a tendency to become emotionally a r o u s e d , aggressive, impulsive, a n d fearful), a n d to drop to t h e b o t t o m of d o m i n a n c e hierarchies (Higley, King, e t al. 1996; S u o m i 1997). If their early a t t a c h m e n t experiences a r e poor, t h e n their n e u r o - e n d o c r i n e functioning will become highly a b n o r m a l ; they will h a v e lower CSF (cerebrospinal fluid) c o n c e n t r a t i o n s of 5-HIAA (Higley, Supmi, a n d Linnoila 1996), indicating d e c r e a s e d serotonergic functioning. They will also c o n s u m e larger a m o u n t s of alcohol (Higley, Hasert, Suomi, a n d Linnoila 1991) a n d will develop tolerance to it faster, in line with their serotonin t u r n o v e r r a t e s (Higley et al. in press), which, in t u r n , is associated with serotonin t r a n s porter availability (Heinz et al. 1998). The 5-HTT is t h e serotonin t r a n s p o r t e r gene t h a t h a s b e e n implicated' in impaired serotonergic function (Lesch et al. 1996) for t h e s h o r t allele of the gene (Heils et al. 1996). ! In t h e S u o m i r h e s u s - m o n k e y colony, 5-HIAA CSF concentration w a s lower in m o n k e y s with t h e s h o r t allele of 5-HTT—^-but only for peer-reared monkeys. For motherreared subjects, 5-HIAA c o n c e n t r a t i o n s were identical for m o n keys with either allele (Bennett et al. 2002). T h e experience of a n i n a d e q u a t e early environment triggered t h e expression of t h e 5HTT gene. T h e reversibility of genetic vulnerability w a s indicated in s t u d i e s where t h e foster-mothering of specially b r e d high-reactive m o n k e y infants w a s experimentally m a n i p u l a t e d . Reactive infants assigned to n u r t u r a n t foster-mothers a p p e a r e d to be 'The literature reveals four studies that found an association between the short allele and harm avoidance and/or high anxiety measures (Greenberg et al. 2000; Katsuragl et al. 1999; Osher, Hamer, and Benjamin 2000; Ricketts et al. 1998). Two further studies showed mixed findings (Gelernter, Kranzler, Coccaro, Siever, and New 1998; Rosenthal et al. 1998). Nine studies, however, found no association (Ball et al. 1997; Deary et al. 1999; Ebstein et al. 1997; Flory et al. 1999; Gustavsson et al. 1999; Hamilton et al. 1999; Herbst, Zonderman, McCrae, and Costa 2000; Jorm et al. 2000; Kumakiri et al. 1999). Thus, as in many instances in this complex new area, the real significance of the short allele of 5-HTT is not known.

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behaviorally precocious a n d u n u s u a l l y secure. W h e n moved into a larger social group, t h e y were particularly a d e p t a t recruiting and retaining o t h e r g r o u p m e m b e r s a s allies, a n d t h e y rose to and m a i n t a i n e d high positions in t h e d o m i n a n c e h i e r a r c h y (Suomi 1991). T h e m a t e r n a l style of high-reactive females raised by n u r t u r a n t m o t h e r s reflected t h e style of their n u r t u r a n t fost e r - m o t h e r s r a t h e r t h a n their own t e m p e r a m e n t . T h u s t h e b e n efits of n u r t u r a n t foster-mothering c a n evidently be t r a n s m i t t e d to t h e next generation, even t h o u g h t h e m o d e of t r a n s m i s s i o n is nongenetic in n a t u r e (Suomi a n d Levine 1998). Calm m o t h e r i n g of these genetically vulnerable individuals n o t only will reduce the risk associated with t h i s genotype, b u t t h e r e is some evidence t h a t if t h e y receive particularly sensitive caregiving, t h e s e individuals will develop special capacities of resilience. A further e x a m p l e of t h e s a m e kind of g e n e - e n v i r o n m e n t interaction c o m e s from o u r collaborative s t u d i e s a t t h e Menninger Clinic (Fonagy, Stein, a n d White 2001). We h a v e focused on the alleles o f t h e second d o p a m i n e receptor (DRD2). T h e A l or A1A2 allele exists in only a minority of n o r m a l subjects (usually no more t h a n 20%). Its prevalence h a s b e e n s h o w n to be elevated in a n u m b e r of clinical g r o u p s , particularly t h o s e with p r o b l e m s of alcoholism (Blum et al. 1990; Gelernter, Goldman, a n d Risch 1993), gambling (Comings, M u h l e m a n , a n d Gysin 1996), s u b stance m i s u s e (Uhl, Blum, Noble, a n d S m i t h 1993), a n d eating disorders (Comings 1997). A c c o u n t s of t h e s e findings mostly invoke t h e observations of r e d u c e d n u m b e r s of D2 receptors. We have b e e n able to replicate t h e s e r e s u l t s in a t r a u m a t i z e d borderline-personality-disordered s a m p l e a t t h e Menninger Clinic, m a n y of w h o m n a t u r a l l y h a v e d e p e n d e n c y a n d other similar problems. As p a r t of a s t u d y o n t h e effect of early t r a u m a , we a r e collecting retrospective information on childhood t r a u m a u s i n g Toni Bifulco's Childhood Experience of Care a n d A b u s e I n s t r u ment (Bifulco, Brown, a n d Harris 1987). Concurrently, childhood data were collected on a s u b s t a n t i a l s u b g r o u p of t h e individuals assessed, a s t h e s e individuals a t t e n d e d t h e Menninger t h e r a p e u tic preschool. A very preliminary analysis of a relatively s m a l t s a m p l e [n = 78) suggests t h a t t h e A l allele m a y b e a biological m a r k e r for t h e effect of certain t y p e s of t r a u m a . Based on largely retrospective

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information, we found t h a t t h e i m p a c t of t r a u m a o n a d u l t personality functioning a s m e a s u r e d by J o n a t h a n Hill a n d colleagues' APFA m e a s u r e (Hill, Harrington, Fudge, Rutter, a n d Pickles 1989) w a s restricted to t h e s u b g r o u p w h o h a d t h e A l allele. However, t h e effect a p p e a r e d to be limited to certain k i n d s of interpersonal t r a u m a , namely physical a n d sexual a b u s e . This is a very preliminary analysis on quite a small sample, so t h e s e findings might very well n o t hold. It is introduced h e r e merely to illustrate a specific type of g e n e - e n v i r o n m e n t interaction. It is, however, consistent with t h e mixed evidence t h a t sometimes (but n o t invariably) links DRD2*A1 with susceptibility to t r a u m a (Comings et al. 1991, 1999). T h e implication is t h a t early t r a u m a activates t h e gene, which, t h r o u g h r e d u c i n g t h e capacity for interpersonal adaptation, m a k e s t h e individual vulnerable to later t r a u m a t a . We have some evidence c o n s i s t e n t with this hypothesis. As p a r t of o u r b a t t e r y we u s e d Simon B a r o n - C o h e n ' s "reading t h e m i n d in t h e eyes" t e s t (Baron-Cohen 2000). We found t h a t subjects with t r a u m a t i c experiences were less sensitive on t h i s test. F u r t h e r m o r e , w h e n we controlled for mentalization u s i n g t h e eyes t e s t score a s a covariate, t h e previously observed g e n e - e n v i r o n m e n t interaction d i s a p p e a r e d . This implies t h a t sensitivity to m e n t a l s t a t e s m a y indeed h a v e b e e n the mediator of t h e selective effect of t r a u m a . Those with t h e A l allele, either a s a c o n s e q u e n c e of t r a u m a or associated with a genetic predisposition, h a d less interpersonal sensitivity a n d showed greater t r a u m a - r e l a t e d i m p a i r m e n t in social functioning. T h e A l allele is probably a m a r k e r for low d o p a m i n e t r a n s porter binding, w h i c h predicts, a m o n g o t h e r things, a detached personality in h e a l t h y subjects (Laakso et al. 2000), vulnerability to relapse in alcoholics (Guardia et al. 2000), a n d social phobia (Schneier et al. 2000). It is a t least possible to a r g u e t h a t t h e D2 alleles provide a m a r k e r for a certain k i n d of interpersonal vulnerability. In o u r sample, t h e A l allele was, in t h e a b s e n c e of t r a u m a , coupled with significant elevation of personality dysfunction, b u t dysfunction associated with t r a u m a w a s evident in t h e p r e s e n c e of t r a u m a . It is either t r a u m a t h a t leads to the expression of t h e gene t h a t generates pathology, p e r h a p s via the reduction of D2 receptors, or else t h e other alleles m a r k a n individual's capacity to metabolize early t r a u m a t i c experience

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adequately a n d avoid t h e diverse forms of sequelae t h a t m i g h t be expected to follow early t r a u m a t i z a t i o n . It should be e m p h a s i z e d t h a t t h e s e d a t a come from t h e analysis of pilot d a t a from a n ongoing study; t h e u l t i m a t e r e s u l t s might n o t s u p p o r t t h e s e provisional conclusions. Finally, a n i m p o r t a n t r e s u l t h a s recently b e e n published from the B u d a p e s t I n f a n t - P a r e n t S t u d y (Lakatos et al. 2000). T h e s e workers found a n association between t h e DRD4 receptor III exon p o l y m o r p h i s m a n d disorganized a t t a c h m e n t classification in 12-month-old infants. Over t h e years, considerable evidence h a s linked behavioral p r o b l e m s in b o t h children a n d a d u l t s with the 7-repeat allele of t h e DRD4 gene. In particular, ADHD h a s been implicated (Faraone et al. 1999; LaHoste et al. 1996; Rowe et al. 1998; Smalley et al. 1998; S w a n s o n et al. 1998), a l t h o u g h not all s t u d i e s c o n c u r (Castellanos et al. 1998). T h e review by S w a n s o n a n d colleagues (Swanson et al. 2000) confirmed t h e likely role of t h e 7-repeat allele of t h i s gene in m a k i n g t h e postsynaptic receptor subsensitive, t h u s possibly r e d u c i n g t h e efficiency of n e u r a l circuits for behavior inhibition. Comings et al. (1999) report findings related to impulsive, compulsive, addictive behaviors t h a t indicate a greater complexity t h a n does a sole focus on t h e 7- v e r s u s n o n - 7 alleles o f t h e DRD4 gene. In view of recent findings, w h i c h h a v e linked disorganized a t t a c h m e n t in infancy to clinical conditions in middle childhood, it m a y be particularly i m p o r t a n t t h a t in t h i s s t u d y 71% of t h e infants classified a s disorganized were found to h a v e a t least one 7repeat allele, in c o n t r a s t with only 29% of t h e nondisorganized group. T h u s infants classified a s disorganized were more t h a n four times m o r e likely to be carrying t h i s allele. This finding is c o n s i s t e n t with observations t h a t neurological (Pipp-Siegel, Siegel, a n d D e a n 1999) a n d n e o n a t a l (Spangler, Fremmer-Bombik, a n d G r o s s m a n n 1996) behavioral organization m a y anticipate a disorganized a t t a c h m e n t classification. It might a t first sight seem a t odds, however, with t h e classical observation t h a t disorganized infant a t t a c h m e n t w a s linked to unresolved loss or t r a u m a in t h e m o t h e r (Lyons-Ruth a n d Jacobovitz 1999; Main a n d Hesse 1990). A r e c e n t prospective study led by Pat H u g h e s confirmed t h a t m o t h e r s with a history of perinatal b e r e a v e m e n t were far more likely to h a v e disorgan-

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ized infants t h a n were controls. W h e r e a s a l m o s t 4 5 % of t h e m o t h e r s who h a d lost their last b a b y d u r i n g p r e g n a n c y h a d infants classified a s disorganized a t 1 year, only 2 0 % of t h e control m o t h e r s m a t c h e d for age, S E S (socioeconomic status); a n d education did so. Adult a t t a c h m e n t interviews collected before t h e birth of t h e child picked u p t h e risk for disorganization. Lack of resolution of m o u r n i n g m e d i a t e s t h e association of stillbirth experience a n d disorganization of t h e "replacement infant" in t h e S t r a n g e Situation. B u t only 62% of t h e m o t h e r s with unresolved AAI classification h a d infants classified a s disorganized, a l t h o u g h specificity w a s relatively high (over 80% of disorganized infants h a d u n r e solved mothers). It s e e m s t h a t lack of resolution of m o u r n i n g m a y be a n e c e s s a r y b u t n o t a sufficient condition for disorganization. Since only a third of t h e children in t h e B u d a p e s t s t u d y with t h e 7-repeat allele showed disorganized a t t a c h m e n t , checking for t h e p r e s e n c e of t h e 7-repeat allele might, of course, explain t h e discrepancy. It is possible t h a t t h e a b n o r m a l i t i e s in i n f a n t - m o t h e r interaction; a s s u m e d to be associated with lack of resolution of bereavement, m a y i m p a c t m o r e on individuals whose mesolimbic d o p a m i n e s y s t e m is functioning less efficiently, for w h i c h t h e 7-repeat allele of t h e D4 receptor m a y be a m a r k e r . T h e mesolimbic d o p a m i n e s y s t e m h a s b e e n proposed to control behavior motivated by reward (Robbins a n d Everitt 1999), a n d less sensitive D4 d o p a m i n e receptors (Van Tol et al. 1992) could further distort t h e signal value of t h e m o t h e r ' s response. The review by S w a n s o n a n d colleagues (Swanson et al. 2000) s u g g e s t s t h a t d o p a m i n e underactivity c o m p r o m i s e s attentional systems, w h i c h might exaggerate t h e i m p a c t of s u b t l e a n o m a l i e s o f t h e m o t h e r ' s behavior in relation to h e r infant (e.g., m o m e n t a r y dissociation, frightened or frightening behavior, etc.—see Solomon a n d George 1999). This is clearly speculative, b u t it is a readily testable h y p o t h e s i s t h a t is in line with t h e general interactional model t h a t we propose. To s u m m a r i z e , we h a v e identified t h r e e i n s t a n c e s w h e r e d a t a from molecular biology might be illuminated by s t u d y of t h e early family environment, particularly p a r e n t i n g a n d a t t a c h m e n t . In one case, lack-of a d e q u a t e p a r e n t i n g w a s clearly linked to t h e p e n e t r a t i o n of o n e of t h e alleles of t h e 5-HTT gene, c a u s -

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ing dysfunction in serotonergic activity. In t h e second case, t h o s e w h o s e experience 1 included psychological (and physical) a b u s e a n d t h e A l allele of t h e D2 gene showed t h e g r e a t e s t personality dysfunction. In t h e third case, a p o s t t r a u m a t i c s t a t e in t h e m o t h e r m i g h t possibly interact with a n o t h e r d o p a m i n e receptor, c a u s i n g dysfunctional a t t a c h m e n t organization a n d s u b s e q u e n t psychological d i s t u r b a n c e . All t h e s e findings a r e r a t h e r t e n u o u s a t t h e m o m e n t , b u t all t h r e e are consistent with t h e h y p o t h e s i s t h a t early experience with t h e object is formative, even for genetically determined predisposition t h r o u g h t h e triggering of gene expression. T a k e n together, t h e y suggest quite a fruitful line of investigation, which, given t h e relative facility with w h i c h s a m p l e s c a n b e collected a n d analyzed, might become a n i m p o r t a n t a d j u n c t to m o s t of o u r work in developmental psychopathology.

The G e n e s i s of an Appraisal M e c h a n i s m So far, we h a v e a r g u e d t h a t t h e i m p o r t a n c e of family environm e n t m a y h a v e b e e n u n d e r e s t i m a t e d in behavioral genetics research, for methodological a n d c o n c e p t u a l a s well a s empirical r e a s o n s . We h a v e also tried to c o n s t r u c t a primafacie case for a r e p r e s e n t a t i o n a l s y s t e m t h a t forms a n active filter between t h e genotype a n d t h e p h e n o t y p e . In o t h e r words, t h e m e n t a l processing of experience is critical for t h e expression of genetic material, a n d t h e r e i n lie s u b s t a n t i a l interactions between gene a n d environment. We will n o w a r g u e t h a t t h e genesis of t h e representational s y s t e m t h a t forms a n active filter between t h e genotype a n d t h e p h e n o t y p e is intrinsically linked to t h e quality of early object relationships. P e r h a p s m o r e t h a n s h a p i n g t h e quality of s u b s e q u e n t relationships (for w h i c h evidence is lacking), t h e early relationship e n v i r o n m e n t serves to equip t h e individual with a processing system. T h e creation of this representational s y s t e m is a r g u a b l y t h e m o s t i m p o r t a n t evolutionary function for a t t a c h m e n t to a caregiver. Adopting t h i s perspective helps to r e d r e s s t h e prevailing b i a s a g a i n s t t h e centrality of t h e family a s t h e major force in socialization, b u t it also shifts t h e e m p h a s i s from c o n t e n t of experience to psychological s t r u c t u r e

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or m e n t a l m e c h a n i s m a n d involves e x p a n d i n g on c u r r e n t ideas of t h e evolutionary function of a t t a c h m e n t . J o h n Bowlby, a major Darwin scholar (Bowlby 1991), w a s impressed by t h e obvious selection a d v a n t a g e s of infant protest a t separation—that is, protection from predation (Bowlby 1969). Given t h a t phylogenetically a n d ontogenetically infancy is a period of extreme risk, it is u n a r g u a b l e t h a t n a t u r a l selection would favor individuals with a capacity for a t t a c h m e n t . There h a s b e e n a revolution in evolutionary theory since Bowlby's time. We now realize t h a t "survival of t h e fittest" c a n n o t g u a r a n t e e t h e n a t u r a l selection of a behavior. Only t h e reproduction of genetic material c a n achieve t h i s (W. D. Hamilton 1964). This is t h e theory of inclusive fitness. One does n o t need to survive a n d r e p r o d u c e oneself in order for one's g e n e s to be replicated. For example, some o r g a n i s m s will forgo r e p r o d u c t i o n in order to e n s u r e t h e reproductive potential of their genetically close relatives. The concept of "inclusive fitness" places a t t a c h m e n t theory a t t h e center stage of evolutionary sociobiology a s a key behavioral m e c h a n i s m mediating t h e e s t a b l i s h m e n t of genetic proximity, for a t t a c h m e n t is t h e p r o c e s s t h a t e n s u r e s t h a t we k n o w whose survival will a d v a n t a g e t h e reproduction of o u r genes. Of course, it m a y have additional evolutionary functions. F r e u d ' s (1900a) principle of multiple d e t e r m i n a t i o n w o r k s in evolutionary theory j u s t a s m u c h a s in d r e a m Interpretation a n d s y m p t o m generation. It is possible t h a t a t t a c h m e n t m a r k s individuals with w h o m we should not m a t e b e c a u s e of t h e biological r i s k s associated with interbreeding a n d incest. Adult a t t a c h m e n t m a y also be a m a r k e r for reciprocal altruism. Altruism a n d cooperatlveness (Axelrod 1984; Trivers 1971)—the "quid-pro-quo" strategy of helping n o n - k i n if, a n d only if, they h a v e d o n e s o m e t h i n g for one—might also be u n d e r p i n n e d by t h e m e c h a n i s m of attachm e n t . A t t a c h m e n t is likely to minimize t h e adverse effects of "cheaters"—individuals w h o do n o t reciprocate equitably in g r o u p s over time a n d to w h o m we are unlikely to b e c o m e attached. This would be a good example of a further interesting facet of evolution: how a m e c h a n i s m t h a t evolved for one p u r p o s e (the protection of t h e vulnerable infant) m a y be p u t to good biological u s e in t h e context of t h e adaptive p r o b l e m s of s u b s e q u e n t developmental p h a s e s . B u t all t h e s e potential biological

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functions would apply a s readily to a n i m a l models of a t t a c h m e n t a s to t h e h u m a n infant. If t h e biological function of a t t a c h m e n t is to be a pillar in o u r a r g u m e n t for t h e i m p o r t a n c e of parenting, w e need to restrict ourselves to uniquely h u m a n capacities. The generally recognized c o m p o n e n t s of a t t a c h m e n t behaviors t h a t serve to e s t a b l i s h a n d m a i n t a i n proximity are: {a) signals t h a t d r a w t h e caregivers to their children (such a s smiling), (b) aversive behaviors (such a s crying), w h i c h perform t h e s a m e function, a n d (c) skeletal-muscle activity (primarily locomotion), w h i c h brings t h e child to t h e caregiver. B u t t h e r e is a fourth c o m p o n e n t t h a t provides a better evolutionary rationale for t h e entire enterprise of h u m a n a t t a c h m e n t , going beyond t h e issue of physical protection: (d) according to Bowlby, a t a b o u t the age of 3 y e a r s behaviors signifying a goal-corrected p a r t n e r ship begin to emerge. T h e central psychological p r o c e s s e s for mediating goal-corrected p a r t n e r s h i p s a r e t h e internal working models. Bowlby's original concept h a s b e e n thoughtfully elaborated by some of t h e g r e a t e s t m i n d s in t h e a t t a c h m e n t field (Bretherton 1991b; B r e t h e r t o n a n d M u n h o l l a n d 1999; Crittenden 1990. 1994; M. Main 1991; Main et al. 1985; Sroufe 1990, 1996), a n d no a t t e m p t to duplicate t h i s will be u n d e r t a k e n here. However, it might be helpful to s u m m a r i z e t h e four representational s y s t e m s t h a t a r e implied in t h e s e reformulations: (a) expectations of interactive a t t r i b u t e s of early caregivers created in t h e first year of life a n d s u b s e q u e n t l y elaborated, (b) event r e p r e s e n t a t i o n s by which general a n d specific memories of a t t a c h m e n t - r e l a t e d experiences are encoded a n d retrieved, (c) autobiographical memories by w h i c h specific events are conceptually connected b e c a u s e of their relation to a c o n t i n u i n g p e r s o n a l narrative a n d developing self-understanding, a n d (d) u n d e r s t a n d i n g of t h e psychological characteristics of other people (inferring a n d attributing causal motivational m i n d s t a t e s s u c h a s desires a n d emotions and epistemic m i n d s t a t e s s u c h a s i n t e n t i o n s a n d beliefs) and differentiating these from those ofthe self. T h u s a key developmental a t t a i n m e n t of t h e i n t e r n a l working model is t h e creation of a processing s y s t e m for t h e self (and significant others) in terms of a set of s t a b l e a n d generalized intentional a t t r i b u t e s , s u c h a s desires, emotions, intentions, a n d beliefs inferred from

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recurring invariant p a t t e r n s in t h e history of previous interactions. The child comes to be able to u s e t h i s r e p r e s e n t a t i o n a l system to predict t h e other's or t h e self s behavior in conjunction with local, m o r e t r a n s i e n t intentional s t a t e s inferred from a given situation. Classically, in a t t a c h m e n t theory this p h a s e c h a n g e from behavior to r e p r e s e n t a t i o n is generally regarded a s a modification of t h e a t t a c h m e n t s y s t e m propelled by cognitive developm e n t (Marvin a n d Britner 1999). O u r contention h e r e is the reverse: r a t h e r t h a n seeing t h e biological role of a t t a c h m e n t shifting ontogenetically a s a c o n s e q u e n c e of other, biologically driven m a t u r a t i o n a l changes, we propose t h a t a major selective advantage conferred by a t t a c h m e n t to h u m a n s w a s t h e opport u n i t y it afforded for t h e development of social intelligence a n d m e a n i n g - m a k i n g . The capacity for "interpretation," which Bogdan defined a s "organisms m a k i n g s e n s e of e a c h other in contexts where t h i s m a t t e r s biologically" (1997, p. 10), b e c o m e s uniquely h u m a n w h e n o t h e r s a r e engaged "psychologically in s h a r i n g experiences, information a n d affects" (p. 94). T h e capacity to interpret h u m a n behavior—to m a k e s e n s e of e a c h other— requires t h e intentional s t a n c e : "treating t h e object w h o s e behavior you w a n t to predict a s a rational agent with beliefs a n d desires" (Dennett 1987, p. 15). T h e capacity for interpretation in psychological terms—let u s call t h i s t h e "Interpersonal Interpretive Mechanism," or IIM—is n o t j u s t a generator or mediator of a t t a c h m e n t experience; it is also a p r o d u c t of t h e complex psychological p r o c e s s e s engendered by close proximity in infancy to a n o t h e r h u m a n being—the primary object or a t t a c h m e n t figure. It is n o t Bowlby's TWM; it is j u s t a p a r t of t h e IWM (Bowlby, 1980) a n d p e r h a p s Kernberg's self-object-affect triad (1983). It does n o t c o n t a i n representations of experiences a n d is n o t a repository of p e r s o n a l encounters with t h e caregiver. Rather, it is a m e c h a n i s m for processing new experiences, m o r e like Bion's (1962a) a l p h a function. The IIM is closely related to t h e notion of a "theory of mind"—the ability to a t t r i b u t e i n d e p e n d e n t m e n t a l s t a t e s to o t h e r s in order to explain a n d predict their behavior (Leslie 1987). Earlier in this volume, we introduced t h e concept of reflective function a n d mentalization (chapter 1) to b r o a d e n t h e r a t h e r n a r r o w scope a

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a n d operationalization of t h e theory-of-mind c o n s t r u c t . We see the IIM a s a n overarching hypothetical n e u r a l s t r u c t u r e , a processing s y s t e m for social information t h a t underlies reflective function or mentalization b u t m a y h a v e m a n y functions beyond these. In t h e p r e s e n t c h a p t e r , we u s e IIM a s t h e a s s u m e d n e u r a l m e c h a n i s m t h a t i n t e r a c t s with t h e genotype to e n h a n c e or red u c e t h e likelihood of genetic expression. In later c h a p t e r s , we restrict ourselves a l m o s t entirely to psychological observations a n d m a r k t h i s by u s i n g t h e t e r m s "mentalization" or "reflective function"—the latter w h e n referring to mentalization a s it is operationalized in o u r work. We a s s u m e t h a t t h e quality of functioning of t h e IIM is reflected in t h e quality of mentalization. In c h a p t e r 4 we outline how t h e development of t h e IIM is facilitated by sensitive a n d a t t u n e d early care, a n d c h a p t e r 5 gives a c o m p r e h e n s i v e a c c o u n t of t h e ontogenesis of mentalization a s it relates to t h e formation of t h e self. The IIM m a y b e a final step in t h e t r a n s c r i p t i o n of genetic influence into a p a t t e r n of behavior, in a way a n a l o g o u s to RNA. The interpretive m e c h a n i s m encodes genetic information in t h e form of biases, b u t , we would s u s p e c t , of a very specific a n d situational c h a r a c t e r . Interpreting social behavior in one context may correlate poorly with u n d e r s t a n d i n g of a n o t h e r . For example, from t h e work of Mary Target with Arietta Slade a n d h e r colleagues on t h e PDI (Parents Development Interview—Slade, Bernbach, Grienenberger, Wohlgemuth-Levy, a n d Locker, u n published m a n u s c r i p t ) , we a r e finding t h a t p a r e n t a l reflective function is specific to e a c h p a r e n t - c h i l d relationship. In o u r twin study, p a r e n t s ' r e p r e s e n t a t i o n of e a c h twin w a s independently predictive of S t r a n g e Situation observation. The IIM, or a m e c h a nism like it, is responsible for t h e m o d e r a t i o n of genetic influence by modifying t h e child's perception of h i s social environment. T h u s given a genetic predisposition for antisocial behavior, for example, positive behaviors in t h e family c a n protect t h e child from becoming antisocial (Reiss et al. 2000), b e c a u s e s u c h positive behaviors e n h a n c e t h e functioning of t h e interpersonal interpretive m e c h a n i s m in t h a t child, which, in t u r n , h e l p s in generating less malevolent interpersonal attributions. Of course, s u c h w a r m t h may, in t u r n , be t h e c o n s e q u e n c e of inherited characteristics in t h e child, s u c h a s physical attractiveness, easy

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t e m p e r a m e n t , a n d so on. O u r proposal for e n v i r o n m e n t a l influence does n o t entail a r e t u r n to naive e n v i r o n m e n t a l i s m .

T h e O n t o g e n e s i s o f t h e IIM How is t h e IIM created o u t of t h e s e c u r e b a s e ? Clearly there m u s t b e biological p r e p a r e d n e s s , b u t in o u r view t h i s is n o t separable from, t h e infant's experience o f t h e caregiving environm e n t . In a n s w e r i n g t h i s question we are drawing on George Gergely a n d J o h n W a t s o n ' s model (Gergely a n d W a t s o n 1996, 1999). A core proposition in this book is t h e rejection of t h e notion t h a t t h e c o n s c i o u s a p p r e h e n s i o n of o u r m i n d s t a t e s through, introspection m i g h t be a basic, direct, a n d probably prewired ability of o u r mind. We do n o t believe t h a t knowledge of t h e self a s a m e n t a l agent is innately given. Rather, we see it a s a developing or c o n s t r u c t e d capacity t h a t evolves o u t of t h e earliest relationships. In c h a p t e r 4 t h e developmental roots of o u r model of t h e a p p r e h e n s i o n of emotional s t a t e s is described in full, a n d in c h a p t e r 5 some of t h e p r o b l e m s of t h e nativist intersubjective position are critically considered. In t h e c u r r e n t chapter, we anticipate t h e s e a r g u m e n t s with a brief outline of t h e ontogenetic model a n d focus on t h e b r o a d e r implications of t h e a s s u m p t i o n of a n interpersonal interpretive processing syst e m t h a t m o d e r a t e s genetic influences on personality. O u r core idea is t h a t t h e a t t a c h m e n t context provides t h e setting in w h i c h t h e infant c a n develop a sensitivity to self-states, t h r o u g h w h a t Gergely h a s termed "psycho-feedback" or social biofeedback—a m e c h a n i s m t h a t is fully described in c h a p t e r 4. The child acquires t h i s capacity for sensitivity by developing a second-order symbolic r e p r e s e n t a t i o n a l s y s t e m for motivational a n d epistemic m i n d states. W h a t initiates t h e development of t h i s r e p r e s e n t a t i o n a l s y s t e m is t h e internalization of t h e mother's mirroring r e s p o n s e of t h e infant's d i s t r e s s (caregiving behavior), w h i c h c o m e s to r e p r e s e n t a n i n t e r n a l state. T h e mother's e m p a t h i c emotion provides t h e infant with feedback on his emotional state. T h e infant internalizes t h e m o t h e r ' s e m p a t h i c expression by developing a s e c o n d a r y r e p r e s e n t a t i o n of h i s emotional state, with t h e m o t h e r ' s e m p a t h i c face a s t h e signifler a n d

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h i s own emotional a r o u s a l a s t h e signified. T h e m o t h e r ' s expression t e m p e r s emotion to t h e extent t h a t it is s e p a r a t e a n d different from t h e p r i m a r y experience, a l t h o u g h crucially it is recognized n o t a s t h e m o t h e r ' s experience, b u t a s a n organizer of a self-state. It is t h i s "intersubjectivity" t h a t is t h e bedrock o f t h e intimate connection between a t t a c h m e n t a n d self-regulation. As s h o w n in c h a p t e r 5. however, intersubjectivity in t h i s context m a y be a m i s n o m e r . At t h i s stage t h e infant is u n a w a r e t h a t he is seeing t h e other's subjective state. It is likely t h a t t h e infant does n o t yet k n o w t h a t o t h e r s h a v e internal feelings. At this level of h u m a n proximity t h e other's subjective s t a t e is automatically referred to t h e self. In infancy t h e contingent responding of t h e a t t a c h m e n t figure does far m o r e t h a n provide r e a s s u r a n c e a b o u t a protective presence. It is t h e principal m e a n s by w h i c h we acquire u n d e r s t a n d i n g of o u r own internal states, w h i c h is a n i n t e r m e d i a t e step in t h e acquisition of a n u n d e r s t a n d i n g of o t h e r s a s psychological entities—the intentional s t a n c e . We believe t h a t w h e n relational a n a l y s t s s u c h a s the brilliant late S t e p h e n Mitchell (2000) describe intersubjectivity in t h e context of therapy, t h e y a r e invoking t h i s m e c h a n i s m . In t h e first y e a r t h e infant only h a s p r i m a r y a w a r e n e s s of being in a p a r t i c u l a r internal, emotional state. S u c h a w a r e n e s s is n o n c a u s a l or e p i p h e n o m e n a l in t h a t it is n o t p u t to a n y functional u s e by t h e system. It is in t h e p r o c e s s of psychofeedback b e t w e e n infant a n d m o t h e r t h a t t h e s e internal experiences a r e m o r e closely a t t e n d e d to, evolve a functional role (a signal value), a n d acquire a function in m o d u l a t i n g or inhibiting action. T h u s it is a t t a c h m e n t p r o c e s s e s t h a t e n s u r e t h e move from primary a w a r e n e s s of i n t e r n a l s t a t e s to functional awareness. In functional a w a r e n e s s a feeling of a n g e r m a y be u s e d to simulate a n d so to infer t h e other's corresponding m e n t a l state. This is achieved n o t t h r o u g h reflection b u t by action: t h e child "knows" t h a t acting in a p a r t i c u l a r way will r e s u l t in a specified outcome b u t does n o t n e e d to—or is n o t yet able to—make t h e further inference t h a t t h e o u t c o m e is a c o n s e q u e n c e of t h e internal s t a t e h e generated in t h e object. Functional a w a r e n e s s of internal s t a t e s c a n also be u s e d to serve a signal value to direct action. T h e next level of a w a r e n e s s is reflective a w a r e n e s s , where t h e individual c a n m a k e a c a u s a l m i n d s t a t e become t h e

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object of attention w i t h o u t it c a u s i n g action. W h e r e a s functional a w a r e n e s s is intrinsically coupled with action, reflective awaren e s s is s e p a r a t e from it. It h a s t h e capacity to move away from physical reality a n d m a y be felt to be n o t for real. A final level is autobiographical, where t h e child is able to place r e c o r d s of experiences i m b u e d with psychological s t a t e s into a s e q u e n c e t h a t r e p r e s e n t s h i s history a s a n individual. T h e s e s t a g e s of the development of self a s agent a r e detailed in c h a p t e r 5. Many s t u d i e s provide evidence c o n s i s t e n t with t h i s model (see c h a p t e r s 1 a n d 5). For example, a s t u d y m e n t i o n e d earlier showed t h a t t h e rapid soothing of distressed 6 - m o n t h - o l d s could be predicted on t h e b a s i s of ratings of emotional c o n t e n t of the m o t h e r ' s facial expression d u r i n g t h e p r o c e s s of soothing: m o t h ers of rapid r e s p o n d e r s showed s o m e w h a t m o r e fear, s o m e w h a t less joy, b u t m o s t typically a r a n g e of other affects in addition to fear a n d s a d n e s s . Mothers of rapid r e s p o n d e r s were far more likely to manifest multiple affect s t a t e s (complex affects). We interpreted t h e s e r e s u l t s a s s u p p o r t i n g Gergely a n d W a t s o n ' s notion of t h e m o t h e r ' s face being a s e c o n d a r y r e p r e s e n t a t i o n of t h e infant's experience—the s a m e , a n d yet n o t t h e s a m e . This is functional a w a r e n e s s with t h e capacity to m o d u l a t e affect states. A further set of s t u d i e s performed by Gergely a n d h i s colleagues in B u d a p e s t a s well a s o u r laboratory in London a n d with a n ongoing replication in Topeka, Kansas, explored 1-yearolds' u n d e r s t a n d i n g of conflicting affect (Koos, Gergely, Gervai, a n d Toth 2000). In one study, 1 2 - m o n t h a t t a c h m e n t classification—particularly s e c u r e a n d disorganized—was found to b e predicted by infant behavior a t 6 . 5 m o n t h s in a modified still p a r a d i g m (Koos et al. 2000). T h e p a r a d i g m involves t h e m o t h e r being i n s t r u c t e d according to t h e still-face protocol b u t facing a mirror, w h e r e t h e infant h a s a choice between looking a t t h e m o t h e r ' s face or looking a t a perfectly contingent image (themselves). Infants classified a s securely a t t a c h e d engaged six m o n t h s later in significant a m o u n t s of active testing of their mirror self-image only w h e n their m o t h e r b e c a m e temporarily inaccessible.(the still-face period). In c o n t r a s t , b a b i e s w h o went on to manifest disorganized a t t a c h m e n t six m o n t h s later were d r a w n to t h e image of their fully contingent self m o v e m e n t s t h r o u g h o u t t h e laboratory testing. Interestingly, t h e Koos et al.

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(2000) s t u d y also d e m o n s t r a t e d t h a t following t h e still-face period t h e infants w h o engaged in m o r e contingency testing while looking a t their self-image showed more positive affect following the procedure. T h i s led to m o r e successful affect regulation in disorganized infants t h a n in s e c u r e ones. Yet seeking for perfect contingency in a t t e m p t s a t detecting internal s t a t e s in t h e context of h u m a n interaction will b e of limited effectiveness in t h e long r u n . It characterizes t h e dissociative style of attention organization t h a t is typical of disorganized a t t a c h m e n t . In c h a p t e r 5 we consider t h e developmental move from a stage when t h e infant s e e m s to prefer stimuli t h a t are perfectly contingent with h i s a c t i o n s to a stage w h e n infants indicate greater interest in stimuli t h a t only partially mirror their actions, which are contingent b u t clearly n o t perfectly so. T h e preference for perfect contingency t h a t characterizes t h e infant of less t h a n 5 m o n t h s clearly orients h i m toward h i s own physical self. It establishes t h e p a r a m e t e r s of h i s body a s proprioceptive a n d provides h i m with visual experiences t h a t are perfectly contingent, a n d also contingent with r u d i m e n t a r y volitional s t a t e s related to action. In c h a p t e r 5 we a r g u e t h a t t h e developmental step entailed by t h e preference for high b u t imperfect contingencies after t h e age of 5 m o n t h s t u r n s t h e h u m a n infant toward social interaction with h i s a t t a c h m e n t figures. H u m a n beings are incapable of r e s p o n d i n g with perfect contingency. An orientation to t h e social world entails a greater tolerance for imperfect contingencies, a s t h e caregiver fails to r e s p o n d to a high proportion o f t h e infant's signals (Tronick 1989, 1998). Notwithstanding the biological p r e p a r e d n e s s for imperfect contingency, t h e interpersonal learning e n v i r o n m e n t within w h i c h t h e IIM c a n develop probably r e q u i r e s a m i n i m u m level of contingent r e s p o n d i n g for the experience of "nearly, but clearly not the same" to evolve—the experience t h a t is u n d o u b t e d l y key to t h e creation of interpersonal symbolic capacity. Disorganized a t t a c h m e n t p e r h a p s m a r k s t h e historical a b s e n c e of a n interpersonal context t h a t failed to m e e t t h e tolerance limits of t h e infant's capacity to absorb imperfect contingency. T h u s , t h e experience of misa t t u n e m e n t (or noncontingency), w h i c h c a u s e s all of u s to internalize a n "other within t h e self" (the p a r t of t h e self we will be calling t h e "alien self*), goes in some c a s e s beyond w h a t t h e

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infant c a n tolerate a n d still feel a s e n s e of coherent, c o n t i n u o u s identity. For m o s t u s , t h e experience of u n r e s p o n s i v e n e s s or i n a p p r o p r i a t e r e s p o n s e c a n b e incorporated w i t h i n o u r selfs t r u c t u r e t h r o u g h mentalization, w h i c h l e n d s a n illusion of coherence, normally t h r o u g h creating a narrative self. This coherence b e c o m e s a functional reality a s we weave incompatible experiences together into o n e identity. Arguably, t h e nagging s e n s e of incongruity a n d of "loose ends" within t h e self-structure supplies some of t h e motivation for seeking o u t further attachm e n t relationships t h r o u g h o u t life, in a s e a r c h for greater integration a n d u n d e r s t a n d i n g . For o t h e r people, t h e alien experience within t h e self r e m a i n s a n inassimilable core t h a t creates a n even more powerful n e e d for integration t h r o u g h later attachm e n t relationships b u t t h a t also gets in t h e w a y of forming a n d m a i n t a i n i n g s u c h relationships. The vulnerability of reflective function m a y t h e n be c o m p o u n d e d by later a t t a c h m e n t t r a u m a , which, in a n effort to restore a feeling of control, m a y lead to identification w i t h t h e a b u s e r ' s s t a t e of m i n d . This s e q u e n c e is explored further in c h a p t e r 10.

E v i d e n c e for t h e I n t e r p e r s o n a l Interpretive Mechanism Is t h e r e a n y evidence for a n IIM t h a t evolves o u t of t h e attachm e n t relationship, with its efficiency conditioned by a t t a c h m e n t security? 1. There is unequivocal evidence from two d e c a d e s of longitudin a l r e s e a r c h t h a t s e c u r e a t t a c h m e n t in infancy is strongly associated with t h e precocious development of a r a n g e of capacities t h a t d e p e n d on interpretive or symbolic skills, s u c h a s exploration a n d play, intelligence a n d l a n g u a g e ability, ego resilience a n d ego control; frustration tolerance, curiosity, self-recognition, social cognitive capacities, a n d s o on. A t t a c h m e n t security fores h a d o w s cognitive competence, exploratory skill, emotion regulation, c o m m u n i c a t i o n style, a n d other o u t c o m e s . In o u r view, this is n o t b e c a u s e of t h e general i m p a c t of a t t a c h m e n t security

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on t h e child's self-confidence, initiative, ego functioning, or other broader personality p r o c e s s e s b u t , r a t h e r , b e c a u s e a t t a c h m e n t processes provide t h e key evolutionarily p r e p a r e d p a t h s for a n interpersonal interpretive capacity to develop. T h u s it is n o t t h e first a t t a c h m e n t s t h a t a r e formative, it is not a t t a c h m e n t security per se t h a t predicts good outcome on this dazzling a r r a y of m e a s u r e s ; r a t h e r , t h e features of t h e interpersonal e n v i r o n m e n t t h a t generate a t t a c h m e n t security d u r i n g t h e first y e a r of life also p r e p a r e t h e g r o u n d for t h e rapid a n d c o m p e t e n t ontogenetic evolution of interpersonal interpretation. O n e problem in a t t e m p t i n g to trace some of t h e long-term outcomes of s e c u r e a t t a c h m e n t in infancy h a s b e e n t h e appropriately conservative strategy of controlling for n u m e r o u s aspects of t h i s interpretive capacity. Controlling for verbal fluency or even IQ removes a p a r t of t h e variability in which t h e a t t a c h m e n t relationship a r g u a b l y plays a c a u s a l role. B u t t h i s is a n issue for a n o t h e r time. 2. A n u m b e r of specific findings in t h e literature link a t t a c h m e n t to t h e development of a n IIM. Laible a n d T h o m p s o n (1998) reported t h a t securely a t t a c h e d children h a v e higher competence in u n d e r s t a n d i n g negative emotion. A u n i q u e s t u d y by J u d e Cassidy a n d colleagues (Cassidy, Kirsh, Scolton, a n d Parke 1996) found t h a t securely a t t a c h e d k i n d e r g a r t e n e r s were less likely to infer hostile i n t e n t in stories with a m b i g u o u s content. This bias a p p e a r e d to m e d i a t e their superiority in sociometric s t a t u s . In t h e London P a r e n t - C h i l d S t u d y Peter Fonagy, Miriam and Howard Steele, a n d J u l i e t Holder (1997) reported precocious performance o n theory-of-mind t a s k s a m o n g 5-year-olds with a history of s e c u r e a t t a c h m e n t in infancy. This finding h a s also been reported by other investigators since t h e n (Fonagy 1997; Meins et al. 1998). 3. In a relatively full exploration of findings linking early att a c h m e n t a n d later development, Ross T h o m p s o n concludes t h a t "the s t r e n g t h of t h e relationship between infant security a n d later socio-personality functioning is modest" (1999, p. 280). T h e associations a r e stronger c o n t e m p o r a n e o u s l y t h a n t h e y a r e predictively. Within t h e context of t h e p r e s e n t theory, it is n o t t h e

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content of internal working models t h a t is likely to be determined by early experience; r a t h e r , t h e p r e s e n c e of a model or t h e quality or r o b u s t n e s s of t h e model d e t e r m i n e s later socio-personality functioning. T h u s , a t t a c h m e n t classification might or might n o t be stable from infancy t h r o u g h middle childhood to adolescence. As prediction comes from t h e IIM, n o t from attachm e n t security per se, t h i s is of n o great concern. T h e focus of s t u d y s h o u l d n o t b e a t t a c h m e n t security, w h i c h achieved significance a s a correlate of t h e IIM b u t h a s little stability a n d possibly little predictive value. Within t h e context of t h e p r e s e n t theory, it is n o t t h e n a t u r e of self-other representations t h a t is t h o u g h t to b e determined by early experience. Rather, t h e focus of t h e p r e s e n t enquiry is t h e extent to which early experience m a y jeopardize t h e very existence of a s t r u c t u r e to r e p r e s e n t object relationships, t h e processing skills required to deal with interpersonal interaction, t h e r o b u s t n e s s of the model, t h e extent to w h i c h t h i s interpretive m e c h a n i s m c a n function u n d e r s t r e s s a n d p r o c e s s emotionally c h a r g e d information, a n d so forth. The m e c h a n i s m of predictive significance is t h e interpersonal interpretive m e c h a n i s m , w h i c h is a genetically defined capacity t h a t is probably localized in t h e medial prefrontal cortex. S t u d i e s of p a t i e n t s with orbital-frontal a n d medialfrontal lesions h a v e repeatedly suggested specific deficits in t a s k s t h a t call for thinking a b o u t m e n t a l s t a t e s in o t h e r s (Chann o n a n d Crawford 1999, 2000; S t u s s , Gallup, a n d Alexander 2001). Both PET (positron emission tomography) a n d fMRI (functional magnetic r e s o n a n c e imaging) s t u d i e s in w h i c h subjects were a s k e d to m a k e inferences a b o u t t h e m e n t a l s t a t e s of others found activity associated with mentalizing in t h e medial prefrontal cortex. In addition, activity w a s elicited in t h e temperoparietal j u n c t i o n (Gallagher et al. 2000; Goel, Grafman, Sadato, a n d Hallett 1995). There is i n d e p e n d e n t evidence for t h e developmental vulnerability of t h i s s t r u c t u r e from PET-scan s t u d i e s of R o m a n i a n a d o p t e e s who were deprived of t h e i n t e r p e r s o n a l experiences t h a t we t h i n k m i g h t g e n e r a t e t h e IIM (B. Perry 1997). D a m a g e to t h e s e frontal a r e a s (Adolphs, Tranel, Damasio, a n d D a m a s i o 1995; Alexander, S t u s s , a n d B e n s o n 1979; Brazzelli, Colombo, Delia Sala, a n d Spinnler 1994; C h a n n o n a n d Crawford 1999,

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2000; D a m a s i o 1994; Rogers et al. 1999) h a s b e e n consistently associated with social a n d personality deficits t h a t a r e consistent with t h e n o t i o n of t h e loss of interpersonal interpretive capacity: impaired social j u d g m e n t s , impaired pragmatics, deficient self-regulation, a n d impoverished association of social situations with p e r s o n a l affective m a r k e r s (e.g., Craik et al. 1999; S t u s s 1983, 1991). Independently, we know, of course, t h a t t h e a t t a c h m e n t classification of t h e s e a d o p t e e s r e m a i n s disorganized a t t h e age of 3 y e a r s a n d their social behavior is a b n o r m a l a t age 8. We also h a v e evidence t h a t t h e mentalizing capacity of individuals m a l t r e a t e d in early childhood c o n t i n u e s to have significant limitations. 4. Myron Hofer's work with r o d e n t p u p s identified regulatory interactions within t h e m o t h e r - i n f a n t relationship t h a t have clear analogies to w h a t is proposed h e r e (Hofer 1995; Polan a n d Hofer 1999). Hofer's w o r k over t h r e e d e c a d e s h a s revealed t h a t the evolutionary survival value of staying close to a n d interacting with t h e m o t h e r goes far beyond protection a n d m a y be exp a n d e d to m a n y p a t h w a y s available for regulation of t h e infant's physiological a n d behavioral system. Hofer's view is a n a l o g o u s to ours in t h a t h e p r o p o s e s t h a t t h e a t t a c h m e n t "relationship provides a n o p p o r t u n i t y for t h e m o t h e r to s h a p e b o t h t h e developing physiology a n d t h e behavior of h e r offspring t h r o u g h h e r patterned interactions with h e r infant" (Polan a n d Hofer 1999, p. 177). A t t a c h m e n t is n o t a n e n d in itself—it is a s y s t e m adapted by evolution to fulfill key ontogenetic physiological a n d psychological t a s k s . Hofer's reformulation of a t t a c h m e n t in t e r m s of regulatory processes, h i d d e n b u t observable within t h e p a r e n t - i n f a n t interaction, provides a very different way of explaining t h e r a n g e of p h e n o m e n a u s u a l l y d i s c u s s e d u n d e r t h e h e a d i n g of a t t a c h m e n t . The traditional a t t a c h m e n t model is clearly circular. T h e response to s e p a r a t i o n is a t t r i b u t e d to t h e d i s r u p t i o n of a social bond, t h e existence of w h i c h is inferred from t h e p r e s e n c e o f t h e separation r e s p o n s e . We a r g u e t h a t w h a t is lost in "loss" is n o t the b o n d b u t t h e o p p o r t u n i t y to g e n e r a t e a higher-order regulatory m e c h a n i s m : t h e m e c h a n i s m for a p p r a i s a l a n d reorganization of m e n t a l c o n t e n t s . We conceptualize a t t a c h m e n t a s a

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process t h a t b r i n g s complex m e n t a l life into being from a complex a n d a d a p t a b l e behavioral system. Some, b u t by n o m e a n s all, s u c h m e n t a l function is u n i q u e to h u m a n s . T h e m e c h a n i s m s t h a t generate t h e s e ( a t t a c h m e n t relationships) s h o w evolutionary continuity a c r o s s n o n h u m a n species. J u s t a s in r a t p u p s the ontogenetic development of biological regulators crucially dep e n d s on ,the m o t h e r - i n f a n t unit, so in h u m a n development psychological interpretive capacity evolves in t h e context of the repetitive interactions with t h e m o t h e r . 5. In a series of s t u d i e s a t t h e Menninger Clinic we explored the factor s t r u c t u r e of a n u m b e r of self-report m e a s u r e s of adult a t t a c h m e n t . On b o t h c o m m u n i t y a n d clinical s a m p l e s we found very similar r e s u l t s a c r o s s t h r e e investigations. In t h e first study (Allen et al. 2000), two m e a s u r e s of a d u l t a t t a c h m e n t style—the Relationship Q u e s t i o n n a i r e (Bartholomew a n d Horowitz .1991) a n d t h e Adult A t t a c h m e n t Scale (Collins a n d Read 1990)—were administered-to 2 5 3 individuals (99 female t r a u m a p a t i e n t s and 154 c o m m u n i t y controls). The factor s p a c e provided a reasonable two-dimensional solution with a secure-fearful axis a n d a dismissive-preoccupied axis. 2 We found t h e s a m e two factors—a secure-fearful axis a n d a dismissive-preoccupied axis—in a replication s t u d y by Stein a n d colleagues, w h i c h u s e d five adult a t t a c h m e n t - q u e s t i o n n a i r e m e a s u r e s , again on a mixed population1; W h e n we plotted t h e subjects in t h e sample—both p a t i e n t s a n d c o m m u n i t y controls—on t h e s a m e two principal compon e n t s , it w a s clear t h a t while t h e secure-fearful axis w a s excellent a t distinguishing t h e c o m m u n i t y s a m p l e from t h e patient group, t h e dismissive-preoccupied axis did n o t distinguish the g r o u p s well. W h a t w a s also clear w a s a s o m e w h a t unexpected relationship between c o m p o n e n t scores. Although t h e overall correlation between t h e two scales w a s negligible, a s you would expect, t h e discrimination between dismissive a n d preoccupied w a s s o m e w h a t greater toward t h e middle point of t h e s e c u r e fearful dimension. 2 In a principal-component analysis, a two-component solution accounted for all eigen values greater than 1 and for 67.2% ofthe total variance.

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One way of interpreting t h e s e d a t a is to a s s u m e t h a t security represents a n experience of safety in closeness, w h e r e a s fearfulness relates to a disorganization of a t t a c h m e n t . T h e fearfulness a p p e a r s to b e specific to a t t a c h m e n t relationships, a s n o n a t t a c h m e n t relationships rarely score highly on t h i s dimension. The dismissing a t t a c h m e n t style a p p e a r s to offer protection to the self by isolation, w h e r e a s in e n m e s h e d preoccupation selfprotection i s ' p e r h a p s afforded by a n amplification of t h e other, by a denial or s u b j u g a t i o n o f t h e self. We would a r g u e t h a t t h e safety-to-fearfulness d i m e n s i o n corresponds to t h e quality of functioning o f t h e IIM. At t h e high end, the individual is well able to r e p r e s e n t complex internal s t a t e s of the other a n d of t h e self. With a well-established higher-order capacity for distinguishing psychological s t a t e s of t h e other a n d the self, they n e e d n o additional strategies for conducting productive i n t e r p e r s o n a l relationships. W h e n t h e psychological m e c h a n i s m crucially u n d e r p i n n i n g a t t a c h m e n t is s o m e w h a t weaker (as a function of a t t a c h m e n t history or biology), t h e capacity for s u s t a i n i n g a clear distinction between self a n d other also b e c o m e s weaker. In s u c h a s i t u a t i o n t h e individual will require specific strategies to a c c o m m o d a t e to interpersonal encounters. The-two prototypical strategies a r e t h e avoidant a n d resistant strategies. But why a r e s u c h strategies n e c e s s a r y ? Both serve to protect the self in t h e context of i n t e n s e i n t e r p e r s o n a l relations. We a s s u m e t h a t t h e s e strategies m a y be n e c e s s a r y b e c a u s e t h e self, which is, a s we h a v e seen, t h e p r o d u c t o f t h e other, always remains vulnerable to social influence. To avoid s u c h instability, against a b a c k g r o u n d of a relatively i n s e c u r e internal working model, t h e individual c a n either deliberately w i t h d r a w a n d enhance t h e self-representation relative to t h e other r e p r e s e n t a tions (dismissing) or protectively overamplify a n d exaggerate t h e other r e p r e s e n t a t i o n (preoccupied). In either case, t h e strategies in representational t e r m s are a b o u t deliberately s e p a r a t i n g t h e other from t h e self-representation. Neither of t h e s e strategies is inherently pathological, although b o t h signal a certain degree of w e a k n e s s . At t h e extreme end of t h e safety-to-fearfulness dimension, t h e r e c a n be n o

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strategy b e c a u s e t h e a t t a c h m e n t s y s t e m is n o t t h e r e to s u s t a i n a consistent set of defenses. In t h e s e c a s e s t h e interpretive mechan i s m t h a t s u s t a i n s social relations functions so poorly t h a t the capacity to arrive a t r e p r e s e n t a t i o n s of t h e motivational or epistemic mind s t a t e s of t h e other, i n d e p e n d e n t of t h o s e of t h e self, is profoundly compromised. This is a t t a c h m e n t disorganization or, r a t h e r , t h e a b s e n c e of t h e m e n t a l function t h a t s u s t a i n s a t t a c h m e n t . T h u s we conceive of a t t a c h m e n t disorganization as lying a t t h e opposite e n d of t h e scale to a t t a c h m e n t security and a s a n indicator of t h e regular failure of t h e interpersonal interpretive m e c h a n i s m . As we a r g u e t h r o u g h o u t t h i s book, we consider the quality of interpretive capacity to vary substantially a c r o s s n o r m a l a n d clinical g r o u p s . At t h e low e n d of t h i s scale are individuals w h o u s e a teleological r a t h e r t h a n a n intentional s t a n c e in interpreting their own a n d others' behavior (see chapt e r s 5 a n d 8). As we shall see, t h e r e a s o n s for t h i s w e a k n e s s might be linked to early s u b o p t i m a l e n v i r o n m e n t s t h a t could create a vulnerability t h r o u g h u n d e r m i n i n g t h e r o b u s t n e s s of t h e IIM (see particularly c h a p t e r 4) or t h e failure to appropriately integrate developmentally early forms of r e p r e s e n t a t i o n s for subjectivity (see c h a p t e r 6) d u e , for example, to a lack of playful interactions with p a r e n t s or frank m a l t r e a t m e n t a t m u c h later ages (see c h a p t e r s 10 a n d 11). To s u m m a r i z e , we feel t h a t t h e r e a r e a t least five s t r a n d s of converging evidence to suggest t h a t a key selective advantage of a t t a c h m e n t might be t h e development of a n u n d e r s t a n d i n g of internal states: (a) t h a t s e c u r e a t t a c h m e n t is associated with favorable o u t c o m e s a c r o s s a wide r a n g e of relevant t a s k s ; (b) t h a t s e c u r e a t t a c h m e n t predicts precocious performance in t a s k s specifically calling for symbolic capacity; (c) t h a t t h e class of early a t t a c h m e n t classification h a s less predictive weight t h a n w h e t h e r a t t a c h m e n t experiences occurred; (d) t h a t a t t a c h m e n t h a s b e e n d e m o n s t r a t e d to h a v e other ontogenetic biological functions in m a m m a l i a n species t h a t have analogies or m a y parallel t h e evolutionary function for a t t a c h m e n t proposed here; (e) t h a t t h e factor s t r u c t u r e of a d u l t a t t a c h m e n t scales s e p a r a t e s out a factor to do with type of a t t a c h m e n t (perhaps t h e i n t e r n a l working model) a n d t h e quality of a t t a c h m e n t (perhaps t h e interpersonal interpretive m e c h a n i s m ) .

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THE NEURO-ANATOMICAL BASIS OF IIM-a AND IIM-c So far we h a v e d i s c u s s e d t h e IIM a s if we t h o u g h t of it a s a singular a n d u n i t a r y s y s t e m . In c h a p t e r 5 we p r e s e n t evidence t h a t t h e acquisition of a n u n d e r s t a n d i n g of desires might a n t e date t h e acquisition of a capacity to u n d e r s t a n d epistemic s t a t e s (such a s beliefs) by a s m u c h a s 18 m o n t h s . This discrepancy in the developmental timetable s u g g e s t s t h a t s e p a r a t e m e c h a n i s m s for interpersonal u n d e r s t a n d i n g concerning emotions a n d belief states should b e considered. In t h i s section we p r e s e n t some neuropsychological evidence t h a t p o i n t s in t h e s a m e direction. We believe t h a t t h e IIM subdivides anatomically into two s u b s t r u c t u r e s : t h e IIM-a (a for affect) a n d t h e IIM-c (c for cognition). Emotional r e s o n a n c e (empathy) m a y exemplify t h e former, while reasoning a b o u t epistemic s t a t e s might b e prototypical of t h e latter. T h e t e r m "theory of mind" or "mentalization" a s currently used covers b o t h t h e s e aspects, a l t h o u g h t h e r e is a b i a s in t h e literature toward e q u a t i n g mentalization with t h e u n d e r s t a n d i n g of belief states. The concept of e m p a t h y h a s b e e n variously defined. In t h i s context t h e availability of a m e c h a n i s m t h a t allows one individual to a s s u m e a n o t h e r ' s perspective a n d to infer a n d , to some degree, experience their emotional s t a t e of m i n d is central. We believe t h a t t h e psychological m e c h a n i s m t h a t we have labeled the IIM-a is responsible for t h i s (Bleiberg, Fonagy, a n d Target 1997; Fonagy 2000). O t h e r w o r k e r s have independently come to very similar theoretical conclusions (Blair 1995; Corcoran 2000). Darwin considered s y m p a t h y to be t h e core moral emotion a s it involved t h e a u t o m a t i c experiencing of t h e other's distress, which gives rise to altruistic a t t e m p t s to offer comfort or relief (O'Cormell 1998). Neurophysiological s t u d i e s s u p p o r t t h e distinction. The p u r e ly cognitive t a s k of identifying belief s t a t e s in t h e other h a s b e e n associated with activation of medial prefrontal foci a r o u n d BA8 using SPECT (single-photon emission c o m p u t e d tomography) (Baron-Cohen et al. 1994), PET (Blair, J o n e s , Clark, a n d S m i t h 1997; Goel et al. 1995) a n d fMRI (Gallagher et al. 2000). The infant's u n d e r s t a n d i n g of h i s own emotional r e s p o n s e s (by definition, a p r e c u r s o r of empathy) itself arises o u t of a complex

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specific gene expression. Knowledge of t h e s e m e c h a n i s m s would help u s s h a r p e n o u r intervention strategies a n d m a y p r o m p t u s to advance n e w m o d e s of prevention or t r e a t m e n t intervention. We would suggest t h a t a t least some psychosocial t r e a t m e n t s , like psychoanalysis, or preventive efforts, like affect training—for example, t h e PATHS Program (Kusche a n d Greenberg 2001)— work b e c a u s e they e n h a n c e t h e functioning of t h e IIM a n d moderate gene expression. Of course, by e n h a n c i n g mentalization, social a d a p t a t i o n in general might also be e n h a n c e d . In either case, we m a i n t a i n t h a t a t t a c h m e n t - r e l a t e d early social experiences of other m i n d s are n e c e s s a r y for t h i s to t a k e place b e c a u s e t h e n o r m a l functioning of interpersonal interpretive p r o c e s s e s r e q u i r e s s i m u l t a n e o u s a c c e s s to epistemic a n d affective information. Most probably, social experience in a n attachm e n t context in developmental periods of n e u r a l plasticity e n h a n c e s connections between w h a t we a s s u m e to b e t h e a n a tomically s e p a r a t e b u t functionally normally integrated affective a n d cognitive s t r u c t u r e s . This is why effective psychotherapy, particularly with individuals w h o s e capacity for m e n t a l repres e n t a t i o n s of i n t e r n a l s t a t e s is vulnerable, m u s t focus on affect a s well a s cognition, be delivered in a n interpersonal context t h a t permits t h e development of a t t a c h m e n t relationships, a n d meet a criterion for coherence t h a t is consistent with t h e requirement of repetition of stimuli in t h e generation of n e u r a l n e t w o r k s (e.g., R u m e l h a r t a n d McClelland 1986) a n d t h e switching-on of specific genes (Kandel 1998, 1999). P e r h a p s , further into t h e future, we m a y envision t h e measu r e m e n t of t h e o u t c o m e of psychosocial interventions by tracking c h a n g e s in t h e expression of specific g e n e s in specific sites relevant for t h e development of psychopathology (the brain, endocrine organs, etc.). More realistically, suitability for specific types of t r e a t m e n t m a y be determined in t e r m s of genetic variability. In t h e m e a n t i m e , we c a n m e a s u r e t h e i m p a c t of interventions on m e a s u r e s t h a t might tap,into t h e IIM (the RF scale, the "reading t h e m i n d in t h e eyes" test).

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CONCLUSIONS Though w h a t is proposed h e r e m a y s o u n d radical, w h e n closely scrutinized it actually c o n t a i n s very little t h a t is new. We suggest t h a t p s y c h o a n a l y s i s n e e d s to look to t h e cognitive n e u r o s c i e n c e s to find its intellectual fulfillment. C u r r e n t theorization in n e u r o science is sadly devoid of c o n s i d e r a t i o n s of emotional life a n d relationality even a r o u n d topics s u c h a s social development, where t h e subject m a t t e r directly c o n c e r n s t h e child's subjectivity. Happily, t h e r e are a n u m b e r of energetic initiatives u n d e r way t h a t p u r s u e this p a t h for knowledge acquisition (e.g., Solms 1997a, 1997b), a n d a n e w j o u r n a l , Neuro-Psychoanalysis, offers a ready forum for t h e s e developments. The evidence clearly s h o w s t h a t it is naive to a s s u m e t h a t t h e child's genotypic destiny is fulfilled in a hermetically sealed brain, s o m e h o w isolated from t h e social environment within which ontogeny o c c u r s a n d t h e s o u n d a d a p t a t i o n to w h i c h is t h e organizing p u r p o s e of t h e whole system. Subjectivity, t h e u n d e r standing of t h e individual response, will be a n essential piece in putting together t h e microbiological puzzle of genetic expression. Psychoanalysis, with its focus on t h e r e p r e s e n t a t i o n of subjectivity a n d h o w t h i s emerges from early development, might have m u c h to c o n t r i b u t e to t h e u n d e r s t a n d i n g of how individual differences in t h e quality of functioning of basic m e n t a l m e c h a nisms arise. We a r e suggesting t h a t infant a t t a c h m e n t functions —In p a r t a t least—to facilitate t h e development of a n interpersonal interpretive capacity. T h e quality of t h e early relationship plays a major role in determining t h e r o b u s t n e s s of t h a t capacity, b u t a t t a c h m e n t security per se is less relevant to later development. T h e interpretive capacity, in t u r n , plays a key role in t h e processing of social experience. T h e level of functioning of t h e IIM will be reflected in a n individual's ability to function in close interpersonal r e l a t i o n s h i p s w i t h o u t r e c o u r s e to strategies for amplifying t h e distinction between self a n d other r e p r e s e n t a tions. The unfolding of d i s t u r b a n c e over time is conditioned by the interpretive capacity—we s p e c u l a t e t h a t t h e expression of pathogenic genotypes is m a d e m o r e likely by t h e poor functioning of a m e c h a n i s m designed to differentiate the psychological states of self a n d other.

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This is a function of i m m e n s e importance, a s t h e laborious move from genotype t o p h e n o t y p e is conditioned in t h i s way. A full u n d e r s t a n d i n g of t h e interaction between individual m e n t a l ized r e p r e s e n t a t i o n s of life experience a n d t h e expression of genetic dispositions is t h e t a s k of t h e developmental p s y c h o p a thology of t h e next decades. Eric Kandel (1998)'cites Francois J a c o b (1998), who wrote in Of Flies, Mice and Men: "The c e n t u r y t h a t is ending h a s b e e n preoccupied with nucleic acids a n d proteins. T h e next one will c o n c e n t r a t e on memory and desire. Will it b e able to a n s w e r t h e q u e s t i o n s they pose?" (Jacob 1998, p. 152).

PART I I

D E V E L O P M E N T A L

P E R S P E C T I V E S

In Part II, we present a comprehensive picture of the development of a psychological sense of self, beginning with infancy and ending with adolescence. In chapter 4 we introduce the social biofeedback view of mirroring, a precise account of the mechanisms through which infants learn to identify and control affect states through interaction with primary caregivers—moving from coregulation to being self-regulating agents. The social biofeedback view of mirroring is a fundamental extension of psychoanalytic theory; it is important not just as an account of normal development but as a basis for explaining later vulnerability to psychosocial stress and psychopathology. (This is made evident in the case material in chapter 7.) Chapter 5 moves on to delineate five distinct aspects of the self: physical, social, teleological, intentional, and representational—which is also autobiographical. The notion of the intentional stance—and its relation to the teleological stance—borrowed from the philosophy of mind is particularly important to our point of view, as it spells out how we learn to fathom ourselves through fathoming others. We make the case here for the central importance of intersubjectivity once it urfolds in early development However, we criticize currently popular arguments that intersubjectivity is present from the start

and argue instead that it emerges within the attachment relationship together with the capacity for mentalization. Chapter 6 continues the developmental sequence: it highlights the dialectic between "psychic equivalence" (that mental reality must map onto physical reality) and "pretend" (that mental and physical reality are completely separate from each other)—two modes of childhood experience that become integrated through "playing with reality," leading to the appreciation that the mind only partially reflects external reality. Chapter 7 is a clinical illustration of the usefulness of these concepts to the understanding of a young boy whose disturbed relationship with his mother resulted in the distortion of these developmental processes. Chapter 8 focuses on the processes underpinning normal and pathological stresses in adolescence and presents case material illustrating serious psychopathology.

The Social Biofeedback of Affect-Mirroring: T h e of Emotional

Theory

Development

Self-Awareness

a n d Self-Control in

Infancy

In m a n y w a y s t h i s c h a p t e r forms t h e core of o u r t h i n k i n g a b o u t t h e role of affects in self-development—a theoretical a n d concept u a l problem t h a t we tackle m o r e fully in c h a p t e r 5. We s t a r t t h i s c h a p t e r by placing t h e c o n s t r u c t of emotions within t h e framework of t h e development of intentionality a n d mentalization, t h e c o n c e p t s t h a t lie a t t h e core of o u r theoretical a n d clinical work. We t h e n focus on t h e n a t u r e of t h e developmental p r o c e s s e s involved in t h e emergence of u n d e r s t a n d i n g of emotions in self a n d other. T h e development of emotions d u r i n g t h e first year of life is outlined a n d placed in t h e context of one of t h e organizing concept^ of t h i s book: t h e infant's sensitivity to contingencies b e t w e e n h i s a c t i o n s a n d their perceived environmental effects. We describe t h e social biofeedback theory of emotional development, w h i c h we see a s t h e key to u n d e r s t a n d i n g t h e link between early experience a n d later vulnerability to psychosocial stress. We also point briefly to a n u m b e r of pathological m o d e s of early infant-careglver interaction t h a t could give rise to later psychological d i s t u r b a n c e a n d t h e vulnerability of t h e self a s agent. C h a p t e r 5 t h e n a t t e m p t s to integrate t h e p a r t i c u l a r view of emotional development described in this c h a p t e r within o u r more general theoretical a p p r o a c h to t h e early development of self a n d agency. 145

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EMOTIONAL DEVELOPMENT FROM A THEORY-OF-MIND PERSPECTIVE During t h e last decade philosophers (Dennett 1987; Fodor 1987, 1992) a n d cognitive developmentalists (Astington, Harris, a n d Olson 1988; B a r o n - C o h e n et al. 1993; Hirschfeld a n d G e l m a n 1994; Perner 1991; Wellman 1990; Whiten 1991) h a v e focused on t h e n a t u r e a n d developmental origins of o u r capacity to attribute c a u s a l m e n t a l s t a t e s to others. D e n n e t t (1987) h a s argued t h a t applying s u c h a mentalistic interpretational s t r a t egy, which he calls t h e "intentional stance," is a n evolutionary a d a p t a t i o n t h a t is highly successful in predicting t h e behavior of other agents. T h u s , t h e currently d o m i n a n t cognitive developmental view h o l d s t h a t even y o u n g children a r e so-called belief-desire psychologists w h o a t t r i b u t e intentional m e n t a l s t a t e s — s u c h a s goals, emotions, desires, a n d beliefs—to o t h e r s a s t h e c a u s e s of their actions. Researchers t a k e different views, however, w h e n t h e y a d d r e s s t h e question of how children identify a n d a t t r i b u t e m i n d s t a t e s to o t h e r s or to themselves. Simulation theorists (e.g., G o l d m a n 1993; P. L. Harris 1991, 1992) a s s u m e t h a t h u m a n s h a v e direct introspective a c c e s s to their own m e n t a l s t a t e s , while t h e y have to infer t h o s e of o t h e r s indirectly t h r o u g h imagining themselves in their place a n d t h e n a t t r i b u t i n g t h e s i m u l a t e d m e n t a l experience to t h e other. In c o n t r a s t , o t h e r s (Dennett 1987; Gopnik 1993; Gopnik a n d Wellman 1994) a r g u e t h a t direct p e r c e p t u a l access to m i n d s t a t e s is illusory, a n d they p r o p o s e t h a t t h e identification of m e n t a l s t a t e s is equally inferential in t h e c a s e of self a n d other. W h e n do children t a k e t h e intentional s t a n c e a n d s t a r t to infer m i n d s t a t e s In other a g e n t s ? While t h e a t t r i b u t i o n of a p p a r ently more complex intentional states, s u c h a s false beliefs, generally a p p e a r only a t a r o u n d 3 - 4 y e a r s of age (see c h a p t e r 5 for a comprehensive developmental a c c o u n t of t h e emergence of this ability—Perner 1991; Wellman 1990; W i m m e r a n d Perner 1983), m a n y (e.g., B r e t h e r t o h 1991a; S t e r n 1985; Tomasello 1999) believe t h a t certain n e w behaviors emerging d u r i n g t h e last q u a r t e r of t h e first year, s u c h a s pointing a n d gaze alteration (E. Bates .1979; B r e t h e r t o n a n d B a t e s 1979; M u r p h y a n d Messer

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1977) o r social referencing (Campos a n d S t e n b e r g 1981; Klinnert, Campos, Sorce, Emde, a n d Svejda 1983), imply t h e a p p e a r a n c e of a r u d i m e n t a r y ability on t h e infant's p a r t to a t t r i b u t e a t least some k i n d s of m i n d s t a t e s — s u c h a s attention s t a t e s or emotions—to other agents. In a series of h a b i t u a t i o n studies, Gergely, Csibra, a n d their colleagues (Csibra, Gergely, Brockb a n k , Biro, a n d Koos 1999; Gergely et al. 1995) have provided evidence t h a t 9- a n d 12-month-old infants can, indeed, interpret a n agent's behavior a s goal-directed a n d rational a n d c a n predict its future action toward t h e goal in a new situation on t h a t b a s i s . However, 6 - m o n t h - o l d s showed n o signs yet of s u c h a n u n d e r s t a n d i n g of intentional behavior, w h i c h is in line with t h e general a s s u m p t i o n t h a t t h e earliest time in development w h e n infants m a y be able to t a k e t h e "intentional stance" toward other a g e n t s is a r o u n d t h e e n d of t h e first y e a r (Tomasello 1995, 1999). T h e "theory-of-mind" perspective is clearly relevant w h e n we consider t h e origins of t h e infant's ability to u n d e r s t a n d a n d a t t r i b u t e emotional s t a t e s to others. While m u c h of t h e discussion in t h e theory-of-mind literature h a s c o n c e n t r a t e d on beliefs a n d desires, it s h o u l d be clear t h a t emotions also belong to t h e types of intentional m e n t a l s t a t e s t h a t we attribute to other m i n d s to explain a n d predict their behavior. In fact, emotions s h a r e m a n y of t h e r e p r e s e n t a t i o n a l properties t h a t characterize intentional m e n t a l states. The "intentionality" of m e n t a l s t a t e s s u c h a s beliefs a n d desires refers to their "aboutness" (Brentano 1874; D e n n e t t a n d H a u g e l a n d 1987)—thus, a belief is "about" a n a c t u a l or possible s t a t e of affairs in t h e world, w h e r e a s a desire is "about" a future s t a t e of affairs. Clearly, in t h a t s e n s e emotions a r e also m e n t a l a t t i t u d e s t h a t are "about" some s t a t e of affairs (as w h e n Peter is angry a b o u t having lost h i s wallet 1 ) a n d attributing t h a t information to a p e r s o n c a n certainly help to explain or predict h i s behavior.

1

That emotions belong to the class of Intentional mental states is also shown by the fact that emotion terms, similarly to other "intentional idioms," express propositional attitudes and are characterized by the semantic property of "referential opacity" (Dennett and Haugeland 1987; Quine 1960). This property refers to the fact that certain logical operations, such as substitutability of terms with

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However, w h e n a t t r i b u t i n g a n emotion to someone, o n e also attributes dispositional information t h a t is related m o r e t o - t h e attitude itself t h a n to t h e intentional object t h a t t h e a t t i t u d e is about. Attributing "anger a b o u t having lost h i s wallet" to Peter allows one to generate a set of predictions a b o u t h i s future behavior t h a t a r e only incidentally related to w h a t h i s a n g e r is about—for example, predicting t h a t Peter is likely to kick t h e dog if h e s e e s it. T h e dispositional information t h a t e m o t i o n s e x p r e s s specifies t h a t u n d e r certain c i r c u m s t a n c e s a p e r s o n w h o is in the given dispositional emotion s t a t e is likely to b e h a v e in cert a i n ways r a t h e r t h a n in others. In o t h e r words, it specifies a set of potential s t a t e s of affairs t h a t c a n be propositionally described in t e r m s of a set of "if-then" conditional s t a t e m e n t s . W h e n we a t t r i b u t e a n emotion s t a t e to someone, we m u s t be able to generate a t least some of t h e s e conditional s t a t e s of affairs in o u r mind, otherwise we would n o t be able to infer a n y t h i n g a b o u t t h e p e r s o n ' s future behavior. 2 Therefore, from a theory-of-mind perspective t h e central questions of t h e psychology of emotional development would b e t h e following: {a) How do infants come to k n o w a b o u t t h e dispositional c o n t e n t of emotions? (b) How do t h e y identify w h a t a n emotion s t a t e is a b o u t ? (c) W h e n do they s t a r t to a t t r i b u t e either k i n d s of information to other m i n d s to s u p p o r t r e a s o n i n g a b o u t behavior? (d) How do they learn t h e conditions u n d e r w h i c h t h e attribution of emotions to others—or, for t h a t m a t t e r , to t h e m selves—is justified? In t h e latter regard, we s h o u l d n o t e t h a t emotions differ in interesting ways from other intentional m e n t a l s t a t e s s u c h a s beliefs a n d desires. First, emotions m a y be easier to infer in a n o t h e r person, b e c a u s e t h e y tend to be a c c o m p a n i e d by sali-

identical referents, break down in the case of expressions involving intentional relations such as "x believes that p" or "y desires that q." Thus, while the statement "Oedipus was angry about Laius's comments" is true, it does not follow that "Oedipus was angry about his father's comments" is also true, even though "Laius" and "Oedipus's father" refer to the same individual. 2 In fact, apart from their dispositional content, we often exploit other types of knowledge as well when we reason about emotions—for example, knowledge about the typical causes of emotions or about the typical consequences of acting emotionally (Watson 1995).

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e n t — a n d , in t h e case of b a s i c emotions, possibly universal— expressive facial displays (Ekman 1992; E k m a n , Friesen, a n d Ellsworth 1972; Izard 1977). Also, having a n emotion s e e m s to involve specific a n d differential c h a n g e s in physiological a r o u s a l (at least, in t h e c a s e of some b a s i c emotions—see E k m a n , Levenson, a n d Friesen 1983), a s well a s a characteristic subjective feeling state, which, it c a n be a r g u e d , m a k e s correct self-attribution relatively easy. F u r t h e r m o r e , t h e r e is evidence suggesting t h a t t h e r e m a y be a set of b a s i c emotions t h a t is universal a n d i n n a t e ( E k m a n 1992; E k m a n et al. 1972; Izard 1977, 1978). O n t h e b a s i s of t h e s e c o n s i d e r a t i o n s it s e e m s plausible to a s k w h e t h e r emotions a r e among—if n o t the—earliest m e n t a l s t a t e s t h a t infants a t t r i b u t e to m i n d s (cf. Meltzoff a n d Gopnik 1993),

IMITATION-BASED ATTRIBUTION OF EMOTIONAL STATES: T H E MELTZOFF-GOPNIK HYPOTHESIS Meltzoff a n d Gopnik (1993) proposed t h a t i n n a t e m e c h a n i s m s allow t h e infant to a t t r i b u t e emotional s t a t e s to o t h e r s from t h e beginning of life. Their theory is b a s e d on Meltzoff s extended work (Meltzoff a n d Moore 1977, 1989) d e m o n s t r a t i n g a n i n n a t e ability a n d inclination in n e w b o r n b a b i e s to imitate certain facial g e s t u r e s of a d u l t s — s u c h a s t o n g u e p r o t r u s i o n a n d m o u t h opening—and m a y b e also t h e c o m p o n e n t s of some of t h e basic facial emotion expressions (Field, Woodson, Cohen, Garcia, a n d Greenberg 1983). Additionally, their model a s s u m e s t h e existence of a n i n n a t e set of p r i m a r y emotions t h a t a r e expressed by prewired facial m u s c u l a r action p a t t e r n s (Ekman 1992b; E k m a n e t a l . 1972; Izard 1977, 1978). Based on E k m a n et al.'s (1983} findings with a d u l t s , Meltzoff a n d Gopnik suggest t h a t t h e r e a r e prewired bidirectional connections between facial emotion expressions a n d corresponding differential physiological emotion s t a t e s , w h i c h are active from birth. T h u s , they e m b r a c e a basic a s s u m p t i o n of differential emotions theory (Izard 1977; Izard a n d Malatesta 1987; Mala^ t e s t a a n d Izard 1984), according to w h i c h "there is a n i n n a t e expression-to-feeling c o n c o r d a n c e in t h e y o u n g infant" (Mala-

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testa et al. 1989, p. 6). They hypothesize t h a t w h e n t h e infant imitates the adult's facial emotion expression, h e automatically activates, t h r o u g h t h e s e prewired connections, t h e corresponding bodily emotion s t a t e in himself. In their words, "imitation of behavior provides t h e bridge t h a t allows t h e i n t e r n a l m e n t a l state of a n o t h e r to 'cross over' to a n d become one's own experienced m e n t a l state" (Meltzoff a n d Gopnik 1993, p. 358). According to Meltzoff a n d Gopnik, t h e imitation-generated emotion state is t h e n introspectively accessed, a n d t h e felt affect is attributed to t h e other's m i n d . However, t h e r e is n o direct evidence to s u p p o r t t h e a s s u m p tion t h a t discrete i n n a t e emotion displays automatically activate emotion-specific c o n s c i o u s feeling s t a t e s in early infancy. In fact, several r e s e a r c h e r s explicitly reject t h i s possibility, a r g u i n g t h a t affect s t a t e s a r e likely to b e undifferentiated d u r i n g t h e first few m o n t h s of life a n d t h a t t h e a p p e a r a n c e of differentiated conscious feeling s t a t e s is t h e c o n s e q u e n c e of cognitive development (e.g., Sroufe 1979). Lewis a n d Michaelsoh (1983) a r g u e t h a t , d u r i n g t h e earliest p h a s e s of infancy, internal s t a t e s a n d expressive behaviors a r e n o t yet coordinated a n d t h a t c o n s c i o u s feeling s t a t e s t h a t are linked to discrete expressive displays emerge only later d u e to t h e influence of socialization a n d cognitive growth (see also Kagan 1992; Lewis a n d Brooks 1978). In addition to e m b r a c i n g t h e — a s yet u n s u p p o r t e d — i n n a t i s t a s s u m p t i o n of a n initial linkage between emotion expressions a n d specific feeling states, t h e Meltzoff-Gopnik model m u s t m a k e a further nativist a s s u m p t i o n to a c c o u n t for t h e e n s u i n g a t t r i b u tion of t h e imitation-generated emotion s t a t e to t h e other's m i n d . Without that, t h e proposed imitation-mediated emotional contagion p r o c e s s would g e n e r a t e a n emotion s t a t e in t h e infant t h a t would m a t c h t h e adult's expressed affect, b u t t h e p r o c e s s would stop there, a n d n o m e n t a l - s t a t e a t t r i b u t i o n would occur. Accordingly, Meltzoff a n d Gopnik go on to a r g u e t h a t "one f u n d a m e n t a l a s s u m p t i o n of m e n t a l i s m — t h a t external, visible behaviors a r e m a p p e d onto phenomenologically m e n t a l states—is a p p a r e n t l y given innately" (1993, p. 340). This a s s u m p t i o n of "primary intersubjectivity" is extensively scrutinized in c h a p t e r 5. But even if one were to accept t h e i n n a t i s t set of a s s u m p t i o n s of the Meltzoff-Gopnik model; t h e r e would still r e m a i n a ques-

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tion c o n c e r n i n g t h e n a t u r e of t h e imitation-generated affect s t a t e t h a t s e e m s crucial from t h e point of view of t h e theory-of-mind a p p r o a c h to emotional development. Apart from experiencing a differential phenomenological quality, is it proposed t h a t t h e b a b y b e c o m e s a w a r e of t h e dispositional c o n t e n t of t h e emotion s t a t e a s well—not to m e n t i o n its a b o u t n e s s ? It is n o t clear w h e t h e r Meltzoff a n d Gopnik (1993) conceive of t h e dispositional c o n t e n t of emotions a s also genetically specified, b u t it is clear that without making that strong innatist assumption, attributing pure—uninterpreted—physiological feeling s t a t e s to t h e other would n o t serve t h e vital evolutionary function of t h e "intentional stance": it would n o t help t h e infant in predicting t h e o t h e r ' s behavior. Finally, a central a s s u m p t i o n of t h e Meltzoff-Gopnik model is t h e proposition t h a t from t h e beginning of life infants h a v e direct introspective a c c e s s to their i n t e r n a l emotion states. However, t h e viability of t h e classical C a r t e s i a n position, according to w h i c h t h e m e n t a l s t a t e s of t h e self a r e accessed directly t h r o u g h (infallible) introspection while t h o s e of t h e other h a v e to be inferred on t h e b a s i s of indirect evidence, h a s b e e n a m a t t e r of lively d e b a t e in t h e theory-of-mind literature. (See c h a p t e r 5 for a detailed criticism of t h i s C a r t e s i a n a s s u m p t i o n . ) In fact, Gopnik (1993) herself a r g u e d forcefully t h a t in development, u n d e r s t a n d i n g of m i n d s t a t e s in t h e other a n d in t h e self a p p e a r s s i m u l t a n e o u s l y a n d is b a s e d on-similar inferential p r o c e s s e s in b o t h c a s e s . (See also D e n n e t t 1987, c h a p t e r 4.) In contrast, for t h e c a s e of emotions, t h e Meltzoff-Gopnik (1993) model implies innately given direct introspective a c c e s s to t h e affective s t a t e s of t h e self. Below we argue, however, t h a t emotions should n o t be considered a special c a s e in t h i s respect. We propose a n alternative view, according to w h i c h t h e infant in h i s initial s t a t e is n o t yet sensitive to t h e g r o u p s of i n t e r n a l - s t a t e c u e s t h a t a r e indicative of discrete emotion categories. In s u m , it s e e m s t h a t t h e Meltzoff-Gopnik model, while intellectually intriguing a n d b a s e d on s o m e i m p o r t a n t insights, is heavily b u r d e n e d with i n n a t i s t a s s u m p t i o n s , some of which, we believe, m i g h t be avoided in a c c o u n t i n g for t h e developmental lines leading to t h e u n d e r s t a n d i n g a n d attribution of emotions in infancy. In w h a t follows, we outline a n alternative a p p r o a c h to

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conceptualizing early emotional development, which, while perh a p s more p a r s i m o n i o u s , is, admittedly, equally speculative.

INITIAL SENSITIVITY TO INTERNAL V E R S U S EXTERNAL STIMULI We believe t h a t t h e r e is n o compelling r e a s o n to a s s u m e t h a t t h e dispositional c o n t e n t s of emotion s t a t e s a r e available to t h e infant a t birth. This is, of course, n o t to deny t h e potential presence of i n n a t e p r i m a r y emotions, which c a n be conceptualized a s complex prewired behavioral organizations activated u n der specific i n p u t conditions. S u c h emotion p r o g r a m s a r e likely to contain information a b o u t t h e goal—such a s removal of obstacle—and: t h e specific action tendencies—for example, a p p r o a c h a n d attack—characteristic of t h e given emotion (anger), w h i c h could b e u s e d to s u p p o r t a t least s o m e predictions a b o u t likely actions. However, we a s s u m e t h a t t h i s information is represented in a n implicit form a s p r o c e d u r a l knowledge, a n d a s s u c h it is at first cognitively inaccessible to.the infant. Instead, we propose t h a t t h e dispositional c o n t e n t of emotions is learned first b y observing t h e affect-expressive displays of o t h e r s a n d associating t h e m with t h e s i t u a t i o n s a n d behavioral o u t c o m e s t h a t a c c o m p a n y t h e s e emotion expressions. Of course, if Meltzoff a n d Gopnik a r e right in a s s u m i n g t h a t t h e infant h a s direct introspective a c c e s s to h i s i n n a t e p r i m a r y emotion s t a t e s , s u c h p e r c e p t u a l learning could be b a s e d on monitoring t h e emotional s t a t e s of t h e self a s well a s t h o s e of others. In a s s u m i n g t h a t t h e infant's initial s t a t e is characterized by direct introspective a c c e s s to i n t e r n a l s t a t e s , Meltzoff a n d Gop7 nik (1993) follow t h e tradition of a long line of developmental theorists. For example, F r e u d a n d o t h e r p s y c h o a n a l y s t s (e.g., Mahler et al. 1975) h a v e long held t h e view t h a t t h e infant is initially more sensitive to internal t h a n to external stimuli. Bruner, Olver, a n d Greenfield (1966) also proposed t h a t t h e infant moves from a n initial reliance on internal, proprioceptive c u e s to a reliance on exteroceptive c u e s (see also Birch a n d Lefford 1967; Gholson 1980; for a review, see Rovee-Collier 1987).

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However, a s Colombo, Mitchell, Coldren, a n d Atwater (1990) h a v e pointed out, t h e r e a r e practically n o empirical d a t a in t h e infant learning literature to s u p p o r t t h i s classical a s s u m p t i o n directly. In c o n t r a s t , in a series of experiments designed to t e s t t h e a s s u m p t i o n , t h e s e a u t h o r s have d e m o n s t r a t e d t h a t 3 - m o n t h - o l d s s h o w discrimination learning on t h e b a s i s of exteroceptive a s well a s interoceptive c u e s . 3 Moreover, in 6- a n d 9 - m o n t h - o l d s t h e y actually found d o m i n a n c e of t h e exteroceptive over t h e interoceptive c u e s in learning. Therefore, it s e e m s to u s t h a t it might be worthwhile to explore t h e c o n s e q u e n c e s of a b a n d o n i n g t h e classical a s s u m p tion concerning t h e p r e s u m e d d o m i n a n c e of internal stimuli in t h e initial s t a t e of t h e infant. In fact, we hypothesize t h a t a t t h e beginning of life the perceptual system is set with a bias to attend to and explore the external world and builds representations primarily on the basis of exteroceptive stimuli. In t h i s view, t h e n , t h e set of internal—visceral a s well a s proprioceptive—cues t h a t a r e activated w h e n being in a n d expressing a n emotion state are, a t first, n o t perceived consciously by t h e infant, or, a t least, a r e n o t grouped together categorically in s u c h a m a n n e r t h a t they could be perceptually a c c e s s e d a s a distinctive emotion state. 4 This r a i s e s t h e question; How, on t h e b a s i s of this theory, does t h e infant develop a w a r e n e s s of a n d conie to r e p r e s e n t t h e s e t s of i n t e r n a l - s t a t e c u e s a s indicating categorically distinct

3 Note furthermore that'one cannot rule out the possibility that the position cues in Colombo et al.'s (1990) study, which were based on eye fixation, might have been computed on the basis of the position of the nose, which is, in fact, an exteroceptive cue, see Bower (1974). 4 As will become apparent, our proposal does not necessarily imply—while being compatible with—the more radical view that at the beginning of life infants are lacking any kind of awareness of their internal states. It is possible that the infant has some awareness of the component stimuli that belong to the groups of internal-state cues that are indicative of categorical emotions, but only as part of the "blooming, buzzing confusion" (W. James, 1890) of internal sense impressions he may experience. Such state cues may also contribute to the overall— positive or negative—hedonic quality of the infant's awareness. Our—less radical—suggestion is (a) that the groups of internal-state cues that are indicative of dispositional emotion states are initially not perceptually accessible as distinct feeling states, and (b) that the infant's perceptual system is at the start set with a bias to actively explore and categorize external rather than internal stimuli.

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emotion s t a t e s ? We propose t h a t t h e species-specific h u m a n propensity for t h e facial a n d vocal reflection of t h e infant's emotion-expressive displays d u r i n g affect-regulative interactions plays a crucial role in this developmental process. Below we identify a n u m b e r of significant developmental c o n s e q u e n c e s of t h e instinctive h u m a n inclination to expose infants to affectreflective behavioral displays d u r i n g emotion-regulative interactions. We also a r g u e t h a t all of t h e s e c o n s e q u e n c e s a r e mediated by t h e s a m e underlying m e c h a n i s m — n a m e l y , contingency detection a n d maximizing. Before describing o u r model, however, let u s briefly review t h e available empirical evidence on t h e role a n d n a t u r e of affect-regulative interactions d u r i n g emotional development in t h e first year of life.

EMOTIONAL DEVELOPMENT DURING T H E F I R S T YEAR OF LIFE During t h e last thirty y e a r s we h a v e w i t n e s s e d t h e a c c u m u l a t i o n of a large body of compelling evidence in developmental psychology t h a t h a s radically c h a n g e d o u r conceptualization of t h e initial state of t h e infant. While n o t so long ago t h e s t a n d a r d view held t h a t a t t h e beginning of life infants a r e basically passive, undifferentiated, diffuse o r g a n i s m s s u r r o u n d e d by a s t i m u l u s barrier (e.g., Mahler et al. 1975), it is now generally accepted t h a t they are equipped from t h e s t a r t with r e m a r k a b l y rich perceptual, learning, a n d r e p r e s e n t a t i o n a l capacities a n d specific p r e p a r e d n e s s for t h e s t r u c t u r e of t h e physical a n d social world a r o u n d t h e m (Bower 1974; E m d e 1988; Gergely 1992; Meltzoff 1990; S t e r n 1985). \ This c h a n g e of perspective h a s certainly also characterized recent r e s e a r c h on early emotional development ( E k m a n 1992a; E k m a n a n d Oster 1979; Izard 1977; Izard a n d Malatesta 1987; Malatesta et al. 1989; Tronick a n d C o h n 1989), w h i c h a s s u m e s a strong biosocial p r e p a r e d n e s s for emotion expression a n d emotional c o m m u n i c a t i o n in infancy. Following Darwin's (1872) early insight, recent c r o s s - c u l t u r a l r e s e a r c h o n facial emotion expressions (Ekman 1992b; E k m a n et al. 1972; Izard 1977,

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1978) h a s indicated t h a t t h e r e is a set of i n n a t e basic emotions— including, a t least, enjoyment, anger, fear, s a d n e s s , disgust, a n d s u r p r i s e — t h a t are expressed by t h e s a m e facial m u s c u l a r action p a t t e r n s a c r o s s c u l t u r e s a n d a r e universally recognized. Young infants h a v e b e e n reported to m a k e nearly all t h e m u s c l e movem e n t s t h a t a r e u s e d by a d u l t s to e x p r e s s t h e primary emotions ( E k m a n a n d Oster 1979; Oster 1978), a n d t h e facial expressions of interest, joy, disgust, surprise, a n d d i s t r e s s have b e e n identified in y o u n g b a b i e s (Izard 1978). Furthermore, t h e facial m u s c u l a r a c t i o n s involved in t h e expression of a t least some of t h e universal emotions have b e e n s h o w n in a d u l t s to generate specific a n d differential physiological a r o u s a l p a t t e r n s characteristic of t h e given emotion (Ekman et al. 1983). Based on findings s u c h a s these, n u m e r o u s psychologists e m b r a c e d t h e view t h a t basic emotions a r e i n n a t e dynamic behavioral organizations with adaptive functions, characterized by specific facial display p a t t e r n s t h a t a r e connected t h r o u g h prewired activation c h a n n e l s to differential physiological res p o n s e s t r u c t u r e s ( E k m a n 1992b; E k m a n a n d Oster 1979; Izard 1977, 1978; Izard a n d M a l a t e s t a 1987; Malatesta et al. 1989; Meltzoff a n d Gopnik 1993). F u r t h e r m o r e , t h e c u r r e n t l y d o m i n a n t biosocial view of emotional development holds t h a t m o t h e r a n d infant form a n affective c o m m u n i c a t i o n s y s t e m from t h e beginning of life (Beebe, Jaffe, a n d L a c h m a n n 1992; Bowlby 1969; Brazelton, Kowslowski, a n d Main 1974; Hobson 1993; S a n d e r 1970; S t e r n 1977, 1985; T r e v a r t h e n 1979; Tronick a n d C o h n 1989) in w h i c h t h e m o t h e r plays a vital interactive role in m o d u l a t i n g t h e infant's affective s t a t e s . While y o u n g infants do have some r u d i m e n t a r y m e a n s of affective self-regulation—such a s t u r n i n g away from overarousing stimuli or t h u m b - s u c k i n g (Demos 1986; Malatesta et al. 1989)—there is a g r e e m e n t t h a t t h e quality of m a t e r n a l interactions exerts a s t r o n g regulative influence on t h e infant's affective s t a t e c h a n g e s (Field 1994; Malatesta a n d Izard 1984, 1989; Tronick, Ricks, a n d C o h n 1982). Mothers a r e generally r a t h e r efficient in r e a d i n g their infants' emotion displays, a n d sensitive m o t h e r s t e n d to a t t u n e their own affective r e s p o n s e s to m o d u l a t e their infants' emotional s t a t e s (Malatesta et al. 1989; Tronick a n d C o h n 1989). There is also some evidence t h a t in-

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fants c a n perceptually differentiate a t least some facial emotion expressions early in life (Field et al. 1983; Malatesta a n d Izard 1984), t h o u g h w h e t h e r t h e b a s i s of this discrimination is t h e full expressive p a t t e r n s e e m s questionable before 4 m o n t h s of age (see C. Nelson 1987). S t u d i e s u s i n g t h e still-face p r o c e d u r e (Tronick, Als, A d a m s o n , Wise, a n d Brazeltoh 1978) or delayedfeedback t e c h n i q u e s (Murray a n d T r e v a r t h e n 1985; see also Nadel, C a r c h o n , Kervella, Marcelli, a n d Reserbat-Plantey 1999; Bigelow a n d DeCoste, in press) suggest t h a t y o u n g infants a r e sensitive to t h e contingency s t r u c t u r e of face-to-face interaction a n d , a t least after 3 m o n t h s of age, a r e actively s e a r c h i n g to reestablish s u c h a .pattern of c o m m u n i c a t i o n w h e n being abruptly deprived of it. By u s i n g time-based microanafytic m e t h ods (e.g., G o t t m a n 1981) to e x a m i n e t h e s t r u c t u r e of face-to-face interactions, several r e s e a r c h e r s provided evidence for t h e early existence of bidirectional influence of behavior a n d m u t u a l regulation of affective c o m m u n i c a t i o n between m o t h e r s a n d infants (Beebe, Jaffe, Feldstein, Mays, a n d Alson 1985; Beebe a n d Lachm a n n 1988; C o h n a n d Tronick 1988; Tronick, Als, a n d Brazelton 1977; Tronick a n d C o h n 1989). Bytfie age of 6 m o n t h s , infants' emotional expressions are already well organized a n d are systematically related to environmental events (Weinberg a n d Tronick 1996). There is evidence t h a t imitative m a t c h i n g activity is frequent d u r i n g m o t h e r - i n f a n t interactions (Uzgiris, B e n s o n , Kruper, a n d Vasek 1989), a n d m o t h e r - i n f a n t p a i r s h a v e b e e n s h o w n to increase their degree of coordination in t e r m s of m a t c h ing a n d s y n c h r o n y with infant age (Tronick a n d C o h n 1989). Maternal imitative behavior h a s b e e n s h o w n to evoke more smiling a n d vocalization t h a n nonimitative r e s p o n s e s in 3Vfe-monthold b a b i e s (Field, Guy, a n d Umbel 1985). A n u m b e r of infant r e s e a r c h e r s (e.g., Beebe a n d L a c h m a n n 1988; P a p o u s e k a n d P a p o u s e k 1987, 1989; S t e r n 1985; Trevart h e n 1979; Tronick et al. 1982) h a v e proposed t h a t facial and vocal mirroring of affective behavior m a y be a central feature of p a r e n t a l affect-regulative interactions d u r i n g t h e first year. In line with t h i s view, it h a s b e e n reported (Malatesta, Culver, T e s m a n , a n d S h e p a r d 1989; Malatesta a n d Izard 1984) t h a t m o t h e r s react with differential facial a t t u n e m e n t s to infants' emotion expressions, a n d are m o r e likely to imitate their b a b y ' s

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categorical emotion displays t h a n their more "random" facial m o v e m e n t s — s u c h a s twitches or half-smiles. Infants' expressions of s a d n e s s a n d a n g e r h a v e b e e n observed to p r o d u c e affective r e s p o n s e s of s a d n e s s a n d a n g e r in their m o t h e r s (Tronick 1989), a n d m a t e r n a l r e a c t i o n s to negative affect include mock e x p r e s s i o n s of negative affect (Malatesta a n d Izard 1984). R e s e a r c h on t h e facial a n d vocal interaction between dep r e s s e d m o t h e r s a n d their infants (Bettes 1988; Cohn, Matias, Tronick, Connell, a n d Lyons-Ruth 1986; Tronick 1989) h a s s h o w n t h a t t h e r e is a d e c r e a s e in t h e n u m b e r of contingent affective i n t e r a c t i o n s a s well a s more i n t r u s i v e n e s s a n d more negative affect expression on t h e p a r t of t h e mother. F u r t h e r more, s u c h infants' affective a n d regulatory reactions a s well a s their later security of a t t a c h m e n t h a v e b e e n found to be related to t h e affect a n d behavior of their d e p r e s s e d m o t h e r s (Field 1994; Field et al. 1988; M u r r a y 1992; Pickens a n d Field 1993; Tronick 1989). In general, s u c h findings s e e m to s u p p o r t t h e view of psychoanalytic t h e o r i s t s w h o h a v e long identified t h e m a t e r n a l mirroring function a s a n i m p o r t a n t c a u s a l factor in early emotional a n d personality development (e.g., Bion 1962a, 1962b; J a c o b son 1964; P. F. K e m b e r g 1984; Kohut 1971, 1977; Mahler a n d McDevitt 1982; Mahler et al. 1975; Winnicott 1967). However, t h e exact n a t u r e of t h e c a u s a l m e c h a n i s m mediating s u c h effects h a s n o t yet b e e n identified. In s u m , t h e reviewed findings indicate t h a t infants d u r i n g their first y e a r of life [a] s h o w a n i n n a t e t e n d e n c y to express their emotion s t a t e s automatically, (b) a r e sensitive to t h e contingency s t r u c t u r e of face-to-face affective c o m m u n i c a t i o n , (c) c a n discriminate, discrete facial p a t t e r n s of emotion expression, (d) are, to a large extent, d e p e n d e n t on their p a r e n t ' s affect-regulative interactions a s a m e a n s of emotional self-regulation, a n d (e) t h e quality of their affective s t a t e s a n d their emerging self-regulative reactions a r e strongly influenced by t h e characteristics of their p a r e n t s ' affective communicative behavior. Toward t h e end of t h e first year, however, o n e c a n w i t n e s s t h e e m e r g e n c e o f a set of qualitatively n e w communicative behavioral c o m p e t e n c i e s that, s e e m to indicate a n e w level of emotional a w a r e n e s s a n d control a s well a s t h e beginning of u n d e r s t a n d -

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ing, attributing, a n d r e a s o n i n g a b o u t emotional s t a t e s . O n e of t h e first signs of voluntary control over emotion expressions is shown by t h e behavior of avoidant (A-type) infants in t h e S t r a n g e Situation (Ainsworth et al. 1978) a t 1 year of age. T h e s e b a b i e s seem to s u p p r e s s t h e a u t o m a t i c expression of separation-induced negative affect, w h o s e p r e s e n c e is indicated by a n increase in h e a r t r a t e (Sroufe a n d W a t e r s 1977b) a s well a s in Cortisol level (Spangler a n d G r o s s m a n n 1993). There is also evidence (Demos 1986; Malatesta et al. 1989) of some degree of affect m o d u l a t i o n t h r o u g h control of facial m u s c u l a t u r e emerging d u r i n g t h e second year of life. Another early form of i n s t r u m e n t a l self-regulation of affective behavior is indicated by t h e emergence of social referencing by t h e e n d of t h e first year (e.g., C a m p o s a n d S t e n b e r g 1981; Klinhert et al. 1983). At t h i s time infants w h o find t h e m s e l v e s in a n a m b i g u o u s situation a n d c a n n o t decide a m o n g several behavioral a l t e r n a t i v e s ^ s u c h a s w h e t h e r or n o t to crawl a c r o s s a visual cliff to their m o t h e r — t e n d to e x a m i n e their p a r e n t ' s facial emotion display a n d u s e t h e emotional information expressed to m o d u l a t e their own behavior. T h e exact m e c h a n i s m underlying social referencing is a s yet u n c l e a r . A n u m b e r of different i n t e r p r e t a t i o n s have b e e n proposed. Some would prefer to explain t h e p h e n o m e n o n a s a simple c a s e of o p e r a n t conditioning (Barresi a n d Moore 1996; Gewirtz a n d Pelaez-Nogueras 1992; Moore a n d C o r k u m 1994), while o t h e r s a r g u e t h a t it is o n e of t h e first signs of t h e infant's emerging theory of m i n d a s it involves inferring a n d a t t r i b u t i n g a m i n d s t a t e to t h e p a r e n t (Bretherton 1991a; S t e r n 1985). It s e e m s also possible t h a t t h e infant, w h o is by now well-trained in emotion-regulative mirroring interactions, is actively seeking o u t a clarifying affect-mirroring c u e from t h e p a r e n t t h a t will s t r e n g t h e n a n d bring one of h i s c u r r e n t conflicting emotion s t a t e s to d o m i n a n c e , t h e r e b y resolving h i s indecision. This would b e a n interesting case of active i n s t r u m e n t a l u s e of p a r e n t a l emotional c o m m u n i c a t i o n for selfregulative p u r p o s e s . Social referencing a p p e a r s s i m u l t a n e o u s l y with other novel forms of intentional c o m m u n i c a t i o n involving t h e v o l u n t a r y m a nipulation of t h e other's attentional s t a t e (Bretherton a n d B a t e s 1979; Bates, Benigni, Bretherton, Camaioni, a n d Volterra 1979;

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Carpenter, Nagell, a n d Tomasello 1998; Moore a n d C o r k u m 1994; M u r p h y a n d Messer 1977; Tomasello 1995, 1999). These include pointing a n d gaze-following a s well a s protodeclarative g e s t u r e s s u c h a s object-showing. T h e emerging ability a t t h e e n d of t h e first year to r e a s o n a b o u t behavior o n t h e b a s i s of a n a t t r i b u t e d emotion s t a t e is d e m o n s t r a t e d by a s t u d y by Spelke, Phillips, a n d Woodward (1995), w h o showed t h a t while 8 - m o n t h - o l d s were n o t yet able to infer a p e r s o n ' s next behavior on t h e b a s i s of h e r gaze direction a n d facial emotion expression, 12-month-old infants could alr e a d y do so. T h u s , 1-year-old b a b i e s are n o t only able to discriminate discrete emotion expressions of others, b u t are also able to m a k e inferences on t h e b a s i s of t h e dispositional content of t h e emotion displayed. It seems, therefore, t h a t by t h e e n d of t h e first year infants c a n already do s o m e t h i n g more t h a n simply "be in" a n emotion s t a t e a n d react in a n affective way to other people's emotion displays: t h e y a r e able to a t t r i b u t e emotions to o t h e r s a n d u s e t h a t information to r e a s o n a b o u t their behavior. This s e e m s to imply t h a t infants a r e already able to r e p r e s e n t t h e dispositional c o n t e n t of a t least s o m e basic-emotion s t a t e s in a cognitively accessible form. We w i s h to a r g u e t h a t t h i s level of r e p r e s e n t a tion of emotions is qualitatively different from t h e primary-level, implicit, p r o c e d u r a l r e p r e s e n t a t i o n s of prewired a u t o m a t i s m s of t h e b a s i c emotions.

LEVELS OF REPRESENTATIONS OF SELF-STATES: AUTOMATIC V E R S U S CONTROLLED P R O C E S S E S There a r e a n u m b e r of dichotomies in cognitive theory, s u c h a s t h e p r o c e d u r a l / d e c l a r a t i v e , implicit/explicit, u n c o n s c i o u s / conscious, or a u t o m a t i c / c o n t r o l l e d distinctions (e.g., KarmiloffSmith 1992; Shiffrin a n d S c h n e i d e r 1977), t h a t refer to qualitatively different levels of information r e p r e s e n t a t i o n in h u m a n s . Automatized processes refer to prewired or overlearned struct u r e s of behavioral organization in w h i c h information is repre-

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sented implicitly, e m b e d d e d in procedures, a n d is unavailable to other representational s y s t e m s of t h e m i n d . S u c h a u t o m a t i s m s are inflexible a n d perceptually driven, a n d t h e y operate outside consciousness. In c o n t r a s t , deliberative or controlled processes refer to voluntary a n d c o n s c i o u s operations t h a t a r e flexible a n d modifiable, c a n be governed by higher-order cognitive goals, a n d c a n override a u t o m a t i s m s . In this framework, t h e infant's p r i m a r y emotions c a n be conceived of a s prewired, stimulus-driven, d y n a m i c behavioral a u t o m a t i s m s over w h i c h h e h a s n o control at first. Affect regulation is carried o u t mainly by t h e caregiver who, reading t h e infant's a u t o m a t i c emotion expressions, r e a c t s to t h e m with a p p r o p r i a t e affect-modulating interactions. In t h i s view, emotional self-control will become possible with t h e e s t a b l i s h m e n t of secondary control structures t h a t (a) monitor, detect, a n d evaluate t h e primary-level d y n a m i c affective - s t a t e c h a n g e s of t h e organism, a n d (b) c a n inhibit or modify t h e emotional reaction if t h e anticipated a u t o m a t i c affective r e s p o n s e would jeopardize higher-order cognitive plans. Therefore, a precondition for t h e v o l u n t a r y control a n d selfregulation of primary affective s t a t e s is t h a t t h e level of deliberative p r o c e s s e s b e informed a b o u t t h e ongoing dispositional s t a t e c h a n g e s of t h e o r g a n i s m t h a t t a k e place a t t h e level of a u t o m a tized processes. Within t h i s framework, consciously felt emotions c a n be conceived of a s signals t h a t inform t h e level of deliberative p r o c e s s e s a b o u t t h e a u t o m a t i c affective s t a t e c h a n g e s of t h e organism. As t h e s e c o n d a r y r e p r e s e n t a t i o n s of p r i m a r y affect s t a t e s become established, t h e y will be subject to a p r o c e s s of r e p r e s e n tational elaboration a s a r e s u l t of t h e learning p r o c e s s e s linking emotion expressions with types of s i t u a t i o n s a n d characteristic behavioral o u t c o m e s . At this point, t h e dispositional c o n t e n t of emotions, w h i c h comes to be encoded in t h e s e c o n d a r y representational s t r u c t u r e s , b e c o m e s cognitively accessible a n d c a n serve a s t h e b a s i s for action prediction w h e n t h e emotion s t a t e is attributed to t h e self or t h e other. As we develop below o u r a c c o u n t of t h e v a r i o u s functions served by-parental mirroring of affects, we propose t h a t mirror-

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ing also plays a n i m p o r t a n t c a u s a l role in t h e e s t a b l i s h m e n t of s e c o n d a r y emotion r e p r e s e n t a t i o n s by t h e e n d of t h e first year of life.

T H E SOCIAL BIOFEEDBACK MODEL OF PARENTAL AFFECT-MIRRORING Earlier we hypothesized t h a t t h e internal-state c u e s t h a t are activated w h e n being in a n emotion state a r e initially n o t perceived consciously or, a t least, do n o t form a categorical g r o u p t h a t could be perceptually a c c e s s e d a s a distinctive emotion s t a t e . Now we wish to p r o p o s e t h a t t h e repetitive p r e s e n t a t i o n of a n external reflection of t h e infant's affect-expressive displays serves a vital "teaching" function t h a t r e s u l t s in g r a d u a l sensitization to t h e relevant i n t e r n a l - s t a t e c u e s a s well a s to t h e identification of t h e correct set of i n t e r n a l stimuli t h a t corres p o n d to t h e distinctive emotion category t h a t t h e b a b y is in. As a r e s u l t of t h i s p r o c e s s t h e infant will eventually come to develop a n a w a r e n e s s of t h e distinctive internal c u e s t h a t are indicative of categorical emotion s t a t e s a n d will b e c o m e able to detect a n d r e p r e s e n t h i s p a r t i c u l a r dispositional emotion s t a t e s . O n e may, of course, a s k in w h a t way t h e p r e s e n t a t i o n of a n external emotion display t h a t is contingent o n t h e b a b y ' s on-line i n t e r n a l affect s t a t e would lead to t h e sensitization to a n d recognition of t h e internal s t a t e t h a t w a s n o t consciously accessible before. F u r t h e r m o r e , is t h e r e a n y evidence t h a t would indicate t h a t s u c h externally i n d u c e d sensitization to internal s t a t e s is possible? In fact, we c a n point to a t least one intriguing example of s u c h a process, w h i c h s h o w s a high degree of family resemb l a n c e to t h e c u r r e n t proposal, n a m e l y biofeedback training procedures (e.g., Dicara 1970; Miller 1969, 1978). In s u c h s t u d ies c o n t i n u o u s m e a s u r e m e n t s are m a d e of t h e ongoing s t a t e c h a n g e s of some internal s t i m u l u s s t a t e to w h i c h t h e subject initially h a s n o direct p e r c e p t u a l access, s u c h a s blood p r e s s u r e . T h e i n t e r n a l - s t a t e c h a n g e s are m a p p e d onto a n external s t i m u -

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l u s equivalent directly observable to t h e subject, t h e s t a t e of which covaries with t h a t of t h e i n t e r n a l s t i m u l u s . Repeated exposure to s u c h a n externalized r e p r e s e n t a t i o n of t h e internal state eventually r e s u l t s in sensitization to—and in certain c a s e s s u b s e q u e n t control over—the internal state. We hypothesize t h a t t h e psychological m e c h a n i s m involved in affect-mirroring is t h e s a m e p r o c e s s a s t h a t d e m o n s t r a t e d in biofeedback training p r o c e d u r e s . O u r proposal is t h a t p a r e n t a l affect-mirroring provides a kind of natural social biofeedback training for t h e infant t h a t plays a crucial role in emotional development, a n d t h a t t h e underlying learning m e c h a n i s m t h a t m e d i a t e s t h e influence of b o t h affect-mirroring a n d biofeedback training is t h a t of contingency detection and contingency maximizing [see Gergely a n d W a t s o n 1996, 1999; see also Lewicka 1988; W a t s o n 1972, 1979, 1985, 1994). Before developing this h y p o t h e s i s in detail, let u s , therefore, briefly s u m m a r i z e w h a t is k n o w n a b o u t t h e m e c h a n i s m of contingency detection a n d its role in infant development.

THE CONTINGENCY-DETECTION MODULE: CONTINGENCY ANALYSIS AND MAXIMIZING IN INFANCY N u m e r o u s s t u d i e s h a v e d e m o n s t r a t e d t h a t y o u n g infants are highly sensitive to t h e contingent relations b e t w e e n their physical r e s p o n s e s a n d c o n s e q u e n t s t i m u l u s events (e.g., Bahrick and W a t s o n 1985; Field 1979; Lewis, Allessandri, a n d Sullivan 1990; Lewis a n d B r o o k s - G u n n 1979; P a p o u s e k a n d P a p o u s e k 1974; Rochat a n d Morgan 1995; W a t s o n 1972, 1994). For example, W a t s o n (1972) h a s s h o w n t h a t 2 - m o n t h - o l d s i n c r e a s e their rate of leg kicking w h e n it r e s u l t s in a contingent event (the movem e n t of a mobile), b u t n o t w h e n t h e y experience a similar b u t n o n c o n t i n g e n t event. In fact, t h e detection of c a u s a l control over t h e mobile's m o v e m e n t proved positively a r o u s i n g for t h e s e infants. After some experience with t h e contingency, t h e y started to smile a n d coo a t t h e contingent mobile. In a similar paradigm, Lewis a n d colleagues (1990) also d e m o n s t r a t e d t h a t w h e n 2-

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m o n t h - o l d s detect t h a t their previously experienced contingent control over a s t i m u l u s event n o longer holds, t h e y e x p r e s s frustration a n d distress. How do y o u n g infants perceive r e s p o n s e - s t i m u l u s contingencies so efficiently? Based on W a t s o n ' s extensive s t u d i e s (Watson 1979, 1985, 1994), Gergely a n d W a t s o n (1999) have recently proposed t h e existence of a n i n n a t e contingency-detection module t h a t a n a l y s e s t h e probability s t r u c t u r e of contingent relations between r e s p o n s e s a n d s t i m u l u s events. W a t s o n (1979, 1994) h a s provided evidence t h a t t h e infant's contingency-detection device applies two i n d e p e n d e n t m e c h a n i s m s for analyzing t h e conditional probability s t r u c t u r e of contingent r e s p o n s e - s t i m u lus events: o n e looks forward in time, registering t h e conditional probability of a n u p c o m i n g s t i m u l u s event a s a function of a n emitted r e s p o n s e , called t h e "sufficiency index," while t h e other tests b a c k w a r d in time, monitoring t h e relative likelihood t h a t a given s t i m u l u s event w a s preceded by a given response, called the "necessity index." The two s e p a r a t e indices estimate two a s p e c t s of t h e contingency relation t h a t c a n vary independently of e a c h other, providing a scale of different m a g n i t u d e s of contingent r e l a t e d n e s s . To illustrate: imagine t h a t t h e infant's right leg is a t t a c h e d by a string to a mobile, w h i c h moves whenever t h e b a b y kicks with his leg. T h u s , t h e conditional probability of t h e infant's r e s p o n s e resulting in t h e s t i m u l u s event is 1.0 (sufficiency index). If t h e mobile always moves w h e n t h e infant kicks b u t never in t h e a b s e n c e of a kick (which m a k e s t h e "necessity index" also 1.0), the infant is in perfect contingent control over t h e mobile's movements. Imagine, however, t h a t half of t h e mobile's movem e n t s are i n d u c e d b y t h e wind or by t h e experimenter, w h o h a s a n o t h e r string a t t a c h e d to t h e mobile. In this case, checking backward in time for t h e p r e s e n c e of a leg kick preceding t h e mobile's m o v e m e n t will p r o d u c e only a conditional probability of 0.5 (necessity index), while t h e sufficiency index will r e m a i n perfect a t 1.0. T h u s , even t h o u g h t h e infant's r e s p o n s e continues to be fully effective in bringing a b o u t t h e s t i m u l u s event, h i s overall degree of control over t h e mobile's m o v e m e n t s is reduced. Such a s i t u a t i o n is, in fact, r a t h e r typical of t h e baby's relation-

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ship to h i s social environment: even t h e m o s t responsive p a r e n t will n o t be able to pick u p t h e b a b y ( s t i m u l u s event) every time t h e infant cries (response) (thus reducing sufficiency), a n d t h e r e will be occasions w h e n s h e picks t h e b a b y u p even t h o u g h he w a s not crying (which r e d u c e s necessity). We need one m o r e piece of information a b o u t t h e workings of t h e contingency-detection m o d u l e before we c a n t u r n b a c k to t h e question of affect-mirroring. W a t s o n (1979) a r g u e d t h a t w h e n ever t h e two indices of contingent control are u n e q u a l , it is always possible t h a t t h e infant h a s failed to detect t h e t r u e degree of control he h a s over t h e s t i m u l u s event. Imagine, for example, t h a t t h e r e s p o n s e class t h a t t h e infant is monitoring is "kicking with either leg." Let u s a s s u m e , however, t h a t the mobile is tied to t h e b a b y ' s right leg only a n d so it moves whenever t h e infant kicks with h i s right leg b u t does n o t move otherwise. Given t h a t t h e infant kicks equally frequently with either leg, h e would find t h a t a leg kick r e s u l t s in mobile movem e n t only half of t h e time, setting t h e sufficiency index a t 0.5. The necessity index, however, will b e 1.0, since every mobile m o v e m e n t is preceded by a (right-) leg kick. Therefore, whenever t h e necessity index is higher t h a n the sufficiency index, it is always possible t h a t t h e r e s p o n s e class monitored is too wide, a n d by r e d u c i n g it t h e infant m a y discover t h a t he is exerting m o r e control over t h e s t i m u l u s event t h a n previously estimated. In o u r example, if t h e infant goes on to r e d u c e t h e r e s p o n s e class examined to t h a t of "kicking with the right leg," h e will raise t h e sufficiency index higher, a n d t h e two indices will m a t c h , indicating perfect control over t h e mobile's movements. In general, t h e n , whenever t h e necessity index is h i g h e r t h a n t h e sufficiency index, it is a good strategy for t h e infant to reduce t h e r e s p o n s e class examined in order to discover t h e maximal degree of contingent control h e actually h a s over t h e s t i m u l u s event. (This w o r k s in t h e opposite direction a s well: w h e n t h e sufficiency index is higher t h a n t h e necessity index, it is n e c e s s a r y to e x p a n d t h e r e s p o n s e class examined to maximize t h e contingency.) W a t s o n (1979) a r g u e s t h a t t h e infant may, in fact, be able to apply s u c h a fancy contingency-maximizing strategy by actively

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experimenting with r e d u c i n g or extending t h e r e s p o n s e category examined a s a function of t h e u n e q u a l degree of contingent control indicated by t h e sufficiency v e r s u s t h e necessity index. His finding t h a t t h e r a t e of r e s p o n d i n g is highest w h e n b o t h t h e sufficiency a n d t h e necessity index a r e reasonably high a n d equal is in line with t h i s hypothesis. (For further details of t h e contingency-detection a n d -maximizing model a n d t h e s u p p o r t ing evidence, see Gergely a n d W a t s o n 1996; W a t s o n 1972, 1979, 1994.) Up to n o w we have described t h e workings of t h e contingency-detection m o d u l e only in relation to temporal contingency. However, t h o u g h m u c h of t h e evidence for t h i s m e c h a n i s m h a s come from s t u d y i n g p u r e l y t e m p o r a l contingencies, t h e r e are, in fact, t h r e e s e p a r a t e a n d i n d e p e n d e n t b a s e s of contingency: temporal sensory relational (relative intensity), a n d spatial (similarity of spatial distribution or pattern) (Watson 1984). This is especially relevant w h e n we consider t h e case of affect-mirroring (see below), a s s u c h p a r e n t a l displays are contingently related to the infant's emotion-expressive behavior n o t only in t e r m s of temporal contingency, b u t also in t e r m s of relative intensity a n d similarity of p a t t e r n . (See also S t e i n ' s 1984, 1985, views on "affect a t t u n e m e n t , " w h i c h we critically d i s c u s s below.) Correspondingly, Gergely a n d W a t s o n (1999) a r g u e t h a t t h e contingency-detection m o d u l e is a n analytic device t h a t a t its input end m o n i t o r s for a n d t h e n registers all the three parameters of contingency in parallel a n d c o m p u t e s a s its o u t p u t a n overall value indicating t h e e s t i m a t e d degree of causal relatedness between r e s p o n s e s a n d stimuli. There is converging evidence t h a t infants u s e all t h r e e informational b a s e s in contingency detection. (For a review, see Gergely a n d W a t s o n 1999, pp. 103-107.)

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T H E DEVELOPMENTAL FUNCTIONS OF CONTINGENCY DETECTION Differentiation of t h e Self W a t s o n (1994, 1995) proposed t h a t one of t h e p r i m a r y functions of t h e contingency-detection m e c h a n i s m is self-detection. One's motor actions p r o d u c e stimuli t h a t a r e necessarily perfectly response-contingent (e.g., w a t c h i n g one's h a n d s a s o n e is moving them), while t h e perception of stimuli e m a n a t i n g from the external world typically s h o w a lesser degree of response-contingency. Therefore, t h e detection of t h e degree of contingency between efferent (motor) activation p a t t e r n s a n d consequently perceived stimuli m a y serve a s t h e original criterion for disting u i s h i n g t h e self from t h e external world. In a seminal s t u d y Bahrick a n d W a t s o n (1985; see also Rochat a n d Morgan 1995; S c h m u c k l e r 1996) h a v e d e m o n s t r a t e d t h a t infants c a n u s e their perception of perfect contingency between their physical actions a n d t h e c o n s e q u e n t feedback for selfdetection a n d self-orientation a s early a s a t 3 m o n t h s of age. In a series of e x p e r i m e n t s 5- a n d 3-month-old infants were seated on a high chair in front of two m o n i t o r s in s u c h a way t h a t they could freely move their legs. O n e monitor p r e s e n t e d a live image of t h e subject's moving legs, providing a visual s t i m u l u s t h a t w a s perfectly contingent with t h e infant's r e s p o n s e s . T h e other monitor p r e s e n t e d a previously recorded image of t h e infant's moving legs, w h i c h w a s , therefore, not contingent with t h e b a b y ' s p r e s e n t movements. Five-month-olds clearly differentiated between the two displays, looking significantly m o r e a t t h e noncontingent image. A n u m b e r of other preferential looking s t u d i e s (Lewis a n d B r o o k s - G u n n 1979; P a p o u s e k a n d P a p o u s e k 1974; Rochat a n d Morgan 1995; S c h m u c k l e r 1996) in w h i c h t h e live image of the self w a s c o n t r a s t e d with t h e moving b u t n o n c o n t i n g e n t image of a n o t h e r b a b y also indicate t h a t 4- to 5-month-old infants differentiate self from other on t h e b a s i s of r e s p o n s e - s t i m u l u s contingencies a n d prefer to fixate away from t h e self. Interestingly, Bahrick a n d W a t s o n (1985) found t h a t for 3-month-olds t h e distribution of preference w a s significantly

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bimodal: o n e s u b g r o u p preferred t h e perfectly contingent image, w h e r e a s t h e other preferred t h e n o n c o n t i n g e n t image. Field (1979) also reported a preferential visual orientation in h e r s a m ple of 3 - m o n t h - o l d s toward t h e perfectly contingent self-image a s opposed to a n o n c o n t i n g e n t image. Piaget's (1936) observation t h a t d u r i n g t h e first m o n t h s of life cyclic repetitions of actions on the self, w h i c h h e called "primary circular reactions," d o m i n a t e also s u g g e s t s a n initial p h a s e of preoccupation with perfect r e s p o n s e - s t i m u l u s contingencies. Based o n s u c h data, W a t s o n (1994, 1995) proposed t h a t d u r i n g t h e first two to t h r e e m o n t h s the contingency-detection m o d u l e is genetically set to seek o u t a n d explore perfectly r e s p o n s e - c o n t i n g e n t stimulation. W a t s o n hypothesizes t h a t t h i s initial attention b i a s serves t h e evolutionary function of developing a primary representation of the bodily self a s a distinct object in t h e e n v i r o n m e n t by identifying t h o s e stimuli t h a t a r e t h e n e c e s s a r y sensory c o n s e q u e n c e s of t h e body's motor actions a n d over w h i c h t h e infant exercises perfect control. Referring to t h e r e s u l t s of connectionist simulations teaching a c o m p u t e r net to guide a m e c h a n i c a l a r m in a c c u r a t e reaching for objects ( J o r d a n a n d R u m e l h a r t 1991), W a t s o n (1995) s u g g e s t s t h a t a n initial p h a s e of self-seeking behavior may be a n e c e s s a r y p r e p a r a t o r y stage for t h e later capacity to cope with t h e environment.

Orientation toward Social Objects Watson (1994) further hypothesized t h a t a t a r o u n d 3 m o n t h s , d u e to m a t u r a t i o n a l factors, t h e preferred target value of t h e contingency-detection m e c h a n i s m is "switched" to high but imperfect degrees of (social) contingencies typically provided by t h e reactions of a t t a c h m e n t figures a t t u n e d to t h e infants' affectivecommunicative displays. In s u p p o r t of t h i s hypothesis, in further studies W a t s o n (1979, 1985) d e m o n s t r a t e d t h a t w h e n tested on a range of different degrees of contingencies, 4- to 6 - m o n t h - o l d s were m o s t motivated to engage moderately high contingencies while failing with very low or near-perfect contingency magnitudes. T h e hypothesized "switch" a t 3 m o n t h s resulting in a n

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attention b i a s toward h i g h b u t imperfect contingencies also acc o u n t s for t h e avoidance of t h e perfectly contingent self-image after 3 m o n t h s in Bahrick a n d W a t s o n ' s (1985) older g r o u p of 5m o n t h - o l d s a n d t h e other s u b g r o u p of their 3 - m o n t h - o l d s (whose contingency "switch" h a s already b e e n reset). This m a t u r a t i o n a l change functions to orient t h e infant after 3 m o n t h s of age away from self-exploration (perfect contingencies) a n d toward the exploration and representation of the social world a s p r e s e n t e d by t h e (necessarily less-than-perfectly response-contingent) p a r e n tal environment.

CONTINGENCY DETECTION A S T H E MECHANISM UNDERLYING BIOFEEDBACK TRAINING AND PARENTAL AFFECT-MIRRORING We propose t h a t one of t h e functions of t h e contingency-detection m e c h a n i s m outlined above is to m e d i a t e t h e sensitization to internal-state c u e s t h a t is b r o u g h t a b o u t a s a r e s u l t of biofeedb a c k training (Dicara 1970; Miller 1969, 1978). In biofeedback, subjects are i n s t r u c t e d to try to m o n i t o r for a n internal target state—say, blood p r e s s u r e — w h o s e state c h a n g e s a r e contingently related to t h e p r e s e n c e or a b s e n c e of a n externally pres e n t e d s t i m u l u s equivalent. C h a n g e s in t h e target s t a t e will result in a set of c o n s e q u e n t c h a n g e s in t h e subject's internal (interoceptive a n d proprioceptive) s t a t e s a n d will possibly induce peripheral, externally perceptible s t a t e c h a n g e s a s well. This set of internal a n d external s t i m u l u s c u e s will exhibit contingent variation n o t only with t h e internal target s t a t e t h a t is c a u s i n g them, b u t also with t h e external feedback s t i m u l u s t h a t covaries with t h e internal target state. Let u s a s s u m e t h a t whenever the external feedback cue is on, t h e subject will carry o u t a contingency analysis b a c k w a r d in time (the necessity index) s c a n n i n g for t h e p r e s e n c e of internal a n d .behavioral r e s p o n s e s t h a t were p r e s e n t before t h e o n s e t of t h e "teaching" s t i m u l u s — t h a t is, the external biofeedback cue. F u r t h e r m o r e , t h e subject will also monitor for t h e contingent effects of t h e s a m p l e d set of internalr a n d external-state c u e s forward in time (the sufficiency index),

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testing to w h a t degree t h e y predict t h e a p p e a r a n c e of t h e external biofeedback s t i m u l u s . By gradually expanding or reducing t h e set of s t a t e c u e s considered to be associated with t h e target state a s a function of t h e direction of inequality between t h e necessity v e r s u s t h e sufficiency indices of contingent control (contingency maximizing), t h e subject will eventually identify t h e set of internal a n d e x t e r n a l - s t a t e c u e s t h a t s h o w t h e h i g h e s t degree of contingent variation with t h e biofeedback cue a n d , by association, with t h e i n t e r n a l target s t a t e a s well. As a result, t h e subject will eventually b e c o m e sensitive to a n d learn to g r o u p together t h o s e (internal a n d external) s t a t e c u e s whose combined p r e s e n c e is indicative of t h e c h a n g e in t h e internal target state a n d so will b e c o m e able to detect a n d a t t r i b u t e t h e presence of t h e i n t e r n a l s t a t e to himself. Similarly, we hypothesize t h a t t h e developmental p r o c e s s leading to sensitization to a n d categorization of emotion s t a t e cues in t h e self a s a function of p a r e n t a l affect-mirroring is also mediated by t h e contingency-detection module. The o n s e t of a n emotion s t a t e in t h e b a b y will r e s u l t in two types of a u t o m a t i c s t i m u l u s c o n s e q u e n c e s : (a) It will i n d u c e a set of internal physiological s t a t e c h a n g e s , (b) It will trigger t h e expressive behavioral display of t h e emotion category. T h e activation of t h e emotionexpressive display behaviors will p r o d u c e a further set of internal (proprioceptive) stimuli t h a t s h o w contingent variation with the internal target state. Some of t h e s e s t i m u l u s cues, w h e n considered in isolation, will have a relatively low degree of predictive validity in relation to t h e target s t a t e a s t h e y m a y be evoked by t h e p r e s e n c e of other i n t e r n a l s t a t e s a s well. However, t h e r e is evidence ( E k m a n 1992b; E k m a n et al. 1983; Izard a n d Malatesta 1987) indicating t h a t t h e r e is a set of basic-emotion s t a t e s t h a t i n d u c e t h e activation of distinctive p a t t e r n s of internal-state c u e s a s well a s a distinctive configuration of expressive behavioral cues. Therefore, t h e predictive validity of t h e s e c u e s w h e n combined a s a group is highly indicative of t h e p r e s e n c e of t h e underlying emotion state. However, a s we hypothesized earlier, infants are initially u n a w a r e of t h e categorical s e t s of i n t e r n a l - s t a t e c u e s in question. Therefore, to achieve t h e capacity to detect a n d attribute their i n t e r n a l emotion s t a t e s to themselves, they m u s t

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become sensitive to a n d categorize together t h e relevant g r o u p of internal-state c u e s t h a t covary with t h e internal dispositional state. It is this learning p r o c e s s that, according to t h e p r e s e n t hypothesis, is m a d e possible by t h e p a r e n t ' s intuitive provision of a state-contingent external biofeedback c u e in t h e form of t h e e m p a t h i c reflection of t h e infant's state-expressive emotion displays. In this view, t h e p a r e n t who—unlike t h e infant—is able to read a n d interpret t h e b a b y ' s affect-expressive facial, vocal, or p o s t u r a l emotion displays will p r o d u c e affect-modulating interactive behaviors t h a t will include t h e r e p e a t e d p r o d u c t i o n of a n external reflection of t h e affect-expressive displays of t h e baby. This interactive p r o c e s s c a n be conceived of a s a c a s e of intuitive i n s t r u c t e d learning in w h i c h t h e "teacher" role is played by t h e repeated p r e s e n t a t i o n of t h e p a r e n t ' s affect-reflective emotion expression t h a t is contingent o n t h e p r e s e n c e of t h e dispositional emotion s t a t e in t h e infant. 5 T h u s , we a s s u m e t h a t perceiving t h e p a r e n t ' s affect-mirroring emotion expression, t h e b a b y will s t a r t to apply t h e contingencydetection algorithm b a c k w a r d in time (the necessity index) to identify w h i c h of h i s i n t e r n a l a n d behavioral r e s p o n s e s preceded t h e onset of t h e p a r e n t ' s affect-mirroring display. T h e infant will also examine t h e contingent c o n s e q u e n c e s of t h e s a m p l e d g r o u p 5

Among his numerous insightful suggestions to psychologists, Dennett (1991) outlines a somewhat similar biofeedback training procedure designed to "raise consciousness" in Hindsight patients. It is well known that, as a result of brain injury in the occipital cortex, blindsight patients fWeiskrantz 1986) lose conscious awareness of part of their visual field, but they can nevertheless report about the presence and certain features of visual stimuli in their scotoma above chance level when asked to guess. However, they-can make use of the nonconscious visual information in this way only when prompted when to guess. Dennett's suggestion is to try to train blindsight patients to "guess when to guess" by providing them with an external biofeedback cue that indicates to them when they are in an (unconscious) informational state that allows for successful guessing. Dennett wonders (1991, p. 332) whether by initially relying on such a "biofeedback crutch," blindsight patients may eventually come to learn to guess when to guess successfully. Were this the case, he speculates, then such patients may also develop a sense of being conscious about being informed. As he puts it: the patient "doesn't just come to be informed about the motion of the light; he realizes he's come to be informed; . . . he has a secondorder thought to the effect that he's just had a first-order thought" (pp. 332333).

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of internal a n d behavioral c u e s forward in time (the sufficiency index) to identify t h e degree of predictive power they h a v e over the p a r e n t a l target behavior. Following a strategy of contingency maximizing (Watson 1979), t h e b a b y ' s learning m e c h a n i s m will c o m p a r e t h e registered degree of contingent control experienced w h e n testing forward v e r s u s b a c k w a r d in time a n d will t h e n expand or r e d u c e t h e set of c u e s considered to contribute to t h e contingent control over t h e external p a r e n t a l feedback, a s a function of t h e direction of inequality between t h e necessity v e r s u s t h e sufficiency indices. This p r o c e s s will zero in on t h e set of internal a n d behavioral c u e s w h o s e combined predictive validity s h o w s t h e h i g h e s t degree of contingent control over t h e p a r e n t ' s affect-mirroring display. F u r t h e r m o r e , since t h e latter covaries with t h e infant's i n t e r n a l dispositional emotion state a s attributed by t h e p a r e n t , t h e set of i n t e r n a l a n d behavioral c u e s categorized together in t h e p r o c e s s of t h e contingency analysis will also be indicative of t h e emotion s t a t e of t h e infant.

PARENTAL AFFECT-MIRRORING AND T H E ON-LINE REGULATION OF EMOTION STATES The s t a n d a r d view concerning t h e function of p a r e n t a l affectmirroring behaviors is t h a t t h e y a r e involved in t h e on-line s t a t e regulation of t h e infant achieved by p a r e n t a l ministrations. This s t a t e m e n t m a y s o u n d uncontroversial—nevertheless, it m a y be worthwhile to consider a few observations t h a t could i n d u c e doubt in its validity. One m a y argue, for example, t h a t j u s t b e c a u s e e m p a t h i c emotion-mirroring behaviors occur d u r i n g affect-modulating interactions, one c a n n o t be certain t h a t they play a n a c t u a l c a u s a l role in bringing a b o u t t h e desired state change in t h e infant. After all, affect-mirroring is e m b e d d e d in a set of other p a r e n t a l behaviors (such a s physical contact, t e n d e r holding, vocal stimulation, reorienting from obnoxious stimuli), which seem to be clearly i n s t r u m e n t a l in bringing a b o u t t h e modification of t h e infant's s t a t e . F u r t h e r m o r e , it m a y also seem paradoxical to some t h a t t h e p a r e n t a l display of a negative affect, even t h o u g h it reflects t h e to-be-regulated emotion display of t h e

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infant, would, in fact, lead to a decrease—rather t h a n a n escalation—in t h e negative emotion s t a t e of t h e baby. On t h e b a s i s of s u c h a r g u m e n t s o n e could in fact r e a s o n a b l y claim t h a t the p a r e n t ' s affect-mirroring displays m a y play n o direct c a u s a l role in t h e affect regulation of t h e infant. Instead, t h e y could be viewed simply a s b y - p r o d u c t s of t h e p a r e n t ' s emotional recognition of a n d e m p a t h i c identification with t h e b a b y ' s affective state, w h i c h would, in t u r n , lead to t h e actually effective affectregulative activities s u c h a s holding. Nevertheless, in o u r view t h e p a r e n t ' s affect-mirroring display behaviors d u r i n g state-regulative interactions do, indeed, play a significant role in bringing a b o u t t h e modification of t h e infant's emotion state. We shall a r g u e t h a t t h e r e a r e several w a y s in which t h e contingency-detection a n d maximizing p r o c e s s involved in interpreting t h e emotion-reflective displays of p a r e n t s c o n t r i b u t e s to t h e affect-regulative influence of p a r e n t a l interactions with t h e infant. First, observations of soothing interactions indicate t h a t p a r e n t a l affect-mirroring does n o t a c c o m p a n y t h e infant's ongoing negative emotion displays in a c o n t i n u o u s m a n n e r . Rather, t h e p a r e n t is m o r e likely to "join in" for brief periods with short b o u t s of e m p a t h i c emotion-reflective displays a n d t h e n to t a k e "time-outs" or b r e a k s before r e t u r n i n g again to mirroring. (During t h e t i m e - o u t s t h e caregiver may, of course, c o n t i n u e to engage in other, nonreflective soothing activities, s u c h a s holding, caressing, a n d talking to t h e baby.) This cyclic c h a r a c t e r of t h e distribution of mirroring a c t s over time m a y be a n a t u r a l c o n s e q u e n c e of t h e n a t u r e of e m p a t h i c identification with a n o t h e r p e r s o n ' s emotion state: e m p a t h i c emotion expressions tend to be brief communicative a c t s or g e s t u r e s r a t h e r t h a n more c o n t i n u o u s state-expressions. However, t h e e n s u i n g onand-off temporal s t r u c t u r e of mirroring interactions h a s interesting c o n s e q u e n c e s w h e n we consider it from t h e point of view of contingency analysis. Let u s a s s u m e t h a t t h e infant's contingency-detection system is testing b a c k w a r d in time (the necessity index) for t h e conditional probability of t h e b a b y ' s emotional s t a t e c u e s preceding t h e a p p e a r a n c e of t h e p a r e n t ' s mirroring display. Clearly, this will provide a very high contingency value on t h e necessity

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index, a s t h e a t t u n e d p a r e n t will t e n d to p r o d u c e e m p a t h i c mirroring displays only w h e n t h e b a b y is actively expressing t h e negative emotion in q u e s t i o n . However, w h e n t h e b a b y is testing forward in,.time (the sufficiency index) to see with w h a t probability h i s emotion r e s p o n s e s r e s u l t in t h e o n s e t of t h e p a r e n t ' s mirroring display, h e will register only a m o d e r a t e degree of contingent control in t h e sufficiency index, a s d u r i n g "time-outs" h i s emotional displays a r e n o t going to be followed by e m p a t h i c affect reflections on t h e p a r t of t h e p a r e n t . Overall, therefore, a s s u m i n g a n a t t u n e d a n d e m p a t h i c p a r e n t , t h e sufficiency index will s h o w a lower degree of contingent control t h a n will t h e necessity index d u e to t h e cyclic distribution of e m p a t h i c emotion-mirroring displays over time. According to t h e contingency-maximizing h y p o t h e s i s (Watson 1979), finding t h a t t h e necessity index is higher t h a n t h e sufficiency index will i n d u c e t h e infant to reduce t h e r e s p o n s e class to see w h e t h e r he c a n bring t h e two indices closer to m a t c h i n g a n d t h e r e b y to discover t h e t r u e degree of contingent control h e h a s over t h e p a r e n t a l mirroring display. As a result, t h e infant will d e c r e a s e t h e set of a n d / o r t h e frequency a n d intensity of emotion r e s p o n s e s h e is producing. T h e n e t effect, therefore, of t h e infant's a t t e m p t a t identifying t h e m a x i m a l degree of contingent control h e h a s over t h e mirroring display is t h e reduction in the frequency and intensity of negative emotion expression, which t h u s leads to t h e regulation (diminishing) of t h e negative affect state. A further s o u r c e of affect regulation t h a t r e s u l t s from t h e infant's contingency a n a l y s i s is t h e resulting experience of causal efficacy in controlling a n d bringing a b o u t t h e p a r e n t a l affectmirroring display. As we h a v e seen, t h e r e is evidence (Watson 1972, 1994) indicating t h a t t h e detection of a high level of contingent control is positively a r o u s i n g for infants—resulting in positive social r e s p o n s e s s u c h a s smiling—and t h a t they a r e motivated to modify their behavior in order to discover t h e a c t u a l degree of their contingent control (Watson 1979). Therefore, t h e detection of contingent control over t h e p a r e n t ' s affect-mirroring display will i n d u c e positive affect in t h e infant, which, t h r o u g h reciprocal inhibition, c a n be expected to decrease h i s negative affect s t a t e further.

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An interesting additional feature of t h e complex contingencydetection a n d -maximizing p r o c e s s described above is t h a t t h e infant will experience t h e e n s u i n g emotional s t a t e regulation a s a n active causal agent Apart from experiencing c a u s a l efficacy in bringing a b o u t a n externalized version of h i s i n t e r n a l affective state in t h e form of t h e a d u l t ' s emotion-reflective displays, t h e infant will s i m u l t a n e o u s l y register t h e e n s u i n g positive modification of h i s negative affect state a s well. Therefore, it c a n be hypothesized t h a t successful emotion-regulative interactions involving p a r e n t a l affect-mirroring m a y provide experiential b a s i s for t h e e s t a b l i s h m e n t of a sense of self as self-regulating agent6 In other words, it is suggested t h a t affect-regulative mirroring interactions m a y provide t h e original proto-situation in which infants c a n learn t h a t by externalizing their i n t e r n a l emotion s t a t e s they c a n achieve successful regulation of their affective impulses. While a t t h i s stage t h e p a r e n t is vitally i n s t r u m e n t a l in this p r o c e s s a s t h e m e d i u m of externalization, later in pretend play t h e child will already be able to p r o d u c e a n externalized version of h i s internal s t a t e s w i t h o u t p a r e n t a l mediation. (This point is further elaborated in t h e description of t h e c a s e of "Mat" in c h a p t e r 7.)

6

From this point of view, it may be worthwhile to contrast emotion-regulative interactions involving parental affect-mirroring with other, often equally effective, parental styles of emotion-regulation, such as, for example, the practice that can be called "disruption-soothing." This type of affect-regulation involves the abrupt induction of some intensive alternative emotion in the infant that is incompatible with the to-be-regulated negative affect—for example, by throwing the baby up in the air or by tickling him. Since in such emotion-regulative events the infant has no contingent control over the state transformation he is going through, it is likely that his experience will be a passive one of externally induced affect-modulation. A further interesting difference between disruptionsoothing versus soothing-by-mirroring has to do with the perceived locus of causal control over the state transformation that the infant is experiencing. In soothing-by-mirroring the infant perceives internal causal control as he experiences active causal efficacy and agency in having contingent control over the ensuing state regulation. In contrast, in disruption-soothing the infant will locate the locus of causal control over his state transformation in an external agent or event. One may speculate that being systematically exposed to one versus the other type of parental soothing styles in infancy may contribute to the establishment of the individual differences in cognitive causal attribution styles (internal vs. external control) documented in the locus-of-control literature (Rotter 1966).

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T H E REPRESENTATIONAL CONSEQUENCES OP PARENTAL AFFECT-MIRRORING: T H E "MARKEDNESS" HYPOTHESIS Let u s t u r n n o w to a s o m e w h a t different question concerning t h e n a t u r e of p a r e n t a l affect-mirroring interactions. As we h a v e said, one of t h e m o s t intriguing a n d a p p a r e n t l y paradoxical a s p e c t s of p a r e n t a l affect-mirroring d u r i n g state-regulative interactions is the fact t h a t w h e n t h e b a b y is in a negative state, t h e p a r e n t p r e s e n t s a reflection of a negative emotion display while s u c c e s s fully soothing t h e infant. How does t h e b a b y interpret t h e negative affect-expression of t h e p a r e n t , a n d how is it possible t h a t t h e p r e s e n t a t i o n of a negative emotion display is i n s t r u m e n t a l in m o d u l a t i n g t h e infant's emotion s t a t e in a positive direction? Previously, we h a v e a r g u e d t h a t t h e infant first l e a r n s a b o u t t h e dispositional c o n t e n t of emotion expressive displays by observing t h e behavioral c o n s e q u e n c e s of affect expressions in others. A s s u m i n g t h a t t h e infant h a s in t h i s way already come to represent t h e dispositional c o n t e n t of a given affect expression, the p r e s e n t a t i o n of a c o r r e s p o n d i n g emotion-reflective display by the p a r e n t d u r i n g affect-regulative interactions m a y pose a potential d a n g e r of m i s a t t r i b u t i o n . Clearly, t h e p a r e n t ' s affectreflecting display e x p r e s s e s a n emotion s t a t e w h o s e category is recognizable to t h e infant, b u t h o w does t h e b a b y k n o w t h a t t h i s expression refers to h i s own s t a t e a n d n o t to t h a t of t h e p a r e n t ? Misattributing t h e expressed emotion to t h e p a r e n t would be especially problematic in t h e c a s e of affect-regulative interactions in w h i c h t h e p a r e n t ' s affect-reflective display e x p r e s s e s t h e infant's negative emotion state—say, h i s fear or anger. Were t h e infant to m i s a t t r i b u t e t h e expressed negative affect to t h e p a r ent, h i s own negative emotion s t a t e would, i n s t e a d of becoming regulated, b e likely to escalate, a s t h e sight of a fearful or angry p a r e n t is clearly c a u s e for a l a r m (and, if occurring systematically, of possible t r a u m a — s e e Main a n d Hesse 1990, a n d also the case vignette in c h a p t e r 7). T h u s , t h e q u e s t i o n arises: How does t h e b a b y come to k n o w t h a t t h e dispositional s t a t e expressed by t h e external emotion display he s e e m s to be controlling belongs to himself r a t h e r t h a n to t h e p a r e n t , w h o is, after all, expressing it? In other words,

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how does t h e b a b y come to u n d e r s t a n d t h a t t h e p a r e n t ' s affectmirroring display is characterized by a special kind of referential property insofar a s it is a reflection of t h e infant's s t a t e r a t h e r t h a n t h a t of t h e p a r e n t ? We a r g u e t h a t t h i s a t t r i b u t i o n problem is solved by a specific perceptual feature of t h e p a r e n t ' s affectexpressive displays, w h i c h we refer to a s their "markedness." In h i s s e m i n a l p a p e r on t h e m o t h e r ' s mirroring function, Winnicott s u g g e s t s t h a t infants, w h e n looking a t their m o t h e r w h o is looking a t t h e m , see themselves in h e r face. This is so, says Winnicott, b e c a u s e w h e n "the m o t h e r is looking a t the b a b y . . . what she looks like is related to what she sees there" (1967, p. 131, e m p h a s i s in original). Winnicott's insight, however, leaves implicit t h e complex s t r u c t u r a l n a t u r e of t h e way t h e m o t h e r ' s face is related to t h a t of t h e baby. In w h a t follows we t a k e a closer look a t t h e s t r u c t u r e of affect-regulative mirroring interactions in a n a t t e m p t to specify t h o s e a s p e c t s of t h e mirroring stimuli t h a t allow t h e infant to interpret the mirroring face as a reflection of his own state. First of all, we s h o u l d recognize t h a t looking a t t h e mirroring expression of t h e p a r e n t ' s face is qualitatively different from looking a t one's reflection in a mirror. Recognizing himself in t h e mirror is n o easy t a s k for t h e baby; in fact, t h a t cognitive feat is n o t achieved before t h e e n d of t h e second y e a r of life (Gallup a n d S u a r e z 1986; Gergely 1994, 2 0 0 1 a ; Lewis a n d B r o o k s - G u n n 1979). Note, furthermore, that, unlike t h e p a r e n t ' s affect-reflecting emotion displays, t h e mirror image is perfectly contingent b o t h with t h e infant's visual features a n d with h i s behavior. Therefore, it c a n b e a r g u e d t h a t t h e p r o c e s s e s t h a t enable the infant to interpret t h e p a r e n t a l affect- mirroring displays a s referring to t h e self a r e different from t h o s e involved in t h e u n d e r s t a n d i n g of t h e reflective properties of mirrors. In fact, w h e n we look a t t h e s t r u c t u r a l relation between t h e s t i m u l u s features of t h e p a r e n t ' s mirroring expression a n d t h o s e of t h e infant's state-expressive behavior, it b e c o m e s clear t h a t t h e t e r m "mirroring" is a seriously misleading one. First of all, let u s note t h a t n o m a t t e r how well a t t u n e d t h e p a r e n t is to t h e b a b y ' s state, h e r mirroring facial a n d v o c a l behavior will never perfectly m a t c h t h e temporal, spatial, a n d s e n s o r y intensity p a r a m e t e r s of t h e infant's behavioral expressions. This is a a

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crucial difference, a s t h e r e is evidence to suggest t h a t t h e infant is extremely sensitive to t h e distinction between perfect a n d high b u t imperfect degrees of r e s p o n s e - s t i m u l u s contingencies, a n d he u s e s t h i s information very early in life to categorize stimuli a s belonging to t h e self or to a social object, respectively (Bahrick a n d W a t s o n 1985; W a t s o n 1979, 1994). This is i m p o r t a n t bec a u s e it m a k e s it clear t h a t t h e simple recognition of t h e high— b u t necessarily imperfect—degree of correspondence between t h e infant's own state-expressive behaviors a n d t h e adult's affect-mirroring displays will n o t b e sufficient for t h e b a b y to interpret t h e p a r e n t ' s expressive display a s referring to himself. Second, we s h o u l d also realize t h a t if t h e m o t h e r , in h e r a t t e m p t to m i r r o r t h e b a b y ' s affect display a s authentically a s she can, were to p r o d u c e h e r n o r m a l , realistic expression of t h e corresponding emotion, t h e c h a n c e s of m i s a t t r i b u t i o n would dramatically increase, a s t h e infant would identify t h e m o t h e r ' s affect expression a s a realistic emotion display a n d would attribute t h e c o r r e s p o n d i n g dispositional emotion s t a t e to her. Therefore, to avoid t h e m i s a t t r i b u t i o n of t h e reflected emotion to t h e p a r e n t , it is proposed (see Gergely 1995a, 1995b, 2000) t h a t m o t h e r s a r e instinctually driven to saliently mark their affect-mirroring displays to m a k e t h e m perceptually differentiable from their realistic emotion expressions. Marking is typically achieved by p r o d u c i n g an exaggerated version of t h e parent's realistic emotion expression, 7 similarly to t h e m a r k e d 7

Of course, the idea of a separate register or marked communicative code for expressions directed to young children is not new. It has been described in the realm of verbal communication as "infant-directed speech" or "motherese" (Ferguson 1964; Femald 1991, 1992; Snow 1972). and it is characterized by phonological and syntactic modifications and prosodic cues such as elevated pitch and exaggerated pitch modulation. While several aspects of the distinctive prosodic patterns of child-directed speech have been suggested to facilitate early linguistic development (e.g., by highlighting word boundaries), researchers have also identified a number of primary, prelinguistic functions associated with infant-directed speech such as directing the infant's attention, modulating arousal and affect, or communicating emotions and intentions {Fernald 1991, 1992; Stem. Spieker, Barnett, and Mackaln 1983). In fact, there is evidence (Femald 1991) for the cross-cultural universality of exaggerated intonation contour in infant-directed speech as well as for an innate preference for exaggerated prosody (Cooper and Aslin 1990). Femald (1992) argues that the exaggerated prosody of infant-directed speech is an evolutionary adaptation to the

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"as-if m a n n e r of emotion display t h a t is characteristically prod u c e d in p r e t e n d play. The m a r k e d affect-display, r e m a i n s , nevertheless, sufficiently similar to t h e p a r e n t ' s normative emotion expression for t h e infant to recognize t h e dispositional c o n t e n t of the emotion. However, it is hypothesized t h a t d u e to t h e m a r k e d n e s s of t h e display t h e attribution of t h e perceived emotion to the p a r e n t will be inhibited. We shall call t h i s p r o c e s s referential decoupling,8 referring to t h e fact t h a t in t h e interpretation of t h e m a r k e d affect-display t h e referential connection between the emotion expression a n d t h e c o r r e s p o n d i n g dispositional state of t h e agent p r o d u c i n g t h e display will b e suspended: t h e perceived emotion display will b e "decoupled" from its referent. However, while d u e to its m a r k e d n e s s t h e p a r e n t a l emotion display m a y b e c o m e "decoupled" from its referent, it still n e e d s to be interpreted by t h e infant from a referential point of view a s expressing someone's emotion. We suggest t h a t this p r o c e s s of referential anchoring is determined by t h e high degree of contingent relation between t h e p a r e n t ' s affect-reflecting display a n d t h e infant's emotion-expressive behavior. T h e infant's contin-

infant's perceptual and physiological system with signal-enhancing as well as direct state-modulating properties. The current proposal is that the universal tendency to use exaggerated expressive patterns in infant-directed interactions will be present in affectmirroring displays as well. We suggest that apart from exaggerating the intonational vocal pattern of their affect-expressive displays, caretakers will also exaggerate the visual facial features of the emotion display. In fact, Fernald (1992) reports that mothers of deaf children intuitively exaggerate the visual features of their facial communicative expressions. As an automatic consequence, emotion-mirroring facial and vocal parental expressions will be marked as perceptually different from the corresponding realistic affect expressions of parents. Therefore, the "markedness" of affect-mirroring expressions and its representational consequences (see below) can be conceived of as a further and separate evolutionary function of the universal parental inclination to address infants with exaggerated expressive patterns of communication. 8 The terms "referential decoupling" and "referential anchoring" were first introduced by Alan Leslie (1987, 1994) to characterize the representational properties of communicative expressions produced in pretend play. The potential functional and representational relationship between the markedness of affect-mirroring expressions, on the one hand, and the markedness of expressions in the "pretend" mode of communication, on the other, is illustrated by the case vignette of "Mat" in chapter 7.

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gency-detection s y s t e m will register t h e temporal contingency a n d cross-modal similarity of p a t t e r n between t h e p a r e n t ' s expression a n d h i s own on-going affective behavior. The perception of this contingent relation will provide t h e b a s i s for t h e referential interpretation a n d g r o u n d i n g of t h e decoupled emotion display. As a result, t h e infant will referentially anchor t h e m a r k e d mirroring s t i m u l u s a s expressing h i s own self-state. In t h i s view, t h e n , over t i m e infants a r e likely to experience emotion displays of o t h e r s in two differentforms: in their realistic a n d in their marked versions. We'hypothesize t h a t t h e b a b y will come to r e p r e s e n t t h e s e two forms a s qualitatively different versions of t h e emotion expression n o t only b e c a u s e of their m a r k e d differences in t e r m s of p e r c e p t u a l features, b u t also b e c a u s e of two further distinguishing characteristics: 1. The situational features a n d behavioral o u t c o m e s t h a t will become associated with t h e realistic emotion expression—such a s with t h e sight of a n angry mother—will be qualitatively different from t h o s e t h a t a r e characteristic of t h e corresponding m a r k e d display—that is, t h e sight of a n anger-reflecting m o t h e r . In other words, t h e dispositional outcomes associated with t h e realistic emotion will n o t hold for t h e case of t h e m a r k e d expression: instead of t h e negative behavioral a n d emotional conseq u e n c e s typically a c c o m p a n y i n g a realistic anger display, w h e n faced with a m a r k e d anger-reflecting display t h e infant will be likely to experience positive o u t c o m e s in t h e form of successful affect regulation. 2. The realistic a n d t h e m a r k e d emotion displays of o t h e r s will also become differentiated in t e r m s of their different contingency relation to t h e infant's ongoing activity. Realistic emotion expressions are likely to be m u c h less u n d e r t h e infant's contingent control t h a n a r e t h e m a r k e d emotion-reflective displays. A realistic expression of, say, fear on t h e m o t h e r ' s face is more likely to be contingent on s o m e external event or to b e i n d u c e d by some intrapsychic s t i m u l u s in t h e m o t h e r t h a n to b e u n d e r t h e control of a particular behavior of t h e infant. T h e m a r k e d affect-reflective version of t h e emotion display is, however, u n d e r t h e contingent

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behavioral control of t h e baby, a s it is p r o d u c e d a s a r e s p o n s e to t h e infant's corresponding emotion expression d u r i n g affectregulative mirroring interactions. We hypothesize t h a t in n o r m a l development t h e behavioral t r a n s formations distinguishing t h e m a r k e d displays from t h e realistic ones will become established a s a generalized communicative code associated with (a) referential decoupling of t h e expressed content from t h e agent p r o d u c i n g t h e display, (b) referentially a n c h o r i n g t h e expressed c o n t e n t in a n a g e n t other t h a n t h e one displaying t h e emotion, 9 a n d (c) s u s p e n s i o n of t h e dispositional c o n s e q u e n c e s of t h e realistic version of t h e expressed content (Gergely 1995a, 1995b, 2000). These features will become t h e central characteristics of t h e "as-if' mode of communication a s it first emerges in t h e ability to c o m p r e h e n d a n d p r o d u c e pretend play d u r i n g t h e second year of life (see Fonagy a n d Target 1996; Leslie 1987, 1994). T h e m a r k e d n e s s of t h e affect-mirroring display is likely to have a further interesting effect a s well. Since t h e mirroring display is differentiated from t h e c o r r e s p o n d i n g realistic emotion expression by its p e r c e p t u a l m a r k e d n e s s , its differential dispositional c o n s e q u e n c e s , a n d its h i g h degree of contingency with t h e baby's affective behavior, we hypothesize t h a t t h e infant will c o n s t r u c t a separate representation for it. D u e to its contingent association with t h e infant's a u t o m a t i c affective reactions registered d u r i n g t h e affect-regulative interactions, t h i s r e p r e s e n t a tion will r e t a i n its associative link to t h e b a b y ' s primary-level affective states. Therefore, t h e separately r e p r e s e n t e d m a r k e d emotion display will come to function a s a secondary representational structure, w h i c h will b e c o m e activated t h r o u g h associative r o u t e s whenever t h e set of i n t e r n a l - s t a t e c u e s corresponding to

9 Note that in the original proto- situation of affect-regulative interactions the marked emotion is anchored in the infant as a result of the experience of contingent control; later, however—for example, in the use of the marked code in pretend play—the expressed content may be anchored in another—possibly imaginary—agent with whom the person producing the marked behavior identifies (see Leslie 1987, 1994).

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the given dispositional emotion s t a t e a r e activated in t h e infant. Henceforth, t h e o n s e t of a n emotion state will r e s u l t in t h e a u t o m a t i c activation of t h i s "proto-symbolic" s e c o n d a r y emotion r e p r e s e n t a t i o n in t h e b a b y ' s a w a r e n e s s , allowing h i m to attribute t h e dispositional emotion s t a t e to himself. In s u m , it c a n b e a r g u e d t h a t t h e instinctive inclination of p a r e n t s to expose their infants to m a r k e d affect-reflective behavioral displays d u r i n g emotion-regulative interactions r e s u l t s in t h r e e significant developmental c o n s e q u e n c e s : [a) The infant will come to detect a n d g r o u p together t h e s e t s of internal-state c u e s t h a t a r e indicative of h i s categorically distinct dispositional emotion s t a t e s , (b) He will establish s e c o n d a r y r e p r e s e n t a t i o n s associated with h i s primary-level procedural affect s t a t e s providing t h e cognitive m e a n s for accessing a n d attributing emotion s t a t e s to t h e self, (c) He will acquire a generalized communicative code of "marked" expressions characterized by t h e representational functions of referential decoupling, anchoring, a n d s u s pension of realistic c o n s e q u e n c e s .

'AFFECT ATTUNEMENT" FROM T H E POINT OF VIEW OF T H E SOCIAL BIOFEEDBACK THEORY Stern (1984, 1985; Stern, Hofer, Haft,.and Dore 1985) h a s also proposed a theory concerning t h e role of p a r e n t a l affect-reflective behaviors in early socio-emotional development. Similarly to our position, S t e r n believes t h a t interactions involving emotionreflective p a r e n t a l displays h a v e a significant influence on self-development a n d affective self-regulation. His views on t h e developmental functions a n d mediating m e c h a n i s m s involved in affect-reflective p a r e n t a l interactions, however, differ from o u r s in several i m p o r t a n t respects. Stern's t h e o r y focuses on a specific type of affect-reflective interaction t h a t h e calls "affect a t t u n e m e n t s , " which h e d e m o n strated to o c c u r regularly in n o r m a l m o t h e r - i n f a n t interactions between t h e ages of 9 a n d 12 m o n t h s (Stern et al. 1985). He noted t h a t d u r i n g free play m o t h e r s periodically reflect some

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aspect of their infant's actions by providing a partial m a t c h of t h e baby's behavior in a n o t h e r modality. For example, h e describes a n 8 ^ - m o n t h - o l d boy who is r e a c h i n g for a toy j u s t beyond r e a c h . As h e is stretching h i s b o d y in a n obvious voluntary effort to achieve h i s goal, "his m o t h e r says ' u u u u u h . . . u u u u u h ! ' with a crescendo of vocal effort. T h e m o t h e r ' s accelerating vocal-respiratory effort m a t c h e d t h e infant's accelerating physical effort" (Stern et al. 1985, p. 250). Stern m a k e s several interesting p o i n t s concerning t h e n a t u r e of s u c h a c t s of behavioral a t t u n e m e n t . Among o t h e r things, he e m p h a s i z e s t h e fact t h a t t h e y a r e n o t simple a c t s of imitation, a s they involve only a partial m a t c h of t h e a m o d a l (temporal, intensity, a n d shape) characteristics of t h e infant's target a c t rendered in a different modality. He also p o i n t s o u t t h a t "during t h e first half year of life it is o u r impression—as yet u n t e s t e d — t h a t imitations p r e d o m i n a t e over a t t u n e m e n t s . The reverse is t r u e after nine m o n t h s " (Stern 1984, p. 11). S t e r n proposes t h a t t h e r e a s o n why a t a r o u n d 9 m o n t h s the mother—nonconsciously—chooses to "attune" to, r a t h e r t h a n simply provide a n imitative replica of, t h e infant's behavior is t h a t s h e i n t e n d s to refer to t h e i n t e r n a l affect s t a t e of t h e infant r a t h e r t h a n to h i s surface behavior. In S t e r n ' s view, t h e m a t c h e d a m o d a l characteristics correspond to t h e a b s t r a c t r e p r e s e n t a tional forms of affects t h a t a c c o m p a n y t h e external behavioral act. T h u s , t h e suggested function of s u c h affect a t t u n e m e n t s is t h a t of "interpersonal communion": "to share" or "to participate in" t h e i n t e r n a l affective experience of t h e infant. Of course, for t h e infant to interpret affect a t t u n e m e n t s a s indicating p a r e n t a l s h a r i n g of h i s i n t e r n a l m e n t a l state, h e m u s t b e [a) a w a r e of h i s affect state, a n d h e (b) m u s t u n d e r s t a n d t h a t t h e p a r e n t also experiences internal m e n t a l s t a t e s , w h i c h (c) c a n b e either s h a r e d or different from t h e p a r t i c u l a r m e n t a l s t a t e of t h e infant. S t e r n a r g u e s for t h i s view by pointing o u t a p u r p o r t e d correlation between t h e emerging d o m i n a n c e of p a r e n t a l a t t u n e m e n t s — over i m i t a t i o n s ^ s t a r t i n g a t 9 m o n t h s on t h e one h a n d , a n d t h e emergence of t h e infant's "naive theory of interfaceable minds" (Bretherton a n d B a t e s 1979) d u r i n g t h e s a m e period on the other.

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Before c o n t r a s t i n g S t e r n ' s ideas with ours, let u s point o u t some a s p e c t s of h i s proposal t h a t seem questionable to u s . 1. Central to S t e r n ' s a r g u m e n t is t h e contention t h a t a t a r o u n d 9 m o n t h s t h e r e is a shift in t h e m o t h e r ' s reflective behaviors from intramodal faithful imitations to cross-modal a t t u n e m e n t s of amodal properties r e n d e r e d in a different modality. However, it should b e pointed o u t t h a t in t h e technical s e n s e , all imitative behaviors are—at least partially—cross-modal: if a t o n g u e protrusion is faithfully imitated with a t o n g u e protrusion, t h e infant experiences a n i n t e r m o d a l (motor-visual) correspondence between h i s own behavior a n d t h e imitative act of t h e parent. It is also well k n o w n t h a t even n e w b o r n infants are able to appreciate cross-modal correspondence, a s s h o w n by p h e n o m e n a s u c h a s neonatal imitation (Kaye a n d Bower 1994, 1979; Meltzoff a n d Moore 1977, 1989; S t e m 1985). Obviously, t h e n , w h a t Stern h a s in mind is n o t so m u c h t h e question of intra- vs. intersensory modality b u t , r a t h e r , t h e fact t h a t t h e a t t u n e m e n t behavior, while showing a partial m a t c h in t e r m s of a m o d a l properties, is a n act t h a t is different from t h e target behavior of t h e infant. 2. W h e t h e r S t e r n ' s i m p r e s s i o n a b o u t a qualitative shift a t a r o u n d 9 m o n t h s from imitations to a t t u n e m e n t s c a n be empirically s u b s t a n t i a t e d r e m a i n s to be seen. Certainly, m o t h e r s do engage in a t t u n e m e n t behaviors even m u c h earlier (as in t h e prototypical theme-variation g a m e s described by W a t s o n 1972). However, even if we a s s u m e with S t e r n t h a t t h e r e is a statistical tendency to engage, in more a t t u n e m e n t s t h a n imitations after 9 m o n t h s , t h e r e s e e m s to be a m o r e m u n d a n e r e a s o n for this t h a n Stern's a c c o u n t in t e r m s of t h e emerging m e n t a l i s m of t h e infant. At t h e e n d of t h e first year, infants become m o r e mobile, a n d t h e previously d o m i n a n t face-to-face interactions a r e s u p e r s e d e d by object-oriented joint activities (Stern 1985; Trevarthen a n d Hubley 1978). This i m p o s e s a p r a g m a t i c c o n s t r a i n t on t h e mother's choice of behavior w h e n s h e i n t e n d s to reflect t h e infant's target a c t in a way t h a t is accessible to t h e infant; for example, if t h e b a b y is visually orienting toward a toy t h a t h e is reaching for r a t h e r t h a n toward t h e p a r e n t , t h e m o t h e r m a y b e forced to a t t u n e to t h e b a b y ' s m o t o r effort vocally.

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3. While t h e m o m e n t o u s c h a n g e s in t h e infant's competence after t h e age of 9 m o n t h s — s u c h a s joint attention, pointing, gaze-following, or social referencing—have b e e n interpreted by some r e s e a r c h e r s a s indicating t h e emergence of u n d e r s t a n d i n g of intentional m i n d s t a t e s (Bretherton 1991a; B r e t h e r t o n a n d Bates 1979; S t e r n 1985), o t h e r s h a v e resisted t h i s t e m p t a t i o n a n d proposed n o n m e n t a l i s t i c i n t e r p r e t a t i o n s for t h e s a m e phen o m e n a (Barresi a n d Moore 1996; Gergely et al. 1995; Gewirtz a n d Pelaez-Nogueras 1992; Moore a n d C o r k u m 1994). For example, a s one of u s h a s a r g u e d in detail elsewhere (Csibra a n d Gergely 1998; Gergely a n d Csibra 1997), t h e emerging new competencies a t t h e e n d of t h e first year c a n b e u n d e r s t o o d in t e r m s of a "naive theory of rational action," w h i c h is a n a s yet n o n m e n t a l i s t i c teleological interpretational s y s t e m . F u r t h e r more, while t h e 9-month-old m a y n o t h a v e a n appreciation of m i n d s t a t e s a s yet, m o t h e r s certainly a t t r i b u t e intentionality a n d mentalizing to their infant even a t a m u c h earlier age (as s h o w n by t h e work on cognitive scaffolding by B r u n e r , Stern, a n d others: see, e.g., B r u n e r 1983; Reznick 1999; S t e r n 1985; Wood, Bruner, a n d Ross 1976). In t e r m s of Stern's h y p o t h e s i s t h a t the function of a t t u n e m e n t s is to signal t h e s h a r i n g of a t t r i b u t e d internal affect s t a t e s , this would predict t h a t caregivers engage in affect a t t u n e m e n t s even before their infant is 9 m o n t h s of age. In o u r m i n d s , t h e above a r g u m e n t s raise e n o u g h d o u b t s concerning S t e r n ' s interpretation of t h e function a n d n a t u r e of affect a t t u n e m e n t s t h a t it m a y be worthwhile to explore a n alternative a p p r o a c h to t h i s intriguing developmental p h e n o m enon. O u r contingency-based social biofeedback model of affectreflective p a r e n t a l behaviors provides s u c h a n alternative. Note first of all t h a t t h e t h r e e a m o d a l features—time, intensity, a n d shape—identified by S t e r n a s t h e a b s t r a c t s t i m u l u s properties m a t c h e d in affect a t t u n e m e n t s c o r r e s p o n d to the t h r e e s o u r c e s of contingency monitored by t h e contingencydetection m o d u l e (Gergely a n d W a t s o n 1999). Therefore, even if a n a t t u n e m e n t behavior is p r e s e n t e d only on a single occasion, t h e combined value of t h e t h r e e contingency p a r a m e t e r s c a n be sufficient to indicate a highly-but- imperfectly contingent extern a l s t i m u l u s t h a t is controlled by t h e infant's preceding H

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behavior. In o t h e r words, t h e contingency-detection device will categorize t h e p a r e n t ' s a t t u n e m e n t behavior a s a c a u s a l consequence of t h e infant's on-going activity, resulting in a m o m e n tary s e n s e of c a u s a l efficacy a n d t h e concomitant i n d u c t i o n of positive a r o u s a l . T h e e n s u i n g fleeting s e n s e of c a u s a l control a n d instrumentality will b e c o m e associated with the particular a c t in which t h e infant is engaged while being a t t u n e d to. This leads to our first proposal concerning t h e developmental function of reflective a t t u n e m e n t s : by momentarily a t t u n i n g to them, t h e p a r ent c a n selectively reinforce t h o s e affective, voluntary, or playful acts of t h e infant t h a t s h e would like to see continued or repeated in t h e future. In o t h e r words, reflective a t t u n e m e n t s a r e a n efficient tool of early nonverbal socialization whereby t h e parent c a n selectively reinforce a n d s h a p e t h e infant's emerging voluntary, goal-oriented, or playful social activities. In a s o m e w h a t m o r e speculative vein, we would also like to propose t h a t selective a t t u n e m e n t s m i g h t serve a n additional sensitizing a n d representation-building function a s well. Recall t h a t o u r model, unlike Stern's, a s s u m e s t h a t infants initially lack a w a r e n e s s of their internal affective a n d proprioceptive states t h a t a c c o m p a n y their behaviors. By providing a partial rendering of s o m e of t h e a m o d a l features of t h e target act in a different behavioral format, t h e a t t u n e m e n t behavior p r e s e n t s the infant with a nonidentical b u t highly contingent externalized version of h i s p r o c e d u r a l behavioral routine. As a result, t h e infant will form a r e p r e s e n t a t i o n of t h e reflected a m o d a l features t h a t will b e c o m e associated, d u e to their high degree of perceived contingency, with t h e n o n c o n s c i o u s , primary, procedural r e p r e s e n t a t i o n of h i s on-going activity. In this way, reflective a t t u n e m e n t s c o n t r i b u t e to t h e e s t a b l i s h m e n t of secondary representations of primary p r o c e d u r a l s t a t e s , w h i c h will be more cognitively accessible a n d m o r e subject to conscious a w a r e n e s s . This hypothesized s e c o n d a r y representation-building p r o c e s s can be conceived of a s a special case of w h a t Annette KarmiloffSmith (1992) h a s called "representational redescription." S h e h a s argued t h a t t h e h u m a n m i n d h a s t h e capacity to a c c e s s a n d re-represent in a m o r e explicit a n d cognitively accessible form the implicitly r e p r e s e n t e d s t r u c t u r a l information e m b e d d e d in nonconscious, a u t o m a t i c p r o c e d u r a l r o u t i n e s . While Karmiloff-

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Smith's theory p o s t u l a t e s a n i n n a t e e n d o g e n o u s epistemic drive t h a t carries o u t s u c h a p r o c e s s of "self-discovery" of one's own mind, o u r social biofeedback model identifies t h e contingent reflective externalizations provided by social p a r t n e r s a s t h e informational b a s i s for re-representing t h e amodal internal s t r u c t u r e of n o n c o n s c i o u s p r i m a r y r e p r e s e n t a t i o n s . B u t do affect a t t u n e m e n t s serve t h e function of interpersonal c o m m u n i o n or i n t e r n a l s t a t e s h a r i n g a s well, a s suggested by S t e r n ? O u r g u e s s is t h a t initially this m a y n o t yet be t h e case, especially insofar a s t h e infant h a s n o t yet b e e n sensitized to his internal categorical affect s t a t e s a s a r e s u l t of t h e social biofeedb a c k training provided by affect-reflective interactions. We do agree, however, t h a t c o m m u n i c a t i n g t h e s h a r i n g of internal s t a t e s m a y become a s e c o n d a r y function of a t t u n e m e n t behaviors later in life. In verbal behavior, p a r a p h r a s i n g often serves t h e function of informing t h e other t h a t t h e underlying m e a n i n g of h i s surface u t t e r a n c e h a s b e e n correctly encoded. Nonverbal reflective a t t u n e m e n t s a r e also likely to come to serve a similar communicative function later in life.

MELTZOFF AND G O P N I K S "LIKE ME" HYPOTHESIS Meltzoff a n d Gopnik (1993; Gopnik a n d Meltzoff 1997; Meltzoff 1990) h a v e proposed t h a t imitative interactions between caregivers a n d infants c a n provide a b a s i s t h a t could lead b a b i e s to pay special attention to fellow h u m a n beings. This arises in specific regard to t h e times t h a t t h e caregivers imitate their infants a s opposed to w h e n t h e b a b i e s imitate t h e caregivers. Meltzoff a n d Gopnik propose t h a t a n infant m a y u s e h i s i n n a t e cross-modal capacity to m a p t h e caregiver's visual m o v e m e n t s onto t h e proprioceptive feelings of h i s own m o v e m e n t s , which t h e p a r e n t is imitating. The caregiver's m o v e m e n t s b e c o m e attractive (attention capturing) b e c a u s e t h e y a r e perceived (via the mapping) to be very m u c h like t h e b a b y ' s own. For example, Meltzoff (1990) u s e d a preferential interaction p a r a d i g m in which 14-month-old infants were faced with two a d u l t models, one of w h o m imitated t h e child's object-related behaviors a s b e s t a s s h e &

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could, w h e r e a s t h e o t h e r always performed a temporally contingent b u t dissimilar (spatially noncontingent) action. T h e infants looked a n d smiled m o r e a t t h e a d u l t who mimicked t h e m t h a n a t the one w h o s e actions were only temporally contingent with theirs. Meltzoff a n d Gopnik hypothesize t h a t it is t h e infants* "like me" experience t h a t explains their preferential a t t e n t i o n a n d smiling to t h e mimicking a d u l t model over t h e only temporally contingent one. Since o u r contingency-based social biofeedback theory also generates specific predictions for t h e infant's attraction to p a r e n tal "mirroring" acts, we would like to m a k e explicit two i m p o r t a n t differences between o u r position a n d t h a t of Meltzoff a n d Gopnik. First, Meltzoff a n d Gopnik (1993) a s s u m e t h a t infants h a v e direct introspective a c c e s s to their i n t e r n a l "feeling states" from the beginning of life. In c o n t r a s t , we a r e a s s u m i n g t h a t initially m a n y of t h e infants' s t a t e t r a n s i t i o n s a r e outside their perceptual awareness. We a s s u m e t h i s to b e so b o t h for t h e visceral a n d for t h e physiological s t a t e c u e s t h a t a c c o m p a n y basic-emotion s t a t e s a n d for m a n y of t h e proprioceptive c o n s e q u e n c e s of facial m u s c u l a r m o v e m e n t . Indeed, a central a s p e c t of o u r model is t h a t t h e s e i n t e r n a l - s t a t e c u e s of t h e infant only become liminal after a period of biofeedback sensitization b r o u g h t a b o u t a s a result of p a r e n t a l mirroring interactions. This difference in ass u m p t i o n a b o u t w h a t is a n d w h a t is n o t "felt" by t h e infant is n o t likely to b e resolvable empirically, however. The r e a s o n for this pessimism is t h a t we, a n d very probably Meltzoff a n d Gopnik a s well, are u s i n g t h e t e r m "felt" in t h e s e n s e of a state of conscious awareness. For example, we do n o t c o n t e n d t h a t t h e infant h a s no functional u s e of proprioceptive feedback from facial m u s c l e movement prior to social mirroring experiences. W h a t we contend is t h a t while s u c h feedback exists a n d is u s e d in various motor control s y s t e m s , it does n o t e n t e r conscious a w a r e n e s s . For u s a s a d u l t s , m a n y m o t o r e v e n t s — s u c h a s eye movement, head rotation, c h e s t d i a p h r a g m expansion, a n d even limb motion—are s u b l i m i n a l until we a t t e n d to t h e m . B u t it is n o t easy to think of h o w to m e a s u r e s u c h a distinction in relation to t h e subjective experience of a n infant. The second point of difference between o u r model a n d Meltzoff and Gopnik's "like me" h y p o t h e s i s a b o u t t h e attractiveness of

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social mirroring is far m o r e a s s e s s a b l e empirically. T h e "like me" hypothesis would s e e m to predict clearly t h a t t h e m o r e closely t h e mirroring act r e p r o d u c e s t h e infant's behavior, t h e more attractive it will be for t h e baby. In c o n t r a s t , we a s s u m e (see Bahrick a n d W a t s o n 1985; W a t s o n 1994) t h a t after t h e age of a b o u t 3 m o n t h s , t h e target setting of t h e contingency-detection m e c h a n i s m of t h e n o r m a l h u m a n infant is switched toward seeking o u t high b u t imperfect degrees of contingency. This predicts a preference for high b u t imperfectly contingent mirroring displays over perfectly contingent ones, w h e r e a s t h e opposite prediction follows from t h e "like me" hypothesis. O u r explanation for t h e looking p a t t e r n in Meltzoffs (1990) s t u d y is t h a t t h e mimicking model provides a high b u t nevertheless only imperfectly contingent action t h a t is preferred a s s u c h over t h e simply temporally contingent model, w h i c h p r o d u c e s a m u c h lower degree of contingency. We agree with Meltzoff a n d Gopnik t h a t t h e infants a p p e a r to u s e t h e spatial—or, in their words, structural—information in differentiating between t h e two models. S o m e w h a t tautologically, however, we p r o p o s e t h a t t h e preference for t h e temporal p l u s spatial (the mimicking adult) over t h e merely temporal (the alternative model) contingency simply indicates t h a t t h e imitating model provided a contingency m a g n i t u d e t h a t w a s closer to t h e target criterion of best—high-but-not-perfect—contingency of t h e contingency-detection m e c h a n i s m t h a n w a s t h e alternative model.

THE "NEARLY, BUT CLEARLY NOT, LIKE ME" HYPOTHESIS In c o n t r a s t to Meltzoff a n d Gopnik's "like me" hypothesis, however, we predict t h a t if given a choice between a perfectly contingent a n d t h e highly b u t only imperfectly contingent imitative display u s e d by Meltzoff, after t h e age. of 3 m o n t h s t h e infant would preferentially a t t e n d to t h e latter. In other words, we predict t h a t t h e infant would b e a t t r a c t e d to t h e "nearly, b u t clearly not, like me" v e r s u s t h e "like me" display b e c a u s e , r a t h e r t h a n preferentially orienting toward a self-like (perfect) contin-

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gency, h e is committed to engaging contingencies t h a t are spe^ cifically n o t self-based (i.e., n o t perfect). To t e s t t h i s hypothesis, o n e of u s h a s carried o u t a s t u d y t h a t h a s specifically c o n t r a s t e d t h e effect on y o u n g children's behavior of t h e availability of perfect a s against imitative feedb a c k of their m a n u a l activity (see Magyar a n d Gergely 1998). We tested 3 2 children between 18 a n d 3 6 m o n t h s of age, w h o s a t in front of two TV m o n i t o r s e a c h displaying t h e moving image of a schematic h a n d . T h e subjects moved a small metal bowl (with a c o m p u t e r m o u s e h i d d e n inside) freely on t h e surface of t h e table in front of t h e m . On one of t h e s c r e e n s t h e y saw t h e perfectly r e s p o n s e - c o n t i n g e n t m o v e m e n t s of t h e s c h e m a t i c h a n d , generated by a c o m p u t e r p r o g r a m controlled by t h e subjects' m a n u a l m a n i p u l a t i o n of t h e bowl. T h e second screen displayed a highly b u t imperfectly response-contingent image of t h e schematic h a n d , w h i c h w a s generated by t h e imitative efforts of a h u m a n experimenter. This p e r s o n a t t e m p t e d to copy t h e s u b ject's m a n u a l behavior faithfully by moving a m o u s e u n d e r t h e visual g u i d a n c e of t h e subject-generated m o v e m e n t s of t h e schematic h a n d (the perfect feedback display) viewed on a s e p a r a t e monitor in a n o t h e r room. This p r o c e d u r e w a s u s e d in a n a t t e m p t to provide t h e n o r m a l lag a n d imperfection of a h u m a n act of direct imitation. We found t h a t t h e children a t t e n d e d more to t h e imitation-based (highly b u t imperfectly) contingent image t h a n to the perfectly contingent o n e (p < 0.04). This, then, provides s u p p o r t for o u r h y p o t h e s i s t h a t children are selectively attracted to r e s p o n s e - c o n t i n g e n t stimuli t h a t a r e "nearly, b u t clearly not, like them" r a t h e r t h a n being "just like them."

IMPLICATIONS FOR DEVELOPMENTAL PSYCHOPATHOLOGY AND THERAPEUTIC INTERVENTIONS Having p r e s e n t e d o u r social biofeedback model of affect-mirroring within t h e framework of a theory of n o r m a l emotional development, we shall d i s c u s s some clinical implications of o u r model

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with t h e a i m of integrating it with c u r r e n t p s y c h o d y n a m i c app r o a c h e s to mirroring developed in object-relations theory a n d a t t a c h m e n t theory. O u r social biofeedback model of affect-mirroring p o s t u l a t e s a complex biosocial s y s t e m in which t h e infant is instinctually driven to e x p r e s s t h e d y n a m i c c h a n g e s in h i s i n t e r n a l affect s t a t e s behaviorally, while t h e m o t h e r is instinctually driven to reflect t h e infant's state-expressive behaviors in a m a r k e d form. This s y s t e m serves two major developmental functions: the mirroring environment (a) c o n t r i b u t e s to t h e on-line homeostatic regulation of t h e infant's d y n a m i c affective s t a t e c h a n g e s a n d (b) provides a kind of "teaching" or "scaffolding" e n v i r o n m e n t t h a t r e s u l t s in t h e internalization of t h e m a t e r n a l affect-regulative function t h r o u g h t h e e s t a b l i s h m e n t of s e c o n d a r y r e p r e s e n t a tions of t h e infant's p r i m a r y emotion s t a t e s . In fact, it c a n be argued t h a t this theory is close in spirit to certain psychodyn a m i c characterizations of t h e developmental functions of t h e infant's m a t e r n a l e n v i r o n m e n t a s formulated in a t t a c h m e n t theory (Bowlby 1969), object-relations theory (Bion 1962a; Winnicott 1965), self psychology (Kohut 1971, 1977), or analytically oriented developmental theory (Stern 1985). T h e s e diverse a p p r o a c h e s s h a r e a s t r o n g e m p h a s i s o n t h e vital c a u s a l role played in t h e infant's early psychic development by t h e m o t h e r ' s biologically determined ability a n d inclination to read, modulate, a n d reflect b a c k t h e infant's state-expressive behaviors. T h e s e theories also agree t h a t s u c h m a t e r n a l ministrations, a p a r t from providing on-line need satisfaction a n d state regulation for t h e baby, also c o n t r i b u t e significantly to psychic s t r u c t u r e - b u i l d i n g a n d to t h e emergence of emotional selfa w a r e n e s s a n d control. In fact, a n u m b e r of t h e s e theories have explicitly identified t h e m o t h e r ' s ability to adaptively "mirror," "echo," or "match" t h e infant's affective s t a t e s a s a significant a n d central m e c h a n i s m underlying t h e early development of t h e self (Bion 1962a, 1962b; P. F. Kernberg 1984; Kohut 1971, 1977; Mahler a n d McDevitt 1982; Mahler et al. 1975; S t e r n 1985; Winnicott 1967). However, no specific models h a v e b e e n adv a n c e d to characterize t h e psychological p r o c e s s e s t h r o u g h which affect-mirroring achieves t h e v a r i o u s developmental func-

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tions t h a t h a v e b e e n a t t r i b u t e d to it. Therefore, we w i s h to suggest t h a t o u r social biofeedback model c a n be interpreted a s specifying a n u n d e r l y i n g psychological m e c h a n i s m t h a t mediates—at least s o m e of—the developmental effects of t h e affectreflective m a t e r n a l e n v i r o n m e n t a s discussed, for example, in Winnicott's model of t h e m o t h e r ' s holding function (Winnicott 1965), Kohut's model of t h e m a t e r n a l mirroring function (Kohut 1971, 1977), or Bion's model of m a t e r n a l c o n t a i n m e n t (Bion 1962a, 1962b). For example, b o t h Winnicott a n d Kohut emphasize t h e import a n c e of t h e infant's early experience of omnipotence for h e a l t h y self-development t h a t is afforded by m a t e r n a l a t t u n e m e n t to a n d mirroring of t h e infant's n e e d s t a t e s . This clinical insight m a y be related to t h e workings of t h e contingency-detection m e c h a n i s m proposed in o u r social biofeedback model. In this view, t h e s e n s e of infantile o m n i p o t e n c e m a y be interpreted a s corresponding to t h e s e n s e of c a u s a l efficacy a n d control t h a t is generated by t h e contingency-detection m e c h a n i s m d u r i n g adaptive mirroring interactions. Another example is contained in certain features of Bion's influential notion of t h e m a t e r n a l "container" function (Bion 1962a, 1962b). According to Bion, t h e m o t h e r "contains" a n d rep r e s e n t s in a modified form t h e negative c o n t e n t s t h a t t h e infant projects into h e r . He s u g g e s t s t h a t "the m o t h e r , with h e r capacity for reverie, t r a n s f o r m s t h e u n p l e a s a n t s e n s a t i o n s . . . a n d provides relief for t h e infant w h o t h e n reintrojects t h e mitigated a n d modified emotional experience" (Grinberg, Sor, a n d De Bianchedi 1977, p. 57). Bion (1962a) also e m p h a s i z e s t h a t m a t e r n a l containment, transformation, a n d r e - p r e s e n t a t i o n of t h e b a b y ' s negative i n t e r n a l s t a t e s is a n e c e s s a r y prerequisite for t h e infant to become able to reflect u p o n a n d p r o c e s s h i s experience, or in Bion's words, to t h i n k h i s own t h o u g h t s a n d feel h i s own feelings. In t e r m s of o u r social biofeedback model, t h e s e ideas c a n be interpreted a s referring to t h e m o t h e r ' s ability to m o d u l a t e the infant's negative affect by p r o d u c i n g contingent a n d marked emotion-reflective displays on t h e one h a n d , a n d to t h e ensuing e s t a b l i s h m e n t of t h e s e c o n d a r y r e p r e s e n t a t i o n s of the infant's p r i m a r y emotion s t a t e s t h r o u g h t h e introjection

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of t h e m a r k e d a n d decoupled affect-reflective m a t e r n a l expressions on t h e other. Until now o u r d i s c u s s i o n of t h e n a t u r e of p a r e n t a l affectmirroring h a s c o n c e n t r a t e d on t h e c a s e of adaptive a n d s u c c e s s ful emotion-regulative interactions a n d their c o n s e q u e n c e s for n o r m a l development. However, b a s e d on o u r model, we c a n also specify some of t h e p r o c e s s e s t h a t m a y r e s u l t in pathological development of emotions in deviant p a r e n t a l mirroring environments.

NORMAL V E R S U S PATHOLOGICAL CONSEQUENCES OF AFFECT-MIRRORING According to o u r model, adaptive affect-reflective interactions r e s u l t in t h e following c o n s e q u e n c e s in n o r m a l development: (a) D u e to t h e m a r k e d n e s s of t h e mirroring display, t h e expressed affect will be decoupled from t h e p a r e n t , (b) As a result of t h e high degree of contingency between t h e infant's emotion state a n d t h e m a r k e d affect-mirroring display, t h e expressed emotion will be referentially a n c h o r e d a s belonging to t h e baby, (c) The infant will establish a s e p a r a t e r e p r e s e n t a t i o n for t h e m a r k e d emotion-expression of t h e p a r e n t t h a t will be associatively linked to h i s implicit p r o c e d u r a l p r i m a r y emotion state, (d) D u e to its similarity to—and categorical identity with—the parent's c o r r e s p o n d i n g realistic emotion display, t h e internalized m a r k e d emotion r e p r e s e n t a t i o n will "inherit" t h e dispositional information already associated with t h e p a r e n t ' s realistic emotion expression. In t h i s way, t h e infant will n o t only acquire a secondary, cognitively accessible r e p r e s e n t a t i o n of h i s primary emotion state, b u t will also b e c o m e able t o a t t r i b u t e to himself t h e dispositional information associated with t h a t emotion, resulting in a n ability to r e p r e s e n t a n d predict h i s likely behavior w h e n being in t h a t state. Given t h e s e c o n s e q u e n c e s for n o r m a l development, o u r social biofeedback model of affect-mirroring c a n also identify certain s t r u c t u r a l types of deviant mirroring styles t h a t m a y r e s u l t in pathological o u t c o m e s . In particular, t h e selective lack of either #

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m a r k e d n e s s or category c o n g r u e n c e m a y p r o d u c e deviant mirroring styles t h a t , if t h e y b e c o m e d o m i n a n t in t h e infant's experience, m a y to lead to characteristic pathological c o n s e q u e n c e s .

Deviant Affect-Mirroring S t y l e s 1. Lack of markedness. Let u s first t a k e t h e case of affectmirroring t h a t is categorically congruent but lacks perceptual marking. (A c a s e illustration of t h i s k i n d of deviant affect-mirroring is provided in c h a p t e r 7.) M o t h e r s who, d u e to their own unresolved intrapsychic conflicts, are u n a b l e to contain a n d become overwhelmed by their infant's negative affect-expressions c a n be expected to s h o w t h i s s t r u c t u r a l p a t t e r n of mirroring. Borderline p a t i e n t s or p a r e n t s showing t h e "preoccupied" (E) profile in Mary Main's Adult A t t a c h m e n t Interview 10 (George et al. 1985; Main a n d Goldwyn 1991) a r e likely c a n d i d a t e s for exhibiting u n m a r k e d affective r e s p o n s e s of t h i s kind. (See also Fonagy, Steele, et al. 1995.) S u c h p a r e n t s react to their infant's negative affect-expression by p r o d u c i n g t h e same—categorically congruent—emotion-expression, b u t in a n unmarked, realistic m a n n e r . According to o u r hypothesis, t h e d o m i n a n c e of this kind of deviant mirroring style is likely to lead to t h e following c o n s e q u e n c e s : (a) Since t h e mirroring affect-display is n o t m a r k e d , it is n o t going to b e decoupled from t h e caregiver a n d will b e a t t r i b u t e d to t h e p a r e n t a s her real emotion, (b) As t h e u n m a r k e d emotion display is n o t decoupled, it will also n o t become a n c h o r e d to t h e infant. Consequently, t h e s e c o n d a r y r e p r e s e n t a t i o n of t h e b a b y ' s p r i m a r y emotion s t a t e will n o t be established, leading to a corresponding deficiency in self-perception a n d self-control of affect, (c) Since t h e infant will a t t r i b u t e t h e mirrored affect to t h e p a r e n t , h e will experience h i s own negative affect "out there" a s belonging to t h e other, r a t h e r t h a n to himself, (d) I n s t e a d of regulating t h e in-

10

Patrick, Hobson, Castle, Howard, and Maughan (1994) provided evidence indicating a strong correlation between borderline pathology and "E" classification on the AA1, and this was confirmed in a larger study with personalitydisordered controls (Fonagy, Leigh, et al. 1996).

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fant's.negative affect, t h e perception of a c o r r e s p o n d i n g realistic negative emotion in t h e p a r e n t will escalate t h e b a b y ' s negative state, leading to t r a u m a t i z a t i o n r a t h e r t h a n c o n t a i n m e n t (Main a n d Hesse 1990). This constellation c o r r e s p o n d s to t h e clinical characterization of projective identification a s a pathological defensive m e c h a n i s m characteristic of borderline personality disorder (Kernberg 1976; Klein 1946; S a n d l e r 1987; H. Segal 1964). Therefore, it c a n be hypothesized t h a t s u s t a i n e d experience with categorically congruent but unmarked affect-mirroring in infancy might play a n i m p o r t a n t c a u s a l role in t h e e s t a b l i s h m e n t of projective identification a s t h e d o m i n a n t form of emotional experience in borderline personality development. 2. Lack of category congruence. A second type of deviant mirroring s t r u c t u r e might be p r o d u c e d by t h e d o m i n a n c e of marked, but incongruent, categorically distorted parental mirroring. Overcontrolling p a r e n t a l a t t i t u d e a n d / o r defensively distorted p a r e n tal perception of t h e infant's affect m a y p r o d u c e a mirroring style of this sort. T h i n k of a n infant whose erotically colored excitem e n t a b o u t physical c o n t a c t i n d u c e s anxiety a n d defensive a n ger in t h e m o t h e r d u e to h e r i n t r a p s y c h i c conflicts in relation to bodily t e n d e r n e s s . The m o t h e r m i g h t project h e r defensive emotional reaction onto t h e infant, a s a r e s u l t of w h i c h s h e will distortedly perceive t h e b a b y ' s libidinal excitement a s aggression. S h e m a y t h e n proceed to m o d u l a t e t h i s t h u s (mis) perceived affect in h e r b a b y by properly m a r k e d mirroring of a n aggressive display. According to t h e p r e s e n t hypothesis, m a r k e d b u t categorically distorted affect-mirroring of t h i s kind, w h e n d o m i n a n t in t h e infant's experience, m a y lead to t h e following c o n s e q u e n c e s : [a) D u e to t h e m a r k e d n e s s of t h e mirrored affect, it will be decoupled from t h e p a r e n t , (b) As t h e mirroring display s h o w s a sufficiently high degree of contingency with t h e infant's—miscategorized—affect state, h e will referentially a n c h o r t h e mirrored affect-display to h i s p r i m a r y emotion state, (c) However, since t h e category of t h e mirrored affect is i n c o n g r u e n t with t h e a c t u a l affect s t a t e of t h e infant, he will establish a distorted secondary representation of h i s p r i m a r y emotion state. As a

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result, t h e infant will a t t r i b u t e dispositional information to himself t h a t is i n c o n g r u e n t with h i s a c t u a l (primary) emotion state, leading to a distorted perception of h i s self-state. T h u s , one m a y s p e c u l a t e t h a t m a r k e d , b u t categorically distorted, i n c o n g r u e n t mirroring of affects might be causally related to pathologically distorted self-representations, w h i c h may, for example, u n d e r l i e s e x u a l pathologies in which libidinal excitem e n t is perceived a s aggression. This type of deviant mirroring provides a link between o u r model a n d Winnicott's concept of t h e false self. According to Winnicott (1960a), i m p i n g e m e n t s from t h e environment m a y arise o u t of t h e caregiver's difficulty in u n d e r s t a n d i n g t h e infant's t h o u g h t s or feelings, s u b s t i t u t i n g h e r g e s t u r e s instead of representing h i s own intentional s t a t e to t h e baby, invalidating the g e s t u r e s , a n d o b s t r u c t i n g h i s illusion of omnipotence. W h e n this c o n t i n u e s despite persistence by t h e infant, Winnicott suggests t h a t a n u m b e r of r e a c t i o n s c a n arise: t h e self m a y b e overwhelmed, it m a y b e c o m e a n x i o u s anticipating further impingement, it m a y come to experience itself only w h e n it a c t s in opposition to i m p i n g e m e n t s , a n d , finally, it c a n acquiesce a n d hide its own g e s t u r e s , u n d e r m i n i n g its own ability. In this latter case, Winnicott a s s u m e d , t h e self e n d s u p mimicking its caretaking environment, resigned to t h e deficiency, setting aside creative g e s t u r e s , a n d p e r h a p s even forgetting they ever existed. Winnicott s u g g e s t e d t h a t t h e infant compliantly relates to t h e caregiver's g e s t u r e s a s if t h e y were h i s own, a n d t h i s compliant stance lies a t t h e root of t h e falser self-structure. It follows from Winnicott's view of t h e h a l l m a r k s of t h e t r u e self t h a t t h e false self is revealed by a lack of s p o n t a n e i t y or originality. It also follows from h i s u n d e r s t a n d i n g of how false-self-structure origin a t e s t h a t s u c h individuals later seek o u t external impingem e n t s to recreate t h e experience of compliant relating a n d , with it, a s e n s e of r e a l n e s s a b o u t their own existence. Winnicott also identified t h e k i n d of self t h a t a p p e a r s to be real b u t is built on identification with early objects a n d t h u s lacks s o m e t h i n g uniquely its own. Winnicott described h o w ,the false self m a y s o m e t i m e s set itself u p a s real a n d generally convey this impression to others, b u t it does so mechanically, lacking g e n u i n e links between inter-

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n a l s t a t e s a n d actions, A self w h o s e own constitutional s t a t e h a s n o t b e e n recognized is a n empty self. T h e e m p t i n e s s reflects t h e activation of s e c o n d a r y r e p r e s e n t a t i o n s t h a t lack t h e corres p o n d i n g c o n n e c t i o n s to affective activation within t h e constitutional self. Emotional experience will be meaningless, a n d t h e individual m i g h t look for powerful o t h e r s to merge with or extraneously c a u s e d (drug-induced) physical experiences of a r o u s a l to fill t h e v a c u u m w i t h borrowed s t r e n g t h or ideals. Only w h e n t h e p e r s o n is challenged by t h e need to a c t s p o n t a n e o u s l y a s a whole person, particularly in i n t e n s e relationships, will t h e limit a t i o n s become evident. T h e false self is t h o u g h t to serve to hide, a n d t h u s protect, the t r u e self. The t r u e self is t h e constitutional s t a t e t h a t w a s largely u n r e p r e s e n t e d by p a r e n t a l mirroring. T h u s it m a y emerge only in t h e c o u r s e of extreme s t a t e s of emotional a r o u s a l , w h e n the internalized b u t nonreferential expression c a n n o longer serve to m a s k emotional upheaval—for example, in t h e c o u r s e of physical or psychological illness. S y m p t o m formation m a y e x p r e s s the t r u e self b e c a u s e historically t h i s w a s how t h e emerging self found t h a t it could exist w i t h o u t being overwhelmed by t h e environment, h a v i n g creative g e s t u r e s replaced or ignored. In distinguishing between deprivation a n d privation, Winnicott (1960a) b r o u g h t a critical concept to a n u n d e r s t a n d i n g of t h e influence of t h e environment, w h i c h is closely related to t h e c u r r e n t formulation of two styles of affect-mirroring. Privation is experienced a t a stage w h e r e t h e infant d o e s n o t h a v e a n awaren e s s of m a t e r n a l care; deprivation c a n occur only once t h e infant b e c o m e s a w a r e b o t h of h i s own n e e d s a n d of t h e object a n d is able to perceive environmental m a l a d j u s t m e n t . Privation occurs w h e n mirroring is m a r k e d b u t distorted, u n d e r r n i n i n g t h e infant's a w a r e n e s s of h i s own experience. Deprivation o c c u r s w h e n mirroring is u n m a r k e d a n d t h e caregiver's c o n g r u e n t affect is foisted on t h e infant w i t h o u t modulation. This distinction is crucial to o u r u n d e r s t a n d i n g of antisocial behavior where, in Winnicott's formulation, a certain degree of integration within t h e self h a s already t a k e n place b u t deprivation is sufficiently severe a n d chronic for t h e r e p r e s e n t a t i o n of t h e good-enough e n v i r o n m e n t to be compromised (Winnicott 1967). In t h e s e c a s e s t h e r e is n o active d i s c o u r a g e m e n t of the

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expression of t h e t r u e self; r a t h e r , t h e child c a n n o t cope with t h e failure or w i t h d r a w a l of ego s u p p o r t , a n d a n antisocial t e n d e n c y develops to protect h i s s e n s e of self. Capacity for c o n c e r n is limited b e c a u s e t h e self is reorganized a t a more primitive level. Within Winnicott's model, t h e capacity for concern is achieved only toward t h e e n d of t h e second year of life, when 1 constructive a n d creative experiences of r e p a r a t i o n lead t h e child to feel responsibility. Once concern h a s b e e n established, t h e individual c a n u s e constructive e l e m e n t s of aggression in t h e service of work a n d play. T h e perception of t h e self in t h e m i n d of t h e other b e c o m e s the r e p r e s e n t a t i o n of t h e child's experience, t h e r e p r e s e n t a t i o n of t h e r e p r e s e n t a t i o n a l world. C o n s i s t e n t with Winnicott's observations, t h e child w h o fails to develop a r e p r e s e n t a t i o n of a n intentional self is likely to incorporate in h i s image of himself the r e p r e s e n t a t i o n of t h e other, sometimes mental, sometimes physical. T h e p i c t u r e of t h e self will t h e n b e "false": distorted, a s the child's experience of himself is overly influenced by his early perceptions of w h a t o t h e r s t h i n k a n d feel, a n d strangely o u t of t o u c h with w h a t h e himself or o t h e r s a r e currently experiencing. This m a y be why m a n y neglected or m a l t r e a t e d children show a p p a r e n t failures of object p e r m a n e n c e , leading to primitive separation anxiety or feelings of merger with t h e object. In reality, t h e y c o n t i n u e existentially to d e p e n d on t h e physical presence of t h e other, b o t h for self-sustaining auxiliary reflective function—continuing to seek a n d find their intentionality in t h e mind of t h e o t h e r — a n d , m o r e subtly, a s a vehicle for t h e externalization of p a r t s of t h e self-representation t h a t are experienced a s alien a n d i n c o n g r u e n t with t h e self. This alien other is still internalized a s p a r t of t h e self-structure, b u t w i t h o u t t h e appropriate links a n d a s s o c i a t i o n s t h a t would enable t h e self-representation to function coherently. This state of affairs places a massive b u r d e n on t h o s e with severe personality disorder. In order for t h e self to be coherent, the alien a n d u n a s s i m i l a b l e p a r t s require externalization: t h a t is, they need to be s e e n a s p a r t of t h e other where t h e y c a n be hated, denigrated, a n d often destroyed. The physical other w h o performs t h i s function m u s t r e m a i n p r e s e n t for t h i s complex process to operate. T h e borderline child or a d u l t c a n n o t feel t h a t

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h e is a self u n l e s s h e h a s t h e other—often t h e t h e r a p i s t — p r e s e n t to frighten a n d intimidate, to s e d u c e a n d excite, to humiliate a n d reduce to h e l p l e s s n e s s . T h e other's d e p a r t u r e signals t h e r e t u r n of t h e s e "exterojects" a n d t h e d e s t r u c t i o n of t h e coherence the child achieves by s u c h projection. T h e alien self is p r e s e n t in all of u s , b e c a u s e t r a n s i e n t neglect is p a r t of ordinary caregiving; i t i s pernicious w h e n later experie n c e s of t r a u m a in t h e family or t h e peer g r o u p force t h e child to dissociate from p a i n by u s i n g t h e alien self to identify with the aggressor. Hence t h e v a c u o u s self comes to be colonized by the image of t h e aggressor, a n d t h e child comes to experience himself a s evil a n d m o n s t r o u s . In later c h a p t e r s we elaborate on how this, in t u r n , leads to t h r e e i m p o r t a n t changes: (a) a repudiation of mentalization in a n a t t a c h m e n t context, (b) d i s r u p t i o n of t h e psychological self by t h e emergence of t h e o t h e r within t h e self, a n d (c) vital d e p e n d e n c e o n t h e physical p r e s e n c e of t h e other a s a vehicle for externalization. A further twist to t h i s s e q u e n c e can be a d d e d w h e n later brutalization within a n a t t a c h m e n t relationship g e n e r a t e s i n t e n s e s h a m e . Coupled with a history of neglect in infancy a n d a c o n s e q u e n t w e a k n e s s in t h e capacity for mentalization, this b e c o m e s a p o t e n t trigger for violence b e c a u s e of t h e intensity of t h e humiliation experienced w h e n t r a u m a c a n n o t b e a t t e n u a t e d via mentalization. Unmentalized s h a m e is t h e n experienced a s t h e d e s t r u c t i o n of t h e self—we h a v e called it "ego-destructive shame." T h e concept of "ego-destructive s h a m e " plays a key role in o u r d i s c u s s i o n s of violence in adolescence a n d adulthood. (See c h a p t e r s 8-10.)

AFFECT-MIRRORING A S A MECHANISM OF THERAPEUTIC INTERVENTION There is n o p a r t i c u l a r r e a s o n to believe t h a t affect-mirroring a n d its c o n s e q u e n t effects on psychic s t r u c t u r e - b u i l d i n g would be restricted to t h e initial s t a g e s of development only. Contingency detection is likely to b e a pervasive information-processing m e c h a n i s m active over t h e life s p a n , a n d e m p a t h i c affect-reflectt

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tive g e s t u r e s a r e characteristic of a d u l t c o m m u n i c a t i o n a s well a s of p a r e n t - ' n f a n t interactions. In fact, emotional mirroring c a n be identified a s a potentially c e n t r a l m e c h a n i s m of t h e r a p e u t i c change in child p s y c h o t h e r a p y , a n d it h a s b e e n d e m o n s t r a t e d to characterize face-to-face p a t i e n t - t h e r a p i s t interactions in a d u l t p s y c h o t h e r a p y a s well (Krause 1997). In fact, it is t e m p t i n g to suggest t h a t t h e social biofeedback model of affect-mirroring specifies a n i m p o r t a n t mediating m e c h a n i s m u n d e r l y i n g t h e t h e r a p e u t i c influence of so-called mirroring i n t e r p r e t a t i o n s in p s y c h o t h e r a p y . C h a p t e r 6 e x t e n d s t h e social biofeedback model to t h e theory-of-mind perspective in t h e context of a n a s s u m e d model of t h e development of psychic reality. Briefly, we p r o p o s e t h e existence of two levels of representational functioning in n o r m a l development, which we call the "psychic equivalence" a n d t h e "pretend" m o d e s of m e n t a l izing. "Psychic equivalence" (derived from F r e u d ' s original concept of psychic reality—see F r e u d 1900a, 1950 [1895]) refers to t h e more primitive level of m e n t a l functioning where t h e feelings a n d fantasies a r e experienced a s reality a n d n o t a s m e n t a l s t a t e s representing reality. T h e "pretend" mode, on t h e other h a n d , involves a n a w a r e n e s s of t h e representational, mentalistic n a t u r e of experiences, w h i c h is m a d e possible by "decoupling" t h e mental r e p r e s e n t a t i o n s involved from external reality. In t h e "pretend" m o d e t r a u m a t i c memories, t h r e a t e n i n g emotional impulses, or unacceptable, fantasies c a n be safely activated a n d dealt with a s their connection to reality h a s b e e n suspended, (see also F r e u d 1920g; Gergely 1995a; Gergely a n d Watson 1996). The "pretend" m o d e h a s to be clearly m a r k e d , a n d t h e lack of correspondence to a c t u a l reality is frequently exaggerated (cf Fonagy a n d Fonagy 1995). We also suggest t h a t a s a precondition for t h e e s t a b l i s h m e n t of t h e "pretend" mode, t h e child n e e d s to experience h i s feelings a n d t h o u g h t s being repeatedly reflected in a m a r k e d m a n n e r by a n o t h e r p e r s o n . T h e child n e e d s a n a d u l t or older child w h o will "play along," so t h a t t h e child sees h i s fantasy or idea r e p r e s e n t e d in t h e a d u l t ' s mind, reintrojects this, a n d u s e s it a s a r e p r e s e n t a t i o n of h i s own thinking. (See also o u r case illustration in c h a p t e r 7.) In c h a p t e r 6 we consider t h e psychoanalytic p s y c h o t h e r a p y of a 4-year-old girl, "Rebecca." While s h e h a d already achieved t h e

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general ability to u s e t h e "pretend" m o d e of rhentalizing, there r e m a i n e d in h e r m i n d a n "island of psychic equivalence" related to t h e t r a u m a t i c feelings a n d fantasies involving h e r u n k n o w n father a n d t h e r e c e n t d e a t h of a grandfather. This local a r r e s t of t h e development of t h e "pretend" m o d e of m e n t a l functioning w a s related to h e r m o t h e r ' s inability to tolerate a n d reflect in a m a r k e d m a n n e r t h e child's expressions of frustration a n d aggressive fantasies a b o u t h e r a b s e n t father, a s t h e m o t h e r herself also t e n d e d to be stuck—in this area—in a m o d e of psychic equivalence. During a n a l y s i s it proved to b e possible to integrate this "island of psychic equivalence" into t h e "pretend" mode of mentalizing by providing m a r k e d mirroring i n t e r p r e t a t i o n s a b o u t t h e child's feelings a n d t h o u g h t s within t h e framework of play therapy. It s e e m s to u s t h a t o u r social biofeedback model of affectmirroring c a n be fruitfully applied to t h e above c a s e a s the psychological m e c h a n i s m mediating b o t h t h e developmental arrest resulting in t h e "island of psychic equivalence" a n d the t h e r a p e u t i c intervention leading to its integration into t h e "pretend" m o d e of functioning. T h u s , it c a n b e suggested t h a t the little girl's m o t h e r is likely to h a v e either systematically avoided affect-reflective interactions in relation to t h e child's expressed emotions concerning h e r a b s e n t father, or engaged in u n m a r k e d , realistic r e - p r e s e n t a t i o n s of t h e child's i n t e n s e negative affects. This is likely to h a v e intensified t h e child's t r a u m a t i c negative emotional reactions even more, a s well a s leading to the a b s e n c e of secondary m a r k e d emotion r e p r e s e n t a t i o n s in this c o n t e n t area. However, since t h e little girl h a d already acquired t h e m a r k e d "pretend" m o d e of mentalizing in o t h e r a r e a s of t h o u g h t , t h e generalized communicative code of m a r k e d expressions a s indicative of decoupling a n d a s suggestive of self-reference w a s available for her. As a result, t h r o u g h t h e application of m a r k e d mirroring interpretations of h e r t r a u m a t i c feelings a n d fantasies in t h e framework of reality-decoupled play therapy, it b e c a m e possible to establish t h e s e c o n d a r y m a r k e d representational s t r u c t u r e s t h a t could raise t h e "island of psychic equivalence" into t h e safer a n d more tolerable "pretend" mode of emotional experience.

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CONCLUSION Parental mirroring of t h e infant's emotion expressions s e e m s to be a u n i q u e l y h u m a n i n s t i n c t u a l propensity t h a t h a s long b e e n considered in b o t h a c a d e m i c a n d psychoanalytic developmental psychology a s playing a central role in early psychological development. However, t h e v a r i o u s developmental functions associated with p a r e n t a l affect-reflective interactions have, with few exceptions, b e e n b a s e d on clinical reconstruction a n d insight r a t h e r t h a n direct evidence, a n d t h e underlying psychological m e c h a n i s m s m e d i a t i n g t h e hypothesized developmental effects remained mostly unspecified. In c o n t r a s t , in this c h a p t e r we have a d v a n c e d a n e w theory of t h e n a t u r e of p a r e n t a l affectmirroring d u r i n g early emotion-regulative interactions, w h i c h provides a specific model of t h e psychological p r o c e s s e s involved a n d identifies t h e set of developmental functions t h a t are served by t h e s e processes. O u r social biofeedback model of p a r e n t a l affect-mirroring is specifically b a s e d on two s o u r c e s of empirical evidence: it b u i l d s on t h e infant learning literature concerning contingency detection a n d maximization on t h e one h a n d , a n d o n a d u l t biofeedback training s t u d i e s on t h e other. O u r central proposal h a s been t h a t by reflecting in a "marked," exaggerated form t h e infant's emotion expressive displays, t h e caregiver provides a kind of n a t u r a l biofeedback sensitization training to t h e infant whose effects a r e mediated by t h e b a b y ' s sophisticated ability to detect a n d analyze r e s p o n s e - e v e n t contingency relations. We have identified four s e p a r a t e developmental functions t h a t are served by p a r e n t a l mirroring of affects: 1. The sensitization function: As a result of t h e biofeedback training, t h e infant will b e c o m e able to detect a n d g r o u p together the sets of i n t e r n a l - s t a t e c u e s t h a t a r e indicative of h i s categorically distinct dispositional emotion states. 2. The representation-building function: By setting u p s e p a r a t e representations for t h e p a r e n t ' s "marked" emotion-reflective displays t h a t a r e contingent with t h e infant's emotion-expressive

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behaviors, t h e b a b y e s t a b l i s h e s s e c o n d a r y r e p r e s e n t a t i o n s t h a t become associated with h i s primary, n o n c o n s c i o u s , procedural affect states. T h e s e s e c o n d a r y r e p r e s e n t a t i o n a l s t r u c t u r e s will provide t h e cognitive m e a n s for accessing a n d a t t r i b u t i n g emotion s t a t e s to t h e self t h a t will form t h e b a s i s for t h e infant's emerging ability to control a s well a s to r e a s o n a b o u t h i s dispositional emotion s t a t e s . 3. The state-regulation function: During empathic parental mirroring of t h e b a b y ' s negative affect expressions, t h e infant's contingency-detection device registers t h e high degree of contingent control of t h e b a b y ' s emotion expressions over t h e caregiver's mirroring displays. This g e n e r a t e s a s e n s e of c a u s a l efficacy a n d positive a r o u s a l t h a t , t h r o u g h reciprocal inhibition, leads to a decrease of t h e infant's negative affect state. Furthermore, a s a by-product of t h e infant's a t t e m p t s to identify the maximal degree of contingent control h e h a s over t h e p a r e n t ' s affect-reflective displays d u r i n g soothing interactions, t h e baby will modify—in fact, reduce—his negative emotion-expressive behaviors, t h e r e b y also contributing to t h e soothing effect. 4. The communicative and mentalizing function: By internalizing t h e "marked" s e c o n d a r y r e p r e s e n t a t i o n s associated with p r i m a r y self-states, t h e infant will acquire a generalized c o m m u nicative code of "marked" expressions characterized by t h e representational functions of referential decoupling, referential anchoring, a n d s u s p e n s i o n of realistic c o n s e q u e n c e s . This crea t e s a n e w "pretend" mode of mentalizing a n d c o m m u n i c a t i n g a b o u t affective s t a t e s t h a t will provide t h e y o u n g child with powerful r e p r e s e n t a t i o n a l m e a n s of emotional self-regulation a n d expression.

T h e D e v e l o p m e n t of a n

Understanding

of Self a n d

Agency

The a i m of t h i s c h a p t e r is to p r e s e n t t h e m o s t i m p o r t a n t discoveries from developmental r e s e a r c h over t h e l a s t twenty y e a r s t h a t in o u r view p e r t a i n directly to t h e psychoanalytic u n d e r standing of self-development a n d h a v e clear clinical implications for t h e t r e a t m e n t of individuals w h o s e p r i m a r y d i s t u r b a n c e is rooted in disorganized self-representation a n d affect dysregulation. We wish to d i s t i n g u i s h t h e model of self-development a n d affect regulation proposed in t h i s volume from other contemporary developmentally g r o u n d e d psychoanalytic views. We trace the development of mentalization from infancy a n d engage in the developmental d e b a t e a b o u t exactly w h e n t h e intentional stance is achieved. In o u r view m a n y r e c e n t contributions h a v e overstated t h e c a s e for early intersubjective p r o c e s s e s in selfdevelopment. We a r g u e t h a t intersubjectivity is a n emergent p h e n o m e n o n w h o s e e s t a b l i s h m e n t is a function of early interactive p r o c e s s e s within a n a t t a c h m e n t context. In c h a p t e r 3 we laid the foundations for a model of self-development rooted in interpersonal u n d e r s t a n d i n g ; in this c h a p t e r t h i s model is elaborated, and five s t a g e s in t h e development of t h e self a s a g e n t a r e distinguished. T h e c h a p t e r also lays t h e crucial g r o u n d w o r k for the explorations of borderline personality disorder in t e r m s of a n early n o n m e n t a l i s t i c perception of causality in social actions— the teleological s t a n c e . Finally, t h e c h a p t e r gives a relatively 203

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comprehensive s u m m a r y of t h e developmental literature concerning t h e development of a n u n d e r s t a n d i n g of self a n d others a s intentional m e n t a l agents.

INTRODUCTION: EARLY UNDERSTANDING OF T H E SELF A S AGENT FROM T H E POINT OF VIEW OF THEORY-OF-MIND DEVELOPMENT For a long time, t h e s t u d y of t h e "self a s a m e n t a l agent" w a s a neglected topic. Historically, it h a s received m u c h less attention t h a n t h e other major a s p e c t of self-knowledge t h a t William J a m e s (1890) classically termed t h e "empirical self* or "Me" and which in c u r r e n t terminology is often called t h e "conceptual" or "categorical" self-concept or r e p r e s e n t a t i o n (Harter 1999; Lewis a n d B r o o k s - G u n n 1979: Neisser 1988). T h e "categorical s e l f refers to t h e r e p r e s e n t a t i o n of t h e collection of t h o s e features a n d properties t h a t t h e p e r s o n believes to b e t r u e of himself (blue-eyed, h a n d s o m e , good in m a t h , poor soccer player, etc.) a n d t h a t h e h a s mostly inferred from t h e self-directed reactions of h i s social environment. (For a r e c e n t review, see H a r t e r 1999.) The historical bias toward s t u d y i n g t h e social construction of t h e categorical self-concept r a t h e r t h a n t h e J a m e s i a n "subjective self" or "I" c a n be explained by t h e traditionally s t r o n g conceptual influence of t h e C a r t e s i a n doctrine of "first-person a u t h o r ity," w h i c h claims t h a t o n e h a s direct a n d infallible introspective a c c e s s to one's own intentional m i n d s t a t e s . T h e influence of C a r t e s i a n doctrine h a s encouraged t h e belief t h a t t h e conscious a p p r e h e n s i o n of o u r m i n d s t a t e s t h r o u g h introspection is a basic, direct, a n d probably prewired ability of o u r m i n d , leading to t h e conviction t h a t knowledge of t h e self a s a m e n t a l agent is a n innately given r a t h e r t h a n a developing or c o n s t r u c t e d capacity. As we shall see (especially in o u r d i s c u s s i o n of currently p o p u l a r views of initial-state "intersubjectivity"), t h e Cartesian doctrine still s e e m s to h a v e its sway a m o n g m a n y developmental r e s e a r c h e r s . However, c u r r e n t philosophy of mind, cognitive neuroscience, a n d developmental theory have seriously challenged t h e Cartesian view of t h e m i n d (Damasio 1994a; Dennett a

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1991; Gopnik 1993; Wegner a n d Wheatley 1999). At t h e s a m e time, r e c e n t philosophical (D. Davidson 1980; Searle 1983), cognitive, a n d neuropsychological (C. D. Frith 1992; J e a n n e r o d 1999; Pacherie 1997; Prinz 1997) models of t h e r e p r e s e n t a t i o n of intentional action indicate t h a t t h e r e p r e s e n t a t i o n of intentional mind s t a t e s h a s a r a t h e r complex internal s t r u c t u r e w h o s e conscious a c c e s s m a y be a b s e n t or only partial a n d m a y d e p e n d on a variety of factors (Dienes a n d Perner 1999). This, together with t h e d e m o n s t r a t i o n s from c u r r e n t theory-of-mind r e s e a r c h d o c u m e n t i n g a n intriguingly complex developmental unfolding of the u n d e r s t a n d i n g of different types of intentional mind states— s u c h a s desires, intentions, a n d beliefs (Bartsch a n d Wellman 1995; Perner 1991)—strongly indicates t h a t t h e m a t u r e u n d e r s t a n d i n g of t h e self a s a m e n t a l agent is also likely to be t h e product of r a t h e r complex developmental processes. The aim of this c h a p t e r , therefore, is to trace in t h e light of t h e s e n e w theoretical a n d empirical a d v a n c e s t h e different stages of t h e development of self-knowledge from t h e early u n d e r s t a n d i n g of physical a n d social agency in infancy to t h e more m a t u r e u n d e r standing of t h e self a s a m e n t a l agent in early childhood. We c a n differentiate five levels of agency of t h e self, of w h i c h the developing h u m a n infant acquires a progressive u n d e r s t a n d ing: physical, social, teleological, intentional, a n d representational. (These were briefly introduced in c h a p t e r 3.) At t h e level of physical description, actions e n t e r into two types of c a u s a l relations: t h e y a r e related to bodies t h a t provide their c a u s a l source of energy, a n d t h e y h a v e a c a u s a l i m p a c t on t h e environment, bringing a b o u t s t a t e s of affairs t h a t did n o t exist before. Understanding t h e self as a "physical agent," therefore, minimally involves s o m e appreciation of t h e s e c a u s a l relations: the self a s a physical entity with force t h a t is t h e source of action a n d t h e self a s a n agent w h o s e a c t i o n s bring a b o u t c h a n g e s in their proximal environment (Leslie 1994). F u r t h e r m o r e , starting from birth, h u m a n infants engage in species-specific interactions with their caregivers (Meltzoff a n d Moore 1977; S t e r n 1985; Trevarthen 1979). In s u c h e x c h a n g e s t h e infant's displays h a v e effects in t h e form of t h e behavioral r e a c t i o n s a n d emotion displays they induce in their p a r e n t s . Early u n d e r s t a n d i n g of t h e self as a "social agent" involves, therefore, a t least t h e r e p r e s e n t a t i o n of

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t h e c a u s a l effects a t a d i s t a n c e t h a t species-specific c o m m u n i c a tive displays c a n bring a b o u t in t h e social e n v i r o n m e n t (Neisser 1988). However, t h e types of c a u s a l relations t h a t connect actions to their a g e n t s on t h e one h a n d a n d to t h e world on the other go beyond t h e level of physical description, a n d , correspondingly, a d u l t s a n d y o u n g children come to u n d e r s t a n d m u c h more a b o u t b o t h of t h e s e relations a s t h e y develop. T h u s , a t a r o u n d 8 - 9 m o n t h s of age, (Tomasello 1999), infants come to differentiate actions from their o u t c o m e s a n d r e p r e s e n t actions a s m e a n s t h a t function to bring a b o u t goal s t a t e s . At t h i s level the self is understood as a "teleological agent" (Csibra a n d Gergely 1998; Leslie 1994) w h o c a n choose a m o n g alternative actions t h e one t h a t is m o s t efficient in bringing a b o u t a goal given t h e c o n s t r a i n t s of a p a r t i c u l a r situation. S o m e t i m e s d u r i n g t h e second year infants seem to develop a n already mentalistic u n d e r s t a n d i n g of agency: t h e y s t a r t to c o n s t r u e t h e self as an "intentional agent" w h o s e actions a r e c a u s e d by prior intentional m e n t a l s t a t e s s u c h a s desires (Wellman a n d Phillips 2000). At this point, they also u n d e r s t a n d t h a t a c t i o n s c a n c h a n g e m e n t a l a s well a s physical properties of t h e world: for example, they clearly u n d e r s t a n d t h a t a declarative pointing g e s t u r e functions to c h a n g e t h e attentional s t a t e of a n o t h e r agent (Corkum a n d Moore 1995). At a r o u n d 3 to 4 y e a r s of age t h i s u n d e r s t a n d i n g of agency in t e r m s of m e n t a l c a u s a t i o n also c o m e s to include t h e r e p r e s e n t a t i o n of epistemic m i n d s t a t e s — s u c h a s beliefs (Wimmer a n d Perner 1983). At t h i s stage, t h e y o u n g child already s h o w s a n u n d e r s t a n d i n g of t h e self as a "representational agent" w h o s e actions a r e c a u s e d by intentional m e n t a l states (desires a n d beliefs) t h a t are c o n s t r u e d a s r e p r e s e n t a t i o n a l in n a t u r e (Perner 1991; Wellman 1990). Related a d v a n c e s at this stage, s u c h a s t h e ability to u n d e r s t a n d t h e "causal selfreferentiality" of intentional m i n d s t a t e s (Pacherie 1997; Perner 2000b; Searle 1983) a n d t h e r e p r e s e n t a t i o n a l capacity to relate t h e memories of t h e self s intentional activities a n d experiences into a coherent c a u s a l - t e m p o r a l organization (Povinelli and Eddy 1995), leads to t h e e s t a b l i s h m e n t of the—temporally— "extended" or "proper" self (W. J a m e s , 1890)—in other words, to a n u n d e r s t a n d i n g of t h e "autobiographical self." As t h i s brief preview indicates, t h e development of a n u n d e r s t a n d i n g of self

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a n d agency is a highly complex a n d currently m u c h r e s e a r c h e d field of s t u d y .

EARLY DEVELOPMENT OF T H E SELF A S A "PHYSICAL AGENT" Traditionally, it w a s believed (Freud 191 lb; Piaget 1936} t h a t t h e newborn b a b y ' s world is basically solipsistic a n d t h a t infants are at first u n a b l e to differentiate between stimuli t h a t belong to t h e self a n d t h o s e t h a t belong to t h e environment. S u c h a differentiation, however, s e e m s to be a prerequisite for t h e development of a s e n s e of physical agency, w h i c h involves representing t h e c a u s a l relationships b e t w e e n actions a n d t h e physical self oh t h e one h a n d , a n d a c t i o n s a n d t h e external world on t h e other. Contemporary r e s e a r c h h a s challenged t h e traditional belief in a n initial undifferentiated state, uncovering a n u m b e r of objective information s o u r c e s a n d c o r r e s p o n d i n g i n n a t e detection m e c h a n i s m s t h a t provide for t h e direct perception of t h e "ecological self" (Butterworth 1995; Neisser 1988) a s a differentiated objective entity moving in s p a c e a m o n g other physical objects. Following Gibson's (1966) ecological perspective, a series of s t u d i e s demonstrated t h a t y o u n g infants c a n detect a n d differentiate t h e bodily self in relation to t h e e n v i r o n m e n t on t h e b a s i s of invariance p a t t e r n s in t h e flow of visual information t h a t a c c o m p a n i e s selfmovement in space. For example, Lee a n d Aronson (1974) demonstrated t h a t w h e n tested in a "moving room" (whose walls a p p r o a c h or recede), b a b i e s c o m p e n s a t e d for visually specified— b u t nonexistent—loss of b a l a n c e by adjusting their body posture, resulting in swaying, staggering, or even falling. Follow-up s t u d ies by B u t t e r w o r t h a n d colleagues (Butterworth a n d Cicchetti 1978; B u t t e r w o r t h a n d Hicks 1977) h a v e s h o w n t h a t even 2month-olds c a n u s e visual feedback to control their h e a d posture, showing c o m p e n s a t o r y h e a d m o v e m e n t s w h e n perceiving visually specified instability in t h e moving room. Young infants also modify t h e position of their h e a d s a n d / o r blink w h e n perceiving a n object a p p r o a c h i n g on a collision c o u r s e (Dunkeld a n d Bower 1980; Pettersen, Yonas, a n d Fisch 1980).

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As d i s c u s s e d in some detail in c h a p t e r 4, a n u m b e r of s t u d i e s have d e m o n s t r a t e d t h a t y o u n g infants are highly sensitive to t h e contingent relations b e t w e e n their physical r e s p o n s e s a n d cons e q u e n t s t i m u l u s events (e.g., Bahrick a n d W a t s o n 1985; Field 1979; Lewis et al. 1990; Lewis a n d B r o o k s - G u n n 1979; Papousek a n d P a p o u s e k 1974; Rochat a n d Morgan 1995; W a t s o n 1972, 1994). As we have argued (see also Gergely a n d W a t s o n 1999), t h e evidence s u p p o r t s t h e view t h a t infants p o s s e s s a n i n n a t e contingency-detection module for analyzing t h e degree of contingent r e l a t e d n e s s between m o t o r r e s p o n s e s , a n d conseq u e n t sensory events. Bahrick a n d W a t s o n (1985) d e m o n s t r a t e d t h a t before 3 m o n t h s of age infants s h o w a preferential b i a s to a t t e n d to a n d explore perfect contingencies. Based on findings s u c h a s these, W a t s o n (1994) hypothesized t h a t t h e primary function of t h e contingency analyzer is t h a t of self-detection: by identifying t h o s e sensory stimuli t h a t a r e perfectly contingent with one's motor r e s p o n s e s t h e m o d u l e c o n s t r u c t s a primary r e p r e s e n t a t i o n of t h e physical self a s a distinct object in t h e environment. (See c h a p t e r 4 for details.) After 3 m o n t h s of age infants s t a r t to t u r n their attention toward t h e less-than-perfectly contingent effects of their actions on t h e external world (Watson 1994). Piaget (1936) reported t h a t from a b o u t t h e age of 4 m o n t h s infants tend to r e p e a t motor actions t h a t r e s u l t in salient c h a n g e s in t h e external environm e n t ("secondary circular reactions") in order to "make interesting t h i n g s last." H a b i t u a t i o n s t u d i e s with 5- to 6-month-olds (Leslie 1984; Woodward 1998) suggest t h a t by this age infants discriminate grasping h a n d s from other—inanimate—physical objects, attributing to t h e m special c a u s a l powers s u c h a s t r a n s porting objects t h r o u g h space. In s u m , t h e r e is converging evidence t h a t i n n a t e informationprocessing devices enable infants d u r i n g t h e first six m o n t h s of life to r e p r e s e n t their bodily self a s a differentiated object in s p a c e t h a t c a n initiate action a n d exert c a u s a l influence on its environment. While s u c h a r e p r e s e n t a t i o n of t h e self a s a physical agent certainly involves sensitivity to t h e c a u s a l relations t h a t relate a g e n t s to actions on t h e one h a n d a n d actions to o u t c o m e s on t h e other, t h i s u n d e r s t a n d i n g is still restricted in i m p o r t a n t ways a t t h i s stage. For example, a w a r e n e s s t h a t ac-

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tions h a v e a c a u s a l power in bringing a b o u t salient o u t c o m e s does n o t yet involve a differentiation between goals a n d behavioral m e a n s (Piaget 1936). T h i s is s h o w n b y t h e fact t h a t while infants y o u n g e r t h a n 6 - 8 m o n t h s would repeat a c t s t h a t h a d previously resulted in a salient outcome, they would n o t modify their action in r e s p o n s e to relevant c h a n g e s in t h e situation—for example, t h e y would n o t m a k e a d e t o u r a r o u n d a newly inserted obstacle to r e a c h a n object. T h e ability to differentiate between goals a n d m e a n s is, however, a prerequisite for u n d e r s t a n d i n g intentional goal-directed action within a teleological framework (Csibra a n d Gergely 1998; Gergely et al. 1995; Tomasello 1995, 1999). This involves t h e ability to choose from multiple alternatives, whichever action realizes a goal s t a t e in t h e m o s t efficient m a n n e r , given t h e c h a n g i n g c o n s t r a i n t s of reality. Infants s t a r t to organize t h e i r . b e h a v i o r in relation to goal s t a t e s in t h i s rational m a n n e r only a t a r o u n d 8 - 9 m o n t h s of age (Piaget 1936; Tomasello 1999; Willatts 1999), w h e n they also begin to interpret a n d predict other agents* goal-directed actions within t h e s a m e teleological interpretive framework (Csibra a n d Gergely 1998; Csibra et al. 1999). Apart from a n early u n d e r s t a n d i n g of their c a u s a l power over the physical e n v i r o n m e n t t h r o u g h action involving direct contact, infants also s h o w a n e a r l y sensitivity to their c a u s a l influence over objects a t a distance, a s in W a t s o n ' s (1972) mobile s t u d i e s — a sensitivity mediated by t h e contingency-detection m o d u l e (discussed in detail in c h a p t e r 4; see also Gergely a n d W a t s o n 1999). T h e n a t u r a l d o m a i n of s u c h c a u s a l efficacy a t a distance is t h a t of social interactions, so in t h e next section we consider t h e origins of u n d e r s t a n d i n g t h e self a s a "social agent."

EARLY UNDERSTANDING OF T H E SELF A S A "SOCIAL AGENT" A large body of evidence indicates t h a t from t h e beginning of life infants discriminate a n d actively orient toward people (Stern 1985). They s h o w a very early sensitivity to facial p a t t e r n s (Fantz 1963; Morton a n d J o h n s o n 1991), they h a b i t u a t e to their

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m o t h e r s ' voice in utero a n d recognize it after b i r t h (DeCasper a n d Fifer 1980), a n d t h e y s h o w n e o n a t a l imitation of facial g e s t u r e s (Meltzoff a n d Moore 1977, 1989). Young infants engage in interactions with their caregivers t h a t a r e characterized by a "protoconversational" t u r n - t a k i n g s t r u c t u r e (Beebe et al. 1985; Brazelton et al. 1974; Brazelton a n d Tronick 1980; S t e r n 1985; T r e v a r t h e n 1979; Tronick 1989). T h e c u r r e n t l y d o m i n a n t biosocial view of emotional development h o l d s t h a t m o t h e r a n d infant form a n affective c o m m u n i c a t i o n s y s t e m from t h e beginning of life (Bowlby 1969; Brazelton et al. 1974; H o b s o n 1993; S a n d e r 1970; S t e r n 1977, 1985; T r e v a r t h e n 1979; Tronick 1989) in w h i c h t h e m o t h e r plays a vital interactive role in m o d u l a t i n g t h e infant's affective s t a t e s . During their interactions, caregivers often engage in facial a n d vocal mirroring of their b a b y ' s displays of emotion in order to regulate t h e infant's affects (Gergely a n d W a t s o n 1996, 1999; Malatesta a n d Izard 1984; P a p o u s e k a n d P a p o u s e k 1987; S t e r n 1985). Infants, therefore, s e e m to s h o w a n initial species-specific sensitivity to h u m a n facial/vocal a n d behavioral displays a n d a n i n n a t e propensity to engage in affective interactions with caregivers. B u t how do they u n d e r s t a n d s u c h affective social interactions and= their own c a u s a l role in t h e m a s social a g e n t s ? There is a large s p e c t r u m of different theoretical views on this intriguing question. 1. First of all, t h e r e is w h a t we shall call t h e "strong intersubjectivist" position, which a s s u m e s (a) t h a t h u m a n infants are b o m with i n n a t e m e c h a n i s m s to identify a n d a t t r i b u t e m e n t a l s t a t e s s u c h a s i n t e n t i o n s a n d feelings to t h e other's m i n d during early contingent social interactions, (b) t h a t from t h e beginning of life t h e r e is a relatively rich set of differentiated m e n t a l s t a t e s of t h e self s u c h a s emotions, intentions, motives, a n d goals t h a t are introspectively accessible to t h e infant, a n d (c) t h a t s u c h subjective m e n t a l s t a t e s of t h e self c a n be recognized a s being similar to corresponding m e n t a l s t a t e s of t h e other a n d , a s such, are experienced a s "being s h a r e d " with h e r (e.g., B r a t e n 1988, 1992; for a recent collection of p a p e r s on intersubjectivity, see B r a t e n 1998; S t e r n 1995; T r e v a r t h e n 1979, 1993).

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For example, T r e v a r t h e n (1979) claims t h a t t h e richly s t r u c tured early affective interactive e x c h a n g e s observable between m o t h e r s a n d infants imply w h a t h e calls "primary intersubjectivity." A well-known s t u d y by M u r r a y a n d Trevarthen (1985) u s i n g 6- to 12-month-old infants a s subjects is often cited a s providing empirical s u p p o r t for t h i s position. In a n ingenious p a r a d i g m infants were observed while interacting with their m o t h e r ' s live image t h r o u g h a TV monitor. After a certain period, t h e TV image w a s switched to a n o n c o n t i n g e n t image recorded earlier of t h e m o t h e r engaged in interaction with h e r baby. These very y o u n g infants were reported to h a v e detected t h e subtle c h a n g e in t h e contingency s t r u c t u r e of t h e interaction a n d reacted with displays of dissatisfaction a n d negative affect to t h e loss of m a t e r n a l contingency. T r e v a r t h e n (1993) therefore proposes t h a t infants a r e b o r n with a dialogic m i n d , with a n i n n a t e s e n s e of "the virtual other" (see also B r a t e n 1988) a n d c a n interpret t h e other's affectively a t t u n e d interactions in t e r m s of a rich set of underlying motives, feelings, intentions, a n d goals. Stern also suggests t h a t "from a very early age, t h e infant perceives intentions in t h e self a n d t h e other, t h a t h e 'sees past* t h e specific overt behaviors in order to read in t h e m t h e intentions t h a t organize t h e s e behaviors" (1995, p. 420). As s h o w n in c h a p t e r 4, Meltzoff a n d Gopnik (see 1993; Meltzoff a n d Moore 1997, 1998) also e m b r a c e t h e p r i m a r y intersubjectivity a s s u m p t i o n w h e n they s p e c u l a t e t h a t t h e i n n a t e "active intermodal mapping" m e c h a n i s m t h a t m e d i a t e s n e o n a t a l imitation also functions a s a m e c h a n i s m for a t t r i b u t i n g intentional, motivational, a n d feeling states to t h e o t h e r d u r i n g early imitative interactions. In c o n t r a s t t o advocates of t h e "strong intersubjectivist" position, a n u m b e r of r e s e a r c h e r s believe t h a t t h e p h e n o m e n a of early affective a n d imitative social interactions c a n be parsimoniously explained w i t h o u t a s s u m i n g "primary intersubjectivity" (e.g., Gergely a n d W a t s o n 1996, 1999; R. T h o m p s o n 1998; Tomasello 1999). In t h i s view, if attentiveness a n d reactivity to h u m a n facial p a t t e r n s a n d affective displays a r e innate, a n early sensitivity to t h e contingency s t r u c t u r e of interactive behavioral exchanges a n d a n i n n a t e propensity to imitate h u m a n facial gestures provide sufficient b a s i s to explain t h e s t r u c t u r e d two-

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way affective interactions of early infancy a s well a s t h e infant's affective/behavioral reactions to experimentally i n d u c e d p e r t u r b a t i o n s of t h e flow of contingent exchanges—for example, the "still-face" p r o c e d u r e (Tronick et al. 1978) or t h e delayed-feedb a c k p r o c e d u r e of t h e M u r r a y a n d T r e v a r t h e n (1985) paradigm. First, a s described above, t h e r e is a good deal of evidence to indicate t h a t while y o u n g infants a r e positively a r o u s e d w h e n t h e y find t h a t they h a v e a high degree of control over w h e t h e r a s t i m u l u s event h a p p e n s (Lewis et al. 1990; W a t s o n 1972), loss of previously experienced contingency r e s u l t s in frustration a n d expressions of distress, even w h e n t h e s t i m u l u s is n o t a h u m a n p e r s o n (Lewis et al. 1990). T h u s , sensitivity to loss of contingent control would seem sufficient to explain t h e M u r r a y a n d Trevart h e n ' s (1985) finding d i s c u s s e d above. (For a t t r i b u t i n g a central role for social contingency perception in infancy, see also Bigelow, 2001; Bigelow a n d DeCoste, in press; Muir a n d Hains 1999; Nadel a n d Tremblay-Leveau 1999; Rochat a n d Striano 1999; Tomasello 1999.) F u r t h e r m o r e , it h a s proved difficult to replicate t h e findings of M u r r a y a n d Trevarthen—whose original s t u d y w a s b a s e d on four 2-month-old infants only—with infants u n d e r 3 m o n t h s of age in s t u d i e s u s i n g methodologically improved designs. Nadel, Carchon, Kervella, Marcelli, a n d Reserbat-Plantey (1999) did replicate t h e effect in 2-month-olds, b u t Rochat, Neisser, a n d Marian (1998) failed to do so in two s t u d i e s u s i n g 2- to 3 - m o n t h old infants a n d Bigelow a n d DeCoste (in press) found t h e effect in 4- a n d 6 - m o n t h - o l d s b u t also failed to replicate it with a g r o u p of 2-month-olds. It is interesting to consider this p a t t e r n of findings in t h e light of W a t s o n ' s (1994) hypothesis t h a t a m a t u r a t i o n a l "switch" takes place a t a r o u n d t h e age of 3 m o n t h s in t h e preferred target value of t h e contingency-detection module. As we h a v e seen, a signific a n t proportion of 3 - m o n t h - o l d s in t h e Bahrick a n d W a t s o n (1985) s t u d y seemed preoccupied with their perfectly contingent self-image (see also Field 1979), w h e r e a s 5 - m o n t h - o l d s preferred to avoid t h e perfectly contingent display, looking m o r e a t t h e n o n c o n t i n g e n t image. F u r t h e r s t u d i e s by W a t s o n suggest t h a t this t e n d e n c y is d u e to a n avoidance of perfect contingencies r a t h e r t h a n to a preference for noncontingency. W a t s o n (1979,

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1985) aimed to identify t h e preferred degree of contingency after 3 m o n t h s of age. He examined 4- to 6-month-olds' r e a c t i o n s to different m a g n i t u d e s of r e s p o n s e - s t i m u l u s contingencies in t h e range from slightly greater t h a n 0 to slightly less t h a n 1 (in t e r m s of conditional probability). He found t h a t a t this age infants h a v e great difficulty with contingency m a g n i t u d e s t h a t a r e less t h a n 0.5. At t h e s a m e time, t h e y also failed to engage contingencies t h a t a p p r o a c h e d a m a g n i t u d e of 1. In contrast, t h e infants were very motivated to engage high-but-imperfect contingencies. As d i s c u s s e d in c h a p t e r 4, W a t s o n (Gergely a n d W a t s o n 1999; W a t s o n 1994) therefore hypothesized t h a t a t a r o u n d 3 m o n t h s the target value of t h e contingency analyzer in n o r m a l infants is "switched" to a preference for high-but-imperfect contingencies t h a t are characteristic of t h e infant-directed reactive behaviors of well-attuned social objects. This m a t u r a t i o n a l c h a n g e functions to orient t h e infant after 3 m o n t h s of age away from selfexploration (perfect contingencies) a n d toward the exploration and representation of the social world. T h e s e a s s u m p t i o n s raise the possibility t h a t before 3 m o n t h s of age t h e degree of contingency provided by p a r e n t a l interactions m a y n o t be high e n o u g h for its d i s a p p e a r a n c e to b e detected by t h e infant w h e n t h e p a r e n t c o n t i n u e s to display similar interactive b u t noncontingent behavior. This, t h e n , m a y explain t h e difficulty found in several s t u d i e s of replicating t h e M u r r a y a n d Trevarthen (1985) finding u n d e r 3 m o n t h s of age (cf. Bigelow, 2001). Some recent findings provide further s u p p o r t for t h e position t h a t infants a r o u n d 3 m o n t h s of age a r e in a transitional period in which sensitivity to high-but-imperfect social contingencies begins to emerge. Even t h o u g h in t h e Bigelow a n d DeCoste (in press) s t u d y the 2 - m o n t h - o l d s a s a g r o u p did n o t distinguish between contingent a n d n o n c o n t i n g e n t displays, approximately half of t h e infants did s h o w a decrease in visual attention to t h e noncontingent display w h e n t h e y were examined individually. F u r t h e r more, Legerstee a n d Varghese (2001), u s i n g a similar paradigm, reported t h a t a s u b g r o u p of their s a m p l e of 3 - m o n t h - o l d s whose mothers were w a r m , sensitive, a n d a t t u n e d to t h e infants' cues' in their interactions r e a c t e d with m o r e visual attention, smiling, and melodic vocalizations to t h e contingent t h a n to t h e noncontingent displays. Infants of m o t h e r s who scored low on t h e s e

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m e a s u r e s , however, showed no s u c h differentiation between the two types of displays. It s e e m s likely t h a t t h e m o t h e r s in the a t t u n e d , highly responsive g r o u p provided degrees of contingent reactivity t h a t were high e n o u g h for their 3 - m o n t h - o l d infants to detect, a n d so t h e s u d d e n loss of contingency in t h e noncontingent display b e c a m e discriminable for t h e s e babies. This finding also s u p p o r t s t h e a r g u m e n t , m o r e fully explicated in c h a p t e r 3,^ t h a t t h e level of sensitivity manifested by,the caregiver influences t h e r a t e a t w h i c h t h e child acquires t h e capacity to exert control over its i n t e r n a l states. The second objection to t h e "strong intersubjectivist" position c o n c e r n s its a s s u m p t i o n t h a t i n n a t e m e c h a n i s m s identify a n d a t t r i b u t e intentional a n d emotional s t a t e s to t h e m i n d s of others. Two types of prewired a r c h i t e c t u r e for accessing subjective m e n t a l s t a t e s of o t h e r s c a n be imagined to accomplish t h i s task: {a) direct perception t h r o u g h ' innately specified* triggering displays, a n d (b) inferential a c c e s s to t h e other's subjective s t a t e s t h r o u g h motor simulation. S o m e r e s e a r c h e r s h a v e indeed claimed t h a t n e w b o r n infants c a n differentiate a m o n g a set of discrete basic-emotion expressions (Field et al. 1983; Haviland a n d Lelwica 1987; Izard a n d Malatesta 1987) s u c h a s h a p p i n e s s , surprise, or s a d n e s s . However, later r e s e a r c h (C. Nelson 1987) h a s questioned w h e t h e r the b a b i e s are really differentiating between emotions or, rather, between some other non-emotion-specific p e r c e p t u a l features. For example, Caron, Caron, a n d Myers (1985) d e m o n s t r a t e d t h a t 4- to 7-month-olds could differentiate between toothy a n d nontoothy emotion expressions, b u t t h e y could n o t differentiate between angry a n d h a p p y expressions if b o t h of t h e m showed teeth. Caron, Caron, a n d MacLean (1988) also showed t h a t 4 - m o n t h - o l d s could n o t discriminate h a p p y from s a d dynamic facial/vocal expressions, a n d 5 - m o n t h - o l d s failed to do so with h a p p y a n d angry displays. S u c h findings suggest-that even if one accepts t h e notion t h a t t h e r e is a set of universal, prewired, discrete facial emotion expressions ( E k m a n 1992b; Izard 1991; Malatesta a n d Izard 1984), t h e r e s e e m s to be n o compelling evidence t h a t infants c a n discriminate between s u c h emotionexpressive facial p a t t e r n s in o t h e r s before 5 to 6 m o n t h s of age.

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Apart from facial emotion expressions, some i n n a t i s t t h i n k e r s have proposed t h a t certain t y p e s of behavioral c u e s , s u c h a s self-propelled m o v e m e n t or direction of movement, automatically trigger a t t r i b u t i o n of intentionality or goal to other a g e n t s (Leslie 1994; P r e m a c k 1990; P r e m a c k a n d P r e m a c k 1995). However, recent h a b i t u a t i o n s t u d i e s (Csibra et al. 1999) a n d elicited gazefollowing s t u d i e s (Johnson, Slaughter, a n d Carey 1998) h a v e d e m o n s t r a t e d t h a t while s u c h c u e s m a y be informative, they a r e neither n e c e s s a r y n o r sufficient for triggering goal attribution even in 9- a n d 12-month-old infants. The alternative to t h e idea t h a t infants perceive emotions directly t h r o u g h i n n a t e releasers is t h e suggestion t h a t they c a n infer t h e o t h e r ' s i n t e n t i o n s a n d feelings by generating a n d experiencing t h e m t h r o u g h motor simulation. As we h a v e seen, Meltzoff a n d h i s colleagues (Meltzoff a n d Gopnik 1993; Meltzoff a n d Moore 1989) h a v e proposed s u c h a m e c h a n i s m in their "active i n t e r m o d a l m a p p i n g " a c c o u n t of n e o n a t a l imitation. Their u s e of t h i s m e c h a n i s m to explain n o t only t h e fact of infantile imitation per se b u t . a l s o t h e a s s u m e d fact of attributing subjective m e n t a l s t a t e s to t h e other r e q u i r e s s o m e further s t r o n g innatist a s s u m p t i o n s a b o u t t h e extent to w h i c h infants are able to differentiate between intentional a n d emotional self-states on the one h a n d , a n d a b o u t t h e introspective accessibility of s u c h differentiated m e n t a l s t a t e s on t h e other. T h u s , t h e "strong intersubjectivist" view implies [a) t h a t imitation of t h e other's expressive displays i n d u c e s c o r r e s p o n d i n g emotional a n d intentional self-states (the C o r r e s p o n d e n c e Assumption), (b) t h a t t h e self-states generated by m o t o r simulation are directly accessible to t h e infant t h r o u g h introspection (the Primary Access a n d SelfAwareness Assumption), a n d (c) t h a t t h e infant a t t r i b u t e s s u b jective i n t e r n a l s t a t e s to t h e other's m i n d by consulting h i s own felt subjective state, w h i c h is generated by h i s imitation (the Other Mind Assumption). There is very little evidence to s u p p o r t a n y of t h e s e a s s u m p tions, however. For example, do infants experience t h e s a m e types of emotion s t a t e s t h e expression of which they observe in their m o t h e r s d u r i n g early affective interactions? Even t h o u g h proponents of differential emotions theory (Izard 1991; Malatesta

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a n d Izard 1984) claim t h a t — u s i n g t h e MAX (Izard 1979) or the AFFEX (Izard, Dougherty, a n d Hembree 1983) coding systems— expressions of emotions s u c h a s fear, anger, or s a d n e s s c a n be objectively differentiated in early infancy, o t h e r s (Oster, Hegley, a n d Nagel 1992) u s i n g a different coding system, t h e Baby-FACS (Oster a n d Rosenstein, in press), d i s p u t e this claim a n d a r g u e t h a t y o u n g babies' negative expressions s h o w only undifferentiated d i s t r e s s a t first. C a m r a s (1992) pointed o u t t h a t t h e conditions t h a t i n d u c e p a r t i c u l a r emotion expressions in y o u n g b a b i e s a r e often idiosyncratic a n d unexpected, a s in t h e c a s e of a 1-month-old w h o expressed s a d n e s s w h e n eating a s o u r vitamin. Recently, C a m r a s (2000) reviewed a n u m b e r of further empirical p h e n o m e n a t h a t raise p r o b l e m s for t h e view t h a t babies* expressions of emotion a r e linked to internal feelings like t h o s e t h a t a d u l t s experience a n d t h a t t h e s e expressions will be prompted by t h e s a m e k i n d s of stimuli a s t h o s e to which a d u l t s react. In fact, m a n y emotion r e s e a r c h e r s believe t h a t b a b i e s a r e not yet able to differentiate emotions a n d / o r do n o t yet h a v e conscious a c c e s s to t h e m d u r i n g t h e first few m o n t h s : they argue t h a t t h e s e abilities a r e t h e c o n s e q u e n c e of early self-organizing d y n a m i c s y s t e m s p r o c e s s e s (Fogel et al. 1992; Lewis a n d Granic 2000) or early socialization of emotions d u r i n g affective interactions (Gergely a n d W a t s o n 1996, 1999; Sroufe 1979, 1996), a s well a s cognitive development (Barrett a n d C a m p o s 1987; Kagan 1992; Lewis a n d Brooks 1978; Lewis a n d Michaelson 1983). There are two alternative theoretical a p p r o a c h e s , b o t h compatible with t h e above criticisms of t h e "strong intersubjectivist" view: (a) one t h a t c a n b e called t h e "weak intersubjectivist" position, a n d (b) o n e t h a t we will call t h e "no s t a r t i n g - s t a t e intersubjectivism" position. 2. The "weak intersubjectivist" position (see Tomasello 1999) accepts t h a t t h e existence of early affective a n d imitative interactions reflects a specifically h u m a n biological a d a p t a t i o n to "identifying" with other p e r s o n s a s "like me." In Tomasello's simulation theory t h e h u m a n propensity for "identification" plays a crucial role in t h e developing u n d e r s t a n d i n g of other m i n d s insofar a s t h e infant comes to u n d e r s t a n d — a n d attribute subjective s t a t e s to—the o t h e r t h r o u g h analogy to t h e internally

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experienced subjective m e n t a l s t a t e s of t h e self. However, Tomasello e m p h a s i z e s t h a t "in a t t e m p t i n g to u n d e r s t a n d other p e r s o n s h u m a n infants apply w h a t they already experience of themselves— . . . [but] this experience of t h e self c h a n g e s in early development, especially with regard to self-agency" (1999, p. 70). T h u s , Tomasello differs significantly from p r o p o n e n t s of t h e "strong intersubjectivist" position in t h a t h e believes t h a t before 9 m o n t h s of age infants do n o t yet have a differentiated u n d e r s t a n d i n g of their own subjective internal s t a t e s s u c h a s intentions or goals, a n d so t h e y c a n n o t u n d e r s t a n d s u c h intentional s t a t e s in o t h e r s either.-As h e p u t s it: "Some r e s e a r c h e r s , especially Trevarthen, believe t h a t t h e s e early interactions are 'intersubjective*, b u t in m y view t h e y c a n n o t be intersubjective until infants u n d e r s t a n d o t h e r s a s subjects of experience— which t h e y will n o t do until n i n e m o n t h s of age" (p. 59). Some of Meltzoff s writings s e e m also to b e b e s t interpreted within t h e "weak intersubjectivist" framework. For example, Meltzoff a n d Moore suggest t h a t "infants progress from conceptions of o t h e r s a s entities with w h o m one c a n s h a r e actions to p e r s o n s with w h o m one c a n s h a r e goals a n d intentions" (1998, p. 49). They also s t a t e t h a t "newborns a r e n o t isolated from others a t birth, b u t . . . do n o t yet u n d e r s t a n d t h e internal feelings a n d m e n t a l s t a t e s of o t h e r s in t h e way a 2-year-old does" (p. 49). T h u s , a l t h o u g h t h e s e views of "weak intersubjectivity" a s s u m e a n i n n a t e m e c h a n i s m for identification with other h u m a n s , t h i s m e c h a n i s m c a n only r e s u l t in attributing subjective m e n t a l s t a t e s to t h e other if t h e corresponding subjective s t a t e s have already b e e n established a n d c a n be consciously accessed in t h e self. 3. O u r third theoretical alternative, t h e "no starting-state intersubjectivism" position, r a i s e s a further objection to t h e functions t h a t p r o p o n e n t s of initial-state intersubjectivity tend to a t t r i b u t e to early affective/communicative a n d imitative exchanges. It is often a s s u m e d t h a t infants a n d caregivers engage in s u c h interactions in order to " s h a r e or participate in" e a c h other's subjective affective a n d intentional s t a t e s or to "discover" t h e subjective world of i n t e n t i o n s a n d feelings of t h e other (Meltzoff a n d Gopnik 1993; S t e r n 1985; T r e v a r t h e n 1979). These a s s u m e d functions

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p r e s u p p o s e , of course, t h e infant's i n n a t e ability to a t t r i b u t e subjective m e n t a l s t a t e s to t h e other from t h e beginning of life. There are, however, plausible alternative evolutionary functions for s u c h early interactions t h a t do n o t require t h e a s s u m p tion of t h i s ability: (a) T h e infant's i n n a t e r e a d i n e s s to engage in affective interactions with caregivers m a y function to establish a n d m a i n t a i n proximity to t h e a t t a c h m e n t figure (Bowlby 1969), a s t h e infant's reactivity is highly reinforcing to t h e caregiver, (b). Infants' i n n a t e propensity to engage p a r e n t s in affective interc h a n g e s c o n t r i b u t e s to affective self-regulation in two ways: t h e b a b y experiences a n d m a i n t a i n s positive a r o u s a l t h r o u g h t h e direct affect-regulative influence of interaction with t h e p a r e n t a n d , if contingent control over t h e p a r e n t ' s behaviors is detected (see above), t h e b a b y also experiences feelings of c a u s a l efficacy, (c) Finally, i n n a t e social reactivity m a y h a v e t h e evolutionary function of creating a facilitating learning environment—in the form of t h e infant-directed affect-expressive a n d mirroring displays of t h e p a r e n t — i n w h i c h learning a b o u t t h e dispositional displays of others, sensitization to intentional a n d affective selfs t a t e s , a n d t h e e s t a b l i s h m e n t of s e c o n d a r y r e p r e s e n t a t i o n s for primary emotion s t a t e s of t h e self a r e optimized (cf. Fonagy 2000; Gergely, Koos, a n d Watson, in press; Gergely a n d W a t s o n 1996, 1999). This a r g u m e n t w a s vigorously a d v a n c e d in c h a p t e r 3 of t h e p r e s e n t volume. To s t a t e t h e a r g u m e n t explicated in detail in t h a t c h a p t e r m o r e generally, we believe t h a t a strong case c a n be m a d e for t h e early interactions between infant a n d caregiver a s having a primary biological function of facilitating t h e development of t h e m e n t a l m e c h a n i s m s essential for the e s t a b l i s h m e n t of a s e n s e of subjectivity a n d t h e interpersonal interpretive p r o c e s s e s t h a t u n d e r p i n self-agency. At t h e h e a r t of this a r g u m e n t is t h e view t h a t subjectivity in t h e infant c a n n o t be a s s u m e d b u t , r a t h e r , m u s t b e considered a s acquired in the p r o c e s s of interaction. For example, Gergely a n d W a t s o n (1996, 1999; Gergely, Koos, a n d Watson, in press) have proposed t h a t i n s t e a d of providing a vehicle for intersubjective c o m m u n i c a t i o n between m i n d s , early contingent affect-regulative interactions serve—among a n u m b e r of other functions—to establish o n e i m p o r t a n t precondition for later intersubjectivity: namely, t h e introspective accessibility of

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differentiated emotional a n d intentional s t a t e s of t h e self. Contrary to t h e classical C a r t e s i a n view, t h e "social biofeedback theory of p a r e n t a l affect-mirroring" outlined in c h a p t e r 4 a s s u m e s t h a t infants initially lack introspective a w a r e n e s s of differential basic-emotion states. It is suggested t h a t t h e p e r c e p t u a l system is set with a bias to a t t e n d i n g to a n d exploring t h e external world a n d t h a t it b u i l d s r e p r e s e n t a t i o n s primarily b a s e d on stimuli received from t h e outside. Babies become sensitive to t h e distinctive i n t e r n a l p a t t e r n s of physiological a n d visceral stimulation t h a t a c c o m p a n y discrete emotion expressions t h r o u g h t h e application of t h e contingency-detection m e c h a n i s m to t h e contingent relation between t h e a u t o m a t i c emotion exp r e s s i o n s of t h e infant on t h e one h a n d , a n d t h e caregiver's c o n s e q u e n t affect-reflective facial/vocal displays on t h e other. The clinical relevance of t h i s is considerable. If t h e mirroring of internal s t a t e s is dysfunctional, i n t e r n a l s t a t e s will be u n l a belled, confusing, a n d experienced a s unsymbolized a n d therefore difficult to regulate. T h e case of "Emma" described in c h a p t e r 10 m i g h t b e a n example of t h i s p h e n o m e n o n . As we shall see in c h a p t e r 6, t h e interactive origins of t h e s e n s e of subjective self-states c a n a c c o u n t for s u b s t a n t i a l differences between t h e w a y s children interpret their subjective experiences a n d ultimately p e r h a p s even clinical conditions t h a t are strongly linked to distorted i n t e r p r e t a t i o n s of internal s t a t e s s u c h a s certain types of p a n i c disorders. To conclude—there is n o compelling evidence to s u p p o r t t h e intersubjectivist notion t h a t s t r u c t u r e d affective mother-infant interactions d u r i n g t h e first m o n t h s of life involve a n ability on the p a r t of y o u n g infants to a c c e s s their own differentiated mental s t a t e s introspectively or t h a t t h e y are able to a t t r i b u t e corresponding subjective intentional a n d feeling s t a t e s to t h e other's m i n d . Of course, t h i s is n o t to deny t h a t d u r i n g s u c h a t t u n e d or imitative interactions m o t h e r a n d infant m a y experience similar subjective s t a t e s . However, in o u r view s u c h "affect sharing" can, a t best, b e called "objective intersubjectivity," because a l t h o u g h t h e subjective s t a t e s of p a r e n t a n d infant m a y become aligned d u e to e m p a t h i c p a r e n t a l mirroring or infantile imitation of p a r e n t a l affect expressions, this does n o t imply t h a t

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t h e y o u n g infant is a w a r e of s h a r i n g t h e subjective s t a t e with the other,-or, for t h a t m a t t e r , t h a t t h e other experiences a subjective state at all. How, t h e n , c a n we characterize y o u n g infants' experience of their social agency d u r i n g early affect-regulative interactions -with their caregivers? We have s e e n t h a t after 3 m o n t h s of age infants begin to be m o s t interested in interactions w h e r e t h e degree of contingency of stimuli on their r e s p o n s e s is high b u t imperfect (Watson 1994). Since a t t u n e d a n d imitative interactions with t h e caregiver provide s u c h rich—but imperfect—contingencies, we c a n a s s u m e t h a t infants' discovery of their high degree of contingent control over their caregivers' reactions positively a r o u s e s t h e m a n d gives t h e m feelings of c a u s a l efficacy. They are also likely to experience t h e p l e a s u r a b l e c h a n g e s in their affective s t a t e s t h a t t h e p a r e n t ' s affect-modulating soothing interactions bring a b o u t (and become associated with—see Gergely a n d W a t s o n 1996, 1999) . Since s u c h a t t u n e d interactions often involve affect-miiToring, infants m a y come to associate t h e control t h e y have over their p a r e n t ' s mirroring displays with t h e e n s u i n g positive c h a n g e in their affect state, leading to a n experience of t h e self a s a self-regulating-agent (Gergely a n d W a t s o n 1996, 1999; Gergely et al. in press). W h e t h e r a t this stage infants experience m o r e differentiated, discrete emotions or i n t e n t i o n s a n d goals with specific c o n t e n t s is currently u n c e r tain, b u t clearly t h e evidence available a t t h e p r e s e n t time does n o t call for s u c h a n a s s u m p t i o n . At w h a t point in infancy does "true" intersubjective u n d e r s t a n d i n g of other m i n d s begin, t h e n ? O n e clear sign of u n d e r s t a n d i n g t h e other's subjective feeling s t a t e while differentiating it from one's own comes with t h e a p p e a r a n c e of m a t u r e emp a t h i c reactions a t some point d u r i n g t h e second p a r t of the second y e a r (Hoffman 2000; R. T h o m p s o n 1998). U n d e r s t a n d i n g others' intentional m e n t a l s t a t e s , s u c h a s their attention, desire, or intention, also b e c o m e s d o m i n a n t d u r i n g t h e second year of life (Bartsch a n d Wellman 1995; C o r k u m a n d Moore 1995; Wellman 1990), t h o u g h t h e s e abilities first s t a r t to emerge between 9 a n d 12 m o n t h s of age w h e n t h e set of so-called jointattention skills first a p p e a r s (Carpenter et al. 1998; Tomasello 1999). Some of t h e s e skills—such a s protodeclarattve pointing, a

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communicative g e s t u r e w h o s e goal is to modify t h e o t h e r ' s m e n tal s t a t e of a t t e n t i o n — s e e m to imply a n ability to a t t r i b u t e a t least some type of intentional m e n t a l s t a t e s to others, w h e r e a s o t h e r s — s u c h a s protoimperative pointing or imitative learning— may be explained in a still n o n m e n t a l i s t i c teleological interpretive framework (see below; see also Gergely a n d Csibra 2000). An i m p o r t a n t theoretical question, t h e n , concerns t h e w a y in which t h e i n n a t e propensity of h u m a n infants to engage in affective a n d imitative interactions with caregivers d u r i n g t h e first 6 to 9 m o n t h s of life m a y b e related to t h e later emergence of the intersubjective mentalistic s t a n c e s t a r t i n g at a r o u n d 1 year of age. We h a v e reviewed t h r e e positions: (a) The "strong intersubjectivist" view (Trevarthen 1979) holds t h a t s u c h early affective c o m m u n i c a t i v e e x c h a n g e s are examples of a n already fully functioning m i n d - r e a d i n g capacity p r e s e n t from birth, (b) The "weak intersubjectivist" position considers s u c h early affective interactions a s evidence for t h e p r e s e n c e of a h u m a n specific i n n a t e m e c h a n i s m specialized to "identify" with t h e subjective perspective of o t h e r h u m a n p e r s o n s . This view holds, however, t h a t t h e simulation of differentiated intentional m i n d s t a t e s of others by t h i s m e c h a n i s m b e c o m e s possible only a t a r o u n d 9 m o n t h s of age. T h i s is so b e c a u s e certain types of intentional mind s t a t e s of t h e self do n o t b e c o m e differentiated a n d introspectively accessible to serve a s t h e b a s i s for attributing corresponding subjective s t a t e s to o t h e r s until this age is reached (Tomasello 1999). (c) Finally, we considered t h e "no startingstate intersubjectivism" view. This position holds -that early affect-regulative a n d imitative interactions serve a n u m b e r of important evolutionary functions (such a s proximity mainten a n c e a n d affect regulation), b u t t h a t t h e s e functions do n o t involve, on t h e infant's part, t h e ability to read a n d a t t r i b u t e subjective m e n t a l s t a t e s to others. However, it is hypothesized t h a t one of t h e s e evolutionary functions h a s a relationship to t h e later emerging intersubjective mentalistic s t a n c e in t h a t it h e l p s to establish one of its preconditions: t h e cognitive accessibility of the infant's own discrete emotional a n d intentional m i n d s t a t e s (Gergely a n d W a t s o n 1996, 1999). In t h i s view, early affectregulative mirroring interaction with t h e caregiver provides a n environment in which, t h r o u g h t h e p r o c e s s e s of contingency

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detection a n d social biofeedback, sensitization to internal s t a t e s a n d secondary representation-building c a n t a k e place, leading to t h e e s t a b l i s h m e n t of cognitively accessible r e p r e s e n t a t i o n s of t h e subjective m e n t a l s t a t e s of t h e self. However, t h e emergence of a truly mentalistic intersubjective s t a n c e d u r i n g t h e second year is viewed a s a r e s u l t of t h e m a t u r a t i o n of r e p r e s e n t a t i o n a l abilities (theory of mind), which m a k e t h e c a u s a l mentalistic interpretation of actions in t e r m s of intentional m i n d s t a t e s possible b o t h for t h e other a n d for t h e self.

UNDERSTANDING SELF AND OTHER A S "TELEOLOGICAL AGENTS": T H E NINE-MONTH SOCIAL-COGNITIVE REVOLUTION A large body of evidence indicates t h a t by 9 m o n t h s of age infants develop a qualitatively n e w level of u n d e r s t a n d i n g of goal-directed action (e.g., Csibra et al. 1999; Piaget 1936; Tomasello 1999; Uzgiris a n d H u n t 1975; Willatts 1999). This h a s b e e n aptly referred to a s t h e 9 - m o n t h social-cognitive revolution (Rochat a n d S t r i a n o 1999; Tomasello 1999). This n e w capacity involves t h e ability to differentiate goals from t h e m e a n s t h a t bring t h e m about, to modify a n action to s u i t a . n e w situation, a n d to choose t h e m e a n s t h a t bring a b o u t t h e goal in t h e m o s t efficient m a n n e r from t h e available options. Piaget (1936) described t h e first a p p e a r a n c e of s u c h intentional coordinated m e a n s - e n d behaviors between 7 a n d 9 m o n t h s of age (Stage IV). Before this stage, infants would r e p e a t previously successful action s c h e m e s to recreate salient effects; however, t h e y would fail to a d j u s t a n d vary their actions to fit t h e r e q u i r e m e n t s of changing c i r c u m s t a n c e s . For example, w h e n a n obstacle w a s placed between t h e infant a n d t h e goal object, 4- to 6 - m o n t h olds would either simply give u p or s t a r t acting on t h e obstacle itself, seemingly becoming oblivious of t h e goal object, w h e r e a s 8 - m o n t h - o l d s would already proceed to remove t h e obstacle in a deliberate m a n n e r in order to r e a c h for a n d g r a s p t h e desired object (Piaget 1936; Willatts 1999).

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Recently, Gergely, Csibra, a n d their colleagues (Csibra et al. 1999; Gergely a n d C s i b r a 1998; Gergely et al. 1995; see also Woodward a n d Sommerville, 2000) h a v e d e m o n s t r a t e d in a series of visual h a b i t u a t i o n s t u d i e s t h a t at t h e s a m e time a s t h e y become c a p a b l e of m e a n s - e n d coordination in producing intentional goal-directed' actions, infants also s t a r t to interpret t h e actions of o t h e r s a s goal-directed a n d rational. For example, 9a n d 12-month'Olds—but n o t 6-month-olds—were s h o w n to interpret, t h e behavior of a n a b s t r a c t c o m p u t e r - a n i m a t e d figure a s goal-directed a n d could infer its novel action in a new situation. Infants were h a b i t u a t e d to a n event in w h i c h a small circle repeatedly a p p r o a c h e d a large circle by "jumping over" a rectangle s e p a r a t i n g t h e m . In t h e t e s t p h a s e , w h e n t h e "obstacle" w a s removed, infants looked longer if t h e small circle repeated its familiar j u m p i n g action—which, given t h e a b s e n c e of t h e "obstacle," w a s n o longer s e e n a s a "sensible" goal a p p r o a c h — t h a n when it took a novel more efficient straight-line r o u t e (rational approach). No s u c h looking-time differences were found, however, in a control condition t h a t differed only in t h a t there w a s no "obstacle" in t h e h a b i t u a t i o n p h a s e to s t a r t with—and so t h e small circle a p p r o a c h e d t h e large one in a n o n r a t i o n a l m a n n e r by j u m p i n g over nothing. This s u g g e s t s t h a t infants a t t r i b u t e d the end s t a t e (contacting t h e large circle) a s t h e goal of t h e action only if t h e action (the j u m p i n g approach) w a s evaluated a s a rational or efficient m e a n s to bring a b o u t t h e outcome s t a t e given t h e c o n s t r a i n t s of t h e situation (i.e., t h e p r e s e n c e of t h e "obstacle"). On t h e b a s i s of t h e s e results, Gergely a n d Csibra (1997; Csibra a n d Gergely 1998) proposed t h a t by 9 m o n t h s of age infants come to interpret goal-directed spatial behavior in t e r m s of a "teleological stance" or a "naive theory of rational action." Teleological e x p l a n a t i o n s differ from c a u s a l ones in two respects: (a) The explanatory element referred to is in a different temporal relation to t h e to-be-explained action. Teleological interpretations refer to t h e o u t c o m e t h a t follows t h e action, w h e r e a s causal e x p l a n a t i o n s point a t some n e c e s s a r y condition t h a t is prior to t h e event, (b) They u s e different criteria of acceptance. Causal e x p l a n a t i o n s single o u t a prior condition t h a t necessi-

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tates t h e action providing its generative source. In contrast, reference to t h e o u t c o m e s t a t e is accepted a s a teleological explanation (reason) for a behavior w h e n it justifies it—that is, when, given t h e c o n s t r a i n t s of reality, t h e behavior c a n be seen a s a sensible way to bring a b o u t t h e goal state. The teleological interpretive s y s t e m r e p r e s e n t s goal-directed action by establishing a n explanatory r e l a t i o n . a m o n g t h r e e representational elements: t h e action (A), t h e goal s t a t e (G), a n d t h e relevant c o n s t r a i n t s of physical reality (RC)—in t h e above case, t h e p r e s e n c e or a b s e n c e of a n obstacle. S u c h teleological repres e n t a t i o n s are b a s e d on t h e "principle of rational action," which a s s u m e s t h a t a g e n t s p u r s u e their goals in t h e m o s t rational or efficient m a n n e r available to t h e m given t h e c o n s t r a i n t s of physical reality. Gergely a n d Csibra h a v e s h o w n t h a t , relying on t h e principle of rational action, 1-year-olds c a n infer a n y one of t h e t h r e e r e p r e s e n t a t i o n a l e l e m e n t s (A, G, or RC) given perceptual information a b o u t t h e other two. (See Csibra et al. 1999; Csibra, Biro, Koos, a n d Gergely, 2002; Gergely a n d Csibra 1998, 2000.) Adults t e n d to describe t h e goal-directed j u m p i n g action in mentalistic t e r m s s u c h a s "it wants to get to t h e other circle a n d thinks t h a t t h e obstacle is impenetrable, so it j u m p s over it" (cf. Heider a n d Simmel 1944). However, it is possible to m a k e a viable teleological interpretation w i t h o u t s u c h mentalistic attrib u t i o n s . T h e interpretation w o r k s even if it m a k e s reference only -to -the relevant s t a t e s of c u r r e n t reality, s u c h a s t h e p r e s e n c e of a n obstacle, t h a t c o n s t r a i n t h e goal a p p r o a c h a n d to future reality—the goal state of contacting t h e large circle—as represented by t h e infant himself. T h u s , infants could c o n s t r u c t a viable teleological action interpretation or prediction without a t t r i b u t i n g prior desires a n d beliefs to t h e actor's m i n d . Gergely a n d Csibra (1997; Csibra a n d Gergely 1998) hypothesize, therefore, t h a t in its initial form t h e infant's "teleological stance" generates reality-based r e p r e s e n t a t i o n s for goal-directed actions t h a t are n e i t h e r mentalistic n o r causal. 1 1

The representational requirements of the "teleological stance" correspond to those of the second level of Leslie's modularist theory of Agency (ToMM/Systeml), which represents the actional properties of agents in terms o f teleological causality" (Leslie 1995J. In Leslie's view, however, teleological interpretation of action is triggered by innately specified stimulus cues such as self-propelled

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In c h a p t e r 9 we c o n s t r u c t a developmental psychopathology model t h a t h a s t h e notion of t h e teleological s t a n c e a t its core. To anticipate t h e s e d i s c u s s i o n s , we shall a r g u e t h a t individuals whose u s e of t h e intentional s t a n c e is only partially accessible or is blocked by either biological deficits or social experiences beyond t h e n o r m a l r a n g e frequently revert to t h e teleological stance in their i n t e r p r e t a t i o n s of interpersonal behavior, p a r ticularly in t h e a t t a c h m e n t context. It is i m p o r t a n t to note t h a t s u c h a d o m i n a n c e of t h e teleological c o n s t r u a l of social reality is t h o u g h t to be m o r e likely in t h o s e individuals for w h o m t h e building blocks of t h e intentional stance, s u c h a s t h e secondorder r e p r e s e n t a t i o n s of p r i m a r y constitutional self-states, were not firmly established in t h e first place. The 9 - m o n t h social-cognitive revolution also manifests itself in the emergence of a set of qualitatively n e w communicative behaviors: goal-directed coordinated activities between infants a n d p a r e n t s involving j o i n t a t t e n t i o n to objects or situations (Carpenter et al. 1998; C o r k u m a n d Moore 1995; Tomasello 1995; Trevarthen a n d Hubley 1978). At this stage infants s t a r t to follow t h e a d u l t ' s gaze reliably (gaze following), actively a t t e n d to the adult's facial a n d vocal attitude expressions a b o u t unfamiliar objects or s i t u a t i o n s to modify their own behavior (social referencing), a n d a c t on objects in t h e way a d u l t s a r e acting on t h e m (imitative learning). They also begin to u s e communicative gestures t h e m s e l v e s (such a s pointing or object showing) in order to direct a d u l t s ' a t t e n t i o n a n d behavior to objects or situations (imperative a n d declarative gestures). C a r p e n t e r et al. (1998) have d e m o n s t r a t e d t h a t this series of "joint-attention skills" (including protoimperative a n d protodeclarative gestures, imitative learning, cooperative learning, a n d intentional teaching), movement (Leslie 1994) that identify the actor as a physical agent with internal "force." In the alternative modularist approaches of Premack (1990) and BaronCohen (1994) self-propulsion directly triggers the categorization of the actor as an intentional agent. In contrast to these proposals. Csibra et al. (1999) provided evidence indicating that movement cues of agency or animacy are neither necessary nor sufficient for teleological interpretation to occur. In their view, goal attribution is based on the applicability of the principle of rational action rather than the perception of innately specified stimulus cues, and a teleological interpretation is set up as a result of the perception of justifiable adjustment of behavior as a function of situational constraints.

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emerges in a coordinated fashion between t h e ages of 9 a n d 15 m o n t h s in h u m a n infants. On t h e b a s i s of this evidence, Tomasello (1995, 1999) h a s developed a n alternative theory to c a p t u r e t h e n a t u r e of infants' emerging capacity to interpret rational goal-directed action, proposing t h a t a t a r o u n d 9 m o n t h s of age infants s t a r t u s i n g a qualitatively n e w interpretational s y s t e m to u n d e r s t a n d other p e r s o n s . He calls this t h e "intentional stance." Tomasello (1999) a r g u e s t h a t t h e set of j o i n t - a t t e n t i o n skills emerging a t t h e end of t h e first year—as well a s infants' performance in t h e C s i b r a Gergely type of h a b i t u a t i o n tasks)—are different behavioral m a n ifestations of t h e s a m e underlying n e w u n d e r s t a n d i n g of other p e r s o n s a s intentional agents. According to Tomasello (1999), t h e emergence of t h e intentional s t a n c e d e p e n d s on two factors. First, it p r e s u p p o s e s the ability to differentiate goal s t a t e s from t h e m e a n s leading to t h e m (Piaget 1936) a s well a s t h e related capacity to choose the m o s t rational or efficient action from t h e set of alternatives available in a given situation, to realize t h e goal (cf. Gergely et al. 1995). In Tomasello's view, a s soon a s infants c a n represent their goals separately from their action s c h e m e s a n d s t a r t to show flexible m e a n s - e n d coordination, they immediately also become able to interpret other agents* goal-directed behavior in t e r m s of intentions a n d rational choice of m e a n s . T h i s inference is m a d e possible by t h e second c o m p o n e n t of Tomasello's theory: h e a s s u m e s t h a t infants are b o r n with t h e ability to "identify" with other h u m a n s w h o are "just like them" a n d a t t r i b u t e subjective intentional s t a t e s to t h e m t h r o u g h analogy to their own self-experience. Therefore, t h e s i m u l t a n e o u s emergence by 9 m o n t h s of m e a n s - e n d coordination in action p r o d u c t i o n on the one h a n d , a n d t h e ability to u n d e r s t a n d intentional goal-directed action in o t h e r s o n t h e other, is explained b y t h e fact t h a t infants become able to s i m u l a t e t h e intentional actions of others in t e r m s of goal a t t r i b u t i o n a n d rational choice of m e a n s only w h e n they themselves h a v e achieved a differentiated a n d coordin a t e d r e p r e s e n t a t i o n of their own intentional actions in t e r m s of goals a n d available m e a n s . W h e n c o m p a r i n g Gergely a n d Csibra's "teleological stance" a c c o u n t with Tomasello's "intentional s t a n c e " a c c o u n t of t h e 9-

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m o n t h social-cognitive revolution, we c a n identify three—clearly related—theoretical i s s u e s t h a t differentiate the two a p p r o a c h e s . These c o n c e r n (a) t h e role of simulation, (b) t h e m e c h a n i s m s for u n d e r s t a n d i n g self v e r s u s o t h e r a s goal-directed agents, a n d (c) the i s s u e of m e n t a l i s m . 1. The role of simulation in understanding others as goaldirected agents—full simulation versus default simulation. S i m u lationist theories of u n d e r s t a n d i n g intentional action t e n d to a s s u m e t h a t m e n t a l s t a t e s s u c h a s desires or intentions a r e a t t r i b u t e d to o t h e r s to t h e e x t e n t t h a t t h e other's behavior is perceived a s "just like me." An often cited example is Meltzoffs (1995) i m p o r t a n t d e m o n s t r a t i o n t h a t 18-month-olds infer a n d reenact a n u n d e r l y i n g intention w h e n observing a h u m a n model's failed a t t e m p t s a t realizing it, b u t t h e y do n o t do so if t h e s a m e a c t s a r e performed by a robot—which does n o t behave in a "just like me" m a n n e r . However, in h a b i t u a t i o n s t u d i e s t h a t involve n o imitation, Gergely a n d C s i b r a (1998; Csibra a n d Gergely 1998; Csibra et al. 2002) d e m o n s t r a t e d t h a t already a t 12 m o n t h s infants c a n infer t h e goal of a n incomplete action, even w h e n t h e a c t o r is n o t h u m a n b u t a c o m p u t e r - a n i m a t e d 2D disk with n o facial features or biomechanical m o v e m e n t characteristics. In fact, Csibra a n d colleagues (1999) showed goal attribution a s early a s 9 m o n t h s of age even w h e n t h e actor's (again a 2D disk) behavior w a s lacking all a n i m a c y o r agency c u e s s u c h a s self-propelled, irregular, a n d biomechanical m o v e m e n t t h a t could b e expected to trigger a "just like me" j u d g m e n t . These findings suggest, therefore, t h a t early goal attribution may, in fact, not be restricted to h u m a n s or a n i m a t e agents. (See also J o h n s o n et al. 1998.) Why is it, t h e n , t h a t Meltzoffs 18-monthold subjects did n o t imitate t h e i n a n i m a t e robot w h o s e behavior could h a v e s u g g e s t e d goal-directedness? Csibra a n d colleagues (1999) suggested t h a t t h i s m a y be b e c a u s e it is Imitation r a t h e r t h a n goal a t t r i b u t i o n t h a t is restricted to h u m a n action only. In fact, Legerstee (1991) provided evidence suggesting t h a t w h e n presented with a n a l o g o u s actions performed by h u m a n s v e r s u s inanimate objects, infants imitate only t h e h u m a n model. The above findings suggest t h a t early goal a t t r i b u t i o n m a y be a r a t h e r general p r o c e s s t h a t is—at least initially—not restricted

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to t h e domain of p e r s o n s or a n i m a t e a g e n t s w h o s e surface behavior w a r r a n t s a "just like me" j u d g m e n t . This, in t u r n , suggests t h a t simulation t h r o u g h analogy to t h e self m a y not be t h e only—or, for t h a t m a t t e r , t h e m o s t c e n t r a l — m e c h a n i s m t h r o u g h w h i c h interpretation of goal-directed intentional actions of o t h e r s is mediated. In c o n t r a s t to Tomasello's "intentional stance," Gergely a n d Csibra's "teleological stance" is n o t b a s e d primarily on simulation. Rather, t h e infant's "naive theory of rational action" is seen a s directly applicable to goal-directed actions, w h e t h e r t h e s e are performed by t h e o t h e r or by t h e self. A central c o m p o n e n t of the theory is t h e principle of rational action t h a t drives t h e process of evaluating w h e t h e r t h e observed action c o n s t i t u t e s a n efficient m e a n s of bringing a b o u t t h e end s t a t e in t h e particular situation. This j u d g m e n t is m a d e in t h e light of t h e infant's available knowledge a b o u t situational c o n s t r a i n t s — s u c h a s the impenetrability of a solid o b s t a c l e ^ - a n d a b o u t biological a n d dispositional c o n s t r a i n t s t h a t characterize t h e actor. To illust r a t e t h i s latter point: while a straight-line a p p r o a c h to a goal m a y be j u d g e d a s t h e m o s t efficient m e a n s for a h u m a n actor, a hopping a p p r o a c h m a y be seen a s more a p p r o p r i a t e in t h e case of a kangaroo, a s s u m i n g t h a t t h e infant k n o w s t h a t kangaroos have a n overriding disposition to hop. T h u s , relevant information a b o u t t h e a g e n t c a n influence t h e evaluation of rational goal-directed action even if s u c h properties do n o t correspond to t h o s e of t h e self. Nevertheless, simulation also plays a n i m p o r t a n t role in Gergely a n d Csibra's teleological model; we c a n call t h i s "default simulation." If n o previous knowledge or c u r r e n t p e r c e p t u a l evidence is available a b o u t the dispositional c o n s t r a i n t s of the agent, t h e infant will simulate t h e agent by default a s being similar to—and so being subject to t h e s a m e c o n s t r a i n t s on possible action a s — t h e self. However, simulation is only a default option to fall b a c k on w h e n lacking relevant information a b o u t t h e other. In fact, Csibra a n d Gergely (1998) h a v e recently d e m o n s t r a t e d t h a t perceptual information a b o u t t h e agent's dispositions c a n indeed modify t h e infant's expectations a b o u t w h a t particular goal a p p r o a c h t h e agent will follow.

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2. Understanding the self versus the other. A corollary to Tomasello's simulationist a c c o u n t is h i s view t h a t before infants c a n u n d e r s t a n d t h e other's behavior a s intentional a n d goal-directed, they m u s t first achieve m e a n s - e n d differentiation of action s c h e m e s a n d their effects in relation to their own actions p r i m a rily on t h e b a s i s of introspective evidence—such a s feelings of intentional effort (Piaget 1936; Tomasello 1999). For Tomasello, this is a r e p r e s e n t a t i o n a l precondition for simulating t h e other's behavior a s goal-directed a n d intentional. W h e t h e r u n d e r s t a n d ing intentional action is, indeed, achieved first in relation to t h e self r a t h e r t h a n t h e other is difficult to ascertain, however. This is b e c a u s e t h e behavioral evidence suggesting s u c h u n d e r s t a n d i n g emerges m o r e or less simultaneously—somewhere between t h e ages of 7 a n d 9 m o n t h s — b o t h in p r o d u c i n g a n d interpreting goaldirected intentional acts. Tomasello (1999) a c c o u n t s for this simultaneity of emergence by proposing t h a t a s soon a s m e a n s end differentiation is achieved in relation to t h e s e l f s own actions, it is immediately applied t h r o u g h simulation to u n d e r standing intentional actions of other a g e n t s a s well. There is n o developmental a s y n c h r o n y t h a t would indicate t h a t u n d e r s t a n d i n g intentional action d e p e n d s primarily on accessing self-states. T h e literature on t h e ability of a d u l t s to rely on internal information in m a k i n g c o n s c i o u s agency j u d g m e n t s a b o u t perceived a c t i o n s indicates a d o m i n a n c e of exteroceptive— for example, visual—information over internal c u e s (Jeannerod 1997; Pacherie 1997). We k n o w even less a b o u t t h e degree of introspective accessibility of i n t e r n a l correlates of intentional action in infancy, t h o u g h again t h e r e is evidence from 6- a n d 9month-olds indicating t h e d o m i n a n c e of exteroceptive—visual— cues over proprioceptive—head orientation—cues in discriminative learning (Colombo et al. 1990). Gergely a n d W a t s o n (1996, 1999) have, therefore, a r g u e d t h a t learning on t h e b a s i s of exteroceptive stimuli may, in fact, have primacy in infancy, a n d sensitivity to i n t e r n a l c u e s correlated with differential emotional and intentional s t a t e s m a y develop a s a function of contingency detection a n d "social biofeedback" p r o c e s s e s (see above). S u c h considerations, together with t h e a p p a r e n t simultaneity of the emergence of u n d e r s t a n d i n g of intentional action in t h e

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self a n d in others, are, therefore, compatible with t h e view t h a t t h e development of self-knowledge does n o t enjoy p r i m a c y in t h e 9 - m o n t h revolution. In this vein, Gergely a n d Csibra's (1997) theory of t h e infant's teleological s t a n c e holds t h a t t h e inferential principle of rational action b r i n g s a b o u t a qualitatively new level of u n d e r s t a n d i n g of goal-directed action s i m u l t a n e o u s l y in t h e other a n d in t h e self. (See also D e n n e t t 1987, a n d Gopnik 1993, for a r g u m e n t s a g a i n s t t h e C a r t e s i a n notion of t h e primacy of "first-person authority" i n . u n d e r s t a n d i n g agency.) 3. The origins of mentalism. For Tomasello (1995, 1999) t h e 9-month-old's intentional s t a n c e m a r k s t h e first a p p e a r a n c e of u n d e r s t a n d i n g t h a t t h e actions of o t h e r a g e n t s — a s well a s of t h e self—are driven by c a u s a l mental s t a t e s s u c h a s desires a n d intentions. Tomasello's evidence for-this claim is twofold: (a) He e m p h a s i z e s t h e i m p o r t a n t fact t h a t a t least some of t h e joint-attention skills emerging between t h e ages of 9 a n d 15 m o n t h s (see C a r p e n t e r et al. 1998), s u c h a s protodeclarative gestures, seem to involve u n d e r s t a n d i n g — a n d influencing—another agent's intentional mental state, s u c h a s h e r attention. (See also Leslie a n d H a p p e 1989.) (b) Tomasello's simulationist view implies t h a t 9 - m o n t h - o l d s s t a r t to r e p r e s e n t t h e c a u s a l conditions of t h e other's goal-directed actions by m a k i n g reference to their own internally experienced subjective m e n t a l s t a t e s —attention, i n t e n t i o n — t h r o u g h w h i c h they s i m u l a t e t h e m e n t a l c a u s e s of t h e other's observable behavior. T h i s is m a d e possible by the hypothesized human-specific evolutionary a d a p t a t i o n to "identify" with t h e subjective perspective of other p e r s o n s who are perceived a s "just like me." For Tomasello, t h e coordinated emergence of t h e set of joint-attention skills a t t h e e n d of t h e first year is u n d e r p i n n e d by this propensity for m e n t a l simulation. In s u p p o r t of this view, Tomasello (1999) a r g u e s t h a t the r e a s o n why p r i m a t e s do n o t s e e m to acquire j o i n t - a t t e n t i o n skills in their n a t u r a l environment is n o t b e c a u s e t h e y c a n n o t achieve differentiated r e p r e s e n t a t i o n s of m e a n s a n d goals in relation to their own actions. (They clearly do—see Tomasello a n d Call's excellent .1997 review on p r i m a t e cognition.) Rather, w h a t they a r e lacking is t h e human-specific biological a d a p t a t i o n to "iden-

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tify" with t h e subjective perspective of o t h e r a g e n t s — t h a t is, t h e y lack t h e ability mentally to simulate: t h e subjective experience of others. In contrast, Gergely a n d C s i b r a (1997; Csibra a n d Gergely 1998) argue t h a t t h e teleological s t a n c e mediating t h e 9-month-old's u n d e r s t a n d i n g of goal-directed rational action c a n be p a r s i m o n i ously modeled w i t h o u t a t t r i b u t i n g a n ability to represent c a u s a l intentional mental s t a t e s yet. In their view (see Csibra a n d Gergely 1998; Gergely a n d Csibra 2000) t h e r e q u i r e m e n t s for a "purely" teleological i n t e r p r e t a t i o n a l s y s t e m a r e l e s s severe t h a n are t h o s e for later theory of m i n d , b e c a u s e teleological u n d e r standing does n o t require r e p r e s e n t a t i o n of propositional attitude s t a t e s — s u c h a s beliefs a n d desires (Fodor 1992; Leslie 1987, 1994) or c o m p r e h e n s i o n of t h e r e p r e s e n t a t i o n a l n a t u r e of intentional m i n d s t a t e s (Perner 1991). T h u s , t h e teleological system is ontologically more restricted a s its explanatory elem e n t s involve only t h e interpreter's own r e p r e s e n t a t i o n s of— present a n d future—reality s t a t e s , a n d it is computationally simpler a s it does n o t involve t h e inference a n d attribution of intentional m e n t a l s t a t e s to t h e other. It c a n also work w i t h o u t u n d e r s t a n d i n g t h e c a u s a l conditions of belief fixation (Leslie 1995) s u c h a s t h e fact t h a t perception leads to knowledge. T h e s e differences may, in fact, help to explain t h e r e m a r k a b l y early a p p e a r a n c e of s u c h i n t e r p r e t a t i o n s by 9 m o n t h s of age. Of course, n o t h i n g in Gergely a n d Csibra's h a b i t u a t i o n results directly n e c e s s i t a t e s t h i s "lean" n o n m e n t a l i s t i c interpretation. For example, Kelemen (1999) suggested t h a t infants' early competence on s u c h t a s k s m a y already reflect t h e attribution of mental s t a t e s s u c h a s desires or i n t e n t i o n s to t h e actors. How could one empirically differentiate between t h e s e views? Kelemen's mentalistic c o n s t r u a l of teleological reasoning suggests t h a t t h e infant's u n d e r s t a n d i n g of teleological relations and t h a t of intentional m i n d s t a t e s are n o t i n d e p e n d e n t b u t a r e aspects of t h e s a m e underlying i n n a t e ability to attribute c a u s a l mental s t a t e s to a g e n t s . This view predicts t h a t t h e two types of ability m u s t be either p r e s e n t or a b s e n t c o n c u r r e n t l y in a n y organism or species. Therefore, a dissociation between t h e abil-

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ity for teleological interpretation o n t h e one h a n d a n d u n d e r s t a n d i n g c a u s a l intentional m i n d s t a t e s on t h e other would represent potential counterevidence for t h i s position. In contrast, t h e "independent teleology" position m a i n t a i n e d by Gergely a n d Csibra (2000; Csibra a n d Gergely 1998) holds t h a t t h e teleological s t a n c e is a biological a d a p t a t i o n t h a t may have evolved independently from theory of m i n d to interpret a n d r e p r e s e n t goal-directed a n d rational spatial behavior. T h e wider a n g i n g p r e s e n c e of goal-directed organization of behavior a m o n g n u m e r o u s species (including rats—see Tolman, Ritchie, a n d Kalish 1946) in t h e evolutionary e n v i r o n m e n t m a y have exerted selective p r e s s u r e for t h e evolution of a m e c h a n i s m specialized for t h e discrimination a n d prediction of goal-directed action. In this view, t h e mentalistic "theory-of-mind" s t a n c e repr e s e n t s a further biological a d a p t a t i o n t h a t leads to t h e ontological e n r i c h m e n t of t h e teleological s t a n c e by including, a p a r t from r e p r e s e n t a t i o n s of—current a n d future—states of reality, the m e n t a l r e p r e s e n t a t i o n s of fictional or counterfactual states as well in t h e form of mentally r e p r e s e n t e d propositional attitude relations (Fodor 1992; Leslie 1987, 1994). Therefore, t h e teleological s t a n c e m a y b e a useful interpretational strategy only in the—restricted—domain of intentional actions t h a t are driven by c a u s a l m e n t a l s t a t e s t h a t represent a s p e c t s of a c t u a l reality truthfully. This is so b e c a u s e in s u c h c a s e s teleological interpretation of action c a n be b a s e d directly on reality w i t h o u t t a k i n g into consideration t h e actor's m e n t a l r e p r e s e n t a t i o n s of t h a t reality. The teleological s t a n c e would, however, b r e a k down in c a s e s of intentional action where the actor's c a u s a l m i n d s t a t e s r e p r e s e n t fictional or counterfactual realities s u c h a s in p r e t e n s e or false-belief-based action. This predicts t h e possibility of dissociation within a n o r g a n i s m or a species t h a t could exhibit a n intact—reality-based—teleological r e a s o n i n g capacity, while lacking a mentalistic u n d e r s t a n d i n g of intentional action. The clinical usefulness of t h e p r e s e n t propositions r e s t s on t h e a s s u m p t i o n t h a t teleological t h i n k i n g does n o t necessarily entail knowledge of t h e intentional s t a n c e or mentalization. In c h a p t e r s 9 - 1 1 we review clinical evidence t h a t is c o n s i s t e n t with t h e a s s u m p t i o n t h a t s o m e individuals with profound disorders of a

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character a r e u n a b l e to m a k e u s e of t h e intentional s t a n c e in a t t a c h m e n t contexts b u t c a n a n d do t h i n k teleologically, to t h e great d e t r i m e n t of their social relations. Below we c o n s i d e r two types of dissociative 2 evidence t h a t seem to favor t h e " i n d e p e n d e n t teleology" position (see Gergely and Csibra 2000).

D i s s o c i a t i o n 1: Intact Teleological Understanding, but Impaired T h e o r y of Mind in Children w i t h A u t i s m Children with a u t i s m perform poorly in tests t h a t require t h e m to a t t r i b u t e i n t e n t i o n a l m i n d s t a t e s — s u c h a s false beliefs—to others (Baron-Cohen, Leslie, a n d Frith 1985; Leslie a n d T h a i s s 1992). According to t h e "theory-of-mind deficit" a c c o u n t , childhood a u t i s m is a p r i m a r y cognitive dysfunction, c a u s e d by a genetic defect of t h e i n n a t e "theory-of-mind" m o d u l e t h a t enables t h e r e p r e s e n t a t i o n of intentional m e n t a l states. Therefore, if teleological i n t e r p r e t a t i o n s always involve representing intentional m i n d s t a t e s , children with a u t i s m should be equally impaired in t e s t s t h a t require teleological reasoning, like t h o s e used in t h e Csibra-Gergely type of infant h a b i t u a t i o n s t u d i e s (Csibra et al. 1999; Gergely et al. 1995). In contrast, t h e "indep e n d e n t teleology" position predicts t h a t children with a u t i s m may have a n i n t a c t reality-based "teleological stance" to interpret goal-directed actions, while, d u e to their pervasive m e t a r e p r e s e n t a t i o n a l deficit (Leslie 1994), t h e y m a y b e u n a b l e ontologically to enrich their teleology to form a "proper" theory of mind. For example, a s t u d y by Abell, Happe, a n d Frith (2001) provides evidence for t h i s dissociation. Children with a u t i s m a n d m a t c h e d controls were p r e s e n t e d with t h r e e types of computeranimated e v e n t s involving a b s t r a c t figures—such a s triangles— to elicit verbal descriptions for t h e s e events. In their R a n d o m

2

The term "dissociative" is used here in the logical rather than the psychiatric context.

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Animations condition t h e triangles did n o t i n t e r a c t b u t moved a r o u n d purposelessly a n d i n d e p e n d e n t l y of e a c h other—floating in space; b o u n c i n g off t h e sides. Their Goal-directed s e q u e n c e s involved one of t h e triangles reacting to t h e other's behavior— s u c h as, following, chasing, or fighting. In their Theory-of-mind s e q u e n c e s one c h a r a c t e r reacted to t h e other's m e n t a l state—for example, seducing, hiding a n d surprising, coaxing, or mocking. Normal a d u l t s p r e d o m i n a n t l y u s e d physicalist action descriptions for t h e R a n d o m sequences, teleological interactive descriptions for t h e Goal-directed events, a n d mentalistic descriptions for t h e Theory-of-mind s e q u e n c e s . Interestingly, while highfunctioning children with a u t i s m were n o t a s good a t providing a c c u r a t e mentalistic descriptions for t h e Theory-of-mind seq u e n c e s a s were t h e m a t c h e d controls, t h e r e w a s n o difference in their ability to provide physicalist or teleological descriptions. T h u s , their performance indicates a dissociation between their intact capacity to interpret goal-directed interactions teleologically, on t h e one h a n d , a n d their impaired theory of m i n d , on the other. Aldridge, Stone, Sweeney, a n d Bower (2000) h a v e reported a n intriguing replication in children with a u t i s m of Meltzoffs (1995) t a s k in which 18-month-old n o r m a l infants were s h o w n to infer a n d r e e n a c t t h e goal-directed action t h a t a n a d u l t model int e n d e d to perform after witnessing t h r e e failed a t t e m p t s by the model to realize t h e intended act (see above). Aldridge a n d colleagues found t h a t while children with a u t i s m were m u c h worse t h a n t h e controls a t imitating a d u l t g e s t u r e s — s u c h a s tongue p r o t r u s i o n — t h a t were n o t goal-directed, t h e y nevertheless h a d no difficulties with r e e n a c t i n g t h e i n t e n d e d (but n o t actually observed) goal-directed actions implied by t h e model's failed a t t e m p t s . Aldridge a n d coworkers a r g u e t h a t t h i s finding demons t r a t e s t h a t children with a u t i s m infer a n d a t t r i b u t e a mentally r e p r e s e n t e d intention to t h e actor's m i n d — a r e s u l t t h a t they portray a s paradoxical given t h e theory-of-mind deficit a c c o u n t of childhood a u t i s m . Meltzoff offered a m o r e c a u t i o u s view, suggesting t h a t h i s 18-month-old "infants m a y t h i n k t h a t h u m a n a c t s have goals w i t h o u t yet ascribing underlying m e n t a l s t a t e s in t h e mind" (1995, p. 848). This, in fact, c o r r e s p o n d s precisely to t h e a s s u m p t i o n s of t h e teleological s t a n c e (Gergely a n d Csibra ix

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1997). T h e Aldridge et al. d e m o n s t r a t i o n c a n therefore b e seen a s further evidence for t h e proposition t h a t autistic children's ability to interpret actions a s goal-directed—which does n o t necessarily require a s s u m p t i o n s a b o u t others' s t a t e s of mind—is n o t affected by their lack of capacity to infer intentional m e n t a l states in o t h e r s .

Dissociation 2: Differential E m e r g e n c e of Teleologically— but n o t Mentalistic ally—Based J o i n t - A t t e n t i o n Skills in Apes as a F u n c t i o n of H u m a n E n c u l t u r a t i o n As we h a v e seen, Tomasello (1999) a r g u e s t h a t n o n h u m a n primates lack t h e human-specific evolutionary a d a p t a t i o n to "identify" with t h e i n t e r n a l experience of o t h e r s who b e h a v e "just like them." As a result, even t h o u g h they achieve m e a n s - e n d coordination of their own goal-directed actions in a way similar to 9-month-old h u m a n s , they nevertheless c a n n o t u s e t h e s e self-representations to s i m u l a t e t h e c a u s a l intentional m i n d states t h a t drive t h e goal-directed actions of other agents. This inability to t a k e t h e intentional s t a n c e m a y explain why nonh u m a n p r i m a t e s do n o t normally develop t h e series of c o m m u n i cative j o i n t - a t t e n t i o n skills t h a t emerge in h u m a n infants between t h e a g e s of 9 a n d 15 m o n t h s (Carpenter et al. 1998), which are t h o u g h t to d e p e n d on t h e ability to t a k e t h e intentional s t a n c e . In h i s review on t h e effects of h u m a n e n c u l t u r a t i o n on apes, Tomasello (1999; Call a n d Tomasello 1996) t a k e s a position t h a t is partly a t o d d s with t h i s theoretical view. He reports t h a t two "joint-attention skills" do emerge in c h i m p a n z e e s w h o have b e e n raised by h u m a n s . T h e s e skills a r e protoimperative pointing a t objects in order to get t h e m a n d acquiring novel object-directed actions t h r o u g h imitative learning. However, c h i m p a n z e e s w h o have b e e n b r o u g h t u p by h u m a n s do n o t seem to acquire t h e other skills in t h e set of j o i n t - a t t e n t i o n behaviors—such a s protodeclarative g e s t u r e s or intentional teaching. B u t if, a s Tomasello hypothesizes, t h e human-specific i n n a t e capacity to s i m u l a t e t h e other's intentional s t a t e s t h r o u g h "identification" is, indeed, a

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prerequisite for all of t h e s e j o i n t - a t t e n t i o n skills, t h e n how is it t h a t a p e s t h a t are raised by h u m a n s c a n develop even this partial u n d e r s t a n d i n g of intentionality? If we accept t h e view t h a t n o n h u m a n p r i m a t e s lack t h e i n n a t e capacity to r e p r e s e n t intentional m i n d s t a t e s b u t nevertheless c a n a d o p t t h e n o n m e n t a l i s t i c teleological s t a n c e to interpret goal-directed actions, it b e c o m e s possible to explain why chimp a n z e e s b r o u g h t u p by h u m a n s develop t h i s p a r t i c u l a r s u b s e t — t h a t is, protoimperatives a n d imitative learning—of t h e "jointattention skills." T h e crucial difference between t h e s e skills and, say, protodeclarative c o m m u n i c a t i o n or intentional teaching is t h a t t h e y consist of goal-directed activities w h o s e goals involve visible c h a n g e s of external reality. In c o n t r a s t , a protodeclarative c o m m u n i c a t i o n a i m s to i n d u c e or modify a nonvisible intentional mind state of t h e other. Significantly, children with a u t i s m are also able to p r o d u c e a n d u n d e r s t a n d protoimperative pointing g e s t u r e s t h a t a r e goal-directed a c t s t h a t c a n b e •teleologically interpreted, b u t they fail to u n d e r s t a n d or p r o d u c e protodeclarative pointing, w h i c h r e q u i r e s a mentalistic c o n s t r u a l of goals (see B a r o n - C o h e n 1991). The n o n m e n t a l i s t i c teleological interpretational s y s t e m comm o n to b o t h h u m a n s a n d a p e s e n a b l e s a p e s to p a r s e a n d repres e n t protoimperative communicative a c t s or n e w i n s t r u m e n t a l actions modeled to t h e m in imitative learning s i t u a t i o n s in t e r m s of their visible o u t c o m e s — a s goals-of-action—differentiated from t h e m e a n s t h a t bring t h o s e goal s t a t e s a b o u t . In addition, a n u p b r i n g i n g by h u m a n s c a n t e a c h t h e m — t h r o u g h modeling, shaping, selective rewarding, a n d so on—specifically to a t t e n d to a n d imitatively p r o d u c e t h e p a r t i c u l a r m e a n s modeled, a n d so to overcome their n a t u r a l l y d o m i n a n t t e n d e n c y to selectively a t t e n d to t h e salient o u t c o m e state only—as evidenced in emulation. However, e n c u l t u r a t i o n cannot t e a c h t h e m to r e p r e s e n t goals-ofaction t h a t a r e nonvisible and mental s u c h a s inducing, sharing, or modifying a n intentional m i n d s t a t e of t h e other—because they lack t h e theory-of-mind capacity to r e p r e s e n t intentional mental'states. To conclude—we have reviewed two types of dissociative evidence in s u p p o r t of t h e view t h a t t h e n o n m e n t a l i s t i c teleological

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s t a n c e m a y h a v e evolved i n d e p e n d e n t l y of t h e human-specific ability to r e p r e s e n t a n d a t t r i b u t e intentional mind s t a t e s s u c h a s intentions to others. This teleological interpretational s y s t e m c a n p a r s i m o n i o u s l y a c c o u n t for t h e 9 - m o n t h social-cognitive revolution in h u m a n infants t h a t involves t h e emergence of qualitatively n e w abilities to p r o d u c e goal-directed rational actions a n d to i n t e r p r e t s u c h actions in others. There is evidence to suggest t h a t t h e teleological s t a n c e is p r e s e n t n o t only in normal h u m a n infants by 9 m o n t h s of age, b u t also in nonh u m a n p r i m a t e s a n d in children with a u t i s m . Both of t h e latter seem, however, to lack t h e mentalistic intentional stance, w h i c h is likely to be a n additional human-specific a d a p t a t i o n t h a t h a s evolved to enable u s to u n d e r s t a n d a n d c o m m u n i c a t e with other minds.

UNDERSTANDING T H E S E L F AND OTHER A S "INTENTIONAL MENTAL AGENTS" The next qualitative s t e p in h u m a n development is t h e emerging ability to a t t r i b u t e "prior intentions" (Searle 1983) to t h e other a n d t h e self to explain or predict future goalTdirected actions. By 2 years of age infants s h o w t h e first signs of u n d e r s t a n d i n g t h a t the other c a n h a v e a prior intention or desire before or w i t h o u t actually acting on it a n d c a n a t t r i b u t e s u c h prior intentions to others from evidence o t h e r t h a n observing t h e goal-directed action itself. T h i s clearly implies t h e capacity to r e p r e s e n t intentional mental states (mentalism), a n d t h e ability to predict goal-directed action from inferred prior intentions implies t h e capacity to t h i n k in t e r m s of mental causation. Evidence for t h e a p p e a r a n c e of s u c h a mentalistic u n d e r standing of c a u s a l i n t e n t i o n s by t h e second year comes from a n u m b e r of s o u r c e s . (For a recent review, see Wellman a n d Phillips 2000.) For example, B a r t s c h a n d Wellman (1995) demonstrated t h a t 2-year-olds s p o n t a n e o u s l y u s e verbal references to their own or a n o t h e r p e r s o n ' s specific desires—using mostly the word "want"—even w h e n t h e desire-based action h a s n o t yet

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b e e n performed or w h e n t h e action executed did n o t fulfill the attributed desire. Verbal references to desires or i n t e n t i o n s at this age also clearly d e m o n s t r a t e t h a t 2-year-olds c a n differentiate between their own a n d other people's subjective desire states. Repacholi a n d Gopnik (1997) d e m o n s t r a t e d t h a t w h e n 18-month-olds were a s k e d to give t h e experimenter s o m e t h i n g to eat, t h e y provided h e r with t h e p a r t i c u l a r food item—broccoli vs. goldfish c r a c k e r s — t h a t s h e h a d previously expressed a liking for—by saying "yuck" or "yummy" w h e n first facing t h e food item. T h u s , t h e y m o d u l a t e d their own goal-directed action—to give food to t h e experimenter—by considering t h e specific cont e n t of t h e desire t h e y h a d a t t r i b u t e d to t h e other previously, b a s e d on a n earlier a n d different action, even w h e n t h a t desire w a s different from their own preference. In c o n t r a s t , 14-montholds gave t h e experimenter t h e item t h e y themselves liked, basing their choice on their own preference w i t h o u t being able to consider t h e other's relevant prior intention. M a t u r e e m p a t h i c reactions of c o n c e r n leading to pro-social a c t s also a p p e a r d u r i n g t h e second y e a r (Hoffman 2000; R. T h o m p s o n 1998; Zahn-Waxler a n d Radke-Yarrow 1990). Infants of t h i s age c a n a t t r i b u t e a subjective emotion s t a t e to t h e other a n d differentiate t h i s s t a t e from their own felt emotion a s shown by t h e capacity to devise a goal-directed pro-social act aimed at modifying t h e emotion state of t h e other. From t h e age of 2 y e a r s on, y o u n g children also s t a r t to show s o m e sensitivity to t h e c a u s a l c o n n e c t i o n s t h a t exist between different types of intentional m e n t a l s t a t e s . For example, they c a n infer t h a t a desire t h a t is unfulfilled by a given action triggers s a d n e s s or frustration r a t h e r t h a n joy a n d will g e n e r a t e further alternative goal-directed action. (See Wellman a n d Phillips 2000.) S u c h d e m o n s t r a t i o n s , therefore, clearly imply t h a t by 2 years of age infants p o s s e s s a r u d i m e n t a r y concept of desire a s a n intentional m e n t a l s t a t e t h a t represents—is "about"—a hypothetical s t a t e of t h e world—the goal s t a t e — t h a t h a s t h e power to c a u s e i n s t r u m e n t a l action a n d t h a t h a s c a u s a l connections to other types of m e n t a l s t a t e s . This r e p r e s e n t a t i o n a l s y s t e m a m o u n t s to a "naive theory of m i n d " (Fodor 1992; Leslie 1987, 1994; Leslie a n d Keeble 1987), w h i c h holds t h a t goal-directed

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actions a r e c a u s e d by intentional m e n t a l s t a t e s t h a t r e p r e s e n t states of affairs in t h e world a n d t h a t a r e systematically connected to e a c h o t h e r causally. The ability to r e p r e s e n t a g e n t s in t e r m s of relatively e n d u r i n g c a u s a l intentional m e n t a l s t a t e s t h a t c a n be divorced from p a r ticular goal-directed actions also establishes new conditions for how children will predict a n d interpret behavior. As a r e s u l t of repeated experiences with similar types of goal-directed actions of significant o t h e r s — s u c h a s caregivers or siblings—in comparable s i t u a t i o n s , children will begin to a t t r i b u t e generalized intentions or attitudes to t h e m : t h e s e become stable characteristics of their r e p r e s e n t a t i o n s of t h e s e others. S u c h generalized a n d e n d u r i n g intentional properties of p a r t i c u l a r p e r s o n s will come to function a s further constraining factors, in addition to situational a n d dispositional c o n s t r a i n t s , w h e n t h e principle of rational action is applied to predict or interpret their behavior. At this point, a n e w principle of r e a s o n i n g of naive theory of mind, which we c a n call t h e "principle of m e n t a l coherence" (cf. Dennett 1987), comes into play: this is t h e a s s u m p t i o n t h a t a rational a g e n t ' s c a u s a l i n t e n t i o n s are n o t contradictory. The child h a s to be able to m a k e t h i s a s s u m p t i o n if he is to p r o d u c e well-formed action predictions: if a n agent's i n t e n t i o n s involve contradictory goals, it is impossible to infer a rational c o u r s e of action. In developmental psychopathology p a r e n t s whose behavior toward their children is abusive a n d dissociative provide inferential g r o u n d s to a t t r i b u t e contradictory generalized intentions to t h e m . In c a s e s w h e r e this h a p p e n s , it h a s b e e n hypothesized t h a t t h i s will lead to a dysfunctional theory of m i n d a n d c o n s e q u e n t pathological p a t t e r n s of self-development involving disorganization a n d splitting (see Fonagy, Target, a n d Gergely 2000; Gergely 2 0 0 0 ; Gergely, Koos, a n d Watson, in press). T h e developmental distortions of t h e capacity to a t t r i b u t e generalized i n t e n t i o n s or a t t i t u d e s a r e manifest in a r a n g e of clinical features of borderline disorder, particularly in t h e p r e d o m i n a n c e of split r e p r e s e n t a t i o n s of self a n d o t h e r s (see c h a p t e r 9) a n d the c o m m o n failure to r e p r e s e n t t h e distinction between external reality a n d i n t e r n a l r e p r e s e n t a t i o n s of t h a t reality (see c h a p ter 10).

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D e v e l o p m e n t o f t h e S e l f - C o n c e p t d u r i n g t h e S e c o n d Year The ability of t h e 2-year-old to a d o p t t h i s mentalistic intentional stance, r e p r e s e n t i n g a g e n t s in t e r m s of generalized a n d e n d u r i n g intentional properties, also b r i n g s a b o u t a n e w level of selfu n d e r s t a n d i n g . As Tomasello (1993, 1999) a r g u e s (in keeping with t h e long tradition of social constructivism in self-development—see, e.g., Baldwin 1902; Cooley 1912; Fonagy a n d Target 1997; Mead 1934), t h e intentional actions a n d a t t i t u d e s repeatedly expressed toward t h e y o u n g child by caregivers a n d peers lead t h e child to infer a n d a t t r i b u t e generalized intentional properties to himself in a n a t t e m p t to rationalize h i s social p a r t n e r s ' behavior. This is how t h e e s t a b l i s h m e n t of a "categorical" selfconcept or r e p r e s e n t a t i o n — t h e J a m e s i a n "Me"—originates (Harter 1999; Lewis a n d B r o o k s - G u n n 1979). Apart from t h e directly perceivable features of t h e "empirical" self, t h i s self-representation includes generalized intentional properties t h a t a r e socially inferred. For example, in developmental psychopathology unrealistically negative self-attributions a r e s e e n to arise from the child's a t t e m p t s to rationalize t h e abusive or seriously neglectful t r e a t m e n t t h a t h e h a s received from a t t a c h m e n t figures (Allen 1995, 2001; Cicchetti a n d Toth 1994; Fonagy a n d Target 1997; Fonagy, Target, a n d Gergely 2000). The case of "Emma" (chapter 10) m a y be a helpful illustration. C a r e d for by a suicidal m o t h e r with bipolar disorder a n d a p a r a n o i d psychotic father, s h e internalized a picture of herself a s m a d a n d u n p r e d i c t a b l e a n d could behave accordingly. These internalizations into t h e self-structure were, however, distinct a n d s e p a r a t e from h e r r e p r e s e n t a t i o n of herself a s a c o m p e t e n t a n d helpful p e r s o n w h o could sort o u t the p r o b l e m s of o t h e r s with their difficulties in t h i n k i n g a n d feeling. Clinically, t h e challenge is t h a t t h e m a d a n d s o m e t i m e s abusive caregiving figure is internalized into t h e s a m e representational s y s t e m a s t h e r e p r e s e n t a t i o n of t h e constitutional self, a n d t h u s b o t h a r e felt to be p a r t s of t h e J a m e s i a n "Me." The developmental origins of t h e cognitive concept or representation of t h e self a s a n objective entity with e n d u r i n g properties h a s also b e e n tied to t h e end of t h e second year by t h e r e s u l t s of extended r e s e a r c h on early self-recognition in the mirror (Amsterdam 1972; Gallup 1991; Gallup a n d S u a r e z 1986; Lewis it

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and B r o o k s - G u n n 1979; Parker, Mitchell, a n d Boccia 1994). The fact t h a t between 18 a n d 2 4 m o n t h s of age—but n o t before— infants c a n recognize in t h e mirror a n inadvertently placed rouge m a r k on their n o s e or forehead a s belonging to themselves (as shown by t h e fact t h a t t h e y a t t e m p t to remove it from their own body r a t h e r t h a n from t h e mirror image) indicates that, b a s e d o n previous experience with their mirror image, infants h a v e inferred a n d a t t r i b u t e d to their self-representation the directly n o t perceivable visual features of their faces. T h e implications of t h i s finding for t h e r e p r e s e n t a t i o n a l n a t u r e of t h e self-concept a t t h i s age, however, have b e e n a subject of controversy (see Parker et al. 1994). While for s o m e (e.g., Bertenthal a n d Fisher 1978; Menzel, S a v a g e - R u m b a u g h , a n d Lawson 1985) mirror self-recognition c a n b e a c c o u n t e d for in t e r m s of increased perceptuomotor skills, a t t h e other extreme Gallup a n d h i s followers (e.g., Gallup a n d S u a r e z 1986) a r g u e t h a t this capacity implies selfa w a r e n e s s a n d t h e achievement of a r e p r e s e n t a t i o n a l self-concept t h a t is inherently linked to u n d e r s t a n d i n g intentional mind states of others. This s t r o n g mentalistic interpretation of mirror self-recognition h a s , however, b e e n challenged by n u m e r o u s r e s e a r c h e r s on a n u m b e r of g r o u n d s (e.g., Gergely 1994; R. W. Mitchell 1993; Povinelli 1995; Povinelli a n d Simon 1998)—for example, by observing t h e fact t h a t mirror self-recognition is p r e s e n t in c h i m p a n z e e s (Gallup 1970) a s well a s in children with a u t i s m (Dawson a n d McKissick 1984), b o t h of w h o m seem to lack a theory of m i n d (Baron-Cohen et al. 1985; Call a n d Tomasello 1999). Howe a n d Courage (1993, 1997) have a r g u e d t h a t t h e a p p e a r ance of t h e cognitive self-concept a t 2 y e a r s of age, a s evidenced by mirror self-recognition, is a precondition for—and m a r k s t h e lower b o u n d of—autobiographical m e m o r y for personally experienced events. In their view, t h e well-known p h e n o m e n o n of infantile a m n e s i a c a n be a t t r i b u t e d to t h e lack of a cognitive selfconcept before 2 y e a r s of age. They propose t h a t t h e organization of p e r s o n a l event m e m o r i e s into a n integrated a n d coherent memory s t r u c t u r e t h a t allows for later autobiographical recall is m a d e possible by t h e e s t a b l i s h m e n t of t h e cognitive concept of the self a s a r e p r e s e n t a t i o n of a n objective entity with temporal and c a u s a l continuity. This provides a c o m m o n c o n c e p t u a l

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s c h e m a in t e r m s of w h i c h t h e p a r t i c u l a r m e m o r y t r a c e s of personal experiences become encoded. In t h e next—final—section we review s o m e intriguing n e w findings a b o u t t h e development of t h e self-concept, w h i c h suggest t h a t m i r r o r self-recognition m a y indicate only a limited u n d e r s t a n d i n g of t h e self t h a t is tied to t h e p r e s e n t (the "present s e l f — s e e Povinelli 1995). T h e construction of a temporally "extended self" underlying autobiographical m e m o r y in w h i c h p a s t events experienced by t h e self a r e causally integrated with t h e p r e s e n t self into a unified selfconcept (the "proper s e l f — s e e W. J a m e s , 1890) s e e m s to require some further developments in r e p r e s e n t a t i o n a l capacities: it app e a r s to b e achieved only a t a r o u n d 4 to 5 y e a r s of age.

U N D E R S T A N D I N G SELF A N D O T H E R AS "REPRESENTATIONAL AGENTS" AND THE DEVELOPMENT O F T H E " A U T O B I O G R A P H I C A L SELF" A m a t u r e u n d e r s t a n d i n g of m e n t a l agency—that is, naive theory of mind—involves a n u m b e r of factors (see Fodor 1992; Leslie 1987), including t h e ability to a t t r i b u t e a n d r e p r e s e n t different types of intentional m i n d s t a t e s (such a s desires a n d beliefs), u n d e r s t a n d i n g how t h e y a r e causally related, c o m p r e h e n d i n g t h e r e p r e s e n t a t i o n a l n a t u r e of s u c h m e n t a l s t a t e s (Perner 1991), a n d knowing b o t h t h a t they h a v e c a u s a l potential" to generate action a n d t h a t they themselves are c a u s e d by p e r c e p t u a l experiences, verbal testimony, or inference (i.e., their properties of "causal self-referentiality"—Campbell 1997; Perner 2000a; Searle 1983). T h e r e a s o n s for t h e fact t h a t t h e s e different a s p e c t s of knowledge a b o u t t h e m i n d surface a t different ages in y o u n g children h a v e b e e n t h e subject of h e a t e d controversy a n d theorizing for t h e last twenty y e a r s or so (e.g., Astington et al. 1988; Baron-Cohen, Tager-Flusberg, a n d C o h e n 2000; C a r r u t h e r s 1996; Davis a n d Stone 1995; Lewis a n d Mitchell 1994; Whiten 1991). Three major positions, outlined in brief already in c h a p t e r 1, have b e e n identified concerning t h e n a t u r e of t h e underlying

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cognitive m e c h a n i s m s t h a t lead to t h e development of m a t u r e theory of m i n d by a b o u t 4 y e a r s of age. These a r e (a) t h e i n n a t e modularist a p p r o a c h (Fodor 1992; Leslie 1987, 1995), (b) t h e simulationist view (Gordon 1995; P. L. Harris 1991, 1992), a n d (c) t h e t h e o r y - t h e o r y position (Gopnik a n d Wellman 1992, 1994; Perner 1991). In c h a p t e r 1 we c o n t r a s t e d t h e s e formulations from t h e s t a n d p o i n t of t h e a c c o u n t t h e y might give of the integration of a t t a c h m e n t p r o c e s s e s with t h e development of theory of mind. Here we shall n o t a t t e m p t to review a n d evaluate t h e relative m e r i t s of t h e s e theories. Rather, we shall simply concentrate on characterizing some of t h e qualitatively novel a s p e c t s of u n d e r s t a n d i n g self a n d other a s r e p r e s e n t a t i o n a l a g e n t s t h a t seem to arise between 3 a n d 4 y e a r s of age. One of t h e central i s s u e s is t h e q u e s t i o n of why it is t h a t , while a mentalistic u n d e r s t a n d i n g of desires s e e m s to be p r e s e n t by 2 y e a r s of age, t h e r e p r e s e n t a t i o n a l u n d e r s t a n d i n g of belief, a s diagnosed by t h e ability to c o m p r e h e n d false-belief-based actions, is delayed until 3 to 4 y e a r s of age. W i m m e r a n d Perner (1983) were t h e first to d e m o n s t r a t e t h a t 3-year-olds w h o witn e s s a p e r s o n leaving a n object in container A before leaving the room a n d w h o see t h e object being transferred to c o n t a i n e r B in t h a t p e r s o n ' s a b s e n c e m a k e the—reality-based—error of predicting t h a t s h e will s e a r c h in c o n t a i n e r B—where t h e object actually is—rather t h a n in c o n t a i n e r A—where s h e left t h e object—when s h e comes b a c k . By t h e age of 4 or 5, children n o longer commit t h i s error: they tend to predict correctly t h a t t h e person will look in c o n t a i n e r A, b e c a u s e t h e y are able to attribute a false belief to her. A n u m b e r of theoretical positions h a v e b e e n p u t forward to explain t h i s late occurrence of u n d e r s t a n d i n g false beliefs. Modularists like Leslie (1987, 1994) a n d Fodor (1992) a r g u e t h a t t h e m e t a r e p r e s e n t a t i o n a l s y s t e m n e c e s s a r y to r e p r e s e n t propositional a t t i t u d e c o n c e p t s s u c h a s desire, pretense, or belief is fully in place by t h e e n d of t h e second year (as evidenced by t h e capacity to p r o d u c e a n d u n d e r s t a n d pretend play—see Leslie 1987). In Leslie's view, attributing false beliefs is delayed b e c a u s e of performance limitations in a t t e n d i n g to a n d learning a b o u t t h e c a u s a l conditions of belief fixation—for example, t h a t perception leads to knowledge (see Leslie a n d Roth 1993). In contrast,

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Perner a n d o t h e r s (e.g., Gopnik a n d Wellman 1992, 1994; Perner 1991, 2000b) a r g u e t h a t before 4 y e a r s of age children do n o t yet u n d e r s t a n d intentional'mind s t a t e s "as representations": t h a t is, a s m e n t a l s t a t e s t h a t a r e "about" some—real or hypothetical— state of affairs a n d t h a t c a n be evaluated a s t r u e or false in relation to s u c h a s t a t e of affairs (Perner 2000b). Perner also a r g u e s t h a t u n d e r s t a n d i n g beliefs "as r e p r e s e n t a t i o n s " is also a n e c e s s a r y r e q u i r e m e n t for u n d e r s t a n d i n g t h a t actions a r e mentally caused by representations of reality r a t h e r t h a n by reality itself. One kind of—newly emerging—evidence on w h i c h Perner a n d o t h e r s (see Mitchell a n d Riggs 2000; Perner a n d Lang 1999) rely in arguing t h a t u n d e r s t a n d i n g intentional s t a t e s a s m e n t a l repr e s e n t a t i o n s with c a u s a l power over behavior is arrived a t only a r o u n d 3 to 5 y e a r s of age comes from intriguing correlations t h a t have b e e n discovered between u n d e r s t a n d i n g false-beliefb a s e d action (theory of mind) on t h e one h a n d a n d showing m a t u r e self-control abilities in executive function t a s k s a n d m a s t e r y of counterfactual r e a s o n i n g t a s k s on t h e other. To explain t h e correlated d r a m a t i c improvement in t h e s e r a t h e r differe n t t a s k d o m a i n s a t a r o u n d 4 y e a r s of age, Perner. (2000a) a r g u e s t h a t t h e y all require a n u n d e r s t a n d i n g of t h e fact t h a t the intentional m e n t a l s t a t e s they involve have t h e property of "causal self-referentiality"—a notion t a k e n over from philosophy of m i n d (see Campbell 1997; Searle 1983). Briefly, t h i s notion s u g g e s t s t h a t to u n d e r s t a n d a m e n t a l intentional s t a t e properly, say, a n intention to act, we m u s t be aware n o t only t h a t t h e intention r e p r e s e n t s some state of affairs, b u t also t h a t it specifies—represents in its c o n t e n t — t h a t t h e i n t e n d e d action be c a u s e d by t h e intention to a c t (Perner 2 0 0 0 b , p. 300). (This forms t h e r e p r e s e n t a t i o n a l b a s i s for o u r a w a r e n e s s or s e n s e of agency a s well a s ownership of action.) Similarly, in order to be recalled a s a n item in autobiographical memory, t h e memory r e p r e s e n t a t i o n of a specific event t h a t a p e r s o n h a s experienced m u s t n o t only specify t h e event itself b u t m u s t also r e p r e s e n t the fact t h a t t h e m e m o r y h a s b e e n c a u s e d by t h a t event (memory for c a u s a l s o u r c e of knowledge). Perner (2000b) reviews evidence from theory-of-mind res e a r c h indicating t h a t children before 4 to 5 y e a r s of age are it

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notoriously b a d at identifying t h e c a u s a l s o u r c e s of their beliefs (such a s w h e t h e r t h e y h a v e seen, "were told a b o u t , or inferred w h a t is in a box—see, e.g., Gopnik a n d Graf 1988; Wimmer, Hogrefe, a n d Perner 1988; Wimmer, Hogrefe, a n d S o d i a n 1988). Executive function t a s k s , s u c h a s t h e Wisconsin card sorting task, in w h i c h failure in 3-year-olds a n d in children with a u t i s m (see H u g h e s a n d Russell 1993; J . Russell 1996) correlates with failure on theory-of-mind t a s k s , involve t h e need to inhibit a n a t u r a l r e s p o n s e t e n d e n c y in favor of a n adaptive response. It is suggested (see Pacherie 1997; Perner 2000b; J . Russell 1996, 1997) t h a t self-awareness of t h e c a u s a l power of t h e m e n t a l disposition t h a t r e s u l t s in t h e n a t u r a l r e s p o n s e is a n e c e s s a r y prerequisite before t h i s n a t u r a l r e s p o n s e c a n be inhibited. It h a s also b e e n hypothesized t h a t difficulties in self-monitoring of intentions underlie t h e co-occurrence of self-control difficulties—and m i s t a k e n a t t r i b u t i o n s of one's own intentional cont e n t s to external s o u r c e s — a n d theory-of-mind p r o b l e m s in schizophrenia (C. D. Frith 1992) on t h e one h a n d , a n d t h e cooccurrence of executive function p r o b l e m s a n d theory-of-mind difficulties in children with a u t i s m on t h e other (Carruthers a n d Smith 1996; Pacherie 1997; J . Russell 1996, 1997).

The E m e r g e n c e of t h e Autobiographical Self Perner also a r g u e s t h a t infantile a m n e s i a (the lack of g e n u i n e memories of personally experienced events t h a t occurred prior to a b o u t 3 to 4 y e a r s of age—see K, Nelson 1992, 1993; Perner 1990, 1991) is d u e to y o u n g children's inability to "encode personally experienced events as-personally experienced' (Perner 2000b, p. 306)—that is, in t e r m s of their c a u s a l informational source "as having b e e n seen." At a r o u n d 4 to 5 y e a r s of age, a s the ability to r e p r e s e n t t h e informational s o u r c e a s well a s the c o n t e n t of knowledge emerges in theory-of-mind t a s k s , t h e autobiographic organization of memories a s personally experienced events is also established. An ingenious r e c e n t series of s t u d i e s by Povinelli a n d h i s colleagues h a s confirmed t h a t children below 4 to 5 y e a r s of age find it extremely difficult to integrate self-related experiences

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into a coherent c a u s a l - t e m p o r a l organization a r o u n d a selfconcept extended in time (Povinelli a n d E d d y 1995; Povinelli, Landau, a n d Perilloux 1996; Povinelli, Landry, Theall, Clark, a n d Castille 1999; Povinelli a n d Simon 1998). T h e previously widely h e l d belief t h a t mirror self-recognition by 2 y e a r s of age signals the construction of a stable cognitive concept of t h e self (see Gallup a n d S u a r e z 1986; Howe a n d Courage 1993; Lewis a n d B r o o k s - G u n n 1979) h a s b e e n challenged by Povinelli's demons t r a t i o n s t h a t recognition of t h e self on a briefly delayed video feedback is a b s e n t before 4 to 5 y e a r s of age. In one study (Povinelli a n d Simon 1998) children were videotaped while playing a g a m e with a n experimenter w h o covertly placed a large sticker on t h e child's h e a d d u r i n g t h e game. Three m i n u t e s later, w h e n t h e videotape w a s played b a c k to t h e children, 3-year-olds failed to r e a c h u p to remove t h e sticker (visible o n t h e videotape) from their head, even t h o u g h they generally m a n a g e d to "recognize" their video image a s themselves verbally by saying "it's me" or their proper n a m e w h e n a s k e d w h o t h e child w a s on t h e video. (However, w h e n a s k e d w h e r e t h e sticker w a s , t h e y t e n d e d to reply t h a t "it's on his head" instead of their own!) They nevertheless did r e a c h u p to remove t h e sticker w h e n p r e s e n t e d with a mirror. In c o n t r a s t , 4- to 5-year-olds could relate t h e delayed video feedback to their c u r r e n t self: t h e y removed t h e sticker w h e n p r e s e n t e d with t h e videotape. Perner explains this finding by a r g u i n g t h a t "3-year-olds seem to lack a n u n d e r s t a n d i n g of t h e c a u s a l link between recorded events a n d w h a t t h e y see on t h e video record" (2000b, p. 302). However, in a series of control s t u d i e s Povinelli et al. (1999) d e m o n s t r a t e d t h a t 3-year-olds do u n d e r s t a n d t h e equivalence between delayed video images a n d t h e real world, a s they are able to w i t n e s s a n object being h i d d e n on video a n d t h e n successfully locate it. In Povinelli's theory (Povinelli a n d Eddy 1995; Povinelli a n d Simon 1998; Povinelli et al. 1999) t h e concept of a n "autobiographical self emerges a t a r o u n d 4 y e a r s a s a function of c h a n g e s in t h e child's r e p r e s e n t a t i o n a l capacities. First, a t the end of t h e second year infants develop t h e ability to hold a single r e p r e s e n t a t i o n or model of t h e world in m i n d (see also Olson a n d Campbell 1993; Perner 1991), w h i c h t h e y c a n c o m p a r e to pres-

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ently perceived a s p e c t s of reality. This underlies t h e ability to recognize t h e self in t h e m i r r o r between 18 a n d 2 4 m o n t h s : t h e single m e n t a l r e p r e s e n t a t i o n of t h e s e l f s actions a n d physical features—the "present s e l f — i s compared to t h e mirror image with w h i c h a n equivalence relation is a s s u m e d . At a r o u n d 4 years, however, "children become able to hold in m i n d multiple r e p r e s e n t a t i o n s or models of t h e world simultaneously" (Povinelli a n d Simon 1998, p. 189). This enables t h e m to establish temporal a n d c a u s a l relations a m o n g memories of previously encoded experiences of t h e self a n d , in particular, to causally "evaluate the relevance of previous s t a t e s of t h e self to t h e p r e s e n t s e l f (p. 189). T h u s , 4- to 5-year-olds c a n d r a w a c a u s a l inference t h a t if a few m i n u t e s ago a sticker w a s placed on their h e a d (as revealed by t h e videotape), their p r e s e n t s t a t e is likely to be affected by this p a s t event, so t h a t t h e sticker is probably still on their h e a d . The ability to relate multiple r e p r e s e n t a t i o n s underlies, therefore, t h e e s t a b l i s h m e n t of a n a b s t r a c t historical-causal selfconcept (the "autobiographical stance"), w h i c h integrates memories of previously u n r e l a t e d s t a t e s of t h e self into a n organized, coherent, a n d unified autobiographical self-representation. The t h e r a p e u t i c implications of t h e profound restriction on individuals with severe self-pathology to m a n i p u l a t e multiple r e p r e s e n t a tions of t h e self a r e t a k e n u p again in c h a p t e r 10.

IMPLICATIONS FOR DEVELOPMENTAL PSYCHOPATHOLOGY In this c h a p t e r we h a v e traced t h e complex a n d intricate develo p m e n t of t h e y o u n g child's emerging u n d e r s t a n d i n g of t h e self a n d o t h e r s a s a g e n t s in t h e e n v i r o n m e n t starting from b i r t h to a b o u t 5 y e a r s of age. O u r d i s c u s s i o n focused on t h e w a y s in which t h e y o u n g child develops a representational u n d e r s t a n d ing of t h e c a u s a l relations—both physical a n d mental—between p e r s o n s a n d their actions a n d between actions a n d c o n s e q u e n t c h a n g e s in t h e environment. We found it useful to distinguish a m o n g five different levels of t h e development of u n d e r s t a n d i n g agency a n d selfhood:

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1. the self as a "physical agent," w h i c h involves t h e differentiated r e p r e s e n t a t i o n of t h e body a s a s e p a r a t e a n d dynamic entity t h a t c a n c a u s e physical c h a n g e s in t h e environment; 2. the self as a "social agent," w h i c h r e p r e s e n t s t h e speciesspecific affective-communicative interactions—as well a s their subjective emotional-intentional correlates—in which infants a n d caregivers engage from b i r t h on; 3. the self as a "teleological agent," w h i c h refers to t h e qualitatively n e w b u t still n o n m e n t a l i s t i c u n d e r s t a n d i n g of goaldirected rational action emerging a t a r o u n d 9 m o n t h s of age a n d underlying t h e so-called " 9 - m o n t h social-cognitive revolution"; 4. the self as an "intentional mental agent," w h i c h emerges during t h e second year a n d involves a n already mentalistic u n d e r s t a n d i n g of s o m e c a u s a l intentional m i n d s t a t e s s u c h a s desires a n d - i n t e n t i o n s t h a t a r e r e p r e s e n t e d a s existing prior to a n d separately from t h e actions t h e y generate; 5. the self as a "representational agent" and the emergence of the "autobiographical self a r o u n d 4 to 5 y e a r s of age, which involves t h e ability to c o m p r e h e n d t h e "representational" a n d "causally self-referential" properties of intentional mind states, leading, a m o n g other things, to t h e e s t a b l i s h m e n t of a n abstract, temporally extended, historical-causal concept of t h e "autobiographical self." Contingency detection m a y h a v e a key role to play in several forms of psychopathology t h a t involve t h e malformation of t h e self a s agent. We envision a s p e c t r u m of d i s t u r b a n c e s all involving a b n o r m a l sensitivities to contingencies. At one extreme might be c a s e s where, for primarily biological r e a s o n s , a lack of sensitivity to a n y t h i n g other t h a n perfect contingencies might entirely u n d e r m i n e t h e possibility of social development. W a t s o n h a s hypothesized (Gergely 2001b; Gergely et al. in p r e s s ; Gergely a n d W a t s o n 1999; W a t s o n 1994) t h a t t h e etiology of childhood autism m a y be related to a genetically b a s e d malfunctioning of t h e "switching m e c h a n i s m " of t h e contingency-detection module. According to t h i s hypothesis, in autistic individuals the contingency analyzer gets "stuck" forever in its original setting of &

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preferentially seeking o u t a n d processing perfectly self-contingent stimuli. As a result, children with a u t i s m c o n t i n u e to invest in perfect contingencies—generated by stereotypic self-stimulation or repetitive object-manipulation—throughout their lives, while showing a lack of interest in t h e less-than-perfect contingencies provided' by their social environment. (See Gergely 2001b; for some preliminary s u p p o r t i n g evidence, see Gergely, Magyar, a n d Balazs 1999; Gergely a n d W a t s o n 1999, pp. 1 2 5 130.) From s u c h a p r i m a r y deficit in contingency detection o n e c a n derive a r a n g e of t h e focal s y m p t o m s associated with childhood a u t i s m , s u c h a s t h e p r e p o n d e r a n c e of behavioral stereotypies a n d rhythmicities, intolerance to variation in routines, difficulties in inhibiting prepotent or h a b i t u a l r e s p o n s e s involved in executive function deficits, aversion to social objects, a n d even t h e lack of sensitivity to t h e social c u e s t h a t drive m i n d reading skills. (For details, see Gergely 2001b; Gergely a n d Watson 1999.) T h r o u g h o u t t h i s volume we suggest t h a t in less severe cases, a t t a c h m e n t e n v i r o n m e n t s t h a t involve dysfunctional p a t t e r n s of contingencies between actions of t h e self a n d t h e r e s p o n s e of t h e other m a y lead to a distorted functioning of contingency detection. This, in t u r n , m i g h t u n d e r m i n e t h e n o r m a l development of self-agency by depriving t h e individual of some key building blocks for t h e development of t h i s s t r u c t u r e . As we have indicated above, i n a d e q u a c i e s of t h e structuralization of t h e self might arise o u t of a biologically determined predisposition to fail to engage less-than-perfect social contingencies in a n interpersonal context. Alternatively, t h e n o r m a l development of t h e self may become u n d e r m i n e d a s a r e s u l t of t h e caregiver's inadequate provision of adaptive contingent responsiveness. For example, abusive caregivers or preoccupied, dissociating caregivers who a r e unresolved in relation to t r a u m a periodically s h o w a severe reduction of contingent responsivity—during a b u s i v e episodes or periods of p a r e n t a l dissociation. During s u c h r e c u r r i n g episodes, t h e child repeatedly experiences periods of d r a s t i c loss in the contingent effectivity of h i s affective a n d communicative r e s p o n s e s (Koos a n d Gergely 2001). This m a y lead to disorganization in self-development c h a r a c terized by a t e n d e n c y for dissociation a c c o m p a n i e d by preoccu-

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pation with self-generated perfect contingencies in t h e attachm e n t context. In s u p p o r t of t h i s view, we h a v e preliminary evidence indicating a n early association b e t w e e n disorganized infant a t t a c h m e n t a n d a n a b n o r m a l preference for perfect contingencies (Koos a n d Gergely 2001; Koos et al. 2000). In o u r view, t h e n , b o t h t h e maladaptive features of t h e caregiver's contingent r e s p o n s i v e n e s s a n d t h e infant's i n a d e q u a t e sensitivity to social contingencies m a y d e t e r m i n e t h e establishm e n t of a n a b n o r m a l focus on perfect contingencies a n d a pathological development of self-agency. In either case, t h e most pertinent observation is one of early vulnerability, w h i c h s t e m s from t h e poor e s t a b l i s h m e n t of agentive self-structure. Taking t h e perspective of t h e developmental psychopathologist, t h e s e distinctions m i g h t help u s to u n d e r s t a n d s o m e key features of later d i s t u r b a n c e , particularly personality disorders. It is clear t h a t , associated with certain extreme social dysfunct i o n s — s u c h a s childhood m a l t r e a t m e n t , environmental t r a u m a of various k i n d s — a n individual's capacity to b e h a v e with a n y degree of flexibility comes to be compromised. S o m e of t h e s e dysfunctions of interpersonal behavior might be u n d e r s t o o d a s reflecting a n intensified n e e d on t h e p a r t of t h e individual to d e m a n d closer-to-perfect contingent r e s p o n s e s from individuals with w h o m they h a v e emotionally loaded relationships. It is a s if t h e s e relationships triggered t h e need to rediscover t h e self in t h e r e s p o n s e of t h e o t h e r (see c h a p t e r s 3 a n d 4) a n d therefore reactivated t h e need for high levels of contingent responsiveness. In later c h a p t e r s we describe w a y s in w h i c h we t h i n k this need is u n c o n s c i o u s l y experienced a n d ' h o w we u n d e r s t a n d t h e pathological solutions t h a t come to be e n a c t e d in later a t t a c h m e n t relationships. In t h e c h a p t e r s t h a t follow we a t t e m p t to integrate t h e develo p m e n t a l c o n c e p t s a n d r e s e a r c h reviewed in t h e last t h r e e chapters with a clinical model for t h e development of subjectivity (see c h a p t e r 6) a n d its distortions in childhood (see c h a p t e r s 7 a n d 10) a n d a d u l t personality disorders (see c h a p t e r s 8 a n d 9). In this c h a p t e r we h o p e we have laid t h e g r o u n d w o r k for t h e developmental models of severe personality p r o b l e m s described in t h e c h a p t e r s t h a t follow. We h o p e t h a t we h a v e established some of t h e characteristics of prementalistic functioning t h a t we

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believe to be relevant to o u r developmental u n d e r s t a n d i n g of personality disorder. In general, we believe t h a t m a n y c o m m o n s y m p t o m s a n d p r o b l e m s identified in t h e s e p a t i e n t s a r e "revealed" by a b s e n c e of mentalistic functioning in t h e self a s agent. F e a t u r e s s u c h a s impulsivity, emotion dysregulation, a n d t h e p r e d o m i n a n c e of primitive defenses c a n be seen either a s a n a d a p t a t i o n of p r o c e s s e s t h a t anteceded mentalization or a s att e m p t s of t h e m i n d to a d a p t to t h e limited r a n g e of capacities available to it, or s o m e combination of t h e s e two possibilities.

"Playing with Developmental

Reality": Research

a n d a Psychoanalytic for t h e D e v e l o p m e n t of

Model

Subjectivity

This c h a p t e r c o n c e r n s c h a n g e s in t h e child's perception of psychic reality d u r i n g n o r m a l development, culminating in t h e major shift in t h e child's u n d e r s t a n d i n g of m i n d s (theory of mind) a t t h e oedipal stage, w h i c h we e q u a t e with t h e qualitative shift in t h e development of mentalization whereby t h e self becomes a r e p r e s e n t a t i o n a l agent (see c h a p t e r 5). We integrate empirical s t u d i e s of t h i s t r a n s i t i o n with material from t h e analysis of a 4-year-old girl. We propose a psychoanalytic model of t h e development of a n a w a r e n e s s of m e n t a l s t a t e s , which conceives of t h e very y o u n g child a s u s i n g two m o d e s for r e p r e s e n t i n g internal s t a t e s or—using psychoanalytic terminology—psychic reality; we h a v e called t h e s e "psychic equivalent" a n d "pretend" modes, w h i c h differ primarily in t h e a s s u m e d relationship between i n t e r n a l a n d external realities. We a r g u e t h a t t h e integration of t h e d u a l m o d e s into a singular reflective m o d e is normally completed by a b o u t t h e age of 4, with t h e mentalization of affect leading t h e mentalization of belief s t a t e s or cognitions: t h e child first u n d e r s t a n d s t h a t people have different feelings, t h e n t h a t they m a y h a v e different t h o u g h t s a b o u t t h e s a m e external reality. We link F r e u d ' s classic notion of psychic reality a n d c u r r e n t psychoanalytic formulations of symbolization. This c h a p t e r describes n o r m a l psychological growth in childhood; t h e next offers a further clinical example, w h i c h applies t h e model outlined in 253

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t h i s c h a p t e r a n d c h a p t e r 4 to a y o u n g child. C h a p t e r 8 c o n c e r n s t h e c h a n g e s t h a t o c c u r in adolescence, a n d t h e following two chapters, u s i n g t h e s a m e developmental model, consider failures of t h e s e crucial cognitive t r a n s i t i o n s a s s e e n in a d u l t personality disorder.

THE CONCEPT OF PSYCHIC REALITY Most p s y c h o a n a l y s t s u s e t h e t e r m "psychic reality" informally, to m e a n subjective experience influenced by u n c o n s c i o u s processes (Michels 1984). T h u s in t h e psychic reality of t h e patient, t h e analyst m a y be alternately r e p r e s e n t e d a s destructive a n d cruel or perfect a n d o m n i p o t e n t in t h e transference. Freud's original concept w a s of "thought-reality," w h i c h h e distinguished from "external reality." T h e import of this distinction w a s t h a t internal experience could in certain c i r c u m s t a n c e s b e treated a s t h o u g h it were a s real a s t h e external world, a n d F r e u d w a s particularly interested in h o w t h e ego j u d g e s t h e "quality" of t h o u g h t a n d t h e i m p a c t on t h i s ego function of emotional cathexis a n d language: "Thus thought accompanied by a cathexis of the indications of thought-reality or of the indications of speech is the highest, securest form of cognitive thought process" (1895, p. 374, e m p h a s i s in original). In t h i s c h a p t e r we investigate how t h e individual experiences a n d evaluates h i s "thought-reality" at different s t a g e s of development a n d how, all being well, h e comes to exercise t h e h i g h e s t form of cognitive process, a sort of reality testing of i n t e r n a l s t a t e s ( H a r t m a n n 1956), in b o t h oneself a n d others. Freud w e n t on to u s e t h e concept of psychic reality to explain how neurotic p h e n o m e n a provoked by childhood t r a u m a — s e duction—could be indistinguishable from c a s e s w h e r e t h e supposedly pathogenic events h a d never t a k e n place (Freud 1900a). The events could b e "real" psychologically, a n d t h e individual might react to wishful fantasies in t h e w a y t h a t they or others would r e s p o n d to a c t u a l events. F r e u d wrote: "What lie behind t h e s e n s e of guilt of n e u r o t i c s a r e always psychical realities and never factual ones. W h a t characterizes n e u r o t i c s is t h a t they prefer psychical to factual reality, a n d react j u s t a s seriously to

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t h o u g h t s a s n o r m a l people do to realities" (1912-13, p. 159)*. This s e n s e of equivalence is also suggested by Laplanche a n d Pontalis's definition of psychic reality a s "whatever in t h e subr ject's p s y c h e p r e s e n t s a consistency a n d r e s i s t a n c e c o m p a r a b l e to t h o s e displayed by material reality" (Laplanche a n d Pontalis 1973, p. 363). F r e u d t h o u g h t t h a t psychic reality poses a d a n g e r w h e n t h e r e is imperfect discrimination ("reality testing," B r e n n e r 1955) between stimuli from t h e o u t e r world a n d stimuli t h a t arise a s p r o d u c t s of u n c o n s c i o u s processes. Although t h e n e u rotic a d u l t k n o w s w h e t h e r experiences originate internally or externally, h e gives m o r e weight to certain internal experiences t h a n h e does to h i s knowledge of t h e outside world. An obsessional person, for i n s t a n c e , "knows" t h a t t h e door is locked b u t still c h e c k s several times, b e c a u s e for h i m t h e internal image of a n u n s e c u r e d h o u s e h a s m u c h more m e a n i n g a n d power t h a n the external i m a g e s provided by h i s s e n s e s . B e c a u s e "psychic reality" now h a s a variety of connotations, we u s e t h e t e r m "psychic equivalence" to denote domination by psychic reality in Freud's s e n s e .

T H E IMPORTANCE OF A DEVELOPMENTAL PERSPECTIVE Ambiguity in t h e t e r m "psychic reality" m a y be d u e to insufficient utilization of a developmental perspective in psychoanalysis. Arlow (1984) u n d e r s c o r e s t h e qualitative differences in t h e perception of physical a n d human—psychological—realities. We may infer from h i s p a p e r t h a t a r o b u s t s e n s e of this psychological reality will lag b e h i n d t h e acquisition of a clear portrayal of the physical world, b o t h developmentally a n d in t e r m s of complexity. W h a t m a y u n d e r l i e t h i s difference is t h e relative opaqueness of o u r m e n t a l world (Brentano 1874); in fact, t h e concept of psychic reality begs a whole r a n g e of q u e s t i o n s concerning t h e n a t u r e of subjective experience with which, a s we h a v e said, Freud w a s grappling from t h e time of t h e 1895 "Project" (Freud 1950 [1895]). How do we k n o w o u r m i n d s ? Is psychic reality directly experienced, a s p e r h a p s is t h e case for p a i n a n d other

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sensations, or a r e t h o u g h t s , beliefs, desires, a n d intentions— m e n t a l s t a t e s — p e r h a p s c o n s t r u c t i o n s of o u r m i n d s , built u p over the early y e a r s of development? If a developmental process underlies t h e evolution of psychic reality, w h a t is its n a t u r e , a n d how does t h e child's subjective experience of reality differ from t h a t of t h e a d u l t ? Do psychoanalytic clinical d a t a s h e d light on this evolution? C a n we learn from philosophers of m i n d or observational s t u d i e s in developmental psychology a b o u t t h e way psychic reality evolves? A n u m b e r of philosophers of m i n d a s s u m e t h a t t h e experience of m e n t a l s t a t e s is intrinsic, psychic reality is a "given" (e.g., Searle 1983), a n d a w a r e n e s s of others' m e n t a l s t a t e s is arrived a t by simulating t h e m e n t a l s t a t e s of o t h e r s (Goldman 1992; Gordon 1986, 1992). The model t h a t we p r o p o s e places F r e u d ' s notion of psychic reality in a developmental perspective. We have already p r e s e n t e d empirical evidence a n d developmental observations in t h e previous t h r e e c h a p t e r s to s u p p o r t the view t h a t o u r u n d e r s t a n d i n g of t h e m e n t a l world is n o t a given, is radically different in t h e y o u n g child, a n d crucially d e p e n d s for its healthy development on interaction with other people who are sufficiently benign a n d reflective. (For a philosophical demonstration of this b a s i c position see Cavell 1991.) In c h a p t e r 3 we m a d e a claim—one t h a t m a y be perceived a s risky from t h e point of view of cognitive science b u t is far less so from a p s y c h o a n a lytic perspective—that one of t h e key evolutionary functions of early object relations for h u m a n s w a s to equip t h e very young child with a n environment w h e r e t h e processing capacity for t h e u n d e r s t a n d i n g of m e n t a l s t a t e s in o t h e r s a n d t h e self c a n fully develop. The social n a t u r e of t h o u g h t is t h u s p a r t of t h e very e s s e n c e of subjectivity.

EMPIRICAL OBSERVATIONS CONCERNING THE DEVELOPMENT OF PSYCHIC REALITY In c h a p t e r 4 we considered evidence t h a t d e m o n s t r a t e s t h a t from t h e first m o n t h s of life a child is intensely concerned a b o u t t h e social world (e.g., S t e r n 1985, 1994; T r e v a r t h e n 1980). How-

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ever, it is also evident t h a t t h e way in w h i c h a child of 3 or 4 years experiences i n t e r p e r s o n a l reality—and h i s role within it— is qualitatively different from t h e way t h a t a n older child or a d u l t experiences it. O n e i n s t a n c e of t h i s critical difference is in t h e u n d e r s t a n d i n g t h a t children h a v e of t h e m i n d , in their theory of mind (e.g., B a r o n - C o h e n 1995; Mayes a n d Cohen 1992). The ability to a t t r i b u t e intentional m e n t a l states—goals, desires, a n d beliefs—to oneself or o t h e r s a s a n explanation for actions is n o t fully developed u n t i l a r o u n d 4 y e a r s of age (Wellman 1990). However, m o s t developmental psychologists believe t h a t p r e c u r sors of this capacity—pointing a n d looking, or checking b a c k for the caregiver's reaction to s t r a n g e situations—imply a w a r e n e s s of other people's m i n d s in t h e first year of life (Butterworth, Harris, Leslie, a n d Wellman 1991; Klinnert et al. 1983; see also Stern 1985). Gergely's experimental paradigms, described in c h a p t e r s 4 a n d 5, a p p e a r to s h o w t h a t b a b i e s of 8 to 9 m o n t h s attribute p u r p o s e to events. Soon after t h e end of t h e first year children show, implicitly, a partial a w a r e n e s s of t h e difference between i n t e r n a l r e p r e s e n t a t i o n s a n d reality. Reddy (1991) offers a m u s i n g e x a m p l e s of t h e 1-year-old's a w a r e n e s s of t h e a p p e a r ance/reality distinction from h i s observations of children "mucking about" a n d d e m o n s t r a t i n g in their delight t h a t they did n o t really imagine t h a t their m o t h e r would allow t h e m to keep t h e whole chocolate b a r for themselves, or to walk across t h e road without holding h a n d s , a n d so on. As s h o w n in c h a p t e r 5, by t h e age of 3 y e a r s m a n y i m p o r t a n t building blocks for u n d e r s t a n d i n g t h e n a t u r e of psychic reality are in place (e.g., Wellman 1990). For i n s t a n c e , children c a n distinguish between d r e a m images, t h o u g h t s , a n d real things, they s t a r t p r e t e n d games, a n d t h e y easily appreciate someone else's intention to pretend—for example, t h a t D a d d y is a dog. Nevertheless, t h e 2- or 3-year-old's a w a r e n e s s of his inner world is markedly different from t h a t of a child in h i s fifth year. We wish to p r o p o s e t h a t t h e very small child's s e n s e of psychic reality h a s a d u a l c h a r a c t e r . T h e child generally operates in "psychic equivalence" mode, where ideas are n o t felt to b e representations b u t , r a t h e r , direct replicas of reality, a n d consequently always t r u e . At other times, however, t h e child u s e s a "pretend" m o d e in w h i c h ideas are felt to be r e p r e s e n t a t i o n a l b u t

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their correspondence with reality is n o t examined. We will look a t the evidence for t h e s e in t u r n .

The "Psychic Equivalence" Mode of E x p e r i e n c i n g P s y c h i c Reality W h e n a 3-year-old is given a sponge t h a t h a s b e e n p a i n t e d a n d s h a p e d to look like a rock, h i s a n s w e r s to t h e q u e s t i o n s of w h a t t h e object looks like a n d w h a t it actually is t e n d to be identical (Flavell, Green, a n d Flavell 1986). T h e child is s h o w n a n d allowed to feel t h e object. Q:

"What does it look like?"

A:

"It looks like a rock."

Q:

"What is it?"

A:

"It's a rock."

T h e child is prompted to squeeze t h e object. Q:

"What do you t h i n k it is?"

A;

"It's a sponge."

Q:

"What does it look like?"

A:

"It looks like a sponge."

The child e q u a t e s a p p e a r a n c e a n d reality. Very y o u n g children b e h a v e a s t h o u g h .their own a n d others' t h o u g h t s faithfully mirror t h e real world. Philosophers of t h e n i n e t e e n t h a n d early twentieth centuries pointed o u t t h a t once a p e r s o n c a n imagine false beliefs, the a s s u m p t i o n of equivalence between a p p e a r a n c e a n d reality becomes u n t e n a b l e (Brentano 1874; B. Russell 1905). Conversely, w i t h o u t u n d e r s t a n d i n g t h a t t h e s a m e physical reality c a n generate alternative ideas, small children a r e unlikely to appreciate t h a t their beliefs m a y vary, be false, a n d differ from t h o s e of a n o t h e r person. T h e ability to imagine different perspectives is therefore a crucial indicator of t h e child's a s s u m p t i o n s a b o u t the

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s t a t u s of h i s t h o u g h t s : h o w h i s psychic reality c o r r e s p o n d s to the external world. We will give o n e example of m a n y experimental s t u d i e s of t h i s indicator: P e r n e r a n d h i s colleagues (Perner et al. 1987) showed a series of 3-year-old children a familiar candy box. E a c h child expected t h e box to be filled with c a n d y b u t w a s s h o w n t h a t it contained pencils. E a c h w a s t h e n a s k e d w h a t they t h o u g h t their friend waiting outside would t h i n k t h e box h a d in it, to w h i c h they confidently replied t h a t t h e o t h e r p e r s o n would t h i n k t h a t it contained pencils. Here, their c u r r e n t psychic reality, w h i c h reflected physical reality, d o m i n a t e d their r e p r e s e n t a t i o n of t h e psychic reality of t h e other, a n d t h e y a p p e a r e d n o t to u n d e r s t a n d t h a t t h e other p e r s o n ' s belief might b e false. They continued to m a k e t h i s error w h e n t h e y s a w t h e other p e r s o n r e s p o n d with s u r p r i s e a n d w h e n t h e y were explicitly told w h a t t h e other person t h o u g h t (Moses a n d Flavell 1990; Wellman 1990). The mind of t h e o t h e r could n o t yet be r e p r e s e n t e d a s a s e p a r a t e entity, with a potentially different point of view. Equally, t h e children were u n a b l e to recall t h a t they themselves h a d ever t h o u g h t t h e box h a d c a n d y in it. They firmly believed t h a t they knew it h a d pencils inside from t h e beginning, while freely admitting o t h e r k i n d s of difficulty or m i s t a k e . It s e e m s t h a t , if the y o u n g child believes something, it m u s t be so; if it is so, t h e n someone else will see it in t h e s a m e way; if it w a s so before, h e m u s t h a v e s e e n it t h a t way before. Young children's s e n s e of t h e psychic reality of their own a n d others' feelings a n d desires, a s opposed to beliefs, s e e m s to be more advanced. Children in their second year learn, a t least superficially, to acknowledge t h a t some w i s h e s m a y not be fulfilled (Astington a n d Gopnik 1991). By t h e third year they c a n appreciate t h a t their own feelings m i g h t n o t correspond to t h o s e of other people. "Do you w a n t m e to look b o t h ways? I don't w a n n a look b o t h ways!" (Wellman a n d Banerjee 1991). They are more ready to s a y t h a t they t h i n k of s o m e t h i n g t h a t s o m e o n e else t h o u g h t w a s u n d e s i r a b l e ("yucky") a s desirable ("yummy") t h a n they a r e to recognize a n alternative belief a s to w h e t h e r a box is full of c a n d y or pencils (Flavell, Flavell, Green, a n d Moses 1990). T h e s e a n d other findings a r e consistent with t h e psychoanalytic e m p h a s i s , pointing to t h e developmental lead t h a t emo-

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tions a n d desires h a v e over beliefs a n d t h e developmental p u s h t h a t we m a y expect from t h e child's unfolding . a w a r e n e s s of the diversity of desire. T h e y o u n g child's n e e d to m a i n t a i n t h e equivalence between psychic a n d physical reality is clearest w h e n t h e external world requires a n a d j u s t m e n t of h i s i n t e r n a l r e p r e s e n t a t i o n . It follows t h a t w h e n a child is offered a n external r e p r e s e n t a t i o n , a symbol, of h i s m e n t a l state, h i s performance of s u c h t a s k s should improve. This t u r n s o u t to be t h e case. W h e n Mitchell a n d Lacohe (1991) gave children a drawing of t h e chocolate they h a d expected to be in t h e c a n d y box in t h e belief-change t a s k , they were better able to a n s w e r q u e s t i o n s concerning b o t h their own a n d others' beliefs. Having a c c e s s to a t o k e n of their belief created a n identity for it i n d e p e n d e n t of c u r r e n t physical reality. In t h e a b s e n c e of a representation—or symbol—of their earlier representation, t h e s e 3-year-old children were u n a b l e to keep it in mind. So how does t h e 3-year-old u n d e r s t a n d h i s m i n d ? W h a t is the n a t u r e of h i s psychic reality? T h e very y o u n g child- does n o t yet have t h e capacity to appreciate t h e merely representational nat u r e of ideas a n d feelings. Older children k n o w t h a t w h a t they t h i n k or believe a b o u t s o m e t h i n g does n o t necessarily reflect reality. T h e y o u n g child; w h o is n o t yet able to mentalize, to reflect on t h o u g h t s a n d feelings, a s it were, from outside, is forced to believe t h a t h i s t h o u g h t s a n d beliefs inevitably a n d correctly mirror t h e real world. Britton h a s considered t h e relationship between belief a n d knowledge in Kleinian terms. It is i m p o r t a n t to clarify t h e difference between o u r position a n d h i s related ideas. He describes m a t u r e mentalization a s a n "epistemic attitude" in which a p e r s o n c a n believe b u t k n o w t h a t h e does n o t know; Britton c o n t r a s t s this with a more psychotic frame of m i n d : "The contrary a s s u m p t i o n t h a t belief is knowledge is t h e b a s i s of delusion a n d characterizes t h e paranoid-schizoid position. E m a n c i p a t i o n from t h e e q u a t i o n of belief with knowledge is a n a s p e c t of working t h r o u g h t h e depressive position" (1995, p. 22). We suggest t h a t a l t h o u g h t h e very y o u n g child does in a s e n s e believe t h a t belief is knowledge, h i s a t t i t u d e differs from t h a t of t h e psychotic in t h a t t h e child is more inclined to fit "mind-to-world" t h a n

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"world-to-mind" (Searle 1983), a n d in t h i s way is m o r e like a w e a t h e r - v a n e t h a n like a psychotic person. W h e n working with y o u n g children a n d o t h e r p a t i e n t s w h o a r e still functioning in this m o d e of psychic experience, it is external reality, n o t t h e contents of t h e child's mind, t h a t is immensely a n d s o m e t i m e s terrifyingly compelling; t h e child's t h o u g h t s a n d beliefs seem very vulnerable a n d e v a n e s c e n t by contrast. We r e t u r n to t h i s point later, w h e n d i s c u s s i n g play.

The "Pretend" Mode of Experiencing Psychic Reality T h u s far, we h a v e only looked a t one side of this story, which may have led r e a d e r s to feel t h a t we, together with developmental psychologists, a r e only looking a t t h e less interesting side of the real child, a t cognition r a t h e r t h a n imagination. We m a i n t a i n t h a t we need to u n d e r s t a n d t h e form a n d limitations of t h e child's thinking, partly in order to u n d e r s t a n d t h e great importance of imagination in h i s life a t t h i s age, a n d partly in order to adopt a p p r o p r i a t e t e c h n i q u e s with y o u n g children a n d with older p a t i e n t s w h o c o n t i n u e to s h o w t h e s e limitations. A child c a n p r e t e n d t h a t a chair is a t a n k a n d yet n o t expect it to shoot real shells, a n d t h e r e h a v e b e e n experimental demonstrations t h a t small children c a n keep alternative or changing beliefs in m i n d if t h e y are doing a t a s k in play r a t h e r t h a n for real. 1 Vygotsky wrote: "in play t h e child is always above h i s average age, above h i s daily behavior; in play it is a s t h o u g h he were a h e a d taller t h a n h i m s e l f (1978, p. 102). In t h e world of play it b e c o m e s possible partially to free r e p r e s e n t a t i o n s from their referents a n d allow t h e s e freed r e p r e s e n t a t i o n s to be modified, creating a m o r e flexible m o d e of t h o u g h t t h a t e n c o u r a g e s the emergence of l a t e n t m e n t a l s t r u c t u r e s (Marans et al. 1991). Playfulness e n a b l e s ways of functioning t h a t are rarely u s e d , 1

Gopnik and Slaughter (1991) created a "pretend version" of the beliefchange task. They asked children to pretend that an empty glass had a chocolate drink in it; the glass was then "pretend emptied" by the adult, and the child was asked to pretend that the glass was now full of lemonade. Almost no 3-yearolds had any difficulty in remembering that the original imagined content was chocolate.

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developmentally s u r p a s s e d , or only j u s t being formed to occupy center stage. T h u s playing or p r e t e n d i n g a t t i m e s reveals surprising competencies, while a t o t h e r times it offers opportunities for regression a n d t h e expression of u n c o n s c i o u s concerns. W h e n small children a r e a s k e d to visualize s o m e t h i n g t h a t does not exist, t h e y readily u n d e r s t a n d t h e p h r a s e , "make a picture in y o u r head." They u s e . t h e m e t a p h o r of t h e h e a d a s a c o n t a i n e r in w h i c h imaginary s i t u a t i o n s or objects m a y b e created a n d examined. W h e n playing, even t h e y o u n g child h a s a mentalizing model of psychic experience a n d s e e s h i s m i n d a s representing ideas, desires, a n d other feelings. However, it s e e m s to be necessary for children of this age to prevent c o r r e s p o n d e n c e between t h e "pretend world" a n d external reality in t h e "pretend" modes of thinking. Not surprisingly, t h e difference b e t w e e n t h e equivalent a n d pretend m o d e h a s to be clearly m a r k e d , a n d t h e lack of correspondence to a c t u a l reality is frequently exaggerated (Fonagy a n d Fonagy 1995). If t h i s is n o t e n s u r e d , it quickly b e c o m e s clear j u s t how t h r e a t e n i n g t h e i s o m o r p h i s m of internal a n d external realities c a n become for t h e child, w h o h a s limited a w a r e n e s s of t h e implications a n d realistic d a n g e r s of m a n y events. Although t h e child strictly s e p a r a t e s t h e two realities in h i s thinking, h i s affective investment in h i s play m a y directly reflect t h e extent to w h i c h h i s p h a n t a s y incorporates a.disguised piece of "serious" reality, s u c h a s t h e relationship between his p a r e n t s or t h e imagined c o n s e q u e n c e s of acting on d a n g e r o u s wishes. Two examples from n o r m a l development m a y illustrate the potency of t h o u g h t for t h e small child. A 4-year-old boy w a s read a ghost story by h i s mother. Although t h e story w a s n o t expected to be particularly frightening, h e w a s visibly s h a k e n by it. The m o t h e r quickly offered r e a s s u r a n c e : "Don't worry, Simon, it didn't really h a p p e n . " T h e child, clearly feeling m i s u n d e r s t o o d , protested in reply: "But w h e n you read it, it did really h a p p e n to me!" A further example is provided by t h e father of a 3-year-old boy, w h o s e s o n a s k e d h i m to find a B a t m a n outfit on h i s trip abroad. The father h a d great difficulty, b u t eventually h e found a fancy-dress s h o p a n d b o u g h t a n expensive c o s t u m e . Unfortunately, t h e c o s t u m e w a s so realistic t h a t t h e boy w a s frightened w h e n h e s a w himself in t h e mirror, refused to w e a r it again, a n d I-

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went b a c k to u s i n g h i s m o t h e r ' s skirt a s his B a t m a n cloak. Similarly, t h e c o m m o n observation t h a t children of 2 or 3 s p e n d m u c h time t o g e t h e r "scene-setting," negotiating t h e roles a n d rules of their p r e t e n d games, sometimes leaving little opportunity for entering into t h e g a m e itself, u n d e r l i n e s t h e i m p o r t a n c e of a clear division between "playing" a n d "reality" for children of this age. W h e n a d u l t s t h i n k a b o u t children playing, they often t h i n k of it u s i n g their own, r a t h e r t h a n t h e child's, perspective on psychic reality. It is easy to a s s u m e t h a t b e c a u s e a child a t play c a n reflect on s t a t e s of m i n d including false beliefs, h e is able to do this outside h i s play. T h e small child playing c a n t h i n k a b o u t t h o u g h t s a s t h o u g h t s b e c a u s e t h e s e a r e clearly a n d deliberately stripped of their connection to t h e real world of people a n d even things. It is also easy to overlook t h e fact t h a t t h e child m a y only be able to reflect on t h o u g h t s a n d feelings a b o u t real-life events d u r i n g play if a n a d u l t is t h e r e to provide a necessary frame a n d insulate h i m from t h e compelling c h a r a c t e r of external reality. Winnicott recognized t h e vital mediating role children need from adults in order to play. He pointed o u t t h a t o u r attitude toward play " m u s t include recognition t h a t playing is always liable to become frightening. G a m e s a n d their organization m u s t be looked a t a s p a r t of a n a t t e m p t to forestall t h e frightening aspect of playing. T h e p r e c a r i o u s n e s s of play belongs to t h e fact t h a t it is always o n t h e theoretical line between t h e subjective a n d t h a t which is objectively perceived" (1971, pp. 58-59). The very y o u n g child's u n d e r s t a n d i n g of m i n d s m a y be d e v e l o p m e n t a l ^ advanced in play b e c a u s e of t h e segregation of t h i s from external reality, a n d t h e avoidance of t h e s e n s e of e n c r o a c h m e n t of reality on t h o u g h t , w h i c h t h e child would otherwise experience.

The Integration of Dual M o d e s of Experience: Learning t o Mentalize In the fourth a n d fifth year, t h e "psychic equivalence" a n d "pretend" m o d e s normally become increasingly integrated, a n d a reflective or mentalizing m o d e of psychic reality is established (Gopnik 1993). Children begin to acknowledge t h a t t h i n g s m a y

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not be w h a t t h e y a p p e a r to be, t h a t a n o t h e r p e r s o n m a y perceive external reality differently, t h a t beliefs m a y be held with different degrees of certainty, a n d t h a t t h e y felt differently in t h e p a s t a b o u t something (Baron-Cohen et al. 1985). With t h i s n e w way of t h i n k i n g a b o u t h i s experience, t h e child n o t only s h o w s a n u n d e r s t a n d i n g t h a t h i s own a n d h i s object's behavior m a k e s e n s e in t e r m s of m e n t a l states, b u t also l e a r n s to recognize t h a t t h e s e s t a t e s are r e p r e s e n t a t i o n s , which m a y be fallible a n d may c h a n g e b e c a u s e t h e y are b a s e d on b u t o n e of a r a n g e of possible perspectives. We m u s t e m p h a s i z e t h e crucial i m p o r t a n c e of t h i s cognitive integration a n d acquisition of t h e capacity to mentalize: (a) It brings with it t h e possibility of continuity in t h e experience of t h e psychological self (Fonagy, Moran, a n d Target 1993). The child c a n fit h i s t h i n k i n g to t h e world w i t h o u t feeling a s t h o u g h h e h a s to c h a n g e himself in order to c h a n g e h i s m i n d (literally h a s to "change h i s mind"), losing continuity with t h e self t h a t t h o u g h t before, (b) It e n a b l e s t h e child to see people's actions a s meaningful t h r o u g h t h e a t t r i b u t i o n of t h o u g h t s a n d feelings. This m e a n s t h a t their actions b e c o m e predictable, w h i c h in t u r n r e d u c e s m o m e n t - t o - m o m e n t d e p e n d e n c y on others. This is a n i m p o r t a n t c o m p o n e n t of t h e p r o c e s s of individuation. The child of a r o u n d 4 or 5 y e a r s is frequently able to u n d e r s t a n d w h a t t h e m o t h e r is doing a n d why, w i t h o u t h e r needing c o n s t a n t l y to b e a r h i s limited perspective in mind. ("I can't do t h a t now b e c a u s e I a m worried a b o u t g r a n n y ' s illness," etc.). T h i s allows b o t h child a n d caregiver to a t t a i n increasing m e n t a l a n d physical independence, needing to refer far less to e a c h other in order to allow the child to borrow t h e m o t h e r ' s u n d e r s t a n d i n g , (c) It allows for a distinction between inner a n d o u t e r t r u t h , enabling t h e child to u n d e r s t a n d t h a t t h e fact t h a t s o m e o n e is behaving in a particular way does n o t m e a n t h a t t h i n g s are like t h a t . While t h i s may n o t be i m p o r t a n t in all contexts, we believe t h a t it becomes critical in c a s e s of m a l t r e a t m e n t or t r a u m a , allowing t h e child to survive psychologically a n d relieving t h e p r e s s u r e to relive the experience in concrete ways. Once t h e child c a n mentalize, he h a s available a crucial a t t e n u a t i n g function for psychic experience, (d) Without a clear r e p r e s e n t a t i o n of t h e m e n t a l state of the other, c o m m u n i c a t i o n m u s t be profoundly limited. T h e philosoii

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p h e r Grice (1975) formulated t h e overriding principle of conversation a s o n e of collaboration, whereby t h e effective s p e a k e r n e e d s c o n s t a n t l y to b e a r in m i n d t h e other p e r s o n ' s point of view. The a b s e n c e or u n d e r d e v e l o p m e n t of t h e capacity to mentalize c a n h a v e a limiting effect on t h e possibility of doing analytic work, a n d t h e r e a r e implications for t e c h n i q u e w h e n u n d e r t a k i n g analysis of s u c h p e r s o n s , (e) Finally a n d m o s t importantly, mentalizing c a n help a n individual to achieve a higher level of intersubjectivity, in t e r m s of deeper experiences with o t h e r s a n d ultimately a life experienced a s m o r e meaningful. We t h i n k t h a t it is t h e successful connecting of internal a n d external t h a t allows belief to be endowed with m e a n i n g t h a t is emotionally alive b u t is m a n a g e a b l e a n d therefore does n o t h a v e to be defended against. A partial failure to achieve this integration c a n lead to n e u r o t i c states. In more profound a n d pervasive failures of integration, reality m a y be experienced a s emotionally meaningless. In s u c h c a s e s other people a n d t h e self are related to a s things, a n d t h e relating itself o c c u r s a t a very concrete level. It m u s t n o t be forgotten, however, t h a t achievement of t h e capacity to mentalize also h a s t h e potential massively to increase conflict, w h e n fantasies s u c h a s oedipal w i s h e s become stable r e p r e s e n t a t i o n s t h a t c a n be set a g a i n s t external reality. As Winnicott (1971) wrote: It is assumed here that the task of reality acceptance is never completed, that no human being is free from the strain of relating inner and outer reality, and that relief from this strain is provided by an intermediate area of experience (cf. Riviere, 1936) which is not challenged (arts, religion, etc.). This intermediate area is in direct continuity with the play area of the small child who is "lost" in play." [p. 15]

T H E ROLE OF T H E OTHER IN DEVELOPING T H E CAPACITY TO MENTALIZE Most developmentalists regard t h e development of mentalizing capacity a s simply m a t u r a t i o n a l . Many psychoanalytic theories of development h a v e a s s u m e d t h a t t h e self develops t r a n s c e n -

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dentally, from within t h e individual. In h i s p a p e r on n a r c i s s i s m (Freud 1914c), F r e u d a r g u e d t h a t t h e r e w a s "an original libidinal cathexis of t h e ego, from which some is later given off to objects, b u t w h i c h fundamentally p e r s i s t s a n d is related to t h e objectcathexis m u c h a s t h e body of a n a m o e b a is related to the p s e u d o p o d i a which it p u t s out" (p. 75). For Freud, in infancy a n d early childhood o t h e r s in t h e external world a r e extensions of t h e self. While this m a y b e a n a c c u r a t e description of t h e p h e n o m enology, for u s it s e e m s m o r e a c c u r a t e to see t h e self a s originally a n extension of experience of t h e other. Its development is a n interpersonal p r o c e s s requiring interaction with t h e m i n d s of others, a s described in relation to earlier infancy. In t h i s chapter, we a r g u e t h a t t h e involvement of t h e caregiver, a n d to a lesser extent of older siblings, is crucial in helping t h e child of 3 or 4. y e a r s to accept t h e two realities, i n t e r n a l a n d external, w i t h o u t needing to split h i s ego functioning to m a i n t a i n dual m o d e s of thinking. In order to achieve t h e integration of a nonmentalizing realityoriented a n d mentalizing nonreality-connected mode, to create fully mentalized psychic;reality, t h e child n e e d s r e p e a t e d experience of t h r e e things: h i s c u r r e n t m e n t a l s t a t e s , t h e s e s t a t e s r e p r e s e n t e d — t h o u g h t about—in t h e object's m i n d , a n d the frame r e p r e s e n t e d by t h e a d u l t ' s normally externally realityoriented perspective. We believe t h a t t h e "frame" provided by the p a r e n t , or by other children, is a n essential p a r t of t h i s model. T h e child n e e d s a n a d u l t or older child w h o will "play along," so t h a t t h e child c a n see h i s fantasy or idea r e p r e s e n t e d in the adult's mind, reintroject this, a n d u s e it a s a r e p r e s e n t a t i o n of h i s own thinking. W h e n t h e omniscient a n d o m n i p o t e n t p a r e n t playfully p r e t e n d s with t h e child t h a t a b a n a n a is a telephone, t h e child is able s i m u l t a n e o u s l y to e q u a t e t h e a p p a r e n t a n d the real while clarifying t h e distinction between p r e t e n d a n d serious mode. He b e c o m e s able to "know about" h i s idea or wish, alongside experiencing it. By entering into t h e child's world in a playful way, t h e child sees t h e a d u l t adopting a n "as-if' attitude to h i s intentional state. The frame is p r e s e n t so t h a t h e knows t h a t h i s t h o u g h t s or feelings a r e n o t "for real," yet h e perceives t h e m outside, in t h e p a r e n t ' s mind. Linking h i s i n t e r n a l state to

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a perception of t h a t state outside offers a r e p r e s e n t a t i o n — a symbol—of t h e i n t e r n a l state: it corresponds to, yet it is n o t equivalent to, t h e state. T h e playful attitude of t h e p a r e n t is crucial. T h e child's m e n t a l s t a t e m u s t be represented sufficiently clearly a n d accurately for t h e child to recognize it, yet sufficiently playfully for t h e child n o t to be overwhelmed by its realness. In t h i s way h e c a n ultimately u s e t h e p a r e n t ' s representation of h i s internal reality a s t h e seed for h i s own symbolic thought, h i s r e p r e s e n t a t i o n of h i s own representations. If t h e a d u l t ' s a t t i t u d e p r e c l u d e s t h e duality of holding t h e frame of external reality while offering mirroring or reflection, t h e child's t r a n s i t i o n toward Integration a n d mentalization m a y be jeopardized. He m a y n o t feel free—secure—to explore t h e adult's m i n d a n d find himself in it, or w h a t he finds t h e r e may be a distorted, spoiled picture of h i s m e n t a l state, w h i c h t h e child c a n n o t safely u s e to r e p r e s e n t h i s experience. If, on t h e other h a n d , t h e caregiver c a n frequently provide links between reality a n d fantasy in a way t h a t includes a n accepting, recognizable reflection of t h e child's m e n t a l states, t h e n h e affords t h e child a b a s i s for organizing a n d comparing n u m e r o u s experiences bridging t h e psychic equivalence a n d p r e t e n d modes. Gradually, the child comes to be able to m a i n t a i n a mentalizing s t a n c e himself, having internalized t h e p r o c e s s t h r o u g h repeated interactions with t h e caregiver a n d probably also with other children. The essence of t h e p r o c e s s is n o t simply play, b u t play t h a t b r e a k s away from psychic equivalence while retaining contact with reality. In other words, t h e child, u s i n g t h e p a r e n t ' s mind, is able to play with reality. We suggest t h a t it is no coincidence t h a t t h e child m a k e s , or fails to m a k e , t h i s cognitive t r a n s i t i o n a t t h e time traditionally a s s o c i a t e d with oedipal conflict. A n u m b e r of writers have recently suggested t h a t successful working-through of the oedipal situation involves t h e sort of o p e n i n g - u p of thinking into a triangular s p a c e w h i c h we a n d o t h e r s suggest c a n occur t h r o u g h play with reality. Following H a n n a Segal's (1957) work on symbol formation a n d Bion's (1970) a b s t r a c t exploration of t h e oedipal triangle a s a model, Ogden (1985) conceives of t h e pretend mode of functioning a s developed o u t of t h e triangularity of t h e sym-

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bol, the symbolized, a n d t h e interpreting subject. Britton (1989, 1994) h a s done m u c h to explore t h e s o u r c e a n d significance of this triangularity, in t h e context of applying depressive-position thinking to t h e m o u r n i n g involved in resolving t h e oedipal situation. He a r g u e s t h a t n o t only does t h e a c c e p t a n c e of internal triangular relationships provide s p a c e for t h i n k i n g a n d t h e possibility of looking at.dyadic relationships from t h e perspective of a third, b u t it consolidates t h e depressive position a n d provides a "stabilizing s t r u c t u r e " (Britton 1994). He e m p h a s i z e s t h a t a n i m p o r t a n t a s p e c t of t h e t r i a n g u l a r oedipal s i t u a t i o n is t h a t it enables t h e child to conceive of being observed a n d , by implication, being t h o u g h t a b o u t : "This provides u s with a capacity for seeing ourselves in interaction with o t h e r s a n d for entertaining a n o t h e r point of view whilst retaining o u r own, for reflecting on ourselves whilst being ourselves" (Britton 1989, p. 87). We suggest t h a t this capacity is specifically fostered by t h e s u p p o r t of a d u l t s or sometimes of other children for t h e child's play, providing a safe internal context in w h i c h to reflect; t h e child c a n t r u s t t h e other p e r s o n to k n o w a b o u t reality. Although we have emphasized t h e t r a n s i t i o n t h a t normally o c c u r s a r o u n d 4 y e a r s of age, we m u s t e m p h a s i z e t h a t t h e ability to r e p r e s e n t m e n t a l s t a t e s is n o t acquired all a t once; r a t h e r , it is a developmental achievement, which, like all m e n t a l capacities, m a y be p r e s e n t to a greater or lesser extent in a n y individual at a n y o n e time. T h e t e n d e n c y of t h e empirical d a t a we h a v e referred to is to suggest t h a t in some s e n s e t h e function does not exist until t h e child "passes" a t a s k in a n experimental situation. (Experimentalists a r e usually, of course, a s aware a s a n y o n e else t h a t n o capacity emerges s u d d e n l y into t h e m i n d - a n d t h a t all t h a t t h e experimental t a s k c a n imply is t h a t from t h a t m o m e n t t h e child is likely to be able to perform t h a t function in that situation.) The experimentalist frame of reference is concerned with d e m o n s t r a b l e c a u s e s a n d effects. Observers of child behavior, w h e t h e r clinical or social psychological (e.g., D u n n 1994), a r e interpreting t h e child's behavior with a developmental end-point in m i n d a n d c a n t h u s see c o m p o n e n t s of a function in t h e p r o c e s s of coming together. The w e a k n e s s of this interpretive tradition is t h e unavoidable t e n d e n c y to ascribe to t h e child the

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full capacity, on t h e b a s i s of w h a t m u s t be partial evidence. O u r formulation is linked to t h e c u r r e n t Kleinian view t h a t t h e r e is continuing oscillation or equilibrium (Bion 1963) between t h e paranoid-schizoid a n d depressive positions in t h e face of n e w experience. Even after integration h a s t a k e n place, emotional factors c a n impede t h e availability of t h e capacity for mentalization in specific a r e a s . Steiner (1992) explores t h e defenses operating a t different levels within t h e two basic Kleinian positions, a n d h i s d i s c u s s i o n of t h e differentiation within t h e depressive position is relevant to t h e t r a n s i t i o n we h a v e written a b o u t in this c h a p t e r . At t h e risk of oversimplifying Steiner's s u b t l e distinctions, we suggest t h a t t h e "normal splitting" h e describes in t h e depressive position, a t t h e level of "fear of loss of t h e object," m a y b e t h o u g h t of—at least in t h e y o u n g child—as including operating with a d u a l m o d e of psychic reality. T h e mode of psychic equivalence might t h e n be seen a s operating t h r o u g h (relatively benign) projective identification, which h e describes a s a key m e c h a n i s m in r e d u c i n g t h i s fear of loss. T h e more m a t u r e depressive position, a s described by Steiner, involves "experience of loss of t h e object," relinquishing (the p h a n t a s y of) control of t h e object, a n d allowing separation a n d m o u r n i n g to t a k e place. While in t h i s p a p e r Steiner does not link the process to t h e resolution of t h e oedipal situation, we speculate t h a t , in n o r m a l development, accepting t h e loss of the illusion of exclusive p o s s e s s i o n a n d allowing t h e emergence of a triangular relationship m a y be a major t u r n i n g point t h a t offers the opportunity to function a t t h e higher level within the depressive position, a n d t h a t t h i s is crucially connected with accepting t h a t ideas are merely ideas. We would like now to illustrate t h e s e ideas with material from a n analysis d u r i n g w h i c h a y o u n g child overcame her r e s i s t a n c e to this developmental p r o g r e s s a n d w a s t h u s enabled to link h e r two m o d e s of u n d e r s t a n d i n g psychic reality a n d to find a greater integration of i n n e r a n d outer.

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FRAGMENT FROM T H E PSYCHOANALYTIC TREATMENT OF AN UNDER-FIVE: "REBECCA" Rebecca 2 w a s a pretty little girl, c h a r m i n g a n d precocious, even w h e n clearly d e p r e s s e d . W h e n s h e w a s 4 y e a r s old, h e r m o t h e r b r o u g h t h e r to t h e A n n a F r e u d Centre b e c a u s e over t h e p a s t year s h e h a d developed a variety of problems, including recurr e n t n i g h t m a r e s , daytime terrors often b u t n o t always associated with separation, d e m a n d i n g clinginess, a n d other indications of h e r anxiety, s u c h a s hyperactivity, aggressiveness, a n d fear of loneliness a n d d e a t h . At times h e r anxiety led h e r to b e d e s t r u c tive, disobedient, a n d aggressive a n d a bit of a bully a t school a s well a s with h e r m o t h e r . In h e r a s s e s s m e n t s h e w a s willing to talk a b o u t h e r n i g h t m a r e s a n d h e r fear of spiders a n d snails. S h e w e n t on to e n a c t a s c e n e of a D a d d y doll cuddling Mommy doll, w h i c h s h e concluded by b a n g i n g t h e D a d d y figure's h e a d on t h e skirting-board, a n n o u n c i n g t h a t h e w a s killed, a n d t a k i n g h i m off t h e scene. In t h i s way s h e quickly c o m m u n i c a t e d h e r m u r d e r o u s fantasy a b o u t w h y h e r father h a d b e e n a b s e n t from h e r life. Rebecca w a s t h e only child of a n u n m a r r i e d y o u n g w o m a n who h a d given b i r t h to h e r a t 18, having h a d two previo u s t e r m i n a t i o n s . The m o t h e r w a s a m b i t i o u s a n d impatient to p u r s u e a career. Rebecca's father w a s a c a s u a l p a r t n e r of the mother; h e a p p a r e n t l y totally withdrew from h e r soon after her p r e g n a n c y w a s confirmed. Rebecca h a d never m e t h e r father, a l t h o u g h s h e h a d a p h o t o g r a p h of him, w h i c h s h e frequentiy looked at. S h e h a d often said t h a t s h e w a n t e d to meet him, b u t by t h e time of t h e referral t h e s e d e m a n d s h a d a b a t e d . In her interview with me, Rebecca's m o t h e r b e c a m e immediately tearful w h e n t h e i s s u e of h e r feelings a b o u t t h e father of t h i s child w a s raised. S h e m a d e it clear t h a t s h e felt quite u n a b l e to a d d r e s s this subject with h e r d a u g h t e r . Rebecca h a d b e e n b r o u g h t u p in a complicated environment, partly with h e r g r a n d p a r e n t s a n d partly with h e r m o t h e r , who

2

The case is narrated in the first person; the analyst was Peter Fonagy. Peter Fonagy would like to acknowledge his indebtedness to Rose Edgcumbe, who supervised the case.

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worked a s a child-minder. The h o u s e h o l d included h e r m o t h e r ' s occasional p a r t n e r s a n d o t h e r children from h e r grandfather's previous m a r r i a g e s . In h e r fourth year, h e r charismatic grandfat h e r died. Rebecca's m o t h e r ' s b e r e a v e m e n t reaction signaled t h e onset of Rebecca's s y m p t o m s . There were difficulties in t h e initial p h a s e of Rebecca's treatm e n t . S h e insisted t h a t h e r m o t h e r should s t a y in t h e room, yet s h e w a s clearly inhibited by h e r presence, h e r play s u b d u e d a n d repetitive. S h e drew stereotyped figures, e a c h drawing having to be s h o w n to m o t h e r , a n d h e r defensive exclusion of m e w a s clear. I decided to tackle h e r anxiety directly, t h a t a relationship with m e would exclude h e r Mommy, which might m a k e Mommy become a n g r y a n d love h e r less. Although t h i s allowed h e r to let her m o t h e r leave t h e room, h e r anxiety h a d n o t a b a t e d entirely. Being alone with m e m a d e h e r immensely anxious. S h e defended against t h e anxiety by t a k i n g c o m m a n d of t h e environment. She ordered me, in a n agitated way, to r e a r r a n g e t h e positions of t h e chairs, h e r play table, a n d even m y big desk, a n d t h e n s h e charged m e with t h e t a s k of controlling t h e lights, to help h e r to "organize t h e show." It w a s daylight, so it w a s clear t h a t t h e lights stood for a n o t h e r a s p e c t of t h e environment t h a t s h e needed desperately to bring u n d e r h e r control. I felt t h a t s h e w a s moving t h e external furniture, b o t h to m a k e t h e unfamiliar territory of t h e consulting-room a s m u c h h e r s a s m i n e a n d to prevent u s from moving forward in o u r dialogue a b o u t her s t a t e of mind. I said t h a t s h e felt worried s h e would be moved a r o u n d by me, like s h e moved t h e furniture a b o u t . B u t while, s h e moved the furniture, s h e didn't h a v e to t h i n k a b o u t her worries. Later, I added t h a t it w a s terribly h a r d for h e r t h a t o u r time together began a n d e n d e d so abruptly, j u s t a s t h e light c a m e on for s u c h brief m o m e n t s . This refocusing on h e r psychic reality w a s helpful. Rebecca's p a t t e r n of play t h e n c h a n g e d . S h e s t a r t e d playing with Plasticene (modeling clay), h e r declared intention being to "make a Plasticene world." My role w a s to "make t h e Plasticene soft," while s h e molded t h e figures. This w a s t h e first time t h a t Rebecca played with m e cooperatively. She symbolically conveyed h e r need for m e to m a k e pliable t h e h a r s h a n d fixed ideas in her mind, w h i c h s h e w a s n o t able to m a n i p u l a t e . S h e con-

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firmed t h e generality of m y feeling a b o u t t h e role s h e p u t m e into by claiming t h a t s h e h a d m a d e a "Plasticene world blanket," which would cover everyone a n d everything, a n d s h e placed all t h e figures in h e r toy box u n d e r t h e flat piece of Plasticene s h e made. The t a s k w a s difficult; even t h o u g h s h e flattened a sizeable piece of Plasticene, it could n o t cover all t h e figures properly. Despite h e r careful positioning, some were "left o u t in t h e cold." Noticing h e r anxiety a b o u t this, I c o m m e n t e d t h a t I t h o u g h t it might b e troubling h e r t h a t s o m e o n e m i g h t be s h u t o u t of o u r little world. S h e confirmed t h a t t h e s o u r c e of her anxiety might have, a t least in part, b e e n t h e exclusiveness of my relationship with her, by rolling u p t h e "world blanket" so t h a t t h e r e w a s room for only two of t h e figures u n d e r it; all t h e others were p u t b a c k into t h e box with great care. I noticed t h a t t h e last to be tentatively picked u p were t h e Mommy a n d G r a n n y dolls. I said: "Many children a r e frightened a b o u t coming u p h e r e a n d leaving their Mommy downstairs. S o m e t i m e s t h e y a r e frightened a b o u t w h a t might h a p p e n to their Mommies, a n d sometimes a b o u t w h a t might h a p p e n to t h e m . " S h e t h e n w e n t on to play with t h e Plasticene on h e r own, rolling a piece into t h e s h a p e of a s n a k e , a n d placing it r o u n d a doll's h e a d , like a crown. She c o m m e n t e d t h a t all t h e other figures were frightened of t h e little girl doll, b e c a u s e s h e h a d t h e big s n a k e . I said t h a t t h e b i g s n a k e w a s like t h e worries inside h e r h e a d , w h i c h were scaring her w h e n h e r m o t h e r w a s n ' t t h e r e to protect her, now b u t also at night. S h e looked u p a t m e a n d smiled slightly for t h e first time a n d said t h a t t h e people were only p r e t e n d i n g to b e frightened of t h e s n a k e . I said t h a t I w a s s u r e t h a t people often told h e r t h a t s h e should n o t feel frightened b e c a u s e t h e r e w a s n o t h i n g there really to be afraid of, b u t t h e two of u s k n e w t h a t h e r worries felt terribly real. S h e said: "You m e a n , like t h e pirates?" I said: "Perhaps w h e n you can't see Mommy, you a r e frightened t h a t s h e m i g h t h e t a k e n away by pirates?" To m y s u r p r i s e , s h e said, "She is." Only s u b s e q u e n t l y did I u n d e r s t a n d t h a t in h e r nightm a r e s a n d daytime terrors, h e r m o t h e r or h e r g r a n d m o t h e r were a b d u c t e d by pirates. My a c c e p t a n c e of t h e reality of h e r anxieties a n d other emotions w a s critical in freeing h e r m i n d from t h e grip of t h e worry-snakes.

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At t h i s time Rebecca b e g a n to play more complex games, a n d h e r oedipal anxieties, distorted by t h e c i r c u m s t a n c e s of h e r childhood, c a m e to t h e fore. S h e played royal families: t h e king a n d q u e e n doll h a d a d a u g h t e r . T h e d a u g h t e r doll w a s a b a n doned w h e n t h e king a n d q u e e n dolls cuddled, b u t later s h e w a s inserted between t h e king a n d q u e e n doll. The sexualization of this t h e m e w a s m a d e m o r e explicit by t h e whole scene being transferred to t h e c o u c h a n d everyone j u m p i n g a b o u t until t h e d a u g h t e r doll fell off. T h e n t h e r e w a s a street fire, which filled the h o u s e with s m o k e a n d b u r n e d down t h e whole street. I said: "I k n o w some little girls w h o a r e very frightened of being so excited, b e c a u s e their t h o u g h t s m a k e t h e m feel h o t a n d m u d d l e d a n d t h e n everything goes wrong." S h e said: "I t h i n k I a m one of those girls." M u c h of Rebecca's t r e a t m e n t consisted of a single game, with apparently infinite variations. In t h e game, s h e is a somewhat older girl, H a n n a h , w h o h a s a father, which w a s t h e analyst's role. H a n n a h a n d h e r father "Peter" h a d m a n y a d v e n t u r e s , m o s t of which involved visiting H a n n a h ' s friend, "pretend Rebecca," 3 who lived in t h e s a m e h o u s e a s real Rebecca b u t whcj—in t h e game—had a father "Jeff a s well a s a m o t h e r . Jeff w a s a pathetic, i n c o m p e t e n t figure w h o frequently got t h i n g s wrong, a n d on s u c h occasions would often be u n c e r e m o n i o u s l y dismissed, mostly by m o t h e r a n d s o m e t i m e s by her. H a n n a h would sensitively intercede with p r e t e n d Rebecca a n d Rebecca's m o t h e r on Jeffs behalf: "You don't u n d e r s t a n d him!" s h e berated pretend Rebecca on one occasion, "He is only u p s e t b e c a u s e you told h i m off for m a k i n g a m e s s . " I, a s H a n n a h ' s father, w a s encouraged to do t h e s a m e : "Let's p r e t e n d t h a t Rebecca does n o t u n d e r s t a n d . You pretend to tell h e r (pretend Rebecca) t h a t s h e is not being nice to him." I said s h e (Rebecca) p e r h a p s did not w a n t to u n d e r s t a n d b e c a u s e it w a s frightening to t h i n k t h a t h e r a n g e r could be so powerful t h a t it could send a big m a n like Jeff away and s h e w a s very frightened of feeling angry. 3

Pretend Rebecca was an imaginary friend. She shared the patient's first name but was definitely not identical with the narrator (the patient or real Rebecca). Both patient and analyst talked to her, and the patient, mostly as Hannah, spoke for her.

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Rebecca's rage with h e r m o t h e r for n o t providing h e r with a father also quickly surfaced in t h e s e interchanges, a s did her s h a m e a n d frustration a b o u t failing to hold on to h i m herself. For instance, on o n e occasion, H a n n a h b e r a t e d h e r m o t h e r for n o t looking after t h e family dog, w h i c h t h e n w e n t m i s s i n g a n d H a n n a h ' s D a d d y h a d to go o u t to find it a n d therefore could not be t h e r e to play with H a n n a h . Rebecca, playing H a n n a h , quite angry a n d flushed, r e m o n s t r a t e d with t h e c h a i r w h e r e t h e imagin a r y m o t h e r w a s sitting: "It's all y o u r fault t h a t D a d d y isn't in!" I reflected t h a t H a n n a h w a s very, very u p s e t , a n d t h a t p e r h a p s s h e felt t h a t H a n n a h ' s m o t h e r h a d let t h e dog go deliberately. H a n n a h confirmed m y suspicion a n d , still in role, added: "She didn't w a n t u s to be playing m a k i n g breakfast." Later on in the game, it t u r n e d o u t t h a t H a n n a h h a d lost t h e dog herself b u t w a s e m b a r r a s s e d to a d m i t it. I w a s able to a d d r e s s H a n n a h ' s a n g e r from a slightly different viewpoint: "Perhaps H a n n a h got so angry with h e r Mom b e c a u s e s h e felt a s h a m e d of losing the dog a n d spoiling t h e c h a n c e to play with Daddy." Rebecca agreed t h a t s h e probably m u s t h a v e done. Gradually, t h e terrifying fantasy t h a t h e r father h a d died in a n overwhelmingly exciting sexual u n i o n with h e r m o t h e r w a s enacted, a n d I w a s able to interpret h e r terror t h a t h e (as Jeff) m i g h t r u n away b e c a u s e he w a s so frightened of b o t h h e r a n d h e r m o t h e r ' s violent rage a n d voracious, m a n - c o n s u m i n g sexual appetites. All this is p a r for t h e analytic c o u r s e a n d clearly illustrates a s p e c t s of t h i s child's psychic reality. Here, we w a n t to focus on a specific feature of t h e work with her: t h e import a n c e of t h e subtle distinctions between p r e t e n s e a n d reality in Rebecca's g a m e s a n d w h a t w a s learned a b o u t t h e n a t u r e of her p r o b l e m s t h r o u g h playing with reality. T h e confusion of identities w a s a r e c u r r e n t t h e m e . When H a n n a h stayed a t Rebecca's overnight, h e r father c a m e to find h e r in Rebecca's bedroom b u t , u n b e k n o w n s t to him, H a n n a h a n d Rebecca h a d changed places in t h e b u n k b e d s . Looking for H a n n a h a n d finding Rebecca, h e would be s u r p r i s e d . Depending on t h e context, t h e r e w a s m u c h to interpret in t h i s game. On one occasion, w h e n b o t h H a n n a h a n d p r e t e n d Rebecca seemed particularly excited a b o u t w h o m H a n n a h ' s father w a s going to find, I could point to b o t h H a n n a h ' s a n d p r e t e n d Rebecca's wish to be a

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found, a s father's special p e r s o n . T h e oedipal wish to be found by t h e father, defensively displaced to a pretend child, w a s selfevident. However, t h i s scenario occurred so often t h a t clearly there were m a n y other d e t e r m i n a n t s : t h e transference gratification of externalizing h e r confusion onto t h e a d u l t analyst, representing in t h e transference t h e m u d d l e d c h a r a c t e r of h e r internal world with its confusions of identities; the split in h e r self- a n d object-representations between a n idealized H a n n a h , who h a d control over h e r father, a n d t h e impoverished Rebecca, struggling to m a i n t a i n h e r self-esteem with h e r delinquent, u n caring p a t e r n a l figure. No single interpretation seemed crucially important, a n d t h e g a m e c o n t i n u e d . The scenario offered by Rebecca, m a r k e d by t h e experience of surprise, seemed above all to create a rich opportunity to s p e c u l a t e a b o u t w h a t everybody in t h e story w a s thinking. For example, pretend Rebecca's father would be i n c e s s a n t l y quizzed by p r e t e n d Rebecca: "What did you think w h e n you found H a n n a h ? Did you t h i n k I h a d gone?" At other times w h e n Jeff could n o t be found, patient a n d analyst would s p e n d considerable time trying to work o u t why h e w a s not t h e r e a n d w h a t p r e t e n d Rebecca t h o u g h t a b o u t it. Trickiest to tackle w a s t h e n a r r a t o r ' s (Rebecca's) experience that, d u r i n g t h e g a m e s , she, a s H a n n a h or t h e p r e t e n d Rebecca, experienced m e a s h e r father, in all t h e roles I w a s assigned. There w a s n o i n s t a n c e w h e n H a n n a h or p r e t e n d Rebecca a d dressed m e in a n y w a y other t h a n a s Daddy. W h e n I spoke a s a n analyst, Rebecca immediately switched o u t of t h e game. W h e n Rebecca needed slight limit-setting, to b e d i s s u a d e d from leaning too far w h e n looking o u t of t h e window, t h e H a n n a h game would come to a n a b r u p t h a l t u n l e s s I intervened a s t h e pretend father. I noticed in t h e counter-transference h o w h a r d it felt to a d d r e s s my a c t u a l role vis-a-vis real Rebecca, a s n a r r a t o r . It seemed impossible to m a k e a n y observation on why Rebecca might be playing this game. There seemed to be n o room for interpretation in this domain, b e c a u s e Rebecca a n d I were dealing with h e r experience of a n actuality. For Rebecca, a n d probably for all children a t h e r stage of development, t h e transference was, a t the m o m e n t s h e felt it, n o t a fantasy b u t a subjective experience a s real a s t h a t of a physical object. O n o n e occasion, w h e n Jeff had disappeared, Rebecca w a s a l m o s t in tears. I said, "It is

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terribly h a r d for little girls who have never h a d a father a t h o m e to t h i n k a b o u t fathers w h o might s u d d e n l y d i s a p p e a r , w i t h o u t a clue a s to w h e r e t h e y might be." I w a s t h u s a d d r e s s i n g t h e narrator's, r a t h e r t h a n p r e t e n d Rebecca's, s a d n e s s t h a t h e r fat h e r h a d gone. Here, Rebecca immediately stopped t h e game. T h e next session, Rebecca cheerfully a n n o u n c e d t h a t s h e h a d met h e r father a n d described h i m a s tall, b e a r d e d , a n d bald. I said t h a t y e s t e r d a y I h a d m u d d l e d a n d s o m e h o w spoiled there being a real father, b u t Rebecca k n e w how i m p o r t a n t it w a s for t h e m to h a v e h i m here, a n d s h e w a s helping by bringing a n o t h e r picture of him. For t h e first time, s h e cried a n d eventually said, "You look j u s t like a Daddy, b u t I k n o w you are m y therapist." In t h i s way Rebecca m a d e m e recognize t h e s a d n e s s involved in giving u p t h e m o m e n t a r y illusion of t h e equivalence of t h o u g h t a n d reality. Very gradually I interpreted w h a t w a s evident from t h e first time we played t h i s game: Rebecca's u n b e a r a b l e d i s a p p o i n t m e n t a t realizing t h a t h e r w i s h for h e r g r a n d f a t h e r or t h e a n a l y s t to be h e r real father did n o t m a k e it true. In t h e role plays s h e could explore h e r confusion a b o u t why h e r father refused to acknowledge paternity a n d why h e r m o t h e r , w h o clearly felt guilty a n d angry, could n o t d i s c u s s the m a t t e r w i t h her, a n d how real it felt to h e r t h a t if s h e d e m a n d e d to see h e r father, h e r m o t h e r would s e n d h e r away in anger, a s s h e h a d t h e father. T h e following vignette illustrates some a s p e c t s of t h e c h a n g e in t h e n a t u r e of t h e material. In one session, Rebecca w a s excited a b o u t going to see t h e m u s i c a l "Oliver." S h e claimed t h a t s h e w a s only going for t h e songs, b e c a u s e t h e y were funny, t h e n a d d e d "Oliver w a s lost, very s a d you know," a n d n o d d e d emphatically. I said t h a t I s u p p o s e d Rebecca w a n t e d to concentrate on t h e funny p a r t s , b e c a u s e she, like Oliver, so often felt lost a n d alone. Rebecca t h e n asked, "Do you k n o w t h a t b a b i e s a r e very s a d w i t h o u t daddies?" S h e t h e n a s k e d m e to play t h e giraffe game, with a s h a d o w - p u p p e t d a d d y giraffe a n d b a b y giraffe. The d a d d y giraffe w a s expected to t e a c h b a b y giraffe a b o u t j u m p i n g , walking, a n d eating from trees. Although t h e phallic narcissistic a s p e c t s of t h i s g a m e were evident, I only took h e r enjoyment of t h i s g a m e u p in t h e context of it m a k i n g h e r s a d n e s s better to feel t h a t t h e giraffe b a b y h a d s u c h a clever giraffe daddy,

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b e c a u s e s h e w a s so s a d t h a t s h e did n o t have a real D a d d y to teach her a n d t h a t I w a s n o t really a proper D a d d y to h e r either. She t u r n e d to face me, a n d , looking a t m e in a s o m e w h a t schoolm a r m i s h way, s h e said, "You are j u s t a s h a d o w Daddy."

Psychoanalytic Conceptualization Most psychoanalytic formulations of t h e r a p e u t i c action s h a r e two principal propositions (e.g., A b r a m s 1987, 1990)—namely, t h a t pathology is associated with t h e persistence of developmentally primitive m e n t a l s t r u c t u r e s , a n d t h a t psychoanalysis exerts its m u t a t i v e influence t h r o u g h a p r o c e s s of reorganization and integration of r e p u d i a t e d u n c o n s c i o u s m e n t a l s t r u c t u r e s with developmentally higher-order conscious ones. To t a k e one example, Rebecca's fantasy a b o u t t h e m o t h e r having driven away or killed t h e father, wherein t h e m o t h e r is s e e n a s a terrifying m o n s t e r , w a s a primitive idea amplified by t h e projection of Rebecca's own considerable aggression. Rebecca h a d got stuck with t h i s developmentally primitive, u n c o n s c i o u s picture, u n m o d u l a t e d by higher-level thinking. Her a n a l y s i s helped her to reintegrate t h e r e p u d i a t e d a n d t h r e a t e n i n g p h a n t a s i e s rooted in her father's a b s e n c e from h e r life, amplified by oedipal a n d more regressive o m n i p o t e n t p h a n t a s i e s , s t r u c t u r e d to protect her injured n a r c i s s i s m . From a m o d e r n Kleinian perspective (e.g., Spillius 1994), one m i g h t a d d t h a t t h e projective identification of Rebecca's terrifying envy a n d rage with t h e m o t h e r (characteristic of t h e developmentally primitive paranoid-schizoid mode of thought), together with h e r total d e p e n d e n c e on h e r single a n d r a t h e r u n p r e d i c t a b l e p a r e n t , led to a p e r s i s t e n t split in her r e p r e s e n t a t i o n of objects a n d in h e r own i m m a t u r e ego. Thus, a l t h o u g h s h e w a s in m a n y w a y s functioning well, Rebecca was prevented from developing a more integrated view of t h e mother characteristic of t h e experience of objects in t h e depressive position (Klein 1935, 1940). These ways of t h i n k i n g a b o u t Rebecca's difficulties are helpful in u n d e r s t a n d i n g a s p e c t s of t h e analytic material. However, it is clear t h a t in m o s t traditional psychoanalytic a c c o u n t s metaphors referring to developmental a r r e s t or c h a n g e s in psychic

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s t r u c t u r e s a s a c c o u n t s of pathology a n d t h e r a p e u t i c action t u r n out, u p o n closer scrutiny, to be relatively e m p t y a n d circular, given t h e lack of specificity a b o u t t h e w a y s in which t h e young child's i n n e r experience differs from t h a t of a n older one a n d how t h e former places t h e child a t risk of d i s t u r b a n c e a n d t h e latter m a y come to t h e r e s c u e in t h e context of t h e psychoanalytic encounter.

R e b e c c a and Her Analysis: Play and t h e Self W h a t do t h e empirical findings a n d o u r model of cognitive develo p m e n t have to say a b o u t Rebecca's difficulties a n d their treatm e n t ? Rebecca's behavior w a s fully symbolic a n d could not be regarded a s "concrete" in a n y general s e n s e . S h e initiated pretend play with h e r a n a l y s t a n d readily accepted t h e analyst's e s t a b l i s h m e n t of t h e analytic s i t u a t i o n a s one w h e r e pretend play w a s welcome. S h e could label a n d talk a b o u t h e r feelings, d r e a m s , a n d fantasies a n d d i s t i n g u i s h t h e s e from physical reality. S h e w a s s p o n t a n e o u s a n d rarely resorted to cliches t h a t m i g h t h a v e raised d o u b t s a b o u t h e r g e n u i n e a w a r e n e s s of her inner world. Nevertheless, h e r mentalizing capacity w a s in some i m p o r t a n t r e s p e c t s flawed, a n d certain c h a n g e s t h a t took place in t h e c o u r s e of t h e r a p y resembled t h o s e described in empirical s t u d i e s of t h e development of the psychic reality of t h e child between t h e ages of 3 a n d 5 years. While Rebecca would probably h a v e b e e n able to conceive of a sponge t h a t looks like a rock, w h e n it c a m e to accepting t h a t h e r a n a l y s t w a s b o t h a t h e r a p i s t a n d s o m e o n e w h o looked like a daddy, s h e retreated from t h e kind of integration of appeara n c e a n d reality required by h e r experience of t h e transference. Rebecca could 1 pretend t h a t h e r a n a l y s t w a s pretend Rebecca's father a n d k n o w it w a s n o t real. W h a t real Rebecca did n o t know while playing w a s t h a t s h e w a s playing with a n a n a l y s t w h o only felt like a father. For her, t h e a n a l y s t looking a n d acting like a father was, for t h a t m o m e n t , t h e reality. To question t h i s spoiled t h e g a m e a n d led to a devastating s e n s e of loss. This h a p p e n e d t h r o u g h t h e developmental a n a l o g u e of t h e preference for psychic reality over factual reality described by F r e u d (1912-13) a s a

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being characteristic of n e u r o t i c s . Rebecca w a s developmentally ready to see t h e distinction a n d could u s e it in c i r c u m s t a n c e s t h a t were less emotionally salient, b u t s h e w a s prevented from fully experiencing it in t h i s context by h e r i n t e n s e desire for a real father, for t h e actualization of t h e father figure in t h e transference. At t h e m o m e n t s h e felt it, t h e transference was, for Rebecca, a n d probably for all children a t h e r stage of development, n o t a fantasy, b u t a subjective experience a s real a s t h a t of a physical object. This can, of course, be equally t r u e for m a n y patients a t certain times in their analysis, b u t Rebecca's analysis was, a t least initially, completely dominated by t h e m o d e of psychic equivalence, w h e r e t h e r e w a s n o "potential space" (Winnicott 1971) in w h i c h t h e n a r r a t o r ' s experience of t h e analyst a s a father could be looked a t a n d u n d e r s t o o d . Only by playing with reality in analysis, perrnitting Rebecca to observe t h e analyst's mental r e p r e s e n t a t i o n of h e r playing, w a s s h e able to develop a tentatively held image of h e r own desires for a father a n d see these a s w i s h e s t h a t were p a r t of p h a n t a s y r a t h e r t h a n t h e outside world. T h e w i s h e s could' t h e n be b r o u g h t into Rebecca's thinking a b o u t external reality. We suggest t h a t Rebecca could n o t afford to "play" t h a t s h e had a father b e c a u s e h e r m o t h e r reacted too severely to this fantasy. T h e reflection in herself of Rebecca's s a d n e s s a b o u t her absent father w a s too real. This m a y h a v e b e e n t h e principal reason for Rebecca's initial inability to play t h a t s h e h a d a father and for t h e compulsive, addictive quality of this play w h e n it became possible. Normally t h e y o u n g child t e n d s to a d o p t a defensive strategy of dealing with u n a c c e p t a b l e ideas in t h e realm of p r e t e n s e a n d p h a n t a s y , w h e r e they c a n be played with, all connections to actuality removed. P e r h a p s t h i s is a way in which play c a n be said to have a vital role in t h e development of mastery (Freud 1920g)—the reworking of a passive experience into a n active o n e (Drucker 1975). In "pretend" m o d e ideas cannot t h r e a t e n ; t h e y h a v e lost their equivalence to w h a t is real. However, Rebecca's a t t e m p t to decouple p h a n t a s y from reality, inner from outer, m a y h a v e b e e n u n d e r m i n e d n o t j u s t by t h e intensity of h e r desires—and h e r unwillingness to give u p t h e idea of their actuality, b u t also by her, m o t h e r ' s inability to t a k e Rebecca's ideas a n d feelings into h e r subjective reality.

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Her m o t h e r could n o t tolerate a g e n u i n e a w a r e n e s s of Rebecca's frustration a n d u n h a p p i n e s s b e c a u s e s h e herself also t e n d e d to b e s t u c k (in t h i s area) in a m o d e of psychic equivalence. T h e p h a n t a s y father, Rebecca's exploration of t h e idea of a father, w a s too real a n d intolerable for h e r m o t h e r . T h e idea could n o t be played with or genuinely e n t e r t a i n e d a s a wish. Rebecca arrived a t t h e analytic situation troubled by t h e "realness" of h e r psychic reality. Her n o r m a l developmental progression w a s a r r e s t e d b e c a u s e t h e intensity of h e r feelings forced a n idea from t h e p r e t e n d b u t u n r e a l world of fantasy into t h e p a r t of h e r m i n d w h e r e m e n t a l c o n t e n t s corresponded to physical realities. In t h e s e c i r c u m s t a n c e s , we suggest, t h e p r e t e n d mode may be given u p by t h e child in t h i s area, a n d t h e idea is forced into t h e mode of psychic equivalence: It b e c o m e s a s "real" for the child a s it t h r e a t e n e d to b e for t h e m o t h e r . The y o u n g child, a t t e m p t i n g to m a k e t h e developmental step between a n o n r e p r e s e n t a t i o n a l a n d a r e p r e s e n t a t i o n a l mode of psychic reality, is in a highly vulnerable state. T h e integration of t h e pretend (representational b u t unreal) a n d t h e a c t u a l (nonr e p r e s e n t a t i o n a l b u t real) confronts t h e child with particular difficulties w h e n a representation, m a d e actual, signals danger. While t h e worlds of p r e t e n d a n d reality are s e p a r a t e , t h e child's psychic reality c a n include fantasy r e p r e s e n t a t i o n s t h a t would be highly conflictual if their t r u t h or falsity were to be examined in conjunction with t h e world outside. T h e fantasy of t h e sexual p o s s e s s i o n of t h e p a r e n t of t h e opposite sex is safe a s long a s it is held in t h e pretend m o d e of psychic reality, where c o n c e r n s with possibility or impossibility, or relation to physical reality, are a b s e n t . Pretend desire, even if conscious, a r o u s e s n o conflict. Only w h e n t h e r e p r e s e n t a t i o n a l m o d e of p r e t e n s e comes gradually to be integrated with t h e experience of psychic reality corresponding to external reality—where t h e t h o u g h t s u d d e n l y b e c o m e s real—do terrifying conflicts arise t h r o u g h t h e increasingly clear image of t h e feelings of t h e other, in seeing t h e child's wish. Resolution of t h i s d i l e m m a normally a r i s e s t h r o u g h the radical restriction of s u c h d a n g e r o u s fantasies, t h r o u g h the e s t a b l i s h m e n t of t h e repression barrier, first to a p r e t e n d mode a n d later to a n u n c o n s c i o u s m o d e of t h o u g h t .

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Internal a n d external c i r c u m s t a n c e s c a n conspire to m a k e s u c h a progression difficult, a s w a s t h e case for Rebecca. Before t h e two m o d e s of functioning a r e fully integrated, r e p r e s e n t a tions from t h e p r e t e n d m o d e m a y become so intensively a n d actively s t i m u l a t e d t h a t t h e y e n c r o a c h u p o n t h e child's m e n t a l world in its m o d e of psychic equivalence. The a b s e n c e a n d unknowability of Rebecca's father m a y have b e e n s u c h a circ u m s t a n c e . Her belief t h a t h e r charismatic g r a n d f a t h e r w a s her father acquired t h e qualities of a fact, m a k i n g h i s d e a t h a t r a u m a of far g r e a t e r intensity t h a n it might otherwise h a v e been. T h e p e n e t r a t i o n of t h e psychic barrier between real a n d pretend, t h e feeling of actualization t h a t comes to characterize worrying t h o u g h t s , t h e difficulty in discriminating between possibility a n d certainty, all serve to magnify t h e small child's anxiety. T h e a c k n o w l e d g m e n t of t h e reality of t h e s e experiences for t h e child is t h e only t h e r a p e u t i c starting point a n d a major source of r e a s s u r a n c e a s it begins t h e move toward a representational level. Because Rebecca h a d n o "other" to pretend a n d reflect with, she was, in a s e n s e , obliged to keep a n idea in h e r mind (the image of h e r father) t h a t w a s isomorphic with reality. Rebecca m u s t have found s o m e comfort in t h e solution t h a t "believing is having." The h u r t a n d s h a m e of being fatherless could not be tolerated a n d w a s avoided by retaining t h i s "psychotic island" (Rosenfeld 1971) within h e r subjective experience. According to Rosenfeld's notion, t h e r e is a p a r t of t h e p a t i e n t ' s thinking where the equivalence of subjective experience a n d physical reality h a s been retained, b u t in s u c h a way t h a t subjective experience is projected onto a n d distorts a c t u a l reality, which then, in t u r n , becomes a s o u r c e of terrifying anxiety. Rebecca's m e t a p h o r of t h e s n a k e , which placed h e r worries outside herself, w a s a characteristic example of t h e t h o u g h t a s a concrete physical object. S h e needed t h e a d u l t to soften h e r ideas so t h a t s h e could herself s h a p e t h e m a n d create a psychic world t h a t w a s n o longer either p u r e fantasy or h a r d reality, b u t which could cover h e r entire r a n g e of experiences, j u s t a s s h e wished t h a t t h e "world blanket" would cover all t h e objects in her internal world. M a n y m i g h t see t h e image of t h e s n a k e a s a

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phallic, d a n g e r o u s , b u t highly prized possession, p e r h a p s representing t h e analysis or j u s t t h e devoted attention of a male adult. The "world blanket" also m a y h a v e b e e n a protection against anxiety, w h i c h increased a s h e r sexual w i s h e s a n d h o p e s became more t r a n s p a r e n t . This view of t h e material is quite compatible with t h e perspective we offer, in t h a t we suggest t h a t the r e a s o n t h e sexual w i s h e s were so worrying w a s t h a t t h e y were experienced in t h e mode of psychic equivalence. They felt too real to be fantasies. It needed t h e a n a l y s t to recognize t h a t t h e y could be pretend a n d yet feel real. As always, t h e n , t h e r e w a s a price to pay, a n d t h e comfort of keeping a n idea of h e r father alive could only be short-lived. Her u n c o n s c i o u s p h a n t a s i e s of sexual d e s t r u c t i v e n e s s a n d annihilation c a m e with t h i s idea, entering into t h e real world of psychic equivalence, m a k i n g t h e m even m o r e real a n d terrifying. All children h a v e s u c h fantasies, b u t normally t h e ideas m a y be "metabolized" (to borrow Bion's terminology) t h r o u g h play, licensed a n d s u p p o r t e d by t h e p a r e n t s , a n d w i t h o u t consequence. A father sits down d u r i n g a m o c k battle, only to be told, "You are t h e m o n s t e r — y o u ' h a v e to s t a n d u p so t h a t I c a n kill you!" If t h e father dutifully s t a n d s u p , he is helping h i s child to metabolize a n d w o r k t h r o u g h t h e m u r d e r o u s p h a n t a s y . If he s t a y s sitting down—or especially if h e r e s p o n d s to t h e p h a n t a s y with disapproval, anger, s a d n e s s , or fear, reinforcing t h e child's s e n s e t h a t it might become too real—the m u r d e r o u s t h o u g h t s r e m a i n unmetabolized. They m a y p a s s b a c k from t h e pretend m o d e to t h e m o d e of psychic equivalence, a n d a n opportunity for t h e child to see h i s idea a s a n idea is lost. Rebecca's mother's depression following t h e d e a t h of h e r own father m a y well have m a d e it intolerable for h e r to c o n t e m p l a t e Rebecca's feelings of loss a t t h e time t h a t s h e felt t h e m , a n d h e r reaction of real s a d n e s s reinstated a mode of psychic equivalence in relation to those thoughts. T h e a c u t e s e p a r a t i o n anxiety t h a t b r o u g h t Rebecca to analysis in t h e first place m a y also be u n d e r s t o o d a s indicating a lack of continuity in t h e experience of t h e psychological self. In previous c h a p t e r s we h a v e described (see also Fonagy, Moran, and Target 1993: Fonagy a n d Target 1995) a dialectical theory of early self-development, drawing on work by Winnicott a n d Bion,

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according to w h i c h t h e infant finds a n image of himself, in h i s mother's m i n d , a s a n individual with t h o u g h t s a n d feelings. Winnicott (e.g., 1967) s t r e s s e d t h a t it is vital for t h e infant to see a reflection of h i s own s t a t e (albeit processed to m a k e it m o r e containable—Bion 1962a, 1962b), n o t of t h e mother's own fixed preoccupations or defensive m a n e u v e r s , w h e n h e looks to h e r for images of himself. Rebecca's m o t h e r w a s , apparently, d e p r e s s e d and angry w h e n Rebecca w a s b o r n . The b a b y h a d n o t b e e n planned, a n d t h e father a b a n d o n e d t h e m o t h e r in r e s p o n s e to news of t h e p r e g n a n c y . Rebecca's m o t h e r felt t h e b a b y to be a d i s a s t r o u s t h r e a t to h e r i n d e p e n d e n c e , destroying her h o p e s for the future. We s u g g e s t t h a t t h e infant Rebecca, in searching for her m o t h e r ' s picture of h e r a n d h e r s t a t e s of mind, m a y h a v e been confronted with t h e picture of a wrecker,, a r u t h l e s s invader who steals w h a t is m o s t precious: a pirate, in Rebecca's later frightened image. This idea of t h e pirate, like t h e ideas a b o u t h e r father's d i s a p p e a r a n c e , b e c a m e all too real for Rebecca by becoming p a r t of t h e world of "psychic equivalence" r a t h e r t h a n of play a n d p h a n t a s y . Rebecca m a y h a v e clung to h e r m o t h e r n o t only b e c a u s e of the fear of t h e d e s t r u c t i v e n e s s felt to t h r e a t e n b o t h of them, b u t also b e c a u s e t h e only time Rebecca could get away from t h e negative "pirate" image of herself, internalized from t h e early mother, w a s , paradoxically, w h e n s h e w a s with h e r real, external mother of t h e p r e s e n t . W h e n with h e r m o t h e r , s h e could externalize t h e alien, frightening image of t h e pirate a n d retain a clearer, u n c o n t a m i n a t e d image of herself. W h e n s h e battled with her mother, a s s h e frequently did, this introjected image n o longer o b s c u r e d Rebecca's self-representation, a n d s h e felt obvious relief. T h e price of t h i s strategy w a s t h a t Rebecca needed to stay physically close to t h e object if s h e w a s to avoid t h e image of the pirate emerging a s t h e core experience of herself, a s it did in her daytime terrors a n d n i g h t m a r e s . So Rebecca's t h o u g h t s , a b o u t t h e d a n g e r o u s n e s s of h e r own and her m o t h e r ' s aggression a n d sexuality, s e e m partly to have blocked t h e development a n d integration of t h e girl's psychic reality a n d forced h e r to retain a p a r t of h e r m i n d in w h i c h thought a n d actuality were treated a s t h e s a m e . This protected her from anxiety related to h e r m o t h e r ' s a c t u a l angry a n d reject-

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ing r e s p o n s e to her, b u t it deprived h e r of a n o t h e r form of protection, w h i c h would have followed integration of t h e two m o d e s of thinking. With t h i s integrationTfhe capacity to mentalize, to see ideas a s merely ideas a n d n o t facts, to play with different p o i n t s of view, t h e r e comes t h e capacity to t e s t ideas a g a i n s t reality a n d therefore to m o d e r a t e their impact. Insulated from knowledge of w h a t could or could n o t "really" h a p p e n in relation to h e r anxiety-provoking ideas, Rebecca's terror of her t h o u g h t s a n d feelings in this a r e a w a s magnified a s t h e s e repeatedly surfaced, to b e experienced a s "real." The s a m e p h e n o m e n o n emerged in t h e transference, where t h e a n a l y s t could be either Rebecca's a n a l y s t or h e r father, b u t never t h e a n a l y s t r e p r e s e n t i n g t h e father. W h e n he drew her attention to t h e d u a l reality t h a t h e looked like a D a d d y b u t was actually a therapist, Rebecca r e s p o n d e d by m a k i n g t h e father more real—someone s h e h a d really m e t w h o really looked like the analyst. However, we c a n also see how i m p o r t a n t it w a s t h a t the a n a l y s t could play with Rebecca's ideas a n d recognize t h a t they were p a r t of h e r internal world a n d n o t external reality. T h e loss involved in giving u p t h e fulfillment of a wish w a s b a l a n c e d , over t h e c o u r s e of t h e analysis, by t h e r e a s s u r a n c e of finding t h a t her fears were fears r a t h e r t h a n facts a n d t h a t , a l t h o u g h t h e y could n o t be m a s t e r e d by Rebecca alone, t h e y could b e played with and m a d e safer in t h e "potential space" between two m i n d s . Psychoanalysis is in m a n y r e s p e c t s a "pretend" experience. Play is essential to it, j u s t a s it is essential to o u r psychoanalytic model of t h e developing mind. Analyst a n d patient d i s c u s s fantasies, feelings, a n d ideas t h a t they "know" a t t h e s a m e time to b e false. Klauber (1987) wrote beautifully a b o u t t h i s in h i s p a p e r on transference a s a n illusion. This refocusing of t h e role of the a n a l y s t highlights t h e role played by t h e a d u l t in t h e child's c o n s t r u c t i o n of h i s own mind a n d t h e development of a representation of it (effectively a metarepresentation). Rebecca w a s able to arrive at a n integration represented by t h e a n a l y s t / f a t h e r , real a s a subjective experience b u t at t h e s a m e time k n o w n to be a m e r e idea. In h e r role play, Rebecca moved t h e experience of h e r t h o u g h t s a n d feelings to a developmentally higher level, w h e r e t h e s e b e c a m e increasingly differentiated. S h e repeatedly explored t h e b o u n d a r i e s of her ii

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self-experience, looking a t herself from within (as p r e t e n d Rebecca} a n d w i t h o u t (as H a n n a h ) while also constantly monitoring whether s h e w a s recognized a n d u n d e r s t o o d by t h e other in t h e specific role t h a t s h e herself assigned. Her play allowed h e r to adopt n u m e r o u s perspectives, e a c h o n e offering a t e s t of h e r imagined place in relation to t h e object, e a c h self-representation clearly s e p a r a t e a n d distinct from t h e internal picture of t h e object. She a d o p t e d t h e point of view of t h e third, observing a relationship between herself a n d t h e object a n d t h u s greatly strengthening t h e coherence a n d stability of h e r r e p r e s e n t a t i o n of herself a s s h e related to others. In this way, s h e could relinquish t h e w i s h reinforced by psychic equivalence a n d exchange it for t h e defenses t h a t mentalizing offers to t h e child. This h a p p e n s gradually, in ordinary family life or in analysis, n o t j u s t by a d d r e s s i n g p a r t i c u l a r t h o u g h t s b u t also by a d d r e s s i n g t h o u g h t s in general. In Rebecca's game, w h a t w a s i m p o r t a n t w a s not simply playing with t h e idea of a n a b s e n t father, b u t setting u p a s t r u c t u r e w h e r e t h e t h o u g h t s a n d feelings of e a c h p e r s o n could be imagined a n d considered. In time, a n d with m u c h analytic work s h e b e c a m e far clearer a b o u t t h e analyst's role. When t h e a n a l y s t m i s t a k e n l y a d d r e s s e d h e r s h a d o w g a m e with the d a d d y giraffe a s a consolation for h e r Oliver Twist feelings of a b a n d o n m e n t , s h e w a s able to set t h e a n a l y s t right a n d indicate t h a t s h e k n e w t h a t t h e experience t h a t it created w a s like a shadow—real yet a t t h e s a m e time illusory. The b a c k g r o u n d to Rebecca's p r o b l e m s w a s a s t a t e of confusion a n d ignorance a b o u t t h e a c t u a l c i r c u m s t a n c e s of h e r family, resulting from t h e m o t h e r ' s unwillingness to contemplate them, w h i c h m a d e t h i n k i n g a b o u t t h e possible feelings of t h o s e around h e r m o r e frightening t h a n u s u a l a n d m a d e it impossible for her to work h e r anxieties o u t w i t h o u t help. In t h e a b s e n c e of a n adult a t h o m e w h o could help h e r bridge t h e gap between inner a n d outer, s h e needed a n o t h e r adult, t h e analyst, to provide the n e c e s s a r y frame for play and, reflection. T h u s t h e a n a l y s t ' s play with t h e child h a s a n i m p o r t a n t development—enhancing function. Not only is it h i s sole r o u t e to engaging t h e child's r e p r e s e n t a t i o n a l system, b u t it is also a developmental o p p o r t u n i t y for t h e child to gain better u n d e r standing of t h e n a t u r e of m e n t a l s t a t e s . In Rebecca's play, all t h e

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c h a r a c t e r s (eight in all) felt, t h o u g h t , believed a n d wished, a n d their s h a r e d world—the consulting-room—brought into s h a r p c o n t r a s t their different perceptions, their s o m e t i m e s painfully i n c o n g r u e n t experiences of t h e world. Naturally their (interpersonal a n d intrapsychic) conflicts, worries, relationships provided a rich source of material for interpretation a s well a s insight into Rebecca's perceptions a n d feelings a b o u t t h e transference a s well a s t h e general s t a t e of h e r psychic functioning. B u t there w a s s o m e t h i n g else. Rebecca u s e d h e r play w i t h t h e a n a l y s t to test o u t h e r ideas a b o u t how h e r own m i n d a n d t h e m i n d s of o t h e r s functioned. W h e n s h e repeated again a n d again t h e scenario where t h e a n a l y s t (as H a n n a h ' s father) w a s startled to find Rebecca where H a n n a h h a d b e e n expected, s h e n o t only enjoyed t h e fantasy of a s u r p r i s e r e u n i o n with her father, or t h e reversal of t h e n o r m a l d o m i n a n c e of g r o w n - u p over child, b u t s h e also practiced, in a safer context t h a n h e r h o m e e n v i r o n m e n t normally provided, t h e experience of t h e fallibility of a d u l t s ' beliefs a n d rejoiced in h e r a w a r e n e s s of t h e r e e s t a b l i s h m e n t of her existence in t h e a d u l t ' s mind.

A DEVELOPMENTAL MODEL OF EARLY O B J E C T RELATIONSHIPS AND T H E EVOLUTION OF PSYCHIC REALITY As described above, t h e caregiver p r o d u c e s intentionality t h r o u g h complex linguistic a n d interactional processes, primarily t h r o u g h b e h a v i n g toward t h e b a b y a n d child in s u c h a way t h a t it leads h i m eventually to p o s t u l a t e t h a t h i s own behavior m a y be b e s t u n d e r s t o o d in t e r m s of ideas a n d beliefs, feelings a n d w i s h e s t h a t determine h i s actions a n d t h e reactions of o t h e r s to him. Unconsciously a n d pervasively, with h e r behavior t h e caregiver a s c r i b e s a m e n t a l s t a t e to t h e child t h a t is ultimately perceived by t h e child a n d internalized, permitting the development of a core s e n s e of m e n t a l selfhood. Prototypically in playfulness, t h e a d u l t a d o p t s t h e child's m e n t a l s t a n c e a n d rep r e s e n t s it to h i m in relation to a third object, 1 held symbolically in m i n d by b o t h . We a s s u m e t h a t this, by a n d large, is a ii

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m u n d a n e process, in t h e s e n s e of h a p p e n i n g every day t h r o u g h out early life, p r e c o n s c i o u s to b o t h infant a n d caregiver, inaccessible to reflection o r modification. Caregivers, however, differ in their ways of carrying o u t t h i s m o s t n a t u r a l of h u m a n functions. Some m a y be alert to t h e earliest suggestions of intentionality, others m a y n e e d stronger indications before perceiving t h e child's m e n t a l s t a t e a n d r e s p o n d i n g to it. Using Vygotsky's (1966) framework, we m a y conceive of this a s t h e s t r e n g t h of t h e scaffolding provided for t h e "artificial development" of t h e child's u n d e r s t a n d i n g of h i s own m i n d . We m a y a s s u m e , a s do m o s t cognitivists working in t h i s area, t h a t t h e development of a theory of m i n d is canalized, in Waddington's (1966) u s e of t h e term, b u t t h e c a n a l is d u g n o t by biology, b u t by i n f a n t - p a r e n t interaction. We suggest t h a t t h e symbiotic relation of caregiver a n d infant s t r u c t u r e s t h e e m e r g e n c e of t h e psychological self, t h e "I" of intentional ascriptions. Knowledge of m i n d s a n d t h e intentional stance arise o u t of a p h a s e w h e n t h e m e n t a l worlds of child a n d caregiver overlap. This intersubjective s t a t e does n o t necessarily imply t h e experience or even p h a n t a s y of fusion between t h e child a n d caregiver, yet b o t h t h e child a n d t h e m o t h e r are in a state of p r i m a r y preoccupation, building intimate knowledge of the other parallel to their knowledge of themselves. The developing child's perception of m e n t a l s t a t e s in himself a n d o t h e r s t h u s depends on h i s s e n s e of t h e psychic reality of h i s caregiver. U n d e r s t a n d i n g t h e n a t u r e of t h e m e n t a l world c a n n o t be done alone—it r e q u i r e s u n d e r s t a n d i n g of t h e self in t h e eye of t h e other. We suggest t h a t w h e r e t h e p a r e n t is u n a b l e to incorporate a n d t h i n k a b o u t a piece of reality a n d c a n n o t t h e n enable t h e child to do so safely t h r o u g h playing with t h e frightening ideas, this reality r e m a i n s to be experienced in t h e mode of psychic equivalence. Neither child n o r p a r e n t c a n "metabolize" t h e thoughts, a n d t h e "unthinkable" t h o u g h t s a r e p a s s e d o n from one generation to t h e next. On a n everyday scale, Rebecca's mother could n o t help h e r with t h e u n a c c e p t a b l e reality of h e r fatherless situation. O n a massive scale, t r a u m a s s u c h a s Holoc a u s t experiences m a y b e p a s s e d on, or not, d e p e n d i n g on t h e parents' capacity to allow t h e t r a u m a to be p a r t of s h a r e d reality.

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which c a n be t h o u g h t a n d talked about, n o t only relived a s a continuing a n d fixed reality. Once t h e child c a n mentalize, h e h a s available a crucial a t t e n u a t i n g function for psychic experience. He is able to manipulate m e n t a l r e p r e s e n t a t i o n s to defensively b a r or modify perceptions of reality. T h e neurotic child fails to achieve a full integration of t h e "actual" a n d "pretend" m o d e s into a representational framework, a n d certain ideas r e t a i n t h e immediacy of external reality. Before t h e integration of t h e two m o d e s is achieved, t h e child is vulnerable to all k i n d s of a p p e a r a n c e s , particularly in relation to a d u l t s a r o u n d t h e m . By mentalizing, attributing ideas a n d feelings to himself a n d to others, t h e child m a k e s h i s h u m a n world more explicable to himself. Until he is able to step beyond a p p e a r a n c e a n d g r a s p t h e distinction between this a n d t h e m e n t a l s t a t e t h a t might u n d e r p i n it, he r e m a i n s vulnerable to t h e i m m e d i a t e emotional reaction of his object. Inconsistency or hostility in t h e object's behavior may t h e n b e t a k e n a t face v a l u e a s showing s o m e t h i n g b a d a b o u t him. In contrast, if t h e child is able to a t t r i b u t e a withdrawn, u n h a p p y m o t h e r ' s a p p a r e n t l y rejecting behavior to h e r emotional state—of depression, or a n g e r a b o u t s o m e external circ u m s t a n c e s — r a t h e r t h a n to himself a s b a d a n d u n s t i m u l a t i n g , t h e child m a y be protected from lasting injury to h i s view of himself. O u r a c c e p t a n c e of a dialectical perspective of self-developm e n t shifts t h e traditional psychoanalytic e m p h a s i s from the internalization of t h e containing object to t h e internalization of t h e t h i n k i n g self from within t h e containing object. This is w h a t m a k e s s u c h c o n c e p t s a s t h i n k i n g inherently intersubjective. S h a r e d experience is p a r t of t h e "very logic" (Sellars 1963, p. 189) of m e n t a l - s t a t e concepts. All analytic work with y o u n g children c o n t a i n s a n e l e m e n t of t h i s developmental process, a n d s o m e p a t i e n t s ' t r e a t m e n t m a y be almost entirely focused on the elaboration of t h e self a s a m e n t a l or psychological entity. The reflective a s p e c t of t h e analytic p r o c e s s is u n d e r s t a n d i n g a n d not simply e m p a t h y (the a c c u r a t e mirroring of m e n t a l state). In order to move t h e child from t h e m o d e of psychic equivalence to t h e mentalizing mode, analytic reflection, of w h a t e v e r orientation, c a n n o t j u s t "copy" t h e child's i n t e r n a l state—it h a s to move

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beyond it a n d go a step further, offering a different, yet experientially appropriate, r e - p r e s e n t a t i o n . The analyst's m i n d a c t s a s scaffolding (Vygotsky 1966) designed to e n h a n c e t h e developm e n t of r e p r e s e n t a t i o n in t h e child's psychic reality b y being constantly o n e step a h e a d of t h e child's experience of h i s m e n t a l self. T h u s child p s y c h o a n a l y s i s is m o r e t h a n j u s t t h e removal of obstacles to mentalization. It is t h e exercise of a developmental universal in p u r e form. T h e a n a l y s t m u s t begin by acknowledging t h e compelling reality of t h e child's experience, entering into the pretend world, a n d only gradually showing him, t h r o u g h contact with h i s m e n t a l experience, t h a t it is a set of r e p r e s e n t a tions t h a t c a n be s h a r e d , played with, a n d c h a n g e d .

Marked

Affect-Mirroring

a n d the

Development

of Affect-Regulative of Pretend

Use Play

Chapter 6 p r o p o s e d a psychoanalytic model for t h e development of full subjectivity, closely linked to t h e quality of interaction between p a r e n t a n d child. A clinical illustration w a s offered to show t h a t , for i n t e r n a l reality to be experienced a s truly representational r a t h e r t h a n a s either totally real o r totally unreal, t h e object's mirroring of t h e child's internal reality, preferably in a playful m a n n e r , w a s a prerequisite. In t h i s c h a p t e r , t h e psychological u n d e r p i n n i n g s of t h e p r o c e s s e s involved in playful mirroring interactions between child a n d caregiver a r e elaborated in the context of a further case report. It is argued t h a t t h e specific features of interactions t h a t effect a c h a n g e in t h e quality of internal r e p r e s e n t a t i o n involve t h e caregiver creating "marked externalizations" of t h e child's i n t e r n a l s t a t e s with t h e key qualities of s e p a r a t i n g or decoupling internal experience from physical reality, offering a s e n s e of control over t h e experience a n d potentially modifying t h e c o n t e n t of t h e experience in t h e direction of increased p l e a s u r e or w i s h fulfillment. Marked p a r e n t a l mirroring in t h e context of p r e t e n d play or e m p a t h i c pro-social actions offer early o p p o r t u n i t i e s for t h e infant to encode features of m a r k e d n e s s of e x p r e s s i o n s (signaling "nonconsequentiality" a n d decoupling from physical reality), c o n t e n t modifications (leading to reduction of u n p l e a s u r e a n d wish fulfillment), a n d t h e en291

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h a n c e m e n t of agentive a s p e c t s (which exert control a n d m a s t e r y over affective experience). S u c h interactions m a y provide import a n t experiential preconditions t h a t facilitate t h e emergence of t h e active u s e of t h e s e features for emotional self-regulation by t h e infants themselves. We a r g u e t h a t t h e a b s e n c e of p a r e n t a l mirroring c a n lead to a developmental a r r e s t a t t h e level of psychic equivalence. The a b s e n c e of " m a r k e d n e s s " in t h e caregiver's r e s p o n s e c a n lead to affective dysregulation, w h i c h ultimately r e s u l t s in a fear of extemalization on t h e p a r t of t h e child: h e b e c o m e s r e l u c t a n t to e n t e r social interactions where mirroring would b e expected from t h e caregiver. This discourages t h e child from seeking social experiences t h a t might correct t h i s developmental deviation. We p r e s e n t a c a s e of a 4-year-old child where t h e r a p e u t i c intervention a p p e a r e d to h a v e t h e power to s u p p l e m e n t t h e child's psychosocial deprivation. A cognitive a n a l y s i s of t h e t r e a t m e n t is u s e d a s a springboard for u n d e r s t a n d i n g a facet of w h a t might be effective in t h e psychoanalytic t h e r a p e u t i c p r o c e s s for adolesc e n t s a n d a d u l t s a s well.

INTRODUCTION In previous c h a p t e r s we h a v e proposed two closely related develo p m e n t a l theories a b o u t t h e relationship between u n d e r s t a n d i n g t h e r e p r e s e n t a t i o n a l n a t u r e of m i n d s a n d affect regulation— t h e theory of psychic equivalence a n d t h e p r e t e n d mode of mentalizing on t h e one h a n d (chapter 6), a n d t h e social biofeedb a c k theory of p a r e n t a l affect-mirroring on t h e o t h e r (chapter 4). From a historical point of view, b o t h of t h e s e theories c a n be seen a s p r e s e n t - d a y elaborations within t h e framework of theory-ofm i n d development of F r e u d ' s original p r o p o s a l s a b o u t t h e n a t u r e of psychic reality (Freud 1900a, 1950 [1895]) a n d a b o u t t h e role of pretend play in affective life (Freud 1920g). The first theory, p u t forward in c h a p t e r 6, d i s t i n g u i s h e s between two basic types of r e p r e s e n t a t i o n a l functioning: the "psychic equivalence" a n d t h e "pretend" m o d e s of representing internal experience, w h i c h a n t e d a t e t h e full development of the

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capacity for mentalization (see also Fonagy 1995b; Fonagy a n d Target 1996; Target a n d Fonagy 1996). "Psychic equivalence" refers to t h e m o r e primitive level of m e n t a l functioning, where internal m i n d s t a t e s s u c h a s t h o u g h t s , fantasies, a n d feelings are confused with a n d experienced a s reality a n d n o t a s representations of reality. In c o n t r a s t , t h e "pretend" mode of mentalizing involves a n a w a r e n e s s of t h e representational n a t u r e of internal m i n d s t a t e s : by s e p a r a t i n g or "decoupling" (Leslie 1987) the m e n t a l r e p r e s e n t a t i o n s from reality, t h e child c a n differentiate t h o u g h t s a n d fantasies from a c t u a l reality, although on h i s own he c a n create n o useful connection between this representation a n d physical reality. T h e theory holds t h a t t h e development of mentalization is a function of t h e quality of early a t t a c h m e n t experiences, a s t h e integration of t h e "pretend" a n d "equivalence" m o d e s o c c u r s principally in t h e c o u r s e of repeated experiences of i n t e r a c t i o n s with a playful caregiver w h o reflects t h e child's feelings a n d t h o u g h t s in a "marked" m a n n e r . The theory also considers t h e role t h a t t h e s e two levels of m e n t a l functioning play in t h e development of n o r m a l a n d psychopathological forms of affect regulation a n d self-organization a n d u s e s t h e Gergely-Watson social biofeedback model of t h e development of emotional self-awareness (see c h a p t e r 4). The second theory, originally developed by Gergely a n d Watson (1996) a n d described h e r e in c h a p t e r 4, p r o p o s e s a specific, contingency-based psychological m e c h a n i s m (the "social biofeedback model of p a r e n t a l affect-mirroring") t h a t explains how empathic affect-regulative mirroring interactions within t h e att a c h m e n t context c o n t r i b u t e ontogenetically to t h e establishm e n t of s e c o n d - o r d e r r e p r e s e n t a t i o n s of affect s t a t e s a n d their adaptive u s e in m o r e m a t u r e forms of affective self-regulation. The theory also outlines specific h y p o t h e s e s a b o u t how a lack or deviant forms of early affect-regulative mirroring interactions by a t t a c h m e n t figures m a y be involved in t h e etiology of affective and dissociative d i s o r d e r s a n d pathologies of t h e self (see c h a p ters 4 a n d 5). In this c h a p t e r , we p r e s e n t a clinical c a s e t h a t illustrates t h e explanatory relevance of t h e s e two theories for o u r u n d e r s t a n d ing of t h e ontogenesis of certain pathologies of t h e self t h a t involve deficits in mentalization a n d affect regulation. The case

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vignette also s h e d s some light on how t h e s e theories c a n lead to a n u n d e r s t a n d i n g of t h e psychological p r o c e s s e s t h r o u g h which p s y c h o t h e r a p e u t i c interventions m a y i n d u c e corrective change in r e p r e s e n t a t i o n a l functioning in s u c h p a t i e n t s . Before turning to t h e case material, however, we shall first t a k e a closer look at a n i m p o r t a n t key concept t h a t plays a crucial role in b o t h of our theories a n d t h a t also looms large in t h e c a s e s t u d y to be discussed: namely, t h e concept of "marked externalizations" of affectively charged internal m e n t a l c o n t e n t s . We briefly d i s c u s s t h e characteristics a n d functional properties of t h e construct a n d identify its different forms—such a s p r e t e n d play, fiction, art, fantasy, daydreaming, or imagination—encountered in mat u r e representational functioning. Finally, we d i s c u s s t h e representational a n d experiential prerequisites for t h e unfolding ability to u s e m a r k e d externalizations for affective self-regulation a n d outline o u r central developmental h y p o t h e s e s a b o u t t h e role t h a t contingent affect-regulative mirroring interactions play in t h e development of t h i s ability.

"MARKED EXTERNALIZATIONS" AND AFFECTIVE SELF-REGULATION H u m a n s h a v e evolved a u n i q u e m e n t a l capacity for representing t h e intentionality—that is, "aboutness"—of symbols, s u c h as language, pictorial r e p r e s e n t a t i o n s , conventional g e s t u r e s , and so on. This ability is widely u s e d by h u m a n s to externalize their m e n t a l c o n t e n t s (such a s their beliefs, desires, intentions, and emotions) in order to c o m m u n i c a t e with e a c h o t h e r — t h a t is, to exchange culturally relevant information with other m e m b e r s of their species t h a t fosters survival. However, t h r o u g h o u t this book we h a v e emphasized t h a t a p a r t from c o m m u n i c a t i n g knowledge, t h i s vital r e p r e s e n t a t i o n a l ability also serves a r a t h e r different evolutionary function: people often externalize their afiectively charged m e n t a l c o n t e n t s in order to regulate—maintain, modify, reduce, or intensify—their affective states. Evidently, o n e c a n externalize b o t h positive a n d negative affective i m p u l s e s in t h e service of emotion regulation (cf. S t e r n 1985).

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Nonetheless, historically a t least, clinicians have b e e n particularly interested in their p a t i e n t s ' t e n d e n c y to u s e different forms of externalizations to "get rid o f or modify their negative affect states. T h e s e s t a t e s could; arise from painful memories of t r a u matic life events, from—conscious or u n c o n s c i o u s — m e n t a l representations of (real or/fantasized) interpersonal conflicts a n d interactions, or from socially u n a c c e p t a b l e desires t h a t g e n e r a t e painful feelings of anxiety, helplessness, guilt, s h a m e , anger, fear, rage, a n d so on. / The clinical m e a n i n g of t h e t e r m "externalization," however, is rather broad, a s it i n c l u d e s p h e n o m e n a s u c h a s projection, projective identification, e n a c t m e n t , a n d acting out. In all t h e s e instances, t h e i n t e r n a l experience t h a t is being externalized for affect-regulative p u r p o s e s a p p e a r s to be perceived by t h e individual a s being p a r t of a c t u a l external reality a n d a s n o t belonging to t h e self. We would like to distinguish c a s e s of externalizations t h a t involve a defensive distortion of reality perception from c a s e s s u c h a s p r e t e n d play, symbolic drawing a n d painting, t h e a t e r a n d d r a m a , listening to fairy tales, creating art, fantasizing, or daydreaming, where t h e affect-regulative function of externalization is fulfilled w i t h o u t u n d e r m i n i n g reality testing. In s u c h c a s e s t h e externalized affective c o n t e n t is clearly u n d e r stood to be "not for real": it' is conceptualized a s being "decoupled" from reality (Leslie 1987), a s being (only) a representation of reality (Perner 1991) t h a t belongs to a fictional world instead of the real one. We u s e t h e t e r m s "marked externalizations" a n d "symbolic externalizations" to refer only to t h e latter types of expressions of i n t e r n a l contents, w h e r e t h e subject always m a i n tains some level of a w a r e n e s s a n d u n d e r s t a n d i n g of t h e representational n a t u r e of t h e externalized symbolic form. W h e n interpreting s u c h externalized expressions, their representation n e e d s to b e c o m e s o m e h o w "tagged" or "marked" a s being only a "representation" of reality in order to avoid confusion with a c t u a l reality. Earlier we.have argued t h a t in t h e c a s e s of pretend play a s well a s of t h e affect-reflective p a r e n t a l mirroring displays d i s c u s s e d in c h a p t e r s 4 a n d 6, t h e negative emotional c o n t e n t s of t h e child's m i n d a r e externalized in a perceptually clearly "marked" form t h a t signals t h a t t h e externalization is "not for real." T a k e t h e c a s e of p r e t e n d play: here

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markedness is conveyed by a series of salient p e r c e p t u a l feat u r e s t h a t distinguish a p r e t e n d action or p r e t e n d emotion expression from a realistic one. Knowing looks, slightly tilted head, high pitch a n d slowed down, exaggerated intonation contour, schematic, abbreviated, or only partial execution of action s c h e m e s , a n d t h e u s e of invisible imaginary objects all clearly a n d saliently m a r k for t h e child t h a t t h e p r e t e n d expression is categorically different from its realistic equivalent—that it is "not for real." We h a v e a r g u e d (see c h a p t e r 4) t h a t in t h e case of adaptive p a r e n t a l affect-mirroring interactions, t h e affect-reflective emotion display is also modified by t h e s a m e k i n d s of transformations of t h e corresponding realistic emotion display resulting in a saliently different, m a r k e d form of emotion expression. As a result, while t h e affective c o n t e n t of t h e mirroring display will be recognized by t h e child, it will n o t be attributed to t h e p a r e n t a s h e r real emotion: it will be interpreted a s "not for real." This reality-decoupled interpretation is further reinforced by t h e experienced "nonconsequentialUy" of m a r k e d expressions a n d actions, b o t h in p r e t e n s e a n d in e m p a t h i c mirroring: the normally experienced typical c o n s e q u e n c e s t h a t would be expected to follow t h e realistic, u n m a r k e d form of t h e same expression do n o t e n s u e w h e n t h e perceived display or action is performed in a "marked" pretend mode. We have hypothesized (see c h a p t e r 4 a n d Gergely a n d W a t s o n 1996) t h a t t h e perception of m a r k e d n e s s activates t h e y o u n g child's m e t a r e p r e s e n t a t i o n a l s y s t e m (Leslie 1987), w h i c h allows for t h e "decoupling" of the expression from its referents in a c t u a l reality. T h e e n s u i n g u n d e r s t a n d i n g of t h e m a r k e d p r e t e n s e or affect-mirroring display a s referring to a fictional world a n d , a s s u c h , a s having no realistic c o n s e q u e n c e s c o n t r i b u t e s crucially to affect regulation. T h e child feels safe in t h e "decoupled," fictional world of representational r e e n a c t m e n t in w h i c h no realistic negative outcomes c a n o c c u r (Gergely a n d W a t s o n 1996). Freud's (1920g) famous analysis of t h e "fort-da" p r e t e n d game of h i s 18-month-old g r a n d s o n highlights some further important features of t h e u s e of m a r k e d externalizations t h a t foster affective coping with negative affect. He. observed h i s g r a n d s o n playing o u t repeatedly t h e very s a m e event, which involved throwing a b o b b i n of t h r e a d over t h e c u r t a i n of h i s crib, saying "fort" it

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[away] a s t h e object d i s a p p e a r e d from sight a n d t h e n retrieving it, saying "da" [back]. According to Freud's interpretation, in t h e first event of t h e p r e t e n d episode {"fort") t h e child w a s externalizing t h e s e p a r a t i o n s from h i s m o t h e r t h a t inevitably occurred in the course of their daily lives. T h e second p a r t of t h e s e q u e n c e {"da"), however, corresponded to a wishful imaginary u n d o i n g of these painful s e p a r a t i o n s . T h e externalized pretend version differed from t h e internally r e p r e s e n t e d t r a u m a t i c event encoded in memory in t h a t d u r i n g t h e r e e n a c t m e n t t h e child w a s a n active agent who was in control over t h e unfolding of t h e p r e t e n d episode, w h e r e a s d u r i n g t h e a c t u a l event a s r e p r e s e n t e d in h i s memory h e w a s a helpless subject, passively experiencing t h e traumatizing s e p a r a t i o n event. This resulted in a n emotionally corrective experience insofar a s t h e perception of t h e qualitatively transformed, m a r k e d externalization of t h e originally t r a u matic event g e n e r a t e s positive affects of agency a n d r e u n i o n t h a t counteract t h e negative emotions associated with t h e original event memory. T h i s type of self-controlled modified r e e n a c t m e n t within t h e safe "pretend mode" of a fictional representational world provides, therefore, a n effective way of helping to cope with the painful m e m o r y of t h e t r a u m a t i c event. Up to n o w we h a v e d i s c u s s e d two types of p h e n o m e n a exemplifying w h a t we called "marked externalizations": empathic parental affect-mirroring a n d p r e t e n d play. In b o t h c a s e s t h e marked e x p r e s s i o n s of t h e child's internal affective c o n t e n t s are, indeed, "externalized": they are.perceived by t h e child a s external events "out there" in t h e world. (The s a m e is true, of course, in the case of "symbolic externalizations" u s i n g external m e d i a of expression s u c h a s drawings, paintings, sculptures, or protagonists in a play.) However, t h e r e are also other ways of expressing one's internal affective c o n t e n t s for self-regulative p u r p o s e s t h a t involve purely mentally generated subjective "internal events" t h a t are perceived only introspectively, a s in daydreaming, fantasizing, a n d imagination. (Pretend play a n d d i s c u s s i o n s with a n imaginary p a r t n e r exemplify a truly "mixed" form of externalization a n d internal imagery.) In c h a p t e r 11 o n mentalized affectivity dealing with forms of affect regulation in a d u l t patients, we develop t h e concept of "inward expression of affects" t h a t involves self-reflective a n d

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introspective a p p r e h e n s i o n a n d a w a r e n e s s of one's own emotions a s t h o s e a r e expressed a n d r e p r e s e n t e d to oneself in one's mind. We w i s h to a r g u e t h a t t h e s e "inner forms of self-reflective emotional experiences" belong to t h e s a m e category of "marked" a n d "symbolic externalizations" a s p r e t e n d play a n d empathic affect-mirroring, except for t h e fact t h a t t h e y u s e a n internal— r a t h e r t h a n external—medium of r e p r e s e n t a t i o n for t h e affectregulative expression of p r i m a r y emotional experiences. The t h r e e features t h a t we identified a s contributing to t h e emotionally corrective affect-regulative experience in m a r k e d externalizations—perceptual m a r k e d n e s s , transformation of t h e role of t h e experiencer from passive subject into active agent, a n d cont e n t modification—can also b e found in daydreaming, fantasy, a n d imagination. In fact, t h e s e "internal expressions" a r e also perceived (in t h e "mind's eye") a s decoupled a n d representational in n a t u r e (markedness). As s u c h , t h e y are n o t confused with the a c t u a l emotional experience they inwardly express: t h e introspecting subject r e m a i n s a w a r e t h a t t h e s e internafaffect expressions are "not for real." In t h e s a m e vein, inward expressions of emotionally charged event m e m o r i e s or fantasies c a n b e actively controlled by t h e subject a n d their c o n t e n t s c a n b e modified willfully, j u s t a s in t h e c a s e of externally r e p r e s e n t e d pretend play. From a developmental point of view, we hypothesize t h a t m a r k e d externalizations of internal affective c o n t e n t s u s i n g a n external m e d i u m of expression precede a n d pave t h e way for the development of forms of purely "inward expressions" of affect s t a t e s in t h e service of affective self-regulation. In particular, it is noteworthy t h a t in e m p a t h i c p a r e n t a l affect-mirroring t h e act of externalization, t h e p e r c e p t u a l m a r k i n g of t h e expression, and t h e partial modification of its c o n t e n t (as in t h e c a s e of partial mirroring or p r e s e n t i n g "mixed emotions"—cf. Fonagy and Fonagy 1995) are all carried o u t by t h e mirroring adult, n o t by t h e infant. In t h i s case, even t h e infant's s e n s e of control and agency over t h e e n s u i n g affect-regulative experience is generated automatically by t h e detection of t h e high degree of contingent r e l a t e d n e s s between t h e b a b y ' s emotion e x p r e s s i o n s a n d the mirroring display. Therefore, we suggest t h a t r e p e a t e d experience with affect-regulative p a r e n t a l mirroring m a y provide infants

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with a n early proto-form of m a r k e d externalizations a t a n age when they a r e a s yet u n a b l e on their own to g e n e r a t e m a r k e d externalizations of their internal affective states. T h u s , we believe t h a t early o p p o r t u n i t i e s to encode t h e m a r k e d n e s s (signaling "nonconsequentiality" a n d decoupling from physical reality), t h e content modifications (leading to reduction of u n p l e a s u r e a n d wish fulfillment), a n d t h e agentive a s p e c t s of p a r e n t a l mirroring displays (exerting control a n d mastery), together with t h e establishment of a n association between t h e s e features a n d t h e ensuing affect-regulative experience, m a y provide i m p o r t a n t experiential preconditions t h a t facilitate t h e emergence of t h e active u s e of t h e s e features for emotional self-regulation by t h e infants themselves (as in p r e t e n d play or e m p a t h i c pro-social actions appearing d u r i n g t h e second year of life—see c h a p t e r 5).

BIOLOGICAL AND SOCIAL DETERMINANTS OF T H E AFFECT-REGULATIVE U S E OF 'MARKED EXTERNALIZATIONS" From t h e r e p r e s e n t a t i o n a l point of view, all of t h e s e different— external a n d internal—forms of intentional self-expressions are metarepresentational in n a t u r e (Leslie 1987): they p r e s u p p o s e the availability of second-order representations (Dennett 1991; Dennett a n d H a u g e l a n d 1987) a n d t h e ability to "decouple" representations from reality (Leslie 1987, 1994). It is precisely for t h a t r e a s o n t h a t all t h e s e different forms of self-expressions of primary affective c o n t e n t s h a v e t h e potential to be u s e d for affective self-regulation: they c a n be experienced a s "not for real" and a s "nonconsequential," t h e y provide a n experience of safety and agency t h r o u g h t h e exertion of control, a n d they c a n generate corrective emotional "rewriting" of t h e negative affect m e m o r y by reexperiencing it in t h e m a r k e d "as-if" mode with a modified emotional c o n t e n t . From this view it follows t h a t lacking second-order representations to e x p r e s s internal affective s t a t e s or lacking t h e m e t a r e p r e s e n t a t i o n a l capacity for referential decoupling c a n be expected to lead to a n impoverished or nonexistent u n d e r s t a n d -

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ing of intentional m e n t a l s t a t e s — s u c h a s beliefs a n d desires—in t h e self a n d others. S u c h a primary deficit in theory of m i n d is t h e central feature of t h e debilitating condition of "mindblindness" (Baron-Cohen 1995) t h a t is characteristic of t h e disorder of childhood a u t i s m . A further predictable c o n s e q u e n c e t h a t we wish to e m p h a s i z e here is t h e lack of affective impulse control t h a t is also highly typical of children with a u t i s m (see Hobson 1993). The m e n t a l capacity to r e p r e s e n t second-order represent a t i o n s a n d t h e related ability for referential decoupling m a y well t u r n o u t to be i n n a t e a d a p t a t i o n s of t h e h u m a n m i n d (Fodor 1992; Leslie 1987, 1994) t h a t m a y be genetically impaired in childhood a u t i s m (Baron-Cohen et al. 1985; U. Frith 1989). However, even if t h e i n n a t e r e p r e s e n t a t i o n a l abilities necessary for theory of m i n d were intact, o u r view is t h a t certain types of dysfunctional early a t t a c h m e n t e n v i r o n m e n t s m a y still result in a delayed or impoverished unfolding of t h e capacity to mentalize a n d / o r in a n acquired inhibition of its adaptive u s e for affective self-regulation. The case for a partially psychosocial model of t h e development of mentalization w a s m a d e in chapter 3 against t h e b a c k g r o u n d of behavior-genetics r e s e a r c h . There are several c a u s a l p a t h w a y s t h r o u g h w h i c h deviant p a t t e r n s of affective reactivity within t h e a t t a c h m e n t context m a y lead to acquired deficits or developmental a r r e s t s in t h e unfolding of the functional u s e of early mentalization capacities. 1. As hypothesized in c h a p t e r 4 (see also Gergely a n d Watson 1996), t h r o u g h p r o c e s s e s of social biofeedback, t h e infant-att u n e d affect-mirroring environment m a y play a n i m p o r t a n t role in establishing differentiated emotion r e p r e s e n t a t i o n s t h r o u g h sensitization to emotion-specific p a t t e r n s of i n t e r n a l - s t a t e cues. F u r t h e r m o r e , already d u r i n g t h e preverbal stage adaptive affectmirroring m a y provide a n early o p p o r t u n i t y for establishing second-order r e p r e s e n t a t i o n s of p r i m a r y affect s t a t e s in t h e form of internalized r e p r e s e n t a t i o n s of t h e m a r k e d mirroring displays t h a t t h e infant comes to associate with t h e contingent internal affect state. Serious a b s e n c e of s u c h adaptive mirroring within t h e a t t a c h m e n t context may, therefore, r e s u l t in undifferentiated internal affective s t a t e s , in impoverished a w a r e n e s s of emotional self-states, a n d in a t e n d e n c y to confuse internal m i n d states

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with external reality. In other words, it m a y lead to a developmental arrest at the level of "psychic equivalence" functioning where m e n t a l s t a t e s a n d reality s t a t e s r e m a i n confused a n d undifferentiated. 2. Deviant mirroring e x c h a n g e s t h a t involve externalization of t h e infant's negative affects in t h e form of u n m a r k e d a n d realistic negative emotional reactions of t h e caregiver m a y lead to escalation r a t h e r t h a n m o d u l a t i o n in t h e baby's negative affect state. This c a n e s t a b l i s h a s t r o n g association between externalizations of negative i n t e r n a l c o n t e n t s a n d c o n s e q u e n t dysequilibratiori a n d t r a u m a t i z a t i o n . S u c h a n a t t a c h m e n t environment c a n lead to a generalized avoidance of externalization as a means of selfregulation, r e s u l t i n g in serious p r o b l e m s of i m p u l s e control. F u r t h e r m o r e , learning a b o u t t h e significance of perceptual c u e s of m a r k e d n e s s a s signaling referential decoupling a n d n o n c o n sequentiality (i.e., acquiring t h e generalized communicative code of t h e p r e t e n d m o d e a s indicating decoupling from reality) m a y become seriously delayed a n d impoverished. This would lead to a kind of "blindness to m a r k e d n e s s , " leading to a tendency to confuse p r e t e n s e with reality.

CLINICAL ILLUSTRATION: "MAT" Mat w a s b r o u g h t to p s y c h o t h e r a p y by h i s m o t h e r at 4.1 y e a r s of age with a series of behavioral a n d impulse-control problems. In his m o t h e r ' s view t h e m o s t s e r i o u s of t h e s e w a s failure to achieve toilet training by 4 y e a r s of age a n d t h e child's s t r o n g tendency to withhold h i s feces. Mat would obstipate for several days, would refuse to p a s s stool sitting on t h e toilet, a n d would oblige only if given a diaper. His m o t h e r also complained bitterly a b o u t Mat's uncontrollable emotional o u t b u r s t s , frequent t a n t r u m s , a n d externalizing violent behavior, b o t h a t t h e day-care center a n d a t home. He often a t t a c k e d smaller children a t t h e day-care center, and h e t o r t u r e d h i s dog a t h o m e . He w a s also described a s being obstinate, oppositional, a n d controlling ("giving orders") in h i s relationship with h i s m o t h e r . Mat's m o t h e r complained t h a t he

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w a s always a s k i n g "silly questions," w h i c h indicated serious castration anxiety, fantasies of physical i n t r u s i o n , a phobic fear of babies, a n d a n a n x i o u s interest in C e s a r e a n b i r t h s . Mat w a s a sickly child, with a history of illnesses (croup, a form of a c u t e respiratory d i s t r e s s in children, p n e u m o n i a , allergies) a n d hospitalizations. Following t h e pediatrician's advice, h i s m o t h e r stayed a t h o m e with h i m for t h e first t h r e e y e a r s of h i s life. He s t a r t e d to go to day-care only shortly before starting t h e r a p y a n d only for t h e m o r n i n g h o u r s . Mat showed a n anxious, ambivalent a t t a c h m e n t a t t i t u d e to h i s m o t h e r , clinging to her yet avoiding h e r gaze a t t h e s a m e time. He exhibited strong s e p a r a t i o n anxiety w h e n left in day-care or w h e n entering my room for therapy. 1 Mat's m o t h e r w a s a stiff, poker-faced w o m a n with flat emotionality who, nevertheless, did n o t hesitate to convey to m e h e r exasperation, dissatisfaction, a n d often openly hostile feelings (including a n g e r a n d disgust) toward h e r s o n . S h e w a s r a t h e r dismissive of h e r child, w h o m s h e described a s hopelessly spoiled a n d worthless. S h e w a s cold, intrusive, a n d overcontrolling in h e r interactions with Mat. S h e told m e t h a t s h e often "lost h e r head," s h o u t i n g a t h i m a n d b e a t i n g h i m u p . They lived in a closely symbiotic relationship t h a t w a s d o m i n a t e d by aggression, rage, a n d often escalating negative affects. S h e s t r u c k m e a s being r e m a r k a b l y incapable of feeling e m p a t h y or a t t u n e m e n t to h e r child's m e n t a l states, a n d a s being in general quite u n a b l e to cope with h e r s o n ' s negative emotions. W h e n faced with Mat's negative affective displays, s h e often reacted with complementary a n d realistic negative emotions herself, w h i c h typically led to a n escalation of t h e child's negative state. A good example of t h i s is h e r description of t h e recurring p a t t e r n of interaction in relation to Mat's willful refusal to open h i s bowels. W h e n left in t h e n u r s e r y by h i s m o t h e r , Mat would refuse to p a s s stool, b u t w h e n h e w a s picked u p by h e r in the afternoon, he could hardly withhold it on t h e w a y h o m e . At home s h e would m a k e h i m sit on t h e toilet a n d would sit d o w n next to h i m herself. He would, however, refuse to p a s s stool (even t h o u g h often in pain), a n d t h e y would b e sitting t h e r e like this 1

The therapist was Gyorgy Gergely; &

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"for h o u r s . " S h e would get more a n d more angry with h i m a n d would plead with h i m to do it, reinforcing h e r pleas by t h r e a t e n ing h i m with p u n i s h m e n t s a n d by m a k i n g promises. Eventually, she would become deeply resentful, p u t diapers on Mat, place him in h i s crib, a n d a t t e m p t to leave t h e room. Facing t h e prospect of separation, however, Mat would t h e n promptly soil his diapers. T h i s would outrage h i s m o t h e r , b e c a u s e s h e would need to come b a c k a n d c h a n g e him. At this point s h e would often s h o u t a t h i m a n d hit h i m in h e r rage. I h a d t h e s t r o n g i m p r e s s i o n t h a t Mat's m o t h e r w a s quite incapable of a t t e n d i n g to a n d r e a d i n g t h e dispositional displays t h a t would allow h e r to identify h e r child's m e n t a l states. This w a s corroborated by t h e a l m o s t incredible story a b o u t Mat's older sister t h a t Mat's m o t h e r s h a r e d with m e in a r a t h e r c a s u a l tone of voice. Mat's sister w a s b o r n practically blind, b u t t h i s fact went u n n o t i c e d by h e r p a r e n t s for several years. They found out a b o u t h e r condition only w h e n a t a r o u n d t h e age of 3 or 4 years s h e w a s t a k e n to a r o u t i n e medical c h e c k u p in h e r n u r s e r y school. Both p a r e n t s h a d a p p a r e n t l y m i s s e d t h e girl's almost total inability to see t h e m clearly u n l e s s very close a n d directly facing t h e m . This m a d e m e w o n d e r a b o u t t h e s e r i o u s n e s s of this dismissive m o t h e r ' s insensitivity to a n d lack of monitoring of t h e dispositional facial c u e s of h e r children. For a long time Mat showed seriously regressive functioning during t h e r a p y sessions. W h e n h e arrived, h e would be extremely frightened, crying a n d clinging to h i s m o t h e r a n d trying to stop h e r from going o u t to t h e waiting-room. Mat w a s clumsy a n d s o m e w h a t dirty a n d smelly; h e b r e a t h e d heavily, continually salivated slightly, a n d w a s easily frightened of small s o u n d s . He would disregard m y p r e s e n c e a n d avoid eye contact with me, a n d he would n o t r e a c t verbally or otherwise to m y a t t e m p t s a t making c o n t a c t with him. He only spoke to m e w h e n giving orders. Here, we will c o n c e n t r a t e on two pathological features of Mat's behavior t h a t b e c a m e increasingly a p p a r e n t d u r i n g t h e early p h a s e s of t h e t h e r a p y . One w a s Mat's i n a d e q u a t e a n d sometimes bizarre u s e of language. He did n o t obey t h e implicit p r a g m a t i c rules (Grice 1975) underlying n o r m a l c o m m u n i c a t i v e exchanges: h e would very often n o t r e s p o n d to verbal inquiries b u t would sometimes

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repeat t h e question in a m o n o t o n o u s , echolalic fashion. When speaking, h e would s o m e t i m e s mix u p t h e first-, second-, a n d third-person p r o n o u n s in h i s s e n t e n c e s . His interpretations were concretistic a n d literal, a n d h e often u s e d w o r d s with obscure, idiosyncratic m e a n i n g s a n d interpreted expressions independently of their context of u s e . The second strikingly dysfunctional feature w a s t h e fact t h a t Mat seemed incapable of either producing or understanding symbolic play and pretense. His play activities consisted solely of repetitive, stereotypic actions u s i n g mainly w o o d e n building blocks to m a k e towers a n d r o a d s . He w a s fascinated with toy cars, w h i c h he p u s h e d b a c k a n d forth between t h e wooden s t r u c t u r e s . However, for t h e m o s t p a r t he avoided u s i n g figurative toys s u c h a s dolls, a n d h e did n o t engage in a n y pretend activities. My efforts a t engaging h i m in symbolic play were generally futile. In fact, Mat showed a clear aversion to h u m a n or a n i m a l toy figures a n d would t u r n away from t h e m or throw t h e m away w h e n t h e y were offered to him. According to his mother, h e never played with figurative toys a t h o m e either: he w a s only interested in c o m p u t e r g a m e s a n d in building blocks. He never h a d a transitional object. His paintings were composed of diffuse lines a n d s m e a r e d paint, w i t h o u t a n y discernible figurative content. It also soon b e c a m e clear t h a t Mat h a d s e r i o u s difficulties with interpreting p r e t e n d activities a n d c o m m u n i c a t i o n s a n d h a d trouble u n d e r s t a n d i n g t h e m a r k e d , exaggerated pretend mode of expressions. For example, while he w a s painting, I pointed at t h e orange-colored w a t e r in h i s c u p a n d said: "Look, it's j u s t like orange juice!" He looked u p with fright a n d said: "But you c a n n o t d r i n k that!" "Of c o u r s e I can," I replied jokingly, with a marked- p r e t e n d intonation a n d raising t h e c u p to my m o u t h , obviously p r e t e n d i n g to d r i n k t h e "orange juice." Mat b e c a m e even m o r e frightened (apparently believing t h a t I was actually drinking t h e p a i n t i n g water) a n d s h o u t e d : "Don't do that, it c a n n o t be drunk!" O n a n o t h e r occasion I took out a p u p p e t figure of a fox a n d asked- Mat if h e w a n t e d to play with t h e p u p p e t . He said immediately t h a t h e didn't. B u t I proceeded to a n i m a t e t h e p u p p e t , m a k i n g it walk a r o u n d while speaking with a "foxy" m a r k e d intonation. Mat looked a t t h e fox with

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intense fear, a s if it h a d really come alive. Then, nearly crying, he begged m e to stop, almost s h o u t i n g t h a t he didn't like p u p p e t s . A final example: in o n e session, Mat a n d I played a b o a r d g a m e in which one could win small t r e a s u r e c h e s t s w h e n arriving a t certain positions. Without following t h e rules of t h e game, Mat always p u t h i s pieces on t h e winning positions a n d collected all the t r e a s u r e c h e s t s , while I received nothing. I p r e t e n d e d to cry (in a clearly m a r k e d m a n n e r ) , complaining t h a t I didn't get a n y treasure. Mat looked a t m e with fright, shouting: "Don't do t h a t ! Only b a b i e s cry! You are n o t a baby!" Both Mat's inability to u n d e r s t a n d or p r o d u c e pretend play a n d h i s dysfunctions of language u s e described above are core features of t h e symptomatology of childhood a u t i s m . Other features of Mat's pathology, s u c h a s h i s difficulties with impulse control, h i s t e n d e n c y for t a n t r u m s , h i s perseverative, repetitive, a n d stereotypic object-manipulative activities with nonfigurative objects, h i s lack of eye contact, a n d h i s obsessive interest in vehicles, were also suggestive of a possible autistic disorder. Children with a u t i s m s e e m to lack t h e m e t a r e p r e s e n t a t i o n a l ability for "decoupling" (Baron-Cohen et al. 1985; Leslie 1994) t h a t is a r g u e d to be a r e p r e s e n t a t i o n a l prerequisite both for u n d e r s t a n d i n g intentional m e n t a l s t a t e s in o t h e r s s u c h a s false beliefs a n d for u n d e r s t a n d i n g p r e t e n s e (Leslie 1987). In n o r m a l development, children s t a r t to u n d e r s t a n d a n d produce pretend play by t h e e n d of t h e second year (Harris a n d K a v a n a u g h 1993), and they p a s s t h e so-called false-belief theory-of-mind t a s k s (Wimmer a n d P e r n e r 1983) by 4 y e a r s of age (see c h a p t e r 5). Children with a u t i s m , however, tend to fail on t h e s e t a s k s even at a significantly h i g h e r m e n t a l age t h a n 4 years. The related ability to d i s t i n g u i s h a p p e a r a n c e from reality ( u n d e r s t a n d i n g t h a t s o m e t h i n g looks like X, b u t is really Y) also emerges a t around 4 y e a r s of age (Flavell et al. 1987). I tested Mat on two versions of t h e s t a n d a r d false-belief t a s k s a s well a s on a s t a n d ard a p p e a r a n c e - r e a l i t y t a s k a t 4.6 a n d a t 5.0 y e a r s (an age a t which n o r m a l children already p a s s t h e s e tasks). He failed e a c h time, showing a clear lack of u n d e r s t a n d i n g of false beliefs a s well a s of t h e a p p e a r a n c e - r e a l i t y distinction. While t h i s provided potentially s u p p o r t i n g evidence for t h e possibility t h a t Mat w a s , in fact, autistic, t h i s early suspicion

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w a s clearly refuted by later developments in t h e therapy, when h i s previously d o r m a n t ability to u n d e r s t a n d a n d u s e pretend play s t a r t e d to emerge. In t h e light of t h e s e developments, it b e c a m e clear t h a t h i s pervasive difficulties with u n d e r s t a n d i n g a n d p r o d u c i n g symbolic play a n d p r e t e n s e were n o t d u e to a genetically b a s e d lack of m e t a r e p r e s e n t a t i o n a l competence, b u t h a d a psychosocial origin. We believe t h a t Mat w a s arrested in h i s development functioning a t t h e level of "psychic equivalence" (cf. Fonagy a n d Target 1996 a n d c h a p t e r 6) b e c a u s e of the deviant a n d t r a u m a t i z i n g affect-mirroring e n v i r o n m e n t t h a t his m o t h e r provided h i m with. B u t before e x p a n d i n g t h i s hypothesis, let u s briefly describe two d i s t u r b i n g episodes from Mat's t h e r a p y that, we believe, illustrate well o u r h y p o t h e s i s t h a t Mat's m e n t a l functioning w a s arrested a t t h e level of psychic equivalence.

T r a u m a t i z i n g "Reality-Play": F u n c t i o n i n g at t h e Level of P s y c h i c E q u i v a l e n c e At t h e beginning s t a g e s of t h e t h e r a p y t h e r e were, in fact, two occasions w h e n it proved possible to engage Mat in "playing" u s i n g figurative, symbolic toys t h a t depicted h u m a n persons. However, on b o t h occasions Mat showed a clear lack of unders t a n d i n g of t h e " a s - i f n a t u r e of t h e situation, confusing play with reality a n d experiencing t h e aggressive a n d a n x i o u s fantasies externalized in t h e play a s a c t u a l reality of (re)traumatizing intensity. As a result, d u r i n g t h e s e play episodes h e became m o r e a n d more excited, fearful, aggressive, a n d anxiety-rid den. T h e s e negative affects escalated to s u c h t r a u m a t i c intensity t h a t for weeks to come Mat avoided t h e toys a n d even t h e corner of t h e room where t h e s e play episodes h a d t a k e n place. During t h e first episode, I called Mat's a t t e n t i o n to a toy b a t h r o o m a t t h e c o r n e r of t h e room. In it t h e r e w a s a b a t h t u b , a toilet, and—for s o m e accidental r e a s o n — a n oven. There w a s also a large c h u n k of playdough a t h a n d a n d two (a smaller and a larger) n a k e d b a b y dolls. Mat first took one of t h e dolls a n d p u t it in t h e b a t h t u b . T h e n he took it o u t a n d m a d e it sit on t h e toilet to m a k e it poop. I called h i s a t t e n t i o n to t h e c h u n k of playdough

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a n d told h i m h e could m a k e poop o u t of it if h e w a n t e d to. Mat tore off a piece excitedly a n d placed it in the toilet u n d e r t h e doll. He t h e n found a toy s p a t u l a , showed it to me, a n d a s k e d m e w h a t it w a s for. I told him, b u t h e refused m y explanation with a definite "no." He s t a r t e d to u s e t h e s p a t u l a to c u t pieces off t h e c h u n k of playdough a n d said: T h i s Is for p u t t i n g t h e big poop into them!" He t h e n took t h e doll from t h e toilet a n d s t u c k t h e "poop" h e h a d c u t off with t h e s p a t u l a to its bottom. He took a n o t h e r piece of playdough, o n e end of which looked elongated a n d "spiky." "This is t h e big spiky poop!" he said excitedly a n d , wheezing heavily, h e s t u c k it to t h e bottom of the other doll. "Is the first one d o n e yet?"—I a s k e d . "No, no, he n e e d s to poop a lot, he is going to s t a y t h e r e until Spring!"—Mat said. Then he took t h e small doll off t h e toilet a n d p u t t h e big doll on instead to m a k e it poop a s well. He s t a r t e d to squeeze t h e small doll with its bottom forward into t h e oven, s h o u t i n g : "We will cook h i s bottom!" He t h e n took t h e "cooked" small doll o u t of t h e oven a n d tried to squeeze in t h e large one, b u t didn't quite succeed. So h e p u t it into t h e b a t h t u b instead. "Is h e t a k i n g a bath?"—I asked. "No, h e is dead!"—he answered. "How did he die?" "From the fire a n d t h e water, from t h e fire a n d t h e water!!!"—he s h o u t e d in uncontrollable excitement, h i s whole body s h a k i n g . T h e n h e p u t the other doll b a c k into t h e oven: "We'll cook h i s bottom, too, a n d so he will die a s well!" "Who a r e t h e s e children?—I asked him. " J o h n n y a n d Mat"—he said ( J o h n n y w a s h i s friend at t h e n u r s ery). At t h e beginning of t h e second episode some two m o n t h s later, I called Mat's attention to a large painted R u s s i a n doll t h a t could be t a k e n a p a r t to reveal a smaller doll inside, which again could be t a k e n a p a r t to reveal a n even smaller doll, a n d so on. Mat w a s very interested; h e p u t t h e dolls b a c k a n d t h e n took t h e m a p a r t again. He t h e n said: "I've seen a lot of b a b i e s on TV; they were all crippled: they didn't h a v e h a n d s , a n d legs, a n d ears, a n d t h e y d i d n ' t h a v e a weenie!" He laughed in excitement a n d r a n to t h e dolls placed on a shelf to look for one with a penis. He found one, r a n with it to t h e corner of t h e room where t h e toy b a t h r o o m w a s with t h e oven t h a t w a s u s e d in t h e first t r a u m a tizing "reality-play." He opened t h e oven, looking for t h e small doll t h a t h e h a d "cooked to death" in it two m o n t h s earlier. He

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took t h e doll with t h e p e n i s a n d s t a r t e d to s h o u t : "I'm giving him a n injection into h i s weenie, a n d into h i s bottom, a n d into his arm," a n d so on. He u s e d a s h a r p pencil a s h i s needle a n d injected t h e different p a r t s of t h e doll with increasing excitem e n t . "Did you also get a n injection?"—I a s k e d him. "Yes, into m y arm"—he said. He t h e n ordered m e to inject t h e doll's bottom while h e w a s wildly poking h i s pencil into its penis. T h e n he s h o u t e d out: "Let's c u t u p h i s s t o m a c h a n d t a k e o u t t h e baby!" He c o n t i n u e d to give s h o t s to t h e doll, more a n d m o r e wildly, until t h e pencil broke. "Now we'll p u t a nail into h i s weenie! . . . Nailed baby!!!"—he cried. "We'll h e a t h i m up! . . . We'll give h i m a cold shower!!!"—he s h o u t e d a s h e w a s p r e s s i n g a toy pretzel (the "cold shower") a s h a r d a s h e could into t h e doll's nailed penis.

Moving t o t h e Pretend Mode of F u n c t i o n i n g : The D i s c o v e r y of t h e Affect-Regulative P o t e n t i a l s of M a r k e d n e s s and Pretend Play After a b o u t six m o n t h s Mat's behavior a n d m e t a c o m m u n i c a t i o n started to s h o w signs of qualitative improvement. He w a s m u c h less disorganized, h i s speech cleared u p a n d showed m u c h less confusion a n d fewer idiosyncratic elements, h e held a n d even initiated eye contact, a n d h e seemed to s t a r t to enjoy coming to t h e sessions. T h e s e c h a n g e s coincided with a r e m a r k a b l e play episode in w h i c h h e seemed to h a v e "discovered" t h e m e a n i n g of t h e m a r k e d "as-if" m o d e of expressions a n d t h e affect-regulative potentials of t h e pretend m o d e of functioning. This episode clearly c h a n g e d t h e c o u r s e of t h e therapy. We were playing t h e b o a r d g a m e m e n t i o n e d before in which small t r e a s u r e c h e s t s could be won. Disregarding b o t h m e a n d t h e rules of t h e game, Mat t h r e w h i s dice a n d collected a s m a n y t r e a s u r e c h e s t s a s h e could again a n d again, while I got nothing. This w a s t h e occasion w h e n I p r e t e n d e d to cry a little, with a clearly m a r k e d , exaggerated " a s - i f intonation. Mat b e c a m e very frightened a n d told m e to stop b e c a u s e only b a b i e s cry, a n d I w a s n o t a baby. I stopped immediately a n d tried to calm Mat by explaining gently t h a t I w a s n ' t really s a d a n d w a s n ' t really cry-

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ing—that I w a s j u s t p r e t e n d i n g to cry. Mat looked a t m e attentively a n d for a long time, a s if slowly u n d e r s t a n d i n g (maybe for the first time) w h a t w a s m e a n t by t h e s e words. He seemed to calm down a n d c o n t i n u e d to play. At t h e next session h e c a m e in with a b r o a d smile on h i s face a n d a n n o u n c e d immediately t h a t he w a n t e d to play t h e b o a r d g a m e again. W h e n it w a s m y t u r n . Mat looked a t m e smiling a n d told m e t h a t he r e m e m b e r e d t h a t last time I w a s s a d , b u t now I didn't need to be s a d a n y more b e c a u s e h e would let m e go directly to t h e position where I c a n get t h e t r e a s u r e c h e s t s . T h e n h e pointed a t t h e bolted door of t h e tower on t h e b o a r d g a m e t h a t w a s g u a r d e d by a dragon a n d said: "This is w h e r e we need to go in a n d save t h e woman!" "Aren't you afraid of t h e dragon?"—I a s k e d him. "No, together we shall kill it!"—Mat said, smiling. T h e n h e again asked m e w h e t h e r I was sad. I a n s w e r e d t h a t indeed I w a s feeling a bit sad, a n d I pretended to cry a little. He w a t c h e d m e "crying" with fascination and t h e n consoled m e by helping m e win some m o r e t r e a s u r e . He t h e n w e n t directly to t h e tower, killed t h e dragon, a n d saved the "woman." When we finished playing. Mat found a n o t h e r b o a r d game: a game s o m e w h a t like checkers. He a s k e d m e how to play it, a n d I told h i m t h a t if h e stepped over m y piece, I would "die" a n d would h a v e to t a k e m y piece off t h e b o a r d . Mat t h e n stepped over my piece a n d took it off t h e board, w a t c h i n g m e carefully a n d asking w h e t h e r I w a s s a d to h a v e died. G u e s s i n g w h a t he expected m e to do, I p r e t e n d e d to cry a little. Mat smiled broadly and told me: "Don't be s a d , b u t step over me, a n d t h e n I shall die!" "And you won't be sad?"—I a s k e d . "No, b e c a u s e I like to die!"—he a n s w e r e d cheerfully. We w e n t o n playing t h e s e two g a m e s repeatedly for a few months. We developed several variations on t h e s a m e theme: one of u s would get into s o m e kind of trouble, p r e t e n d to be s a d a n d cry or even die, u n t i l t h e other invariably c a m e to t h e rescue. The themes always h a d to do with dying a n d coming alive, getting into trouble a n d being saved, getting w o u n d e d a n d being cured, becoming s a d a n d being cheered u p . Mat enjoyed t h e s e g a m e s enormously. It w a s a s if h e h a d discovered a whole n e w world: the world of "as-if" reality.

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During o u r last session we played a n e w b o a r d g a m e in which we were h u n t e r s in t h e jungle. "You a r e t h e M o t h e r - h u n t e r , a n d I a m t h e F a t h e r - h u n t e r , " Mat said. As u s u a l , we got into all sorts of trouble again a n d again, b u t e a c h w a s invariably saved by the other. At t h e end of t h e h o u r I w a n t e d to escort Mat to the waiting-room (we h a d to p a s s t h r o u g h two d o o r s a n d go u p a staircase). Mat said: "No, s t a y here, I'll go on m y own." I followed h i m from a d i s t a n c e a n d s a w how h e m e t h i s s u r p r i s e d m o t h e r on h i s own, smiling broadly a n d telling her: "When I grow up, I'll be a h u n t e r , a n d I'll* shoot a rabbit!" His m o t h e r never b r o u g h t h i m to t h e r a p y again.

DISCUSSION We believe t h a t Mat's case illustrates well o u r theory of t h e role of m a r k e d n e s s a s a vehicle of affective self-regulation, b o t h in affect-mirroring i n t e r a c t i o n s a n d in imaginary p r e t e n d play. It also h e l p s u s illustrate o u r h y p o t h e s i s t h a t adaptive mirroring of negative affects m a y play a n i m p o r t a n t role in t h e y o u n g child's t r a n s i t i o n in r e p r e s e n t a t i o n a l functioning from t h e level of psychic equivalence to a level of mentalizing where p r e t e n d play is possible. Finally, it s h e d s light on how a certain type of deviant p a r e n t a l mirroring environment, in w h i c h t h e negative affective displays of t h e child r e s u l t in contingent b u t u n m a r k e d and realistic negative emotional reactions of t h e caregiver, m a y lead to a developmental a r r e s t a t t h e level of psychic equivalence functioning. In o u r d i s c u s s i o n we shall restrict o u r attention to only t h e s e a s p e c t s of Mat's case. Mat's m o t h e r h a d a dismissive, b u t a t t h e s a m e time intrusive a n d overcontrolling personality. S h e also s e e m e d to lack the ability adaptively to mirror a n d t h e r e b y to m o d u l a t e t h e negative affect s t a t e s of h e r child. Their emotional life w a s d o m i n a t e d by negative affect t h a t t e n d e d to escalate r a t h e r t h a n s u b s i d e a s a r e s u l t of their affective interactions. Mat's e x p r e s s i o n s of negative feelings t e n d e d to r e s u l t in contingent a n d realistic negative affective reactions by h e r m o t h e r , leading to a n i n c r e a s e in Mat's negative affect state, w h i c h s o m e t i m e s r e a c h e d traumatizing

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intensity. An example of s u c h deviant affect-mirroring interactions (lacking m a r k e d n e s s ) is t h e r e c u r r i n g episode in w h i c h t h e obstinately withholding boy would sit on t h e toilet "for h o u r s " while h i s m o t h e r , sitting next to him, tried to p e r s u a d e h i m to defecate. O n e c a n a s s u m e t h a t Mat w a s experiencing a variety of growing negative feelings, s u c h a s abdominal pain, anxiety, anger, a n d anticipatory fear, a n d h e displayed at least some of these feelings. His o b s t i n a t e refusal to produce feces a n d h i s negative affect displays i n d u c e d growing frustration, anger, hatred, a n d , eventually, rage in h i s m o t h e r . This g r u e s o m e interchange predictably c u l m i n a t e d in violence a n d t r a u m a t i z a t i o n when Mat's m o t h e r "lost h e r head" a n d b e a t Mat. In adaptive affect-regulative interactions involving m a r k e d parental mirroring of negative affects, t h e child's experience is t h a t t h e contingent externalization of h i s negative emotion s t a t e s (in t h e form of t h e p a r e n t ' s m a r k e d mirroring displays) results in a positive soothing effect (Gergely a n d W a t s o n 1996, 1999). S u c h interactions e s t a b l i s h a n association between externalizing one's negative affects a n d c o n s e q u e n t affect regulation. We hypothesized t h a t s u c h affect-regulative mirroring interactions may, therefore, provide a proto-form a n d experiential prerequisite for the child's later ability to actively u s e m a r k e d forms of externalizations of h i s negative s t a t e s in pretend play a n d in imagination in a n effort to achieve successful self-regulation. We believe t h a t Mat w a s deprived of s u c h crucial experiences of emotionregulative interactions in w h i c h m a r k e d n e s s , externalization of negative affects, a n d c o n s e q u e n t affect regulation could have become associated. Instead, h i s t r a u m a t i z i n g interactions with his m o t h e r , in w h i c h s h e mirrored h i s negative s t a t e s in a n u n m a r k e d , realistic m a n n e r , leading to escalation (rather t h a n modulation) of h i s painful affects, led to a n association t h a t related contingent externalization of negative internal s t a t e s to anticipated t r a u m a t i z a t i o n . This t h e n led to a phobic avoidance of possibilities for symbolic externalization of internal s t a t e s in t h e forms of imagination, symbolic play, or figurative drawing and painting. The lack of adaptive mirroring interactions involving m a r k e d ness also r e s u l t e d in a decreased ability to recognize t h e functional significance of m a r k e d n e s s a s a generalized c o m m u n i c a -

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tive code indicating decoupling from reality. As a result, Mat was initially quite i n c a p a b l e of differentiating p r e t e n s e from reality a n d would experience .the m a r k e d symbolic externalizations of negative affects a s being real r a t h e r t h a n a s being only representations of reality. In other words, Mat w a s a r r e s t e d a t t h e level of psychic equivalence functioning where feelings, t h o u g h t s , fantasies, a n d pretend activities were all experienced a t a single level a s being p a r t s of reality. For example, w h e n h e u s e d t h e s p a t u l a for scooping feces, h e could n o t s i m u l t a n e o u s l y u n d e r s t a n d t h a t t h e proper function of a s p a t u l a in reality is entirely different: t h e imaginary function b e c a m e reality itself. However, Mat w a s n o t imprisoned forever in a m e n t a l world of psychic equivalence. T h e t h e r a p e u t i c b r e a k t h r o u g h involving the "pretending to cry" episode indicates t h a t corrective emotional a n d r e p r e s e n t a t i o n a l experience involving adaptive mirroring of negative affects w a s possible a n d t h e r a p e u t i c . His first reaction to t h e t h e r a p i s t ' s m a r k e d a n d playful expression of s a d n e s s and crying w a s a t t h e level of psychic equivalence: h e showed a n initial confusion of p r e t e n s e with reality a n d consequently became frightened. However, t h e c o n s p i c u o u s lack of negative consequences, t h e repeated p r e s e n t a t i o n of a clearly marked emotion display, a n d t h e calming verbal explanation t h a t "this is n o t for real" could activate t h e child's d o r m a n t representational capacities t h a t , eventually a n d with practice, led to a n adaptive u n d e r s t a n d i n g of t h e functional u s e of m a r k e d n e s s a n d the p r e t e n d mode of mentalizing. Mat, p e r h a p s for t h e first time, could experience t h a t m a r k e d externalizations of negative affective s t a t e s do n o t necessarily c u l m i n a t e in t r a u m a b u t c a n lead to positive emotions of sharing, e m p a t h y , a n d soothing. He discovered t h a t "he likes to die" a s long a s h e is in t h e p r e t e n d mode with a self-regulating other.

CONCLUSION Mat's case illustrated two central points a b o u t t h e role of marked externalizations in emotional self-regulation: (a) It exemplified how t h e s u s t a i n e d lack of early emotion-regulative experiences

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involving m a r k e d affect-mirroring with t h e p r i m a r y a t t a c h m e n t figure m a y r e s u l t in a developmental a r r e s t a t t h e level of psychic equivalence functioning, (b) It showed t h a t in child psychotherapy, t h e sensitive u s e of m a r k e d externalizations of negative affects by t h e t h e r a p i s t m a y lead to corrective emotional a n d representational experience, helping t h e child to move from t h e level of psychic equivalence to t h e adaptive u s e of t h e p r e t e n d mode of m e n t a l functioning in t h e service of affect regulation. It s e e m s clear in Mat's c a s e t h a t h i s m e t a r e p r e s e n t a t i o n a l capacities were n o t genetically impaired, b u t their u s e for affective self-regulation w a s seriously undeveloped or inhibited by h i s experience with t h e deviant style of affective reactivity of h i s mother, w h i c h lacked m a r k e d n e s s a n d resulted in a t r a u m a t i c escalation of Mat's negative affect states. However, we do n o t know how general t h i s acquired representational dysfunction w a s in Mat's case. It is possible t h a t t h e boy's phobic avoidance of symbolic externalizations w a s restricted to t h e specific a t t a c h m e n t context involving h i s m o t h e r a n d to s i t u a t i o n s involving separation from h i s m o t h e r (as in t h e n u r s e r y or in t h e theraT peutic setting). We could n o t rule o u t t h e possibility t h a t Mat may have h a d different a n d possibly more adaptive emotional interactions with o t h e r a t t a c h m e n t figures in h i s life—such a s his father or g r a n d m o t h e r — w h e r e he, in fact, could already have attained t h e p r e t e n d m o d e of m e n t a l functioning. As d i s c u s s e d in c h a p t e r 1 (see also Cicchetti a n d Rogosch 1997; R u t t e r 1987; E. E. Werner 1990), t h e existence of a t least one congenial a t t a c h m e n t context fostering representational development m a y be sufficient to establish relatively m a t u r e mentalizing or reflective functioning. High reflective function, in turn, h a s b e e n s h o w n to correlate with t h e capacity successfully to metabolize a n d cope with t h e potentially d a n g e r o u s affective c o n s e q u e n c e s of t r a u m a t i z a t i o n (Allen 2001; Fonagy, Steele, et al. 1994). If Mat h a d already established t h e capacity to u s e t h e pretend m o d e in some alternative a t t a c h m e n t context, t h e n t h e therapist's s u c c e s s m a y h a v e involved n o more t h a n lifting t h e domain-specific inhibition of Mat's otherwise functioning ability to u s e m a r k e d a n d symbolic externalizations for self-regulation (for a similar example, see t h e case of Rebecca d i s c u s s e d in chapter 6).

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B u t w h a t if a child h a s n o r e a s o n a b l e a t t a c h m e n t relations h i p s a t all a n d comes to experience m a r k e d affect-mirroring a n d affect-regulative symbolic externalizations only in psychot h e r a p y ? This, in fact, m a y have b e e n so in Mat's case. To w h a t degree c a n s u c h t h e r a p e u t i c experiences functionally s u b s t i t u t e for t h e effects of s e c u r e a t t a c h m e n t in bringing a b o u t t h e unfolding of mentalization capacities—thereby transforming psychic equivalence into t h e p r e t e n d mode of m e n t a l functioning? We hope t h a t future clinical r e s e a r c h will s h e d m o r e light on this i m p o r t a n t question. A further related i s s u e c o n c e r n s t h e t r e a t m e n t of adolescents a n d a d u l t p a t i e n t s who s h o w a pathological fixation of m e n t a l functioning a t t h e level of psychic equivalence. Can, for example, o u r developmental model a n d its application to child psychot h e r a p y shed n e w light on t h e n a t u r e of t h e r a p e u t i c c h a n g e t h a t t h e psychoanalytic t r e a t m e n t of a d u l t borderline p a t i e n t s can achieve? In c h a p t e r s 9 - 1 1 we t a k e u p this i s s u e in greater detail. Here it will be sufficient to point o u t t h a t even t h o u g h psychoanalytic p s y c h o t h e r a p y of a d u l t p a t i e n t s applies different—and more age-appropriate—methods from t h o s e u s e d in child p s y c h o t h e r a p y (such a s free association a n d verbal interpretations i n s t e a d of evocative p r e t e n d play), t h e s e t e c h n i q u e s nevertheless seem to exploit t h e s a m e underlying psychological m e c h a n i s m s — m a r k e d n e s s , contingency detection, a n d social biofeedback—that are operative in p a r e n t a l affect-mirroring a n d symbolic play. For example, t h e formal features of t h e psychoanalytic setting a s well a s t h e rules of c o n d u c t specified in the analytic c o n t r a c t c a n b e interpreted a s e s t a b l i s h i n g salient feat u r e s of m a r k e d n e s s t h a t clearly d i s t i n g u i s h t h e u s e of language in t h e analytic discourse from its everyday u s e in communicative exchanges. T h e primary normative function of everyday linguistic c o m m u n i c a t i o n is t h e efficient exchange of novel a n d relevant information between m e m b e r s of t h e l a n g u a g e c o m m u n i t y t h a t fosters survival. T h e implicit p r a g m a t i c rules of verbal c o m m u n i cation specified in t h e so-called Gricean m a x i m s (such a s "Be relevant" or "Be succinct"—Grice 1975), to w h i c h we a u t o m a t i cally a d h e r e in everyday c o m m u n i c a t i o n , serve to optimize precisely t h i s function (see Sperber a n d Wilson 1995). In psychoanalysis a n d psychoanalytic therapy, however, t h i s primary U

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function of l a n g u a g e u s e is explicitly de-emphasized: t h e p a tient—as well a s t h e therapist—is effectively "unplugged" from the normative c o n s t r a i n t s of linguistic c o m m u n i c a t i o n by s u s pending t h e Gricean m a x i m s a n d replacing t h e m with t h e r u l e of "free association." In classical psychoanalysis, lying on t h e couch, lack of eye contact, a n d t h e c o n s e q u e n t deprivation from on-line m e t a c o m m u n i c a t i v e feedback from t h e therapist d u r i n g verbal e x c h a n g e s also serve to s u s p e n d t h e application of t h e pragmatic r u l e s t h a t govern everyday communication. T h e s e normative r u l e s a r e similarly s u s p e n d e d a s regards t h e analyst: she c a n choose to r e m a i n silent, is free to provide n o informative a n s w e r s to t h e p a t i e n t ' s inquiries, or c a n t u r n t h e question back, asking a b o u t t h e underlying motives of t h e patient r a t h e r t h a n dealing with h i s consciously intended meaning. The analyst is also s a n c t i o n e d to provide i n t e r p r e t a t i o n s t h a t do n o t refer to t h e literal m e a n i n g of t h e p a t i e n t ' s verbal c o m m u n i c a t i o n b u t to its inferred u n d e r l y i n g affective content. Note t h a t t h e s e highly specialized psychoanalytic rules of verbal exchange serve to m a k e t h e externalization of internal affective contents t h e p r i m a r y function of l a n g u a g e u s e within the t h e r a p e u t i c context. T h e d a r k e n e d room, t h e relaxed a n d safe a t m o s p h e r e , a n d t h e p a t i e n t ' s lying on t h e c o u c h all serve the p u r p o s e of focusing t h e p a t i e n t ' s a t t e n t i o n on h i s internal mental c o n t e n t s , w h i c h are to be externalized within t h e safe, reality-decoupled " a s - i f world of t h e analytic situation. The differential features a n d rules of t h e psychoanalytic setting function to "mark" t h e externalized verbal expressions of internal affective c o n t e n t s a s "being n o t for real" a n d a s being "nonconsequential." The t h e r a p i s t ' s "hovering attention" is a specialized state of a t t u n e m e n t t h e a i m of which is to identify t h e p a t i e n t ' s internal affect s t a t e s in order to m i r r o r t h e m b a c k to t h e patient in the form of m a r k e d i n t e r p r e t a t i o n s a n d reactions. T h r o u g h t h e transference t h e developmental setting of t h e original a t t a c h m e n t context is recreated a n d t h e dysfunctional forms of parental affective r e a c t i o n s a r e reexperienced in t h e reality-decoupled safe e n v i r o n m e n t of t h e analytic situation. At t h e s a m e time, t h e a n a l y s t provides corrective emotional a n d r e p r e s e n t a tional experience for t h e p a t i e n t t h r o u g h emotion-regulative

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m a r k e d externalizations of t h e p a t i e n t ' s affects in t h e form of mirroring i n t e r p r e t a t i o n s or expressions. Similarly to t h e processes of social biofeedback in p a r e n t a l affect-mirroring, these contingent a n d m a r k e d externalizations serve t h e multiple functions of (a) sensitizing t h e p a t i e n t to h i s i n t e r n a l affective states, (b) establishing second-order r e p r e s e n t a t i o n s for t h e s e s t a t e s by providing verbal labels for t h e m , a n d (c) adaptively transforming their affective c o n t e n t by externalizing t h e m in a modified interpretive perspective. The central t h e r a p e u t i c aim of psychoanalysis is therefore to foster t h e capacity for "mentalization of affectivity" in the patient—a topic t h a t we a d d r e s s in greater detail in c h a p t e r 11. T h r o u g h sensitization to a n d establishing second-order repres e n t a t i o n s for h i s internal affective states, t h e p a t i e n t becomes able to a p p r e h e n d a n d reflect on h i s subjective affective contents a s mentalized r e p r e s e n t a t i o n a l s t a t e s , with minimal risk of these being confused with external reality. T h r o u g h t h e p r o c e s s e s of social biofeedback, t h e t h e r a p i s t ' s m a r k e d externalizations of the patient's internal affective c o n t e n t s help to establish a n e w introspective capacity in t h e p a t i e n t for t h e "inward expression of affects." This comes a b o u t t h r o u g h t h e internalization of t h e newly experienced safe forms of affect-regulative marked externalizations provided b y t h e t h e r a p i s t ' s mirroring interpretations. This way t h e patient gradually l e a r n s n e w m e n t a l skills of affective self-regulation: h e b e c o m e s able to e x p r e s s internally, a p p r e h e n d , a n d modify h i s emotional i m p u l s e s .by "mirroring himself" t h r o u g h generating m a r k e d forms of inward expressions of internal affective c o n t e n t s . In c h a p t e r 11 we provide clinical case illustrations for t h e different levels of mentalization of affectivity t h a t we c a n e n c o u n t e r in a d u l t p a t i e n t s with affective disorders of varying severities.

8

Developmental in Normal and Adolescent

Issues

Adolescence Breakdown

In previous c h a p t e r s we h a v e considered t h e development of mentalization u p to a b o u t t h e age of 5 years, w h e n t h e autobiographical self first emerges (see c h a p t e r 5). While certain developmental disorders are already a p p a r e n t a t this age, m a n y do n o t emerge u n t i l adolescence or later. T h i s c h a p t e r a d d s a further stage to o u r description of t h e development of reflective function, considering t h e implications of t h e cognitive developm e n t s associated with adolescence for t h e ontogeny of mentalization. T h e key q u e s t i o n a d d r e s s e d in this c h a p t e r concerns the increased frequency of v a r i o u s k i n d s of m e n t a l disorder a t this developmental stage, t h e worsening of preexisting conditions, a n d t h e emergence of n e w conditions specifically linked to adolescence, a s well a s t h e o n s e t of m a n y t h a t are lifelong problems b u t w h o s e o n s e t is linked with t h i s age. T h a t is, we attempt to a n s w e r t h e deceptively simple question of why b r e a k down o c c u r s relatively often in adolescence. We suggest t h a t t h i s might be u n d e r s t o o d partly in t e r m s of t h e vicissitudes of reflective function d u r i n g t h i s developmental p h a s e . T h e c h a p t e r begins with a s u m m a r y of t h e view of self-development advocated in t h i s book, w h i c h pulls together t h e t h r e a d s of t h e a r g u m e n t so far.

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INTRODUCTION One explanation of t h e rise in psychopathology in adolescence w a s provided by t h e Laufers: "The b r e a k in t h e developmental p r o c e s s of adolescence is t h e pathology, b e c a u s e t h e o u t c o m e of s u c h a b r e a k m u s t be a distorted relationship to oneself a s a sexual being, a passive relationship to t h e p a r e n t of t h e s a m e sex, a n d t h e giving u p of t h e wish or t h e ability to leave infantile sexuality behind" (Laufer a n d Laufer 1984, pp. ix-x). We all recall t h e h e a t of sexuality in adolescence, b u t is it generally t h e c a u s e of t h e b r e a k d o w n , or is t h e b r e a k d o w n t h e result of earlier developmental d i s t u r b a n c e s , its form colored by t h e intensification of sexual feelings? We t h i n k t h a t t h e latter is more likely. An example of t h e clues t h a t suggest t h a t we need to look beyond a h o r m o n a l u p h e a v a l is t h a t while p u b e r t y arrives earlier a n d earlier, n o t all adolescent disorders a r e occurring at a n earlier age. T h u s , a l t h o u g h eating disorders h a v e b e e n developing a t y o u n g e r ages, criminal activity a n d suicide h a v e n o t (D. J . S m i t h 1995). This s u g g e s t s t h a t t h e prevalence reflects social more t h a n physical—sexual—pressures. The picture of "adolescent turmoil" w a s replaced in t h e 1980s a n d 1990s by a model in w h i c h t h e r e is a s e q u e n c e of bodily c h a n g e s , a n y of w h i c h might trigger emotional u p h e a v a l . W h i c h biological events m i g h t do so could be quite idiosyncratic, d e p e n d i n g to a degree on w h a t particular c h a n g e s r e p r e s e n t to t h e adolescent (Paikoff a n d B r o o k s - G u n n 1991). In this c h a p t e r , we focus on t h e interaction of two m a t u r a tional processes, which m a y be quite central to a n u m b e r of different k i n d s of pathology in adolescence. T h e first is t h e leap to formal o p e r a t i o n s t h i n k i n g a n d t h e c o n s e q u e n t intensification of p r e s s u r e for interpersonal u n d e r s t a n d i n g . This is normally t h o u g h t of in biological terms, b u t in o u r frame of reference the development of symbolic t h o u g h t is intertwined t h r o u g h o u t childhood with emotional growth in t h e context of a t t a c h m e n t . This is w h e r e we m a k e a link to t h e second process: t h e p r e s s u r e toward separation from t h e external a n d internally represented p a r e n t s , which, we suggest, c a n reveal developmental failures or w e a k n e s s e s t h a t were established m u c h earlier in life, b u t which it m a y have b e e n possible to conceal a t t h i s earlier stage. More n

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specifically, we try to describe how some affective d i s t u r b a n c e s in adolescence c a n be t h o u g h t a b o u t in t e r m s of a n i n a d e q u a t e consolidation of symbolic capacity. T h u s , we believe t h a t one t h i n g t h a t drives—but c a n also derail—the achievement of s e p a r a t e n e s s is freshly e n h a n c e d cognitive complexity, w h i c h m e a n s t h a t t h e adolescent is faced with t h e t a s k of integrating a far more complicated set of t h o u g h t s a b o u t h i s own a n d others' feelings a n d motivations. As a result, t h e r e is a developmental hypersensitivity to m e n t a l states, w h i c h m a y overwhelm t h e adolescent's capacity to cope with t h o u g h t s a n d feelings except t h r o u g h bodily s y m p t o m s or physical action. Although s u c h adolescents m a y seem able to talk a n d t h i n k a b o u t m e n t a l s t a t e s quite fluently, m o r e a b s t r a c t ideas a b o u t m e n t a l s t a t e s create a considerable s t r a i n on t h e adolescent's system. This c a n lead to a n a p p a r e n t l y d r a m a t i c b r e a k d o w n in mentalization, withdrawal from t h e social world, and t h e intensification of anxiety a n d e n a c t m e n t s . The extent to which t h e s e c h a n g e s lead to long-term difficulty m a y depend n o t only on t h e i n h e r e n t s t r e n g t h of t h e adolescent's psychic structures, b u t also on t h e capacity of t h e environment to s u p p o r t t h e adolescent's w e a k e n e d mentalizing function. Naturally, this is further complicated by t h e fact t h a t t h e adolescent m a y u n d e r mine t h e capacity of institutions to s u p p o r t him.

THEORY OF SELF-DEVELOPMENT The theory of self-development on w h i c h o u r ideas a b o u t adolescence are b a s e d h a s b e e n described in t h e preceding c h a p t e r s . Here we briefly s u m m a r i z e t h e propositions within t h e theory t h a t will b e c e n t r a l in o u r d i s c u s s i o n of adolescent psychopathology: 1. The psychological self is rooted in t h e attribution of m e n t a l s t a t e s to self a n d other (chapters 1 a n d 3); 2. This capacity emerges t h r o u g h interaction with t h e caregiver, in t h e context of a n a t t a c h m e n t relationship, via a p r o c e s s of mirroring (see c h a p t e r 4). Internal experience acquires a

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second-order r e p r e s e n t a t i o n t h r o u g h t h e internalization of t h e mirroring actions of t h e caregiver (chapter 5). 3. The r u d i m e n t a r y early experience of t h e internal world cons i s t s of two alternating modes—a m o d e of "psychic equivalence" (where i n t e r n a l = external) a n d a m o d e of "pretend" (where internal is forever s e p a r a t e d from external) (chapter 6). 4. Safe, playful interaction with caregivers leads to t h e integration of t h e s e m o d e s , creating mentalization (chapter 6). 5. In t h e case of chronically insensitive or m i s a t t u n e d caregiving, a fault is created in t h e c o n s t r u c t i o n of t h e self, whereby t h e infant is forced to internalize t h e representation of t h e object's s t a t e of m i n d a s a core p a r t of himself (chapter 7). 6. In early development t h i s "alien s e l f is nalization; a s mentalization develops, it woven into t h e self, creating a n illusion d i s c u s s e d more fully in p a r t III, c h a p t e r s

dealt with by exterc a n be increasingly of cohesion (this is 9 a n d 10).

7. T h e disorganization of t h e self disorganizes a t t a c h m e n t relat i o n s h i p s b y creating a c o n s t a n t need for projective identification (for t h e externalization of t h e alien self) in a n y attachm e n t relationship (part III, c h a p t e r 10).

SEPARATION A S T H E PRIMARY TASK OF ADOLESCENCE So how c a n this model help u s to u n d e r s t a n d n o r m a l a n d a b n o r m a l development in adolescence? Margaret Mahler (Mahler et al. 1975) s a w separation-individuation a s a g r a d u a l distancing from t h e m o t h e r , whereby t h e t r a n s i t i o n from d e p e n d e n c y to i n d e p e n d e n t functioning w e n t on t h r o u g h o u t t h e life-cycle a s a more or less c o n t i n u o u s p r o c e s s of d i s t a n c i n g from t h e introject of t h e lost symbiotic m o t h e r . Peter Bios (1979) e x t e n d e d Mahler's model a n d identified t h e critical c h a n g e in adolescence a s t h e loosening of infantile object ties. He e m p h a s i z e d t h a t individu-

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ation could be s e e n a s a p r o c e s s or a s a n achievement, b u t b o t h were integral c o m p o n e n t s of t h e adolescent process. Mahler's model, a n d its extension in t h e work of Peter Bios, a r e clearly related to o u r formulation. Mahler's symbiotic m o t h e r is functionally equivalent to o u r notion of a n alien self. l Greater s e p a ration in adolescence m e a n s t h a t t h e alien self, or symbiotic mother, c a n n o longer be externalized in interaction with t h e caregiver. T h e e n a c t m e n t s a n d m a n i p u l a t i o n s necessary to project t h e alien self into t h e p a r e n t have to become more d r a m a t i c a s separation i n c r e a s e s . This (for example, fighting with t h e parents) m i g h t h a v e b e e n m i s t a k e n for striving to achieve a n i n d e p e n d e n t identity. Until a p a r t n e r c a n be found with w h o m the adolescent c a n r e e s t a b l i s h a symbiotic relationship, t h e r e is a h i a t u s in externalization, which creates e n o r m o u s p r e s s u r e for adolescents w h o s e alien self c a n n o t be integrated. Erikson s e e s t h e a t t a i n m e n t of self-identity a s a precondition of t r u e e n g a g e m e n t (Erikson 1968). This overriding e m p h a s i s on individuation neglects its dialectic c o u n t e r p a r t , a t t a c h m e n t (Blatt a n d B e h r e n d s 1987; Blatt a n d Blass 1990). Real separaten e s s implies a n ability to recognize b o t h difference and similarity, a n d it is paradoxically t h e latter r a t h e r t h a n t h e former t h a t may b e a t r u e m a r k of a u t o n o m y . T h e challenge to identity in adolescence comes from accepting n o t difference, b u t similarity. The adolescent with a s e c u r e s e n s e of connection a n d likeness to the caregiver c a n tolerate physical separation, w h e r e a s one who h a s projected p a r t s of t h e self a n d n e e d s to perceive t h e caregiver a s completely different feels t h a t h e h a s lost h i s identity if h e is separated from her. T h u s , a n exaggerated claim to be different may be seen a s a defensive r e s p o n s e to p r e s s u r e for separation, which t h r e a t e n s t h e r e t u r n of projected p a r t s of t h e self. Internal coherence a n d m e n t a l s e p a r a t i o n of self a n d object, then, require t h e physical p r e s e n c e of t h e other. Otherwise, t h e adolescent fears t h a t t h e r e s i d u a l core self will be s w a m p e d , h e will lose c o n t a c t with it, a n d h i s s e n s e of identity will be lost.

1

With the exception that, in agreement with Stem, we do not see symbiosis as a normal stage, but the "symbiotic mother" as a very common deviation from normal development.

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Physical s e p a r a t e n e s s is, in o u r view, t h e smaller of two developmental challenges t h a t face e a c h child in adolescence. The second arises o u t of t h e e n h a n c e d a w a r e n e s s of emotional a n d cognitive complexity, m o s t pivotally in t h e context of att a c h m e n t relationships. In adolescence, emotional development r e a c h e s "a n e w developmental tier" (Fischer et al. 1990) with the capacity for a b s t r a c t thinking. Both t h e appreciation a n d the expression of affect t a k e on a n e w d i m e n s i o n a n d t h u s m a n y n e w m e a n i n g s . For example, r a t h e r t h a n a t t r i b u t i n g b a s i c emotional s t a t e s , a d o l e s c e n t s s t a r t to c o n t e m p l a t e adultlike scripts for emotions. Feelings s u c h a s j e a l o u s y or r e s e n t m e n t become elaborated into scenarios. This n e w capacity for a b s t r a c t i o n a n d elaboration is t e n u o u s l y m a i n t a i n e d a n d quickly reversed by emotional s t r e s s e s generated by t h e developmental process. These s t r e s s e s are often internal—for example, d u e to conflict or unfamiliar a n d i n t e n s e emotional s t a t e s — b u t t h e y m a y also arise from overwhelming external s i t u a t i o n s s u c h a s parental m e n t a l illness. Building on Piaget's concept of reversibility, A. E. T h o m p s o n (1985, 1986) considers affect "irreversible" w h e n t h e child cann o t imagine other reactions to t h e object, or feelings other t h a n t h e o n e h e currently feels. Reversibility gradually emerges between middle childhood a n d early adolescence. Slowly t h e child w o n d e r s w h a t it might t a k e not to feel a s h e does, or to change t h e feeling state of,the object. With 5 formal o p e r a t i o n s fully deployed, t h e child begins to t h i n k of general principles r a t h e r t h a n a s p e c t s of t h e specific situation t h a t c a n explain or change emotions. However, while a d v a n c e s in t h e capacity for a b s t r a c t t h o u g h t enable t h e adolescent to t a k e a s t e p b a c k a n d to monitor himself a n d others, this does n o t necessarily feel like a good thing. For t h e adolescent, a s experiencer of affect in himself and others, t h e world is s u d d e n l y m u c h m o r e complicated a n d confusing. T h u s , h e n e e d s a t times to w i t h d r a w from interactions, or from mentalization in general, to t a k e a r e s t from t h e ramifications of alternative motivations. For example, t h e child of a d e p r e s s e d m o t h e r m a y a t t h e age of 3 y e a r s feel t h a t h i s m o t h e r lies in bed b e c a u s e h e is b a d or boring or unlovable. At 5, this child m a y h a v e come to realize t h a t t h e m o t h e r ' s behavior reflects a s t a t e of m i n d , depression,

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which does n o t necessarily relate to h e r feelings a b o u t him; it is something in h e r own h e a d . At 7, t h e child m a y h a v e p r o d u c e d a contextual explanation: "Mom is depressed b e c a u s e h e r Mom died, t h e n Dad left, a n d we've got hardly a n y money, a n d s h e h a s n ' t got friends." However, from p e r h a p s 11 on m a n y d i s t u r b ing new possibilities e n t e r t h e picture, hinging on t h e fact t h a t emotional s t a t e s n e e d n o t be a s they are a n d people have choices a b o u t h o w t h e y r e s p o n d to t h e m . Interestingly, t h i s m a y lead t h e child b a c k to a m o r e sophisticated version of h i s first assumptions—"Why doesn't Mom get u p a n d do s o m e t h i n g if she feels so terrible? If s h e w a s n ' t getting something o u t of lying in bed, s h e w o u l d n ' t keep doing it for so long. OK, s h e feels terrible, b u t s h e could get u p a n d come to m y p a r e n t - t e a c h e r evening. If s h e really loved me, s h e would." Later, t h e adolescent formulation m i g h t b e in t e r m s of depression being a r e s u l t of loss of love, or conflict, or t h e p a r e n t s ' marriage, or, more egocentrically, t h e p a r e n t s ' d i s a p p o i n t m e n t in him. These n e w ways of thinking a b o u t people's feelings a n d behavior, a s well a s about his own feelings a n d behavior, c a n be overwhelming, a n d the adolescent n e e d s to a b s o r b t h e implications. There m a y also be a reaction a g a i n s t mentalizing. Some a d o l e s c e n t s m a y engage in a r c a d e games, surfing t h e Internet, a n d so on; o t h e r s m a y develop a p a s s i o n for stereotyped s o a p - o p e r a s a n d r o m a n t i c novels, in w h i c h emotions a r e again p r e s e n t e d a s simple a n d intense. They m a y also r e t r e a t into a p p a r e n t l y m i n d - n u m b i n g music. The entire developmental p r o c e s s is fluid a n d dynamic, with e n h a n c e d cognitive capacity generating enriched mentalizing, which, in t u r n , leads to anxiety a n d / o r preoccupation. As t h i s state u n d e r m i n e s a b s t r a c t t h o u g h t , t h e adolescent may—in addition to s o m e t i m e s switching off into really m i n d l e s s activity— regress in a p p a r e n t relief to a t h o u g h t l e s s , socially insensitive state. T h u s , t h e p a r e n t s become infuriated t h a t t h e adolescent, who is obviously capable of keeping other people in m i n d a n d imagining t h e effect of h i s actions, b e h a v e s a s t h o u g h h e were oblivious, selfish, a n d willfully inconsiderate. In t h e second section we describe two c a s e s t h a t illustrate, in their different w a y s a n d degrees of i m p a i r m e n t of mentalization, what we see a s t h e d u a l challenge of adolescence: t h e potentially

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d i s a s t r o u s c o n s e q u e n c e s of t h e drive for s e p a r a t e n e s s in a n adverse a t t a c h m e n t context a n d regression in t h e face of t h e leap forward in mentalizing.

CLINICAL ILLUSTRATION: "TONY" Tony w a s 15 y e a r s old w h e n h e w a s referred to a residential adolescent psychiatric unit. His p a r e n t s , h i s t e a c h e r s , a n d his psychiatrist h a d become very concerned a b o u t explicit violent t h r e a t s t h a t h e h a d m a d e to h i s p a r e n t s , peers, a n d women t e a c h e r s . He w a s a d m i t t e d after t h r e a t e n i n g a n o t h e r boy with a knife. He w a s a sullen, stocky boy w h o did n o t talk to staff or p e e r s on t h e unit, u s u a l l y glaring a n d snarling a t t h e m if they tried to engage him. Tony w a s t h e only s o n of a failed b u s i n e s s m a n a n d a former teacher. His u n p r e d i c t a b l e violent o u t b u r s t s h a d worsened six m o n t h s before admission, a t which point h i s p a r e n t s h a d asked for h i m to b e t a k e n into t h e care of t h e social services. His history is far from u n u s u a l for a violent adolescent, except for t h e r e m a r k a b l y close relationship t h a t Tony h a d with h i s outwardly loving a n d affectionate m o t h e r . As a b a b y h e w a s said to h a v e b e e n valued beyond m e a s u r e , after a long period w h e n his p a r e n t s h a d t h o u g h t they could n o t have a child. His mother a b a n d o n e d h e r promising career in educational administration to s p e n d all h e r time looking after little Tony. T h e relationship between t h e m w a s so i n t e n s e t h a t t h e father often felt jealous a n d resentful, even t h o u g h he, too, h a d b e e n delighted to have a son. The m o t h e r insisted for some y e a r s on s h a r i n g their bedroom with Tony, excluding t h e father; until Tony w a s 10 years old, s h e would n o t go o u t a t night with t h e father b e c a u s e she did n o t w a n t to leave Tony with a n y o n e else. Tony's father w a s never violent toward h i m . He w a s , however, abusive to h i s wife. His frustration in h i s b u s i n e s s dealings a n d h i s s e n s e of being neglected by Tony's m o t h e r led him to become increasingly aggressive, s c r e a m i n g a n d threatening. He occasionally hit t h e mother, to w h i c h s h e r e s p o n d e d with

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hysterical rage of h e r own a n d intimate d i s c u s s i o n s with h e r son a b o u t t h e father's behavior. As you might expect, Tony w a s frequently t h e focus of t h e father's rage. Her wish to protect a n d indulge Tony w a s treated with derision a n d t h r e a t s to leave her. Tony often w i t n e s s e d t h e s e confrontations, a n d a s a y o u n g boy he w a s reported to h a v e tried to shield her; w h e n he w a s older, he t h r e a t e n e d to kill h i s father if h e did n o t leave h i s m o t h e r alone. Meanwhile, Tony w a s doing badly. He w a s encopretic until he was 10; a t e l e m e n t a r y school h e m a d e poor educational progress, a n d he w a s teased a n d bullied. Once a t secondary school, he increasingly b e c a m e t h e bully, terrorizing t h e playground with his u n p r e d i c t a b l e violent o u t b u r s t s a n d too difficult for teachers to c o n t a i n in class. When Tony w a s a d m i t t e d to t h e adolescent unit, everyone was frightened of him. He refused to give a history to t h e admitting psychiatrist a n d barely talked to t h e n u r s e s or other residents. No one w a n t e d to s h a r e a room with him. T h e y o u n g m e n in particular s h u n n e d a n d ridiculed him, a n d he w a s defended only by a girl, Elaine, who, like him, w a s surly a n d isolated. After Elaine stood u p for Tony, t h e y formed a wordless friendship based on h a t r e d of t h e others. T h e only p e r s o n h e talked to a little w a s a y o u n g t r a i n e e psychologist w h o w a s assigned to carry out his psychological testing. S h e found t h a t h e could hardly read a n d h a d m i n i m a l m a t h e m a t i c a l skills, a n d s h e realized t h a t she needed to help h i m navigate t h e minefield of mortification represented by a p t i t u d e a n d a t t a i n m e n t tests. In doing so, Tony began to e x p r e s s h o w h e h a d h a t e d school a n d everyone there, and how h e h a d desperately tried, on h i s own, to learn to read better b u t h a d t h e n given u p in s h a m e a n d frustration. B e c a u s e he seemed able to talk to h e r to s o m e degree, t h e t e a m decided to offer him some s e s s i o n s with h e r to see w h e t h e r some t h e r a p e u tic relationship m i g h t b e possible. In the first m e e t i n g with t h e psychologist, Tony described h i s rage with h i s father, a d d i n g t h a t h e would like to m u r d e r him. He was filled with a n g e r a n d talked venomously a b o u t other y o u n g people who, h e felt, h a d b e e n set a g a i n s t h i m a n d were all ridiculing h i m b e h i n d h i s b a c k . He w a s enraged by t h e r a t h e r

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minimal rules of t h e u n i t a n d said t h a t he refused to fit in with t h e s t u p i d w a r d timetable for meals, meetings, a n d so on. The psychologist gently suggested t h a t if h e felt h e w a s h a t e d so m u c h , it w a s n o t s u r p r i s i n g h e preferred to do t h i n g s alone, b u t h e also seemed to be lonely. He talked a b o u t h o w h e h a d never b e e n able to m a k e friends. T h e psychologist reported Tony's wish to kill h i s father to t h e staff team, b u t a s h e seemed to b e settling in, h e w a s kept on t h e open u n i t u n d e r closer observation. His next session w a s in t h e afternoon, two d a y s later. That m o r n i n g Elaine h a d seriously s l a s h e d h e r wrists a n d h a d been t a k e n o u t of t h e u n i t on a stretcher. Tony c a m e to h i s session clearly agitated, b l a m i n g t h e staff for failing to protect Elaine. His a n g e r quickly engulfed t h e interview-room, a n d h e became menacing. He grabbed t h e psychologist's keys from t h e table, locked t h e interview-room door from t h e inside, a n d shoved the keys down h i s shirt a n d into h i s p a n t s . His excitement was obvious a s h e t a u n t e d t h e psychologist t h a t s h e h a d to get the keys b a c k . S h e a s k e d h i m to give t h e m b a c k to h e r a n d t h e n sit down a n d talk a b o u t how he felt a n d w h a t h a d h a p p e n e d , b u t it w a s clear t h a t h e w a s very excited by feeling h e h a d h e r a t his mercy a n d he w a s n o t going to give u p t h a t position willingly. He p u s h e d h e r a n d repeatedly said t h a t s h e would h a v e to reach into h i s p a n t s to get h e r keys. S h e pressed t h e a l a r m b u t t o n and explained to h i m t h a t this m e a n t staff would come a n d be available outside t h e door to help; however, it would be m u c h b e t t e r if h e would r e t u r n t h e keys a n d c o n t i n u e t h e session w i t h o u t needing to bring o t h e r people in. He u n f a s t e n e d his p a n t s a s t h o u g h to give h e r t h e keys, b u t t h e n exposed himself to h e r a n d got more excited, p u s h i n g h e r a g a i n s t a window away from t h e p a n i c b u t t o n a n d trying to t a k e h e r clothes off. Two male m e m b e r s of staff c a m e into t h e room. Tony w a s grabbed a n d dragged away with h i s p a n t s r o u n d his knees, t h r o u g h t h e m a i n u n i t r o o m w h e r e t h e other residents a n d staff were gathering for tea. W h e n interviewed, Tony aggressively claimed t h a t t h e psychologist h a d "had it coming to her," b u t he also w a n t e d to m a k e s u r e t h a t s h e would see h i m for t h e p l a n n e d sessions. He w a s told t h a t t h i s would n o t h a p p e n b e c a u s e h e would be moved t h a t day to t h e high-security adult

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unit—a place d r e a d e d by all t h e y o u n g people in t h e unit. He w a s also given a forcible injection a n d placed in extended "time out" while t h e transfer w a s a r r a n g e d . Tony b r o k e h i s window a n d abseiled o u t of t h e unit. T h e police were u n a b l e to find h i m for 2 4 h o u r s , w h e n they were called to h i s p a r e n t s ' h o m e by h i s m o t h e r . Tony h a d b r o k e n in during the night a n d h a d s t a b b e d h i s father to d e a t h . He w a s committed for a n indefinite period to a m a x i m u m - s e c u r i t y psy^ chiatric hospital. Tony h a d n o t b e e n neglected. He h a d n o t b e e n b e a t e n by h i s p a r e n t s (although h e w a s extensively bullied a t school), a n d t h e m u r d e r w a s triggered by a n incident t h a t occurred in a relatively caring setting. We would like to suggest (as we have argued m o r e fully elsewhere—Fonagy a n d Target 1995) t h a t , a l t h o u g h Tony was not neglected physically, at t h e level of emotional experience and development of self-organization he was. Neither h i s mother, with h e r excessive devotion—which seemed to serve h e r own needs n o t to s e p a r a t e — n o r his father, with h i s anger a n d jealousy, w a s actually able to relate to Tony a s himself. They could not relate to h i s real feelings a n d experiences, a n d this a b s e n c e of recognition by t h e a t t a c h m e n t figures generated a vulnerability to c o n d u c t disorder a n d violence. Excessive closeness, like excessive distance, u n d e r m i n e s t h e psychological self. In vain does t h e infant try to find representations corresponding to h i s i n t e r n a l s t a t e in t h e expression of t h e caregiver. The self r e m a i n s incompletely organized, a n d internal reality c o n t i n u e s to be experienced in t h e "psychic equivalence" mode. It is t h u s vulnerable to t h e introjection of later malign experience. Tony w a s n o t a bright boy. He w a s cruelly teased by h i s peers for being slow, clumsy, odd-looking, a n d u n k e m p t . S u c h teasing m a y s e e m m i n o r to t h e a d u l t s s u r r o u n d i n g t h e child and even to other children, w h o are c a p a b l e of adopting a mentalizing perspective. B u t bullying is experienced a s literally lethal to t h o s e children w h o c a n n o t distinguish a feeling of humiliation from obliteration. A similar s e n s e of ego-destructive s h a m e accompanied Tony's experience of thinly veiled violence at home. In witnessing t h e a r g u m e n t s , overly identified with t h e

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mother, h e felt a b u s e d himself a n d powerless to prevent his or h i s m o t h e r ' s suffering. This a r o u s e d t h e s a m e s e n s e of helpless shameful humiliation from which h e could e s c a p e only t h r o u g h identification with t h e aggression. In t h e context of t h e incomplete self-organization t h a t is t h e r e s i d u e of disorganized attachm e n t , identification with t h e aggressor c a n never be successful. It is t h e dissociated, alien p a r t of t h e self t h a t a c c o m m o d a t e s to aggression a n d comes to be colored by a climate of violence, be t h a t a t school, a t home, or p e r h a p s in t h e c u l t u r e a t large. The tragic c o n s e q u e n c e for Tony, a s for o t h e r children whose experience of relative neglect is followed by brutalization, is t h a t a p a r t of t h e self h a s become a destroyer of t h e rest. Given t h e very real s e n s e of i n t e r n a l persecution, tingeing all of Tony's relationships with p a r a n o i a , t h e coherence of t h e self could only be restored by externalization. In disorganized a t t a c h m e n t generally, t h e externalization m a y b e of s o m e t h i n g t h a t is not destructive, a n d t h e r e s u l t m a y simply be a controlling style of interaction. Where t h i s disorganization h a s b e e n followed at some point by brutalization, violence to self or other is likely. The alien self is so persecutory t h a t its projection is a m u c h more u r g e n t a n d c o n s t a n t t a s k . Any t h r e a t to self-esteem triggers this externalization, w h i c h can, in t u r n trigger a n a t t a c k in t h e hope of destroying t h e alien other. Let u s revisit t h e s e q u e n c e of events t h a t c u l m i n a t e d in Tony's m u r d e r of h i s father. Notwithstanding h i s surly behavior, Tony w a s relieved to b e in t h e adolescent unit. He t h e n found two w o m e n who, h e felt, -understood him. Feeling u n d e r s t o o d b r o u g h t forward inarticulate b u t i n t e n s e affection a n d hopefuln e s s . Their consideration toward h i m a r o u s e d feelings of love a n d need to be loved, w h i c h h e could n o t titrate—either internally or externally—appropriately to t h e situation. Often when we consider t h e deficit in affect regulation in t h e s e cases, we focus on t h e difficulty in containing negative affects, forgetting t h a t t h e s a m e difficulty applies to positive feelings w h e n t h e y are a r o u s e d . Losing t h e hope of love, h e felt humiliated, a n d this experience in t u r n triggered h i s aggression. His sexual a s s a u l t on t h e psychologist w a s at o n e level a n act of self-protection. He arrived feeling t h r e a t e n e d a n d frightened by Elaine's disappear-

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ance, a n d t h e only w a y h e could e x p r e s s h i s love a n d n e e d w a s by first externalizing h i s alien self, filled with fear a n d helplessness, into t h e psychologist. While holding her hostage, h i s affection a n d g r a t i t u d e could be (clumsily) shown. Once t h e discontinuity in h i s self-representation h a d b e e n dealt with, h e w a s almost able to e x p r e s s affection. Sadly, it could only be d o n e while m a i n t a i n i n g this t h r e a t e n i n g posture. He destroyed t h e possibility of being accepted by h i s d e s p e r a t e defensive m a n e u ver—the psychologist w h o h a d b e e n able to see h i m a n d to s h o w u n d e r s t a n d i n g w a s n o w bringing further humiliation on him. She r e s p o n d e d to h i s t a u n t i n g by calling for help: u n d e r s t a n d able a n d probably necessary, b u t for h i m a double loss. We c a n imagine t h a t Tony m a y have felt t h a t s h e first lost sight of his gentler a n d m o r e loving side, t h e n s a w only t h e m e n a c i n g posture, apparently relating to t h a t (as in psychic equivalence) a s the only reality. To destroy t h e vision of h i m in her mind a s evil, he would have felt t h a t s h e h a d to b e a t t a c k e d . The r e s t of t h e story d e m o n s t r a t e s with tragic inevitability what c a n so often h a p p e n w h e n institutions—always p r o n e to mindlessness, even'with t h e b e s t of i n t e n t i o n s — a t t e m p t to contain a p e r s o n struggling to achieve mentalizing. T h e incident created some p a n i c a n d m u c h guilt a b o u t having exposed a trainee to t h i s d a n g e r , a n d all t h e p a r t i c i p a n t s r e s p o n d e d by belatedly showing their s u p p o r t for her, meting o u t a n excessive, ego-destructive p u n i s h m e n t . No one, in t h e r a t h e r chaotic afterm a t h of t h e incident, c o m m u n i c a t e d a n u n d e r s t a n d i n g of Tony's actions a n d t h e feelings of loss a n d love contained in t h e m . He was alone with t h e m e m o r y of h i s complete humiliation in front of his peers, t h e irreversible loss of h i s h o p e s of closeness, a n d the terror of a n e n v i r o n m e n t far m o r e m i n d l e s s t h a n t h e one h e was already finding excruciating. We c a n s p e c u l a t e a b o u t h o w this state of mind led to m u r d e r . Tony probably experienced Elaine's serious suicide a t t e m p t a s a repetition of h i s father's a t t a c k on h i s m o t h e r a n d his failure to save her. With t h e s e feelings left u n c o n t a i n e d , he chose the following night to t a k e h i s u l t i m a t e revenge. He h a d to reestablish h i s s e n s e of self, w h i c h humiliation h a d t h r e a t e n e d with annihilation. T h e u n i t a n d t h e father c a m e to be fused, a n d

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their d e s t r u c t i o n generated t h e illusion t h a t h e could attain identity. These feelings were n o t far from h i s c o n s c i o u s a w a r e n e s s . W h e n visited by t h e a d o l e s c e n t - u n i t psychologist in t h e maxim u m - s e c u r i t y hospital, Tony w a s able to talk a b o u t h i s h o p e for (an idealized) u n i o n with h i s m o t h e r now t h a t h i s father w a s out of t h e way. P e r h a p s a deeper, u n c o n s c i o u s hope, however, w a s for a s e p a r a t i o n from her, w h i c h h i s a c t of m u r d e r clearly achieved. J u s t a s t h e u n i t ' s a u t h o r i t y probably r e p r e s e n t e d the father, so t h e possibility of u n d e r s t a n d i n g a n d closeness perh a p s reminded h i m of t h e m a d d e n i n g s e d u c t i v e n e s s of intimacy with h i s mother. He m a y h a v e hoped that, s e p a r a t e d from her, h e might rediscover a coherent s e n s e of self, even a genuinely u n d e r s t a n d i n g a t t a c h m e n t relationship. Sadly, h e found instead a place where mentalization t e n d e d to be eroded still further.

Discussion In w h a t s e n s e s w a s Tony's p r e d i c a m e n t characteristic of adolescence? Tony's violence, always present, b e c a m e increasingly lethal from t h e time h e r e a c h e d puberty. His "symbiotic relationship" with h i s m o t h e r h a d disguised t h e extent to w h i c h h e used h e r a s a vehicle for h i s experience of h i s own m e n t a l states. His father, in a far m o r e destructive way, performed t h e s a m e function in enabling h i m to externalize h i s h a t r e d a n d revulsion and place himself in t h e role of protector. Longer periods away from h i s p a r e n t s m a d e this difficult to s u s t a i n . His e n a c t m e n t s h a d to b e c o m e increasingly d r a m a t i c to achieve t h e c h a n g e s in affect in h i s p a r e n t s n e c e s s a r y for h i s self to feel coherent. As in a conversation, t h e voices m u s t get louder a s t h e s p e a k e r s move farther a p a r t . Paradoxically, t h i s resulted in a n even greater separation: h i s p l a c e m e n t in t h e care of social services, creating t h e c l a u s t r o p h o b i c anxiety described by J o h n Steiner (1993) and before t h a t by Herbert Rosenfeld (1987). T h e terror w a s t h a t the alien p a r t of t h e self would be t r a p p e d forever, with n o possibility for externalization. This drove Tony to t h e d e s p e r a t i o n so characteristic of violent adolescents.

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CLINICAL ILLUSTRATION: "GLEN" Glen 2 s t a r t e d h i s a n a l y s i s in a profoundly dissociated state. Although h e w a s 15, h e h a d t h e a p p e a r a n c e of a 10-year-old a n d behaved like a child half t h a t age. He j u s t s a t in a chair, withdrawn, angry, a n d d e p r e s s e d , h u d d l e d u p in a tentlike coat t h a t was far too big for h i s small s t a t u r e ; sometimes h e hid h i s face in his h a n d s , occasionally looking a t m e t h r o u g h a gap he m a d e between h i s fingers. T h e r e w a s i m m e n s e hostility in t h e room, and a s e n s e of u n c o n t a i n e d confusion. There were s e s s i o n s when he w a s able to talk, a n d a t t h e s e times t h e infantile n a t u r e of his m e n t a l functioning w a s revealed in a s t a r k a n d disturbing way. Glen's clinical diagnosis would h a v e b e e n obsessive-compulsive disorder, together with a major depression. S u c h labels cannot, however, adequately convey t h e word a n d t h o u g h t magic that h a d overtaken h i s life. His life w a s organized a r o u n d rituals from t h e m o m e n t h e got u p a n d h a d to tidy h i s room in a particular order—sometimes repeatedly if he felt h e might have got t h e order wrong—to t h e m o m e n t h e got into bed, w h e n he had to place h i s pillows a t certain angles to t h e room a n d to h i s body. On t h e surface, h e wished to avoid "bad luck," b u t it w a s easy to see t h a t u n d e r n e a t h w a s a dread of intrusive ideas, concretized a s alien beings, spiders, a n d bacteria. He w a s terrorized by t h e c o n t i n u o u s l y intrusive t h o u g h t t h a t t h e c r e a t u r e from the film Alien w a s in t h e fireplace or in t h e garden. He w a s also oppressed by h i s aggressive fantasies a n d his c o n s t a n t dread t h a t a n y s p o n t a n e o u s action o n h i s p a r t might bring h a r m to someone else. There w a s little in Glen's b a c k g r o u n d to justify h i s state of mind. His father w a s a n a u t h o r i t a r i a n m a n w h o certainly lacked empathy b u t w h o w a s also r a t h e r concerned a b o u t h i s s o n a n d felt helpless in t h e face of h i s odd behavior. His m o t h e r also seemed to be a c a r i n g p e r s o n , even if also depressed; s h e denied the pervasive n a t u r e of Glen's d i s t u r b a n c e a n d described h e r

2

Glen was treated by Peter Fonagy, whose report this is.

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relationship with Glen's father a s deeply troubled. T h e trigger for Glen's difficulties m a y h a v e b e e n h i s m o t h e r ' s chronic illness a n d c o n s e q u e n t surgery. It w a s difficult to k n o w how to u n d e r s t a n d Glen's difficulties; h e seemed relatively bright, a n d in some ways even talented, b u t e m b a t t l e d in a c o n s t a n t struggle against a regressive pull in order to c o n t a i n i n t e n s e destructive fantasies. His s y m p t o m s h a d b e e n intensifying rapidly before his referral for t r e a t m e n t , a n d h e w a s terrified t h a t h e w a s going mad. I w a s a t a loss a s to how to help Glen. I did interpretive work with little success; I focused o n h i s fear of m e confusing h i m and c a u s i n g h i m to b e c o m e m a d , h i s terror of m y aggression toward him a n d of h i s toward me, h i s s e n s e t h a t h i s p a r e n t s had a b a n d o n e d h i m with me, having given u p on him, h i s hopelessn e s s a b o u t himself a n d me, h i s isolation outside t h e treatment, which h e showed m e concretely inside t h e room, h i s fear that talking would b r e a k his t e n u o u s control over h i s mind, a n d so on. None of t h e s e i n t e r p r e t a t i o n s h a d a n y a p p a r e n t effect; I was n o t getting t h r o u g h to him. I b e c a m e angry a n d found it quite h a r d to resist t h e t e m p t a t i o n to give u p on h i m . I b l a m e d others: t h e diagnostic t e a m for n o t screening h i m adequately, h i s pare n t s for n o t recognizing h i s difficulties, b u t above all Glen for r e m a i n i n g inaccessible a n d m a k i n g m e so helpless. About two a n d a half m o n t h s into t h e t r e a t m e n t , a r o u n d the C h r i s t m a s break, I decided to c h a n g e tack. I a b a n d o n e d some of m y formal interpretive style with h i m a n d b e c a m e livelier, almost trying to p e r s u a d e h i m o u t of h i s passive-aggressive stance. I s t a r t e d m a k i n g j o k e s a n d h u m o r e d h i m a b o u t h i s feelings of a n g e r with m e a n d h i s wish to kill m e so I would s t o p bothering h i m "once a n d for all." I imitated h i s behavior, showing him r a t h e r t h a n telling h i m how h e a p p e a r e d to me. I c h a t t e d to him a b o u t m y m e s s y room a n d how I t h o u g h t h e disliked it b u t didn't w a n t to s a y so in case I would be offended. O n a wet morning we talked a b o u t h i m being cross a b o u t getting wet, j u s t so h e could come a n d be bored by m e for 50 m i n u t e s . I talked to h i m about h i s wonderful feeling of liberation w h e n it c a m e to t h e C h r i s t m a s b r e a k from analysis. On a n o t h e r occasion, w h e n h e mentioned a t e a c h e r of h i s who w a s bald, h e inadvertently glanced a t me, and

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I said to h i m how pleased h e m u s t feel t h a t h e h a d h a i r a n d I didn't, a n d how ridiculous he t h o u g h t I looked. Happily, t h i s c h a n g e of strategy b e g a n to b e a r fruit. Slowly h e became visibly more relaxed, h i s p o s t u r e changed, h e took h i s coat off. He also opened u p verbally a n d told m e a b o u t w h a t turned o u t to be crucial anxieties, particularly a b o u t work. He shared h i s worries a b o u t n o t being able to do his homework, h i s wish to be appreciated by h i s t e a c h e r s , a n d t h e d r e a d t h a t h e might d i s a p p o i n t t h e m . I w a s able to interpret w h a t m u s t have been a d o m i n a n t feature of t h e transference all along, t h e terrible feeling of disappointing m e if h e let himself care w h a t I thought a n d felt a b o u t h i m . The a t m o s p h e r e c h a n g e d . Glen s t a r t e d looking a t me, a n d there were fewer periods of long silence. He b e g a n to talk a b o u t his t h o u g h t s a n d feelings w h e n he h a d b e e n w i t h d r a w n . He h a d imagined t h a t h e w a s throwing knives into m y body or j u s t missing me, loving t h e feeling of control a n d torture. He gave m e room to interpret t h a t h i s fear of m y power over h i m could be related to h i s w i s h to control a n d frighten me; t h a t h e wished to destroy people b e c a u s e he w a s so afraid of t h e m , b u t h i s a n g e r was so clear t h a t it frightened h i m a n d m a d e h i m feel terribly guilty. He w a s increasingly grateful for m y interpretations a n d almost seemed pleased to see me. By t h e end of t h e six-month period a t h e r a p e u t i c alliance h a d developed where I w a s s e e n a s both useful a n d , on t h e whole, benign. T h e major transference theme, however, r e m a i n e d t h e s a m e — t h a t I could n o t contain and tolerate h i s rage a n d m a d t h o u g h t s ; t h e tiniest a n d m o s t subtle shift in m y s t a n c e could lead to i m m e n s e anxiety a n d could trigger withdrawal from me. I felt t h a t o u r work h a d begun. Over t h e next y e a r h e m a d e increasingly good u s e of t h e analysis a n d improved symptomatically in w a y s t h a t b o t h h e and his p a r e n t s clearly noticed. For example, t h e rituals ceased to preoccupy him, a n d h i s obsessional work p a t t e r n s gave way to a far more relaxed b u t still organized attitude. There were several key points. T h e first w a s o u r joint recognition of t h e significance of his early period at school, w h e n he h a d b e e n regarded a s a slow learner a n d offered remedial teaching. He h a d found t h e

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experience humiliating, n o t least b e c a u s e of t h e exceptionally high performance of h i s older b r o t h e r a n d h i s father's thinly disguised mockery. As we recognized t h a t h i s obsessional work p a t t e r n s reflected h i s conflict over wishing to avoid educational humiliation on t h e one h a n d , a n d h i s a n g e r with b o t h his p a r e n t s , h i s brother, a n d h i s t e a c h e r s for mocking h i m on the other, h i s a t t i t u d e toward h i s work c h a n g e d . He stopped forcing himself to do t h e s a m e piece of work half a dozen times; instead, h e decided to work only a certain n u m b e r of h o u r s after he came h o m e from school, a n d h e stopped worrying a b o u t work accumulating. His self-esteem took a boost w h e n h i s fear of h i s sadism entered t h e material. This w a s triggered by a school visit to the film Schindler's List, which h e h a d w a n t e d to avoid. He was greatly d i s t u r b e d by t h e film a n d eventually disclosed t h a t he h a d fantasized being t h e C a m p C o m m a n d a n t w h o w a s using J e w i s h workers for target practice. This quickly led to t h e elaboration of t h e s e fantasies a n d to a shameful disclosure t h a t he constantly fantasized a b o u t a t t a c k i n g people a n d killing t h e m in painful ways. We talked a t some length a b o u t h i s enjoyment of t h e fantasy of t o r t u r i n g me, a n d h e described t h e various ways h e h a d t h o u g h t of c a u s i n g m e pain, particularly enjoying the idea of m y begging for mercy. Interestingly, t h i s linked with Glen's neurotic concern a b o u t h i s father's m o o d s . He w a s worried t h a t h i s father s h u t himself off in h i s s t u d y , particularly after h e h a d b e e n subjected to playful t e a s i n g by h i s family. He feared t h a t h i s father might commit suicide, a n d h e dreaded b o t h being blamed a n d blaming himself. Historical material emerged a b o u t h i s experience of h i s father's sensitivity and c u r r e n t a n d p a s t t h o u g h t s a b o u t t h e fragility of h i s parents' marriage. Eventually it t r a n s p i r e d t h a t h i s c o n c e r n w a s far greater a b o u t h i s m o t h e r ' s d e p r e s s i o n t h a n a b o u t h i s father's. It seemed t h a t h i s m o t h e r terrified h i m by retiring to bed, sometimes a s early a s 6 p.m., leaving t h e children to look after themselves. His fears a b o u t m y fragility s u d d e n l y m a d e more s e n s e to b o t h of u s , a n d h e told m e how r e a s s u r e d h e h a d been w h e n he realized "that y o u c a n t a k e a joke." He b e c a m e increasingly relaxed in t h e sessions: h e would sit slouched in t h e chair,

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play g a m e s a t m y expense, m o c k m y room, mimic m y h a b i t s , and c o m m e n t on m y b a l d n e s s a n d m y m o n o t o n o u s clothes. In the transference I seemed to b e c o m e a predepressed m o t h e r , a n d he visibly enjoyed this. O t h e r clinicians working a t t h e c e n t e r noted t h e c h a n g e in him: u n b e k n o w n to me, h e w a s walking down t h e s t a i r s whistling. About twelve m o n t h s into t h e t r e a t m e n t h e b e g a n to t r u s t m e with his sexual secrets. It t r a n s p i r e d t h a t he h a d reached sexual m a t u r a t i o n a n d h a d s t a r t e d m a s t u r b a t i n g to ejaculation. He w a s excited by p i c t u r e s of n a k e d w o m e n . He felt deeply a s h a m e d about this a n d wondered if I would refuse to see h i m after h e disclosed h i s practices. Part of t h e fear of t h e Alien w a s clearly linked to a split-off a s p e c t of h i s sadistic sexual wishes. His aggression p e r m e a t e d h i s sexuality. The excitement of guns, pain in others, a n d sexual p l e a s u r e a p p e a r e d to be confused in his mind. My a c c e p t a n c e of t h e s e fantasies led to a n i m m e n s e sense of relief, a n d h e s t a r t e d t h i n k i n g a b o u t a s k i n g girls out. An extract from a s e s s i o n m a y illustrate h i s progress. I h a d canceled t h e previous Friday's session, a n d he c a m e on Monday depressed, h a v i n g h a d a "bad weekend." He told m e a b o u t a school fireworks p a r t y where h e w a n d e r e d a r o u n d feeling lonely; also, he told m e a b o u t feeling overwhelmed by t h e a m o u n t of homework h e h a d to do; a n d h e e n d e d by saying he w a s "really pissed off." I m a d e a n a t t e m p t to link h i s loneliness a n d h i s s e n s e of being overwhelmed to t h e canceled session, a n d h e r e s p o n d e d that he k n e w I would say t h a t , a n d h e scathingly wondered why it took a t r a i n e d a n a l y s t to spot t h a t he w a s feeling depressed. He claimed t h a t h e h a d actually enjoyed Friday, particularly n o t having to get u p early, b u t immediately w e n t on to talk a b o u t t h e school p a r t y a n d h i s father's p a t h e t i c a t t e m p t s a t cheering him up. B u t t h e real problem w a s t h a t h e didn't have a n y friends. I said t h a t I t h o u g h t m y canceling t h e s e s s i o n m u s t h a v e felt to him a s if I too w a s n ' t really h i s friend, a n d t h e analysis w a s n o more t h a n a p a t h e t i c a t t e m p t a t trying to cheer h i m u p . He talked in a s a d w a y a b o u t walking a b o u t a t t h e party, finding n o one to talk to, a n d t h e n , in a derogatory way, a b o u t boys r u s h i n g around squirting e a c h other with w a t e r pistols; even fireworks weren't a s good a s t h e y u s e d to be. He t h o u g h t h i s father h a d

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h a d a good time talking to other p a r e n t s . He h a d listened for a while b u t decided t h a t they, too, were s t u p i d . I took u p h i s d i s a p p o i n t m e n t with m e a n d t h e p a i n of being excluded: t h a t he w a s n ' t good e n o u g h , j u s t like t h e fireworks. He w e n t b a c k to talking a b o u t work. He w a s really worried, he said, a b o u t h i s work n o t being good e n o u g h , a b o u t being perfectionistic a n d t h e n getting b e h i n d . T h e n h e m e n t i o n e d t h e clown at t h e party, who h a d followed h i m a b o u t ; h e w a s quite distressed a s h e described trying to get away from h i m a n d all t h e revelry going on a r o u n d him. I said t h a t I t h o u g h t h e felt mocked by the party, j u s t like h e felt mocked by m y claimed interest in h i m and by h i s father's a t t e m p t to cheer h i m u p . None of t h e s e felt genuine, a n d . h e w a s feeling really pissed off by t h e t h o u g h t t h a t I h a d b e e n mocking h i m secretly all along. He agreed; h e said h e felt ridiculous a n d h a d n o t w a n t e d to come to see m e this morning. There w a s a long tirade a b o u t h i s p e t - h a t e s u b j e c t photography. He complained t h a t h e s h o u l d h a v e s h o t a roll of film t h i s weekend a n d described h i s struggles to get s o m e work d o n e for h i s project. He gave a clue a b o u t t h e n a t u r e of his inhibition a b o u t t a k i n g p i c t u r e s w h e n h e m e n t i o n e d h i s feeling t h a t h i s p h o t o g r a p h y t e a c h e r only liked t a k i n g p i c t u r e s of girls. I suggested t h a t m a y b e h e w a s frightened t h a t I would mock or ridicule h i s interest in girls, yet p e r h a p s h e wouldn't m i n d taking p i c t u r e s of girls if he h a d t h e opportunity. T h e tirade a b o u t the p h o t o g r a p h y t e a c h e r c o n t i n u e d with increased ferocity—he was a "real l e c h e r o u s b a s t a r d , " h e only gave a d e q u a t e teaching to girls, yet h e w a s fat a n d ugly. They called h i m "Fat S a m the blow-job m a n . " I said t h a t I t h o u g h t it w a s very h a r d for him b e c a u s e h e felt so guilty a b o u t n o t really being able to set aside h i s interest in p i c t u r e s of girls, a n d t h a t every o t h e r t a s k , including t h e analysis, seemed overwhelming. He w e n t on< to describe h i s struggle with himself over not w a n t i n g to m a s t u r b a t e d u r i n g t h e weekend until h e h a d finished h i s homework; ultimately h e lost t h e struggle a n d gave in, b u t he felt terrible a b o u t it. B u t t h a t w a s n ' t t h e s a m e a s t h e teacher— "He should be able to control his interest, he's sixty, for goodness sake," t h a t ' s why h e h a t e d him. I said t h a t p e r h a p s h e h a d wondered if I h a d n o t canceled Friday's session b e c a u s e I was

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not able to p u t m y w o r k with h i m above m y interest in girls. He laughed a n d said t h a t p e r h a p s he would call m e S a m from now on. B u t h e a d d e d t h a t h e found it very disturbing to t h i n k of adults having s e x u a l interests; t h e n h e talked of his father being away a lot recently. I said tentatively t h a t p e r h a p s t h e r e w a s something a b o u t h i s p a r e n t s ' sexuality t h a t disturbed him. He w a s relieved a n d replied: "I'm glad you mentioned it first." Over t h e weekend h e h a d overheard h i s p a r e n t s arguing a b o u t sex; it seemed to h i m t h a t h i s m o t h e r didn't w a n t to h a v e sex with h i s father a n y more. He w a s worried t h a t they would s t a r t fighting or t h a t h i s m o t h e r would leave. He said t h a t h e h a t e d his father, t h a t h e could b e a real shit sometimes. I said t h a t I understood how u p s e t t i n g a n d confusing overhearing h i s parents' conversation m u s t h a v e been, t h a t p e r h a p s he j u s t w a n t e d to walk away from it like he did from h i s father's excited discussions at t h e party, b e c a u s e it m a d e h i m h a t e a p a r t of himself so m u c h . I w a n t e d to a d d t h a t s o m e t i m e s h e w a s afraid of growing up, in case h e would grow into a m a n like h i s father, b u t h e said: "Do you t h i n k I'll t u r n into a little shit like m y father w h e n I grow up?" I said t h a t I t h o u g h t t h a t w h a t h e w a s describing w a s a terrible t r a p h e felt h e w a s in, between feeling like a little boy who w a s isolated a n d a b a n d o n e d , w h o could be ridiculed because he only h a d a w a t e r pistol n o t a proper penis, or feeling h e would grow u p a n d be like Fat Sam, w h o s e sexuality w a s a subject of ridicule a s well a s r e s e n t m e n t a n d h a t r e d . There seemed n o alternative, n o possibility of being j u s t a n ordinary man. He said r a t h e r sadly t h a t h e didn't t h i n k he'd ever have a girl friend, t h a t nobody would w a n t him. I a d d e d t h a t t h a t w a s part of it, b u t h e w a s also frightened t h a t somebody might. He said t h a t w a s very t r u e . T h e s e s s i o n ended with Glen leaving m u c h cheered b u t adding, on h i s way out: "I still haven't forgiven you for last Friday, though." Glen's a n a l y s i s w a s completed in t h r e e a n d a half years. During this time anxieties a b o u t performance in exams, m a s t u r bation, a n d other a s p e c t s of sexuality emerged, a s would be developmentally expected. His obsessional rituals either stopped or they n o longer b o t h e r e d him. His exam performance w a s very

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good, a n d he w a s offered places in a n u m b e r of universities. He c o n t i n u e d in p s y c h o t h e r a p y for a further y e a r a n d h a s made good progress since ending.

Discussion Glen's p r o b l e m s resolved quickly, n o t j u s t t h r o u g h addressing h i s u n c o n s c i o u s conflicts b u t t h r o u g h being given s p a c e to play with feelings a n d ideas. The analytic setting allowed h i m once again to bring together h i s two m o d e s of experiencing inner reality. He h a d w i t h d r a w n from t h e complexity of interpersonal relations into h i s tentlike coat, a p p a r e n t l y u n a b l e to t h i n k . Yet h i s difficulty w a s rooted in a hyperactivity of mentalizing brought forth by h i s developmental leap. T h e leap h a d t h r o w n h i m back into a mode of psychic equivalence t h a t m a d e t h e c o n t e n t s of his m i n d terrifying to h i m b u t could be alleviated by t h e analyst's scaffolding. Glen h a d k n o w n t h a t t h o u g h t s were only t h o u g h t s a n d feelings were only feelings, b u t t h e p r e o c c u p a t i o n with the complexity of h i s own a n d h i s p a r e n t s ' feelings, w h i c h h e had discovered in adolescence, defeated him, a n d h e took refuge in a m e n t a l s t a t e t h a t does n o t recognize t h e n a t u r e of psychic reality. J u s t like t h e 2Tyear-old w h o e s c a p e s into p r e t e n d in order to avoid t h e terror t h a t psychic equivalence generates, so Glen, like m a n y adolescents, retreated into a s t a t e of dissociation. His obsessionality w a s a m o r e direct expression of psychic equivalence; however, it w a s n o t characterological, a n d it disappeared s i m u l t a n e o u s l y with t h e r e t u r n of mentalization. There a r e m a n y differences between t h e c a s e s of Tony and Glen, b u t one feature in p a r t i c u l a r c o n c e r n s u s here. While both Tony a n d Glen experienced a regression to a d u a l mode of m e n t a l functioning, only in Tony's case did t h i s reveal a destructive a n d hostile alien self. Both were immensely vulnerable to humiliation a n d s h a m e b e c a u s e of t h e r e t u r n of psychic equivalence. Only in Tony, w h o h a d b e e n far m o r e brutalized by earlier experiences, did t h i s s h a m e become ego-destructive. T h e power of externalization (projective identification) w a s i n t e n s e in both patients, a n d t h i s m a y indeed b e a feature in m o s t adolescent

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analyses given t h e p r e s s u r e s for s e p a r a t e n e s s to w h i c h we referred above. In Glen's case t h e externalization of h i s alien self left a more m a t u r e a n d intact s t r u c t u r e , which needed little by way of external s u p p o r t . T h e challenge of trying to t r e a t s o m e o n e like Tony is t h a t n o t only is t h e t h e r a p i s t required to accept t h e externalization w i t h o u t w h i c h t h e p a t i e n t is u n a b l e to relate, b u t that having b e c o m e w h a t t h e patient n e e d s h e r to be, s h e is required to provide scaffolding a n d support, recognition of t h e patient's t r u e (even loving) self. To do t h i s while reflecting t h e terror t h a t t h e p a t i e n t n e e d s to see outside a n d fending off physical a s s a u l t is m o r e t h a n c a n b e a s k e d of m o s t therapists. So how c a n we cope with regressed adolescent p a t i e n t s ? T h e patients we a r e considering experience very deep anxieties a b o u t the self being overwhelmed, b e c a u s e t h e p a r e n t is n o longer there to h a v e a n a r c h a i c image of herself projected b a c k onto her. T e c h n i q u e h a s to t a k e a c c o u n t of this. Accepting projections, often initially w i t h o u t interpretation, m a y be particularly important. O n e is likely to be m a d e into a good, b a d , valued, a n d hated figure, to be t r a n s p o r t e d a t magical s p e e d s a n d unpredictably t h r o u g h a m a s s i v e intrapsychic terrain. There is a c o n s t a n t search for alternative figures to serve a s h o s t s for t h e alien self, which gives rise to t h e a p p a r e n t "promiscuity" of t h e s e adolescents. Sadly, m o s t people are n o t accepting of their projections, and experiences of profound rejection t e n d to dog these y o u n g people. One technical difficulty is likely to be t h a t t h e more real something feels to t h e patient, t h e more it is to talk about, because it feels like a primitive, concrete experience t h a t c a n only be m a n a g e d in physical ways. The t h i n g s t h a t feel real c a n be apparently trivial experiences, particularly in t h e transference, w h i c h c a n feel entirely u n b e a r a b l e , a n d if t h e analyst approaches t h o s e things, t h e r e c a n be d r a m a t i c r u p t u r e s to t h e alliance. There m a y b e bizarre d e m a n d s for concrete solutions, which it is t e m p t i n g to interpret in t e r m s of m o r e ordinary transference. Analytic help n e e d s to be offered in a way t h a t is consistent with t h e developmental challenges of this stage, facilitating t h e forward m o v e m e n t toward a n a u t o n o m o u s identity. This occurs

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t h r o u g h a p r o c e s s t h a t is a n a l o g o u s to playing with a young child, helping t h e adolescent to r e p r e s e n t a n d m a n a g e his m e n t a l s t a t e s psychologically r a t h e r t h a n physically. This h a s to t a k e place alongside t h e patient's efforts to re-find a n external vehicle, t h r o u g h t h e transference, for intolerable a s p e c t s of his earliest relationships.

PART I I I

CLINICAL

P E R S P E C T I V E S

In part III, we extend our analysis of case material from children and adolescents to adults, illustrating the theoretical and developmental views we have introduced. We have two chapters on serious character pathology, focusing on cases of borderline personality disorder, demonstrating how this pathology has its source in the failure of mentalization and in problems with sustaining the intentional stance. We also propose the notion of an alien self to account for intolerable disturbances in the sense of identity in these patients, the vulnerability to self-harm, and the fact that attachment is both desperately needed and rapidly unbearable, including in the therapeutic relationship. In chapter 11, we broaden our focus to include four case studies of adults, ranging from relatively mild to severe psychopathology. In this chapter, we describe the processing of affects through mentalization—what we term "mentalized affectivity," Finally, the clinical material shows what mentalized affectivity is and how it can be enhanced in and by psychotherapy.

The of Borderline Personality in Disorganized

Roots

Disorder

Attachment

THE ATTACHMENT SYSTEM AND THE DISTORTION OF INTERPERSONAL RELATIONSHIPS IN PERSONALITY DISORDER There h a v e b e e n m a n y a t t e m p t s in t h e p a s t to illuminate t h e symptomatology of borderline personality disorder u s i n g attachm e n t theory. Implicitly or explicitly, Bowlby's suggestion t h a t early experience with t h e caregiver serves to organize later att a c h m e n t r e l a t i o n s h i p s h a s b e e n u s e d in explanations of psychopathology in BPD. For example, it h a s b e e n suggested t h a t the borderline p e r s o n ' s experiences of interpersonal attack, neglect, a n d t h r e a t s of a b a n d o n m e n t m a y a c c o u n t for a perception of c u r r e n t r e l a t i o n s h i p s a s a t t a c k i n g a n d neglectful (Benjamin 1993). O t h e r s h a v e suggested t h a t borderline individuals are specifically characterized by a fearful a n d preoccupied a t t a c h ment style reflecting "an emotional template of intimacy anxiety/ anger" (Dutton, S a u n d e r s , Starzomski, a n d Bartholomew 1994). In s t u d i e s of AAI n a r r a t i v e s of borderline patients, t h e classification of "preoccupied" is m o s t frequently assigned (Fonagy et al. 1996) a n d , within this, t h e "confused," "fearful," a n d "overwhelmed" subclassification a p p e a r s to be m o s t c o m m o n (Patrick

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et al. 1994). Not surprisingly, s u c h p a t i e n t s also tend to be unresolved with regard to their experience of t r a u m a or a b u s e . P a s t a t t e m p t s a t linking work on a t t a c h m e n t with theories of borderline pathology h a v e s t r e s s e d t h e c o m m o n characteristic s h a r e d by t h e ambivalently a t t a c h e d / p r e o c c u p i e d a n d borderline g r o u p s "to check for proximity, signaling to establish contact by pleading or other calls for a t t e n t i o n or help, a n d clinging behaviors" (Gunderson 1996). G u n d e r s o n highlights t h e theme of intolerance of a l o n e n e s s a n d terror of a b a n d o n m e n t in s u c h patients, which h a s b e e n claimed to a c c o u n t for m a n y of the clinical features observed in this g r o u p of p a t i e n t s . Consistent with this view is t h e lack of stable r e p r e s e n t a t i o n of t h e other a n d t h e u s e of t h e t h e r a p i s t a s a transitional object, a n extension of t h e patient, w h o lacks s e p a r a t e identity a n d feelings (Modell 1963). Transitional r e l a t e d n e s s in t h e s e p a t i e n t s is m a r k e d by histories of u s i n g transitional objects (Morris, Gunderson, a n d Zanarini 1986) a s well a s bringing s u c h objects to hospital m o r e frequently t h a n p a t i e n t s with o t h e r psychiatric disorders (Cardasis, H o c h m a n , a n d Silk 1997). However, directly applied, normative observations of attachm e n t in infancy a r e probably insufficient to provide a n account of t h e behavior of borderline p a t i e n t s . There is n o d o u b t t h a t borderline individuals a r e i n s e c u r e in their a t t a c h m e n t , b u t for several r e a s o n s descriptions of i n s e c u r e a t t a c h m e n t from infancy or a d u l t h o o d provide a n i n a d e q u a t e clinical account: [a] Anxious a t t a c h m e n t is very c o m m o n ; in working-class samples t h e majority of children a r e anxiously a t t a c h e d (Broussard 1995). (b) Anxious p a t t e r n s of a t t a c h m e n t in infancy correspond to relatively stable a d u l t strategies (Main et al. 1985), yet the h a l l m a r k of t h e disordered a t t a c h m e n t s of borderline individuals is t h e a b s e n c e of stability (Higgitt a n d Fonagy 1992). (c) While the angry p r o t e s t s of t h e r e s i s t a n t infant m a y s e e m to provide a challenging analogy for t h e pervasively aggressive s t a n c e in interpersonal relationships of t h e borderline individual (Dutton et al. 1994), t h e clinical p r e s e n t a t i o n of borderline patients frequently includes a violent a t t a c k on t h e p a t i e n t ' s own body or t h a t of a n o t h e r h u m a n being. It is likely t h a t t h e propensity for s u c h violence m u s t include a n additional component, which

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predisposes s u c h individuals to act u p o n bodies r a t h e r t h a n u p o n m i n d s , a n d indeed it is t h i s very i n a d e q u a c y in their capacity to r e p r e s e n t aggression-related a t t a c h m e n t ideation mentally t h a t m a y place t h e m a t risk of violent a c t s in t h e context of i n t i m a t e interpersonal relationships (Fonagy a n d Target 1995b). There is s o m e evidence of a specific link between childhood maltreatment—particularly childhood sexual a b u s e — a n d borderline personality disorder (Paris, Zweig-Frank, a n d Guzder 1993). As children, s u c h individuals frequently h a d caregivers who were themselves within t h e so-called borderline s p e c t r u m of severe personality disorder (Shachnow et al. 1997). Many writers have criticized t h e t e r m "borderline" a s too imprecise, b u t most c o n t i n u e to find it useful. It m a y be helpful to clarify t h e clinical p h e n o m e n a t h a t we shall be discussing. There are two main psychoanalytic u s e s of t h e term, one rooted in psychiatry (e.g., Kernberg 1987) a n d t h e other rooted in psychoanalytic clinical practice. Here we are concerned with t h e second of t h e s e meanings; furthermore, t h e model described h e r e is intended to explain borderline p h e n o m e n a in m a n y patients, n o t simply those w h o fulfill diagnostic criteria of borderline personality disorder. Although we refer to borderline patients, we are therefore n o t referring to t h e diagnostic group. O u r aim is to elucidate the m e n t a l functioning of a larger g r o u p of p a t i e n t s whose thinking a n d affective experience b e c o m e massively disorganized in the clinical setting a s well a s elsewhere. Clinical descriptions of borderline p h e n o m e n a (e.g., Rey 1979) a r e of individuals who regress dramatically in psychoanalytic t r e a t m e n t , showing psychotic-like p h e n o m e n a , a n d w h o evoke i n t e n s e feelings in t h e analyst. T h e s e feelings, in combination with t h e patient's intense emotional lability, create a troubled a n d t r o u b l e s o m e analytic process. Their j o u r n e y t h r o u g h a n a l y s i s is m a r k e d by transference a n d often c o u n t e r t r a n s f e r e n c e e n a c t m e n t s , with periods of intense d e p e n d e n c e p u n c t u a t e d by r u p t u r e s of t h e t r e a t m e n t process. Analysis t e n d s to be prolonged a n d limited in its results. This c h a p t e r is i n t e n d e d to be integrative, in t h a t we aim to a c c o u n t for t h e experience of borderline p a t i e n t s within t h e analytic relationship by providing n o t so m u c h a new clinical

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description, b u t m o r e a developmental perspective on t h e ego m e c h a n i s m s underlying t h e s e p h e n o m e n a . We also offer some technical suggestions t h a t seem to u s to follow from a n u n d e r s t a n d i n g of t h e developmental roots of t h e s e patients' difficulties. We have proposed t h a t s o m e personality-disordered individuals are t h o s e victims of childhood a b u s e w h o coped by refusing to conceive of their a t t a c h m e n t figure's t h o u g h t s a n d t h u s avoided having to t h i n k a b o u t their caregiver's w i s h to h a r m t h e m (Fonagy, Leigh, et al. 1996). There is a c c u m u l a t i n g evidence t h a t m a l t r e a t m e n t impairs t h e child's reflective capacities a n d s e n s e of self. Schneider-Rosen a n d Cicchetti (1984, 1991) noted t h a t a b u s e d toddlers showed less positive affect on recognizing themselves in t h e mirror t h a n did controls. Beeghly and Cicchetti (1994) showed t h a t t h e s e toddlers h a d a specific deficit in t h e u s e of i n t e r n a l - s t a t e w o r d s a n d t h a t s u c h l a n g u a g e tended to be context-bound. O u r Menninger s t u d y of m a l t r e a t e d 5- to 8year-olds found specific deficits in t a s k s requiring mentalization, particularly a m o n g t h o s e referred for sexual or physical a b u s e . These r e s u l t s suggest t h a t m a l t r e a t m e n t m a y c a u s e children to w i t h d r a w from t h e m e n t a l world. C o n t i n u i n g defensively to disr u p t their capacity to depict m e n t a l s t a t e s in t h e m s e l v e s a n d in o t h e r s leaves t h e m operating on i n a c c u r a t e , s c h e m a t i c impressions of t h o u g h t s a n d feelings. They a r e t h e n immensely vulnerable in i n t i m a t e relationships. There a r e two propositions here: [a] individuals w h o experience early t r a u m a m a y defensively inhibit their capacity to mentalize; a n d (b) s o m e characteristics of personality disorder m a y b e rooted in t h i s inhibition. In t h i s chapter, we consider a limited set of s y m p t o m s a n d personality characteristics found in BPD in t h e light of these propositions: (a) disorganized a n d dysfunctional self-organization a n d c o n s e q u e n t p r o b l e m s in affect regulation a n d emotional self-control (including feelings of e m p t i n e s s , lack of a stable s e n s e of self, emotional instability, a n d impulsivity); (b) dysfunctional a n d distorting "social-reality-testing" abilities: t h e domin a n c e of defensive m o d e s of functioning in intimate relationships a n d in t h e analytic transference characterized by splitting a n d projective identification; (c) vulnerability to t r a u m a , s e r i o u s difficulties in m a i n t a i n i n g intimate a t t a c h m e n t relations, p r o n e n e s s to provoke a b a n d o n m e n t , a n d c o n s e q u e n t suicidality. We will

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show how t h e developmental theory we have a d v a n c e d in previous c h a p t e r s c a n s h e d light on t h e symptomatology of BPD.

ATTACHMENT E X P E R I E N C E S A S DETERMINANTS OF CAPACITIES FOR SOCIAL COGNITION To deepen o u r u n d e r s t a n d i n g of t h e relation of a t t a c h m e n t a n d BPD, let u s consider t h e question of how the t r a n s g e n e r a t i o n a l t r a n s m i s s i o n of a t t a c h m e n t m a y be mediated. Genetics m a y seem to provide a n obvious explanation. However, t h e early findings of a n ongoing twin s t u d y in o u r laboratory have yielded no evidence of differential levels of concordance of a t t a c h m e n t classification between identical a n d nonidentical twins (Fonagy, Fearon, a n d Target 1999). A t t a c h m e n t theorists have a s s u m e d t h a t securely a t t a c h e d a d u l t s are more sensitive to their children's n e e d s , t h u s fostering a n expectation in t h e infant t h a t dysregulation will be rapidly a n d effectively met (Belsky et al. 1995; De Wolff a n d v a n IJzendoorn 1997). Disappointingly, s t a n dard m e a s u r e s of caregiver sensitivity do n o t a p p e a r to explain transgenerational consistencies in a t t a c h m e n t classification a t all well (van U z e n d o o m 1995). An alternative a c c o u n t of t h e crucial mediator of a t t a c h m e n t security is provided by Mary Main (1991) a n d Inge Bretherton (1991a), w h o i n d e p e n d e n t l y drew attention to Daniel Dennett's concept of t h e "intentional stance," w h i c h h a s b e e n a core construct in t h i s m o n o g r a p h a s well (see c h a p t e r s 3-5). As we have described, D e n n e t t (1987) theorized t h a t h u m a n s have evolved a mentalistic interpretational s y s t e m t h a t h e calls t h e "intentional stance," w h o s e function is efficiently to predict a n d explain other people's actions by inferring a n d a t t r i b u t i n g c a u s a l intentional mind s t a t e s (such a s beliefs, intentions, a n d desires) to t h e m . This s y s t e m implies a n u n d e r s t a n d i n g t h a t behavior c a n be caused by r e p r e s e n t a t i o n a l m e n t a l s t a t e s t h a t c a n be either t r u e or false in relation to a c t u a l reality. Since intentional m i n d states (such a s beliefs) a r e n o t directly visible, t h e y need to be inferred from a variety of behavioral a n d situational c u e s t h a t the interpreter n e e d s to monitor constantly. The ability to

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mentalize, w h i c h c a n be s e e n a s t h e central m e c h a n i s m of "social (or mental) reality testing," is therefore a developmental achievement t h a t unfolds t h r o u g h t h e g r a d u a l sensitization to a n d learning a b o u t t h e m e n t a l significance of relevant expressive, behavioral, verbal, a n d situational c u e s t h a t indicate the presence of m i n d s t a t e s in p e r s o n s . T h e ability to mentalize affords t h e child a m e a s u r e of protection: for example, a child who is confronted with a n u n r e s p o n s i v e , d e p r e s s e d m o t h e r is protected from confusion a n d a negative view of himself if h e is able to hypothesize t h a t her s a d n e s s is d u e to a loss. As we h a v e seen, c u r r e n t evidence indicates t h a t normally developing children only c o n s t r u c t a relatively m a t u r e naive theory of m i n d a t a r o u n d 3 to 4 y e a r s of age. This is well illustrated by t h e false-belief t a s k first developed by W i m m e r and Perner (1983) a n d described in detail in c h a p t e r 5. S u c h studies indicate t h a t a l t h o u g h a t t h e age of 3 y e a r s t h e great majority of children fail in t a s k s t h a t require t h e m to predict a n o t h e r person's action b a s e d on a false belief a t t r i b u t e d to h i s m i n d , by 4 y e a r s of age they h a v e u s u a l l y m a s t e r e d t h i s ability. In Wimmer a n d Perner's experiment, 4-year-old children showed sensitivity to t h e situational c u e s t h a t enabled t h e m to infer t h a t the experimenter would c o n t i n u e to a c t on t h e b a s i s of a n outdated false belief a b o u t reality. So by 4 y e a r s of age children can u n d e r s t a n d t h a t actions are c a u s e d by m e n t a l r e p r e s e n t a t i o n s of reality r a t h e r t h a n by reality itself (as they see it). By t h i s time, t h e y have also learned t h e significance of t h e relevant mindc u e — t h a t seeing leads to knowing—that would h a v e sanctioned t h e m to a t t r i b u t e a c h a n g e in belief to t h e other's mind. The securely a t t a c h e d child perceives in t h e caregiver's reflective s t a n c e a n image of himself a s desiring a n d believing. He sees t h a t t h e caregiver r e p r e s e n t s h i m a s a n intentional being, and t h i s r e p r e s e n t a t i o n is internalized to form t h e self. If t h e caregiver's reflective capacity h a s enabled h e r accurately to picture t h e child's intentional stance, t h e n t h e child will h a v e t h e opport u n i t y to "find himself in t h e other" a s a mentalizing individual. At t h e core of o u r selves is t h e r e p r e s e n t a t i o n of h o w we were seen. O u r reflective capacity is t h u s a t r a n s g e n e r a t i o n a l acquisition. We t h i n k of o t h e r s in t e r m s of desires a n d beliefs because— a n d to t h e extent that—we were t h o u g h t of a s intentional beings.

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Only following t h i s p r o c e s s of internalization c a n t h e developm e n t of a w a r e n e s s of m e n t a l s t a t e s in oneself b e generalized to others, including t h e caregiver.

ATTACHMENT AND T H E NORMAL DEVELOPMENT OF T H E SELF A t t a c h m e n t is involved in t h e development of reflective function at three levels: 1. We a s s u m e t h a t t h e internalization of second-order representations of i n t e r n a l s t a t e s (self-states) d e p e n d s u p o n t h e sensitive reflection of t h e caregiver, a s d i s c u s s e d in c h a p t e r 4. T h e child's concept of affect is n o t arrived a t by introspection; r a t h e r , the caregiver's emotional expression, c o n g r u e n t with t h e child's state, is internalized a n d b e c o m e s its "representation" (Gergely and W a t s o n 1996; Target a n d Fonagy 1996). These self-states become t h e building blocks with w h i c h a reflective internal working model c a n be c o n s t r u c t e d . The combination of t h e representation of self-experience a n d t h e r e p r e s e n t a t i o n of t h e reaction of t h e caregiver elaborates t h e child's teleological model of t h e m i n d a n d ultimately enables h i m to interpret a n d u n d e r s t a n d affective displays in o t h e r s a s well a s arriving a t t h e regulation a n d control of h i s own emotions. 2. The g r a d u a l move from a teleological to a n intentional s t a n c e is intrinsically linked to t h e child's experience of safety in exploring t h e caregiver's m i n d to disentangle t h e feelings a n d t h o u g h t s t h a t might a c c o u n t for t h e caregiver's behavior. T h e s e c u r e infant feels safe in m a k i n g a t t r i b u t i o n s of m e n t a l s t a t e s to account for t h i s behavior. In c o n t r a s t , t h e avoidant child s h u n s t h e mental s t a t e of t h e o t h e r to some degree, while t h e r e s i s t a n t child focuses on h i s own state of distress, to t h e exclusion of close intersubjective exchanges. Disorganized infants m a y represent a special category; hypervigilant of t h e caregiver's behavior, they u s e all c u e s available for prediction a n d m a y be acutely sensitized to intentional s t a t e s , a n d t h u s they m a y be more

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ready to c o n s t r u c t a mentalized a c c o u n t of t h e caregiver's behavior. In s u c h children mentalization m a y be evident, b u t it does n o t have t h e central a n d effective role in self-organization t h a t characterizes securely a t t a c h e d children. There m a y be a n u m b e r of linked r e a s o n s for this: (a) t h e caregiver of t h e disorganized infant is less likely to be reliably contingent in r e s p o n d ing to t h e infant's self-state, a n d further to s h o w systematic b i a s e s in h e r perception a n d reflection of h i s state; (b) t h e m e n t a l s t a t e of t h e caregiver evokes i n t e n s e anxiety, either t h r o u g h frightening behavior, suggesting malevolence toward t h e child, or behavior suggesting fear, w h i c h m a y include fear of t h e child himself; (c) t h e child n e e d s to u s e disproportionate r e s o u r c e s to u n d e r s t a n d t h e p a r e n t ' s behavior, at t h e expense of reflecting on self-states. T h e s e factors combine, p e r h a p s , to m a k e disorganized infants k e e n r e a d e r s of t h e caregiver's m i n d u n d e r certain c i r c u m s t a n c e s , b u t (we suggest) poor r e a d e r s of their own mental states. 3. T h e caregiver m a k e s a further i m p o r t a n t contribution, perh a p s m o s t i m p o r t a n t a t a s o m e w h a t later stage. Prototypically, while playing with t h e child, t h e caregiver s i m u l t a n e o u s l y engages t h e child's internal world while retaining a n external reality-based perspective (Fonagy a n d Target 1996; Target a n d Fonagy 1996). T h e child is moved from a subjective world of psychic equivalence—where i n t e r n a l experience a n d external reality are a s s u m e d to be equivalent—to a mentalized internal world where subjective experiences a r e recognized a s b u t one version of external reality, a "representation of reality." This is a n a l o g o u s to psychoanalytic d i s c u s s i o n s of t h e cognitive impact of t h e oedipal triad, where t h e s h a r e d reality of two people is s u d d e n l y experienced from t h e point of view of t h e third (Britton 1998). The p a r e n t s ' e n g a g e m e n t in t h e child's i n t e r n a l world moves h i m beyond t h e conception of h i s m i n d a s a replica of the external world. These t h r e e c o m p o n e n t s — t h e second-order r e p r e s e n t a t i o n of affect a n d t h e intentional r e p r e s e n t a t i o n of t h e caregiver a n d of t h e self—equip t h e child to confront a s o m e t i m e s h a r s h social reality. The r o b u s t e s t a b l i s h m e n t of reflective function is protects

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tive; fragile reflective function predicts a vulnerability to later t r a u m a . S e c u r e a t t a c h m e n t a n d reflective function a r e overlapping c o n s t r u c t s , a n d t h e vulnerability associated with i n s e c u r e a t t a c h m e n t lies primarily in t h e child's diffidence in conceiving of t h e world in t e r m s of psychic r a t h e r t h a n physical reality. Given t r a u m a of sufficient intensity, even a s e c u r e b o n d m a y sometimes crumble, yet in t h e a b s e n c e of psychosocial press u r e s , reflective function m a y offer only marginal developmental advantage. To u n d e r s t a n d severe personality disorder, it is important t h a t we a r e a t t u n e d to t h e limited capacity of t h e patient to u s e t h e l a n g u a g e of m e n t a l s t a t e s for self-organization a s well a s social u n d e r s t a n d i n g .

A TRANSGENERATIONAL MODEL OF PERSONALITY DISORDER The social i n h e r i t a n c e a s p e c t of BPD m a y be a n i m p o r t a n t clue in our u n d e r s t a n d i n g of t h e disorder. S t u d i e s by o u r g r o u p (Fonagy et al. 1996) a s well a s o t h e r s (Patrick et al. 1994) have demonstrated considerable distortions of a t t a c h m e n t representation in personality-disordered, particularly borderline, individuals. In our study, individuals with BPD diagnosis h a d predominantly preoccupied a t t a c h m e n t s , associated with unresolved experiences of t r a u m a a n d a striking reduction in reflective capacity. In a further s t u d y we compared o u r p a t i e n t g r o u p to a m a t c h e d group of forensic psychiatric referrals. In t h e latter group, dismissing p a t t e r n s of a t t a c h m e n t p r e d o m i n a t e d , unresolved t r a u m a w a s less evident (although t h e prevalence of t r a u m a w a s comparable), a n d reflective capacity w a s even lower (Levinson and Fonagy, u n p u b l i s h e d m a n u s c r i p t , UCL). We shall a r g u e t h a t t h e dysfunctional a n d distorted u n d e r standing of other m i n d s (and of t h e mind of t h e self) characteristic of some personality-disordered individuals is t h e r e s u l t of adverse t r a u m a t i c experiences with a t t a c h m e n t figures (often involving physical m a l t r e a t m e n t a n d / o r sexual abuse) d u r i n g the early formation of a t t a c h m e n t r e p r e s e n t a t i o n s . We recognize, however, t h a t explicit m a l t r e a t m e n t is n o t a n inevitable p a r t of

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BPD pathology. Early neglect m a y sensitize individuals to later a t t a c h m e n t t r a u m a , a n d psychological a b u s e associated with p e r s i s t e n t neglect of t h e y o u n g child's s e n s e of subjectivity might be h a r d e r to recognize t h a n frank m a l t r e a t m e n t . The pathological c o n s e q u e n c e s of early a t t a c h m e n t t r a u m a a r e mediated by t h e distorting effect t h a t s u c h a deviant a t t a c h m e n t context exerts on t h e n o r m a l unfolding of m i n d r e a d i n g abilities.

T H E IMPACT OF M A L T R E A T M E N T ON REFLECTIVE FUNCTION One serious c o n s e q u e n c e of p a r e n t a l neglect, m a l t r e a t m e n t , a n d a b u s e is t h e lack of a sensitive a n d i n f a n t - a t t u n e d emotionalintentional mirroring environment t h a t we hypothesized to be n e c e s s a r y for t h e e s t a b l i s h m e n t of s e c o n d a r y r e p r e s e n t a t i o n s for t h e infant's self-states. Lacking s u c h s e c o n d a r y representations, t h e affective i m p u l s e s of t h e "constitutional s e l f r e m a i n relatively inaccessible a n d n o n c o n s c i o u s , r e s u l t i n g in feelings of e m p t i n e s s a n d disorganization a n d in a deficient ability for imp u l s e control. There is a c c u m u l a t i n g evidence t h a t m a l t r e a t m e n t impairs t h e child's reflective capacities a n d s e n s e of self (Beeghly a n d Cicchetti 1994; Schneider-Rosen a n d Cicchetti 1984, 1991). This situation can, a n d probably often does, i n d u c e a severe a n d vicious developmental cycle. Poor c o m p r e h e n s i o n of mental s t a t e s associated with m a l t r e a t m e n t amplifies distress, activating t h e a t t a c h m e n t system. T h e need for proximity t h u s persists a n d p e r h a p s even increases a s a c o n s e q u e n c e of t h e distress c a u s e d by a b u s e . Mental proximity b e c o m e s u n b e a r a b l y painful, a n d t h e need for closeness is expressed a t a physical level. Thus, t h e child m a y paradoxically be driven physically closer to the a b u s e r . This ability to a d a p t to, modify, or avoid t h e perpetrator's behavior is likely to be constrained by limited mentalizing skills, a n d e x p o s u r e to further a b u s e is likely. T h e p a r a d o x of proximity seeking a t t h e physical level c o n c u r r e n t with psychological avoidance lies a t t h e root of t h e disorganized a t t a c h m e n t so consistently s e e n in a b u s e d children.

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Why s h o u l d t h e family environment of m a l t r e a t m e n t u n d e r mine reflective function? (a) Recognition of t h e m e n t a l s t a t e of t h e o t h e r c a n b e d a n g e r o u s to t h e developing self. T h e child w h o recognizes t h e h a t r e d or m u r d e r o u s n e s s implied by t h e p a r e n t ' s acts of a b u s e is forced to see himself a s worthless or unlovable, (fa) The m e a n i n g of intentional s t a t e s m a y be denied or distorted; abusive p a r e n t s commonly claim beliefs or feelings a t o d d s with their behavior, (c) T h e a t t a c h m e n t context a n d t h e public world, where reflective function is common, are kept rigidly separate, (d) Last, t h e dysfunction m a y occur, n o t b e c a u s e of t h e maltreatm e n t itself, b u t b e c a u s e of t h e family a t m o s p h e r e t h a t s u r r o u n d s it. Authoritarian parenting, commonly associated with maltreatment, is also k n o w n to retard t h e development of mentalization (Astington 1996). T h e s e y o u n g s t e r s a n d their m o t h e r s find it difficult to t a k e a playful s t a n c e (Alessandri 1992), so t h e social scaffolding needed for t h e development of mentalization m a y b e absent. A mentalizing s t a n c e is also unlikely to develop in a child who generally feels treated a s a n uncared-for physical object. Stating t h i s m o r e generally, we would a r g u e t h a t exploring the infant-directed i n t e n t i o n s a n d emotional a t t i t u d e s inferable from t h e a b u s e r ' s actions c a n r e s u l t in seriously dysfunctional c o n s e q u e n c e s for t h e developing self. On t h e one h a n d , t h e persecutory i n t e n t i o n s a t t r i b u t e d to t h e a b u s i v e a t t a c h m e n t figure r e p r e s e n t c o n t i n u o u s d a n g e r to t h e self a n d a n a c u t e lack of feelings of a t t a c h m e n t security. On t h e other h a n d , t h e child, in a n a t t e m p t to rationalize t h e p e r s e c u t o r y i n t e n t i o n s of t h e caregiver, often e n d s u p a t t r i b u t i n g seriously negative properties of worthlessness, u n w a n t e d n e s s , ugliness, a n d so forth to h i s own self-image. We h a v e proposed (Fonagy 1991) t h a t t h e characteristic defensive reaction of coping with t h e s e c o n s e q u e n c e s by t h e general inhibition of t h e t e n d e n c y to mentalize a b o u t t h e abusive caregiver's i n t e n t i o n s is m o s t likely to o c c u r if t h e capacity to mentalize w a s poorly established in early infancy. The child is more likely to develop a t e n d e n c y to avoid contemplating the mental s t a t e s of t h e a b u s e r if t h i n k i n g h a s r e m a i n e d s o m e w h a t teleological a n d t h e internal world is m o r e likely to be represented in t h e m o d e of psychic equivalence (see c h a p t e r s 5 a n d 6). In t h e long r u n , t h e selective exclusion of i n t e r n a l - s t a t e repre-

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s e n t a t i o n s vis-a-vis t h e m a l t r e a t i n g caregiver r e s u l t s in a deficit in mentalization capacities, at least, in object relations t h a t are related or similar to t h e abusive a t t a c h m e n t context. We see this a s t h e result of a reversible inhibition of a n a t u r a l biological t e n d e n c y to try to read t h e m i n d s t a t e s of t h e a t t a c h m e n t figure; t h e child's t e n d e n c y to stop monitoring a n d learning a b o u t the relevant c u e s t h a t s u p p o r t m e n t a l - s t a t e a t t r i b u t i o n s , however, leads gradually to a n increasingly impoverished u n d e r s t a n d i n g of other m i n d s . This, t h e n , creates a deficit-like s t a t e t h a t is a great deal m o r e difficult to reverse, even given m o r e favorable social c i r c u m s t a n c e s .

PERSONALITY D I S O R D E R AND DEFICIT IN MENTALIZING Are some characteristics of personality disorder rooted in a deficit of mentalization? It m a y be t e m p t i n g to a r g u e t h a t some p r o b l e m s of violence and f borderline s t a t e s c a n be explained as dismissive a n d preoccupied forms of nonmentalizing self-organizations, respectively. This would be oversimplistic. In both i n s t a n c e s t h e r e are variations a c r o s s s i t u a t i o n s or types of relationships. The delinquent adolescent is, for example, a w a r e of t h e m e n t a l s t a t e s of o t h e r s in h i s g a n g a n d t h e borderline individual is a t times hypersensitive to t h e emotional s t a t e s of m e n t a l - h e a l t h professionals a n d family m e m b e r s . Following t h e principles of Kurt Fischer's "dynamic skills theory" of development (Fischer et al. 1990), we a s s u m e t h a t m a l t r e a t m e n t is associated with a "fractionation" or splitting of reflective function a c r o s s t a s k s a n d d o m a i n s . During t h e earlier stages of Piagetian development, j u s t a s t h e u n d e r s t a n d i n g of conservation of liquid does n o t a s yet generalize to conservation of area, reflective capacity in one d o m a i n of interpersonal interaction m a y n o t a t first generalize to others. In n o r m a l developm e n t , t h e r e would be some degree of integration a n d generalization of a mentalizing model of behavior. In severe personality disorder, however, development goes awry—the n o r m a l coordination of previously s e p a r a t e skills does n o t come a b o u t .

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Teleological models of behavior persist in all of u s a n d develop in sophistication, a s in m a n y c i r c u m s t a n c e s they provide useful predictions a n d a d e q u a t e explanations. For example, if on a wet day o n e observes one's friend crossing t h e road, one might, taking t h e intentional s t a n c e , infer t h a t h e does n o t wish to get wet (desire state) a n d h e t h i n k s t h e r e is still a s h o p on t h a t side t h a t sells u m b r e l l a s (belief state). (It actually closed two weeks ago—I snigger with a p p r o p r i a t e Schadenfreude.) However, t h e s a m e action could also be interpreted a s rational within t h e teleological framework. One could conclude t h a t one's friend h a s crossed t h e road in order to be able to walk faster (visible outcome) b e c a u s e t h e r e a r e too m a n y people on this side (visible constraint). Clearly, t h e application of t h e teleological s t a n c e can become problematic in t h e context of a t t a c h m e n t relationships. A s s u m e t h a t X is a close friend. Adopting t h e teleological s t a n c e m a y b e helpful in avoiding i m p u t i n g t h e desire to X t h a t he w a n t e d to avoid m e a n d t h e belief s t a t e t h a t h e t h i n k s I did n o t see him or t h a t h e t h i n k s t h a t I t h i n k t h a t h e did n o t see me. The mentalizing inferences of t h e intentional s t a n c e are n o more likely to be correct t h a n t h e physicalistic ones of t h e teleological mode. However, mentalizing models are uniquely valuable in complex interpersonal situations, involving for ins t a n c e conflict, deception, or irrationality. Unfortunately, nonreflective i n t e r n a l working models come to d o m i n a t e t h e behavior of personality-disordered individuals in emotionally charged or intimate relationships, a n d a n y interpersonal situation t h a t calls forth relationship r e p r e s e n t a t i o n s t h a t derive from t h e primary a t t a c h m e n t relationships. T h e s e individuals c a n be disadvantaged b e c a u s e (a) their caregivers did n o t facilitate mentalizing capacity within a s e c u r e a t t a c h m e n t relationship (vulnerability), (b) they h a v e s u b s e q u e n t l y acquired a n emotional disincentive for taking t h e perspective of o t h e r s w h o a r e hostile a s well a s nonreflective (trauma), (c) s u b s e q u e n t relationships are j e o p a r d ized by t h e lack of a m e n t a l - s t a t e attributional model of t h e original t r a u m a a n d s u b s e q u e n t experiences (lack of resilience), a n d (d) t h e y m a y divide mentalizing r e s o u r c e s unevenly between their external a n d i n t e r n a l worlds, becoming hypervigilant toward o t h e r s b u t u n c o m p r e h e n d i n g of their own s t a t e s (uneven adaptation).

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DISORGANIZED ATTACHMENT AND PERSONALITY D I S O R D E R Why should emotionally charged interactions trigger a "regression" to n o n m e n t a l i s t i c thinking? We h a v e suggested t h a t reflective function a n d its a t t a c h m e n t context a r e a t t h e root of selforganization. There is overwhelming p r e s s u r e on t h e child to develop a r e p r e s e n t a t i o n for i n t e r n a l states. As we s a w in c h a p t e r 4, within t h e biopsychosocial a t t a c h m e n t s y s t e m t h e child seeks o u t a s p e c t s of t h e e n v i r o n m e n t t h a t are contingently related to h i s self-expressions. T h e child's emerging self-representation will m a p onto w h a t could,be called a p r i m a r y or "constitutional self* (the child's a c t u a l internal states). In t h e c a s e of disorganized a t t a c h m e n t , however, t h e self-representation will n o t b e t r u e to this. Winnicott (1967, p. 33) w a r n e d u s t h a t a child w h o fails to find h i s c u r r e n t state mirrored is likely to internalize t h e m o t h e r ' s a c t u a l s t a t e a s p a r t of h i s own self-structure. Evidence is a c c u m u l a t i n g t h a t caregivers of disorganized infants frequently r e s p o n d to t h e infant's d i s t r e s s by hostile-helpless (LyonsRuth, Bronfman, a n d P a r s o n s 1999), dissociated or disorganized, frightened or frightening (Jacobovitz, Hazen, a n d Riggs 1997; Schuengel 1997; Schuengel, B a k e r m a n s - K r a n e n b u r g , a n d v a n U z e n d o o r n 1999) behavior. It is a s if t h e infant's emotional expression triggers a t e m p o r a r y failure on t h e p a r t of t h e caret a k e r to perceive t h e child a s a n intentional person, a n d s h e r e s p o n d s with massive withdrawal, c o m m u n i c a t i o n errors, role confusion, or negative-intrusive or frightening behavior. Consequently, t h e s e children come to experience their own a r o u s a l a s a d a n g e r signal for a b a n d o n m e n t , w h i c h triggers teleological, nonmentalizing functioning; it brings forth a n image of t h e pare n t who w i t h d r a w s from t h e child in a s t a t e of anxiety or rage, to w h i c h t h e child r e a c t s with a c o m p l e m e n t a r y dissociative res p o n s e (Liotti 1999). T h u s t h e i n t e r n a l experience of s u c h individuals r e m a i n s unlabelled a n d chaotic, a n d t h e u n c o n t a i n e d affect generates further dysregulation. R a t h e r t h a n internalizing a coherent self-representation from t h e caregiver, t h e child incorporates a r e p r e s e n t a t i o n of t h e other into h i s n a s c e n t selfs t r u c t u r e (Fonagy a n d Target 1995a). W h e n confronted with a frightened" or frightening caregiver, t h e infant t a k e s in a s p a r t of #

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himself t h e m o t h e r ' s feeling of rage, h a t r e d , or fear a n d h e r image of h i m a s frightening or u n m a n a g e a b l e . As t h i s image u n d e r m i n e s self-organization, often it n e e d s to be externalized for t h e child to achieve a coherent self-representation. T h e disorganized a t t a c h m e n t behavior of t h e infant (Main a n d Solomon 1990) a n d its sequelae, bossy a n d controlling interactions with t h e p a r e n t , m a y b e u n d e r s t o o d a s a r u d i m e n t a r y a t t e m p t to blot o u t t h e u n a c c e p t a b l e a s p e c t s of t h e self-representation. R e s e a r c h s h o w s t h a t t h e disoriented disorganized behavior of t h e infant is gradually replaced, over t h e first 5 - 7 years of life, by brittle behavioral strategies t h a t seek to control the p a r e n t , t h r o u g h either punitive a c t s or age-inappropriate care-giving behavior (Cassidy a n d Marvin 1992; Main a n d Cassidy 1988). S u c h a t t e m p t s a t m a n i p u l a t i n g t h e behavior of the caregiver (George a n d Solomon 1998; Solomon, George, a n d Dejong 1995; Wartner, G r o s s m a n n , Fremmer-Bombrik, a n d S u e s s 1994) p e r m i t t h e externalization of p a r t s of t h e self a n d limit further i n t r u s i o n into t h e self-representation. Similar patterns are reported in observations of peer interactions (Jacobovitz a n d Hazen 1999). There is further evidence t h a t t h e p a r e n t s of s u c h children experience t h e child a s taking control of t h e relationship a n d , consequently, experience themselves a s increasingly immobilized a n d helpless a n d failing to provide caregiving (George a n d Solomon 1996; Solomon a n d George 1996). The descriptions by m o t h e r s of disorganized children are often quite r e m a r k a b l e ; t h e y see t h e child a s a replica of themselves and experience themselves a s merging with t h e child. We a s s u m e t h a t t h e s e experiences are explained by t h e child externalizing aspects of h i s self-representation t h a t relate, n o t to t h e internalization of t h e m o t h e r ' s r e p r e s e n t a t i o n of t h e self, b u t to t h e representation of t h e m o t h e r within t h e self. The tendency for s u c h children to s h o w precocious care-giving behavior (West a n d George, in press) is also c o n s i s t e n t w i t h t h e idea t h a t t h e representation of t h e m o t h e r is internalized into t h e self. In line with Lyons-Ruth's d i a t h e s i s model (Lyons-Ruth, Bronfman, a n d Atwood 1999; Lyons-Ruth a n d Jacobovitz 1999), we conceive of t h e flawed self-organization t h a t follows disorganized a t t a c h m e n t a s a vulnerability. In particular, the poorly constructed self-structure of s u c h children sensitizes t h e m to

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later t r a u m a . We believe t h a t t h e r e is a biological drive to c o n s t r u c t a s e c o n d a r y r e p r e s e n t a t i o n of t h e constitutional self t h r o u g h internalizing t h e infant-directed reactions of attachm e n t figures. This w a s d i s c u s s e d in some detail in c h a p t e r 4. We argued t h a t w h e n a contingent affect-mirroring e n v i r o n m e n t is provided, t h e internalized self-representations will m a p onto t h e primary, procedural self-states of t h e constitutional self. The biologically driven internalization of t h e self-directed a t t i t u d e s of t h e a t t a c h m e n t figure into t h e self-structure t a k e s place, however, even w h e n t h e caregiver is nonreflective, neglectful, or abusive. In s u c h cases, t h e internalized other will r e m a i n alien a n d u n c o n n e c t e d to t h e s t r u c t u r e s of t h e constitutional self. Furthermore, in seriously abusive a n d m a l t r e a t i n g environments t h e internalized alien p a r t of t h e self will be p e r s e c u t o r y a n d will r e p r e s e n t a c o n t i n u o u s d a n g e r of self-harm a n d c o n s e q u e n t lack of feelings of a t t a c h m e n t security. T h e a b s e n c e of a d e q u a t e second-order (symbolic) r e p r e s e n t a t i o n s of self-states creates a c o n t i n u o u s a n d i n t e n s e desire for u n d e r s t a n d i n g w h a t is experienced a s internal chaos. T h e child's self-development is delayed, a n d he r e m a i n s on t h e look-out for a n object t h a t , once internalized, would be capable of bringing a b o u t a n integration of selfstates. Disastrously, in t h e case of some children maltreated later in development, t h i s will n o t be a n e u t r a l o t h e r b u t , rather, a t o r t u r i n g one. Once internalized a n d lodged within t h e selfrepresentation, t h i s hostile "alien" r e p r e s e n t a t i o n will h a v e to be expelled n o t only b e c a u s e it does n o t m a t c h t h e constitutional self, b u t also b e c a u s e it is persecutory. T h e c o n s e q u e n c e s for interpersonal relationships a n d for affect regulation are t h e n d i s a s t r o u s (Carlson a n d Sroufe 1995). T h e fact t h a t t h e internalized alien is n o t g r o u n d e d in or b o u n d to t h e a c t u a l self-states of t h e constitutional self, together with t h e further fact t h a t it r e p r e s e n t s a persecutory t h r e a t to t h e self, motivates a strong defensive t e n d e n c y to externalize t h e alien p a r t of t h e self by projecting it onto others. As long a s t h e internalized torturing alien is projected onto t h e other, t h e self achieves a temporary (and illusory) s e n s e of control a n d feeling of security. T h e price to pay for t h i s fleeting s e n s e of self-organization a n d control is great, however.

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The m e c h a n i s m described here m a y be a prototypical example of t h e psychoanalytic notion of projective identification or, more specifically, w h a t Elizabeth Spillius (1994) h a s t e r m e d "evocatory projective identification." Simply p u t , disorganized a t t a c h m e n t gives rise to a disorganized self. The individual, w h e n alone, feels unsafe a n d vulnerable b e c a u s e of t h e proximity of a torturing a n d destructive r e p r e s e n t a t i o n from which he c a n n o t escape b e c a u s e it is experienced from within t h e self. Unless h i s relationships permit externalization, h e feels almost literally a t risk of d i s a p p e a r a n c e , psychological merging, a n d t h e dissolution of all relationship b o u n d a r i e s (Gunderson 1984).

SYMPTOMATOLOGY OF BORDERLINE PERSONALITY DISORDER Several lines of evidence suggest t h a t borderline p a t i e n t s a r e seriously deficient in social (or mental) reality testing. In particular, their ability to monitor a n d interpret correctly t h e relevant mind-state c u e s available in intimate a t t a c h m e n t relationships s e e m s inhibited, undeveloped, or distorted. W h e n a t t r i b u t i n g mental s t a t e s , t h e y often disregard or b y p a s s s u c h cues, a n d , instead, t h e y identify t h e m i n d s t a t e s of o t h e r s in a distorted way t h r o u g h defensive splitting a n d projective identification. Nor do they do m u c h b e t t e r w h e n it comes to u n d e r s t a n d i n g their own mind states: t h e y often report feelings of e m p t i n e s s or chaotic and undifferentiated self-states. Their emotional instability, their p r o n e n e s s for acting o u t a n d for externalizing violent impulses, all indicate a r a t h e r low degree of a w a r e n e s s of selfstates a n d a c o n s e q u e n t lack of self-control. Let u s briefly review s o m e c o m m o n symptomatology of borderline s t a t e s from t h e point of view of t h e model we have outlined. 1. The unstable sense of self of m a n y s u c h p a t i e n t s is a consequence of t h e a b s e n c e of reflective capacity a n d of a c c u r a t e second-order r e p r e s e n t a t i o n s of i n t e r n a l s t a t e s (feelings, beliefs, wishes, ideas). A s t a b l e s e n s e of self is illusorily achieved w h e n

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t h e alien self is externalized onto t h e other a n d controlled therein. T h e individual, then, is a n active agent w h o is in control, despite t h e fragility of t h e self. The heavy price paid is t h a t by forcing t h e other to b e h a v e a s if h e or s h e were p a r t of his internal representation, t h e potential for a "real" relationship h a s b e e n lost, a n d t h e p a t i e n t is actually p r e p a r i n g t h e way for a b a n d o n m e n t . T h e projective a n d p e r s e c u t o r y construction of t h e other's m i n d in intimate relationships r e p r e s e n t s a coercive, aggressive, a n d distorting communicative a t t i t u d e t h a t is u s u ally greatly r e s e n t e d by t h e p a r t n e r . As a result, t h e r e is a serious realistic risk of a b a n d o n m e n t in s u c h relationships. The eventual a b a n d o n m e n t also m e a n s a r e t u r n of t h e projected hostile a n d t o r t u r i n g alien into t h e self, together with t h e conseq u e n t feelings of danger, terror, a n d disorganization. 2. The impulsivity of s u c h p a t i e n t s m a y also be d u e to a lack of a w a r e n e s s of their own emotional s t a t e s associated with t h e a b s e n c e of symbolic r e p r e s e n t a t i o n s of emotions. Borderline patients often find themselves in s t a t e s of emotional a r o u s a l t h a t are beyond self-control, since mentalization is a n essential comp o n e n t of affect regulation. Other affects a r e often b r o u g h t forth to protect t h e self, a n d a p p a r e n t l y uncontrollable rage may express, a s well a s obscure, t h e experience of fragmentation. Impulsivity m a y also be d u e to t h e d o m i n a n c e of prementalistic physical action-centered strategies, particularly in t h r e a t e n i n g relationships. It is only w h e n behavior is c o n s t r u e d a s intentional t h a t one c a n conceive of influencing it t h r o u g h changing t h e other's s t a t e of mind. Talking a b o u t it only m a k e s s e n s e if t h e behavior of t h e other h a s b e e n explained in t e r m s of wishes a n d beliefs. If, on t h e other h a n d , it is interpreted solely in t e r m s of its observable consequence, a kind of "learned mentalistic helplessness" s e t s in. T h e obvious way t h e n to intervene will be t h r o u g h physical action. This m a y include w o r d s t h a t s o u n d like a n a t t e m p t a t c h a n g i n g t h e other p e r s o n ' s i n t e n t i o n s b u t are, in fact, intimidation—efforts to force t h e o t h e r p e r s o n into a different c o u r s e of action. Only a physical e n d - s t a t e is seen. This may be represented in t e r m s of t h a t p e r s o n ' s body. T h e p a t i e n t may physically t h r e a t e n , hit, damage, or even kill; alternatively, he m a y tease, excite, even seduce.

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S u c h p a t i e n t s bring m a n y memories of having b e e n treated in s u c h ways. A y o u n g m a n confessed to h i s father t h a t h e h a d accidentally b r o k e n a l a m p . T h e father r e a s s u r e d h i m t h a t it w a s OK since h e didn't do it on p u r p o s e . The father later s a w t h a t t h e l a m p t h e child h a d b r o k e n w a s h i s favorite, a n d he b e a t h i s s o n so h a r d t h a t h e fractured h i s a r m a s t h e child raised it to protect himself. T h e father's m i n d is working in a nonmentalizing (teleological) m o d e in t h e s e examples. It is w h a t t h e child h a s d o n e (visible outcome), r a t h e r t h a n h i s intention (mental state), t h a t drives t h e father's action. In t h i s context t h e distinction between t h e two a p p a r e n t l y overlapping m o d e s of r e p r e s e n t i n g intentional action is particularly helpful. It will b e r e m e m b e r e d t h a t following J e a n n e r o d (1994) a n "intention-in-action" w a s defined a s a r e p r e s e n t a t i o n with a c o n t e n t t h a t specifies t h e particular bodily action in relation to its goal s t a t e a n d is t h e proximal c a u s e of t h e motor behavior. It is a r e p r e s e n t a t i o n a l state t h a t does n o t simply trigger t h e action b u t also functions to monitor a n d guide it, allowing for a n on-line c o m p a r i s o n between perceptual feedback a b o u t t h e o u t c o m e s t a t e achieved a n d t h e goal state a s specified in t h e r e p r e s e n t a t i o n . Their c o n t e n t c a n become t h e subject of c o n s c i o u s n e s s especially if their execution is blocked, which might m a k e t h e m a p p e a r a s if t h e y were mentalized representations, b u t in e s s e n c e t h e y are n o n c o n s c i o u s actions carried o u t automatically. In c o n t r a s t , "prior intentions" are r e p r e s e n t a t i o n s t h a t a r e p r e s e n t prior to t h e m o t o r action (and t h e concomitant intention-in-action). They c a n b e active a n d consciously experienced even w h e n t h e intended action does n o t get executed. Prior i n t e n t i o n s c o n t a i n a r e p r e s e n t a t i o n of t h e self in relation to the desired goal s t a t e (future reality) a n d c a n generate particular intention-in-actions w h e n conditions in t h e external world allow the self to execute a viable action to fulfill t h e goal. Prior intentions need n o t r e p r e s e n t t h e specific goal s t a t e aimed at b u t j u s t t h e general motivational s t a t e prior to t h e action. Impulsivity in BPD m a y be t h u s s e e n a s r e p r e s e n t a t i o n s of intentional actions generated by t h e "teleological stance" corresponding to t h e level of r e p r e s e n t a t i o n s of intention-in-actions. T h e principle of rational action still g u i d e s impulsive a c t s b u t a s a function of available evidence a b o u t t h e "pragmatic" a s p e c t s of a goal object.

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a b o u t t h e specific situational c o n s t r a i n t s on action, a n d a b o u t t h e dispositional c o n s t r a i n t s characteristic of t h e actor. T h u s , for example, prior intention is n o t a t t r i b u t e d to t h e other, a n d t h e c o n s e q u e n c e s of t h e action are n o t predicted, commonly leading to sizable interpersonal conflicts a n d other social disasters. 3. Emotional instability and irritability require u s to t h i n k a b o u t t h e r e p r e s e n t a t i o n of reality in borderline p a t i e n t s . Interpersonal s c h e m a t a are notably rigid in borderline p a t i e n t s b e c a u s e they c a n n o t imagine t h a t t h e other could h a v e a c o n s t r u c t i o n of reality t h a t is different from t h e one t h e y experience a s compelling. If t h e behavior of t h e other a n d knowledge of reality do not fit, we normally try to u n d e r s t a n d t h e behavior in mentalizing terms. For example, "He mistook m y $ 2 0 for a $ 1 0 bill (false belief)—that is why h e only gave m e $ 5 change." If t h i s a n d other possibilities do n o t readily occur to one, a n d alternatives c a n n o t easily be compared, a n oversimplified c o n s t r u c t i o n is uncritically accepted: "He w a s cheating me!" Especially for individuals who h a d nonreflective, coercive caregivihg, t h i s frequently leads to p a r a n o i d c o n s t r u c t i o n s of t h e other's desire state. 1 Mentalization a c t s a s a buffer: w h e n actions of o t h e r s are u n e x p e c t e d , this buffer function allows one to create auxiliary h y p o t h e s e s a b o u t beliefs, which forestall a u t o m a t i c t h r e a t e n i n g conclusions. Once again, we see t h e t r a u m a t i z e d individual doubly disadvantaged. Internal working models c o n s t r u c t e d on t h e b a s i s of a b u s e a s s u m e t h a t malevolence is n o t improbable; being u n able to generate auxiliary h y p o t h e s e s , particularly u n d e r stress, m a k e s t h e experience of d a n g e r even m o r e compelling. Psychic equivalence m a k e s it real. Normally, a c c e s s to t h e mentalization buffer allows one to play with reality (Target a n d Fonagy 1996). U n d e r s t a n d i n g is k n o w n to be fallible. B u t if t h e r e is only one way of seeing things, a n a t t e m p t by a third party, s u c h a s a therapist, to p e r s u a d e t h e patient t h a t h e is w r o n g might be perceived a s a n a t t e m p t to drive h i m crazy. 1 The striking facet of such constructions is that they tend to be self-related. The individual with a self-representation constructed around an abusive caregiver is constantly on the alert to externalize this persecutory self-representation. He needs enemies to prevent the destructiveness within.

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4. A brief word a b o u t suicidality. Clinicians a r e familiar with the e n o r m o u s fear of physical a b a n d o n m e n t in borderline p a tients ( G u n d e r s o n 1996). This, p e r h a p s more t h a n a n y o t h e r aspect, alerts clinicians to t h e disorganized a t t a c h m e n t models with w h i c h s u c h p a t i e n t s a r e forced to live. W h e n t h e o t h e r is needed for self-coherence, a b a n d o n m e n t m e a n s reinternalizing the intolerable, alien self-image a n d c o n s e q u e n t d e s t r u c t i o n of the self. Suicide r e p r e s e n t s t h e fantasized destruction of this alien other within t h e self. Suicide a t t e m p t s are often aimed a t forestalling t h e possibility of a b a n d o n m e n t ; they seem a lastditch a t t e m p t a t reestablishing a relationship. The child's experience m a y h a v e b e e n t h a t only s o m e t h i n g extreme would bring a b o u t c h a n g e s in t h e a d u l t ' s behavior, a n d t h a t their caregivers used similarly coercive m e a s u r e s to influence their own behavior. T h e s t r o n g t e n d e n c y for suicide so often triggered by a b a n d o n m e n t in borderline p a t i e n t s c a n also be u n d e r s t o o d to represent a fantasized d e s t r u c t i o n of t h e internalized hostile alien, a final a t t e m p t to liberate t h e constitutional self from its torturer. W h e r e a s suicide a n d self-harm are c o m m o n manifestations of disorganized a t t a c h m e n t in women, in m e n with similar pathology it is violence a g a i n s t t h e other t h a t is m o r e c o m m o n . S u c h a person c a n only m a i n t a i n a relationship if this enables him to externalize alien p a r t s of t h e self. The relationship t h a t violent m e n are forced to establish is o n e where their significant other can act a s a vehicle for intolerable self-states. They control their relationship t h r o u g h c r u d e m a n i p u l a t i o n .in order to engender the self-image t h a t t h e y feel d e s p e r a t e to disown. They resort to violence a t t i m e s w h e n t h e i n d e p e n d e n t m e n t a l existence of t h e other t h r e a t e n s t h i s p r o c e s s of externalization. At t h e s e times, dramatic a n d radical action is t a k e n b e c a u s e t h e individual is terrorized by t h e possibility t h a t t h e coherence of self achieved t h r o u g h control a n d m a n i p u l a t i o n will be destroyed by t h e r e t u r n of w h a t h a s b e e n externalized. The act of violence a t s u c h m o m e n t s performs a d u a l function: (a) to recreate a n d reexperience t h e alien self within t h e other, a n d (b) to destroy it in t h e u n c o n s c i o u s h o p e t h a t it will t h e n b e destroyed forever. Perceiving t h e terror in t h e eyes of their victim, they are once again r e a s s u r e d , a n d t h e relationship regains its p a r a m o u n t

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i m p o r t a n c e in their psychic organization: T h u s their p l e a s for forgiveness a n d u n r e s e r v e d contrition are genuine, in t h e s e n s e t h a t their need for a relationship where t h i s externalization is possible is u n d o u b t e d l y absolute. 5. Splitting, t h e partial r e p r e s e n t a t i o n of t h e other (or t h e self) is a c o m m o n obstacle to a d e q u a t e c o m m u n i c a t i o n with s u c h patients. U n d e r s t a n d i n g t h e other in m e n t a l t e r m s initially requires integrating a s s u m e d i n t e n t i o n s in a c o h e r e n t m a n n e r . The h o p e l e s s n e s s of t h i s t a s k in t h e face of t h e contradictory a t t i t u d e s of a n a b u s e r is s e e n a s o n e of t h e c a u s e s of the mentalizing deficit. T h e emergent solution for t h e child, given the imperative to arrive a t coherent r e p r e s e n t a t i o n s , is to split the r e p r e s e n t a t i o n of t h e other into several c o h e r e n t s u b s e t s of intentions (Gergely 1997, 2000)—primarily, into a n idealized a n d a persecutory identity. In t h e a b s e n c e of reflective function, the individual finds it impossible to u s e b o t h r e p r e s e n t a t i o n s simultaneously. Splitting e n a b l e s t h e individual to create mentalized images of others, b u t t h e s e a r e i n a c c u r a t e a n d oversimplified a n d allow for only a n illusion of mentalized i n t e r p e r s o n a l interchange. As splitting is generally agreed to b e t h e prototypical defense of borderline personality disorder, it s e e m s a p p r o p r i a t e to exp a n d on this idea further. In naive theory of m i n d , predicting a n o t h e r p e r s o n ' s actions from h i s beliefs a n d desires is driven by a basic principle of "rational action" (Gergely et al. 1995). This principle a s s u m e s t h a t h u m a n a g e n t s tend to p u r s u e a c o u r s e of action to fulfill their desires t h a t s e e m s m o s t rational or efficient, given their beliefs a b o u t . t h e situation. This is s u p p l e m e n t e d by a further a s s u m p t i o n t h a t we c a n call t h e principle of "mental coherence" (Dennett 1987; Gergely 2000). This additional principle a s s u m e s t h a t t h e intentions, beliefs, a n d desires of rational h u m a n beings a r e n o t contradictory or ambivalent. Clearly, if this a s s u m p t i o n is seriously violated, it b e c o m e s impossible to identify a n d predict a rational c o u r s e of action t h a t would satisfy t h e s i m u l t a n e o u s l y p r e s e n t contradictory i n t e n t i o n s of t h e other. In s u c h a case, t h e other's behavior b e c o m e s u n p r e d i c t a b l e by t h e child t h r o u g h mentalization, a n d feelings of anxiety, helplessness, a n d insecurity a r e generated.

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Gergely (2000) proposed t h a t t h e m a l t r e a t m e n t a t t a c h m e n t context r e p r e s e n t s precisely s u c h a d i l e m m a for y o u n g children. By a b o u t 2 y e a r s of age infants become able to derive generalized intentions a n d a t t i t u d e s t h a t characterize t h e mind of t h e att a c h m e n t figure. T h e caregiver w h o generates a t t a c h m e n t disorganization (Lyons-Ruth a n d Jacobovitz 1999; Schuengel et al. 1999), however, typically provides contradictory information regarding h e r infant-directed m e n t a l attitudes: sometimes s h e a b u s e s t h e child, while a t other times s h e s e e m s to deny t h i s and even b e h a v e s in a caring fashion. By inferring t h e corresponding p e r s e c u t o r y a n d benevolent intentions a n d attributing t h e m to t h e caregiver's m i n d , t h e child faces t h e impossible t a s k of anticipating t h e other's behavior from contradictory or a m bivalent intentions. As a defense against t h e e n s u i n g u n c e r tainty, anxiety, a n d helplessness, t h e child splits t h e identity of the a b u s e r into s e p a r a t e m i n d s with noncontradictory (persecutory v e r s u s benevolent) s e t s of intentions. As a result, predicting action t h r o u g h mentalization b e c o m e s possible again, since within t h e s e p a r a t e a n d split identities of t h e other t h e principle of m e n t a l coherence c a n be m a i n t a i n e d . In t h i s way t h e feelings of h e l p l e s s n e s s a n d anxiety triggered by t h e inability to predict t h e other's behavior t h r o u g h mentalization are avoided. The great price to be paid for this defensive construction of social experience is, of course, t h e e n s u i n g distortion of reality a n d t h e generation of m i s t a k e n a n d maladaptive r e s p o n s e s w h e n actions are anticipated incorrectly b a s e d on t h e split r e p r e s e n t a t i o n s of the other's m i n d . 6. The second prototypical borderline defense is held to be projective identification (Ogden 1979; Spillius 1992). We have argued t h a t in t h e n o r m a l development of m i n d r e a d i n g there are two m e c h a n i s m s by w h i c h a t t r i b u t i o n of m e n t a l s t a t e s to t h e other is accomplished: (a) by monitoring t h e relevant behavioral a n d situational c u e s to infer t h e m i n d s t a t e s of t h e other, or, if s u c h c u e s are n o t available or n o t recognized, one c a n (b) resort to "default simulation": a t t r i b u t i n g m e n t a l s t a t e s to t h e other t h r o u g h analogy to t h e self. Above we a r g u e d t h a t in a n abusive a t t a c h m e n t context t h e child often develops a defensive inhibition to mentalizing a b o u t t h e caregiver's intentions. This may, in

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t u r n , result in a general deficiency of attention p r o c e s s e s in monitoring for a n d reading t h e relevant behavioral a n d situational c u e s t h a t would allow t h e child to infer t h e other's m e n t a l states. As a result, t h e child will automatically resort to interpreting t h e other's m i n d t h r o u g h "default simulation" even w h e n t h e relevant informative c u e s are, in principle, available. Now t h e question is: w h a t c o n t e n t s of h i s own mind will t h e child u s e to "default simulate" t h e other's m e n t a l experience? We have seen t h a t a s a r e s u l t of abusive caregiving, t h e y o u n g child internalizes t h e r e p r e s e n t a t i o n of t h e hostile a n d alien o t h e r into h i s self-structure. We have also a r g u e d t h a t d u e to t h e d a n g e r t h a t its persecutory a s p e c t s r e p r e s e n t to t h e self, a n d d u e to its lack of g r o u n d e d n e s s in t h e a c t u a l self-states of t h e constitutional self, a defensive t e n d e n c y to expel this internalized alien t h r o u g h projection onto o t h e r s will be established. Now if the other's m e n t a l s t a t e s c a n n o t be identified t h r o u g h cue-reading a s a r e s u l t of t h e defensive inhibition of mentalizing a b o u t the a b u s e r ' s mind, w h e n resorting to "default simulation," t h e to-beexpelled alien p a r t of t h e self-representation will be readily available to provide t h e informational b a s i s for s i m u l a t i n g t h e other. T h u s , borderline p a t i e n t s will s h o w a t e n d e n c y to "default simulate" t h e other's m e n t a l state automatically by projecting onto h i m t h e internalized persecutory r e p r e s e n t a t i o n of t h e abusive caregiver. This is why t h e defense m e c h a n i s m of "projective identification" b e c o m e s so p r o m i n e n t in t h e m a n n e r in which borderline p a t i e n t s c o n s t r u c t distorted r e p r e s e n t a t i o n s of the m e n t a l s t a t e s of o t h e r s in intimate relationships a n d in the analytic transference. 7. A further c o m m o n experience of s u c h p a t i e n t s is t h e feeling of emptiness t h a t a c c o m p a n i e s m u c h of their lives. The emptin e s s is a direct c o n s e q u e n c e of t h e a b s e n c e of s e c o n d a r y repres e n t a t i o n s of self-states, certainly a t t h e c o n s c i o u s level, a n d of t h e shallowness with which other people a n d relationships are experienced. T h e a b a n d o n m e n t of mentalization c r e a t e s a deep s e n s e of isolation. To experience being with a n o t h e r , t h e p e r s o n h a s to be t h e r e a s a mind; to feel t h e continuity between p a s t a n d present, it is m e n t a l s t a t e s t h a t provide t h e link; e m p t i n e s s a n d , a t a n extreme, dissociation is t h e b e s t description s u c h

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individuals c a n give of t h e a b s e n c e of m e a n i n g t h a t the. failure of mentalization creates.

S O M E QUALIFICATIONS OF T H E MODEL PROPOSED A n u m b e r of qualifications are in order. 1. Abnormalities of p a r e n t i n g r e p r e s e n t b u t one route to difficulties with mentalization. Biological vulnerabilities, s u c h a s attention deficits, a r e also likely to limit t h e child's opportunities for evolving reflective capacity. We should be aware t h a t , a s in most a s p e c t s of development, t h e r e is a subtle bidirectional c a u s a l p r o c e s s i n h e r e n t in s u c h biological vulnerabilities. Vulnerabilities provoke s i t u a t i o n s of interpersonal conflict a s well a s placing limitations on t h e child's capacities. T h u s biological factors c a n limit mentalizing potential b u t m a y also act t h r o u g h generating e n v i r o n m e n t s where mentalization is unlikely to be fully established. 2. Many of u s working with borderline p a t i e n t s willingly a t t e s t to their a t times a p p a r e n t l y a c u t e sensitivity to m i n d states, certainly for t h e p u r p o s e s of m a n i p u l a t i o n a n d control. Does t h i s imply t h a t mentalization is n o t a core dysfunction? The likely solution to t h i s puzzle is t h a t p a t i e n t s with severe personality disorders do develop a certain level of n o n c o n s c i o u s mindreading skills. C l e m e n t s a n d Perner (1994) s h o w t h a t children j u s t before the age of 3 y e a r s h a v e a n intuitive u n d e r s t a n d i n g of false belief, which they a r e u n a b l e to c o m m u n i c a t e verbally b u t c a n demonstrate in their nonverbal reactions, s u c h a s eye movements. It is conceivable t h a t , a t a stage w h e n s u c h n o n c o n s c i o u s m i n d reading skills begin to evolve, t h e implications of t h e child trying to infer t h e i n t e n t i o n s b e h i n d their caregivers' reactions a r e so negative t h a t t h e y are forced' to fall b a c k on t h e strategy of influencing t h e o t h e r by action r a t h e r t h a n by words. However, they retain access, a t a n o n c o n s c i o u s level, to m e n t a l s t a t e s b u t r e p u d i a t e c o n s c i o u s n e s s of it. Reflective function does n o t

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p e r m a n e n t l y disappear: borderline p a t i e n t s are n o t "mind blind": r a t h e r , they a r e n o t "mind conscious." They pick u p on cues t h a t influence t h e behavioral system, b u t t h i s does n o t surface in t e r m s of conscious inferences. The developmental deficit is: [a] restricted to specific i n t e r n a l working models (or relationship patterns); (b) likely to be activated in specific a t t a c h m e n t contexts; a n d (c) m a y p e r t a i n m o r e to reflective self-function (reflection on self-states) t h a n to envisioning t h e m e n t a l world of t h e other. 3. Not all p a r e n t s of individuals with p r o b l e m s related to mentalization a r e borderline. Some p a r e n t s , in o u r experience a t least, are highly reflective Individuals, w h o have, however, significant p r o b l e m s related to their children a n d s o m e t i m e s to a specific child. Lack of sensitivity to intentional s t a t e s is n o t a global variable affecting all situations. It m u s t be a s s e s s e d in relation to a specific child-caregiver relationship.

PSYCHOTHERAPY AND MENTALIZING Psychotherapy, in all its i n c a r n a t i o n s , is a b o u t t h e rekindling of mentalization. W h e t h e r we look a t Marcia Linehan's dialectic behavior t h e r a p y protocol (Linehan 1993), J o h n Clarkin's a n d Otto Kernberg's r e c o m m e n d a t i o n s for psychoanalytic psychot h e r a p y (Clarkin, Kernberg, a n d Y e o m a n s 1999; Kernberg a n d Clarkin 1993), or Anthony Ryle's cognitive analytic t h e r a p y (Ryle 1997), they all: (a) a i m to establish a n a t t a c h m e n t relationship with t h e patient, (b) a i m to u s e t h i s to create a n interpersonal context where u n d e r s t a n d i n g of m e n t a l s t a t e s b e c o m e s a focus, a n d (c) a t t e m p t (mostly implicitly) to recreate a s i t u a t i o n where t h e self is recognized a s intentional a n d real by t h e therapist, a n d this recognition is clearly perceived by t h e patient. The core of psychological t h e r a p y with individuals with severe personality disorder is t h e e n h a n c e m e n t of reflective processes. The t h e r a p i s t m u s t help t h e p a t i e n t to u n d e r s t a n d a n d label emotional s t a t e s with a view to s t r e n g t h e n i n g t h e secondary r e p r e s e n t a t i o n a l system. Often t h i s is achieved n o t j u s t by interi

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pretations of m o m e n t - t o - m o m e n t c h a n g e s in t h e p a t i e n t ' s emotional s t a n c e b u t by focusing t h e patient's attention on t h e therapist's experience. T h e p a t i e n t comes in looking s o m e w h a t timid. T h e t h e r a p i s t says: "You see m e a s frightening." T h e therapist avoids describing complex m e n t a l s t a t e s a n d rarely refers to t h e p a t i e n t ' s conflicts or to h i s ambivalence (conscious or unconscious). C h a n g e is generated in t h e s e p a t i e n t s by brief, specific interpretation. T h e inevitable destructiveness of t h e s e patients in relation to t h e t h e r a p e u t i c enterprise is rarely adequately dealt with by confrontation or interpretations of their aggressive i n t e n t . Rather, c o m m e n t s are often more helpfully aimed a t t h e emotional a n t e c e d e n t s of e n a c t m e n t s — t h e emotions t h a t c a u s e confusion a n d disorganization. As we h a v e seen, g a p s in mentalization engender impulsivity, and t h e intensification of t h e t h e r a p e u t i c relationship frequently highlights t h e p a t i e n t ' s difficulties in creating a distance between i n t e r n a l a n d external reality. The therapist's t a s k is in some way a n a l o g o u s to t h a t of t h e p a r e n t s w h o create a frame for pretend play—except in this c a s e it is t h o u g h t s a n d feelings t h a t need to become accessible t h r o u g h t h e creation of s u c h a transitional area. T h e t h e r a p i s t m u s t get u s e d to working with p r e c u r s o r s of mentalization. T h e t a s k is t h e elaboration of teleological models into intentional ones. Integrating or trying to bridge t h e dissociated m o d e of t h e patient's functioning where nothing feels real (certainly n o t w o r d s or ideas) with m o m e n t s when w o r d s a n d ideas carry unbelievable potency a n d d e s t r u c tiveness c a n s e e m a n a w e s o m e t a s k . Yet progress is only conceivable by being able to become p a r t of t h e patient's pretend world, trying to m a k e it real while a t t h e s a m e time avoiding entanglement with t h e e q u a t i o n of t h o u g h t s a n d reality. Should t h e psychoanalytic t h e r a p i s t work in t h e transference with borderline p a t i e n t s ? The a n s w e r is No a n d Yes. No—in t h e sense t h a t t h e transference of early relationship p a t t e r n s onto current relationships, while ever-present, is rarely helpful to highlight. W i t h o u t mentalization, transference is n o t displacem e n t b u t is experienced a s real. T h e t h e r a p i s t is t h e a b u s e r — n o as-if a b o u t it. W h e n s u c h transference interpretations are m a d e , the patient is often t h r o w n into a p r e t e n d mode, a n d gradually patient a n d t h e r a p i s t m a y elaborate a world t h a t , however

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detailed a n d complex, h a s little experiential c o n t a c t with reality. T h u s a more productive line is t h e simple a c k n o w l e d g m e n t of affect in t h e h e r e - a n d - n o w while conveying, in words, tone, a n d p o s t u r e , t h a t t h e t h e r a p i s t is able to cope with t h e patient's emotional state. Yes—in t h a t t h e transference, u s i n g t h e t e r m in its b r o a d e s t sense, is helpful a s a concrete d e m o n s t r a t i o n of alternative perspectives. T h e c o n t r a s t between t h e p a t i e n t ' s perception of t h e t h e r a p i s t a s s h e or h e is imagined a n d a s s h e or he is m a y help to place quotation m a r k s a r o u n d t h e transference experience. The m o s t complicated challenge arising o u t of treating s u c h p a t i e n t s relates to externalizations of u n b e a r a b l e self-states. Some t h e r a p i s t s split t h e transference by creating alternative foci for t h e p a t i e n t ' s feelings—a p h a r m a c o t h e r a p i s t a n d a psychotherapist, individual a n d g r o u p t r e a t m e n t s . O t h e r s a t t e m p t to control e n a c t m e n t s by m a k i n g t h e r a p y contractually dependent. S o m e t i m e s n e i t h e r of t h e s e is possible, a t o t h e r times n e i t h e r is sufficient. Often, having m o d e s t a i m s is t h e m o s t helpful device. With p a t i e n t s like these, insight will n o t prevent e n a c t m e n t : t h e t h e r a p e u t i c a i m is simply t h e g r a d u a l encouragem e n t of mentalization. R a t h e r t h a n interpreting e n a c t m e n t s , the t h e r a p i s t tries to deal with their a n t e c e d e n t s a n d consequences. S h e n e e d s to be equally permissive a b o u t h e r own t e n d e n c y to e n a c t in t h e countertransference. Within this model, it is necess a r y to accept t h a t in order for t h e p a t i e n t to s t a y in m e n t a l proximity, t h e t h e r a p i s t m u s t occasionally allow herself to become t h e vehicle for t h e alien p a r t within h i s self. If s h e is to be of a n y u s e to him, s h e h a s to become w h a t h e n e e d s h e r to be. Yet if s h e b e c o m e s t h a t p e r s o n fully, s h e c a n b e of n o help to him. S h e a i m s for a state of equipoise between t h e s e two positions—allowing herself to do a s required yet trying to retain in h e r mind a s clear a n d coherent a n image of t h e s t a t e of h i s mind a s s h e is able to achieve. W h a t are t h e h a l l m a r k s of a successful t h e r a p y with a n individual with severe borderline features? While we do not believe t h a t a n y theory, including t h e p r e s e n t one, gets anywhere close to explaining t h e p a t i e n t ' s problems, we do believe t h a t it is i m p o r t a n t to h a v e a theoretically c o h e r e n t a p p r o a c h . S u c h p a t i e n t s require t h a t we a r e predictable, a n d o u r models of

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t h e m c a n t h e n come to form t h e core of their self-representations. A stable, coherent image is h a r d to m a i n t a i n should t h e t h e r a p i s t s w a p theoretical a p p r o a c h e s a t a n alarming rate. Mentalization c a n only be acquired in t h e context of a n a t t a c h m e n t relationship. And this m e a n s t h a t t h e t h e r a p y m u s t embody a s e c u r e b a s e . A t t a c h m e n t is i n s e p a r a b l e from a focus on t h e m e n t a l s t a t e of t h e other. There c a n be n o b o n d without u n d e r standing, even if u n d e r s t a n d i n g is possible without a bond. In our experience t h e s e t r e a t m e n t s always t a k e considerable time, a n d consistency over s u c h prolonged periods is often h a r d to m a i n t a i n . T h e p a t i e n t is terrified of a n d actively fights m e n t a l closeness, even w h e n physical proximity a p p e a r s to be h i s overarching goal. Retaining s u c h proximity while u n d e r persistent a t t a c k is n e i t h e r comfortable n o r likely to b e achieved u n l e s s one leaves one's n a r c i s s i s m a t t h e door. If t h e t h e r a p i s t is able to m a i n t a i n a m e n t a l proximity to t h e patient w i t h o u t allowing herself to be overwhelmed by t h e alien other, t h e n h e r mentalistic, elaborative s t a n c e c a n ultimately enable t h e p a t i e n t to find himself in t h e t h e r a p i s t ' s mind a s a thinking, feeling being a n d to integrate t h i s image a s p a r t of h i s sense of himself. There is a g r a d u a l transformation of a nonreflective m o d e of experiencing t h e i n t e r n a l world t h a t forces t h e equation of t h e i n t e r n a l a n d external to o n e where t h e internal world is treated with m o r e circumspection a n d respect, s e p a r a t e a n d qualitatively different from physical reality. Even if work were to s t o p here, m u c h would h a v e b e e n achieved in t e r m s of m a k i n g behavior u n d e r s t a n d a b l e , meaningful, a n d predictable. The internalization of t h e t h e r a p i s t ' s concern with m e n t a l s t a t e s e n h a n c e s t h e patient's capacity for similar concern toward his own experience. Respect for m i n d s g e n e r a t e s respect for self, respect for other, a n d ultimately respect for t h e h u m a n c o m m u nity. It is t h i s r e s p e c t t h a t drives a n d organizes t h e t h e r a p e u t i c endeavor a n d s p e a k s with g r e a t e s t clarity to o u r psychological heritage.

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Psychic Reality in Borderline

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States

This c h a p t e r is a contribution toward u n d e r s t a n d i n g the difficulties of severely borderline p a t i e n t s a s they are uncovered within the psychoanalytic process. We consider how t h e p a t t e r n of behavior a n d relationship—including t h e transference relationship—characteristics of borderline p a t i e n t s m a y be u n d e r s t o o d in t e r m s of a n i n a d e q u a t e integration of t h e two early m o d e s of experiencing psychic reality, a s elaborated in this c h a p t e r a n d summarized below. Specifically, we suggest t h a t t h e borderline patient's failure to mentalize adequately is c o m p o u n d e d by t h e persistence of a n undifferentiated mode of representing external and internal experience. It is rooted in a childlike u n d e r s t a n d i n g of m e n t a l s t a t e s , where feelings a n d ideas are c o n s t r u e d a s direct (or equivalent) r e p r e s e n t a t i o n s of reality with c o n s e q u e n t exaggeration of their i m p o r t a n c e a n d extension of their implications. The p e r s i s t e n c e of t h i s mode of functioning is a selfperpetuating c o n s e q u e n c e of t h e failure of mentalization. T h e experience of u n c o n s c i o u s a s well a s conscious feelings a n d ideas a s equivalent to physical reality inhibits individuals' capacity to s u s p e n d t h e immediacy of their experience a n d create t h e psychological s p a c e to "play with reality." In this way, borderline individuals are forced to accept a mental e n v i r o n m e n t w h e r e ideas are too terrifying to t h i n k a b o u t and feelings too i n t e n s e to experience. In t h e long t e r m they 373

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defensively forgo mentalization a n d s h o w a n intolerance of alternative perspectives. The extensive failure of mentalization only occurs, however, in individuals whose psychic reality— whose m e n t a l experience of themselves—was n o t properly established in infancy. In place of some r e p r e s e n t a t i o n s of their intern a l states, t h e s e individuals experience a d i s t u r b i n g s e n s e of o t h e r n e s s , historically t h e internalization of t h e infantile perception of t h e m o t h e r , in place of t h e m o t h e r ' s image of t h e infant's self-states. This m a y be combined with a r e t r e a t into compelling fantasy, w h i c h c a n only be minimally integrated with perceptions a n d experiences of reality. However, we see t h e s e deficits a s partial a n d m o s t likely to be s e e n w h e n feelings a n d t h o u g h t s related to a t t a c h m e n t a r e a r o u s e d . In t h i s c h a p t e r we e x p a n d o n t h e theory of borderline pathology outlined in c h a p t e r 9 u s i n g t h e framework of dysfunctions of psychic reality in addition to a t t a c h m e n t disorganization to help u s to u n d e r s t a n d two severe c a s e s of borderline personality disorder, b o t h of w h o m u n d e r w e n t successful five-times-weekly psychoanalytic t r e a t m e n t . Self-harm played a m o r e central role in t h e first of t h e c a s e s to b e considered, w h e r e a s violence toward o t h e r s w a s m o r e significant in t h e second case, creating a n interesting contrast; t h e theoretical a n d technical considerations are, however, surprisingly similar.

INTRODUCTION: T H E NORMAL DEVELOPMENT OF PSYCHIC REALITY In c h a p t e r 6, we u s e d b o t h clinical a n d r e s e a r c h evidence to s h o w t h a t t h e n o r m a l experience of psychic reality is n o t a n i n h e r e n t property of t h e m i n d b u t , r a t h e r , a developmental achievement. We see t h e child's development a s normally moving from a n experience of psychic reality where m e n t a l s t a t e s a r e not depicted a s r e p r e s e n t a t i o n s to a n increasingly complex view of t h e internal world, w h i c h h a s a s its h a l l m a r k t h e capacity to mentalize. Initially, t h e child's experience of t h e m i n d is a s if it were a recording device, with exact c o r r e s p o n d e n c e between internal s t a t e a n d external reality. We have u s e d t h e t e r m "psy-

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chic equivalence" to denote t h i s m o d e of functioning in order to emphasize t h a t for t h e y o u n g child m e n t a l events are equivalent, in t e r m s of power, causality, a n d implications, to events in t h e physical world. E q u a t i n g i n t e r n a l a n d external is inevitably a two-way process. Not only will t h e small child feel compelled to equate a p p e a r a n c e with reality (how it s e e m s is how it is), b u t also t h o u g h t s a n d feelings—distorted by phantasy—will be projected onto external reality in a m a n n e r u n m o d u l a t e d by awareness t h a t t h e experience of t h e external world might have b e e n distorted in t h i s way. P e r h a p s b e c a u s e it c a n be terrifying for t h o u g h t s a n d feelings to be experienced a s concretely "real," t h e infant develops a n alternative w a y of c o n s t r u i n g m e n t a l states. In "pretend mode," the child experiences feelings a n d ideas a s totally representational, or symbolic: a s h a v i n g n o implication for t h e world outside. Only gradually, a n d t h r o u g h t h e close participation of another m i n d t h a t c a n s i m u l t a n e o u s l y hold together t h e child's pretend a n d s e r i o u s perspectives, does t h e integration of t h e s e two m o d e s give rise to a psychic reality in which feelings a n d ideas are k n o w n to b e internal yet in close relationship with what is outside ( D u n n 1996). The notion of a n increasingly symbolic a n d reflexive awareness of m e n t a l s t a t e s is a s s u m e d by m a n y psychoanalytic formulations of self-development (see review in c h a p t e r 6). More recently, it h a s also come to b e a t t h e core of conceptual a n d empirical work in cognitive a n d developmental psychology (see review in c h a p t e r 5). O u r formulation differs from m o s t developmentalists in considering reflective function to be a developmental achievement t h a t is never fully acquired—that is, maintained across s i t u a t i o n s — a n d to h a v e roots in t h e earliest a t t a c h m e n t relationships, n o t j u s t in t h e verbal, toddler stage. Also, o u r emphasis, along with t h a t of o t h e r psychoanalytic a u t h o r s , is on t h e self-organizing quality of mentalizing, a n d t h e implica 1 tions t h a t individual differences in t h i s capacity have for later pathology. We have s u g g e s t e d t h a t t h e emergence of mentalizing is deeply e m b e d d e d in t h e child's primary-object relationships, first in the mirroring relationship with t h e caregiver. This is conceived s o m e w h a t differently from t h e traditional psychoanalytic

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concepts of mirroring proposed by Kohut (1977), Bion (1962a), a n d Winnicott (1967). It is m u c h m o r e a k i n to t h e model recently described by Gergely a n d W a t s o n (1996) a n d p r e s e n t e d in c h a p ters 4 a n d 5. We suggest t h a t t h e infant only gradually realizes t h a t he h a s feelings a n d . t h o u g h t s a n d slowly b e c o m e s able to distinguish t h e s e . This h a p p e n s mainly t h r o u g h learning t h a t h i s internal experiences a r e meaningfully related to by t h e p a r e n t , t h r o u g h h e r expressions a n d other r e s p o n s e s . These habitual: reactions to h i s emotional expressions focus t h e infant's attention on h i s internal experiences, giving t h e m a shape, so t h a t t h e y become meaningful a n d increasingly manageable. Primary, r e p r e s e n t a t i o n s of experience a r e organized into secondary r e p r e s e n t a t i o n s of t h e s e s t a t e s of m i n d a n d body (Fonagy a n d Target 1997). T h e experience of affect is t h e b u d from which eventually mentalization c a n grow, b u t only in t h e context of at least one continuing, safe a t t a c h m e n t relationship. The p a r e n t w h o c a n n o t t h i n k a b o u t t h e child's m e n t a l experience deprives h i m of a core self-structure t h a t h e n e e d s to build a viable s e n s e of himself. For t h e infant, repeated internalization of t h e m o t h e r ' s processed image of h i s t h o u g h t s a n d feelings provides "containment" (Bion 1962a); J o y c e McDougall h a s observed t h a t "a nursling, t h r o u g h its cries, bodily g e s t u r e s and somato-psychic reactions to s t r e s s , gives nonverbal c o m m u n i c a tions t h a t only a m o t h e r is able to interpret. S h e functions, in this respect, a s h e r b a b y ' s t h i n k i n g system, a n d finds a n ade q u a t e r e s p o n s e to h e r infant's distress" (McDougall 1989, p. 169). This "adequate" r e s p o n s e involves n o t only interpreting the b a b y ' s physical expressions, b u t also giving h i m b a c k a manageable version of w h a t h e is c o m m u n i c a t i n g (Winnicott 1967). The a b s e n c e or distortion of this mirroring function early in life may lead to a d e s p e r a t e s e a r c h for alternative ways of containing psychological experience a n d t h e m e n t a l world. T h e s e w a y s may, for example, come to involve v a r i o u s forms of self-harm or aggression toward others. Why should s u c h failure of a t t u n e m e n t o c c u r ? M a n y factors m a y m a k e t h e m o t h e r u n r e s p o n s i v e to t h e b a b y ' s c o m m u n i c a tion of need; m o s t commonly p e r h a p s , d i s t r e s s mobilizes u n a c ceptable anxiety. Reactions s u c h a s t h e s e d i s r u p t t h e mother's

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capacity to reflect on t h e b a b y ' s feelings a n d a r o u s e h e r h a b i t u a l defenses a g a i n s t u n m a n a g e a b l e affect. A. Stein (1994) d e m o n strated t h a t m o t h e r s with c u r r e n t diagnoses of bulimia n e r v o s a h a d specific difficulties in r e s p o n d i n g accurately to 6-month-old babies, particularly in t h e feeding situation. They were very intolerant of m e s s i n e s s a n d insisted on controlling t h e infant's access to t h e food: As a consequence, they consistently m i s r e a d the child's cries, a n d t h i s t e n d e n c y w a s also seen in play with toys. O n e of t h e m o s t distressing observations d u r i n g feeding was t h a t cries of frustration a n d h u n g e r were misread a s rejection, of t h e offered food, leading to serious failure to thrive in some cases. In t h e s e c u r e relationship, t h e sensitivity—and, we might a d d , availability—of t h e caregiver (Belsky et al. 1995) e n s u r e s t h a t t h e infant is able to find o u t w h a t he feels a n d hence increasingly to feel u n d e r s t o o d . This allows h i m to internalize t h e experience of c o n t a i n m e n t a n d develop a r e p r e s e n t a tional s y s t e m for i n t e r n a l s t a t e s . Within a s e c u r e or containing relationship, t h e baby's affective signals a r e interpreted by t h e p a r e n t , who is able to reflect on the m e n t a l s t a t e s underlying t h e b a b y ' s distress. For this reflection to help t h e baby, it m u s t involve a s u b t l e combination of mirroring a n d t h e c o m m u n i c a t i o n of a c o n t r a s t i n g affect. The n a t u r e of t h e object's mirroring m a y be m o s t easily u n d e r s t o o d in the context of o u r description of t h e p a r e n t ' s pretend play with the child: in order to contain t h e child's anxiety, t h e m o t h e r ' s mirroring expression will display a complex affect, which combines fear with a conflicting emotion, s u c h a s irony. At one level, this c o m m u n i c a t e s t h a t t h e r e is n o t h i n g "truly" to worry about, but, more importantly, t h e p a r e n t ' s reaction, which is t h e s a m e yet not t h e s a m e a s t h e b a b y ' s experience, c r e a t e s t h e possibility of generating a second-order (symbolic) r e p r e s e n t a t i o n of t h e anxiety. This is t h e beginning of symbolization. In a n o t h e r p a per, we h a v e d i s c u s s e d h o w in l a n g u a g e (Fonagy a n d Fonagy 1995) s p e a k e r s frequently, quite unconsciously, combine two p a t t e r n s of intonation, e a c h characteristic of a different emotion. The listener is affected by b o t h , even w h e n only one of t h e affects expressed is consciously perceived. We believe t h a t t h e infant is soothed (or contained) t h r o u g h m u c h t h e s a m e process.

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There m a y be m a n y r e a s o n s for t h e failure of a t t u n e m e n t between infant a n d p a r e n t , some rooted in t h e p a r e n t ' s pathology, o t h e r s in constitutional factors, t r a u m a , a n d o t h e r experiences. Whatever the-reason, if t h e p a r e n t is u n a b l e to r e s p o n d in t h e way described above, w h a t will b e internalized by t h e child will tend to be t h e p a r e n t ' s own experience or defenses; t h e infant's d i s t r e s s is either avoided or mirrored w i t h o u t first being "metabolized." In extreme cases, t h e child m a y be p u s h e d toward t h e highly m a l a d a p t i v e defense of inhibiting mentalization. Even in less extreme cases, p a r e n t - c h i l d relationships in w h i c h mirroring h a s b e e n i n a d e q u a t e m a y lay t h e g r o u n d w o r k for s u b s e q u e n t distortions of personality development in one of two ways. These correspond to t h e two m o d e s of experiencing psychic reality t h a t we described in c h a p t e r 6. T h e m o t h e r m a y echo the child's s t a t e w i t h o u t modulation, a s in t h e m o d e of psychic equivalence, concretizing or p a n i c k i n g a t t h e child's distress. Alternatively, s h e m a y avoid reflection on t h e child's affect t h r o u g h a p r o c e s s a k i n to dissociation, w h i c h effectively places t h e m o t h e r in a pretend mode, u n r e l a t e d to external reality, including t h e child. T h e m o t h e r m a y t h e n ignore t h e child's distress, or t r a n s l a t e it into illness, tiredness, a n d so on. Both strip t h e child's c o m m u n i c a t i o n of m e a n i n g t h a t h e c a n recognize a n d u s e . It m a y also lead to a c u r r e n c y between m o t h e r a n d child of interpretation of feelings in physical terms, so t h a t the physical s t a t e is t h e "real" thing. Lynne M u r r a y (1992), in her work with m o t h e r s suffering from p u e r p e r a l depression, h a s provided some vivid illustrations of s u c h m o t h e r s offering a n alternative reality, m a r k e d by t h e exaggeration associated with p r e t e n s e b u t n o t related to t h e infant's experience. Psychoanalytic observers of this type of interaction would rapidly identify t h e operation of massive denial a n d even m a n i c defense. The infant h a s n o t b e e n able to find a recognizable version of his m e n t a l s t a t e s in a n o t h e r p e r s o n ' s m i n d , a n d t h e opportunity to acquire a symbolic representation-of t h o s e s t a t e s h a s b e e n lost. As s h o w n m o r e fully in c h a p t e r s 4 a n d 5, normally t h e child achieves control over affect partly t h r o u g h t h i s kind of symbolization. T h e r e p r e s e n t a t i o n of h i s feelings is increasingly associated with t h e m o d u l a t i o n included in h e r reflection of his emotional state. The reflection is clearly related to t h e original &

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state b u t is n o t t h e s a m e . T h e infant will m a t c h t h e m o t h e r ' s modulated reaction to h i s own feelings a n d slowly l e a r n s t h a t symbolic play with affect h a s t h e potential to bind h i s emotional a n d physiological reactions. Clinically t h i s m e a n s t h a t t h e child 1 who h a s n o t received recognizable b u t modified images of h i s affective s t a t e s m a y later h a v e trouble in differentiating reality from fantasy a n d physical from psychic reality. This m a y restrict him to a n i n s t r u m e n t a l or functional (manipulative), r a t h e r t h a n signal (communicative) u s e of affect. (See c h a p t e r 5 for t h e stages of development of agency.) In c h a p t e r . 9 we described t h e way in which this i n s t r u m e n t a l u s e of affect is a key a s p e c t of t h e t e n d e n c y of borderline p a t i e n t s to express a n d cope with t h o u g h t s a n d feelings t h r o u g h physical action, a g a i n s t their own bodies or in relation to other people. Central in t h i s c h a p t e r is t h e limitation imposed by t h e delayed or a b s e n t s e c o n d a r y (or metacognitive) r e p r e s e n t a t i o n of affect on t h e development of t h e child's psychic reality. We a s s u m e t h a t t h e integration of t h e -two primitive m o d e s of experiencing mind (equivalence a n d pretense) r e q u i r e s p r e c u r s o r s of mentalization. Play with reality, r a t h e r t h a n apart from reality, will be possible only if t h e c o n c e p t u a l capacity for representing experience a s a version of reality is p r e s e n t . S u c h integration normally begins in t h e second y e a r of life a n d is partially completed by the fifth or sixth year. Common observations of t h e y o u n g child, toddlers, a n d even 3- a n d 4-year-olds readily confirm t h a t , a s far a s t h e b o u n d a r i e s of the psychological self a r e concerned, a y o u n g child readily a s s u m e s t h a t h i s object's desires a r e t h e s a m e a s h i s own. A boy of 4, in a considerable temper, w a r n e d h i s m o t h e r t h a t he no longer w a n t e d to sleep in h e r bed, or h a v e a b i r t h d a y party, or even wished for a Megazord (a prized model from "The Power Rangers"). Maybe s o m e w h a t more infantile t h a n u s u a l b e c a u s e of his e m o t i o n a l ' a r o u s a l , nevertheless t h i s boy a s s u m e d t h a t h i s mother's desires were identical to his, a n d h e r s e n s e of loss a t these deprivations would be a s great a s his. A borderline child treated by George M o r a n a t t h e A n n a F r e u d Centre offered food to the analyst w h e n George a s k e d w h e t h e r h e w a s h u n g r y . Clinicians often n o t e t h e difficulty s u c h children frequently have with personal p r o n o u n s a s a c o n s e q u e n c e of t h i s confusion. A

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borderline 4-year-old treated a t t h e s a m e clinic by J a c k Novick w a s congratulated on h i s b i r t h d a y t h e following day; h e replied, "that's m y b i r t h d a y too!" In brief, a w a r e n e s s of t h e physical s e p a r a t e n e s s of bodies, a n d even of m e n t a l s t a t e s , does not immediately bring with it t h e capacity to a t t r i b u t e a m e n t a l state appropriately or even to identify a p a r t i c u l a r p e r s o n . The m e n t a l b o u n d a r i e s of t h e self probably r e m a i n permeable t h r o u g h o u t development a n d p e r h a p s even in adulthood. S a n d l e r (1992) s t r e s s e d t h e i m p o r t a n c e of p r i m a r y identification a s u n d e r p i n n i n g e m p a t h i c g e s t u r e s (for example, correcting one's s t a n c e w h e n seeing s o m e o n e else slip). Normally these experiences are circumscribed, preconscious, a n d limited to the earlier stages of perception. Nevertheless their very existence u n d e r s c o r e s t h e i m p o r t a n c e of intersubjective s t a t e s t h a t underpin t h e development of self-knowledge. At t h e core of t h e m a t u r e child's self is t h e other at t h e m o m e n t of reflection. Metacognitions—the m e n t a l r e p r e s e n t a t i o n s of m e n t a l representations— are object images c o n g r u e n t with i n t e r n a l s t a t e s , yet clearly not identical with t h e m . They s h a r e e l e m e n t s of t h e child's self sufficiently c o h e r e n t a n d stable for t h e formation of a symbolic link a n d for t h e child to c o n s t r u c t further self-representations on it in t h e physical a b s e n c e of t h e object.

T H E ROLE OF TRAUMA IN PREVENTING T H E INTEGRATION OF T H E TWO M O D E S OF PSYCHIC REALITY As s h o w n in c h a p t e r 9, t r a u m a plays a significant role in the psychogenesis of borderline s t a t e s (e.g., J o h n s o n et al. 1999). We suggest t h a t w h e n perpetrated by a n a t t a c h m e n t figure, t r a u m a interferes with t h e developmental p r o c e s s described above. Evidence of t h i s c a n be seen in severely a b u s e d children in one or m o r e of t h e following ways: (a) t h e p e r s i s t e n c e of a psychic equivalence mode of experiencing internal reality; (b) t h e propensity to c o n t i n u e to shift into a p r e t e n d m o d e (e.g., t h r o u g h dissociation), (c) a partial inability to reflect on one's^own mental s t a t e s a n d t h o s e of one's objects. We a r e suggesting t h a t these

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ways of t h i n k i n g persist into a d u l t h o o d a n d play a n i m p o r t a n t role in borderline p h e n o m e n a . T h e m a l t r e a t e d child c a n n o t afford t h e l u x u r y of seeing t h e parent's expression a s indicating only a psychic reality, a s "nonconsequential," since t h e p a r e n t ' s feelings c a n carry terrifying r e p e r c u s s i o n s . Normally, between t h e ages of 2 a n d 4 y e a r s the child will increasingly notice discrepancies between h i s internal s t a t e s a n d t h e world outside, or other people's s t a t e s of mind. However, t h e child who is s u r r o u n d e d by t h r e a t or a c t u a l t r a u m a will h a v e little o p p o r t u n i t y to develop a n a w a r e n e s s of any distinction between i n n e r a n d outer; h i s focus o n . t h e outside world a n d its physical a n d emotional d a n g e r s n e e d s to be maintained so closely that" t h e r e is little room for t h e idea of a separate, i n t e r n a l world. In n o r m a l c i r c u m s t a n c e s , a p a r e n t will be able to protect t h e child from some of t h e frightening force of reality, n o t so much- by concealing events a n d feelings, b u t by conveying to t h e child t h a t t h e r e is m o r e t h a n one way of seeing things. P e r h a p s t h e c h i k T h a s s e e n t h e p a r e n t being angry, even frightening; if t h e p a r e n t is able to recognize t h e child's experience b u t also is able to c o m m u n i c a t e t h a t t h a t fear is unjustified, t h e child is safe. However, in c a s e s of m a l t r e a t m e n t , t h e child is n o t safe, a n d a n y r e a s s u r i n g c o m m u n i c a t i o n of containment will be false. It will also further u n d e r m i n e t h e child's capacity to t r u s t i n n e r reality. T h u s , a b u s e inevitably reinforces a lack of integration between the two infantile m o d e s of experience of m e n t a l s t a t e s . It reinforces a psychic equivalent mode of functioning, b e c a u s e it forces t h e child to a t t e n d primarily to the physical world, to m i s t r u s t a n y opportunities for playfulness, and to be s u s p i c i o u s of t h e internal world in general, b e c a u s e the object's i n t e r n a l world is incomprehensible, terrifying, or deceptive. It also reinforces a p r e t e n d m o d e b e c a u s e it may be the only way available to t h e child to sever connection between internal s t a t e s a n d a n intolerable external reality. Parents w h o c a n n o t e n t e r a mentalizing m o d e with their child (where p r e t e n d a n d real c a n coexist) are by n o m e a n s always overtly abusive, neglecting, or mentally ill. A wide range of people share t h e type of early experience associated with insecure attachment. Although frequently found in childhoods t h a t are traumatic, it is by n o m e a n s restricted to t h e s e . This m a y be one

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of t h e r e a s o n s why m a n y characteristics of children who have experienced severe m a l t r e a t m e n t m a y also b e found in t h o s e whose childhoods h a v e a p p a r e n t l y b e e n relatively benign. The p a r e n t m a y h a v e b e e n u n a b l e to reveal herself e n o u g h to t h e child, preventing h i m from finding himself within h e r m i n d . We s p e c u l a t e t h a t t h e capacity on t h e p a r e n t ' s p a r t to a d o p t a playfully e m p a t h i c a t t i t u d e m a y be essential for t h e child to experience h i s projections a s contained. Instead, t h e p a r e n t may be emotionally inaccessible to t h e child, preventing h i m from creating a n image of h i s internal world in t h e p a r e n t ' s mind, w h i c h would t h e n h a v e b e e n available for internalization to form t h e core s e n s e of himself. Some p a r e n t s m a y in addition u n c o n sciously reveal s t a t e s of m i n d (hatred, disgust) t h a t , if pervasive, constitute psychological a b u s e , b e c a u s e t h e child h a s to recoil from t h e implied 1 image of himself. T h e m o s t d i s t u r b i n g aspect for t h e child might be to c o n t e m p l a t e t h e cruelty or h a t r e d the caregiver feels toward him. He c a n h a v e n o protection from this, other t h a n b a r r i n g ideas a b o u t feelings a n d t h o u g h t s in others a n d in himself from h i s c o n s c i o u s n e s s . T h e m a l t r e a t e d child can t h u s grow u p to fear m i n d s a n d to r e p u d i a t e a w a r e n e s s of feelings or motives, with t h e persistence of psychic equivalence a s t h e inevitable by-product of t h i s process. F u r t h e r m o r e , a s Main a n d H e s s e (1992) h a v e pointed out, it is a s disruptive for t h e p a r e n t to be experienced a s frightened a s for h e r to be seen a s frightening. There m a y b e a t least two p r o c e s s e s in operation here: (a) B e c a u s e a t t h i s early stage the infant perceives t h e object a s p a r t of t h e self, t h e child will tend to a s s u m e t h a t his own m e n t a l s t a t e is d a n g e r o u s or even catastrophic, b e c a u s e it is associated' with frightening behavior from t h e p a r e n t . For instance, a b a b y m i g h t bite t h e m o t h e r ' s b r e a s t in excited: p l e a s u r e a n d find a reaction of a n g e r a n d rejection. If s u c h experiences were frequent, t h e n t h e y could be expected to h a v e a disorganizing effect on t h e b a b y ' s u n d e r s t a n d i n g of h i s own s t a t e s of mind; excited p l e a s u r e becomes e q u a t e d with a n g e r a n d rejection, (b) The child m a y perceive the caregiver's image of h i m a s a frightening, u n m a n a g e a b l e person—for i n s t a n c e , a r e m i n d e r of a n abusive figure from the m o t h e r ' s own history—and t h i s m a y be internalized a s a n u n a c c e p t a b l e ' a n d confusing p a r t of t h e child's self-image. (In chapter

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6 we d i s c u s s e d t h e role t h a t this p r o c e s s m a y h a v e played in t h e case of Rebecca.) T r a u m a m a y also d i s r u p t t h e representation of feelings or t h o u g h t s by creating a propensity for shifting into t h e infantile mode of p r e t e n d . S o m e t r a u m a t i z e d children grow u p with a n a p p a r e n t hypersensitivity to m e n t a l states, needing to g u e s s immediately w h a t t h o s e a r o u n d t h e m feel a n d t h i n k in order to preempt further t r a u m a . As p a r t of this, a pseudo-knowledge of m i n d s c a n develop, w h i c h is superficial a n d m a y be very selective, s c a n n i n g for p a r t i c u l a r d a n g e r signals a n d avoiding reflection on m e a n i n g s or connections. W h a t s e e m s to result is a k e e n n e s s to identify psychological s t a t e s in others, b u t t h e s e states are essentially m e a n i n g l e s s to t h e patient, a c o m m o n b u t heavily devalued currency. "Expertise" in t h e psychological world of the other develops a t t h e expense of knowledge of t h e patient's own mind. This thinking, w h i c h in r e s e a r c h we have called "hyperactive mentalizing," o c c u r s in t h e pretend mode, w i t h o u t firm ties to i n t e r n a l a n d external experience t h a t is felt to be real. An example m a y be helpful. "Sandra" is a 35-year-old w o m a n with a twenty-year history of self-mutilation a n d suicidal gestures a n d a b a c k g r o u n d of psychological a b u s e from t h e grandmother w h o b r o u g h t h e r u p . 1 In t h e first p a r t of h e r analysis, S a n d r a w a s endlessly preoccupied with analyzing t h e motives behind t h e reportedly cruel a n d p a r a n o i d behavior of her grandmother a n d h e r psychiatrist. T h e events described, w h e t h e r from childhood or yesterday, h a d a h a c k n e y e d quality, like a soap opera. The motives t h a t S a n d r a a t t r i b u t e d to t h e offending characters were u n c o n v i n c i n g a n d quite interchangeable. They were also often t r a n s p a r e n t l y projected. S a n d r a habitually twisted h e r reflective function, deflecting attention from h e r own m e n t a l states a n d distorting or negating t h o s e of other people. Her systematic a b u s e of mentalization protected h e r from a c t u a l insight or intimacy. Her reflective capacity seemed to have b e e n hijacked into t h e p r e t e n d m o d e of experience, in which psychological events, like h e r relationships, were idealized b u t emptied of emotional d e p t h . An illustration of this w a s t h a t , after a night of self-cutting a n d getting h e r 9-year-old s o n to help h e r write a 1

Mary Target was her fourth analyst.

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suicide note, S a n d r a c a m e to h e r s e s s i o n excitedly trying to u n d e r s t a n d t h e stinginess of h e r b r o t h e r ' s n e w wife a n d only mentioning in p a s s i n g h e r own o u t b u r s t s of t h e previous day. More commonly, m i n d l e s s or cruel t r e a t m e n t of a child leads to t h e rejection of mentalization (Fonagy, Steele, Steele, a n d Target 1997). This s h o u l d be t h o u g h t a b o u t n o t simply a s a deficit, b u t a s a n adaptation t h a t h a s helped t h e child to attain some d i s t a n c e from a t r a u m a t i z i n g s i t u a t i o n (see c h a p t e r 7 for a clear example). Although restriction of mentalization w a s originally adaptive, t h e r e is a clear a n d powerful link between this restricted capacity a n d vulnerability to later t r a u m a . T h e inability to reflect u p o n t h e m e n t a l s t a t e of t h e perpetrator, a s well a s t h e reaction of t h e self, m a y prevent t h e child from resolving the original t r a u m a t i c experience or coping with s u b s e q u e n t a s s a u l t . Conversely, mentalizing is a n i m p o r t a n t c o m p o n e n t of t h e selfrighting capacity of individuals w h o a r e able to w i t h s t a n d early adversity (Fonagy, Steele, et al. 1994). There is a m u t u a l develo p m e n t a l relationship between t r a u m a a n d mentalizing; t r a u m a m a y u n d e r m i n e t h e child's willingness to play with feelings a n d ideas (felt a s too real) in relation to external events, b u t , a t the s a m e time, t h e lack of a full mentalizing m o d e of i n t e r n a l organization will create a propensity for t h e c o n t i n u o u s repetition of t h e t r a u m a , in t h e a b s e n c e of t h e m o d u l a t i o n t h a t a representational view of psychic reality would bring.

THE RIGIDITY OF RELATIONSHIP PATTERNS AND T H E PETRIFICATION OF S Y S T E M S OF REPRESENTATION As described in c h a p t e r 9, one of t h e m o s t characteristic features of borderline psychopathology is t h e instability a n d t e m p e s t u o u s n e s s of relationships. T h e s e s h o w a rapidly accelerating tempo, w h e r e intimacy immediately follows a c q u a i n t a n c e , and t h e r e a r e n u m e r o u s crises, often featuring d e p e n d e n c e , masochism, a n d d o m i n a n c e . In fact, we m a y say, p a r a p h r a s i n g Win-

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nicott, t h a t in some s e n s e "there is no s u c h thing a s a borderline person, t h e r e is only t h e borderline couple—the borderline person a n d h e r object." However, t h e s e p a t i e n t s tend to lack a realistic s e n s e of the psychic reality of t h e other person. W h a t is represented is a n association between a self-state a n d t h e s t a t e in a "virtual other" t h a t is n o t consistently plausible. For example, S a n d r a talked extensively a b o u t friends, b u t t h e feelings a n d t h o u g h t s a t t r i b u t e d to t h e m were often improbable a n d inconsistent with their actions. In t h e narrative, t h e s e people felt twodimensional, a n d a s t h e p a t i e n t incorporated t h e analyst into the c a s t of c h a r a c t e r s , t h e a n a l y s t strongly felt a shallowness and artificiality in t h e w a y s h e w a s represented. This w a s n o t like t h e elaboration of distortions a s transferences developed; rather, it felt like being a j o k e r in a card game, which could stand for a n y o t h e r card b u t h a d n o a c t u a l identity or continuity. While all psychoanalytic t r e a t m e n t is likely to develop a capacity for reflective function in t h e patient (and in t h e analyst), work with borderline p a t i e n t s s u g g e s t s t h a t t h e s t u n t i n g or twisting of t h i s capacity m a y b e a key to their pathology. Treatment t h e n n e e d s to be intensively—though n o t necessarily directly—focused o n its development. We suggest t h a t some aspects of borderline pathology arise from t h e i n a d e q u a t e integration of early forms of t h e r e p r e s e n t a t i o n of internal experience, which would normally form t h e b a s i s of a mentalizing mode of experiencing psychic reality. P e r h a p s t h e single m o s t important indicator of this is t h e quality of rigidity t h a t i m b u e s the internal r e p r e s e n t a t i o n a l world, t h e experience of t h e self, and relationships with others. Borderline p a t i e n t s persist in p a r t i c u l a r p a t t e r n s of relating with a tenacity far beyond t h a t associated with h a b i t u a l defenses. These individuals, like other patients, organize the a n a lytic relationship to conform to their u n c o n s c i o u s expectations, b u t for borderline p a t i e n t s t h e s e expectations h a v e t h e full force of reality a n d t h e r e is n o s e n s e of alternative perspectives. At m o m e n t s w h e n external reality does n o t fit with t h e tenaciously held active s c h e m a , t h e r e is e m p t i n e s s a n d confusion. J u s t a s behavior a n d interpersonal relations a r e rigidly restricted, so is i n t e r n a l experience; of t h e total s p e c t r u m of

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experiences, only s o m e are registered- a n d felt, leading to a discontinuity in self-experience. B e c a u s e of t h e lack of flexibility of t h e r e p r e s e n t a t i o n a l s y s t e m for m e n t a l states, t h e individual c a n n o t evoke psychic experiences other t h a n by e n a c t m e n t a n d provocation. Subjective states, s u c h a s anxiety, m a y be k n o w n mainly t h r o u g h creating t h e m in a n o t h e r p e r s o n . Many have explained t h e manipulative a s p e c t s of eating disorders a n d other forms of self-harm (e.g., B r u c h 1982; T. Main 1957) in t e r m s of t h e projection or projective identification of intolerable p a r t s of t h e self, or a s p a r t of c o m m u n i c a t i o n . Here o u r e m p h a s i s is s o m e w h a t different. It is t h e creation of a n i n t e r n a l experience a k i n to reflection, normally intrapsychic, t h a t is established t h r o u g h interpersonal interaction. Not being able to feel themselves from within, they are forced to experience the self from without. S a n d r a , a t v a r i o u s times of crisis, said s h e k n e w t h a t s h e h a d b e e n overwhelmed with anxiety b e c a u s e h e r s o n h a d called t h e police, or h e r a n a l y s t h a d talked to h e r psychiatrist. T h e s e reactions m a d e s e n s e of w h a t s h e h a d felt to b e a "mental mess," a n d s h e w a s t h e n s o m e w h a t more able to deal with it appropriately. An i m p o r t a n t a s p e c t of s u c h rigidity is t h e persistence of psychic equivalence a s a p r e d o m i n a n t m o d e of experiencing psychic reality. M u c h of t h e a p p a r e n t inflexibility of s u c h patients m a y be u n d e r s t o o d in t e r m s of t h e increased weight they give to psychic reality. W h e n m e n t a l experience c a n n o t b e conceived of in a symbolic way, t h o u g h t s a n d feelings h a v e a direct a n d s o m e t i m e s devastating i m p a c t t h a t c a n only b e avoided t h r o u g h drastic a n d primitive defensive moves. Early in h i s analysis, one m a l e p a t i e n t reported a very acrim o n i o u s a r g u m e n t between himself a n d a s h o p a s s i s t a n t about t h e c h a n g e h e w a s given."/ knew I gave h e r five p o u n d s , b u t the s t u p i d w o m a n only gave m e 3 0 pence c h a n g e , w h e n s h e should h a v e given m e 80. S h e kept saying t h a t s h e gave m e 8 0 pence, b u t I k n e w t h a t s h e h a d kept 50." W h a t w a s interesting from an analytic s t a n d p o i n t in h i s a c c o u n t w a s n o t simply h i s obvious s e n s e of omnipotence in relation to h e r (i.e., "he knew") a n d the s e n s e of betrayal by t h e a n a l y s t in t h e transference, b u t his inability to c o n t e m p l a t e a n y other point of view. Reflecting on t h i s episode s o m e y e a r s into h i s analysis, h e said: "I j u s t could

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not see a n y possibility, other t h a n I w a s right; it's n o t t h a t I did not w a n t to see it, it simply did n o t exist." A borderline y o u n g m a n treated by Peter Fonagy a n d described more fully in a n earlier p a p e r (Fonagy 1991) w a s p r o n e to long periods of silence d u r i n g a n early p h a s e of h i s analysis. T h e silences were i m p e n e t r a b l e a n d , for some time, unexplained. On one occasion, t h e trigger w a s a two-minute delay in t h e a n a l y s t ' s arrival for t h e session, w h i c h led to over a week of silence. Interpreting t h e silence a s p u n i s h i n g t h e analyst, c o m m u n i c a t ing frustration, or a s e n s e of being excluded or not u n d e r s t o o d failed to b r e a k t h e deadlock. Eventually it transpired t h a t on this and m a n y other occasions t h e analyst's l a t e n e s s created a n image of being with s o m e o n e u n c a r i n g a n d unreliable to t h e point of being m a d . "You a r e j u s t a n unprofessional, u n c a r i n g bastard, a n d you k n o w it." At t h o s e times, t h e analyst w a s experienced a s someone^totally unsafe to be with, a n d questioning this perception carried n o meaning. While t h e r e is little t h a t w a s u n u s u a l a b o u t this transference image, it w a s held with e n o r m o u s tenacity, impervious to a n y consideration of o t h e r times t h a t h a d b e e n experienced equally definitively a s showing a n opposite reality. E a c h view replaced the other completely, a n d e a c h w a s s e e n a s so clear t h a t it w a s not even w o r t h d i s c u s s i n g . T h e a n a l y s t s a w t h a t a s b a s e d in a lack of ability to "play with reality"; t h e patient w a s mesmerized by a n idea a n d u n a b l e to experience it a s psychic r a t h e r t h a n physical reality. T h e a n a l y s t h a d to accept t h e distortion. Attempting to evoke t h e p a t i e n t ' s complete picture of t h e analyst was inevitably perceived a s a n a t t a c k on t h e patient's sanity. While often n o t consciously a w a r e of this, we respect it by entering t h e p a t i e n t ' s reality a n d accepting t h e role of the "unprofessional, u n c a r i n g b a s t a r d , " or whatever it m a y be. We now describe work with a p a t i e n t w h o s e difficulties illustrate m a n y of t h e theoretical p o i n t s we h a v e b e e n p u t t i n g forward. We t h e n d i s c u s s m o r e specifically some a s p e c t s of t h e failure to achieve full mentalization in a d u l t s with severe p e r s o n ality disorder a n d t h e w a y in which, u s i n g borderline disorder a s a n example, s u c h s t a t e s m a y be u n d e r s t o o d in t e r m s of the persistence of primitive m o d e s of u n d e r s t a n d i n g psychic experience.

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DYSFUNCTIONAL PSYCHIC REALITY IN SELF-DESTRUCTIVENESS— CLINICAL EXAMPLE: "EMMA" Emma? at 1 9 w a s a slightly overweight, highly intelligent young w o m a n , looking y o u n g e r t h a n h e r years. S h e w a s referred to u s a t t h e A n n a F r e u d Centre from a n o t h e r c e n t e r b e c a u s e her diabetes h a d b e e n hopelessly o u t of control since s h e w a s first diagnosed diabetic a t t h e age of 12. S h e openly a d m i t t e d to m a n i p u l a t i n g h e r insulin to control h e r weight. S h e h a d been hospitalized with keto-acidosis eight times d u r i n g t h e previous year. After h e r last a d m i s s i o n h e r diabetologist, w h o is renowned for h i s antipsychoanalytic s e n t i m e n t , agreed to t h e p s y c h o a n a lytic referral with t h e c o m m e n t : "We might a s well let somebody else w a t c h h e r kill herself." W h e n E m m a w a s a s s e s s e d , h e r m a i n c o n c e r n w a s a b o u t her i m m i n e n t failure in h e r Arts F o u n d a t i o n Course, for w h i c h she found herself u n a b l e to s u b m i t t h e n e c e s s a r y course-work. She w a s living on h e r own in a tiny single room a n d s p e n d i n g her m o n e y on drugs, alcohol, a n d v a s t q u a n t i t i e s of "bad" food. She smoked c a n n a b i s a n d heroin, d r a n k excessively, a n d binged on potatochips, chocolate, cheese, a n d cakes. S h e would " b u r n off' t h e c a r b o h y d r a t e s b y omitting insulin a n d a b u s i n g alcohol. The alcohol would also anesthetize her, a s would t h e c a n n a b i s . The m o s t d r a m a t i c expression of aggression w a s in t h e lacerations s h e inflicted on herself with a razor blade. S h e described the triggers for s u c h a c t s a s a "sinister little voice" inside h e r head, t e m p t i n g a n d daring her to self-mutilate: "You' k n o w you'll feel better. Do it! Do it! Do it!" S h e openly d i s c u s s e d h e r suicidal intent a n d readily agreed with m e w h e n I suggested t h a t a part of h e r h a d lost all h o p e for herself. Her family h a d b e e n t o r n a p a r t by psychiatric a n d physical illness. In h e r early y e a r s s h e w a s cared for by h e r m o t h e r , who h a d b e e n diagnosed a t various times a s b o t h schizophrenic and

2 The patient was treated by Peter Fonagy, and this Is his report. The treatment was part of the Anna Freud Centre's Brittle Diabetes Research Programme headed by the late George Moran, who provided much direction and inspiration to the thinking about this case.

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manic-depressive. D u r i n g h e r m o t h e r ' s psychotic episodes, a n d later d u r i n g h e r physical illness, E m m a w a s looked after by h e r three older sisters, t h e family's neighbors, or whoever h a p p e n e d to be a r o u n d a t t h e time. From h e r a c c o u n t s it s e e m s clear t h a t despite being t h e youngest, h e r role in t h e family w a s a pivotal one. As t h e y o u n g e s t child, s h e w a s t h e p e r s o n a r o u n d w h o m t h e family rallied a n d w h o s e survival justified t h e c o n t i n u e d existence of t h e family u n i t . Soon after s h e t u r n e d 10 t h e b u r d e n s h e had a s s u m e d a s p e a c e m a k e r in family a r g u m e n t s b e c a m e even heavier w h e n h e r b r o t h e r a n d sisters a s well a s h e r m o t h e r began a p p r o a c h i n g h e r for advice. It w a s a p p a r e n t in t h e way she described t h e interminable family conversations, s o m e t i m e s reaching far into t h e night, t h a t even a s a relatively y o u n g girl she h a d a capacity to create in h e r mind a little s p a c e where s h e was able to deal with other people's confusions in a rational, even if n o t yet m a t u r e , way. S h e referred to this in a disparaging way a s being a "rubbish bin" for other people's troubles. Yet s h e also recalled feeling valued a n d appreciated. T h u s , s h e h a d some capacity to mentalize, even if t h i s could only b e achieved a t s u b s t a n t i a l cost, by needing t h o s e a r o u n d h e r to r e p r e s e n t t h e confused a n d u n t h i n k i n g p a r t s of herself. E m m a ' s father's psychiatric d i s t u r b a n c e w a s probably a s severe a s h e r m o t h e r ' s . E m m a recalls a very early memory of h e r father s c r e a m i n g t h r o u g h t h e h o u s e , t u r n i n g all t h e children o u t of their beds, a n d m a k i n g t h e m s t a n d outside in t h e g a r d e n so t h a t t h e "evil spirits'' would n o t p o s s e s s their souls. She also recalls violent b a t t l e s between h e r p a r e n t s , w h e n they would set a b o u t e a c h other with ferocious intensity. Her father left t h e home w h e n E m m a w a s 6 y e a r s old, a n d h i s d e p a r t u r e w a s b o t h s u d d e n a n d u n e x p l a i n e d . He c o n t i n u e d to live in t h e s a m e provincial English town a n d kept u p superficial c o n t a c t with t h e children. He w a s , however, o u t of work a n d in a n d o u t of psychiatric hospitals a n d offered t h e family little by way of physical or psychological s u p p o r t . E m m a s p o k e warmly a b o u t h e r mother, a s someone who w a s trying to do h e r b e s t in very difficult c i r c u m s t a n c e s . W h a t u n i t e d the family w a s their w a r of attrition with Social Services, w h o repeatedly t h r e a t e n e d to t a k e t h e children into care, particularly at times w h e n their m o t h e r ' s illness b e c a m e a c u t e . There clearly

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w a s a d e s p e r a t e b o n d between t h e m o t h e r a n d t h e children. E m m a recalls p r e t e n d i n g to a social worker t h a t h e r m o t h e r was o u t s h o p p i n g w h e n in fact h e r b r o t h e r a n d sister were holding h e r down a n d trying to stop h e r from c u t t i n g h e r wrists. When m o t h e r w a s hospitalized, t h e children would go a n d visit her regularly, despite t h e fact t h a t t h e hospital w a s far away. Her m o t h e r .became ill with a rapidly d i s s e m i n a t i n g cancer w h e n E m m a w a s 8. S h e u n d e r w e n t a radical m a s t e c t o m y a n d a further operation on h e r neck. Finally, in t h e last s t a g e s of the illness, E m m a ' s m o t h e r took h e r own life. E m m a emphatically did n o t w a n t to come into t r e a t m e n t . Her r e a s o n s for this were b o t h complex a n d telling. Having t r e a t m e n t w a s escaping—"not facing t h e music." S h e s h o u l d be able to battle it o u t on h e r own. I said to h e r t h a t I u n d e r s t o o d how h a r d it m u s t be for h e r to c o n t e m p l a t e receiving help w h e n so m a n y of h e r good feelings a b o u t herself were to do with being t h e one who could help h e r sisters a n d h e r m o t h e r . At this point s h e began to weep a n d told m e t h a t s h e h a d h e a r d , a t t h e Bulimics Anonym o u s g r o u p s h e h a d once a t t e n d e d , t h a t I k n e w a b o u t diabetics. I said t h a t p e r h a p s s h e w a s concerned t h a t I might think t h a t I k n e w a b o u t her, w h e r e a s s h e k n e w t h a t nobody could really k n o w a b o u t t h e impossibility of h e r situation. S h e w e n t on to say t h a t n o n e of t h e people a t t h e hospital u n d e r s t o o d w h a t s h e was going t h r o u g h . "They all t h i n k I a m a n a u g h t y child, w a n t i n g to get attention, a n d w h e n ignoring m e doesn't work, t h e y j u s t don't k n o w how to deal with me. B u t I really don't c a r e a b o u t w h a t t h e y do, t h e y a r e n o u s e to me." I said t h a t p e r h a p s s h e felt worried a b o u t t h e prospect of p s y c h o a n a l y s i s b e c a u s e it might be a s i t u a t i o n in w h i c h s h e would m i n d w h e t h e r s h e w a s ignored or not. S h e said t h a t s h e could n o t imagine t h a t coming to see s o m e o n e every day would do a n y t h i n g except m a k e t h e person a n addict, a s food a n d heroin did, "except t h a t food a n d heroin a r e u p to m e a n d in psychoanalysis you a r e in control." I suggested t h a t s h e m i g h t be far more worried a b o u t being o u t of control t h a n s h e knew. F u r t h e r m o r e , if s h e could force the doctors a t t h e hospital to lose their t e m p e r s with her, s h e might also be able to force a n a n a l y s t to lose control. M a n y m o n t h s into t h e a n a l y s i s s h e told m e h o w important this interview h a d b e e n for her, in t h a t s h e felt I w a s a w a r e of her

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need to create m a d n e s s a n d confusion in me, in t h e t r e a t m e n t . In t h e first m o n t h s of t h e a n a l y s i s h e r anxieties a b o u t t h e destructiveness of h e r t h o u g h t s a n d fantasies often c a u s e d h e r to be silent, s o m e t i m e s to r e m a i n so for entire, sessions. S h e would a t t e n d punctually, despite a long a n d complex j o u r n e y , b u t t h e n s h e would j u s t lie on t h e couch, m a k e a few a p p a r e n t l y superficial c o m m e n t s a b o u t t h e j o u r n e y or a b o u t t h e room or even a b o u t t h e w e a t h e r , a n d t h e n lapse into a state of selfimposed q u a r a n t i n e . At n o stage did o n e h a v e t h e feeling, however, t h a t s h e did n o t wish to c o m m u n i c a t e . I a t t e n d e d carefully to h e r body movem e n t s a n d from time to time c o m m e n t e d on w h a t I t h o u g h t these said a b o u t h e r c u r r e n t m e n t a l s t a t e (and this, in a n u n r e m a r k a b l e n u t s h e l l , is t h e e s s e n c e of o u r technique): t h e c o n s t a n t availability a n d active offering of t h e analyst's mind so that within it s h e m a y discover h e r own self. For example, on one occasion, w h e n s h e greeted m e a t t h e beginning of t h e session b u t t h e n said n o t h i n g else, I noticed how s h e took o u t her b u s p a s s a n d p r e s s e d it a g a i n s t h e r fingers until it w a s b e n t almost double u n d e r t h e p r e s s u r e , t h e n s h e released it, allowing it to s n a p b a c k into its n o r m a l s h a p e . S h e repeated t h e movement exactly five times. I said t h a t p e r h a p s s h e w a n t e d m e to k n o w what a n effort it felt to h a v e to come a n d see m e five times a week. Realizing t h a t I m u s t h a v e b e e n reacting to w h a t s h e w a s doing with h e r b u s p a s s , s h e . t u c k e d it away into h e r p u r s e . The action w a s incomplete a n d t h e b u s p a s s disappeared only halfway, so t h a t t h e p a r t with h e r p h o t o g r a p h on it w a s still sticking out, a s if peering over t h e edge. I said t h a t I u n d e r s t o o d t h a t a frightened p a r t w a s always on t h e look-out to m a k e s u r e t h a t nothing h a d b e e n revealed inadvertently, b u t t h a t t h e r e w a s another p a r t of h e r t h a t w a n t e d m e to u n d e r s t a n d her, a n d n o matter how h a r d t h e frightened p a r t might try to e n s u r e t h a t everything w a s carefully t u c k e d away, t h i s other more c o m m u n i cative p a r t of h e r would leave a nice clear trail for m e to follow. She t h e n said indignantly: "What do you m e a n , communicative? I could n o m o r e c o m m u n i c a t e to you t h a n I could talk to Medusa." I said: "You know, even M e d u s a could be confronted with the help of a mirror." S h e t u r n e d away so t h a t I would n o t be able to see h e r face, b u t I could tell t h a t s h e w a s smiling.

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The m o m e n t w h e n s h e decided t h a t s h e w a n t e d to talk w a s r a t h e r d r a m a t i c a n d illustrates b o t h t h e n a t u r e of h e r pathology a n d t h e clinical a p p r o a c h t h a t we t a k e in dealing with borderline patients. I h a d b e e n told, n o t by h e r b u t by t h e physician treating her, t h a t s h e w a s a b o u t to u n d e r g o a fundoscopy to c h e c k for diabetic retinopathy. F u n d o s c o p y involves instilling a mydriatic into t h e eye to dilate t h e pupil a n d c a u s e s a temporary b l u r r i n g of vision. S h e c a m e into t h e s e s s i o n directly after her investigation a n d uncharacteristically avoided looking a t m e a n d lay on t h e couch, burying h e r h e a d in t h e c u s h i o n . T h e silence lasted for a t least ten m i n u t e s . Eventually I noticed t h a t her index finger w a s tracing small grooves a l m o s t imperceptibly in t h e texture of t h e couch. Fascinated, I t h o u g h t t h e grooves she w a s tracing looked like rivers a n d their t r i b u t a r i e s a n d also like t h e small blood vessels t h a t a r e involved in diabetic retinopathy. It t h e n s t r u c k m e t h a t E m m a w a s tracing two rivers t h a t sometimes seemed to be joined u p by their t r i b u t a r i e s b u t sometimes drifted sharply away from one a n o t h e r . W h e n I w a s reasonably confident of t h e p a t t e r n , I wondered aloud if s h e didn't suddenly feel t h a t s h e m i g h t lose me, even if s h e did n o t quite u n d e r s t a n d why s h e feared this. In r e s p o n s e s h e b u r i e d h e r face even deeper in t h e c u s h i o n . I said t h a t we b o t h realized h o w terrified s h e was of losing h e r sight, b u t t h a t p e r h a p s t h e r e w a s also a p a r t of her t h a t felt t h a t if s h e could n o t k e e p a n eye on things, t h e analysis might b r e a k u p , a n d everything would b e c o m e b l u r r e d . She r e m a i n e d silent.but drove h e r fingernail deeper a n d deeper into t h e couch. Eventually s h e w a s violently c r i s s c r o s s i n g over w h a t h a d b e e n t h e river p a t t e r n . I said t h a t I k n e w t h a t somewhere s h e felt deeply a s h a m e d a b o u t w h a t w a s h a p p e n i n g to h e r body a n d w a s very angry with t h e analysis a n d with m e for j u s t s t a n d i n g by a n d w a t c h i n g it h a p p e n . S h e t h e n b r o k e h e r silence. S h e said, a l m o s t shouting: "If you a r e so fucking clever, why don't you stop m e from doing t h i s before I go blind?" Reflecting on E m m a ' s s e n s e of h e l p l e s s n e s s a n d t h e h e l p l e s s n e s s s h e engendered in me, I r e m a r k e d : "I t h i n k you would like m e to stop you from feeling t h e s a d n e s s a n d t h e rage t h a t drive you to do t h i s to yourself. I t h i n k you a r e frightened t h a t if we come together to see t h e feelings t h a t lead you to h u r t yourself, it will become so u n b e a r a b l e t h a t we will b o t h be destroyed." E m m a

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w a s quite still for a m o m e n t a n d t h e n said: "I s u p p o s e it would not do if I a s k e d w h a t it is t h a t you w a n t to know?" This point in E m m a ' s analysis, a n d in t h a t of n u m e r o u s other s u c h self-harming a n d self-destructive p a t i e n t s w h o m we h a v e treated, r e p r e s e n t e d a s p o k e n or u n s p o k e n realization on t h e part of t h e s e p a t i e n t s t h a t t h e y a r e more frightened of their m e n t a l experience, their emotions a n d p h a n t a s i e s , t h a n of t h e immediate physical p a i n of t h e long-term c o n s e q u e n c e s of their self-destructive actions, s u c h a s E m m a ' s m i s m a n a g e m e n t of h e r diabetes. The central t h e m e of E m m a ' s a n a l y s i s concerned t h e externalization—which to h e r w a s real—of h e r confusion a n d m a d n e s s . B e c a u s e s h e w a s operating in a m o d e of psychic equivalence, s h e felt a s t h o u g h t h e s e a s p e c t s of h e r experience really h a d left h e r m i n d , a n d t h e c a l m n e s s t h a t w a s left felt like h e r real self. The p e r s o n w h o h a d b e e n in turmoil, who w a s insanely ravaging h e r own body, w a s n o t she. Frequently, in her free association a n d d r e a m s , s h e described t h e image of a b u b b l e or a vessel s t u c k in o u t e r space. S h e elaborated s u c h images mostly in tranquil t e r m s . For example, s h e referred to w a t c h i n g lights flicker from h e r s p a c e capsule, imagining t h a t e a c h w a s a light from a p e r s o n too far a w a y to s e e m h u m a n . However, w h e n e v e r she seemed to feel t h a t s h e h a d h a d a good analytic experience, anxiety would t e n d to overwhelm t h e s e n s e of calmness. T h e reality of o u r relationship a s a n a l y s t a n d patient seemed to m a k e it impossible for h e r to m a i n t a i n t h e conviction of m a d n e s s a n d d i s t u r b a n c e being s o m e w h e r e else. On one occasion, I commented on h e r fear t h a t if s h e a b a n d o n e d her seclusion, t h e alternative w a s m a d n e s s . Responding, characteristically seeing her m e n t a l s t a t e in me, a s if it w a s I w h o w a s terrified, s h e said: "Don't worry, its i m p o r t a n t to let t h i n g s float a bit." For example s h e fantasized t h a t m y g a r d e n w a s t h e only ordered, well-kept one in t h e area, in t h e middle of a veritable jungle of w e e d s a n d overgrown g r a s s of t h e neighboring g a r d e n s . When I pointed o u t h o w frightening it m u s t be to feel s u r r o u n d e d by t h e m e n a c e of s u c h chaos, s h e shrugged: "Well, t h a t ' s y o u r problem, isn't it?" Her self-esteem a n d grandiosity were noticeably e n h a n c e d when s h e inflicted p a i n a n d d a m a g e on herself t h r o u g h gross

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diabetic m i s m a n a g e m e n t . S h e flaunted h e r ill-treatment of herself constantly a n d conveyed h e r capacity calmly to d a m a g e or kill herself. S h e imagined m e to be "pleading" with h e r to take care of herself, like h e r relatives a n d t h e staff of t h e medical (endocrine) u n i t , who h a d s p a r e d little effort to keep h e r alive. On one occasion s h e entered t h e consulting-room a n d told me t h a t s h e h a d j u s t tested h e r blood s u g a r . It w a s so high, she boasted, t h a t it n o longer registered on t h e glucometer. S h e gave off a p u n g e n t odor of ketones, like nail-varnish remover. I replied t h a t s h e seemed to feel so t r i u m p h a n t over p a i n a n d t h e fear of d e a t h t h a t t h e r e w a s n o t h i n g I could offer t h a t could compare. S h e said, "When you a r e diabetic, you h a v e to h a v e s o m e t h i n g to feel good about." This seemed to s h o w t h a t experiencing her psychic reality in a mode of psychic equivalence enabled her to feel t h a t s h e h a d destroyed p a r t s of h e r mind externalized into t h e body, a s well a s t r i u m p h i n g over d e a t h . In t h e a n a l y s i s s h e created a shallow, half-hearted concern for h e r objects a n d for m e in t h e transference. I w a s a w a r e of being kept a t a d i s t a n c e from s o m e t h i n g s h e felt w a s highly d a n g e r o u s . I w a s also a w a r e of t h e t e n d e n c y to let myself drift into a s t a t e of near-complete inattentiveness. I u n d e r s t o o d this c o u n t e r t r a n s f e r e n c e to derive from m y r e l u c t a n c e to allow myself to experience h e r terror in t h e face of relating to t h e p a r t of her mind representing h e r mentally ill p a r e n t s of t h e p a s t . Likewise, externalized in t h e transference, s h e reacted" to m e with tentativeness for fear t h a t I w a s u n s t a b l e a n d could r e s p o n d a t any m o m e n t with m a d rage. O n e day, w h e n it w a s possible to smell h e r ketotic state several m e t e r s from t h e waiting-room a n d f could discern from h e r s l u r r e d speech a n d general v a g u e n e s s t h a t s h e w a s profoundly unwell, h e r conscious t h o u g h t s seemed to be t a k e n u p with m y s t a t e of health. Her fantasy w a s t h a t I w a s suffering continuously from a cold b e c a u s e I worked too h a r d . S h e w a s confident t h a t work w a s m y way of avoiding depression. When I p u t it to h e r t h a t I t h o u g h t s h e w a s telling m e h o w h a r d s h e felt s h e h a d to work to protect u s from her s a d n e s s , s h e responded facetiously: "Well, one does w h a t one can." At this stage it seemed to be n e c e s s a r y for t h e analysis to r e p r e s e n t t h a t p a r t of E m m a ' s m i n d w h i c h s h e endeavored to

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keep safe a n d t r a n q u i l a n d isolated; t h e p r e s s u r e on m e to mold m y r e s p o n s e s to h e r expectations w a s intense, b e c a u s e perceiving a n y u n e x p e c t e d feelings a n d t h o u g h t s from me, a n d h e n c e having to see m e a s a real p e r s o n with a s e p a r a t e reality, constantly t h r e a t e n e d to confuse a n d overwhelm her. Her careful monitoring of m y well-being (again, a characteristic hypervigilance) w a s a key feature of this transference. S h e faced a n insoluble d i l e m m a in needing m e to be m a d b u t being terrified by t h e perception of m y m a d n e s s — t h a t is, finding h e r m a d n e s s within me. These a s p e c t s were particularly vividly illustrated by t h e following episode: a b o u t two y e a r s into E m m a ' s analysis, I w a s involved in a small bicycle accident, w h i c h led to quite significant b r u i s i n g on m y forehead a s well a s a sizeable cut above m y right eye, w h i c h required stitches. T h e total effect, which included a n extremely bloodshot eye, w a s a s unattractive a s it w a s d r a m a t i c . Equally striking w a s E m m a ' s capacity to scotomize m y injury. W h e n I collected E m m a from t h e waitingroom s h e avoided even glancing a t me. S h e w e n t t h r o u g h t h e session mostly in silence. The only way of knowing t h a t something w a s a m i s s w a s t h a t t h e a t m o s p h e r e of t h e session h a d a d r e a m i n e s s a b o u t it in w h i c h it w a s a l m o s t impossible to s u s t a i n a n y k i n d of a l e r t n e s s o r concentration. T h i s gave a s e n s e of E m m a ' s s t a t e of m i n d a s it tried to grapple with h e r fantasies a b o u t t h e injury t h r o u g h striving for a s t a t e of a l m o s t complete dissociation. We would u n d e r s t a n d t h i s on a very pathological form of a p r e t e n d m o d e of experiencing psychic reality: E m m a w a s desperately trying to create a s t a t e of m i n d t h a t h a d n o connection with external reality, in w h i c h h e r t h o u g h t s a n d imaginings h a d n o power. At t h e end of t h e session s h e walked out of t h e room w i t h o u t looking a t me, a n d s h e again seemed to take n o notice of m y face a t t h e beginning of next day's session. In t h i s session, u n u s u a l l y , E m m a reported a d r e a m in w h i c h a number of horses had broken out of their stables. They were blind and threatened to trample all over her. S h e woke u p j u s t before t h e h o r s e s were u p o n h e r . The d r e a m seemed to b e vaguely c o n n e c t e d to Peter Shaffer's play, Equus. In h e r associations it w a s difficult to tell w h e n s h e w a s recounting t h e d r e a m and w h e n s h e w a s giving a highly distorted a c c o u n t of t h e play. In E m m a ' s version of t h e play, t h e boy, w h o w a s in a hospital for

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t h e violently i n s a n e , developed hysterical b l i n d n e s s after he h a d flown into a rage a n d blinded a horse. T h e focus of h e r account, however, w a s t h e insanity of t h e psychiatrist treating t h e boy, who w a s , according to her, t h e villain of t h e piece. I said I t h o u g h t t h a t E m m a w a s terrified in c a s e s o m e h o w her a n g e r might b r e a k o u t of t h e stables s h e created for it a n d m a k e everyone in o u r "analytic hospital" violent a n d m a d . S h e res p o n d e d t h a t t h e night before s h e h a d b e e n so a n x i o u s a b o u t n o t being able to see t h a t s h e could n o t t a k e h e r insulin. S h e found t h a t t h e p a i n of hyperglycemia distracted her. Nevertheless, she still h a d to s m o k e heroin to get to sleep. S h e w e n t o n to wonder why people talked of "blind rage." I said t h a t it w a s so painful for h e r to see t h e manifestations of violence t h a t being blind was a l m o s t preferable. And yesterday, w h e n s h e h a d noticed my facial injury, s h e h a d s u d d e n l y felt t h a t s h e w a s in terrible d a n g e r b e c a u s e s h e w a s evidently u n a b l e to k e e p t h e violence o u t of t h e room. S h e now b e c a m e extremely a n x i o u s a n d a s k e d repeatedly w h a t injury I w a s talking a b o u t . I replied t h a t I u n d e r s t o o d how frightening it w a s for h e r to feel t h a t t h e r e h a d b e e n violence, b e c a u s e it m a d e h e r feel b o t h a s if s h e might, inadvertently have c a u s e d it a n d also a s if it were h a p p e n i n g to her. S h e shouted t h a t I w a s talking n o n s e n s e , like t h e psychiatrist in t h e play. How could I expect h e r to b e able to see t h i n g s if I could not m a k e m y m e a n i n g s clear to h e r ? I said t h a t t h e s e t h o u g h t s were particularly frightening b e c a u s e if s h e found t h a t I w a s m a d , I might terrify h e r a n d drive h e r i n s a n e . S h e w a s silent for a while. T h e n slowly a n d very deliberately s h e said: "I m u s t h a v e seen y o u r eyes y e s t e r d a y b e c a u s e I have n o t b e e n able to get a picture o u t of m y m i n d since t h e n . The first time I r e m e m b e r visiting m y m o t h e r in hospital, I could not recognize h e r b e c a u s e one of t h e other p a t i e n t s h a d hit h e r and given h e r a black eye." S h e recalled feeling terrified of h e r mother a n d responsible for h e r injury. The infantile perception of t h e m o t h e r w a s p a r t of E m m a ' s self-representation a n d contained, h e r own u n i n t e g r a t e d aggressive wishes. It could only be dealt with a s p a r t of h e r body, not a s a m e n t a l r e p r e s e n t a t i o n t h a t could be t h o u g h t a b o u t consciously or unconsciously. In a less d a m a g e d p a t i e n t it m a y h a v e been

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r e p u d i a t e d a n d t h u s avoided—but this would a s s u m e a capacity to mentalize, which*was not, a t t h i s stage, within E m m a ' s capabilities. T h e fusion of self with t h e nonreflective m o t h e r constit u t e d a n overwhelming t h r e a t to t h e fragile, s a n e p a r t of h e r self-representation t h a t she, a n d all t h o s e a r o u n d her, clearly valued. To conserve t h i s limited self-representational s t r u c t u r e , the r e p r e s e n t a t i o n of m o t h e r ' s m e n t a l state within t h e self w a s externalized into h e r body, w h e r e it could be attacked a n d perh a p s destroyed. E m m a ' s i n s a n e a c t s of self-destruction p a r a doxically helped h e r to d e n y t h e p r e s e n c e of h e r m o t h e r within her m i n d a n d were associated with relief a n d hope b e c a u s e within h e r i m m a t u r e m o d e of r e s p o n d i n g to m e n t a l states, domin a t e d by psychic equivalence, t h e s e a c t s signaled t h e restored integrity of h e r self-representation. Although s h e enacted destructive w i s h e s on h e r body, s h e experienced t h e s e a c t s a s safe, inconsequential, a n d even desirable, b e c a u s e t h e body u p o n which t h e y were p e r p e t r a t e d w a s alien a n d deliberately excluded from h e r s e n s e of self. It w a s only w h e n conflicts s u r r o u n d i n g t h e emotional investm e n t in t h e object r e p r e s e n t a t i o n of h e r m o t h e r a s a s e p a r a t e being (outside t h e self-representation) could become t h e focus of the a n a l y s i s t h a t h e r fear of loss of love a n d its relation to h e r self-injury could be clarified. In h e r material, a s in h e r actions, physical c l o s e n e s s to d e a t h (in keto-acidosis) r e p r e s e n t e d t h e only possible way of achieving m e n t a l closeness to h e r m o t h e r a s the object w h o h a d her in mind. As s h e improved, s h e increasingly feared t h a t t h e g h o s t of h e r m o t h e r w a s in t h e consultingroom. To illustrate, we will now describe a Monday session. She b e g a n t h e s e s s i o n by reporting a d r e a m a b o u t a bomb threat, s h e described t h e i n t e n s e fear s h e felt a n d t h e conflict over w h e t h e r to s t a y in t h e building. In h e r associations s h e told m e t h a t s h e felt terrific physically, now t h a t s h e h a d stopped eating a n i m a l p r o d u c t s , a n d t h a t w h e n s h e w a s keto-acidotic, she felt vital a n d s o m e h o w real. S h e said s h e h a d loads of life left in her. I replied: "You s e e m to feel alive a n d real w h e n you are on the edge of a d i s a s t e r a n d y o u r life is actually in danger." I a d d e d t h a t it w a s a t s u c h times t h a t s h e seemed to feel I w a s m o s t worried a b o u t h e r . S h e said: "How did you k n o w t h a t I did n o t take m y insulin l a s t night?"

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S h e said angrily t h a t s h e felt t h a t t h e r e w a s t h i s evil inside her, t h a t . p e r h a p s it could only be exorcized by some "physical m e a n s , " n o t by talking alone. S h e t h e n h a d a n image of injecting insulin into a n e m p t y shell. This w a s followed by a long lecture on t h e way t h a t confidence c a n affect y o u r a p p e a r a n c e . S h e w a s particularly s t r u c k by F r e n c h w o m e n who, by wearing appropriate clothes, were able to m a k e themselves a l m o s t beautiful. She wondered vaguely if t h e r e w a s s u c h a t h i n g a s real b e a u t y . I responded: "You seem frightened t h a t I m i g h t recognize something good in you, t h a t I might b e t a k e n in a n d find y o u appealing a s a person." Her voice dropped a n octave. "You despise me, don't y o u ? You m u s t do." S h e t h e n w e n t o n t h e a t t a c k . W h e n s h e deliberately c u t h e r leg t h e other day s h e w a s terrified, b e c a u s e s h e h a d not felt a thing. Dr. Y h a d looked into h e r eye a t t h e clinic a n d h a d shaken, h i s h e a d . He, too, m u s t b e wondering w h a t t h e analysis w a s achieving. For two y e a r s s h e h a d b e e n coming, a n d things were, if anything, worse now t h a n t h e y h a d ever b e e n . She couldn't afford a n o t h e r year of n o t getting better. I said: "You are frightened t h a t you a r e too ill ever to feel loved." S h e p a u s e d a n d t h e n spoke of h e r Bible r e a d i n g in t h e evenings. T h e previous night s h e h a d read t h e p a s s a g e on the j u d g m e n t of Solomon in w h i c h King Solomon w a s confronted by two w o m e n who b o t h claimed to be t h e m o t h e r of t h e s a m e baby. S h e emphasized with horror t h a t t h e wrong m o t h e r h a d t h e live b a b y a n d t h e i n n o c e n t m o t h e r h a d t h e d e a d baby, again e m p h a sizing t h a t it w a s t h e wrong one. Despite r e a d i n g t h e passage again a n d again, E m m a could n o t see why, if Solomon w a s wise, h e h a d said t h a t t h e y should c u t t h e b a b y in half a n d divide it between t h e m o t h e r s . I r e m a r k e d : "You feel t h a t 'something is wrong,' t h a t t h e p a r t of you t h a t c a n be cared a b o u t is dead, and you are terrified in case you m a y stop m e from being able to see t h e difference between w h a t is alive a n d w h a t is dead. T h e n you will b e in t h e care of a n a n a l y s t w h o is n o t capable of keeping his p a t i e n t s alive." I held b a c k t h e m o r e i m p o r t a n t interpretation, t h a t s h e could n o t u n d e r s t a n d why splitting t h e b a b y in two would be of concern, a s in h e r p h a n t a s y t h e u n i t y of h e r body did n o t c o n t a i n h e r m e n t a l existence a n d t h u s m a d e n o s e n s e to her a s t h e focus of t h e object's concern.

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S h e b e c a m e a n x i o u s a n d said t h a t today s h e h a d t h o u g h t of her m o t h e r for t h e first time in a long while. S h e h a d looked into the m i r r o r a n d h a d felt for a m o m e n t t h a t s h e w a s going crazy b e c a u s e s h e h a d s e e n h e r m o t h e r . S h e t h e n went on to tell m e how h e r m o t h e r h a d b e e n so s a d t h a t s h e went to see a psychiatrist shortly before s h e died, b u t by t h e n it w a s too late; how nobody h a d told h e r t h a t s h e h a d cancer. S h e ended by saying: "The poor w o m a n , you k n o w s h e stole from a s h o p a n d t h e local p a p e r s were going to report it. It m u s t h a v e been terribly humiliating for her." I said: "I t h i n k it is very i m p o r t a n t to you to try to hide, from m e a n d from yourself, h o w a s h a m e d a n d humiliated you feel b e c a u s e it s e e m s a s if nobody could w a n t to look after y o u r body, a n d it feels a s if you've stolen whatever affection you get." In r e s p o n s e E m m a showed g e n u i n e emotion almost for t h e first time In t h e analysis. S h e said: "I j u s t can't listen to m y body, I w a n t to ignore it. My m i n d gets in t h e way, I can't b e a r to hear w h a t it is saying to me. It's j u s t n o u s e for anything, it's worthless." I said: "I t h i n k you feel terrified by how m u c h you need m e to listen to you a n d talk to you. You would prefer to kill that p a r t of yourself t h a t n e e d s to be liked a n d loved." E m m a said t h a t it h u r t terribly w h e n h e r s e n s e s were awake, particularly h e r s e n s e of smell, which s h e could experience w h e n she w a s n o t acidotic. U n d e r s t a n d i n g in analysis w a s like taking insulin. Getting n e a r e r to being better m a d e h e r feel how hopeless everything w a s . I r e s p o n d e d : "If you come b a c k to life, you feel m y r e a s o n for caring for you will b e gone. If you a r e n e a r death, I t h i n k you also feel you a r e n e a r to m e a n d s o m e h o w close to y o u r mother." Toward t h e e n d of t h i s s e s s i o n s h e revealed a n i m p o r t a n t memory a b o u t h e r m o t h e r ' s double incontinence before h e r death a n d t h e s h a m e a n d humiliation s h e h a d felt on h e r m o t h er's behalf. S h e also r e m e m b e r e d h a t i n g to go into the room to see her b e c a u s e of t h e smell. At t h e very end of t h e session s h e surprised m e with h e r reflectiveness; s h e said: "I s u p p o s e now I m a k e myself smell b e c a u s e I a m frightened you don't w a n t to see me." This material enabled u s to u n d e r s t a n d better E m m a ' s extreme m i s m a n a g e m e n t of diabetes. C o n t i n u i n g to live by a d h e r -

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ing to her medical regimen i n d u c e d anxiety a n d terror b e c a u s e it b r o u g h t h e r in c o n t a c t with h e r d e s p e r a t e infantile need to be loved a n d u n d e r s t o o d by a frequently psychotic m o t h e r . To cope with t h e terror, t h e s e p a r a t e existence of t h e m o t h e r w a s denied, foreclosing t h e opportunity for h e r achievement of full mentalization. Yet retaining only primitive m o d e s of experience of psychic reality b r o u g h t with it a c t u a l grave physical danger. Experience, particularly t r a u m a t i c experience, could be lived b u t n o t t h o u g h t about. The n e e d to keep t h e object close t h r o u g h provocation a n d aggression recreated in t h e transference t h e guilt a n d helplessn e s s t h a t E m m a m u s t h a v e felt a b o u t h e r intermittently crazy a n d dying m o t h e r . S h e n e e d e d to k n o w w h e t h e r I w a s able to r e m a i n close to h e r despite h e r furious a t t a c k s u p o n herself a n d u p o n m e w h e n I b e c a m e t h e vehicle of t h e m a d other within the self. Equally, i n , h e r a t t a c k s on h e r own body E m m a w a s her suicidal m o t h e r experienced within t h e self. In h e r symptoms, s h e w a s t h e destroyer of h e r remote a n d mentally inaccessible m o t h e r ' s body, a s well a s t h e victim of its destruction. E m m a felt t h a t s h e could be safe only a s long a s s h e m a d e s u r e t h a t s h e kept a small p a r t of h e r m i n d clear, s e p a r a t e from h e r d a n g e r o u s a n d chaotic feelings a n d ideas. Her active selfr e p r e s e n t a t i o n w a s s e p a r a t e , physically d i s t a n t from t h e source of danger, t h e alien other externalized into h e r body. T h e affectional tie to t h e m o t h e r , w h i c h could n o t be mentally represented (and therefore felt), could only be recreated in e n a c t m e n t . Her interactions with h e r chaotic a n d crazy p a r e n t s resulted in heavily invested b u t confusing internalizations, w h i c h she could n o t easily integrate. Consequently s h e tried to disavow t h e s e a s p e c t s of self-structure a n d p r e s e n t e d herself to herself a s vulnerable b u t free of confusion. B e c a u s e of t h e fragmented n a t u r e of h e r self-representations, s h e could only interact with t h e object in superficial a n d i n c o n s e q u e n t i a l ways. T h e repudiated a s p e c t s of herself, w h i c h derived from t h e introjections of m a d family m e m b e r s into t h e self, expressed t h e m s e l v e s in her crazy ill-treatment of h e r body a n d in fantasies of h e r destructive influence on others, particularly t h e a n a l y s t in t h e transference. Her body offered a favored locus for s u c h a n expression b e c a u s e it a p p e a r e d to be possible for h e r to exclude it from her

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self-representation. Her partial r e p r e s e n t a t i o n of herself implied that, experientially a t least, w h a t w a s h a p p e n i n g to h e r body w a s h a p p e n i n g to t h a t disavowed p a r t of herself in w h i c h w a s located her experience of confusion a n d s e n s e l e s s ill-treatment t h a t only gained m e n t a l r e p r e s e n t a t i o n outside t h e subjective d o m a i n of her mind. It gradually emerged t h a t h e r r e s i s t a n c e against analysis contained within it h e r terror t h a t in letting down t h e b a r r i e r s to h e r h a v e n s h e would be confronted by t h e m a d a n d u n p r e d i c t able r e a c t i o n s of h e r objects. Notwithstanding h e r symptomatic m i s u s e of h e r body, E m m a ' s irresolvable problem w a s t h a t h e r internalizations of h e r m a d objects were inseparably interwoven with m e n t a l r e p r e s e n t a t i o n s t h a t c o n s t i t u t e d her s e n s e of h e r own m e n t a l existence. The intensity of t h e psychoanalytic e n c o u n t e r gave E m m a t h e opportunity to extend h e r self-representation on the b a s i s of differentiated perceptions of t h e chaotic r e s p o n s e s of h e r objects. The p r o c e s s w a s a long a n d p a i n s t a k i n g one. Its critical component w a s t h a t E m m a gradually b e c a m e able to reintegrate within her self-representation t h e d a n g e r o u s images from which s h e sought refuge in t h e p a i n of keto-acidosis. To give u p t h e relative safety of h e r e n c a p s u l a t e d identity, s e p a r a t e d from t h e c h a o s t h a t s u r r o u n d e d it, m e a n t experiencing in t h e transference a terrifying s e n s e of fusion with m e a s a psychotic object. This occurred repeatedly, a n d s e s s i o n s s u c h a s t h e o n e in w h i c h t h e Equus d r e a m emerged were b u t particularly d r a m a t i c examples of a long-term p r o c e s s t h a t , in o u r view, w a s critical in bringing a b o u t h e r improvement. E m m a w a s n o t easy to treat, b u t in six y e a r s s h e m a d e s u b s t a n t i a l g a i n s a n d w a s n o longer brittle diabetic or selfharming, a l t h o u g h s h e r e m a i n s deeply confused a b o u t relationships a n d h e r own role in t h e m . S h e is a reasonably successful art s t u d e n t a n d now h a s a boyfriend who is a competent sculptor a n d is very encouraging of h e r work. E m m a h a s finished h e r treatment. Her bingeing a n d a l m o s t delusional disregard for insulin h a v e ceased. Her periods of improved control were, for a time, still p u n c t u a t e d by episodes of a c u t e self-destructiveness. At h e r discharge from t h e clinic s h e w a s symptom-free, a n d we hope t h a t h e r t r e a t m e n t will h a v e ultimately b e e n comparatively successful.

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Separation and Separateness Let u s begin by considering t h e dysfunction in E m m a ' s psychic reality a n d its implications for key a s p e c t s of h e r psychopathology: h e r dependency, h e r self-harming, a n d h e r reaction to t h e analysis. E m m a ' s major difficulty w a s a t t h e level of metarepresentations (see c h a p t e r 4). E m m a , like other borderline patients, h a d only partial p i c t u r e s of h e r own m e n t a l experience (her representational world). T h e m e n t a l p r o c e s s e s t h a t u n d e r p i n psychic reality were dysfunctional a s a c o n s e q u e n c e of early t r a u m a . She therefore h a d n o clear vision of herself; s h e experienced herself a s a n empty shell into which insulin w a s injected, a s a vehicle s t u c k in outer space, remote from t h e "terra firma" of h e r prim a r y representations, a n d consequently s h e h a d little control over h e r feelings a n d t h o u g h t s , a n d h e r identity rapidly shifted between a n y incompatible images. An essential s o u r c e of psychic organization—reflective capacity—was a b s e n t . A striking a s p e c t of t h e a n a l y s t ' s relationship with E m m a was h e r clear d e p e n d e n c y on h i m a s a physical presence. Her attenda n c e w a s remarkable, particularly within a lifestyle totally lacking in self-discipline. It is t e m p t i n g t o u n d e r s t a n d t h i s a s a n indication of a b o n d or a t least a s p a r t of a n idealized identificatory process. We believe t h a t h e r d e p e n d e n c e m a y h a v e been more primitive t h a n t h e s e possibilities suggest. E m m a required t h e c o n t i n u e d physical p r e s e n c e of t h e other principally n o t for h e r protection (Bowlby 1988) b u t b e c a u s e , w i t h o u t a n external mirror, s h e w a s incapable of becoming a w a r e of herself a s somet h i n g more t h a n a physical being, a s a thinker, a s a c o n t a i n e r of feelings a n d desires, a s a n intentional - h u m a n being. O u r core s e n s e of self d e p e n d s on t h e coherence a n d clarity with which we were able to perceive ourselves a s intentional beings in the m i n d s of a t t a c h m e n t figures. E m m a ' s i n c o h e r e n t s e n s e of herself required t h e c o n t i n u e d physical p r e s e n c e of a n o t h e r in whose voice, face, a n d behavior s h e could identify herself a s a person. As t h e analyst d i s a p p e a r e d a t t h e end of t h e s e s s i o n or a t the time of a break, s h e n o longer h a d a c c e s s to t h i s image. S h e felt literally lost in t h e ferment of h e r feelings a n d ideas over which s h e h a d s u c h poor control. Her capacity to mentalize w a s tenu-

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ous, a n d in t h e a n a l y s t ' s a b s e n c e s h e felt a b a n d o n e d to a n experience of h e r m e n t a l world, w h i c h felt m a d a n d overwhelming. Again a n d again t h e a n a l y s t ' s simple mentalization of h e r feelings visibly calmed her. In t h i s context h e r need w a s n o t for the recapitulation of a failed developmental experience (Kohut 1984) b u t , r a t h e r , a solution to a c u r r e n t problem—the a d d r e s s ing of a deviant developmental process. E m m a ' s need w a s n o t for the provision of a general holding environment (Winnicott 1962) b u t for t h e creation of a n i n t e r p e r s o n a l situation where h e r potential for reflective function could be specifically a n d safelyexercised. As E d i t h J a c o b s o n (1964) noted, t h e internalization of t h e r e p r e s e n t a t i o n of a n o t h e r before t h e b o u n d a r i e s of t h e self are fully formed u n d e r m i n e s t h e creation of a coherent s e n s e of self b e c a u s e t h e infant is forced to internalize t h e other a s a core part of h i s self. Now, n o t only is t h e creation of a n integrated psychic reality compromised b e c a u s e of t h e w e a k n e s s of t h e core self, b u t t h e individual h a s to c o n t e n d with a n alien being lodged within t h e self-structure: t h e t h o u g h t s a n d feelings associated with t h e introjected m o t h e r r a t h e r t h a n t h e experiences of t h e child himself feel real. T h e suggestion h e r e is t h a t t h e child, experiencing t h e internal world in t h e mode of psychic equivalence, frequently solves this problem by externalizing t h e s e alien a s p e c t s of t h e selfr e p r e s e n t a t i o n b a c k onto t h e real object. While t h i s may lead to great conflict or ambivalence in t h e external relationship (oppositional behavior, aggression to protect t h e self from t h e object, etc.), it w o r k s in t h a t t h e individual c a n experience himself in a more a u t h e n t i c way, a s long a s t h e r e a r e other p a r t s of t h e selfrepresentation t h a t a r e n o t seriously distorted a n d c a n be d r a w n on to create a c o h e r e n t if impoverished i n n e r world. This m a y be a relatively s t a b l e s t r u c t u r e t h r o u g h o u t childhood, or a s long a s t h e physical p r e s e n c e of t h e object c a n be e n s u r e d . This w a s t h e c a s e for E m m a , whose psychological problems were clearly linked with t h e physical loss of t h e m a t e r nal object. T h e o n s e t of h e r s y m p t o m s might be u n d e r s t o o d a s having b e e n triggered by t h e loss of a n ambivalent relationship (Freud 1917e [1915]). We believe t h a t t h e analytic material suggests t h a t t h e crisis for E m m a w a s a result of t h e loss of

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somebody who w a s required to embody a s p e c t s of t h e self t h a t could n o t be a c c o m m o d a t e d . T h e loss of this p e r s o n t h u s precipitated a s e n s e of loss of t h e self; t h i s loss could, t h e n , only be dealt with by finding a n o t h e r object into w h i c h t h e s e a s p e c t s could be externalized. This b e c o m e s a critical problem for adolesc e n t s with t h i s form of disorganization of t h e self—an i s s u e t h a t w a s a d d r e s s e d in detail in c h a p t e r 8.

The Use of t h e B o d y as a C h a n n e l for U n p r o c e s s e d M e n t a l S t a t e s T h e a b s e n c e of a n object t h a t could contain h e r feelings forced E m m a to create interpersonal' experiences with physical objects r a t h e r t h a n with people. Even m o r e i m p o r t a n t , t h e r e w a s a c o n s t a n t p r e s s u r e for t h e c u r r e n c y of t h e relationship between analyst a n d a n a l y s a n d , a s between t h e p r i m a r y caregiver a n d t h e infant, to become physical—the real thing, a s opposed to a t h o u g h t , a feeling, or a n idea. E m m a would c o m m u n i c a t e anxiety by becoming ketotic. Her bodily s t a t e s of "highs" a n d "lows" conveyed h e r mood far better t h a n did h e r verbalizations. This is a manifestation of a m i n d functioning within a psychic equivalence mode, in t h e a b s e n c e of mentalization. T h u s , s h e enacted with h e r body in t h e session, created real anxiety, real anger, a n d real confusion, r a t h e r t h a n being able to describe t h e s e a s c u r r e n t internal states. The focus of h e r d i s t u r b a n c e on h e r body is characteristic of t h e s e patients, a s t h i s indeed is t h e only p a r t of t h e internal world t h a t they c a n feel in control of. M a n y of t h e feelings a n d ideas t h a t E m m a w a s u n a b l e to r e p r e s e n t a s t h o u g h t s a n d feelings were experienced in relation to h e r body. Her a w a r e n e s s of t h e r e being s o m e t h i n g wrong with h e r a s well a s h e r efforts a t self-improvement were focused on t h e body, which, s h e felt, achieved a degree of lethal perfection. S h e w a s able to m a i n t a i n h e r diabetes a t t h e edge of ketotic c o m a a n d , at t h e s a m e time, m a i n t a i n h e r weight within t h e r a n g e s h e considered ideal. Clinical experience provides a m p l e evidence for t h e often deeply distorted a t t i t u d e s of borderline p a t i e n t s to their bodies.

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Why s h o u l d developmental failures in t h e psychological self h a v e a significant i m p a c t on physical identity a n d a d j u s t m e n t ? 1. W h e n psychic reality is poorly integrated, the body t a k e s on a n excessively central role for t h e continuity of t h e s e n s e of self. This m a y b e c o m e critical in adolescence, w h e n c h a n g e s in body s h a p e a n d function signify a far greater c h a n g e in identity for t h e s e individuals t h a n for t h o s e w h o s e psychological self-representation is developmentally m o r e advanced. Some a d o l e s c e n t s (such a s early-onset anorexics) experience existential anxieties in relation to p u b e r t y : a s if t h e y have ceased to exist—have become different people. There is psychic equivalence between the experience of b o d y s h a p e a n d its concrete p a r a m e t e r s ; to b e t h i n n e r is felt to be s u p e r i o r a n d is therefore superior. 2. The p e r s i s t e n c e of psychic equivalence contributes to specific physical s t a t e s acquiring exaggerated significance in relation to t h e self. Mental s t a t e s , u n a b l e to achieve r e p r e s e n t a t i o n a s ideas or feelings, come to be r e p r e s e n t e d in t h e bodily domain. Physical a t t r i b u t e s s u c h a s weight come to reflect s t a t e s s u c h a s internal well-being, control, s e n s e of self-worth, a n d so on, far beyond t h e n o r m a l t e n d e n c y for t h i s to h a p p e n in adolescence. For E m m a , getting t h i n n e r could m a k e h e r feel n o t j u s t better a b o u t herself b u t a different p e r s o n . Serious eating disorders show u s how concretely t h e body s h a p e c a n b e felt to represent aspects of personality. E m m a looked a t h e r body, a n d her perception w a s distorted n o t b e c a u s e s h e looked fat, b u t b e c a u s e she felt t h a t t h e r e were u n a c c e p t a b l e t h i n g s inside h e r t h a t could b e controlled, by m a n i p u l a t i n g h e r diet a n d insulin, or even got rid of (from t h e m i n d via t h e body) by inducing hyperglycemic s t a t e s of confusion or coma. 3. A further complication is t h a t n o t only were E m m a ' s own states of m i n d a n d self-experience experienced a s externalized into t h e body, b u t so also w a s t h e alien p a r t of her self-representation. This gave a further r e a s o n for p u n i s h i n g it. For E m m a , this alien object w a s t h e psychotic p a r t of h e r m o t h e r . S h e looked into t h e mirror a n d s a w h e r m o t h e r . The destructive

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a t t a c k on t h e other experienced a s in one's own b o d y p e r h a p s gives a n additional feeling of well-being a n d integrity of t h e self, which c a n be seen in some of t h e s e a b n o r m a l s t a t e s , s u c h a s self-cutting or starvation. Hurting t h e body helps, we would suggest, by leaving t h e m i n d feeling m o r e c o h e r e n t a n d b o u n d ed, belonging m o r e clearly to t h e self while t h e body is sacrificed. T h e object c a n n o t be genuinely a t t a c k e d mentally b e c a u s e it resides within t h e m e n t a l self. The body, however, b e c a u s e of its s e p a r a t e n e s s from t h e self-representation, c a n be readily converted into a vehicle for t h e introjected other p a r t of t h e self. We are suggesting t h a t self-harm, in particular, c a n b e u s e d to create a s e n s e of reflection t h a t would normally be intrapsychic b u t h a s to be established for some people t h r o u g h external relationships or t h r o u g h visible a t t a c k s on their bodies. Not having a clear s e n s e of themselves from within, t h e y n e e d to find a s e n s e of t h e self t h r o u g h getting other people, to r e a c t to them, a n d t h r o u g h treating themselves a s objects, literally r a t h e r t h a n metaphorically, b e c a u s e t h e self is experienced a s a physical being without psychological meaning.

I m p l i c a t i o n s for t h e A n a l y t i c P r o c e s s W h a t m a y be crucial h e r e is t h e s e n s e of psychic equivalence in t h e relationship between a s t a t e of m i n d a n d a physical reality. In this sense, it is wrong to t h i n k of a r e p r e s e n t a t i o n a l process mediating t h e s e forms of pathology: t h e body is n o t symbolic of a state of m i n d in t h e mother; it is a t t h a t m o m e n t experienced a s equivalent to t h e m o t h e r ' s s t a t e of m i n d a n d is reacted to accordingly. The interpretation of t h e symbolic m e a n i n g of t h e state of t h e body for t h e individual h a s b e e n found, in o u r work with brittle diabetics, rarely to be effective (Fonagy, Moran, a n d Target 1993b; Moran 1984). It is t h e split-off p a r t of t h e self (the alien object) t h a t interpretive work m a y a s s i s t in restoring to a n d t h e n distinguishing from t h e self-representation. As in t h e analysis of E m m a , this will often m e a n t h a t t h e alien other comes to be experienced in t h e transference: t h e a n a l y s t b e c o m e s the m a d m o t h e r with t h e d a m a g e d eye. Once t h e analyst, t h r o u g h mentalizing this experience repeatedly, h a s helped E m m a to

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u n d e r s t a n d t h a t t h i s m a d m o t h e r is actually p a r t of herself, s h e could a t t h e s a m e time own a n d d i s t a n c e herself from it. S h e came to be able to resist d a m a g i n g her own eyesight in t h e service of t h i s externalization. Only after this disentangling h a d been achieved could t h e complexity of m e n t a l states, s u c h a s conflicts a n d defenses, begin to be considered therapeutically. Unfortunately, b a l a n c i n g t h e t h e r a p e u t i c effect of t h e relationship with t h e a n a l y s t w a s also a c o u n t e r t h e r a p e u t i c tendency i n h e r e n t to s u c h analytic relationships. W h e r e a s with m a n y p a t i e n t s it is possible to interpret t h e p r e s s u r e toward role-responsiveness, p a t i e n t s s u c h a s E m m a are invested in t h e externalization in a m u c h m o r e m a l i g n a n t way. They a r e n o t j u s t trying to p u s h t h e a n a l y s t into r e p r e s e n t i n g p a r t of themselves b u t (because of t h e p r e d o m i n a n c e of psychic equivalence) to b e the disavowed p a r t of t h e self-representation. If t h e a n a l y s t were to reject t h e function of E m m a ' s psychotic mother, a b o u t w h o m s h e could feel concern, t h a t would have left h e r with having to contain it within herself, w h i c h s h e could only do by externalizing it into h e r body. On t h e other h a n d , if h e did accept t h e role of the m a d doctor, a s s h e said, h o w could h e possibly help h e r ? The physical other w h o performs t h i s function m u s t r e m a i n p r e s e n t for t h i s complex p r o c e s s to operate. E m m a could n o t feel t h a t s h e w a s herself u n l e s s s h e h a d h e r a n a l y s t t h e r e to intimidate a n d r e d u c e to h e l p l e s s n e s s . His d e p a r t u r e would signal t h e r e t u r n of t h o s e "exterojects" a n d t h e d e s t r u c t i o n of t h e coherence s h e achieved by projection. T h e a n a l y s t w a s t h u s faced with a seemingly impossible challenge. For t h e relationship to serve a function a n d to b e tolerable, t h e a n a l y s t h a s to become w h a t t h e patient w i s h e s h i m to be. To be a n a n a l y s t a n d help t h e patient overcome s u c h primitive m o d e s of relating, t h e analyst m u s t be anything b u t w h a t is projected onto h i m . Unless h e is able to adopt a n a t t i t u d e a n a l o g o u s to t h a t of t h e p a r e n t engaged in pretend play with a child, constantly juggling r e s p o n s e s to t h e s e opposing p r e s s u r e s , t h e a n a l y s i s is doomed to become a rigid stereotypic repetition of pathological exchanges. There a r e further complications in working with p a t i e n t s whose psychic reality r e m a i n s a t a n a r c h a i c level, predominantly of psychic equivalence. E m m a ' s observation of h e r analyst's injury led h e r to reexperience, r a t h e r t h a n to r e m e m b e r , t h e real

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violence of h e r childhood. At m o m e n t s w h e n s h e could experience t h e m a d p a r t of herself a s in her body, E m m a succeeded in achieving a calm d e t a c h m e n t t h a t totally p r e c l u d e d t h e n e e d for analysis, while (at a physical level) a fierce b a t t l e raged for her life. S h e needed t h e c o n t a c t with t h e analyst for t h e r e a s o n s t h a t we h a v e mentioned, b u t s h e genuinely s a w n o r e a s o n for h e r to be analyzed. Her a t t i t u d e s were u n d e r s t a n d a b l e in t e r m s of the belief t h a t w a n t i n g to b e a particular type of p e r s o n m a d e it t r u e for o t h e r s a n d t r u e for herself a s well. This clearly involved a split way of experiencing internal reality. There w a s a n imperfect integration between t h e child's-two m o d e s of r e p r e s e n t i n g ideas a n d feelings.

I m p l i c a t i o n s for T e c h n i q u e T h e focus of t e c h n i q u e in s u c h c a s e s is t h u s n o longer on m a k i n g c o n s c i o u s w h a t h a d b e e n u n c o n s c i o u s . E m m a improved symptomatically, in t e r m s of h e r diabetes, h e r depressions, a n d h e r relationships, b u t it would be even more i n a p p r o p r i a t e for t h e a n a l y s t to be focusing on c h a n g i n g t h e s e s y m p t o m s with a borderline individual t h a n it is with n e u r o t i c patients. We believe t h a t t h e appropriate technical priority is t h e a n a l y s t ' s survival, with a coherent identity, or, more specifically, t h e preservation of a clear picture of t h e p a t i e n t ' s m e n t a l s t a t e in t h e analyst's mind. T h e analyst's survival e n s u r e d t h a t E m m a did n o t succeed in destroying t h e perception of herself a s a p e r s o n . He needed to hold on to a s e n s e of himself a n d of h e r experience, so t h a t she could slowly discover this apperception of herself in h i s mind, to gain a foothold for h e r own r e p r e s e n t a t i o n of h e r t h o u g h t s a n d feelings. A major h u r d l e c a n lie in overcoming t h e countertransference r e s i s t a n c e to a full recognition of t h e d e p t h of t h e patient's d i s t u r b a n c e . T h e s o u r c e of t h e . r e s i s t a n c e is partly narcissistic— a r e l u c t a n c e to see oneself a s o n e is being seen. Allowing t h e real possibility of being psychotic, relinquishing t h e need to assert one's sanity a s a w a y of r e a s s u r i n g oneself, or interpreting the p a t i e n t ' s n e e d to t a k e over a n d totally p o s s e s s a s a n aggressive attack, all serve to give p a t i e n t s s p a c e to t h i n k for themselves,

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b u t n a t u r a l l y a t t h e expense of t h e analyst's capacity to do so. Analytic capacity is called for n o t in deciphering u n c o n s c i o u s motivation, b u t in being able to reflect on one's own very u n c o m fortable experience sufficiently to be able to resist t h e pull of t h i s psychic equivalence mode, to r e t a i n a mentalizing s t a n c e . Clinicians m a y confront t h e discrepancy between their perception of themselves a n d t h a t of t h e patient (Kernberg 1995). The p a t i e n t ' s rigid c o m m i t m e n t to a false belief might p r o m p t one to say: "Either I a m m a d or a liar, or you are mistaken." We feel t h a t it is i m p o r t a n t to appreciate t h a t t h e s t a t u s of psychic reality for s u c h individuals involves a direct c o r r e s p o n d e n c e between their beliefs a n d reality. T h e possibility of false belief or d o u b t is inaccessible. Only o n e version of reality c a n be true; t h e possibility of viable alternatives implies terrifying a n d deeply resisted mentalization a n d m u s t be obliterated. In n o r m a l child development, it is prototypically t h r o u g h engaging playfully with a n a d u l t s i m u l t a n e o u s l y entertaining two realities t h a t t h e child b e c o m e s able to a d o p t t h e p a r e n t ' s perspective on t h e play (see also Emde, Kubicek, a n d O p p e n h e i m 1997). Ultimately, t h i s allows t h e child to integrate t h e psychic equivalence a n d p r e t e n d m o d e s of representing psychic reality and, having m a d e t h i s step, to develop a reflective mentalizing capacity. T h e a n a l y s t ' s s t a n c e toward t h e p a t i e n t is not a playful one; we t h i n k t h a t t h i s would be a n i n a p p r o p r i a t e extension of the developmental m e t a p h o r . However, t h e r e is a n analogy with play. W h a t we believe t h e a n a l y s t n e e d s to try to do is to provide a n alternative perspective on t h e p a t i e n t ' s state of mind while all the time s u p p o r t i n g h e r in retaining h e r s e n s e of h e r own experience, a way of p r e s e n t i n g t h e s a m e yet n o t t h e same. This is t h e idea t h a t u n d e r p i n s Winnicott's notion of object p r e s e n t a t i o n (Winnicott 1960). This is a functional, b u t n o t a developmental, equivalent of a n a b s e n c e of environmental impingement, in Win-1 nicott's s e n s e . A p a t i e n t a t t h e opposite e n d of t h e dichotomy of externally v e r s u s internally focused aggression, a violent m a n , w a s veryu p s e t by a r a t h e r c l u m s y interpretation m a d e by h i s a n a l y s t (Peter Fonagy). Aiming to be empathic, t h e analyst h a d referred to t h e p a i n t h e p a t i e n t h a d felt a b o u t a canceled session. The patient j u m p e d u p , shoved a fist u n d e r t h e analyst's nose, a n d

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said, "I'll s h o w you w h a t p a i n is, you little shit!" W i t h o u t thinking, t h e analyst said, "You know, a s I get older I c a n ' t see t h i n g s so clearly w h e n t h e y a r e too close to m y eyes," a n d with t h a t he gently moved t h e clenched fist away from h i s face. To t h e a n a lyst's relief a n d surprise, t h e patient immediately calmed down a n d smiled. On reflection, it s e e m s clear w h a t might have been critical in this exchange: t h e a n a l y s t ' s a w a r e n e s s of t h e patient's pain, while a c c u r a t e , r e a c h e d t h e p a t i e n t in a m o d e of psychic equivalence, m a k i n g h i s d i s t r e s s frighteningly real. T h e s a m e interpretation to E m m a m i g h t have r e a c h e d h e r in p r e t e n d mode a n d led to i m m e d i a t e a c c e p t a n c e a n d m e a n i n g l e s s integration with h e r false self-representation. T h e a n a l y s t ' s intuitive playful r e s p o n s e forced t h i s p a t i e n t to experience t h e world t h r o u g h his s o m e w h a t long-sighted perspective a n d t h u s to see h i m a s a real person, allowing t h e p a t i e n t to e n t e r h i s m e n t a l world. Let u s e x a m i n e a t greater length a n o t h e r female c a s e w h o s e problems with dysfunctional psychic reality found expression in signific a n t externalizing a s well a s internalizing behavior problems.

DYSFUNCTIONAL PSYCHIC REALITY IN INTERPERSONAL VIOLENCE: "HENRIETTA" Henrietta 3 w a s in h e r mid-thirties w h e n s h e referred herself to a forensic psychiatrist colleague for counseling. Strangely, the referral on to m e m e n t i o n e d n o t h i n g a b o u t a forensic history b u t described repeated suicide a t t e m p t s , u n s t a b l e b u t i n t e n s e relationships, a n d a b u s e of h e r medication. The referral did not p r e p a r e me, however, for t h e paranoid, a l m o s t psychotic, b u t in fact dissociated episodes with h a l l u c i n a t i o n s a n d s o m e t h o u g h t disorder t h a t were to be so striking in m y work with her. Two facts m a k e Henrietta's history u n u s u a l from a psychoanalytic s t a n d p o i n t . The first is t h a t s h e w a s a m u r d e r e r — n o t of h e r internal objects, h e r self-representation, h e r t h i n k i n g and 3

The analyst was Peter Fonagy, and this is his account.

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feeling or other p a r t s of h e r a n d h e r object's mind, a l t h o u g h s h e was u n d o u b t e d l y guilty of all these, b u t of h e r boyfriend. S h e h a d s t a b b e d h i m in t h e c o u r s e of a violent quarrel. S h e pleaded self-defense a n d t h a t t h e s t a b b i n g w a s accidental. S h e w a s charged with m a n s l a u g h t e r a n d w a s freed with a s u s p e n d e d sentence. About four y e a r s into t h e analysis s h e confessed to m e t h a t t h e s t a b b i n g h a d not, in fact, b e e n a n accident. While n o t premeditated, it h a d certainly b e e n intentional. S h e h a d felt driven by violent, blinding rage. By t h a t time, four y e a r s into t h e analysis, I w a s familiar with Henrietta's vicious, explosive attacks of rage. I w a s n o t really s u r p r i s e d by h e r revelation. The second fact w a s h e r experience of a b u s e . S h e described having first b e e n sexually a b u s e d by h e r alcoholic father, t h e n a s a teenager by a t e a c h e r in h e r b o a r d i n g school. Both experiences included intercourse. Her father also b e a t Henrietta for various m i s d e m e a n o r s a t least once a week a n d more severely, u s u a l l y for "answering back," a t least once a m o n t h . The a b u s e by h e r father r e m a i n e d a secret between t h e m until his d e a t h shortly before t h e s t a r t of h e r t r e a t m e n t . The relationship with t h e teacher b e c a m e public, a n d t h e m a n concerned w a s dismissed. Why would s o m e o n e like Henrietta come into analysis? S h e seemed never to h a v e h a d a n u n d e r s t a n d i n g relationship. She said s h e w a n t e d to get help with t h e terrifying d r e a m s t h a t h a d started with t h e d e a t h of h e r father. S h e c a m e to t h e first interview in a s t r i d e n t mood, d e m a n d i n g a brief period of counseling. S h e did n o t k n o w t h a t I w a s a psychoanalyst, a n d , on noticing t h e c o u c h s o m e time into t h e interview, s h e said, "So, this is w h e r e you fuck y o u r patients?" A feeling of fear w a s h e d over me. R a t h e r t h a n reacting directly to h e r combative intrusive m a n n e r , I w a s a w a r e of t h e vulnerability a n d e n o r m o u s anxiety behind h e r n e e d to strike o u t a n d h u r t . I said, aiming to be reassuring, "You m u s t feel quite brave t h a t you dared to come and see me." S h e said, c o n t i n u i n g h e r c o n t e m p t u o u s tone, "You s h r i n k s a r e a b u s e r s . It's j u s t a power trip." I said, now m o r e confident of m y counter-transference response, "I t h i n k it is y o u r own power to destroy a n d a b u s e t h a t frightens you a b o u t therapy. You feel m u c h m o r e confident a b o u t being able to cope with me." S h e stopped s h o r t a n d a s k e d m e w h a t I m e a n t by "therapy."

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S h e s t a r t e d once a week, b u t over eighteen m o n t h s built u p to four times a week. S h e would h a v e come five times, h u t h e r work w a s n o longer in London. S h e missed a l m o s t n o s e s s i o n s . Her c o m m i t m e n t to t h e analytic p r o c e s s w a s h u m b l i n g a n d s t r e n g t h ened m y belief in t h e pervasiveness of t h e w i s h to b e h e a r d a n d recognized. However, w h a t h a p p e n e d between Henrietta a n d myself might n o t generally be regarded a s analysis. My interventions were rarely experienced a s interpretations. I a m certain t h a t s h e h a d little s e n s e of insight, a t least d u r i n g t h e early years. Let u s illustrate w h a t h a p p e n e d a t t h a t time. S h e arrived on time to t h e session, s a t in a chair, and said s h e felt u p s e t , a n d s h e looked a t m e challengingly without s p e a k i n g further. I said, "I don't u n d e r s t a n d . You n e e d to tell m e w h a t u p s e t is for you a t t h e m o m e n t . " S h e said t h a t s h e h a d h a d a n o t h e r d r e a m a b o u t h e r father, w h i c h h a d u p s e t her. In the d r e a m , he had asked her to put her head up his backside and she did not want to do it. S h e w a s r e a d y to follow t h r o u g h with a string of obscene images depicting .the sexual life between her father a n d herself. I i n t e r r u p t e d : "I t h i n k you a r e u p s e t . b e c a u s e you are frightened t h a t I will m a k e you b u r y y o u r h e a d in messy t h o u g h t s here." S h e stopped in h e r t r a c k s , told m e in a rapid s e q u e n c e I could hardly follow t h a t s h e w a s lost, t h a t h e r m o t h e r didn't u n d e r s t a n d , s h e w a s n ' t trying to h u r t anybody, t h a t the d e a t h w a s a n accident, t h a t s h e tried to r e s u s c i t a t e him, to give h i m t h e kiss of life, b u t failed, a n d now I w a s trying to kill her. There w a s a g r a d u a l acceleration of t e m p o a n d intensification of affect. By t h e e n d I w a s in t h e room with a n a p p a r e n t l y angry yet basically terrified p e r s o n . It w a s u n c l e a r w h a t t h e s e feelings were a b o u t . S h e seemed terrified by violence—her own or mine. S h e expected to be killed by a raging j e a l o u s object or to kill a n invading, t h r e a t e n i n g one. I said, trying to calm h e r by stepping outside t h e fray: "It s e e m s t h a t you feel driven by a terror t h a t you might lose m e in t h i s violence. You feel you c o n s t a n t l y have to r e s u s c i t a t e me, to b r e a t h e life into m e j u s t to k e e p m e alive for yourself." S h e w a s silent. Eventually s h e r e s p o n d e d , somewhat more calmly, t h a t s h e w a s frightened of being a p e r s o n . She preferred being empty; people only a t t a c k e d you if t h e y k n e w you were somebody. I said, "I agree. I t h i n k you feel safer with me w h e n you feel empty. It feels even safer if you feel you have it

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emptied m e too." Her terror t h a t I might kill h e r a n d t h e even greater fear t h a t s h e might kill me, intentionally or accidentally, overrode all other c o n c e r n s . This brief vignette raises several i s s u e s . The a n a l y s t did n o t p r e s u m e to k n o w w h a t "upset" m e a n t for Henrietta a t t h i s time. Most p a t i e n t s would h a v e b e e n aware t h a t t h e a n a l y s t w a s n o t going to k n o w w h a t w a s u p s e t t i n g t h e m , b u t for a p a t i e n t working in psychic equivalence mode, t h e analyst already k n o w s w h a t s h e k n o w s (perhaps b e t t e r t h a n s h e does) a n d does n o t need to be told. After t h e intervention, Henrietta immediately shifted into a kind of p r e t e n d mode w h e n s h e s t a r t e d to talk a b o u t t h e d r e a m images. Unlike t h e situation with a n e u r o t i c patient, for w h o m t h e exploration of a sexual fantasy might b e very t h e r a p e u t i c , for a p a t i e n t like Henrietta it seemed vital to interrupt t h i s r e t r e a t into s o m e t h i n g t h a t w a s r e p r e s e n t e d a s unreal. T h e a n a l y s t ' s t a s k w a s t h e n to find something t h a t w a s felt to be real, t h o u g h obscure, within t h a t image. T h e a n a l y s t therefore focused on t h e anxiety a b o u t t h e confusion with w h i c h having to talk a b o u t h e r t h o u g h t s a n d feelings evidently confronted h e r . T h a t in itself provoked more anxiety t h a n it contained. S u d d e n l y , t h e fantasies b e c a m e real: s h e shifted into a psychic equivalence m o d e a n d seemed a l m o s t to feel t h a t her life w a s in danger. T h i s p a n i c escalated until somebody else contained it. Somebody w a s going to get killed. T h e aim of this sort of cathartic o u t b u r s t is n o t mainly, we suggest, a wish to be contained or to work t h r o u g h a n experience b u t , r a t h e r , a n emptying of t h e self w h i c h quite consciously feels like preempting a n i m m i n e n t a t t a c k . The c o u n t e r t r a n s f e r e n c e r e s p o n s e is often a s e n s e of e m p t i n e s s , w h i c h is seen a s t h e result of a n attempt to relieve anxiety by reducing b o t h people to a n equally u n t h i n k i n g state, r a t h e r t h a n a primarily destructive attack on the a n a l y s t ' s thinking. Psychoanalysts often write a b o u t t h e c o n c r e t e n e s s of t h o u g h t , broadly building on F r e u d ' s distinction between word a n d t h i n g representations. Mostly, t h e s e concern c o n c r e t e n e s s of meaning, whereas with Henrietta it w a s t h e reality of t h e t h o u g h t processes t h e m s e l v e s t h a t created s u c h a n obstacle. For Henrietta, her t h o u g h t s s o m e t i m e s did n o t feel owned by her m i n d b u t were, r a t h e r , experienced a s if s p o k e n a n d t h u s m a d e externally

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real. We see this a s o n e possible c o n s e q u e n c e of e q u a t i n g inner experience with outer reality. It took m e some time to realize t h a t in t h e s e conversations t h e r e w a s often a third presence. There w a s a voice inside her h e a d — s o m e o n e who, s h e felt, w a s she, b u t n o t s h e a t t h e s a m e time, a n alien a s p e c t of h e r often dissociated state. Her t h o u g h t s seemed to p o s s e s s a n immediacy t h a t w a s difficult to appreciate fully. Fleeting ideas or i m a g e s were experienced a s disembodied voices, s o m e t i m e s friendly b u t mostly p e r s e c u t o r y a n d vicious. While clearly n o t hallucinations, h e r t h o u g h t s were also n o t felt to be coming from h e r own mind. Her "associations" a t these times were r e s p o n s e s to w h a t s h e "heard" a s m u c h a s a dialogue with me. This posed a n interesting challenge for m y work in the transference. Eventually, I b e g a n to a d d r e s s t h i s voice more directly. In one session Henrietta c a m e in confused, obviously more t h a n u s u a l l y so. S h e s a t d o w n o n t h e c o u c h a n d looked a t m e quizzically, a s if asking, "What is going to h a p p e n next?" I said, equally puzzled: "You don't k n o w w h a t to say to me, a n d I don't k n o w w h a t to say to you." This p r o m p t e d h e r to l a u n c h into a long a n d puzzling narrative a b o u t d a n c e r s who "gave their blood" in training a n d practice, w e n t to endless auditions, b u t found no work. S h e said s h e w a s u p s e t a b o u t t h e injustice of it all. But t h e n , a s t h o u g h s h e were r e s p o n d i n g to s o m e o n e else—almost a s if s h e were a w a r e of t h e transference m e a n i n g of w h a t s h e had b e e n saying—she said in quite a different voice, "You a r e going to h a v e to s t o p this t r e a t m e n t , a r e n ' t you?" T h i n k i n g of t h e concrete reality of h e r internal experience a n d w a n t i n g to acknowledge how completely compelling it felt to her, I said, "I t h i n k t h a t you a r e being told t h a t I will reject you, n o m a t t e r how h a r d you try here. You want m e to u n d e r s t a n d y o u r d i s t r e s s b u t you are n o t being allowed to tell m e a b o u t it. It all feels so real t h a t you m u s t feel terribly confused." S h e b u r i e d h e r h e a d in t h e pillow a n d s t a r t e d to sob violently: "I a m so confused. I feel so b a d . I a m told I a m fine, b u t I feel hopeless. Please tell m e w h a t is wrong with me." I replied with t h e intention to e n t e r into h e r mental world, b u t a t t h e s a m e time to insert t h e a n a l y s t ' s voice a s a n o t h e r perspective t h a t could eventually b e c o m e therapeutic: "You feel t h a t b e c a u s e I a s k you to come h e r e for only 50

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m i n u t e s on a p a r t i c u l a r day, I can't possibly u n d e r s t a n d w h a t your n e e d s really are. I t h i n k you have a voice inside y o u r h e a d telling you 'you a r e fine.' And it s o m e t i m e s s o u n d s like m y voice." She calmed d o w n a bit, a n d t h e n s h e seemed to suffer s o m e t h i n g like a n allergic r e s p o n s e to c o n t a c t with t h e analyst. S h e s u d denly said, a s if u n a w a r e of t h e contradictions, "I don't n e e d help. I a m fine. I a m sick. I w a n t to t h r o w up." T h e n a p a u s e . "I want to t h r o w u p w h e n people get-too close. You get t a k e n over. You m u s t u n d e r s t a n d me. You don't u n d e r s t a n d me. Do you u n d e r s t a n d me?" I said, trying to identify t h e source of anxiety, "You a r e terrified of w h a t I do u n d e r s t a n d . It m u s t be so sickening t h a t I h a v e to t h r o w you out." S h e said, still sobbing, "It's t h e sex. It's so wrong. I a m so frightened you might m i s u n d e r s t a n d . I a m trying so h a r d to m a k e s o m e t h i n g h a p p e n this time." I said, regarding t h e reference to sex a s defensive, aiming to distract u s from t h e i m m e d i a t e s o u r c e of h e r anxiety: "You hope for something good to h a p p e n here, b u t y o u a r e also frightened b e c a u s e you h e a r a voice telling you to spoil it by confusing a n d misleadT ing me." There a r e m a n y analytic u n d e r s t a n d i n g s to explain w h a t w a s h a p p e n i n g b e t w e e n u s : t h e w i s h to create a perverted analytic intercourse filled with sexual excitement, which hid her guilt and vulnerability; t h e w i s h to m a k e m e into a pathetic d a n c e r to her t u n e a n d observe m e "giving m y blood" in a futile a t t e m p t to save her; t h e regressive infantile omnipotence of t h e t r i u m p h of c h a o s over u n d e r s t a n d i n g ; t h e self, defensively split between a pleading v u l n e r a b l e identity a n d a n omnipotent, invulnerable dictator; a n d so on. All t h e s e a n d more were true. T h e additional u n d e r s t a n d i n g t h a t I h a d to hold on to over t h e s e early years w a s s o m e w h a t different. Alongside h e r craving for anything t h a t m i g h t give a s e n s e of order to h e r psychic chaos, s h e desperately fought t h e t r u t h of any idea, n o t for its specific contents, b u t b e c a u s e of t h e intolerable sickness engendered by the closeness of two h u m a n m i n d s . There w a s s o m e t h i n g t h a t felt sickening a n d d i s g u s t i n g a b o u t g e n u i n e feelings a n d ideas; there w a s a n a b h o r r e n c e of c o m m u n i c a t i o n a n d reflection. S h e had tried to r e p u d i a t e h e r capacity to conceive of m e n t a l s t a t e s , in herself a n d in me, leaving h e r with rigid, s c h e m a t i c representations.

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Analysis w a s a n obscene s e d u c t i o n b e c a u s e t h i n k i n g a b o u t m e n t a l s t a t e s w a s an incestuous act, experienced a s t h e intrusion of a n object into a s p a c e far too small to c o n t a i n it. Her a d a p t a t i o n to t r a u m a entailed t h e disavowal of feelings a n d intentions, in herself a n d in all o t h e r s close to h e r . T h e primary thoroughfare for s h a r i n g psychic reality—symbolic thought— w a s blocked. Instead, t h e t h o u g h t s were experienced a s literally, externally real a n d u n c h a n g e a b l e , t h i n k i n g w a s felt a s words t h a t have b e e n s p o k e n a n d c a n n o t b e t a k e n b a c k . Talking of t h o u g h t s a s t h o u g h t h e y were voices w a s a way of depicting t h e s e n s e t h a t t h e y were perceived r a t h e r t h a n conceived by her. The transference could n o t b e referred to a s a n " a s - i f experience; at this stage p e r h a p s t h e a n a l y s t n e e d s to work partly within t h e frame of reference of psychic equivalence, n o t w i t h s t a n d i n g the immense countertransference resistance against entering that frame of reference with somebody w h o s e t h o u g h t s were terrifyingly violent a n d confused. It w a s t h e a n a l y s t ' s t a s k to m a k e the capacity for t h e r e p r e s e n t a t i o n of h e r i n t e r n a l s t a t e s safe. This is w h a t a p a r e n t n e e d s to b e able to do with a small child, b u t to identify with t h e perspective of a violent, uncontrolled a d u l t is far rnore t h r e a t e n i n g a n d d i s t u r b i n g t h a n doing t h e s a m e with a child, even a child with similar feelings. Ideally, t h e p a r e n t a c c e p t s t h e child's experience w h e n the child is in a m o d e of psychic equivalence, b u t a t t h e s a m e time b e h a v e s in a way t h a t implies t h a t t h e p a r e n t does n o t h a v e the s a m e experience. A small child m a y b e too frightened to sleep b e c a u s e t h e d r e s s i n g gown h a n g i n g b e h i n d t h e door s e e m s to be a m a n waiting to j u m p out. This is real to t h e child a t those times, a n d t h e feeling of terror is correspondingly compelling. T h e p a r e n t does n o t simply tell t h e child t h a t t h e d r e s s i n g gown is n o t a m a n , or t h a t it is silly to be frightened, b u t removes the dressing gown in a way t h a t recognizes t h e reality of t h e frightening idea, ; b u t w i t h o u t showing fear. 4 T h u s , t h e p a r e n t both 4 This may come close to a psychoanalytic account of the effectiveness of behavioral treatments involving exposure, which appear on the surface to involve little by way of cognition or interpretation but in reality entail the same communication of the simultaneous acknowledgment of psychic reality and an alternative perspective signaling safety.

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enters into a n d provides t h e possibility of d i s t a n c e from t h e child's perception, introducing a different perspective. This is parallel to t h e introduction of alternative perspectives t h r o u g h playing a n d p r e t e n d i n g with t h e child, b u t this time in a s e r i o u s frame of m i n d . This is w h a t t h e analyst is engaged in with borderline p a t i e n t s . Henrietta's a n a l y s t respected t h e reality of her terror of closeness, b u t in doing so also introduced t h e idea t h a t t h e t e r r o r w a s b a s e d o n belief r a t h e r t h a n fact. No technical innovation is implied here. This is t h e very ordinary thing t h a t a n a l y s t s do, particularly w h e n working in t h e transference. Individuals with borderline pathology h a v e s u c h a powerful predisposition to distortion t h a t t h e a n a l y s t c a n n o t a s s u m e t h a t t h e mere act of interpretation will convey t h i s idea without specifically a n d repeatedly a d d r e s s i n g alternative perspectives. In t h e s e s s i o n s with Henrietta, t h e affect w a s intense. T h e terror a n d t h e d i s t r e s s were real: a d e s p e r a t e h u n g e r for u n d e r standing w a s only m a t c h e d by h e r desire to empty h e r mind. The c o u n t e r t r a n s f e r e n c e w a s b r i m m i n g with discomfort a n d confusion. S h e acted dangerously, regularly t h r e a t e n e d to kill herself, a n d got into violent q u a r r e l s with b o t h friends a n d strangers for w h i c h I w a s m a d e to feel culpable. She frightened me with t h e t h r e a t of litigation for negligence a n d gave m e a letter of complaint t h a t s h e drafted for m y professional association, where m y "incompetence" w a s carefully d o c u m e n t e d : a n y change of a p p o i n t m e n t , cancellation, lateness, confusion a b o u t times, m i s r e m e m b e r i n g of names—all were listed a n d dated. I was criticized for s p e a k i n g a n d t h e n ridiculed for m y silences. At other times I w a s m a d e to feel h e r savior. T h e fluidity of h e r psychic reality m e a n t t h a t m u c h of t h e time I could not k n o w what I w a s doing, beyond t h e basic effort to appreciate w h a t h e r psychic equivalence exposed m e to, a n d t h e n to a t t e m p t to c o m m u n i c a t e t h a t a w a r e n e s s to her. The kind of d r a m a t i c splitting reflected in Henrietta's u n d e r standing of h e r a n a l y s t ' s i n t e n t i o n s is, of course, a h a l l m a r k of t h e paranoid-schizoid position in general, a n d of borderline states in particular. Elsewhere (Fonagy, Target, a n d Gergely 2000) we h a v e speculated, following Gergely (2000), t h a t t h e m e c h a n i s m of splitting is a developmental by-product of t h e

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infant's need to create a coherent image of t h e m e n t a l state of t h e other, w h i c h in t h e i m m a t u r e m i n d g e n e r a t e s coherent b u t limited s u b s e t s of intentional states, primarily a n idealized a n d a p e r s e c u t o r y identity. My ability to orientate to Henrietta's psychic reality w a s furt h e r r e d u c e d by w h a t I c a m e to refer to a s t h e "gaps" in the analytic dialogue. There were periods of m i n u t e s w h e r e m y sense of t h e r e being a n y m e a n i n g simply d i s a p p e a r e d . Usually, these occurred in periods of silence. In c o n t r a s t to p a t i e n t s whose silence implies thoughtfulness, or o t h e r s for w h o m it indicates withholding o r resistance, o r yet o t h e r s w h o s e silence is a comm u n i c a t i o n in t h e transference, Henrietta's silences communicated nothing. On t h e first few occasions, I b l u n d e r e d into the silences a n d tried to a t t r i b u t e m e a n i n g to t h e m : "My words frightened you, a n d you feel you n e e d to c u t m e out," or "You feel rejected, so you a r e n o w rejecting me." Mostly, t h e s e suggestions would get n o response, a n d w h e n this occasionally w a s n o t the case, Henrietta r e s p o n d e d a s if I h a d w o k e n h e r from a s t a t e of reverie: "What did you j u s t say?" I gradually noticed t h a t these episodes extended beyond t h e silence. Henrietta would sometimes s t a r t to s p e a k with some feeling, b u t w h e n I m a d e a comment, s h e would h e quite u n a b l e to r e s p o n d , sometimes even a p p a r e n t l y n o t hearing. For example, on one occasion she described h e r father's funeral with a clarity t h a t a l m o s t m a d e me feel t h a t I w a s there. Later, w h e n s h e m e n t i o n e d n o t being able to cry, I mentioned t h a t s h e h a d cried a t t h e funeral; to my surprise, s h e r e s p o n d e d , "What funeral? Don't you r e m e m b e r I never went to m y father's funeral?" T h e s e e n c o u n t e r s with dissociation in t h e analytic setting are probably n o t u n u s u a l with t h i s g r o u p of p a t i e n t s . Henrietta's m o m e n t s of self-seclusion seemed to be a t t e m p t s a t escaping from t h e intensity of t h e feelings evoked b y m e n t a l closeness to t h e analyst. However, while clearly defensive, t h e s e g a p s in the narrative could not, a t least at t h e time, be interpreted. The experiences h a d n o m e a n i n g for Henrietta, a n d s h e w a s unable to reflect on t h e m . They a p p e a r , to t h a t extent, to be analogous to t h e play of a 2-year-old child, w h i c h c a n n o t yet a d m i t playm a t e s a n d t a k e s place within a subjective world radically sev-

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ered from t h e world outside. We could say t h a t Henrietta imagined t h a t s h e w a s a t h e r f a t h e r ' s funeral, b u t a t t h a t m o m e n t s h e h a d n o a w a r e n e s s of a n a c t of imagination. The s u s p e n s i o n of mentalization, triggered by t h e t h r e a t s t h a t a t t a c h m e n t relationships bring, t h r o w s into relief t h e persistence of t h e infantile mode of experiencing psychic reality, which we have called t h e "pretend mode." P e r h a p s a key p a r t of dissociation a s a p h e n o m enon is t h e reemergence of t h e p r e t e n d mode—the m o d e in which t h e very y o u n g child fully e n t e r s a s e p a r a t e psychic world a n d c a n n o t s i m u l t a n e o u s l y m a i n t a i n contact with ordinary reality.

The Alien Self The lack of a stable s e n s e of self is a central difficulty for borderline p a t i e n t s . We h a v e written elsewhere a b o u t t h e role of reflective function in self-organization (Fonagy a n d Target 1997). The p a t i e n t lacks a n a u t h e n t i c , organic self-image built a r o u n d internalized r e p r e s e n t a t i o n s of self-states. T h e a b s e n c e or weakn e s s of s u c h a self-image leaves t h e child, a n d later t h e adult, with affect t h a t r e m a i n s unlabelled a n d confusing—uncontained (Bion 1962a). T h e a b s e n c e of a reflective object for t h e child's experience c r e a t e s a v a c u u m within t h e self, where internal reality r e m a i n s n a m e l e s s , s o m e t i m e s d r e a d e d . This will create a desperation for m e a n i n g a n d a willingness to t a k e in reflections from t h e o t h e r t h a t do n o t m a p onto a n y t h i n g within t h e child's own experience. We suggest t h a t this leads to t h e internalization of r e p r e s e n t a t i o n s of t h e p a r e n t ' s state, r a t h e r t h a n of a u s a b l e version of t h e child's own experience. This c r e a t e s w h a t we t e r m an "alien experience within t h e self," b a s e d on r e p r e s e n t a t i o n s of the other w i t h i n t h e self. T h i s m a y b e close to w h a t Britton (1998) described in similar terms, on t h e b a s i s of clinical work with p a t i e n t s s u c h a s these. Once internalized, the alien presence interferes with t h e relationship between t h o u g h t a n d identity: ideas or feelings t h a t do n o t s e e m to belong to t h e self are experienced. T h e alien self destroys t h e s e n s e of coherence of self, which c a n only be restored by c o n s t a n t a n d i n t e n s e projec-

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tion. U n d e r s t a n d i n g t h i s p r o c e s s is vital clinically, b e c a u s e — i n c o n t r a s t to t h e neurotic case—the projection is motivated n o t by superego p r e s s u r e s b u t by t h e need to establish a b a s i c continuity of self-experience. With Henrietta, d r e a m s were like small o a s e s in a cruel desert of e n a c t m e n t s a n d m a n i p u l a t i o n s , w h i c h all b u t destroyed t h e possibility of reflectiveness. T h e d r e a m s were vivid a n d varied, b u t I gradually noticed a c o n s i s t e n t t h e m e . T h e r e w a s always s o m e t h i n g within s o m e t h i n g else, a n d t h e t h i n g within w a s absolutely d e p e n d e n t — a l m o s t p a r a s i t i c — u p o n t h e t h i n g without. For example, t h e r e w a s a d r e a m a b o u t a lizard with a fly buzzing inside its stomach. S h e h a d a particularly u n p l e a s a n t r e c u r r e n t d r e a m t h a t a beetle's larva was growing inside her brain. She h a d a whole series of d r e a m s w h e r e s h e d r e a m t t h a t she was dreaming another dream. I c a m e to believe t h a t in p a t i e n t s i n c a p a b l e of reflectiveness, d r e a m s still provide a valuable window. P e r h a p s d r e a m s are, in p a r t , r e s i d u e s of a n a s c e n t reflective capacity w h e r e t h e d r e a m e r tries u n c o n s c i o u s l y to depict t h e s t r u c t u r a l constellation within h i s m i n d (the state t h a t p r e c l u d e s intentional reflection). In t h e s e Russian-doll constellations, Henrietta p e r h a p s repres e n t e d a n i n n e r world in w h i c h a self contained a n o t h e r self or, in fact, a r e p r e s e n t a t i o n of t h e other. This could be internalized in early infancy w h e n t h e m o t h e r ' s reflective function too often failed t h e infant. T h e infant, trying to find herself in t h e mother's m i n d m a y find—as Winnicott (1967, p. 32) so accurately p u t it— t h e m o t h e r instead 1 . T h e image of t h e m o t h e r would come to colonize t h e self. This alien o t h e r probably exists in seed form in all o u r self-representations. It m a y come into its own w h e n later t r a u m a calls it forth a s p a r t of a defensive m a n e u v e r : identifying with t h e s t a t e of m i n d of t h e a b u s e r , in a n a t t e m p t to restore a feeling of control. T h e alien o t h e r within t h e self, fostered by m a l t r e a t m e n t , is u n m a s k e d by t h e a b s e n c e of reflective function. Normally, p a r t s of t h e self-representation t h a t are n o t rooted in t h e internalized mirroring of self-states are nevertheless integrated into a singular, fairly coherent self-structure b y the capacity for mentalization. This p r o c e s s preconsciously w o r k s to lend a coherence a n d psychological m e a n i n g to one's life, actions, a n d identity. Henrietta lacked t h e capacity to u n d e r s t a n d

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the experience of t h e buzzing fly inside h e r self-representation, or to metabolize t h e feelings a n d ideas t h a t s h e experienced a s having b e e n placed there, like a larva in h e r brain. Henrietta could learn little a b o u t herself t h r o u g h interpretations of t h i s kind, yet t h e m e n t a l l a n g u a g e of t h e analyst's c o m m u n i c a t i o n s strengthened h e r reflective capacities, w h i c h in t u r n s t r e n g t h ened t h e integrity of t h e self. Let u s illustrate w h a t we m e a n by elaborating o n h e r experience of h a v i n g b e e n a b u s e d a n d of h e r own violence. Henrietta's m o t h e r , probably herself a "survivor," h a d suffered a prolonged p o s t n a t a l d e p r e s s i o n after t h e b i r t h of h e r second child w h e n Henrietta w a s 2 y e a r s old. S h e withdrew almost completely from b o t h Henrietta a n d her father, a n d eventually s h e left t h e family. This probably exacerbated t h e father's already considerable d r u g problems, a n d he began to seek solace at first from cuddling a n d finally from vaginally a n d t h e n anally penetrating h i s d a u g h t e r . This h a d a p p a r e n t l y b e g u n w h e n s h e was a b o u t 7 y e a r s old a n d h a d gone on for a t least four years. Henrietta recalled initially welcoming h i s attention (even e n c o u r aging it) a n d gradually, w h e n "the pain" started, going blank, which helped h i m get inside her. S h e described imagining herself a s one of h e r dolls. This m e a n t t h a t s h e blocked a n y awareness of t h o u g h t s a n d feelings in herself a n d t h e other. It w a s impossible for h e r to u n d e r s t a n d h o w h e r father could m e a n to h u r t h e r a s p a r t of w h a t grew o u t of a n a c t of affection. The disavowal of m e n t a l s t a t e s gave h e r d i s t a n c e from w h a t h e might have felt, a s well a s from h e r own feelings. As s h e t u r n e d away these, s h e w a s forced to rely on t h e nonreflective organization within t h e self—the alien other. The alien other is n o t entirely a creation of t r a u m a . It is a n infantile s t r u c t u r e internalized in place of, yet also within, p a r t s of t h e self. Henrietta's m o t h e r of infancy could probably n o t satisfy h e r b a b y ' s need for reflection of h e r d i s t r e s s a n d h e r needs. (Her d a u g h t e r ' s d e p e n d e n c y m a y h a v e b e e n a n u n b e a r able r e m i n d e r of h e r own experience of helplessness—by all accounts s h e did b e t t e r with her. son.) We suggest t h a t Henrietta, neglected or unrecognized a s a small child, internalized a b l a n k image of a b s e n c e as the representation of her state of distress. This state w a s reactivated in t h e a c u t e d i s t r e s s of s e d u c t i o n a n d .

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later, w h e n t h e s e experiences were relived in analysis. Reflectiven e s s temporarily a b a n d o n e d a n d t h e self-other b o u n d a r y destroyed, t h e a b u s i n g father's cruelty w a s t h e n internalized into t h e alien self-representation t h r o u g h a p r o c e s s t h a t m a y be related to t h e m e c h a n i s m whereby t h e victim identifies with the aggressor. T h u s , t h e alien p a r t of t h e self b e c a m e torturing a s well a s v a c u o u s . Her experience of a b u s e at b o a r d i n g school, after t h e age of 11, p r e s u m a b l y reinforced t h i s pathological selforganization. Finding o t h e r s to be a vehicle for t h i s t o r t u r i n g p a r t of her self-representation b e c a m e vital. Her experience of self-coherence d e p e n d e d on finding s o m e o n e willing to a b u s e her. The teacher w a s p e r h a p s t h e first. A series of severely s a d o m a s o c h i s tic relationships showed t h a t h e w a s certainly n o t t h e last. The transference w a s a lived i n s t a n c e . In c o n t r a s t to t h e "roleresponsiveness" model of t r a n s f e r e n c e - c o u n t e r t r a n s f e r e n c e (Jos e p h 1985; S a n d l e r 1976), w h e r e a n a s p e c t of t h e self-other relationship is externalized, a self-self transference evolved, in w h i c h t h e a n a l y s t b e c a m e a t e m p o r a r y h o m e to t h e alien aspect of Henrietta's self-representation. T h e s e i n s t a n c e s of evocatory projective identification (Spillius 1992) a r e pervasive for two r e a s o n s : (a) a s we h a v e already m e n t i o n e d , t h e n o r m a l binding of alien a s p e c t s of t h e self by mentalization does n o t occur, a n d therefore t h e s e a s p e c t s are m o r e likely to be externalized, (b) Even m o r e critically, once t h e s e experiences a r e created, they are actually far more compelling for t h e s e individuals, b e c a u s e they a r e experienced in a mode of psychic equivalence. Let u s give a relatively mild example. O n e day Henrietta c a m e in late, complaining t h a t s h e could no longer p a r k h e r c a r for free. The c h a n g e in p a r k i n g regulations w a s s o m e h o w m y fault. It w a s also m y fault t h a t s h e could n o t afford t h e p a r k i n g fees, a n d I w a s going to be away again the following week. In fact, h e r lack of progress w a s entirely down to me. S h e h a d heard* of a senior Kleinian colleague w h o was renowned for h e r abilities to deal with difficult p a t i e n t s . She wished s h e h a d b e e n referred to her. / w a s a disaster. S h e would have gone on, b u t , a s far a s I w a s concerned, s h e h a d said e n o u g h . I said, p e r h a p s a t t e m p t i n g to imitate t h e colleague whose r e p u t a t i o n I envy a n d failing to recognize t h e obvious

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manipulativeness: "You a r e trying to destroy m y ability to help you, to t h i n k a b o u t you clearly." This w a s a m i s u n d e r s t a n d i n g . I think s h e h a d n o intention to destroy m e b u t , r a t h e r , a w i s h to bring forth a critical, irritated reaction. S h e w a s silent for a while and t h e n said, "You see. I w a s right. You can't cope. You a r e too young, too inexperienced." I found myself saying, "You see, you are frightened! You m a y h a v e destroyed me, b u t without m e you can't cope a n d you feel lost." S h e got u p , said, "For me, you a n d this analysis a r e dead," a n d walked o u t of t h e session. Of course, a s soon a s s h e left, I k n e w I h a d m i s u n d e r s t o o d . I had become t h e vehicle for h e r alien self by becoming critical and irritated, a n d I h a d ^abandoned m y analytic self with some capacity to c o m m u n i c a t e u n d e r s t a n d i n g . This w a s confirmed in the next session, w h e n s h e c a m e in, feeling a lot better, full of apologies, h o p i n g t h a t I w a s n o t too angry with her, r e a s s u r i n g me left, right, a n d c e n t e r a b o u t how helpful I w a s being a n d t h a t she would surely h a v e killed herself by now were it n o t for m y remarkable c o m m i t m e n t a n d skills. I said, "I t h i n k you hope t h a t I will believe you, b e c a u s e t h a t will confirm y o u r picture of m e a s conceited a n d s t u p i d . W h a t you said yesterday w a s far closer to what you need to feel a b o u t me." S h e said, contemptuously, "Don't you realize it m a k e s n o difference w h a t you t h i n k ? You mean nothing to me. Nothing!" I said, "I t h i n k you are right. B u t being able to m a k e m e into s o m e o n e w h o m e a n s nothing to you makes you feel in control, a n d t h a t m a k e s all t h e difference." S h e thought for a m o m e n t a n d t h e n said, "You a r e j u s t clever with words, like m y t e a c h e r X (the abuser). You a r e evil. You care nothing a b o u t y o u r patients." I said, "If you c a n m a k e it so t h a t you c a n see m e a s evil, t h e n you c a n kill me, a n d t h e n you will be free." S h e fell silent, b u t t h e s e n s e w a s t h a t we b o t h knew t h a t this w a s t h e t r u t h . Not t h a t s t a t i n g t h e t r u t h ever necessarily m a d e Henrietta feel better—it m a d e h e r s a d a n d s o m e t i m e s suicidal. What seemed to be helpful were t h o s e few precious m o m e n t s (like this last session) w h e n I c o u l d ' b e c o m e w h a t s h e needed m e to be, yet retain my capacity to hold h e r in m i n d with h e r fears a n d anxieties a n d enable h e r to see t h i s in, m y w o r d s a n d actions. Like E m m a a n d o t h e r p a t i e n t s with borderline features, Henrietta absolutely required m y physical presence. While s u c h

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d e p e n d e n c y might a p p e a r a s classical s e c u r e - b a s e behavior, I never felt t h a t . I w a s able to offer h e r m u c h by w a y of safety or protection. Rather, I w a s required a s a n a s s u r a n c e of h e r existence. Her m i n d w a s u n a b l e to s u s t a i n a n experience of continuity a s a n agent. Only in relation to h e r i m p r e s s i o n of t h e impact of h e r t h o u g h t s a n d feelings on m e could s h e experience t h e s e a s e n d u r i n g a n d stable. As we have said before, t h i s p r o c e s s should n o t be seen a s a n a t t e m p t to recapitulate a developmental experience t h a t w a s , in Henrietta's case, deeply distorted. More simply, her terror of a b a n d o n m e n t reflected a n intrapsychic s t a t e of affairs where s h e w a s n o t confident of being able to locate her intentional s t a t e s once s e p a r a t e d from h e r object. Over its fourth year, h e r analysis b e g a n . t o t a k e on a tragic quality, a n d t h e d r a m a t i c o u t b u r s t s receded. S h e w a s functioning better, b u t t h e s e s s i o n s h a d come to be d o m i n a t e d by expressions of bitterness. Hatred for h e r father h a d b e g u n to emerge, together with a heart-felt dislike of me. T h e transference could now become sexualized, a n d a t times, w h e n s h e w a s angry with me, s h e explicitly a s k e d m e to molest h e r . S h e c a m e in one T h u r s d a y evening a n d r e c o u n t e d a particularly ghastly episode of allowing herself to be u s e d a n d a b u s e d by "an old friend" who regularly visited her a s h i s n e e d s dictated. My m i n d w a s filled with bizarre a n d perverse associations. I said t h a t I suspected t h a t it w a s particularly i m p o r t a n t to feel t h a t s h e could control m e by exciting m e or worrying me, a n d I s u s p e c t e d t h a t s h e had felt t h e s a m e vital s e n s e of control in relation to h e r "old friend." S h e r e s p o n d e d t h a t s h e h a d n ' t b e e n going to tell m e b u t that s h e h a d h a d a d r e a m a b o u t m e where J had offered her my penis, suggesting that she should take it in her mouth. She was revolted by it because it was smelly and dirty. She was frightened because she knew I was going to beat her unless she submitted. She p a u s e d , waiting for m e to say something. I r e m a i n e d silent. She said t h a t s h e t h o u g h t t h a t I w a s probably extremely clean since I always wore well-ironed white shirts. B u t in t h e d r e a m my shirt was deep red. S h e a d d e d , s p e a k i n g particularly calmly, t h a t red w a s t h e color of anger. I said t h a t I u n d e r s t o o d very well h o w i m p o r t a n t it w a s for her to:feel t h a t s h e w a s in control, b e c a u s e .she w a s terrified t h a t I would be angry b e c a u s e of w h a t s h e h a d d o n e with h e r friend.

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The d r e a m w a s like a n a p p e a s e m e n t . If s h e s e n s e d t h a t I w a s repelled, it w a s better for m e to be dead. I a d d e d t h a t r e d w a s also t h e color of blood. Her body shook a s if a n electric c u r r e n t h a d p a s s e d t h r o u g h it. "I t h i n k t h a t is why I h a d to kill him," s h e said. "I couldn't b e a r h i m t h i n k i n g I w a s disgusting." T h e tragic story unfolded. S h e h a d regularly allowed herself to be maltreated by h e r boyfriend. Normally, s h e h a d felt "cleansed" by t h e experience, particularly by h i s s h a m e a b o u t h i s own actions. But on t h e final occasion s h e s a w c o n t e m p t in his eyes. S h e screamed a n d s h o u t e d a t him. He ridiculed a n d disparaged her. She picked u p t h e knife, a n d a s h e moved toward her, still mocking a n d sneering, s h e s t a b b e d him. And with it s h e hoped to have killed h e r self-hatred a n d humiliation. My work with Henrietta h a s now ended. S h e improved enormously in t e r m s of b o t h s t r u c t u r a l a n d symptomatic criteria— yet horror a n d d e s p a i r were never far away, right until t h e end.

Psychic Equivalence and Violent Enactment Why is t h e brutalization of a t t a c h m e n t so potent a trigger for violence? We believe t h a t t h e brutalization of affectional b o n d s serves to partially deactivate t h e a t t a c h m e n t system in specific contexts a n d s u g g e s t s t h a t t h e malign n a t u r e of brutalization experiences is rooted in t h e intensity of t h e humiliation associated with t h e m . T h e a b s e n c e of t h e capacity for mentalization and t h e r e e m e r g e n c e of psychic equivalence m a k e individuals with a history of psychological neglect exceptionally vulnerable to brutalization in t h e s e contexts. T h e a t t a c k s c a n n o t be a t t e n u ated by mentalization of t h e p a i n engendered by the d e h u m a n i zation of a t t a c h m e n t . Unmentalized s h a m e is n o t a n " a s - i f experience. It is t a n t a m o u n t to t h e destruction of the self. It would n o t be a n exaggeration to label this emotion "ego-destructive shame" (Gilligan 1997). T h e coherence of t h e self-representation—identity itself—is u n d e r a t t a c k . T h e ability to m e n t a l i z e would mitigate t h i s process, permitting t h e individual to continue to conceive of himself a s a meaningful intentional subjectivity in spite of t h e lack of recognition from t h e a t t a c h m e n t

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figure a t t h a t m o m e n t . T h e more r o b u s t t h e capacity for mentalization, t h e more easily t h e p e r s o n m a y see w h a t lies b e h i n d the attack, its m e a n i n g , a n d n o t m i s t a k e it for t h e possibility of a real d e s t r u c t i o n of t h e ego. T h e intensity of t h e humiliation might be t h e i m m e d i a t e c a u s e of the- inhibition of mentalization following a b u s e : all t h i n g s felt to be i n t e r n a l (subjectivity) become experiences to b e resisted. In describing h e r experience of brutalization, Henrietta reported finding t h e very a c t of t h i n k i n g u n b e a r a b l e : "I stopped thinking" . . . "I w e n t n u m b " . . . "I could n o t b e a r to think." Why should t h e brutalization of affectional b o n d s , w h e t h e r in t h e context of relationships with p a r e n t s or with i n t i m a t e peers, be associated with s u c h a n i n t e n s e a n d destructive s e n s e of selfdisgust verging on self-hatred? Once again, t h e r e is a paradox: t h e s h a m e c o n c e r n s being treated a s a physical object in t h e very context where special p e r s o n a l recognition is expected. Overwhelming m e n t a l p a i n is associated with experiencing a discrepa n c y between t h e r e p r e s e n t a t i o n of a n a c t u a l self, b a s e d on how one is being treated a n d t h e r e p r e s e n t a t i o n of t h e ideal s h a p e of t h e self (Joffe a n d S a n d l e r 1967). The expectation of being seen a n d u n d e r s t o o d a s a feeling a n d thinking person, w h i c h is created by t h e a t t a c h m e n t context, c l a s h e s violently with the brutalized p e r s o n ' s objectification a n d d e h u m a n i z a t i o n . S h a m e is a higher-order derivative of t h i s basic affect of pain. Unbearable s h a m e is generated t h r o u g h t h e incongruity of h a v i n g one's h u m a n i t y negated, exactly w h e n one is legitimately expecting to be cherished. Violence or t h e t h r e a t of violence to t h e body kills t h e soul b e c a u s e it is t h e u l t i m a t e way of c o m m u n i c a t i n g the a b s e n c e of love by t h e p e r s o n inflicting t h e violence, from whom u n d e r s t a n d i n g is expected. As F r e u d (1914c) t a u g h t u s , t h e self is. s u s t a i n e d by t h e love of t h e object, so it c a n b e c o m e self-love; t h e sign of a self starved of love is s h a m e , j u s t a s cold is the indication of a n a b s e n c e of h e a t (Gilligan 1997). And, j u s t like cold, s h a m e , while painful a s a n a c u t e experience, is, w h e n it is i n t e n s e a n d severe, experienced a s a feeling of n u m b n e s s or deadness. T h e s t a t e of humiliation c a n only be e r a s e d t h r o u g h selective b u t deep disavowal of t h e subjectivities of b o t h t h e object and

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the self. A p r i s o n e r who w a s incarcerated for aggravated a s s a u l t recalled h i s alcoholic father u r i n a t i n g on h i m a n d on h i s sister regularly w h e n h e r e t u r n e d h o m e late a t night from drinking. He reported t h a t h i s terror of h i s father coming h o m e a t a certain point c h a n g e d into a n explicit w i s h to m a i m a n d disfigure him. At t h a t point, h e said, "The fucking b a s t a r d stopped existing for me." In m a n y criminals a similar d r a m a t i c reconfiguration of t h e self s e e m s to t a k e place. T h e r e is a t u r n i n g point w h e n t h e normal b a r r i e r a g a i n s t intentionally injuring a n o t h e r h u m a n is penetrated. From t h i s point, t h e p e r s o n a p p e a r s to feel n o remorse for violent a c t s performed on others. A state t h a t might be m i s t a k e n for p s y c h o p a t h y s e t s in. T h e word "functional" might be inserted before p s y c h o p a t h y since t h e d i s a p p e a r a n c e of interpersonal sensibility is t h o u g h t to be defensive, temporary, a n d reversible. It s h o u l d not, therefore, be considered a deficit b u t , rather, a n a d a p t a t i o n . So far we h a v e talked a b o u t t h e predisposition to violent crime. T h i s m u s t be distinguished from t h e a c t of violence itself. While t h e predisposition involves t h e d e s t r u c tion of i n t e r p e r s o n a l a w a r e n e s s in a specific context, I would suggest t h a t t h e a c t of violence itself r e p r e s e n t s t h e perverted restoration of a r u d i m e n t a r y mentalizing function. There is a traditional psychoanalytic a s s u m p t i o n t h a t violence is a n a c t of m a d n e s s — t h e ego's a b a n d o n m e n t of logical thought in favor of primitive a n d profoundly destructive impulses. T h e a c t of violence, w h e t h e r impulsive or calculated, is rarely one of blind rage. Rather, it is a d e s p e r a t e a t t e m p t to protect t h e fragile self a g a i n s t t h e o n s l a u g h t of s h a m e , often innocently triggered by a n other. T h e experience of humiliation, which t h e individual tries to contain within t h e alien p a r t of t h e self, comes to r e p r e s e n t a n existential t h r e a t a n d is therefore abruptly externalized. Once outside a n d perceived a s p a r t of t h e representation of t h e victim in t h e p e r p e t r a t o r ' s mind, it is seen a s possible to destroy once a n d for all. In this s e n s e violence is a gesture of hope, a w i s h for a n e w beginning, even if in reality it is usually j u s t a tragic end. We suggest t h a t it is i m p o r t a n t , in u n d e r s t a n d i n g borderline states, to g r a s p t h e s e n s e of psychic equivalence between a s t a t e of mind a n d a physical reality. Henrietta's victim did n o t symbol-

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ize a n attitude or a m e n t a l state—he w a s killed b e c a u s e h e was, a t t h a t m o m e n t , t h e e m b o d i m e n t of h e r s h a m e , a n d destroying h i m w a s also felt to destroy t h e u n b e a r a b l e m e n t a l s t a t e . Small children a r e generally n o t physically capable of dealing with their intolerable feelings in t h i s way, b u t a d u l t s w h o experience their internal worlds in s u c h ways c a n be d a n g e r o u s to themselves a n d others. Henrietta resorted to violence to destroy a m e n t a l state—a m e n t a l s t a t e t h a t w a s h e r s a n d yet did n o t feel like h e r s . At t h e m o m e n t of t h e m u r d e r , h e r object t u r n e d from feeling h e r s h a m e to s h a m i n g her—a feeling s h e w a s d e s p e r a t e to disown. S h e h a d tried to disown it, b u t w h e n it t h r e a t e n e d to r e t u r n , m u r d e r seemed t h e only solution. S h e felt a terror t h a t t h e coherence of h e r self would be destroyed. The a c t of violence w a s felt to destroy b o t h h e r s h a m e a n d t h i s terror. Her u n c o n s c i o u s hope seemed t o be t h a t t h e y would t h e n be gone forever. T h e lack of a capacity to mentalize reveals t h e alien self a s m u c h a s it c r e a t e s it. It also reveals a mode of t h i n k i n g where feelings a n d t h o u g h t s feel real a n d only one version of reality is possible. The i m p a c t of h e r boyfriend's affect could n o t be reinterpreted or p u t into context t h r o u g h mentalization. Her primitive experience of psychic reality, w h i c h e q u a t e d external with internal, m a d e h e r into a j o k e a n d t h r e a t e n e d t h e actual destruction of her s e n s e of self. Psychic equivalence m a k e s humiliation a m a t t e r of life a n d d e a t h . The killing t h a t e n s u e d was n o t lacking in e m p a t h y , a n a c t of "blind rage." It s e e m e d essential t h a t s h e saw h i s reaction a n d , within that, s o m e t h i n g t h a t s h e would otherwise h a v e h a d to experience a s p a r t of herself. His struggle a n d suffering were vital features of t h e experience a s s h e later w e n t over it in analysis. At t h e m o m e n t of m u r d e r Henrietta felt alive, coherent, a n d real, o u t of r e a c h of t h e deadly rejections, insults, a n d t a u n t s , a n d m o m e n t a r i l y for once experiencing self-respect. S h e described having felt a s t r a n g e b u t deep tranquility. Henrietta needed h e r a b u s e r s — t h e a n a l y s t in c o u n t e r t r a n s ference e n a c t m e n t s a n d a series of o t h e r s who, t h r o u g h their m a l t r e a t m e n t of her, helped h e r temporarily r e d u c e t h e u n b e a r able s e n s e of diffused identity. T h e o t h e r w h o performs this

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function m u s t r e m a i n p r e s e n t for this complex p r o c e s s to operate. Henrietta could n o t feel t h a t s h e w a s herself u n l e s s s h e h a d her a n a l y s t or s o m e o n e else to frighten,, a n d humiliate. Alternatively, s h e would a t t e m p t to provoke t h e analyst to become rejecting a n d c o n t e m p t u o u s . However, having succeeded in provoking s u c h reactions, s h e felt attacked by t h e immediacy a n d reality of.her perceptions, w h i c h were too compelling to be j u x t a posed with other experiences with t h e object. Nor is escape from the object a solution—with t h e d e p a r t u r e of t h e other p e r s o n the "exterojects" would r e t u r n , destroying t h e coherence s h e achieved by projection. The seemingly impossible challenge p r e s e n t e d by p a t i e n t s s u c h a s Henrietta a n d E m m a is, we believe, rooted in this a s p e c t of t h e transference. For t h e relationship to serve a function a n d to be tolerable, t h e a n a l y s t h a s to become w h a t t h e p a t i e n t wishes h i m to be. B u t a t t h e s e m o m e n t s he is likely to be too terrifying to b e able to offer help t h a t c a n be accepted. To be a n analyst a n d help t h e p a t i e n t overcome s u c h primitive m o d e s of relating, t h e a n a l y s t m u s t be a n y t h i n g b u t w h a t is projected onto him. U n l e s s h e is able to juggle r e s p o n s e s to t h e s e opposing p r e s s u r e s , t h e a n a l y s i s is doomed to become a rigid repetition of pathological exchanges. Part of t h e difficulty u n d o u b t e d l y arises o u t of t h e p r e s s u r e we inevitably feel a s clinicians to e n a c t t h a t which is projected onto u s . We a r e p u s h e d , to be a s o u r p a t i e n t s wish u s to be b e c a u s e we s e n s e t h a t w i t h o u t this, prolonged c o n t a c t with u s might be intolerable. This, of course, h a p p e n s to a degree in a n y transference situation, b u t it is vital to appreciate t h e difference introduced w h e n t h e p a t i e n t is experiencing events primarily in the mode of psychic equivalence. If ordinary transference experiences a r e illusions, t h e experience of borderline p a t i e n t s is felt a s a delusion it s e e m s u n q u e s t i o n a b l y real. Because, a s a n a lysts, we try extremely h a r d n o t to react a s expected to provocation, we unwittingly p u s h borderline p a t i e n t s to become even more difficult. All s u c h p a t i e n t s get u n d e r o u r skin a n d eventually discover w h a t will m a k e u s react with anger, w h a t will c a u s e u s to neglect or reject t h e m or to feel excited by them, in all instances temporarily losing o u r t h e r a p e u t i c balance.

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I m p l i c a t i o n s for T e c h n i q u e : Between the Psychic Equivalence and the Pretend Mode As with- E m m a , we believe t h a t with Henrietta a n appropriate technical priority w a s t h e survival of t h e a n a l y s t ' s picture of t h e patient's m e n t a l s t a t e in h i s m i n d . It w a s vital t h a t Henrietta did n o t succeed in destroying t h e perception of herself a s a person, which s h e needed if s h e were gradually to discover t h i s image of herself in h i s mind, to gain a foothold for h e r own representation of h e r t h o u g h t s a n d feelings. This description might create t h e impression t h a t p a t i e n t s s u c h a s Henrietta c a n n o t r e s p o n d to psychoanalysis; interpretation necessarily involves some o p e n n e s s to a n alternative perspective. In t h e a d u l t mind, however, r e p u d i a t i o n of mentalization is in reality never absolute. It is likely to be g r e a t e s t at m o m e n t s of p a r t i c u l a r s t r e s s a n d / o r in a t t a c h m e n t relationships; h e n c e t h e patient h a s s o m e experience of mentalizing in other contexts t h a t c a n begin to be built on. T h e a n a l y s t preconsciously a s s e s s e s how m u c h o p e n n e s s t h e r e might b e a n d a i m s progressively to enlarge t h a t space, if only very slowly. There are wide, m o m e n t - t o - m o m e n t variations in t h e capacity available, a n d interventions need to be titrated a g a i n s t t h e c u r r e n t potential. 5 A n t h o n y B a t e m a n (1997) described t h e s a m e p h e n o m e n o n sensitively in t h e context of Rosenfeld's (1964) distinction between t h i c k - s k i n n e d a n d t h i n - s k i n n e d n a r c i s s i s t s . Extending Rosenfeld's description, B a t e m a n a r g u e d t h a t n a r c i s s i s t s altern a t e b e t w e e n t h e t h i c k - s k i n n e d (derogatory a n d grandiose) a n d t h i n - s k i n n e d (vulnerable a n d self-loathing) s t a t e s . B a t e m a n s h o w s t h a t interpretive work c a n only b e d o n e with s u c h patients a t t h e d a n g e r o u s m o m e n t s w h e n they a r e in movement from one s t a t e to t h e other. We t h i n k w h a t B a t e m a n describes is t h e successful externalization of t h e alien self (derogatory or selfhating). The externalization of t h e p e r s e c u t o r y object within the self leaves t h e patient able to listen a n d even experience concern. 5

We are indebted to Dr. Efrain Bleiberg for this observation.

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The analyst n e e d s to be in a d u a l functioning mode, to infer a n d create a c o h e r e n t r e p r e s e n t a t i o n of t h e patient's t r u e self, separate from b u t c o n c u r r e n t l y with a n y countertransference enactment. However, t h i s is w h e r e analysis often fails, b e c a u s e a s soon a s t h e p a t i e n t h e a r s a n y t h i n g other t h a n w h a t h e projected, he m u s t once again b e on t h e alert. He might be risking t h e r e t u r n of h i s laboriously ejected introject. One risk of t r e a t m e n t for t h e s e p a t i e n t s is t h a t t h e a n a l y s t will p r e s e n t t h e p a t i e n t with m o r e t h a n h e is able to absorb, overwhelming t h e r e s i d u a l capacity truly to u n d e r s t a n d . This might r e s u l t either in a n overflow into action or, p e r h a p s , in t h e development of a false "analytic" attitude, which we have called "hyperactive mentalizing." In contrast, a lack of ambition to expand t h e p a t i e n t ' s experience of psychic reality, a s in some supportive p s y c h o t h e r a p y , m i s s e s t h e opportunity of increasing affect regulation, a n d , a s i n t e n s e a t t a c h m e n t to t h e a n a l y s t develops, so t h e n e e d to create their feelings in action is likely to escalate, a n d serious suicide a t t e m p t s m a y be t h e result. In this context, t h e r e is t h e further d a n g e r also t o u c h e d on in connection with E m m a ' s case of crediting t h e patient's material with more m e a n i n g t h a n it really contains. Henrietta, like m a n y other similar p a t i e n t s , b r o u g h t m u c h pseudo-symbolic c o m m u nication, especially in t h e early p h a s e s of her t r e a t m e n t . Her words referred to i n t e r n a l states, yet after a while it b e c a m e clear t h a t their m e a n i n g h a d little in c o m m o n with t h e way other patients might h a v e described feelings or fantasies. Normal interpretive dialogue seemed mostly useless; in Henrietta's case it created a n e n d l e s s s t r e a m of w o r d s without leading to real change. Analysis of borderline p a t i e n t s c a n switch into a pretend mode in w h i c h w o r d s a r e exchanged b u t m e a n i n g a n d therefore psychic c h a n g e a r e elusive; patients' verbalizations of mental s t a t e are, of necessity, "pseudo-insights," a s they c a n n o t link to t h e p a t i e n t ' s p r i m a r y level of internal experience. T h e progress of s u c h a n analysis m i g h t resemble t h a t of a car w h o s e wheels are s p i n n i n g in s a n d . T h e overestimation of t h e p a t i e n t ' s mental capacity, t h e a s s u m p t i o n t h a t her psychic reality is experienced like t h a t of t h e analyst, c a n lead to a fruitless search after t r u t h . Mentalization c a n exist separately from t h e

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a c t u a l affective experience b u t t h i s is w o r t h little, certainly in a t h e r a p e u t i c context. Interpretations in t h e classical s e n s e have n o place in the early p h a s e s with s u c h p a t i e n t s . S o m e e n a c t m e n t on t h e p a r t of t h e analyst is inevitable; a realistic a i m is for h i m to retain sufficient insight to be able to c o n t i n u e to reflect on h i s experience to t h e patient. Henrietta's a n a l y s t h a d to t e a c h h e r a b o u t a n i n n e r world, principally by opening h i s m i n d to h e r experience. "Deep" i n t e r p r e t a t i o n s felt like t a u n t s , i n t r u s i o n s , distractions, or seductions. T h e a p p r o p r i a t e focus seemed to be the exploration of triggers for feelings, small c h a n g e s in mental states, highlighting differences in p e r c e p t i o n s of t h e s a m e event a n d bringing a w a r e n e s s of t h e intricate relationships between action a n d feeling, a s in t h e analyst's r e s p o n s e to h e r nonverbal g e s t u r e s i n - t h e early p h a s e of t h e t r e a t m e n t . S u c h interpretive work a s t h e r e w a s h a d to h a v e a strict focus on t h e consultingroom a n d on t h e feelings a n d a t t i t u d e s of patient a n d analyst. (Note t h a t if t h e t e r m "transference" is u s e d in t h i s context, it is being u s e d s o m e w h a t differently from t h e traditional definition— see Sandler, Dare, a n d Holder 1992.) T h e p a t i e n t ' s actions in relation to t h e a n a l y s t — s u c h a s t h e terrifying p a r a - s u i c i d a l behavior t h a t w a s t h e b a c k d r o p to Henrietta's t r e a t m e n t — a r e not seen by u s a s u n c o n s c i o u s l y intended c o m m u n i c a t i o n s , b u t a s d e s p e r a t e reactions to intolerable intimacy. The a n a l y s t ' s t a s k is to elaborate on t h e emotional s t a t e s t h a t m i g h t h a v e triggered t h e e n a c t m e n t . The difficulty is t h e preservation of t h e "as-if n a t u r e of t h e t h e r a p e u t i c exercise in t h e face of t h e powerful, intrusive projections t h a t t h e a n a l y s t also h a s to accept. Sometimes t h e r e is a place for h u m o r or playfulness i n t h e struggle with psychic equivalent m o d e s of functioning, b u t n a t u r a l l y this requires m u c h delicacy a n d j u d g m e n t of t h e p a t i e n t ' s likely experience of t h i s a p p r o a c h . T h e p s y c h o t h e r a p i s t ' s mentalistic elaborative s t a n c e enables t h e p a t i e n t ultimately to find himself in t h e t h e r a p i s t ' s mind a n d integrate t h i s image a s p a r t of h i s s e n s e of himself. In successful t r e a t m e n t , t h e p a t i e n t gradually comes to accept t h a t feelings c a n safely be felt a n d ideas m a y safely be t h o u g h t a b o u t . There is a g r a d u a l shift to experience of t h e internal world a s s e p a r a t e a n d qualitatively different from external reality (Fonagy a n d Tar-

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get 1996). This is p a r t of a m a t u r a t i o n a l p r o c e s s t h a t w a s , we suggest, defensively a b a n d o n e d by t h e s e p a t i e n t s in a n a t t e m p t to avoid overwhelming conflict. T h r o u g h all t h e s e devices, t h e analyst a d o p t s a n o n p r a g m a t i c elaborative, mentalistic s t a n c e , w h i c h places a d e m a n d on t h e patient to focus on t h e m e n t a l s t a t e of a benevolent other. T h i s stance in itself e n h a n c e s or disinhibits t h e patient's biological propensity for reflection a n d self-reflection. P e r h a p s more important, he is able to find himself in t h e mind of t h e t h e r a p i s t a s a thinking a n d feeling being—the r e p r e s e n t a t i o n t h a t never fully developed in early childhood a n d w a s probably further u n d e r mined by s u b s e q u e n t painful interpersonal experience. In t h i s way, t h e p a t i e n t ' s core self-structure is strengthened a n d sufficient control is acquired over m e n t a l r e p r e s e n t a t i o n s of internal states so t h a t p s y c h o t h e r a p e u t i c work proper c a n begin. Even if work were to s t o p here, m u c h would have been achieved in terms of m a k i n g behaviors u n d e r s t a n d a b l e , meaningful, a n d predictable. T h e internalization of t h e analyst's concern with mental s t a t e s e n h a n c e s t h e p a t i e n t ' s capacity for similar concern toward h e r own experience.

1

Mentalized

1

Affectivity

in the Clinical

Setting

In this c h a p t e r , we focus o n t h e idea of mentalized affectivity, which will allow u s to elaborate on a form of affect regulation t h a t is particularly relevant for adults. As introduced in c h a p t e r 2, mentalized affectivity is a sophisticated kind of affect regulation t h a t d e n o t e s h o w affects a r e experienced t h r o u g h t h e lens of self-reflexivity. It would be m i s t a k e n to a s s u m e t h a t all a d u l t s are capable of s u c h affectivity; yet n e i t h e r is it a rarified achievement. As we d e m o n s t r a t e in t h i s c h a p t e r , mentalized affectivity is a concept t h a t c a n be e n h a n c e d by p s y c h o t h e r a p y a n d t h u s pertains to a p h e n o m e n o n t h a t is especially relevant to t h e clinical realm. In t h e first section of this c h a p t e r we begin with a description of mentalized affectivity a s a concept, in t h e second we delineate t h r e e e l e m e n t s of mentalized affectivity, a n d in the third we t u r n to four clinical examples to illustrate its importance.

THE CONCEPT OF MENTALIZED AFFECTIVITY Affects a r e m e n t a l s t a t e s t h a t c a n be subjectively or u n c o n sciously experienced. Affect regulation is a p r o c e s s of crafting mental s t a t e s in a c c o r d a n c e with a s e n s e of agency. It o c c u r s 435

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a t different levels—from s o m e t h i n g like homeostatic regulation, which o c c u r s w i t h o u t a w a r e n e s s , to self-regulation t h r o u g h o u r relations with others, in which a w a r e n e s s is critical. It is fair to a s s u m e t h a t t h e more familiar one is with one's subjective experience, t h e m o r e effective regulation c a n be. Correspondingly, t h e more a d v a n c e d one is with affect regulation, t h e closer it is to self-regulation. Mentalized affectivity t r a n s c e n d s being a s t a t e or a process; in its u l t i m a t e form, it b e a r s a close relation to c h a r a c t e r style. It is i m p o r t a n t to appreciate, however, t h a t n o t all forms of mentalization h a v e to do with affective experience. Mentalized affectivity is predicated u p o n familiarity a s well a s a s e n s e of comfort with one's own subjective experience. Indeed, s u c h affectivity p r e s u m e s a n agent w h o is self-reflective. W h a t distinguishes mentalized affectivity from other p o i n t s of view— like t h e one w h e r e cognition is applied to d e t e r m i n e a n d alter affective experience—is t h a t t h e agent r e m a i n s within or recapt u r e s t h e affective state. As a n y o n e engaged in p s y c h o t h e r a p y recognizes, t h e r e is a profound difference between a b s t r a c t selfu n d e r s t a n d i n g a n d t h e kind of insight t h a t is mediated by live affective experience. T h r o u g h mentalized affectivity, one acquires a m o r e complex u n d e r s t a n d i n g of o n e ' s own affective experience. T h i s will often m e a n t h a t affects a r e r e n d e r e d into n e w a n d / o r s u b t l e r s h a p e s ; however, it does n o t necessarily require t h a t affects a r e t r a n s formed in n a t u r e . It is possible t h a t mentalized affectivity directs u s to appreciate n e w m e a n i n g s in t h e s a m e affects, n o t simply to create new affects. Affectivity of t h i s sort h a s t h e a i m of promoting positive affect, b u t it s h o u l d also help u s to be able to accept a n d cope with negative affect. In its essence, mentalized affectivity d e s i g n a t e s t h e h u m a n n e e d to fathom a n d reinterpret one's affects a n d is particularly exemplified t h r o u g h t h e i n t e r n a l exp r e s s i o n of affects. As we have a r g u e d t h r o u g h o u t t h i s book, mentalization d e n o t e s interest in one's m i n d in general. The t e r m "affectivity" d e n o t e s interest in one's own affects—that is, in a specific d o m a i n of one's mind. The t e r m "mentalized affectivity" describes how affect regulation is transformed by mentalization.

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T H E ELEMENTS OF MENTALIZED AFFECTIVITY Having characterized mentalized affectivity broadly, let u s a d d r e s s its composition in a m o r e specific way. This will provide a deeper u n d e r s t a n d i n g of t h e concept, a n d it will also serve a s a b a s i s for how t h e concept m i g h t be operationalized for t h e p u r p o s e s of r e s e a r c h . There a r e t h r e e elements of mentalized affectivity: identifying, modulating, a n d expressing affects. E a c h of t h e t h r e e e l e m e n t s h a s a b a s i c a n d more complex form. As we imagine it, identifying affects is t h e prelude to modulating t h e m . It is n o t impossible to c h a n g e w h a t one feels w i t h o u t knowing w h a t it is; however, it is m o s t plausible t h a t r e g u l a t i n g / m o d u l a t ing one's affect will d e p e n d u p o n having some a w a r e n e s s of t h e affect itself. Similarly, expressing one's affects is contingent h e r e u p o n modulation; on o u r account, t h o u g h , it is also i m p o r t a n t to realize t h a t affects c a n be expressed inwardly a s well a s outwardly. Let u s t a k e a closer look a t e a c h of t h e t h r e e individual elements. In its m o s t basic form, identifying affects will m e a n n a m i n g t h e b a s i c emotion t h a t one feels. There a r e some patients who, one m i g h t begin to notice, characteristically avoid n a m i n g their affects or in s o m e c a s e s omit t h e n a m e s of specific affects. T h e p r o c e s s of u n d e r s t a n d i n g w h a t t h i s m e a n s m u s t c o m m e n c e w i t h t h e a t t e m p t to clarify w h e t h e r t h e p a t i e n t is j u s t s o m e w h a t uncomfortable with or is actually in ignorance a b o u t t h e affect in question. Indeed, one c a n glimpse how readily t h e m a t t e r of n a m i n g affects c a n b e complicated a n d is n o t n e c e s s a r ily a straightforward m a t t e r of knowing w h a t s t a t e one is in. Someone c a n be confused a b o u t w h a t he feels—that is, w h e t h e r it is o n e affect or a n o t h e r or some combination of both. In i n s t a n c e s w h e r e one feels a combination of affects, it c a n be w o r t h while to,sort o u t t h e relative degrees of e a c h affect. T h e complex a s p e c t of identifying affects is exemplified by c a s e s in w h i c h t h e r e a r e links—sometimes h i d d e n ones— between affects. An example would be of someone who, w h e n ever h e feels angry, u n d e r g o e s a shift to becoming a n x i o u s . S o m e s u c h links m a y b e predictable, like oscillation between a n g e r a n d s a d n e s s w h e n one is disappointed in love. Other links c a n

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be more u n u s u a l , a s in t h e p a t i e n t who, w h e n e v e r s h e becomes angry, quickly moves to explain it a w a y by focusing sympathetic a n d even w a r m attention on t h e motivation of t h e a g e n t who h a d c a u s e d h e r to be angry. T h u s , beyond t h e t a s k of n a m i n g affects, identifying affects c a n include t h e p r o c e s s of discerning the relation a m o n g distinct affects. In its basic form, m o d u l a t i n g affects will m e a n t h a t t h e affect is altered in some way. T h i s c a n entail modifications in intensity or duration, or it c a n refer to more s u b t l e a d j u s t m e n t s , where t h e affect is refined. Modulation c a n m e a n t h a t t h e affect is s u s t a i n e d a s well a s adjusted u p w a r d or d o w n w a r d . O n e of u s h a s a highly narcissistic patient (see "Scott," below), who, j u s t after h e a r i n g t h a t a w o m a n on w h o m h e h a d a c r u s h w a s getting engaged, a n n o u n c e d t h a t he w a s "feeling pretty good." Upon further exploration, h e claimed n o t t h a t h e h a d n o t b e e n sad a b o u t t h i s news, b u t t h a t h i s s a d n e s s h a d s u b s i d e d . This s e e m s like a case in which m o d u l a t i o n m i g h t serve to s u s t a i n t h e affect in order for t h e p a t i e n t to experience 'it fully, r a t h e r t h a n either increase or decrease it. It is easy to imagine examples in which s o m e o n e clings persistently to negative affects—let u s say anger or r e s e n t m e n t — i n a way t h a t colors too m u c h of h i s experience. This would m e a n t h a t m o d u l a t i o n p o i n t s to t h e value of adjusting t h e negative affect downward. T h e complex form of affectivity c o n c e r n s t h e revaluing of affects. This is a crucial m o m e n t within t h e p r o c e s s of affectivity, a s it brings o u t t h a t one does n o t necessarily a d o p t n e w affects a s m u c h a s one reinterprets t h e m e a n i n g of t h e s a m e affects. So t h r o u g h revaluing affects o n e c o m e s to h a v e a greater s e n s e of t h e complexity of one's affective experience. This m i g h t b e illustrated with a c a s e in which o n e comes to u n d e r s t a n d h o w one's predisposition to experience a n affect in a certain w a y extends from early interactions a n d experiences. Modulating t h e affect t h r o u g h revaluation would m e a n t a k i n g one's own experience a n d history into a c c o u n t . This is s h o w n m o r e specifically in the example of a p a t i e n t (see "Rob," below) w h o revalues h i s experience of t h e e n d i n g of a relationship: h e does so by coming to t e r m s with how h i s p a r e n t s ' divorce influenced h i s experience, leading h i m to regard himself m o r e a s a victim r a t h e r t h a n a n agent in w h a t t r a n s p i r e d .

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The t h i r d element of affectivity is t h e expression of affects. At the m o s t r u d i m e n t a r y level; we c a n distinguish between t h e choice to r e s t r a i n expression or to let it flow. Although one might readily p r e s u m e that, expression m e a n s t h e o u t w a r d manifestation of t h e affect in t h e world, t h i s is n o t necessarily t h e case. In our view, it is i m p o r t a n t - n o t to ignore t h e s e n s e in w h i c h affects can b e e x p r e s s e d inwardly. Insofar a s sociobiological a c c o u n t s regard e m o t i o n s a s manifest in facial expression a n d a s action r e s p o n s e s t h a t aid-survival,, it is legitimate to question w h a t t h e idea of expressing one's affects inwardly could m e a n . Here we would e m p h a s i z e t h a t t h e c o n c e a l m e n t of emotional r e s p o n s e s can be a useful a n d beneficial strategy for a n organism. Expressing one's affects inwardly, t h e n , c a n b e u n d e r s t o o d a s a strategy to resort to in a s i t u a t i o n in w h i c h expressing one's affects outwardly is u n d e s i r a b l e . T h e inward expression of affects is predicated u p o n t h e existence of a r e p r e s e n t a t i o n a l s y s t e m ' t h a t gives u s a n option, other t h a n o u t w a r d expression. There a r e i m p o r t a n t implications for p s y c h o t h e r a p y here. One might u n d e r s t a n d p s y c h o t h e r a p y a s experimenting with t h e inward expression of affects t h r o u g h expressing t h e m within a n a t m o s p h e r e t h a t is contained a n d safe compared to t h e real world. As we h a v e described in c h a p t e r 6—"Playing with Reality"—psychotherapy c a n be u n d e r s t o o d a s relying on a kind of pretend m o d e of functioning in w h i c h t h e t h e r a p i s t a c t s a s a playful p a r e n t a n d t h u s serves to promote.fantasy a n d imagination in t h e way t h a t a p a t i e n t regulates h i s affects. Indeed, it is often a n indication of progress in p s y c h o t h e r a p y to observe t h a t a patient h a s b e g u n to e x p r e s s h i s affects inwardly. This entails no slight to v a l u e a n d i m p o r t a n c e of o u t w a r d expression; t h e key m a t t e r is w h e t h e r a n agent .is able to m a k e a choice t h a t is genuinely in h i s self-interest. The inward expression of affects is especially c o n s i s t e n t with self-reflexivity. Recall t h a t a s we h a v e outlined t h e concept of mentalized affectivity, it entails reflecting on one's affects while one r e m a i n s within a n affective state, r a t h e r t h a n from a position of distance. In moving to e x p r e s s t h e affect, it c a n be sufficient to let one feel t h e affect a n e w w i t h o u t having it emerge in t h e world. For example, a p a t i e n t realized how angry h e w a s at h i s wife b e c a u s e s h e b l a m e d h i m for h e r pregnancy, a l t h o u g h

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he believed a t t h e time t h a t h i s wife w a s feeling too vulnerable to h e a r t h i s from him. The point is t h a t it w a s helpful for him to experience h i s a n g e r a t a deeper level t h a n h e h a d done, b u t it w a s equally i m p o r t a n t to confirm t h e choice n o t to convey h i s affect directly to h i s wife. We w a n t to s t r e s s h e r e how this a c c o u n t differs from one in w h i c h one recognizes one's anger from a n intellectual s t a n d p o i n t . Mentalized affectivity goes furt h e r in p u s h i n g u s to own o u r affects; being able to express affects inwardly a d d s a n option in s i t u a t i o n s w h e r e outward expression is n o t desirable. Expressing affects t a k e s on greater complexity a s a form of c o m m u n i c a t i o n . Especially in t h o s e i n s t a n c e s w h e r e t h e affect is expressed outwardly, we c a n d i s t i n g u i s h between a n expression t h a t o c c u r s w i t h o u t regard for o t h e r s a n d o n e t h a t o c c u r s within t h e context of a dialogue with others. C o m m u n i c a t i n g affects m e a n s t h a t t h e expression is offered with t h e expectation of how it will be received by others. O n e w a n t s t h e other person(s) n o t j u s t to k n o w w h a t o n e feels, b u t also to u n d e r s t a n d a n d perh a p s r e s p o n d to t h i s feeling. For i n s t a n c e , a p a t i e n t expressed a n n o y a n c e a t a break, inquiring w h e t h e r h e w a s right t h a t last year's b r e a k h a d lasted for a s h o r t e r time. T h i s goes beyond a s t a t e m e n t of h o w t h e patient feels; it includes t h e expectation of a r e s p o n s e . T h u s , t h e r e is s o m e t h i n g m o r e self-conscious a b o u t c o m m u n i c a t i n g affects t h a t reflects a n i n v e s t m e n t in intimate a n d social" relationships. We s h o u l d recall h e r e t h a t t h e development of a c o m m u n i c a t i v e a s p e c t of affects was s t r e s s e d in c h a p t e r 4, "The Social Biofeedback Theory of AffectMirroring." Aifect-mirroring is a b a s i s for later c o m m u n i c a t i o n in language. Although delineating t h e e l e m e n t s of mentalized affectivity gives u s a better s e n s e of w h a t t h e concept involves, so far we still h a v e r e m a i n e d a t a n a b s t r a c t level. We h a v e h a d some occasion to refer to case material; however, t h e value of mentalized affectivity a s a concept will be enriched considerably by a n elaboration of its clinical, manifestations. In t h e n e x t section we look a t four different c a s e s t h a t highlight diverse a s p e c t s of s u c h affectivity.

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CLINICAL EXAMPLES In this section, we p r e s e n t four c a s e s from o u r clinical work. 1 The p r e s e n t a t i o n s a r e guided by o u r interest in t h e concept of affectivity; inevitably, t h i s involves t h e inclusion of material t h a t goes beyond t h e idea of affectivity. It is n o t o u r intention, however, to offer full c a s e p r e s e n t a t i o n s . T h u s , interesting a s pects of t h e s e c a s e s a r e raised w i t h o u t being fully explored. T h e case material reveals a r a n g e of affectivity—from very little affectivity (and t h e d i s a s t r o u s c o n s e q u e n c e s of this) to a case in which affectivity h a s s t a r t e d to emerge within t h e treatment, a n d a n o t h e r c a s e in w h i c h t h e p a t i e n t c a m e to t h e t r e a t m e n t with considerable affectivity. We also occasionally contend with affectivity a s it p e r t a i n s to t h e clinician. Any form of psychotherapy h a s , in o u r view, t h e a i m of altering t h e patient's relation to h i s own affects, a n d affectivity r e p r e s e n t s this possibility. Even for t h o s e w h o p o s s e s s affectivity, t h o u g h , it is a continuing struggle.

"TERESA" Teresa is a n African-American w o m a n in h e r late thirties who grew u p in New York; in- fact, s h e once told m e t h a t s h e h a d never b e e n outside M a n h a t t a n . S h e is quite disturbed a n d h a s been in a n d o u t of hospitals, diagnosed a t different times over the last twenty y e a r s a s schizophrenic, bipolar, a n d borderline. She w a s n o t psychotic d u r i n g t h e two-and-half y e a r s d u r i n g which s h e w a s treated. S h e w a s disheveled a n d occasionally smelled b a d l y (to t h e extent t h a t t h e p a t i e n t w h o followed h e r once complained t h a t t h e c h a i r smelled like urine). She w a s also not very responsive a t first, a n d I often wondered how I could help her, especially a s s h e would:reject a n d even ridicule w h a t ever I said.

'Written in the first person; the clinician was Elliot L. Jurist.

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There w a s , n o n e t h e l e s s , s o m e t h i n g likable a b o u t Teresa: s h e h a d a lively wit, a n d occasionally s h e would m a k e c o m m e n t s a b o u t other t h e r a p i s t s or p a t i e n t s a t t h e clinic t h a t were m e a n spirited b u t funny a n d devastatingly a c c u r a t e . It interested me t h a t s h e seemed to be able to observe o t h e r s in a w a y t h a t she could n o t observe herself. However, h e r observations of others never included positive affect a n d a t t i m e s seemed to m e to be b a s e d on misinterpretations, which led h e r to a c t in w a y s t h a t h a d u n f o r t u n a t e c o n s e q u e n c e s for h e r . During t h e c o u r s e of working together I c a m e to appreciate how h e r intuitions a b o u t o t h e r s could be u s e d in t h e treatment—serving a s a n affirmation of h e r interest in t h e h u m a n m i n d , even if it w a s n o t h e r own mind. 2 At first glance, it m i g h t s e e m s t r a n g e to claim t h a t a patient with strong borderline t e n d e n c i e s s h o u l d be able to read others' minds, given t h e d i s c u s s i o n of borderline personality disorder in c h a p t e r 9 ("The Roots of Borderline Personality Disorder in- Disorganized Attachment"), w h i c h s t r e s s e s t h a t underlying s u c h pathology is precisely o n e of defective m i n d r e a d i n g . However, we c a n distinguish between t h e capacity to be able to relate to a n d accept a n o t h e r a s a n other, w h i c h T e r e s a clearly lacked, a n d the fleeting, sometimes profoundly a s t u t e i n s i g h t s t h a t borderlines like T e r e s a often exhibit. In u s i n g Teresa's c o m m e n t s on others a s a way of indirectly e n c o u r a g i n g h e r 'to talk a b o u t herself, therefore, we a r e n o t w e a k e n i n g o u r s u p p o r t for a philosophy-ofm i n d point of view. Teresa originally c a m e to t h e r a p y b e c a u s e s h e w a s ordered to in connection with h e r c o u r t b a t t l e s to regain c u s t o d y of her children. S h e h a d four children, all of w h o m h a d b e e n taken away by t h e B u r e a u of Child Welfare (now ACS) for neglect a n d abuse—including a bizarre allegation t h a t s h e h a d performed oral sex o n h e r 8-year-old son. Teresa h a d b e e n physically a n d possibly also sexually a b u s e d herself. T e r e s a did n o t like to talk a b o u t h e r p a s t . S h e h a d a h u s b a n d , with w h o m s h e h a d h a d two of t h e children, b u t t h e y were no 2 Joseph (1989) has pointed out that with patients who are not interested in understanding themselves, one can still work with their wish to be understood. My point is related—that as a prelude to the desire for self-understanding, one can work with the patient's interest in understanding others.

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longer together. Whenever Teresa s a w him, s h e would become agitated afterward, d e n o u n c i n g h i m violently in o u r sessions— although s h e refused to tell m e a n y t h i n g a b o u t t h e e n c o u n t e r s . Teresa rarely spoke a b o u t h e r mother; s h e said t h a t s h e did n o t like to see h e r m o t h e r b e c a u s e "all s h e does is nag me." W h e n I inquired a b o u t w h a t h e r m o t h e r would n a g her about, s h e said: "and now you're going to n a g me?" Teresa also h a d a sister with whom s h e h a d n o contact. Her father h a d deserted t h e family w h e n s h e w a s 9 y e a r s old. S h e did recall one incident shortly before h e r father left, w h e n s h e w a s sitting at t h e kitchen table doing homework, a n d h e c a m e h o m e d r u n k a n d responded to a question s h e a s k e d h i m by s m a s h i n g h e r in t h e h e a d so h a r d t h a t s h e fell o u t of t h e chair. T e r e s a grew edgy a n d defensive in narrating t h i s incident a n d w e n t on to claim boastfully t h a t m a n y other t h i n g s h a p p e n e d to her, b u t they did n o t b o t h e r h e r or have a n y other effect on her. I gathered t h a t from a n early age Teresa h a d b e e n on h e r own. The affect t h a t w a s m o s t p r o m i n e n t in o u r s e s s i o n s w a s h e r rage. Primarily s h e raged against t h e court system—against t h e judges, lawyers (both t h e DAs a n d h e r own lawyers), a n d court officers—but also a g a i n s t t h e m e n t a l h e a l t h system, including me a s its representative. The s e s s i o n s were repetitive a n d varied little in content. This a t m o s p h e r e w e n t on for a long time before I started to observe a change, n o t in t h e c o n t e n t of t h e sessions, b u t in t h a t s h e s t a r t e d to m i s s fewer of them—from coming for two o u t of every four s e s s i o n s to coming almost every week. One day s h e c a m e in, freshly enraged by h e r e n c o u n t e r with a court-appointed psychiatrist a s p a r t on t h e ongoing evaluation of her suitability a s t h e m o t h e r of h e r y o u n g e s t d a u g h t e r . S h e began by telling m e t h a t t h e psychiatrist w a s "all white, alright." When I a s k e d h e r to elaborate, s h e said in a huff: "His h a i r w a s white, h i s coat w a s white, h i s eyebrows were white . . . he w a s all white." S h e t h e n told m e a b o u t a revealing m o m e n t in their interaction. In t h e c o u r s e of h i s interview, t h e psychiatrist posed the s t a n d a r d question: "Do you have t h o u g h t s of h a r m i n g yourself?" Teresa's r e s p o n s e was: "No, b u t I have t h o u g h t s of h a r m ing you!" As' s h e n a r r a t e d t h e story, I felt a r u s h of feelings—in which I w a s able to discern s i m u l t a n e o u s feelings of starting to laugh a n d s t a r t i n g to cry.

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Let m e try to be a s precise a s possible a b o u t m y internal reaction, a s it felt unfamiliar a n d utterly strange. T h e feeling w a s distinct from experiencing a m i x t u r e of opposing things together—expressed, for example, in t h e notion of a "bittersweet feeling" or in t h e way t h a t , in extreme c i r c u m s t a n c e s , pleasure a n d p a i n c a n converge. There w a s s o m e t h i n g unalloyed a n d contradictory a b o u t w h a t I felt, which; it is fair to s u s p e c t , might have b e e n influenced by t h e p a t i e n t ' s desire to rid herself of intolerable feelings a n d , therefore, embodied s o m e t h i n g of her u n i n t e g r a t e d i n n e r world. Having one's own psyche filled in this way from a n o t h e r exemplifies "projective identification." On reflection, I w a s able to analyze m y experience a s follows: I was laughing b e c a u s e of how b r a z e n T e r e s a w a s a n d b e c a u s e I was a m u s e d by h e r (fleeting) s e n s e of having t r i u m p h e d over the psychiatrist. In a way, s h e h a d called h i s bluff: a s h e w a n t e d to k n o w how s h e felt, s h e w a s going to comply a n d tell h i m the u n a d o r n e d t r u t h . I w a s crying, of course, b e c a u s e in drawing attention to h e r own capacity for violence, s h e w a s dooming herself to be j u d g e d unfit a s a m o t h e r . T h e psychiatrist, who met with h e r for a n h o u r , j u d g e d h e r to be incompetent, a n d in his report h e questioned w h e t h e r s h e would ever be fit to be a mother. Teresa's behavior w a s hostile to t h e psychiatrist, a n d it is h a r d l y consoling t h a t h e r avowal of homicidal ideation might be c o n s t r u e d a s intending to a n s w e r t h e question a b o u t suicidal t h o u g h t s in t h e negative. Her behavior w a s b l a t a n t l y self-destructive: it is h a r d to imagine h e r saying a n y t h i n g t h a t would be a s d a m a g i n g to h e r own case. It is helpful to strive to look a t t h i n g s t h r o u g h Teresa's eyes. T e r e s a w a s a w o m a n w h o was incredibly sensitive to slights a n d t e n d e d to m i s r e a d t h e intentions of o t h e r s to h e r a s malevolent: T h u s , I would conjecture t h a t s h e perceived t h e context—and, in particular, t h e psychiatrist's query a n d , indeed, h i s very p e r s o n h o o d — a s a n affront. (His p u r e a n d total w h i t e n e s s exacerbated h e r experience of being j u d g e d a n d condemned.) W h e n t h e .psychiatrist raised the specter of self-harm, s h e felt h a r m e d a n d t h e n r e s p o n d e d in a kind of self-defense. Her w o r d s ostensively deny suicidal intent, b u t on a deeper level this w a s a n e n a c t m e n t in w h i c h she performed h e r own suicide directly in front of the psychiatrist.

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I would like to describe one other incident t h a t occurred in Teresa's t r e a t m e n t . We h a d b e e n meeting for a l m o s t two y e a r s when, o n e day, s h e c a m e in a n d s a t down. After a few m i n u t e s of silence, s h e said sharply: "Man, look a t you! Don't you k n o w anything . . . you're going to c a t c h cold, if you walk a r o u n d like that." (I realized t h a t s h e w a s looking a t m y leg where, between the top of m y s o c k s a n d m y t r o u s e r s , a b o u t two i n c h e s of flesh w a s exposed.) S h e c o n t i n u e d : "Now listen to m e . . . if you c a t c h cold, this is w h a t y o u should do: you m a k e yourself s o m e tea; t h e n you t a k e a t e a s p o o n of h o n e y a n d lemon. You d r i n k t h a t , a n d you'll b e all better." S h e s h o o k her head, grinning a n d t r i u m p h a n t : "You o u g h t to listen-to me. I know w h a t I'm talking about." This little interaction w a s notable a s it c o n t a i n s a r a r e i n s t a n c e of positive affect expressed by Teresa. Teresa m e a n t well, regardless of s o m e t h i n g b o s s y a n d scolding a b o u t h e r tone a n d h e r quirky perception of reality, revealed in h e r loose associations. T h e affective quality to h e r language r e n d e r e d the literal e x c h a n g e of w o r d s to be less relevant. One could discern, I t h i n k , a w i s h on Teresa's p a r t to express concern for my welfare. This interaction w a s moving b e c a u s e of h e r expression of e m p a t h y a n d care, suggesting t h a t , after two years, s h e felt less oppositional a n d , p e r h a p s , w a s offering a reciprocating gesture t h a t s h e felt cared for by me. B u t t h e t r u t h is t h a t I did n o t often have t h e feeling t h a t I w a s helping her. Very little of w h a t I actually said seemed to m a t t e r ; w h a t did matter, I believe, w a s t h a t I listened to her—being listened to, without being j u d g e d , w a s a n experience conspicuously a b s e n t from h e r p a s t history or p r e s e n t reality. (Notice t h e repetition of t h e word "listen" in t h e patient's expression of h e r concern for me.) From w h a t I could tell, T e r e s a lived a n extremely isolated life. Her b e s t friend—the only friend s h e ever spoke about—a h o m e less w o m a n , w h o could u s u a l l y be found in one of t h r e e or four locations, would' d i s a p p e a r for s t r e t c h e s of time. T h u s , it w a s significant t h a t s h e w a s able to form e n o u g h of a b o n d with m e to move from coming halfheartedly a n d u n d e r d u r e s s to coming by choice. Her rage r e m a i n e d o b d u r a t e t h r o u g h o u t t h e treatment. T e r e s a felt wronged in a profound sense, a n d , in i m m e r s ing herself in fighting alone in t h e court system, m a n a g e d to find

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a willing conspirator in m a k i n g h e r feel wrong—not necessarily w i t h o u t justice, b u t certainly w i t h o u t c o m p a s s i o n . I n s t a n c e s of positive affect r e m a i n e d r a r e a n d too c h a r g e d to be openly acknowledged. We h a d some t o u c h i n g m o m e n t s , however, w h e n s h e would m a k e m e l a u g h or smile, a n d while s h e would not overtly reveal it, I could tell t h a t this pleased h e r a n d could even w i t n e s s h e r a t t e m p t to s u p p r e s s h e r own positive reaction. If I tried to d r a w attention to o u r s h a r e d p l e a s u r e , s h e would brutally reject it. T h e t r e a t m e n t ended a b r u p t l y after a problem with h e r Medicaid coverage a n d m y s u b s e q u e n t depart u r e from t h e clinic. T h u s o u r work would r e m a i n incomplete. A year or so later, however, I s a w T e r e s a on t h e street. She w a s preoccupied, looking t h r o u g h a garbage can* a n d did not look u p . I w a n t e d to greet her, b u t I also did n o t w a n t to intrude; I decided t h a t if s h e s a w me, I would say hello. Quickly, the m o m e n t p a s s e d . As I walked away, I felt a n overwhelming feeling of s a d n e s s .

Discussion T h e r a n g e of affects t h a t T e r e s a displayed w a s limited a n d repetitive. Her rage w a s explosive, a n d a t times, frightening. 3 Her reaction to t h e court psychiatrist w a s d i s t u r b i n g b e c a u s e it revealed how seriously s h e m i s r e a d t h e i n t e n t i o n s of others. Her hostility here is b e s t u n d e r s t o o d a s a n a t t e m p t to fend off w h a t felt to h e r like hostility being directed a t h e r . This is suggestive, p e r h a p s , of t r a u m a t i c r e e n a c t m e n t a s well a s a n eruption of p r i m a r y process. T e r e s a showed little evidence of being able to identify or distinguish affects. Not surprisingly, t h i s h a d Implications for 3

Narcissistic rage, in Kohut's sense (Kohut 1972), is relevant here, as this patient's damaged self-esteem leaves her feeling vulnerable, requiring her to keep others at a distance and at times erupting with aggression. I describe an incident that occurred with Teresa, in which she got out of her chair and threatened to hit me, in my review article of John Steiner's Psychic Retreats (Jurist 1997).

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w h e t h e r s h e w a s able to regulate h e r affects. Her rage flared u p and automatically p o u r e d out; it loomed ominously in h e r psychic functioning. T e r e s a m u s t have felt t r e m e n d o u s fear in t h e situation of having to defend herself a s a mother, yet h e r rage c o n t a m i n a t e d t h e experience of this or a n y other affects. Her rage seemed n o t so m u c h like a hyperbolic form of anger, b u t a monolithic, domineering presence. As m y experience of s t a r t i n g to l a u g h a n d cry together s u g gests, T e r e s a ' s projective identification b o t h m a s k e d a n d u n veiled a confused, disorganized i n n e r world. It provided a window into h e r fragmented s e n s e of agency. Problems in h e r s e n s e of agency emerged clearly in t h e episode with t h e court psychiatrist: a l t h o u g h h e r wish to be deemed a worthy m o t h e r w a s strong, h e r behavior e n s u r e d t h a t s h e would be a s s e s s e d a s unworthy. The c o n s e q u e n c e s of T e r e s a n o t being able to regulate h e r affects were d r a m a t i c . Her negative affects overwhelmed her. It is equally p e r t i n e n t t h a t even where s h e felt positive affect (to me), there w a s a tinge of some aggression a s well. It did n o t feel safe for T e r e s a to feel positive affect; indeed, s h e worked at curtailing it, r a t h e r t h a n risk expressing it. In t h i s interaction with me, we c a n w i t n e s s Teresa's struggle to be able to tolerate positive affect. One would b e h a r d p r e s s e d to find evidence t h a t Teresa possessed mentalized affectivity. Indeed, it is interesting how m u c h I felt m y own affect regulation to be undermined—for example, in m y r e s p o n s e to h e r story a b o u t t h e court psychiatrist a n d especially in m y r e s p o n s e to meeting h e r on the street after t h e t r e a t m e n t h a d ended. T e r e s a w a s a difficult patient to whom one's own c o u n t e r t r a n s f e r e n c e reactions were powerful; yet, t h e s e reactions provide one of t h e only clues to infer w h a t she w a s experiencing. Teresa showed h i n t s of developing a connection to h e r t h e r a pist. This w a s a promising sign, in m y opinion, of some potential to develop a m e a s u r e of mentalized affectivity in a long-term, ongoing t r e a t m e n t . Whenever a p a t i e n t exhibits a s e n s e of humor, t h e r e is hope, a n d T e r e s a h a d a delightful if wicked sense of h u m o r . W i t h o u t mentalized affectivity, T e r e s a is b o u n d

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to r u n into a n d repeat p r o b l e m s in h e r life. Her t r e a t m e n t w a s interrupted, a n d , therefore, we c a n only imagine w h e t h e r a n d to w h a t degree s h e might h a v e acquired mentalized affectivity.

"BENNIE" Bennie is a J e w i s h m a n in h i s early fifties. He grew u p in a working-class family j u s t outside New York. He w a s a n excellent s t u d e n t a n d won a s c h o l a r s h i p to a t t e n d a n elite university, where h e majored in history. Bennie fell a p a r t d u r i n g h i s junior year a n d h a s never recovered t h e s a m e level of functioning. He once showed m e h i s college transcript, w h i c h provides dramatic evidence of t h e manifestation of h i s illness: d u r i n g h i s freshman year, he received g r a d e s of Bs mostly a n d a few Cs; d u r i n g his s o p h o m o r e year, h e received mostly B s again, with one A and one C; d u r i n g t h e Fall s e m e s t e r of h i s j u n i o r year, h e failed every course. He m a d e a few a t t e m p t s to enroll again before dropping out permanently. Bennie's d e c o m p e n s a t i o n is c o n s i s t e n t with t h e classic sympt o m s of schizophrenia. Over t h e years, h e h a s h a d n u m e r o u s b r e a k d o w n s a n d hospitalizations. He s p e n t a l m o s t a decade living on t h e s t r e e t s a n d in SRO's (single rooms), refusing medication a n d relishing h i s choice to live within a delusional world. Bennie c a n be extremely articulate a b o u t t h i s time of h i s life, as w h e n h e describes h i s identification with Native Americans, w h i c h led h i m to w a n d e r t h r o u g h Riverside P a r k "on a sacred q u e s t for meaning," i m m e r s i n g himself in observing tiny details of p l a n t a n d a n i m a l life, indifferent only, h e is aware, to the p r e s e n c e of other h u m a n beings. Bennie recalls t h i s time a s a period w h e n h e w a s fully alive, a n d h e b e c o m e s defensive in the face of being reminded of h i s suffering—for example, occasions w h e n h e w a s b e a t e n u p on t h e streets. About eleven y e a r s ago, Bennie moved into a social service hotel. He h a s a social worker there, a n d h e also a t t e n d s a vocational g r o u p once a week. He h a s h a d several psychologists over t h e years, whom, for t h e m o s t part, h e r e m e m b e r s fondly.

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He h a s s e e n n u m e r o u s p s y c h i a t r i s t s w h o m h e recalls more ambivalently. He likes h i s c u r r e n t psychiatrist very m u c h a n d sees h e r once a m o n t h . He is diligent a b o u t taking h i s medication for h i s c u r r e n t diagnosis of schizoaffective disorder. About ten y e a r s ago, h e h a d to be b r o u g h t to t h e emergency room b e c a u s e h e w a s s c r e a m i n g "kill t h e J e w s , kill t h e J e w s " while thinking a b o u t h i s father in h i s room; he w a s released t h e following day. I h a v e b e e n seeing Bennie twice a week for the last nine years. He never m i s s e s h i s a p p o i n t m e n t s , a n d h e t a k e s p s y c h o t h e r a p y seriously—often bringing in a list of topics h e w a n t s to talk about. We h a v e a good working relationship. He is no longer actively delusional, a l t h o u g h h e does have peculiar compulsive habits—like finding himself eating in r e s t a u r a n t s in r h y t h m with conversations a t other tables, or like watching h i s clock until 6:05 b e c a u s e "605" w a s t h e street a d d r e s s of t h e h o u s e where he grew u p . Bennie frequently h a s ideas of reference; interestingly, when we work together on examining these, h e c a n distinguish among their plausibility a n d will jokingly rate t h e m in percentage to their relation to reality—usually with a fair degree of accuracy. H u m o r h a s emerged to be a crucial c o m p o n e n t in m y work with Bennie. It is a w a y for h i m to tolerate s h a r e d m o m e n t s without feeling t h r e a t e n e d . M o m e n t s of h u m o r s t a n d in lieu of, b u t m i g h t be s e e n a s a promise for, a more abiding s e n s e of closeness to others. Bennie's daily life is uneventful. He w o r k s two mornings a week a s a n English-language tutor. He h a n g s o u t in the lobby of his building. He h a s a favorite r e s t a u r a n t in his neighborhood, where h e e a t s a l m o s t all h i s meals; he h a s some social c o n t a c t with o t h e r t e n a n t s in h i s building, a n d he also h a s a few college friends with w h o m h e k e e p s u p . His p a r e n t s have moved far away, to be n e a r a sister who is married a n d who h a s a d a u g h t e r who is in medical school. Minute details of interactions with others often become t h e focus of o u r sessions. Bennie c a n be profoundly affected by a friendly glance from t h e storekeeper a t the Korean grocery. In general, Bennie is hypersensitive to others. However, he is not always a s t u t e in h i s u n d e r s t a n d i n g of others' intentions. T h e

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behavior of o t h e r s c a n swiftly become t h e b a s i s of elaborate fantasies, some of which h a v e a distinctly p a r a n o i d flavor. He will imagine s o m e o n e looking at h i m on t h e b u s a n d t h e n invent tales of who t h e p e r s o n is a n d w h a t h e / s h e t h i n k s of him. Bennie t e n d s to keep h i s d i s t a n c e from others; yet, h e is also d e p e n d e n t in t h e relationships h e has—especially t h e g r o u p of m e n t a l - h e a l t h w o r k e r s on w h o m h e relies to s u s t a i n him. He is b o t h afraid of real c o n t a c t with o t h e r s a n d craves it. Occasionally, Bennie is able to be deeply in t o u c h with his u n c o n s c i o u s life t h r o u g h h i s d r e a m s . He h a s n a r r a t e d d r e a m s t h a t last for 2 5 m i n u t e s , leaving m e overwhelmed a n d confused by t h e s h e e r intensity of t h e imagery. He t e n d s to b e more interested in n a r r a t i n g t h e d r e a m s t h a n h e is in interpreting t h e m . He does h a v e a r a r e capacity to b e in t o u c h with psychotic p a r t s of himself a n d to bring t h e m into t h e t r e a t m e n t . It is difficult to k n o w to w h a t extent Bennie's r e p o r t s a b o u t h i s relationship to h i s p a r e n t s a n d h i s early life in general are reliable. He r e g a r d s h i s m o t h e r a s intrusive a n d domineering, a n d h i s father, who died a t 89 y e a r s of age after m a n y y e a r s of incapacitating illness, a s u n r e s p o n s i v e a n d occasionally cold a n d even hostile. In p h o n e calls prior to h i s father's death, Bennie w a s d i s t u r b e d b y h i s father's r e s p o n s e to. h i m a n d h a d seemingly little appreciation for t h e extent of h i s father's infirmity. Bennie chose n o t to go to h i s father's funeral, b u t he did j o u r n e y to be with h i s family a few w e e k s after t h a t . His reactions to h i s father's d e a t h h a v e mostly featured h i s disappointm e n t with h i s father, a n d he h a s only expressed overt grief on one occasion. Bennie is fragile a n d h a s s t r o n g guilt feelings a b o u t being a d i s a p p o i n t m e n t to h i s p a r e n t s , so I have not p u s h e d h i m to deal with t h i s loss. Bennie u n d e r s t a n d s t h a t h e m u s t b e vigilant a b o u t n o t allowing himself to act on t h e b a s i s of h i s t h o u g h t s . S o m e t i m e s he b e c o m e s grave a n d still, p o n d e r i n g h i s mind, w h i c h regularly m a n u f a c t u r e s false or a t least unreliable beliefs. Although I have confidence t h a t h e c a n identify signs of becoming actively psychotic a n d t h a t we might h a v e a c h a n c e to intervene to stop further d e c o m p e n s a t i o n , it is h a r d e r to k n o w w h a t constitutes s u c c e s s in t h e t r e a t m e n t . M a n y m e n t a l - h e a l t h professionals would scoff a t t h e notion of a successful o u t c o m e for a schizo-

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phrenic in psychotherapy. O t h e r m e n t a l - h e a l t h professionals would b e inclined to e m p h a s i z e t h a t staying t h e c o u r s e a n d monitoring Bennie from getting worse is itself a positive o u t c o m e a n d n o t to be minimized. Indeed, Bennie's positive s y m p t o m s have b e e n well-controlled by t h e combination of p s y c h o t h e r a p y a n d psychopharmacology, a l t h o u g h h i s negative s y m p t o m s — n o t getting o u t of bed, n o t keeping himself a n d h i s room clean, n o t finishing projects he begins—remain a problem. I have b e e n s t r u c k by Bennie's n e e d for self-understanding, a n d this h a s been a guiding light t h r o u g h o u t t h e t r e a t m e n t . Bennie c o n t i n u e s to battle h i s devastating illness. A m e a s u r e of h i s s u c c e s s c a n b e m a r k e d by h i s c u r r e n t work a s a t u t o r in reading a t a public library, for w h i c h h e h a s received heartfelt t h a n k s from a n u m b e r of h i s s t u d e n t s . Yet, Bennie's well-being h a s its vicissitudes, a n d h e s e e m s to be sitting on a well of s a d n e s s . Like m o s t o t h e r people, h e benefits from exploration of his p e r s o n a l history a n d d y n a m i c s . In h i s case, t h o u g h , t h e project of self-understanding m u s t c o n t e n d with t h e e n o r m o u s power a n d force of h i s disorder.

Discussion Bennie is a p a t i e n t w h o h a s a serious m e n t a l illness. The illness interferes with h i s perception of reality, a n d , t h u s , Bennie's reading of t h e i n t e n t i o n s of o t h e r s c a n often be dangerously mistaken. In particular, Bennie c a n be quite p a r a n o i d in t h e way h e c o n s t r u e s w h a t a p p e a r to be i n n o c u o u s interactions. With s u c h a patient, it is n o t possible to expect a high degree of affectivity. Bennie does exhibit a r a n g e of affects. He is able to identify affects like fear, s a d n e s s , a n d anger. Moreover, h e is able to identify, distinguish, a n d e x p r e s s positive affects a s well. Bennie h a s activities t h a t h e enjoys, like listening to m u s i c a n d drawing. He c a n be w a r m a n d concerned for others—he notices a n d expresses s y m p a t h y if I have a cold, a n d h e dotes on h i s 3-yearold nephew. He h a s intervened to get help for o t h e r s in t h e social services building in w h i c h h e lives. Yet, it is difficult for h i m to s u s t a i n positive affects in relationships.

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Although Bennie h a s a r a n g e of affects, h e h a s difficulty modulating t h e m . Let m e offer a n example: d u r i n g a visit with h i s n e p h e w a t a r e s t a u r a n t , h e w a s pleased to engage in a game of hide a n d seek u s i n g a m e n u , b u t w h e n t h e n e p h e w fell asleep shortly thereafter, Bennie's interpretation w a s t h a t it m u s t have b e e n b e c a u s e he w a s bored with Bennie's c o m p a n y . His anxiety a b o u t being disregarded is played o u t with a y o u n g child— without a n y appreciation t h a t t h e child's sleepiness m i g h t have a n i n d e p e n d e n t c a u s e . W h e n I tried to d r a w a t t e n t i o n to other possible i n t e r p r e t a t i o n s of t h e n e p h e w ' s behavior, Bennie could appreciate t h a t h e w a s j u m p i n g to a conclusion. Yet, it is clear t h a t h e would n o t h a v e come to this point by himself. W h a t a b o u t Bennie's reaction to a major life experience, s u c h a s h i s father's d e a t h ? It does n o t a p p e a r t h a t h e is p a s s i n g t h r o u g h some of t h e c o m m o n , expected s t a g e s of grief. In one sense, he uncompromisingly refuses to revise or minimize the extent of h i s negative feelings a b o u t h i s father. Yet, t h e r e is some kind of failure in regulation t h a t is revealed in h o w h e t h i n k s a b o u t h i s father—as well a s h i s widowed m o t h e r . Bennie is a t a loss a b o u t w h a t to do a b o u t h i s father's d e a t h . He r e p o r t s having m o m e n t s w h e r e s o m e t h i n g a b o u t h i s father flashes t h r o u g h his mind, b u t h e is n o t inclined to u s e t h i s a s a b a s i s of reflection a b o u t w h a t h i s father m e a n t to him. Bennie feels a deep, deep s a d n e s s a b o u t t h e trajectory of his life. He is aware of having a m i n d t h a t does n o t w o r k right. At t h i s point in h i s life, h e is r e m a r k a b l y a d e p t a t r e m a i n i n g free of trouble. I try to be with h i m in h i s m o m e n t s of s a d n e s s without unrealistically raising expectations of a b e t t e r tomorrow. The work t h a t we do together h a s implications for mentalized affectivity. In reviewing h i s ideas of reference, Bennie c a n sometimes d i s t a n c e himself from some of h i s a s s u m p t i o n s t h a t h e is inclined to m a k e by himself. This often leads h i m to distinguish his affects better a n d to b e able to m o d u l a t e t h e m . It is significant t h a t t h i s does n o t h a p p e n w h e n Bennie is alone. However, he would h a v e resisted s u c h a m u t u a l effort d u r i n g t h e first five to six y e a r s of t h e t r e a t m e n t . In conclusion, I would like to r e t u r n to Bennie's s e n s e of h u m o r . W h e n h e l a u g h s , it s o u n d s like t h e clanking of a r u s t y

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machine. Bennie c a n tolerate m u t u a l positive affect t h r o u g h h u m o r . As I h a v e already suggested, h u m o r serves to join u s in intimate m o m e n t s a n d a s a fleeting m a r k e r of greater satisfaction. Bennie feels closer to m e t h a n to anyone else in h i s life. Indeed, it is not all i n a d v e r t e n t t h a t Bennie's closest relationships a r e with m e n t a l - h e a l t h professionals; relations with o t h e r s have b e e n m u c h m o r e conflicted a n d confusing. O u r work together e n a b l e s Bennie to experience g e n u i n e m o m e n t s of connection a n d to s u s t a i n h i s c o m m i t m e n t to finding a meaningful life for himself. With some help, Bennie h a s m o m e n t s in w h i c h he exhibits t h e capacity to reflect on h i s affects. Although it is p e r h a p s idealistic to h o p e t h a t h e m i g h t attain mentalized affectivity m o r e fully, t h e battle to seek it is surely worth fighting.

"SCOTT" Scott is a 40-year-old m a n who w a s raised in a middle-class family a n d grew u p in v a r i o u s places in t h e Midwest a n d in Arizona. His early life w a s characterized by n u m e r o u s moves, which left h i m with few friends a n d lonely. In high school, h e started to t r u a n t a n d to d r i n k a n d do d r u g s . In h i s early twenties, h e moved to New Mexico to b e c o m e a p a i n t e r a n d to work in a n art gallery. At t h i s time, h e d r a n k a n d s m o k e d heavily a n d did lots of d r u g s . Scott w a s married for t h r e e years, neglecting his wife until eventually s h e left h i m to r e t u r n to h e r p a r e n t s ' home. Scott h a d m a n y c a s u a l relationships a n d a few more serious ones d u r i n g t h e s e years. As h i s life in t h e fast lane b e c a m e increasingly self-destructive, Scott t u r n e d to t h e r a p y for help. He spent t h r e e y e a r s in t h e r a p y a t t h a t time, which helped h i m to stop a b u s i n g s u b s t a n c e s a n d led to h i s decision to move to New York. Scott h a s little c o n t a c t with h i s family. He h a s n o t s e e n h i s p a r e n t s in seven years; h e receives letters from h i s m o t h e r a few times a year, including C h r i s t m a s . His father, a fairly successful b u s i n e s s m a n , w a s t o u g h a n d bullying a n d disdained h i s s o n ' s artistic leanings. He himself h a d n o t gone to college, a n d h e

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t h o u g h t it w a s a w a s t e of time for others. Scott describes his m o t h e r in generic t e r m s : a s a typical 1950s' housewife, passive a n d conventional. Scott h a s a y o u n g e r sister, who is gay a n d who h a s b e e n in a committed relationship for m a n y years; Scott h a s n o t s e e n h i s sister in four years. Scott w a s particularly close to h i s p a t e r n a l g r a n d m o t h e r . W h e n h e w a s 6 y e a r s old, he w a s s e n t to live with h e r for two years—ostensively b e c a u s e t h e air in Arizona would be better for his health. (He h a d a respiratory problem of u n k n o w n severity.) Scott now s u s p e c t s , however, t h a t he m i g h t h a v e b e e n s e n t away b e c a u s e h i s m o t h e r felt overwhelmed with dealing with him. This insight is b a s e d u p o n some key memories where Scott recalls beseeching h e r to play with h i m a s s h e ironed or cleaned, a n d s h e reacted by getting fed u p , fleeing to t h e bedroom, a n d s h u t ting t h e door b e h i n d her. Although Scott felt loved by h i s g r a n d m o t h e r , h e h a d a dawning a w a r e n e s s t h a t s h e w a s d i s t u r b e d . He c a m e to see t h a t she w a s unreliable a s a storyteller, m a k i n g u p t h a t s h e owned property t h a t h e would inherit a n d t h a t s h e w a s friendly with famous people w h o m t h e y s a w on television. S h e u s e d multiple n a m e s , which, Scott later ascertained, h a d to do with t h e fact t h a t she h a d b e e n m a r r i e d six times. S h e also tried to influence Scott a g a i n s t h i s m o t h e r . Later in life, s h e traveled a r o u n d for years, staying with a c q u a i n t a n c e s all over t h e c o u n t r y w i t h o u t having h e r own h o m e . This g r a n d m o t h e r died alienated from Scott a s well a s from Scott's p a r e n t s . Scott h a d some s u c c e s s in t h e a r t world in New Mexico, b u t h e also h a d some failures, a n d in h i s mid-thirties h e decided t h a t w h a t h e really w a n t e d to do w a s to get a n education. At the time he entered t r e a t m e n t with me, he h a d a t t e m p t e d to attend college n u m e r o u s times w i t h o u t h a v i n g completed a semester. Scott h a s b e e n in t r e a t m e n t for five years; D u r i n g t h a t time, h e h a s won two s c h o l a r s h i p s a n d several a w a r d s , a n d h e h a s s p e n t a year a b r o a d . He h a s also r e t u r n e d to painting. Interestingly, h e formed a relationship with a w o m a n while h e w a s away. W h e n h e r e t u r n e d to t r e a t m e n t after t h e year a b r o a d , h e rejected t h e possibility of trying to r e m a i n in a long-distance relationship. Scott h a s a m b i t i o u s career plans, including organizing a n art exhibition a t a major m u s e u m . At t h e s a m e time, h e h a s h a d to

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struggle n o t to allow incompletes to m o u n t up—jeopardizing h i s achievement. In t h e context of d i s c u s s i n g this situation, h e told the following story: h e h a d t u r n e d in a p a p e r for a n English class to complete a course, w h i c h w a s a n a c c o m p l i s h m e n t a n d also a great relief. T h e following week h e w a s reading in t h e library, a n d he b e c a m e a w a r e of s o m e o n e walking by him, a n d h e h e a r d a voice. He looked u p to see t h a t it w a s h i s English professor, w h o w a s talking to him, telling h i m t h a t t h e p a p e r w a s excellent a n d t h a t h e h a d enjoyed reading it. Scott realized t h a t h e did n o t c o m p r e h e n d w h a t w a s said until later, a n d h e w a s u n a b l e to respond directly, m u m b l i n g s o m e t h i n g t h a t w a s incoherent. As Scott s a t a n d t h o u g h t a b o u t t h e incident, h e b e c a m e aware t h a t , a t t h e m o m e n t h e perceived t h a t t h e p e r s o n n e a r him w a s h i s professor, h e w a s anticipating criticism—that he would b e told t h a t t h e p a p e r w a s terrible a n d t h a t t h e professor was disappointed in h i s efforts. His s e n s e of confusion d u r i n g the interaction w a s produced, according to Scott, by t h e conflict between t h e imagined voice in h i s h e a d a n d the real external voice. He averred t h a t t h i s conflict h a d to do with difficulty in believing in h i s own success—even t h o u g h h e h a d worked h a r d a n d deserved it. Moreover, t h e internal voice reminded h i m of h i s domineering father, w h o never believed in h i s s u c c e s s a n d who derided h i s interest in education. It is interesting how t h e professor's praise m a n a g e s to be blocked, in effect preventing a n experience of positive affect. As Scott reflected a b o u t t h e incident after it h a d occurred a n d before talking a b o u t it in therapy, h e was c o n s u m e d with worry t h a t he h a d insulted t h e professor by not r e s p o n d i n g appropriately; h e also felt vaguely u p s e t at himself. In o u r session, Scott w a s able to allow himself gratification with s o m e p r o m p t i n g a n d to e x p r e s s pride t h a t his work w a s praised. This incident s h o w s Scott's internal world prohibiting t h e experience of positive affect—the intermingling between (imagined) negative affect a n d (actual) positive affect paralyzed h i m . Scott w a s also able to m a k e s e n s e of s o m e of h i s emotions. Still, when he is by himself, he s t a y s with feeling b a d . With help in t h e session, h e moves to a m e n d this, r e s u l t i n g in some regret a b o u t what h a p p e n e d b u t primarily a s e n s e t h a t h e ought to feel good. The patient's t e n d e n c y toward negative affect is e n t r e n c h e d

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e n o u g h to prevent h i m from h a v i n g positive affect a t first, b u t n o t so e n t r e n c h e d t h a t it m u s t be excluded a t all cost. The interaction, which h e r e p o r t s a s a kind of b y s t a n d e r to himself, is altered so t h a t h e u n d e r s t a n d s t h e incident a n d t h e n reexperiences it. There h a s b e e n a n interesting c h a n g e in Scott's relationship to h i s own affects over t h e c o u r s e of t h e t h e r a p y . At t h e beginning of t h e t r e a t m e n t , it w a s a s striking a s it w a s perplexing t h a t he would omit reports of feelings a n d a t times mislabel his feelings—like t h e opening m o m e n t of a s e s s i o n (already mentioned in t h e section on T h e E l e m e n t s of Mentalized Affectivity" in this chapter), after h e h a d j u s t learned t h a t a w o m a n on w h o m he h a d a c r u s h for several m o n t h s w a s getting engaged, w h e n h e a n n o u n c e d : "I've b e e n feeling pretty good. . . ." Alt h o u g h it is helpful to aid Scott in identifying h i s feelings, being too direct in doing so c a n actually backfire. A few y e a r s into t h e t r e a t m e n t , Scott c o n t i n u e s to struggle to be able to experience h i s own affects. For i n s t a n c e , h e r e t u r n e d from a n a p p o i n t m e n t with a doctor who, after a n u m b e r of tests, told h i m t h a t a chronic urological problem h e h a s is d u e to a congenital problem with h i s kidney. Scott w a s told t h a t h e might require surgery—with two options: a m o r e serious operation or a newer, less painful, b u t also m o r e u n c e r t a i n high-tech procedure. I a s k e d Scott w h a t h e t h o u g h t a b o u t t h e situation. He responded: "Well, I don't feel too worried. . . . I m e a n , I h o p e t h a t I won't end u p having kidney failure. I would h a t e to have to go to dialysis, which is t i m e - c o n s u m i n g a n d would get in t h e way of m y work." Despite t h e ostensive denial of feeling worried, Scott went on to m a k e it fairly evident by j u m p i n g to a worst-case scenario— t h a t , naturally, he w a s quite concerned. From experience I was a w a r e t h a t Scott's i m p u l s e n o t to acknowledge w h a t he feels could h a v e t h e u n d e s i r a b l e effect of r e n d e r i n g h i s feelings more extreme. However, I w a s also concerned t h a t too active a n interpretation a b o u t h i s affect s t a t e m i g h t m a k e h i m defensive a n d d i s p u t a t i o u s . Scott h a d s o m e t h i n g a t s t a k e in talking a b o u t his affect s t a t e w i t h o u t specifying it—as if to w a r d off falling into the s t a t e w i t h o u t h o p e of getting o u t of it. With s o m e help, though,

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h e w a s a b l e to move in t h i s direction—that is, to feel appropriately worried, mindful of b o t h h i s personal history a n d t h e immediate c i r c u m s t a n c e s . Scott a n d I h a v e h a d s u c c e s s in working on h i s relation to h i s affects, particularly t h r o u g h h i s interest in art. Art serves t h e complex function of allowing h i m to d i s t a n c e himself from a n d a t the s a m e time to p r o c e s s h i s affects. There is one painting in which h e h a s developed a s t r o n g interest, which depicts a s c e n e from Homer's Odyssey. T h e context is O d y s s e u s ' famous encounter with t h e Cyclops, Polyphemos, who savagely gobbles u p a few of O d y s s e u s ' m e n . T h e s c e n e reveals O d y s s e u s a t h i s b e s t a n d worst: h e r e s t r a i n s himself from acting, devising a resourceful way to save h i s m e n a n d himself, b u t t h e n h e jeopardizes all of their survival by indulging in his omnipotence. He devises t h e resourceful p l a n of getting Polyphemos d r u n k a n d t h e n blinding him with a huge, s h a r p e n e d pole. This e n a b l e s O d y s s e u s a n d h i s m e n to crawl o u t of Polyphemos' cave by tying themselves to t h e underbelly of sheep; w h e n t h e blinded Cyclops s e a r c h e s for them, t o u c h i n g t h e b a c k s of t h e sheep, they escape u n d e t e c t e d . After t h e y h a v e successfully e s c a p e d a n d a r e a b o u t to depart, however, O d y s s e u s yells o u t to Polyphemos, t a u n t i n g h i m t h a t his n a m e is "Nobody." This provokes Polyphemos into tossing a massive boulder, w h i c h comes close to shipwrecking t h e b o a t a n d dooming their survival. T h e p a i n t i n g t h a t Scott is working on r e p r e s e n t s t h e precise m o m e n t w h e n O d y s s e u s b o a s t s to t h e Cyclops. O u r interpretation of t h e p a i n t i n g h a s b e e n ongoing a n d from multiple angles. First of all, Scott's father, w h o m h e experienced a s bullying a n d uncivilized, r e s e m b l e s t h e d a n g e r o u s Cyclops. This r e s e m b l a n c e w a s confirmed t h r o u g h a quite extraordinary fact t h a t c a m e o u t in interpreting Scott's relationship to t h e painting: like t h e one-eyed Cyclops, Scott's father is blind in one eye—having suffered a n accident a s a y o u n g m a n . T h e oedipal theme is p r o m i n e n t , a s Scott identifies with O d y s s e u s who asserts himself with phallic aggression a g a i n s t Polyphemos. The blinding of Polyphemos, like O e d i p u s ' s self-blinding, is a kind of symbolic c a s t r a t i o n . However, we have also p o n d e r e d t h e importance of t h e (pre-oedipal) t h e m e of omnipotence suggested by t h e

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painting. 4 The p a i n t i n g r e s o n a t e s with Scott, we discovered together, precisely b e c a u s e it gives expression to t h e d a n g e r he associates with s t r o n g affect. T h r o u g h t h e external r e p r e s e n t a t i o n of art, Scott h a s found a way to observe h i s inner conflicts. Indeed, it is h a r d to imagine t h a t h e would be able to deal with t h e s e i s s u e s a s comfortably without t h i s distance. It is interesting t h a t h i s intellectuality provides a m e a n s for h i m to be in t o u c h with deep emotional i s s u e s . Scott h a s articulated t h e insight t h a t h e m i g h t have learned t h a t it is b e t t e r n o t to feel, since feeling is linked to aggression t h a t gets o u t of control. It is r a t h e r interesting t h a t O d y s s e u s a c t s uncharacteristically here: he is u s u a l l y depicted a s someone who gets w h a t h e w a n t s t h r o u g h r e s t r a i n t a n d a d h e r i n g to a c o u r s e of moderation. Ironically e n o u g h , t h e n , we might conclude t h a t t h e p a i n t i n g provides n o t merely a diagnosis, b u t t h e p a t h for a c u r e for Scott.

Discussion The a b s e n c e of affect w a s a notable p a r t of t h e early p h a s e s of Scott's therapy. 5 Not only did h e omit affects w h e r e one would expect t h e m , b u t often h e did n o t describe t h e m a s p a r t of his experience a t all. At times, h e would s e e m to mislabel h i s feelings. Not surprisingly, h e h a d very little overt r e s p o n s e in his transference to me. I recall t h a t Scott would p a u s e to h e a r me s p e a k a n d t h e n c o n t i n u e a s if it were merely a n interruption of h i s own line of thinking. This changed, particularly d u r i n g b r e a k s for vacations, w h e n Scott reported physical illnesses t h a t

4 The oscillation of narcissistic self-esteem is conveyed in the contrast of extremes between "Polyphemos." which means "much-famed" in Greek, and "Nobody," the false name Odysseus gives to himself (the Greek word "Oudos" here is a play on Odysseus* real name). In the treatment, Scott's narcissism came up in the context of his reading and his awareness of his own narcissistic tendencies. 5 Scott reminded me of the alexithymic patients whom Krystal (1988) describes who often abuse substances as a way of distancing themselves from painful affects. Also, like the patients Krystal describes, Scott would report onesentence dreams—without any ability to provide associations.

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we could u n d e r s t a n d in t e r m s of t h e t r e a t m e n t a s protection against p a i n . It w a s quite i m p o r t a n t t h a t t h e t r e a t m e n t r e s u m e d after Scott's y e a r a b r o a d : he b e c a m e m o r e vulnerable, manifested in a new interest in examining t h e past—like w h e n h e h a d b e e n s e n t away a n d t h e n r e t u r n e d h o m e to h i s family. Although Scott still did n o t openly display h i s affects, I could observe a shift—which can be conveyed in t h e difference between h i s p o s t u r e of "I've been feeling pretty good" in t h e face of a narcissistic rejection a n d a n implicit recognition of h i s s a d n e s s of t h e narcissistic rejection in feeling alone a n d confused after being sent away from h o m e a t t h e age of 6 years. Scott h a s trouble identifying h i s affects, b u t h e is growing to be more interested in m a k i n g s e n s e of h i s affective experience. Given h i s difficulty in identifying a n d distinguishing affects, it is predictable t h a t h e also struggles with regulating t h e m . This is nicely illustrated in Scott's reaction to h i s kidney disorder, where he is e s t r a n g e d from h i s anxieties a n d t a k e s t h e m in a n extreme direction— before m o d u l a t i n g t h e m with t h e help of m y i n p u t . We also see t h a t Scott is more comfortable exploring h i s affects with t h e d i s t a n c e t h a t aesthetic objects provide. There also h a s b e e n evolution in t h e transference. He registers w h a t I say to a greater degree. T h e value of t h e r a p y for h i m is conveyed in t h e way he divides h i s life into a before a n d a n after. Scott does n o t e x p r e s s positive affect a b o u t t h e r a p y or me; this is c o n s i s t e n t with s o m e o n e w h o would need to block positive affect, a s h e does in t h e incident with h i s English professor. Not only h a s h e never a s k e d m e a q u e s t i o n a b o u t myself, he h a s shown very few signs of having s u c h curiosity. Yet, Scott is now able to e x p r e s s negative transference reactions to me—like being bothered by i n t e r r u p t i o n s with vacations a n d occasionally being annoyed by s o m e t h i n g I've said". Scott is now clearly more alive in t h e way he lives. After m a n y years of living precariously—with periods of being down a n d out—he h a s h a d s o m e g e n u i n e s u c c e s s . His education represents a t r i u m p h over t h e d i s c o u r a g e m e n t he received a t h o m e . It is still difficult for h i m to accept w h a t h e feels inside himself. Yet, mentalized affectivity h a s emerged within t h e c o u r s e of t h e r a p y . With s o m e help, Scott is able to reflect u p o n t h e incident with

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t h e English professor, moving from focusing on h i s fear of having insulted t h e professor to p o n d e r i n g h i s own n e e d to interfere with a p l e a s u r a b l e experience. S o m e t h i n g similar o c c u r s with Scott's reflection a b o u t h i s kidney disorder. Although t h e s e ins t a n c e s of affectivity occur in sessions, h e is doing m o r e of t h e work by himself. A promising example of Scott's e m e r g e n t affectivity c a n be s e e n in h i s choice n o t to engage in fruitless confrontations d u r i n g t h e c o u r s e of h i s daily life. T h e first few y e a r s of t h e r a p y were filled with s u c h antagonistic e n c o u n t e r s with others. I recall t h a t in o u r very first s e s s i o n h e described a n u n p l e a s a n t e n c o u n t e r with a security g u a r d , who w a s talking on t h e telep h o n e instead of doing h i s job—checking t h e b a g s of s t u d e n t s exiting t h e library. Scott m a d e a n audible c o m m e n t a b o u t his r e s e n t m e n t a t having to wait a r o u n d ; t h e result, of course, w a s t h a t t h e security g u a r d took h i s time, t h e y exchanged angry words, a n d h e ended u p being delayed still further. Let u s compare this to a r e c e n t incident: Scott w a s crossing t h e street a s a taxi w a s letting a p a s s e n g e r off, blocking h i s way. He tossed t h e driver a dirty look, which p r o m p t e d t h e driver to get o u t of h i s taxi a n d s t a r t yelling a t Scott. Scott h a d a n i m p u l s e to r e t u r n fire with fire, b u t h e decided it w a s n o t w o r t h t h e effort and walked away. Although Scott is still responsible for initiating t h e conflict in t h e second incident, he r e s t r a i n s himself from exacerbating it. Moreover, we c a n see t h i s a s a m o m e n t in w h i c h initially Scott displays h i s feeling of d i s g u s t a t t h e driver outwardly; t h e n he shifts a n d m a k e s t h e choice to e x p r e s s h i s affects internally. In Scott's n a r r a t i o n of this incident, h e w a s a w a r e t h a t h e remained u p s e t a t t h a t m o m e n t , b u t h e felt good a b o u t h a v i n g opted to act in a c c o r d a n c e with a deeper s e n s e of h i s own p u r p o s e . Here Scott displays mentalized affectivity in precisely t h e m a n n e r t h a t t h e Odyssey e n t e r t a i n s in t h e s c e n e of O d y s s e u s deriding Polyp h e m o s . Like O d y s s e u s , w h o m Homer describes a s "polytropos" (he is, literally, t h e m a n of "many ways"), Scott h a s options a b o u t how h e will r e s p o n d . Reflecting u p o n r e a d i n g s of the Odyssey h a s m a d e Scott aware of t h e d a n g e r h e a s s o c i a t e s with t h e expression of affects. His fascination with t h e Odyssey,

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which I h a p p e n to s h a r e , h a s b e e n a meeting place in o u r relationship. Although Scott does n o t exteriorize h i s transference to me, m y r e s p o n s i v e n e s s to interpreting a work of great emotional i m p o r t h a s helped h i m to feel more s e c u r e a n d begin to thrive. T h e c h a n g e in h i s affectivity t h a t we glimpse over time is central to h i s t h e r a p e u t i c progress.

"ROB" Rob is a bright a n d sensitive y o u n g m a n in h i s mid-twenties w h o grew u p in a W a s p (White Anglo-Saxon Protestant) family from the S o u t h . His family w a s close w h e n h e w a s young. Rob got along with h i s y o u n g e r sister, even t h o u g h s h e is extroverted and h e is introverted. Rob h a s always b e e n particularly close to his m o t h e r : h e r e m e m b e r s coming h o m e from school a n d sitting down with h e r a s s h e attentively listened to h i m describe h i s day while h e enjoyed milk a n d cookies. Rob b e g a n t h e r a p y b e c a u s e he w a s d e p r e s s e d after splitting u p with h i s girl friend of five years. Their relationship h a d started d u r i n g h i s f r e s h m a n year in college—the s a m e year, it t u r n s out, t h a t h i s p a r e n t s a n n o u n c e d t h a t they were getting divorced. His p a r e n t s informed h i m of this by flying o u t together to visit h i m a n d d i s c u s s i n g their decision. Rob h a d h a d n o idea t h a t h i s p a r e n t s were having trouble. T h e family dynamic mixed sensitive p a r e n t i n g with a s t r o n g u n d e r c u r r e n t of s u p p r e s s i n g all conflict. At first, Rob w a s s o m e w h a t r e s i s t a n t to m y suggestion t h a t h e might b e reexperiencing t h e p a i n of h i s p a r e n t s ' divorce t h r o u g h the c u r r e n t b r e a k u p with h i s girl friend. B u t a s h e gained more distance from t h e end of t h e relationship a n d formed a connection to me, h e b e g a n to realize t h a t h e h a d avoided dealing with his reactions to h i s parents* divorce. More specifically, Rob recalled how in college h e t h r e w himself into activity—his work, politics, a n d s p o r t s . He h a d n o t h a d m u c h experience with women u p to t h a t point, b u t h e soon c o m m e n c e d h i s first serious relationship (with t h e w o m a n with w h o m he b r o k e u p j u s t

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before entering treatment). A couple of y e a r s into t h e t r e a t m e n t , Rob s t a r t e d to become interested in how h i s d e p r e s s i o n a t the end of a relationship reactivated older feelings a b o u t h i s p a r e n t s ' divorce. Not only could h e see t h a t h e had* m u c h stronger feelings a b o u t the divorce t h a n he realized a t t h e time, b u t he came to b e in t o u c h with h i s a n g e r w i t h h i s father, w h o m h e s a w a s t h e one responsible for b r e a k i n g u p t h e family. As h i s involvement in t h e r a p y deepened, Rob a n d I explored n e w a n d different angles of h i s p a s t . His u n d e r s t a n d i n g of w h a t h a d h a p p e n e d in t h e relationship u n d e r w e n t a shift: h e b e g a n to see t h e o u t c o m e less a s a m a t t e r of h i s girl friend leaving him, a n d more a s a m a t t e r of their i n t e r e s t s diverging a n d t h e inhere n t difficulty of s u s t a i n i n g a relationship t h a t b e g a n in college. Rob w a s able to acknowledge a s p e c t s of h i s own dissatisfaction in t h e relationship. He also b e c a m e aware of s o m e differences between h i s p a r e n t s ' divorce, which occurred w i t h o u t warning a n d w i t h o u t his i n p u t , a n d t h e b r e a k u p of t h e relationship, which, at least to s o m e degree, reflected h i s own choice. Rob developed a complex interpretation here, starting from h i s flight into a relationship in t h e face of h i s p a r e n t s ' divorce, which enabled h i m n o t to feel hopeless a b o u t relationships a n d to be a little l e s s involved with h i s family in t h e aftermath of h i s parents' divorce b u t also served to d i s t a n c e h i m from t h e r a n g e of feelings h e h a d a b o u t it. Rob gave voice, too, to t h e frustratingly symbiotic quality of this relationship. Finally, he h a d i n s i g h t s a b o u t how t h e divorce, while looming largely in h i s late-adolescent experience, itself reenacted m u c h earlier developmental issues. The divorce h a d a n a s p e c t of being a n oedipal victory for him, since h e h a d always b e e n close to h i s m o t h e r a n d s h e t u r n e d to h i m m o r e d u r i n g a n d after t h e divorce, a n d also b e c a u s e it b r o u g h t heightened conflict with h i s father. Yet, t h e divorce evoked i n t e n s e anxiety b e c a u s e Rob felt t h a t he w a s prematurely on h i s own a n d would have to fend for himself with less support. There w a s a n d t h e r e r e m a i n s real s a d n e s s a b o u t t h e b r e a k u p of his family: Rob wept in a session a s h e realized t h a t leaving h o m e for h i m coincided with t h e r e being no more h o m e left. Over t h e next year, Rob moved from feeling d e s p a i r a b o u t relations h i p s a n d from isolating himself to being s a d from time to time,

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b u t r e a d y to move a h e a d in h i s life. He b e c a m e involved in a n e w relationship. O u r work h a s focused m o r e on his t e n d e n c y to drift into how h e t h i n k s h e s h o u l d feel r a t h e r t h a n staying with how he really feels. Since t h e divorce, Rob's m o t h e r h a s n o t become involved in a new relationship, a n d s h e r e m a i n s very m u c h involved in h e r children's lives. Rob's father r e m a r r i e d a few years ago with a younger w o m a n ; h i s father h a s m a d e a n effort to m a i n t a i n a relationship with him, b u t Rob feels t h a t it is perfunctory. Rob does n o t like h i s s t e p m o t h e r a n d r e s e n t s t h a t s h e controls h i s father, a l t h o u g h h e is also critical of h i s father for allowing h e r to do so. During a family gathering, w h i c h concluded a long weekend together, Rob's father m a d e a n a n n o u n c e m e n t in front of Rob a n d h i s y o u n g e r sister (as well a s their g r a n d m o t h e r a n d some cousins) t h a t startled Rob: h i s wife a n d h e p l a n n e d to a d o p t a baby. Rob w a s a w a r e t h a t they were contemplating having a child, b u t figured t h e m a t t e r h a d b e e n resolved w h e n h i s stepm o t h e r did n o t get p r e g n a n t . Rob h a d a negative reaction to t h e way t h e i s s u e of adopting a child w a s raised—just a t t h e conclusion of t h e gathering, a s if to e n s u r e t h a t t h e r e would be n o discussion, m a k i n g h i m feel doubly left out. In therapy, we focused on t h e possibility of Rob disclosing h i s feelings to his father. He wrote h i s father a letter; h i s father a n s w e r e d promptly with a n email—not r e s p o n d i n g to w h a t Rob said, b u t affirming the value of talking a n d openly exchanging their opinions. No h e a r t - t o - h e a r t talk e n s u e d . Rob felt t h a t h i s father w a s obliged to be t h e one to follow u p . Neither Rob n o r h i s father m a d e t h e time to initiate a serious conversation on t h e next occasion w h e n t h e y got together. Rob b e g a n to t h i n k t h a t perh a p s they h a d cooled to t h e idea of adoption, b u t several m o n t h s later h e received a p h o n e call from h i s father, explaining that, on short notice, t h e y were leaving to pick u p a baby girl to adopt. Rob felt a n g r y a n d betrayed. He u n d e r s t a n d s t h a t p a r t of h i s reaction is irrational: t h a t a t some level h e k n e w this might happen, t h a t h i s father is perfectly entitled to choose to h a v e a new family, a n d t h a t t h i s need n o t exclude him. T h e inception of this n e w family, however, h a s m e a n t t h a t Rob is facing a n e w t h e

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demise of h i s old family. Rob acknowledged h i s anxiety of both being rejected by h i s father a n d being left with h i s m o t h e r . This experience r e p e a t e d e l e m e n t s of h i s p a r e n t s ' divorce: t h a t t h e a n n o u n c e m e n t w a s precipitous a n d especially t h a t his father voiced t h e right s e n t i m e n t s , b u t failed to follow t h r o u g h . Rob's negative reaction to h i s father w a s exacerbated shortly thereafter w h e n h i s father p h o n e d after t h e b a b y w a s a t home b u t did n o t h a v e time to talk, a n d m e n t i o n e d in a n off-hand way t h a t h e h a d t h o u g h t Rob would n o t be a t home, a n d h e h a d p l a n n e d to leave a m e s s a g e . T h e s i t u a t i o n is actually even more complicated by t h e fact t h a t Rob's m o t h e r h a s m a d e n o effort to conceal h e r r e s e n t m e n t s a b o u t h e r former h u s b a n d from Rob or h i s sister. Rob h a s h a d m o m e n t s of s a d n e s s in t h e r a p y a b o u t this situation, b u t he h a s also m u t e d h i s emotional reaction and initially withheld t h e extent of h i s t r u e feelings. A week or so after finding o u t a b o u t t h e adoption, Rob left for a (scheduled) vacation. His girl friend w a s n o t able to go with him, so he p l a n n e d to go away by himself—a first for h i m . T h e trip itself went fine, b u t on t h e way h o m e , h e suffered from a phobic reaction while flying. He w a s a n x i o u s a n d distracted d u r i n g the two takeoffs, r u m i n a t i n g a b o u t w h a t could go wrong. It was crucial, according to h i s report of w h a t h e w a s feeling a t the time, t h a t h i s fate w a s completely o u t of h i s h a n d s . Rob h a d h a d a flying p h o b i a before, a l t h o u g h t h i s time was worse. We h a d b e e n successful in reducing h i s fear of flying, especially after linking h i s fear to h i s f r e s h m a n y e a r in college, w h e n h i s p a r e n t s got divorced. Rob realized t h a t prior to this he h a d suffered n o fear of flying. J u s t a s h e felt t h a t h i s life w a s out of h i s control in a n airplane, so h e felt t h a t t h e life of h i s family w a s o u t of h i s control w h e n h i s p a r e n t s a n n o u n c e d their intention to divorce. Rob could see t h a t t h e r e t u r n of t h e p h o b i a seemed to be precipitated by t h e painful r e m i n d e r of t h e p a s t t h a t h i s father's n e w family rekindled. His struggle to achieve a u t o n o m y is conveyed in h i s a t t e m p t to go away by himself, only to have a r e c u r r e n c e of h i s p h o b i a on t h e flight h o m e — a s h e w a s returning to face negative affects t h a t h e h a d p u s h e d aside during h i s trip.

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Discussion Rob exhibits a wide r a n g e of affects. The influence of h i s family style, w h i c h minimizes affects, is also evident. This interferes with h i s regulation of affects. On occasion, t h e regulation does not work, a n d h i s s a d n e s s slips into depression, h i s anxiety into phobia. In spite of a t e n d e n c y to intellectualize w h a t h e feels, Rob's affect regulation should n o t b e overly pathologized. He is high-functioning in h i s work life, a n d h e is well adjusted socially. It is evident t h a t Rob brings to t h e r a p y a capacity for mentalized affectivity a n d is able to p u t it to good effect in t h e t r e a t m e n t . Rob's affectivity is revealed in h i s reassessment(s) of w h a t h e felt about h i s p a r e n t s ' divorce, allowing h i m to experience his own feelings in a m o r e open a n d complex way. He h a s come to see t h a t he h a d opted n o t to experience negative affects fully in connection with a n i m p o r t a n t event from t h e p a s t a n d t h a t this h a s c o n t i n u e d to influence h i s relationship in t h e present, a n d he e m b r a c e s t h e ongoing t a s k of reinterpretation. Rob's recognition t h a t h e h a d w a r d e d off feelings of depression a b o u t t h e divorce h a s s p u r r e d h i s m o v e m e n t into n e w affective experiences. He is able to move from feeling morose to feeling s a d in a way t h a t is a c c o m p a n i e d by a n affirmative s e n s e of self-understanding. 6 His s a d n e s s p e r t a i n s to t h e demise of both h i s p a r e n t s ' a n d h i s own (first) relationship, b u t h e h a s also come to appreciate t h a t while he h a d n o control over w h a t happened with h i s p a r e n t s , t h e e n d of h i s own relationship w a s neither o u t of h i s control n o r opposed to h i s real wishes. As he h a s come to a c c e p t w h a t h e felt, so h i s s e n s e of agency h a s been enhanced. An overall s e n s e of gloom h a s lessened.

6

Sadness is an affect, of course, that can be regarded as a developmental achievement. Melanie Klein's depressive position, for instance, occurs when a child is able to see the mother as a whole object—that is, as differentiated from himself—and thus experiences her absence as a loss. The distinction between sadness and depression is, I think, important to uphold—marking the difference between the normal and the pathological, but also highlighting that not all negative affects are equally undesirable. It can feel good to be sad, while the same cannot be said about being depressed (although it might feel comfortable, because it is familiar). The work of Samuel Beckett is preoccupied with discerning the boundary between sadness and depression.

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Rob's capacity for mentalized affectivity h a s room for growth. He h a s a t e n d e n c y to s u p p r e s s h i s feelings—a good example of this is revealed in h i s reaction to h i s father's n e w family. Rob k n o w s t h a t he w a s displeased with t h i s development, a n d he is able to c o m m u n i c a t e this to a certain extent. However, there is s o m e t h i n g r e s t r a i n e d a b o u t h i s reaction, reflecting h i s wish to s o u n d r e a s o n a b l e a n d to edit h i s real feelings. Rob's tendency n o t to allow h i s affects to be expressed freely h a s produced countertransference r e s p o n s e s on m y p a r t w h e r e I a m aware of p u t t i n g m o r e affect into m y voice, a s if to provide examples of immediate affective reactions a n d to c o m p e n s a t e for h i s low-key r e s p o n s e s . This h a s b e e n a n i s s u e in h i s relationship with his c u r r e n t girl friend: s h e h a s complained t h a t h e is n o t demonstrative enough. Although Rob is s o m e o n e w h o struggles to allow himself to express h i s affects, t h i s s h o u l d n o t be c o n s t r u e d a s exclusively m e a n i n g t h a t h e n e e d s to learn to e x p r e s s t h e m outwardly. The inward expression of affects is equally i m p o r t a n t . For example, Rob h a s s t a r t e d to become progressively m o r e a w a r e of h i s anger toward h i s father. Apart from w h e t h e r a n d h o w h e chooses to c o m m u n i c a t e t h i s to h i s father, it h a s b e e n crucial for Rob to allow himself to feel h i s r e s e n t m e n t a n d to begin to s e p a r a t e himself from h i s family's style of downplaying all affective res p o n s e s . In glimpsing t h a t h i s father m a y n o t be willing to r e s p o n d to h i s a t t e m p t s to c o m m u n i c a t e with him, Rob's expression of h i s affects inwardly serves a s a valuable affirmation of his own experience of t h e n e w family situation. T h e mentalized affectivity t h a t Rob does exhibit in coming to t e r m s with h i s p a r e n t s ' divorce a n d t h e i m p a c t it h a d on his life h a s come u n d e r s t r e s s with t h e fresh r e m i n d e r t h a t h i s own n u c l e a r family dissolved a s h i s father begins to c o n s t i t u t e a new family. This does n o t contradict t h e suggestion t h a t h e p o s s e s s e s mentalized affectivity; r a t h e r , it highlights t h a t c i r c u m s t a n c e s c a n temporarily u n d e r m i n e affectivity or a t least m a k e it difficult to s u s t a i n . Indeed, mentalized affectivity c a n b r e a k down a t the m o m e n t w h e n t h e i m p a c t of a s t r o n g affect is felt. Normally, mentalized affectivity r e q u i r e s gaining some perspective, which, in t h e h e a t of t h e m o m e n t , c a n be beyond t h e capacity of most of u s . It is certainly possible to acquire mentalized affectivity in

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situations w h e r e o n e h a s previously lacked It, b u t it would i m p r u d e n t to fail to heed how m u c h of a struggle it is to m a i n t a i n it consistently. In d r a w i n g a t t e n t i o n to Rob's ability t o reflect on a n d craft h i s affects, I a m acknowledging t h e s e n s e in which affects a r e chosen; it should be clear, however, t h a t I a m not d i s p u t i n g t h e s e n s e in w h i c h Rob feels t h a t affects h a p p e n to him. My point is simply to e m p h a s i z e t h a t we c a n influence w h a t we feel a n d , in addition, t h a t p s y c h o t h e r a p y c a n serve to develop a n d e n h a n c e mentalized affectivity.

CONCLUSION These four c a s e s p r e s e n t a s p e c t r u m from severe to mild psychopathology, a n d correspondingly affectivity is better where t h e psychopathology is less severe. The first two examples a r e c a s e s of severe m e n t a l illness: Teresa a n d Bennie have extensive psychiatric histories a n d major m e n t a l disorders, a n d they have h a d n u m e r o u s hospitalizations over t h e years. Teresa's r a n g e of affect display is more limited t h a n is Bennie's, a n d s h e lives a m u c h more isolated life. Bennie h a s c h o s e n to r e m a i n in t h e r a p y for a longer time; h e h a s a s t r o n g b o n d with h i s t h e r a p i s t a n d is able to h a v e m o m e n t s of mentalized affectivity within t h e clinical setting. For b o t h Teresa a n d Bennie, h u m o r h a s b e e n a way of establishing a connection with their t h e r a p i s t — t h e least dangerous way of s h a r i n g positive affect. Scott h a s a c h a r a c t e r disorder a s well a s a history of s u b stance a b u s e . He h a s b e e n able to free himself from t h e latter, and, after a n u m b e r of y e a r s in t r e a t m e n t , h i s life h a s started to change significantly for t h e better. The quality of h i s relationships is improving. He h a s b e g u n to c h a n n e l h i s considerable intellectual abilities in a productive direction. His ambitions a r e being realized, a l t h o u g h grandiose fantasies continue to obtrude. In t h e c a s e of Scott, we w i t n e s s t h e development of mentalized affectivity within t h e c o u r s e of t h e t r e a t m e n t itself. Rob's psychopathology is relatively mild. Despite t h e phobia and his unresolved feelings a b o u t h i s p a r e n t s ' divorce, h e is high-functioning. He c o n t i n u e s to have academic success; h e

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h a s a j o b in w h i c h h e h a s b e e n given increased responsibility; he h a s n u m e r o u s friends—both a c q u a i n t a n c e s a n d close relations h i p s ; a n d h e is working h a r d a t figuring o u t w h e t h e r p r o b l e m s in h i s relationship c a n be resolved. He brings a high level of mentalized affectivity with h i m to t h e t r e a t m e n t , b u t t h e treatm e n t h a s also served to d e e p e n it. T h e concept of mentalized affectivity describes a clinical phen o m e n o n t h a t p e r t a i n s to t h e mediation of affective experience t h r o u g h self-reflexivity. This is a compelling concept b e c a u s e at t h e h e a r t of p s y c h o t h e r a p y is t h e a i m of c h a n g i n g one's relation to one's own affects. Mentalized affectivity, w h i c h includes the elements of identifying, modulating, a n d expressing affects, helps u s to u n d e r s t a n d h o w one's relation to one's own affects c a n be c h a n g e d . Ultimately, t h e justification for s u c h a concept m u s t be found in empirical r e s e a r c h . O u r h o p e in t h i s c h a p t e r is to d e m o n s t r a t e t h a t t h e r e is a need for s u c h a concept, a n d t h a t u n d e r t a k i n g further r e s e a r c h on t h i s subject would be worth while.

Epilogue

Research on t h e social development of infants h a s probably b e e n the m o s t influential a d v a n c e in empirical science for psychoanalysis. T h e work of Daniel S t e r n (1985, 1994) a n d Robert E m d e (1997, 1980a, 1980b, 1981, 1988, 1992) established infant res e a r c h a t t h e c e n t e r of psychoanalytic theorization. T h e w o r k reported in t h i s volume h a s built on t h e achievement of t h e s e a n d other pioneers of infant r e s e a r c h to p r o d u c e a psychoanalytic model t h a t , we hope, is of relevance to clinicians. There h a v e b e e n s o m e cogent objections to t h e impact of infancy r e s e a r c h on psychoanalysis. For example, Wolff (1996) warned of t h e epistemological d a n g e r s in extrapolating from infant r e s e a r c h to t h e behavior of a d u l t p a t i e n t s . O t h e r s point to what s u c h perspectives omit from t h e traditional psychoanalytic a p p r o a c h (e.g., Fajardo 1993; Green 2000). We welcome this dialogue a n d to a n extent agree with t h e s e cautions—particularly t h a t n e w ideas s h o u l d n o t b e felt to devalue t h e t r u t h of t h e old, t h a t t h e b a b y should always be t a k e n safely o u t before dealing with t h e b a t h water. Nevertheless, we s e n s e t h a t m a n y clinicians would join u s in seeing t h e findings of psychoanalytically oriented empirical s t u d i e s of early development a s being of clear relevance to clinical u n d e r s t a n d i n g a n d technique. The general body of psychoanalytic opinion warmly welcomes infant research. For example, J o s e p h Lichtenberg wrote: "Seen t h r o u g h 469

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modifications of theory a n d technique, t h e findings of psychoanalytically oriented empirical s t u d i e s of early development have a n d will have, I believe, a cumulative effect far greater t h a n we have a s yet appreciated" (1995, p. 275).

MENTAL MODELS AND P R O C E D U R E S Developmental r e s e a r c h h a s helped to revise s o m e developmental propositions of psychoanalysis t h a t t u r n e d o u t to be naive. For instance, t h e r e h a s b e e n a shift in e m p h a s i s in p s y c h o a n a lytic practice from a focus on t h e retrieval of forgotten experience to one w h e r e t h e creation of a meaningful narrative is regarded a s mutative (e.g., Spence 1982, 1984). T h e interactional a n d interpersonal a s p e c t s of clinical work h a v e b e c o m e recognized a s crucial, giving insight into t h e more primitive a s p e c t s of interaction s e e n in psychoanalysis (e.g., S. A. Mitchell' 1997). While we do n o t a s s u m e t h a t formative experiences underlying these a s p e c t s have b e e n retained in a w a y t h a t allowed t h e m to be recalled, analogies continually emerge between a s p e c t s of pare n t - i n f a n t interaction a n d t h e a n a l y s t - p a t i e n t relationship. Implicit in t h e u n d e r s t a n d i n g of t h e s e analogies is t h e idea t h a t procedures, or p a t t e r n s of actions r a t h e r t h a n individual experiences, are retained from infant-caregiver interactions a n d t h a t t h e s e p r o c e d u r e s come to organize later behavior (Clyman 1991). The procedures are organized a s m e n t a l models (JohnsonLaird a n d Byrne 1991, 1993). They s h o u l d n o t be conceived of a s pictures; t h e y are better t h o u g h t of a s intricately interlinked s e q u e n c e s of events. Nevertheless, t a k e n together, g r o u p s of p r o c e d u r e s a m o u n t to a r e p r e s e n t a t i o n of a relationship, forever confined to t h e u n c o n s c i o u s (phenomenologically r a t h e r t h a n dynamically speaking) a n d observable only t h r o u g h a n individual's m a n n e r or style of relating, r a t h e r t h a n t h r o u g h t h e ideas or memories described. T h e goal of therapy, t h e n , is t h e observation of p a t t e r n s of interaction a n d t h e identification a n d correction of maladaptive models, principally t h r o u g h s t r e n g t h e n i n g a n overarching m e n t a l capacity to activate alternative models of interaction selectively; in l a n g u a g e influenced by cognitive science, ii

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this capacity m a y be labeled "mentalization" or "reflective function.''

T H E O B J E C T A T T H E C O R E O F T H E SELF O u r concern in t h i s book h a s b e e n with individual differences in self-representational capacities a n d c o n s e q u e n t differences in affect (Bleiberg 1984, 1994) a n d mentalization. At one extreme clinically we e n c o u n t e r e d individuals whose self-representation w a s so fragmented a s to a p p e a r a l m o s t nonexistent, or so distorted t h a t it seemed completely o u t of t o u c h with real emotional experience. Bleiberg (Bleiberg et al. 1997) h a s described severely personality-disordered children who experienced a s e n s e of almost total alienation from their core self. These children p r e s e n t significant d i s t u r b a n c e s of social a n d emotional development, including m a r k e d i m p a i r m e n t of peer relationships, affect regulation, frustration tolerance, a n d i m p u l s e control, a s well a s poor self-esteem a n d poor self-image. S o m e of them, designated a s Cluster A, s h o w a more fragile reality c o n t a c t a n d t h o u g h t organization, particularly w h e n faced w i t h lack of s t r u c t u r e . Idiosyncratic, magical t h i n k i n g pervades their lives, b u t it acquires g r e a t e r intensity in emotionally charged contexts. S h y a n d friendless, t h e y r e t r e a t to a world of bizarre fantasies, h a u n t e d by ideas of reference, s u s p i c i o u s n e s s , a n d extreme discomfort in social situations. Their ability to "make sense" of h u m a n exchanges a n d e m p a t h i z e with o t h e r s is strikingly limited. They are equally impoverished in their capacity to c o m m u n i c a t e , which is h a m p e r e d by t h e o d d n e s s of their speech a n d t h e constriction or i n a p p r o p r i a t e n e s s of their affect. Descriptively, t h e y generally resemble a r a n g e of DSM-IVs diagnoses t h a t include schizotypal, schizoid, a n d milder forms of pervasive developmental disorder. They also resemble t h e children described by Cohen a n d colleagues a s suffering from "multiplex developmental disorder" (Cohen, Towbin, Mayes, a n d V o l k m a r 1994). In c o n t r a s t , a second g r o u p of youngsters, designated a s Cluster B, s h o w s intense, d r a m a t i c affect a n d h u n g e r for social response. Clinginess a n d a vulnerability to separations, hyper-

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activity, a n d t e m p e r t a n t r u m s are c o m m o n features of their early development. By school age, they m e e t diagnostic criteria for a n Axis I diagnosis; m o r e commonly, attention-deficit hyperactivity disorder, c o n d u c t disorder, s e p a r a t i o n anxiety disorder, or mood disorder. Many of t h e s e children a p p e a r anxious, moody, irritable, a n d explosive. Minor u p s e t s or frustrations trigger intense affective storms—episodes of uncontrolled emotion, w h i c h are wholly o u t of proportion to t h e a p p a r e n t precipitant. This affective lability mirrors t h e kaleidoscopic quality of t h e s e children's s e n s e of self a n d others. O n e m o m e n t t h e y feel elated a n d expansive, blissfully connected in perfect love a n d h a r m o n y with a n idealized p a r t n e r ; t h e next m o m e n t t h e y p l u n g e into bitter d i s a p p o i n t m e n t a n d rage, coupled with self-loathing and despair. Self-centeredness is a striking characteristic of t h e s e children. They need c o n s t a n t a t t e n t i o n a n d r e s p o n d with rage to rejection or indifference. Alternating between idealization and devaluation, t h e y seductively a n d manipulatively strive to coerce o t h e r s to provide t h e m with a s t r e a m of emotional supplies. By t h e time they r e a c h adolescence, drugs, food, or p r o m i s c u o u s sex have become c o m m o n strategies to block feelings of subjective dyscontrol, fragmentation, a n d loneliness. Self-mutilation a n d suicidal g e s t u r e s a r e c o m m o n a m o n g girls, while aggression, coupled with h i d d e n fears of rejection, is m o r e typical of boys. This c l u s t e r of p a t i e n t s h a s b e e n linked to early manifestations of "dramatic** personality disorders (in t h e a d u l t personality disorder classification of DSM-IV, t h e s e would be t h e Cluster B disorders). In spite of t h e heterogeneity—and t h e obvious need for systematic s t u d i e s to d e t e r m i n e t h e validity a n d reliability of p a r t i c u l a r clinical a n d developmental c l u s t e r s — t h e s e youngsters seem to s h a r e a crucial characteristic: some pervasively— Cluster A—and o t h e r s intermittently—Cluster B—seem to lack t h e capacity to b e a w a r e of their own a n d o t h e r people's mental states. We conceive of s u c h children a s showing a n extreme version of t h e strategy of i n s e c u r e infants. Confronted with a frightened or frightening caregiver, t h e y a d a p t via a wholesale internalization of t h e caregiver's reaction to t h e m . This leaves a t t h e core of

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their self-structure t h e r e p r e s e n t a t i o n of t h e object r a t h e r t h a n of t h e self. Not only is t h e child t h e n o u t of t o u c h with h i s affect, b u t h e also experiences t h e self-representation a s foreign to h i s internal experience, yet very m u c h a p a r t of himself. Internal coherence later b e c o m e s impossible to achieve without first externalizing t h i s alien p a r t of t h e self-representation. We have suggested t h a t t h i s is why y o u n g children, classified in infancy a s disorganized in their a t t a c h m e n t , have been s h o w n to behave in a n u n u s u a l l y controlling way toward their p a r e n t s . The object m u s t be consistently controlled in order t h a t It c a n r e m a i n a n effective vehicle for t h e alien p a r t of t h e self. The m e c h a n i s m we h a v e described in this book is a type of projective identification, a l t h o u g h t h a t c o n s t r u c t is p e r h a p s too broad to convey exactly w h a t we intend here. O n e hallmark of the special category of projective identification we are describing is t h e d e s p e r a t i o n felt by t h e individual to be able to get rid of t h e u n w a n t e d a s p e c t s of t h e self. T h e alien p a r t m u s t be externalized for t h e child to feel a s e n s e of being in t o u c h with t h e real, experiencing self. T h e closer to t h e core of t h e self s u c h a n alien object resides, t h e greater t h e need for t h e physical p r e s e n c e of the other, to p e r m i t t h i s externalization. For t h e child who w a s disorganized a s a n infant, t h e object w h o w a s internalized a s part of t h e self-representation is t h e m o s t likely vehicle for this projective process. T h u s , even brief s e p a r a t i o n s m a y feel like a n impossible challenge. Often, in y o u n g children, t h e difficulty is compounded by t h e c o n t i n u i n g need of t h e child for a mirroring object. They c o n t i n u e to a t t e m p t to find themselves in t h e other, at the s a m e time a s externalizing o n t o t h e other their alien selfrepresentation. This is very often a self-perpetuating pattern, where t h e child struggles to rid himself of p a r t s of himself a n d actualize t h e m in t h e p a r e n t , a t t h e s a m e time desperately needing t h e p a r e n t to reflect a n d s t r e n g t h e n t h e feeble b u t t r u e core. If t h e p a r e n t or later a t t a c h m e n t figure is able to accept t h e projection a n d yet r e t a i n s o m e capacity for reflective functioning, then the c o u r s e of the-child's development m a y be changed. In our experience, relatively few p a r e n t s a r e able to c h a n g e in t h i s way. Commonly, quite a vicious t r a n s a c t i o n a l cycle develops, where t h e relative s t r e n g t h of t h e t r u e self w e a k e n s a n d t h e corresponding need for externalization increases; t h e c o n t a c t

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between p a r e n t a n d child t h e n b e c o m e s a struggle t h a t is often described a s a s a d o m a s o c h i s t i c relationship, t h o u g h we would see this a s misleading in t h a t it s u g g e s t s perverse erotic gratification a s t h e driving force.

S O M E SPECULATIONS ABOUT PATHOLOGICAL DEVELOPMENT As we have said, a f u n d a m e n t a l need of every infant is to find his own m i n d , or intentional state, in t h e m i n d of t h e object. For the infant, internalization of t h i s image performs t h e function of "containment," which Winnicott h a s written of a s "giving b a c k to t h e b a b y t h e b a b y ' s own self* (Winnicott 1967, p. 33) . Failure of t h i s function leads to a d e s p e r a t e s e a r c h for alternative ways of containing t h o u g h t s a n d t h e i n t e n s e feelings they engender. The s e a r c h for alternative ways of m e n t a l c o n t a i n m e n t may, we have suggested, give rise to m a n y pathological solutions, including t a k i n g t h e m i n d of t h e other, with its distorted, a b s e n t , or malign picture of t h e child, a s p a r t of t h e child's own s e n s e of identity. With development, a n d exacerbated by t h e a p p a r e n t l y sadomasochistic p a t t e r n s described above, t h i s picture c a n become t h e germ of a persecutory object t h a t is lodged in t h e self b u t is alien a n d unassimilable. There will b e a d e s p e r a t e wish for separation in t h e h o p e of establishing a n a u t o n o m o u s identity or existence. However, sadly, t h i s identity is centered a r o u n d a m e n t a l s t a t e t h a t c a n n o t reflect t h e c h a n g i n g emotional and cognitive s t a t e s of t h e individual b e c a u s e it is b a s e d on an a r c h a i c r e p r e s e n t a t i o n of t h e other r a t h e r t h a n on t h e thinking a n d feeling self a s s e e n by t h e other. As for children, so for a d u l t s w h o s e s e a r c h for mirroring or c o n t a i n m e n t h a s failed, t h e striving for s e p a r a t i o n will only p r o d u c e a m o v e m e n t toward fusion. T h e m o r e t h e p e r s o n att e m p t s to become himself, t h e closer h e moves toward becoming h i s object, b e c a u s e t h e latter is p a r t of t h e self-structure. This m a y a c c o u n t for t h e familiar oscillation of borderline patients between t h e struggle for i n d e p e n d e n c e a n d t h e terrifying wish

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for extreme closeness a n d fantasized union. Developmentally, a crisis m a y be expected to arise in late adolescence a n d early adulthood, w h e n t h e external d e m a n d for s e p a r a t e n e s s b e c o m e s irresistible. Self-destructive a n d (in t h e extreme) suicidal behavior m a y t h e n be perceived a s t h e only feasible solution to a n insoluble dilemma: t h e freeing of t h e self from t h e other t h r o u g h t h e d e s t r u c t i o n of t h e other within t h e self. In s o m e people, for w h o m s e p a r a t e n e s s is a chronic problem, we h a v e a s s u m e d t h a t t h e experience of selfhood c a n only be achieved t h r o u g h finding a physical other onto w h o m t h e other within t h e self c a n be projected. T h u s , m a n y will find leaving home very difficult a n d only s u s t a i n a b l e by finding a n alternative, c o m p a r a b l e figure onto w h o m t h e other within t h e self may be projected. If t h e other p e r s o n dies or leaves, a pathological m o u r n i n g p r o c e s s m a y be initiated, whereby t h e p e r s o n feels compelled to m a i n t a i n a live picture of t h e other in order to shore u p t h e integrity of t h e self. A n o t h e r possible o u t c o m e of poor development of t h e psychological self is t h a t t h e body m a y be u s e d to contain a n d e n a c t m e n t a l s t a t e s . In t h e s e c a s e s t h e child's own body comes to serve the function of second-order r e p r e s e n t a t i o n of feelings, ideas, a n d wishes. Violence toward t h e body of t h e self (e.g., selfcutting) or t h a t of t h e o t h e r (apparently unprovoked aggression or "mindless violence") m a y b e a way of "controlling" m e n t a l s t a t e s t h a t a r e invested in bodily s t a t e s (e.g., t h e m o t h e r seen a s part of one's own body) or destroying "ideas" experienced a s being within t h e body of t h e other. In b o t h physical violence a n d self-destructive acts, a n u m b e r of factors combine, (a) In t h e s e a c t s t h e individual functions in a nonmentalizing mode of psychic equivalence. There is b o t h a n intolerance of alternative perspectives—that is, t h e s e have to be destroyed—and a belief t h a t by destroying t h e p e r s o n representing t h e idea, t h e p e r s e c u t i n g idea itself will b e eradicated from the p e r s o n ' s own mind, (b) In b o t h externally a n d internally directed aggression, t h e r e are indications of t h e persistence of a pretend m o d e of functioning, in t h a t a t one level t h e individual perceives h i s a c t s a s inconsequential, except in obliterating t h e intolerable t h o u g h t s . External reality c a n be ignored: t h e overr dose c a n be conceived a s getting rid of certain t h o u g h t s belong-

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ing to a n o t h e r , yet leaving t h e body u n h a r m e d , (c) The a b s e n c e of mentalizing removes key r e s t r a i n t s on action a g a i n s t b o t h the self a n d t h e other. Even w h e n s o m e o n e c a n intellectually conceive of t h e i m p a c t of h i s or h e r actions on a n o t h e r person, this m a y be felt a s meaningless, empty of emotional conviction (Blair 1995). Linked to t h i s m a y be a r e a s o n why w o m e n more commonly self-harm, w h e r e a s m e n are m o r e often aggressive toward others. We would suggest t h a t for women, t h e image of the m o t h e r (most often t h e p r i m a r y caregiver in early life) resides more easily in their own body, w h e r e a s for m e n it is easier to externalize t h i s a n d t h e t h o u g h t s it r e p r e s e n t s onto o t h e r s . In extreme cases, where t h e child h a s found n o alternative relationship in which h i s t h o u g h t s a n d feelings a r e perceived a n d reflected, h i s own potential for reflective capacity will n o t be fulfilled. In c a s e s of abusive, hostile, or simply totally v a c u o u s relationships with t h e caregiver, t h e infant m a y deliberately t u r n away from t h e object; t h e contemplation of t h e object's m i n d is overwhelming a s it h a r b o r s frankly hostile i n t e n t i o n s toward the infant's self. This m a y lead to a widespread avoidance of mental states, w h i c h further r e d u c e s t h e c h a n c e of identifying a n d establishing intimate links with a n u n d e r s t a n d i n g object. As s t u d i e s of resilient children suggest, even a single s e c u r e / u n d e r s t a n d i n g relationship m a y b e sufficient for t h e developm e n t of reflective p r o c e s s e s a n d m a y "save" t h e child. We do not anticipate t h a t t r a u m a outside t h e context of a close a t t a c h m e n t would pervasively s t u n t t h e development of mentalization. It is b e c a u s e reflective function evolves in t h e context of intense interpersonal relationships t h a t t h e fear of t h e m i n d of a n o t h e r c a n have s u c h devastating c o n s e q u e n c e s on t h e emergence of social u n d e r s t a n d i n g . If t h e t r a u m a t i z e d child h a s h a d n o social s u p p o r t of sufficient s t r e n g t h a n d intensity for a n a t t a c h m e n t b o n d a n d t h e n reflectiveness to develop, t h e n t h e experience of later t r a u m a or a b u s e will probably n o t be reflected on or resolved. Naturally, t h e unresolved experience of a b u s e d i m i n i s h e s t h e likelihood of meaningful relationships, which, in a self-perpetuating way, m a k e s it more difficult to r e a c h a satisfactory resolution of the disturbing experience t h r o u g h reflective processes. In fact, a

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p a t t e r n m a y be established w h e r e b y suspicion a n d d i s t r u s t generalize a n d lead to a t u r n i n g a w a y from t h e m e n t a l s t a t e of m o s t i m p o r t a n t o t h e r s a n d to a n a p p a r e n t "decoupling" of t h i n k i n g a b o u t people, leaving t h e p e r s o n bereft. The "neediness" of people with borderline personality disorders s e e m s to be a step in this direction; n o sooner do t h e y become involved with a n o t h e r person t h a n t h e malfunctioning of their mentalizing capacity leads t h e m into confusion a n d c h a o s within t h e relationship. They m a y r e g r e s s to t h e intersubjective s t a t e of earlier m e n t a l representation, n o longer able to differentiate their own m e n t a l r e p r e s e n t a t i o n s from t h o s e of o t h e r s a n d either of t h e s e from external reality. As t h e s e p r o c e s s e s combine, they m a y become terrorized by their own t h o u g h t s a b o u t t h e other—particularly their aggressive i m p u l s e s a n d fantasies—experienced (via projection) a s in t h e other; t h e s e become crippling, a n d m o s t commonly t h e y reject or a r r a n g e to be rejected by their object. Psychoanalysis or p s y c h o t h e r a p y c a n b r e a k t h e vicious cycle by reinforcing reflective capacity.

PSYCHOTHERAPY AND MENTALIZING Acceptance of t h i s model does n o t imply a c h a n g e in psychot h e r a p e u t i c practice, or t h a t t h e s e ideas a r e relevant to m o s t forms of later pathology. M a n y p a t i e n t s with n e u r o t i c problems have relatively good reflective capacities, founded (we would suggest) on a d e q u a t e early a t t a c h m e n t relationships a n d on a d e q u a t e mentalizing capacities in a t least one caregiver. In t h e s e cases, we see traditional psychoanalytic u n d e r s t a n d i n g a n d t h e interpretation of c u r r e n t u n c o n s c i o u s conflicts a s very powerful a n d able to p r o d u c e s u b s t a n t i a l , lasting change. It does, however, call for a r e a p p r a i s a l of t h e relative i m p o r t a n c e of a s p e c t s of technique in c a s e s showing t h e k i n d s of early developmental failure t h a t we h a v e tried to describe. This m e a n s t h a t certain more supportive t e c h n i q u e s m a y shift from t h e s t a t u s of p a r a m eter to m u t a t i v e c o m p o n e n t s , a t least in t h e early stages of w h a t is likely to be a prolonged analysis.

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In t h e s e c a s e s of severe c h a r a c t e r a n d developmental pathology t h e focus on reflective function in psychopathology brings with it a n implication concerning t h e role of insight. Insight is a n unlikely goal early on, given t h e profound limitations on listening to a n d u n d e r s t a n d i n g interpretations s h o w n by t h e s e patients. In some less severe cases, t h e t h e r a p i s t m a y be impressed by t h e patient's a p p a r e n t receptiveness to i n t e r p r e t a t i o n s a n d m a y only b e c o m e s u s p i c i o u s in t h e long t e r m w h e n t h e a p p a r e n t building of insight fails to lead to significant c h a n g e . Patients s u c h a s t h e s e acquire insight within w h a t we would see a s a p r e t e n d mode, w h e r e reflection is possible a s long a s it is kept s e p a r a t e from everyday reality. In other words, t h e p a t i e n t plays at being in analysis b u t is u n a b l e to integrate it with genuine feeling or meaning. W h a t are t h e a n a l y s t ' s goals w h e n u n d e r s t a n d i n g is u n a t t a i n able a t first a n d is in fact perceived a s a serious t h r e a t ? We aim to e n h a n c e certain psychic processes. To do this, t h e analyst needs, of course, to create a n e n v i r o n m e n t within w h i c h thinking a b o u t feelings a n d ideas c a n be experienced a s safe, p e r h a p s for t h e first time. There is t h e n t h e opportunity for t h e patient to find himself a s a t h i n k i n g a n d feeling p e r s o n within t h e analyst's mind. The analyst p r e s e n t s a picture to t h e p a t i e n t t h a t is related to t h e p a t i e n t ' s experience at t h a t m o m e n t b u t is also sufficiently different for t h e p a t i e n t to learn t h e possibility of alternative perspectives. There is a c o n s t a n t a n d sometimes overwhelming p r e s s u r e on t h e a n a l y s t to accept t h e patient's externalization, a n d this s h e m u s t do, in a way, for a refusal to do so brings a b o u t t h e experience of t h e self a s destroyed by the r e t u r n of t h e alien other. Yet by becoming t h i s o t h e r person, t h e a n a l y s t would have obliterated h e r capacity to t h i n k a b o u t t h e patient. The situation is m a d e more difficult b e c a u s e unlike talking to more neurotic p a t i e n t s a b o u t t h e transference, t h e simple p r e s e n t a t i o n of t h e d i l e m m a to t h e p a t i e n t h a s little effect. T h e analyst's t a s k is primarily to r e m a i n in t o u c h with the patient's m e n t a l state, despite t h e p a t i e n t ' s d r a m a t i c enactm e n t s , to a d d r e s s a n d challenge t h e patient's m e n t a l capacities by verbalizing internal states, differentiating feelings, breaking

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down u n m a n a g e a b l e anxiety-provoking experiences into simpler, more m a n a g e a b l e entities, helping t h e development of a n "as-if* a t t i t u d e w h e r e ideas c a n begin to be t h o u g h t a b o u t a s ideas r a t h e r t h a n a s reality, yet retaining their links to t h e internal world, a n d so on. We t h i n k of t h e s e interventions a s "small interpretations," generally pertaining to a s p e c t s of t h e m e n t a l world t h a t a r e n e i t h e r u n c o n s c i o u s n o r overly complex. In n e u rotic patients, s u c h feelings a n d t h o u g h t s would require no elaboration on t h e p a r t of t h e analyst, yet w i t h o u t s u c h background work t h e a n a l y s i s of severely disturbed people is, we suggest, b o u n d to fail, e n d i n g p r e m a t u r e l y or t u r n i n g into a n impasse. Psychoanalysis inevitably deals with individuals whose p a s t experience h a s left t h e m vulnerable to c u r r e n t s t r e s s a n d to t h e repetition of adverse early experiences. The t r e a t m e n t of people s u c h a s t h o s e we have focused on in this c h a p t e r involves a n elaborative, mentalistic s t a n c e . This e n h a n c e s t h e development of reflective self-function a n d m a y in t h e long r u n e n h a n c e t h e psychic resilience of individuals in a generic way, providing t h e m with improved control over their s y s t e m of representation of relationships. It c a n equip t h e m with a kind of self-righting capacity where, t h r o u g h being able to m a k e their representational models m o r e flexible, they c a n be reviewed a n d changed. S u c h g r a d u a l a n d c o n s t a n t a d j u s t m e n t s facilitate t h e developm e n t of a n internal world where t h e behavior of o t h e r s m a y be experienced a s u n d e r s t a n d a b l e , meaningful, predictable, a n d h u m a n . This r e d u c e s t h e n e e d for t h e splitting of frightening a n d incoherent m e n t a l r e p r e s e n t a t i o n s of m e n t a l states, a n d n e w experiences of other m i n d s c a n more readily be integrated into the framework of p a s t relationship representations. The a b u s e d or t r a u m a t i z e d child, evading or entangled in t h e m e n t a l world, never acquires a d e q u a t e regulatory control over the r e p r e s e n t a t i o n a l world of internal working models. Unhelpful models of relationship p a t t e r n s emerge frequently, a n d t h e internal world of t h e child a n d a d u l t comes to be dominated by negative affect. C a u g h t in a vicious cycle of p a r a n o i d anxiety a n d exaggerated defensive m a n e u v e r s , t h e p e r s o n b e c o m e s inextricably entangled in a n internal world d o m i n a t e d by d a n g e r o u s , evil,

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m i n d l e s s objects. He h a s a b a n d o n e d t h e very p r o c e s s t h a t could extract h i m from h i s p r e d i c a m e n t — t h e capacity to reflect on why people do things, w h a t goes on in their m i n d s . Over a long period, frequent a n d diverse i n t e r p r e t a t i o n s a b o u t t h e patient's perception of himself, t h e analyst, a n d their a n a lytic relationship m a y enable h i m to a t t e m p t to create a m e n t a l r e p r e s e n t a t i o n b o t h of himself a n d of h i s analyst, a s thinking a n d feeling, together a n d independently. This c a n t h e n form the core of a s e n s e of himself with a capacity to r e p r e s e n t ideas a n d m e a n i n g s a n d create t h e b a s i s for t h e b o n d t h a t ultimately permits new possibilities of s e p a r a t i o n a n d intimacy.

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Index

AAI: see Adult Attachment Interview abandonment: fear of: of BPD patients, 343, 344, 356, 363-364 clinical illustration: "Henrietta," 410-433 feeling of, clinical illustration: "Rebecca." 270-289 provoking, in BPD patients, 346, 360 Abel.T., 114 Abell, F., 233 Aber, L., 43 Abrams, S.. 277 abuse, childhood, 64, 105, 112, 130, 476, 479 and BPD, 344, 353. 362-366, 380, 381 clinical illustration: "Tony," 324-330 and disorganized self, 39 and mentalization, 13, 59 physical, 39, 118, 121, 346, 351 psychological, 121. 352, 382 clinical illustration: "Sandra," 383-384 sexual, 39, 118, 345, 346, 351. 411 clinical illustrations: "Henrietta,"

410-433; "Teresa," 441-448 see also aggressor, identification with; trauma ACS: see Bureau of Child Welfare acting out. 295, 359 active intermodal mapping, 211,215 adaptation, 61, 62, 251. 300, 384, 427 behavioral, 76, 94 biological, 216, 231. 232 evolutionary, intentional stance as, 146 interpersonal, 118, 140, 141,230, 235. 237 dysfunctional, 100 uneven, 355 adolescence: antisocial behavior in, 104 delinquency in, 59, 354 developmental issues In, 105, 317340, 475 dissociation In, clinical illustration: "Glen," 331-340 psychopathology in, 18, 314, 317340, 404, 472 self-representation In, 405 violence In, 198 clinical illustration: "Tony," 324330 549

550

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Index

Adolphs, R., 132 adoption study(ies): behavior-genetic, 6, 97, 104-106, 107, 133 Colorado Adoption Project, 105, 106 Finnish adoptive family study of schizophrenia, 113 PET-scan studies of Romanian adoptees, 132 Adult Attachment Interview (AAI), 39, 41-43, 52, 59, 120. 193, 343 Adult Attachment Scale, 134, 136 affect(s) (passim): attunement, 165, 181-186 inward expression of: see inward expression of affects -mirroring (passim): and language, 440 and pretend play, 291-316 social biofeedback theory of (Gergely/Watson). 2, 8, 17, 126136, 143, 145, 161-202, 219. 292, 293, 300 in therapeutic Intervention, 198202 regulation: definition, 93 and early object relations, 65-96 and mentalization (passim): and second-order representations, 15 representation of: primary, 19 second-order, 19 sharing. 219 training, 140 affective action state, 34 affectivity (passim): mentalized: see mentalized affectivity AFFEX coding system, 216 agentlve self, 3, 7, 8 aggression, 63, 110, 197, 345, 376. 472, 475 clinical illustrations: "Emma," 388-410 "Glen," 331-340 "Mat," 301-316

"Rebecca," 270-289 "Scott," 453-461 "Teresa," 441-448 "Tony," 324-330 phallic, 457 aggressor, identification with, 12, 198, 328, 422 clinical illustration: "Henrietta," 410-433 Ainsworth, M. D. S., 32, 41, 52, 54, 158 attachment theory, 37 Albershelm, L., 40 alcoholism, 117 Aldridge. M. A., 234, 235 Alessandri, S. M., 353 Alexander, J. F., 100 Alexander, M. P., 132 alexithymia, 458 alien self, 2, 12, 44 in BPD, 341, 363, 419-433 concept of. 11-14, 129, 321 externalization of, 11-13, 320, 321, 360, 430, 473 clinical illustration: "Glen," 331340 and identification with aggressor, 12, 198,328.422 clinical illustration: "Henrietta," 410-433 pernicious, 12, 198.419 in adolescence, 338-339 clinical illustration: "Tony," 324330 symbiotic mother, 321 Allen, J., xii, 134, 240, 313 Allessandri, S. M., 162 Allison. E.,xi alpha function, 28, 124 Als, H„ 156 Alson, D., 156 altruism, reciprocal, 122 amnesia, infantile, 241, 245 Amsterdam, B., 240 Anderson, S., 138, 139 Anna Freud Centre, 270, 379 Brittle Diabetes Research Programme, 388 annihilation, phantasies of, 282

Index anorexia, 405 see afso bulimia nervosa; eating disorder(s) antisocial personality disorder, 138 anxiety, paranoid, 479 "anxious/ambivalent" attachment, 90 "anxious/ avoidant" attachment, 38, 90 "anxious/resistant" attachment, 38 APFA (adult personality functioning) measure, 118 Appleton, M., 48 Arend, R.A.,47 Aristotle. 67-69, 85 Aristotelian view of affects, 69-70, 76, 80. 85, 86, 90 Arlow, J. A.,255 Aronson, E.,207 arrest, 61 Arsenlo,W.,63 "as-if": mode of communication, 178, 180, 266, 299, 308 reality, 306, 309, 315 Aslin. R. N., 177 Astington, J., 30, 47, 48, 50, 51, 56, 146, 242, 259, 353 attachment (passim): classification. 49, 136, 347 infant's, 40, 41, 119, 128 mothers'. 42, 52 neonatal, 119 and personality disorders, 59 stability of, 40, 132 twins', 111,347 disorganization of, 98, 119. 128, 133, 135 and borderline personality disorder, 343-371 early, and mentalization, 293 insecure, 7 pattern(s): classification of: see classification of attachment patterns infants', 37-39 "preoccupied": see "preoccupied" attachment patterns and reflective function, 23-64 relationships, role of, 7

/

551

security, 7, 130-132, 136. 14], 347, 353. 358 and IIM, 130 and reflective function, 36-37, 4458 system, and interpersonal relationships, 39-44 theory. 2-3, 21, 65, 103, 114, 124 and affect regulation. 66, 67, 80, 81,87-96 Ainsworth, 37-39 Bowlby, 36, 88, 91, 102. 190, 343 and BPD, 343 and evolutionary sociobiology, 122 Fonagy (passim) and interpersonal understanding, 17 and molecular genetics, 115 and theory of mind, 16 transgenerational transmission of, 347-349 attention deficit(s). 367 hyperactivity disorder (ADHD), 104, 472 Atwater, J. D., 153 Atwood, G.,357 Auerbach, J. S., 29 autism, 248, 305 childhood, 235-237, 241. 245, 248, 249, 300, 305 impaired theory of mind, 233-235 autobiographical memory, 41, 241, 242, 244 autobiographical self, 79. 80, 86. 143, 206,246-248,317 development of, 242-247 autobiographical stance, 247 automatized processes vs. controlled processes, 159-161 autonomy, 27, 55, 63, 321, 464 Averill.J.,72, 73 avoidant (A-type) infants, 98, 158 awareness, Interpersonal, 17, 427 Axelrod, R., 122 Ayoub, C.,60, 61, 102 Baby-FACS coding system, 216 Bahrick, L. R.. 8, 162. 166, 168, 177, 188,208,212

552

/

Index

Bakermans-Kranenburg, M., 356 Balazs, A. C, 249 Baldwin, J. M.. 240 Ball, D., 116 Bandura, A., 101 Banerjee, M., 259 Barasalou, L. W., 101 Barnes, J., 68 Barnett, D.,39 Barnett. R.. 177 Baron-Cohen, S., 225. 233, 236, 241, 242, 257, 264 on childhood autism, 300, 305 "reading the mind in the eyes" test, 118 on reflective function, 24, 57, 146 locus of, 29, 137 Barresi, J., 158, 184 Barrett, E., 102 Barrett, K., 216 Bartholomew. K., 134, 343 Bartsch, K., 56, 205, 220, 237 basic emotion(s), 71-74, 76, 85-90, 149, 159.322,437 innate, 155 states, 159, 169, 187,219 Bateman, A., 15, 430 Bates, E., 44, 55, 146, 158, 182. 184 Bates. J., 54, 102 Beardsall, L., 30 Bechara. A., 138 Beck, A. T., 73, 101 Beckett. S-, 465 Beebe, B., 8, 31, 33, 155, 156, 210 Beeghly, M.,346, 352 behavior genetics, 7. 97-142 behaviorism, 71 Behrends, R. S., 321 belief, false: see false belief Bell, S. M.,52 Belsky, J., 42, 43, 47, 54. 102, 347, 377 Benigni, L.. 44, 158 Benjamin, J„ 116 Benjamin. L. S., 343 Bennett, A. J., 116 "Bennie" [clinical illustration), 448453, 467

Benson, D. F., 132 Benson, J. B., 156 Bentley, K. S., 102 Bergeman.C. S., 106 Bergman, A., 2, 44 Bembach, E., 125 Bernstein, D. P., 110 Berridge, D., 51 Bertenthal, B., 241 beta-elements, 28 Bettes, B. A., 157 BideU.T. R.,61 Bifulco,A„ 117 Bigelow, A. E., 156,212,213 Bindung [linking]. 28 biofeedback, 143. 145-202, 170 model of affect, -mirroring, social, 189-192 training. 161-162, 168-171.201 seeaisoaffect(s), -mirroring, social biofeedback theory of biological determinism, 6 biology, 6. 83, 86, 100, 135, 287 Bion, W. R., 267, 269, 283, 376, 419 alpha function, 28, 124 beta elements, 28 containment, maternal, 14,43, 191, 376 on metabolization of terrifying fantasies, 282 mother-child relationship, 28, 157 object-relations theory, 190 Birch, H„ 152 Biro, S., 33, 147,224 Blair, R., 59, 137, 138, 139, 476 Blass, R. B.,321 Blatt, S. J., 29, 321 Blehar, M. C, 37 Bleiberg, E., xii, 44, 137, 430, 471 blindsight, 170 Bios, P.. 320, 321 Blum.K., 117 Boccla, M. L.,241 Bogdan, R. J., 14, 124 Bohman, M„ 113 Bolton. D.. 26, 27 borderline personality disorder (BPD), 13-15,203,314,341

Index AAI narratives of. 59, 193 clinical features of, 239, 343-371, 474, 477 clinical illustrations: "Emma," 388-410 "Henrietta," 410-433 "Sandra," 383-386 Teresa," 441-148 and disorganized attachment, 343371 Kernberg's concept of, 10 and mentalization. 18 and projective identification, 10, 194, 198 psychic reality in, 373-433 psychogenesis of, 380 and study of early trauma, 117-118 symptomatology of, 343-344, 359367 Boston group on therapeutic process, 109 Botterlll, G.,29 Bouchard, M.-A., 27 Bower, T. G., 153, 154, 183, 207, 234 Bowlby, J., 7, 39, 91. 100, 343 affective communication system, 155,210,218 attachment: security, with mother, 44 theory of, 5, 36-37, 40, 88-89, 102. 190 goal-corrected partnership, 123 internal working models, 37, 40 protection, 402 separation, 122 BPD: see borderline personality disorder Bracken, B. A., 24 Braswell, L.,6, 102 Braten. S., 210. 211 Braunwald, K.,39 Brazelton, T, 155, 156, 210 Brazzelli, M., 132 Brenner, C, 255 Brentano. F., 147, 255. 258 Bretherton, I., 123, 182. 184 attachment, secure, 49, 347 pretense, 47

I

553

representational mapping, 34, 146, 158 symbolic thought, 44 Brlerley, M.,84 Britner, PA., 124 Brittle Diabetes Research Programme, Anna Freud Centre, 388 Britton, R., 260. 268, 350, 419 Brockbank, M., 147 Brody, E., 2 Bronfenbrenner, U., 101 Bronfman, E., 356, 357 Brooks, J., 150, 216 Brooks-Gunn, J., 162, 166, 176,208, 318 self-concept. 3. 204, 240, 241, 246 Broussard, E. R., 344 Brown, G., 117 Brown, J., 30, 48, 50, 51, 110 Brownell, C. A.,31 Bruch, H..386 Bruner, J., 50, 152, 184 Budapest Infant-Parent Study, 119, 120 bulimia nervosa, 377 see also anorexia: eating disorder(s) Bureau of Child Welfare (now ACS), 442 Busch, F., 29 Butterworth. G., 207, 257 Byrne, R. M., 32, 470 Cadoret, R., 107, 110 Call, J., 230, 235, 241 Camaioni, L„ 44, 158 Campbell, J., 242, 244 Campbell, R., 246 Campos. J., 147, 158,216 Camras, L. A., 216 Carchon, I., 156,212 Cardasis,W.,344 Carey, G., 110 Carey, S., 215 Carlson, E., 42, 47, 49, 358 Carlson, S. M., 47 Carlson, V., 39, 40 Caron, A. J., 214 Caron, R. F., 214

554

/

Index

Carpenter. M., 159, 220, 225, 230, 235 Carruthers, P., 242, 245 Caspi. A., 105 Cassam, Q., 27 Cassidy, J., 42, 44, 47. 49, 89, 90, 131, 357 Castellanos, F.X., 119 Castllle. C. M.,246 Castle, D., 193 castration anxiety, 302 categorical self-concept. 204, 240 category congruence, lack of, 194-198 causal self-referentlality, 206, 242. 244 Cavell, M.. 3, 256 Channon, S.. 132 Charman,T.,45 Chess, L. K., 101 Chew, S. J., 114 Childhood Experience of Care and Abuse Instrument, 117 chimpanzees, 235. 236, 241 Chipuer, H. M., 106 Chisolm, K„ 39 Chomsky, N., 29 Churchland, P. S.,26 Cicchetti, D., 6, 24. 39, 102. 207. 240. 313,346,352 Clark, B. R.. 246 Clark, F., 137 Clark-Carter, D., 45 Clarkin, J.,4, 368 classification of attachment patterns, 7.40-42, i l l , 119, 128 of adoptees, 133 "autonomous." 39 "avoidant," 49 confused. 343 "dismissing," 39. 43, 98, 134, 135. 351,354 -"preoccupied," 134 disorganized, 44. 119. 120, 128, 129 "fearful," 343 "insecure." 45 /"dismissing," 39 /"preoccupied," 39

overwhelmed,' 343 prediction of, 49, 52, 136 "preoccupied," 39. 343 "secure," 37, 45. 47. 49, 52, 128 /"autonomous." 39 stability of. 132 transgenerational consistencies in. 347 unresolved, 39 Clements, W„ 30, 46, 367 clinical Illustrations: "Bennie," 448-453, 467 "Emma," 19, 219. 240. 388-410, 423,429,430.431 "Glen," 18,331-340 "Henrietta," 19,410-433 "Mat." 18, 174, 178,293,301-316 "Rebecca." 18, 199-200, 270r289, 253,313,383 "Rob," 461-467 "Sandra," 383-386 "Scott," 438, 453-461, 467 Teresa," 441-448, 467, 468 Tony," 18. 324-330, 338. 339 Cluster A, B disorders. 471. 472 Clyman, R. B., 470 Coates, S.,xii Cobbs, G., 44 Coccaro. E. F., 116 cognitive analytic therapy, with BPD patients, 368 , cognitive competence. 130 cognitive development, 60, 124, 150, 216.278 in adolescence. 317 studies of. 16, 146 cognitive neuroscience, 24, 141,204 cognitive scaffolding, 184 cognitive self-concept, 241 Cohen. D.. 6. 24, 102, 149. 242, 257. 471 Cohen, P., 110 Cohn, J. F.. 154, 155, 156, 157 Coldren, J.T., 153 Collins, N., 39, 134 Colombo, J., 153,229 Colombo, N., 132 Colorado Adoption Project, 105, 106

Index

m

Comings. B. G.. 117 Comings, D. E., 117-119 communication: "as-if mode of. 180 mother-infant, 155. 156.210 style, 130 communicative code, 177 generalized, 200, 202 marked, 180. 181 pretend mode. 301, 311 conceptual self-concept, 204 concern, capacity for, 197 see also empathy concrete functioning, 14. 28. 264, 265 concrete thinking. 413 conduct disorder. 472 conflict management, 51 "confused" classification. 343 Conger. R. D., 102. 107 Connell, D.. 157 consciousness: core. 79 extended, 80 constitutional self, 11, 15, 196.225. 240, 352, 356, 358. 363. 366 containment, 9, 14, 55, 191, 194, 377, 381,474 maternal, 43, 191,376 contingency: detection, 168-174, 198, 201, 219, 221,229,249.314 developmental functions of, 154. 162-168 malfunctioning of, 248 mechanism, 8 module. 162-165, 167. 169, 184, 208,209,212 maximization. 164, 165. 169, 171174.201 developmental functions of. 154. 162-165 control structures, secondary, 160 Controversial Discussions (A. FreudM. Klein). 17 Cooley, C. H.,25,240 Cooper. R P.. 177 Corcoran. R., 137

1

555

core consciousness, 79, 80 coregulation, 66, 88. 91, 92 and self-regulation. 143 core self, 44, 79. 80, 321, 376. 403, 433 alienation from, 471 Corkum, V., 158. 159, 184.206,220, 225 Corley, R.,99, 104 Correspondence Assumption, 215 corticotrophin-releaslng factor (CRF), 115 Costa. P. T., Jr.. 116 CottreU. D., 112 Couchoud, E. A., 30 countertransference, 19,345,370, 422. 447. 466 analyst's role in. clinical illustration: "Rebecca," 270-289 enactment, clinical Illustration: "Henrietta." 410-433 resistance, 408 clinical illustration: "Henrietta." 410-433 in work with of BPD patients: clinical illustration: "Emma," 388410 feeling of emptiness in. 413 Courage. M. L., 241. 246 Cox, D. N., 138 Cox, M.J.,39 Craik, F. I. M.. 133 Crawford. S., 132 criminality. 112. 113.318,427 Crittenden. P. M.. 39-41, 43. 44, 102, 123 Crnlc, C, 42 Crowell.J., 40 Crown. C. L.. 8 Csibra. G., 221-228, 230-234 habituation studies, 147, 215, 227 rational action, naive theory of, 184 teleological stance, 33, 206, 209, 228, 230 visual habituation studies. 223 Culver. C. 89. 156 curiosity, 130 Currie, G., 47

556

/

Index

Dalgleish,T.,74 Damasio, A., 77^82, 86. 90, 95, 132, 133, 138,204 internal milieu, 84 somatic marker hypothesis, 84 Damasio, H., 132, 138 Daniels, D., 106 Dare, C, 432 Darwin, C, 71, 122, 137, 154 Davidson, D., 205 Davidson, R.,71, 72 Davis, M., 242 Dawson, G., 241 daydreaming, 294. 295, 297. 298 Dean, J., 119 Deary, I. J., 116 Deater-Deckard, K., 106, 107 DeBianchedi, E., 191 DeCasper, A. J., 210 DeCoste, C, 156,212,213 decoupling, referential, 299 default simulation, 227-228, 365366 DeFries, J. C, 99, 104, 105, 114 Dejong, A., 357 delayed feedback procedure, 212 delinquency, 59, 110, 112, 354 Delia Sala.S., 132 Demos, V., 155, 158 Denham, S.A.,30, 48 Dennett, D., 146, 147, 151, 204, 230, 239, 299 on blindsight, 170 on intentional stance, 31, 33, 124, 347 on mental coherence, 364 on prediction of behavior, stances in, 25-26 depression, 323 in adolescence, clinical illustration: "Glen," 331-340 postnatal, 421 depressive position, 28, 260, 268, 269, 277, 465 Descartes, R., 67, 69, 77 Cartesian doctrine: of dualism, 69, 84 of first-person authority, 3-4, 204-207,219,230

of introspection, 151 design stance, in prediction of behavior, 25 DeSousa, R.,69, 70 development: cognitive: see cognitive development of self (passim): as physical agent, 207-209 social: see social development developmental pathology, 478 developmental psychopathology, 6, 30, 64, 102. 142, 225 cognitive behavioral approaches to, 101 and development of understanding agency and self, 247-251 genetic and environmental factors In, 99, 103, 106, 109, 113, 121, 140 research In, 101-113 role of reflective function, 478 see also affect(s), -mirroring, social biofeedback theory of developmental theory, 83 Devor, E., 110 De Wolff, M. S„ 347 diabetes: Brittle Diabetes Research Programme, 388 clinical illustration: "Emma," 388410 dialectic behavior therapy protocol, 368 Dias, M. G., 56 diathesis model, 357 Dicara, L.V., 161. 168 Dienes, Z.,205 differential emotions theory, 149, 215 DILalla, D.,43 discourse patterns, mother-child, 49 "dismissing" attachment patterns, 39, 43, 98, 135, 351,354 -"preoccupied," 134 disobedience, 63 disorganization: of attachment system, 39, 135, 136, 365, 374 and mentalization, 8, 98

Index of self, 28, 37, 120, 239, 249, 352, 360, 369, 404 clinical illustrations: "Emma," 388-410; "Henrietta." 410-433; Tony," 324-330 and failure of mentalization, 19 and projective Identification, 12, 320 disorganized/disoriented pattern of behavior, 38 disruption-soothing, 174 .dissociation, in adolescence, clinical Illustration: "Glen," 331-340 Dobzhansky,T.,6 Dodge, K., 66, 102 Doian, R., 138 Donelan-McCall, N.. 48 Dore. J.. 181 Dougherty, L. M., 216 dream(s), 26, 29 clinical illustrations: "Bennie," 448-453 "Emma." 388-410 "Henrietta," 410-433 "Scott," 453-461 interpretation. 122 vs. reality, 257, 278 Drucker, J., 279 Dumas, J. E., 112 Dunkeld, J.,207 Dunn, J., 51, 61. 268 on interaction, cooperative, 47 internal working model of, 40 on mental states, understanding of others', 30, 58, 375 observational studies of, 111 on reflective function, 48, 49 Dutton, D. G.,343, 344 Duyvesteyn, M. G. C 53 dynamic skills theory of development, 60, 354 eating disorder(s), 110, 117, 318, 386, 405 see also anorexia; bulimia nervosa Eaves, L. J., 6 Ebstein, R. P., 116 ecological aspect of self, 34 Eddy, T.J., 206, 246

I

557

Edelman, G., 78 Edgcumbe. R.. 5. 25. 270 Egeland, B.,54 ego: control, 130 regulatory, 83 -destructive shame, 13. 198. 425 clinical illustration: Tony," 324330 functioning, 130 resilience, 130 Eisenberg, N., 66 Ekman, P., 71-73, 78, 149, 154, 155. 169, 214 Elder, G. H., 102 Elicker, J.,50 Ellsworth. P.. 149 Elman.J. L., 109, 114 Emde, R., 2, 85, 102. 115. 147, 154. 409 infant research, 469 "Emma" [clinical illustration], 19, 219, 240, 388^410, 423, 429. 430, 431 emotion(s) (passim): basic: see basic emotion dysregulatlon, 251 regulation, 66, 130 state(s), regulation of, 171-174 emotional development, infant's, 154159 emotional responses, types of, 75 emotional template of intimacy anxiety/anger, 343 empathic affect mirroring, 170, 172. 293, 296, 297, 298 parental, 173, 198,202,219 empathic concern, development of, 50, 220, 238. 299 clinical illustration: Teresa," 441448 empathy, 139, 171. 288, 291, 312. 380. 382 concept of, 137 development of, 138 emotional resonance, 137 maternal. 126, 302 parental, 172 empirical self, 3, 204

558

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Index

emptiness, feeling of: in BPD. 346. 352. 366-367. 385 in countertransference, 413 empty self, 196 enactment. 14. 295, 432, 478 in adolescent breakdown, 319, 321 clinical illustration: Tony," 324330 by BPD patients, 10,369-371,386 clinical illustrations: "Emma," 388-410; "Henrietta," 410-433 countertransference, 431 in work with BPD patients, 345 "Henrietta." 410-433 suicidal, clinical illustration: Teresa," 441-448 transference, in work with BPD patients, 345 violent, psychic equivalence and, 425-433 Englund, M., 50 environment, psychosocial: early, effect of, 97-98, 101-104 experience of, 114, 115 environmental determination, 110 environmentalist position, in psychoanalytic theory, 97-99, 101,103-113, 126, 139 equivalence mode: see psychic equivalence Erikson, E. H., 321 Evans, J. D., 113 Everitt, B.J.. 120 evolutionary sociobiology, 122 exploratory skill, 130 expressing affects, 437-440 extended consciousness, 80 externalization, 292, 338, 339, 357, 359, 363, 364, 478 of alien self. 11-13. 197,320.321. 430, 473 clinical illustrations: "Glen," 331340; Tony," 324-330 role of other In, 197, 198; clinical illustration: "Mat." 301-316 avoidance of, 301 clinical meaning of, 295-299 of confusion and madness, clinical illustration: "Emma," 388-410

marked: of affectively charged internal mental contents, 294 affect-regulative, 291-316 biological and social determinants. 299-301 use of by therapist, 301-310, 313 reflective, 186 symbolic. 295, 297, 298, 311-314 avoidance of, 313 of unbearable self-state, 370 exterojects, 198. 407. 429 Fabes. R.. 66 facial emotion expressions, 150, 154, 156, 158, 159.214,215 basic, 149 Fairbairn.W. R. D.,28 Fajardo, B.,469 false belief, 29. 30, 46. 48, 146, 243, 258. 263, 305, 348, 362, 367, 409 false self, 195-198,410 Fantz, R., 209 Faraone, S. V., 119 Farber, E. A., 54 Farrar, M. J.,60 "fearful" attachment patterns, 134, 343 Fearon. P.. 111.347 Feldsteln, S., 8, 156 felt security, 89, 91 Ferguson, C. A., 177 Femald, A., 177 Fernyhough, C, 45 Field. T., 149. 155-157. 162. 167, 208,212,214 Fifer.W. P..210 Finnish adoptive family study of schizophrenia, 113 Fisch, R. O..207 Fischer. K.. 354 Fischer. K. W., 60. 61", 102, 322, 354 Fisher, K., 241 fixation, 61 Flanagan, O., 70 Flavell. E. R., 48, 60, 258, 259, 305 Flavell, J., 48, 258,259 Flory, J. D., 116

Index Fodor, J. A., 26, 146.231,232,238, 242. 243. 300 Fogel. A., 91,216 Fonagy, I., 36, 199, 262, 298, 377 Fonagy, J., 36 Fonagy, P. (passim): clinical illustrations, 387 "Emma," 388-410 "Henrietta." 410-433 "Rebecca," 270-289 London Parent-Child Study. 131 Menninger Clinic study, 117-118, 134 studies of attachment and BPD. 351-352 twin study, 111-112.347 Fox, N.. 66, 90 Fox,R.A., 102 fractionation of reflective function. 6064, 354 Frankel, K.. 54 free association, 314, 315, 393 freedom, 24, 27 Freeman. A. T., 73 Freeman, N. H., 51 Fremmer-Bombrik, E., 119, 357 Freud. A., 6 Controversial Discussions (with M. Klein), 17 developmental theory of, 2 Freud, S., 19, 65, 101. 207, 403, 413, 426 on affects, 82-87 concept of psychic reality, 199,253, 255, 256, 278, 292 "fort-da" pretend game, 296-297 on infancy, 8 on linking [Bindung], 28 on narcissism. 266 on pretend play, 292 on primary and secondary processes, 28 principle of multiple determination, 122 reality, thought vs. external, 254255 role of pretend play, 279 sensitivity to Internal stimuli, 152 theory of unconscious mind, 26

I

559

Friesen, W. V., 149 Frith. C. D., 138. 205. 245 Frith, U., 3, 24, 25. 233, 300 Frosch, A., 29 frustration tolerance, 130,471 Fudge. H.. 118 Fulker, D., 99, 104, 106. 107 full simulation, 227-228 functionalist position, 90 Gaensbauer, T., 85 Gallagher. H. L., 132, 137 Gallup. G. G., 132, 176, 240, 241, 246 Garber. J., 66 Garcia, R., 149 Garduque, L., 47 Garmezy, M., 102 Garmezy. N., 101. 102 gaze-following, 146, 159, 184.215, 225 Ge.X., 102, 107 Gelernter. J.. 116 Gelman, S., 146 gene-environment Interaction, 7, 113. 117. 118 genetic-biological frame of reference, 98, 107 geneticlzation, 6 genetics, 7 as potentialist, 6 genotype, 105, 107. 113, 114, 117. 121, 125, 141, 142 -environment correlation, passive, 105 and phenotype, 7 George, C. 39, 120,357 Gergely, G. (passim): clinical illustration: "Mat," 301-316 contingency detection/ maximization hypotheses of, 163, 184. 208 habituation studies of, 147, 208, 215.227,233 visual, 223 on marking, 177-181 on teleological stance, 228, 230. 234 visual habituation studies of, 223 seeafsoaffect(s), -mirroring, social biofeedback theory of

560

/

Index

German Idealism, 2 Gerow, L.,47 Gervai, J., 128 gestures, protodeclarative, 159 Gewlrtz. J., 158, 184 Gholson, B.. 152 Gibson, J. J., 207 Gllligan.J.. 425,426 "Glen" (clinical illustration], 18, 331340 goal: attribution, 215, 225, 226, 227 -corrected partnership, 123 -directed action, 209, 222-239 ability to predict, 237-242 intentional, 209, 223, 226 state(s), 33, 206, 209, 224, 226, 236. 238. 361 GoeLV., 132, 137 Goldman, A., 29, 47. 146, 256 Goldman, D., 117 Goldsmith, H. H., 104 Goldwyn, R., 39, 49, 193 Golinkoff. R.,34 Gopnik, A.. 155,205 on Cartesian first-person authority, 230 imitation in neonate, 34 Meltzoff-Gopnik hypotheses, 34, 149-152, 186-188,211.215, 217 theory of mind, 29, 53, 56, 57, 146, 243. 263 research, 238, 244, 245, 259, 261 Gordon, R. M., 29, 243, 256 Gosling, J. C. B., 68 Gosselin, C.,45 Gottman, J. M., 156 Gould. S. J.. 6, 7 Gove, F., 55 Graf, P., 245 Grafman, N., 132 Granlc, I., 91, 216 Green. A., 1. 29, 83, 84, 469 Green, F.L., 48. 258, 259 Greenberg, B. D.. 116 Greenberg, M. T., 140 Greenberg, R., 149

Greenfield. P. M., 152 Greenspan, P., 70 Grice, H. P.. 49. 265, 303, 314 Gricean maxims, 314, 315 Grienenberger, J., 125 Griffiths. P., 70 Grinberg, L., 191 Gross, J. J..66, 93 Grossmann, K., 38, 54, 357 Grossmann, K. E„ 38, 43, 54, 119, 158 Guardia, J., 118 Gunderson, J. G., 344, 359, 363 Gustavsson, J. P., 116 Guy, L., 156 Guzder, H..345 Gysin, R., 117 habituation studies, 147. 208. 215. 227, 233 visual. 223 Haft.W.. 181 Hams, S.. 212 Hallett, M., 132 Hamer. D., 116 Hamilton. C, 40 Hamilton, S. P., 116 Hamilton, W. D., 122 Happe, F.,230, 233 Hare, R. D., 138 Harrington. R. C, 118 Harris, J. R., 105, 112 Harris, P. L.. 29, 48. 49, 56, 146, 243, 257 Harris, R. D., 305 Harris, T., 117 Hart, D.. 63 Harter, S., 3, 44, 204, 240 Hartmann, H..254 Hasert, M., 116 Haugeland, J. C, 147, 299 Haviland, J. M.,214 Hazen, N„ 356, 357 Hegeman, E., 68. 70 Hegley, D..216 Heider, F.. 224 Hells, A., 116 Heinz, A., 116 Helmig, L., 108

Index Hembree, E. A.,216 "Henrietta" [clinical illustration], 19, 410-433 Herbst, J. H., 116 Herrera, C.. 58 Hesse, E., 119, 175. 194, 382 Hetherington. E. M.. 99, 104. 105, 110 Hewitt, J. K„ 6 Hickie. I. B.. 102 Hicks, L., 207 Higgitt, A., 12. 42. 43, 344 Higley. J. D., 116 Hill, J., 26, 27. 118 Hirschfeld, L., 146 historical-causal self-concept, 247 Hbbsoh, R. P.. 155, 193, 210, 300 Hochman, J. A., 344 Hofer, L„ 133, 181 Hofer, M. A., 37, 90, 95, 133 Hoffman. M. L.. 220, 238 Hogan,A.,34 Hogrefe, G.-J., 245 Holder, A., 432 Holder, J., 131 homeostasis, 37, 95 homunculus, 79 Hopkins. J., 26 Horowitz, L. M., 134 Horowitz, M.J.,40 hovering attention, therapist's. 315 Howard, R.. 193 Howe. M. L., 241, 246 Hoyt, I. P., 40 Hrncir, E.,47 Hubley, P., 183,225 Hughes, C, 245 Hughes, P., 119 Hull, J., 1 Hullian learning-theory research, 1 Hume, J.,70, 81 humor, 26, 432. 447, 449, 452, 453. 467 Hunt, J. M., 222 Hurry,A.,xiii hyperactive mentalizing, 383, 431 identification: primary. 380

/

561

projective: see projective identification identifying affects. 437-440 imagination, 24. 294, 297, 298. 311, 439 child's, Importance of, 261-265 imitation. 150, 182. 183, 189, 215, 227 -based attribution of emotional states, 149-152 infantile, 182,219 intramodal, 183 neonatal, 34, 183,210.211,215 impulse control, 471 impulsivity, 251 in BPD, 346, 360-362, 369 Incest. 122 inclusive fitness. 122 independent teleology position, 232, 233 individuation, 264, 320, 321 separation-, 320 infant-directed speech, 177 inference, 74, 127. 132, 159, 231, 242, 355, 368 of mental state of other, 29 innate modularist approach, 243 "Insecure"/"Dismissing" individuals, 39 "Insecure"/"Preoccupied" individuals, 39 Instability, emotional, in BPD. 346, 359, 362 instrumental action state, 34 intelligence, 91, 130 quotient (IQ), 131 social, 124 Intentional action, 4 "lntention-in-action," 361-362 intentional agent, self as. 206, 237242 intentional idioms, 147 intentionality: attribution of, 215, 236 development of, 11, 286 of mental states, 147 sense of, 26, 54. 64. 145. 184, 197, 287 of symbols, 294

562

/

Index

intentional mental states, understanding and attribution of, 146-148, 206. 220. 221. 230-239, 244. 257. 300, 305 intentional self, 143, 197, 205, 215, 299 intentional stance. 2, 64, 136, 226, 228. 230, 233. 235. 237. 240 acquisition of, 30-33, 58. 63. 127, 146-147, 203, 287, 348 in BPD. 341 concept of, 143, 146, 347 role of, 25, 27, 33, 124, 151 vs. teleological stance, 225, 349, 355 interactionism, 6 internal milieu, 84 Internal working model(s) (IWM). 368 and abuse, 362, 479 Bowlby on. 37. 39, 123 concept of, 40, 91 of infants, study of, by Ainsworth, 37 Kernberg on, 40 nonreflective, 62, 355 reflective, 62, 349 role of. 123 interpersonal adaptation: see adaptation, interpersonal interpersonal aspect of self, 34 interpersonal awareness, 17,427 interpersonal communion, 182, 186 Interpersonal interpretive mechanism (IIM), 16-17, 124-136, 140. 141 IIM-a (affect). 137-142 IIM-c (cognition), 137-142 interpersonal reality, 257 interpersonal relationship(s) (passim): and attachment, 39-44 distorted, in personality disorder, 343-347. 358 interpersonal self, 34 intersubjectivity. 67, 81. 127, 143, 203,210,265 Inherent, 17 initial state, 204, 217 objective, 219 primary, 17, 150,211

weak, 217 introspection, 29, 31. 126. 151, 204. 215, 349 vs. reflective function, 27 inward expression of affects, 297, 316, 439, 466 IQ (intelligence quotient), 131 irascibility, 68 irritability, in BPD, 362 irritation, 68 Isabella, R., 52, 54 island of psychic equivalence, 200 Izard, C. E.: on basic emotions. Innate, 88-89, 149, 169,214 on caregivers, 210 differential emotions theory of, 215216 on emotional development, 154-157 Jacob, F., 142 Jacobovitz. D., 119. 356. 357, 365 Jacobson, E., 85. 86, 157, 403 Jaffe, J., 8, 31,32, 155, 156 James, S-. 67 James, W., 3, 24, 153, 204, 206. 240, 242 -Lange theory, 72-73 Jasnow, M. D., 8 Jeannerod, M., 205, 229, 361 Jenkins, J.,30, 47, 50 Joffe.W. G.,426 Johnson, J. G., 110. 380 Johnson. M. H., 209 Johnson. M. K., 40 Johnson, S. C, 215, 227 Johnson-Laird, P. N., 32, 40, 74, 101, 470 joint-attention skills, 220, 225, 226, 230 communicative, 235 ideologically based, 235-237 Jones, L., 137 Jordan, M. I., 167 Jorm, A. F., 116 Joseph. B., 422, 442 Juffer, F.,53 Jurist, E. L., viii, 2, 68 clinical illustrations, 441-468

Index Kagan. J., 101, 150,216 Kalish, D.,232 Kandel, E.. 114, 115. 139, 140, 142 Kaplan, B., 44 Kaplan, N.. 39, 47 Kaplan-Solms, K.,86 Karmiloff-Smith.A., 159, 185 Katsuragi, S., 116 Kavanaugh, R. D., 48, 305 Kaye, K. L.. 183 Keeble, S..238 Kelemen, D., 231 Kendler, K. S., 104 Kennedy, E., 63 Kennedy, H., 5, 25 Kenny, S. L., 60 Kernberg, O. F.. 10, 40, 194, 345, 368, 409 self-object-affect triad, 124' Kernberg, P. F., 157. 190 Kervella, C, 156,212 Klhlstrom, J. F..40 Killen, M., 62. 63 King, P., 17 King, S.T., 116 Klrsh. S. J., 131 Klauber, J..284 Klein, M.: Controversial Discussions (with A. Freud). 17 depressive position, 28, 277, 465 developmental theory. 2 projective Identification, 194 Klinnert, M. D.. 147, 158, 257 Knight, C. C. 60 Kohut, H., 28, 157, 376, 403 Infantile omnipotence, 191 maternal mirroring function, 191 narcissistic rage, 446 self psychology, 190 Koos. O., 128, 147, 218, 224. 239, 249, 250 Kopp, C. B..31 Kowslowskl, B., 155 Kranenburg, M. J., 42 Kranzler, H., 116 Krause, R., 199 Kruper, J., 156 Krystal, H.. 458

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563

Kubicek. L.,409 Kumakiri, C, 116 Kurtz, Z., 112 Kusche, C. A., 140 Kyrlakldou, C.,51 Laakso, A., 118 Lachmann, F., 31, 155, 156 Lacohe. H.,260 LaHoste, G. J.. 119 Lahti, L, 113 Laible, D. J., 131 Lakatos, K., 119 Lambermon, M. W. E., 42 Landau, K. R.,246 Landry, A. M., 246 Lang, B., 244 Lange, C. G. James-Lange theory. 72-73 language, 5, 51, 53, 73, 79. 294, 440 ability, 130 in analytic discourse, 1, 314, 315, 421 dysfunctions of, clinical illustration: "Mat." 301-316 and ego function, 254 intonation in, 377 mental-state, 51, 61, 351 role of, in mentalizing. 49 theory of, 28 Laplanche, J.. 255 Laufer, E., 318 Laufer, M.. 318 Lawson. J., 241 Lazarus. R., 73.80 Zajonc-Lazarus debate, 74 Leach, K., xt Leach, P., 100 learned mentalistic helplessness, in BPD, 360 learning-theory research, 1 Lecours, S., 27 LeDoux, J. E., 74-78, 80, 81. 90 Lee, D., 207 Leekam, S. R.. 30, 56 Lefford.A.. 152 Legerstee, M., 213, 227 Leigh, T., 193,346 Lelwlca, M.,214

564

/

Index

Lenzenweger, M. F„ 4 Lesch, K. P., 116 Leslie, A., 29, 215, 230, 257, 296 decoupling, 178, 293, 295, 299 habituation studies, 208 innate modularist approach, 243 modularist theory of Agency. 224 pretend play, 47, 178, 180,305 teleologica] system, 206, 224, 231233 theory of mind, 47, 124, 205, 224225, 300 naive. 238, 242 Leve, L. D., 110 Levenson, R., 149 Levine, S.. 117 LevJnson, A., 59, 351 Lewicka, M., 162 Lewis, C, 50, 51, 212, 242 Lewis, M., 3, 91, 162. 166. 204. 208. 240 on conscious feeling states, 150 on contingent control, 212 on emotions, differentiating, 216 on mirror recognition, 176, 246 Lichtenberg, J. D., 469 Liddle, C, 102 Lieberman.A. F.. 50 "like me" hypothesis, 186-188 Ullard.A. S.,48 Linehan, M., 368 linking \Bindung], 28 Linnoila, M., 116 Liotd, G.,356 Liu, D., 115 Locker, A., 125 LonderviHe, S., 55 London Parent-Child Study. 41. 43, 52, 131 Lorenz, F. O., 102 Lover, A., 63 Luborsky, E., 40 Luborsky, L., 40 Luquet, P., 28 Lyons-Ruth, K., 109, 119, 157. 356, 357. 365 MacArthur Working Group on Attachment, 44

Maccoby, E., 100, 108 Mackaln, K., 177 MacLean, D. J., 214 MacLean. P., 91 Magai, C.,66, 89 see also Malatesta. C. Z. magical thinking. 471 Magyar, J.. 189.249 Mahler, M.. 2. 154 developmental theory, 2 Internal states, 152 mirroring, 157, 190 separaMon-mdlvlduatlon, 320-321 symbolic thought, emergence of, 44 Mahoney, M. J., 73 Main, M.: on attachment: adult, 49, 55 Adult Attachment Interview (AAIJ, 39, 193 disorganized, 38, 44, 119, 357 in Infancy, 344, 347 Infant, 49, 55 longitudinal studies of, 40, 47 theory. 123 metacognition, 91 mother-infant communication, 155, 194 perception of caregiver's emotion, effect of on infant, 119. 175,382 Main, T., 386 Malatesta. C. Z.. 89. 149. 154-158. 169,210,214,215 see also Magai. C. Maldonado-Duran, M., 108 Mandler, G.. 24. 74 Marans, S., 261 Marcelli, D.. 156.212 Marenco, S., 6 Marian, V., 212 Maridaki-Kassotaki, K.. 51 markedness. 192. 292, 296. 299. 308314 blindness to, 301 of expressions, 178, 291 hypothesis, 175-181 lack of. 193-194 of mirroring display, 9 perceptual, 180, 298

Index Marold, D. B.,44 Martin, J. A.. 108 Marty, P., 28 Marvin, R. S., 44, 124, 357 Maslin, C 54 Masten, A. S.. 6. 102 "Mat" [clinical Illustrationl, 18, 174, 178.301-316 Matas, L.,47, 55 maternal deprivation, 115 Matlas, R., 157 Maughan, B., 193 MAX coding system, 216 Mayes, L.. 257. 471 Mays, K., 156 McClelland. J. L., 140 McCrae, R. R., 116 McDevitt, J. B.. 157, 190 McDougall, J.. 29, 376 McGulre. S.. I l l McKlssick. F. C..241 McLearn. G. E.. 114 McLoyd, V.C., 102 Mead, G. H., 240 Meaney, M. J., 115 Meichenbaum, D., 73, 101 Meln9,E.,45. 47, 131 Mele.A. R..26 Meltzoff, A., 34, 154, 155, 183, 205, 210.227,234 -Gopnik hypotheses, 149-152, 186188,211.215.217 memory(Ies): autobiographical, 41, 241. 242, 244 procedural, 40, 41 system, 41 nonvoluntary, 41 working. 77, 79, 80 Menninger Child and Family Center, 108 Menninger Clinic, 117, 134,346 study, 117-118 mental coherence, principle of. 239, 364. 365 mentalism, origins of, 230 mentalization (passim): development of, 11-13,203-251 facilitation of, 12 theories on, 29-31

/

565

extension of, aim of psychotherapy, 14 historical context of, 23-31 as mediator of psychosocial risk, 16 primary. 28 repudiation of. 13. 198 symbolic, secondary, 29 mentalized affectivity, 5. 11, 15, 16. 19,25,91,92,96,297,341 in clinical setting, 435—468 concept of. 435-436 elements of, 437-440 mentalizing (passim): hyperactive, 383, 431 pretend modes of, 199 mental states, unprocessed, body as channel for, clinical illustration: "Emma," 388-410 Menzel, E.. 241 Meredith. M., 48 Merrick, S„ 40 Messer, D.J., 146, 159 metacognition, 91, 380 metarepresentations. 35, 233, 243. 284. 296. 299, 402 with autistic disorder, clinical illustration: "Mat," 301-316 Michaelson, L.. 150. 216 Michels, R.. 254 Miles, D„ 110 Miller, N. E., 161, 168 Millhuff, C, 108 mlndblindness, 300. 368 mind-reading, 47, 52, 58, 249 defective, 442 development of, 49-51, 55, 221, 365 and attachment, 51, 52, 352 social-learning aspects, 29, 31 nonconscious, 367 and symbolic play, 48 tasks, "off line simulation" of, 47 Mlnuchin, S., 101 mirroring. 35-36. 58. 156, 473, 474 affect- (passim): deviant, 10-11, 192-198,293, 306.310.311 see also affectfsj, -mirroring, social biofeedback theory of

566

/

Index

mirroring (continued): of child's internal reality, maternal, of child's own self, 11. 28, 44, 157, 176, 190-191, 356, 420, 474 deviant, 192-195. 301 empathic, 173 maternal. 157 partial, 298 misattunement, 129 Mischel. W., 101 Mitchell, D. W., 153 Mitchell, P., 242, 244. 260 Mitchell, RW., 241 Mitchell, S.. 127,470 Modell, A.,344 modularist theory of Agency (ToMM/ Systeml), 29, 224 modulating affects, 437—440 molecular biology. 120 molecular genetics, 99, 104, 114-115 Moody, C, 108 Moore, C, 158, 159. 184, 206, 220, 225 Moore, M. K., 149, 183,205.210,211, 215,217 moral emoUon(s). 63. 137. 138 moral imbecility, 138 morality, 70, 138, 139 Moran, G., 282, 379, 388 on attachment, security of, 43, 52 on body, symbolic meaning of, 406 on caregiver, sensitivity of, 42, 52 on mental functioning, inhibition of, 5 on mentalization, 25, 264 psychological self, 3 Morgan, R., 162, 166, 208 Moring, J., 113 Morris, H., 344 Morris, J., 138 Morton, J., 3, 24, 25. 209 Moses, L. J., 259 Moskowltz, M.. xii Moss, E., 45 mother(s) (passim) motherese, 177 motivation, 38, 71, 88, 130, 409. 438 motor events, subliminal, 187 mourning. 120, 268, 269, 475

Muhleman, D., 117 Muir, D.,212 Multhaup, K. S.,40 multiplex developmental disorder, 471 Mundy. P., 34 Munholland, K.A., 123 murder, clinical illustrations: "Henrietta," 410-433 Tony," 324-330 murderousness, 353 Murphy, C. M.. 146, 159 Murray, L., 156, 157, 211-213, 378 Myers, RS.. 214 Naarala, M., 113 Nadasdy, Z.,33 Nadel. J., 156,212 Nagel. L., 216 Nagell, K., 159 Nalto, M.. 30 naive theory of rational action, 184, 223, 228 narcissism, 266, 277, 371, 458 thick-skinned and thin-skinned. 430 narcissistic personality disorder, 10 "nearly, but clearly not, like me" hypothesis. 188-189 necessity index, 163-165, 168, 170, 172, 173 negativity, 63. 106, 111 Neiderhiser, J., 99, 104-107 Neisser, U., 34, 204, 206, 207, 212 Nelson, C, 156,214 Nelson, K., 245 Neu.J., 101 neural self, 79 neuroscience, cognitive, 141 perspectives on affect regulation, 74-82 neurotic phenomena, 254 neurotic symptoms, 26 New, A. S., 116 Nguyen, P. V., 114 Nlgg. J. T., 104 Noam, G. G.,61 Noble, E. P., 117 nonconsequentiality, 291, 296, 299. 301.315,381

Index

I

567

parent(s)/caregiver(s) (passim) parental affect mirroring, 160.291299.310.311 social biofeedback theory of: see affect(s), -mirroring, social biofeedback theory of parenting (passim): and child development, 97, 100-113 dysfunctional, 12, 19, 38, 59, 63. Oakley, J., 70 353, 367 Oatley, K.,74 vs. genetics, 100-113 object relations: role of, 6 studies of, 103, 120 early, and mentalization, 65-96 Parents Development Interview (PDI), theory, 190 125 obsessive-compulsive disorder, 331 Paris, J.. 345 O'Connell, S., 137 Park, K., 50 O'Connor, T., 99, 105, 107 Parke, R.D., 131 Odysseus, 457^58 Parker. G., 102 oedipal situation, 267-269 Parker, S.T., 241 oedipal stage, 253 Parkin. L., 30 oedipal wishes, 265 Parsons, B. V., 100 Oedipus, 148,457 Parsons, E., 356 Ogden, T., 267, 365 Olds, D.. 112 pathological development, 474—477 Olson, D., 146,246 PATHS Program, 140 Olver, P.. 152 Patrick, M„ 193, 343, 351 omnipotence, 195. 386, 457 Patterson, G. R., 63, 100 peer group interaction, 50 infantile, 191,415 Pelaez-Nogueras, M., 158, 184 ontogenetic model, 126 Pennington, B., 34 Oppenheim, D., 409 perceptual action state, 34 Oppositional Defiant Disorder, 112 Perilloux, H. K.,246 Osher, Y„ 116 Perner, J.. 56, 259, 295, 367 Oster, H.. 154, 155,216 Other Mind Assumption, 215 on causal self-referentiality, 242"overwhelmed" classification, 343 246 Owen, M.T.,39 on false-belief tasks, 30, 46, 305, 348. 367 on mind states, 146. 205, 206, 231 Pacherie, E., 205, 206, 229, 245 on siblings. Interaction with, 50 Paikoff, R. L..318 Perrett. D., 138 Pancake, V., 50 Perry, B., 132 panic disorders, 35, 219 Perry, D. G., 63 Panksepp, J.. 76, 77 Perry, L.C., 63 Papousek, H., 156, 162, 166, 208. 210 Papousek, M.. 156, 162, 166, 208, Petit, G. S„ 102 Pettersen, L.,207 210 Phelps, J. L.. 43 paranoid anxiety, 479 phenotype. 7. 16, 110, 114, 121, 142 paranoid-schizoid position, 260, 269, Phillips, A., 159, 206, 237, 238 417 Phillips, J.. 112 Parent, S., 45

noncontlngency, 129 nonvoluntary memory system, 41 "no starting-state intersubjectivism" position, 217-219. 221 Nottebohm, F., 114 Novick, J.,380 Nucci, L. P., 62 Nussbaum, M., 69

568

/

Index

philosophical perspectives, on affect regulation. 67-70 physical agent, self as, 207-209 physical self, 31. 129, 143,205,207, 208 physical stance, in prediction of behavior, 25 Piaget. J., 167, 207-209, 222, 226, 229, 322 Pickens, J.. 157 Pickles, A., 118 Pillemer, D. B.,40, 41 Pine, F„ 44 Pinker. S., 91 Pipp, S. L..60 Plpp-Siegel, S., 119 Platz, D. L., 102 play, 130 pretend: see pretend play reality-, traumatizing, clinical illustration: "Mat." 301-316 symbolic; see symbolic play playing with reality. 18, 144,253-289 pleasure. 68. 72. 79. 85, 291 Plomin, R., 99, 104-107, 110, 114 Plotsky, P. M., 115 pointing, 46. 146, 159, 184. 225, 257 declarative, 206 protodeclarative. 220, 236 protoimperative, 221. 235, 236 Polan, H. J..90, 133 Polyphemos, 457-458 Pontalis, J. B.,255 postnatal depression, 421 potential space. 279, 284 Povinelli. D. J., 206. 241, 242, 245247 Power. M., 74 prediction, 55, 124, 132, 224, 232. 349 of action, 239 of behavior. 25, 33, 160 Premack, A. J., 215 Premack, D., 215,225 "preoccupied" attachment patterns. 39, 98. 135, 193, 249, 343. 344,351.354 -"dismissive," 134

preoccupied caregiver, 43, 52 present self. 242. 247 pretend mode of communication. 178 pretend mode of functioning, 9. 57, 200, 253. 261-265, 439, 475, 478 In BPD, 369, 375, 378, 380, 381 clinical illustrations: "Emma," 388-410; "Henrietta," 410-433; "Sandra," 383-386 and development, 296, 297 clinical Illustration: "Rebecca," 270-289 Ogden on. 267 and psychic equivalence mode, 2. 57. 144, 199. 257, 292-293, 320 integration of. 263-265, 267, 293, 409 vs. real. 25 pretend play, 47-48. 51, 54, 174, 178, 180, 257, 278. 369, 377, 407 affect-regulative use of. 291-316 clinical illustration: "Mat." 301316; pretense, 24, 47-53, 199-202, 232. 243.296,301-306.312 in BPD. 378. 379 in play, clinical Illustration: "Rebecca." 270-289 see also pretend mode of functioning Primary Access and Self-Awareness Assumption, 215 primary circular reactions, 167 primary Identification, 380 primary object relationships, 4 primitive defenses, 251 principle of mental coherence, 239. 365 principle of rational action. 33, 224. 225, 228. 230. 239, 361 Prlnz,W.,205 prior intentions, 206, 237. 238, 361362 procedural memory, 40. 41 projection, 9, 198, 277, 295, 339, 473, 477 of alien self, 328

Index in BPD, 366. 382. 386. 407. 419. 429 intrusive, 432 projective identification, 10-13. 194, 269, 277, 295, 320, 338, 444, 447. 473 in BPD, 346, 359, 365, 366, 386 evocatory. 105, 359, 422 proper self, 206, 242 proprioceptive feedback, 58, 187 protodeclarative gestures, 159. 225, 230, 235 communication, 236 pointing, 220, 236 protoimperative gestures, 225, 236 pointing, 221,235, 236 proto-self, 79 pseudo-Insights. 431 pseudo-symbolic communication, 431 psychic equivalence: of body shape, 405 island of, 200 psychic equivalence functioning. 9, 13. 14.57,253,255-261, 306-316, in adolescence, clinical illustration: "Glen." 331-340 in BPD. 350, 353, 362, 374. 378 clinical Illustrations: "Emma," 388-^410; "Henrietta," 410-433 and pretend play: clinical illustration: "Rebecca," 270-289 developmental arrest at level of, 200, 301, 313, 314, 380. 382, 386, 405 clinical illustration: Tony," 324330 and pretend mode, 2, 56, 144, 199, 257. 282. 292-293. 320, 430433 integration of, 263^265, 267, 409 and projective Identification, 269 regression to. clinical illustration: "Glen," 331-340 violence and self-destructive acts in. 475

I

569

psychic reality: in borderline personality disorder, 373-433 in borderline states, 373-433 concept of: Freud's, 199, 292, 254-255 Laplanche and Pontalis's, 255 development of. 199, 256-265 normal, 374-380 dysfunctional, in BPD. clinical illustrations: "Emma," 388-410 "Henrietta," 410-433 mentalizing mode of, 263 perception of, 253-289 pretend mode of, 2. 261-265 clinical illustration: "Rebecca," 270-289 state of dissociation, clinical Illustration: "Glen." 331-340 understanding, clinical illustration: "Rebecca," 270-289 psychoanalytic psychotherapy, with BPD patients, 368 psychological perspectives on affect regulation, 71-74 psychological reality. 255 psychological self, 3-13, 28. 264, 282, 287,319,327,475 in BPD, 379, 405 disruption of, 198 theory. 25 psychopathology (passim): adolescent. 318. 319 borderline: see borderline personality disorder clinical illustrations: "Bennie." 448-453 "Rob." 461-467 "Scott," 453-161 Teresa." 441-448 developmental: see developmental psychopathology theories of. 4 Pulver, S., 83 Quine, W.V. O., 147 Quinton, D., 102

570

/

Index

Radke-Yarrow, M., 238 Rapaport. D.. 83 rational action: naive theory of, 184. 223, 228 principle of: see principle of rational action Read, S. J., 39, 134 Reagan, R, 102 reality: constraints. 33, 36 inner vs. outer, 4, 25 Interpersonal, 257 -play, traumatizing, clinical illustration: "Mat," 301-316 playingwith, 18, 144, 253-289 psychic: see psychic reality psychological. 255 testing, 254. 255, 295 social. 346. 348 "Rebecca" [clinical illustration], 18. 199-200. 270-289. 253, 313, 383 Reddy,V.,48. 257 Redfern. S..45 referential anchoring, 178, 202 referential decoupling, 178, 180, 181, 202, 299, 300, 301 referential opacity. 147 reflective capacity, 354 acquisition of, 49, 60, 348 aided by analysis/ therapy, 477 clinical illustration: "Henrietta," 410-433 caregiver's, 348 and dreams, 420 and false-belief reasoning, 46 impaired, 359 by biological vulnerabilities, 367; clinical illustration: "Emma." 388^410 clinical illustration: "Sandra." 383-384 by maltreatment, 346, 351, 352. 476 reflective function, 2, 14, 473 abnormal, 59-64, 364. 367, 420 clinical illustration: "Sandra," 383-384

In psychopathology. 385, 478 and attachment, 36-58, 313. 349351,356,375 capacity for: see reflective capacity concept of. 3. 23, 124-136, 375, 471 psychoanalytic. 27-31 development of. 29-36, 317-340, 476 in infancy, 31-36 mechanisms for, 65-96 normal, 56-58 effect of therapy on, 403 historical context of, 23-31 Impact of maltreatment on, 352354 vs. introspection, 27 parental, 125.420 robustness of. 350 scale, 140 and self-development, 58-59 and self-organization, 23-64, 356. 419 self-sustaining auxiliary, 197 regression, 61, 62, 262. 324, 338, 356 regulation, 86 Reiss. D., 99. 104, 105, 109-111, 125 relationship patterns, rigidity of. In BPD, 384-387 Relationship Questionnaire, 134 Repacholi, B. M.. 238 representation: -building training, 185, 201, 222 systems of, petrification of, in BPD, 384-387 representational agent, self as, 206 representational mapping, 34-36, 40 representational redescription, 185 representational self, 143. 205 -concept. 241 Reserbat-Plantey, D., 156, 212 resilience, ego, 117, 130 lack of. 64. 355 reslstance(s); 5, 98 responsibility, 27. 197 reversibility, concept of. 322 Rey.J. H.. 10,345

Index Reznick.J. S.. 184 RF: see reflective function Rlcketts. M. H., 116 Ricks, M., 155 Rldgeway, D., 49 Rlggs, K. J„ 244 Rlggs, S., 356 Rlsch. N., 117 Ritchie, B. F., 232 Riviere. J.. 265 "Rob" [clinical illustration], 461-467 Robbins, W.T., 120 Rochat, P., 162, 166. 208. 212. 222 Rogers. R.D., 133 Rogers. S.. 34 Rogoff. B., 61 Rogosch. F.A.,313 Rorty,A..70 Rosenberger, K., 42 Rosenfeld, H.. 281, 330, 430 Rosenstein, D., 216 Rosenthal, N. E., 116 Ross, G„ 184 Roth, D., 243 Rothenberg, M. B., 100 Rotter, J. B., 174 Rovee-Collier. C. K.. 152 Rowe, D.. 105. 112. 119 Ruffman,T.,30, 50 Rumelhart, D. E., 140, 167 Russel, J.,45 Russell, B., 245, 258 Russell, J„ 72, 73, 245 Rutter. M.. 6, 99, 102, 104, 107, 115, 118.313 Rutter. R. 114 Ryle,A.,368 Sadato, M.. 132 sadism, 334 Sameroff.A. J., 6. 102 Sander, L. W., 155,210 Sandler. J., 194, 380. 422, 426, 432 "Sandra" [clinical illustration]. 383386 Saunders, K., 343 Savage-Rumbaugh, E. S., 241 Scarr, S., 103

I

571

Schachter. D.L.. 40. 41 Schachter, S.. 73 schizophrenia, 113, 245 clinical illustrations: "Bennie," 448-453 Teresa," 441-448 Schmuckler, M. A., 166 Schneider, W„ 159 Schneider-Rosen. K., 346. 352 Schneier.F. R, 118 Schore.A. N.,86 Schuengel, C, 356, 365 Schwan. A.,38 Scolton, K. L„ 131 "Scott" [clinical illustration], 438. 453461, 467 Searle. J. R„ 205, 206, 237, 242, 244. 256. 261 secondary control structures, 160 second-order representations, 15. 19, 299. 300, 316, 349, 359 of affect states, 300 of self-states, 225. 293 "secure": /"autonomous" individuals, 39 -"fearful" attachment patterns, 134 pattern of behavior, 37 Segal, G., 29 Segal, H., 29. 194. 267 self: as agent. 204-207 see also agentive self alien: see alien self autobiographical: see autobiographical self constitutional: see constitutional self core: see core self development (passim): normal. 349-351 differentiation of, 166-167 disorganization of, 12. 320, 404 empirical: see empirical self empty, 196 false: see false self as Intentional mental agent. 237242, 248 see also intentional self

572

/

Index

self (continued): neural, 79 neurobiological basis of, 86 as physical agent, 207-209, 248 see also physical self present, 242, 247 proper. 206, 242 proto-, 79 psychological: see psychological self psychology, 190 as representational agent, 248 see also representational self as social agent, 209-222, 248 see also social self structurallzation of, 249 as teleological agent, 222-237. 248 see also teleological self temporally extended, 206, 242, 246, 248 true: see true self unstable sense of, in BPD, 346, 359-360 self-awareness, emotional, infant's, 145-202 self-concept: categorical: see categorical selfconcept cognitive, 241 development of. 24, 240-242 historical-causal, 247 representational: see representational self-concept unified. 242 self-confidence, 89, 130 self-consciousness, 27 self-control, infant's, 145-202 self-cutting: see self-harm self-detection, 166, 208 self-development, 191, 358 disturbances of. 12, 19, 35, 64, 239, 249 psychoanalytic formulations of, 375 and reflective function, 58-59 role of affects in. 145, 181 social constructivism in, 240 theories of, 28, 203-251, 282, 288, 317,319-320 self-discovery, 186

self-esteem. 89 self-exploration, 168, 213 self-harm, 341, 358, 374, 376, 475, 476 in BPD. 363 clinical illustrations: "Emma," 388-410 "Sandra," 383-386 Teresa." 441-448 among girls, 472 self-identity, 321 self-mutilation: see self-harm self-narrative, 12 self-organization: attachment and reflective function in, 23 development of, 16,31 self-orientation, 166 self-recognition, 130 mirror, 240-242, 246 self-referentiality, causal, 206, 242, 244 self-reflective function, 5, 21 self-reflexlvity, 435, 439. 468 self-regulation, 32, 89. 95. 96, 127, 133, 158, 160,436 affective. 155, 157, 181, 202. 218. 292, 293. 300 and marked externalization, 294299; clinical illustration: "Mat," 301-316 vs. coregulation, 66, 88, 91, 92, 143 self-reliance, 89 self-representation, 3 self-states, levels of representations of, 159-161 Sellars.W..288 sensitization training, 161, 162, 168, 169, 187. 201, 218. 222, 300, 316, 348 sensory action state, 34 separation: anxiety, 197, 282. 302 disorder, 472 test, 45 -individuation, 320 as primary task of adolescence, 320-324 Serketich.W. J., 112

Index sexual destructiveness, phantasies of, 282 Shachnow, J.,345 Shaffer. P.. 395 shame, 12, 198, 399, 427, 428 ego-destructive, 13, 198, 425, 426 clinical Illustration: Tony," 324330 Shepard. B.,89, 156 Sherman, N., 85 Shiffrin, R, 159 Shweder. R, 72, 73 Siegel, C. H.. 119 Slever, L. J., 116 Silberg, J.,99 Silk, K. R.,344 Simmel, M.,224 Simon, B. B., 241, 246, 247 Simonoff, E.. 99 Simons, R, 102 simulation: default:see default simulation full: see full simulation role of, 227-228 theory, 50, 146,216 Singer. J., 73 Sklnnerian learning-theory research, 1 Slade, A., xii. 43. 47, 90, 125 Slaughter, V., 215, 261 Slomkowski, C, 30. 51 Smailes, E. M., 110 Smalley, S. L.. 104, 119 Smith, D. J„ 318 Smith, M., 137 Smith, P. K., 49, 245 Smith, S.. 117 Snow, C. E., 177 social agent, self as, 209-222 social biofeedback. 126. 222. 229, 300,314,316 theory of parental affect-mirroring: seeaffect(s), -mirroring, social biofeedback theory of social cognitive capacities, 16, 130 social-cognitive revolution, 9-month, 222-237 social development, 248 early, studies of, 16, 111. 141,469

I

573

social referencing, 147. 158. 184, 225 social self, 143, 205 Sodian, B.,245 Solms, M., 86, 141 Solomon, J., 38. 120. 357 somatic marker hypothesis, 78, 84 Sommervllle. J. A., 223 Sor. D.. 191 Sorce.J. F„ 147 Spangler, G.. 43, 54, 119, 158 Spelke, E. S., 159 Spence, D., 470 Sperber, D.. 314 Spleker, S., 177 Spillius. E. B„ 105, 277, 359, 365, 422 Spinnler, H., 132 Spinoza, B., 69, 70, 84, 95 splitting, 13, 60, 61, 239, 346, 354, 359, 479 in BPD, 364-365 clinical illustration: "Henrietta." 410-433 normal, 269 Spock, B., 100 Squire, L. R., 40, 41 Sroufe, L.: affect regulation, 102.358 attachment system, 37, 42, 49-50, 123 cognitive development, 150 early social development, 6 emotions: negative, 38, 158 role of in development, 88-91, 216 self, development of, 40 SSn: see Strange Situation Starzomski, A.,343 state-regulation training, 202 Stayton, D. J.,52 Steele. H., 3. 12. 40-43. 52, 131, 384 Steele. M., 3, 12, 35, 40-43, 131, 193. 313.384 Stein. A., 134,377 Stein, H.. xii, 117 Stein, R., 83 Steiner, J., 269, 330. 446 Steiner, R., 17

574

/

Index

Stenberg. C. R., 147, 158 Stern, D., 2, 109, 154-156, 158, 177. 256.257,321 on affective communication, 8, 165, 205.210.211.217 affect-reflective interaction, 18186 developmental theory, 190 emotion regulation. 294 false beliefs. 146 Infant research. 469 interpersonal self, 34 self-agency, 58 "still-face" procedure. 212 stimuli, internal vs. external, 152-154 Stocker, M.. 68, 70 Stoic view of affects. 68-70, 72, 76, 80, 85,90 Stone, K. R. 234 Stone. T., 242 Strange Situation (SSn), 32, 39, 41. 45, 120, 125. 158 Striano.T., 212, 222 strong intersubjectivist position. 210216,221 structuralization of self, 249 Stuss, D.T.. 132, 133 Suarez. S. D.. 176, 240, 241. 246 subjective self, 204 subjectivity, 7. 9. 19, 73, 79, 136, 141. 218.250.352,425.426 development of, 291 psychoanalytic model for. 253289 and gene-environment interface, 113-136 growth of. 18 substance abuse. 117. 453, 458. 467 Suess, G., 54, 357 sufficiency index, 163, 164, 168, 171, 173 suicidally, 318. 475 In BPD, 346, 363-364 clinical illustrations: "Emma," 388-410 "Henrietta," 410-433 "Sandra," 383-386 Teresa," 441-448 among girls, 472

Sullivan. M.W.,.162 Suomi, S. J., 115-117 Svejda. M.. 147 Swanson, J. M., 119, 120 Sweeney. M. H..234 Swettenham, J., 29 symbiosis, 287, 321, 330 symbiotic mother. 320. 321 symbol formation, 36. 267 symbolic play, 48, 304, 306. 311, 314, 379 symbolic representation, secondorder, 126 symbolization, 28, 29, 35, 44, 136, 253, 267, 318, 377. 378, 416 inadequate. 319 Interpersonal. 129 Tager-Flusberg, H., 24, 242 talking. 48-49 Target, M. (passim): clinical illustration: "Sandra," 383386 Parents Development Interview (PD1), 125 psychological self, 3 twin study, 347 Taylor. C. 68. 70 Taylor, M., 47 teleological agent, self as, 206. 222237 teleological causality, 33, 224 teleological interpretive framework, 209,224 nonmentalistic. 221 teleological model of mind, 33, 34. 36, 41,52,54,61.209-251 teleological self, 143 teleological stance, 2, 31-34. 136. 143, 203, 205, 223-226. 228, 230-237,355.361 nonmentalistic. 236 nonmentalistic infantile, 184 Tellegen.A., 102 * Telsa, C, 30 temporally extended self, 206, 242. 246, 248 Teresa" [clinical illustration], 441448, 467, 468

Index Tesman. J. R,89, 156 Thalss, L.,233 Thatcher. M.. 102 Theall, L. A., 246 theory of mind. 26-29. 199. 231-233, 245, 257, 287 and attachment, 53 competence, 50, 52, 53 definition, 23-24, 26, 29, 137 development of. 16. 52-56, 146149, 158, 204-207, 222, 253289, 292, 305 dysfunctional. 233-236, 239. 244 in autism, 233-235, 241, 245. 300 in schizophrenia. 245 in folk psychology, 26, 29 and IIM, 124 mechanisms of, 47 naive. 238, 239. 242. 348. 364 performance. 53, 131 research, 45, 124, 205, 234-235. 244, 245 theory-theory, 29-31, 50, 56, 243 Thomas, C. G., 101 Thompson, A. E., 322 Thompson. R. 66. 93. 94. 131.211. 220.238 thought-reality, vs. external reality, 254 Tienari, P.. 113 Tobias. B. A.. 40. 41 Tolman, E. C, 232 Tomasello, M., 146, 147, 241' actions, differentiating from outcomes, 206. 209 attentional states, manipulation of, 159,220-222.225 intentional stance. 226-230. 235. 240 social contingency perception, 211, 212 weak intersubjectivist position. 216217 Tomkins, S.,71,78, 89 ToMM/Systeml, 224 Tony" (clinical Illustration], 18, 324330. 338, 339 Toth, I.. 128

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Toth, S. L., 24. 240 Towbln. K. E.,471 Tranel. D.. 132, 138 transference, 14, 19, 315, 478 in work with adolescents, 333. 335. 339, 340, 345, 346 analyst as father figure In, clinical Illustration: "Rebecca," 270289 in work with BPD patients. 369371. 373. 385-387, 417. 429 clinical illustrations: "Emma," 388-410; "Henrietta." 410-433 projective Identification in, 366 as illusion. 284 negative, clinical illustration: "Scott," 453-461 perception of analyst in, 254 reality of, clinical illustration: "Rebecca." 270-289 self-self, in BPD. 422 trauma, 105, 175, 198, 249, 250, 264, 295, 297, 344, 352, 378 childhood, 39. 117-119 Freud on, 254 see also abuse, childhood clinical examples: "Emma." 388-410 "Henrietta," 410-433 "Mat." 301-316 "Rebecca," 270-289 deviant mirroring. 9. 194, 301 in mother, 119 reality, psychic, modes of, integration of, 380-384 unresolved, 476 vulnerability to, 12, 130, 136, 143, 145. 346. 351, 355-358, 384 clinical illustration: "Henrietta," 410-433 genetic, 113-118 see also aggressor, identification with traumatic reenactment, 446 Treboux, D.,40 Tremblay-Leveau, H., 212 Trevarthen, C, 155, 156. 183, 205. 210-213, 217. 221. 225. 256 triune brain, 91

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Trlvers. R. 122 Tronick. E., 31, 109, 129, 154-157. 210. 212 true self. 14,28. 195-198,431,473 Turkhelmer, E., 109 twin study(Ies). behavior rgenetic, 6, 97, 104, 109-112, 125,347 Uhl.G.. 117 Umbel. V.. 156 unpleasure, 85, 291, 299 "unresolved" individuals, 39 Unzner, L.. 54 Uzgiris, I.C., 156,222 Van Busschbach, A. M.. 42 vanderKolk, B.,41 van Uzendoorn, M., 40. 42. 53, 111, 347, 356 VanParys, M.,60 VanTol, H.H. M., 120 Varghese, J.,213 Vasek.M.E., 156 Vicario. D. S.T.. 114 violence, 475 in adolescence, clinical illustration: Tony," 324-330 interpersonal, clinical illustration: "Henrietta." 410-433 visual habituation studies, 223 Volkmar. F.. 471 Volterra, V„ 44, 158 vulnerability to trauma: see trauma, vulnerability to Vygotsky, L. S., 44, 48. 261. 287, 289 Waddington. C. H., 287 Wall, S., 37 Ward, M. J., 40, 42 Wartner. U. G.. 357 Waters. E., 37. 40, 50, 89. 158 Watson, J. S„ xii, 138, 148, 177, 199, 218,221.296 affect regulation, 95 attunement, shift to. 183 childhood autism, 248-249 contingency detection, 17, 171, 173, 188,208-213.220,229

/maximization hypothesis, 162168. 184 mechanism, 8 contingency maximizing, 162 hypothesis, 163-165, 173 emotions, differentiating. 216 mirroring, by caregiver, 58, 210, 311,349 mobile studies. 209 reflective abilities, development of. 35 self-detection. 208 see also affect(s), -mirroring, social biofeedback theory of "weak intersubjectivist" position, 216217,221 Wegner. D. M..205 Weinberg, K. M., 156 Weinberger. D. R, 6 Welskrantz, L..170 Wellman. H., 56, 146, 220, 257, 259 intentional mind states. 34, 205, 206, 237-238. 244 theory-theory position, 243 Werner. E.. 313 Werner, H., 44 West, M., 357 Westen, D.,87 Wheatley,T.,205 Wheeler. D. E.. 113 White, R, 117 White. S. H.,40, 41 Whiten, A., 146, 242 Whitesell, N. R.,44 Willatts, P.. 209, 222 Wilson. D., 314 Wimmer, H., 56. 146. 206. 243. 245. 305. 348 Winnicott. D. W., 195 on borderline state, 384 on holding environment. 403 inner and outer reality, intermediate area between, 265 on maternal holding, 191 on mirroring, 376 maternal, of child's own self. 11, 28.44, 157. 176, 190. 191.356. 420, 474

Index on play, 263 on potential space, 279 psychoanalytic object relations theory of, 40, 190,409 on role of parents, 100 on self: development of, 282 false, 195-198 true, emergence of, 28 Wisconsin card sorting task, 245 Wise, S., 156 , wish fulfillment, 291. 299 Wohlgemuth-Levy, D., 125 Wolff, P. H., 1,469 Wollheim, R, 26, 70 Wood. D., 184 Woodson, R, 149

Woodward. A.. 159, 208, 223 working memory, 77, 79, 80 Wynne. L. C. 113 Yates, W., 107 Yeomans. F., 368 Yonas, A., 207 Youngblade. L.. 30. 47. 51 Zahn-Waxier, C, 238 Zajonc, R.B..78, 80 -Lazarus debate, 74 Zanarini, M. C, 344 Zoller, D., 30 Zonderman, A. B.. 116 Zwart-Woudstra, H. A., 42 Zweig-Frank, H.. 345

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