Abstract
Recently, mentalization theory has risen to fame as a theoretical framework emphasising social cognition as a key issue in its approach to psychopathology and psychotherapy. In this article, I review and criticise the social-ontological assumptions made by mentalization theory, arguing that, in spite of a strong interactive focus, it remains fundamentally rooted in a Cartesian ontology, overlooking embodied, expressive, enactive, and sociocultural dimensions of social cognition. Furthermore, since mentalization theory was originally developed as a framework for understanding Borderline Personality Disorder (BPD), I offer a reinterpretation of the issue of social cognition reported in BPD from a more embodied and interactional perspective. Contrary to the received view, I suggest that issues of social cognition in BPD should not necessarily be seen as a partial or total inability to mentalize, but rather as a hypersensitivity to expressivity resulting in what I suggest we understand as acts of disnarration.
The concept of mentalization and the corresponding theoretical construction, mentalization theory (MT), has increasingly become a significant framework for the understanding of psychopathology in clinical settings and research. Although the concept of mentalization originally grew out of the École Psychosomatique de Paris, it is through the more recent endeavour of, notably, Peter Fonagy and Anthony Bateman that the contemporary framework of MT has been developed throughout the past 25 years.
In colloquial terms, mentalization refers to the ability to “Hold mind in mind” (Allen, 2006), designating the imaginative capacity of the individual to perceive and interpret human behaviour as conjoined with mental states such as desires, beliefs, reasons, and intentions. Importantly, according to MT, this ability to mentalize is fundamentally a developmental achievement rooted in the attachment context of the early infant/caretaker interaction, in which the infant needs to be exposed to appropriate or “marked” mirroring in order to develop adequate mentalizing models. Hence, when Borderline Personality Disorder (BPD) is seen as consisting of an unstable ability to mentalize, this can be traced back to a disruption of this process in the infant/caretaker dyad (Bateman & Fonagy, 2006).
Although MT, and the resultant framework of mentalization-based therapy (MBT), was originally developed as a response to BPD—and is today considered among the two dominant frameworks for treating BPD (Swenson & Choi-Kain, 2015)—MT is now used as a key clinical framework for treating a number of disorders, such as post-traumatic stress disorder, eating disorders, and depression (Bateman & Fonagy, 2010). In some cases MT is even used as a framework for social work; for example, interventions in schools (Twemlow & Fonagy, 2006). This broadening of the applicability of MT is rooted in the more bold claim that not only is dysfunction in the ability to mentalize responsible for all severe conditions leading to referral to psychological therapy, but increasing the ability to mentalize is also the primary common factor in all therapeutic achievements (Bateman & Fonagy, 2012a). In this sense, MBT is aimed at restoring the capacity to mentalize as the “psychological equivalent to physiotherapy addressed to a particular muscle group” (Bateman & Fonagy, 2012a, p. 275).
In recent years, however, a range of critiques have pointed to the problem that while it might be true that something like mentalization is present in all of these processes, stating this is neither very illuminating nor helpful, since the concept of mentalization is too broadly defined to merit the significant status it is proposed to have. In recognition of this problem, mentalization theorists have instigated a process of specifying the concept of mentalization based on the assumptions it incorporates from attachment theory, cognitive psychology, and recent developments in neuropsychology. This has resulted in what is now identified as a multidimensional approach to mentalization. According to Fonagy and Luyten (2009), we need to distinguish between four dimensions that define mentalization, where each dimension is suspended between two poles: the first specifies a distinction between explicit vs. implicit mentalization. Whereas explicit mentalization refers to a process of making sense of ourselves and others that is slow, conscious, and verbal, implicit mentalization is perceived as a nonconscious, nonverbal, and automatic cognitive process. The second dimension specifies whether mentalization is based on internal or external features of self and others, designating whether focus is on the mental interior or responding to the behavioural expressions of the other. The third dimension specifies whether mentalization is primarily related to cognitive or affective content. Lastly, the fourth dimension specifies if mentalization is related to oneself or to others. As such, MT now designates a complex framework denoting a variety of processes throughout which we come to understand the mind of ourselves and others.
Although it should be clear from the above description that the capacity to mentalize refers to both a self-reflective as well as an interpersonal component, there is undoubtedly a strong emphasis on social cognition in MT. Often mentalizing gets defined as a “form of social cognition” (Bateman & Fonagy, 2012b, p. 4) and Jon Allen (2006) even suggests that mentalizing would be synonymous with empathy if we “extend the concept of empathy to include empathy for oneself” (p. 13). At the same time, however, and without further specification, it is pointed out that “the process by which we mentalize explicitly about ourselves and other persons is substantially different” (p. 9).
I believe that this strong focus on social cognition is one of the most important contributions of MT to both clinical work and research in psychopathology. In recognition of the importance of this focus, and in response to the prominent place MT has recently received in the contemporary debate, this article offers a detailed and critical theoretical discussion of the social ontology assumed in MT. Hence, I will leave aside the intricacies of how we come to know our own minds.
My basic claim is that, in spite of a strong interactional focus inherited from attachment theory, MT remains fundamentally rooted within the lonely and phenomenologically inadequate social ontology of the Cartesian mind, viewing social understanding as a matter of bridging two closed off subjectivities through inner mental representations. This is problematic since the philosophical assumptions made in MT prescribe both a specific understanding of psychopathology, as in the case of research on BPD, but also the appropriate therapeutic interventions.
In order to specify and delimit this focus, the first section of the article offers an analysis and explication of the social ontological assumptions made in MT. The second section then offers a detailed critique hereof, emphasising how MT overlooks fundamental expressive, enactive, and sociocultural dimensions of social cognition. Since MT was originally developed as a response to the particular issues of social cognition found in BPD, the last section suggests a more embodied and contextual-interactional understanding of the impaired social functioning reported in BPD.
Mentalization theory and social cognition
In perusing the literature on MT, it quickly becomes apparent that it is a child of the Theory of Mind (ToM) framework and committed to Daniel Dennett’s (1989) “intentional stance,” which posits social cognition as a rational process of attributing beliefs and desires to the other person in order to predict behaviour. This commitment is often and explicitly stated in the literature (e.g., Allen, 2006; Bateman, Fonagy, & Luyten, 2012; Fonagy, 2006). However, ToM is not a unified theoretical framework and MT’s commitment to ToM is not without ambiguity. Therefore, it is necessary to begin by mapping the terrain: according to the received view, ToM can be divided into two branches which are most often blended and combined: “Theory Theory” (TT) and “Simulation Theory” (ST). The shared assumption is that the mind of the other person is fundamentally closed off and unavailable to perception; hence, in need of some sort of instrumental mediation. The type of mediation needed is, however, where the two positions differ. TT proposes that access to the other person’s mental life depends on making theoretical inferences based on a folk psychological framework, i.e., inferring from the other person’s behaviour to her inner mental states by attributing beliefs, desires, and intentions to her. ST, on the other hand, dismisses that we reach an understanding of the other person through theory, suggesting that the process is more affectively rooted, utilising a pretence mode, where our own minds are used to model a simulation of the other person’s mental states. This notion of simulation can again be distinguished into: (a) a “conscious and explicit” version, which assumes that the simulation process is essentially one in which the “attributer attempts to put herself in the target’s mental shoes” (Goldman, 2005, p. 80) and (b) a “sub-personal and implicit” version, which sees the process as automatic and non-reflective, often referring to an interpretation of mirror neurons as expressing simulation (e.g., Gallese, 2009). In spite of these differences, the shared and important assumption of ToM is that the social realm is something achieved through ascribing mental states to closed-off minds. This, in turn, is the reason why any access to these states has to go through my own inner mental representations. 1
How does MT fit into this social-cognitive framework? Initially, it should be remarked that the commitments to a Cartesian understanding of the mind as closed off and in need of mediation through inner mental representations are abundant in the literature. In a recent text, for instance, Bateman and Fonagy (2012b) define mentalizing as “the remarkable and pervasive human tendency to look beyond the visible shell of the body in understanding behaviour and seeking descriptions and explanations in terms of state of mind” (p. 3). Elsewhere, it is stated that “mentalizing is imaginative because we have to imagine what other people might be thinking or feeling; an important indicator of high quality of mentalization is the awareness that we do not and cannot know what is in someone else’s mind” (Fonagy, 2006, p. 54). More specifically, it seems that MT should be understood as utilising both classical TT and ST. That classical TT is at the heart of mentalization theory is, inter alia, clear from the explicit commitment to Dennett’s intentional stance and the fact that Fonagy designates “mentalization proper” as “thinking explicitly about mental states” (Fonagy, 2006, p. 54). Furthermore, the repeated talk of mentalizing as an “imaginative capacity”—one that can be explicitly trained in MBT—resonates clearly with the basic tenets of explicit simulation theory. Finally, extensive attempts to base MT in current developments in neuropsychology are also made, drawing on advances in research on mirror neurons. This level is probably best interpreted within the notion of “implicit mentalization.” Where controlled or explicit mentalization “reflects a serial and relatively slow process, which is typically verbal and requires reflection, attention, awareness and effort,” automatic or implicit mentalization “involves parallel and therefore much faster processing; is typically reflexive; and requires little or no attention, intention or awareness and effort” (Bateman et al., 2012, p. 20).
How does all this come together? Contrary to dominant nativist accounts in ToM, MT is critical towards seeing our capacity for mindreading as an expression of the maturation of an innate cognitive module. Rather, as mentioned in the last section, MT views our capacity for mindreading as a developmental achievement: one that owes its genesis to, and is emphatically nourished by, the attachment context of the early infant–caretaker interaction. As Fonagy states:
We have argued that the evidence for relational influences on mentalization is best explained by the assumption that the acquisition of theory of mind is part of an inter-subjective process between the infant and the caregiver. In our view, the caregiver helps the child create mentalizing models through complex linguistic and quasi-linguistic processes that involve non-verbal as well as verbal aspects of social interaction within an attachment context. (2006, p. 77)
In order to tell this story of a fully developed capacity to mentalize, MT refers to and utilises ST. This is particularly clear in the emphasis that the development of a healthy mentalizing capacity is dependent on an appropriate or marked mirroring in the early interaction between infant and caretaker (Bateman et al., 2012). In this way, the simulation process is burdened with serving as explanans for the development of mentalizing capacity, assuming that the simulation process is in no further need of explanation.
Construing of mentalization as a developmental achievement leads Fonagy to distinguish between two modes of what he calls the “interpersonal interpretive function”: (a) a “cognition-oriented” mode, referring to the fully rationalistic, belief/desire theory and (b) an “affect-oriented” mode based on ST. Fonagy suggests that the former is developed on the basis of the latter, but without eventually replacing it (2006, p. 56). Here, it is important to remember that there is a strong emphasis on the affective in all levels of mentalizing in MT (Jurist, 2010). In the case of BPD, it is, according to MT, exactly this early affective mirroring process that is disrupted, leading to a reduced capacity to mentalize because the child has not been facilitated in developing mentalizing models.
To summarise, MT is situated within the broader ToM framework, utilising both TT and ST in giving a developmental account of the competency to mentalize. Mentalizing is considered the ability to form adequate inner mental representations of the other person, in the sense of imaginatively and rationally attributing beliefs and desires in order to predict behaviour. These mentalizing models are developed through an affective and simulation-based interaction located in the early infant/caretaker interaction. In the case of BPD, this process is disrupted, leading to dispositions of mindblindness and aberrant social functioning.
Critical comments on the approach to social cognition in mentalization theory
Recently, ToM approaches to social cognition—TT as well as ST—have been met with extensive critique both internally and externally, suggesting, amongst other things, that the various experimental bases supporting ToM are at best indeterminate (e.g., Leudar & Costall, 2009). In the following, I will leave the discussion of the experimental and empirical basis for ToM aside, restricting myself to reviewing the fundamental philosophical and theoretical assumptions made in respect to social cognition in MT, drawing on contemporary discussions within the phenomenological tradition and the more recent framework of enactivism in cognitive sciences.
More specifically, I will argue that due to its commitment to the ToM framework, MT remains within a phenomenologically inadequate Cartesian understanding of social cognition, overlooking vital embodied, enacted, sociocultural, and contextual sources of social cognition.
The assumption that the mind is essentially closed off: Forgetting embodiment
One line of critique that has been consistently directed against ToM approaches in recent years has a phenomenological heritage (e.g., Heidegger, 1927/2001; Merleau-Ponty, 1945/2012; Scheler, 1931/1973). According to this perspective, the view of the mind as an impenetrable interiority, only accessible through mediation, is phenomenologically inadequate. Rather, if one resigns on this assumption and attempts a phenomenological description of social cognition, the emerging view is that the basic understanding of the other person is not a developmental achievement, but given directly. In the contemporary debate, this view has been put forth primarily through an appeal to what is referred to as the direct perception hypothesis (e.g., Gallagher, 2008; Zahavi, 2011), which is often elaborated through an appeal to the Merleau-Pontian notion of “Intercorporeity” (e.g., Gallagher, 2005; Tanaka, 2015). The claim from phenomenology is that once we attend to the structure of experience, there is only rarely recourse to such things as theory or simulation in our daily interactions with and understanding of other people. Instead, the other presents himself directly to me through his embodied expressions. According to Merleau-Ponty: “I do not perceive the anger or the threat as a psychological fact hidden behind the gesture, I read the anger in the gesture. The gesture does not make me think of anger, it is the anger itself” (1945/2012, p. 190). In these experiences, the other person is not given as a split entity, divided between a hidden interiority and a mere physical appearance, but rather as what Scheler calls an “expressive unity” (Ausdruckseinheit). However, as Zahavi (2011) and Gallagher (2008) have recently pointed out, it is important to specify what precisely is meant by “direct” in this context. The point is not to understand direct as if the other person’s mind would conflate with mine in full transparency, but rather that my experience of others is not mediated through conscious inferences or simulations, as ToM would have it. My experience of others is indeed often contextualised by my personal history or social background, knowledge, etc., but not in the sense of an epistemic operation.
2
As Merleau-Ponty specifies:
The sense of the gestures is not given but rather understood, which is to say taken up by an act of the spectator. The entire difficulty is to conceive of this act properly and not to confuse it with an epistemic operation [emphasis added]. Communication or the understanding of gestures is achieved through the reciprocity between my intentions and the other person’s gestures, and between my gestures and the intentions, which can be read in the other person’s behaviour. Everything happens as if the other person’s intention inhabited my body, or as if my intentions inhabited his body. (1945/2012, pp. 190–191)
This reciprocity between my intentions and the other person’s gesture, which must not be mistaken for an epistemic operation, is what Merleau-Ponty (1964) terms intercorporeity (intercorporéité) in his later writings. The important point is that the problem of understanding other minds only becomes an epistemic question in so far as one thinks of the mind as a Cartesian interiority, invisible from the outside. But this assumption only allows for two modes of being: subjective interiority and objective exteriority, which in turn entirely misses the phenomenon of expressivity, resulting from us being embodied beings. From this fact of embodiment, it follows that the very distinction between interior/exterior distinction is problematic; not only is the Other not given as mere exteriority with a hidden interiority but I am also given to myself ambiguously as both object and subject. Merleau-Ponty explains:
If my left hand can touch my right hand while it palpates the tangibles, can touch it touching, can turn its palpation back upon it, why, when touching the hand of another, would I not touch in it the same power to espouse the things that I have touched in my own? It is true that “the things” in question are my own, that the whole operation takes place (as we say) “in me,” within my landscape, whereas the problem is to institute another landscape. When one of my hands touches the other, the world of each opens upon that of the other because the operation is reversible at will, because they both belong (as we say) to one sole space of consciousness, because one sole man touches one sole thing through both hands. (1964, p. 148)
The dual aspect of embodiment, simultaneously constituted as both subjectivity (Leib) and objectivity (Körper), is co-given with the very structure of experience itself. The expressions of others are therefore not given in the mode of “a visible shell we need to move beyond” (Bateman & Fonagy, 2012b, p. 3) through the use of our imagination or inferences, as MT would have it. Qua embodied, the boundary between self and Other is not hermetically closed, but deeply intertwined in intercorporeity:
There is, between my consciousness and my body such as I live it, and between this phenomenal body and the other person’s phenomenal body such as I see it from the outside, an internal relation that makes the other person appear as the completion of the system. Others can be evident because I am not transparent for myself, and because my subjectivity draws its body along behind itself. (Merleau-Ponty, 1945/2012, p. 368)
It is important to realise that was this not the case, if the basic expressions of Others did not show themselves directly as the presence of another subjectivity, social cognition would never be able to get off the ground, as both Merleau-Ponty and Scheler have repeatedly argued. Rather, any resort to ideas of simulation or theory in social cognition already presupposes that which they are supposed to achieve. This is easily seen when one considers what would motivate interpreting the Other as Other in the first place and not only as yet another physical occurrence. Hence, TT and ST are not constitutive of the social, but presuppose it. This is, of course, not to say that the phenomenological account denies the possibility of hiding intentions and feelings, or that we cannot utilise simulations or theories in order to understand others. Hiding intentions and feelings is, of course, possible but the claim is that they are secondary acts and that our basic interaction is in no need of such deciphering or inferences. Resorting to means of mediation is secondary to our primary interaction, and only becomes necessary when our basic understanding breaks down.
In recognition of a similar line of critique, Davidsen and Fosgerau (2015) have recently argued that the concept of “implicit mentalization” could be interpreted as an expression of this phenomenological level of social understanding. According to Davidsen and Fosgerau, the phenomenon of implicit mentalization suffers the somewhat unfortunate fate within MT of being attributed a gross significance in the literature while never receiving a systematic theoretical articulation. In order to remedy this, they suggest that the phenomenological account of social cognition could serve this purpose.
I strongly endorse the suggestion of integrating phenomenological insights into MT. However, I do not believe that the phenomenological account of basic social cognition can readily be added to the existing framework of MT without imposing theoretical inconsistencies. In order to achieve a theoretically consistent integration of phenomenological accounts of social cognition, MT would need to revise the fundamental Cartesian assumption that the mind is essentially closed off. Furthermore, whereas MT sees social cognition as a developmental achievement, one that “is not constitutionally guaranteed” (Fonagy & Allison, 2014, p. 372), but is crucially dependent upon the attachment context, the most basic social cognition is exactly constitutionally guaranteed and primordial on the phenomenological account. This dispute is not merely terminological but an expression of the fundamental social-ontological assumption made in MT.
The assumption that social cognition is rooted in inner mental representations: Forgetting the enacted dimensions of social understanding
A similar criticism of ToM approaches has been raised from the field of enactivism, arguing that the idea of social cognition in ToM essentially remains a solitary enterprise; one in which one individual tries to decipher or simulate the other person’s mind through inner mental representations. This radically misses the phenomenon of the social and how social understanding is situated in interaction (De Jaegher & Di Paolo, 2007; Fuchs & De Jaegher, 2009). According to enactivism, basic social understanding should rather be understood as embodied and non-representational, which is elaborated as a dynamic coupling and coordination between two inter-actors—not unlike the idea of intercorporeity (Fuchs & De Jaegher, 2009). According to this account, social cognition is something that is constituted in-between, and which is “arising in the moment-to-moment interaction of two subjects” (p. 466). The intentions involved and expressed in interaction are often generated and transformed throughout the process of interaction. In this way, the interaction process gains “a life of its own” and a “kind of autonomy” (p. 471). These patterns of interaction can again sediment into identifiable patterns; a kind of disposition of the participants based on the history of interaction.
How does this critique apply to MT? At face value, MT should not be alien to the notion of interaction due to its significant emphasis on the importance of early interaction between caretaker and infant in an attachment context. But the vital difference is, once again, that MT starts from a notion of the mental as closed off and rooted in inner mental representations. Mentalizing is essentially an ability attributed to the individual that can be more or less developed, rendering social understanding an individual matter and not something arising out of the particular interaction. Mentalizing is an individualised ability to develop adequate inner representations of others, rooted in the mentalizing models established in early childhood. In the case of BPD, this capacity is supposedly impaired and further weakened in heightened states of arousal (Bateman et al., 2012). As Fuchs and De Jaegher remark, this differs fundamentally from their account of interaction:
This account of inter-subjectivity is quite different from concepts of mentalization and mind-reading. To illustrate this, let us take the example of an infant of a borderline mother, which has learnt to withhold its impulses to approach the mother because of her repeatedly aggressive behaviour. According to Fonagy’s mentalization concept, the infant would inhibit its ability to reflect on the mother’s affect because of the unbearable content of the representation of her aggressive affects. The alternative view is that the mother’s hate is expressed through the quality and dynamics of the embodied interaction, e.g., repeatedly rejecting the infant’s approach or overriding its initiative. As a result, these interaction sequences are taken up in the infant’s implicit memory in their process form, not their content form, e.g., as a bodily tension and resistance which the child builds up against his own impulses to approach the mother. He does not need to create a representation of the mother’s inner state but enacts his implicit knowledge in the situational context, as an avoidant coping style. (Fuchs & De Jaegher, 2009, p. 481)
From the enactivist approach to social cognition, we are, furthermore, perfectly able to account for the consequences of problematic attachment patterns as seen in BPD cases without reference to inner mental representations. Rather, attachment issues could be seen as resultant from the particular history of interactions in the individual, which sediment into a specific, embodied response and interaction repertoire; one that affords itself to be re-enacted in attachment relations with adequate similarity: explaining part of the aberrant attachment style found in BPD.
From the emphasis placed on interaction in the MT literature, I believe that enactivist analysis, such as this, would be welcomed in MT. This would, however, once more, require a fundamental revision of the social ontological assumptions made in MT. MT would need to revise the strong emphasis on inner representations and allow for more enacted and embodied views on social cognition; a view that sees social understanding as emerging from situated patterns of interaction in context.
The assumption that social understanding can be tracked back to the infant/caretaker dyad: Forgetting the sociocultural basis of social understanding
The critical comments made so far have primarily addressed the levels of social cognition pertaining to our everyday face-to-face social interaction. However, an account of social cognition that does not include how we understand each other through more mediated settings and situations would hardly be convincing. In accounting for this dimension of social cognition, we can once again find ground for questioning the social ontology of MT. As we remember, according to MT, models of social understanding owe their ontogenesis to the early infant/caretaker interaction, placing a tremendous emphasis on the quality of this early relation. Some proponents of MT take this to express no less than a Hegelian position, in so far as they see something like the dialectics of recognition in this early interaction (e.g., Jurist, 2010). Apart from rousing speculations as to how Hegel might have felt about being associated with the broader framework on social cognition found in MT, I believe it is important to raise the fundamental question of whether our capacity for more complex social understanding should exclusively be traced back to the early dyadic attachment context.
From within philosophy, two lines of criticism have been raised to this point, proposing a different social ontology which emphasises that complex social understanding has a sociocultural basis. The first line of criticism points out that in most everyday social situations, we do not employ any such thing as mentalizing models in understanding others; rather, the intentions of other people suggest themselves from the affordances and the norms regulating the pragmatic contexts we engage in (Gallagher & Hutto, 2008; Ratcliffe, 2007). In order to understand why a person stops her car before a red light, I need not consult either theory or simulation to read the intention of others; the intention is directly available through familiarity with the norm-governed practical context. Similarly, the implicit social rules governing how to wait in line at an English supermarket structure that everyday activity and relieve us from any speculation about what the other person might be thinking. Only in rare cases where these norm-governed practices break down might we need to re-coordinate or, in some case, even theorise about the other people’s intentions. What is important to notice is that the social understanding emerging in these situations should in no way be understood as inner mentalizing models, but rather as broad sociocultural frameworks that the child gradually appropriates through engaging with others in a variety of contexts. One way of specifying the alternative social-ontological framework pointed to here, is to follow Bernhard Waldenfels’ (2015) distinction between “frontal” vs. “lateral” variants of sociality. Whereas frontal sociality refers to the type of “face-to-face interaction” which completely dominates the framework of MT, lateral sociality designates the equally prominent dimension that we find ourselves “side-by-side” in a shared relation to a cultural world of practices, norms, objects, etc., which are saturated with social reference and meaning. Whereas the early attachment context might supply the child with a basic understanding of the rhythm and structure of this lateral dimension, it hardly seems persuasive to claim that these forms of social understanding exclusively or even primarily owe their ontogenesis to the early infant/caretaker interaction. Rather, these norms are learned from actual engagement in these social practices in their proper contexts.
The second line of criticism starts from the obvious fact that in spite of our more immediate understanding of others—present in expressions, participatory sense-making, and norm-governed interaction—social understanding does sometimes break down, forcing me to speculate about the intentions and feelings of other persons. But, as Daniel Hutto (2008) has recently argued, in such cases—much less frequently than we tend to assume—the attribution of beliefs and desires, or attempting simulations, would be a radically individualised and decontextualised means of social understanding. The problem is, as Hutto points out, that “having an understanding of beliefs is logically distinct from having an understanding of what it is to act for a reason” (p. 26). Whereas belief attribution is a somewhat rudimentary skill, usually considered to be developed around the age of 4–5, the ability to understand actual reasons for acting is not only a much more complex phenomenon with a considerably longer developmental trajectory, it is also highly dependent on a second-person perspective. This is not to say that belief/desire attribution is not part of the process of understanding reasons for acting but that a lot more is always implied for this to amount to an actual understanding. What we need, according to Hutto, is an understanding of how these propositions contextualise in a particular person’s life. The medium for this is narrative. 3
The idea is quite intuitive: imagine a man suspects his wife might be cheating on him due to what he considers suspicious activities on her part. In order to dismantle this suspicion, the man would hardly be satisfied by a mere confirmation of her commitment to him (desire to be with him, belief that he is the one she loves, etc.). Instead, what he needs is an account of her concrete actions and for them to be placed into the broader development of events; one that is at least consistent with her character, as well as the context she is currently in. A narrative will achieve exactly this. Hutto frames this notion in what he calls the “Narrative Practice Hypothesis” (NPH). According to NPH, “the normal route [to understanding reasons] is through encounters with stories about people who act for reasons” (Hutto, 2008, p. 28). It should be noted that although Hutto (2008) is very liberal as to what qualifies as a narrative, what he has in mind is the myriad folk narratives that any child’s life will be discursively emerged in. From these narratives, the child gets a basic, yet richly contextualised, understanding of how reasons to act emerge in context from the interacting elements of character, personal history, and broader social and material circumstances (p. 34). This is not to suggest that these stories are idealised types:
They are snapshots of the adventures of situated persons, presented in the kinds of settings in which all the important factors needed for understanding reasons are described – that is, those that are relevant for making sense of what is done and why. (p. 34)
Narratives serve as exemplars to train and rehearse us in contextualised understanding and this kind of narrative competency is a sophisticated, discursive skill in need of a cultivation that undoubtedly transgresses the confines of the infant/caretaker dyad. As Jerome Bruner has famously argued, training a person’s narrative competency should be seen as a broader educational task (Bruner, 2009; see also Gallagher, 2014).
Furthermore, employing narratives in attempting to compensate for the failure of more immediate understanding also implies a strong second-person and interaction-based perspective. As Hutto (2008) remarks, in these situations of failed social understanding, by far the best solution is to engage in an actual conversation with the other person and ask them to explicate and explain why an action was performed. Recently, Tim Henning (2009) has explicitly taken up this line of thought and argued that narratives play a constitutive role in the social epistemology regulating our interpersonal understanding on the level of normative justifications for actions. The intuition Henning is referring to is that whereas we usually rely on a preconceived understanding of the character and actions of the people we are familiar with, based on our interaction history with them, we are sometimes confronted with the fact that a person acts out of character. In these cases, the epistemology governing interpersonal understanding requires an account for this shift that goes beyond mere belief/desire attribution. To illustrate, Henning asks us to imagine a conversation between two people: person A and person B. Throughout his life, person A has consistently prioritised career and personal hobbies, swearing never to settle down in a suburban life with a wife and kids. However, in conversation, it emerges that these priorities have suddenly shifted, and that person A now wants to marry a woman he recently met, have kids, move to the suburbs and quit the job he loves, due to these circumstances. Confronted with this, person B would find himself requiring an explanation in order to understand that this is actually still his friend he is talking to. Person B will attempt such an understanding through prompting what Henning calls critical “since-when-questions” (p. 19). In this case, person A is normatively expected to provide a narrative that gives an adequate, temporal account for the development of this change in his character. Meeting these normative requirements would call for extensive references to the elements taught to us through narrative as justifying reasons for acting in context. Again, in this case, social understanding is not something regulated by inner mentalizing models of how people act, but rather through a contextualising and interactive epistemology that goes beyond basic belief/desire attributions and is extensively regulated by social norms: what exactly counts as a good explanation is regulated by normative expectation.
What does this imply for MT? Whereas NPH and MT share the claim that social understanding is a developmental achievement, they differ exactly in their appreciation of the role of context in this development. First of all, whereas MT reduces social understanding to an affective and rational level in the developed mentalizing model (Fonagy, 2006), NPH places tremendous emphasis on the context of action, focusing on how the particular action was influenced by the particular characters, personal history, larger projects, past choices, existing commitments and circumstances, etc. Though MT sometimes mentions the importance of narrative accounts, it has very little to say about this story-telling context and instead stays at the abstract level of inner mental representations. Second, whereas MT seems to confine the achievement of social understanding to the mentalizing models developed through the infant/caretaker dyad, NPH proposes that our capacity for complex social understanding is a gradually developed narrative competency appropriated throughout the various contexts of operations we engage in and one that is nurtured by the broader sociocultural context. This is not to suggest that primary caretakers do not play an important role in scaffolding this process, but rather that the ontogenesis of complex social understanding is seen as fundamentally sociocultural in nature, and not primarily based on the attachment dyad.
Finally, in restricting the development of mentalizing models to the infant/caretaker dyad, it is worth considering whether or not MT might be susceptible to a variant of what Gallagher (2012) has called “the diversity problem” in simulation theories. Gallagher proposes that the simulationist idea—that we use our own experiences to project ourselves imaginatively into the Other’s perspective—is problematic because it is nowhere given from this account of social cognition that my mental life would be similar to that of the other. In an equivalent manner, one might raise doubt as to whether the caretaker/infant dyad is an adequate model for the diversity of motives, beliefs, and reasons people have for acting across social contexts and cultural diversity, and, therefore, as a model of social understanding. Rather, does the diversity of culturally patterned actions not imply the need for a richer platform for understanding reasons?
Reinterpreting the impaired social cognition in BPD from an embodied, contextual, and interactional perspective
In the critique voiced so far, the Cartesian tendencies of MT have been contested and it has been argued that an adequate account of social cognition needs to encompass the expressive dimensions of embodiment, how intentions grow out of interaction, and how these are embedded in a broader sociocultural and normative framework of understanding. From the point of view of MT however, one might object that while this focus may be relevant as long as we are talking about normal everyday social interaction, MT was originally developed as a response to abnormal psychology: to the impaired social functioning found in BPD, and that this focus on disorders tends to shift attention towards the individual rather than the contextual level. One obvious response to this objection would be to point to the fact that although MT was originally developed to account for BPD, it now lays claim to being a general theory on social cognition and developmental psychology, which is applied across a range of domains. Nevertheless, it seems fair to request that we illustrate how we might account for pathological cases, such as BPD, from this more embodied and interactional understanding. If this is possible, it should provide further grounds for revising the Cartesian assumptions of MT.
Before taking on this task, I would like to slightly alter the premise set by MT, that understanding psychopathology is a matter of locating a functional deficit: I generally agree with Merleau-Ponty when he warns us against thinking of psychopathology in these terms. Rather, psychopathology should be seen as constituting an entirely new existential mode of being-towards-the-world of the individual (1945/2012, p. 110). In giving an account of BPD, we therefore cannot simply deduce the existential meaning of the affliction from identifying a dysfunction; we need to ask for the specific existential meaning of the condition—for the very mode of being-towards-the-world characteristic of BPD.
As we have already seen, MT approaches BPD in terms of deficits and suggests we interpret the issues in social interaction as a result of a reduced capacity to mentalize, particularly within attachment contexts and states of arousal where “the capacity to think about mental states” and “even the capacity to identify the mental states associated with specific facial expressions may be impaired” (Fonagy & Bateman, 2008, p. 5). Following this, BPD is sometimes perceived as partially overlapping with autism in so far as a certain kind of mindblindness is seen as a defining deficit in both conditions (Smith, 2013, p. 223). That people diagnosed with BPD show an aberrant way of engaging in interpersonal relations should, however, not be disputed. But the question is whether the dynamics of social interaction in BPD should be interpreted as a clear-cut deficit in social cognition: as a state of mindblindness?
In the following, I will propose an interpretation of the difficulties in social cognition reported in BPD from two levels. Taken together, they give an impression of how we might account for the impaired social cognition in BPD from an embodied and contextual-interactional perspective: (a) BPD as state of enhanced sensitivity to embodied expressivity, leading to (b) acts of what I suggest we term disnarration.
In the current research literature on BPD, multiple studies describe what Krohn (1974) originally termed “the borderline empathy paradox,” referring to clinical anecdotes of the apparent paradox of enhanced empathy in people diagnosed with BPD in spite of impaired interpersonal functioning (Dinsdale & Crespi, 2013). This has, in turn, inspired a range of experimental studies, which are taken to indicate a heightened sensitivity to the expressive dimension and where people diagnosed with BPD score significantly above the healthy test groups in identifying facial expressions (e.g., Fertuck et al., 2009; Schulze, Domes, Köppen, & Herpertz, 2012; von Ceumern-Lindenstjerna et al., 2009). 4 Though not all studies have been able to reproduce these results (e.g., Hagenhoff et al., 2013), this could be taken to indicate a heightened sensitivity to facial expressions in BPD, which from a phenomenological perspective would be interpreted as a more general hypersensitivity to the embodied, expressive dimension of social interaction. This should resonate with clinical experiences in interacting with people diagnosed with BPD; as most people with experience in this field would appreciate, not much goes unnoticed on this expressive level of interaction.
Since intentions and emotions are read directly from expressive bodily comportment, this implies that the experiential perspective of the person with BPD is overflowing with perceived emotions and intentions. Importantly, this does not entail that the registered intentions are not actually there and merely constitute a delusional misreading of the other. Rather, I propose that the characteristic world of BPD is constituted by the fact that all perceived embodied emotions and intentions seem to take centre stage. 5 To account for this phenomenon, one might turn to philosopher H. G. Frankfurt (1988) who notably pointed out that not everything that runs through my mind “willy nilly” should be said to belong to me proper. I might, for instance, feel temporary frustration and anger towards my children when they misbehave but that does not imply that it can be said of me as a person that I feel hostility towards my children. This distinction between what belongs to a person proper and what is merely a fluctuating emotion (usually not attributed significance) is what does not get properly filtered in BPD. We could perhaps understand this existential modality within an enactivist framework, by reference to the fact that exposure to early trauma is highly prevalent in the personal histories of individuals with BPD (e.g., Fonagy & Bateman, 2008; Sansone, Sansone, & Gaither, 2004), and that past traumatic interaction patterns might sediment in implicit memory, creating an all-encompassing attunement to the emotional landscape. Qua enactivist, this is to be understood as process form and not as content form, as already emphasised by Fuchs and De Jaeger. Hence, the particular way of being-towards-the-world characteristic of BPD is, I suggest, a state of exceptionally heightened attunement to the expressive landscape.
However, this heightened attunement to expressivity far from accounts for the aberrant style of interpreting others present in BPD; so, how do we account for this without reference to a functional deficit in the ability to mind-read or mentalize? As previously mentioned, the point is not to deny that such a thing as attributions of beliefs and desires occur, but rather that doing this takes place within the wider sociocultural context of understanding reasons and that this is done by employing culturally patterned narratives and narrative justification in interaction. In BPD, the challenge is that the person is overwhelmed with emotions and intentions that all seem to take centre stage and, therefore, call for a meaning-giving context. Contrary to more deeply rooted intentions, mere fluctuating emotions and intentions seldom have natural and obvious meaning-giving contexts; hence, immediate understanding breaks down. In line with the argument so far, this implies a turn to narratives for contextualisation. Yet, whereas the turn to narratives is less pronounced in normal everyday interaction, the person with BPD needs to do this to a much higher degree: be it by emplotting the actions and expressions of others through cultural narratives in monologue 6 or by prompting for narrative justifications in interaction. This can lead to a particular style of narration that I suggest we term disnarration.
The notion of “the disnarrated” was first introduced to narratology by Gerald Prince as a category distinguished from the simply “unnarrated” (that which has not been narrated) and the “unnarratable” (that which cannot be narrated) to account for the phenomenon in fictional literature of “all the events that do not happen though they could have and are nonetheless referred to by the narrative text” (1988, p. 2). According to Prince (1988), this involves, inter alia: unrealised possibilities, imagined worlds, unfulfilled expectations, etc. Moving this terminology out of the perspective of literary texts and into the context of a narrative psychology, I suggest we slightly alter the disnarrated to specify: Acts of, in vivo, narration where there is no adequate underlying event-structure. That is: narrating virtual scenarios that might have happened, but in fact did not. Hence, the disnarrated refers to a discrepancy between the narrated and the underlying event-structure, where the event-structure designates what Bruner (1987) refers to as the landscape of action; that is the sequence of events exposed to narrative configuration.
Returning to BPD, I believe the concept of disnarration can help us shed light on the distorted way in which expressions are interpreted in BPD without reference to mindblindness. What is distorted is, rather, how expressions get contextualised through narrative emplotment. Due to the heightened sensitivity to expressions, the person with BPD perceives a certain random silence, fluctuating emotion of hostility, or unreturned smile as standing in the foreground. As we have seen, this presses the need for making sense of the perceived expression; referring the individual to contextualise through narrative thinking. Since these perceived intentions and emotions are exactly fluctuating (cf. Frankfurt, 1988), there need not be an adequate contextualising event-structure to narrate. This, in turn, may lead to acts of disnarration; in the sense that virtual scenarios are narrated in order to contextualise and make sense of the excess of perceived intentions. The structure of emplotment for these virtual scenarios is built from the currently available cultural repertoire of narratives.
As such, disnarration bears similarities to what has recently been termed “hypermentalizing.” In recognition of evidence suggesting that BPD is in fact not associated with deficits in mentalizing, Carla Sharp (2014) proposes, much in line with my argument so far, that we understand BPD as constituting an altogether different cognitive style, which she terms hypermentalization. Hypermentalizing is defined as “a social-cognitive process that involves making assumptions about other people’s mental states that go so far beyond observable data that the average observer will struggle to see how they are justified” (p. 217). Bo et al. (2015) further specify hypermentalizing as a process “where individuals attribute intentions, ideas, beliefs, wishes and so forth to other people where there is no objective data to support such attributions” (p. 174). As such, this concept of hypermentalizing clearly resembles my proposed concept of disnarration. The important difference is, however, that whereas the concept of hypermentalization explicitly remains on the level of ToM, of attributing beliefs and desires to a closed state of mind, in what we might call a decontextualised monologue, disnarration refers to a modality of contextualising actions and expressions through narrative emplotment based on sociocultural resources, which are produced in social interaction and therefore vitally dependent on the “story-telling context” (De Fina & Georgakopoulou, 2011). As we have seen, contextualising narratives imply that we can engage in a critical second-person inquiry, providing justifications for the adequateness of the narrative given. Since prompting for justification in cases of disnarration is not bearing on an actual underlying event-structure, it is easy to imagine how this interaction might catalyse a negative spiral, which—dependent on how the interlocutor responds—could escalate, perhaps to levels resembling psychosis. Not surprisingly, this impedes the ability to maintain stable interpersonal relationships.
While this only presents a glimpse of the complex existential world of BPD, I hope to have illustrated how an account of the issues of social understanding in BPD might be understood from a more embodied and contextual perspective. This account indicates that the particular issue of social cognition in BPD does not stem from a mere functional deficit, but rather from a particular existential mode of being-towards-the-world; one where emotional and expressive intensity is more pronounced, making social interaction somewhat skewed. This perspective differs from MT in that it does not trace the problem back to a deficit in the ability of one closed-off mind to deduce or simulate the impenetrable interiority of another. Rather, the problems of social understanding in BPD are rooted in a general hypersensitivity to bodily expressions that affords a distorted contextualisation through acts of disnarration. These, in turn, manifest in both monologue and interactional processes of participatory sense-making.
Concluding remarks
The strength of MT is that it has been able to put social cognition at the very forefront of research into psychopathology as well as psychotherapeutic practice. But in doing so, MT unfortunately stays within the guise of a Cartesian approach to social understanding. I have attempted to spell out some of the issues in this position and encouraged a more phenomenological, enactive, and sociocultural approach. In doing so, I do not mean to discount the otherwise fruitful field of MT, but rather hope to contribute to a critical discussion of the assumptions guiding this new paradigm in psychotherapy. While integrating the suggested elements in MT will require a revision of the basic social ontology assumed, it is my contention that not only is this possible but that such a broadening of the field could lead to new therapeutic possibilities and avenues and perhaps even invite dialogue with more embodied and narrative approaches to therapy.
Footnotes
Author’s Note
Author Allan Køster is now affiliated to the Department of Communication and Psychology at Aalborg University, Denmark.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the Danish Counsel of Independent Research (DFF).