In this article, I endeavor to explain the essence of mentalization and how it aided my understanding when working with individuals struggling with severe suicidal ideation. Although this article is adapted from my experiences in 2017, the lessons I learned remain relevant, even before the advent of neuromodulation tools.
I have had the opportunity to work in diverse settings, including a Children's State Hospital, the City of New York public psychiatry system, and private practice in Brooklyn. Currently, my focus lies on creating a mentalizing milieu at the State Hospital in Rockland County, which serves as the ICU for attachment disorders in children.
State hospitals, which serve as the last resort in the American healthcare system, house individuals who are medication-resistant and have not responded to standard treatments. While this may be true for adults, children often exhibit illnesses that require alternative approaches beyond medication. In my role at the state hospital, I aim to understand and, when possible, reduce the reliance on medications for such cases, frequently linked to borderline personality disorder.
Mentalizing, or the active form called mentalization, is a fundamental ability that enables us to comprehend what others may be experiencing based on their internal states. It involves curiosity about our own emotions and actions, as well as those of others. Rather than arriving at absolute conclusions, genuine mentalizing thrives on the appreciation of uncertainty.
The concept of mentalization gained prominence through research on attachment disorders, pioneered by Peter Fonagy and colleagues at UCL and the Anna Freud Centre. Video cameras played a pivotal role in advancing psychotherapy research, allowing for precise observation and analysis of interactions between individuals. Fonagy's work emphasized the significance of early interactions with parents in fostering the development of mentalization.
Moreover, the Strange Situation Paradigm, an experiment by Mary Ainsworth, unveiled attachment styles formed during the first year of life, which tend to persist throughout an individual's lifetime. These styles, such as secure, avoidant, anxious, and disorganized attachment, are closely related to borderline personality disorder and other attachment-related issues.
While various treatments may engage the frontal lobe, mentalization stands out as a remarkable approach that fosters well-being and positive outcomes.
-Dr. Owen Muir
