Mentalizing, Mindfulness, and the Drive for Evidence

 In reading about attachment theory, David Wallin's description of Peter Fonagy's work was intriguing, so I went down that rabbit hole. 

Fonagy developed Mentalization-Based Treatment (MBT) to improve emotional regulation, as distinct from Jon Kabat-Zinn's Mindfulness-Based Stress Reduction (MBSR). Fonagy sees our mental development as relational, but in order to have empathy for others, we need awareness of our own feelings, which can be helped with mindfulness work. However, in looking at the evidence of efficacy of these separate modalities, I question the attempt, since Freud, to make psychology into a natural science. Each of the various ways to help are useful, but there's an element of the unknowable in the way when we treat them scientifically.

According to Wallin, Fonagy's focus was on developing the understanding of the mental states of others, which he calls mentalizing, to let us understand the depths of ourselves and others. For instance, it can help heal old wounds if we understand that dad's rejection of us might be due to his depression and not our behaviour as a child. Other people's reactions to us aren't just caused by us, but there are always multiple factors at play affecting how people behave. It seems very similar to Theory of Mind. He met Bowby in the 1980s, and studied adults' behaviour relative to their own descriptions of childhood attachment, and found, when comparing severely deprived to well-connected adults, that a weak attachment was correlated with a weak "reflective functioning" (the ability to understand behaviours in terms of their thoughts, feelings, and mental states). From this, he says psychotherapy should be the "effort to restore or kindle patients' capacity to mentalize," to simultaneously feel our feelings and reflect on their meaning. To help people develop mentalizing requires a relationship that mirrors and guides emotional responses.

The Necessity of Feeling Seen

Attachment theory is part of the vernacular now. Even the Norwegian show Porni mentions it, and the dramatic eldest daughter blames her mom for her “relational damage”! We’ve largely accepted the questionable idea that mom’s attentiveness in childhood creates our attachment patterns for life — the gist of the theory as it’s largely understood, but what’s usefully generalizable from the actual studies? There are many criticisms of the theory, yet some university psych courses applaud it without reservation. I’m dubious about it, but I also don’t want to entirely throw this baby out with the bathwater.

 This is a huge topic, and I’ll hardly do it justice here. There are a few excellent books on it, but part of the problem with how we understand the studies might be that the most nuanced books seem to be the most academically written, and likely the least read. As it morphed into popular consumption it may have strayed further from the original intention. On top of the reading, I went to a couple workshops on attachment to find the magic solution to all our relationship ills, and my big takeaway is this (for free!): if you’re a bit distant, consider being open to getting closer, and if you’re a bit clingy, try to step back a bit. It’s good advice to notice and change patterns that are a problem, absolutely, but I’m not sure it merits the number of workshops, courses, and self-help books that it’s provoked. At worst, some books actually counsel people to avoid any “avoidant or disordered people” as if there’s no saving them from their dastardly origins. Therapeutic discussions of childhood misconnections definitely have helped people better understand themselves, but I think this theory produces such volumes of celebration and condemnation because, in difficult relationships, it feels like the answer, but to parents, it feels like blame.

Attachment Theory Criticisms 

Heidi Keller’s The Myth of Attachment Theory (2022) is an extremely thorough takedown of the theory. If attachment notions make you feel like a crappy parent, this book is vindicating. She explores the offense of putting it all on moms both because of the narrow focus on a single person as well as on singular causation, but her best work is in exploring the creation of a norm of interaction from upper-middle class, western assumptions around what it means to be sensitive to a baby’s needs, an analysis that was made at the time as well: