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.

On Approaching Death

 CW: As the title suggests, there will be discussion of death and dying and some mention of suicide in this post.

I thought nothing of following up my last post on Irvin Yalom on the meaning of life with Yalom on the meaning of death, until I started writing here. The very reality of being a bit wary of broaching the subject reveals the strength of societal taboos against admitting that we’re all going to die. Until it’s staring us in the face, we delude ourselves into thinking we will get better and better, mentally and physically, despite that our brain starts to shrink in our 30s, and our joints and organs will start to give out not so long after. We work hard to keep death clean and sanitized so the reality doesn’t seep in too much, and we try to do all the right things to keep death at bay: exercise, various special diets, wearing masks to avoid viruses. We can fix some evidence of erosion with meds and surgeries, sometimes miraculously, but some people even hope to keep their brain going long after their body dies.

Yalom on Approaching Meaning

About 45 years ago, psychiatrist Irvin Yalom estimated that a good 30-50% of all cases of depression might actually be a crisis of meaninglessness, an existential sickness, and these cases require a different method of treatment. We experience this lack of purpose as boredom, apathy, or emptiness. We are "not told by instinct what one must do, or any longer by tradition what one should do. Nor does one know what one wants to do," so we feel lost and directionless. Instead of addressing meaninglessness as the problem, though, we've been merely addressing the symptoms of it: addictions, compulsions, obsessions, malaise. In today's context, it might suggest that even social media issues could be problems with a lack of meaning. 

The last sentences of his lengthy tome, Existential Psychotherapy, sum up his solution: "The question of meaning in life is, as the Buddha taught, not edifying. One must immerse oneself in the river of life and let the question drift away." How he lands here is an intriguing path through a slew of philosophers and psychiatrists. Even without symptoms of a problem, attention to meaning is necessary as it gives birth to values, which become principles to live by as we place behaviours into our own hierarchy of acceptability. 

"One creates oneself by a series of ongoing decisions. But one cannot make each and every decision de novo throughout one's life; certain superordinate decisions must be made that provide an organizing principle for subsequent decisions." 

Yalom doesn't, however, suggest coming up with a list of values that can become meaningful to us, but that we immerse ourselves in life to become more aware of which values we already have. 

WHAT'S THE POINT? IT'S FOR US TO DECIDE

According to Yalom, we've hit this crisis point in meaninglessness because we have the leisure to think and because our work is no longer clearly purposeful, both of which are relatively recent experiences for such a large proportion of civilization. It's no longer just the philosophers of the day asking, What's it all for? What's the point of it all? He takes the existential position that it's up to us to figure it out.