Mentalizing- the power of mind-wondering 

by Tim 11.8.2023  @Medical Footnotes 

If you´re like me, you tend to mind-wander from time to time. Your thoughts may be all over the place: “I should go out for a bike ride”, “my neighbor looked funny at me this morning”, or “my colleague isn´t doing her part in our shared project”, and so on. The subject of mind-wandering is usually yourself (I guess we´re the most interesting thing to wander about!). Well, that´s ok of course, it´s part of life. It´s not so often, however, that we mind-wander about thoughts or, for that matter, other people´s thoughts. This reflective stance in our minds doesn´t come naturally to us. It´s the difference between thinking a thought or feeling a feeling and asking the question: “What do I think or feel right now”. Or: “What does my neighbor think or feel”. Or: “What does my neighbor think that I think?”.. and so on. I go on to argue that, to wonder about people - to wonder about people´s minds specifically - is useful. So, let´s talk about what mind-wondering is.

Allow me to give you a definition first: Mind-wondering is a spin-off word and a synonym for mentalizing (1) - which I shall explore in this post! To put it in rather simple terms, to mentalize (to mind-wonder you might say) is to imagine mental phenomena that underlie human behavior. It´s an act of the mind that allows us to think about other people´s mental states and our own (One day, I hope to find how to “mind-read” or how to use the force.. but mentalizing isn´t a synonym for either of these concepts I´m afraid.) By deliberately thinking of your own and others´ minds, you make an effort to understand mental states - thoughts, feelings, and all that good stuff - that predict behavior (Just to clarify: I´m not talking about mentalists who, interestingly enough, ostensibly possess magical powers and can make an elephant balance on a circus ball and talk to birds and what not.)

 “There is nothing either good or bad, but thinking makes it so.” - Shakespeare

The world exists and we have our perceptions about it. A book is a book, not much to it. We, however, have mental states which are about something - such as a book. (Your boy Franz Brentano was a German philosopher, a Privatdozent (private teacher), and intensely interested in how the mind acts. He basically said mental states are about something in their essence). We also have mental states (thoughts and feelings) about others and ourselves when we interact. Our actions in the world are not the same as our mental states. This important difference is what lies at the heart of mentalizing. When one mentalizes - consciously or unconsciously - we acknowledge that.. well.. people have their own mind. The way your neighbor acts, let´s say, as observed in the outer world, is separate from the fact that your neighbor has her own thoughts and feelings -  a mind. You can see how this may lead to misunderstandings: One acts in a certain way (as perceived by yourself and others), but one thinks in another way. Indeed, we make judgments about people´s behavior all the time: Sure, the “funny” look someone gives you might be interpreted one way or another, thereby assuming someone else´s mental state that preceded a behavior: “This person doesn´t like me” or “This person must be in a cheerful mood”. There is, in other words, more than a body and the way someone acts.

We differ in how accurately we mentalize -one can see it as a social skill, really. The argument that follows is this: By reflecting explicitly on the mental phenomena that underlie people´s behavior and our own, we tend to interact with fewer difficulties - it´s like putting some oil on the machinery of social interaction. Being understood (or trying to be understood) feels great. However, being misunderstood (or not even trying to be understood) feels, well, not so great. We live in a complex social world where ´seeing the unseen´ or ´reading between the lines´ helps us tremendously. Here  are a few common ways of explaining the concept of mentalizing in short form:

• “To see ourselves from the outside and others from the inside”

• “Understanding misunderstandings”

• “Holding mind in mind” 

• “Mindreading”

(I´m quite sure one of these lines is found in Star Wars.. somewhere. Responsible for these quotes are the mentalizing wizards of our modern time: Anthony Bateman and Peter Fonagy)

Does perfect mentalizing exist, you may ask? Nah, not really. As Norwegian psychiatrist Finn Skårderud underlines, “..in order to understand the minds of others better..”, we must acknowledge that “..the minds of others are only partially accessible to us.” – I found one exception though, in Japanese folklore: Deep in the mountains, one can find Satori (覚 -  Japanese Buddhist term for awakening, "comprehension; understanding" according to Wiki): Ape-like creatures that apparently are avid mind-readers. They appear on mountain paths to oncoming travelers and, unfortunately for us, humans are part of their diet. One could say they possess the ultimate mentalizing capacity, but use it for their own benefit! Since they possess unworldly jedi-mind-tricks, they are able to read a person´s thoughts quicker than they can speak them aloud. In line with Buddhist thinking, travelers with an “empty” mind wouldn´t be much bothered by this fact since there wasn´t much to read. Now, I´m not saying you should be like the Satori, but it shows the immense advantage of being interested in other minds. One will never be able to mind-read like that, but if you have good intentions (like not having humans as part of your diet), the effort you put into trying to understand others´ thoughts and emotions will surely pay off.

To give a view on which dimensions mentalizing works, you may find this quote by the infamous poet and essayist Oliver Wendell useful:

• “Whenever two people meet, there are really six people present. There is each man as he sees himself, each man as the other person sees him, and each man as he really is.”(4) ( This quote´s often attributed to the brilliant writer, physician and psychologist William James. The roots of this misquotation is beyond the scope of this article (read: it´s beyond the scope of my capabilities, lol). 

This quote showcases the very foundations of mentalizing, namely, the importance of the meeting of the minds. It also acknowledges that mentalizing can never be fully perfect by stressing: “...and each man as he really is”. If we were perfect ´mentalizers´, we could read minds and know perfectly how a person really is. I guess we can´t read minds just yet, but we can make a certain effort.

Okay. So, mentalizing may remind you of empathy a bit. Empathy is a feeling you get based on your capacity to imagine what someone else is feeling. It´s like saying this: “If I was in your shoes, I´d feel like this.” You hit your head, I feel the ´ouch´ as well. Mentalization, however, underlines this capacity part: It´s about the capacity to understand the thoughts and feelings that underlie one´s behavior (The formal definition by the folks who coined the term: “The mental process by which an individual implicitly and explicitly interprets the actions of herself and others as meaningful on the basis of intentional mental states such as personal desires, needs, feelings, beliefs, and reasons"). To interact from a mentalizing stance may often lead to empathizing with someone, however. We may pick up someone´s perspective, thought, or feeling, and we adapt our own response to it. We see the other person more clearly in a way. The cross-section of where one mind meets another is like a social Valhalla - we feel valued, acknowledged and validated. As Skårderud puts it: “we feel felt”, and we tend to strengthen a form of interhuman connection because of it. In many ways, it goes deeper than “listening carefully” or “communicating well”, it´s about allowing for interhuman connection to flourish. 

Bateman and Fonagy deserve a mention for re-coining mentalizing and expanding its psychological definition. In the 90s, they both worked in the UK as psychologists with patients who were diagnosed with borderline personality disorder (BPD) - individuals who experience intense mood swings, paired with an unstable sense of self. Fonagy and Bateman noticed that these patients found it difficult to understand and relate to the mental content of other people and to their own. As a consequence, these patients often struggled to understand mental phenomena that underlie certain behaviors. Consequently, many struggled in maintaining social relationships. The idea is that intense emotions disrupt the capacity to mentalize, leading one into a negative spiral of social misunderstandings and more emotional turmoil. So Fonagy and Bateman worked out a psychotherapeutic model that is based on this observation: Mentalization Based Treatment (MBT). Therapists working from this model, aim to increase the mentalizing capacity in patients (with BPD for example) - It´s super interesting to see how individuals with personality disorders benefit from MBT (3). 

Since the birth of the MBT model, other patient groups who struggle with social cognition have been shown to benefit from MBT (4). Skårderud and colleagues spearheaded mentalization-based treatment for individuals with eating disorders. These individuals often struggle to relate to themselves and others socially. They report having obsessive thoughts about food, body weight, and the way one looks  in the outer world. This becomes their identity, so to speak - a world of “concrete things that are measurable and relatively easy to relate to”, which is in direct opposition to mental phenomena which aren´t concrete, nor visible to the eye. In focusing on such concrete things as calories, types of food, or a certain time on the clock when it is OK to eat, they tend to lose interest in their own and other people´s thoughts. 

One could say a person with an ED lives in a world of outward control. This sense of “control” regulates difficult feelings and increases certain behaviors like controlling the things one eats, starving oneself, overeating, working out a lot, or abusing medications (4). Hell, even other people might ´compliment them on the way they look. We shouldn´t compliment people on the way they look because people are not in essence their bodies. One can look a certain way that aligns with a socially constructed ideal (Ken and Barbie spring to mind), but one´s mind is very different from that. 

The identity and self-worth of a person with ED tends to depend on how well they control the way they eat and the way they look (I´m the person that eats only this type of food and I get compliments for my strict “no-sugar” regiment.. and more). Sooner or later, they feel less and less of this all-important “interhuman connection” mentioned before. When they go into treatment, they require a therapeutic team that cares for his or her physical, psychological, and intersocial well-being. We should acknowledge the fact that symptoms aren´t a stand-alone thing - but that people are relational beings with symptoms. 

Here´s a hypothetical example of how mentalization might work in practice between a caregiver and a patient diagnosed with anorexia nervosa.

Dialogue

Patient:
“I haven´t eaten in two days. I guess it started on monday. I think I even might have eaten to much according to my plan. My plan wasn´t to feel hungry at 8PM, and normally I don´t eat after that time, but on Tuesday I ate a piece of bread with low-fat cheese. I feel that I lose control and I also feel like I´m huge. Yesterday I managed to not eat anything after 3 pm because I felt huge and big”

Therapist:

“That is a serious thing to do, isn´t it? You tell me that you haven´t eaten much at all and that you have this feeling of being big. I wonder if you can tell me more about how when this feeling started”

Patient: 

“I don´t know, it just started. I guess on Sunday. I was going for a walk with my sister and she told me that she said that she is leaving for a year to live abroad. She´s like the only one that knows me well.”

Therapist:
“That sounds like that was important news to you. Tell me more about what happened after she told you that she was leaving?”

Patient:
“Well. We were actually supposed to eat together, something we hadn´t done for ages. You know. But I didn´t like that she was leaving. I dropped our plans to eat together that night. And she didn´t really like that I guess. When I came home I basically threw out the food that I had.”

Therapist:
“So you hopped over dinner and got rid of some of the food in your home. How did that make you feel?”

Patient:
“Well, I felt like I had some control over my life, you know. I felt better. I felt hungry and that made me feel comfortable. I can trust that feeling”

Therapist:
I wonder if, by throwing out food starving yourself, you felt like you could manage the difficult feelings that you had after talking to your sister. 

Patient:
Yes. I felt better, more control I guess.

Therapist:
What do you think that I think about you? Just now when you told me that you threw out food and starved yourself.

Patient:
Well. I guess you are worried? You are a therapist. I know you think that I´m not eating enough.

The patient focuses on the outside world and equates a sense of self-worth to it. It´s a type of “concrete” thinking (non-mentalizing) that is often seen in ED. There is little insight into what the patient actually feels in emotional terms, or even what describes the patient´s current state of mind. The therapist tries to rewind and focus on making the link between mental phenomena (thoughts and feelings) to behavior. Notice tha the therapist has a stance that is inquisitive, interested, open and curious.

The dialogue above represents a shortened version of the patient-therapist dialogue described by Robinson, Skårderud and Sommerfeldt in their seminal book, “Hunger” (2020, page 127). It tries to make the patient understand that starving oneself and throwing out food is a way of coping with negative feelings. The patient described a sense of “feeling big”. She felt better and more in control by engaging in disordered behavior. From the patient´s point of view (non-mentalized version), she simply felt “big” and felt like she had to be more strict and “control” more.

Turning away from mentalizing in patients with ED, we can turn back  to mentalizing in everyday life. You may agree now that to wonder explicitly about other people´s mental phenomena that underlie behavior is helpful in order to..

1. ..connect with a person from a place of curiosity

2. ..avoid misunderstandings 

3. ..have a (more) accurate understanding of what others think and feel

4. ..see the relationship between thoughts, emotions and behavior

5. ..interact from a place of flexibility, spontaneity and humor

6. ..increase interhuman bonding and ´feeling felt´

Rather than living within one´s own assumptions, to mentalize effectively one must by open, flexible, curious and a bit playful. It´s true that we often guess what´s going on in other people´s minds without really checking it. I certainly catch myself doing this.  But the fact is, we can´t decide what others think. And sure, even though we can´t go around checking what people think all the time, you might want to give it a try, especially experiencing interpersonal conflict. What's more: You don't need to be in agreement to mentalize. Maybe I think chocolate ice cream is the best, while you argue for peach-berry. As long as we understand each other we'll be fine. Understanding the other makes for a good discussion since you're more likely to use steel-man arguments as opposed to straw-man arguments. 

To round off here, it´s interesting to ask what the opposite of mentalizing: Mentalizing is absent “...when an individual interprets their own or others’ psychological experience and/or social behavior without reference to mental states (thoughts and/or feelings)” (6). 

Our lives depend on interacting socially with others. From the moment we come into this world, we are nurtured and weaned into existence (Alan Watts - a philosophical hero of mine - famously said that “..we come out of this world”, rather than into it. I think he´s right! But we´ll stick with the more common phrases and terms for now.) We socialize with our friends and family and, eventually, find ourselves in more and more complex relationships. Mentalizing is an interesting and fruitful endeavor. After learning about mentalizing I (selfishly) decided to apply it to individuals around me in the best way I could. Perhaps not surprisingly, I generally got some positive social responses. I noticed that people responded well to me trying to understand them. In the most literal sense, I specifically tried to embrace the “mentalizing stance”. That is, adopting an attitude of curiosity, not-knowing, non-judgment and interest in others´ mental states (7). It´s not as easy as it sounds, but oh boy, it can be such a superpower. 

For now: I´ll finish with some questions (since you read this far!)

1. What is mentalizing, and how is it different from empathy?

2. What situations do you think mentalizing is beneficial?

3. What is the basis of misunderstanding in social interaction?

4. What can be said to be “mentalizing-stance”

5. What else, besides mentalizing, can you do to improve social interaction?

Literature

1. Bateman, A., Fonagy, P., Campbell, C., Luyten, P., & Debbané, M. (2023). A History of Mentalizing and Mentalization-Based Treatment. In Cambridge Guide to Mentalization-Based Treatment (MBT) (Cambridge Guides to the Psychological Therapies, pp. 1-3). Cambridge: Cambridge University Press. doi:10.1017/9781108896054.002

2. Bateman A, Fonagy P (2004). Psychotherapy for Borderline Personality Disorder. Mentalization-Based Treatment. Oxford, U.K.: Oxford University Press.

3. Bateman, A. W., & Fonagy, P. (2016). Mentalization-based treatment for personality disorders: A practical guide. Oxford: Oxford University Press.

4. Robinson, P., Skårderud, F., & Sommerfeldt, B. (2018). Mentalization-based Treatments for Eating Disorders. Sveits: Springer.

5. Skårderud (2016). Falske kropper. Intervju med Susie Orbach. Aftenposten, 18 desember 2016.

6. Duschinsky, Robbie, and Sarah Foster, 'Forms of non-mentalizing', Mentalizing and Epistemic Trust: The work of Peter Fonagy and colleagues at the Anna Freud Centre https://doi.org/10.1093/med-psych/9780198871187.003.0006, accessed 1 Aug. 2023.

7. (y) Fonagy, P. (2020). Mentalization-Based Treatment (MBT). In: Zeigler-Hill, V., Shackelford, T.K. (eds) Encyclopedia of Personality and Individual Differences. Springer, Cham. https://doi.org/10.1007/978-3-319-24612-3_912

Citation source: 

• Citation from: https://psykologisk.no/2016/05/hva-er-mentalisering/#_ENREF_1 

Check out Bateman in action here:

• https://www.youtube.com/watch?v=BZl4OtQvDDg&t=387s&ab_channel=AnnaFreud

More resources:

• English: annafreud.org, in particular, MBT Training Workshop  

• Norsk: Hva er mentalisering? av Skårderud

• Nederlands: Dit artikel beschrijft Mentaliseren Bevorderende Therapie