Mentalization and psychosis Citation for published version (APA): Weijers, J. (2020). Mentalization and psychosis: trying to understand the un-understandable. Ridderprint. https://doi.org/10.26481/dis.20201208jw Document status and date: Published: 01/01/2020 DOI: 10.26481/dis.20201208jw Document Version: Publisher's PDF, also known as Version of record Please check the document version of this publication: • A submitted manuscript is the version of the article upon submission and before peer-review. There can be important differences between the submitted version and the official published version of record. People interested in the research are advised to contact the author for the final version of the publication, or visit the DOI to the publisher's website. • The final author version and the galley proof are versions of the publication after peer review. • The final published version features the final layout of the paper including the volume, issue and page numbers. 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Download date: 02 Oct. 2021 Mentalization and psychosis Trying to understand the “un-understandable” Jonas Gijs Weijers 146807_JonasWeijers_BNW_def.indd 1 28-10-2020 15:08 Mentalization and Psychosis: trying to understand the “un-understandable” ͻ͹ͺǦͻͶǦ͸Ͷͳ͸ǦʹͳͷǦͺ ̹ ǡʹͲʹͲǡ Ǥ ǡǤ ǣȁǤǤ 146807_JonasWeijers_BNW_def.indd 2 28-10-2020 15:08 Mentalization and psychosis Trying to understand the “un-understandable” ǡ ǡǤǤǤ ǡ ͺ ʹͲʹͲͳͲǤͲͲ ͺͳͻͺ͸ 146807_JonasWeijers_BNW_def.indd 3 28-10-2020 15:08 Promotores ǤǤ ǤǦǤǤ Ǥ ǤǤǤ ǤǤǦȋȌ Copromotor ǤǤǤ Beoordelingscommissie ǤǤǤǤ ǤȋȌ ǤǤǤǤ ǤǤǤǤ Ǥ ǤǤǤȋǡ´Ȍ ǤǤǤǤȋȌ ȋ Ȍǡ ǡ Ǥ 146807_JonasWeijers_BNW_def.indd 4 28-10-2020 15:08 Table of contents PART I Theoretical outline 7 ͻ ǣ ʹͷ PART II Childhood abuse and psychosis Ǧ 47 ǣ Ͷͻ ͸ͻ ǣ ͺ͹ PART III Mentalization based treatment for psychotic disorder 107 Ǧ ǣ ͳͲͻ ǣ Ǧ ͳ͵͵ PART IV ǡConclusion Ǧ ǡ Ǥ 157 Addendum ͳͷͻ185 ͳͺ͸ ʹͳʹ ʹͳ͸ ʹͳͺ ʹʹ͵ 146807_JonasWeijers_BNW_def.indd 5 28-10-2020 15:08 146807_JonasWeijers_BNW_def.indd 6 28-10-2020 15:08 PART I: THEORETICAL OUTLINE I Part Part 146807_JonasWeijers_BNW_def.indd 7 28-10-2020 15:08 146807_JonasWeijers_BNW_def.indd 8 28-10-2020 15:08 Chapter One: GENERAL INTRODUCTION 1 J.G. Weijers Chapter Chapter 146807_JonasWeijers_BNW_def.indd 9 28-10-2020 15:08 Chapter One Psychosis and non-affective psychotic disorder Ǧ Mentalization and psychosis: trying to understand the Ǧ“un - ȋunderstandable” ȌǤ – – ǡ Ǥ . ǡ ǡǤǤǡ ǡǤǤ Ǥ term ‘unǦunderstandability’ was first introduced in 1910 by psychiatrist and philosopher Karl Ǧ Ǥ ǡǦ others “rationally or emotionally as arising from the situation of the patient and due to the situation and his emotions” (Fish Ƭ ǡͳͻͺͶȌǤǡ ȋ Ƭ ǡͳͻͺͶȌǦwhat today would be referred to as ‘aberrant experience’ – Ǥ ǡ ǡ Ǥ ͸Ψ Ǧ ǡ Ǥ ǡ ǡ ǡǤ Ǧͷȋ ǡʹͲͳ͵Ȍǡ ǣǡ ǡ ȋ as ‘positive symptoms’), grossly disorganized or abnormal motor behavior, and negative symptoms, Ǥ ǡ ǡ manic or depressive episodes, and the so called ‘nonǦaffective psychotic disorders’ (Ȍǡ Ǧ Ǥ Ǧͷ ǡ ǡ ǡ ǡ ǡ Ǥ Ǥ 10 146807_JonasWeijers_BNW_def.indd 10 28-10-2020 15:08 General Introduction Social functioning and social cognition in NAPD ǡ ǡ Ǧ ǡǡ Ǥǡ ǡ 1 ȋ ǡ ƬǡʹͲͳͷȌǤ ǡ ȋ ǡ ǡǡǡƬ ǡ2011). Social cognition is the multifaceted domain of “the mental processes ns” (Fett et al., 2011). It entails the capacity to perceive, interpret, and ȋƬǡʹͲͳͶȌǤ Ǥǡ ǡ ȋǡ ƬǦ ǡʹͲͳ͹ȌǤ ǡ Ǥ ǡ Ǥ ǡ Ǥ Ǥ ǡ Ǥ Social cognition according to mentalization theory ǡ Ǥ ǡǡǡǤ to “put ourselves in another situation and feel ourselves into another’s shoes” (Fish Ƭ ǡ ͳͻͺͶȌǤ mentalisation French psychoanalytic term ‘ ’ and the empirical term ‘theory of mind’, which relates to 11 146807_JonasWeijers_BNW_def.indd 11 28-10-2020 15:08 Chapter One ȋƬǡʹͲͳͶȌǤ ǡ of the concept’s theoretical underpinnings,mentalisation while also diminishing its conceptual depth and clinical Ǥ Ǧ ǡ ǡmentalisation Ǥ ǡ used to mean ‘to make mental’ or ‘to sym’ (see Ƭ ǡͳͻͻ͹). As such, “understandability” also applies to the activity of mentalizing, meaning ‘to understandmentalisation that which has not yet been understood’. ǡ ȋͳͻͻͳȌ ǡ Ǥ Ǧ ǡ –– Ǥ for ǡ ǡ Ǥ ǡ Ǥ ǡ ǡ ǡ Ǥ ǡ responsive, sensitive and slightly exaggerated or ‘marked’ feedback to the infant’s sensoryǦ ǡ‘motherese’ (see chapter 2). Providing feedback that accurately reflects the child’s sensoryǦ ǡ Ǥ ǡ ǡ ǡǤ allows the child to come into contact with another’s view of its inner experiences, which constitutes Ǥ ǡ ǡ ǦȋǦǡǡ ǡƬ ǡʹͲͲ͵ȌǤ ǡ Ǣ Ǧ ǡǤǤ ǡ Ǥ ǡ ȋǤǤǡǡ ƬǡʹͲͲ͹ȌǤ 12 146807_JonasWeijers_BNW_def.indd 12 28-10-2020 15:08 General Introduction ǡ ȋ ƬǡʹͲͲ͸ǢǤǡʹͲͳ͵ȌǤ Childhood abuse, mentalizing and psychosis ǡ ǡǡ ǡ 1 Ǥ ǡ inappropriate responses to a child’s affective states, which may communicate that such states are Ǥ Ǥ ǡ“unǦunderstandability” Ǥǡ ǡͶ͹ǤͷΨȋǤǡʹͲͳͳȌ ͺͷΨȋǤǡʹͲͳͷǢǤǡʹͲͳ͵Ȍǡ ȋǤǤǡǡƬǡʹͲͲ͹Ǣ ǡǡǡ ǡƬ ǡʹͲͳ͵ȌǤ ȋǤǡʹͲͳʹȌǤ Ǧ ȋƬǡʹͲͳʹȌǡ ǡ ȋǤǡʹͲͳͲǢ ǤǡʹͲͳͲǡǤǡʹͲͳͳǢǤǡʹͲͳ͵ȌǤ ǡ ǡȋǡǡǡƬǡ ʹͲͳͷǢ ǡǡǡǡȋʹͲͲͷȌǢǡǡǡ Ƭ ǡʹͲͲ͸ǢǤǡʹͲͳͷȌ ȋǤǡʹͲͳͷǢ ǤǡʹͲͳ͵ȌǤ ȋǡǡǡƬǡʹͲͲͷǢ ƬǡʹͲͳͶȌǡ Ǥ ǡ Ǥ ǡǤǤ ǡ ȋ ͵ȌǤ expectations of others’ abilities to help coǦǡ 13 146807_JonasWeijers_BNW_def.indd 13 28-10-2020 15:08 Chapter One Ǥ Ǧǡ ȋ ͶȌǤǡ ȋ ͷȌǤ ǡǤ ǡ uncaring caregiver’s mind may be so overwhelmingly painful for a child, that it instills ȋ ͷȌǤ Operationalization of mentalization Ǥ “ungainly” and “allǦencompassing” (ChoiǦƬ ǡʹͲͲͺȌ Ǥ ȋʹͲͲͻȌ ǣ ǡ ǡ ǡǤǡ ǡ ǡ ǡǡƬ (2012a) introduced a fifth polarity by introducing the term ‘embodied mentalizing’. Ǧ mentalizing. Implicit mentalizing involves reflexive and intuitive ‘snap’ judgments about internal or Ǥ ǡ process of reflection on one’s own and someone else’s mental states (Fonagy ƬǡʹͲͲͻȌǤ ǡ Ǥ ǡ capacity to detect and process signals on an affective basis, i.e. ‘to feel for someone’. ǦǦ Ǣ people are able to reflect on their own or others’ mental states. Here the two must not be seen as discrete polarities but as dynamically interacting domains. Reflecting on one’s own feelings can ǡ Ǥ clearly distinguish between one’s own mental state and those of others. Ȁ Ǥ ǡ Ǥ 14 146807_JonasWeijers_BNW_def.indd 14 28-10-2020 15:08 General Introduction ǡ ȋʹͲͳʹȌ “the ability to experience the body as the seat of emotions’’. Specifically, embodied mentalizing pertains to the degree of certainty that is attributed to one’s cognitive beliefs or one’s sensoryǦ ȋ ʹȌǤ Measurement of mentalization 1 Ǥ Ǧ ǡ understand one’s mentalizing deficits. Furthermore, the field of ǤǦǦ ǡ ȋ ǡʹͲͲͺǢ Ƭ ǡʹͲͳͻȌǤ ǡ Ǥ Ǧ Hinting Task ȋ Ȍ ȋǤǡʹͲͳ͵ȌǤ another’s wishes from indirect speech, i.e. the cognitive, otherǦ ‘theory of mind’. ǡ Ǥ ǡ Ǥ Ǧǡ ǡ Ǥ ǡǡ ȋǤǡʹͲͳ͵ȌǤ Ǣ ȋǤǤǡƬǡʹͲͲͻȌǤ Ǧ ȋǢǡ ͳͻͶ͵ȌǤ Ǥ ȋǤǡʹͲͳ͵Ǣ ǡƬ ʹͲͳͻȌǤǡ Ǧ Ǥ ǦǦ Ǥǡ Ǥ 15 146807_JonasWeijers_BNW_def.