Empathy and mentalization

I have started to be able to recognize affection. I can’t explain to you why I was unable to recognize it before. I think it created so much cognitive dissonance, I didn’t process it. I didn’t realize it was a distinct feeling, with its own facial expression, its own tone of voice, or that it was as evident as happiness or anger.

I am beginning to recognize it because there is one boy in my class who feels it for me and it’s very clear and obvious in his face. I also hear it in C’s dad voice when I talk to him, and sometimes in his older sister’s manner. (She lives in Y-town.)

I was writing last time about mentalization. I read some things that were interesting to me. I am trying to organize them in my mind this morning, because they are lying there in my head in disarray, like loose threads on the verge of tangling.

The first of these threads is that the ability to understand inner states–to make sense of motives and beliefs and feelings–develops over time. Under stress, we tend to lose later-learned abilities.

Our initial ability to mentalize is teleological–in other words, concrete. I know what you are thinking or feeling only from easily recognizable physical actions. If you do things that I understand will bring comfort to me, then I know that you care.

The process of learning to mentalize is disrupted in abused children, because the malignant intentions of the parent are so unfathomable, and it is stalled in neglected children because of loss of opportunity.

Under stress, we are all vulnerable to regressing to this earlier state.

To me, it explains the controlling people I have encountered, as well as C’s tendency to make demands for money or possessions which can feel exploitative to me. If only actions can communicate care, and even then only actions which you have predetermined to be caring actions, then the only way to feel cared about is to control someone’s actions very carefully. It also explains to me why when I first began to work with parts, I needed to find things which were very sensory and physical to help myself calm down. Self-talk had no impact, because I have learned people can lie. I am even capable of lying to myself.

The other strand lying loose in my mind, ready to tangle, has to do with non-mentalizing. Because borderlines hypermentalize (and I think I do too), then trying to make sense of other’s and one’s one mental states can seem impossible or even destructive. I think I ended up in therapy which discouraged mentalization. I and the therapist lived in worlds where attempts to understand motives, especially the motives of others, felt destructive. The only way to stop the spiral of trying to grapple with real or imagined malignancy was to suppress one’s natural attempt to make sense of the world.

My therapy became action-oriented, rather than reflective. “How do you take care of yourself?” stopped me from attempting to make sense of my partner’s motives and encouraged me to stay in a concrete mode, where I could at least act in ways I understood.

The end result of this, however, was to increase my sense of loneliness. Without engaging in the imaginative process of trying to understand other people or find ways to communicate my own inner states to others, the loneliness was unbearable.

In one article I read, it warned clinicians of this: that people form systems, and clinicians can become part of systems along with their clients in which mentalization is no longer engaged in and curiosity about mental states is discouraged.

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Mentalizing

I read some things yesterday and the day before about borderline personality disorder and also about mentalizing which were very explanatory, both about what’s going on with me and what was in my mother’s mind when she interacted with me. Some of it explains C to me.

It’s still kicking around in my head.

The newer idea is that borderlines hypermentalize. They are hypervigilant about social interactions and ascribe motives and feelings to people beyond what’s really observable and most of the time these motives and feelings are very negative, so the borderline lives in a hostile world of their own making. They may even begin to ascribe motives and feelings to objects which do not have motives or feelings.

This is not meant in as critical way as it sounds. They aren’t doing this on purpose. That is just what their brains do. I think there are times when I do this, even when I do not verbalize to myself what I am responding to and do not know. I can tell you it’s not fun.

But you can see that if you start making up ulterior motives with a crying baby, it would not go well. You can also see if my mother did this, the image of the parent that would emerge in my mind would be of a very malignant caretaker, and if it happened enough, I would internalize an image of myself as being malignant, because that is what my mother saw when she saw me.

There is more to say, but it’s six am now. Time to get the kids up and make breakfast.

Motor Empathy

We don't copy each other just to fit in or be liked. Really, it's about all running away from the same lion instead of standing around stupidly until you see it too.
We don’t copy each other just to fit in or be liked. Really, it’s about all running away from the same lion instead of standing around stupidly until you see it too.

There are actually three systems that work together to help us understand how others are thinking and feeling and that allow us to relate to each other as social beings. The third one, which I haven’t really mentioned up until now, is motor empathy.

Motor empathy is the reason you find yourself looking in the same direction a stranger suddenly turns toward. It is the reason you tend to cross your arms if your conversational partner is crossing hers.

It is probably also the reason my cat smiles after more than a decade of my smiling at her.

Motor empathy is also called mirroring. We do it unconsciously for the most part, although life coaches and job interview tips might advocated doing it on purpose. Mirroring the actions of others makes us likable. It is an advertisement of your success as a social human being. It says you are skilled at understanding how others feel. It says you care about other people. It says you share your toys and play nicely in the schoolyard.

To some extent this may really be true, because motor empathy may be the precursor of affective (emotional) empathy. And you need affective empathy to develop real concern for other people. Cognitive empathy alone doesn’t seem to do it.

It works like this. Someone smiles at you. you smile back. The smile makes you feel happy, and consequently you understand that people who are smiling are happy.

The Russian doll model (that I don't totally buy) that moves from simplest to most complex responses.
The Russian doll model (that I don’t totally buy) that moves from simplest to most complex responses.

So motor empathy may be the mode of transmission for contagious emotions. You mimic the expression and the expression creates the emotion that goes with it.

But it’s not entirely clear. Autistic people have great difficulty with motor empathy. However, we don’t know whether they have difficulty with affective empathy. They may not. The jury on that is still very much out.

Even if it is, good motor empathy as an indicator for other kinds of empathy only works for some people–most people, in fact, but not everyone.

It doesn’t work for people with personality disorders. They all have perfectly fine motor empathy skills and major gaps in others systems. Borderlines feel what you feel, but cannot make sense of it. Narcissists lack affective empathy. Psychopaths do too. They do not feel what you are feeling, even if they are doing what you are doing.

Motor empathy is a part of what makes us feel connected to others. There are other elements involved, but motor empathy is one of them. That is why you can develop the most intense feeling of connection to a narcissist or psychopath–they can seem so absolutely in synch with you–but still be dropped like a hot potato.

They don’t feel what you are feeling, even when they look like they are. The connection is entirely on your side.

Empathic Distress, Guilt and Moral Reasoning

A Chinese vendor selling halal meets. Photo credit:  Aaron D. Feen
A Chinese vendor selling halal meets. Photo credit: Aaron D. Feen

I’m wondering something today.

I’m wondering something that I don’t have any answers to yet. But let’s just play with some ideas for a while, shall we? Let’s just hypothesize today.

And tomorrow, if I have time, I can read like hell and see if I’m right.

What I’m wondering is if empathic distress leads to guilt, or is part of what leads to guilt. Specifically, I’m wondering if the equation for guilt is this: suffering —> empathic distress –> cognition, “I did that,” –> guilt.

There are two kinds of morality, two categories of things we tend to feel guilty about. The first of these involves harming others: Thou shalt not kill; Thou shalt not commit adultery; Thou shalt not steal, and so on.

The other involves following rules that don’t obviously result in harm to anyone else: Remember the Sabbath Day, for example. Many of these are dietary or involve hygiene rules, such as keeping kosher or halal. When I was growing up in the 2×2s, we had a thousand different rules with very strong moral implications: don’t own a TV, don’t watch movies, don’t go to dances, don’t play on organized sports teams, to name a few.

Tharold Sylvester, Eldon Tenniswood, Ernest Nelson, and Howard Mooney, ca. 1970s.
Tharold Sylvester, Eldon Tenniswood, Ernest Nelson, and Howard Mooney, ca. 1970s.

If you really want to know all about them, you might enjoy a sermon I heard as a child from one of our most respected ministers, Eldon Tenniswood. He may have missed a few things, but it’s rather hard slogging anyway.

They seem different, but I’m not sure they are. What will happen if you are an orthodox Jew and fail to keep kosher? Well, bad things, right? God will be angry at you. He may be angry at your family. You will most likely be punished, or at the very least, he’ll turn his back on you when you most need him. People will be hurt in the long run by what you have done. You will be hurt.

And in the short-run, you will wound the hearts of those closest to you, who will take your failure to support your shared traditions as a personal betrayal.

I know I felt that way, leaving the church. My grandmother probably had a heart “episode” over it, as my mother always called them. Like it was TV.

Certainly, I would be hurting those around me in the long term. They were very clear about this. Car accidents came up a lot, as did drug and alcohol use.

Eldon gave this example in his sermon that night in 1982, “There was a young mother in Ohio who was quite angry when I went there for a visit.  She said to me, “When my little girl ( five years old) goes to school, she is going to be like other little girls.”  She told me about her parents, how hard they had made it for her.  Twelve years later it was my privilege to visit the same mother who sat in the same rocking chair.  Tears were streaming down her face when telling me about her 17-year-old girl.  She was just like other very rebellious girls and now the mother wanted her to be different.”

Guilt isn’t just about fear of punishment, even when the cause seems to be a bunch of silly rules. It’s not even about disapproval or rejection. It’s about not wanting to hurt our parents, our siblings, our children, or even God. It’s about feeling we have caused someone harm or will cause someone harm and we regret it.

It’s about empathic distress: seeing someone in distress and feeling it as if it were our feeling. With one additional element: a sense that we are the agent of that distress.

People who feel the most painful guilt are the most confused about their own agency, what power over others they really have, and what others can and should be expected to do for themselves.

Borderlines are famous for this. Individuals with BPD typically have difficulty regulating their own emotions and consequently expect everyone else to do it for them. People who spend a lot of time around them usually end up with the same belief–that we have a control over others we simply don’t have. If the BPD is experiencing distress, someone else must have caused it, or should have acted to prevent it, or should be able to stop it.

No, no, and no. The distress is partly just a normal part of being alive, partly about the deficits in cognitive empathy associated with BPD, and partly the result of difficulty with emotion regulation: the BPD may be no more distressed than anyone else would be in the same situation. It’s just that she can’t calm down.

Alcoholics have similar beliefs.

If you feel an unreasonable amount of guilt, you can deal with it in one of three ways: act to minimize the harm you feel you have caused (make amends), reconsider the extent of the harm you caused or might be causing (maybe it’s not such a big deal), or reevaluate your role as a cause (maybe it’s not your fault).

“It wasn’t your fault,” is necessary and so powerful.

I started thinking about this all a few days ago, watching Longmire. This is just a trailer, but you might like it anyway.

There is an episode in which a young girl with a developmental disorder is gang raped by four boys. One of them, it is later discovered, was not a willing participant, but he is nonetheless racked with guilt and rage. Another boy held a gun to his head. What else could he do?

A deputy tells him, “If someone threatens you with violence and makes you do something you don’t want to do, that’s kidnapping.” In fact, it isn’t. Not unless it’s a felony. But rape is a felony.

It’s not your faultIf someone threatened you, directly or indirectly, into taking off your clothes so that someone could more conveniently rape you, if they told you to go to an isolated area so that no one one would hear your screams, if they made you harm someone else, if someone said hold still or I’ll hit you harder, that’s kidnapping.

And it wasn’t your fault. If you still think it was, it’s because you won’t admit how powerless and terrified you really were.

Empathy in Personality Disorders

Russian dolls.
Russian dolls.

One of the diagnostic criteria for Narcissistic Personality Disorder (NPD) is “lack of empathy.” But what kind? Affective, cognitive, or both?

So I read a study. Granted, I only read one study. You should probably read more before you decide if their findings are valid.

According to K. Ritter and a bunch of other researchers, narcissists have average cognitive empathy. They can see things from your perspective. They can’t always be bothered though.

However, they have impaired affective empathy. When you are distressed, they aren’t also distressed. Which I think probably explains a lot.

The same study looked at empathy in those with Borderline Personality Disorder (BPD). They found what other studies have found about borderlines and empathy. Individuals with BPD have impaired cognitive empathy but average or above-average affective empathy. They feel distressed when you are distressed–maybe even very distressed–but they don’t know why.

The Skill Gaps, a Follow-Up

There is something I should clarify about my last post, Empathy, Mentalization, and Complex Trauma. Actually, several things.

The first of these is that I made an assumption about complex trauma, which may not be correct, but that I do think was probably reasonable. I assumed that most or nearly individuals with complex trauma have someone in their immediate family with a mental illness which affects that person’s ability to empathize, mentalize, or regulate emotions. I am assuming that complex trauma is not just about having lived through repeated traumas, but about other factors that tend to go along with spending a lot of time around the kinds of people that are more likely to harm themselves or others or risk harm to themselves or others.

In other words, if your parent (like mine) attempted suicide when you were a kid, there was probably a lot more going wrong than just that. And it probably had something to do with empathy, mentalization, or regulating emotions. Because most things that make us really unhappy or really unable to function do.

In my last post, I also talked about skill gaps in mentalization. There are three types of skill gaps that can occur really. One of them has to do with understanding the minds of people you care about and are close to that have a mental illness.

Shared neural circuits for mentalizing about the self and other. a) Activation for mentalizing about self (red voxels) or other (blue voxels). White voxels denote overlap for self- and other-mentalizing. b) Common functional connectivity from shared vMPFC, PCC, and RTPJ seed regions. Red voxels show connectivity for self-mentalizing and blue voxels are for other-mentalizing. White voxels denote the overlap in connectivity for self- and other-mentalizing
Shared neural circuits for mentalizing about the self and other. a) Activation for mentalizing about self (red voxels) or other (blue voxels). White voxels denote overlap for self- and other-mentalizing. b) Common functional connectivity from shared vMPFC, PCC, and RTPJ seed regions. Red voxels show connectivity for self-mentalizing and blue voxels are for other-mentalizing. White voxels denote the overlap in connectivity for self- and other-mentalizing

I’ll put it to you like this. I have a number of skill gaps as an accountant. In fact, I really know almost nothing about accounting. However, I am not an accountant. It really doesn’t matter.

If you have no one close to you who doesn’t, for example, have BPD, then you really don’t need to understand how people with that disorder think. “That’s a whack job if I’ve ever seen one,” is probably as complex as your understanding of their inner emotional lives needs to go.

If that person is your sibling, your parent, your spouse, or your best friend, then that just isn’t going to cut it.

But the other skill gaps affect the rest of your life. They will still be there even if you decide to cut out of your life altogether everyone who is mentally ill, emotional unstable, or neuro-atypical.

One of them is understanding your own mind and how it works, how you think and feel and what motivates you. If you spent a lot of time with someone who had difficulty mentalizing (as BPDs are speculated to have), especially during your growing up years, you are likely to have trouble with it yourself.

It’s a little like learning math from someone who is mixed up about math. You may learn it, but you may also learn it wrong, or you may learn some things but not others. You may be able to do it, but not with any fluency or confidence.

When you spend a lot of time around someone with difficulty mentalizing, you may be told frequently that you think or feel something you do not think or feel, or be told you feel things you don’t feel or that you don’t feel what you do.

Because we are profoundly social creatures, we often believe what people tell us, especially if we are told it repeatedly. Even if we know it can’t be the truth. If you were a kid and just getting a handle on this whole mentalization business in the first place, you are doubly likely to believe this. You will mislabel your own feelings and motives and misunderstand how your own mind works. And that’s going to be a problem for you.

Not difficult.
Not difficult.

The third skill gap has to do with how we learn how to mentalize in the first place. And although there are a several different theories about how mentalization develops, as a completely non-expert observer, it seems to me that mostly we base our models of the mind on our own minds and on the kinds of minds we have the most experience with.

As the child of a psychopath, it’s not really very difficult for me to understand how a psychopath thinks or what motivates him. I spent a lot of time with one and it’s really not very complicated.

It took me a lot longer to understand the minds of people who aren’t disordered. I had very little experience with them.

So it may also be difficult for you to understand the minds of people who aren’t mentally ill, or who are mentally ill in a different way. And that’s going to make a lot of things just hard.

In sum, those with complex trauma can have difficulty with mentalization in three distinct areas. You may have difficulty mentalizing about an important person who is mentally ill, because that person’s mind is so unlike yours. You may have difficulty mentalizing about your own mind, because it was so deeply misunderstood by someone else for so long. And you may have difficulty mentalizing about ordinary people, because their minds are so unlike the minds of people who shaped your view of how minds work.

It’s a problem. Indeed.

Happy Mother’s Day…Maybe

My mother was abusive. She was also mentally ill. Those things seem to go together. Mental illness affects your ability to exercise good judgment, to manage the social aspects of life, and ultimately it affects your ability to raise your children. And sometimes parents who are mentally ill neglect or hurt their children.

I’d like to say that being mentally ill is a disability like any other, and it doesn’t affect your ability to be a good parent. But in at least some cases it does. It does profoundly.

Spirit_ApplePieSaleSo, I’m thinking about Mother’s Day. And I’m thinking about having things thrown at my head.

As far as I can tell, my mother had borderline personality disorder (BPD), with strong elements of narcissism. She sometimes ventured into the realm of out-and-out psychosis. She had comorbid depression and generalized anxiety. She spent a lot of time in bed when I was growing up, attempted suicide on a regular basis, and was murderously angry at least two or three times a week.

She’s a hard person to be around.

Holidays were hard. They often are for borderlines and their families. I’m not sure why, but it’s something all of us KOs (kids of) seem to be able to relate to. Maybe expectations get built up, and are later cruelly smashed–since life is never, ever quite as good as our fantasies. Or maybe the anxiety of needing to remain the center of attention–even if the day is about someone else–becomes too much.

So Mother’s Day was a hard day, a dangerous day. A lot of things were thrown. There were tears and shouting.

Hallmark, you’ve made the day so much harder for all of us. For those of us who were orphaned, motherless, abused, or simply forgotten. It’s so much harder.