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In previous posts I drew attention to the finding predicted by the imprinted brain theory that borderline personality disorder (BPD) might confer enhanced mentalistic skills of various kinds—specifically recognition of facial emotion.
Why predicted by the theory? Because it holds that, just as autism spectrum disorders symptomatically feature hypo-mentalism—mentalistic deficits, or mind-blindness—so psychotic spectrum disorders like BPD feature the converse: hyper-mentalism, or mind-reading in overdrive. Indeed, in a paper currently in press (kindly brought to my attention by my colleague and co-author of the imprinted brain theory, Bernard Crespi) the authors explicitly describe “Such an improved performance” on the part of BPD patients as “a kind of hypermentalization.” (Franzen, N., et al., Superior ‘theory of mind’ in borderline personality disorder: An analysis of interaction behavior in a virtual trust game, Psychiatry Res. (2010), doi:10.1016/j.psychres.2010.11.012)
Players judged the fairness or otherwise of partners in a mutual investment game with and without relevant facial cues. BPD players equaled normal controls in recognizing emotions and assessing fairness, but were superior to normal controls when emotional cues were present. Unlike the normal controls, the patients noticed the unfair behavior of partners in spite of emotional cues and adjusted their response accordingly. The authors add that "These results are in accordance with the description of BPD patients as beeing highly vigilant for social stimuli, especially for those cues that signal social threat or rejection (...). They agree with clinical observations that emphasize the ability of many BPD patients to very precisely recognize mental states of social interaction partners."
The experimenters speculate that “One explanation for the deviating behavior of BPD patients might be that they process information in a social context in an explicit controlled processing mode. This processing mode is slower and attention demanding, however more flexible and modifiable once started. Such a mode might result in a slower and more rational behavior which nevertheless deviates from normal and thus expected behavior in social interactions.”
Indeed, they also cite a classic paper by the psychoanalyst Alan Krohn in which he observed that “a patient diagnosed as borderline … demonstrates a curious reasonance [sic!] with the immediate inner experience of other people... Miss L. had a remarkable sensitivity to turmoil in other patients and staff. The patient described strange ‘vibrations’ from a staff member who it later turned out, was in a great deal of turmoil over traumatic war experiences.” Another patient “would regularly put into words … private associations of the analyst just as the therapist was having them. It was as if he was tuned in to the immediate associations and impulses of the therapist.” Yet another “zeroed in on parapraxes made by others and at times would take people aback by holding them accountable for their slips of the tongue, their forgetfulness etc.” (Krohn, A. 1974 ‘Borderline "empathy" and differentiation of object representations: a contribution to the psychology of object relations.’ International Journal of Psychoanalytic Psychotherapy 3 (2): 147).
Krohn added that “It is as if the therapist has suddenly been dealt a very deep, confronting interpretation by the patient!” and of course it was psychoanalysts who notoriously went in for deep, confronting interpretations and held people accountable for their slips of the tongue, forgetfulness—and just about everything else. Psychoanalysts certainly were in an explicit, controlled processing mode that was slow and attention-demanding, and psychoanalysis was also a trust game to the extent that patients both invested real money—often a great deal of it—and put all their trust in the analyst. But of course it was a very one-sided one. In classical Freudian analysis at least, the patient was denied the sight of the analyst’s face even though the analyst could see them, and the verbal side of the interaction was about as even-handed as a police interrogation!
Krohn was writing in 1974—long before the concept was born—but it is not hard to see that if BPD patients can be credited with hyper-mentalism, then so too can the psychoanalysts they seem to mimic so uncomfortably closely. Indeed, from my own bitter experience, I would add that some psychoanalysts probably were somewhat borderline—particularly one who would threaten you with the reminder, “I’m a psychoanalyst, you know!” whenever his high level of vigilence for social stimuli detected a social threat or rejection.
Perhaps the moral in the tale of psychoanalysis is that trust is a game for two players, and the sting in the tail the realization that hyper-mentalizing wasn’t confined to the patient prostrate on the couch!
