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Michael J. Horne » Book Review, Featured » Book Review: Affect Regulation, Mentalization, and the Development of the Self

Book Review: Affect Regulation, Mentalization, and the Development of the Self


Fort da: The Journal of the Northern California Society for Psychoanalytic Psychology (2003), 9(2), 107-111

Book Review: Affect Regulation, Mentalization, and the Development of the Self
by Peter Fonagy, Gyorgy Gergely, Eliot Jurist, and Mary Target
New York:  Other Press, 2002; 577 pp.
Reviewed by Michael Horne, M.D.

Although this book very thoroughly discusses many of the current issues in child development, such as attachment and mother/infant attunement, the concepts of analytic praxis proposed add little to ideas on current practice. I am suggesting that this is because of the authors’ scientific approach to the understanding of analytic practice. In this review I have critiqued their scientific approach and have outlined some of the features of a phenomenological mode of analytic practice as a contrast to the authors’ perspective.

The four authors of this book all have academic appointments that involve various aspects of psychoanalysis. Peter Fonagy, the senior author, is a training and supervising analyst in child and adult analysis in the British Psychoanalytical Society, and Freud Memorial Professor of Psychoanalysis at the University of London. Gyorgy Gergely is a clinical psychologist, Director of the Developmental Psychology Laboratory of the Psychology Institute of the Hungarian Academy of Sciences, and Senior Lecturer in the Cognitive Developmental Doctoral Program of the Eotvos Lorand University in Budapest. Eliot Jurist is a Professor of Philosophy at Hofstra University, and a Lecturer in the Department of Psychiatry at Columbia University. Mary Target is an Associate Member of the British Psychoanalytical Society, and a Senior Lecturer in Psychoanalysis at University College London.

A good example of the authors’ scientific approach is their assertion that “we rely on attachment theory, which provides empirical support for the notion that an infant’s sense of self emerges from the affective quality of relationship with the primary caregiver”  (p. 2). The notion of “empirical support” implies that the relational phenomena are not being understood on their own terms but, rather, are being reduced to an underlying explanatory principle — in this case, attachment. In addition, the authors’ definitions of terms are vague in that they refer to the infant’s “sense of self” without an explanation of what this entails, either in terms of a sense of being here as “I,” or of self-concept (Harre, 1998). In this quote they imply that the “sense of self” is a concretized object or thing.

In relation to the development of this “sense of self,” the authors propose the concept of mentalization, which they define as “the process by which we realize that having a mind mediates our experience of the world” (p. 3).  They go on to say that:
Mentalization is intrinsically linked to the development of self, to its gradually elaborated inner organization, and to its participation in human society, a network of human relationships with other beings who share this unique capacity. We have used the term “reflective function” to refer to our operationalization of the mental capacities that generate mentalization. (p. 3)

In these quotes, the authors are again referring to the mind as a thing that performs activities, such as the mediation of experience. Likewise, their concept of self is thing-like. It seems to be the end-product of a building process. In addition, the author’s definition of “mentalization” seems to refer to the end result of the activities of reflective function. Here, again, reflective function is described as something concrete, sounding somewhat like a homunculus turning on a machine that manufactures mentalization.

Fonagy has published other books on the relevance of attachment theory to psychoanalytic practice (Fonagy 2001), and on outcome and process research in psychoanalysis (Roth & Fonagy 1998). His and his collaborators’ work is part of a contemporary psychoanalytic zeitgeist — of which the work of Solms (Solms & Turnbull 2002) and Schore (2001) are other prominent examples — that involves an attempt to use scientific concepts and methods to legitimize psychoanalytic theory and practice. This return to scientific empiricism is in contrast to an opposing contemporary paradigm that uses insights from social psychology and contemporary philosophy to completely reformulate analytic practice.

This clash of views is also occurring world-wide in psychology, sociology, and anthropology departments, where scholars deal with the study of humans as organisms and as persons. As the discussions around this question have progressed, the debate has been seen to involve a philosophical issue concerning the being or essence of the human as a person. The scientific view of the person is that he/she is an expression of the functioning of the brain, and the opposing view maintains that the person is a phenomenon that has to be understood on its own terms. This latter approach is called phenomenology (Sokolowski, 2000).

According to the phenomenologists, our most basic personal characteristic is our sense of being here (Heidegger, 1962). This is expressed by statements we make beginning with I (Harre, 1998). When we speak in this way we “take a position.”  It is also expressed by our sense of having a base, which we talk about as “having our feet on the ground” (Money-Kyrle, 1968; Horne, 2002). We are first aware of being here by our experience of our state of mind or mood, which we express as “how we are doing” (Heidegger, 1962). Damasio (1999) calls this experience “the feeling of what happens,” and says that this provides one with a “core consciousness” (pp. 82-106).

Out of the experience of being here develops an understanding of being in the world (Heidegger, 1962). This is not a being-in with objects; it is, rather, a being immersed in the significance of the world per se. Out of this immersion comes a provisional understanding of one’s situation expressed as “what seems to be going on.”  Repetitive experiences of our understanding of the immersion of ourselves as I in the world, leads to the development of a self-concept (Harre, 1998). Damasio (1999) calls this state “extended consciousness” (pp. 195-233), which he says involves the mapping of person and object in feeling interchange, and which is supplemented by the ability to represent these experiences symbolically, particularly in the form of language. Damasio says that the presence of memory and symbolic reasoning allows for planning and judgment, and the existence of memory and understanding allows for the creation of a self-concept. Phenomenologists agree with these assertions that the human as a person exists in signifiers, particularly those of language (Heidegger, 1962).

While some contemporary intersubjective analysts have become consciously phenomenological (Orange, 2001), Klein, Bion, and Winnicott already developed phenomenological approaches via their insights concerning object relations. Klein’s concept of the paranoid/ schizoid and depressive positions are, respectively, one-dimensional and multi-dimensional stances to being in the world. Moreover, in the depressive position, the person has a self-reflective capacity as a result of the very fact of being in the multi-dimensional perspective (Klein, 1952).

Bion developed a phenomenological approach to analytic theory and practice by carrying out an inventory — which he called the grid — of the basic elements of the analytic process itself. He identified the most primordial of these elements as undifferentiated sensory/emotive experiences, which he called “beta-elements.” He said that these were converted by mental activity, which he called “alpha function,” into alpha elements called dream thoughts. Bion (1989) said that alpha function does further mental work on these elements, converting them to preconceptions, and then to conceptions, and finally into concepts.  He used the metaphor of container/contained to describe this process.

Winnicott (1951) was more overtly phenomenological than either Klein or Bion. From his observations of infants’ and children’s early use of real objects, he postulated an “intermediate area of experience” that he said was neither real nor imagined but, rather, illusory. It was neither inside nor outside humans, but somewhere between them. In a later formulation, he called this area of experience “potential space” saying, first, that it was  “the location of cultural experience” and then later, “the place where we live.” Winnicott described the function of play as being the means by which we create ourselves in a lived-in world (Winnicott, 1971).

Throughout the book under review, the authors argue that developmental concepts, such as attachment, are essential for the praxis of adult psychoanalysis. A phenomenological approach would eschew all concepts of development while conducting the analytic work. Any focus on this, or any other concept, would violate the most essential tenet of phenomenology, which is to allow the phenomena to be understood in their own terms. Bion captured this attitude eloquently in his prescription to the analyst to be free of memory, desire, and understanding.

What the authors describe as evidence of attachment disturbances in adult analytic work can be phenomenologically understood and interpreted using Klein’s concept of the positions. For example, a patient exhibiting anxious/avoidant attachment could be seen as being in the paranoid/schizoid position, experiencing anxiety about being attacked by the analyst. When the patient was exhibiting avoidant behavior, he/she could be seen as being in the depressive position, and experiencing anxiety about attacking the analyst. The emphasis on the experience of anxiety as an indicator of how one is being-with is what makes the Kleinian approach phenomenological.

In summary, in their insistence that the human person can be understood scientifically, the authors preclude the possibility of giving an account of psychoanalytic praxis that is in accord with the nature of personhood. More importantly to their project, other authors such as Bion, Klein, and Winnicott have already sketched out the basis of a psychoanalytic praxis that is appropriate to the characteristics of the human as person. In addition, Damasio’s theory of levels of consciousness has provided a scientific explanation for personhood, which supports the phenomenological understanding of persons as beings in the world in states of mind that Bion,  Klein, and Winnicott so eloquently point to, and that Heidegger describes philosophically.

Bion, W. R. (1989). Elements of psychoanalysis. London: Maresfield Reprints.
Damasio, A. R. (1999). The feeling of what happens. New York: Harcourt Brace & Company.
Fonagy, P. (2001). Attachment theory and psychoanalysis. New York: Other Press.
Harre, R. (1998). The singular self: An introduction to the psychology of personhood.  London: Sage Publications.
Heidegger, M. (1962). Being and time. San Francisco: Harper and Row.
Horne, M., (2002, October). Opening space in space: An ontological inquiry into the relationship of space and mental experience. Paper presented at the 13th Annual Conference of the International Federation for Psychoanalytic Education, Fort Lauderdale, FL.
Klein, M. (1952). Some theoretical conclusions regarding the emotional life of the infant.  In Envy and gratitude and other works 1946-1963. New York: The Free Press.
Money-Kyrle, R. E. (1968). Cognitive development. International Journal of Psychoanalysis, 49,  691-698.
Orange, D.M. (2001). From Cartesian minds to experiential worlds in psychoanalysis. Psychoanalytic Psychology, 18, 287-302.
Roth, A. & Fonagy, P. (1998). What works for whom: A critical review of psychotherapy research. London: Guilford.
Winnicott, D. W. (1971) Playing and reality. London: Tavistock Publications.
Winnicott, D. W. (1951). Transitional objects and transitional phenomena.  In Collected papers: Through paediatrics to psychoanalysis. New York: Brunner/Mazel.
Michael Horne, M.D.
Box 359896
Department of Psychiatry, University of Washington
Seattle, WA, 98195
(206) 749-4111

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