You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
Mentalization as the link between brain/mind in personality disorders.
This is a synthesis of the Chapter's discussions during the first six months of 2006, centered on an analysis of a keynote lecture given by Peter Fonagy (2005) at the 44th IPA Congress, “Attachment, Trauma and Psychoanalysis: Where Psychoanalysis Meets Neuroscience” and the paper by Gabbard (2005) “Mind, Brain, and Personality Disorders.”
In recent years there has been a growing interest in the idea of integrating and complementing the theories on the etiology of personality disorders by using findings from investigations of the nature-nurture interaction. Gabbard (1994, 2005) argues that the psychoanalytically oriented psychiatrist who is interested in the treatment of these disorders should begin to think as much in terms of psychodynamic forces, conflict, and defense mechanisms as in terms of genetic polymorphism, neuro-circuits, genome-environment interaction, pharmaco-dynamics, etc. Studies of ethology, epidemiology, and populations at risk for personality disorders arising from early adverse traumatic experiences have led us to posit the following from the point of view of the brain-mind relationship in borderline personality disorder (BPD) and antisocial personality disorder (ASPD) disorders (Caspi et al., 2002; Schore, 1994):
The development of the brain/mind requires input from the environment. Although the brain is not a clean slate even at birth, since intrauterine environment facilitates brain/mind development, it appears that after birth affective relationships exert a powerful influence on neuronal growth and synaptic connection, which underlie the shaping of neuro-anatomical structures, which then mediate the affective regulation process including internalization and memory of positive interactions with the primary object (Bateman & Fonagy, 2003; Gabbard, 1994; Schore, 1994). According to Bowlby (1969, 1988), the brain/mind stores patterns of emotional interaction with objects that co