Epilogue

When Read Together. These Papers Spark Questions about the mental equipment with which humans make sense of their internal and external worlds, and about how these meaning-making mechanisms develop and operate. As Basch 1988 and Gedo 1988 discerned, the payoff in psychoanalysis theoretically and clinically is not in studying mental contents, but in understanding mental processes, looking for the glitches in an individual's brain-based information processing systems.

Peter Fonagy has contributed a valuable concept that can be used to operationalize key questions. Instead of looking directly at a child's observable interpersonal environment, Fonagy looks at the brain-based equipment that the child uses to make sense of his world. The use of carefully designed measures of Fonagy's Interpersonal Interpretive Mechanism (IIM) may help us examine how individuals perceive and evaluate interpersonal transactions, what factors influence the development of these capacities, and how these processes can change throughout development, including in interaction with a therapist.

These are questions that researchers can address in carefully designed longitudinal studies, such as are under way in Massachusetts and Minnesota. Such studies rely on the cross fertilization of ideas from clinical, developmental, and neuroscientific work.

Findings may surprise us, particularly when sophisticated variables are used. For example, at the fall 2001 meeting of the American Psychoanalytic Association, Karlen Lyons-Ruth reported that dissociative symptoms in adolescents were predicted not from trauma perse, but from more subtle maternal behaviors recorded 19 years earlier. Adolescent dissociation was linked to mother-infant interactions, failures in self- and interactive regulation, such as role reversals and inappropriate and contradictory maternal responses to infant communication. Discussing Lyons-Ruth's findings at the meeting, Fonagy proposed that the link between early maternal behavior and ad