Ataralel Pala in Clinical Practice Yon @. Allen Peter Fonagy Anthony W. BatemanChapter 4 Neurobiology f mentalizing required understanding the neurocognitive basis of this activity, none of us would have learned to do it. Yet we clinicians have ample reason to become familiar with the general direction of neurobi- ological research on mentalizing. First, neuroscience is putting some steel reinforcement in the scientific foundation of the developmental re- search we reviewed in the last chapter. Second, we have delineated both heterogeneity and unity in the concept of mentalizing, and neurobio- logical research is putting our conceptualization to the test; the brain, through its responses to our neuroimaging probes, can inform our ways of mentalizing it. Third, appreciating how neurobiological deficits con- tribute to impaired mentalizing can point our attention to strategies for clinical intervention. Finally, the neurocognitive perspective under- scores the potential therapeutic value of psychopharmacological treat- ment in tandem with psychosocial interventions. ‘Taking Bowlby’s (1982) lead, we begin this chapter by considering the pivotal role of mentalizing in the evolution of attachment. Then, relying largely on recent neuroimaging research, we devote the bulk of the chap- 13" WIN a, tertodelineting brain regions that contribute to various componengy sentalizing Moreconcemed with mind than brain, we organize this. view around eritional, cognitive, and interpersonal processes to ig fore our understanding of mentalizing, A word of caution to the ung, tiated: with the advent of neuroimaging, the research literature petngy to menilizing is mushrooming; the complexity of the finding ‘once the chapter with a consideration of two neurodevelopmen, ‘mentalzing disorders with genetic bases: autism and psychopathy. ng disorder exemplify mentalzing failures associated with impaired ie toning in bain regions that contribute to mentalizing, Evolution ‘Aswe have already noted, Premack and Woodruff (1978) intreducg “theory of mind” into the literature in their study of chimpanzee soc inteligence. Individuals were construed as having a theory of mind ‘hey were capable of predicting behavior on the basis of imputing observable mental states to conspecifics. Although Premack and Woot. ruff presented evidence that a chimpanzee imputed unobservable in tentions to an actor who was engaging in solving, various problens, subsequent researchers have varied in their inclination to attribue mentalizing to nonhuman primates; hence among researchers then: selves, ome are more willing than others to mentalize in imputing ‘heir elationships to one another, interpret behavioral cues so stop: dict others actions; formulate social strategies and communicate toi ‘uence others’ actions; and learn from observing the behavior of tes. Yet Tomasllo and Call argued that Premack and Woodruft’s inital sults have not held up to further scrutiny, concluding that “there ism soli evidence that nonhuman primates understand the intentorlty cor mental 5” (p. 340), notwithstanding their ability» ‘Wile not disagreeing about the lack of evidence that primates an impute hidden mental states, Gémez (2004) argued for a broader and ‘more pluralistic conception of theory of mind that would encompass cert mental states, that i, mental states observable in behavior, such’ ‘expressing emotion, paying attention to something, or intending 0 something—an example being “who is trying to do what to whom and Neurobiology 1s with what final goal” (p. 236). Gémez.concluded that “Chimpanzees primates may have some rudimentary vers ‘mentalistic schemas for making sense of the social world ss perceive other primates’ behaviors as they may see each other a being connecte demonstrate incipient mentalizing and that we humans have taken a quantum leap forward in our capacity to develop a fully representa- tional theory of mind that enables us to impute covert as well as overt mental states and to reason in sophisticated ways about them, not only in regard to others but also in elation to ourselves. Accordingly, the tra- ditional view that practical problem solving—foraging and tool mak- ing—drove the evolution of the neocortex has been supplanted by the view that in evolution, an escalating demand for socal intelligence has fueled the cognitive equivalent of an arms race (Bogdan 1997; Hum- phey 1988) Alexander, for example, proposed that our superior intl gence evolved not for the sake of dealing with the hostile forces of nature but rather forthe sake of competition with each other; we became our own “principal hostile frces of nature” (Alexander 158.46). ‘Thus, while we also master folk physics and folk biology (Carey 1985), the sheer cognitive complexity of folk psychology (Godfrey Smith 2004) has provided the greatest impetus to neocortical development. Group (and inter-group) living requires highly complex socal skills not urpose of competition (eg, for resources or mates) need dedicated brain apparatus to keep track of our own and othe liances as well as the social jes within which these alliances are embedded (Byme and Whiten 1988; de Waal 1989).Such social cognition required increasingly sophisticated problem-solving skills of a unique sort. Bogdan (1997) characterized these relationships skills in terms of the capacity for interpretation—yet another term for ment defined as “a competence that allows primates to make sense spontane- ously and effectively of each other in terms of behavioral dispositions ‘and psychological attributes, such as character traits, emotions, feelings, and attitudes” (p.1),16 ‘Mentallzing In Clinleal Practcg accumulated knowledge. He identified three types of social learning imitative learning, instructed learning, and collaborative learning, al lives like their own, This understanding enables themselves "in the mental shoes” of some other person, so that they can learn not just from the other but trough the other. (pp 5-6) ‘As we described in Chapter 3 (“Development”), Gergely and Csibra lopment of the social brain” 1ry function of attachment goes far ion ofthe offspring by assuring physical prox- imity, as Bowlby (1982) originally proposed. As Fonagy (2006) notes, at- ‘ated with the exceptional dependence of the human infant on caregiv ‘emergence of intensive promotes brain developm 1955) We should not loses