"Mama was my greatest teacher, a teacher of compassion, love and fearlessness. If love is sweet as a flower, then my mother is that sweet flower of love." —Stevie Wonder
What Is Mentalizing and How Does It Relate to Parental Reflective Function?
Mentalization, popularized by Peter Fonagy and colleagues, helps us understand how infants develop the capacity to “mind-read," accurately sensing others’ intentions and inner states. Mentalization draws upon attachment theory and psychoanalysis. It is key to understanding and treating disorganized attachment style, borderline personality disorder, complex PTSD (posttraumatic stress disorder), and related. Without mentalizing, “primitive” defenses like splitting, projection, and denial dominate.
Parents who can’t mentalize well often had developmental trauma with subsequent impairments in mentalization. “Parental Reflective Function” (PRF) — the capacity to mentalize and reflect in relation to one’s own children — is also affected. Impaired PRF, spurred by parental childhood mistreatment, leads to repetition of trauma from parent to child, a cycle called “intergenerational” or “transgenerational transmission of trauma." It is hard to self-correct traumatized parenting, as the aftereffects of trauma interfere with working out how to mitigate the trauma.
The Neuroscience of Parental Reflective Function
In their paper "Parental Reflective Functioning Correlates to Brain Activation in Response to Video-stimuli of Mother-Child Dyads: Links to Maternal Trauma History and PTSD," Moser and colleagues review the prior literature.
They report that areas of the prefrontal cortex (PFC) — such as the ventromedial and dorsomedial PFC (vmPFC and dmPFC) — have a top-down effect on deeper emotional (“limbic”) systems. Interpersonal trauma changes the way higher areas appraise emotions and social information so they don't regulate the deeper areas correctly. Top-down and bottom-up effects (in which the deeper brain areas cause negative changes in higher brain functions) impair day-to-day relations, disrupting attachment.
Distortions in fear-conditioning also impede PRF. An abuse-survivor parent may misinterpret their child's behavior, responding to anxiety as aggression and threat, with reactive aggression and avoidance — rather than approaching with compassionate parenting. A neglected parent may overcompensate, “spoiling” their child, setting loose boundaries, providing inconsistent discipline, even triggered to unintended physical aggression to repeat abuse.
The First Study of PRF and Brain Activity in Abused and Non-Abused Mothers
Moser and colleagues looked at parental reflective function and mistreatment history, correlating those findings with brain activity under experimental conditions showing parent-child dyads during play and separation.
Forty-eight mothers participated: 26 had experienced childhood physical abuse, and 22 had not. Of the 26 with a history of abuse, 17 had PTSD. Of the 22 without childhood abuse history, 9 had PTSD from adult interpersonal violence. This allowed researchers to compare different patterns of abuse, and to make comparisons between those with PTSD and non-traumatized peers.
Study measures included:
- Working Model of the Child Interview (WMCI). A semi-structured interview, WMCI analyzes maternal narratives to estimate Parental Reflective Function.
- Maternal Life-Events and IPV-PTSD (Interpersonal Violence-Posttraumatic Stress Disorder). Participants completed the Brief Physical and Sexual Abuse Questionnaire (a narrative analysis) and Trauma Life Events Questionnaire.
- fMRI (functional magnetic resonance imaging). Mothers viewed videos of mother-child interactions in the brain scanner. Clips showed situations in which mother and child played freely together and when they were separated. Mothers viewed the happiest, least stressful play clips and the most stressful separation clips to get the strongest signals. They viewed multiple clips showing both play and separation with their own child, and clips of unfamiliar mother-child pairs.
Research Findings for Parental Reflective Function
Mothers with a history of childhood physical abuse had lower PRF than mothers without abuse; 93 percent of the abusers had been primary caregivers, usually mothers (73 percent).
DorsolateralPFC activity reflected PRF differences in play versus separation conditions, along with the insula, operculum, and right superior temporal gyrus. Only the right middle temporal gyrus correlated with differences in PRF between play and separation for the mothers’ own children.
For childhood physically abused mothers, play versus separation, PRF differences were reflected in dmPFC, dlPFC, right operculum and insula, right temporo-parietal junction, and left superior temporal gyrus.
For PRF in non-abused mothers, play versus separation, regions involved were vmPFC and left middle temporal gyrus. For abused mothers exclusively, PRF in play versus separation correlated with right thalamus and temporo-parietal junction. PTSD severity correlated with activity in the vmPFC, exclusively for non-abused mothers.
Overall, there was no correlation between brain areas in play versus separation between abused versus non-abused groups.
This research is the first to look at brain activity and Parental Reflective Function in physically abused versus non-abused mothers, across play versus separation, in mothers with and without PTSD.
PRF was reflected in dlPFC activity, and not, as expected, in any other PFC areas. The dlPFC influences emotional judgment, less active with lower empathy. PRF is impaired in mothers with childhood physical abuse, regardless of PTSD diagnosis: Trauma affects how we relate even if it doesn’t cause PTSD.
Notable that the MTG was involved only when mothers viewed their own children, with increased activity there correlated with higher PRF. The MTG, in the temporal lobe, is involved with making meaning with words, autobiographical tasks, understanding experiences and actions and encoding relational meaning. Does MTG play a role in self-recognition? Our children are to some extent narcissistic extensions of ourselves, so it makes sense that MTG activates while mentalizing one's own child.
VmPFC, which was different for non-abused mothers only, is involved with emotion regulation, empathy, and mentalization. VmPFC may support adaptive PRF when people haven’t been traumatized. Non-abused mothers may also have impaired PRF, but the underlying brain activity is different.
It’s important to note that abused and non-abused mothers showed no overlap in patterns of brain activity related to PRF in this study. The developmentally traumatized brain is arguably a “different brain" when it comes to Paternal Reflective Function. Prior research shows that different brain regions and networks are dominant in traumatized versus non-traumized peoples’ brains, supporting the different-brain idea.
While PRF may be impaired in abused and non-abused mothers, it is impaired differently on the level of brain activity. Future research should look at how PRF impairment may differ in actual parent-child relations for abused versus non-abused mothers.
Is the Traumatic World Fundamentally Different from the World Without Trauma?
In a sense, trauma means living in a different reality because the brain processes information in fundamentally different ways. Trauma in childhood relationships with caregivers changes brain development, and ultimately both mentalization in general and Parental Reflective Function in particular. Changes in brain function affect perception, behavior and outcomes — and negative relationship outcomes in turn reinforce patterns of traumatized brain activity. Where does resilience come in? Can building resilience — healing — change the nature of reality by changing the brain by changing relationships, in a virtuous cycle?
This is one of the ways therapy can be so beneficial: Therapists are trained to respond in more adaptive ways, exerting, for example, healthy attachment forces, which in principle help re-wire the traumatized brain, and also help the person to “patch” more adaptive behaviors on top of reflexively traumatic responses by learning to notice when things are going awry, pausing, and doing something different even if the deeper feeling are the same.
While we may wish so, even if we can’t change our inner reactions, it’s OK; the effort to make better choices, and being successful at doing so, still serves to reduce intergenerational transmission of trauma. Slowing down and noticing deficits in PRF, and practicing more adaptive choices, may additionally prevent passing on abuse patterns from parent to child. Future research will continue to refine our understanding of what’s happening and define better interventions.
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