Theory of Mind and the Psychoanalytic Model

When we first began teaching our course on the psychoanalytic model of the mind to Cornell residents in the 1980s, some of the brightest PGY-2 residents used to confront my co-teacher and me with the question, “Why do we need a model of the mind? Can’t we help our patients without it?” At the time, we responded to these students with arguments about good clinical practice, reminders about the biopsychosocial model, and other lofty arguments about the philosophy of mind. But things have changed. Ever since the field of psychiatry has become familiar with a fascinating idea called “theory of mind” (ToM), emerging from cognitive neuroscience in the late 1970s, the argument is quite different. As it turns out, having a theory of mind is not an option. The question becomes moot as to whether mental health professionals need a model of mind. We have one, whether we like it or not.

The concept of theory of mind suggests that we are all hardwired with the potential to develop a theory about how minds work—our own mind as well as those of other people. In their groundbreaking 1978 paper “Does the Chimpanzee Have a Theory of Mind?,” cognitive scientists Premack and Woodruff used the phrase “theory of mind” for the first time to describe what cognitive psychologists had been discussing for a number of years, to designate specific capacity to (1) understand that other people have beliefs, desires, and intentions; (2) know that these beliefs, desires, and intentions might be different from one’s own; and (3) form operational hypotheses, theories, or mental models about what these beliefs, desires, and intentions might be. Theory of mind (ToM, as it is often called) is something with which each of us is endowed as part of the equipment we use to get by in a world where complex interactions with others are part of everyday life. As an evolutionary biologist might put it, ToM is essential to survival in our evolutionary niche.

ToM begins as an innate potential in infancy and develops in a facilitating matrix of normal maturation, social interactions, and other experiences. Under normal circumstances, ToM can be shown to be present in children by about age 4. In adults, ToM exists on a continuum ranging from the elaborate, complex, and reasonably accurate to the rudimentary, barely functional, or virtually nonexistent. The ability of each of us to accurately represent what others are feeling or trying to do predicts how well we will perform in a variety of interpersonal tasks. At one end of the spectrum, individuals with autism, who often have specific defects in the ToM module, have a very hard time functioning in the social world. At the other end of the spectrum, people with highly developed capacities for ToM can negotiate a range of social and interpersonal transactions ranging from parenting, friendship, and romantic intimacy to business, teaching, politics, and, of course, practicing psychiatry!

Cognitive psychologists have developed a wonderful array of ingenious experiments testing whether adults, children, and nonhuman primates have a functioning theory of mind. It is very difficult to discern whether nonverbal children and animals can imagine the minds of other creatures, and scientists argue like crazy among themselves about this question. Experiments in support of each side of these arguments make for interesting reading. Recently, some scientists, using the techniques of functional neuroimaging (fMRI), can illuminate brain regions that may play a role in the brain systems responsible for ToM. Even more recently, other neuroscientists have demonstrated the existence of mirror neurons, widely distributed throughout the primate brain, that fire when we perform an action and when we see someone else perform the same action. Scientists believe they may be a crucial part of the neural substrate for our capacity to understand what others are thinking, feeling, and planning to do.

ToM reminds us that, like it or not, most human beings are born with the ability to know and make sense of what goes on in the minds of other people. Therefore, when our students ask why we need a model of the mind, we respond with the statement: “You already have a theory of mind. Therefore, it might as well be a good one!” In our view, the psychoanalytic model of the mind is not altogether different from what ordinary people do every day. We all use our innate capacity for understanding minds to explain ourselves to ourselves and to understand the behavior of others. In other words, when things go as planned, we are all psychologists. ■