My favorite way to teach medical students involves using analogies from “the real world” to explain mental health topics.  One of these involves the application of a principle from game theory called “ordered-level thinking” and its psychological term, mentalization.  This essentially means “being in someone else’s head.”  How a poker bluff is interpreted is an example of ordered-level thinking.  This can also be illustrated through a baseball example.

A baseball pitcher has two basic options: throw a strike or a ball.  A batter has two options: swing at the pitch or hold back.  If the pitcher throws a strike and the batter swings, the batter connects and wins the duel.  If the pitcher throws a ball and the batter swings, “strike” is called and the pitcher has won.  There is an inherent mind game unfolding as to how each player will choose to proceed.  An understanding of patterns of the mind can help a sophisticated player have the upper hand.  Even if they don’t know it, the players are demonstrating mentalization.

Some psychological conditions involve a limited ability to understand what someone else may be thinking at any given time.  Often, the person has internal thoughts that are ‘projected.’  These can be thoughts of anger, love, or self-loathing.  It is very difficult to communicate and have healthy relationships with others if you are always unclear about the reality of another’s mind.  It also becomes draining on the family.  Can you imagine how it would feel to have your child or spouse sporadically saying to you “You don’t really care about me?”  The roots of this pathology are often from childhood attachment problems.  Abuse or neglect can cause these breakdowns to occur.

Fortunately, psychotherapy techniques have been developed to improve deficits in mentalization.  One method is called Mentalization Based Therapy, developed by the psychologist Peter Fonagy.  This involves the therapist helping the patient enhance his or her ability to determine what is the reality of other’s thoughts.  The patient becomes more accurate at understanding others and this allows interpersonal closeness to develop in a genuine way.  This therapy takes time, but can provide long-term improvement in relationships.

The next time you are watching a baseball game or professional poker broadcast on TV, try and think a little about what someone else might be thinking!