ABSTRACT
Metacognitive function refers to how individuals make sense of their own and others' behaviour in terms of mental states and their utilization of this capacity to solve problems and to cope with speci®c mental states that are a source of distress (Semerari et al., 2003). Related to this, mentalization which has been de®ned as the `process by which an individual implicitly or explicitly interprets his own actions and those of others as meaningful on the basis of intentional mental states (e.g. desires, needs, feelings, beliefs and reasons)' (Bateman and Fonagy, 2004: 302). Problems in metacognition have been implicated in schizophrenia (Frith, 1992), borderline personality disorder (BPD; Fonagy and Bateman, 2006) and personality disorders in general (see Colle et al., this volume, Chapter 11), complex trauma and post traumatic stress disorder (PTSD; Liotti and Prunetti, this volume, Chapter 12). This chapter explores the developmental roots of compromised metacognition and mentalization in severe adult mental disorders. It focuses on how metacognitive processes have been differentially conceptualized in different adult psychological disturbances and explores how an attachmentbased approach to understanding the development of metacognition can help us understand these processes from a normative perspective. This approach is in line with Sroufe (1997: 252) who argued that `behavioural and emotional disturbance is viewed as a developmental construction, re¯ecting a succession of adaptations that evolve over time in accord with the same principles that govern normal development'. I propose that these normative developmental pathways, which are important to metacognition, are compromised amongst people who are later diagnosed with complex mental health problems, particularly trauma-related disorders, personality disorders and psychotic disorders including schizophrenia. These groups of disorders in many ways typify the tension between a predominant medical model which emphasizes the interplay between neurobiology and environment (as in schizophrenia) versus a developmental model which places emphasis on the interplay between the environment and the individual's history of successive adaptations in the context of risk and protective factors and the individual's progressively active role in these adaptations over time.
The chapter will conclude by considering the implications of this analysis for the further development of research and theory of metacognition in complex adult psychological problems. I propose that personality disorders and psychotic disorders including schizophrenia can be conceived as disorders of affect regulation underpinned by weakened or compromised metacognition and mentalization. A crucial implication of this model is that change is possible at many points despite earlier unsuccessful attempts at adaptation and the return to positive functioning also remains possible. This has important implications for the development of psychological therapies focused upon recovery from complex mental health problems.
