“Over-Pleasing Others”: An Introduction to Supermentalization Highlighted

Why do some people believe that it is their responsibility to make everyone around them happy? Why do these individuals do almost anything in their power to avoid disappointing others to the point that they are unable to say “no” to others’ requests of them, no matter how inappropriate the requests might be? Why do they prioritize the needs of others over their own and rely almost exclusively on others for their personal validation? What biological and psychosocial factors lead a person to over-please others, what are the psychiatric consequences of over-pleasing, and what can psychiatrists do help people who are stuck in this way?

Stuart C. Yudofsky, M.D., Distinguished Service Professor and Chairman of the Menninger Department of Psychiatry of Baylor College of Medicine, posed and answered these questions today at APA’s 2015 annual meeting in Toronto. Using a case study of a young woman with anorexia nervosa, he introduced a new theoretical concept that he has termed supermentalization.

“Mentalization refers to a person’s ability to be simultaneously aware of the current mental state of oneself as well as of others during interactions and relationships,” Yudofsky explained. “‘Keeping mind in mind’ is how Menninger Clinic Psychologist John Allen summarizes this ability.”

He then described known forms of disordered mentalization. The first, hypomentalization is when people have profound difficulties attending to what is going on in the minds of others with whom they interact. “These individuals often are not facile in interpreting social cues such as facial expressions, eye gaze, or body language. As a result, they tend to think and respond to others in concrete ways and have difficulties in seeing things from another person’s perspective. They are focused primarily on their own immediate thoughts, wants, and needs to the exclusion of others. People with autism spectrum disorder exhibit hypomentalization.”

A second form of impaired mentalization, called hypermentalization, occurs when a person is oversensitive to and overvigilant of what is going on in the minds of others: “Hypermentalization is the result of distortions and misinterpretations of the mental states of others, which leads to that individual feeling insecure or unsafe. People with borderline personality disorder and paranoid psychoses exhibit this condition.”

Yudofsky coined the term supermentalization to help explain what causes over-pleasing and certain related psychiatric conditions and traits. He stated, “At rare and exceptional levels, supermentalizers not only keep the minds of themselves and others in mind but also the feelings of themselves and others in mind as they interact with people. These individuals tend to be highly cognizant of the behavioral and emotional patterns of others and notice when these patterns change. They also tend to be intuitive, caring, and thoughtful. They make outstanding leaders, educators, theologians, writers, poets, and psychiatrists. Problems occur when supermentalizers abrogate their personal agency and autonomy based on what they accurately perceive as the wishes and needs of others. Consequently, supermentalizers are prone to become stuck in over-pleasing.”

Yudofsky is the author of Fatal Pauses: Getting Unstuck through the Power of No and the Power of Go from American Psychiatric Publishing. In the book, he describes how people become stuck in a variety of ways—including in jobs they detest, in destructive relationships, with alcohol and drugs abuse, with overeating, in devoting too much time to surfing the Internet or playing videogames, with over-pleasing, and even with success—and about how to go about getting unstuck. APA members may purchase the book at a discount here.