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In these weeks in which the theme of war has returned dramatically topical even in the most civilized Europe, reading the articles and letters on the Blog and trying to look around me there was an aspect of the various discussions on geo-geographyIt is a policy that has made me think and from which I have taken inspiration for the subject to be dealt with today, that of borders.

If a certain geography is so to speak “given” by nature, the shape of the planet, the conformation of the continents etc., it was the history of the human being and his political choices that have drawn the globe for how we know it today, that is, place (and imposed!) borders far from natural, territories and conquests obtained mostly as a result of wars and oppression.

The limits and the lines therefore are just made to divide and separate, one thing from another if it is space, the first from the next if it is time, conventions maybe very useful as the Greenwich meridian or the Equator, or simply curious as the “line” by Karman: ideally located 100 km above sea level, “marks” in fact the border between the Earth’s atmosphere and the space for which those who fly over that altitude is no longer an aviator but. an astronaut.

But are we sure that’s how it works with humans?

The division between mental health services of the developmental age dedicated to adolescents, adopts by convention the age group from 12 to 18 years, in which the take-over affects Child Neuropsychiatry, while at the age of “majority” The children pass in charge to the Psychiatric Services for adults (CSM)* and is not at all a “discounted” passage, indeed anything, can be delicate and not devoid of consequences, especially when it is not done with the necessary sensitivity and attention.

Obviously I am not referring to the simple change of location, but to the separation from the clinician with whom until that moment the boys have been related, working together on crises or moments of anger and hatred, new and beautiful relationships or dramatic breaks, events, however, capable of characterizing or compromising mental development in that age group so difficult and fundamental.

Someone will know, someone else remembers, how long and complicated those years can be, how many upheavals human beings go through in such a limited period of life, and how certain experiences can leave very deep marks. 

So, after the famous 18?

As a rule, children are “prepared” in time for such separation but, as is easy to understand, it is not only a material fact or relationship with the calendar, but rather the experiences of disappointment (if not abandonment) that can creep in and cause disasters, and that maybe they are the same who brought them to the attention of the clinician, especially in the light of what happens “after”..

They are in fact waiting for a specialized environment for adults who, beyond the preparation of everyone, know little or nothing about them, if not clinical history diagnosis and therapy, and where taking charge can consist in repeating interviews tests and evaluations, as well as in telling your life story again.

What, we start over?

Obviously not, it is well hoped that all relationships are somewhat different, but in the specific case if such an important separation is experienced as a constraint, the new personal possibilities/ responsibilities, such as the school that “becomes” university, or work, risk to appear as insurmountable obstacles, difficult and exciting stages when a boy is well (and there is if his relationships were valid) may turn out to be insurmountable limits in the cases to which I refer, because what is proposed is not that a “continuum” or worse, a repetition.

There are no simple and immediate solutions, of course, but the great attention and interventions put in place on the subject do not seem to be reflected in a real improvement in clinical practice with boys, perhaps because there is a lot of talk about prevention (and in fact the average age of the first diagnosis has been reduced) but we continue to see and treat them in the same way.

In short, more than trying to disrupt the services would be already so much to find a common vision on this, so that you do not give the impression of staying to transfer a file, since they are certainly not the room or the department that make the care (the institution is not that the context where you try to make it) but the relationship with the therapist who works in that context.

Otherwise we might as well tell them that to cure is the coat and not the doctor, the role and not the person, the container (which in fact offers to assist and.. contain) and not its contents. 

If these are the misguided beliefs that we try to face first, however, certain “wild-passages” that I happen to see do nothing but confirm them, with the more than concrete risk that the institution, in addition to delimiting it, becomes a limit for therapy, and that it puts/ opposes the request for change with the rigidity of the norm, that is, trying to normalize and stabilize, which in the psychological field, however, can mean chronic.

In short, you can not be “promoted by seniority” if not in the perspective of a psychiatric “career”, which is precisely what the paradigm of prevention should try to avert.

If the purpose of any cure is the end of the cure itself, match (and equate) the age change with that of the clinician makes sense in neonatology or pediatrics or, logically, in geriatrics, while interrupting a relationship maybe very deep with a psychotherapist for “reached age limits” is completely different from ending it because you are finally fine.

Speaking of flesh and bones it would be a bit like changing the dentist we like (well, let’s say) just because there are sprouted wisdom teeth, while such a delicate step should correspond to a much deeper personal movement, matured within that relationship so important and not because you have suddenly become.. ripe!

You know, getting old is easy, it’s growing up that’s complicated.

If the great work of adolescents is in fact separating themselves from the family, moving from “vertical and hierarchical” relationships to “peer-to-peer” relationships up to the most complicated challenge, the one with the other/a other than oneself, is the need not to miss anything of everything that has been the life of thoughts images and affections that can make a difference, because to become “great” so, with the axe, you risk cutting off the root of the tree so that sooner or later the one dries..

Which is also the meaning of every true separation.

Doing what we never thought we could do on our own.

Marco Randisi

* The specialization and services of Neuropsychiatry “resist” only in the context of the developmental age. In fact, Neurology and Psychiatry were divided in 1976. This often leads to hospitalization in the same ward both boys with psychological-relational problems such as anxiety, depression, panic attacks, self-harm, and others suffering from neurodevelopmental disorders (often associated with intellectual disability) or also severe epilepsy pictures that instead have proven organic matrix. It is my personal opinion that this ambiguity only frightens and confuses children and families.


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Credits by: Ben Mack