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In these days the usual diatribe about the Basaglia law has returned to light, taking inspiration from the incident of the psychiatrist Barbara Capovani killed by her former patient, incident of which Gioia Piazzi also speaks in her latest article. I do not intend to enter this discussion between those who are in favour and those who are against the Basaglia law, it is a fact that I am convinced that freedom in itself doesn’t cure anything at all. It always remains rather difficult to think that if a person believes that their neighbour is the devil, they can change their mind after a nice walk in the fresh air. I also believe that violence lies in mental illness but this violence is usually contained in a psychic setting and rarely gives rise to violent behaviour. 

But, beyond the clash between these two schools of thought, the element that everyone agrees on is that there’s the need of more practitioners in public mental health services, be they psychiatrists, psychologists or nurses. 

But I want to be politically incorrect and ask another question: what is meant by treatment in psychiatry? If a child is admitted for a psychotic attack, in addition to numbing them with drugs, is there anyone who is able to explain to them, to interpret the reason why they made this crisis? Not someone asking the kid why they went into crisis – because the kid doesn’t know – but a therapist who can tell them why they made the crisis, because this maybe could calm the kid much more than one hundred thousand drugs that anyway in certain situations are absolutely necessary, for goodness sake, but they cannot be the only mode of intervention.

In psychotherapy now we tend only to a containment, we talk about “management” of anger, “management” of anxiety and so on. But what is there to manage? Anxiety and anger do have a cause, where do they come from? Should we consider them natural elements of the individual or genetically determined? The research on etiopathogenesis seems now gone, reduced to the search of the usual unavailable gene responsible for this or that disorder. Gene that would be activated by a generic, unidentified environmental element. 

I remember that a few years ago a psychiatrist I worked with in the care of a young patient, absolutely wanted to admit the girl of 18 years in a Psychiatric Service Diagnosis and Treatment because she had cut herself. He felt that because she had cut herself after she was dumped by her boyfriend, it meant that she was depressed and that she had tried to kill herself. Unfortunately, this is the level! And on the other hand I understand the poor psychiatrist who is distressed because he has no tool to understand the internal dynamics of the girl, he has his good DSM5 in his hand and he acts according to it. He doesn’t know at all that the girl could have made a crisis of anaffectivity for the abandonment suffered, abandonment to which she had responded with an annulment and cut herself could be a way to try to find a feeling at least physical. But killing herself wasn’t even going through the antechamber of her brain. Talking to the psychiatrist about these things was like talking to him in Chinese. 

I heard young colleagues who have attended graduate schools in psychotherapy who told me that it is the same professors saying to forget to think that they will cure patients. Some of the teachers went further and said that if anything it is the opposite, that therapists will treat themselves through patients!

I personally attended the defence of a dissertation where a brilliant graduate dared to talk about cure for healing and the tutor had a violent reaction and then went into dissociation and talked for fifteen minutes saying things without any sense!

In movies and TV shows, we are constantly shown the psychologist on duty who is, at best, a friend of the patient, makes them vent, is understanding. But what does all this have to do with the cure? 

They say that a greater presence of psychologists in schools is needed to do prevention: even here, doing the politically incorrect, but do you know that if there is a psychologist in a school with a certain training will say things completely different from another who has a different education? There is no common idea about the physiology of the human being as far as the mental aspect is concerned. 

For me it is indisputable that if you want to deal with the cure of mental illness you must deal with the invisible reality, which we can call irrational, unconscious or even better, non-conscious thought. 

But since we speak precisely of something not visible, not measurable, not quantifiable, we remain within the context of the unprovable.

How do we get out of this?

I may disappoint someone but I believe that at the moment the answer lies in the patient, who must take responsibility for their own care. Of course, in the public sphere the choice is not always easy but it is still possible.

And so let everyone choose the cure that they prefer: the ones who want the pill that solves the problems, the ones who want to vent, the ones who find the infallible technique and the ones who want to question themselves and seek a deep transformation.

I am sure that the choice is always there and I think that everyone has the therapist they deserve!

Marco Michelini

Thanks to Chiara Fanasca for the translation of this article


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