Over a period of thirty five years of scientific research on psychic illness, in the CIRSOPE Centro Italiano di Ricerca Scientifica Operativa nella Psicanalisi e nell'Educazione, one of our main objectives has been to perfect a method of intervention which could be used relatively easily, but by especially trained personnel It must be reiterated that the cause of psychic illness in itself - anaesthesia of feeling activated to avoid suffering - is rather commonplace, even though it has such devastating consequences.
The same can be said of the cause of most illnesses - bacterial or viral infections - and also of natural catastrophes: what is simpler than the cause of a landslide, or a flood, or the eruption of a volcano? In the first case, on a slope, the supports no longer hold, and unstable material collapses towards the bottom. In the second, rainfall is so heavy that it is no longer contained in watercourses, and water invades the surrounding land. In the third, the internal pressure of the earth reaches a level beyond which subterranean materials can only be pushed outwards. Put this way, according to the laws of physics, the causes of these natural phenomena which continue to take lives all over the world, seem fairly controllable, although often only with difficulty. So why should we overestimate the cause of mental illness? We are still afraid of it (just as once upon a time natural catastrophes made us afraid, when we didn't understand their cause) because, thanks to the high levels of camouflage, it is hardly visible, hardly perceptible, and thus hardly known at all.
The first step therefore is that of informing, to make sufferers aware of the risk that they run, and the opportunities there are for cure and recovery, of how many people there are around them, including parents, paediatricians, childminders, kindergarten teachers, trainers, and school teachers, and of practical ways of recognizing disturbance and taking the first steps.
The main symptom of the illness is its main cause, that is to say anaesthesia of feeling. Thus what requires verification is the ability of the person to relate empathetically with others. The absence of use of emotional sensitivity leads the child not to invest emotionally in relations with people and with his surroundings, and, as well as not being very sociable, he may also suffer from difficulty in learning some forms of communication. Language itself is either absent, or stereotyped, or substituted by basic mimicry, reduced to the barest minimum to convey his own elementary needs.
The unmistakable sign of onset of disturbance is seen in an attitude of rejection towards the same-sex parent. Why is the decisive revealing indicator found in rejection of the same-sex parent? Because every human being develops his own identity, his self-awareness, within his relationship of love with the same-sex parent.
And so, if the patient intends to maintain his anaesthesia of feeling, he must keep his same-sex parent at bay, at a distance. He will be aggressive, and provoke him using usually extreme, and unnecessary forms of rejection. The other must understand that the child needs him, and not go away, or abandon him and leave him alone, but help him to find his own equilibrium between reason (the economic component, now predominating) and feeling (the symbiotic component, which he is keeping under control, with notable damage to his psychic health).
Far from being a source of illness, the symbiotic mode of relation is the most balanced relationship in human nature, as we see in the symbiosis between mother and child during pregnancy. Within it there is no dominant or dependent part (as happens of necessity in economic relations); indeed each one participates in the life of the other to the fullness of their freedom and responsibility.
This is made possible because it is a relationship of love: between mother and fetus during pregnancy, and after birth between the child and its same-sex parent, through which the child is constantly recognized as himself, within a love which is so complete and total that it has no equal and which we call primary love.
As said above, it is obvious that those at risk are those who have suffered early interference in primary love, caused for example by: - loss of a parent especially the same-sex one - events after birth (like being in an incubator) and in the first three years - separation from parents, even if only partial (for periods in hospital nursery, nursery school, parents' illness, time with strangers while parents work) in the first three years of life - artificial feeding, or weaning too early and in a traumatic fashion.
The first precaution to take is to encourage, protect and if necessary restore as soon as possible the relationship with the same-sex parent, right from birth. The kind of birth known as "non violent", or "Tibetan" or "Leboyer" answers these requirements. Also in the nursery school any childminder can ask the mother of the girl or the father of the boy to stay behind for a quarter of an hour holding the child to talk about how things have gone. The paediatrician can also encourage the couple to keep breastfeeding as long as possible (reassuring the mother about unjustified fears as to damage to health) and to let the little one sleep near the same-sex parent. If admittance to hospital is necessary, the same-sex parent should be there as much as possible; in the case of a boy, the mother's presence will be enough at meals but the father should be there for twenty-four hours. With these simple precautions it is already possible to eliminate most interference in the primary relationship.
Every situation is characterized by unique manifestations, so that it is not possible in the abstract to outline one procedure for everyone. But there are some fundamental choices necessary for treatment to be successful. Parents are always at the centre of treatment Their session is central to the cure. In it the coded messages from the patient are studied and interpreted, and the direction of treatment is determined. The first requirement of the parents is to learn the basic knowledge required for the cure to be successful. This forms an important initial advantage, which is maintained for the whole duration of treatment, in that they spend most of the time with the child and know all the details of its behaviour.
The diary that we ask them to keep represents for us the main source of information on which to base decisions from time to time. The information contained in the notes of the parents must be understood and interpreted and evaluated together with the parents themselves who at that point take on a role and an importance which are equal to, if not more important than, the psychoanalyst's.
Usually the psychoanalyst says what to do, but how to do it and when to do it must be decided by the homologous parent, the only one who can understand or rather feel if the moment is right and the means effective.
Sometimes the homologous parent is uncertain, doubtful, awkward, unsure, and there's a temptation to help, or even to apply pressure. Nothing could be more dangerous. It is always a mistake for the psychoanalyst to do this, an inappropriate move, dictated or rather determined by inductions that arrive, through the other-sex parent, from the impatient patient.
The psychoanalyst should always remember that, whatever the cost, as far as the ill child is concerned it is the homologous parent who is able to decide how and when to move.
So, as a precondition for starting treatment, we ask two things of the parents:
When the child is very small fortnightly sessions for the couple are enough for total recovery, and recovery is total. But when the subject is older, in addition to sessions with the couple which as said above are the fulcrum of treatment, there are also sessions - every two weeks or sometimes every week - for the child with the same-sex parent, usually carried out by a couple of specialists, only one of whom intervenes, while the other is silent, observing and noting down everything which happens.
They are very specific sessions which require long and detailed preparation.
They are preceded by analysis of the case, a moment of comparison when, periodically, the parents are present as well, and when all the available material is looked at. Reports of previous sessions, opinions of analysts, information provided by parents, material from the patient and, if the parents who keep them are present, the video recordings of the sessions with the homologous parent are reviewed and discussed, pursuing further the points which seem to offer potential as to the direction which the recovery treatment should take.
Then the session objective is established, in view of which a series of written considerations will be made, and which the specialist who intervenes during the session itself will interpret, as usual addressing the parent and never the patient.
The content of the various considerations and its presentation are aimed at encouraging the action which the parent is taking in restoring the relationship of love with the child.
The reasons for interpreting written considerations, and not proceeding spontaneously, is the extreme difficulty of removing oneself from the psychotic inductions of the patient; even with these precautions some undesired effects can be predicted, such as omission of interpretation of a passage, or an interpretation which alters the meaning. But all this, given the presence of a second analyst who contributes to maintaining a certain lucidity in the procedure, can be used on a subsequent occasion.
The sessions of the patient with the parent are therefore structured in such a way as to place the parent themselves at the centre of the session, without giving any room to manoeuvre to the patient. Within these hyperprotected sessions, such as is always created in a session of analysis, and to which are added here some fundamental characteristics of the original primary relationship, given the physical presence of the parent, the patient is offered the possibility of opening up, very gradually, to the use of his own emotional sensitivity, without any particular risk of coming up against fear of suffering, and the feeling inevitably associated with it.
Nonetheless, it is not expected that they be easy sessions, and it often happens that - at least the first times and always in parallel with developmental crises - the patient will manifest all his rejection / requests towards the parent, with shouting, simulated escape, insults, crying, and hiding. But these things are negligible in comparison to the enormous advantages which follow these little scenes and, we add for those who work in the field, in comparison with what they would normally do if the presence of the parent were not stipulated as a condition.
It is this use of the session by the patient which confirms how it is a precious moment of growth (also video-recorded by the other-sex parent for use as a term of comparison in a subsequent phase) which is followed in the family by the child's greater willingness to be cured.