We have seen how illness is manifest in patients with their own affective disturbances, that is to say with endogenous psychosis, which has its origins in events around them and their lives. Now we shall see how the symptoms of illness are manifest in a healthy subject, who takes them on by contagion with a psychotic, in other words from someone affected by endogenous psychosis.
This is exogenous psychosis since it originates in an external influence, outside the person and their story, but is manifest in the person and their behaviours by emotive induction.
The first psychoanalysts noted this phenomenon, when they themselves paid the price, and sometimes a very high price, for "enacting" (in other words letting into their every day lives) the pathological tendencies of disturbed people during the course of their work. They noticed, not always everyone and everything unfortunately, but at least mostly, that during and after sessions their vision of reality changed perceptibly and came closer to that of the patient. So we have the terms "transfert" (the transference by patients of their own conflicts onto the analyst, and a further phenomenon called "projection") and of "countertransference", as the response "enacted" by the analyst was called.
The discovery of the cause of mental illness has clarified how emotive states, which the psychotic subjects to anaesthesia, are transmitted to sane people around him by emotive induction. As we have seen above, to those who have anything to do with him he appears so uninvolved in any emotive state as to encourage in others the belief that what they are feeling are their own states of mind and not - as happens in reality - those states induced by the patient.
These elements can influence the emotive sphere of the receiver, either magnifying states of mind already present in negligible levels, or introducing completely new emotive conditions. Let us see how.
All of us, in the course of the day, are pushed by appetite to nourish ourselves: but under the effect of psychotic induction we can feel hungry, or desirous of certain foods in quantities or qualities which are totally outside our real needs. This type of experience has been known about for some time in analysts who are treating bulimic patients. In the case of anorexic patients, the opposite effects occur, and they increase worries about maintaining one's figure, and not only in female analysts.
As far as new elements are concerned, it can happen that a meeting with a psychotic leaves us with a profound lack of faith in ourselves and in our work, a sense of futility towards what we are doing, which is totally unmotivated, given the confidence we feel in our professional skills, and the motivation which has led us to practice our profession for some time.
In the research carried out at CIRSOPE, it is therefore a natural daily practice to find in operators the consistent presence of emotive induction at pathological levels, originating from cases under treatment. To save time in our work of daily supervision (carried out twice, at the beginning and at the end of work), with educators who are responsible for these patients for many hours in the day, we found it useful to compile a list of inductions which are in fact more or less always the same, given the rigidity and stereotypy which the psychosis determines.
In this way the workload is reduced since each operator rapidly identifies, in the printed sheet of inductions, those that they feel they have. The practice of noting one's own emotive states once or several times a day, which one can do after training in empathic listening for around two years, also facilitates in operators the appearance of fantasies both as images or as stories or simple sentences or verbal expressions which together with emotive elements, represent a source of invaluable information on the patient's disease, for the overall view, the great detail and wealth of particulars that it supplies. Training in empathic listening, in other words "analysis of inductions", is carried to such a depth in our school as to enable the operator to identify the real picture of the pathology present in the patient from the inductions noted.
Psychic disease, through inductions, transmits the patient's emotive and therefore disturbing elements to those around the patient. Contrary to what we might think, they are not particularly original feelings, and not even the result of particular interior conflicts: psychic disease, we should remember, is in itself a very common disturbance, in that it aggravates very normal emotional states to the point of paroxysm, whose natural negative aspects the patient is not used to dealing with, and which he is therefore inordinately afraid of.
They are therefore transmitted to others not alone but also with the component of terror for the feared suffering that the psychotic associates with them. This makes them destructive for a person who is not trained to recognize them and keep them under control. When sane people take on these elements, they consider them "normal" just like all the others that they have felt up till then. The experience leads them therefore to explain these abnormal states with a normal cause, which of course is sought everywhere, and first of all in themselves, but of course not in the psychotic.
This is the reason why such a high number of operators in psychiatric and psychological circles persuade themselves that they are the primary sufferers of affective disturbances which are sometimes very serious. But everything that arrives through psychotic induction deeply affects the person on the receiving end. Anxiety, angst, which are overwhelmingly strong, and can speed up and slow down the heartbeat, sudden amnesia, panic attacks, feelings of total failure, extreme eroticism, uncontrollable impotent rage, sudden attachment to money, to objects and to people as if they were objects too, until serious somatizations occur, such as gastric ulcer, tachycardia, increase in blood pressure and even pre-heart attack states.
And that's not all: once convinced that they are their own in origin, even desires, behaviours and beliefs which the patients censor become "enacted" by the operator in a way which is very different from that which the psychotic, with all his limits, would succeed in achieving.
For the healthy person who finds himself with these elements, it is very difficult to nourish even the slightest doubt that it is material which is not theirs: on the contrary they have the impression that it has always been there and but that they hadn't noticed it.
It is precisely this which is tragic: when people without psychoanalytic tools "enact" psychotic elements, they do it not only with extreme naturalness but also with that breadth, intensity and participation which are unknown to psychotics, blocked as they are in their stereotyped behaviours. The result is that the healthy person soon finds himself involved in behaviours which are not only unfamiliar to him, but which he also disapproves of, or is not really interested in, but which he might find interesting and exciting, as if they are difficult things which he is finally (!) allowed to do. In fact they are usually very normal things, whose originality is only superficial and which are decidedly regressive in character.
But how can all this be? Let us not forget that psychic illness is the result of exclusion of emotive sensitivity, which deeply alters perception of reality because it is partial and limited to only the economic aspect. Hence, the capacity for judgement of an inducted person, who is also not even aware of being in this state, is radically compromised by the invasion of absurd and decidedly petty desires transmitted by the patient (although they are the most he is capable of).
Precisely because psychotic inductions come from a person who cannot accumulate experience (because he doesn't invest emotionally in what he does and hence he has only few memories, which are not deeply etched, aside from data managed by reason) they also modify memory and therefore the inducted person meets serious difficulty in drawing on his own experience, to compare it with what he is doing. In "enacting" under psychotic induction he therefore makes big errors of judgement, and doesn't succeed in correctly evaluating the risks he is running, as if he were totally disarmed and inexperienced.
A typical example of a distorting effect of induction is "fanaticism". We all know how even in sports competitions where it is well known that the competitors are competing for professional reasons, fights can break out amongst the spectators which sometimes lead to death and injury.
If this takes place in contexts which in themselves are outside the real interest of the spectators, as is the case for sports spectators, it should be no surprise to see what happens when fanaticism takes on political or religious connotations, as we see every day on the radio, on TV or in the papers. Although here too motivations are completely false and ridiculous, they end up by appearing normal because of the presence in the group of psychotics who - although remaining tactfully on the edges of events - induce in others elements which can distort a balanced vision of reality. As to the effects of induction on people who take care of psychotics, this is a true professional illness.
The case of the need to be loved by the homologous parent is a classic. The professional that enact it out , feels this feeling every time that he speaks with the disturbed person (and even if he sees or thinks about the patient). It is not difficult then for the professional to think he is in love with the ill-person, and indeed these marriages often take place, under the illusion that something positive is happening for the patient, especially because they are forming a couple with someone who should know about psychosis.
The life of such a couple has no solid foundation, and lacks any affective base, but has only the ephemeral base of a sort of "fatal attraction". The professional also appears as not very competent, since through marriage he puts himself in the position of not being able to carry out his task, which was if anything to cure and not to marry the patient.
Operators who marry psychotics clearly reveal "mad behaviour". In fact the operators simply "enact" through marriage the desire of their patients to take on an appearance of normality, for their own good, and for the good of their spouse and any children - a desire which patients would never have been able to achieve alone because of their rigidity. The crazy plan however is realized thanks to the operator. In taking on this pathological desire of the patient, the operator obviously does not realize how things really are. Indeed, if anyone, even one of his parents, tries to dissuade him, he reacts as if people are trying to stop him realizing his life's dream. Shortly after he will realize he has taken on a nightmare of a life, and he will realize how difficult it is to get out of as well.
But in the meantime, his dominant fantasy is very well-defined: whoever wants to stop him seems like a kind of Don Rodrigo (from the novel "The Betrothed" by Manzoni) wanting to intervene to prevent the marriage, with the aim of winning the future wife himself, or else the future husband, in a sort of erotic mockery which, coincidentally, the object of so much desire would be very happy to participate in. Here too, the mechanism is remarkable. Only a disturbed person can imagine in such paranoid and persecutory terms that people are trying to prevent him getting married.
The very fantasy of having to win the other person, as if they were prey for whoever gets there first, is characteristic of people who have no feelings and see their relationship only in erotic terms, and therefore so ephemeral as to vanish as soon as the eye is turned.
Another very widespread effect of induction, and no less overwhelming, is to convince operators that they themselves are ill (where in reality they are affected by exogenous psychosis) and here too, they do not understand that this belief is external in origin. This always makes it very difficult to organize recovery treatment.
If the influence of the illness is so strong in operators who professionally deal with psychosis, it is logical to expect that induction has an even more devastating effect on people who are much less protected, and less prepared to deal with it, such as for example those who are still developing. We have infact noted how through a playmate or a schoolmate or even an teacher who is a carrier of "affective disturbances" (in other words affected by endogenous psychosis) children can change take on real, and serious, psychotic states.
Catching a little exogenous psychosis is certainly no less dangerous, and can in fact produce lifelong damage, exactly like infection by a physical pathogenic agent. But psychic contagion distinguishes itself from physical contagion in one important respect. While physical contagion means that the person has the cause of the illness in himself and this can be recognized in him and faced up to, in the case of psychic contagion the person is not the carrier of the cause of the disease but only of the effects. These are enough to make him ill but not enough to enable him to trace the cause, which belongs to another person and a reality external to his own. Therefore according to the diagnosis, the approach to treatment is very different for the two types of psychosis.
As might be easily guessed, when there are symptoms of problems of an endogenous nature, extraneous to the patient undergoing analysis - and this is the classical case of the operator who begins to manifest them shortly after taking on a disturbed person - it is dangerously useless to concentrate attention on those problems, even if they are sometimes so virulent as to attract all possible attention. It is necessary therefore to trace the true origin, although they are not always easily found.
Otherwise there is the very real possibility of confirming the conviction that the problems belong to him, with the risk that they become unsolvable, since the source is sought in him, when in fact it is elsewhere. The devastating effects on him then become real if he doesn't recognize them - within a reasonably short time - as the result of induction from the disturbed person. The approach to exogenous psychosis can in fact count on the fundamental mental sanity of the subject, and make use of it to direct intervention towards recognizing the source of induction, with the corresponding handing over to the patient of the psychoanalytic tools necessary to deal with it.
Exposure to the psychoses of others is a decisive moment for the expert psychoanalyst who takes from it - through induction - all the information required to carry out the treatment of the patient towards recovery; but in those who accept as their own the patient's pathological elements it can produce very serious damage, so serious that life can be profoundly and permanently changed.
The person inducted can also come up against serious damage, in the belief they have tendencies and needs which in reality don't belong to them, but that they enact as if they were their own. The problem is serious at all ages, but in particular as we saw above, in the first years of life and during development, given the total lack of any form of prevention. The most upsetting aspect of exogenous psychosis is found in the damage resulting from actions which, for the most part, in psychotics are contained at the level of censored desires and repressed aspirations, either because they require elements of affectivity which they reject, or because in their rational lucidity they understand they are dangerous, or because they are substantially prevented from enacting them by their psychic disease.
A significant example can be observed in the inductions which influence the sphere of eroticism: it can happen that a psychotic with a homosexual type of survival structure induces impotence in heterosexual erotic relationships around him; or that another, with a survival structure of impotence, induces true erotic frenzy in others. It is a complex situation: psychotics who are aware that their own existence runs on a razor's edge can use the influence they exert over others, which appears to be unscrupulous, because of anaesthesia of feeling.
Among the many cases that come to our attention every day, let us take that illustrated in Christopher Hampton's film about the English painter Dora Carrington (Carrington, 1955), "induced" consciously by the homosexual writer Lytton Strachey to "fall in love" with him at just over the age of eighteen (and enact his need to be loved) and to go and live with him. The young girl from the moment she is affected by exogenous psychosis becomes deaf to any reminders of common sense, and not only accepts that it is normal to act as bait for the men who interest her partner, but also takes on his survival structure of always looking for new lovers to replace erotic attraction as it diminishes. Although she marries another man, she will never manage to rid herself of the pathological relationship, and commits suicide at his death. I have described a survival structure that uses eroticism, but the same goes for rage, or greed, or the thirst for money or power: the whole range of behaviours connected to anaesthesia of feeling.
The appearance of normality favours induction, by the disturbed person, of pathological behaviours in those who live with them, and they take them on as their own, without realizing that they are "enacting" beyond their own real requirements, and their own experience, as if they had suddenly become resourceless and inexperienced. Phenomena which are sometimes seriously destructive for those around, such as in the case of the insanity of psychological and psychiatric operators, can be caused by psychotic induction. This is exogenous psychosis, in that its cause is found outside the person who is affected. Psychotic induction, a precious tool for understanding the mental patient if used by expert operators, becomes dangerous to the point of permanently affecting people's lives for those who take on the elements as their own.
The most serious effects of psychotic induction are found in those who are still developing, given the absolute absence of any form of prevention in this field. Treatment of exogenous psychosis can count on the mental sanity of subjects, and therefore on the possibility of handing over to them psychoanalytic tools which they themselves can use effectively.
Let us see now what tools psychoanalysis offers in dealing with the disease.
We have seen that mental illness affects the emotive capacities of people; we have also seen how, in order not to succumb, people can enact "survival structures", based on the economic mode of relating, to compensate for an absence of use of the symbiotic mode. How can the situation of natural equilibrium between economic and symbiotic mode be restored?
Psychoanalysis has always been considered "analysis of the profound": today however we can speak more appropriately of "analysis of feeling", that is to say, work which aims to restore to people their own affective abilities. Whether sessions are individual (on the couch or in front of the psychoanalyst), in couples or with the same-sex parent, they almost immediately require the adoption of rigorous precautions, which make it possible to "miniaturize" the relationship between the patient and the analyst, and hence also emotional exchange.
The absence outside the session of any external relationship between patient and analyst provides the essential condition for the gradual development of an emotive relationship without excessive risk (basically the analyst is and remains a stranger); thanks to the hyperprotected situation of the session itself, the relationship remains microscopic in nature. The work of analysis puts under the magnifying glass this emotive microcosm and the patient can experience the risks and possibilities of symbiotic-type relations without risk.
Early on though it was understood that individual treatment, in other words analysis with analyst and patient alone in the session, is productive for a limited number of patients, because of their problems and age; it is perhaps truly successful only for those who were inducted through exposure to true mental patients, through the phenomenon which as we have seen Jung called "psychic contagion". The poor results therefore led analysts to seek for more effective methods, especially for those patients considered more serious, called "psychotic", to distinguish them from those who seemed less serious, the "neurotics" .
Today we have discovered, as mentioned above, that the seriousness of the disturbance depends exclusively on real possibilities for recovery, that is to say on the physical presence of the same-sex parent, on the level of chronicity, on the social acceptability of the disturbance, on the degree of appearance of normality, on the readiness to collaborate of the environment, and of the involvement in the illness of those around under induction.
The behaviours manifested in fact derive from the "survival structures" adopted. If the seriousness of the disease is related to the resources existing around the ill person and not on those present in the patient, it can be easier to help a subject who can't work and says they "hear voices" (the so-called schizophrenic), than a good worker who is pathologically bound to a socially accepted activity (for example the accumulation of money, success, erotic conquests). We consider the disturbance in all its forms as "psychosis".
Therefore all those who have affective disturbance directly or through induction are affected by psychosis. The old distinction between psychotics and neurotics was based on greater or less evidence for disturbance, and did not always reflect the greater or lesser possibility of recovery. There is a substantial difference in any case between those affected by endogenous disturbance (that is that has arisen in the course of their life story) and inducted sufferers, affected by exogenous disturbance (affected through psychic contagion, that is under psychotic induction from someone in their environment who suffers from endogenous psychosis).
In fact, according to the type of disturbance, it is necessary to follow appropriate methods and in particular, in the case of exogenous psychosis, to act on the true source of the disturbance, often so well disguised that it is difficult to identify. The need to accept patients suffering from endogenous psychosis especially has led us to seek tools suited to being able to carry out this work.
We have thus identified, in the primary love between child and same-sex parent, the fundamental experience from which every person takes their basic emotive reference, the one on which we builds all our psychophysical equilibrium and from which we takes the certainty of our own personal identity. We have experimented for twenty-five years on methods of working within sessions with father and son, and mother and daughter.
When they are small enough, we simply put the child in the parent's arms. When they are adult, we make them embrace each other during the sessions.
In reality it is not an embrace, but an ancient gesture: the gesture with which the parents held the newborn in their arms, supporting the head with one arm and resting the body on the other.
The result are conclusive. It should also be remembered that fortnightly, or sometimes weekly, sessions are sufficient, and thus the costs are low. Analysts with a solid training can try this method for themselves, and verify its effectiveness. There are also more serious cases, cases which are so serious that it is not easy to get the children in physical contact with the parents: but this is not an obstacle.
Usually the parent takes care of this, either in or out of the session, when the right moment arrives for a caress, for tucking back the sheets of the bed, for an affectionate gesture. It is not the analyst's task to teach the parent how to behave: it would be like trying to teach cats to climb. However expert analysts might be, they would never find solutions, or answers that only the love between parent and child can find.
Primary love is therefore the only empathetic place where the emotively deprived person can recognize himself as capable of using his feelings, of releasing them from the anaesthesia where he had wrapped them, waiting for better times to bring them back to life with himself. When the parent is no longer alive, recovery is still possible, since analysis is always around the past experience of love between child and parent, and not the current situation. It is not possible to have a primary experience of love as an adult: if love is missing at the beginning, we die. But the patient is alive, and therefore there has been the experience of love.
Disturbances are related to subsequent interferences in the relationship, to the point of producing the reaction of anaesthesia of feeling; so it is a question of restoring what was once there, not of creating something new. This is why, in the absence of the parent, the treatment is more complex. But results can equally be achieved. Greatest benefits are achieved when there is at least a relative of the same sex in the session - a sister or brother, preferably older than the person doing analysis (but also uncles and aunts, and even cousins or same-sex cousins).
There is of course the problem of those who have no-one. They are a minority, and they are not all desperate. Often they have unimaginable resources. They nevertheless reveal how urgent work in mental prevention and hygiene is necessary on a wide scale.
Recovery from mental illness is possible by restoring the symbiotic mode of relating, based on the experience of love with the same-sex parent, in the first months of life. The presence in the session of the parent makes this restoration certain. Even when the parent is no longer alive recovery is possible since the work is done on a past experience, on memories of it, and not on the current experience.