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n. 3/2000
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Abstract |
Nicola Lalli |
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Approaching
the year 2000 Psychiatry will have to face, like Medicine in general,
very complex problems linked both to an increase in patients,
more differentiated and with more demanding needs, and to a therapeutic
and technological potential that, though it reached an exponential growth
in the last fifty years, it has not always come up to our expectations. The enormous growth, in fact,
of therapeutic possibilities has often "paradoxically"
determined a downright worsening in the physician-patient relation. Overspecialization and hypertechnology
have turned the ill person into an organ or function to repair. They
forced the physician, oblivious of M. Balint's famous phrase
"the cure the physician more often gives is himself",
to propose an aseptic and distant relation, experienced by the patient
as unconcern or even enmity.
We are now approaching the
more specifically psychiatric field, as it is unquestionable that some
kind of psychiatry based only on the psychopharmacological and biological
approach has widely contributed in building and supporting such ideology,
starting with the pill against anxiety on to that against depression
-soon called "pill for happiness"- and to that against shyness
or social inhibitions, etc..
Within the "drug culture",
instead, such a trend has become a mass ideology, and the real problem
lies in the fact that only the comforts of such an approach are emphasized,
whereas its risks and dangers are scrupulously concealed or mystified. Why then should we marvel
at the use of the "saturday night pill"? Since there is a
"soothing pill" for any problem, it was easy for drug dealers
to promote and make believe to youngsters, in a total lack of discernment,
that thanks to a "special pill" one could win any kind of
tiredness and could extend, beyond any physiological limits, the fun. Who will, instead, take care
of alerting all those patients under psychopharmacological treatment
-a treatment that may also be indefinitely extended thanks to self-prescription-
of the risks linked to addiction, to the decrease of mnestic capabilities,
etc..? It is within this cultural,
psychological and social framework that we should think of a possible
change of psychiatry; not only will it have to denounce (and not collude
with such ideology), but also propose solutions to these primary issues. To this purpose Psychiatry
must necessarily become Psychotherapy: that is it has to rehabilitate
the physician-patient relationship and has to emphasize its therapeutic
worth. As I already suggested on
another occasion1 , the psychotrope drug can be utilized as "transitive
purpose" in the context of the therapeutical relation; operating,
then, with the same function of link and growth that the transitive
purpose has in the evolutionary phase of life's early years. But a psychotherapeutic point
of view of the mental illness focuses, besides the treatment, also on
rehabilitation and on prevention. Psychotherapy As Treatment Many and very differentiated descriptions of the psychotherapy
as treatment of the psychic illness were provided referring to theoretical
and operative models.There evidently are different intervention procedures
with their indications and contra-indications of which each operator
has to be aware, even if only works with a specific procedure of psychotherapy. In this historical phase the general orientation is
that of identifying and quantifying the results concerning short, medium
and long-term outcomes, and that of more clearly discovering the correlations
among the different models of psychotherapy and the different needs
of patients, starting not only from their psychopathology, but also
taking into consideration the different phases of the vital cycle, the
difference in the manifestation of the disorder and the personal and
environmental conditions surrounding the patient. In case of major
disorders (psychosis), especially in the early phase, the need to prescribe
an integrated psychotherapeutic and psychopharmacological treatment
is widely proven; but the operator must obviously be as much informed
of the interpersonal dynamics as of the psychopharmacological effect. Psychotherapists-psychiatrists represent an important
experience in terms of collection of data on the specific effects of
psychotrope drugs, both from a symptomatic point of view (with reference
to the symtpoms' remission but also to the onset of secondary symptoms),
and from that of the psychic dynamic that goes with their utilization.
The utilization of the psychotrope drug from the person experiencing
the psychic disorder always implies a specific change in the image of
himself/herself and in the relational dynamic with the person taking
care of him/her, the spouse, the family, the service and more in general
the surrounding milieu. Psychotherapy as Rehabilitation Many times when the psychic disorder has become chronic
(this is often due to "iatrogenic" reasons) a therapy in terms
of transformation is not always possible: it is therefore necessary
to acknowledge the presence of limits that have to be respected. There is significant evidence showing that often when
psychotherapy is rehabilitation-oriented, it obtains more positive results
than if it aimed at reactivating evolutionary projects. Psychotherapy as Prevention In the framework of the research carried out by the
development psychologists and most of all by those who deal with psychopathology
of the evolutionary age, it clearly emerged that psychic disorder
of parents is a risk factor for the evolution of children and for the
onset of disorders in their psychic dynamics. Once overcome the idea that the "trauma is caused
by a childlike fantasy", there is important evidence emerged during
the psychotherapy on the correlation between a difficult relationship
with the parents and the onset of a long-lasting psychic disorder (A.
Miller).
Psychiatry will have, as a first thing, to change itself
as to the issues I mentioned before if it aims at being a methodology
for evolutionary change and not for a mere remission of symptoms. Nicola
Lalli Titolare
di Clinica Psichiatrica Docente
di Psicoterapia Universitą
“La Sapienza” Roma
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