I’m a psychiatrist and psychotherapist, member of the School of Specialization in Psychotherapy, legally recognized by MIUR, of the CESAD Institute (Centro Studi Analisi Dialettica), located in Genoa, Via Maragliano 8/5 (tel. 010-580903).
I work as MD at the San Martino Hospital in Genoa.
In addition to my clinical work, I would like to share some topics of particular interest to me:
- How can one authentically enter into a relationship with the patient affected by psychological or psychiatric disorder?
- The meaning of psychotherapy: is it possible to develop a scientific method about it?
- Is the human being identified with his mechanical body, mind and brain, or does he possess his own form of autonomy and individual freedom?
In this site, as you can see in the initial menu, the contribution of psychotherapists such as E. Fromm, C. Rogers, V. Frankl and L. Binswanger is analyzed and commented.
They are inspirers of the School of Specialization in Psychotherapy of the CESAD Institute, addressed to physicians and psychologists.
These authors, starting from their clinical studies, needed to integrate the natural scientific skills with a method that would include the identification with the feelings of the interlocutor: the patient is considered by them not as an object, but as another subject, a part of me, who suffers because he has suffered an arrest of the inner dialogue that must be reactivated.
This is the psychological point of view of understanding: it starts from the analogy between my states of mind and those of the individual in front of me.
The method of understanding human feelings is not opposed to natural science, but complements it.
The psychology of understanding was born, in Western philosophy, with Socrate (che ha fatto sua l’affermazione “Conosci te stesso”, un tempo visibile sul tempio di Apollo a Delfi) e si sviluppa in modo significativo, in epoca moderna, con il contributo di A. Schopenhauer, F. Nietzsche, the phenomenology of E. Husserl and the existentialist current (M. Heidegger, K. Jaspers, M. Boss).
These philosophical visions have been applied to contemporary psychotherapy, in order to consider not only biology and human behavior (whatthe subject has), but also the sense of existence of the individual (how the subjectis).
Psychopathology becomes a profitable science when the researcher manages to master with balance both the biological method of natural explanation and the personological method of understanding.
In this site there is also a critical analysis of the cognitive psychotherapy of A. T. Beck: the contributions of this author are highlighted, the points in common with our School and some different visions of the relationship between thought and human feeling.
For further study, we recommend the texts listed at the following links:
Here are some basics in order to master the psychopathology of understanding:
The foundations of psychopathology: subject, object, relationship, dialectical reflection .
Ogni scienza, sia naturale che umana, necessita di enti fondamentali a priori che presuppongano la validità dei propri contenuti.
Physics, for example, among its basic principles, presupposes the existence of an energy that is neither created nor destroyed, that remains unchanged according to the principle of its conservation, despite its infinite transformations.
Geometry proposes, as fundamental entities, point, line and plane.
Point has no dimensions, line is an infinite set of dimensionless points, plane is a reality without thickness: they seem indefinable entities in concrete experience. In fact they are, because they are the assumptions of every perceptible object in nature; they are the foundations of an exact science, based on mathematical terms. In fact they are, because they are the assumptions of every perceptible object in nature; they are the foundations of an exact science, based on mathematical terms.
In psychopathology, similarly, we need to use apparently abstract basic terms, which however are fundamental to define all psychic phenomena.
Subject and object..
Let’s start with the subject What’s the subject? First of all it is not a thing: otherwise it would be an object! It’s the feeling of existence that we feel in us (“I am”), in itself verifiable in our interiority.
È il sentimento di esistenza che avvertiamo in noi (“Io sono“), di per sè verificabile nella nostra interiorità.
Subject is an ineradicable term: when I imagine an event, I am always part of it.
For example, I can imagine myself waiting at the bus stop. Or a stranger waiting for the bus Even in this last mental representation, however, I am present: as the observer, the “director” of the scene.
It’is impossible to leave the role of subject. I am present within any reality that I can conceive or imagine, and I am part of it.
Questo presuppone che “io sono”.
But “who” am I?
Subject gains self-awareness through relating to others and knowing the world..
Object is what the subject is not, but what the subject has and uses as a tool to assert itself: matter, the environment in which we live, our own bodies. Objective reality is a passive energy, subordinated to the categories of space, time and to the mechanical principles of causality and necessity.
We can consider any other person as a subject similar to me, or as a “Self-object” (term proposed by H. Kohut): the other as a part of me.
I attribute the role of subject to the other when I identify in him, through a spontaneous identification, a psychic activity comparable to mine, different from the passive set of automatisms “stimulus-response” that constitute an automaton, a computer, an artificial intelligence.
Psychology was born from the interest in the experience of the subject, of the individual, that we would like to analyze from a scientific perspective, not metaphysical (as in religions and spiritualist philosophies).
The problem of modern psychology is that, the more it strives to be objective in order to aspire to universality, the more it must be stripped of the subjective element: it is precisely the latter, however, to give originality to the psychic life of the individual.
Reflection, self-knowledge, dialectical relationship.
Where can we start in order to establish a psychological science that preserves the authenticity of the individual without falling back into the previous contradictions?
The starting point, as seen earlier, is that “I am.” Socrates asserted that I can convince myself of the uselessness of all my knowledge, or even of being totally ignorant. “I know nothing,” but paradoxically this truth implies something undeniable: that I exist, I want to know and affirm myself.
The next step is to identify in the dialectical relationship between subject and object the very engine of psychic life.
In the field of interpersonal relations, one of P. Watzlawick’s merits was to identify a fundamental law of communication, which is an axiom (or a self-evident truth in itself):
“It’s impossible not to communicate.”
Even the refusal to speak and to confront are part of the relationship with the other: they can convey a significant message of distrust, defiance, contempt or renunciation.
When the individual does not speak, moreover, nonverbal communication is an eliminable way of expressing his or her point of view about any reality.
Whether we are aware of it or not, we are all interconnected by relationships, in which we constantly communicate with others: through this process we know the world and ourselves.
The experience of existing would have no meaning without the presence of the other, as well as the contact with the world: an entity that apparently is other than me, but in reality is the representation of myself and my unresolved problems (according to A. Schopenhauer’s teachings).
Self-knowledge occurs through reflection.
Reflection is an active effort that develops from the perception of a conflict, of a dialectical antithesis between myself and the external world. his experience occurs from the earliest stages of life, it’s the very engine of existence.
I want to relate to the world to know myself: it is a process that inevitably leads me to the clash with reality and, only after many efforts, can lead me to reach a synthesis between myself and otherness.
Reached an ideal harmony between myself and the world, it overcomes any antithesis between subject and object: the resulting experience coincides with bliss (described in every culture with different names, such as ecstasy, nirvana, illumination, etc.).
The process of reflection and self-knowledge, which we call dialectical and contradictory (I know who I am only through what I am not) is perceived by the subject first as a feeling, then, in a more elaborate but less spontaneous, as rational thought.
Conscious action is manifested when feeling and thought become, in the individual, a unitary and concrete synthesis, through reflective activity.
To reflect in an authentic way means to consciously direct attention to a goal, with full emotional involvement:if a subject focuses intensely and constantly on a desire to be realized, this can only be achieved (provided that we are free from inner contradictions and uncertainties about what we really want to achieve).
Reflection is not passively adapting one’s intellect to a truth already given, as in traditional philosophy.
It is to actively construct, through dialogue with another person, a new vision of oneself and of the world, personal in its mode of creation and universal in its content.
The methods of explanation and understanding.The logic of identity and the logic of contradiction.
Man has two types of knowledge to shed light on himself and on the other, as stated by a neo-Kantian philosopher, W. Dilthey, and systematized by K. Jaspers in his General Psychopathology: explanation and understanding.
There is no clash between the two methodologies: simply, if I am using one of them, I cannot at the same time use the other.
Through the method of explanation we are able to analyze the objective reality according to the mechanical principles of naturalism. All natural sciences, including those pertaining to medicine, use this methodology. The ultimate goal is to lead back all empirical experiences to universal and necessary mathematical formulas. The ultimate goal is to lead back all empirical experiences to universal and necessary mathematical formulas.
In the methodology of explanation there is no “conflict” or “problem”. There’s no dialectic.
For example, a wave of the sea breaking on a cliff does not, in itself, imply a will of the sea to collide against the cliff (unless I, as a subject, attribute to it). It’s a natural phenomenon, explainable by immutable laws of physics devoid of contradictions.
The natural method presents a reality that is always equal to itself, according to the logic of identity: even in the apparent modifications of external phenomena, the total natural energy remains unchanged.
The methodology of understanding, on the other hand, is characteristic of every interpersonal relationship: once I have attributed the role of subject to another person, I can identify with them, identify myself, to the point of feeling myself what feelings and thoughts the other person is experiencing. These feelings and thoughts are inevitably problematic and contradictory. Sono sentimenti e pensieri inevitabilmente problematici e contraddittori.
There is here an incessant dialectic between myself and the other, term of comparison of my interiority..
Interiority lives in thelogic of contradiction: I exist thanks to a tension towards what I am not but aspire to be (every homeostasis corresponds to the death of the individual).
Logic of contradiction is absent in naturalistic methodology, but it is constant in the human being: we all feel pervaded by doubts, uncertainties, problems, which if neglected and not addressed can lead to emotional crisis.
In the natural sciences the correct method is that of explanation: we must strip our study of all subjectivity and particularity, so that it is consistently neutral and reducible to universal mathematical formulas.
In psychopathology the method of explanation is useful? It is fundamental to define biological alterations related to mental disorders, for their diagnostic classifications and the identification of psychopharmacological therapies. However, it is not optimal for entering into a relationship with the patient, who, reduced to a biological organism, appears in this way as an object to be reprogrammed rather than as a person with whom to relate.
The point of view of understanding arises, instead, from the psychopathologist’s need to immerse himself in the patient’s feelings and thoughts, in his unrepeatable set of conflicts, doubts and uncertainties: they, although unique in the individual case, can be grasped by the caregiver because they are related to universal human problems.
The point of view of understanding can enlight the diagnostic and therapeutic process of the individual clinical case and is essential to know the personality of the subject. It is the method used in psychotherapy, but it is also immanent in every interpersonal relationship.
For further information on the concepts of awareness and ego consciousness, we propose the following article: