6. Pathology

The capability of being well with oneself and others, being an active part of society is fundamentally influenced by the first year of life. If the infant's demand for love and acceptance is constantly disappointed due to relationship that aims only at addressing physical needs, the infant will suffer an unsatisfactory experience. The internal elaboration won't develop a sense of trust or well-being but rather a feeling of insecurity and struggle between a natural tendency toward others and the constant disappointing answer received. In these conditions, the original vitality will be compromised. After going through stages of rage and progressive loss of vitality, an alteration in the relationship characterized by pathological dynamic of introjection and projective identification will occur. On this point, we suggest reading Chapter 2 in [1] and Chapter 4 in [7]. Although altered, these dynamics will still allow a relation with human reality. If in the early stages no other valid human relationship occurs to change this condition, there will be a further evolution toward pathology. The child, in order to defend oneself from the external aggressive human reality, altered by dynamics of introjective and projective identification will annul the existent human world. In other words the infant will make mentally disappear the disappointing human reality. By doing so, personal humanity and capability to love will disappear too. The annulment

pulsion, without vitality, will be addressed toward the human reality, perceived as inanimate, and consequently as non-human. This is a physiological pulsion at birth, as it is turned toward non human reality such as light. Moreover, at birth this pulsion has in itself vitality. Now it is pathological: firstly because of its lack of vitality and secondly because it is addressed toward humans. We recommend the first three books of Massimo Fagioli for a complete explanation of what has just been briefly synthetized [1, 7, 8]. The dynamic explained can occur in the earliest months of life and will determine the onset of serious mental pathology such as schizophrenia in the most serious cases. The signs of this illness will appear only years later. Regarding this pathology we must consider both hebephrenic and simplex schizophrenia, erased in DSM V. The former is identifiable as disorganized and undifferentiated in the DSM-IV-TR whereas the latter not any longer considered, does not comprehend altered behaviors for a long time, sometimes the whole life, if not only with social withdrawal which we still consider a serious mental illness (Bleuler provided a clear specification of the symptoms of these clinical pictures, [28]). In other cases, mental illness can occur later during the first year of life or at weaning with the onset of other serious mental illnesses such as different forms of schizophrenia (paranoid and catatonic to maintain a reference to classic nosography) and depression which is still more likely to be successfully treated. The core of pathology is the formation of anaffettività that addresses the annulment pulsion toward humans, decreasing the individual own libidinal abilities [1, 16]. In the most serious condition the subject makes disappear the whole or part of the human reality of the other because unable to establish a rapport. This dynamic will be triggered not only toward disappointing beings but this mechanism will appear in any human relationship that might be significant or able to touch our deepest dimension. If nobody intervenes to contrast this non conscious relation, the individual will annul every possibility to establish a deep relationship, by making the human world meaningless, and consequently impoverishing its own identity. The core of mental illness finds its roots in the non-conscious individual internal reality. Behavior, language, symptoms and evident signs of pathology must be considered as a direct consequence. The basic dynamic is the annulment pulsion against the human reality. In a nutshell, we can consider two pathological mechanisms that reinforce each other: the annulment pulsion against human and the deficiency—loss of vitality—that leads to an increasing impoverishment of one's humanity and capability to feel the other (this can be partially identified with empathy, although it is wider concept). In this way, lack of affection (anaffettività) of another human being or another caregiver in touch with the newborn can turn into an infant or adolescent anaffective dimension which will usually manifest itself during adolescence or in the earliest stages of adulthood. (In a more or less extensive way from schizophrenic to schizoid to serious depression or other personality disorders such as narcissistic and borderline). A clear reconstruction of the pathological cycle can be found in [16]. I would like to reassert that anaffectivity connected with the annulment pulsion is related to human reality. In regards to material or external reality, adults can develop a sense of indifference and defense, which is not pathological. Moreover this theory helps to comprehend how much mental pathology and its non-conscious reality might be hidden in an apparent behavioral normality.

fundamental principles: a lack of affection in early human relationships can determine the onset of mental illness. At the same time, it is also true that mental illness can be cured through the therapeutic relationship with a healthy therapist who does not present a split between conscious and unconscious dimensions. Obviously this treatment must be based on a medical and clinical method, allowing the therapist to elaborate a psychodynamic diagnosis and prognosis. These have to be constantly verified and monitored throughout the treatment in order to propose a cure for recovery. According to this theoretical approach and clinical practice, psychotherapy is conceived as a medical act that aims at deeply modifying the individual's nonconscious reality. The therapist must be able to refuse the patient's non-conscious violent dimensions. This refusal can occur by identifying and contrasting these realities and by being able to respond to the request of being cured, which even in ambiguous way is a patient's demand. The annulment pulsion and negation are the two fundamental pathological dynamics that the psychotherapy, based on the Theory of Birth, aims at treating and curing. Both of them are non-conscious dynamics. (I shall recall that this psychotherapy mainly addresses the non-conscious mind whereas consciousness and behavior are considered as related to the internal reality). It has already been mentioned how the central core of mental pathology lies in the annulment pulsion which is split from vitality and it is addressed toward another human reality. The annulment pulsion annuls the human reality of the other. As a consequence, the subject itself realizes an emptiness which in turns annuls the possibility of any valid human relationship. This dynamic is strongly associated with many forms of schizophrenia, psychotic manifestation and manic excitement and to some extent to depression. It is also found in some personality disorders and in apparently normal people without evident behavioral disorders. Another common dynamic is negation, in which the subject perceives the other's psychic qualities (beauty, intelligence, sensibility, and interest for others) and immediately ruins, devalues or reverses them. This dynamic happens not so much consciously—in that case it should be considered as a lie—but rather in the nonconscious dimension by manifesting itself through dreams. For instance dreaming as ugly, deformed or stupid a person that in reality is not is a form of negation. Both the annulment pulsion and negation cause illness in human beings as they can result in damaging behaviors or conditions in which there is a lack or absence of interest for the other. A relevant example is the negation of human female qualities. This belief leads to the idea of female inferiority with tangible and dramatic daily consequences everywhere. The annulment of the human reality of another human being can lead to consider this as an object with devastating effects on the individual. In the most dramatic situations we have seen humans becoming object of trafficking, slavery and trade. However, this annulment can be modulated in such a way that it does not always give rise to physically violent behaviors. An example is given by adults that consider only children's physical needs during their growth and not their demand to establish a rapport and being recognized for their identity. This annulment pulsion has major effects on the children's psyche and body. Both the annulment pulsion and negation can determine malaise or the onset of mental illness. However, both cause the pathogenesis of illnesses in the subject acting these same dynamics: the annulment pulsion against human reality makes the subject itself 'anaffettivo' (lacking in affection); the negation of one's or others' qualities makes the individual depressed or envious. In the psychotherapeutic process based on the Theory of Birth, dreams interpretation is crucial to make a diagnosis. Non-conscious human thought expresses itself through oniric images during the night. This originates from the capability to imagine at birth and it is connected to the first year of life. In these images current psychopathological conditions manifest themselves. This point drastically differs from other classical psychoanalytic conceptions and in

Physiology of Human Birth and Mental Disease DOI: http://dx.doi.org/10.5772/intechopen.82216

19

## 7. Psychotherapy

How can the Theory of Birth be applied to the psychotherapeutic treatment? The psychodynamic psychotherapy drawn from this Theory is based on some

## Physiology of Human Birth and Mental Disease DOI: http://dx.doi.org/10.5772/intechopen.82216

pulsion, without vitality, will be addressed toward the human reality, perceived as inanimate, and consequently as non-human. This is a physiological pulsion at birth, as it is turned toward non human reality such as light. Moreover, at birth this pulsion has in itself vitality. Now it is pathological: firstly because of its lack of vitality and secondly because it is addressed toward humans. We recommend the first three books of Massimo Fagioli for a complete explanation of what has just been briefly synthetized [1, 7, 8]. The dynamic explained can occur in the earliest months of life and will determine the onset of serious mental pathology such as schizophrenia in the most serious cases. The signs of this illness will appear only years later. Regarding this pathology we must consider both hebephrenic and simplex schizophrenia, erased in DSM V. The former is identifiable as disorganized and undifferentiated in the DSM-IV-TR whereas the latter not any longer considered, does not comprehend altered behaviors for a long time, sometimes the whole life, if not only with social withdrawal which we still consider a serious mental illness (Bleuler provided a clear specification of the symptoms of these clinical pictures, [28]). In other cases, mental illness can occur later during the first year of life or at weaning with the onset of other serious mental illnesses such as different forms of

Psychology of Health - Biopsychosocial Approach

schizophrenia (paranoid and catatonic to maintain a reference to classic

behavioral normality.

7. Psychotherapy

18

nosography) and depression which is still more likely to be successfully treated. The core of pathology is the formation of anaffettività that addresses the annulment pulsion toward humans, decreasing the individual own libidinal abilities [1, 16]. In the most serious condition the subject makes disappear the whole or part of the human reality of the other because unable to establish a rapport. This dynamic will be triggered not only toward disappointing beings but this mechanism will appear in any human relationship that might be significant or able to touch our deepest dimension. If nobody intervenes to contrast this non conscious relation, the individual will annul every possibility to establish a deep relationship, by making the human world meaningless, and consequently impoverishing its own identity. The core of mental illness finds its roots in the non-conscious individual internal reality. Behavior, language, symptoms and evident signs of pathology must be considered as a direct consequence. The basic dynamic is the annulment pulsion against the human reality. In a nutshell, we can consider two pathological mechanisms that reinforce each other: the annulment pulsion against human and the deficiency—loss of vitality—that leads to an increasing impoverishment of one's humanity and capability to feel the other (this can be partially identified with empathy, although it is wider concept). In this way, lack of affection (anaffettività) of another human being or another caregiver in touch with the newborn can turn into an infant or adolescent anaffective dimension which will usually manifest itself during adolescence or in the earliest stages of adulthood. (In a more or less extensive way from schizophrenic to schizoid to serious depression or other personality disorders such as narcissistic and borderline). A clear reconstruction of the pathological cycle can be found in [16]. I would like to reassert that anaffectivity connected with the annulment pulsion is related to human reality. In regards to material or external reality, adults can develop a sense of indifference and defense, which is not pathological. Moreover this theory helps to comprehend how much mental pathology and its non-conscious reality might be hidden in an apparent

How can the Theory of Birth be applied to the psychotherapeutic treatment? The

psychodynamic psychotherapy drawn from this Theory is based on some

fundamental principles: a lack of affection in early human relationships can determine the onset of mental illness. At the same time, it is also true that mental illness can be cured through the therapeutic relationship with a healthy therapist who does not present a split between conscious and unconscious dimensions. Obviously this treatment must be based on a medical and clinical method, allowing the therapist to elaborate a psychodynamic diagnosis and prognosis. These have to be constantly verified and monitored throughout the treatment in order to propose a cure for recovery. According to this theoretical approach and clinical practice, psychotherapy is conceived as a medical act that aims at deeply modifying the individual's nonconscious reality. The therapist must be able to refuse the patient's non-conscious violent dimensions. This refusal can occur by identifying and contrasting these realities and by being able to respond to the request of being cured, which even in ambiguous way is a patient's demand. The annulment pulsion and negation are the two fundamental pathological dynamics that the psychotherapy, based on the Theory of Birth, aims at treating and curing. Both of them are non-conscious dynamics. (I shall recall that this psychotherapy mainly addresses the non-conscious mind whereas consciousness and behavior are considered as related to the internal reality). It has already been mentioned how the central core of mental pathology lies in the annulment pulsion which is split from vitality and it is addressed toward another human reality. The annulment pulsion annuls the human reality of the other. As a consequence, the subject itself realizes an emptiness which in turns annuls the possibility of any valid human relationship. This dynamic is strongly associated with many forms of schizophrenia, psychotic manifestation and manic excitement and to some extent to depression. It is also found in some personality disorders and in apparently normal people without evident behavioral disorders. Another common dynamic is negation, in which the subject perceives the other's psychic qualities (beauty, intelligence, sensibility, and interest for others) and immediately ruins, devalues or reverses them. This dynamic happens not so much consciously—in that case it should be considered as a lie—but rather in the nonconscious dimension by manifesting itself through dreams. For instance dreaming as ugly, deformed or stupid a person that in reality is not is a form of negation. Both the annulment pulsion and negation cause illness in human beings as they can result in damaging behaviors or conditions in which there is a lack or absence of interest for the other. A relevant example is the negation of human female qualities. This belief leads to the idea of female inferiority with tangible and dramatic daily consequences everywhere. The annulment of the human reality of another human being can lead to consider this as an object with devastating effects on the individual. In the most dramatic situations we have seen humans becoming object of trafficking, slavery and trade. However, this annulment can be modulated in such a way that it does not always give rise to physically violent behaviors. An example is given by adults that consider only children's physical needs during their growth and not their demand to establish a rapport and being recognized for their identity. This annulment pulsion has major effects on the children's psyche and body. Both the annulment pulsion and negation can determine malaise or the onset of mental illness. However, both cause the pathogenesis of illnesses in the subject acting these same dynamics: the annulment pulsion against human reality makes the subject itself 'anaffettivo' (lacking in affection); the negation of one's or others' qualities makes the individual depressed or envious. In the psychotherapeutic process based on the Theory of Birth, dreams interpretation is crucial to make a diagnosis. Non-conscious human thought expresses itself through oniric images during the night. This originates from the capability to imagine at birth and it is connected to the first year of life. In these images current psychopathological conditions manifest themselves. This point drastically differs from other classical psychoanalytic conceptions and in particular the Freudian one, according to which there is no major difference between hallucinations and dreams. These are considered as incoherent daily remnant or 'satisfaction of desire' [29]. According to the psychotherapy based on Theory of Birth, the diagnosis is always a dynamic process and must be related to the personal moment that the patient is experiencing. As it is susceptible to changes and modifications, it should be considered neither as a label nor as a conviction. In the psychotherapeutic relation proposed by Massimo Fagioli with its clinical method, the therapist becomes the object of a relationship with someone who seeks cure. In this relationship the patient will manifest all the unhealthy dynamics that affect his/her personal life. The therapist's interest is particularly focused on the interhuman conscious and non-conscious relationship that arises during the setting. 'Frustrating' unhealthy dynamics is a tool for the cure. In other words, it is fundamental for the therapist to verbalize and pretend that the patient sees and comprehends these dynamics. Only in this way the patient will become able to refuse them, by making them disappear. The patient can achieve this by finding in the relationship with the therapist the vitality that he/she had previously lost in unhealthy relationships. The patient will find that 'disappearance fantasy' experienced at birth and will become able to address this toward those unhealthy interior dimensions. In this rapport, it is crucial that the patient realizes a separation from those relationships that impedes a more profound change. In contrast with what happens in the everyday life, the therapist can interpret and frustrate these dynamics. Moreover, the therapist who was previously cured cannot be confused or attacked by these violent dimensions because of his/her personal vitality and creativity. In this sense the patient does not have the power to think of being omnipotently able to destroy the other. By doing so the patient avoids experiencing a sense of emptiness connected with the annulment pulsion. Furthermore, the therapeutic relationship addresses negative feelings, reducing the suicidal risks and self-destructiveness of depressed patients. The patient starts realizing that it is stimulating and beneficial to maintain a relationship with someone who is not psychically violent. In the case of psychotic patients, it can be crucial for them to experience the constant presence and interest of a human being that proposes a valid human relationship. Another fundamental point in the therapeutic work is the conceptualization of a 'hurtful absence' and the critic of the therapist's absence. For further references we suggest Chapter 1 in [1]. A major point is also the idea that the patient is active in the psychotherapeutic work. Facing another human being who has not lost its original identity and is able to realize a separation from another human relationship without annulment or negation is a crucial realization for the patient. This dynamic encourages the patient to understand and investigate how this could possibly occur. On a wider scale, this dynamic also happened in the Analisi Collettiva's experience. A brief and effective story of this phenomenon and its cultural implications can be found in a writing by Massimo Fagioli [30]. This method is used in much smaller groups and also in individual psychotherapy by many psychiatrists and psychotherapists that in addition to an academic formation in psychiatry and psychology have followed this story and experience firstly as patients.

newborn biological reality, by 'coming to light' immediately creates a merged nonconscious mental reality. Secondly, mental illnesses are an acquired condition affecting the irrational non-conscious dimension which main cause is to be found in social and human disappointing relationships lacking in affection. Lastly, it is possible to pursue a psychotherapeutic treatment based on this theory. This psychotherapy is based on a conscious and non-conscious therapeutic relationship between a healthy human being—the therapist who offers his/her own mental health and human reality as well as professional skills—and one who becomes ill because of a deficiency of conscious and non-conscious affection in human relationships. In particular this is a medical act, which has the intent to cure. Furthermore the physiology of birth is a dynamic equal for all human beings. Consequently the dynamics arising from it are universal. The Human Birth Theory constitutes a solid theoretical apparatus which has had significant effects on mental health care activities and has huge implications not only on the anthropological view of man itself and the ideas concerning its nature and human sociality, but also on bioethics [31].

Thanks to the Human Birth Theory, the unconscious is not unknowable or unmodifiable any more: non-conscious reality is a fundamental part of human reality which can be known and function in harmony with consciousness and, if

Mental Health Center, Local Healthcare Authority, Monterotondo, Rome, Italy

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

\*Address all correspondence to: iri.cale@gmail.com

provided the original work is properly cited.

altered, can be cured.

Physiology of Human Birth and Mental Disease DOI: http://dx.doi.org/10.5772/intechopen.82216

Author details

Irene Calesini

21
