The "chamber of recollections": from change to transformation

Since the late Seventies the biopsychosocial model developed by G. L. Engel (1977) has become dominant in psychiatry. Although this model has highlighted the importance of a comprehensive approach to the patient, the paper... [ view full abstract ]

Since the late Seventies the biopsychosocial model developed by G. L. Engel (1977) has become dominant in psychiatry. Although this model has highlighted the importance of a comprehensive approach to the patient, the paper aims to demonstrate that it does not identify the precise etiopathogenesis of mental illness, knowledge of which is foundamental to plan effective treatment, as happens in other medical fields.

For over ten years the Authors have been working with psychotic patients in a therapeutic community located south of Rome. The Authors have combined the far-reaching anglosaxon concept of the therapeutic community with a wholly Italian methodology and theory: the Teoria della nascita (Human Birth Theory) developed by the Italian psychiatrist M. Fagioli. This theory constitutes an independent model of psychodynamic psychiatry which allows for the identification of the precise etiopathogenesis of mental illness, thus offering patients greater chances of recovery.

Fagioli identified the “annulment drive” as the main cause of the development of mental illness (1972). Through this dynamic individuals can make what for them are intolerable situations disappear from their unconscious, as if they had never existed. The annulment drive can occur already in the first months of one’s life as a reaction to a caregiver whose lack of affectivity is particularly severe.

The Authors describe their work and clinical results to suggest that real change can occur within the psychiatric patient only if his/her unconscious dynamics actually change, since mental illness is mainly illness of the unconscious. When a positive development takes place due to the therapeutic relationship, the pathological unconscious dynamics of the patient which once occured become the inanimate objects in the stanzone dei ricordi (chamber of recollections) described by Fagioli in his book “La marionetta e il burattino” (The Marionnette and the Puppet-1974).