Self-injury is a phenomenon that is widespread in prison today. Defined as: “the deliberate and self-inflicted destruction of body tissues without suicidal intent”, it most often manifests itself with skin cuts on the abdomen, legs or arms.
Research for the treatment of self-injury suggests both the use of pharmacotherapy and some types of psychotherapy. In my short period of clinical practice, however, I have observed that often the solution is the administration of high dosages of tranquilizing drugs, which not only cause excessive sedation with a tendency to toxicophilia, but do not solve the problem.
The theme of this work is to argue that self-injury can be approached with a new method of psychotherapeutic practice based on the therapist’s ability to deal with the patient’s unconscious dynamics. This different approach is based on the idea that the cut is not just the expression of a symptom but that unconscious dynamics are the basis of its genesis.
The causes of self-injury in prisons are still unsolved problems to date. According to the WHO, there is a concomitance of factors related to the environment, inside and outside the prison, combined with the psychic weakness of the prisoner. The latter could be the real psychopathological cause of self-injury of which the previous ones amplify the effect. In fact, according to some authors in self-injury the psychic weakness is linked to anaffectivity: even if the nerurobiological apparatus works perfectly the patient becomes unable to experience sensations and emotions and insensitive to external stimuli belonging to the inter-human relationship, thus cutting becomes the only attempt to recover some sensitivity.
The authors refer this hypothesis to the idea that anaffectivity originates from an unconscious and aggressive dynamic: the annulment pulsion theorized by the psychiatrist Massimo Fagioli in his book “Death Instinct and Knowledge”. The annulment pulsion is directed against the object (human relationship), which in pathological situations, such as the lack of vitality, determines a disappearance of one’s inner self with the consequent lose of the affectivity and one’s sensitivity.
Fagioli through his human Birth Theory also describes a new idea of physiologist of the mind. According to the author the mind is generated by the reaction of human biology towards light. This biological reaction determines a corresponding event at the psychic level the disappearance fantasy. He proposes a vision of human inner image originated at birth: irrational, spontaneously affective and positively oriented to the relationship towards the other. An essential relationship for evolution of the newborn, in which he rediscovers his transformative possibility; in contrast with the idea of narcissism, immutability and negativism of the newborn, the prerogative of psychoanalytic theories.
Following the new theoretical approach the illness, lack of vitality, is caused by a pathological relationship between caregivers and the newborn during his first year of life. The disease can be resolved in another non-pathological inter-human relationship in the psychotherapy of the unconscious. These pathophysiological events would occur even in the self-injured person leading to the manifestation of the pathology but the mechanisms are not totally investigated. This would make it possible to intervene in self-injury by this new psychiatric practice as psychotherapy based on three cornerstones: setting, transfert and the interpretation of dreams; moreover on the therapist’s human possibilities to “see” the other and to relate to his unconscious. .
This article describes the practical application of this psychotherapeutic approach in self-injury combined with drug therapy, if necessary, inside a penitentiary institution. I conclude: the psychotherapy was regular despite the difficulties related to the prison: a closed and rigid institution in which it is difficult to reconcile the idea of treatment with that of punishment. Furthermore it is emphasized that this type of approach has succeeded in eliminating the symptom and determining the progressive recovery of sensitivity. These results lead us to think of a possible extension of psychotherapy to other pathologies in public and closed institutions, where it is often difficult to arrive.
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