Among the numerous clinical observations, interpretazions of dreams and transference dynamics contained in “Death instinct and knowledge”of particular importance are those relating to a case history: in fact they refer to a patient suffering from hallucinations, delusions, depersonalization, subjected to hospitalizations and Esk enough to have psychiatrists consulted previously formulate the diagnosis of schizophrenia. The case treated by Fagioli with psychotherapy takes on a paradigmatic character due to the dynamics that allow us to identify the result of an original research. Since 1962, the psychiatrist of “collective analysis” had expressed his interest in the psychotherapy of psychosis in years in which he had developed his fundamental essay on delusional perception. Compared to the 1960s, Fagioli’s approach to schizophrenia focuses more on what, starting with Eugene Minkoski, had been called the fundamental disorder rather than the description of the delusional and hallucinatory productive aspects of psychosis on which research had focused until the 1970s of the twentieth century.
The discovery of the disappearance fantasy in 1964 and its pathological equivalent, the annulment pulsion , allows the author of “Instinct of death and knowledge”to identify the fundamental psychopathological process at the origin of the psychotic condition. Schizophrenic productivity was made to derive from a phantasmatic activity, rather than organic disturbance, annulment pulsion at the base of the lack of affectivity, of the disappearance of the inner image and of mannerism susceptible, in particular conditions to alter judgment and give rise to delusional perception and hallucinations such as also to manifest itself in paucisymptomatic forms or with negative symptoms attributable to schizophrenia simplex. W. Blankenburg’s 1971 essay “The loss of natural evidence” focuses on paucisymptomatic or subapophanic schizophrenia. According to Arnaldo Ballerini, the contribution of the German psychiatrist marks a turning point in the history of psychiatry with a phenomenological orientation even if it remains anchored to the idea of a consciousness pathology of in line with all the concepts of psychiatry of the twentieth century by E. Blueler, K. Jaspers K. Schneider, Conrad, Ey. Fagioli’s contribution is original because it captures the unconscious root of the psychotic condition: from this approach derives a way of dealing with schizophrenia that rejects the traditional Jaksonian point of view based on the idea of regression and compensatory reactivation of archaic psychic processes at the base of the productive symptomatology. Even in psychoanalysis of Freudian derivation, we did not go beyond the hypothesis of an irruption of the unconscious and the primary process into reality due to a break-in of the boundaries of the conscious ego as in delirium. Based on a new understanding of the mind Fagioli goes beyond the equation and analogy between dream and delirium proposed by E. Bleuler but already present in the entire history of the psychiatry and psychoanalysis. Fagioli’s interpretative work focuses on the annulment pulsion which he considers unconscious and omnipotent phantom or reverie: the clear distinction is drawn between fantasy, as a creative activity and pathological reverie or phantom as denial, delirium and hallucination that runs through the entire work of the psychiatrist of “collective analysis”. From the introduction to Spitz’s “No and Yes”, the stance in favor of a child’s original phantasmatic activity is revealed: fantasy or, on the contrary, phantom or reverie is to be considered the mental correlation of pulsion activity. The Kleinians with Susan Isaac (1948) and Hanna Segal, had hypothesized the existence of unconscious phantasmatic activity or phantasies already identified by Freud, making them derive, however, from the introjective and projective dynamic that would have been present after birth. Instead for Fagioli fantasy is the child’s first psychic expression that manifests itself due to the onset of the pulsion as a reaction to the light stimulus after passing through the birth canal. Even before the relationship with the breast, emerges the fantasy, the disappearance fantasy which is an original creative activity quite distinct from the annulment pulsion which has an omnipotent and delusional character when it is directed against the inter-human relationship.
Fagioli’s clinical observations do not remain in the field of psychopathology and psychiatry but take on an anthropological character that concerns psychic activity, the mental functioning of all human beings. To the universality of the psychic processes of psychoanalysis, based on the inheritance of Oedipus or of phenomenological psychiatry that refers to the disembodied and abstract being of the Heiddegerian ontology, a concept appears in “Instinct of death and knowledge” according to which in the beginning of life it is the reaction to light that makes us human. Mental activity originates from the body considered as the original sphere of subjectivity, as the source of perception and unconscious fantasy.
- Blankenburg, W. (1998) La perdita dell’evidenza naturale, Milano: Cortina.
- Ballerini,A. (2012) Delia,Marta e Filippo, Schizofrenia e sindromi sub- apofaniche, Roma: Fioriti.
- Isaac, S. (2007) La fantasia inconscia, Roma:Il pensiero scientifico editore.
- Spitz, R., il no e il si, Armando, Roma, 1976. Premessa di Massimo Fagioli.
- Minkowski E. (1980) La schizofrenia, Verona: Bertani Editore.
- Segal H. (1996) Sogno, fantasia e arte, Milano: Cortina.
- Fagioli, M. (2009) Alcune note sulla percezione delirante e schizofrenica, Il sogno della farfalla, 3, 9-22.