Neuropsychiatry of childhood and adolescence: the annulment of children and young people as psychic subjects.



The paper analyzes the current situation of Child and Adolescent Neuropsychiatry in Italy and discusses how this could be rethought, both in clinical and organizational terms, on the basis of the revolutionary conception of the child and of the human being proposed by Fagioli starting from the publication of Death instinct and knowledge.


The lack of distinction of children and adolescents between neurology and psychiatry appears to be the result not only of a historical-cultural residue, but also of a reductionistically organicistic approach. Even though there are Childhood and Adolescent Neuropsychiatry Services, the fact is that the Service leads towards neurology much more than psychiatry in terms of professionalism and offered services. This is also reflected in staff training who is mainly hired in a perspective of taking care of neurological diseases. Psychiatric aspects are only taken into consideration at a later stage, mainly at the age of 18 where, however, it is necessary to make the transition to adult psychiatry. Waiting so long before intervening has the consequence of facilitating the chronicity of the disease. (Copeland et al., 2021) This affects also psychiatric services for adults, accentuating their connotation of places for the management of chronicity and not places of treatment of the disease aimed at its healing. The marginality or lack of an idea of ​​care, is therefore clearly outlined.

What is the idea of ​​the child and adolescent that determines these movements?

While adults seem to be granted the right to specifically address their own mental health, at least in terms of dedicated public services, this is denied to children and young people. These in fact do not exist in terms of subjects with mental reality, they are the object of intervention but not the active subject. The examples, unfortunately, are numerous and will be analyzed in detail in this report, outlining an approach that is completely overturned by Fagioli’s idea of ​​a child with an “I (which) exists from birth and must develop” (Fagioli, Massimo, 1975).


The visible consequences of this general approach are that:

In child neuropsychiatry services, there is a disproportionate and often uncritical dedication to the production of certificates for the school of specific learning disabilities or to the issue of disability for italian law 104 (Zampella, Michele, 2021), determining a series of critical issues that will be explored in the report.

The child is the object (and never “subject”) on which we focus not as the one who has needs and requirements but as a problem, most of the time completely disrupting the environment in which the child grows up.

This means, for example, that resources dedicated to family care are not adequately thought of, while the place where the disease is formed is precisely in the family (Regione Emilia Romagna, 2017) (Regione Emilia Romagna, 2018). Overall, the result of all this is that we have arrived completely unprepared for the current Covid-19 pandemic emergency which is also clearly configured as a psychiatric emergency for adolescents (Racine et al., 2021). In the last 2 years with the pandemic and the imposed social life limitations (Soleterre Foundation, 2021) (COVID-19 Emergency Working Group, Presidency of the Council of Ministers, Department for family policies, 2021) there has been a dramatic increase in social withdrawal and life-threatening situations for adolescents (Loades et al., 2020). Several clinical examples will be presented in the report.

Currently there is a real emergency due to the significant increase in the number of children who arrive at clinical observation by presenting a structured suicidal ideation or following a suicide attempt (Dubé et al., 2021) (Regione Piemonte, 2020). Against this, there is a serious shortage of hospitalization points both in acute and sub-acute conditions (Italian Society of Hospital Pharmacy, 2016).


With the discovery of human birth, starting from Death instinct and knowledge, a total change of perspective takes place: the child never considered as a psychic subject is placed at the center of observation and seen as a subject who is born healthy and endowed with a sensitivity. (Fagioli, 2018) which exposes him to the psychic deficiencies of those who take care of him, making the problem linked to inter-human relationships evident. For the first time, the causative agent of the disease is highlighted: the annulment pulsion directed against the human reality of the child (Fagioli, 1972). This revolutionary approach makes a radical transformation in the psychiatric field in terms of diagnosis, therapy and prognosis possible even for the developmental age. Furthermore, it would allow a rethinking in terms of reorganization of the child neuropsychiatry services of our country in which the child and those who take care of him are not only offered a mere functional diagnosis with any related economic advantage, but a real offer of care that safeguards the psychophysical well-being and favors the growth and harmonious development of identity.