Minkowski, in Schizophrenia following Bleuler and Kretschmer on the question of the differential diagnosis between schizophrenia and manic-depressive psychosis, underlines the importance of observing the patient’s attitude towards the environment.
Like Bleuler, he emphasizes the concepts of syntonicity, understood as the person’s ability, despite the symptoms, to remain in contact with the surrounding environment, and of schizoidicity, understood instead as a tendency to isolation.
Schizoidicity takes primary relevance in schizophrenia. Quoting Kretschmer, Minkowski examines the schizoid affective anesthesia and underlines that it isn’t a neurological illness because physical perceptions are not disturbed. What is compromised is the ability to experience the world. He states that the schizoidicity in schizophrenia leads to a loss of vital contact with reality that takes the patient not to feel the world around him. The “vital contact” with reality for M. depends on irrational factors. He notes that the irrational feeling of harmony with oneself and life determines the personal attitude towards the environment. In a schizophrenic subject, this irrational feeling is lacking: he knows only the rational antithesis of yes and no. He sinks into morbid rationalism, becoming rigid and abstract. Describing a schizophrenic patient, Minkowski observes that his attitude toward the environment somehow makes it a blank slate instead of trying to integrate with reality. In the chapter perspectives, M. then re-examines his formulation of “loss of vital contact” and states that we should speak of “break” of vital contact. He makes this reflection after having deepened the concept of spaltung as a phenomenon whereby the subject, unconsciously, mentally breaks something and sees only a part of it despite having it whole in front of his eyes. He underlines that spaltung is an active phenomenon. It is an activity performed by the patient, and it differs from notions such as dissociation or disintegration that are instead actions suffered by the patient.
- tries to investigate the unconscious causes of spaltung but is not satisfied with the theoretical models on the unconscious formulated up to then. Analyzing the formation of complexes based on repression, he says that spaltung is something else.
Massimo Fagioli, with Instinct of Death and Knowledge, between ’71 and ’72, introduces the concept of annulment pulsion, which we can define as a pathological unconscious psychic activity aimed to cancel the image of the human being with whom one is in a relationship.
With the notion of the annulment pulsion, we can reopen the search for what Minkowski was talking about when he spoke about making a blank slate of reality.
Fagioli affirms that the schizophrenic simplex lacks affectivity and eliminates the image of the human relationship. He explains the causes of this pathological activity by formulating a new theory on the functioning of unconscious reality. The lack of affectivity of which Fagioli speaks is a consequence of the annulment pulsion. It is not a simple feeling loss but an unconscious activity that eliminates feeling.
Minkowski affirmed that to evaluate syntonicity or schizoidicity, we have an infallible diagnostic tool: our affective sphere, our personality.
Fagioli appears on the same page, affirming that the psychotherapist must relate to the patient in a deep relationship with his own identity. He also states that the schizophrenic attitude is against the image of human relations and introduces a new tool in psychotherapy: the interpretation of the annulment pulsion.
The annulment pulsion that makes loss affectivity can highlight in the dream activity and the transference and interpreted consistently, session after session. If the psychotherapist can frustrate it and make it disappear, the patient will have the possibility of gradually transforming his internal image and his capacity to live inter-human relationships. According to Fagioli, the key to the therapeutic process is allowing the patient to realize, through separations made with fantasy-memory and not through identifications made through introjection, new images of himself, of the other, and the relationship.
Bibliografia
- Fagioli, M. (1972). Istinto di morte e conoscenza (1st). Roma: L’asino d’oro edizioni.
- Fagioli, M. (1974). La marionetta e il burattino (1st), Roma: L’asino d’oro edizioni.
- Minkowski, E. (1953). La schizophrénie. Paris: Desclée de Brouwer (trad. it. La schizofrenia: psicopatologia degli schizoidi e degli schizofrenici, Einaudi, Torino, 1998).
- Di Gianfrancesco, E., & Gianpà, A. (2016). Car l’homme est fait pour rechercher l’humain. Rileggere Eugène Minkowski. Il sogno della farfalla 3/2016, pp. 51-94.
