The diagnosis of delusional perception opens the way to the psichoterapy


This work is inspired by an extended debate (1) held in Milan in the years 1962 and 1963 that became the first open discussion about “Psychotherapy problems”. Some of the most influential psychiatrists and clinicians of the time, active in psychotherapy practices and research, participated in this important debate.

From that debate emerged an interest in considering the doctor-patient relationship as the central core of the therapeutic relationship, in the case of severe mental illnesses.

From a psychodynamic point of view, the clinicians speculated on the psychopathological symptoms characteristic of schizophrenia that would reveal the unknown in the incomprehensible world of the patient – which is so very important to be understood in order to induce and dynamize the psychotherapeutic relationship.

However, both the residual idea of inevitability that still attributes the genesis of these diseases to organic causes and the influence of the current phenomenological and psychoanalytic approach still prevented a vision of the patient in his reality as a human being and in his transformative possibilities (1).

Forged by his personal clinical experience in psychiatric hospitals, the young Fagioli remarked the meaning of the so-called “creativity” of the schizophrenic, understood as the ability of the patient to create a non-existent world; at the same time, he attempted to bring the debate about the understanding of the psyche back to its deepest meaning.At the time, Massimo Fagioli had already written an article on delusional perception (2), soon to be followed by another article on “group insulin therapy and psychotherapy” (3), in which he presented his clinical researches and observations accumulated during his experience in Padua. In that context of direct relationship with the severely psychotic patients of the ward, he participated in an interesting experience of therapeutic community that he would further develop in the prestigious Kreuzlingen Clinic as a collaborator of the elderly Ludwig Binswanger.

The goal of this work is to understand the simultaneous progression of Dr. Fagioli’s discoveries, training, and practice (5-6-7), starting from his original intuition of delusional perception up to the years in which he wrote his first volume of Theory (4).

Fagioli was able to detect the unconscious features of simultaneity between perception and delusional attribution of meaning. On the other hand he focused on the intuitive possibility of the “praecoxghefuhl” (3), which helps the psychiatrist to understand the meaning of the symptomsin relation to the inner world of the patient.

All these initial discoveries eventually gave rise to a real revolution of the understanding of the mental illness(4-9-10-11). This revolution required a separation from the past, in particular from Freud’s psychoanalysis, which had held back the research on mental pathology and on its treatment for more than a century; it also required a separation from that millenary idea that defined mental illness as the “loss of reason” deliberately ignoring the unconscious reality and representing it as an invisible monster.

Fagioli embarked on his path with a new approach comparedto both that of classical psychopathology, which is held in check by the research on the organic cause of mental illness, and that of psychoanalysis, which is disinterested in the concept of cure and helpless in the face of psychosis. In fact, he perceived human reality as a dimension subject to continuous change that could therefore mutate through the psychotherapy (7), based on the therapist’s intuition of the existence in the patient of a lost physiological and healthy mental reality that can be found again.

The new methodology proposed by Fagioli involves a more complex research compared to that of conventional medicine. Starting from the medical identity, which allows us to acquire those basic concepts of health and illness of the mind necessary to find a treatment, we can see the thread of developing thoughts that will continue with the discoveries on human birth. By means of his sensitivity and affectivity capable of “seeing the invisible”, Fagioli imagined the evolutionary possibilities of the human being, and the transformation of psychic reality at the basis of the possibilities of treatment.

This approach does not bend, even for a moment, to the idea of ​​an organic origin of mental illness (6); instead, it immediately identifies the real cause in poor relationships, especially those experienced by the child in the first year of life. (4)

The intuition, never formulated before, about human birth physiology and thought formation, identify the newborn’s reaction to light as a determinant of the brain’s activation. This reaction results in the so named  disappearance fantasy that determine a cascade of events (12), common to the whole human species, that will be explained with a research that (Fagioli) will continue throughout his life (13-14), in parallel with his therapeutic practice.

This new conception of the “delusional perception” (15), proposing an idea of ​​accessibility of that phenomenon hitherto defined as incomprehensible that is the delusion of the schizophrenic, reveals the mental path leading to the creation of a non-existent world. A world that, in some way and despite its logical absurdity, preserves enough of human dimension to require and justify the psychotherapy intervention.



  • 1) Fagioli, F.(Ed.).(2001).Problemi di psicoterapia nel 1962-63: un dibattito. Il sogno della farfalla, 1, 25-99 (dalle relazioni in AA.VV., “Problemi di psicoterapia”, Atti del I e II Corso di Aggiornamento, Milano 1962-1963.
  • 2) Fagioli, M. (2009).Alcune idee sulla percezione delirante paranoicale e schizofrenica. Il sogno della farfalla, 3, 9-22.
  • 3) Fagioli, M.(2010). Insulinoterapia e psicoterapia di gruppo: valore psicoterapeutico del senso della schizofrenicità. Il sogno della farfalla, 1, 11-21.
  • 4) Fagioli, M.(2017). Istinto di morte e conoscenza (14th ed.). Roma: L’Asino d’oro.
  • 5) Armando, L. A. (1997). Storia della psicoanalisi in Italia dal 1971 al 1996. (2nd ed.)Roma: Nuove Edizioni Romane.
  • 6) Fagioli, F.(Ed.). (2002).Atti degli incontri di ricerca psichiatrica 2001. Roma. Nuove Edizioni Romane.
  • 7) Anzilotti, C.(2010). Psicoterapia di gruppo a Padova 1960-62. Il sogno della farfalla, 1, 5-10.
  • 8)Fagioli, F.(2005).Venticinque anni dopo. Interviste e scritti di Massimo Fagioli su “Lotta continua”. 1979-1981.Il sogno della farfalla, 1, 5-37.
  • 9) Fagioli, M. (2011).La marionetta ed il burattino (10th ed.). Roma: L’Asino d’oro.
  • 10) Fagioli, M. (2012). Teoria della nascita e castrazione umana (10th ed.). Roma: L’Asino d’oro.
  • 11) Fagioli, M. (2013).Bambino donna e trasformazione dell’uomo (8th ed.). Roma: L’Asino d’oro.
  • 12) Fagioli, M. (2019). Left 2016 2017. Roma: L’Asino d’oro.
  • 13) Fagioli, M.(2021). La psichiatria esiste?. Roma: L’Asino d’oro.
  • 14) Fagioli, M. (2021).La psicoterapia come psichiatria. Roma: L’Asino d’oro.
  • 15)Fagioli, M. (Ed.). (2003)Atti degli incontri di ricerca psichiatrica 1997, (2nd ed.) Roma: Nuove Edizioni Romane.