Although the separation of psychiatry from neurology in Italy dates back to 1976, it remains incomplete as concerns developmental years, with the current persistence a single specialization path, called “child neuro-psychiatry”, which is still dominated by neurological aspects over psychopathological-psychiatric ones.
Moreover, there are no developmental, age-specific psychiatry diagnostic manuals, nor developmentally-tailored description of major clinical conditions. Even in the most recent versions of generic ones (ICD-11 and DSM-5) (American Psychiatric Association, 2013) (World Health Organization, 2021 ) only a small section is devoted to the age of development, which contains some categorical diagnoses exclusively used in this age and different from those of adulthood (for example learning DS, ADHD, Autism …).
Therefore it is not an exception that the child / adolescent is attributed with going through temporary or parcel diagnoses that change over time, with the obvious consequence that classic psychopathological diagnoses, such as Depression or Schizophrenia, are relatively unrecognized.
However, it is well-known that clinical conditions such as depression do also emerge in developmental years yet, pending on the age, they are frequently coded through parcel diagnoses that differ from time to time (Zappella M., 2021).
In recent years, while on one hand there has been a greater interest in early diagnosis in the psychiatric field, on the other hand we seem to forget that depression or schizophrenia do not suddenly emerge out of the blue at 18 years, but rather result from many years of previous malaise which we should be able to recognize and correctly name. Only in this way can start the appropriate treatment and, by timely early action, the generative problem can be solved before the disease is completely structured or becomes chronic. Unfortunately, however, it is common that upon reaching major age, the institutional shift from child-adolescent to adult services happens abruptly leading to diagnostic changes.
This is the product of a major clinical-cultural gap: until today there is no “psychopathology” of the child and adolescent that is coherent and systematic, because, upstream, their “physiology” has not yet been conceived, as instead was proposed by Fagioli since 1971 (Fagioli, 1972).
The contemporary approach in child neuropsychiatry on the clinical and nosographic level is strongly conditioned by a series of historical prejudices towards the child, starting from the two conceptions of the “perverse polymorph” child and the “tabula rasa” child, which on closer inspection represent two sides of the same coin.
For example, the idea, absolutely without a scientific substrate, that the onset of psychiatric illness early in childhood necessarily implies the presence of organic aspects is the product of the “tabula rasa” ideology. The child would be a wax tablet on which the correct life coordinates must be imprinted. And it actually happens that the younger the person, the less cultural, social and “environmental” aspects are taken into consideration.
The fact that at the age of development rational thinking, verbal language and behavioral control (main characteristics of man according to the western “logos”) are less developed determines the prejudice that the child is not yet properly or completely human. He is thus alternatively considered a pure “angel” (that is, without a psyche, the idea of the tabula rasa) or a “devil” (the idea of the perverted polymorphic child).
The negation (negazione) of the child through the “angel / devil” split is echoed by its annulment (annullamento): the child or adolescent would not be human, but something else, a sort of “alien”.
From this background attitude discend many commonplaces on the differences between adults and children-adolescents, which are called into question especially when there are situations at the limit of psychosis. Thus it happens that neuropsychiatric professionals completely renounce to the attempt of understanding the motivations, emotions and affects behind that particular behavior if the person who carries it out is a child/adolescent.
Massimo Fagioli has repeatedly denounced what lies behind this approach in which the child is considered as a body, without psyche and psychic dynamics: “this stolidity then is anaffectivity (anaffettività), which is not strictly stupidity because the relationship with things, the relationship with reality is perfect, but there is no relationship with meaning, (with) the inter-human relationship ”(Fagioli, 2016). The lack of affect that is behind this attitude, which can become a real delusional perception, is dangerous, because it hides the cancellation of the human reality of the child himself (Fagioli, 2011).
The theory of birth discovers the presence of a healthy mental reality starting from birth, clarifies that the psychic dynamics of the child and the adult are fundamentally the same and makes it possible to apply psychopathological discernment even in developmental years, while obviously being aware of age differences . Psychopathology is always one. It provides tools that must necessarily be declined and adapted to the subject and the specific situation in order to formulate a correct diagnosis and treatment.
Just like for adults, these concern the clinical examination, the mental status, the psychopathological examination and a comprehensive family and medical history. All within the context of the specific developmental phases, as well as cultural, personal and gender differences.
Bibliography
- American Psychiatric Association. (2013). DSM-5.
- Fagioli, M. (1972). Istinto di morte e conoscenza (14th ed.). Roma: L’Asino d’oro.
- Fagioli, M. (2011). La marionetta e il burattino(10th ed.). Roma: L’Asino d’Oro.
- Fagioli, M. (2016). Materia energia pensiero. Lezioni 2011. Roma: L’Asino d’Oro.
- World Health Organization. (2021). ICD-11.
- Zampella , M. (2021). Bambini con l’etichetta. Dislessici, autistici, iperattivi: Cattive diagnosi ed esclusione. Milano: Feltrinelli Editore.
