In the early 1970s with the publication of Death Instinct and Knowledge (Fagioli, [1972]2019) came a new identity for doctors of the mind and an important change in the field of psychotherapy.The history of psychiatry began in 1773 when Weickard placed the word ′psyche‵ – akin to′soul‵ in meaning, but closer to earth – before the suffix ′-iatria‵, meaning healing, to form one term encompassing diagnosis, treatment and cure.Twenty years later, in 1793, a turning point came for the field of psychiatry when the physician Philippe Pinel released mentally ill patients from the chains which prevented them from moving their bodies. Pinel was a philanthropist, but he was primarily an innovator. Hebegan research in which he applied a rational scientific method and even suggested that ailments of the mind might be curable.This was the Age of Enlightenment and recovering the rational order of the mind was fundamental. However, after Pinel, the idea of curable mental illness faded. The internment of patients began with Esquirol, who talked of monomania.′Moral treatment‵, that is, treatment of the mind, was promoted through an authoritarian approach and rehabilitation. Psychiatric hospitals were considered ′tools of healing‵,including in their architectural appearance inspired by classical Tuscan rationalism. Esquirol suggested there was an analogy between dreams and delirium. The latter was considered the expression of irrational reality with the inevitable consequence of considering reason as the guarantor of sanity. The irrational and, hence, dreams were confined to madness. Gone completely, then, was any access to dreams, their meaning and their importance in the treatment of mental illness.Then, from the middle of the nineteenth century, the idea of brain deterioration was made widespread by Morel’s theory of degeneration: ′′[Anything that could not be explained was thus defined as deteriorated biology, whereby the organism disintegrated before physiological old age.]‵‵ (Fagioli, 2021, p. 51)This last concept reigned uncontested, having been taken up by Kraepelin, who differentiated dementia precox from manic depression. With Bleuler (1911), who ingeniously talked about spaltung as being at the core of schizophrenia, came the hope of understanding and treating severe diseases of the mind. He proposed the concept of an original psychic unity, but the idea of an organic root cause of the spaltung remained unshakeable.
In the twentieth century, phenomenology began to interpret mental illness as a way of being in the world and in Ludwig Binswanger’s work the various pathological manifestation swere interpreted as a form of failure, as a poor performance in human existence.However, the appeal and charm of this general line did not alter the fact that a cure was impossible. Binswanger describes this failure in The case of Ellen West (1944/2001), in which a young woman judged incurable is guided in a kind of assisted suicide by the very psychiatrists who should have been treating her.′′The analyst is absent;The patient experiences frustration.‵‵ (Fagioli, [1972] 2019, p. 15)Shedding light on the absence of a psychotherapist as the primary reason for the impossibility of a cure and for the patient’s malaise, Massimo Fagioli lays the foundation in his first book for training therapists, who must first resolve their own annulment pulsion. In Death Instinct and Knowledge (Fagioli, [1972] 2019) we are told of a severe case of psychosis in a patient who finds his birth and therefore is cured of his mental illness.Today’s therapists face a challenge: a new conception of psychotherapeutic treatment of psychosis requires training that can guarantee a new therapeutic identity.Treating to cure means drawing on the entirety of human reality, the psychotherapist’s sensitivity and affectivity: ′′[…] [there can be no research into the reality of the human mind without an intention to cure […] because the mind of a psychiatrist who’s intention is not to cure is unable to understand anything about the patient’s mind.]‵‵ (Fagioli, 2021)
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