In the last decades, a tsunami has been underway within nosography and psychiatric culture: for some authors, the term schizophrenia should be abolished as it is too “stigmatizing”. In August 2002, the Japanese Society of Psychiatry and Neurology proposed replacing the word schizophrenia with ‘Integration dysregulation syndrome’. In 2005 the Japanese Ministry of Health officially recognized the new name. In Hong Kong, a similar process is initiated. In 2012, the new name of ‘Atunement disorder’ was approved in South Korea. In 2016, psychiatrist van Os published an article with the unequivocal title: Schizophrenia does not exist. Is that so?
In 1971, Wolfgang Blankenburg’s Der Verlust der natürlichen Selbstverständlichkeit was published. The loss of common sense is investigated in paucisymptomatic schizophrenias, without reference to the etiopathogenesis of the disease. For Blankenburg the “basal” element of being schizophrenic should refer to the impairment of the relationship with oneself and with the world. Conscious intentionality for the German psychiatrist is to put reality in parentheses (epochè), in order to grasp the patient’s intentionality, intentionality of conscience, according to Husserl. “What am I really missing?” are the words of the patient Anne Rau, “Something Small, strange, something important, essential to live. At home, with my mother, humanly I was not there. I was not up to it. There, I was simply in that place, but without being present. […] I need a bond to guide me, without everything [being] artificial … […] I can’t do it myself. I lack the common sense. ” The psychiatrist captures the patient’s sense of emptiness, of estrangement, through his own feeling of estrangement. However, the patient commits suicide.
In Death Instinct and knowledge, written in 1971 and published in 1972, a clinical case of schizophrenia is described, within a psychotherapeutic relationship. Two opposing worlds collide: the sick one of the patient with the healthy and creative one of the therapist. In the relationship with the patient, the psychiatrist discovers the disappearance fantasy, realized through the annulment pulsion, which actually coincided with the absence of the therapist and, previously, on the occasion of the death of the father. Fagioli writes: “The unconscious, omnipotent annulment pulsion leads to: a) Internal hollowness and darkness; b) the negation and disappearance of the self because the external object is the projection of an internal condition of the self (identification with his father). Here it is the therapist’s intentionality to cure conscious and unconscious that allows to understand the verbal and non-verbal communications of the patient, to outline the history of his disease, to carry out the relationship, by interpreting the latent: at the death of his father the loss of his “base platform” or “fundamental identification”, resulting in an inner realization of hollowness and darkness. In the relationship with the therapist, the patient attempts suicide during a holiday by throwing himself out of a window, without success. Fagioli interprets this attempt, as repetition of the annulment, on the occasion of a suspension of therapy (holiday). The following pages that close the description of the case are impressive for the intensity of the human presence and the implacable lucidity of the psychiatrist, who actively intervenes like an operating surgeon. Therefore, the therapy continues, the omnipotence cracks, the patient rediscovers an unexpected affectivity and sexuality, together with an image of birth.
The unconscious intentionality of the severe psychiatric patient is faced with an absolutely opposite intentionality. Keeping in mind this intentionality, Fagioli pushes himself to theorize the cause of mental illness, due to the annulment pulsion directed against the human world. Abandoning the conscious approach to mental illness allows the therapist to get out of the blind alley of psychopathology, which brilliantly describes the clinic without investigating, beyond clinical evidence, the unconscious thought of the patient. ‘Seeing’ in the patient a destiny from which it is not possible to escape, whether due to organic alteration of the brain or a particular way of ‘being in the world’ (Dasein), could hide the impossibility of treatment behind an apparent suspension of judgment.
Fagioli, without preconception against the disease and the patient, besides the clinic of the loss of common sense, discovers and interprets the disappearance fantasy at the base of the patient’s hollowness, in order to realize the possibility of treating mental illness having the idea of a mind’s physiology. Hence, the mind can get sick in the relationship with the other human being in the first months of life, losing the common sense, the deepest feeling of one’s own humanity and that of others.
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