SThe forms in which people’s discomfort manifests itself have changed, but what has changed a lot over the years is, above all, the way in which treatment is understood. And for Simona Argentieri, pivotal figure of Italian psychoanalysisit hasn’t changed for the better. To the cureto its idealizations, to its ambiguities, to the risk that it is reduced to a diagnosis-remedy short circuit, Argentieri dedicated The word that cures. Use and misuse of psychoanalysis todaypublished by La nave di Teseo, in collaboration with the Meyer Foundation of Florence, the latest gem in a series in which for the first time a hospital and a publishing house team up to dig up new perspectives.
Simona Argentieri, a life for care
Treat the person who suffersaccompanying her through the remoteness in which she built her personality without her future being determined but, on the contrary, starting from the past to design the future, it is the thread of Argentieri’s long career. Ordinary member and teacher of the Italian Association of Psychoanalysis and of the International Psycho-Analytical Association, she came to psychoanalysis from medicine and dedicated herself, at a very young age, to clinical activity which she combined with psychoanalytic teaching and scientific activity, as well as lively dissemination work.
He said, the forms of malaise have changed. Each generation seems to experience its own. Why? «Culture is a great producer of disease models, so more than on new diseases, on which there is a spasmodic attention in the media and equally in conferences, it is interesting to reflect on what forms the malaise must take in order to be listened to by the culture in which it is formed. If until a few decades ago the form of malaise was depression and, in the more recent past, panic attacks, today the so-called bipolar syndromes, eating disorders and post-traumatic stress syndrome dominate, alongside which gender dysphoria is taking place. I don’t believe there is this massive transformation of psychopathologies: what is transformed, instead, are the symptomatic manifestations, which conform to the models of suffering through which, in that historical moment, attention is awakened.”
The way of thinking of psychoanalysis
In particular, what is the focus on today?
«Attention today is concentrated on what has the characteristics of urgency, of emergency: only in this way do we seem to be able to be listened to. After all, if we pay attention, even on a social level, we tend to give the value of an epochal tragedy to any situation that worries us. But urgency, emergency is precisely the opposite of the psychoanalytic way of thinking.”
Do you think that urgency is also sought in the solutions to one’s suffering?
«Many people ask for the immediate removal of the symptom, without having to address the causes, often projecting the reasons for the discomfort onto others and the outside world. And here a triple collusion is at work. That of the culture of healthcare, that of the patient and also that of the therapists, who often hastily adapt to the most modern manuals, which only talk about symptoms, and organize themselves by symptoms. But the symptom – anxiety, eating too much or too little, sexual inhibition – is a wake-up call, a cry for help. Although I am far from young, I continue to do many clinical consultations. Most people come, sit down and already give me the diagnosis. “I’m anorexic” or “I’m gay”. So, first of all I have to say: can we try to understand – for example – what you mean by anorexic? What does he feel? What do you feel? What is his story?”.
Simona Argentieri, key figure of Italian psychoanalysis (©Basso CANNARSA/Opale.photo)
The choice of the shortest therapy
At the same time, the concept of care has changed. You write that treatment is being diluted in many less specific practices, just as the training of therapists is being diluted. On the other hand, there is no doubt that many patients today choose a type of therapy or therapist for convenience of time, ease of use, promise of results, reduced costs. In this confusion, who gains and who loses?
«Caring and curing are two very different things. I am a doctor by training and I came to psychoanalysis through psychiatry. Clearly, if you are a doctor, you have to take care of and take charge of the person in all their complexity. Curing, on the other hand, is a specific therapy, which aims at an internal change in the structure and at resuming an interrupted or distorted growth process. If a person suffers from an obsessive neurosis or a phobia, he cannot really feel better by eliminating the manifest aspects of the malaise without first understanding what that phobic anguish expresses. And understanding this takes time and effort. One or two meetings, perhaps first mediated by artificial intelligence, are not enough. We forget, however, that symptoms are not randomly created by the unconscious, but also have a defensive function. If the person can focus all his fears on the plane or the elevator, the rest of his life remains relatively free of anxiety. If we believe we can resolve the issue by eliminating only the behavior, the patient will force himself to get on the plane, but he will not be “cured” and the unconscious causes of the phobia will soon reveal themselves in new forms. Thus it happens that some patients, impatient with the length of years and the high weekly frequency of classical psychoanalysis, rely on less demanding psychotherapies. But since the problems are not resolved, they seek new therapeutic help, in a series of approaches that never address the pain points at the root.”
There is a change underway in the world of care: a push to find quick solutions to discomfort. Which however silences listening. And he deceives the patient (Getty)
More fragile personalities
What, therefore, should be the criteria for choosing between a classic analysis and reduced frequency psychotherapy?
«I don’t think that classical psychoanalysis is the only valid tool; indeed it is today intended for a minority of people. However, it remains essential to heal certain deep wounds. In other well-identified cases, a less frequent psychotherapy can be chosen: the important thing is to know that it is something else. In still other cases, episodic consultations may be indicated to address the problem.”
He writes: “For at least three generations, the conflict connected to growth and maturation has been loosened in the process of personal development. The result is personality structures that are more fluid and weak, less rigid, but also less equipped to control impulses – he writes in simple terms – “less guilt and more anger”, and narcissistic.
“If you try to ask a person: ‘But what could be their role in determining the situation that makes them unhappy?’, you often hear the answer: ‘What are you doing? Do you want to blame me?’ The patient rebels against being reminded of his co-responsibilities, of his unconscious collusions. Now I say something unpopular. I fear that currently there is a bit of complacency towards the patient, so as not to upset him, running the risk of interrupting the treatment. However, in this way we fail in our task of highlighting even the inconvenient or tiring truths.”
He also writes that many therapeutic energies are now used to resolve daily difficulties. Are we losing the courage to get involved, to look deeply at ourselves, to really want to change?
«There is a difference that must absolutely be made and respected, between what is a pathology and what is discontent or unhappiness with difficulties in life. The anguish of death, of illnesses, the difficulty of raising children, of being in a couple… These are not pathologies: they are life, and should not be the subject of therapy. First of all because, honestly, we therapists are no more equipped than anyone else with respect to this dimension. We are equal. It is different, obviously, if there are sick ways of dealing with these problems, but there must be, precisely, such conditions. The second reason why I say that this should not be the subject of therapy is that people must use their ego strengths to cope with these difficulties independently. And instead: “What should I do?” is the fateful question now permanently posed by the patient, which in my opinion we cannot and must not answer.”