What do or should we value in the treatment for psychotic individuals?

Even with the biological approach adopted by mainstream psychiatry, it seems necessary to revitalize interest in the use of psychotherapy in the treatment of psychosis. Supporting this idea,  there are compelling reasons. One of the most important of them is the failure of the utilization of the biological approach only in the treatment of psychosis. Thus, reducing the therapy of psychosis solely to the medical aspects of psychiatry implies imposing limits on the psychotic individual´s personal autonomy and choice. With all this in mind, we believed it interesting to reexamine the importance of the role of the therapist, and to reconsider the relevance of Arieti´s work to the treatment of psychosis.

Who was Silvano Arieti (1914-1981)? He was an Italian-born psychiatrist who became especially famous in the field of schizophrenia. He was an Italian Jew from Pisa. For that reason, after receiving his medical degree from the university of Pisa in 1938, he left Italy, where racist laws were already implemented, and emigrated to the United States. There, adopting a humanistic perspective and inspired by  psychoanalysis, he strongly challenged conventional approaches to the treatment of psychosis, from his first contact with psychotic patients at the age of 26 to his death at 67. His appreciation of psychosis, and his dedication to those who suffered from serious mental illness, reflects the value that Arieti placed upon the unique individual. As he noted, one becomes a person by virtue of relations with other human beings and not as a result of inborn instinctual drives. Developing an ethic of responsability to the mentally ill rather than an ethic of control, he learned that whatever benefit the patient could receive had to come from bonds created with a least one other human being. From this perspective, the conflict is not between instincts and culture, as in Freud, but between dependence and separation.

All said, in Arieti´s view, the psychotherapy of psychosis is compatible with medication treatment but not psychosurgery, a treatment responsible for causing permanent damage. His therapeutic optimism was always focused on the psychotic individual and was an inspiration for later therapists. With all, given the current state of scientific knowledge about this mental illness, each new discovery brings a new influence to bear on its approach and treatment. Giving voice to Arieti, himself, he stated:

A psychiatrist who does not want to be only a dispenser of drugs cannot avoid adventuring beyond the field of psychiatry. (…) But when the psychiatrist goes beyond psychiatry, he must do so as a psychiatrist, that is, by making good use of that immense patrimony of knowledge and feeling with which psychiatry has provided him.     

To conclude: I believe that Arieti would be gratified to know that his lifelong devotion to psychotic individuals is still remembered and revisited by those hungry for knowledge.

Francisco Balbuena Rivera
Department of Clinical, Experimental and Social Psychology, University of Huelva, Spain



The Relevance of Arieti’s Work in the Age of Medication.
Balbuena Rivera F
Am J Psychoanal. 2016 Sep


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