The psychotherapy of the schizophrenic patient: an interview with Dr. Silvano Arieti. Interview by Dr. Milton M. Berger.
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Biomedical subjects
Publications and source records attributed to S Arieti.
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The authors examine and evince the links between F.J. Gall's phrenology and Vincenzo Malacarne's studies of encephalous anatomy and mental disorders, especially in the ideas developed by the latter from 1760 to 1794. Malacarne came to believe in those years that mental disorders were organic in nature, being exhibited through alterations in the endocranium organs that could be anatomically detected and diagnosed by studying the patient's cranium. His correspondence with Bonnet enabled Malacarne to anticipate Gall in positing that the faculties of the intellect are congenital and those of the endocranium are organs consisting of individual parts each of which controls a specific intellectual activity. This in turn strengthened Malacarrne's conviction that the cranium's structure matched the development of its parts and led him to invent the cephalometer. Thus convinced of the compound nature of the endocranium's organs, Malacarne went on to develop Bonnet's thesis whereby the peculiarity of the nerve cells and their interaction were assigned a central role in intellectual activities. Yet, despite the evident fact that Malacarne attributed to the cerebellum functions proper to the brain, the points at which his and Gall's ideas overlapped were such as to make ambiguous the former's violent polemics against the latter. Many of the cricticisms he directed at Gall seemed to be dictated by Malacarne's desire to side with Napoleon's and the Catholic Church's condemnation of the former. Others showed that Malacarne wove together personal motives, especially irritation over Gall's outright rejection of his Encefalotomia and scientifically well-grounded criticism of Gall's erroneous ideas concerning the substance of the cortex and the latter's links to nerves, to name the most prominent of many such errors. Even more damaging was Malacarne's unfounded allegation that Gall had less than a thorough grasp of anatomy in that it led the Italian medical establishment to view phrenology as a popular science for many decades thereafter.
In the second half of the 19th century and up to the first two decades of the 20th century a new school of thought about two fundamental trends began and gradually developed; firstly anthropology and secondly the findings of Linneo and Buffon in the 18th century. Consequently, in the field of anthropology and the science of human constitutions, one notes the importance of a chapter which hitherto has remained rather unclear; anthropologic and ethnic psychology which made use of certain experimental data which were increasingly available in various research laboratories. The Italian Giuseppe Sergi, the Frenchman Giuseppe Arturo Visconte di Govineau, the German Guglielmo Wundt and others added their remarkable contributions to this new field of study.
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On the basis of the intensive psychotherapy of about 40 depressed patients over the course of two decades, the authors describe three premorbid types of depressive personality: 1) one based on a "dominant other" relationship, 2) one based on a "dominant goal," and 3) one that is a form of character structure or personality disorder. They also describe typical childhood experiences of depressive adults and discuss their theory of the nature of depression as a human experience. They characterize depression as a limitation of alternate ways of thinking and as self-inhibition from new experiences.
Since the pioneer contributions were made, approximately three decades ago, psychotherapy of schizophrenia has reached a level of development at which basic principles can be formulated, some procedures have been refined or revised, and new ones added. The author outlines these basic principles and describes new or revised techniques during the different stages of treatment. Finally, he reevaluates the role of the family in psychodynamics and in the therapeutic task.
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After having differentiated phobias from pseudophobias, the author describes the three stages in the psychodynamics of this psychoneurotic condition. A case is reported in detail and interpretations offered. The new hypothesis is advanced that the unconscious motivation and the defenses go beyond the individual protection of the patient. Psychotherapy is discussed.
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Even severely depressed patients respond to psychotherapy. A knowledge of the psychodynamic patterns of the life of depressed patients is required for effective therapy. The psychodynamics and main psychotherapeutic procedures for the treatment of two common types of severe depression are described.
The author discusses his clinical experiences in treating severly depressed patients with psychotherapy. The psychotically depressed person cannot use normal mechanisms to recuperate from sadness because he is prevented from doing so by a preexisting life ideology that may include living for a dominant other or a dominant goal and that restricts his vision of alternative approaches to living. The therapist treating the severely depressed must initially assume a strong role; later, he helps the patient recognize depressive cognitive patterns and guides and motivates him to try other ways of living.
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