In recent years we have been witnessing something that I believe is extremely positive, namely that a great many young people are turning to psychotherapists. The taboo that anyone who goes to a psychologist is mad has been shattered. Fortunately, that notion is a thing of the past and now there are loads of young people who go.
However, my feeling – and it is perhaps more than just a feeling – is that psychotherapy has lost its fundamental characteristic, namely that of therapy, and has instead become more of a form of support or assistance. It is as though the daily barrage we are subjected to, which tells us that everything to do with mental health issues has an organic origin, has ended up absolving psychotherapists of responsibility, so that the actual treatment, the real one, is essentially done by medication. So, as long as it’s a bit of a helping hand for a young person going through a bit of a crisis, a way to let off steam, things are fine. But if we start talking about a slightly more serious mental disorder, at that point it’s as if everything is left to medication. For the most part, that’s how it is. Then I know perfectly well that there are many colleagues – I know a great many of them personally – who are excellent, who provide significant treatment, who deal with serious conditions, but it is as if they no longer exist in the cultural consciousness. That is to say, the idea is that of psychotherapy understood as a relationship – I don’t mean friendship, but almost; one that does not undermine whatever condition may be present.
If we look, for example, in recent years there has been a huge surge in young people turning to cosmetic surgery, and often it is the cosmetic surgeons themselves who send the young people home, saying, ‘No, look, you really don’t need to have cosmetic surgery’. Now, I’m not saying that this massive uptake of cosmetic surgery is solely due to the idea that it’s impossible to influence the mind, because there are certainly cultural factors too, but it’s gradually becoming clear that the only thing you can really change is the body.
Consider another area that I find quite worrying: gender transitions. A few months ago, I heard about a young man in Italy who underwent gender transition at the age of 13, which means his journey had begun at least a year earlier, at the age of 12. Now, I’m not going to comment on the merits of that case. I am not familiar with the case and I would not presume to judge it in the slightest, but I am simply raising the issue of consistency. Now the WHO and all the diagnostic manuals tell us that the problem is no longer gender identity. There used to be gender identity disorder; now we talk about dysphoria and incongruence. Let’s try to clarify things a little. The point is that there need be no correlation between the biological sex assigned at birth and the gender identity that the individual experiences. Now, I’m not going into the details, I’m not passing judgement on this, I’m simply observing what they say. So this gender identity is simply linked to how the individual experiences and lives their sense of being male or female, and to the fact that they are not bound by the sex assigned at birth, the biological sex. And gender is not binary – male or female – but is described as a spectrum, in the sense that there are many intermediate situations that are neither male nor female. Now, therefore, what they argue is that the problem is dysphoria, that is, that someone feels a sense of unease at this discrepancy between their biological sex and how they experience it. OK? But this is therefore a psychological problem; at this point, I won’t go into whether I agree or not. I’m not interested. I’m following what these manuals tell us. But then, at this point, treating dysphoria – that is, the discomfort – should be the psychologist’s responsibility. Instead, it is said that in order to access hormone treatment or proceed to surgery, the condition is that there must be a diagnosis of gender dysphoria. So, at this point, I stop, I give up, but it really does seem that one cannot change through psychotherapy. Moreover, you say that this gender identity can change over time, so why perform surgery on the body? I mean, it really strikes me as an inconsistency, but beyond the inconsistency, it at least reveals an inability to influence, to intervene on an entirely psychological aspect, which is precisely that of dysphoria, and therefore this sense of unease.
But it seems to me that, essentially, we are witnessing a general shift away from taking responsibility, starting with the psychologist-psychotherapist we were discussing, but which then somehow involves all the people surrounding the potential patient – that is, parents, teachers, and the socio-cultural context. Nowadays, if someone is unwell, it is exclusively because the brain isn’t functioning properly.
Now, if we look at it, the most obvious situation – or at least one of the most obvious, not the only one – is that of ADHD, which, incidentally, doesn’t really strike me as a diagnostic category in its own right, given the comorbidity with which it presents. However, regardless of this, there is certainly a positive aspect to this whole ADHD business, which has at least shown that there are young people who have problems. But from there, everything slides into Ritalin; that is, the problem is precisely that the brain functions differently, so the psychotherapist need only find compensatory measures, find a way to help the child adapt to this situation of theirs, and so the teachers have nothing to do with it, the parents have nothing to do with it, the psychotherapist has nothing to do with it because they only have to… there used to be a saying, ‘tie the donkey where the master wants’, in short, he basically doesn’t have to do anything. Society doesn’t question itself in the slightest because everything is fine as it is and the child is the one with the problem. Well, I remember that at school, with certain teachers, I had ADHD in full force, only to ‘recover’ perhaps the very next lesson when I had another teacher with whom I got on well. Now, joking aside, but seriously, it seems to me that we’re reaching a point where we’re completely losing sight of the individual, of what they mean.
There’s also this whole discussion about transition, where one could make an extremely interesting point about how perhaps behind it all lies the idea of undermining patriarchy and a heterosexuality that is often merely masturbatory, not to mention violent and so on; yet everything is resolved, in my view, with a certain flippancy – if I say ‘stupidity’, will someone get angry? I don’t know.
Then there’s the other argument that everything is genetic. But if, instead, we look at what epigenetics itself tells us, namely that these genes need certain environmental conditions to be activated, just like vulnerability. This should place even greater emphasis on psychotherapy, because what matters is not so much that certain genes exist which ultimately mean nothing, but rather that what matters is seeing to what extent and how a particular environmental context can activate them rather than not, which is why we speak of genetic predisposition…
And so I would urge all my colleagues to get to work, to start restoring the centrality of the individual, to reiterate this point that feeling unwell, mental distress, is always linked to interpersonal relationships – no nonsense! It is clear that it is difficult; in times like these, it is better to keep quiet, do one’s work in one’s own practice and call it a day. But it also seems unfair to me towards so many young people who are looking for a way out of their problems, because these problems speak of something being wrong, they speak of violence. We really cannot Americanise ourselves in this way, especially at a time like this when I don’t think they’re exactly setting a good example! Oh well, anyway, that’s how it is now. And I believe that we psychotherapists, on the other hand, should be much more active and perhaps study more, commit ourselves more, but take responsibility for the patient ourselves. We shouldn’t think that we’re just there to accompany the medication.
What do you think?
Marco Michelini
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