Good morning, everyone. Today I’d like to make a very short video about some issues that I think are being treated a bit too lightly. I’m obviously still talking about the field of psychiatry, specifically psychotherapy. I’m referring to the fact that we’re hearing more and more often from authoritative sources that psychologists must be defenders of human rights. It seems like a wonderful idea, but in my view, when we’re talking about treatment, these two things—rights and treatment—don’t always align. Let me give a few examples. First, the obvious one: cosmetic surgery. It’s clear that any young man or woman of legal age has every right to access cosmetic surgery. However, since we’re always talking about people who come to my office—obviously not people who freely seek out a cosmetic surgeon—if I see that there’s body dysmorphic disorder underlying it, that is, a psychological issue, I have a duty to address that and treat it regardless of what their rights may be. An even more obvious issue, in my opinion, is that of gender transitions, where if we consider ourselves defenders of rights, in my view, we lose sight of what our specific role is, which should be that of care. We are always talking about a person who comes to my office because today, in order to access gender transition, this diagnosis of gender dysphoria is required. Except that gender dysphoria is a completely conscious experience; that is, the person feels this incongruity between their gender and their biological sex and feels the need to realign things. So, however, I think that at that point, as a psychotherapist, rather than following what the manuals tell us—namely, that if there is this diagnosis of gender dysphoria, then once diagnosed by the psychotherapist, one gains access to treatment—many people today are saying, “But what can we do through the psychotherapist? Since the problem is no longer gender identity, it is no longer a mental health issue.” Okay? Now the point is this: if a patient, a person, comes to me in my office asking for this realignment, I believe I have an obligation to understand what underlying issue is there and whether it is appropriate to try to change the mind rather than the body; otherwise, I become a mere paper-pusher. That is, the moment this person comes to me and says, “I have gender dysphoria”—meaning, “I feel uncomfortable about these things”—I automatically make this diagnosis, and they have the opportunity to access treatment. To me, this narrow focus on defending rights seems truly misguided, because we lose sight of what our specific role is—namely, that we must identify what isn’t working. After that, I’m the first to support those who defend these people’s rights, to take to the streets and defend the rights of transgender individuals, for example. But I can’t confuse the two when this person comes to my office and I believe I have a duty to understand what their problem is. The other thing I wanted to talk to you about is this whole ADHD thing that’s being trumpeted from all sides these days—by now you’ve heard it in every possible way! Diagnoses are increasing exponentially, and there are authoritative scientists telling us that ADHD is due to a brain that functions differently, so we must treat ADHD, the person with ADHD, as different—it really is different in how it functions. Now, it’s clear that no one can think of going to “cure” someone who is different. The Nazis did that, in a way, but it would be a very violent act, obviously. But let’s try to consider instead whether this inattention, this impulsivity—in short, these symptoms that characterize ADHD—are actually due to an internal distress. And at that point, the argument flips: that is, we have a duty to treat it, and if we don’t treat it, we are being violent—so everything changes completely. Now, on these issues, I see there’s little debate—even regarding gender transition. Textbooks state that psychotherapy has had no effect on gender dysphoria, and this could be a great topic to delve deeper into the subject of psychotherapy, or rather psychotherapies, because as you probably know, the field of psychotherapy is by no means uniform today. Depending on which professional you see, you’ll receive a completely different response from another. And here we’re not talking about who’s better or worse—this obviously happens in all professions. No, no, just completely different approaches. Anyway, that’s just to give you some food for thought; if you let me know what you think, I’d appreciate it.
Marco Michelini
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