In recent years we have been witnessing something that, in my opinion, is extremely positive: a great number of young people are turning to psychotherapists. The taboo has collapsed, the idea that whoever goes to a psychologist is \u201ccrazy.\u201d Fortunately, that notion is gone, and now there are a lot of young people who go.<\/p>\n\n\n\n
However, my impression\u2014perhaps more than just an impression\u2014is that psychotherapy has lost its fundamental characteristic, namely that of being a treatment, and has instead become more of a support, an assistance. It is as if this daily bombardment we are subjected to, which tells us that everything related to mental disorders has an organic origin, has ended up relieving psychotherapists of responsibility. As a result, the real treatment is essentially carried out by medications.<\/p>\n\n\n\n
So, as long as it is about giving a bit of help to a young person who is somewhat in crisis, a chance to vent, things more or less work. But when we start talking about a somewhat more serious mental disorder, at that point it is as if everything is delegated to medications. For the most part, that is how it is.<\/p>\n\n\n\n
Then I know perfectly well that there are many colleagues\u2014many of whom I know personally\u2014who are very skilled, who carry out important therapeutic work and deal with serious pathologies. However, it is as if, culturally, they are no longer there. That is, the prevailing idea is that psychotherapy is understood as a kind of relationship\u2014I wouldn\u2019t say friendship, but almost\u2014that does not really affect or challenge a possible pathology.<\/p>\n\n\n\n
If we look, for example, in recent years there has been a huge recourse by young people to cosmetic surgery, and often it is the same cosmetic surgeons who send young people back home, saying, \u201cNo, look, you don\u2019t have any need to undergo cosmetic surgery.\u201d<\/p>\n\n\n\n
Now, I am not saying that this very large access to cosmetic surgery is due exclusively to the idea of an impossibility of acting on the mind, because there are certainly also cultural factors, but little by little it is emerging that the only thing that can really be changed is the body.<\/p>\n\n\n\n
Also look at another field which, in my opinion, is quite concerning: that of gender transitions. A few months ago I heard about a boy who, in Italy, underwent a gender transition at the age of 13, which means that his path had started at least a year earlier, at 12.<\/p>\n\n\n\n
Now, I am not going into the merits of that case. I do not know the case and I absolutely do not allow myself to make any evaluation, but I am making a point simply about consistency.<\/p>\n\n\n\n
Today, the WHO and all the diagnostic manuals tell us that the problem is no longer gender identity. In the past there was gender identity disorder; now we speak of dysphoria and incongruence. Let\u2019s try to bring a bit of clarity. The point is that between biological sex assigned at birth and the gender identity that the subject experiences, there must be no correlation whatsoever. Now, I am not going into the merits, I am not making judgments about this; I am simply limiting myself to observing what they say.<\/p>\n\n\n\n
So this gender identity is simply linked to how the subject experiences and lives their feeling of being male or female, their not being bound to the sex assigned at birth, the biological sex. And gender is not binary, male or female; we speak, in fact, of a spectrum. That is, there are many intermediate situations that are neither male nor female.<\/p>\n\n\n\n
Now, therefore, what they argue is that the problem is dysphoria, that is, that someone feels a discomfort in perceiving this discrepancy between biological sex and how they experience it. Okay? But this is therefore a psychological problem. At this point I am not going into whether I agree or not. I am not interested. I follow what these manuals tell us.<\/p>\n\n\n\n
But then, at this point, treating dysphoria\u2014that is, the distress\u2014should be the responsibility of the psychologist. Instead, it is said that, in order to access hormone treatment or to reach surgical intervention, the condition is that there be a diagnosis of gender dysphoria.<\/p>\n\n\n\n
So, at this point, I stop, I give up, but it really seems that one cannot change through psychotherapy. Moreover, you say that this gender identity can change over time, and then why do you perform an intervention on the body? I mean, it really seems to me an inconsistency, but beyond the inconsistency it at least shows an inability to have an impact, to intervene on an absolutely psychological aspect, which is precisely dysphoria, therefore this distress.<\/p>\n\n\n\n
But it seems to me that, essentially, we are witnessing a general de-responsibilization, starting from the psychologist-psychotherapist we were talking about, but which then somehow ends up involving all the agents around the potential patient, therefore parents, teachers, the socio-cultural context. By now, if there is some kind of distress, it is exclusively because there is a brain that is not functioning.<\/p>\n\n\n\n
Now, if we look at it, the most evident situation\u2014or at least one of the most evident, not the only one\u2014is that of ADHD, which, among other things, does not really seem to me to be a diagnostic category in its own right, considering the comorbidity with which it presents itself. But, regardless of this, this whole ADHD story certainly has one positive aspect, namely that it has shown that there are young people who have problems. But from there everything then slips onto Ritalin; that is, the problem is precisely the brain functioning in a different way, so the psychotherapist has nothing else to do but find compensatory elements, find a way to help the young person adapt to this condition.<\/p>\n\n\n\n
And therefore teachers have nothing to do with it, parents have nothing to do with it, the psychotherapist has nothing to do with it because they must only\u2026 at one time people used to say, \u201ctie the donkey where the owner wants,\u201d in short, basically they must do nothing. Society does not question itself in the slightest because everything is fine as it is, and the young person is a bearer of a problem.<\/p>\n\n\n\n
Then, I remember that at school, with certain teachers, I had an ADHD loaded to the hilt, only to then be cured maybe in the following hour when I had another teacher with whom I managed to get along well. Now, jokes aside, it really seems to me that we are getting to a point where we completely lose sight of the individual, of what they want to say.<\/p>\n\n\n\n
Also this whole issue of transition, where one could have an extremely interesting discussion about how perhaps behind it there is the idea of putting patriarchy into crisis, heterosexuality which is often only masturbatory, not to say violent, and so on\u2014however everything is resolved, in my opinion, with a certain lightness; if I say stupidity, will someone get offended? I don\u2019t know.<\/p>\n\n\n\n
Then the other point is that everything is genetic. But if instead we look at what epigenetics itself tells us, namely that these genes, in order to be activated, need certain environmental conditions, just like vulnerability. This should give even more centrality to psychotherapy, because what matters is not so much that there are certain genes\u2014which in the end do not say much\u2014but rather to see how much and in what way there is a certain environmental context that can activate them or not. That is why we speak of genetic predisposition\u2026<\/p>\n\n\n\n
And so I would invite all colleagues to get to work, to begin to take back the centrality of the individual, to start putting forward again this idea that distress, mental disorder, is always linked to interpersonal relationships\u2014none of this other stuff! And of course it is difficult; in a time like this it is easier to keep quiet, do one\u2019s work in one\u2019s office, and that\u2019s it.<\/p>\n\n\n\n
But it also seems unfair to me toward many young people who are trying to find a way out of their problems, because these problems speak of something that is not right, they speak of a violence. We really cannot become Americanized in this way, especially in a time like this when it does not seem to me that they are exactly setting a good example. Anyway, that\u2019s how things are now.<\/p>\n\n\n\n
And I believe instead that we, psychotherapists, should do much more, perhaps study more, commit ourselves more, but take responsibility for the patient ourselves\u2014not think that we are only there to accompany the medication.<\/p>\n\n\n\n
What do you think?<\/p>\n\n\n\n
Marco Michelini<\/p>\n","protected":false},"excerpt":{"rendered":"
In recent years we have been witnessing something that, in my opinion, is extremely positive: a great number of young people are turning to psychotherapists. The taboo has collapsed, the idea that whoever goes to a psychologist is \u201ccrazy.\u201d Fortunately, that notion is gone, and now there are a lot of young people who go. […]<\/p>\n","protected":false},"author":2,"featured_media":7797,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[4],"tags":[],"class_list":["post-7812","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog"],"acf":[],"yoast_head":"\n