La folie en partage, avec Gaetano Benedetti

Abstract

ObjectivesGaetano Benedetti, a psychoanalyst of Italian origin, was Professor of psychiatry in Basel, having previously trained with Manfred Bleuler, Marguerite Sechehaye, Harry Stack Sullivan, and John N. Rosen, among others. His work, internationally recognised, essentially centres around the concept of markers, models and distinct notions to explain and support the psychotherapeutic relationship with schizophrenics. The originality of his approach lies in the nature of the commitment of the therapist, whose transferential and unconscious movements become tools enabling the therapist to gain access and work on transforming the delirious or autistic reality of his patient. MethodThe main clinical concepts that Beneditti elaborated will be set out here and illustrated with clinical examples, at the same time describing his itinerary as a clinician, and the many stumbling blocks. ResultThe stringency of Benedetti's conceptualisation is not designed to escape a demanding and difficult practice; on the contrary, it aims to engage beyond which orthodox practice allows. He conceived of tools for this purpose enabling reflection not so much on a technique as on a type of mind-set and a way of being/living with psychosis. The “positivisation” of psychopathology, for example, derives from a dual movement whereby the therapist recognises psychotic experiences as desperate attempts in the face of threatening collapse, without looking to confront them with the reality principle, but “partially identifying” with them, sometimes on the verge of “shared madness”, affording the patient's unconscious, as well as that of the therapist, the opportunity to find an “opening”. Patient and therapist elaborate together through shared associations; the therapist is able to supply “transforming images” which, together with “dualisation” and the effect of what Benedetti calls “the transitional subject”, enable a form of sharing, perhaps basic, but fundamental for a subject who can only survive in the most extreme withdrawal. Thus the therapist can, for example, recount his own dreams to the patient, if of course they are relevant, since they may solve conflicts in which the patient finds himself trapped. DiscussionMadness as conceived by Benedetti cannot be reduced to mere concepts, since its treatment requires the therapist to become involved subjectively and to share an essential experience with his patient. According to Benedetti, this sharing enables the joint elaboration of symbols, genuine psychic operators that have never been structured, or that the psychotic process has broken down. ConclusionBenedetti's analytical approach argues point by point against an investigative “archaeological” undertaking, drawing closer to a work of construction where commitment and involvement of the therapist aim essentially to meet with a subject that the psychosis has radically isolated. The on-going theoretical elaboration and the essential supervision offer precious and vital support to back up an approach that is often fraught with risk.