Psychiatry, constitutional law, and political power in a 60s TV debate (2020)

Masserman vs. Szasz

by Federico Soldani

It is surprising in my view, by today’s standards, how explicit some of the TV debates of the 60s could be; it is the case with this one about involuntary commitment and treatment, a topic unfortunately very popular with the 2020 coronavirus pandemic and lockdowns, in which “jurisdiction” of medicine vs. law was addressed openly.

The debaters in this case were psychiatrists Jules Masserman (pro involuntary commitment) and Thomas Szasz (against), moderated by Harold Visotsky, who was leaning on the side of Masserman.

Masserman, surely a giant in his field, had an obituary in the New York Times (like the other two by the way) but to this day has no Wikipedia entry for instance (while Szasz has a long one and in different languages); he is however listed as a past President of the American Psychiatric Association.

Before I watched this video, which I highly recommend in its entirety, I cannot recall ever running into any of the work by Masserman or into his very name, which appears largely forgotten by the field. Instead I have since found out that he wrote several noteworthy books, some with public relevance, such as “Psychiatric Consultations for Public Organizations: Principles and Practice” (1990) or “Social Psychiatry and World Accords” (1992, edited), among others.

After a cursory look at his work, I do not hesitate to say that some, if not most, of it appears central to several of today’s publicly debated problems.

One example is the study of altruistic behavior in primates, on whether a monkey thought there was another monkey on the other side of a screen and how behavior was affected in turn, which might be seen as a pioneering study related to empathic behavior. Ever more relevant today, in a society in which interactions are increasingly mediated by screens via digital technology. He and his colleagues found that “rhesus monkeys will consistently suffer hunger rather than secure food at the expense of electroshock to a conspecific”.

De Waal recently commented in a review of the scientific literature on the evolution of empathy:

“Perhaps the most compelling evidence for emotional contagion came from Wechkin et al. (1964) and Masserman et al. (1964), who found that monkeys refuse to pull a chain that delivers food to them if doing so delivers an electric shock to and triggers pain reactions in a companion.”

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The reason I am presenting here this TV debate in some detail, with a full transcript (emphasis added) and with significant selected frames from the video, is because in my view such debate touched in a relatively short time (less than thirty minutes) several crucial issues. And it did so in an explicit way that is difficult to find in current discussions around such topics.

In this prescient debate, most of the issues discussed nowadays in relation to the conflict of the scientific and medical discourses vs. citizens constitutional rights , for instance during the 2020 coronavirus pandemic, are touched upon: involuntary treatment, application of the concept of “patient”, psychiatric power to contain rulers in history (e.g., see current discussions about D. J. Trump), spread of infectious diseases (syphilis in this case, including its neurological manifestations and legal constitutional protection of someone who believes himself a “Napoleon” as a consequence of neuro-syphilis), the metaphor of society as an airplane and of who should make decisions about the pilot (a classic technocratic analogical argument), not to mention brief incursions into topics such as pollution, cannabis, LSD, etc.

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Below you can find: the video, form the (U.S.) National Library of Medicine; a selection of frames from the video with captions; and the full transcript (at times not entirely clear; emphasis added) as provided with the video by the NLM.

https://collections.nlm.nih.gov/catalog/nlm:nlmuid-8601041A-vid

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Selected frames with captions

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Transcript (emphasis added)

[A National Medical Audiovisual Center Production]

[Jules Masserman:] I’m Jules Masserman, Professor of Psychiatry at Northwestern University and President at the International Society for Social Psychiatry.

I do not believe that total abolition of hospitalization for serious behavior disorders, which is a term preferable to mental diseases, is at present either advisable or practical.

And I’ll try to clarify that position on psychiatric as well as legal and social grounds later in this discussion.

[Thomas Szasz:] I am Thomas Szasz, Professor of Psychiatry at the State University of New York in Syracuse.

My position is that involuntary mental hospitalization should be abolished.

[Harold Visotsky:] I’m Harold Visotsky.

I’m Professor and Chairman of the Department of Psychiatry at Northwestern Medical School, and as a former Director of the Illinois Department of Mental Health I’m interested in a broad discussion of this issue, and I will serve as the moderator for this discussion.

[Involuntary Hospitalization of the Psychiatric Patient: Should It Be Abolished?]

[Host:] Welcome to the exploration of concepts and controversies in modern medicine.

One of a series of programs dedicated to examining the uncertain, candidly recognizing that much of today’s teaching is necessarily based upon opinions and that the opinions of eminent physicians in a given field vary widely.

The National Medical Audiovisual Center believes that openly airing such opposing views is a basic responsibility of medical communications.

Dr. Harold Visotsky, Chairman, Department of Psychiatry at Northwestern Medical School, will act as moderator of this presentation.

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[Harold Visotsky:] We will be discussing the issue of whether any conditions justify involuntary commitment if a person is diagnosed as being mentally ill.

There is a point of view which holds that involuntary commitment is never justified, that only voluntary commitment is ever justified in a democratic society.

This point of view is supported on the basis of both libertarian views and the strong criticism of the quality as well as the intensity of mental health care and treatment in our mental institution.

When this is applied to harmless and eccentric- acting individuals or peculiar-acting individuals in our society, we can see that this position can be strongly supported.

However when we see individuals who are clearly violent in their intent and in their propensity, and we see suicidal persons and patients in catatonic immobility, what does society have to do in order to safeguard their health and the health of society?

And so involuntary commitment may be justifiable, under what conditions, and in this discussion we would like to cover all of these areas.

The second point involves the consideration of confining individuals against their will because of undesirable activities and the role that predictability are, ability to predict their acting out has in involuntary commitment.

I should like to start this discussion with the presentation of the view of Dr. Szasz.

[Thomas Szasz:] Well, I think I can best present my reasoning, which urges abolition of all involuntary mental hospitalization and treatment by first citing a quite typical example of it from the popular press for the kind of circumstance which is considered to be justified and then enumerating my reasoning.

So I will quote very briefly from last week’s Time magazine, which relates to the story of a 62-year-old prominent attorney whose name need not be mentioned, a graduate of the Harvard Law School, an official of the United Church of Christ, who boarded an airplane from Boston to Washington and with a broad grin asked the stewardess, “How long does it take to Cuba?” He was hauled off the plane and then he was not sufficiently contrite.

I quote, one of the police officers told him, “You be careful of what you say or we’ll send you to a state insane asylum for a 30-day examination.”

End of quote.

Now I consider this a typical example of the way psychiatry, institutional psychiatry, is used not in a useful way.

If this man had not been as prominent as he was, he may very well have ended up in a psychiatric hospital.

Now the theoretical underpinnings of my position… first, I contend that psychiatry–and I distinguish sharply between psychiatry and neurology–neurology deals with disease of the brain.

I contend that what we now call psychiatry deals not with any kind of disease, but with human conflict or what I have sometimes called problems in living.

It deals, as Dr. Visotsky already alluded to for example, with people who behave deviantly or violently.

Now that’s, what we call violent behavior actually is conflict.

Somebody does not like, the violence.

Secondly, it is my opinion that confronted with an individual, and I don’t think we should call such an individual “a patient” too readily, because the word “patient” implies that the person is sick and perhaps needs medical treatment.

In my opinion he is not a patient, he’s a person, an individual who feels troubled.

Thirdly, then, we come to the issue that commitment, as presently practiced and as historically justified, has been supported by a very ambiguous and confusing dual justification, namely, that it helps the individual, for example if he is suicidal, by preserving his life, I’ll come back to this, and it also helps society by protecting society from unpleasant or harmful so-called mental patients.

Now I contend that these two functions have nothing in common and must be separated.

Helping an individual must, in my opinion, in a free society, always be free and contractual.

Whereas protecting society is very eminently a legitimate function of society, but must in my opinion be exercised under the rubric of the law and due process, and never under the rubric of medicine or science or mental health.

In short then, taking a category of so-called mental patients, those about whom or with respect to whom involuntary interventions are perhaps most easily justified, namely the so-called violent patients, the Oswalds as it were, my view is that indeed violence is real, and a great many people in modern society who misbehave are nowadays called mentally ill.

What my view is, is that although their violence is real, this is not an illness, that in fact what we witness is the violence and uncivilized behavior of the mental patient being met by the violence, by the counter-violence in similarly uncivilized behavior of psychiatry, so that involuntary mental hospitalization is in effect a kind of counter-violence against sometimes violent so-called mental patients.

In sum, my view is that if individuals do not injure or threaten to injure others, help, medical psychiatric help should be offered to them.

But under no circumstances will it be justifiable to coerce them, to accept so-called help.

If they threaten or injure others or society, then they fall clearly in the class of those individuals for whom the criminal law and the sanctions are designed, and they should be restrained under the auspices of the criminal law and not of psychiatry.

[Harold Visotsky:] I think Dr. Masserman may want to discuss his aspects of this issue a little bit more broadly and perhaps to initiate the discussion of Dr. Szasz’s position, and I think we ought to get to it as soon as possible.

[Jules Masserman:] Thank you, Harold.

Tom, let’s make my discussion completely impersonal so that there’s nothing other than scientific issues between us.

We’re old friends.

We were trained together at the University of Chicago, I think at the beginning of the Pleistocene age as I remember it… and both at the university and at the Institute for Psychoanalysis, both sort of mavericks then, and I’ve followed your career with mixed feelings.

Mostly I must confess, a good deal of admiration for your courage and your honesty and putting your own position on the line for your beliefs.

I think a little bit of amusement because you take yourself so very seriously as a Jeremiah, sort of lecturing the sinning Israelites when most of us agree with you, actually, on very important issues.

I must also say that I’ve had a good deal of trepidation and some sorrow, because some of your extreme statements, I think impair your position, and in a sense make it more difficult to help those with serious behavior disorders or, uh, mental diseases and, you know, in fact impair some of our images more than necessary.

Now I don’t want to play antics with semantics…let’s clarify what we mean by mental diseases in the first place because you use the term.

I use behavior disorders.

Now in modern philosophy and modern science we don’t deal with things, we deal with processes, with interactions, with dynamics.

So when you talk about the mind, it isn’t a thing, it’s a process.

If you change it from a noun to a verb, what does it mean?

When we put our mind to something we perceive, we see, we hear, we feel.

You can say these are neurological processes and therefore are subject to the term of disease when they go awry, perfectly true.

But when we remind ourselves of something we use our memory.

We place it in a context of previous experience.

Now that experience can be highly distorted, don’t you see?

And it gets into the social sphere, the sphere of individual relationships with other people, and then finally when we mind our manners, or mind the laws, or mind society, or mind culture, this is certainly a social process.

And so when we talk about the mind we’re talking not only about physical but also about social relationships.

Now let me be a little bit more radical than you are.

I agree that there’s hardly something we call a mental disease in the back wards of any hospital, that somewhere in this world, in some other culture, would be considered not only normal but commendable.

A person in an epileptic fugue who sees visions might be a holy man somewhere.

A person who is a paranoiac is perfectly normal in a [?] society where everybody is suspicious of everybody else.

Somebody who we call exhibitionistic who would be considered perfectly normal in a nudist colony and if he tried to wear anything is would be considered obsessive-compulsive or what, now that’s perfectly true.

Then it’s a relative thing, but then what do we mean by disease?

Disease means that somebody is uneasy about something, which means that behavior is unpredictable.

Now this can be either individual or social.

And this clarifies the whole concept because an individual can be uneasy about organic disease, but he can also be exceedingly uneasy about his social relationships, he can be uneasy about his philosophy.

So we have existential anxiety, and they can be uneasy enough so they appeal for help and want it, and sometimes can be so uneasy they’re confused and anxious and depressed and sometimes suicidal and don’t know where to seek help and must be given it.

Now the society can be uneasy about these individuals also.

Society is uneasy about the same three categories: physical, social, and philosophic.

So society is uneasy about pollution, and about the spread of diseases, this is physical.

But society is also uneasy about individuals that transgress its cultural norms and this extends beyond crime.

Society is also uneasy about philosophy, so we go to the moon to settle our cosmology and we invent new religious systems to settle what we believe is values in life.

All of these can get so deviant that an individual must interact with society in certain ways so that both are protected.

Now let me give you examples.

Would you call epilepsy a disease?

It’s certainly a physical disease, isn’t it?

It’s deviations in electroencephalogram.

It’s treated by drugs.

You can find lesions in the brain in some cases, and so on.

But that’s also a social disease. Would you want to drive with an epileptic bus driver?

Would you like to have an epileptic pilot fly a plane?

Now who’s going to judge that? A lawyer? Or a judge?

We’ve got to have a psychiatrist say that this individual must be regulated because a psychiatrist has special information both on the physical and on the social planes as to what the interaction can be.

What would you judge about the general paretic, for example?

Can a lawyer diagnose that?

Is it simply a question of some neurologist saying “disease of the brain”?

We must also judge as to what his behavior can be social-wise.

I wish we had psychiatrists at the time, shall we say, of Frederick the Great, who was a paretic.

We could have saved an awful lot of trouble. Or Genghis Khan who may have been a paretic.

But if psychiatrists had judged that these people should have been put under regulation, despite the laws that they themselves passed, a great deal of human sorrow would have been saved.

And so while I agree with you, we must not use our position as determiner of men’s lives and liberty and so on, we still have special information and special training that do indicate when individuals need to be protected from themselves and society needs to be protected from them for mutual benefit.

And this sometimes does take medical and psychiatric as well as legal process.

[Harold Visotsky:] You know I can’t help hearing as I listen to both of you, a certain theme that comes through.

You, Jules, feel that if psychiatrists were around when Genghis Khan was around, or Frederick the Great, that they could have stopped the activity.

That was a political power decision, and I’m not quite sure that psychiatrists are as powerful as you would want them to be or as Tom fears that they are, and I think maybe this is the concept that we have to discuss.

There is one issue that I’d like to take up with you Tom, and that has to do with one of the statements that you said that if individuals threaten or injure others, they fall into the class of criminal law and should be handled by the criminal system.

You know, I am also in agreement with most of the concepts of how to deal humanely with individuals who are deviant or have problems or may be ill, by both their definition and ours.

But when we say that when individuals threaten or injure someone on the basis of illness or what might be deviant behavior, and then to put them into the criminal justice system which is an impure and imperfect system even for others, it seems like we’re doubling the stigma.

They have a clearly deviant pattern which whether we diagnose it as mental illness or society diagnoses as being crazy or queer, you then superimpose another kind of jurisdictional system, that of the criminal law.

And what do we do?

Do we, if they are guilty do we send them to jails, which are imperfect facilities?

You’ve equated jails with state hospitals, so it doesn’t matter.

You’re saying what society is saying: “Let’s get ’em out of here. Let’s extrude them.”

And whether we use a medical system to extrude them or a legal system, we’ll get ’em out. What are you saying?

[Thomas Szasz:] Well, of course it does matter.

We hardly have the time to do justice to this subject but the gist of my writings has been directed in the last two years toward explicating precisely the differences that ensue whether someone is dealt with as a potential mental patient or as a potential criminal.

First of all, if someone is dealt with under the criminal law, this doesn’t mean putting him in prison.

It may mean imposing a money fine on him or possibly imposing a suspended sentence on him.

[Harold Visotsky:] Or putting him in a hospital.

[Thomas Szasz:] Now my contention is that a hospital ought not to be used in lieu of a jail.

But I would like, just like to make one comment, one further comment on what you said Harold, because of course you are right in a historical sense.

Historically, psychiatry in many of the renamings of social problems as mental illnesses, has come into being in an effort to humanize, to liberalize harsh, uncivilized, penologic practices.

But you can’t, I believe you can’t correct one deficiency by erecting an illusory and sometimes equally harsh if not worse, system in place of it.

In other words, the whole tendency to say yes, jails are bad, therefore we should lock up people in mental hospitals, is all wrong.

Because then mental hospitals, A, mental hospitals will become just as bad.

B, what is lost in the process is the entire body built up over the last 700 years in English and American law of determining whether in fact someone is a criminal or not, or whether he has been falsely accused or whether there are mitigating circumstances…

[Jules Masserman:] But Tom, you just raised two issues that I think are very apropos.

In the first place, historically, psychiatrists such as Pinel, Escro, William Tuke, [?] in this country and so on, have liberated people.

They took chains off.

They didn’t put them on.

And modern hospitals do their best to get patients out as soon as possible.

I don’t know whether you’ve visited some of the modern hospitals recently.

I work with them all the time.

There are places that are rather attractive and hygienic and interested in getting people out, curing people, which means caring for them, it’s exactly the same root, as soon as possible.

So I wonder why you would equate hospitals with jails.

[Thomas Szasz:] Well, may I respond to this directly?

As you both know, it’s uh, if I may be allowed to explicate to this audience, my view is that Pinel did not liberate mental patients.

That all this kind of description in psychiatric history is pontification.

Pinel liberated mental patients like Jefferson liberated the negro.

He ran a more elegant plantation.

My essential thesis is that liberty, human liberty, is [?]

If you cannot leave a building, it’s a jail.

If you can’t leave a farm, if you are recaptured and put back to work, it doesn’t matter whether you have, if you eat 2,000 calories or 800, whether you have a decent house, if you can have your wife around you…it’s a plantation and you’re a slave.

And I am not talking about the improvement of mental health.

I’m not talking about doing away with abuses.

I am talking and analogizing involuntary hospitalization to involuntary servitude and analogizing treatments to contractual labor.

You either have contractual labor or you have slavery.

You either have voluntary treatment, or your hospitalization is involuntary.

How much nicer it is is not [?]

[Harold Visotsky:] As a matter of fact I’m not satisfied with the hospitals in Illinois.

I am concerned, if I were following your train of thought Tom, that what do you do with the patient who is suicidal and who’s made suicidal gestures?

Now I’ve had discussions with students of law and they say a man’s body is his own.

You know they follow Mill’s moral concept.

It may be that in a Pollyannaish way John Donne’s “No man is an island” is also a kind of moral concept.

What do you do with a man who is clearly suicidal?

Do you put him in jail? He’s breaking the law if he commits suicide, if he makes an attempt.

[Thomas Szasz:] Well, Harold, first of all you realize, I hope you realize, and I want to make this again very clear, we have slipped into a purely moral discourse.

Now whether or not suicide is or is not a permissible act or what kind of an act it is, has nothing to do as far as I can see with medicine or a psychiatry…

[Harold Visotsky:] Let’s see it as a conflict.

You deal with that as a conflict. A man has a conflict with his environment and he wishes to leave it by killing himself.

[Thomas Szasz:] One second.

The whole concept of a man being suicidal is psychiatric euphemism.

If a man wants to kill himself, how do you know it?

Does he tell you?

In what context does he tell you?

Secondly, my contention is and presumably this differs in a very radical way from the standard psychiatric view, is a purely moral, up to a person, like religion.

One person is Catholic, another one is Jewish.

My view is that suicide is an unqualified human right.

This is not to say that making a suicidal gesture by standing on the twentieth floor of a building in Manhattan is a human right.

That’s disturbing the peace.

[Jules Masserman:] Well in that case Tom, you would also say that alcoholism is a unqualified human right, that a person can deprive his wife and his children of a proper parenthood, that all sorts of things that really affect society rather deeply are human rights.

Now an alcoholic…let’s admit right away, the law is just about as crazy as some of the old psychiatric notions were.

For example in California, if you’re just found with a little marijuana on you, you get five years in jail.

LSD hasn’t gotten around to it yet.

And psychiatrists are put in a position really that are impossible.

For example, you can’t hang a man or electrocute him legally unless he’s found sane.

A psychiatrist can be called in by a lawyer, say, or by the governor, say, “Will you please certify this man as sane so we can electrocute him?”

The psychiatrist becomes the executioner.

There are all sorts of absolutely, if you will, insane things about it.

But on the other hand, suicide affects not only the individual, it affects many other people.

The person’s family, his children, his associates, his friends.

This is a social problem and cannot be left up to the judgment of the individual.

Well, let’s take another instance.

Let’s take general paresis.

Or you can say this syphilis of the brain, this is a disease, this belongs to neurologists and internists, not psychiatrists.

But suppose the general paretic is still infectious and he thinks he’s a Napoleon and he can go around and infect as many women as possible and he is a real social danger.

He doesn’t think he needs to be hospitalized and as a matter of fact, he can hire a lawyer to defend him.

Would you let such an individual, just because he has the advantage of the Constitution, free in society to infect women, to invoke this delusional system on other people, when as a matter of fact he’d be much better off in the long run, so would society, if he were treated under temporary involuntary commitment.

I would want my daughter to be treated so.

[Harold Visotsky:] You can see that we haven’t discussed this as broadly as we would have wanted to.

Rather we have opened the discussion which must go on not only here, and we will go on for the rest of the day I’m sure, but must go in with the members of the audience to look into themselves as to what role they want to play in this.

Do they want to follow a role in which the psychiatrists deals with those individuals who see themselves as being in conflict and having difficulties with society and come voluntarily to them?

Or do they feel that as some of us may feel that some individuals will not come to us, and through not coming to us may injure themselves or others or be in some sort of difficulty with the world around them.

This is a very important issue and can’t be debated.

I think it requires great understanding and broad discussion amongst all of us.

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[Host:] We thank Dr. Jules Masserman, Dr. Thomas Szasz, and Dr. Harold Visotsky for their interesting analysis of a critical problem in patient care.

In subsequent programs we shall continue to record equally significant concepts and controversies in modern medicine.

The opinions expressed on this program do not necessarily constitute endorsement by the Department of Health, Education, and Welfare, the Public Health Service or its constituents.

[Jules H. Masserman, M.D. Professor of Neurology and Psychiatry Co-Chairman of Psychiatry Northwestern University]

[Thomas S. Szasz, M.D. Professor of Psychiatry, State University of New York, Upstate Medical Center Syracuse, New York]

[Harold M. Vistosky, M.D., Professor and Chairman, Department of Psychiatry Northwestern University Medical School, Chicago, Illinois]

[The End V-1478 T-1478]

Se la psicologia politica si fa epidemiologia (2020)

di Federico Soldani

Su Political Psychology, una delle riviste professionali di riferimento nel settore della psicologia politica, due accademici americani hanno proposto nel decennio passato di “ampliare” (sic) il settore. Dal retroterra storico della disciplina, ovvero la psicologia sociale, a quello delle neuroscienze e della psichiatria (ma persino della endocrinologia e della genetica), aggiungendo che la metodologia principe da utilizzare per l’ampliamento della psicologia politica alle sfere medico-scientifiche ‘neuro’ e ‘psico’ dovrebbe diventare quella dell’epidemiologia.

Due parole su queste discipline. La psicologia politica applica le conoscenze acquisite attraverso la ricerca in psicologia alla comprensione dei fenomeni politici, quindi si puo’ affermare che psicologizzi la ricerca nell’ambito delle scienze politiche.

Al contrario, quando si parla di bio-politica (M. Foucault) o di psico-politica (termine di uso non comune e di incerta definizione, del quale proveremo ad occuparci in seguito data la sua problematicita’) si tende a fare un’operazione in un certo senso opposta, ovvero si politicizzano i provvedimenti e le pratiche che fanno riferimento alla salute fisica e/o mentale della popolazione.

Nel primo caso, quello della psicologia politica, si usa la visuale psicologica per studiare i fenomeni politici, sopratutto in un ambito di studio e ricerca.

Nel secondo caso, quello della biopolitica, si usa la visuale politica per studiare i fenomeni relativi a provvedimenti e pratiche per la salute fisica e/o mentale della popolazione.

L’epidemiologia invece e’ lo studio della distribuzione degli stati di salute e di malattia nella popolazione con lo scopo di misurarli (volgarmente “contare”), studiarne le cause a livello di popolazione (operazione diversa, per sorprendente che possa sembrare, dallo studio delle cause a livello dei singoli), e studiare interventi su queste possibili cause per modificare le distribuzioni studiate.

Il padre dell’epidemiologia e’ considerato John Snow, il quale studiando una mappa di Londra noto’ come i casi di colera si concentravano attorno ad una pompa dell’acqua nel distretto di Soho, tolta la maniglia alla quale i casi vennero contenuti.

Ai due studiosi americani che propongono di estendere i metodi dell’epidemiologia alla psicologia politica e alla tendenza di cui si fanno portatori, da alcuni nominata neuro-politica, hanno risposto studiosi svedesi evidenziando come si corra il rischio di portare a una “patologizzazione della politica”, che trasforma problemi politici in deviazioni biologiche.

Nel suo libro Psico-politica tra le due guerre (Palgrave, 2020), Freis afferma:

“Il tentativo psichiatrico di diagnosticare e trattare la societa’ puo’ far luce sulla storia politica del periodo tra le due guerre […]

Pur sottolineando la loro posizione non politica, i membri di queste professioni [psichiatria, ndr] non rinunciarono a dire la loro su come la società dovrebbe essere organizzata e amministrata.

Al contrario, una razionalità scientifica e tecnologica oggettiva e non partigiana appariva come una reale alternativa alla presunta miopia, emotività e interesse personale dei partiti politici. […] gli anni tra i due conflitti mondiali divennero il periodo di massimo splendore delle idee utopiche di “ingegneria sociale” e videro l’ascesa e la caduta della “tecnocrazia” – una nozione introdotta nel 1919 – come movimento organizzato.

La convinzione che la società dovesse essere rimodellata e i suoi problemi risolti razionalmente, oggettivamente e con mezzi tecnoscientifici uni’ esperti di diverse discipline dietro un’idea di politica antipolitica. In quanto influente “ideologia di fondo”, le idee tecnocratiche possono attraversare i confini tra i campi politici stabiliti e anche oltre i confini di una tradizionale definizione di politica.

In fatto di “politica non politica”, la medicina non si distingueva. Durante tutto il diciannovesimo secolo, i medici si erano allontanati con forza dalla sfera politica e insistevano sulla non partigianeria e autonomia della loro disciplina. Verso la fine del secolo, il rifiuto enfatico e la denigrazione di qualsiasi cosa fosse politica sempre più si accompagno’ a richieste di un’appropriazione di responsabilità politiche da parte di esperti medici.

Come ha mostrato lo storico Tobias Weidner, questi due filoni del discorso medico sulla politica erano due facce della stessa medaglia, poiché il ripudio medico della politica divenne il fulcro di un’agenda antipolitica che rifiutò la tradizionale politica dei partiti a favore di idee scientocratiche.”

Come usava dire il grande medico Rudolf Virchow “la politica è medicina su larga scala”.

Biologia ed emozioni per ‘bio’ e ‘psico’ politiche globali (2020)

di Federico Soldani

Per governare globalmente, ovvero su piu’ territori e popoli (un tempo si sarebbe forse detto imperialmente, essendo un impero il governo su piu’ territori e popoli) e’ piu’ facile agire su cio’ che ci accomuna tutti piuttosto che sulle differenze.

Chiunque abbia viaggiato sa quanto possano differire le culture, le tradizioni, le religioni, le istituzioni umane, sociali, economiche, giuridiche, politiche.

Per citare un episodio personale, ricordo che quando dovevo decidere tra studiare giurisprudenza o medicina all’universita’, un argomento che mi convinse per la seconda fu proprio quando mi si fece notare che se avessi voluto viaggiare per il mio lavoro, cosa che poi effettivamente ho fatto, avrei dovuto considerare come gli ordinamenti giuridici varino anche di molto nel mondo, per cui di fondo ciascun esperto legale e’ tale solo nel proprio paese di formazione (infatti si fa il diritto comparato tra diversi paesi), mentre un medico e’ tale sostanzialmente ovunque.

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Interessante notare anche come alcune istituzioni giuridiche vengano in nome dell’efficienza e della supposta maggiore aderenza alla realta’ sempre piu’ psicologizzate. Soprattutto adesso con la pandemia 2020 e la prolungata chiusura dei tribunali.

Si pensi agli avvocati che si stanno riqualificando come conciliatori (mediatori civili in Italia) e fanno corsi di psicologia per prepararsi a queste funzioni da svolgere fuori dalle corti di giustizia. Solo pochi decenni fa, questa istituzione del mediatore / conciliatore non esisteva in Italia, come mi hanno confermato amici avvocati. Con il 2020 in Italia si puo’ persino fare la mediazione digitale, per via cosiddetta telematica.

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A proposito della sempre maggiore enfasi nei mass media e media digitali sulla psicologia, e in particolare su emozioni e percezioni, invece che sul contenuto delle idee e sul pensiero razionale applicato al vivere civile: un esempio e’ il parlare sempre piu’ anche degli uomini come esseri “senzienti”, anziche’ “pensanti”, in questo modo accomunandoli agli altri animali (nel paragonare diverse specie, in psicologia e nella scienza del comportamento si parla di psicologia comparata e di etologia anche umana, in biologia e medicina si puo’ parlare di biologia o anatomia comparate).

Mi pare pertinente citare un libro dell’800 e un film californiano recente.

Si tratta di L’espressione delle emozioni nell’uomo e negli animali (in inglese: The Expression of the Emotions in Man and Animals, 1872) di Charles Darwin e del film della Pixar Inside Out (il titolo non e’ stato nemmeno tradotto nell’edizione italiana), vincitore del Premio Oscar per la sua categoria.

Dalla voce Wikipedia in italiano su L’espressione di Darwin (da cui le due immagini dell’articolo di paura umana e rabbia canina): “La problematica centrale del libro è, d’altra parte, se i movimenti dei muscoli facciali, quando siamo imbarazzati, tristi, adirati o sorpresi, siano acquisiti per apprendimento o innati. Darwin sostiene che tali emozioni visibili esteriormente sono diffuse in tutto il mondo e quindi innate, che anche altri organismi possiedono almeno alcune di queste emozioni e che determinati modi espressivi degli animali somigliano a quelli dell’uomo. Egli basa tra l’altro la sua argomentazione su osservazioni di informatori, che su sua richiesta descrissero le espressioni comportamentali dei cosiddetti “aborigeni” in regioni allora isolate:

«A proposito dell’uomo, sarebbe molto difficile trovare una spiegazione per certe espressioni, come il rizzarsi dei capelli sotto l’influenza di un terrore estremo, o lo scoprire i denti in un accesso di rabbia, se non ammettendo che un tempo l’uomo abbia vissuto in una condizione molto più bassa e più vicina a quella degli animali.»

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Il film d’animazione Inside Out del 2015 invece, ci fa vedere come i cinque protagonisti siano cinque emozioni con le quali si puo’ esprimere praticamente qualsiasi stato mentale. Una visione piuttosto standardizzata ma a mio avviso indicativa sotto il profilo culturale. Il film si avvalse di esperti in psicologia.

Dalla voce Wikipedia in italiano: “All’interno della mente di Riley Andersen, una ragazzina di undici anni che vive nel Minnesota, vivono cinque emozioni: Gioia, che garantisce la felicità alla ragazza; Disgusto, che si assicura che Riley non venga contaminata fisicamente e socialmente; Paura, che tiene Riley lontano dai pericoli; Rabbia, che impedisce che Riley subisca ingiustizie; Tristezza, il cui scopo non è chiaro.

Le cinque emozioni dirigono la mente di Riley all’interno di un quartier generale, agendo su una console piena di comandi. Ogni volta che un’emozione agisce quando Riley fa qualcosa, nasce un ricordo, dall’aspetto di una piccola sfera del colore dell’emozione che lo ha prodotto. La maggior parte dei ricordi viene spedita nella memoria a lungo termine alla fine di ogni giornata, mentre i ricordi più importanti, detti ricordi base, rimangono nel quartier generale, dove agiscono sulla mente della bambina definendone la personalità.”

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“Penso che Winston Churchill avesse assolutamente ragione quando ha detto che gli imperi del futuro sarebbero stati imperi della mente”, ha detto Boris Johnson, oggi premier britannico, in un discorso del 2016. “Nell’esprimere i nostri valori all’estero, credo che la Gran Bretagna globale sia una superpotenza del soft power”.

Somalia, a case of reserpine depression (2010)

by Federico Soldani

Italiano

(Originally published in March 2010 for the blog RCS – Rizzoli Corriere della Sera – OK La Salute Prima di Tutto. Original link no longer available)

In the summer of 1978 a student of the Somali National University of Mogadishu (Italy-Somalia cooperation was very active) who attended the Pharmacology course held by my father that year, knowing that the professor of the course was a doctor asked him if he could go to his home to visit his father.

In fact, the man had been in poor health for some time. In those years Somalia was at war with Ethiopia, the few doctors were busy treating the war wounded and it was therefore difficult to have health care in the area.

When he went to the student’s home, my father was immediately struck by the attitude of the patient who was curled up in a fetal position in a corner of a semi-dark room and who answered questions with difficulty and great effort. The patient appeared severely depressed, apathetic, dehydrated with a maximum blood pressure of less than 100 millimeters of mercury and an elevated heart rate (90-100 beats per minute).

The student reported that the man was suffering from chronic diarrhea – a common clinical condition in African countries – and from a state of emotional indifference that led him to give up a pilgrimage to Mecca sponsored by Saudi Arabia (charter flights departed regularly from Mogadishu).

The pilgrimage to Mecca is the fifth pillar of Islam and every Muslim has the obligation to go to Mecca at least once in their life, if their means allow it. The refusal of the father had particularly affected the boy who had requested the visit for this.

After ruling out any familiarity and possible causes of reactive depression, my father asked if the patient was undergoing therapy for other pathological conditions. After a while the student entered the room carrying a bottle of Serpasil® (reserpine), recommended by a doctor two years earlier following the finding of a hypertensive state (the drug is no longer indicated today). The patient had continued to take this drug without interruption and without further blood pressure checks, undergoing a state of so-called “reserpinization”, of which diarrhea and psychic depression were the most marked effects.

This state is similar to the reserpinization that is experimentally practiced in the laboratory to reset the sympathetic tone of the vegetative nervous system. Reserpine causes a depletion of substances such as nor-adrenaline, dopamine and serotonin in the synaptic granules of the nerve cells, the neurons, where the molecules necessary for the nerve cells to be able to communicate are accumulated: these substances are called neurotransmitters.

The therapy with reserpine was immediately interrupted: the patient had improved a month after the suspension, but had not yet resumed completely normal behavior. Meanwhile, the teaching period was over and my father returned to Italy, still wondering if the recovery was really complete.

L’ “immane trapasso”. Da fuori a dentro, l’anti-politica (2020)

Psichiatrizzazione della politica e Rivoluzione Globalista 

di Federico Soldani

Vi presento, accompagnata da tre citazioni del filosofo tedesco Hegel, dello scrittore inglese Aldous Huxley e del chimico svizzero che sintetizzo’ l’LSD Albert Hofmann, la nuova ipotesi su cui sto lavorando.

A mia conoscenza una simile ipotesi non e’ mai stata formulata in precedenza in questi termini semplici ma a mio avviso straordinariamente attuali. Altri autori e referenze rilevanti, per chi volesse segnalarmeli, sarebbero sicuramente graditi e utili.

La politica e’ un movimento da dentro a fuori, mentre l’anti-politica che vorrebbe sostituire alla politica il discorso tecnocratico, nelle varianti organicista / medica e spiritualista / mistica, e’ un movimento da fuori a dentro. Dalla polis alla psiche.

Ovvero l’anti-politica come una sostanziale e poderosa regressione della civilizzazione umana cosi’ come si e’ svolta storicamente sino ai nostri giorni.

Ci troviamo dunque, secondo la mia ipotesi di lavoro, in una fase di inversione dell’ “immane trapasso” hegeliano che ha comportato la creazione delle istituzioni politiche e giuridiche europee nel corso della storia.

L’ “immane trapasso” hegeliano da dentro a fuori: la politica.

Il movimento contemporaneo da fuori a dentro: la psichiatrizzazione della politica, ovvero l’anti-politica.

Quindi la medicalizzazione e la psicologizzazione della politica come strumenti privilegiati dalla tecnocrazia che sta attuando la Rivoluzione Globalista.

La medicina del comportamento e della psiche, ovvero la psichiatria, nasce infatti e in parte si sviluppa per altro proprio in ambito rivoluzionario, con personaggi quali Rush in America, Pinel in Francia, Bogdanov in Russia. Altro aspetto, quello dei rapporti storici tra psichiatria e rivoluzione politica, che sto studiando e che a mia conoscenza e’ ancora pressoche’ tutto da esplorare.

Il movimento anti-politico in atto ha anche un altro aspetto, apparentemente paradossale: la formazione di una psiche globale. Il focus del discorso pubblico e del linguaggio si sposta contemporaneamente sempre piu’ dentro / vicino al corpo e alla mente e allo stesso tempo “piu’ fuori” / lontano, ovvero assistiamo a psichiatrizzatione, globalizzazione digitale e conseguente scomparsa dei corpi intermedi sociali, economici e politici. 

In tre magnifiche citazioni che fanno capire, a mio avviso, piu’ di tante pagine.

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“Il vero pero’, di contro a questo vero involgentesi nella soggettivita’ del sentire e rappresentare, e’ l’immane trapasso dell’interno nell’esterno, dell’immaginazione della ragione nella realita’; al che ha lavorato l’intera storia del mondo, e grazie al quale lavoro l’umanita’ civilizzata ha conquistato la realta’ e la coscienza del razionale esserci , delle istituzioni dello stato e delle leggi”.

G. W. F. Hegel – Lineamenti di Filosofia del Diritto (1820) 

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“Il problema fondamentale della politica internazionale e’ psicologico.  

I problemi economici sono secondari e, se non fosse per i problemi psicologici non esisterebbero.  

Le buone intenzioni degli uomini di stato che desiderano la pace – e molti di loro neanche la desiderano – sono rese inefficaci dal loro coerente rifiuto di avere a che fare con la malattia-guerra alla sua fonte.  

Il tentativo di curare i sintomi, per esempio guerre dei dazi e armamenti, senza allo stesso tempo attaccare le cause psicologiche di questi sintomi, e’ un modo di procedere destinato al fallimento.  

Quale e’ l’uso di una conferenza per il disarmo o di una World Economic Conference fino a quando i popoli di ciascuna nazione sono incoraggiati deliberatamente dai loro leaders a indulgere in orge di solidarieta’ di gruppo basata su, e in combinazione con, l’auto-congratulazione e l’odio sprezzante per gli stranieri ?

Abbiamo bisogno piuttosto di una World Psychological Conference, alla quale esperti di propaganda decidano le culture emotive da permettere e incoraggiare in ciascuno stato e le mitologie e filosofie appropriate per accompagnare queste culture emotive.” 

Aldous Huxley – Oltre la Baia del Messico (1934)

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“I grandi problemi sociali, ecologici e di salute di oggi sono collegati alla doppia filosofia materialistica della vita che modella l’eta’ industriale. 

L’esperienza psichedelica produce spesso un cambiamento nella coscienza che porta a un’esperienza integrata tra umanità e natura, contribuendo a creare i prerequisiti intellettuali e culturali per il cambiamento necessario nel nostro mondo minacciato”

Albert Hofmann – Psychedelia Britannica (1997)

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Albert Hofmann

The “ultimate revolution” (2019)

The last revolution will be psychedelic and will involve drugs. The prophecy of Aldous Huxley

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by Giulio Lanza

Italiano

(Originally published on April 25, 2019 on l’Occidentale https://loccidentale.it/lultima-rivoluzione-sara-psichedelica-e-avra-a-che-fare-con-le-droghe-la-profezia-di-aldous-huxley/)

The modern age has been characterized by many revolutions: religious, political, social.

This process has been extensively studied and illustrated especially in the context of conservative critical thinking. Some, even if they are exhausted, remain vital in subsequent episodes, overlapping and mixing. For a long time, the revolutions, using a terminology of the schools that underline its unitary character, the Revolution – have affected nations and societies, to the point of touching the essence of man himself, with what we conventionally start in 1968 and that we can consider still in progress (anthropological revolution, also called fourth revolution).

On this front we must look with the utmost attention to the fact that we are facing a phase that Aldous Huxley (in the photo), author of Brave New World and The Doors of Perception, called the “ultimate revolution”, in which the role of drugs becomes central.

In recent years, in fact, we have witnessed the emergence of a pervasive propaganda in favor of the spread of drugs of abuse which, also depending on the substances in question, has been divided into more or less these phases:

  • harm reduction proposals, with or without legalization of all drugs;
  • proposals intended as a tool to improve the health of those who already use drugs and to fight the organized crime that produces and sells;
  • re-branding of drugs of abuse as medications, with simplistic marketing according to which if a substance can in some clinical conditions be used as a medication it would be good by definition, any use made of it (based on the assumption, medication = good);
  • active promotion of drugs of abuse, especially hallucinogens, such as LSD or psilocybin / magic mushrooms, a real marketing on mass media, for now mainly digital / online: this is the most recent phase and includes the promotion of substances that do not yet have a market, presented, through popularization articles of a heterogeneous nature – for example on shamanism and other “primitive” ecstatic techniques – as “micro-doses” (more or less micro) for the healthy, aimed at allegedly improving the functioning of the organism, or to the increase of creativity and even to the prevention of seasonal diseases such as the common cold: therefore truly as a panacea for everyone, young and old, sick or healthy. Real forms of fanaticism are manifested – above all but not only on the web – with regard to hallucinogenic substances presented as a source of well-being and even “illumination”.

In reality, marketing on the use of hallucinogenic substances is a hyper-modern phenomenon, sometimes mystified as a return to very ancient situations and primordial knowledge. An example is LSD, presented as equivalent to Ergot, from which it was synthesized in 1938. This type of claim must be subjected to evaluation and falsification considering: quality (eg, LSD), quantity (eg, proposed mass use), context of use (post-industrial society), method of use (eg, hypodermic needle for heroin, semi-synthetic substance; free base for smoked cocaine, etc.).

Between “ancient” use and “modern” use in many cases the difference is evident: for example, between chewing coca leaves (containing low doses of cocaine absorbed orally) in a culture that has integrated this use for centuries, on one side, and smoking the free base, crack, on the other; or between the use of smoked opium (containing morphine) on the one hand and intravenous injection of heroin, synthesized from morphine, on the other.

Or again, to understand the importance of contexts, think of the devastating introduction of alcohol into the Native American culture of whose tradition it was not part.

LSD – along with other hallucinogenic substances – is even part of a so-called cyberdelic (cyber + psychedelic) culture that combines the use of hallucinogens with personal computers, smartphones, video games, the internet and virtual reality.

In essence, from the proposal of a drug policy that presented itself as realistic, that is the containment of a non-extirpable evil, we are increasingly moving towards the promotion of a dystopian society, towards the marketing by those who produce online shamanism courses to learn how to use hallucinogenic drugs, once they will become available, either for therapeutic use (even for disorders with little distinct and entirely subjective connotations) or as a pastime.

Ultimately, the anthropological mutation of the individual cannot be separated from a mutation in the perception of reality.

Reality? Only a hallucination, one of many infinitely possible, which is increasingly presented as a construction – presumed arbitrary – of the mind, even literally as a hallucination.

Since a hallucination by definition is a subjective perception without an external object, or a false perception, in itself it presupposes a normality, a true perception, with a corresponding external object.

The presentation of consciousness as a hallucination, on the other hand, presupposes two things at the same time: that reality does not exist except as a false state of subjective consciousness and that consciousness as such is false, or relative, or infinitely changeable: therefore there would be no state of awareness that can be considered normal; or “normality” could not be other than an unconscious state, such as that of simple matter, including biological matter, cells, receptors, etc., just like inanimate matter or simple organisms.

If reality is nothing but a fiction of the mind, hallucinogenic substances that profoundly alter consciousness, thought, emotions, perceptions that inform us about both internal and surrounding reality, would be in this sense a way towards enlightenment on the deeper and lower reality of matter. They would make us aware of the more animal, instinctive, individual reality, unfiltered by all mental functions in continuous interaction with the natural, social, family, historical and cultural external environment of which each of us is the result. This is how the anthropological mutation of the “ultimate revolution” takes shape.

Aldous Huxley has not only described a “Brave New World” to us, but also a “new man”.

Aldous Huxley – The Ultimate Revolution (Berkeley Speech 1962)

Somalia, un caso di depressione da reserpina (2010)

di Federico Soldani

English

(Pubblicato originariamente nel marzo 2010 per il blog RCS – Rizzoli Corriere della Sera – OK La Salute Prima di Tutto. Link originale non più disponibile)

Nell’estate 1978 uno studente dell’Università Nazionale Somala di Mogadiscio (la cooperazione Italia-Somalia era molto attiva) che frequentava il corso di Farmacologia tenuto da mio padre quell’anno, sapendo che il professore del corso era un medico gli chiese se poteva recarsi a casa sua per visitare il padre. 

L’uomo infatti da qualche tempo versava in cattive condizioni di salute.  In quegli anni la Somalia era in guerra con l’Etiopia, i pochi medici erano impegnati a curare i feriti di guerra ed era quindi difficile disporre di assistenza sanitaria sul territorio.

Recatosi a casa dello studente, mio padre fu subito colpito dall’atteggiamento del paziente che se ne stava rannicchiato in posizione fetale in un angolo di una stanza semibuia e che rispondeva con difficoltà e grande fatica alle domande.  Il paziente appariva fortemente depresso, apatico, disidratato con pressione arteriosa massima inferiore a 100 millimetri di mercurio e frequenza cardiaca elevata (90-100 battiti al minuto). 

Lo studente riferì che l’uomo era affetto da diarrea cronica – condizione clinica frequente nei paesi africani – e da uno stato d’indifferenza affettiva che lo aveva portato a rinunciare a un pellegrinaggio a La Mecca sponsorizzato dall’Arabia Saudita (voli charter partivano regolarmente da Mogadiscio). 

Il pellegrinaggio a La Mecca è il quinto pilastro dell’Islam e ogni musulmano ha l’obbligo di recarsi a La Mecca almeno una volta nella vita, se i suoi mezzi lo consentono.  Il rifiuto del padre aveva particolarmente colpito il ragazzo che per questo aveva richiesto la visita.

Dopo aver escluso un’eventuale familiarità e possibili cause di depressione reattiva, mio padre chiese se il paziente avesse in corso una terapia per altre condizioni patologiche.  Dopo poco lo studente entrò nella stanza portando con se un flacone di Serpasil® (reserpina), consigliata da un medico due anni prima in seguito al riscontro di uno stato ipertensivo (il farmaco oggi non è più indicato).  Il paziente aveva continuato a prendere questo farmaco senza interruzione e senza ulteriori controlli della pressione arteriosa andando incontro a uno stato di cosiddetta “reserpinizzazione”, di cui la diarrea e la depressione psichica erano gli effetti più marcati.

Questo stato è simile alla reserpinizzazione che viene praticata sperimentalmente in laboratorio per azzerare il tono simpatico del sistema nervoso vegetativo.  La reserpina causa un impoverimento di sostanze quali nor-adrenalina, dopamina e serotonina nei granuli sinaptici delle cellule nervose, i neuroni, dove si accumulano le molecole necessarie affinché le cellule nervose siano in grado di comunicare: queste sostanze si chiamano neurotrasmettitori.

La terapia con reserpina venne subito interrotta: il paziente a un mese dalla sospensione era sì migliorato, ma non aveva ancora ripreso un comportamento del tutto normale.  Nel frattempo il periodo di insegnamento era finito e mio padre tornò in Italia, ancora con il dubbio se la ripresa fosse poi stata davvero completa.

Trump, i suoi peggiori critici e la diagnosi al di fuori di un contesto clinico (2020)

Opposti che giocano allo stesso gioco?

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di Federico Soldani

English

Qual è l’ultima cosa a cui un paziente costretto a essere ricoverato in ospedale per ragioni di salute mentale non può essere legalmente costretto?

Secondo i diversi contesti legali, con significative variazioni nazionali e statali, come ultima risorsa, un paziente può essere costretto al ricovero stesso, per osservazione o cura. Se necessario, anche il trattamento fisico per la salute mentale può diventare obbligatorio: farmaci o, più raramente, procedure come il trattamento elettro-convulsivo.

Tuttavia, i pazienti non possono essere costretti ad aprirsi contro la loro volontà, o a “confessare”, per usare un termine foucaultiano in un contesto clinico [1]. Ancor meno, nessuno può essere legalmente obbligato a fare psicoterapia. Alla fine, tali decisioni relative all’apertura rimangono una prerogativa di ogni paziente, indipendentemente dalle circostanze.

La collaborazione del paziente può essere raggiunta indirettamente, forse più facilmente in un contesto forense in cui i soggiorni sono molto più lunghi, ma in ultima analisi, se un paziente non vuole parlare o aprirsi non può essere costretto legalmente. A riprova di ciò, come già accennato, contrariamente a medicinali o dispositivi / procedure, i trattamenti psicologici non possono essere forniti come misure obbligatorie. Richiedono una collaborazione volontaria come prerequisito.

Anche nella fase in cui sono coinvolte solo l’osservazione, la valutazione del rischio e la diagnosi, prima che qualsiasi trattamento sia contemplato o deciso, un paziente è consapevole dell’ambiente clinico e può presentare ricorso contro il ricovero; o su una decisione clinica; oppure può prendere misure per chiedere di considerare altre diagnosi, se giustificato da una sintomatologia non ponderata in precedenza, ad esempio; oppure può adottare misure affinché la valutazione del rischio tenga conto delle proprie opinioni.

Le diagnosi psichiatriche si basano su un classico, e fino ad oggi considerato inequivocabilmente essenziale, colloquio faccia a faccia. Questo è in aggiunta alle precedenti cartelle cliniche e alla storia collaterale da terze parti. Più l’intervista è collaborativa e aperta, meglio è dal punto di vista diagnostico e prognostico.

In un contesto clinico, quando viene adottata l’opzione di ultima istanza del ricovero obbligatorio, la diagnosi e la valutazione del rischio possono avvenire dopo un colloquio faccia a faccia. Ad un certo livello il paziente può avere ancora voce in capitolo, anche se ricoverato involontariamente in ospedale per ragioni di salute mentale. Oltre a un senso di libertà di azione sul fatto che la collaborazione rimane una propria prerogativa, può effettivamente e in ogni circostanza decidere se collaborare, aprirsi, impegnarsi. O meno.

Ma cosa succede se il requisito di base per un colloquio faccia a faccia per la valutazione diventa obsoleto a seguito del progresso tecnologico e dei corrispondenti cambiamenti culturali?

E se, per esempio, potessimo diagnosticare e valutare il rischio non solo senza il consenso dei pazienti ma anche a loro insaputa? O ancora di più, senza che un cittadino sappia di essere, o di essere visto come, un paziente psichiatrico in primo luogo? E se tale processo diagnostico venisse accettato nel tempo come effettivamente più accurato di quello che coinvolge coscientemente e consapevolmente il paziente attraverso un classico colloquio clinico?

E se potessimo potenzialmente valutare e diagnosticare su scala di massa tutti i cittadini, trattati in questo modo non solo come pazienti, ma in realtà non avendo alcuna voce in questo processo? Che sarebbero effettivamente, per certi versi almeno, in una situazione anche peggiore di un paziente ricoverato involontariamente in ospedale?

Un cittadino che rimarrebbe inconsapevole del processo diagnostico, o che forse saprebbe con più o meno chiarezza che a livello di popolazione tale processo è potenzialmente in corso, ma non avrebbe scelta e nessuna voce in capitolo, forse a causa di presunte ragioni di sicurezza pubblica, sul suo caso specifico o su tale fenomeno collettivo, eminentemente politico?

Alcuni dei peggiori critici del 45° presidente degli Stati Uniti d’America, Donald .J. Trump, del cosiddetto movimento “Duty to Warn” (“Dovere di Allertare”), hanno sostenuto che la collaborazione del presidente non è necessaria per una diagnosi e forse ancora di più per una valutazione della pericolosità [2].

Secondo tale punto di vista, i fatti noti esistenti sarebbero sufficienti e offrirebbero effettivamente un quadro diagnostico più accurato rispetto a un colloquio psichiatrico standard, compreso uno per la valutazione del rischio. I sostenitori di tale punto di vista implicano, tra le altre cose, che un paziente potrebbe, ad esempio, mentire durante un colloquio; al contrario, fatti esistenti abbondanti e già documentati sarebbero difficili da cambiare opportunamente post-hoc qualora venga eseguita una valutazione psichiatrica.

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È un fatto in gran parte sconosciuto e dimenticato, che ho appreso di recente nelle mie letture storiche, che uno dei due fondatori del bolscevismo, insieme a Lenin, era il medico e psichiatra Alexander Bogdanov, all’anagrafe Malinovsky.

Lenin gioca a scacchi con Bogdanov durante una visita alla villa di Gorky a Capri, in Italia, nel 1908

Bogdanov scrisse la prima utopia bolscevica, “Stella Rossa”, e sviluppò una disciplina di organizzazione generale chiamata tectologia, che fu usata per la pianificazione economica quinquennale dell’URSS; la tectologia oggi è considerata un precursore della teoria dei sistemi e della cibernetica, il fondamento della rivoluzione dell’automazione in corso.

Mezzo secolo dopo la nascita dell’URSS, durante l’era Breznev, si diffuse la psichiatria politica: i dissidenti venivano diagnosticati e ricoverati contro la loro volontà, tipicamente etichettati come “schizofrenia sotto-soglia”.

Bogdanov ha avuto un ruolo di primo piano nella rivoluzione bolscevica. Nei suoi scritti ha chiarito come non ci fosse bisogno di garanzie legali per affrontare i “malati mentali”. In un passaggio notevole sull’organizzazione della società socialista, ha scritto:

“Quando la società cesserà di essere anarchica e si svilupperà nella forma armoniosa di un’organizzazione simmetrica, le contraddizioni vitali nel suo ambiente cesseranno di essere un fenomeno fondamentale e permanente e diventeranno parziali e casuali.
Le norme obbligatorie sono una sorta di “legge” nel senso che devono regolare i fenomeni ripetuti che derivano dalla struttura stessa della società; ovviamente con il nuovo sistema perderanno questo significato.

Le contraddizioni casuali e parziali in mezzo a un senso sociale altamente sviluppato e con una conoscenza altamente sviluppata possono essere facilmente superate senza l’ausilio di “leggi” speciali obbligatoriamente eseguite dall'”autorità”.

Ad esempio, se una persona con disturbi mentali minaccia un pericolo e un danno ad altri, non è necessario disporre di “leggi” e organi di “autorità” speciali per rimuovere tale contraddizione; gli insegnamenti della scienza sono sufficienti per indicare le misure con cui curare quella persona, e il senso sociale delle persone che lo circondano sarà sufficiente per prevenire qualsiasi esplosione di violenza da parte sua, applicandogli il minimo di violenza. Tutto il significato delle norme obbligatorie in una forma più elevata di società si perde.” [3]

Quindi, in una società altamente sviluppata e organizzata, la scienza ha la meglio sul diritto, rendendo il diritto non necessario; dal punto di vista di Bogdanov, la costrizione diventerebbe non più una vera costrizione. I dissidenti politici apparentemente non sono contemplati da tale visione; nel peggiore dei casi potrebbero qualificarsi come una “contraddizione parziale e casuale” in un sistema altrimenti armonioso “altamente sviluppato”.

Il filosofo Berdyev ha ricordato nelle sue memorie come Bodganov tendesse a non prestare molta attenzione al contenuto delle loro discussioni filosofiche. Invece, Bogdanov sembrava concentrarsi sullo stato mentale e sulla valutazione del comportamento, su azioni e reazioni, come se il suo collega filosofo Berdyev fosse una macchina biologica che necessita di osservazione esterna, controllo e possibile riparazione.

“In qualche modo curiosi erano i miei rapporti con Bogdanov” – scrive Berdyev – “Ero considerato un “idealista” intriso di ricerche metafisiche. Per Bogdanov questo era un fenomeno completamente anormale. Originariamente si era qualificato come psichiatra.

Cominciò a farmi visita spesso. Notai che mi poneva sistematicamente domande incomprensibili: come mi sentivo al mattino; come avevo dormito; quali erano state le mie reazioni a questo e quello e così via.

Emerse che la mia inclinazione verso l’idealismo e la metafisica, erano da lui considerate i sintomi di un disturbo mentale incipiente, e voleva stabilire fino a che punto questa malattia fosse progredita”. [4]

Dall’altra parte dello spettro politico rispetto a Bogdanov, c’era lo psichiatra tedesco Emil Kraepelin, ampiamente considerato la figura di maggior spicco nella storia della psichiatria biologica.

Fece la distinzione fondamentale, fino ad oggi ritenuta valida, tra “demenza precoce” (più o meno quella che chiamiamo schizofrenia) e psicosi maniaco-depressive.

Nella misura in cui non è richiesta un’intervista per la valutazione o la classificazione diagnostica in psichiatria, ciò potrebbe ricordare Kraepelin, che aveva lavorato in gran parte osservando e registrando il comportamento dei pazienti nel tempo. Infatti, non era in grado di parlare la lingua, l’estone, della maggior parte dei suoi pazienti quando lavorava sulla sua distinzione fondamentale.

Da notare, Kraepelin era anche un sostenitore dell’uso politico della psichiatria, poiché secondo le sue opinioni i socialisti e gli oppositori della prima guerra mondiale erano giudicati malati di mente. [5]

~~~

Al giorno d’oggi, all’inizio del decennio degli anni ’20, il linguaggio “contagioso” della psichiatria applicato alla politica potrebbe essere definito “psyspeak” (“psico-lingua”) o “lessico ideopatologico”, come ho recentemente proposto all’inizio di settembre 2019 durante una relazione tenuta al Royal College of Psychiatrists di Londra. [6]

L’ultimo esempio, tra i troppi per essere contato, è la rivista libertariana Reason che definisce le proposte politiche del candidato alle primarie presidenziali Sanders “deliri socialisti”. [7]

È interessante notare che l’idea di diagnosticare e valutare il rischio senza la partecipazione volontaria, il consenso o persino la conoscenza di qualcuno, forse inconsapevole anche del fatto stesso di essere visto come un “paziente”, viene ora ripresa dall’amministrazione Trump.

L’amministrazione di un presidente che dovrebbe essere contrario, almeno in teoria, ad alcuni degli stessi metodi proposti dai suoi critici per diagnosticarlo. Metodi che ha rifiutato per se stesso, figura politica eletta democraticamente; vale a dire, valutare e diagnosticare senza un colloquio necessario in un contesto clinico.

L’amministrazione Trump sta infatti prendendo seriamente in considerazione l’agenda della “diagnosi digitale” per i cittadini, forse attraverso una nuova agenzia federale che potrebbe andare sotto il nome di HARPA (Health Advanced Research Projects Agency), secondo tra le altre fonti il Washington Post.

Ritratto ufficiale del presidente Donald J. Trump, venerdì 6 ottobre 2017 (foto ufficiale della Casa Bianca di Shealah Craighead)

Secondo una copia della proposta, un’agenzia del genere svilupperebbe “tecnologie innovative con elevata specificità e sensibilità per la diagnosi precoce della violenza neuropsichiatrica”. “Una soluzione multi-modalità, insieme all’analisi dei dati in tempo reale, è necessaria per ottenere una diagnosi così accurata.” [8]

Inoltre, in qualche modo rilevante per tali tecnologie, la cosiddetta “fenotipizzazione digitale” [9] è attualmente una nuovissima area di ricerca e business. Ci sono start-up californiane dedicate, come quella dell’ex direttore del NIMH Thomas Insel (N.B.: il National Institute of Mental Health è il più grande centro di ricerche psichiatriche al mondo), uno psichiatra che ha studiato in modo prominente i modelli animali del cervello sociale, l’ansia di separazione e il ruolo di molecole come la vasopressina e l’ossitocina. Dopo quasi 15 anni come direttore del NIMH è andato a lavorare per Google, fondando in seguito la sua società per la “fenotipizzazione digitale”.

In un clima simile di progressi tecnologici, secondo le proposte di una nuova agenzia federale riportate dalla stampa, i fatti noti esistenti, codificati come dati, potrebbero essere utilizzati dal governo per diagnosticare i cittadini e prevedere il comportamento; valutare il rischio e la pericolosità tramite qualsiasi fonte di dati digitali disponibile, dagli smartphone, ai dispositivi per il benessere / fitness e così via.

Una volta inseriti i dati, il consenso e la collaborazione dei cittadini non sarebbero necessari per archiviare, replicare, conservare i dati e, cruciale, per eseguire una valutazione diagnostica o sul rischio.

Se, ad esempio, le persone potessero optare per essere escluse da tali database in primo luogo, individualmente o collettivamente, ciò vanificherebbe lo scopo di classificare, “taggare” o etichettare elettronicamente gli individui e prevederne patterns comportamentali rischiosi in base ad algoritmi e informazioni digitali disponibili.

Non sarebbe necessario il consenso o la conoscenza di una valutazione a distanza di questo tipo da parte dei cittadini-diventati-pazienti.

Tra i tanti aspri disaccordi in un paese polarizzato come mai prima d’ora, almeno su una questione Trump e i suoi peggiori critici sembrerebbero concordare a un certo livello: diagnosi e valutazione del rischio basate sul coinvolgimento conscio, consapevole, preferibilmente volontario di un soggetto che sa di essere un paziente, e che implichino un colloquio necessario in un contesto clinico, sembrano sempre più istituzioni appartenenti al passato.

Il rischio reale è politico e democratico. Ovvero che un tale nuovo contesto tecnico “clinico” si estenda a tutta la società, aggirando efficacemente i diritti e le garanzie legali e costituzionali dei cittadini.

~~~

[1] Foucault, M. (2003). Le pouvoir psychiatrique : cours au Collège de France, 1973-1974. Paris Seuil Gallimard.

‌[2] Gartner, J., Langford, A. and O’Brien, A. (2018). It is ethical to diagnose a public figure one has not personally examined. The British Journal of Psychiatry, [online] 213, pp.633–637. Available at: https://www.ncbi.nlm.nih.gov/pubmed/30236170.

[3] http://www.marxists.org. (n.d.). Socially Organised Society: Socialist Society by Alexander Bogdanov 1919. [online] Available at: https://www.marxists.org/archive/bogdanov/1919/socialism.htm [Accessed 27 Jun. 2020].

[4] White, J.D. (2019). Red Hamlet : the life and ideas of Alexander Bogdanov. Leiden ; Boston: Brill. 

[5] Bar, K.-J. and Ebert, A. (2010). Emil Kraepelin: A pioneer of scientific understanding of psychiatry and psychopharmacology. Indian Journal of Psychiatry, [online] 52, p.191. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2927892/.

[6] Soldani, F. (2019). Are we witnessing the emergence of a new global psychiatric power? (2019). [online] Foucault News. Available at: https://michel-foucault.com/2019/12/19/are-we-witnessing-the-emergence-of-a-new-global-psychiatric-power-2019/ [Accessed 27 Jun. 2020].

[7] Stossel, J. (2020). The Socialist Delusions of Bernie Sanders. [online] Reason.com. Available at: https://reason.com/2020/02/19/the-socialist-delusions-of-bernie-sanders/ [Accessed 27 Jun. 2020].

[8] Alemany, J. (2019). White House considers new project seeking links between mental health and violent behavior. [online] Washington Post. Available at: https://www.washingtonpost.com/politics/2019/08/22/white-house-considers-new-project-seeking-links-between-mental-health-violent-behavior/ [Accessed 27 Jun. 2020].

[9] Insel, T.R. (2018). Digital phenotyping: a global tool for psychiatry. World Psychiatry, [online] 17, pp.276–277. Available at: https://onlinelibrary.wiley.com/doi/full/10.1002/wps.20550 [Accessed 24 Apr. 2020].

Questo articolo era destinato al blog “Mad in America”, che lo ha richiesto, inizialmente accettato, e dopo l’ultima revisione e aggiunta della parte su Bogdanov, ha deciso infine di non pubblicarlo.

È stato pubblicato in modo indipendente dall’autore tramite social media il 15 marzo 2020 e pubblicato sul blog PsyPolitics.org il 27 giugno.

Joker: welcome to the era of global political psychiatry (2019)

by Giulio Lanza

Italiano

(Originally published on November 7, 2019 on l’Occidentale https://loccidentale.it/joker-benvenuti-nellera-della-psichiatria-politica-globale/)

A great success of public testified the popularity of Joker, the masterfully created Hollywood film presented for the first time last August 31 at the 76th Venice International Film Festival, where it was recognized as deserving of the highest prize, the Golden Lion.

A great cast, starting with the protagonist Joaquin Phoenix, of whom it is superfluous to highlight the amazing interpretation. Robert De Niro has a secondary role but of fundamental importance for the development of the story. Many scenes are inspired by Martin Scorsese’s films (e.g., “The King of Comedy”), such as when in “Taxi Driver” De Niro himself simulated talking to strangers while alone in his squalid room.

A soundtrack that is noticeable, powerful and full of low tones, both the original one (pieces like Confession or Call Me Joker), and made of old songs such as My Name Is Carnival, White Room, Smile, Everybody Plays the Fool, or pieces by Frank Sinatra such as That’s Life and Send in the Clowns.

The era in which the film takes place is unspecified, with elements of the 70s and 80s prevailing, but also elements of the so-called Gilded Age of American capitalism, at the beginning of the 20th century (also, at one point the film’s rich – the elite or establishment that openly attribute to their own merit the wealth and power obtained – are gathered in an old theater to see Chaplin’s “Modern Times”), when the differences between rich and poor became exorbitant: incidentally it was the era in which community psychiatry was conceived by industrialists who wanted to represent the problems of workers as medical issues rather than trade unions issues; before that time, psychiatry was limited to psychiatric hospitals and people did not go to see a psychiatrist in the clinic; before that time, the psychiatrist was associated not with the common person but only with the mad.

In the film, the “fathers” of Joker are two TV celebrities: Robert De Niro, TV presenter, and one of the richest men in the city, running for mayor, represented by the Gotham City media as the only one who can save a city in severe crisis and in full decline.

The mother has an Oedipal role that remains unspecified, partly because it is not possible to understand, even after the end of the film, whether hers were delusions or whether there was instead a plot by the rich man she worked for (the future candidate for mayor) in order to have her conveniently locked up in an asylum, even if healthy, by forging the papers.

Robert De Niro in this film is, for a change, perfect: he is a very famous American talk show host, cynical and in his own way wise at the same time. It is clear from one of the opening scenes that he is seen by Joker as the father he never had: while watching TV from the bed he sits on with his mother, Joker imagines that the TV celebrity would be willing to drop his own show and the entire sideshow, if he could have a kid like him in return.

Another important element is the relationship with a famous person in the film, who is perhaps the biological father of Joker, the super rich financier who wants to stand for mayor of Gotham (a nineteenth-century nickname for New York City, later reused in the Batman comics ), a dark city populated by super-rats, as the city news report in an almost amused way.

The political is represented as ruthless, cynical, indifferent to the suffering of the people: wealth and politics in the film are linked to each other.

Psychiatry, on the other hand, is represented as the last saving glimmer that bad politicians cut mercilessly for the poor of the city, who have little else left in addition to television: Joker takes 7 different drugs, all 7 presumably psychotropics. A de-medicalized psychiatry is presented to a certain extent in the film: a black social worker sees Joker once a week to listlessly ask him the same good-bureaucrat questions each time. Bad politics, good psychiatry.

The film manages to present itself as an almost philosophical or ideological work, taking advantage of the fact that madness and mental illness have been for decades, at least since the 1980s, represented as organic diseases like all the others, the brain a organ like all the others, psychiatry a medical specialty like any other.

Joker reveals itself as a surprising film, making us somehow rediscover – or at least reflect on – the largely psychological and social origins of what we commonly identify as mental disorders or, according to the film’s terminology, “conditions” (the piece of paper that Joker hands or tries to hand to the occasional stranger on the street, when laughing uncontrollably, explains indeed how he does not have a disease or a diagnosis but a “condition”).

In reality, one could see, on the contrary, as surprising the fact that for decades the dominant narrative has made us almost forget about such dimension. Just a few years ago, for instance, a book was published, “Madness is Civilization” which had as its subtitle “when the diagnosis was social”: the dominant narrative first almost prevented us from thinking that the diagnosis could have cultural or social elements, and then when the moment requires it, which is at the present time, to “discover” such dimension which in turn is thus surprising.

The film undoubtedly stigmatizes insanity and mental illness, linking them terribly, despite the ongoing global campaigns for the de-stigmatization of mental disorders, to a crime that becomes merciless and, increasingly over the course of the film, without an external motivation; the motivations that initially appear external and “understandable” in their causality, even if not justifiable (but the viewer is almost led to think that they are justifiable), are increasingly internalized and lead us to look for the cause within almost inscrutable mental processes. In doing this, the narrative draws us from the external world to the internal one, which is precisely one of the greatest effects exerted by the film on the viewer. From outside to inside.

Joker makes the spectator identify with a character represented as insane, sick, criminal, in which even the “spectators” who are inside the film, the people in the film, increasingly seem to identify with. The media in the film portray Joker as a crazed criminal who dresses like a clown, while the people almost instinctively see him as a hero who avenges the injustices that all suffer.

The film appears to present the viewer with a vision of the people exactly as the establishment wants the people to become and how they want them to be represented and how they want the people to feel: freed from their useless rationality, proud of their madness, apolitical and depoliticized, ready for the intervention of the two pillars of public order and of psychiatric technique.

On two occasions in the film these two elements appear clearly: when the Joker is in the elevator of the psychiatric hospital and a patient tied to the stretcher is accompanied by a policeman and a man in a white uniform, probably a nurse, as well as in one of the final scenes in which the police car and the ambulance collide to become the set of a crazy party that doesn’t last for long, the insurrection of the jokerized, wild, criminal, crazy people.

When Joker finally goes on TV on the De Niro show, he’s the one who denies that there is anything political in what he has caused throughout Gotham.

It is interesting to note how a few weeks ago in Italy the comedian Beppe Grillo presented himself on video with the Joker makeup at a political meeting of a ruling party.

The ideology that underlies the film has a precise logic and is entirely declined from the point of view of the elites: in short, in my view, it is a profoundly anti-democratic and even anti-political film.

The people are crazy and must be criminalized and psychiatrized (not demonized, that was the era of power, even temporal, linked to religion). The modern heretic is the madman. The way to stem it is no longer spiritual, an exorcism for example, but technical: containment through diagnosis and drugs.

In representing the people as mad and proud of their own madness, even finally freed through it, the idea that the citizen is irrational, out of control is validated. Who would entrust the destinies of a nation or of the world to someone with these characteristics? Just another madman, in fact.

The field of the citizen and of the people is no longer political citizenship: in such context, in fact, like a stick, the psychiatric terms can be used in the most stigmatizing way possible against the political opponent; the only hope therefore remains to become patient, in every sense, hoping that psychiatric services will be graciously provided in a sufficient manner. The de-stigmatization of psychiatric diagnosis outside of politics and within the clinical context is the carrot. Become patient and something will be granted to you, as a minor treated hopefully well. Refuse and you will be contained anyway but harder.

North of Hollywood, from the Silicon Valley, the so-called Californian ideology has been working for at least two decades to combine libertarian and even Randian hyper-individualism with Marxist collectivism in its purportedly scientific aspects: in our individual isolation, it is machines, software and digital algorithms to make all those who are connected to the network a coordinated community.

It comes to mind the name of Bogdanov, the physician and psychiatrist who founded Bolshevism with Lenin, and who wrote the first Soviet-era utopia, ‘Red Star,’ and devised the discipline of tectology, a kind of general science of organization that was used for economic planning in the USSR and anticipated many aspects of cybernetics, the foundation of the current automation revolution.

In the USSR, half a century later, with the Brezhnev era, the so-called political psychiatry became prevalent: dissidence experienced, even before being represented, as madness. The dissidents were not simply sane passed off for mad, but they were viewed as clinically irrational. There was talk of “latent schizophrenia” and “delusions of reform”. On the other hand, how is it possible not to think that in a perfect system a dissident with hopes of change can be completely normal?

Andreotti also joked in his own way with the famous joke that there are two types of madmen, those who think they are Napoleon and those who think they can reform the State Railways.

Joker sanctions in global popular culture the citizen who becomes patient, proud of this, who finally feels freed from the weight of rationality and rules, almost the foundation of a transnational schizophrenic anarcho-individualist party.

We are witnessing the internalization by the people of spectators precisely of how the elites see the people, ready to claim the psychiatric help they desperately need in the manner of the subject, without any residual claims of sovereignty.

The black psychiatrist from the final scene is taken out, as can be assumed by the blood footprints the Joker leaves behind in the last few frames. In this sense, the film is also anti-psychiatric: the villain in which the people recognize themselves kills the good psychiatrist, perhaps the last possible salvation for those who have completely lost their mind, self-control, and married a criminal and sick will.

Joker is one of those unmissable films, to be watched for sure (in the Anglo-Saxon world, the view is forbidden to minors and for very good reasons).

In my view the anti-political message it conveys is devastating and misleading: the message of the upcoming Globalist Revolution.

To be sent back to the sender in full and with no hesitation.

Cocaine and Morgan: the lesson of Freud (2010)

Italiano

Morgan, an Italian pop musician, in an interview with Max magazine in 2010 revealed using cocaine and in particular crack as an antidepressant, claiming that Sigmund Freud also prescribed it for such purpose.

~~~

by Federico Soldani

(Originally published in February 2010 for the blog RCS – Rizzoli Corriere della Sera – OK La Salute Prima di Tutto. Original link no longer available, transferred to https://www.ok-salute.it/senza-categoria/cocaina-e-morgan-la-lezione-di-freud/)

Freud was among the very first ones who experimented with cocaine with a medical gaze: using it personally, prescribing it to patients, and recommending it to family and friends as a stimulant, as well as studying its effects as a local anesthetic. In fact, he was also among the first doctors to discover, in spite of himself, the adverse effects: the strong dependence above all.

In an attempt to cure the severe pain of his friend and colleague Ernst von Fleischl-Marxow and to reduce his dependence on morphine, Freud administered intravenous (or subcutaneous) cocaine, a route of administration that approaches the onset of action of smoked cocaine, crack.

https://en.wikipedia.org/wiki/Ernst_von_Fleischl-Marxow

Today we know that the shorter the time that passes between taking a drug and the onset of its effects, the stronger the addiction. Today we also know the adverse effects of cocaine use, including when smoked: it is among the major causes of myocardial infarction in young people, to the point that in the emergency room this is the first thing you think about when in front of a young person with clear symptoms of an ongoing heart attack.

Not to mention psychiatric adverse effects, which are well documented and include panic attacks, paranoid delusions, hallucinations. Cocaine also causes behavioral disinhibition and induces a state of euphoria which is soon followed by dysphoria, restlessness and anxiety.

Freud, more than a hundred years ago, publicly claimed that cocaine was not addictive and that it even served to cure morphine addiction ! His friend Ernst von Fleischl-Marxow gradually developed a strong addiction to cocaine, psychotic episodes and phases of delirium with hallucinations in which he saw himself covered with snakes.

Freud apparently developed strong feelings of guilt following the episode. While he was presumably able to quit the cocaine habit, he never gave up his other addiction: cigars.

Instead, his friend died a few years later with a dual addiction to morphine and cocaine.

[It was the first case documented in medicine – or among the first known cases – of dual substance dependence].

Are we witnessing the emergence of a new global psychiatric power? (2019)

by Federico Soldani

Italiano

Why are politics, politicians and citizens involved in politics increasingly represented on the mass media and social media as crazy and out of control?

Why is political language increasingly populated with terms that claim to be technical-scientific or metaphors such as “political pathology” or “political health” or, to cite a recent example, “testosterone politics”? In particular, why do we increasingly apply psychological expressions such as “narcissism”, “mental pathology”, “mental health”, “sociopathy” or “schizophrenia” to social, economic or political categories?

And why do metaphors and political analogies now refer constantly to medicine, psychology, or epidemiology?

Why are ideas slowly but surely associated with sick thoughts? Or the spread of political ideas, and not only, is presented more and more literally as an epidemic, a viral spread, to be stopped and prevented?

Why the U.S. President, “the most powerful man in the world,” is represented as a madman? Or Hollywood blockbusters like ‘Joker’ represent the people and the sovereign citizens as de-politicized, savages, criminals and madmen?

Does “politically correct” language have a disciplinary and “orthopedic” function? If so, how?

Why are hallucinogens, psychedelics and cannabis products spreading on a mass scale and for every possible and imaginable use, ‘therapeutic’ or not?

Are these trends completely new or are they part of an ideology that comes from afar?

Below, the link to a talk that I held at the Royal College of Psychiatrists in the City of London, in the summer of 2019, which tries to explain the new and overbearing avant-garde trends as indispensable preparatory elements for the transition towards a global post-democracy, anti-political, digital, essentially technocratic and in all probability totalitarian.

A path of apparent ‘liberation’ which is instead the path to the de-sovereignization of each of us from one’s own rationality.

(Introductory text above, by the author, 28th October 2019 http://uropia.blogspot.com/2019/10/stiamo-assistendo-alla-nascita-di-un.html)

~~~

Video subtitled in English or Italian:   https://youtu.be/l_yyv_jzfI0

“Are we witnessing the emergence of a new global psychiatric power?”

Federico Soldani, MD, SM, PhD

3rd September 2019 – Royal College of Psychiatrists – London

Philosophy of Psychiatry Special Interest Group
Biennial Conference – “Madness, the Mind, and Politics” See this link for program.

Original conference abstract, submitted 15th May 2019:

Are we witnessing the emergence of a new global psychiatric power?

In recent years we have observed an increasing focus on language and concepts related to mental health in the broader societal and political world.

For instance, political language related to “phobias” has rapidly surged to commonplace.

Similar lexicon derived largely from psychiatry, psychology, and psychoanalysis might lead to a progressive internalization and de-politicization of civic concepts, without most citizens realizing it.

More recently, prominent groups of intellectuals including psychiatrists from global academic institutions argued explicitly for a new necessity of the psychiatrization of old political concepts and institutions.

Among others, Columbia University economist Jeffrey Sachs, in a volume written by 37 contributors titled “The Dangerous Case of Donald Trump” (2nd Edition, 2019), asserted explicitly: “Those who pretend that we are in the realm of politics when we are really in the realm of psychopathology make the situation even more dangerous, because they will not be prepared while the future of the planet and the human race are at stake.”

Former DSM-IV chief Allen Frances, in his essay “Twilight of American Sanity: A Psychiatrist Analyzes the Age of Trump” (2017) argued: “Trump isn’t crazy. We are.”

Michel Foucault, in his 1973-74 lecture series on “Psychiatric Power” at the Collège de France, pointed to the madness of King George III of England, monarch of a global British empire, as reported by Philippe Pinel in the seminal “Traité médico-philosophique sur l’aliénation mentale; ou la manie,” published in 1800 in Paris. According to Foucault, such emblematic scene of madness marked the birth of psychiatry as well as the passage from sovereign to disciplinary power in the modern world.

In this light, the current public psychiatrization of “the most powerful man in the world,” as the media often describe the President of the United States of America, could be seen as a new paradigm shift in contemporary power.

Such a public spectacle is broadcasted around the world via TV and digital social media (e.g, Twitter) in real time. In addition to the increasing use of a psychologized lexicon in everyday speech, a role might be played by such spectacle communicating symbolically, and contributing to, a global cultural shift towards a subjectivist worldview and a progressive de-politicization of citizenship.

Da cittadini a pazienti: una minaccia a cui resistere (2020)

English

Lezioni sulla Pandemia presso l’International University College of Turin http://www.iuctorino.it/

Ugo Mattei e Federico Soldani, 4 maggio 2020

“Il declino della legge come strumento per il controllo sociale e il suo superamento attraverso la gestione tecnologica, mentale e medica volta a prevenire comportamenti devianti, senza preoccupazione alcuna circa gli effetti deleteri di tale sostituzione”.

(Pubblicato anche su Foucault News, 8 maggio 2020 https://michel-foucault.com/2020/05/08/ugo-mattei-federico-soldani-from-citizens-to-patients-a-threat-to-resist-2020/).

Altre lezioni interessanti della serie sono disponibili qui.

L’immagine in alto si riferisce alla prima formulazione pubblica del concetto di trasformazione da cittadini a pazienti (Royal College of Psychiatrists, Londra, 2019).

The political career of Mao, Yale and the “reorientation of thought” (2020)

by Federico Soldani

Italiano

On the Yale Daily News (February 29, 1972), the oldest college newspaper founded in 1878 in Yale, one of the first American universities (1701), on the front page in the central article at the top there is a photo of Mao, the Chinese leader of the “great leap forward”.

As stated in the English Wikipedia entry (access June 7, 2020) dedicated to the Yale-China Association: “Between 1919 and 1920, future Chairman Mao Zedong had several encounters with the school: he edited its student magazine, re-focusing it on “thought reorientation,” and operated a bookshop out of its medical college”.

Below, the text of the Yale Daily News article dated 29 February 1972.

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Yale Group Spurs Mao’s Emergence

[Editor of Yale Journal]

Below the photo of Mao, the following caption:

“Yale has helped many young men begin their political rise to power. In the class of 1919, in addition to the 1,000 male leaders graduating in New Haven, Yale-in-China was helping a young man by the name of Mao-Tse-tung. “


Original article text:
William F. Buckley was not the only Yale figure connected with the Presidential trip to China. Without Yale’s support, Mao Tse Tung may never have risen from obscurity to command China.

Jonathan Spence, professor of Chinese history, was the first to discover Mao-Tse-Tung’s connection with Yale.

The professor noted, “In 1919, Mao, aged 26, was in Changsa, having finished his middle school education. He visited Peking and while there received his…serious introduction to communist theory in Li Ta-chao’s Marxist Study Group.

“Now, if he wanted to develop a reputation in socialist circles, he had to find a forum to propagate his views…

At this crucial point the student union of Yale-in-China invited Mao to take over the editorship of their journal.”

Mao accepted the position and changed the format of the student magazine: it would now deal with social criticism and current problems and focus on “thought reorientation.”….

Mao traveled to Peking and studied Marxist theory. In Shanghai he met Ch’en Tu-hsiu (who later became the leader of the Chinese Communist Party). Mao was told to form an area branch of the Communist party, but he had neither funds nor a meeting place.

“Once again Yale stepped in,” recalled Spence. “The medical college of Yale-in-China agreed to rent him three rooms, which Mao named his “culture bookshop.”

Business boomed and Mao was able to ring up high sales on such Chinese titles as “An Introduction to Marx’s Capital”, “A Study of the New Russia” and “The Soviet System in China”.

“Mao’s reputation grew, and from this base he was able to organize seven branch stores,” continued the professor of Chinese history. “The profits generated were used to finance the socialist youth corps and the communist party.”

Professor Spence further noted that because of the success of the bookstore, Mao was chosen as one of the delegates to the First Congress of the Chinese Communist Party in Shanghai in 1921. From there it was only a small step to becoming one of the founders of the communist movement in his country.

Yale-in-China now supports the New Asia College, part of the Chinese University of Hong Kong. It is maintained on donations and is actively hoping to interest the undergraduate community in its affairs.”

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Viktor Frankl: droghe, LSD e significato soggettivo vs. oggettivo (2020)

English

“Uno degli argomenti principali di Frankl negli anni ’60. Quando insegnò all’Università di Harvard nel 1961, fu tra i pochi che si opposero all’uso sperimentale dell’LSD proposto dal Dr. Timothy Leary, affermando che “la libertà è solo una parte di un fenomeno la cui altra parte è responsabilità”. (California 1968)

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https://logotherapy.univie.ac.at/ 
https://www.viktorfrankl.org/clipgallery.html
https://www.viktorfrankl.org/assets/vid/clip_drugs.mp4

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Giornalista: “Nel discutere di questo problema, il Dr. Frankl fa una distinzione tra significati oggettivi e verificabili esternamente e quelli soggettivi, basati sui sentimenti.

Secondo il Dr. Frankl, nell’esperienza indotta dalla droga si trova solo un significato soggettivo. “

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Dr. Frankl: “Ad esempio quelli che sono stati resi disponibili in uno stato di ebbrezza dall’LSD, potrebbero finire allo stesso modo degli animali che sono stati usati da Olds e Milner in California per i loro esperimenti di auto-stimolazione.

Vale a dire, inserivano elettrodi nei centri più profondi del cervello dei ratti e ogni volta che la corrente elettrica veniva chiusa, evidentemente gli animali sperimentavano qualcosa come l’orgasmo sessuale o la soddisfazione di prendere cibo.

E ora gli animali imparano a saltare sulla leva, chiudendo così il circuito elettrico e fornendo così queste sensazioni di orgasmo o altre forme di soddisfazione.

Quindi sono diventati dipendenti da questa attività, la hanno ripetuta fino a 50.000 volte al giorno.

E la cosa straordinaria ora è che questi animali che potrebbero procurarsi, attraverso l’elettricità, la mera sensazione di orgasmo o altre soddisfazioni, non si prendono più cura dei veri partner, dei partner sessuali offerti loro e trascurano totalmente il vero cibo che è stato offerto loro.”

~~~

“Una volta che assumi l’LSD, improvvisamente il mondo intero assume infinito senso.

Tuttavia, questi sono significati puramente soggettivi, direi che sono sentimenti di senso, piuttosto che veri e propri significati reali.

E il pericolo è che quei giovani che ricorrono a questi sentimenti soggettivi di senso, questi giovani siano minacciati nell’aggirare e trascurare quei significati, quei significati oggettivi che li attendono, che sono in serbo per loro, là fuori nel mondo, piuttosto che all’interno della propria psiche.”

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“Catturati nel vuoto esistenziale, nella disperazione esistenziale, nella disperazione per l’apparente insensatezza della vita, ricorrono a significati soggettivi e quindi trascurano significati oggettivi che sono ancora disponibili, ma trascurati da loro.”

Giornalista: “Il viaggio della vita è un compito della vita da svolgere e da raggiungere e non semplicemente un sentimento soggettivo”.

Dr. Frankl: “Giusto, non solo un’avventura in termini di sensazioni ma un’avventura in termini di potenzialità uniche. Una volta che abbiamo attualizzato la potenzialità, l’abbiamo salvata nel passato, la abbiamo e niente e nessuno potrà mai derubarci di questa, è diventata una realtà per sempre, per l’eternità.

Ma allo stesso modo, se l’abbiamo trascurata e aggirata, allora la potenzialità che non è stata attualizzata è passata per sempre, è persa per sempre.

Ciò costituisce la nostra infinita responsabilità.

Naturalmente nessuno è in grado di attuare pienamente ogni singola potenzialità e quindi diventa in un certo senso, in un senso esistenziale, diventa colpevole. Tuttavia, questa colpa appartiene alla condizione, alla condizione umana, è inevitabile e dobbiamo confessare la nostra fallibilità.

Questo non ci impedisce di continuare ad attualizzare i valori e adempiere ai significati, ma è un avvertimento a non lasciare passare le potenzialità transitorie.

Ciò che è transitorio sono solo le potenzialità, ma una volta che le abbiamo realizzate, le abbiamo realizzate per sempre, le abbiamo salvate in una realtà eterna, per così dire”.

Viktor Frankl: drugs, LSD and subjective vs. objective meaning (2020)

Italiano

“One of Frankl’s main topics in the 1960s. When teaching at Harvard University in 1961, he was among few who opposed the experimental use of LSD proposed by Dr. Timothy Leary, stating that “freedom is only one side of a phenomenon whose other side is responsibility.” (California 1968)

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https://logotherapy.univie.ac.at/ 
https://www.viktorfrankl.org/clipgallery.html
https://www.viktorfrankl.org/assets/vid/clip_drugs.mp4

~~~

Journalist: “In discussing this issue, Dr. Frankl draws a distinction between meanings which are objective and externally verifiable, and those which are subjective, based on feelings.

According to Dr. Frankl, only subjective meaning is found in the drug-induced experience.”

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Dr. Frankl: “For instance those that are made available in a state of intoxication by LSD, may well wind up in the same way as the animals that have been used by Olds and Milner in California for their self-stimulation experiments.  

That is to say, they inserted electrodes into the deepest centers of the brain of rats and whenever the electric current was closed, evidently the animals experienced something such as sexual orgasm or else the satisfaction of taking in food.

And now the animals learn to jump on the lever, thereby closing the electric circuit and thereby providing themselves with these feelings of orgasm or other forms of satisfaction.

Then they became addicted to this business, they did so up to 50,000 times a day.  

And the remarkable thing now is, that these animals that could provide themselves by electricity with the mere feeling of orgasm or other satisfactions, no longer care for the real partners, sexual partners offered to them, and totally neglected the real food that has been offered to them.”

~~~

“Once you take in LSD, suddenly the whole world takes on infinite meaningfulness.  

However, these are merely subjective meanings, I would say these are feelings of meaningfulness, rather than true, real meanings. 

And the danger is, that those youngsters who resort to these subjective feelings of meaningfulness, these youngsters are threatened to bypass and neglect those meanings, those objective meanings which are in wait for them, which are in store for them, out there in the world, rather than within their own psyche.”

~~~

“Caught in the existential vacuum, in the existential despair, in the despair over the apparent meaninglessness of life, they resort to subjective meanings and then neglect the objective meanings that are still available, but neglected by them.”

Journalist:  “The journey of life is a life task to be performed and to be achieved and not simply a subjective feeling.” 

Dr. Frankl:  “Right, not just an adventure in terms of sensations but an adventure in terms of unique potentialities.  Once we have actualized the potentiality, we have rescued it into the past, we have and nothing and nobody can ever rob us, it has become a reality for ever, for eternity.  

But the same also rules, if we have neglected and bypassed it, then the potentiality not having been actualized is past forever, is lost forever.

This constitutes our infinite responsibleness.  

Of course nobody is capable of fully actualizing each and every potentiality and thereby he becomes in a certain sense, in an existential sense, he becomes guilty.  However, this guilt belongs to the condition, to the human condition, is inescapable, and we have to confess to our fallibility.  

This is nothing to hinder us from going on to actualize values and fulfil meanings, but it is a warning not to let pass the transitory potentialities.  

What is transitory is only the potentialities, but once we have actualized them, we have actualized them forever, we have rescued them into an eternal reality, as it were.”