A few books deserve to be read. Among them, "Shock" by Carlo Patriarca, MD and writer, may be a fruitful path for understanding the very idea of 'care' as a metaphysical challenge for the need of an approach to the person that goes beyond the organic dimension.
By Primavera Fisogni
A book that challenges and provides the readers with a lot of questions. "Shock" (Neri Pozza) is the story, written in a sensitive prose by Carlo Patriarca, a medical doctor (the director of the Pathological Anatomy department at the Sant'Anna di Como hospital) born in Sondrio (Valtellina) but living in Milan, the successful author of two previous books ("The battlefield is the heart of men" and "The challenge"). Once again, the leading characters of “Shock” are two clinicians. One, an assistant psychiatrist, is a fictional character, the other one is Ugo Cerletti (1877-1963) (see pic on the left). A psychiatrist, a brilliant man and scientist with a complex profile (Patriarca writes about Cerletti’s sympathy, albeit superficial, for fascism), he entered the history of medicine as the inventor of the electroconvulsive therapy (or electroshock) for the treatment of psychic suffering through administration of high voltage electric shocks. In the era of psychoactive drugs, this therapy appears to us to be a brutal approach to mental disease, but its origin went in the opposite direction. Doctor Patriarca kindly accepted to answer some questions from Rekh Magazine.
Doctor Patriarca, what kind of psychiatry was that of Cerletti's time?
A disheartened psychiatry. A disastrous diagnostic quality, with asylums full of patients with the most disparate organic pathologies alongside real psychiatric patients, was answered with sometimes humanist therapies such as occupational therapy and other heroic attempts to occupy the lives of the sick persons, and sometimes with simple restraint, sloppiness, cold showers and spoonfuls of barbiturates. Cerletti rebelled against this resignation.
Ugo Cerletti entered the history of medicine as the inventor of the electroconvulsive therapy (or electroshock) for the treatment of psychic suffering through administration of high voltage electric shocks.
The brain (organ) is not the mind (emergent property from a systemic perspective). However, in medicine, not only in psychiatry, it is difficult to get out of the organic perspective in favor of a systemic view of the person. In you opinion, why does it happen?
It happens because we are witnessing a rapid development of neurophysiology, which has revealed at least some of the mechanisms of perception, learning, memory and language, and is beginning to offer some insight into how the brain works (neuroscientists such as Anthony Damasio push the study of brain up to the boundaries of the concept of consciousness, thus entering the traditional domain of philosophy). Neurosciences also explain how our brains shape each other, in human interaction and with the outside world, and moreover the nervous system reaches every recess of the body and sense organs. In my perspective, and I believe in that of other practictioners, the theme is not to get out of an organicist vision but to understand how much the organism is shaped by the relationship. Medicine runs the risk of using psycho-neuropharmacology, which places molecules on the market that interact with our neuromediators, to "medicate" isolated individuals, when if anything - if it is really necessary - it should be used to push them out of isolation.
Carlo Patriarca, MD, is the author of "Shock" (Neri Pozza)
Ugo Cerletti seems to me showing an anti-historical profile. This can be said even in his time, when even phenomenological psychiatry was well known. So why talk about him again today?
Well, because he was the victim of an early form of "cancel culture", despite his concrete efforts to improve the asylum condition. In the novel the narrator (a hypothetical assistant of Cerletti) says: "The descriptions of Jaspers, the analysis of Freud, I too had done some reading in German but I had a great desire for new, muscular and decisive treatments, after the agony of those years of helplessness in the treatment of dementia praecox, as the old psychiatrists called it”. In 1930s Italy, autarchic even in the scientific field, readings on "deep psychology" were not very fashionable and, moreover, the treatment of schizophrenia does not seem to have been among the main interests and among the successes of psychoanalysis both at the time of Freud and later. As for Jaspers, I don't think he was part of the baggage of psychiatrists in the first two decades of the twentieth century. For Cerletti (who was faithful but not a slave to a somatic approach to serious mental illness) phenomenological psychiatry remains a distant prospect, despite the fact that he himself directed electroconvulsive therapy (electroshock) above all to patients suffering from major depressive disorders. After all, psychiatry, Italian and beyond, had its roots in pathological anatomy and even when the young neurologist Cerletti goes to Germany he finds himself in the laboratories of Nissl in Heidelberg and Alzheimer's in Munich among slides and autopsies.
© Rekh Magazine