PROLOGUE: a story

A three-year-old boy looks out through the window of a car at the mountains and trees that appear to him as a boundless scene and asks: “but how many of these trees are there and how many of these mountains are there?” The answer he gets is that hundreds and hundreds of trees are supported by their roots embedded in the soil and rocks of dozens and dozens of mountains.
A long moment of silence follows while the child “fiddles” with the fingers of one hand; another question follows: “if I put two fingers with three fingers I get five trees on the mountain hand?” The person listening agrees with a big smile of approval. The child says that he is a subject in the palm of a hand and that he has a law between his fingers: now he counts too....

PLAYS: the people and the facts

This short anecdote introduces the script that follows, which, based on a theory and clinical teaching linked with ethics and enthusiasm in psychoanalysis, is meant to tell about happenings in relation to the question of psychoses and the device of the Analytical Psychodrama (A.P.) proposed in such fields of treatment. Narration is emphasised in the sense of presenting in words some occasions in the management of treatment with persons that, as “subjects”, find themselves located in the region of people who no longer count as they did before; it attempts through word therapy to set out a new way of living, existing, re-humanising oneself.
The psychodramatic game is therefore an important moment in a process within the framework of the group session where psychotic persons “count” by their presence; even if they are not too coherent, they put forward the gist of their arguments; by playing a part in the centre of the group they try to find a sequence of their own being once again, in order to “swap numbers” with the others and perhaps be able to get their own selves back by stating once again who they are.
In a Day-care Centre (D.C.) in Rome, weekly session, the participants seated in a circle, the coordinator and the observer of the A.P. group, a local operator that physically represents the space and time of that therapy centre.
The session starts and M. wonders, addressing the coordinator: “considering the stuff we make in the carpentry workshop, why don’t we open a shop, there is no point of sale here.”
The coordinator asks M. if he has spoken to anybody in the D.C. about this. M. answers that he asked one of the workers a few days previously.
The coordinator suggests playing out that situation through a psychodramatic game. M. chooses R., another member of the group, to play the part of the official.
Who is M in reality: his swaying walk with his head seeming to move independently of the movement of the rest of his body reveals the persona; M. oscillates between doing, doing a lot at the D.C., and not doing anything by withdrawal and daily solitude: between cultural episodes like plays and exhibitions, organised by himself, and entire periods at home where he helps his mother to “do the dusting”.
M. receives a disability pension for a 70% reduction in ability to work, as he says himself.
Who is R. in realty: R is firmly rooted in his pension for 100% disability; he is nice and calm apparently, but touchy inside and his anger and irritability can be sparked off by the slightest word out of place, expressed more by words than deeds.
The D.C. and his parents are R.’s mainstays, women for hire are sometimes mobile landmarks.
Back to the game: the coordinator asks M. why he chose R. for the part of the worker in the scenes to be played; the answer is that R, like the worker, is always present at the D.C.
The play is organised; M. gives R. the words to say; the game starts: M. “why don’t we open a shop considering the stuff we make in the carpentry workshop?”
Worker “M. this is not a shopping centre, this is a place for treating people with problems...”
M. “we need a point of sale!”
Worker “M. this not the place, you have to find something outside, a job, we give away the things you make here in the workshops....”
M. goes back and sits down and tries to “COUNT”: “I heard it said that now if a person wants to work he can give up the disability and sign up at the labour exchange, is it true about this law? In my time, when I got the pension you couldn’t ask for anything else.....”
R. takes the floor in his turn and also starts “counting”: “I asked my father, since I have been coming to the D.C. for more than three years, when will I be cured? He told me that I must take the treatment, keep the pension, do whatever I like. Then I told him that some people have been coming here for more than six years, when does a person get better? He told me to come, to keep the place and then I’ll fit into society. But if I come here to the D.C. and get a pension I’m not part of society anyhow, I don’t really understand this question of time.”

At an institutional community in Rome; weekly session; participants in the group; coordinator and observer; community worker.
The session starts and T. says the following: “every structure has its psychological needs and it’s not easy to understand what they are and how to do things; here we nearly always understand the problem; then the thing is settled and in the end we all have a meal together, no?”
The coordinator asks T. what she is really trying to say and she answers for what she just said, she also says that she has spoken about this, right here in the community.
She is asked to resubmit the situation just put before the group.
For the part of the speaker, T. chooses L., a worker present in the group.
Who is T in reality: mother’s little girl who always goes back to mother in her spare time; the father is neither present nor mentioned; she and her mother always together at home and outside; there’s plenty of time for men (T. is nearly 30 years old) and now, as she says, she just needs to think about having treatment so as to become a “good girl” once again; she wants to work but after every training period they tell her they are not going to employ her; T. does not take on the number of adulthood.
Who is L., the worker: a psychiatric nurse; she has worked in a lunatic asylum; however she has not “withdrawn”; she has always kept up to date and continued her education using the register of humanity consisting of listening and reception; her little-big blind spot is that she assumes the maternal role with perhaps too much emotion to keep a significant burden of unrestrainable eros at bay: one might call her “perfect” for playing T.’s mother.
The scene takes place after the coordinator asks for an explanation of the choice of L. as the interlocutor for the remarks just made. T. smiles, winks at L. and says “when she hugs me she never lets me go....”
T. “every structure has its psychological needs and it is not easy to understand what they are, however the things are understood here...”
Worker (without keeping to the plot assigned to her) “look T., I think that all this confusion you are talking about has to do with the fact that you recently lost your job.”
T. “that’s true, I don’t know what to do, I’m in bits, I didn’t realise that I wasn’t doing the cleaning properly in the bank, I always forgot to empty the wastepaper baskets, I did the rest all right, why did nobody tell me, did nobody there see my problem?”
Worker “did you really not realise about the wastepaper baskets, you just did the rest...”
T. “now what can I do?”
Worker “it would be a good idea for you to start taking some course again.”
T. “I didn’t finish the restoration course, I could go back to it, I liked it then I stopped, so.....”
Worker “then you can start again from there.”
T. “but is restoration any help? Is restoration like therapy? If I’m talking about restoration here does it mean that I am saying something that counts? Well, what does it do for the patient?”
Worker “sometimes T. you stop like that, you just said it, whatever you like and you are left with the rest.”
T., in centre stage, stops motionless for a couple of seconds and then, addressing the coordinator, tries to “work things out”:
“what is the psychodrama then, there at work? It would have been enough for somebody to tell me about the wastepaper baskets and I wouldn’t have lost the job, mother tells me things and I never make a mistake....”
The coordinator remarks, answering T. in a loud voice “when mother hugs me she never lets me go...”
T. (with a puzzled smile) “mother doesn’t sandpaper it off you like with furniture being restored, this is no psychodrama this is a psychotragedy.”
She goes back and sits down.

A community affiliated with the Regione Lazio, in Rome; weekly session; participants in group; coordinator and observer; worker.
F. opens the session by telling about a conversation he had with his father in which he tells him about his work at the kennels; the father appears to be interested and so F. presses him and asks him to let him use the new machinery bought for the family business; he says that he can trust him; the father tells F. that it cannot be done.
The coordinator proposes acting out this game and asks F. to choose a person to impersonate the father; F. chooses another member of the group whose name is the same as his.
Who is F. in reality: he is a twin; one might say a mirror; his brother is his opposite, a person with a rosy future, who can do accounts and is able to handle the family finances; F. is also rosy but from the patches of psoriasis on his face and hands; he often loses his money; he is, as he says himself, very much “understood” - but with his accent the word sounds very like another meaning “constrained”, this might be a lapsus - by his mother and has never got on very well with his father; he says that he sometimes goes out with his brother but does not want charity; perhaps the charity of being the sole heir.
Who in reality is the other F., chosen to play the father: at an early age he loses first his mother and shortly after his father, then the uncle who was acting in the stead of his dead parents dies; he becomes a person who has always taken care of himself, as he often says; he starts work early and supports two brothers at their studies; his means of subsistence is a campsite, which his brother is managing for him now; when he could stand it no longer, depression and alcohol became “his parents”; he has attempted to die several times; now he is having an affair with a married woman who has a child; he says “if her husband finds out and says anything to me I’ll teach him a lesson...”
The scene starts:
F. “Dad, things are going well with the job at the kennels in Rome, everybody is pleased with me, the animals are in a bad way and I try to do everything I can, I take them out, always on the leash, and then they seem to be calmer.”
Father “well F., work is like medicine.”
F. “the new machinery has arrived in the firm, if you explain how it works I could give you a hand.”
Father “no way, it is very expensive machinery, the work is not suited to you and you know that, you get confused.”
F. “Dad, at my job in Rome the people trust me, it’s not only my brother that counts, is it?”
Father “look, these machines need to be looked after, they can’t just be taken for a walk on a leash....”
The coordinator realises that the scene is taking place between F. and his father, face to face; mirror position, very close up, and the father is impersonated by a person with the same name.
He asks F. to change role and the scene is repeated with F. playing the father. At the end F. is asked to think out loud in the role of the father and this is what he re-counts “when playing my father my first thought is what a pain in the butt this son is, always asking for something and always complaining, and then he is so clumsy, so awkward, what can a fellow like that do?”
F. goes back and sits down and thinks, talking about his twin brother whom the father trusts; instead he has always been a bit of a mother’s boy and reels off words that show his state of being on a maternal leash, of not being calm at all, of feeling in a bad way.

LEAVE-TAKING: the pace of reason and the countless things that outpace it

Therefore what counts in the three games just described is how much the position of the subject that enters the game counts and lastly the A.P. makes it possible to re-count for each participant a sense that can relate, from the lost awareness through a possible question, that re-finding of oneself that, even if it is never a guarantee against the ever-present risk of going astray and getting lost, does make it possible, thanks to the meeting with the others outside oneself, to find hints needed about the border to follow to restore and repair a lost existence?
M., like R., wants the therapists and the treatment to SUM UP THE POINT of the question through a real negotiation process.
Like R., M. aims at the central point of their subject and they are both quite right and have plenty of feelings. The game reveals the limitations within the framework of the direction of the treatment between POINTS and POINTS LACKING.
M. and R. are not pawns in the context of the course of treatment; they try to express in precise words that they count as persons and that, as persons, they want to be among the others without ending up “in the middle of” the others, there in that deep hole between points and points lacking.
In her inability to empty herself out of the maternal wastepaper basket, T. is now merely living on scraps. But in the A.P. group she finds presence and words and as a subject experiencing a psychotic situation it becomes possible for her to have access to her own topic in the different aspects that her demand for treatment assumes. This is made possible through the work of the associations and scenes acted, in such a way as to produce a position of possible recognition of self in others where complex identification mechanisms come into play. In the difficult equilibrium between balances and imbalances it becomes possible to think deeply, and not merely sandpaper, with regard to the role played and the role to be played in life.
F. asks himself, through his face-to-face talk with his father, about his possible capabilities now that he needs treatment, presuming that if it is he that holds the leash he can therefore have access to sophisticated and costly “mechanisms”. It is as if F. brings himself back to reality by putting himself in a father’s shoes so as to be faced with something that seems to be external but originates within the subject himself. In his own place he says that he is on his mother’s leash, in his father’s shoes while acting on the stage he reveals this truth in a sophisticated and very weighty way: the validity of a new path around his own mind.

For the trees to stand out against the sky and for them to exist and be many, we need mountains and many of them to provide the land; for all of us to count we need to have hands and to use those hands to count.
One might say that they are the basis for setting up a worksite that permits an existence through re-finding re-counting oneself; the A.P. can be the geometrical field of this treatment experience; the coordinator and the observer the abscissa and coordinate in the direction of the cure; the game the equation that attempts to reveal the unknown quantity proposed by the participant - counting on the inevitable fact of indicating a border that provides such darkly overshadowed people with a faint glimmer that illuminates the squaring of the circle. An impossible operation that, however, certifies desire on a par with the necessary crucial test which is each one’s time in relation to the cure, in the gradual identification of the personal needs of every human being.
The A.P. with its presence in the context of psychoses counts, in the name of the father and the law of desire, on being capable of restoring in people that “do not make sense” the value of ONE who is still someone...

CLOSING NOTE: necessary and sufficient condition for a subject of a topic to emerge.

For there to be an A.P. there must also be people, a physical structure to contain them, an organised team, a declared institution: this geography, complex but clear in its presence, certifies the possibility that the therapeutic device of the group experience thus far described can be relevant and logical.
The attempt of therapeutic work in the field aims, through the mutual intention of every subject involved in the direction of the treatment, at the reality of the suffering, of the disease - without forgetting utopia, that ideal aspect in such situations of the complete integration among all the subjects operating - the patients are this in the first person. The A.P. group is meant to be a tool that allows participants, patients in a treatment centre, to face the complex situation that that centre in any cases presents to the person that “is experiencing” it: to bring out a question about the treatment project that the person has to undergo; to be able to form and construct a network of relationships “making use of” the urgent needs and dramatic situations that accompany the whole treatment path; of being able to think, thanks to the role-playing game, who the other person in the relationship is and how this can really happen; of trying to act out, through one’s one words, the impulses to come together and to separate, so as the allow the subject, through this process linked with the theatre of the unconscious, to re-turn from the individual to the multiple and vice versa.
This attempt at field work cannot neglect the mutual integration between the various subjects responsible for the treatment path proposed to the patients: coming together is as much a requisite of team work as the emergence of individual specific characteristics; while respecting this therapeutic path, A.P. nevertheless attempts something more than a theoretical-clinical challenge: through the group experience used by it, it attempts to produce further space for clinical practice, for the case of each patient, a situating oneself in a group in which we can dare to define the vacant space for the construction of each case.....

ROME OCTOBER 2003