Maurizio Peciccia

The splitting between separate and symbiotic stätes of the self in the psychodynamic of schizophrenia

Abstract We hypothesize that, in the structure of the psychotic self, there is a disintegration between the symbiotic and separate states of the self, of which the patient is painfully aware: to use a metaphor, the light in the schizophrenic self is split: at times it is only in wave form, energy (the patient is living in disintegrated symbiosis), at others it is only matter, corpuscular (the patient is living in disintegrated separation); unfortunately, the wave and the particle are unable to produce a unitary phenomenon: the light becomes two entities. Sometimes we see the psychotic living symbiotically, we feel him to be very close to us, he tells us: “I am the moon, the sun, the universe. I am you”. At other times the patient is in his separate self but, as he is split off from the symbiotic self, his separation is extreme, it is autistic solitude: “nothing exists apart from me: the sun, the moon, the universe, are meaningless shadows which I cannot distinguish …, you are light-years away from me … yo...

Interoception and positive symptoms in Schizophrenia

The present study focuses on the multifaceted concept of self-disturbance in schizophrenia, adding knowledge about a not yet investigated aspect, which is the interoceptive accuracy. Starting from the assumption that interoceptive accuracy requires an intact sense of self, which otherwise was proved to be altered in schizophrenia, the aim of the present study was to explore interoceptive accuracy in a group of schizophrenia patients, compared to healthy controls. Furthermore, the possible association between interoceptive accuracy and patients’ positive and negative symptomatology was assessed. To pursue these goals, a group of 23 schizophrenia patients and a group of 23 healthy controls performed a heartbeat perception task. Patients’ symptomatology was assessed by means of the Positive and Negative Syndrome Scale (PANSS). Results demonstrated significantly lower interoceptive accuracy in schizophrenia patients compared to healthy controls. This difference was not accounted for participants’ age, BMI, anxiety levels, and heart rate. Furthermore, patients’ illness severity, attention and pharmacological treatment did not influence their interoceptive accuracy levels. Interestingly, a strong positive relation between interoceptive accuracy and positive symptoms severity, especially Grandiosity, was found. The present results demonstrate for the first time that interoceptive accuracy is altered in schizophrenia. Furthermore, they prove a specific association between interoceptive accuracy and positive symptomatology, suggesting that the symptom Grandiosity might be protective against an altered basic sense of self in patients characterized by higher sensibility to their inner bodily sensations.

Prof. Dr.med. Gaetano Benedetti (1920–2013), Co-Founder I.S.P.S.

Gaetano Benedetti, co-founder of the ISPS with Christian Müller (1921–2013) in 1956, died in Riehen/Basel (Switzerland) on 2 December 2013, at the age of 93. On 13 December he was buried in the cemetery close to his home, beside his wife Annette, who had suddenly and unexpectedly died on 25 February 2004, and a Protestant service took place at the Riehen Church, at which more than 200 people convened. His children Christoph, Conrad, Jürg and Dorothea remembered him as a sweet and very busy father, who had to struggle for much of his life against the handicaps brought about by the successful operation of a cranial nerve tumor at the age of 40, and whose last years of life were very much shadowed by the death of their mother. Benedetti’s colleague Raymond Battegay, who had known him since 1956, and had worked with him at the Basel University Department of Psychiatry, emphasized “the revolution in psychiatry” which Benedetti brought about through his humane, scientific and optimistic approach to patients diagnosed with “schizophrenia”. Maurizio Peciccia thanked him for the therapeutic and research work done together for the last 25 years, one of the outcomes of which was the foundation in Perugia (Italy) of the Benedetti Institute, a training institute centered around his teaching and legacy. Eugenia Lamparelli remembered Benedetti as a very open, generous and thoughtful analyst and thanked him in the name of all his patients. Brian Martindale, the current ISPS Chairperson, thanked him on behalf of everyone in ISPS, which still works according to the interdisciplinary and international criteria set forth by its founders, and named him “the Mandela of psychosis”. Marco Conci thanked Benedetti in the name of both the Milan Associazione di Studi Psicoanalitici, which he had founded together with Johannes Cremerius (1918–2002) in 1971, and which became an essential setting and motor for the development of his ideas, and of the German Psychoanalytic Society, of which he had become a training analyst in the 1970s and a honorary member in 1983. Last but not least, Patrick Faugeras, the French colleague who translated Benedetti’s masterpiece 1983 Todeslandschaften der Seele (Benedetti, 1983) into French in 1995, reminded us how important it is to keep translating and publishing Benedetti’s work on an international scale. Born in Catania on 26 June 1920, as the oldest of the three sons (Calogero, 1921, and Eugenio, 1929) of a famous surgeon and of a very well-educated and religious mother, Gaetano Benedetti grew-up experiencing the contradictions between the aristocratic character of his early life (he and his older brother were privately taught at home until the age of 14) and the democratic ideas of his parents and extended families, who all contributed to the anti-fascist front. As he wrote in his 1994 autobiography (Benedetti, 1994), many reasons motivated him to study medicine (at the University of Catania), but his sympathy for and empathy with psychiatric patients was the most important one. Because psychiatry was not

A Sensory-Motor Approach for Patients with a Diagnosis of Psychosis. Some Data From an Empirical Investigation on Amniotic Therapy

Background: Amniotic therapy (AT) is a sensory integration group-therapy for psychotic patients. Therapeutic interactions are non-verbal and similar to mother–foetus interactions in amniotic fluid. AT aims to define internal and external self-boundaries through the integration of separate self and symbiotic self. Aims: The aim of this paper is to present the first data regarding an empirical investigation on AT conducted with a group of long-term psychotic patients and their co-therapists. Patients were treated intensively through AT sessions for one year. Results: Outcome clinical data show an improvement in the interpersonal social functioning of the patients as measured by the quality of life and by the clinical judgment of a psychiatrist external to the research project.

Interoception Sensitivity and Autonomic Regulation During Social Interaction in Schizophrenia

Introduction The awareness of ones body constitutes a basic experience of Self which modulates the individual engagement in social interactions. Indeed, Interoception Sensitivity (IS), an index of individual ability to represent one’s own internal body states, is implicated in the autonomic regulation in interpersonal context. Schizophrenia deficits in Self-experience and awareness, which frequently entail anomalies in self-other relationship, capture the ever-growing attention of researchers. Nevertheless, IS and autonomic regulation of schizophrenic patients in social context are completely new and not yet investigated aspects of Schizophrenia. Aim To investigate whether Schizophrenia could be associated with lower IS and with a dysfunctional autonomic regulation during social interaction. Methods 24 chronic schizophrenia patients, and a matched group of healthy controls, performed a Social and a Non-social task while respiratory sinus arrhythmia (an index of autonomic regulation) was measured. In the Social task participants viewed an experimenter performing a caress-like movement at different distances from their hand. In the Non-social task a metal stick was moved at the same distances from the participants’ hand. As measure of IS, a cardiac Mental Tacking Task was performed. Results Comparing to controls, Schizophrenia patients presented lower IS, absence of relation between IS and autonomic regulation, and an anomalous autonomic regulation in social and non-social contexts. Conclusions Deficits in Self-experience, associated with Schizophrenia, could be extended to patients’ sensitivity to internal bodily signals. Moreover, the observed altered autonomic regulation will be part of interpersonal interaction deficit frequently associated to Schizophrenia.