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The problems posed by Leonardo’s pathographies written by Freud are examined. The historical path of the problem of the relationship between genius and psychopathology is reconstructed, showing that psychoanalysis fits into a very active vein at the end of the 19th century, expressing different theoretical approaches with which Freud relates. The interest for the problem then continued, with alternate answers, until the current days. The distortions made by Freud in Leonardo’s pathographical description are examined; these distortions are extensively examined by several authors, which, however, is not distant from what Freud implements in his other works, nor from what other pathographists of the time did. It is a common behavior in the history of science and well known in modern epistemology that identifies in the development of theories also the importance of rhetorical tools with which scientists support them. It is emphasized that one cannot read particular psychological aspects in these Freudian behaviors, making in fact a pathography of the author of pathographies, but only lead his work to the coherence of the historical contexts in which he operates. [ABSTRACT FROM AUTHOR]

Starting from therapeutic rhetoric in the ancient world, the evolution of the various models of persuasion is examined. After the initial opposition between emotional suggestion and persuasion understood as a rational argument, suggestion is absorbed in a broader concept of persuasion where rational and irrational factors on an emotional basis are highlighted. With the two-way models of Petty & Cacioppo and of Chaiken, the irrational component assumes full autonomy by centering its operation on cognitive bias. With “compliance gaining”, a persuasion based on general cognitive mechanisms, such as the need for coherence, is fully exploited, focusing more on the present context than on the person and his history, and criticizing the usual dynamic that requests the need for a change of attitude in order to change behavior, proposing an inverse path. A vision of persuasion emerges as pervasive in human communication, substantially out of awareness and as a base for usual changes in everyday life. This raises the question of the role of persuasion in psychotherapy, of what the actual nature of therapeutic change is, and of the possibility of therapeutic neutrality. [ABSTRACT FROM AUTHOR]

The introduction to the debate on the current crisis of psychiatric care in Italy is an opportunity to summarize how this crisis, its causes and perspectives are described by those who indicate only delays and incompleteness in the implementation of the reform of Law no. 180 of 1978 and those, instead, who identify structural deficits in the reform itself. The various criticalities are reviewed: from the risk of new asylums to the fragile integration of psychiatric wards in general hospitals; from the limits of involuntary hospital commitment to a renewed idea of dangerousness connected to it; from the rigidity of the Community Mental Health Centers to the unchanged aspect of stigma; from the ambiguity of the concept of evidence-based medicine (EBM) to the changes derived by legislative changes. All this occurs while the lack of resources and innovative proposals are intertwined. It is proposed a change that gives back to mental health its specificity far from the trivializations of popular psychiatry, defines the framework of reference for mental health, draws a new project and a clear model strongly anchored to scientific models, clarifying the necessary resources and limiting local administrative autonomies. [ABSTRACT FROM AUTHOR]

Scientific research in psychiatry is creating a gap in the notions of psychiatry that ordinary people actually possess, similar to the progressive distance between scientific psychology and folk and commonsense psychology. The notions that scientific and folk psychiatry share, and those in which they often differ with counterintuitive aspects, are investigated. After outlining the essential features of the concept of common sense and popular psychology and their most representative theories, the central role that popular concepts play not only in psychiatric theory, in particular in diagnosis, but also in daily practice is underlined. These concepts also involve the image of oneself, of the world and interpersonal relationships, showing the impossibility of a psychiatry that aims to do without the common sense, and the need for a careful mediation with popular psychiatry. This aspect is even more important in practical psychiatry which in many ways is similar to popular psychiatry. [ABSTRACT FROM AUTHOR]

The failure of displacement to other suicide methods by reducing some opportunities is examined, particularly regarding the detoxification of domestic gas in England and the obstacles to jumping from the Golden Gate Bridge of San Francisco. Failure of displacement seems to characterize also other behaviors such as gambling, addictions, and crime. The displacement hypothesis is linked to the fundamental error of attribution that privileges the attention given to dispositional over situational aspects. Biases related to this attribution error are examined, such as the lack of stability and coherence of dispositional aspects in time and in different situations, the lack of coherence between attitudes and behaviors, and the errors that dispositional approaches induce in the prediction of behaviors with the variation of the situations. These biases question the traditional concept of personality and its role in symptom formation and behavioral prediction, and the traditional psychological models according to which behaviors are always a consequence of personal attitudes. The role of situational aspects, especially of the so-called "channels", has important preventive and therapeutic implications. [ABSTRACT FROM AUTHOR]

The Italian Law no. 180/1978, that closed mental hospitals in Italy, is a law of principles that cannot prevent the development and the progressive extension of ways of working used in old psychiatric hospitals. Ten aspects are examined which are strongly at risk in this direction and which are in fact facilitated by many national and regional regulations. They are the following: leaving the organization of mental health to the autonomous decisions of Regions; reducing the programming of services to an administrative management; reconstituting spaces that operate according to the old mental hospital system; not using every available tool to oppose chronicity; not making a real integration of the new psychiatric wards in General Hospitals; returning to "dangerous for yourself and others" as the leading model in psychiatric choices; devaluing the centrality of the community and the integrative value of mental health centers; managing any context where there are behavioral or social problems as something related to mental illness; ignoring benchmarking and outcome measures; devaluing the quality of training. [ABSTRACT FROM AUTHOR]

The three Law Drafts presented at the Italian Senate by various political parties for the purpose of reforming the Law no. 180/1978 on psychiatric reform are discussed. Regardless of the diversity of the proposals they formulate, they show many common biases: they don't proceed from a serious analysis of the effects of the Law on psychiatric reform, of the current situation and the causes of existing difficulties; they don't take into account the scientific knowledge and the changes that have occurred during these years; they provide weak answers to the real needs of psychiatry in Italy today. These Law Drafts ignore the progressive changes introduced in the last 40 years aiming at reforming the National Health System; in some cases these changes brought about substantial reforms, but more often introduced interventions on marginal aspects, yet of great impact in their consequences. These changes, in particular the delegation of powers to the Regions concerning health planning and a series of acts adopted by the Government aimed at budget control and spending review, have replaced a capacity for ambitious cultural projects with a poor administrative mentality in every sector of the health system, so that it becomes almost impossible to address the real problems. These changes have wide effects on Italian psychiatry, which in the years following the Law of Reform no. 180/1978 increasingly lacks of a wider cultural perspective and is unable to build a scientific space for itself, because a scientific view would be considered too narrow and unable to include cultural factors. Today's Italian psychiatry, without a wider cultural perspective and a scientific view, is without identity and it is torn between health requests and social demands, between ideological and scientific approaches, between attention to the needs of the people and attention to the political mechanisms of health organization. It is thus transformed into a weak and flat management, poor not only in resources but above all in planning capacity. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to identify services-related and area-based measures together with socio-demographic factors that could improve diagnosis-related groups in explaining length of stay variability in general hospital psychiatric units in Veneto Region (North East of Italy). Methods: Data were collected from the regional hospital discharge records database. A hierarchical multiple regression model with only diagnosis-related groups as predictors of actual and ln-transformed length of stay was compared with a second model in which patient-, service- and area-level variables were included. Local health district was used as group-level in the hierarchical multiple regression analysis. Results: The only diagnosis explains 6.4% of actual length of stay total variance (14.8% for ln-transformation). In the second model length of stay resulted related also to gender, age, severity of hospitalization, patient's local health district, number of psychiatrists, psychologists, hospital attendants/nurses, social workers and educators in the general hospital psychiatric units, number of outpatients in each local health district and percentages of divorced and single people, with almost a 2% point increase on actual length of stay in explained variance (5% point increase for ln-transformation). Conclusions: For the first time the hospital discharge card regional survey of all public acute inpatient psychiatric facilities in Veneto Region were used. The innovative aspect of this study was the attempt to investigate the relationship between length of stay and other indexes, characterizing not only the inpatient facilities, but also the resident population structure in each area. The information about factors that influence length of stay can be useful to inform service planning and resource allocation. [ABSTRACT FROM AUTHOR]