ABSTRACT
Introduction: MC is a 57-year-old man, who arrived in the actual community in 2017 and has been hospitalized in psychiatric facilities for over twenty years, with a diagnosis of paranoid schizophrenia since the age of 17. He went through several discharges in other communities, which often after a short time dismissed him because of the the difficulties in managing his: "Disruptive behaviour". There are several hospitalizations which have occurred over the years, due to strong agitation, worsening hypomanic mood, severe logorrhea, verbal aggression and destructiveness towards objects. MC had little awareness of his condition and a suspicious attitude towards the community team. He asked to return living with his parents, a request impossible to comply with, due to the severity of the psychopathological frame and the old age of the parents. This framework raised the question to the care team of how to create the conditions for the patient to be engaged in a care path that would take his words into account. Method(s): From 2019 to 2020, during the bimonthly meetings with his parents he was supported by the presence of an assistant. After each meeting he was offered a space where to talk with the psychologist, who is under psychoanalytic psychotherapy training with a Lacanian orientation, in a visa- vis setting. From 2020 to the present day, due to the Covid-19 pandemic and the worsening health conditions of the parents, meetings with the family have been suspended, but the patient maintained the therapy on a weekly basis, and the talking therapy was integrated with the support of writing as an expressive method. This case is based on medical records, the therapist's notes taken at the end of each session (January 2019-July 2022) and from the patient's writings, analyzed via textual analysis. Result(s):The case shows how the initial therapeutic engagement was able to take place on the basis of the patient's own words: "relationship with the parents" was the recurrent theme of his speeches at the beginning of the treatment and offered the clue on why he considered the therapist as 'the one who was helping him with his parents', thus giving the therapist a place. In the progression of the sessions, when the writing was introduced while addressing himself as an "author" not only to the therapist (who helped writing the text under dictation) but also to the readers, the patient used new signifiers, placing them in a "before" and a "now" and being able to find new words to say something about his suffering. In the work on the patient's text extrapolated from his "Theory on the History of Rock Music," emerges the narrative of his first crisis that occurred at the age of 15 following a school rejection. The patient situates his own individual crisis by extending it to the "Crisis of '68", "student Revolts," and the "conflicts between musical genres.", and at the same time including (indirectly) himself as one of the main characters of his theory as one of the so-called "conscripts of '64" and explicitly connecting this to the onset of his paranoia to the therapist too. The patient not only narrates the crisis but also how he tried to "overcome" it, again placing this transition at an extended level through the musical evolution that led to the birth of "punk" music in the 1980s, musical genre in which he could have "recognized himself" because Punk allowed "people who suffered this type of depression" for "artistic expression of paranoia". The writing of this 'theory of the history of rock music' took a long time for the patient to work out, arriving at about ten pages over the course of about 2 years of work, implying the rhythm and logical time set by the patient himself. Conclusion(s): The reference of an aim such as "work" ("Helping with his parents", or "Being his collaborator on writing the text") might have been helpful to the therapist in appearing less persecutory and establishing a climate of trust. When, with the arrival of the pandemic, the outings with the parents were suspended, it was necessary to find new wor ing conditions in the therapeutic process because the patient showed disorientation and difficulty in relating even to the therapist in a calm manner. Also in this case, after a period of suspension, it was the patient who again sought a space to talk, through the theme of music. Working on what the patient offers and support the patient's writing of his "Theory on the history of rock music" allowed the therapist to resume working in a more calm and non-persecutory atmosphere. Writing was a support through which, with the help of the therapist, the patient could construct an elaboration of his illness and suffering and find a way to express something otherwise impossible to say. The work is still in progress;so far, supporting MC in his relationship with his parents through a multidisciplinary intervention and working on his own writing had the effect of allowing the patient to invest more in the community relations and activities, to be more satisfied and to have a greater degree of separation in his relationship with his parents, theme that now does not occupy all of the patient's speech, leaving a space to something new to say.