Rivista per le Medical Humanities

Guenda Bernegger
rMH 28, 2014, 13-21

Traum(a): trauma, dream, story

Despite their linguistic proximity in German, the two terms Traum and Trauma, i.e. dream and trauma, respectively, seem, on th e co ntrary, to be opposed in the m ost radical way. The trauma, as an irruption of the real event, seems to supervene, destroying everything that falls within the dimension of the dream, thus closing the opening to the possible which is so peculiar to the dream. Investigating more in depth the relationship existing between these two terms, the contribution highlights a link between these two terms deeper than the one just mentioned, based on which it is possible to offer useful interpretations to consider the clinical practice, the patient, the caregiver, and man in general. According to the hermeneutic-narrativist perspective adopted in the text, the meaning is constructed through the story that is told about the experience. This will ultimately result in the visionary and imaginative dimension of the dream being the place where the ability lies to reconfigure the traumatic experience too, in a narration capable of comprehending it, and therefore the foundation of hope in a sense – that the caregiver must bear witness to. From this point of view, dream and trauma, being both narrative constructions, can thus be rethought and placed in a continuum. Offering itself as an experience of new meaning possibilities, the dream recalls, thanks to its utopian function, that even in front of the hardness of the traumatic reality “another story is possible”. In crisis situations, this possibility, however, is not visible to the person who is suffering: it’s the other – i.e. the therapist, the person who takes care of him – who has to act as a teller of alternative stories.

Micaela Castiglioni
rMH 28, 2014, 22-29

Can you write a trauma?

Can you write of an event, a trauma, which brings about a deep split in a person’s life history? Can you write, more specifically, of the trauma that follows the diagnosis of a major disease, such as a cancer, a degenerative or a chronic disease? Can we write of what, par excellence, escapes the dimension of sense and represents in fact, for each of us, sheer non-sense? Does it have any soothing effect to put in writing a sharp pain, an intense suffering, a real trauma we have been through? Don’t we run, instead, the risk of being confirmed by our own writing of it in our state of immense and almost immeasurable grief, with no way out? And also, who can be the custodian of this narration? These and many other questions arise providing a backdrop for the contribution; which contribution, without failing to raise the possible risks associated with excessive writing in relation to the experience that causes suffering, highlights mainly the soothing function of writing, explaining its working and specifying the conditions required so that it can be carried out fruitfully.

Cristina Alziati
rMH 28, 2014, 30-35

The curls of chemotherapy. The language that originates from the unspeakability of a trauma

The title of the contribution is intended to indicate the absolute silence that reigns in the traumatic moment – in that strange place from where you are not able to communicate anything whatsoever, not even to yourself. It is also meant as an allusion to a return to the word: to the fact that, in the same way (except for hardly any difference), at least for those who had straight hair, this grows back after chemotherapy (unfailingly curly), likewise that word too shows some little difference, since it brings with it, and beyond annihilation, what has proved unspeakable with regard to the trauma, making it comprehensible as a place of origin. The text – whose author herself, a poetess, went through disease personally – offers a reflection on the experience of disease, on the relationship to the loss of the word, on the impossibility to find solace in poetry, until eventually gaining back possession of the language - which at last allows access to the experience lived - witnessed to by some poetic compositions, taken from the book Come non piangenti (As if not weeping) (Marcos y Marcos, Milan, 2011).

Graziano Martignoni
rMH 28, 2014, 36-46

Collective trauma and survival strategies

The individual and collective traumatic event is the staging of the tragedy that becomes manifest in the kind of existential pain of time and space in all its states, the instant, unexpected, becoming, indefinite, casualness until the catastrophic time, the end of times that evokes. Man, after a century of psychoanalysis, in the wake of an increasingly trivialising conception of trauma, reverts to mere biology (by now, behind every mental disorder and existential suffering there must – almost inevitably – be a hidden trauma really happened and suffered in childhood, preferably of a sexual nature, as in the late 19th century theories). In the current reductionism to which the dimension itself of the inner world is subjected, in the aridity of listening (now taking place in a stereotyped way) to its voices, in the predominance of surface and behavioural psychologism, of reality on the phantasmal life that by now dominates the speeches and listening practices concerning mental suffering, the category of trauma has undergone some sort of epistemic regression. Thus, the trauma becomes a mere incident of reality within a psychic world reduced to a mere organic container of emotions or cognitive representations.

Massimo Reichlin
rMH 28, 2014, 75-80

The question of the embryo

The article illustrates the relevance of the problem of the ontological and ethical status of the human embryo. It distinguishes two different conceptions of what it means to be a person, and argues (very briefly) against the “psychological” view of persons and in favour of the view that persons are all individuals endowed with a rational nature. It then discusses four arguments that have been put forward against the conclusion, according to which early human embryos can be considered as persons: it gives reasons to discard the arguments based on the natural loss of early embryos, on the regress from the embryo to the gametes and on parthenogenesis and induced pluripotent stem cells, but acknowledges that the argument for totipotency and the possibility of twinning shows that very early embryos might not be individuals in a strong sense. It concludes by showing two possible practical conclusions that seem plausible in the light of this theoretical discussion, one extending the protection due to human persons also to human embryos, the other accepting some possible use of human embryos in research contexts, under certain conditions.

Maurizio Mori
rMH 28, 2014, 81-87

The embryo,

According to a recurring idea, the assumption whether the embryo is or is not “one of us” is (at least) an undecidable aporia, with equally sound arguments in favour or against it. In contrast to this assumption it is also highlighted that the world’s largest pro-life organization, the Roman Catholic Church, does not claim at all that the embryo is “one of us” in the sense that it is a “person”. Drawing on an important contribution dating from 1953 by Cardinal Giuseppe Siri, it is observed that the embryo participates in the “right of life” despite not having a “right to life”. In this sense, the issue of human embryo protection should be formulated on a different basis and concerns the evaluation contrast concerning the sacredness of human life and the respect due to the alleged pace that would be marked by God in the world. That the embryo is not “one of us” is certain and can be admitted by everyone, including Roman Catholics. The clash in this matter concerns the two different moral paradigms, as in the traditional paradigm human life must be absolutely respected from parents to cradle, while in the new paradigm birth-control seems to be a moral duty of every responsible citizen.

Alberto Bondolfi
rMH 28, 2014, 88-97

Reproductive medicine: ethical and political hints

The purpose of this article is to show both the ethical and legal difficulties that accompany a process of revision of the Swiss law in the matter of medically assisted reproduction. Some of them are linked to the Swiss political system: the need to put to the popular vote every amendment to the Constitution, the fact that the current text contains many precise prohibitions and therefore it needs to be reformulated and submitted again to the people’s vote. The text of the law refers to a technical situation dating back to about two decades ago. The points of greater conflict and discussion are pre-implantation diagnosis and egg donation. The author highlights the need to problematise the criteria for having access to such practices taking into account the following principles: freedom of reproduction, good of the unborn baby and mother’s health. Finally, he also evokes a new issue that the law does not tackle, i.e. that relating to homo-parenthood and therefore to the homosexual couples’ access to reproductive medicine. This issue requires a new effort of reflection, which to date remains largely disregarded.

Ruggero Comi
rMH 28, 2014, 98-103

Assisted reproduction

Couple infertility consists of non-conception after at least two years of regular unprotected sexual intercourses. This disease, steadily increasing in industrialized countries, affects 20% of couples and is approached with the techniques of Medically Assisted Reproduction (MAR), i.e. procedures involving the manipulation of sperm and egg cells in order to achieve a pregnancy. These are divided into first, second and third level MAR procedures. The first level procedures, on an outpatient basis and minimally invasive, consist of Intra-Uterine Insemination (IUI). The second level mar procedures, more invasive and performed on a day surgery basis, consist of ivf and icsi and can be performed with fresh or cryo-preserved gametes and embryos. We refer to third level procedures when the ICSI uses sperm surgically removed from the testicle or the epididymis. Both insemination and IVF/ICSI can be performed with gametes and embryos derived either from the partners (homologous procedures) or from donors (heterologous procedures). The contribution illustrates the methods and results of the various techniques, expounding the data drawn from the 6th Activity Report of the Italian National Registry of Medically Assisted Reproduction held by the National Institute of Health, referring to 2010.

Carlo Alberto Defanti
rMH 28, 2014, 104-110

Eugenics and its taboo

In the article the history of eugenics is briefly reviewed, starting from its foundation by Francis Galton, as set in the peculiar social and cultural framework of the second half of the 19th century. Its development during the 20th century is outlined, with special emphasis on the “appropriation” of the eugenic idea by Nazism. An argument is proposed against the inevitability of the “Nazi drift” and in favour of the possibility of resuming today, in a fully changed scenario, the eugenic idea, targeted, however, not at the “improvement of the race”, but at the wellbeing of each individual. Although the new technical possibilities are not exempt from problems from the ethical point of view, the historical framework of this “new eugenics”, the changed political situation in most of the world, at least in the West, and the radical diversity of means and intents with respect to historic eugenics allow dispelling any fears that it might lead to abuses similar to those reported in the past.

Cristina Borradori Tolsa
rMH 28, 2014, 111-115

Neurodevelopmental disorders in premature infants

Very preterm children – born before 32 weeks of gestation – currently account for 1% of all Switzerland’s annual births. Even in the absence of more severe disorders (in 10 to 20% of cases), we often observe (in 30 to 50% of cases) the occurrence, in infants born at a particularly early gestational age, of a number of difficulties, difficult to diagnose, which are often detected at the preschool or school age (such as attention deficit and learning disorder, specific language difficulties, and motor development problems). This article provides an overview of the main disorders in premature infants that affect their motor, intellectual and behavioural development.