Giovanni Stanghellini's book Lost in Dialogue is a unique work.1 It is not a treatise neither does it represent the systematic and detailed development of a determined psychiatric or philosophic theme, but it consists of a series of brief essays with relatively little bibliography, which are grouped into three large parts, namely "Anthropology: What is a Human Being?" "Psychopathology: What is a Mental Disorder?" and "Therapy: What is Care?" In this essay I will focus on "Psychopathology," the second part of the book, and thereby emphasizing Stanghellini's contributions to melancholic, borderline, and schizoid personalities.

Depression and the Idealization of
Common-Sense Desire

The author begins chapter 9 by quoting a short story by Dostoevsky bearing the title, "A Gentle Creature." It is about a young woman who incarnates the commonly held idea of what it means to be a wife. Her ardent desire to play the role of wife of a man she faces not as a husband, but as an enigma, ends in suicide.

Stanghellini's interpretation is that this woman, rather than loving her husband, is fixated on an idea, on a stereotype of marriage. He writes:

Dostoevsky's Gentle creature tries to solve the riddle of the Other by emptying the Other of his personal identity and reducing him to a stereotype. [LD 95]

Stanghellini adds that she would suffer from idioagnosia, that is, the incapacity to appreciate the Other's individuality. For him, there is self-referentiality in this incapacity,

an extreme and lethal kind of narcissism, not in the sense of love for oneself, but in the sense of being in love with one's own representation of the Other…love is love for an image. [LD 96]

Thus, the Other is transformed into an "abstract and absolute source on impersonal social norms and values" (LD 97). The melancholic person, Stanghellini argues,

over-identifies with the public opinion (heteronomia), and her identity is welded (hypernomia) to its surrogate, namely her social role. [LD 97]

Any form of dialectic relation in the encounter with alterity also disappears for the melancholic person

cannot tolerate any dissonant aspect within herself and with the Other...Existences of this kind, in their gentleness, spontaneity, innocence, and apparent You-orientation, are anything but submissive...they are inflexible, they lack nuance, and they are incapable of compromise and conciliation. [LD 97]

Undoubtedly, many of the characteristics Stanghellini attributes to the personality of unipolar depressive persons correspond to reality, as is the case of the fixation on order, self-demandingness, rigidity, and overidentification with social roles. There are, however, elements in his description which neither coincide with those stated by Hubertus Tellenbach,2 nor with my own longtime personal experience with these patients. For example, in this context Stanghellini speaks of "self-referentiality" and of "an extreme and lethal kind of narcissism." However, Tellenbach describes the interpersonal relationship of the depressive person as one marked by solicitousness (Fürsorglickeit) and reciprocity (Gegenseitigkeit), that is, by a permanent transcending toward the Other, something which is far from a selfish and narcissistic withdrawal toward a mere internal image. In my experience, the relationship of a depressive person with the Other features an important dependence, yet it is not only an exploitation of the Other's force for existing, instead it is rather a real preoccupation for the Other's wellbeing. The Other always comes before one's own conveniences. Now, this strong bond with the Other also implies a vulnerability and a danger, in the sense of the frequent triggering of a depressive episode in the case of partial or total loss of the loved one (as, for example, by death).

What Tellenbach has stated and what has been largely confirmed by my experience, too, is not being questioned by Alfred Kraus' contributions either, when he postulates that a depressive person

eludes the liberty of determining herself and seeks to find in the other person an own identity.3

While it is possible to translate the lack of autonomy of persons who are prone to depression into greater dependence with respect of the Other and, by doing so, into a certain degree of loss of identity, this does not mean that they are not capable of love, if one thinks that love, above all, confirms and helps to construct the existence of the Other, of the real Other rather than merely their ghost, as Stanghellini suggests.

Borderline Existence and the Glorification
of a Thrilled Flesh

According to Stanghellini, in a borderline personality the teleology of desire would be in a certain way the opposite of the one occurring in the typus melancholicus. It is about the glorification of a kind of oceanic encounter with the Other. It is a mystic encounter of the own flesh with the flesh of the Other. The author tells the story of a patient, Ilse, over 40 years of age and divorced, who declares that she prefers clandestine relationships with married men, as "marriage is not the right place to meet a man" (LD 98). She divides her life between erotic passion and the desire of being acknowledged, noting that

emotions are the epicenter of both these passions...I mean the emotions that I only find in my way of being totally in love with someone. [LD 98]

Stanghellini states that the defeat of a borderline person is due to the fact that this person

postulates as essential to life what is more alien and inaccessible to it, what in life itself is unstable and fleeting par excellence: the immediate encounter with the Other. [LD 99]

The encounter is lived by borderline people "as an opportunity for recognition" (LD 99).

In another example, taken from the writer Sarah Kane, the need of the Other as a source of recognition appears again, leading to a loss of identity understood as selfhood. This desire

fulfils the visceral need for recognition with a heroic and empty claim for absolute communion. And, finally, it makes the non-avoidable discord between the partners into the trauma of abandonment of which she considers herself to be the only victim. [LD 100]

Stanghellini describes here fundamental elements in the interpersonal relationship of people with a borderline personality: their search for immediacy, as well as the intensity that is being demanded in each relationship. A further element he underlines is the loss of identity as selfhood when one does not feel being recognized by the Other. He develops the theme of intensity in his work more extensively, particularly referring to the relationship of a borderline person with one's body:

The living body is experienced by borderline persons as the headquarters of a distractive as well as exhilarating power. It is experienced as an energy that takes the representation of oneself to pieces, reducing it to a mere accumulation of disordered emotions and drives...It is the glorification of a thrilled flesh, an intensive body vibrating at one with emotions, needs, desires, and all the powers of the involuntary. It is an intensive body.4

I would like to make two comments on this point. The first comment does not directly have to do with Stanghellini's ideas, but with the construct "borderline personality" in general. The description of this personality type given by Stanghellini does not differ much from the classic one made by Karl Jaspers of hysterical personality, that is stated in his General Psychopathology.5 The following traits are commonly recognized in it:

• theatricality: "the ability of the true hysteric to live wholly in his own drama" (GP 443);
• interior emptiness: "as it can no longer find anything within, it looks for everything without" (GP 443);
• a permanent search for recognition: "hysterical personalities have to ensure their own importance" (GP 443);
• incapacity to maintain stable relationships: "they become unreliable, are no longer capable of enduring emotional relationships" (GP 444);
• inability to differentiate between idealized love and an actualized and real relationship with the other person, and so on: "the more the theatrical aspects develop the more these personalities lose any genuine, personal affect" (GP 444);
• even the typical, so-called "deliberate self-harm behaviors" are mentioned in Jaspers' General Psychopathology: "under some circumstances they will be reckless with themselves and inflict self-injury" (GP 444).

Undoubtedly, there are many common elements between these two personalities and in the first descriptions of borderline personality by Robert Knight and Otto Kernberg in the 1960s one can also recognize elements of the markers regarding hysteria.

Secondly, it is then necessary to search for what distinguishes the one from the other. I believe that this distinction is fundamentally represented by the problem of identity, which is much more fragile and diffuse in the borderline personality than in the hysterical personality. Stanghellini himself mentions this when he asserts:

The Other's absence...is often the reason for feelings of un-recognition and desperate loss of selfhood. [LD 100]

Anneliese Dörr argues that persistent emotional instability, frequent diffusion of sexual identity and, above all, tattoos, cuts, and self-mutilations could well be considered as desperate attempts of searching for one's self.6 Elaborating on this subject, Philipp Schmidt and Thomas Fuchs postulate that all the typical characteristics of borderline personality disorder can better be understood as a disturbance of narrative identity:

The absence of a stable narrative identity may not only cause the mental pain of emptiness and incoherence...it may also exacerbate the distortions to the structure of a person's affective and interpersonal life.7

Similarly, Anneliese Dörr and Paulina Chávez have suggested that the reason why borderline personality disorder has appeared in the late modernity and has highly increased in postmodernity is related to the predominance of the visual world among young people (content processing via the medium of screens in different forms) to the detriment of developing a more differentiated language.8 This has led to a lack of words with the consequent difficulty in constructing the narration of their own life, that is, of their identity.

Schizophrenia and the Disembodiment of Desire

Stanghellini describes a third form of a failed relationship with the Other as the one occurring in the schizophrenic spectrum (or, more precisely, in schizoid personality) and which he calls "out-of-the-world shelter whose cypher is the dis-embodiment of Otherness" (LD 101). He begins with the example of an Italian poet, Dino Campana, who describes a search of the Other by way of penetrating a desert, a spectral landscape in order to find immaterial spirits, shadows, disembodied images, fragments of things, mechanical bodies, and so on. For the schizoid persons, things as well as persons are living as mere objects. The persons lose their condition of being incarnated; they are deprived from their flesh. Schizophrenic existence can be conceived as "the withdrawal from the intolerable failure of the relationship with the Other" (LD 102).

However, what is not said or remains hidden is the fact that despite this failure exists within them an orientation toward the Other, toward the You, in spite of the failure. In Campana's writings the apparitions and abstract visions, which can be seen as failed encounters, do not extinguish one's hunger for the Other.

Stanghellini then proceeds to describing the case of a young artist, Franz Bau, who fails, time after time, in his loving relationships, as he is not able to tolerate a plain encounter with the girls and who feels that they do not satisfy his spiritual desire: "I needed someone to whom I could be spiritually bound" (LD 103). In this incapacity of uniting physical and spiritual love, a psychotic break takes place in him, during which he believes that his previous lover was aware of everything related to his last relationship and that people spied on him, and the doctor was an accomplice, and so on. Franz Bau has a hyperaesthetic temperament, whose narrow circles or relationships push him toward a series of failed attempts to establish an erotic relationship which ends in a distancing from reality in search of an exclusively spiritual bond with the Other.

Two facts seem to characterize these two existences: First, their philosophy of life, consisting in interminable ontological and anthropological disquisitions that move them away from the vital contact with their here-and-now reality. This corresponds also to what Eugène Minkowski had described as morbid rationalism.

The second distinctive fact is discorporalization. In both cases the lived body is the theatre of an uncanny teleology of desire. Stanghellini writes:

This distressing feeling accompanies the epiphany of the Other, as a flesh-and-blood person (the "Sister") or as a phantasm (the "girl"). [LD 104]

The crisis of the harmony between the bodies or inter-corporality could be a primary phenomenon in the schizophrenic existence.

Disincarnation and dis-attunement can arise as secondary, defensive involuntary strategies in a kind of existence faced with the awareness that the Other can only be approximated, not appropriated...The disembodiment of desire can be a shelter, although an extremely vulnerable one, and in its own turn the source for a progressive withdrawal from social encounters. [LD 105]

I would like to comment on three points with respect to this chapter:

(1) The author here establishes a separation between schizophrenic disease and schizoid personality or the prodromes of the disease, unlike in the chapter about depression, where he clearly refers to the previous personality (or to Tellenbach's typus melancholicus) and not to the depressive disease itself.

(2) Both the phenomenon of discorporalization in the encounter and that of the loss of borders between the I and the world constitute an indisputable truth that Stanghellini has brilliantly exposed in this book. Intelligent patients with an introspection capacity are capable to describe both phenomena in a very vivid form. An example of casuistry taken from one of my earlier writings illustrates what Stanghellini describes.9 It is the university student Federico who in the period prior to the explosion of a psychosis, manifests:

I have not yet found the way toward the you...I always have been enclosed in myself, deaf when faced with the exterior world. [DID 2]

And in another moment, he asserts:

The world is very distant, empty and without meaning. For example, if I observe a farm, I see very clearly, in all their details, the house and persons, but only as something material. Beyond that, everything is poor, barren and meaningless. [DID 2]

In a later diary entry, he writes:

For a while I cannot remember the individual who owns the faces of persons known to me anymore. When I look at them, I see only their legs. [DID 2]

(3) This difficulty of contact and this sort of failure in the encounter with the Other do not at all mean indifference. Stanghellini writes:

What...in most schizophrenic narratives may remain concealed, is that there is a You-oriented story, although a story of failed encounters with the Other. [LD 102]

This observation was already mentioned by Eugen Bleuler who writes that in schizophrenic patients

affectivity is not extinguished entirely at all. If one knows one's patients well one discovers that even in states that initially appear to be severe affective deterioration, an emotional life can be recognized...What is more, unexpected expressions of warm and affectionate feelings can be observed in seemingly completely emotionless schizophrenic patients during the process of a psychotherapy.10

This same hypersensitivity has been outlined by other authors in the context of psychotherapy of schizophrenic patients, for example by Christian Müller and by Walter Bräutigam. Similarly, Hans Burckhardt's concept of "schizophrenic defenselessness" (schizophrene Wehrlosigkeit) also points into the same direction, that is, to the high sensibility of schizophrenic patients and the extreme way the world and the Others affect them. This has the consequence that both delusion and autism are often nothing but forms of defenses against the external world.

The contributions by Stanghellini to the psychopathology of melancholic, borderline, and schizoid personalities are fundamental and original. Deepening the study of how the I-You relationship is structured in these different abnormal personalities opens a new field for understanding these somehow tragic human existences, as well as for developing promising therapeutical techniques. In this essay I merely attempted to allude to some psychopathological facts which can perhaps complement the striking findings presented by Stanghellini.