By Giulia Bovassi –
Refined surgical skills and human dexterity are fully manifest in such complex operations as organ transplantations, a difficult intervention and great therapeutic resource. How should we deal with the possibility of a head (or body) transplantation, keeping the patient-person in the center? What risks originate from psychological sciences? Thanks to their professionalism and assisted by well-known cases in literature, several experts helped to shed light, from the psychotherapy’s point of view, on its plausible consequences.
The round-table seminar, part of the Masterclass in Neurobioethics, hosted three major psychotherapy schools and five experts in the field to undertake an interactive experience for mutual exchange and in-depth training on the Masterclass main topic, the so-called “head transplantion” on the human being. The meeting, coordinated by Prof. Alberto Carrara and introduced by Dr. Maria Luisa Pulito, psychiatrist, neurobioethicist and former GdN member, joined the psychological perspectives essential to correctly examine the above-mentioned surgical project. The patient’s psychological rejection, after the transplantation of visible parts of the body, is not a hypothetical deduction, but an objective datum the scientific community must consider. These patients express discomfort towards their new organ in various ways: as highlighted by Dr. Pulito, they feel their integrity undermined and consequently need to assimilate the deconstructed image of themselves again; they are sad for the lack of that particular lost reference of their body; they are animated by anguish, paranoia, sense of persecution and extraneousness towards that novelty applied to their figure; all of this contributes to the expression of that psychological rejection, decisive for that patient called to reassess his own history. Precisely about this story, Dr. Pulito, using the formula coined by P. Ricoeur, «synthesis of the heterogeneous», shows how much the narrative experience and temporality, which determine the “specific” of each human being, are dense synthesis that invests us with its features in the union between the temporal and historical permanence of the personal identity, defined largely by the relational interaction. A balance between permeance and change. In the end, making precise reference to the potential patient, result of a hypothetical fulfillment of the “body-to-head transplantation”, Dr. Pulito asks herself: «Will the impression left in the brain circuit of the original body be felt in the new one? Which synthesis of the heterogeneous will be possible through the head transplantation?».
Dr. Massimo Cotroneo, hypnosis and Ericksonian psychotherapy’s specialist, supports the structuring of hypothetical predictions, starting from already illustrated cases of difficult cohabitation between the patient and his new transplanted organ or limb. Face or hand transplantation experiences, for example, have been subject matter of the verification of the psychological and psychosocial responses of the individuals, who, although gaining evident improvements in their quality of life, had to face many difficulties in the representative identity and in the systemic-relational implications. Despite the increased functional benefits, technically healthy patients developed mental-psychological pathologies that were difficult to ignore and probably already nourished when they joined the intervention. The expert questioned the veracity of the awareness to the consent of a head transplantation, a choice without any return possibility. Here is the Ericksonian approach’s contribution, where the person resides at the center, both in the constitutive globality and in the uniqueness that characterizes it, namely considering her, every time, different from her equals. The effort to consider the set of implications that could arise before and after the intervention, allows practices such as hypnosis to work, thanks to the access to special states of consciousness, «on the deep aspects of consciousness and psycho-corporeal matter, sometimes masked by non-functional choices». The added value of the hypnotic session lies in the access to highly conflictual and complex places, often autonomously unsearchable, that would lead the patient after the intervention to highly uncomfortable conditions. This tool is equally strategic when doubts arise regarding the authenticity of the consent: the transplantation idea could induce confusion or obsessive feelings dictated by the minimum effective experience with similar imaginative representation of the surgery. The integration between subjective experience and the experimentation of an arduous and, sometimes, alienating path, as the weight of the head transplantation, is a contact that can be experienced through hypnosis and it would be, without a doubt, advantageous to support the human aid to the patient.
The director of the S.I.S.P.I., the International School of Specialization on the Imaginative Procedure, Dr. Alberto Passerini, proposeed, together with his colleague Dr. Manuela De Palma, psychologist and psychotherapist, hypothetical considerations on the implications related to the head transplantation, founded on what has already been learned in the Imaginative Experience. Dr. De Palma highlighted how much a transplantation, which is considered “routine” nowadays, already breaks into the recipient’s psychic life, arousing adjustment, assimilation and accommodation’s trends. This transversal impact induces different symptoms, including anxiety, stress, depression, which cause on the patient a crisis due to disturbances in his own body image, self-representation, identity, in addition to the already mentioned obstacles in the perception of his new self-belonging to the transplanted organ (psychological rejection). The body image, as our own body’s psychic representation, lasts despite the change (we modify the image of our body even during the pain and the suffering; yet still the identity, the biographical answer we give to ourselves, remains within the alterations). The relationship between the Corporeal-Imaginary Ego and the Psychic Ego is profoundly changed because of the dissociation between bodily and psychic images (we can understand it if we examine the psychosis cases). The muddled mental adjustment, within the transplantations, involves two phases: first, when the familiar piece has been removed (sorrow), as deprivation of a belonging; second, which is characterized by an oppressive sense of guilt caused by possessing something unduly (because it is property of someone else, who is deceased).
It’s here that Dr. Passerini’s relation, entitled “The inhabited body”, begins, opening with the concept of “accorporation”, recalled at the end of her speech by Dr. De Palma; “accorporation” is the union between integration and incorporation, using Dr. Passerini’s words, a proper junction of a sentient being; it’s that precise indissoluble meeting point between interiority and exteriority, because he is not only appointed to a body but he is his own body (this is glaring in psychosomatic patients, who falsify, in their pathology, every dualism because they use the body to stage inner conflicts). The patient, through the imaginative procedure, pours into the somatization the traumatic psychic experience, as evidence of the Self Relational Ego, related to himself, to the others and to the environment. Holding firmly the information explained until now by the speakers, how could one consider “a healthy patient” a patient whose body no longer has any factor in common with his history? The problem of identity, right from the first lesson of the Masterclass, appeared central in the debate inherent the attempts of the Turinese neurosurgeon. Even under the articulations of the psychological sciences, it’s metaphorically assimilated to a sort of Commonwealth where the members vary, but the substantiality, completely incorporated in the relationship between the parts, is rooted. The fear is to return to a patient, in order to make him feel healthy through a body different from his own, an existence strongly torn in psychotic conditions, where the bodily condensations recombine the identity as sum of history, temporality, biography, otherness and corporeality. It could be wondered if it would be acceptable a proportion of risks / benefits where, on a scale, weighs the well-founded fear of a “delirium of de-personalization”, due to the perception of a split, foreign, recombined body?
According to some mindsets, the human being could be reduced to cerebral activity and content or, by other means, to the information inscribed in his genes, from which what so many call “genomania” was born. These are penetrating linguistic twists, descriptive of a specific type of man, which the experts Dr. Chiara D’Urbano and Dr. Pasquale Ionata, psychologists and psychotherapists, scatter thanks to the psychodynamic experience. Dr. D’Urbano sums up the dense and rich picture until now analyzed both in the round-table seminar, that has seen so many professionals participating, and from the opening of the Masterclass itself. Dr. D’Urbano offered a reflection whose principle is exquisitely anthropological and philosophical, referring to the first introductory lesson on the Transhumanist and Posthumanist movements. It is useful to remember the principles since they themselves demonstrate the ambivalence on which a great part of contemporary society is culturally nourished: the exaltation of the body and of aesthetics until its empowerment and, at the same time, the mortification of corporeity in favor of the cerebral matter alone as summary of the human being himself. The patterns of attachment, the synergy between mind-body and the brain, and relationality, are examples of how life, since its origins, is a path of adherence and adjustment in view of an inexhaustible construction of the identity and of our self-understanding. “Mentalizing”, or “keeping the mind in mind”, indicates exactly the amount of literature that a good reader, as we are with ourselves, must accomplish by looking at himself in his own entirety.
In a head transplantation situation is it plausible to suppose disintegrative states of personality? Asking this question, Prof. Ionata addressed the participants at the end of his report on the exchange between the three brains of man: the cerebral one (whose highest expression is creativity), the cardiac one (whose highest expressions are compassion and love), the enteric one (whose highest expression is courage). These three brains communicate with each other through the vagus nerve, at the point that it has been shown that the greatest quantity of informative material performs movements from the bottom to the top, and not vice versa. The importance of not looking at the person as an assembly of parts and components, as if they were roommates each having its own privacy, refines the critical gaze, so that it cannot be unprepared in cases such as those presented by the professor, for example those following cardiac transplantations. The intrapersonal relational mind is the ability to make the unconscious conscious; to grasp the wisdom that flows from the dialogue between the conscious and the unconscious mind. The activation between the three brains restores consistency to our somatic relationship with the mind, which is very often paraphrased with “psychic abstraction”, while it is actually the unity of an integrated whole. If we consider the dynamism unveiled by enteric or cardiac dreams, how do we guarantee a permanence, a stability to the relationship, in a body transplanted on a cerebral brain which is extraneous to the other two new correspondents brains? A chaotic nothingness is the more plausible and realistic scenario, aggravated by a nonexistent memory, in a patient who would find himself impaired in his ability to respond to himself.
Such a dense experiential content demands in turn for a weighted metabolization, in order that a new piece can be added to the interdisciplinary mosaic that the Masterclass is proposing; but it is equally true -as suggested by Dr. Viviana Kasam- which immediately urges a curiosity about the limit of human action, stimulated precisely by its relapses. These are the questions that Dr. Kasam, president of BrainForum Italy, extended to all those who, faced with the rapid advance of technology, perceive the duty to dwell on this dynamism with a critical gaze. The launch of the second edition of “Cinema & Brain“, which this year will take place in Milan, through the initiative “Neurofiction. A plausible future?“, is functional for this purpose, in so far as there will be a debate, on the occasion of the screening of the film “Frankenstein Jr.” (1974), between the coordinator of the GdN, Alberto Carrara, and the neurosurgeon Sergio Canavero, which will summarize the main theme of our Masterclass: “Head transplantation: the hunt for immortality“. Recalling Prof. Carrara’s initial thought on the posthumanist inspired scenes presented at the recent Gucci’s runway show – cinematography, art, fashion are channels for solicitations and a socio-cultural effect quite in line with the more widespread common feeling. Therefore, through the provocations launched by the Milanese event, we will find further pressure to ask ourselves where the limit is and when the reliability of our awareness is put into crisis by the power that a decision, such as the consent to the head transplantation. The UNESCO Chair in Bioethics and Human Rights is carrying out extensive research on consent, so that the network woven by a man’s decisional freedom can be said to be protected in times of vulnerability.