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The panel consisted of two clinical presentations and a theoretical presentation.
Nicolò began by reporting the periodic emergence of delirious ideas in a 26-year-old man called Alfredo. Her theme was that the psychotic patient tried to recreate forms of his earlier relationships in an attempt to communicate and share those disturbed relationships that were the origin of the psychotic process. The history explored the patient's neglect by parents who were more involved in an older brother's illness, and with the patient's twin sister's regressive behaviour. Mother was described as cold, distant and hysterical. She had had many surgical operations. Mother wanted to save the twin sister, who was ill at birth, even if it cost the patient his own life. During adolescence Alfredo took heavy drugs and began to have a polymorphously perverse sexual life.
Some weeks into analytic treatment, the referring analyst told Nicolò privately that the twins had been born from an illegitimate affair—an example of an enactment of trauma pushed into the transference, such that the knowing and not-knowing became a potent theme in the analysis. Later the patient mentioned his idea of a family romance that the children belonged to another father. Nicolò was interested in the transgenerátional dimension in relation to secrets in the family, which prevented her patient developing a separate identity.
Clinically, the recurrence of psychotic regression was an expression and a means of communicating transgenerational trauma. Self-therapy such as urine drinking was an attempt to heal as well as a communication of aggression towards object and self. The analyst spoke of her need to maintain her own sanity in the face of the patient's aggressive eruptions, at the same time as working ‘along the ridge of the delirium’. Nicolò described points of fracture in the analysis and areas of disintegration, which the patient was unable to think about, and in the shadows was the family's inability t