RISULTATI RICERCA

In questo commento sull’articolo di Bottaccioli & Bottaccioli (2024a) viene analizzato criticamente il ruolo di Franz Alexander nello sviluppo della psicosomatica contemporanea sia negli aspetti innovativi che nei limiti. Da un lato, Alexander ha contribuito a emancipare la spiegazione dei sin-tomi fisici dall’impostazione classica del primo Novecento irrigidita sul modello della conversione isterica e a promuovere organizzativamente il movimento psicosomatico internazionale, anche ita-liano. Dall’altro, i suoi limiti riguardano soprattutto l’impostazione teorica tipica della psicoanalisi novecentesca: l’adozione di un modello monodimensionale centrato sul conflitto intrapsichico e l’indeterminazione – necessaria per l’epoca – di un “fattore X” biologico come mediatore. Nel secondo Novecento si è invece affermato un modello di spiegazione centrato sul deficit (come per esempio l’alessitimia) e della complessità (modello biopsicosociale) in cui i vari fattori biomedici, psicologici e socio-culturali di moderazione assumono pesi relativi differenti nella spiegazione delle malattie fisiche e nella gestione clinica del paziente.

My response to this road map has three aspects. First, I agree that the various fields of psychology do not share a consensus about basic principles, but I remain skeptical whether they could ever be linked by a unified theoretical framework. Any new set of governing concepts would immediately become a contested topic, increasing the already precarious reputation of the field. My more important reaction, however, focuses on the varied practices and theories of clinical psychology. Clearly, the use of diverse empirical methods by many clinical disciplines does not support the unification thesis of the road map, but rather illustrates their fragmentation. Yet, I find myself in accord with the authors that the absence of a theory with well-defined basic concepts condemns clinical psychology to a patchwork of forms of treatment with disparate goals and purposes. Without a theory, practitioners have no place to organize their observations, choose possible interventions, or even design meaningful research. The example of psychoanalysis in the paper demonstrates the inadequacy of adopting metapsychological terms for this effort. Some psychoanalytic concepts may belong to subcategories of a unifying theory to come (not an organized model). What we may need most now are conversations about this issue among clinicians. Whether this process might lead to identification of shared factors for the vast domain of professional psychology remains to be seen.

In my comments on "Poverty, health and health psychology: a critical perspective", by Kerry Chamberlain I discussed three main points. First, I talked about the concerns by development economists related to the establishment of a causal link between health and poverty, highlighting how is empirically challenging testing a causal relationship between these two variables. I then described the wide used of the Randomized Control Trials, an important tool now often use to rigorously test the causal effect of an intervention on different outcomes and provide an example of an intervention in Mexico able to identify the causal association between poverty alleviation and health. Second, I reported the theory behind the design of programs aimed at reducing poverty by describing supply and demand side interventions. Finally, I described the approach and the methodology used by economists to evaluate the efficacy of poverty alleviation interventions, highlighting the need of combining quantitative and qualitative analysis.