The Drive For Self-Assertion And The Reality Principle In A Patient With Malignant Pleural Mesothelioma: The History of Giulia

Our plain-English summary of The Drive For Self-Assertion And The Reality Principle In A Patient With Malignant Pleural Mesothelioma: The History of Giulia, by A. Granieri (American Journal of Psychoanalysis, 2017).

The study

• Author: A. Granieri
• Journal: American Journal of Psychoanalysis
• Published: 2017;77(3):285-294
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Life in a contaminated environment is often marked by a cumulative psychological trauma that exhibits a variety of social-environmental aspects. This is why I suggested a psychotherapeutic group intervention for the population of Casale Monferrato, a municipality in Northern Italy that is sadly renowned for asbestos-related events and the high mortality rate of its inhabitants. Groupality appears to show the point of contact between psyche and soma, while also promoting the birth of a more realistic approach to the various levels of suffering and their configuration. The multifamily approach seemed to be the most adequate to elaborate the feelings of rage and fear that are concurrent with the aerial contagion. In the "long wave" of group work we have learned to work with participants as well as with empty chairs, the ghosts of the dead: live traces in the mind. Whereas the mind recovers the possibility of entering into a dialogue with the feelings connected to the trauma, without bypassing them towards actions that are apparently more assertive of one's sense of Ego, the will of conciliation can reactivate a thought that is oriented towards the plane of reality.

In plain English

This is a psychoanalytic clinical report, not a measured study. The author described a weekly psychotherapy group offered, at the request of local health services, to people in Casale Monferrato, a town in Northern Italy affected by asbestos pollution. The group followed a "multifamily" approach, bringing together patients, family members, operators and citizens. Each session lasted an hour and a half, had about fifteen to twenty participants and was audio-recorded. The article centred on Giulia, a forty-five-year-old woman, the first mesothelioma patient to join, alive five years after diagnosis. She first said she had not told her children about her illness because her husband did not want her to. Before leaving the group to resume chemotherapy, she reported that she had told her sons and felt a sense of peace. The author reported that almost nobody from the top ranks of an association founded to aid people exposed to asbestos attended. The author also reported that the group moved from a "non-mentalized" resilience to one "owned by the group," and saw such turning points as confirming the group approach.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Psychoanalytic clinical case report (a single patient's history) set within a description of a multifamily psychotherapy group intervention; no formal methods or measurements
• Who was studied: A multifamily psychotherapy group in Casale Monferrato, Northern Italy, with about fifteen to twenty participants per session (patients, family members, operators and citizens), centred on one patient, Giulia, a forty-five-year-old woman with mesothelioma
• Exposure: Living in an environment contaminated by asbestos (Casale Monferrato). No fiber types, jobs or doses are given, and Giulia's own exposure is not described.
• Main results:
  • The group met weekly and was co-led by Francesca Viola Borgogno and the author.
  • Sessions lasted an hour and a half and were audio-recorded and transcribed.
  • Giulia was still alive five years after her diagnosis.
  • Giulia initially had not told her children about her illness because her husband did not want her to.
  • Giulia later reported telling her sons about the mesothelioma and feeling a sense of peace. Her older son said he had already understood.
  • Giulia left the group, at least for the time being, to resume chemotherapy.
  • Almost nobody from the top ranks of an association founded to aid people exposed to asbestos attended the sessions.
  • The author reported that the group shifted from a non-mentalized kind of resilience to one fully developed and owned by the group.
  • Some members started spending time together at the end of the group work.
• The authors' conclusion: The author concluded that turning points in the group, such as Giulia's experience, confirmed the choice of a group intervention for people living in the contaminated town.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Casale Monferrato.

Related studies

• A cohort study on mortality among wives of workers in the asbestos cement industry in Casale Monferrato, Italy — C. Magnani, B. Terracini, et al. (1993)
• The asbestos war — L. Kazan-Allen (2003)
• Effects of informing workers of their health risks from exposure to toxic materials — P.S. Houts, V. McDougall (1988)
• Open letter on the asbestos industry in India — L. Kazan-Allen (2000)
• A tailored, supportive care intervention using systematic assessment designed for people with inoperable lung cancer: a randomised controlled trial — P. Schofield, A. Ugalde, et al. (2013)
• Community-level social support responses in a slow-motion technological disaster: the case of Libby, Montana — R.J. Cline, H. Orom, et al. (2010)

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