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As usually it happens to me to say, when asked about the Internet, the Computer Mediated Communication (CMC), the marriage between the Net and Personal Computers represents a real global revolution with not only technological implications but, most of all, social and economical repercussions; Internet is a greet chance, people and professionals can't loose.

Here we are to talk about Internet and Psychiatry, I'd like to put under your attention my thoughts synthetically and in a problematical way, because many aspects are problematical when we turn our attention to this new border, the virtual reality, whose points of contact with the "real" life grow and grow every day.

As Andrew Shapiro says in his new book "The control revolution" Internet is bound to disappear, that is to say that, as telephone and television and radio, it will (especially in western hyper technological side of the world) turn into an household appliance, integral part of our every day life.

I have chosen, for this speech, to talk about one main problem in a "psychiatric view" of CMC: may the Net be or become a therapeutic tool in Psychiatry? May the Net be considered as a space where we can act therapeutically?

Let me proceed point by point:

  1. Without any doubt, Internet is a powerful communication tool. Its revolutionary significance as information carrier and as interpersonal contact tool is reliable and, as such, it represents a therapeutic tool if we consider the easy of contact and the possibility of access to qualified sources a positive event both for our patients and for us, mental health workers.
  2. The eligibility and the certification of net's sources represent the real problem. In this field I hope that, in the next future, Scientific Societies, such as WPA, will carry out a preeminet role in certify the quality of the centents of the psychiatric resources on the net, in my view, the sole way to guarantee a serious and useful use of these technologies.

  3. By now the net sets itself, in the psychiatric field, as therapeutic tool, fundamentally in four ways:

  1. as tool for counselling
  2. as tool for self help
  3. as therapeutic space by itself
  4. as psychotherapeutic tool.

As tool for counselling, Internet will prove to be useful, allowing the overcoming of distances and difficulties of contacts, ending up by allowing therapeutic contacts, which, without the protective filter of the computer screen, could be impossible or really difficult to set up.

As self-help tool the Net will because a great chance. With its possibilities of interaction Internet can create, to say it with Benedict Anderson, real imagined communities, not imaginary, without the territorial limits of classical communities of the real world.

As therapeutic space we have to consider the possibility of the use of net technologies in programs of reinstatement for our patients especially for those included in communities. For us, as psychiatrists, the aim is to begin to study and evaluate the potentiality of the net in this field.

My psychoanalytic training would not allow me, "a priori", to consider the CMC as effective psychotherapeutic tool.

The meaning of the body, the necessity of physical presence, the psychotherapeutic playground, the weight of not-verbal, pre-verbal communications, all these things bring me to put forward many doubts about the real psychotherapeutic power of CMC.

But, as laity, we have to add some further observations, kept in part from the contents of my recent book "Psichiatria Online" edited last May in Italy:

  1. Internet is a real complex and in constant progress communication tool. By now we can find different forms of psychotherapeutic care managed through the net: asynchronous communications with e-mails, synchronous communications with chat-lines, which now have also powerful audio e video capabilities.
  2. The exclusion of any kind of therapeutic value of these forms of psychiatric care must be evaluated in context. We have to consider, with attention and without bias, the valences of the actors in play. Certainly I have to say that more is the experience of the psychiatrist, more will be the eventual psychotherapeutic effect.
  3. The entrance of virtual in our every day life, any way, opens new, unknown scenarios where, probably, another psychoanalysis may make room for itself.

We, as psychiatrists, have to think about it and open serious studies, like we have to study in depth many new aspects of the life on the screen, opening a sort of "Psychiatry of the life on line".

Running to conclusion, I say that we have to begin to consider and study the new meanings of the man on line, with particular regard about themes like identity and group interactions and most of all, psychopathology and its expressions on line.

The Psychiatry of the life on line needs new tools of observation and the skill to combine the old fund of knowledge with specific and peculiar traits of the psychopathology of the life on line, which, as part of our life, can't no more be read as simply passing habit or examined with haughtiness or superficiality.

I think that the WPA session of Informatics and Telematics must play a leading role in Psychiatry, in the next future, setting itself as bridge and translator (following the late Kuhn lesson) between these two worlds, reality and virtual, more and more close ad interconnected.


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