I am convinced that your efforts will bring us closer to the day when psychiatry will, at last, become a truly human psychiatry. – Philosopher Jean-Paul Sartre, Preface to Laing & Cooper’s Reason and Violence Nothing is closer to the heart of therapists across all our clinical professions than the notion of change. Like the title of my first book, A Stranger in the Family (Di Nicola, 1997), “changing the subject” is a polysemous phrase that invokes several layers of change. Family Therapy (FT) changed the subject by changing the frame of therapy, placing the individual in a family context, invoking systems theory. My model of cultural family therapy (CFT) changed the subject by placing the family itself in the larger context of culture. These approaches also changed the subject of our work – both the identified patient (IP) and the family system or culture. Now, I propose to change the subject again, identifying three gaps in relational theory and therapy: a theory of the subject (how we define persons), a theory of therapy (how to conduct therapy), and most important, a theory of change (how change or innovation occurs). While we have many competing theories of these tasks, there no consensus among therapists. To address these gaps, I invoke the event as a new model, based on the philosophy of Alain Badiou (Badiou & Tarby, 2013). Faced with a predicament (crisis, rupture), two potential outcomes arise: trauma or event. Trauma closes down the possibilities of life, while event opens them up. By drawing a clear line, marking a before and after, the event changes a world – as an individual (subject), a family (system, culture), or an entire community (the world). Thus, the Event speaks to the very definition of being – beyond attitudes, behaviour, cognitions, and emotions – to what being-in-the-world means. The three conditions for the Event are: (1) being there to witness the event, (2) naming it, and (3) fidelity to the event, which radically changes the subject by identifying with the event. Recalling the story of Antonella (Di Nicola, 2021), an Italian immigrant to Canada referred by an Italian family therapist, I conduct an evental analysis to examine her lifeworld (Lebenswelt in German), her search for meaning and identity. Then through evental therapy (individual, couple, and family meetings), I bear witness to the event of her life. Reaching beyond the human world to become a dog breeder, Antonella resolves her ambivalent attachments to become – “at last,” as Sartre said – a genuinely human subject with an identity and a purpose in life. References: Badiou A, Tarby F. Philosophy and the Event. Cambridge, UK: Polity Press, 2013. Di Nicola V. A Stranger in the Family: Culture, Families, and Therapy. New York: Norton, 1997. Di Nicola V. Antonella – “A stranger in the family”: A case study of eating disorders across cultures. In: DS Stoyanov, et al. (Eds), International Perspectives in Values-Based Mental Health Practice. Springer, 2021.

1. Family Therapy
The Road that Connects
Individual and Social Resources
Plenary Session
Assisi, Italy
8 July 2023

2. Image courtesy of A Donoyan

3. Plenary Session
From Social Control to a Humanistic
Approach to Mental Disorders
Chair: Alessandra Santona (Italy)
Antonello D’Elia (Italy)
Vincenzo Di Nicola (Canada)
Cor Vreugdenhil (The Netherlands)
Assisi, Italy
8 July 2023

4. “Changing the Subject”
From Systems
to Culture
to the Event

5. Vincenzo Di Nicola
MPhil, MD, PhD, FCAHS
• Institut universitaire en santé mentale
de Montréal
• Professeur titulaire, Département de psychiatrie
& d’addictologie, Université de Montréal
• President, World Association of Social Psychiatry

6. “Changing the Subject”
• I want to speak to you today as a therapist and
as a philosopher
• When I told Matteo Selvini about my doctorate in
philosophy, he replied:
“Tutti i sistemici sono diventati filosofi”
All the systemicists have become philosophers

7. “Changing the Subject”
• Systems theorists and therapists have always
been philosophical including Matteo’s mother
• Mara Selvini Palazzoli’s work with the Milan
Team was grounded in
• Philosophy (Whitehead & Russell)
• Cybernetics (Ashby)
• General System Theory (von Bertalanffy)
Reference: Selvini Palazzoli, et al. (1978)

8. With Mara Selvini Palazzoli & Maurizio Andolfi – Naples, 1996

9. Phenomenology
Source: Stohlman-Vanderveen & Di Nicola, American Philosophical Association (2021)

10. Philosophy & Psychiatry
• Sartre wrote a preface to the work of two
radical 20th century psychiatrists – R D Laing
and David Cooper, Reason and Violence (1964)
I am convinced that your efforts will bring us
closer to the day when psychiatry will, at last,
become a truly human psychiatry.
– Jean-Paul Sartre

11. “Changing the Subject”
• As a philosopher talking to therapists
I want to “change the subject”
• Polysemous phrase – multiple meanings

12. Defining Terms
• Change concerns theorists and therapists
• The subject refers here ambiguously to
• the frame of reference and
• persons as subjects of therapy

13. Overview
If I had to say it in three words …
• Systems
• Culture
• Event

14. Overview
1. Why do we still call them family dynamics?
2. Why do we still call them mental disorders?
3. Why do we still call them systems?
4. Three gaps in relational theory and therapy
5. Predicament and its aliases
6. The Event
7. Evental analysis and therapy

15. 1. Why do we still call them
family dynamics?

16. “The Impossible Profession”
Image from Fellini’s “And The Ship Sailed On”

17. “The Impossible Profession”
It almost looks as if analysis were the third of
those “impossible” professions in which one can
be sure beforehand of achieving unsatisfying
results. The other two, which have been known
much longer, are education and government.
– Sigmund Freud,
“Analysis Terminable and Interminable” (1937)

18. “Changing the Subject”
• Family Therapy (FT) changed the subject by
changing the frame of therapy
• Placed individuals in a family/relational
context
• Invoked Systems theory

19. What are we missing?

20. “Changing the Subject”
• Family Therapy (FT) changed the subject
• Individual is part of a family
• The family is a system
• Result: FT places the child in the context of the
family and calls that a system

21. “Changing the Subject”
• Q: Why do we still call them family dynamics?
• If Systemic Theory and Family Therapy have
supplanted Psychodynamic Psychotherapy
(inspired by thermodymamics) we should call
them systemic properties with their
interactions and relations

22. 2. Why do we still call them
mental disorders?

23. “Changing the Subject”
• Family Therapy (FT) changed the subject
• Individual symptoms are an expression of
relational dysfunction and systemic
misalignments
• Result: FT places the symptom in the context of
the system and calls that relational distress

24. “Changing the Subject”
• Q: Why do we still call them mental disorders?
• If individual symptoms are an expression of
systemic dysfunction and relational distress
why does FT still call them mental disorders
and not relational disorders?

25. Being Singular Plural
Being is always “being with,”
“I” is not prior to “we,”
and existence is essentially co-existence.
– Jean-Luc Nancy (2000)

26. 3. Why do we still call them
systems?

27. Cultural Family Therapy (1997, 1998)
Image courtesy of publisher Image courtesy of publisher

28. Immigrant Families and
Transcultural Psychotherapy (2004)
Image courtesy of publisher

29. “Changing the Subject”
• Cultural Family Therapy (CFT)
• changed the subject by placing the family itself
in the larger context of culture
• Result: CFT places the family in cultural context
and calls that the family’s culture

30. “Changing the Subject”
• Q: Why do we still call them systems?
• Systemic theory expanded psychodynamic
theory by adding interactions and
relationships, changing our language
• By taking anthropology and cultural psychiatry
seriously in FT, CFT expands systems theory
and speaks to the deeper notion of culture

31. “Changing the Subject”
• Q: Why do we still call them systems?
• Accordingly, we should talk about each family’s
culture as an expression of a deeper culture

32. 4. Three gaps in relational theory
and therapy

33. “Changing the Subject”
• Propose to change the subject again
• Three gaps in relational theory and therapy
Reference: Di Nicola & Stoyanov (2021)

34. Psychiatry in Crisis (2021)
Image courtesy of publisher

35. “Changing the Subject”
Three gaps in relational theory and therapy:
• a theory of the subject
how we define persons (subjects)
• a theory of therapy
how to conduct therapy
• a theory of change
how change or innovation occurs

36. “Changing the Subject”
Three gaps in relational theory and therapy:
• many competing theories of these tasks
• no consensus among therapists

37. “Changing the Subject”
• To address these gaps, I invoke the Event as a
new model
• based on the philosophy of Alain Badiou
Reference: Badiou & Tarby (2013)

38. 5. Predicament and its aliases

39. Image courtesy of J Guzder

40. Predicament
• Mental illness, relational distress, and
social suffering are predicaments
• They may become traumas that close
down, constrain and limit life

41. Si sta trasformando
in mia madre!
Si sta trasformando in tuo padre!
Voi due vi state
trasformando nei
miei nonni!

42. Predicament
• Crisis, rupture
• Two potential outcomes:
• Trauma or Event
References: Di Nicola (1996, 2012, 2018)

43. Predicament
Trauma or Event
• Trauma closes down the possibilities of life
• while Event opens them up
References: Di Nicola (2012, 2018)

44. Open Closed Open
Open closed open. Before we are born everything is open
in the universe without us. For as long as we live,
everything is closed within us.
And when we die, everything is open again.
Open closed open. That’s all we are.
—Yehuda Amichai, Open Closed Open (2000)

45. Predicament
Trauma or Event
• Both Trauma and Event draw a line
• there is a before and an after
Reference: Cook, et al. (2005)

46. 46
trauma
Image courtesy of V Di Nicola

47. 47
“There is a
crack in everything
— that’s how the
light gets in”
— Leonard Cohen
“Anthem”

48. 6. The Event

49. Event
• The event changes a world –
• as an individual (subject)
• a family (system, culture)
• or an entire community (the world)

50. Event
• The event speaks to the very definition of
being
– beyond attitudes, behaviour, cognitions, and
emotions –
• to what being-in-the-world means

51. Event
• Cannot be chosen, determined or created
• It just happens
• This evacuates all such notions as
• “things that are meant to be”
• “dark fate” or “bright destiny”
• “guiding hand” or “guardian angel”

52. Evental Site
• Philosophy calls the place where it happens an
Evental site
• CFT calls it a predicament
• Sartre wrote about situations
• Clinically – you may know it as a crisis

53. Evental Site
• We can locate and name the elements of an
Evental site
• It’s like identifying stressors or understanding
Social Determinants of Health (SDH) and
Adverse Childhood Experences (ACE)
References: CSDH (2008), Felitti, et al. (2010)

54. Evental Site
• However, the potential Event that arises from
the Evental site is not one of the elements of
the site
• Event is something different, something new
• Badiou calls this process novation
Reference: Badiou & Tarby (2013)

55. Evental Site
• The Event is not something that is “there”
• it cannot be found waiting
• It is something that emerges from the things
that are there and are occurring in a life
• it arises anew

56. Evental Site
• Congruent with the great Neopolitan thinker,
Giambattista Vico (1668-1744), the founder of
constructivist epistemology
• Vico wrote:
Verum esse ipsum factum
“What is true is precisely what is made”

57. Evental Site
• If people in therapy, in daily life or in politics
decide that what was cooking there all along is
just fine and they don’t want something new,
that’s an option, a choice
• But it isn’t an Event, it isn’t novel –
and it isn’t change!

58. Evental Site
• Psychoanalysis call that resistance or a flight
into health
• Systems theory calls that homeostasis
• Political theory calls that conservatism or
reactionary
• Evental analysis calls that a pseudo-event

59. Pseudo Event
• Resilience is a pseudo Event
• It’s a way of explaining gaps in trauma theory
• It can be a denial of trauma
“All is for the best in the best of all possible worlds”
– Professor Pangloss in Voltaire’s Candide

60. Truth Table
Logic of scientific research
Findings are tested against truth
True Positive False Positive
False Negative True Negative

61. Trauma and Event
Defining True vs Pseudo Trauma and Event
True Event
rupture / open
Pseudo Event
no rupture /
repetition, mimesis
Pseudo Trauma
no rupture /
interruption, mimesis
True Trauma
rupture / closed
stagnation, repetition

62. Pseudo Event
• Since both trauma and Event are predicated on a
rupture, a break in the lifeworld
• We may postulate both pseudo trauma and
pseudo Event
• Resilience implies no such break but rather
continuity of experience

63. Pseudo Event
• No break or rupture = no trauma
• But also = no possibility of an Event
• Hence no change and nothing new arises

64. Event
Three conditions for the Event are:
• 1. Being there to witness the Event
• 2. Naming the Event
• 3. Fidelity to the Event

65. Event
• These conditions radically change the subject
who identifies with the Event
• The Event makes the subject
• So, to update Sartre (1946) philosophically:
The Event precedes the subject
J-P Sartre (1946): “Existence precedes essence”

66. Antonella
Image courtesy of A Donoyan

67. “A Stranger in the Family”
• Antonella – Italian immigrant to Canada
• Referred by Dr. Claudio Angelo for
symptoms of anorexia nervosa
• Northern Italian psychiatrist and family
therapist

68. The Myth of Atlas:
Families & The
Therapeutic Story
(1989)
Image courtesy of publisher

69. “A Stranger in the Family”
• Foundling in Milan
• Adopted by a middle-class family
• Looking vaguely “Asian,” she always felt like
a “stranger in the family”

70. Intimate Strangers
I think of humanity as a family
that has hardly met.
– Theodore Zeldin,
An Intimate History of Humanity
(1994)

71. “A Stranger in the Family”
• This story was so striking that I see it as a
metaphor for Cultural Family Therapy
• Inspired the title of my book
• Revisited “Antonella” in my Advanced Studies
Seminar on eating disorders at Oxford (2019),
published (Di Nicola, 2021)

72. Cultural Family Therapy (1997, 1998)
Image courtesy of publisher Image courtesy of publisher

73. V Di Nicola,
Antonella – “A stranger in the
family”: A case study of eating
disorders across cultures.
In DS Stoyanov, CW Van Staden, G
Stanghellini M Wong & KWM
Fulford (eds),
International Perspectives in
Values-Based Mental Health
Practice: Case Studies and
Commentaries
New York: Springer International
(2021, pp. 27-35)
Image courtesy of publisher

74. “A Stranger in the Family”
• Her adoptive family also “adopted” the myth of
her foreign origins
• Antonio Ferreira (1964) on family myths
• And she played the assigned role of a stranger
• Andolfi’s & Angelo’s (1981) notion of the
therapist as director of the family drama

75. “A Stranger in the Family”
• Together, her adoption as a foreigner and her
role as a stranger in the family
• undermined the possibilities of integrating
into the family and identifying as an Italian

76. Reflection
Childhood is a knife
planted in your throat.
You don’t remove it easily.
– Wajdi Mouawad
playwright
Image courtesy of publisher

77. “A Stranger in the Family”
• This created the conditions for her to follow
other identifications
• When the opportunity presented itself, she
undertook an adventure with an older
Canadian man
• Yet, this turns out to be a pseudo-event

78. 7. Evental analysis and therapy

79. Evental Analysis
• Evental analysis examines a lifeworld

80. Antonella’s Evental Analysis
Lifeworld
• Adoption, search for
identity, meaning
• Moving to Canada
• Marital problems
• Attachment, violence
• Dog breeding
Evental analysis
• Evental site
• Pseudo-event
• Pseudo-trauma
• Trauma
• Event

81. Reflection
Je est un autre.
I is another.
—Arthur Rimbaud, French poet
• In Antonella’s world, her identification is
not only displaced to another but to
another species!

82. Evental Therapy
• Evental therapy helps people recognize that
they are in a place where something new
may arise, leading to change (an Event)
• Sartre called that a situation
• CFT calls it a predicament
• Badiou calls it an Evental site

83. Antonella’s Evental Therapy
• Individual, couple and family meetings
• Bearing witness to the Event of her life
• Richard Mollica’s (2006) work
on the “trauma story”

84. Antonella’s Evental Therapy
• Many meetings – practical, therapeutic
• Key experience:
• Session with the family that came to Canada
• The sister’s violence towards her biological
mother unmasked the real trauma, undoing
the family myth, liberating Antonella

85. “The Trauma Story”
• Richard Mollica (2006) – “the trauma story”
• “A story that must be told” …
• We bear witness to suffering and trauma
• I add: … to someone else in a relational
dialogue, face to face

86. “The Trauma Story”
• A story that must be told to someone else
face to face in a relational dialogue
• Mikhail Bakhtin: dialogism
• What makes a dialogue relational?
• When the relation is part of the dialogue

87. Face à face
La plénitude de l’amour
du prochain c’est
simplement d’être
capable de lui demander :
« Quel est ton
tourment? »
- Simone Weil,
Attente de Dieu (1942)

88. V Di Nicola,
Two trauma communities:
A philosophical archaeology
of cultural and clinical
trauma communities
In P Capretto & E Boynton (eds),
Trauma & Transcendence
NY: Fordham University Press
(2018, pp. 17-52).
Image courtesy of publisher

89. Cultural vs Clinical Trauma
(Humanistic) (PTSD)
• What a humanistic approach to mental
illness, relational distress and social suffering
offers is to assuage trauma
• And when possible, to create openings in
people’s lives so that an Event may occur

90. Evental Therapy: Summary
• Life is an open work, not determined
• The Event accounts for how new things
arise (novation) out of a predicament
(Evental site) – a theory of change
• The Event is a theory of the subject

91. Evental Therapy: Summary
• The Event – eschews the language of symptoms
• Evental analysis – establishes what kind of
subject we are dealing with
• Evental therapy – recognizes and prepares for
the Event

92. Summary
1. Systems Theory asks why do we still call them family
dynamics (rather than systemic properties)?
2. Family Therapy asks why do we still call them mental
disorders (rather than relational distress)?
3. Cultural Family Therapy asks why do we still call them
systems (rather than family cultures)?
4. Philosophy asks why do we still talk about change
(rather than Event)?

93. Summary
5. Predicament and its aliases
6. The Event (the conditions for real change)
7. Evental analysis and therapy

94. For the Assisi Manifesto
Some say that we cannot go home again
(novelist Thomas Wolfe),
others say we can and must go home again
(family therapist James Framo).
I say, we never leave home and
like a snail, bound to its shell,
we take it with us wherever we go.
– Vincenzo Di Nicola (1997)

95. Image courtesy of A Donoyan

96. Acknowledgements
• Maurizio Andolfi, MD (Italy/Australia)
• Claudio Angelo, MD (Italy) for referring Antonella
• John Farnsworth, PhD (New Zealand) for exploring
the Event with me
• KWM (Bill) Fulford, MD, PhD (Oxford) for inviting
me to revisit Antonella’s case

97. References
• Amichai Y. Open Closed Open: Poems. Trans. C Bloch, C Kronfeld. New York:
Harcourt, 2000.
• Andolfi M (Ed), Famiglie Immigrate e Psicoterapia Transculturale [Immigrant
Families and Transcultural Psychotherapy], Milan: FrancoAngeli, 2004.
• Andolfi M, Angelo C. The therapist as director of the family drama. J Mar Fam
Therapy, 1981, 7(3): 255-264.
• Andolfi M, Angelo C, de Nichilo M. The Myth of Atlas: Families and The
Therapeutic Story, Ed. & trans. VF Di Nicola. New York: Brunner/Mazel, 1989.
• Badiou A. with F Tarby. Philosophy and the Event, trans. L Burchill. Cambridge,
UK: Polity Press, 2013.
• Cook A, Spinazzola J, Ford J, et al. Complex trauma in children and adolescents.
Psychiatric Annals, 2005, 35(5): 390-398.
• CSDH. Closing the gap in a generation: Health equity through action on the
social determinants of health. Final Report of the Commission on Social
Determinants of Health. Geneva, Switzerland: World Health Organization; 2008.

98. References
• Di Nicola VF. Le Tiers-monde à notre porte: Les immigrants et la thérapie
familiale. Systèmes Humains, 1985, 1(3): 39-54.
• Di Nicola VF. Ethnocultural aspects of PTSD and related disorders among
children and adolescents. In: Marsella AJ, Friedman MJ, Gerrity ET &
Scurrfield RM (Eds), Ethnocultural Aspects of Posttraumatic Stress
Disorder: Issues, Research, and Clinical Applications. Washington, DC:
American Psychological Association, 1996, pp. 389-414.
• Di Nicola V. A Stranger in the Family: Culture, Families and Therapy. New
York: WW Norton & Co., 1997.
• Di Nicola V. Famiglie sulla soglia. Città invisibili, identità invisibili. In:
Andolfi M. (Ed), Famiglie Immigrate e Psicoterapia Transculturale. Milan:
FrancoAngeli, 2004, pp. 34-47.
• Di Nicola V. Trauma and Event: A Philosophical Archaeology. 2012. PhD
dissertation in philosophy, psychiatry and psychoanalysis. European
Graduate School, Saas-Fee, Valais, Switzerland.

99. References
• Di Nicola V. Two trauma communities: A philosophical archaeology of
cultural and clinical trauma theories. In: PT Capretto & E Boynton
(Eds), Trauma and Transcendence: Limits in Theory and Prospects in
Thinking. New York: Fordham University Press, 2018, pp. 17-52.
• Di Nicola V. Antonella – “A stranger in the family”: A case study of
eating disorders across cultures. In: DS Stoyanov, CW Van Staden, G
Stanghellini M Wong & KWM Fulford (Eds), International Perspectives
in Values-Based Mental Health Practice: Case Studies and
Commentaries. New York: Springer International, 2021, pp. 27-35.
• Felitti VJ, Anda RF. The relationship of adverse childhood experiences
to adult medical disease, psychiatric disorders and sexual behavior:
Implications for health care. In: Lanius RA, Vermetten E, Pain C,
editors. The Impact of Early Trauma on Health and Disease: The
Hidden Epidemic. Cambridge, UK: Cambridge University Press; 2010.
pp. 77-87.

100. References
• Ferreira AJ. Family myths: The covert rules of the relationship.
Confinia Psychiatrica, 1964, 8: 15-20.
• Freud S. Analysis terminable and interminable. The International
Journal of Psychoanalysis, 1937, 18: 373–405.
• Mollica RF. Healing Invisible Wounds: Paths to Hope and Recovery in a
Violent World. New York: Harcourt, International, 2006.
• Nancy JL. Being Singular Plural. Trans. Richardson RD, O'Bourne AE.
Stanford, CA: Stanford University Press, 2000.
• Sartre J-P. Existentialism Is a Humanism, trans. C Macomber, preface
by A Elkaïm-Sartre, ed. J Kulka. New Haven: Yale University Press,
2007. (1946)

101. References
• Sartre J-P. Foreword. In: Laing R.D. & D.G. Cooper, Reason and Violence – A
Decade of Sartre’s Philosophy, 1950-1960. With a foreword by Jean-Paul
Sartre. London, UK: Tavistock Publications, 1964.
• Selvini Palazzoli M, Cecchin G, Prata G, Boscolo L. Paradox and
Counterparadox: A New Model in the Therapy of the Family in
Schizophrenic Transaction. Trans. E Burt. New York: Jason Aronson,
1978.
• Stohlman-Vanderveen M (Interviewer), Di Nicola V, “The Crisis of
Psychiatry Is a Crisis of Being: An Interview with Vincenzo Di Nicola,”
Recently Published Book Spotlight, Blog of the American Philosophical
Association, October 8, 2021.
https://blog.apaonline.org/2021/10/08/the-crisis-of-psychiatry-is-a-
crisis-of-being-an-interview-with-vincenzo-di-nicola/
• Zeldin T. An Intimate History of Humanity. New York: Penguin, 1994.