The

presence of orange-peel skin around the left nipple made gynecologist prescribing her a
mammogram. It turned out to be negative, but Ofelia had already gone on the road of doubt
and the search for absolute certainty. She was spending at least two hours a day in palpating
her breast according to the rules that the gynecologist had indicated her and, as she
understood the importance of early diagnosis, the palpation took place in the morning, after
lunch and in the evening. She was spending all her money in a radiological study near the
house where she was having an ultrasound every week.
Her husband Settimio no longer tolerated the constant requests for reassurance and the long
sessions in which he had to observe his wife's breasts to test changes in their form. On the
breast, with a black marker, he had drawn the boundaries of the orange peel to check for any
alterations. Ofelia smoked continually, and so did her husband.
Settimio was a handsome man, convinced to be irresistible.
My intervention was requested when Ofelia stopped going to work, having decided that health
came first. She was spending the day in the bathroom, in front of the mirror and when
Settimio came back home one evening, he found her in tears. The idea of leaving her sons
Giordana and Luca worried her, but did not stop her from smoking all the time and soothing
her anxieties with generous amounts of alcohol. Breast cancer was at the center of her
concerns, and only that, the other diseases could not steal the scene, and when I asked her
why this difference between illnesses, sobbing Ofelia told me that if they took her breast off
she would become a half-woman, certainly Settimio would have been disgusted by her body
and would have left her. Imagining herself alone was impossible for her, it was like falling into
a dark bottomless pit, relating this desperate loneliness with the guilt of not being sufficiently
engaged in the possible prevention of breast cancer. The illness and the consequent
contemptuous abandonment by Settimio appeared to her as a well-deserved punishment for
her guilty negligence, for which she had always been reproached by her mother, Sara.
She was the second of four children; the eldest daughter, Erminia, had always attracted the
attention of their parents because, since she was a child, she had shown bizarre behavior: At
thirteen she became anorexic and at eighteen, declaring herself lesbian, she had gone to live
with her partner. The third son was Anselmo, who took over from the father in the
management of the family business. The last one, Giovanna, had always been in conflict with
Ophelia, who could not bear her perfectionism and order, and the fact that she was always
obedient to the expectations of their parents and sister. Between the two, there had always
been an explicit jealousy and a competition to win mother Sara's attention. In this game,
Giovanna assumed the identity of the successful, solid and healthy daughter, while Ophelia, by
contrast, stood out as weak, sick and in need of help.
His father Antonio had survived the Nazi extermination camps but had never returned to truly
live. Precisely after giving the family's economic guide to Anselmo, he had withdrawn into a
silence from which he rarely went out, just to go drinking with friends and get drunk on a
weekly basis or to bet on horses, squandering how much the whole family could earn. Ofelia
was fond of this father who, however, seemed more like a grandfather, benevolent but
powerless; she had always perceived herself without protection. This is why she fell in love
with Settimio's latin lover attitude. In this initial phase of therapy I was unable to stop
Settimio who, more than once, interfered with his performance as
“whatistheproblemIcantakecareofthis". Moreover, he was actually involved in the constant
requests for reassurance and for the distortion of family and work life that now revolved
around Ofelia's senological checks. She was somehow happy, because this was a way to get
even closer to Settimio. I always suspected that there was another hidden motive in this
shared desire to be both in therapy: Septimius was jealous of his wife and did not tolerate her
having a relationship, even if therapeutic, from which he was excluded.
Ofelia, who had always been exposed to Settimio's seductive performances with the other
women, could take her revenge.
For her entire life, Ofelia has considered herself a beautiful woman. Ofelia's provocative
clothing has always been criticized by her parents and her husband's jealousy, nevertheless
she never had another man even in fantasy, her mind and body were always and only for
Settimio.
The unwanted presence of her husband in therapy was nevertheless providential: the more
Ofelia was convinced that he really loved her and that he would never leave her, the less the
idea of losing her breast by cancer terrified her. Reassured on the relationship with her
husband, she gradually abandoned the concerns and compulsions of control.
For the next seven years contacts with Ofelia were limited to greetings for the holidays
meaning that everything was "all right!".
At the age of thirty-five years old Ofelia requested a new intervention because, according to
her, she had fallen into depression. In fact, it seemed that more than seven years had passed,
her vivacity, sometimes even excessive, was gone. The most difficult moment was in the
morning as soon as she woke up: imagining her day like in a movie, nothing interested her,
she was afraid of the fatigue that the daily duties would have cost her, she was afraid to make
mistakes, to surrender and to be criticized by all her family of origin and by Settimio as lazy,
incapable, mentally ill, a burden and one good for nothing. Existence seemed like a very
difficult exam and she was an unprepared student. She mentally reviewed the day that was
about to begin and the following days and saw nothing but heaviness and fear. When she felt
in this painful state she cried softly and asked for help like a five-year-old girl lost in the
woods, with the effect of receiving a chorus of criticism for her weakness and lack of will.
In this second tranche of therapy, we focused on three aspects: the stabilization of an idea of
herself that was not so totally dependent on the judgment of others, the identification of
different strategies to ask for help, that were more mature and assertive than transforming
herself in a humid child, the creation of own interests and areas of activity.
Ofelia enrolled in a Hebrew school, taught scripture classes, and started her own business,
involving Giordana's boyfriend. A long period of relative wellbeing followed, she managed to
suspend the anxiolytics who had become inseparable companions of her days and had access
to lost memories. In a dramatic session, she reported that she had vomited when awakening
in the middle of the night before: she had clearly remembered an attempt of abuse by her
father, one night he had returned drunk when she was twelve. She remembered with a sense
of guilt that, frightened at the idea of being taken by force and already aware of sexual
matters, she had consented to masturbate her father so that he would finish as soon as
possible. She had always excused her father by attributing his behavior to the experience of
the lager. Ofelia was also convinced of two things: the worst had happened to Erminia, her
older sister, and that this had been decisive in the development of her homosexuality and that
the mother had known what was happening, keeping quiet not to loose the husband.
The bad luck was that, after a month or so from these revelations, the father decided to take
the shortcut of the stairwell. The family tried to disguise the event with an illness, but the
suicidal will was evident. The reasons for the gesture were sought in various directions: the
present economic difficulties caused by betting on horses, the concern for incurable physical
diseases, the impossibility of overcoming the experience of the concentration camp with the
consequent sense of guilt that always accompanies the survivors. Ofelia was convinced that it
was her fault of the father's gesture, having revealed to me their secret and in her head, my
professional image had to be associated with this presumed guilt and to be, therefore, painful,
the fact is that for ten years I did not hear from her even for the holidays.
"Do you remember me, doctor?", Ofelia began, with a phone call at six in the morning, her
third request for help. She was very surprised that I recognize her immediately and this
surprised me in turn: she did not expect to be able to be in another's mind for long. The hour
of the phone call denoted certain urgency, confirmed by the tone of acute despair. She no
longer looked like the wet girl, abandoned in the woods, but still a desperate woman. Feeling
recognized by me allowed her to tell me that, the previous evening, she had discovered
condoms in Settimio's wallet. After this event, he had confessed a three-year relationship with
a younger woman and a firm intention to separate.
We agreed to meet the following day and I objected to the presence of Settimio, who wanted
to be there to explain his reasons. Ofelia was aging badly. Her world had lost the light, she was
a mask of Greek tragedy of sadness mixed with surprise.
I was afraid. To decide whether to hospitalize her or not, I mentally review all the indicators
of suicidal risk and I chose to take the risk because a hospitalization would confirm, to her and
others, the idea of being a poor crazy woman. We made an agreement for daily phone calls,
twice a week meetings and anxiolytics. The work at this stage had the same objectives as the
previous one, in short, the conquest of autonomy that became urgent because of the imminent
separation. Septimius, in leaving her, brought with him as many resources as possible, and
Ofelia had to face the two monsters with whom she had always fought, solitude and poverty
materialize.
After fifty years old, Ofelia thought it impossible to create a new emotional relationship and
she decided to dedicate herself to the role of mother and grandmother of the four
grandchildren. Unexpectedly, however, Luca and Giordana openly sided with their father.
Although he was the one who went to live with a thirty-year-old woman and had dried up the
accounts in the family bank, the responsible was Ofelia, who had exhausted him with her
character. The same condemnation came from her family of origin, who continued to maintain
good relations with Settimio. Her mother, Sara, was proud of her good relationship with her
son-in-law and organized lunches with her grandchildren, great-grandchildren, Settimio and
his new partner. The only unwanted person was Ofelia.
The sale of the marital home to allow the purchase of a house for the new couple forced her to
make an important change: she had to move to a studio on the Roman coast, purchased with
her part. That couple, which I had considered symbiotic and fused, seemed effectively and
definitively separate.
After almost a year, I felt proud for the result of autonomy reached by Ofelia. Because of the
separation practices she had to meet Settimio several times and, to her great satisfaction for
the revenge on her rival, she had become his clandestine lover. They had resumed clandestine
and transgressive sexual activity with an almost daily frequency. In the studio in Torvaianica
or in the Mercedes of Settimio in car parks, they had rediscovered the overwhelming passion
of eighteen years.
I found out that Settimio had been found dead by a stroke in a motel on Rome-Aquila, where
he had gone to meet a prostitute, so I felt obliged to attend the funeral. Even during the
ceremony the separation of Ophelia from both her family of origin and from the current one
was clearly perceived: her children and grandchildren considered her responsible for the
separation and the subsequent death of Settimio.
By violating any setting rule, I invited her to visit me. When she entered my office, she had
nothing of the twenty-eight-year-old redhead who had arrived thirty years ago: she had the
typical look of the homeless. She told me that her kids had sued her to take the studio in
Torvaianica, claiming that she had bought it with the money of their father's work and,
therefore, it was for them. Fifteen days later, I was back in the cemetery for another funeral
function, Ofelia’s.