My friend Silvia and I were in Rome for the two days organized by Unasam for her birthday: 30 years of presence of families suffering from distress… 30 years of joint work with the many realities that populate the space of mental health and Psychiatry. The venue was the historic “Frentani”, a large room that hosted conferences and assemblies and which could tell a thousand stories… So great anticipation. Disappointed wait, there were few of us, too few and too few. Great hope of finding ourselves together again after a long time and after a thousand events that were certainly not positive, but no. Where were the operators, family members, “users” and “former users” of the services? yet they tell us every day that mental distress is on the increase, that inequalities are digging deep furrows, that the National Health Service is falling apart and that the Psychiatric Services, in the vast majority, are governed with mental hospital logic.
I believe that we must not only ask ourselves but try to dig and understand where we are, where we were in these years in which rights are shouted everywhere but are being lost at every corner.
CPR migrants dead at sea and at every border
Job insecurity and more
New walls everywhere
Wars and genocides
I mention some situations at random but I could also go on to mention others… where the fundamental right to a good life is constantly denied in highly civilized Europe, home of Welfare!!!
This is the framework of my thoughts and Silvia’s… but I want to return to Rome and within this framework highlight some aspects that are worth dwelling on.
Silvia, a long-time nurse, points out to me the disproportionate number of psychiatrists, historians, famous, very good…. but what about the other operators, the other operators? Some volunteers and associations but family members? Stories of positive experiences but it seems like a sad deja vu, a catwalk of beautiful but repeated ideas. And, therefore, a dichotomy emerges which has been left a bit in the void but which I hope can be a source of elaborations and thoughts: some association operators say that mental distress does not need psychiatry, it is better done alone; shared life, work, new-found relationships are more than enough, there is no distinction between good and bad psychiatry, no consideration of what we today pompously call “social determinants”, a lot of love and understanding is enough. Then in the story it emerges that the recipients of these interventions take drugs, that within a good project there is also a good psychiatrist, a good nurse, a good educator but whoever narrates doesn’t seem to detect it.
There was Elio who, without shame and without forgetfulness, spoke to us clearly, told us what was needed and what should be thrown away, there was Janila who told us how “psychiatric symptoms” can be constructed and how they can be deconstructed… they were true.
And who spoke about the conditions of the operators, their training, their needs to know, to understand, to feel involved in meaningful projects? It’s easy to say: there are no operators, no one wants to work in psychiatric services anymore, right! there is an objective shortage of doctors, nurses and many even go abroad but let’s ask ourselves what attraction a poorly paid job has, declared, on every possible occasion, dangerous, devoid of any purpose other than that of defining who is inside or outside of normality… an anonymous workplace, devoid of meaning in a historical moment in which each of us is laboriously trying to give value to our existence, is trying to return to “history”. She is trying to become a good “social determinant”. Psychologists, social workers, educators, terp, os, asa, are there and could fill the services… it would be enough for them to be prepared on “what to do” and why to do it.
And in this terrain, the psychiatrist can come later…..
A speaker whose name I don’t remember asked, almost at the end, an important question: but the associations of family members, the associations… will they still exist after us? Let’s look at each other and look at our associations…. we are all of an advanced age and it seems that there are too few of us after us. Those who are younger have their work cut out for them to survive and certainly don’t have time to look after their brother or sister in difficulty… it’s not a small problem, it’s a very sad fact of reality… the world is changing and what about us?
Basaglia has been mentioned a lot and just feeling his presence evoked is good for the heart but Basaglia proposed that we go beyond the fence of our little things… which all emerged, all of them; we have, I mean we people who grew up in the shadow of Basaglia, we have lost the sense of “utopia”, we have really adhered to what those who govern us ask of us (I don’t just mean the Italian government): everyone cultivates their own little garden, do as he pleases and likes… it doesn’t matter anyway! What is the point of having a Mental Health Coordination if we don’t coordinate anything? What are we talking about when we are scandalized by what the new generation of psychiatric workers say and do? We feel offended by their exasperated technicality, by the loss of the sense of humanity, by the inability to feel that, together, we live in a difficult world and that only together, each with our own skills, will we be able to get out of it. So we, we who think of Health and Mental Health as an inalienable right, what do we think of doing for these new generations of operators… will we be able and will know how to be generous enough to leave our comfortable and rewarding gardens to donate to them what, without knowing it, we have received as a gift?