The drama of Pisa denounces the misery of psychiatry
by Marco Rovelli*
The death of Pisa hospital psychiatrist Barbara Capovani at the hands of a person with a mental disorder who was being treated at the SPDC that she headed has profoundly shaken the entire mental health sector. But the doctor had hardly been attacked that ideological speculation was already rushing into her body. The responsibility lies with anti-psychiatry, wrote Mario Di Fiorino, director of the Versilia DSM to which Seung headed, publishing his photographs together with democratic psychiatrists (and certainly not anti-psychiatrists) such as Peppe Dell’Acqua – historic collaborator of Basaglia, as well as director of the DSM of Trieste for 17 years, and Vito D’Anza, making them appear as the instigators; whereas, instead, Seung had spoken at conferences open to all, associations of family members and users of psychiatric services. A few hours later, the Northern League deputy from Pisa Ziello called for the reopening of the asylums – as, moreover, a bill presented by the League itself in the last legislature, with the advice of Di Fiorino himself (now a candidate with the Brothers of Italy for the elections) municipalities of Pietrasanta). More generally, but in the same sense, the deputies of the League say that “we need to open a reflection on the Basaglia law”, and that the country needs “a new law”.
Then there are those who ask for more places in the Rems, or the structures that replaced the Judicial Psychiatric Hospitals after their closure. But is this really the question? Or maybe this story leads us to reflect on the organizational and cultural model of psychiatry in Italy today? If anything, does it not focus on the need for a paradigm shift, from a biomedical-buroratic psychiatry to a territorial psychiatry? I talked about it with Peppe Dell’Acqua.
“The alarmed requests for safety and beds actually cover a failure, that of the network of mental health services at the territorial level. Talking now only about social danger and safety only makes the situation worse. The more the cultural, organizational and resource impoverishment of mental health services, operators and academies proceeds, these risks will become ever greater. It is stupid to think that the Rems can prevent these events. They are not a prevention tool, they reach the valley. First, there must be prevention and treatment: we need services that take care of a person suffering from a mental disorder, that follow him on the territory, that do not leave him to himself; and instead too often these people are only given long-acting drugs once a month and residency in the centres. We need to overthrow the paradigm, placing the Mental Health Center as the cornerstone of services, invest resources. But from this point of view, regionalization has been a disaster, we don’t even have the tools to compare what is happening in the different regions. And the Spdc have become the only bulwark, a fortress, places very distant from the territory and from treatments: I feel a lot of solidarity with the doctors who work there, because they are the place where everything that should be spread throughout the territory is delegated, and they are like our soldiers from the great war thrown into cold and muddy trenches with old rifles and cardboard shoes. To keep the madness away and protect our normalcy.”
Instead of starting to reflect on these structural issues, the responsibility for not guaranteeing safety for operators is attributed to the “Basaglia law”. But, even in this case, things are very different.
“Once the social dangerousness of a subject has been ascertained, action must be taken. In this case, the DSM of Versilia had to act, which has its own manager, psychiatrists, psychologists and a network of social services. After that, if and when the judiciary receives an expert report declaring the social dangerousness, it’s up to them to act, arranging a security measure in a Rems, or even ordering their stay in prison, where there must be the SSMS to take care of them. But if there isn’t a network that works together, what’s left is a rebound of responsibility.
Having said that, we are certainly not omnipotent, and the crazy spark can always be there anyway. Unfortunately, in fifty years of work I have had to cry more than once for colleagues, before and after the closure of the asylums, before and after the closure of the Opgs.”
Among the various ideological lies of those who speculate on the Pisa tragedy, there is also the one that “democratic” psychiatrists are do-gooders, and want to protect “the mad” at all costs, and deprive him of legal responsibility for crimes committed . But, even in this case, this is not the case at all.
“In our system the theory of the double track persists: on one side the disease, on the other the crime. The moment a person with a mental disorder commits a crime, the principle of subjective responsibility disappears. It is no longer a subject who committed the crime, but an impalpable figure, mental illness. For many jurists and constitutionalists, and we have been saying this for fifty years, we should abandon psychiatric expertise, a legacy of nineteenth-century positivism, and an act that has nothing scientific about it: it is not an instrument of guarantee and protection, but a form of mercy which has nothing scientific about it. It must be stated that each person is responsible for what he does. Which means, in this case, that the judge will sentence Seung, if he is found guilty he will go to prison and, if necessary, during the execution of the sentence, treatment and rehabilitation programs will be resorted to as for all other prisoners. Condemnation is the step that must be taken, like the acknowledgment of guilt and responsibility. For the person responsible for a crime himself, knowing that what he has committed is a crime makes everything less ambiguous. What happens is that justice abdicates, the judges hand over the matter to the psychiatrist in a substantial delegation to psychiatric services by the judicial system and the police forces”.
*author of I suffer therefore we are. Mental distress in the society of individuals.