“Yesterday. Guard until 8pm. I leave at 11pm. In front of you, the choice between remaining “deaf” to the anguish of the patients, and going home early (after all, that guard didn’t even affect you). Or listen to them, the patients, as they deserve. But knowing that you will sacrifice yourself. Your personal needs. That you will go out at night. And that a few hours later you will return to the Mental Health Center. Maybe covering another guard, which you shouldn’t do. But what will you do? Because there are no doctors.
The forced choice between sacrificing interest in the people, to guarantee your preservation. or vice versa. In the indifference of the rotten system, which no longer thinks about what is needed to guarantee the health of the people – and its operators – but on the contrary devours its operators, tramples on their dignity, drains their passion.
Basaglia said that doing mental health means being inside the contradiction. That it was necessary to stay there, in the contradictions of society, like sentinels, to face them, denounce them, fight them. In short, to modify them, those contradictions. Even Mental Health Departments today ask us to stay within the contradictions… but in the sense of accepting them. To shoulder them on your shoulders. To accept them docilely, passively. Are there no doctors? It’s not a problem, you’ll do double. Obviously for free. The DSMs do not want to modify the contradictions, but to squeeze you, make them an “object of consumption”, to guarantee their own survival. On the skin of patients, lost and disappointed. And the operators. Let them leave the healthcare system. Outraged. Exhausted. Or both.
Basaglia would perhaps talk about all this to people. He would speak of a new mental hospital, made of disinvestment and disinterest. It would explain to people why if they go to the emergency room, or to a mental health centre, they find a young person who isn’t even specialized, or a doctor hired on a one-off basis, “token” (who often doesn’t even know your language) or a doctor who listens to you only for 5 minutes, or just pretending to listen to you. It would explain that this system produces disease. And it makes cannon fodder for those who oppose its sick functioning. It would be interesting to talk about it today with Basaglia. Perhaps he would be horrified to see how his services are today. Worn out, drained of resources, and of the spirit with which (and for which) they were born. Who knows what he would do to combat this desertification. Maybe he would report it. He would say “I won’t sign”. Something like that.
I, who am nothing compared to him, but I understand that either I get sick or I give up, in the meantime I will report. Maybe he’d like it. I hope so.
Happy birthday Basaglia.”
This is the story of Stefano Naimthirty-eight-year-old psychiatrist from a mental health center – CSM in Modena, merged with a appeal to the President of the Republic Sergio Mattarella signed by 506 mental health workers. A powerful denunciation of the situation that the services are experiencing, whose staff is often pushed to the limit that they have to choose between their personal lives and taking adequate care of the patients. But it is not just a question of defunding: it is also a cultural climate that has betrayed – or has never fully embraced – the Basaglia revolution. “During specialization they never told us about his approach, except to mystify it,” say some young doctors. We reached out for comment Enrico Di Crocea psychiatrist who worked for twenty years in the Turin services and who was responsible for disseminating the appeal.
Di Croce, where does this appeal come from?
One of the stimuli for this colleague’s outburst, later received and endorsed by many other operators, was the celebration for the centenary of Franco Basaglia, which sounded quite paradoxical to those who know the concrete reality. From the outside it seems that we are talking about something that in his time was accepted and became the standard, but this is not the case at all. The mental hospitals have closed, but the concrete alternative that had been created in that period – the care of the insane within society, which is the most correct way of caring and which requires many other interventions than the merely technical one – she is completely lost. Twenty years ago there were still some places that, at least in words, tried and supported this idea. Today the theory seems to have been lost, as well as the practice.
Doctors have no idea that their profession can be done without scrubs, outside the hospital
Enrico Di Croce
Is this a question of lack of funding?
It is not just a question of resources – although it is true that they are lacking and that more should be invested – because to have mental hospitals, as happens, for example, in Germany, one would spend ten times as much. I believe it is a cultural problem, which does not only concern psychiatry, but medicine in general. We have seen with the pandemic how many perorations have been made on the importance of local medicine and prevention; then, however, practically nothing was achieved. It’s not that doctors aren’t trained in general, they aren’t trained in the area, they have no idea that their profession is something that can be done without a gown, outside the hospital. For goodness sake, it is necessary that there are people in the structures who carry out sophisticated technical interventions, but everything that concerns chronic pathology and prevention cannot be followed in this way.
Does university education also have something to do with it, then?
Absolutely. In universities there is a cultural dominance of the medical-biological model, which is good for vaccines, for example, but worse for prevention. As he recently wrote Andrea Angelozzi, retired head of psychiatry, the territorial psychiatric model should have paved the way for preventive and basic medicine, so that it was proximity, close to the patients. This is something that could be extremely effective from a health point of view, but which has never been realized outside of some specific experiences in the field of mental health. A different type of organization should be created, the model used today is not made to deal with those with a chronic disorder: we get to intervene when the situation is now out of control, in urgency, in the psychiatric ward, with drugs and restraint . Then there is essentially nothing.
Working in a Basaglia way with madmen is not impossible: if you don’t do it it’s because you’re not interested
Enrico Di Croce
So what Basaglia did isn’t an expression of the feelings of the majority of doctors?
It was the example of a minority, which, in a somewhat enlightened way and taking advantage of a window of opportunity due to political and social reasons, managed to get something approved that was absolutely not in the sentiment of the majority of doctors or doctors. psychiatrists. However, what is very frustrating and truly infuriating is that working in a Basaglia way with madmen is not impossible: if you don’t do it it’s because you don’t care.. Where this is done, we start from building a relationship of trust and are therefore able to intervene at the critical moment, to work with the family, to go home. We need to invest time when needed and adapt to the patient’s needs, trying to make him live in the world and activating society’s resources. Trieste’s great strength is the network of cooperatives, which collaborates with the public and manages to follow people not in a medical way, but in a curative way.
How do you do social skills exercises indoors?
Enrico Di Croce
What happens to the “crazy people” now?
In some contexts there is truly a “neo-asylum” situation, for cultural reasons. Instead of there being a structure with 2 thousand places, there are realities – like those found in Lombardy – which have perhaps 20 structures with 20 places, like the pavilions of the old mental asylums. In this way there is no possibility of working in a truly inclusive way: how do you do social skills exercises in a closed place? It’s ridiculous, a joke. The problem is that this is almost no longer talked about even among psychiatrists.
The opening photo is by Claudio Ernè and appeared in the March issue of Vita, dedicated to Franco Basaglia