From “The Small”
by Pier Aldo Rovatti
The specific case of psychiatry is quite eloquent. It shows us that public health is moving towards specialization with lots of regards to territorial health and an idea of community care. The doctor is now usually identifiable with a specialist capable of selecting a localized damage in our body and to provide appropriate medicalization. And so the entire healthcare system tends to organize itself around a specialist vision of the disease. Neither the professionals nor those amateurs personified by each of us with our malaises rebel against such a technicalistic canning. General practitioners have little power, they certainly count but very little: some would like to escape this cultural closure, but their voice seems to be fainter.
The case of psychiatry is exemplary because it seems that there is no choice and one must conform to a decidedly individualistic vision of medicine as if the word “territory” were destined to disappear with all the good practices that it entails.
Basaglia? The law 180? They are becoming memories, archival stuff, anthology at best: traces of a past that by now has very few points of tangency with the present of medicalization.
Speaking with one of the most authoritative heirs of the Basaglia “revolution”, that is Peppe Dell’Acqua, the disturbing example of the “closed door” emerges, that door which previously remained open and which is now closed instead: inside, behind this door stands the specialist who receives his patient in a sort of technical separation which should appear normal, obvious, even a guarantee of the seriousness and quality of the medical experience.
Thus, the so-called territory is destined to lose any value: no communication, no “community”, no group work or support for the sociality that can gather around the bearer of the disturbance (!), who, on the contrary, tends to be detached from the his social surroundings, almost always left to himself, to his family if he has one, to his individual suffering.
The doctor, the “specialist”, is up there, or rather behind his door, and when you go out that door, with a sheet in your hand that is not always decipherable, you remain as if stunned trying to remember the words he said to you and which you did not they are so clear. You feel like going back and asking for a few more words of explanation, but you don’t.
Am I drawing too dark a picture? Of course there are exceptions and perhaps that door remains a little open, however it seems clear that the wind that is blowing, the “trend” that moves current public health in its predominant organization, is precisely of this kind.
On the other hand, it is the same type of air that is perceived in the entire society today: it is difficult to delude oneself that socialization or a spirit of community prevails in it, since it is clear that what dominates is rather an individualistic attitude, a bit everywhere. Medicine, from public health, is transforming itself into an individual and individualizing relationship between technician and patient.
More than ten years ago I had the opportunity to collaborate in the promotion of a series of books entitled “180 Critical Archive of Mental Health”: historical and critical in-depth essays, narrations of personal experiences. Now, in addition to noting the positive balance of this small initiative, it would be time to relaunch it to counter the climate of closure and restriction in which we are floating, both as regards psychiatry and as regards public health as a whole. Indeed, precisely in the regime of closed doors that is establishing itself, we should oppose this rather unhealthy air that we all risk breathing to the detriment of our health.
Trieste has been a beacon for many years. Today, relying on the positive events that the city has been able to experience, we should in any case try to prevent the lighthouse from going out or producing only a thread of light, almost canceled by the unchallenged shine of the medical specialist. We should try to reopen all the doors that have closed at the expense of the territory of health and care.