by Pasquale Califano
07 NOV –
Dear Director,
mental health, unlike other sectors of medicine and public health in general, does not require huge and sophisticated instrumental resources. Today, the choice to allocate resources in specific areas rather than others, obviously in the field of mental health, makes a considerable difference.
Thinking exclusively in terms of organization, business strategies and / or implementation protocols can become a serious problem, both for those who receive services and for those who provide them, if not evaluated (the entire plant) carefully and, first of all, if it is not dutifully anchored to the wealth of theoretical, technical and clinical experiences and knowledge acquired up to now (for more than a hundred years).
Also, if not carefully evaluated (asking ruthlessly!) How a type of organization is at the service of the patient and not exclusively in favor (in a defensive way) of the same Institute. The well-known news events, which by now often involve health institutions and structures, should induce professionals to turn a look to the past – which should not be denied in the name of an elusive and idealized “hyper scientific” future – where it is not relegated only to the merciless and long asylum season, but where one can draw on a rich heritage made up of notable scientific contributions that are waiting to be wisely used.
I note that, although there is a large literature on the relationship between ‘institution and mental health‘, starting from the 1970s, (read for example (1971). Rivista Psicoanal., (17) (1): 67-81 “Semeiological approach to the psychiatric institution” by Dario De Martis and Fausto Petrella) capable of throwing a little light on the intriguing, articulated and powerful complex mental functioning of the group (or of an organization), does not exploit adequately and settles into the use of “strategic modalities” which are often reassuring, however, dehumanizing. Instead, if translated into practice it could provide the weapon to make a serious prevention of conflicts, strong and serious tensions, which often turn into acts of violence, in a community, in hospital wards for psychiatric patients etc!
One realizes, only on these occasions, that the standard protocols, the superficially adopted strategies, only apparently reassuring, evaporate, thus losing consistency, leaving dismay and misery.
When this happens, the question to ask should not be: “but what went wrong from an organizational top …? Or” but what protocol was not observed? But, instead: “what happened in the mind of the health worker or more than one (a group) to push them to lose the necessary sensitivity by recreating, unconsciously and progressively, all those conditions that have reproduced a mental hospital atmosphere?”
Despite the prevailing need to face the question from a psychic apex and above all in an interpersonal and intersubjective framework, the explanation of these phenomena, however, shifts and takes the same common turn, obeying a “pre-established scheme”, showing itself, and being accepted, for what it seems but not for what it is. Usually (I read) these problems are attributable or attributable to lack of funds, organizational aspects and more. It may well be that the reasons are these, but, in my opinion, I would go very cautious to attribute everything to this!
One fundamental element (which I would like to highlight and suggest) is overlooked that should be taken into serious consideration, which could make the difference between a good and / or a bad functioning of the health institutions that deal with mental health: the training of ‘health worker. A large part of the budget should be devoted mainly to this area. A training very different from those that are notoriously offered and carried out.
I’m talking about a type of training that is still a “niche” for a few because it is considered of little or no importance by the institutions (I omit other reasons that reside at deeper levels). A training that aims to protect the mental health of the health worker and at the same time of the client.
I come to the point. Unfortunately, the fundamental role of a personal analysis (individual and / or group) is still little recognized. It is still too much ignored that psychotic anxieties are necessarily activated during the relationship with very serious psychiatric patients; if they are not dealt with comprehensively through personal analysis, they can create confusion and cause a blockage in the relationship, as well as serious tensions and even the collapse of the health worker.
This type of patient often violently projects his or her own feelings and problems, and a practitioner who fears such contact could in turn be severely disturbed in his attempts to assist him. The most frequent anxiety, even if often unconscious, is that of being driven to madness by the patient. It is for this reason that the practitioner has to undergo a particularly thorough personal analysis, which obviously involves the stripping of his psychotic areas, so that the anxieties and psychotic defenses can be processed to a good enough extent during the training period. .
Sometimes a second analysis may also be necessary, a third…. If the practitioner has split or repressed psychotic conflicts, while feeling optimally consciously, he will tend to be numb or defensive; inevitably the patient will consciously or Unconsciously perceive the disturbances present in the operator and will react accordingly or interact with them.
There is also the danger that contact with severe patients will stimulate and activate the latent conflict in the operator. For example, tendencies to perform an omnipotent and omniscient function can be greatly exasperated and lead to forms of violence. We must realize that, in treating these patients (even more than usually happens with other less serious psychopathologies), the main working tools are our personality, and therefore our mental health is an extremely important factor in which we must necessarily invest. . Only in this way can we react to the patient with empathy, but without letting ourselves be excessively involved, and show oneself sensitive, receptive, but without being overwhelmed by her projection.
It is essential to consider (beyond the different orientations and models of reference or the different theoretical and, at times, ideological positions) personal analysis as a form of protection against those “impetuous, silent and catastrophic emotional movements” alike (considered by a biological summit) of the anti Covid vaccination to which all health professionals must undergo to protect their own and others’ physical health.
Last note. If we then allocate a large part of the budget to childhood, adolescence and the family, putting in place a massive capacity for prevention, we could even prevent a person from becoming a psychiatric patient, because one of the most serious and severe psychopathologies, psychosis, it was born in the very first if not very early childhood. The allocation of resources makes a huge difference!
Dr. Pasquale Califano
Child Psychoanalyst
Psychotherapist specialist in Childhood, Adolescence and Family
Ordinary Member of the Italian Association of Child Psychoanalytic Psychotherapy
07 November 2022
© All rights reserved
Other articles in Letters to the editor
