by Andrea Angelozzi
17 APR –
Dear Director,
I confess that the psychiatrists’ letter to the President of the Republic, duly reported in Quotidiano Sanità, struck me. And this is not only due to the fact that addressing it to the President, as happened with other documents in the past, closely resembles requests for pardon, the last resort for those who have finished every possible hearing. This demonstrates a central problem of which we have had ample evidence: the absolute lack of credible interlocutors, with politicians and administrators who have let other dramatic appeals fall on deaf ears or empty promises, an aspect that we continue to neglect, especially when we reformulate in the wind problems and requests.
What surprised me, however, is that there are 450 signatories, a number that is important in some ways, but which in absolute terms marks a void. From a set of not very updated data between the OECD and Eurostat we learn that there are just over 12,000 psychiatrists in Italy, 4,300 of whom work in the public network and in affiliated structures. There are therefore 11,600 psychiatrists missing.
And their absence, in my opinion, is a problem that should be questioned.
I imagine the difficulty of circulating a document and collecting signatures, and I think that the 450 are already a success, also because it is only a part of those who would have signed, leaving us to imagine a value that is certainly higher than that which, however, in fact starts from a 4% of the total.
It’s a very large gap, which pushes me to formulate various explanatory hypotheses, all quite worrying for the problems they would indicate.
The first is that it is not so easy to sign for those who are dependent on the NHS. I am well aware of the many constraints, explicit and implicit, that administrations place on the expression of a correct right of criticism, where dutiful loyalty towards the institution to which one belongs is confused with the expectation of a complicit silence on what does not work. This condition, which in fact represents a limit not only to democracy, but above all to thought, has over time become something that “obviously” regulates behavior and enters the regulations without objection, losing that character of unjustified abuse which is instead its part essential.
The second is that the universe of psychiatry includes, and now increasingly, the vast galaxies of private psychiatry, insensitive to the suffering of the public service – which indeed makes this area flourish – and far from the drama of resources, of neo- mental hospital and the impositions of social control. And on this aspect, that is, the existence of worlds of psychiatry not separated only by ideological settings, but by a different position in relation to the irreplaceable centrality of the public service, I believe it is important to reflect in the future, also because they are not marginal worlds, but rather numerically predominant,
The third is that I have the perception that there has been a progressive flattening of psychiatry on a very pragmatic logic, which only aims to manage everyday life. The dialectical comparison between psychiatry and other areas of medicine has evolved medicine much less than certain medicine has pervaded psychiatry. In this gradual transformation it has emptied it of being proudly on the border between biology, mind and society, and, without protecting it from the unchanged social requests to control unreason and abnormality, it has forced it into a container that must manage and standardize behaviours, where culture is reduced to procedures and science to the daily life of a fragile organization. The same request from the administrations for a logic where accounting reasoning and programming that reach tomorrow at most tends to extinguish those broader and more innovative horizons to which the psychiatrist aspired in the past.
The fourth is the impression that, in this context of difficulty, the university remains on the sidelines, increasingly detached, closed in its own knowledge on minds closed in rigid skulls, with the difficulty of grasping that the real world where research must find concreteness risks being distant and inaccessible, annoyingly devoid of the pure cases required by the rules of inclusion in trials, and dramatically contaminated by the many variables linked to the daily life of services and users, outside of any research protocol. The mind always reminds us in the end how it is not limited to the skull and even less to our nosological constructs, but lives in the world, in relationships and in their problems.
But perhaps we need to acknowledge that a period has come to an end, that for the new generations of psychiatrists the specificity of psychiatry matters less than a need for integration for approval to the general trend of the NHS, and that Basaglia is becoming just an image for a postage stamp commemorative, in an era in which the automatic stamping of post offices and tobacconists has transformed stamps only into objects for collectors.
In the end, despite the best premises and intentions, many operators have been marked by the progressive impoverishment of services, in terms of resources and the ability to find some push for renewal, crushed between a law that promised an ideal world and a reality that barely suggests survival. This has undermined the possibility of seeing broader horizons, of realizing where, beyond the everyday, what we do on a daily basis actually belongs. They are non-adhesions that do not imply opposition to the idea that the situation is dramatic and something must be done, but only a resignation that seeks to survive in a condition that is feared to be immutable.
So I believe that, to overcome the progressive collapse of mental health in Italy, it is important to collect the 450 signatures, but also to ask ourselves how to involve the 96% who have not signed in the problem.
Andrea Angelozzi
Psychiatrist
April 17, 2024
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Tags: Mental health resigned professionals
