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Urban Suffering Studies Center



Dancing the samba while piloting a jet plane

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Benedetto Saraceno


Today we will be talking about those individuals who are employed as psychosocial workers in public and private services, dealing with health and not. These workers have extremely varied professional statutes (in fact we include in this ample notion of psychosocial worker, nurses and doctors, surveillance judges and security forces, educators and teachers). Even if their authority and learning (and salaries) are very different, these subjects have in common the function for social mediation between, on one hand


  • complex needs proposed by the users
  • requests that are not always comprehensible and/or homogeneous but that are always and
    in any case composite being the result of varied and heterogeneous suffering (illness, marginality, exclusion, poverty, stigmatization, discrimination) and, on the other hand
  • replies that are in turn composite insofar as resulting from the action (or inaction) of


different institutions and services, with different mandates and often badly organized or even in conflict with each other. The replies of the psychosocial workers are part of their know]how. This has to do with a know]how that combines technical learning, experience, and the ability to navigate between the possibilities and the impossibilities that characterize each service, each institution. Therefore, the psychosocial worker brings with his know]how, much more than just technical knowledge. First of all, he moves constantly in the intersection (not necessarily harmonious) between his own individual "value system" and the "mission" of the institution where he operates. This intersection, present in any professional practice is, in the case of the psychosocial worker, especially influential on his practice (much more than its influence on professions that are more neutral with regards to the value system). Often these workers complain of the constrictions imposed on them by the institution where they work (constrictions that limit the scale of the intervention, its depth, its duration, its continuity, the available resources, the possibility of a synergy with others, etc.). In other words the institutional mandate (the mission) is often in contrast with the worker's system of values (value system). It should be noted that the mission of every institution is also the result of a choice of values made by the institute itself. Therefore one could say that the worker and the institution often have two contrasting value systems. The psychosocial worker obviously brings technical knowledge as a result of his specific formation (doctor, psychologist, social assistant, nurse, educator, judge, teacher, policeman) but he often comes up against the impracticality or uselessness of his own technical learning. Technical knowledge can result impractical in the conditions of certain environments where the operator works: often a simple lack of time can make it unfeasible for the the worker to dedicate himself to listening to the user as he would like to, or at times the environmental miserableness and inadequacy of the services in which the worker is obliged to operate can make projects for the promotion and growth of the independance and the abilities of the user, unfeasible . Therefore, space and time often work against the practicability of much technical learning making it unusable in reality. Furthermore, technical learning very often results simply useless (even if perhaps practicable) that is unsuitable for meeting the needs and the requests of the users and this has to do with the traditional distance between places for formation ] schools, universities etc ...] and places where the social action happens. In some cases it could even be stated that certain technical knowledge is an obstacle towards an effective reply to needs (for example I am referring to much of the psychiatry taught in the universities and practiced with a useless and/or damaging effect). Finally, the psychosocial worker is also a bearer of experience or rather its knowledge acquired in time, not just more helpful replies to the problems and needs of the users, but also of the mechanisms behind the functioning of the institutions where he finds himself working . Steering through institutions often asks for a keen knowledge of the formal and informal mechanisms that characterize their working. One could say that the scene is triangular: on one hand the value systems, technical learning, experience, that is the instruments of the psychosocial worker, on the other hand the questions and the requirements put forward by the users and, in between, the ground where the meeting takes place: the health sphere or not, the public or private area, the field characterized by a context of decisional and operational urgency or that characterized by a context with a slow rhythm. To make the picture even more complex, a further factor that accompanies the function of the psychosocial worker has to be added: his "style of work", or rather a characteristic that transcends 3 his learning and experiences but that nevertheless plays a decisive role in multiplying or scaling down the impact of the intervention that the worker starts up. The style of work has to do both with the emotional dimension of the worker and his strategic wisdom. "...It's possible to learn... to distinguish between the gestures, the notions, the instruments that can really be useful in fighting against suffering and the parasitic components of the professional identity (the italics are mine)" "....the emotional refusal of the professional identity that "normally" the technician should have taken on, insofar as a refusal of models that are oppressive for oneself and for others.....leads the way to another professional logic (the italics are mine) ". These words were written almost thirty years ago by Luciano Carrino, one of the historical leaders of anti]institutional psychiatry, in an article bearing the meaningful title "The emotional dimension of critical work" (in: Various Authors. Between rules and Utopia. pp147]153. The Editorial Cooperative Democratic Psychiatrist, Rome 1982). In this brief and brilliant text Carrino speaks of the "pleasure of transforming the oppressive aspects of the professional services" and of the "complicity that grows to the extent that one learns to see in the other principally the prey and the victim of institutional models, those models in which we too, in our own way, feel the oppressive weight". Then again Carrino writes: "In an apparent paradox, the more knowledge and techniques are born and live in contact with people, the more one feels the necessity to be near to the needs of the individual who suffers without making him the object of an arbitrary and often destructive manipulation, and the more a necessary professionality becomes complex and refined for technicians who support the need and the rightness of this transformation of knowledge, without getting quickly rid of preceeding techniques in use." It is here then that the style of work becomes defined as the affective dimension of the critical work that the worker undertakes ( ought to undertake ) daily and that, in fact, connotes itself in two complemantary dimensions: affectivity and criticality. A critical but unemotional effort simply sets up the ideology that is behind the intervention and nothing more, while an affective but uncritical effort sets up a confused practice based on the emotions, often on a sense of guilt and alas on redeeming vocations that are generally disastrous for the users. The style of work should be characterized by the coexistence of an affective dimension 4 directed at the user (but also towards oneself), and a critical dimension capable of deconstructing the logics of the institution that reproduces and reproposes itself tireless and never defeated. This style is to be connoted therefore for its double characteristics, a constructive affectivity, and a deconstructive criticality, which results in nothing more than the construction of daily micro liberations. We are talking about a difficult equilibrium that has to allow the worker to stay in the network of the institutions ( because if he stays outside his intervention will not have any transforming impact) without however getting caught up in it. And when we say "institutions" we are not refering only to the services where the operator works but also to those "parasitic components of the professional identity" of which Carrino talks of, or rather those components that turn all techniques and knowledge into "institution", thus losing the capacity for self]questioning, for doubting but that on the contrary form a screen in front of the interrogation of the other and a protective armour. Then again Carrino states: "The same logic that pushes us to transform certain aspects of the professional services such as expectation, authoritarian communication, fear or dependency, also pushes us to look for procedures, techniques, forms of organization capable of making the participation and the autonomy of the people easier.....and it is the same logic that pushes us to substitute the stereotypes of codified knowledge with the collective construction of a new knowledge capable, from time to time, of adapting itself to the peculiarity of the culture, the situations, the contradictions in which suffering manifests itself (my italics)". Some reader will say at this point that this is the idealistic and anti]bourgeois language of the seventies, something to be scrapped, that has prevented exercising practices and techniques purified of any participatory and liberating (for some, rhetorical) aspiration. The criticism of this hypothetical reader is in some way a foregone conclusion but just the same, not justified. If we look at the practices of the "pragmatic" years after the "idealistic" years we don't find an exhilarating picture. After years of psychiatry specialized more and more finely in treating complex pathologies (double and triple diagnosises), of more and more sophisticated diagnosises (DSM IV and then V in a crescendo of diagnosises to which, though, always correspond the same few and poor treatments), of more and more targeted medecines, only to be withdrawn in the following years (but more and more expensive), of masters and residential or correspondence courses for the formation of psychosocial workers who learn to manage traumas and post traumas, to deal with scolastic failures and precocious accesses to drugs, after a fantastic season of the flowering of all this knowledge, how is it possibile that psychiatrists can still accept cronic patients as having no alternative but being sent to private religious institutions, that the services for diagnosis and cures normally practice physical 5 constriction, that the territorial services reproduce medical and out]patient logics, that the pharmaceutical industries hide unfavourable data regarding the medicines they sell, and finally, that the strictness of scientific evidence is called upon on alternate days only or, that is, only when it's convenient? How is it possible that the ignorance, the pregiudice, the xenofobia, the wretchedness of the services available permeate the culture of the institutions and the government of the city? Instead, who knows if it's not just the idealistic ( hopeful) and anti]bourgeois (critical) view which should enlighten the psychosocial practice of the workers once again. The psychosocial worker ought to construct alliances within the institutions and with the institutions but at the same time patiently deconstruct the fine canvas that the institution weaves around the services, the interventions, learning, (and around itself). The institutional prison is not something that is or isn't, but it is a permanent self]reproduction process that begins from the very moment we create something, construct a new service, learn new knowledge, build a project; we must be conscious that, at the same time, the change that has been constructed has in itself the seeds of its own irrational reproduction and therefore mistification. An so, like Penelope, we must tirelessly construct and deconstruct, accepting the challenge of an uncertainty that has in itself all the anxiety of the uncertain but also all the richness of transformation and change. The challenge and uniqueness of psychosocial work is that of promoting perception and subjectivity through strategies and organizational and institutional instruments, to create life and freedom, passing through and using as an instrument of work, institutions that certainly are neither vital nor liberating: the practice of the psychosocial worker is an oxymoron which fulfils itself.


This laceration is not superficial but extremely real and requires affectivity, creativity, civilized passion but also discipline, organization, tactical sense, the capacity for reading the context, the evaluation of strengths and resources. A bit like dancing the samba while piloting a jet plane: maintain the grace and energy of the samba while always in control of the thousand and one sofisticated instruments of the aeroplane.



By the same authors:          SouqBiblio: annotated international bibliography*  A Return to the Way leading to Happiness   Aporeia of empowerment  Deconstructing the paradigm of "migrant emergency"  Defend the ways of liberation  Describing reality but also changing it  Educate in complexity  Empowerment  Global health, local health: a paradigm of the failures of globalization   Health systems are not designed for the needs of citizens  Reject Ferocity, Not Migrants  Souqbiblio (number 1)  SouqBiblio: international annotated bibliography number 8  SouqBiblio: international annotated bibliography*  SouqBiblio: internazional annotated bibliography (number 6)  SouqBiblio: annotated international bibliography  SouqBiblio: annotated international bibliography  SouqBiblio: annotated international bibliography  SouqBiblio: annotated international bibliography  SouqBiblio: international annotated bibliography (number 5)  SouqBiblio: international annotated bibliography (number 3)  SouqBiblio: International annotated bibliography (number 7)  SouqBiblio: internazional annotated bibliography (number 4)  SouqBiblio: References (number 2)  The association Poverty - Mental Disorders and its implications for outcome and care provision   The Confusion to be managed  The paradigm of urban suffering  Time of Siege  Urban Resistance  Verbal violence and social paranoia 

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Center for urban suffering

The study centre wishes to study the phenomenon of urban suffering, in other words the suffering that is specific to the great metropolises. Urban Suffering is a category that describes the meeting of individual suffering with the social fabric that they inhabit. The description, the understanding and the transformation of the psychological and social dynamics that develop from the meeting of ...

Who we are

The Urban Suffering Studies Center - SOUQ - arises from Milan, a place of complexity and economic and social contradictions belonged to global world.Tightly linked to Casa della Carità Foundation, which provides assistance and care to unserved populations in Milan (such as immigrants legal and illegal, homeless, vulnerable minorities), the Urban Suffering Studies Center puts attention on ...


Centro studi Souq Management commitee: Laura Arduini, Virginio Colmegna (presidente), Silvia Landra, Simona Sambati, Benedetto Saraceno ; Scientific commitee: Mario Agostinelli, Angelo Barbato, Maurizio Bonati, Adolfo Ceretti, Giacomo Costa, Ota de Leonardis,  Giulio Ernesti, Sergio Escobar, Luca Formenton, Francesco Maisto, Ambrogio Manenti, Claudia Mazzucato, Daniela ...
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ISSN 2282-5754 Souquaderni [online] by SOUQ - Centro Studi sulla Sofferenza Urbana - CF: 97316770151
Last update: 20/04/2019

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