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BETWEEN TREATMENT AND PUNISHMENT - ANTHROPOLOGICAL PROSPECTS REGARDING THE MANAGEMENT OF MENTAL DISTRESS

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Katia Bellucci

 

By Katia Bellucci

"Usually, a cure is thought of as the solution to a medical problem that, once identified and with the appropriate treatment, leads to the disappearance of symptoms and to a rediscovered state of health. In psychiatry, however, recovery doesn't seem to be connected to the disappearance of symptoms. In many cases the therapy tries to activate an overall change in the person; in the evaluation of its effectiveness one talks of maturation, of a recovered capacity to act, of an awareness of the patient." (Minelli, 2011).
 

The management of mental distress has always been a problem for human societies; the matter is even more difficult when a mental illness meets up with violence, finding its expression in the so-called "insane offender", or rather that person, the offender, who is diagnosed as having a mental illness.
Up to now the situation in Italy has given rise to the existence of the OPG, (Ospedali Psichiatrici Giudiziari) Judicial Psychiatric Hospitals, institutions responsible for the management of these individuals: "a no man's land between a prison and a hospital" (Dell'Aquila, 2009), where concepts such as socially dangerous, disease, and crime can be found to coexist.
Currently this reality is being superseded; the Legislative Decree no. 24, of 25 march 2013, that modifies the law no. 9 of 17 february 2012, in fact indicates that "from 1 april 2014 Judicial Psychiatric Hospitals are closed".
However, the discussion on possible alternatives, on solutions to be adopted, is open, there are no clearly defined paths to be followed, nor prearranged solutions, only general guidelines. It is therefore fundamental to make further considerations on and comparisons between the forms of assistence that are the most suitable for those who are discharged from these structures.
Some realities that have been working in this direction for some time already exist In Italy; it is possible therefore to refer to the practices that they have put into action, so as to be able to gather the strong points and evaluate eventual problems.

From 2007, a structure called Casa Zacchera exists in the locality of Sadurano, in the hills of Castrocaro Terme and Terra del Sole (FC), welcoming patients who are criminal offenders residing in Emilia-Romagna, perpetrators of crimes and suffering from forms of stabilized psychosis with a low degree of problematics and who come from Judicial Psychiatric Hospitals (OPG). We are dealing with patients in a phase of being discharged who do not require the intensive custodial function of the OPG anymore, but who need a therapeutic approach to rehabilitation suitable for their gradual reintegration into society. The guests of the Residence have in fact reached a level of psychopathological compensation and behavioral adequacy that allows them to take part actively in an individual rehabilitation programme, while remaining in a suitably controlled situation".
Casa Zacchera can accomodate up to a maximum of sixteen people, exclusively men; the male and female staff, consisting of psychologists, psychiatrists, nurses and operators, who alternate during the day, to give a total coverage during the various shifts. No one wears white coats or uniforms, or distinguishing signs of any kind. There are no people predisposed for security, nor elements that make one think of some sort of control or restriction.
What strikes one is the gateway, it is always left open, even at night; there are no bars on the windows even if we are certainly not dealing with a "free" space (although not visible, there is a limitation, an insurmountable barrier: to go beyond that open gateway means " to escape", and the guests of Casa Zacchera, well aware of this fact, are careful not to "pass" this limit). The structure came into being with the intention of creating a mediation between the OPG and local services, an intermediate transition between the tougher confinement of the Judicial Psychiatric Hospital and reintegration into the territory, reconnecting with the whole community, with life "outside".
"To care for" the guests is one of the main tasks of Casa Zacchera; the "punishing" factor, undoubtedly present in structures such as the Judicial Psychiatric Hospitals somehow takes second place here, instead a continual therapeutic project forms the background to daily life in the structure.
Even if a pharmacological therapy is present, psychotherapy is mainly relied upon: workers and patients are in agreement in considering this the most suitable instrument for genuine rehabilitation, for a real change.
From an offender to a madman, to a patient: the users find themselves reflecting on the way their subjectivity changes, a course of modifications due not only to external attributions but also to personal changes.
Entering an OPG, transiting through the structure of Casa Zacchera, and afterwards returning to the outside world brings about a change in the definition of ones identity, both by those on the outside, who find themselves seeing the individual and relating to him on the basis of personal categorization, or by the individual himself, involved from time to time in remodelling the image he has of himself.
The task of the operators is therefore to help the patients through the programme, promoting reflection on this changing of subjectivity, helping to understand past, present and future actions.
A look at the past, at the moment of the "split" with society, at the gesture that led to this division is certainly necessary; but equally important is a direct gaze to the future, to the possibility of returning to that society: consequently this is the value of projects for work placement, where it is possible to address expectations and desires.
It is in the continual support offered to patients, genuine thinking on the meaning of suffering,
profound attention to single needs (looking at the individual, unthinkable in OPG), that we find the value of the work carried out at Casa Zacchera, work having clearly in mind that: "whatever kind of organization that takes no account of the patient in his free, personal way of proposing himself to the world, will fail in its job, because it will have a negative impact on him, even if apparently trying to help his recovery" (Basaglia, 2005).

 


BIBLIOGRAPHY

- Basaglia, F. (2005), L'utopia della realtà, Turin, Einaudi
- Biehl, J. - Good, B. - Kleinman, A. (2007), Subjectivity. Ethnographic investigations, Berkeley, University of California Press
- Dell'Aquila, D. S. (2009), Se non ti importa il colore degli occhi. An enquiry into criminal asylums, Naples, Filema edizioni
- Goffman, E. (1968), Asylums. Total institutions: the mechanisms of exclusion and of violence., Turin, Einaudi
- Minelli, M. (2011), Santi, demoni, giocatori. An etnography of the practices for mental health, Lecce, Argo

 

 

 

 

 


 
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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 ...

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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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