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The role of psychology in maintenance and in contrast to health inequalities

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Matteo Bessone


Structural violence, symbolic violence and technical violence
By Matteo Bessone

October 10, 2015 a study day took place in Turin organized by the DUPP Working Group
(Diritti Umani Psicologi Piemonte - Human Rights Psychologists Piedmont) of the Order of the Psychologists of Piedmont on the issue The Right to Health. One thing appeared particularly significant: the very low number of psychologists called to intervene when compared to the large number of psychiatrists and psychotherapists of medical training. Starting from this simple, painful, indisputable consideration the objective we have set is three-fold: the first is to propose a reflection on the positioning of italian psychology today, in particular clinical psychology, with respect to the theme of the right to health and of the inequalities in health, characterized, on a superficial observation, by a scarcity of psychologists in this field. The second objective is to briefly illustrate, from what emerged during the seminar (despite everything promoted by a Working Group of the Order of Psychologists), those processes and forces that shape the conditions in which people are born, grow up, grow old, are more or less likely to get sick and die. Finally, in the light of these considerations, the third objective, the main one, will be to try and outline the role that psychologists and psychology could play in protecting the right to health.

What information could we obtain, starting from the difficulty in finding psychologists able to articulate with expertise, starting from their own work, a debate about the relationship between the right to health and psychology? Benasayag, psychoanalist and philosopher, can help us with the answer by asking if the current decline of psychoanalysis is not due to a difficulty of the discipline in recognizing the challenges posed by what he calls "modern man's suffering". He speaks of a state of being out of phase with respect to the postmodern period of psychoanalysis, arguing that the result of this being out of phase has been the failure of a historic goal for psychoanalysis caused on the one hand by the fall of the discipline into the individualistic trap, and on the other hand by the construction of a universal model, rendered substantial and reified by the psychic apparatus. Can such considerations come to our aid in replying to our question?
Freud can help us further towards a possible answer. In Civilization and Its Discontents (1971) he observes how the clinician tends to turn his back on the great movements of History (in his case the reference is to the Great War and the Great Depression) by severing the threads that bind the individual to his context. These observations, though formulated in very different historical periods, appear to be more relevant than ever. If on one hand, even following the studies on social determinants of health (WHO, 2008), the epidemiological evidence grows exponentially regarding the role that inequalities play in shaping the lives of the population and individuals, on the other psychology does not seem to be prepared yet, lacking the epistemological, theoretical, methodological and operational tools, in order to act with authority in this scenario, so in fact it is often ineffective in protecting the right to health.
Even in the face of compelling evidence on the role of mental health in determining a more general state of health (the title of an article published in the Lancet, 2007 is emblematic: Prince, Martin, and others "No health without mental health), the apparent disinterest of psychology concerning inequalities might find a mitigating factor when referring to non-psychic manifestations of suffering, with respect to which it is given for granted the impact of the "distal" determinants on different exposure to risk factors, on the vulnerability to unfavorable effects of such factors on health, on the unjust vulnerability in respect of the social consequences of the disease. (Costa and others 2014). This apparent indifference results, however, quite frankly bizarre in the light of the evidence related to the comorbidity of psychiatric disorders with pathologies of other kinds and the increasing amount of data that underscores the crucial role of inequalities in the etiopathogenesis of mental diseases. (Compton and others 2015; WHO, 2014). Such detachment from the reality of the epidemiological scene would lead some fanatic of classification to give a diagnosis of a frankly psychotic context. But while this epidemiological evidence begins to proliferate and consolidate within a coherent and worrying international picture, in the psychological field, where the importance of a bio-psycho-social approach is reaffirmed in a loud voice, we are witnessing the emergence of a multiplicity of theories and practices that continue to rotate around a strictly biomedical paradigm and where suffering is represented as a purely individual phenomenon. All this production of knowledge and practices aimed at the aspired overcoming of a rigid cartesian dualism that separated body and mind, however continues to have the individual as a unit of analysis and intervention. The contribution of psychoneuroendocrinoimmunology was very important to knowledge relative to the psycho-biological replies to stress, of EMDR in the treatment of trauma as well as sensorimotor psychotherapy. However you can not help noticing how much these devices continue to reflect and consolidate a specific imagery, pervasively colonized (to quote Habermas) by biomedecine and where individual suffering can not be medicalized. Illich, 1976): the indivudual who suffers is an individual with a flaw, and in the construction of clinical, bio-psychic realities (Keinman, 1978) the objective becomes that of treating the individual (or whatever transcends this) to re-adapt him to the context, thanks to techniques whose effectiveness has been proven scientifically. We can imagine that system, which manifests itself in the hopeful research for a technique with greater empirical solidity, as probably supported by the legitimate desire for recognition of the young discipline. Psychology seems to have preferred to draw almost exclusively from empirical, epistemological paradigms, typical of natural sciences, focusing on predictability, reliability and control of the variables rather than those of the social and human sciences in relation to which the work of the psychologist almost does not seem able to define itself. The epiphenomenon of this choice appears to be the loss of a horizon with a deep meaning that can not always be captured by the instruments that science offers us, that can not be measured. We do not say anything new comparing this biomedical paradigm to a new, more illusorily promising religion. Side by side with a proliferation of models and theories that emphasize the unquestionable importance of the relation between the bio- and psico-aspects, in the individual it is very rare to find psychological models that take into consideration, while remaining on an individual level, the importance of the least proximal social variables. We stress this last term establishing an important distinction: it is not uncommon that social factors are mentioned among the risk factors (for example, family, social isolation or having a relative who committed suicide may be considered as suicide risk factors) but in this case we are dealing with proximal factors, situated on an individual level. It is rare however, and it is to this that we would like draw attention, that it is the distal determinants to be taken into account, those deep mechanisms responsible for social stratification, social ad health inequalities, which are located at the level of context and that act as deeply as extensively on a macro-social level (Compton and others 2015). If during all the demands of the '70 there was no doubt that, to be therapeutic, an act would have to have an effect on the cultural, political, economic and institutional context, the wall having fallen that segregated the insane from the supposedly healthy, with the entry into effect of Law 180, this awareness of the crucial nature of the context in the co-determination of suffering seems to have been weakened with the thrust for change of the context itself. It is not easy to see the link that exists between our privileges and the suffering of others and therapeutic action would seem moved by the unconfessed hope that individuals - including the most disadvantaged - continue to live in the same conditions without succumbing anymore to mental disorders, to teen pregnancy, to school failure, drug use and the spreading of fear, violence and stereotypes. The Dever chart very clearly shows the low impact of technical interventions (downstream, on proximal determinants) aimed at addressing the damage caused by distal determinants (upstream) relative to social stratification: in the face of 90% of the investments of the expenses for health on the health care system, this acts, for example, on reducing mortality by only 11%; while the remaining 89% of which only the remaining 10% is invested, is affected by social, environmental, cultural, biological factors and by chance. These interventions (technical, target-specific) are intended to treat different groups of patients rather than to reduce the incidence of social and health problems, before these are generated in the context. It seems too obvious, in this scenario, to evoke the "Syndrome of Gambling" acclaimed pathology as much a context that sees in gaming a secure source of income as the unfortunate players who stumble into it. We believe it can be effective not to let ones clinical motivation drain in front of the question "how to treat the Syndrome of Gambling?"to push ahead to the following or previous question: "What are those processes that, even in the context, contribute to the spreading of such experiences of suffering, in a differential way in different segments of the population?" Similar questions can only create confusion in the theatre of psychological work from the moment in which one questions oneself about the effectiveness of one's work in the scenario of increasingly growing inequalities, for forty years up to the present day. The monolithic certainty of the effectiveness of our work is scarred by a crack often difficult to accept, in the furrow of which Basaglia (1968), Illich (1976) and Taussig (2006) (each referring to different fields of knowledge) had already highlighted the contradictions of their work to push as far as the awareness of the ‘iatrogenicità'of a certain gait that mystifies the causes of suffering. These are not new processes, but more like renewed talks compared to new forms assumed by deeply rooted processes, but not for this reason impossibe to cope with, in the social body. Benasayag and Smith (2004) clearly state that "the fact of living with a feeling ( almost permanent) of insecurity, instability and crisis produces psychological conflicts and suffering, but that does not mean that the origin of the problem is psycological [...]. That every social fact involves [...] a psychological dimension does not authorize one to think that everything comes from this". With this we can not definitely say that all evils spring from the social dimension, but neither do we want to deny its existence. It is in meeting, in the relationship, in the bond created between subject and context, registered in the body, full of constraints and possibilities, that the experience of health and disease of each person takes shape.
Established this trend of psychology to act in a preferential way on the individual often ignoring the social processes that generate, in a differential manner among the population, states of disease and discomfort in people, what do we know of these processes? What are the terms that we can use to define them? How could psychology act on these processes contributing effectively to the protection of the right to health? To answer the first question, we can refer to Costa who, duing his speech at the seminar of October 10 from where we started, draws liberally from the second report on social inequalities in health. Health equity in Italy, of which he was curator. He demonstrates incontrovertibly how in Italy health inequalities are observable in relation to all the dimensions of health (incidence, prevalence and lethality) and all the dimensions of the social position as well as geographical. This means that health (including also mental health) is arranged according to a gradient: whatever the social position indicator used (income, status, number of rooms in the house, education, ecc.) to every social position corresponds a worst health level (for almost all diseases) than that of the immediately upperposition (Maciocco e Santomauro 2014). Leaving Italy, on a global level, the picture observed is the same. Wilkinson and Pickett (2009) have aggregated into a single indicator comparable data of all health and social problems related to each of the richest1 countries. This indicator includes: the degree of trust in society, life expectancy and infant mortality, educational achievement, murders, mental illness, teenage pregnancy, obesity. The authors note that these social and health problems tend to occur less frequentlty in countries more prone to equality, that their prevalence is correlated to income inequality rather than the average standard of living and, in favour of the robustness of this correlation, the same trends were observed considering the individual states making up the USA. Analyzing child health, UNICEF (2016) arrives at the same results: a negative correlation between child welfare and the inequalities of the contexts in which they are growing. Costa analyzes the main mechanisms that shape inequalities, identifying five. We list them in brief, as they are specified by the author for clarity, referring to his report for a deeper understanding of these aspects and the implications relating to the planning of appropriate health policies and not.
1) Social stratification is the first mechanism underlying health inequalities. It can be measured by indicators of material goods (income, housing conditions), 1. The choice to include the richest countries in the research is linked to the Preston curve, that indicates a linear correlation between the increase in life expectancy and GDP growth up to $25,000 per capita (with the increase in GDP per capita, there is an increase in life expectancy). Over $25,000 the relationship between economic growth and life expectancy fades, finally disappearing altogether.
relational (social status, social support) or mixed (employment status). It refers to the different level of perceived control over ones destiny, autonomy and ability that one has, to be fulfilled within ones own context, social support and recognition of ones role rather than the level of possessed resources. Michael Marmot, Chairman of the WHO Commission on Social Determinants of Health has called this aspect relative to the gradient of health "Status Syndrome" (Marmot 2006) stressing that inequalities are also observed among the highest levels of the social ladder for those who occupy a medium-high position compared to those who occupy an immediately higher position. 2) The different social position influences the exposure to occupational, behavioural and psychosocial environmental risk factors. The lower the social position, the higher the exposure to risk factors both environmental (such as the proximity to landfills), employment (for all professions), behavioural (higher prevalence of unhealthy behaviours among disadvantaged people) and psychosocial (precarious, low-paid, low support), and the higher the prevalence of almost all mental illnesses. 3) Inequalities in health take shape through a different accessibility to health services. The observed relation that systematically binds and in a manner inversely proportional the use of health services and the needs to be answered, for which they were designed is called inverse care law: the services are used much less where they would be needed more. 4) The social posizione affects the degree of vulnerability of people, that is both the ability to cope with the unfavourable effect of a risk factor, before damage has occured, or the ability to cope with a health problem that has already occured, preventing the worst outcomes, or by changing the rate of progression of the disease. A low social status increases susceptibility to the effect of the risk factor and limits the person to prevention opportunities. In general, the lack of available help, namely the extremely precious social capital, represents the minimum common factor of the negative effects of vulnerability. In an equal exposure to risk factors there is a variation in the vulnerability relative to the same exposure. For example, foreign workers on a construction site, are more likely to injury than italian workers in the same yard, exposed to the same risk factors, because they are more vulnerable concerning those risk factors. And further, disadvantaged people have less ability to use the opportunities of early diagnosis that allow the identification and prompt treatment of a disease. The possibilities to counteract this factor involves the need to provide really effective and customized interventions in different contexts. 5) Social consequences of the disease: the compromising of the level of health is adversely retroactive on a person's social position. This is what happens in selection processes that, based on undermined health, interrupt or modify social mobility and it is also what happens when the collusion in the expenditure to deal with a health problem makes one socially vulnerable, or makes one slip into the trap of poverty, triggering recursive stories of health inequalities where it is impossible to determine whether poverty started first or the damage to health. In other words the poorest not only get sick more, but those who are sick are more at risk of impoverishment, in some cases to meet tbe health care costs that can be significant (think of the care needs of people with disabilities), in others because the disease is a predisposing condition for the exit from the labour market and interfering with social mobility.
This is the chain that binds, according to Costa's studies, the differential distribution of psycho-socio-economic resources, to stratification, inequality and the stories and experience of suffering with mental illness (even). All these processes accumulate in autobiographical pathways and their outcome is handed down from one generation to the next. At this point the question may be reformulated: how can psychologists act with awareness and responsibility within these processes, not neglect them, ignore them, maintain them and possible amplify them using the characteristic instruments of psychological sensitivity? How is it possible to acknowledge the challenges that growing inequalities impose, on moral grounds as much as scientific, on the profession?
These are the questions that led to the establishment of the Working Group D.U.P.P. (Diritti Umani Psicologi Piemonte - Human Rights Psychologists Piedmont) within the Order of Psychologists of Piedmont. The Working Group has organized, in addition to the convention on the right to health, a study day in Casale Monferrato on the right to a healthy environment, the work of a year with citizens, operators and casalesi institutions. The objective of this second day was to actively participate in the ongoing community processes to deal with this occurrence, analyse the way through which civil society and institutions have chosen to take action and raise the awareness of the community of psychologists concerning the role of determinants of health (in this case the environmental determinants) in the processes that contribute to the unequal distribution of health in the population. In an attempt to define that which is a working hypothesis, albeit wide enough to allow the freedom to every professional to decline it in their work in a personal way, it is not our intention to attribute to the work done by the DUPP the function of a model (which implies a faithful and ‘eteroimposta' re-proposition), we limit ourselves to suggest some ideas in order to activate that self-reflective process necessary for being in the world, as a psychologist and as a citizen, in the light of the growing inequalities highlighted by the epidemiological picture. The first point regards the need for psychologists, to take a position in this scenario. This need seems to short-circuit with the clinical requirement of neutrality and the absence of judgement. However, to take a stand means returning to take up the social responsibility implied in every profession, it means trying to become aware of the underlying values in our everyday operations, as professionals and as citizens, and that also shape our feelings. To take a clear position, is to recognize the social, cultural and economic processes that act on people and through them, to know how to appoint them responsibly as being co-responsible for the suffering of the person who manifests them. Zamperini (2007) states that the ideology of neutrality, in psychology, is the basis of legitimacy for inaction; impartiality would be nothing more than a socially acceptable form of indifference towards that part of the world that has not been granted the status of victim. To take a stand means bringing the contradictions that characterize every living system into the open field of the clinical relationship. Neutrality if anything, can take on the form of awareness of his own positioning by the psychologist, confidence in the resources of the patient, left free to responsibly decide for himself within the possibilities and the limits that the world around him offers. This does not excuse the clinician from a precise positioning concerning the economic, cultural and political dynamics indispensable for the protection of health not only of the patient but of the whole community, including the clinician. As an example, in Casale's day the Eternit company was cited, against whom it was perceived as a duty to take a clear position, seeing that it constituted one of the main risk factors for the health of the population. During the day for the right to health, from where we started, a specific position was taken with respect to certain economic, fiscal, housing, educational and health policies, the impact of neoliberalism on western policies and culture was also analised together with the way in which this resounds on health; a position has also been taken in relation to an exclusively technical approach to mental health. Another example can be seen in the curious position taken by some psychologists faced with the issue of renumeration, a topic that seems, in the eyes of many, to be relegated exclusively to the economic sphere and being paid back in terms of professional image (a higher value for a higher rate). This position seems to reveal a ruthless indifference to ethical issues, the unequal distribution of suffering and considerations on the use of the services (inverse care law). To take a position may appear an elementary operation, however, one is exposed to the formidable risk of breaking some of the dynamics that often see us among the detractors of their benefits. The second point, issuing from the first, is the re-appropriation and recognition of the social mandate of the profession of psychologist, the recognition of its social and political responsibility coming from taking a definite position. Such recognition can only be born of a different attitude towards the dominant epistemological paradigms. However much a solid anchor to the criteria set in the last century by evidence based research is necessary, the exclusive use of scientifically validated theories and methods is likely to be to the detriment of the complexity and depth of the psychoogical work and its social function, often orthopedic. Classify, categorize, deal with, correct can not be actions performed without a clear understanding of the processes that lead us to perform them, of the consequences that these reverberate, without being oriented towards any value. It's been a long time since facts speak for themselves: the use of our categories has clear effects on the fabric of society and our interventions, all speak of our idea of the world. It is not easy to abandon the idea of a technical intervention free from consequences on a social, cultural, and political level, a work of responsible self-reflection is necessary for carrying out work which fortunately is possible to draw from different fields of knowledge with both hands, from the sociology of health, medical anthropology, economics, philosophy. These reflections emerged immediately during the days of the working group. Why is it like working with people who constitute the symptom of our society? What is the point, in view of the social determinants of health, of working on the treatment of mesothelioma? What consequences can occur by attacking with highly effective treatments the Syndrome of Gambling? Who benefits? Who must bear the brunt? What political meanings can work take on, when people are in anguish by the precariousness of their working life? It is not difficult, in the absence of a reflection on ones work, to find oneself, often unknowingly, being a vector that maintains and feeds inequality and the violence inherent in any society. Similar ideas are proposed by Zamperini (2011): which social and political meanings are conveyed by the choice of working with victims of trauma inflicted on citizens by the State? Atkinson (1987), suggesting a much softer reading of Foucault's reflections on this subject, says of the shaman that he gives hospitality to the community that requested his intervention. From this follows the third idea for reflection. What should be the field of preferential intervention so that this does not risk becoming iatrogenic? Krishnamurti (1982), with a lucidity often reserved for eastern thinkers, affirms that it is not a sign of good health to be well adjusted to a sick society. Clinical psychology favours, we said, speeches and reflections of an individual character, except for family interventions or of a group, an aspect that does not change the substance of our reflection. Considerations on society are often reserved for social psychologists, sociologists and anthropologists and politicians, for which clinical psychologists try to differentiate their actions by appealing to the ideology of neutrality. There is little space, within their reflections and actions, that the clinical psychologists can give to lectures on the community, on the collectivity, and to social, cultural, economic life, to the neighbourhood, that is those dimensions within which inequalities are born, maintained and produced and those areas in which people are born, grow, work, get sick and die. To work focusing exclusively on the individual, deleting the bond, that connects him to society, can be extremely useful to the psychologist who gets paid for doing it. The relationship between psychologist and user is just one of the relationships within which is shaped the life of the two interacting, the experience and the state of health of each one of which is deeply influenced by dynamics entirely immanent to their being used in a context. The feelings of deep shame, humiliation, insecurity, self-loathing, enduring affliction, the anxiety of social evaluation, are all experiences born from the cultural, political, economic and ideological climate that only in a small part can be controlled by the individual and are distributed differently in society as the sociology of emotions reminds us. From the perspective of the social gradient, it is in the interaction between the social-cultural-economic processes and the person, in his variability, that the latter finds his positioning along the health-disease continuum, with the moods that derive from them and from which they derive. To understand the suffering and the experience of disease, says Farmer (2006), it is necessary to call into question the processes historically given and the forces that conspire, structurally and with violence, to limiting the capacity for action of the subject. These social forces, frequently localized globally, are incorporated into the subject giving form to the experience of suffering. Sen argues that individual freedom also depend on contextual factors such as social, economic, and political structures, and political and civil rights. It is not possible to avoid such considerations in planning interventions. It is Costa (2014) who resumes Sen and the paradigm of empowerment, and to highlight the effectiveness of the interventions that have as a target the contexts rather than the individual isolated from these; in doing so he does not hide the difficulties of the former respecting the latter, technical and sharp. To do this the WHO, in its document on the social determinants of mental health in 2014, stresses the need to overshadow short-term interventions to leave more space for programming interventions that have as reference a longer span of time. Costa suggests to pursue this objective in various ways: advocacy actions by groups of professionals who bring to the attention of policy makers the consequences on health of certain choices of policy not strictly medical, on structured interventions in workplaces or schools. A historical example of the awareness of the importance of work on the context is provided by Rudoph Virchow, sent in 1848 by the Prussian government to fight an epidemic of typhus in the Polish population. For Virchow inadequate social conditions increased the susceptibility of the population to the climate and other causal agents (today we would speak of vulnerability); for Virchow social change was considered to be important as much as medical interventions, if not more. He argues: "The advances in medicine can prolong human life but improvements of social conditions can achieve this result more quickly and effectively [...] medecine is a social science and politics is nothing but medecine on a large scale" (Virchow, 1958). In the work carried out with the DUPP this reflection has found various applied consequences: the day of the right to a healthy environment was the result of a year and a half of focus groups made up of members of the working group together with citizens, operators, politicians, doctors, high school students and associations. The work has had beneficial effects on participatory processes that have historically characterized the casale community. During the day on the right to health the issue of the ways of intervention was repeatedly raised. Aillon, spokesman for the Sustainability and Health Network, recalled the moral dilemmas in front of which, we as clinicians, are forced to move: such as how to work with children of foreign parents victims of discriminatory policies? To resolve these dilemmas Aillon indicates a possible double function for the psicologist: the first is advocacy which we have briefly mentioned above, the second function - as part of an approach that, in the wake of the Alma Ata Declaration of 1978, sees health as a common necessity that can and should be taken charge of by the citizenship - aims to enable and empower local communities with respect to community ties and the psychosocial contexts that prevent the onset of pathological conditions. In the Declaration, the right and duty of citizens to participate individually and collectively in the planning and implementation of the health care they need, is reaffirmed. A few years later it was the Ottawa Charter (1986) that resumed this message and renewed it, pointing to the need to strengthen community action in setting priorities and strategies through a development of personal and community skills. Nothing about us without us. To give substance to these guidelines is a challenge for each of us: assuming the role of the professional, animated by the identity built through that specific role, the target to persue can only be the facilitation of participatory processes and community empowerment, with all the difficulties posed by the management of naturally asymmetrical relationships, from the viewpoint of power. If instead, we decide to stage, in the limelight, our civic identity, and to assume the role of the citizen, our action can not but take place in the scenario of social and political life, movementism, militancy and activism. The tension that is generated between these two roles appears irresolvable as much as necessary. The fourth and final incentive that emerged during the days and of which the group's work would like to be the concrete expression, is not made up of a concept but is the cause and the consequence of a movement and a specific intention. It is the impetus towards research, a brave leap with curious eyes open to interdisciplinarity, which is not to be intimidated by contradictions and the inevitable tensions that emerge in approaching the study of man, of his physical, biological, spiritual, political, cultural and ideological manifestations. An outburst which knows how to recognize its own limits, accepting them but without being subjected to them. An opening to doubt, to possibility, to the Other. The DUPP was animated by this research to discover, in contemplation and acceptance of paradoxes and differences that lurk in the complexity of every individual and every society. It was definately not easy, we are not always educated by our culture to recognize being limited, as professionals and people. We are required to know, we are psychologists because we know, because we do. It is a task that may prove painful. Animated by the truth of the experience of our limitations but also of the possibilities that are offered us from other fields of knowledge, one is frequently stopped, along the way, by the ethical and scientific necessity to overcome the dualist approach vociferously denied that separates mind and body, the individual and society, nature and culture. However the safe and reliable pace of such dominant knowledge is to be found in an incontrovertible manner every time a theoretical or practical appendix is questioned, every time it is made into a problem or made more complex: the answer becomes violence. Where, for example in anthropology, the concept of incorporation has provided the opportunity for a self-review of the discipline and the development of regenerated, conceptual tools, also in the psychological field a similar, subtle but revolutionary action is recommendable, that one comes up against with a force that Bourdieu called symbolic violence. Symbolic violence is that subtle form of violence, gentle, invisibile, that does not agitate through explicitly and intentionally cruel actions and that manifests itself "in the imposition of a vision of the world, of roles, categories and in mental structures (cognitive and emotional) through which the world is perceived and that hides the balance of forces underlying the relation in which it is configured". It shapes and is shaped by the ways each one feels, thinks, perceives and acts. Change is stopped by such a force that pushes towards conformism of thought and feeling. Only a great awareness of our being in relation with colleagues can avoid transforming us into a carrier through which this is embodied. In a similar way an awareness of our social mandate in the relationship with patients instead prevents the risk of becoming protagonists of what Basaglia called technical violence, that form of unjust violence stirred up by professionals that, we can say today, contributes to social stratification and to maintaining social and health inequalities. Foucault has taught us that the production of knowledge, of truth and of talks on mankind, are not free from the mechanisms, generators of power, following which often leads to the same mechanisms of stratification of economic, emotional, symbolic and social resources that give shape to suffering.

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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: 26/11/2020

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