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Urban Suffering Studies Center



The paradigm of urban suffering

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More and More di Maria Rosa Fustet
More and More di Maria Rosa Fustet


Benedetto Saraceno


The urban population has risen significantly in the past thirty years: in 1975, 26% of the residents of Africa lived in the city. Today there are 39% and in 2030 there will be 64% and in Europe from 66% to 79%. For the mental health and general health problems however, there will always be more problems for the health and urban suffering.
The World Bank and the World Health Organization estimate that the mental illnesses represent the 13% of the load mortality and has caused disability for all of the illnesses. In other words the contribution of the mental illnesses for the disability is global mortality and is very significant (higher than cancer or other cardiovascular illnesses). This information refers to the definite mental illnesses of the international classification of illnesses of psychological and social suffering caused by poverty, violence, insecurity and the abandoning of infants and adolescents. The forced emigration, the exclusion that strikes individuals, families and the community.
Among those who suffer from a mental illness formally classified and recognized and those who suffer from those other conditions of vulnerability, psycho sociality however have very much in common: stigma, discrimination, abandonment, disrespect of the rights. Furthermore both groups live in settled institutes, open, great numbers and high density like mental hospitals, prisons and refuge camps. Otherwise, they live in unsettled, widespread, low density, like the streets, underground stations, le favelas. There is permeability between the first groups, the mental health and the others that for the nature and heterogeneity from their suffering they cannot have another name that is called "others".

Carlo Maria Martini has commented on the passage of Mark from the Gospel where a man from the city of Gerasa makes bizarre and violent behaviour, questioned by Jesus that they request his name (MC 5, 1-20) replies: - My name is Legion because there are many of us. The man from Gerasa has no name because his name is collected from the suffering without exception.
One or the other like the man, the man from Gerasa. Their name is Legion because they are many and do not have a recognized individuality (crazy, poor, refugees, immigrates). A transverse "nation" with the official nations provide names, where over the suffering the cross each other, get mixed up, they specify and de-specify but they do not find answers.
The city is an individual space where the "Men of the nation of Gerasa" live. The city calls out and attracts, it hides. The city offers adaptability to survive, to hide and to communicate. But the city has no promises or gives no permission for spatial continuity. Or even is real closeness, human community, the people live together, or if anything the join together always more in adjacent slang, in identity evident of ethnicities hoarded from the exclusion and often from the illegality.
We need the answers of the network instead simply because questions are on the networks and the denying of this simply truth creates unilateral answers, seemingly simple, vertical, separate and not clear. It is the suffering of the people which is on the network because it is about the reality which is on a network of risky factors and it is the answer to the suffering that is not on the network. Very often this creates barriers and ineffectiveness of the answer.
Physical illness, mental illness, psychological suffering, social suffering are in reality knots in a complicated web. This simplification of which could be an administrative institutional need, sometimes even understandable. Nevertheless the answer should limit the simplification and keep the same connections proposed by the questions.

An illness is the result of the risk, but also the risk sometimes by another illness. For example poverty, drugs abuse, depression, car accidents or suicide are events and network conditions in the sense that male alcoholics ( that are risks subjects for suicide alcoholics). They are also violent in their families. The women that are victims of domestic violence caused by the male alcoholics that may be will commit suicide are also at the risk of deep depression. Furthermore they will also be someone that could cause a car accident and kill someone or commit suicide. All this is a network web and the answer cannot be consider separate or vertical but connected to each other and horizontal.
The main role of the bio - psycho - medical modal, that is linear, individualistic, not historical and involves all the problems of the life; the illnesses "increase", also because the psychological and social suffering are considered illnesses. The bio- psycho - medical modal absorbs the suffering it classifies, it divides and separates answers. An answer of every question and if the question has no answer it would be necessary to reform the question in order to avoid the risk to have unanswered questions. In this way they create grouped questions that combine with groups of answers: ill of AIDS, homosexuals, adolescents, children become groups of questions meant to be met with answers formulated by experts. This way tribal groups form, persuaded of their belongings to the tribe and progressively the tribe disappears. This is one of the subjects linked simply by their subjects of conditions. That is us.
The identity stars like this, forced from the alternate answers created from the lack of rights.
Certainly the identity is made up and starts from the urgency of the recognization, from the necessity to declare a difference. " We are women and only black women", " we are black and only black". Such a process crosses different areas and forms new knowledge, they make new languages that starts from the strength of the identity. The minority can be like this because the individuals that are formed a numerically less ( the indigent population), or because independently from the numerousness, the individuals that compose this are less in the practice of their rights (the black southafrican during the apartheid). Certainly every process of identity or rather the building of an identity enriches the protagonists.
But what happens when the built identity becomes a prisoner in oneself, tries to become a cause of interaction and speak with the others and limits to make a name for oneself only to come back? What happens when individuals are forced in one or only one identity? If their identity does not result in a proud process of recognization, but that dress that the life puts on and only that dress they have?
The individuals that are recognized in themselves have an identity, about all they are rich, whilst, those who want cannot and have only one identity they are constricted to do their mark of infamy. It is deeply in their poorness. From only one identity you die and often commit suicide.
The statesmen can provide and strengthen the only identity pressing their inhabitants to be "only" Muslims or "only" Serbs but also the economic interests can make this strengthen the individual groups to be only the bearers of a certain illness or represent exclusively like "illness of" also the desperation and misery strengthen the individuals to the individual identity: "only" clandestines or "only" immigrates or "only" mental disable people and nothing else.
The bio - psyco - medical modal does not tolerate the complexity and favours the exclusive and separate identity: the badly treated women are individual clinical "Cases", like this the refugees become cases of post traumatic stress. It is certainly true that every single women is treated badly can "also" be a clinical case like every single refugee can also be a case of post traumatic stress but this possibility / identity takes hold of the rest and does not permit the answers to be "also" clinical and not "only" are exclusively clinical.
The individuals do not understand anymore and are not understood like complex people but like representatives from an unique identity. No more women or men, but Hutu or Tutsi, Serbs or Bosnians, clandestines or legals. The missing richness of the existing and strong thousands of identities of the individuals, the identity fortunately contradicts and generates of multiple competence. Giorgio Agamben in the " The Community to come" (La comunità a venire) suggests the possibility to be human, instead of continuing to look for ones own identity, they can transform in "singular without identity".
The process of the active closure of the institutes by Franco Basaglia has not only been the dynamics that had taken place until the scandal of the Mental Hospital but the process that had supplied the human technology for the multi - identity reconstruction, of the individuals reduces to an unique identity (inpatients from the mental hospitals). The chronically cases, of the mental hospital were and are (where the mental hospital continue and exists) are "only" inpatients, all the same like lots of men from the city of Gerasa, all prisoners with only an identity.
The closure of the Institutes and the denomination of the diversity , of the multiple identity, in their own way the men of Gerasa finish calling them legions. The whole institution (and not only those of the mental field) are afraid of the changes, do not tolerate the difference, are afraid of the strangers, the foreigners, the physical contact and sexuality, and afraid of producing the consciousness because you have to use all your energy for the cause yourself.
The crosswise nation of the mental health disables, the excluded, the refugees, the clandestines is obliged in fields, mental reservation, the health institutes, prisons, diagnose, social aggregation, slang to not pass the limits, make changes between the people, between the culture, , the songs and the crowds.
In France they call them "sans papiers" or rather without documents, therefore illegal, those that migrate from eastern Europe, Africa, or Middle East and settled without permission in the city.
There are lots of ways to be "sans papiers". There are those that the cards identify their identity, they have them in another place where they are poor and without work, but however, they have cards which concretely and metaphorically give them name and identity, there they are individuals and here they stop being so. Others although do not have a "place" because they have always stayed "here" but also they don't have any cards which defined them as individuals because they don't have any identity at this point nor here nor there. Again the transversal nation that returns with all each similarity. Still the city denies the individuality. It dos not recognised the meaning produced from those people who are bearers of forced identity, exclusive.
So the first stage (well known by those people who set the problem in the mental hospital to "rebuild" individual identity) is that the recognization of the produced meaning about everybody: everybody are producers of a sense and this is human production and has the law of being recognized and qualified of dignity and respect (the recognization of the man from Gerasa by Jesus).
The second stage is that of work that cuts the sense of expression, which connects to others to make effective changes and material learning to interact. It's about reciprocal adaptation between the individual and the environment: individuals more competent and more tolerant environment. It's a dynamic power that is acquired, of social and psychological contractual, that rights that are stopped being denied. The protagonists of this dynamic urban? Everyone who interferes, who sabotages, who promotes, who tolerates, who allows, those who adapt, who learn and who impose. It's in these dynamics and institutions, public and private, interests, civil and offering engagements.
Also there should be the democracy that needs public powers that actively promote the citizens rights for all those individuals that are made up individually for the holders definition of the citizens rights.
A democracy is such when instead of standardising the diversity differs the roles getting the complexity and not being scared about the diversity of them. The individuals break from "identity" prison and the collecting breaks free from the fear of diversity: the meeting we places the ability of the exclusion/suffering at the constitution of citizenship.
Such process request double work, of individuals and collectivity. Who does not have one leg needs to learn to walk with prosthesis but also from a city without an architectonical barrier and this presupposes the work of the individual and that from the city. The diversity and the exclusion required to have ability and all that they ask for is the prosthesis required to walk and new rules for walking. The exclusion of the exclusives is not the learning of the game rules of the inclusive, that from the exclusives, but a variation of the rules of the game. So we don't work for a city without differences but for a different city. Places instead of spaces: Franco Rotelli wrote one day "there does not exist the best services of mental health, it's bazaar in an Arabic city". Rather: "la piazza rinascimentale in Toscana" , the market of Chichicastengo in Guatemala, the beach of Rio De Janeiro are places not simply spaces (like instead underground station or supermarket) and in these they meet and experiment the diversity, shops that refused idleness, the identity that cancel themselves to give to place for meeting and changes.
The city "friendly" let's the citizens and the citizenship permit not to be in the prison of the mono-identity. The rights of the citizenship are more than the "negative" rights (not being excluded, object of violence and not being abandoned) but these are added and are "positive" rights (being listened and received, recognized for it's own needing). It's more probably the needing to belong to a unique identity is a forced choice derives from not having a citizenship, from being true citizens from the city. Measurement in which we enjoy the rights of the citizenship full and manifold, we don't need to recognize ourselves a let us be recognized with a mark instead of another, subjectivity and our corporeality.
This is the utopia of a liveable and hospitable city. I don't need to be a prisoner of my identity, unique other than the football stands. (Identity that illudes me that has been chosen) nor prisoner of my clandestine immigrant identity (that I did not choose) because I can be many different identities: father/mother, husband/wife, worker, Christian or Muslim, fool who ever but never only one of these identities. Unfortunately the hooligans are ready to fight against the immigrants because both of them are different.
Tolerance is the paradigm which accompanies us since Illuminism; tolerance as moral effort to accept what is different: "I absolutely don't agree with what you say, but I will fight till the end of my days to enable you keeping on saying that" said Voltaire. Hence a moral effort by the majority to accept the minority was made by a minority of good willing people.
Today the contemporary city doesn't only handle tolerance of some people but assertion and formal protection of the rights by the community and the public powers.
Citizenship is the contemporary form of tolerance, which is no noble dynamic among people anymore, but laws and guarantees that define a new public ethic according to which every person has the right to have the appropriate answer to his own needs. Tolerance is therefore considered as ethic related to the access to emotional and material opportunities: healthcare services, job opportunities, home, but also care, acceptance and exchange among people.
The urban suffering becomes therefore a pattern according to which:
- The sufferings are criss-crossed among themselves
- The suffering is individual
- The answers are disjointed and sketchy
- There is no health/welfare without rights.
- Public and Private environment together or separate can contribute to the creation of agreeable and pleasant cities or the contrary
- All of this can happen in Milan or in Bombay, in Los Angeles and in Jackarta. It means there is not a North or a South part of the world with different problems, but each North wherever it is geographically located has its own South.
- It is necessary to create a situation characterized not only by tolerance but by the new virtue of citizenship that goes beyond the individual virtue and builds up the virtue of the City and no only that of any single citizen.

We all know that all of this is true not only in Milan, Berlin and London, but also in Bombay, Jackarta and Lagos. It means that we can reasonably state that the frontier does no longer exist between North and South (symbolic expression to define Rich and Poor countries) but it goes crosswise among all the North and South and East and West, "inside" the big metropolis. As a matter of fact the "deadly" cities that deny the rights are everywhere as well as everywhere are the histories of those people working to make these places more comfortable, more wellcoming, places where the human rights are guaranteed and not denied. Histories, experiences, that create groups of bravehearted people that want to build up hope. We would like to be an "antenna" that sends and receives messages for this crosswise nation.


By the same authors:                Dancing the samba while piloting a jet plane   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  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: 26/11/2020

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