For Eugenio Borgna mental disorders are typical of the human condition and no one is excluded, "each of us can experience mental suffering regardless of age, culture and social condition”. This means that people who experience a situation of mental suffering are looked at, both by services and citizens, with an attitude of understanding and solidarity. However, a change of pace is needed in the field of mental health towards a "gentle psychiatry” and a public opinion less unfamiliar with the topic.
The beautiful book by Eugenio Borgna, published by Giulio Einaudi Editore (2019), outlines theexcursus historian of psychiatry to the point of glimpsing, or rather hoping for, that of the future, in light of his experience as a psychiatrist who spanned a good part of the twentieth century.
The author starts from the first revolution in psychiatry which at the beginning of the last century, inspired by a philosophical current, proposed as the object of psychiatry not the brain with its dysfunctions, but the subjectivity, the interiority of the patients, that is, the person and not the illness. It is the "phenomenological" approach which, however, has not managed to counter the hegemony of "somatological" psychiatry. This, like a natural science, with its laws and its determinisms establishes the bio-medical approach and the objectivization of the patient reduced to his symptoms and isolated in special containers, the mental hospitals, which have the ambiguous mandate of guaranteeing the “cure” of madness together with social control.
The author is also a participant-protagonist of the second revolution, the ethical one imagined by Basaglia (which inspired law 180/1978), which starting from the phenomenological approach makes possible what seemed impossible, the overcoming of the total institution of the mental hospital and the liberation of the patient because without freedom there is no possibility of treatment. Psychiatry becomes a social science, a human science and the suffering person is taken care of in a complex system of services in the area. However, even today, over 40 years later, law 180 is partly incomplete or betrayed according to two indicators: the orientation towards separateness and containment in the model of hospital diagnosis and treatment departments (SPDC) which does not always guarantee conditions of hospitalizations that respect the human rights of patients, and the same goes for many residential facilities, which are more containment than curative; the application of the dizzying increase in disorders that crowd diagnostic manuals (see DSM), in line with the cultural tendency to exclude subjectivity from behaviors and with it the search for meanings that characterize them. Hence the orientation towards the administration of psychotropic drugs that limits or excludes psychotherapy and social inclusion.
And the psychiatry of the future? It's a "gentle psychiatry", from the human face of the operator who knows how to welcome and enter into emotional resonance with the suffering person to establish an open dialogue that requires time and which starts from active and understanding listening where words and body language are as important as silences . The key word here is "identification" which enhances the psycho-relational approach that comes before any other service, including pharmacological, complementary and never substitutive. For the mental health worker it is a matter of authentically encountering the suffering person in their humanity, of entering into their history and grasping the meaning hidden in mental suffering, allowing themselves to be challenged by emotions and words that reflect their interiority. The psychotherapeutic relationship is thus a meeting between two interiorities, the dialogue arises from deep within, from the search for oneself in the other and for the other in oneself. For Borgna “without the search for what unites us, despite every difference (...) we cannot help those who are ill, nor can we safeguard our interiority which tends to dry up and die”. It's still "psychiatry betrays its reason for being human if there are no ideal goals within us: such as kindness and sensitivity, intuition and grace, fantasy and imagination, solidarity and hope”. This is why we need operators with emotional and cultural aptitudes, with sensitivity open to entering into relationships with others, and to listening to the subdued and neglected voices of pain.
Ultimately it emerges that in mental health services the essential elements to found a therapeutic relationship are: ethics at the service of professionalism, the authentic relationship with the person and the understanding of their suffering.
Emblematic phrase of the book is: “in doing psychiatry it is impossible not to integrate general medical knowledge with internal knowledge: knowledge of oneself, of course, but also that of emotions and interiority, of expectations and hopes, of ours and of the people who ask help, which is never just medicine, but words and silences, which open the heart to trust and hope”.
Renato Frisanco, Luigi Di Liegro Foundation
