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| As you come out of the metro - Il Duomo |
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| Shops in Milan |
Milan is somewhere I have never been before – but I do
remember being told, a few years ago, that when you go to the north of Italy (I
took that to mean further up than Florence or Bologna) you need to dress in a
smart, stylish and rather formal way. Not exactly my usual modus operandi. And I was invited to this occasion about a year ago by the organisers of the annual conference of the Italian association of therapeutic communities‘Mito e Realta’ –
with the flights and hotel booked in the spring, and several reminders to send
my talk for translation at least four weeks in advance. So I had a long time to
get anxious about it.
As I understood it (which, admittedly, wasn’t very well)
this was the first ‘Annual Forum’ of the whole-Italian equivalent of our
British ‘Community of Communities’.
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| Logo of the Italian association of TCs |
They had already invited us (usually
meaning Jan Lees and myself from the British TC movement, but also some others
sometimes – particularly in the months when Jan was having her bionic surgery
done), to the first three of the equivalent Sicilian events – which, by being
in southern Italy (and even more so by being Sicilian), were necessarily
friendly, informal and relaxed affairs. So I was expecting these two days to be
a rather familiar type of event, with a day of leisurely talks, and a day of
celebrating the success of the TCs who had managed to go through all the
processes to be accredited. And all in Armani suits (except me) and with
immaculate northern Italian style (maybe).
But I was wrong. The friendly informality was the same as I
was used to – and there were at least a few people who were less dressed up
than I was. The relative simplicity of the Sicilian ‘visiting project’ was
blown out of the water by the innumerable different levels, processes,
methodologies, clinical and geographical considerations – all with a perplexing
array of different permutations which were presented to us. Simone Bruschetta –
who I have always considered a reasonable and straightforward sort of guy – had
become the mysterious mastermind of a web of inter-related projects, stretching
across Italy.
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| Simone Bruschetta - aka Bond |
Like a true Bond film, the different cells all had their own
secret language – like ‘VIVACOM’ and ‘SCAF’ and numerous other coded messages
for the eyes of the initiated. Acronyms are often hard enough to follow in
English – but when they are in Italian, I have to give up hope of understanding
them at all. But everybody there understood them well enough, and the business
was done.
But then there was the conference programme – which I should
have studied before – as it had included several spaces on the programme for
me, as the UK supervisor and ‘esteemed visitor’, to fill with my erudite
thoughts and utterances. If only…! There were three or four occasion on which the
people on the platform turned to me and said ‘over to you, Rex’ in Italian,
sometimes when I was least expecting it. But, in the lovely Italian tradition
of kindness to visitors and to those who don’t speak the language, it seemed to
go reasonably well. Whatever rambling and disconnected thoughts I managed to
put into the microphone which was then put under my nose, which were then translated
into Italian, seemed to be well-received. I think it was more important to
smile and say friendly things, than try to say anything seriously meaningful!
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| Marta Mingharelli, M&R Presidente |
The pre-arranged part of the proceedings were on the first
day, and seemed to go quite well. John Turberville, one of the leading figures
at the Mulberry Bush School in Oxfordshire and current chair of the Community
of Communities advisory group, gave a talk about how the London-based Community
of Communities project currently works. Then I gave an edited version of the
current bee in my bonnet - about what TCs need to do to cope with
modernisation, globalisation, terminal fragmentation and inevitable
eco-meltdown (see previous blog entries). The questions and discussion points
ranged between the ‘evidence-based practice is killing everything of value’,
‘thank goodness that a proper RCT has been done’ and ‘all you need is love’
(relationships) extremes. I felt a pang of guilt and sense of betrayal to a
couple of elderly and distinguished Italian psychoanalysts, who I had met years
ago, by proposing that we need to ‘get modern’. But no voices were raised,
tempers lost, or friendships hurt in the process.
There was then, despite IT problems, the presentation of a
one hour video film which has been commissioned by Mito e Realta, and produced
by professional film-makers. It was a remarkable exercise which took (only)
three months to film – including dozens of Italian TCs, showing the depth and
intensity of their work. Group members were clearly enthusiastic about
appearing, including in their therapy groups – which is sadly inconceivable
(and probably illegal) in the UK – at least for those in the NHS. The whole
process of their ‘Community of Communities’ process was explained step-by-step,
and in a way that was both intimate and authoritative. The film-makers said
that they hope to produce a version with English sub-titles before long, and I
hope they do. It would be an excellent introduction to the work of therapeutic
communities for a wider audience – but also one which we in the British TC
movement should be doing for ourselves.
The second day was altogether different: the first part was
easy to understand, when three TCs had about a quarter of an hour each to
introduce themselves to us. It started with the external auditor giving a report
about how they did in trying to meet the standards – qualitatively as well as
quantitatively –then a presentation by people from the community, with pictures
and more of an impression of ‘what its really like’. Congratulations to ‘Gnosis
TC’ near Rome for getting top marks in everything – but also for coming across
as lovely people doing a brilliant job, in ways we’d hope all TCs to be.
The next session was led by Raffaele Barone, the Sicilian
public health psychiatrist who I think has worked tirelessly to do as much as
anybody anywhere to humanise mainstream state-provided mental health services –
and demonstrate the intellectual poverty at the core of biomedical-only
psychiatry.
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| Raffaele Barone |
Several of the questions seemed to be rather disbelieving of how
such an approach was possible, and perhaps envious that their own
commissioners, managers and political opinion-formers were not as sympathetic
as they were in Raffaele’s patch (Caltagirone in Sicily). But I have often met
Raffaele over the past few years, and have seen how hard and continuously he
works at building the understanding in the institutions of power, and public
opinion, that psychologically sophisticated approaches need.
After this session, I was called up for one of my impromptu
opinions – and, struggling for something sensible to add, remembered the
conversation that Geoff and I have been having in Slough. We are starting to
think of ‘health as a social movement’ – so I linked that to Basaglia and the
late 20th century Italian psychiatric reforms, along with the 1950s
social psychiatry revolution in the UK, and said that we need another mental
health uprising, led by service users and focussing on ‘mental health as a social
movement’. The time is ripe.
And although the rest of the day went into complex details
about how different communities in different networks had managed to audit
themselves, that conversation, started by Raffaele, is what stayed with me –
and what I think it’s all about. Not just in Italy, but also in Slough, and the
British TC movement, and anywhere else people are oppressed by state-run
organisations that make people’s mental health worse by stripping them of their
power and dignity.
