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“to promote good practices and to avoid bad practices

in a community based service team. Some ideas from our experience."

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Thirty years that we work in this way …

• In year 1977 I spoke for my first time with Franco Basaglia

• At that time I had read everything he wrote• In 2013 I hope all these things are still “working”

in me, and I hope that I remember the majority of them.

• But one of these things, was the most important, I think.


I prefer to use my words, avoiding to betray His words

• The issue was that one day we too could become a new total institution to fight against, and that we should in every moment pay attention to this risk.

• I think we can say that we are not new total institutions. At the same time I ask myself if all of us still pay attention to this issue.


• I have to speak for my self, and so I will put to

myself some questions,

• they should be useful for me, and I hope they

could be, for other mental health workers too

• There are different roots to start from, I’ll try

to summarize them


1. the very practical level …

• “Thirty years that we work in this way”: if you say this, pay attention,

can be dangerous (walls, not windmills…)…

• Separate needs from demands : the result can be surprising (or not?)

• Recognize who has the need and who put the demand

• Separate the need of the patient from yours;

• pay attention to patient’s history, and to worker’s history


so, … the lesson we learnt:

• we have to modify and adapt our practice to real problems, to their context, to actual circumstances.

• we have not to modify and adapt real problems, their context and actual circumstances to our practice.

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2. the emotions …• Don't hide your emotions ,• do not show them in the wrong place or moment..• Also people you dislike have the right to treatment.

(obvious, but so easy to forget in the every day practice.)

• Avoid to follow your first impression (you are a professional, not an “emotional”).

• Avoid not to pay attention to first impression (emotions are important in our work).

• If you feel uneasy, it means something, do not neglect this feeling. Ask a colleague to help you.


On a emotional (and therapeutic) point of view it’s

important what happened, but it can be more

important what will happen, “how” you can

make your condition different from before. If

you are not alone, you can change many things …

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3. Power and responsibility

• Power without responsibility is dangerous, is an error, it's not helpful. Take your responsibility

• Suffering is not oddness or mess. We are not technician of oddness. Our work is targeted on suffering

• To work alone: it is dangerous, it is not therapeutic, it’s an error in front of your patients and your colleagues.


3. Power and responsibility

• The ill parts of ourselves: to pay attention on this

issue helps us in understanding , how, why, when

• and who we are really treating.

• To trust in routine, when you have a doubt, is a big

error (the 30 years wall)

4. Foucault quoted from J.Habermas“Subjectivity and Truth”

It seems that one can distinguish three major types of technique:

• the techniques that permit one to produce, to transform, to manipulate things;

• the techniques hat consent to use systems of signification (that is the representation or conveying of meaning).

• and finally, the techniques that permit one to determine the conduct of individuals, to impose certain aims or objectives.

camarthen-wales renzo bonn - june 2013

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that is to say,

1. techniques of production,

2. techniques of signification or

communication,

3. and techniques of domination.


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Where do we put ourselves, as technicians?

1. production technicians

2. communication technicians

3. domination/control technician


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• It's an old history. But still important

• In theory we should be in the second group:

communication technicians

• But every day we are under pressure in order

to become also, or mostly,

domination/control technicians


The risks, generally speaking

• The minority can be a minority because the

Individuals are numerically less (…), or because

independently from the number, the individuals

that compose it are diminished in their rights (…).

Certainly every process of taking an identity or

rather the building of an identity enriches the

protagonists …


• … But what happens when who built his/her

identity becomes a prisoner in itself, stops to

become a cause of interaction and dialogue with the

others and tries to impose him/herself and to make

copies of him/herself? What happens when

individuals are forced in one or only one identity? Benedetto Saraceno



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The risks, for us• There is a new drive in pushing all the contradictions toward

psychiatry, that is to force them in one or only artificial, one, identity: mental illness

• Mental health mostly should take care of mental suffering, not of mess oddness, social/political disorders

• To control these “identity problems” , doesn’t mean to reduce mental suffering

• Medicalization: Science can be a part of culture, a very important one, but taken alone can be the opposite of culture, and, by the way, violate the identity.

when a practice can be therapeutic

•when it reduces the suffering of somebody, without producing suffering in other people

•when we can reproduce it , study it and foresee it’s implications

We need to think always on this, in front of demands pushing us at the third level (the control level).


communication technicians domination/control technician

• It’s complex, because just to refuse means that other

people will act against our suffering patient, or the

person that somebody pushed toward us.

• We have continuously to work in this contradiction,

clarifying who we are, what we are doing, why.

• It is not always easy, may be not always we do it

completely


a therapeutic practice…

• needs to have a complex balance, it’s always

strictly related to different values that we have to

analyze continuously. These are professional,

ethical and political values. Their borders cannot

be only in psychiatry, nor completely out of it.

So they need to be seen in dialectics. We have to

pay attention to the culture of the service.


cultures

performing / fulfilling

1. Meticulous2. Efficient3. circumscribed (definite

limits)4. Micro5. More quantifiable6. Avoiding responsibility7. Reassuring8. more transferable9. Based on sharing of

procedures

transformative

1. flexible2. Effective3. Inclusive4. Macro5. Less quantifiable6. Making responsible7. Risky8. less transferable9. Based on sharing of aims

and experiences and practices


in other terms, to transform means:

1. to reduce the GAP between your words and your

practice.

2. to reduce the GAP between your practice and

your possibilities.

3. to reduce the GAP between patient’s rights and

everybody’s rights.

4. to reduce the GAP between prejudice and

reality.

and …

4. to reduce the GAP between you and your patient.

5. to reduce the GAPs into your team.6. and …

If you do not find a GAP to reduce …

8. Change your work, this one doesn’t fit you


an important issue to remember,…

• Violence doesn't mean so mach to hurt and to destroy, as to break people’s continuity; to force them to play roles in which they cannot find themselves; to force them to miss not only commitments but their own substance; to force them to make things that result in destroying any possibility of make anything.

E. Levinas


thanks

by Hugo Pratt



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