Subjectivity and institutions: from Franco Basaglia to recovery

Subjectivity and institutions: from Franco Basaglia to recovery Roberto Mezzina Keynote speech at the INTERNATIONAL MEETING “Franco Basaglia’s vision: mental health and complexity of real life. Practice and research”, Trieste, 9-­‐12 December, 2014. WHO CC for Research and Training in MH Trieste -­‐ Azienda per i Servizi Sanitari n.1 “Triestina” Today, the recovery movement seems to be almost as important for some as it was, a few years ago, the anti-­‐institutional movement, although players, methods and philosophies, even the powers involved, appear to be different and completely new. If that were the case, we would really be in the presence of a historical phenomenon and not just a passing trend, or, worse, a fashion. To quote Basaglia, it would not be a mere "change of ideology" from old psychiatric knowledge and powers (Basaglia, 1980), but a true paradigm shift in the field of health and mental health. On the other hand, if what happened in Italy could be seen as an anticipation of these issues – so dramatically topical today -­‐, it would be an important test of the topicality of Basaglia’s theoretical-­‐practical action and of the anti-­‐institutional movement over forty years later. The "recovery" construct was itself a challenge to medical-­‐biological reductionism in psychiatry, since it appeared possible, through it, to oppose the active role of the person, the importance of factors associated with his/her concrete existence, his/her empirical givenness, such to influence the course of his/her psychopathological condition not in a mechanistic and extrinsic, hetero-­‐ determined way, but through the significance of said factors within the world of an individual subject. Precisely because they are identified with this world, they must be contextualized, and so become founding elements of a reconstruction of subjectivity. The emphasis on factors and determinants that are internal and external to the person, subjective and social, versus naturalistic factors related to the "disease", is combined with the need to obtain answers to a whole set of needs and, simultaneously, to demand rights, in a process that sees the "sick person" as an individual and collective subject, protagonist of change in services, culture and knowledge. The task of today’s psychiatry would therefore seem to be that of refusing to seek a solution to mental illness as a "disease", but working to approach and consider this particular type of patient as a problem that – only because existing in our social reality – may represent one of the contradictory aspects to resolve which new approaches and treatment facilities should be set up and invented. (Basaglia, 1967, p. 420) Basaglia’s statement, therefore, calls into question the issue of the interpretative models of psychiatry and the very concept of disease, which has never been, and clearly is not yet so today, protected from criticism. The issue of paradigms was again revived strongly in the recent international reflection (Bracken, Thomas, Timimi et al. 2012; Priebe, Burns, Craig, 2013; Mezzina, 2005; 2012a). The reductionist neurobiological, "technological", paradigm which is connected to the medicalization of daily life and to the various forms of "biopower" (see Foucault), has re-­‐proposed invariances as founding principles of the scientific knowledge within a framework exclusively centered on the positivist vision of the sciences of nature, without taking due account of the crisis of scientific models inspired by the knowledge of complexity (as in the works of Von Forster, Prigogyne, Morin). Psychosocial aspects such as relationships, values and systems of beliefs, different practices are, in this logic, an afterthought if not openly disavowed. The wider definition of bio-­‐psycho-­‐socio-­‐ cultural approach seems to line up these different fields, but while recognizing the interaction, it does not return a meaning to us, in any case. From a theoretical perspective, the criticism of disease models, and particularly of the construct of schizophrenia and its heterogeneity, has now pushed the reliability of this, as well as of psychiatric diagnoses in general, to a critical limit (Bentall, 1990; Boyle, 1994; Buchanan , Carpenter, 1994), and similarly there has been a normalization of experiences such as hearing voices (Romme, Escher, 1989; Coleman, 2011), up to the attempt at reconstructing a meaning in the experience of madness (Geekie, Read, 2009; Read, Mosher, Bentall, 2004; Bentall, 2003); while there has been considerable advancement in the reflection on the limitations of the biomedical model (Rose, 2006; Whitaker, 2010) affected by the creation of a system of expectations, and related economic interests around pharmacological treatments.
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