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This article discusses the importance of avoiding the pitfalls of becoming a new total institution in community-based service teams. It offers practical tips and ideas based on thirty years of experience in mental health work.
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camarthen-wales renzo bonn - june 2013
“to promote good practices and to avoid bad practices in a community based service team. Some ideas from our experience." e
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. camarthen-wales renzo bonn - june 2013
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. camarthen-wales renzo bonn - june 2013
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 camarthen-wales renzo bonn - june 2013
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 camarthen-wales renzo bonn - june 2013
so, … the lesson we learnt: • we haveto modify and adapt our practice to real problems, to their context, to actual circumstances. • we have notto modify and adapt real problems, their context and actual circumstances to our practice.
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. camarthen-wales renzo bonn - june 2013
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 …
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. camarthen-wales renzo bonn - june 2013
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)
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
that is to say, • techniques of production, • techniques of signification or communication, • and techniques of domination. camarthen-wales renzo bonn - june 2013
Where do we put ourselves, as technicians? • production technicians • communication technicians • domination/control technician camarthen-wales renzo bonn - june 2013
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 camarthen-wales renzo bonn - june 2013
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 … camarthen-wales renzo bonn - june 2013
… 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? BenedettoSaraceno camarthen-wales renzo bonn - june 2013
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. camarthen-wales renzo bonn - june 2013
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). camarthen-wales renzo bonn - june 2013
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 camarthen-wales renzo bonn - june 2013
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. camarthen-wales renzo bonn - june 2013
cultures performing / fulfilling transformative flexible Effective Inclusive Macro Less quantifiable Making responsible Risky less transferable Based on sharing of aims and experiences and practices • Meticulous • Efficient • circumscribed (definite limits) • Micro • More quantifiable • Avoiding responsibility • Reassuring • more transferable • Based on sharing of procedures camarthen-wales renzo bonn - june 2013
in other terms, to transform means: to reduce the GAP between your words and your practice. to reduce the GAP between your practice and your possibilities. to reduce the GAP between patient’s rights and everybody’s rights. to reduce the GAP between prejudice and reality.
and … • to reduce the GAP between you and your patient. • to reduce the GAPs into your team. • and … If you do not find a GAP to reduce … • Change your work, this one doesn’t fit you camarthen-wales renzo bonn - june 2013
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 camarthen-wales renzo bonn - june 2013
thanks by Hugo Pratt camarthen-wales renzo bonn - june 2013
camarthen-wales renzo bonn - june 2013
camarthen-wales renzo bonn - june 2013
camarthen-wales renzo bonn - june 2013
camarthen-wales renzo bonn - june 2013
