Prospettive educative e cliniche delle Comunit� Terapeutiche - Obiettivi, modelli organizzativi, esigenze individuali, comunitarie e societarie
Creators: name: MANCA, SALVATORE
Publisher: name: Universit� degli studi di Bergamo
Year: 2017

description: From the birth of Therapeutic Communities until today, there has been a radical transformation of rehabilitation and care practices, and a conceptual and methodological reform of clinical and educational interventions to the Person. In order to understand more deeply the substantial changes that have characterized the psychiatric field, it is appropriate to shed light on the experiences of ?mental hospitals? from the beginning of the twentieth century, investigating the representations of mental illness that have taken place over time, the social and institutional dimension and the related therapeutic paradigms implemented. The first chapter of the text proposes a compendium of the evolution of Italian psychiatry from the twentieth century to the present day, retracing the main legislative stages and the major ideological and clinical expressions that have marked and changed society. The survey takes into consideration a period of time of about a hundred years of stories and events related to psychiatry, in order to reconsider terms such as ?care?, ?subjectivity?, ?social mandate?, ?stigma?, ?normality? and ?madness?, also through a pedagogical glance and the light of the different perspectives of thought, of political guidelines, of socio-cultural contexts and of devices that have built up over time. During the research I refer also several times to the concept of ?customization?, which represents an important theme, closely linked to education, training, relationship and to the individual growth, understood as the realization and awareness of self and of one?s choices. The therapeutic communities have arose in response and in opposition to the totalitarian psychiatric care and institutionalizing systems, promoting an approach inspired by the patient?s subjectivity and the sharing of their therapeutic path, towards a process of humanization, in which �the hypotheses of criticism madhouse is not just a philanthropic assumptions (humanizing the inhuman scenario), but a technical and scientific hypothesis (transform the interdiction to the treatment options)� . Sometimes, though, these experiences have proved purely theoretical, and many communities have not been able or willing to make a substantial change of mental paradigm, presenting different scenarios that however replicate methods similar to those mental hospitals. Or, in other cases, internal factors to the community have proved to be the main obstacle to change and openness toward the territory. The therapeutic communities should be considered as a residential and therapeutic protected setting, in which they accrue personal and professional experiences and interweave stories of life and interpersonal relationships. During the research are described protagonists (psychiatrists, local administrators, practitioners, activists, scholars, politicians involved, etc.), which in various ways have contributed to question and change the paradigms of psychiatric care and the same psychiatric institution, giving a face to the stereotypical image of patients and, more striking appearance, giving them their own voice, the excluded, which, as Foucault argues, had been silenced. The second chapter proposes a specific therapeutic community model, which shows the representation of a complex organization, and to be able to know in depth, it is essential to understand its role, objectives and organization within the social network and health care where it is located; to know which national and regional regulations of reference, which are the actors involved in the care and rehabilitation project; verify whether and how it respond to concerns not only technical nature but also exquisitely professional education to patients and staff. At the same time, it is important to know what are the characteristics, the stories and the experiences which has received the Therapeutic Communities, through the description of episodes, experiences, relationship dynamics, clinical and educational interventions, and therapeutic approaches. Not to be neglected, the description of the structural aspects, as the Community is the place where patients and professionals spend much of their time and live experiential moments; for this reason, the analysis also provides a descriptive brief overview of the most important structural features that determine a good institutional, community and corporate environment. Without these insights, the study would be partial, as the Community would be presented as an isolated system, self-referential, ?asocial?, free from institutional and territorial connections, as well as closer to favor institutive and instituting rules rather than people who have to make it alive. The Community, however, should be seen as an expression of interpersonal relationships and then engaging in various ways, both the totality of every person who has (patients and staff), as well as the set of stakeholders and social and relational connections that are established with individuals inside. It must also be conceived as a protected place where the patient lives and mature personal and social experiences, spends most of his time with other people, sharing common areas, deals with and elaborates aspects related to affective and emotional sphere, takes part in the daily and educational activities, establishes relationships at various levels, adheres to the therapeutic project. The realization of all this is one of the main objectives of this research, which necessarily involves a series of insights, as well as the evaluation of certain theoretical and practical principles and implementation of interventions to propose a dimension of therapeutic community oriented to the person, through human acts that require intentionality, responsibility, logos, awareness. The intent is also to propose a more holistic perspective, which offers an opportunity to interpretations that take into account the person as a whole. The constant effort of the team must be directed mainly towards this perspective and, in the Community context, the educational channel is of fundamental importance. In the third chapter, the track looks for a cross-sectional analysis line and extending multi-level, in order to describe the interactions, cooperation, opinions and operational guidelines present in a community, then turned the focus of interest on importance of continuous training for staff, understood as ethical commitment and active involvement to a pedagogical integration of the person, his family and social environment, as well as the concrete enhancement of its peculiar and whole capacity. Recognizing the importance of education, translated in pedagogical terms, necessarily means inviting to think about the dynamics and the typical working processes of the organization, in order to further enhance the relationship between the operators themselves, patients and stakeholders, intensify therapeutic alliance, to humanize and personalize interventions and psycho-educational choices, by acting with intentionality, reason, freedom and responsibility. The educational process takes a deeper and more complex dimension, because it also extends to professional experiences, emotional and relational conducted by community workers, in addition to traditional educational opportunities. In this sense, training, work and learning are an essential value horizon which helps to give meaning to life experiences and enhance the person in his uniqueness and his being in relationship with the Other. The team in the community (mainly represented by psychiatrist, professional educator, coach of psychiatric rehabilitation, nurses, psychologist, social health operator, doctor) operates and intervenes in a planned and managed collaboratively way, organizing activities, projects and coordinated actions, both inside and outside the residential environment, supporting where possible the participation and involvement of the social actors of the territory and family network. The fourth chapter describes some activities carried out by the patients, their participation in educational and vocational projects, the activation of training courses (for example, the computer course), meetings and expressive groups (such as ?Creative Writing?) and opportunities for discussion and socialization (for example, the ?Group Word?) promoted by the team, in order to promote effective targeted paths and reintegration into society, considering the person's needs and enhancing their capabilities and resources. The fifth chapter, entitled ?Beyond the medicalization?, aims to overcome the exclusively biomedical point of view of mental illness, by promoting a holistic approach that brings all initiatives and actions on the centrality of the person. As Benedetto Saraceno says: �The urgent need for a radical rethink of psychiatry models is unquestionable, especially to prevent the biomedical psychiatry to be promoted as a global reference model� . The survey focuses on intervention models that integrate the psychological dimension, with its social, cultural and biological dimension where are necessarily considered and measured the patient?s capacities, its characteristics and its potential. In this context, I describe some fragments of community life of three patients, surpassing the reductive conception exclusively linked to the symptoms and pathology, also through their direct testimony and their experiential contributions. The patient?s emotional experience and his personal characteristics are fundamental principles in therapeutic area; the survey is developed on this assumption, aware that, as stated by E. Minkowski: in psychiatry, behind the symptom and even more behind the syndrome, for us there is always the whole living personality. And the need to penetrate through the symptoms, up to this living personality to capture in a single effort of knowledge his whole way of being, is so imperious as much as in the field of psychopathology as in the normal you can not subtract . The research deals with sensitive issues and social interest, often the subject of debates, testimonials, anecdotes and controversy: everything generates curiosity, questions and proposals for action that, in some cases, reflect the expression of theoretical and practical models which are appropriate and effective, while others are the result of conceptual and methodological simplifications, highlighting analysis rather superficial and approximate. To overcome this second possibility, throughout the research has tried to avoid rhetoric and demagogy without proposing claims of convenience and reach easy conclusions; this approach does not exempt from possible blunders but induces to look/face the subject matter from diverse angles and through ?slow? different to have a more complete and informed perspective and avoid rush simplistic and summary thesis.