People with mental illness often require treatment at psychiatric hospitals during the acute phase of their condition. But for many, recovery does not end there. They do not get well, or they relapse, or their symptoms remain so severe that independence, family life, and work become impossible or nearly so. We call this chronic illness.
We decided to visit and see for ourselves where and how these people live.
We all know, from encounters with them, that many live on the streets or in family homes in deeply difficult, sometimes tragic circumstances. What about the rest?
The two services we present describe, in broad strokes, two very different realities we visited—contrasting in almost every way.
We pray that far more, much more, will be done to transform the painful and tragic reality of our mentally ill brothers and sisters.
When the Italian Parliament—driven by enlightened people who were also full of illusions—decreed the closure of asylums under the famous Law 180, it shut down one shame (the asylum as a warehouse for the mentally ill and maladjusted) and opened another: the mentally ill person cast adrift, left to family or homelessness. Public facilities capable of treating the mentally ill—facilities that are not simply masked-over asylums—are rare. Rome, for example, has only one public therapeutic community. We went to see it.
The first impression is disheartening. In Primavalle, a neighborhood burdened with serious problems, sits a dilapidated building on neglected land. It looks less like a treatment center than a house condemned for demolition.
See also: Villa San Giovanni di Dio
Fifteen patients from the asylum
These buildings were supposed to be torn down, explains psychologist Cristina Reggio, when we finally succeeded in getting them assigned to us after a hard fight. Eight years ago we moved here, starting with four or five patients, eventually reaching fifteen psychotic patients transferred from the S. Maria della Pietà asylum. We continued the work that had begun in the open ward, directed by Massimo Marà, the psychiatrist who runs this community.
As we spend more time there, we realize increasingly that Dr. Marà is the driving force behind this whole effort. Without his absolute faith in the possibility of treating psychotic patients in an open community founded on psychoanalysis—without his spirit of sacrifice, his tenacity, his willingness to stand "on the front line"—the Primavalle Therapeutic Community, we believe, would not exist. We find ourselves wondering how many Maràs there are in Italy, for all the therapeutic communities the country needs.
Under the most difficult conditions
The reality of this therapeutic community is extremely harsh, Cristina continues, especially given these material conditions. Much depends on the staff member's willingness to sacrifice, to confront the psychotic patient in crisis, to keep going without pretending to have all the answers.
Of the fifteen patients here (cared for by twelve staff working three seven-hour shifts during the day and ten at night) five are ready to leave and two more are close. This result convinces us that the difficult working conditions matter. Seven people from the asylum can now live independently, permanently outside the psychiatric care system. Finding three apartments for them required another grueling struggle. Meanwhile, patients ready to leave have had to live in conditions that could cause them to regress.
The Primavalle neighborhood, plagued by poverty and violence, made this experiment possible. But it also increased the difficulties and harshness. Here there are the political conditions and the human capacity to accept "crazy" people in the neighborhood and welcome them with sympathy. But there are also conditions for violence against them, for theft, even within the community house itself.
Volunteers: better left out
The community runs a carpentry workshop where the more disturbed patients mainly make wooden toys, sold to schools, under the direction of a carpenter who works there for reduced pay. This raises the question of volunteers. The community excludes volunteers for therapeutic purposes. It even forbids the parents of patients to set foot here, and tends to severely limit any volunteer visitors, whether for companionship or manual work. These sick people, Cristina explains, have been wounded by many abandonments and are starving for family, for affection. A volunteer who comes to them for a time—and inevitably bonds with them—when he cannot continue, inflicts another wound, however unintentionally.
Twenty patients and twenty staff
Soon restoration of the buildings will begin. When it is finished—who knows how long that will take—the community will welcome ten men and ten women, cared for by twenty staff members (twelve psychiatric nurses, three psychologists, two social workers, two psychiatrists, and Marà, the director).
The community has a waiting list of hundreds of patients, many from other health districts and regions who therefore cannot be admitted. Some families are even willing to move to this district to gain the right to treatment here.
Three of the patients have minimal prospects for recovery and will need to be placed in other facilities—rehabilitative communities provided for under the new law 49, where mentally ill patients who cannot regain independence should go.
A valid response
Communities like this one strike us as a valid response, at least for some mentally ill people.
To understand this therapeutic community, you must let go of the concept of "community" we know from other experiences—Jean Vanier's communities, for instance. Here in Primavalle, what matters is the therapeutic aspect; the shared life, the communion, is harder to see. What we see is a profession carried out with humanity and commitment in a very difficult environment. The communities of the Arche are communities of life. These are very different things.
We also find it hard to accept the exclusion of volunteers. True, an unreliable volunteer does more harm than good. But it should be possible to find faithful, well-trained volunteers—just as staff members are, in fact, carefully selected. We believe that properly chosen and prepared volunteers could be of real help, especially in a situation as difficult as this.
- Sergio Sciascia, 1988